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Navigating the world of disability services can be overwhelming, especially when trying to understand what support is available and how to access it. Medicaid waivers are programs under Virginia’s Medicaid system (via DMAS and DBHDS) that allow individuals who would otherwise need care in an institution (like a nursing home) to receive long-term services and supports (LTSS) in their home or community instead. They “waive” certain rules about what Medicaid normally pays for, allowing more flexible, community-based services. Virginia Medicaid+2CoverVA+2
Types of Virginia Medicaid Waivers
Virginia offers two main types of waivers:
| Waiver | Who it’s for / Target Population | Is there a Waiting List? |
| Commonwealth Coordinated Care Plus (CCC Plus) | Older adults, people with physical disabilities, chronically ill / severely impaired individuals who require substantial ongoing skilled nursing care. Basically, folks who without the waiver might need a nursing facility or hospital. Serves all ages. Virginia Medicaid+1 | No waiting list. Once you are eligible and screened, you get access to the waiver services. CoverVA+1 |
| Developmental Disabilities (DD) Waivers (three sub-types: Building Independence (BI); Family & Individual Supports (FIS); Community Living (CL)) | For children and adults with developmental disabilities. The different sub-waivers correspond to level of support needed: some more independent, others needing more supports. Virginia DBHDS+1 | Yes, there is a wait list. Slots are limited; they are assigned based on urgency (priority levels). thearcofva.org+2Virginia DBHDS+2 |
Eligibility Criteria
Here are the common eligibility requirements (they vary by waiver type):
- You must be eligible for Medicaid. If you have not already enrolled, you’ll need to apply. Virginia Medicaid+1
- For CCC Plus: you must meet what’s called the “nursing facility level of care” requirement — meaning your medical/functional needs are such that without waiver supports, you would need to be in a nursing facility or hospital for a prolonged period. Also must have required physical/medical/chronic illness/disability. Virginia Medicaid
- For DD Waivers: you must have a diagnosed developmental disability under Virginia’s definition. Also need to meet a “level of care” equivalent to an Intermediate Care Facility for Individuals with Intellectual Disability (ICF/IID). This is usually assessed via what’s called VIDES (Virginia Determination of Intellectual and Developmental Disability Eligibility Screener). Virginia Law+1
- Functional limitations: the person must have limitations in major life activities (e.g. self-care, communication, mobility, learning, etc.) as documented and evaluated. Virginia Law+1
- For waivers that include consumer-direction of services: if the waiver allows, the participant (or their legal representative) may choose to manage their own care, hire attendants, etc. Virginia Medicaid+1
What Services are Provided
The services differ by waiver, but here’s what each typically offers:
| Waiver / Service Type | Typical Services / Supports Provided |
| CCC Plus Waiver | Personal care / assistance, respite care, private duty nursing, adult day health care, assistive technology, environmental modifications to your home, “environmental modifications,” and any services necessary to avoid institutionalization. Also options for consumer-directed services vs agency-direct. SeniorNavigator+3Virginia Medicaid+3Virginia Medicaid+3 |
| DD Waivers (BI, FIS, CL) | A broad set of supports: medical care, habilitative / behavioral supports, employment supports, day services, residential supports (for those needing staffed homes), in-home supports, respite, assistive technology, home modifications, etc. The goal is to support community living, learning, employment and inclusion. Virginia DBHDS+2Virginia Medicaid+2 |
How to Apply
To begin the process, individuals must be screened by their local Community Services Board (CSB) or Department of Health. Eligibility is based on diagnosis, level of need, and other criteria. Importantly, for children under 18, parental income is not considered when determining eligibility.
Wait Lists: How Long, How Many, Priority
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- CCC Plus: no waiting list. Once someone qualifies, they can get waiver services. CoverVA+1
- DD Waivers: there is a waiting list. Slots are not simply first-come/first-served; people are assessed for urgency and placed in priority levels (e.g. Priority 1 = need within a year, etc.). RGA Virginia+2Virginia DBHDS+2
- As of September 2024, there were about 15,555 people on the DD waiver wait list statewide. Of those, around 3,658 were in Priority Level 1 (the most urgent). thearcofva.org
- In the most recent budget, there has been an increase in funded waiver slots (over 3,400 slots added) specifically to help those on Priority Level 1 wait list. Virginia Governor’s Office+1
- Wait times: For the DD waiver, wait might be many months to years, depending on your priority, your county, and funding. The state budget efforts aim to reduce wait times. (There’s not always a published average wait time for every region, but it can be long.) RGA Virginia+1
Virginia’s Three Developmental Disability (DD) Waivers
All three DD Waivers ar designed to help individuals with developmental disabilities live and thrive in the community, but they differ in the level of need they cover and the types of supports available. Here is a breakdown:
1. Building Independence (BI) Waiver
Who is it for:
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- Adults (18+) who do notneed 24/7 supervision.
- People who can live independently (or with roommates) but need some support services to succeed.
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Supports Covered:
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- Supported living (non-24 hour, e.g., help a few hours per day or week).
- Employment supports (job coaching, supported employment).
- Day support or community engagement programs.
- Assistive technology & environmental modifications.
- Personal assistance (limited hours).
- Transportation services.
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What it does not cover:
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- 24/7 residential care.
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Key Difference:
This waiver is for the most independent individuals — it helps with employment, community integration, and maintaining an independent living arrangement.
2. Family & Individual Supports (FIS) Waiver
Who is it for:
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- Children and adults living with their families or in their own home who need regular supports, but not necessarily full residential care.
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Supports Covered:
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- In-home supports (personal care, respite, companion services).
- Community engagement and employment supports.
- Day support programs.
- Nursing services (if needed).
- Therapeutic consultation (behavioral, occupational, speech therapy guidance for families/staff).
- Assistive technology & environmental modifications.
- Crisis support (short-term, less intensive than the Community Living Waiver).
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Key Difference:
Designed for people who live at home with family or on their own, but who need more regular support than the BI Waiver provides. It’s very family-friendly and flexible.
3. Community Living (CL) Waiver
Who is it for:
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- Children and adults who require intensive, 24/7 supports.
- Typically people who otherwise might need care in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID).
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Supports Covered:
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- 24/7 residential support (group homes, sponsored residential, supported living with 24-hour care).
- All services available in FIS (in-home, day, employment, therapeutic, assistive tech, environmental mods).
- Intensive crisis services.
- Skilled nursing.
- More extensive respite care.
- Shared living options.
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Key Difference:
This is the highest level of support waiver, covering people who need round-the-clock residential or medical support.
Quick Comparison
| Feature | BI Waiver | FIS Waiver | CL Waiver |
| Residential | Supported living (non-24 hr) | At home w/ family or alone | 24/7 residential support |
| Ages | Adults only (18+) | Children & adults | Children & adults |
| Employment Supports | ✔️ | ✔️ | ✔️ |
| Day Programs | ✔️ | ✔️ | ✔️ |
| In-Home Supports | Limited | Robust | Robust |
| Nursing | ✖️ | Some | Full |
| Crisis Support | Minimal | Some | Intensive |
| Target Population | Most independent | Moderate needs | Most intensive needs |
In short:
- BI = Independence with light supports.
- FIS = Living at home/family with moderate supports.
- CL = Full residential & intensive supports.
Why These Waivers Matter
Virginia’s Medicaid Waivers empower individuals with disabilities to live fuller lives outside of institutional settings. They assist individuals in achieving personal goals, such as employment, independent living, or community involvement, and offer families resources to support their loved ones.
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