Virginia Medicaid Income & Asset Limits for Nursing Homes & In-Home Long-Term Care

Virginia Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income persons of all ages. While there are many different coverage groups, this page is focused on Medicaid eligibility for older Virginia residents, aged 65 and over. Specifically, long-term care Medicaid is covered. In addition to nursing home care, Virginia Medicaid pays for many non-medical support services that help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which Virginia seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services – Not an entitlement; the number of participants is limited and waiting lists may exist. Intended to delay and prevent the need for nursing home care, benefits are provided at home or adult day care. More on Waivers.

3) Regular Medicaid / Aged Blind and Disabled – An entitlement; persons who are eligible are guaranteed assistance. Various long-term care benefits, such as personal care assistance or adult day care, may be available.

Medicaid in Virginia is also called Cardinal Care. While Medicaid is a jointly funded state and federal program, it is administered by the state. In Virginia, the Department of Medical Assistance Services (DMAS) is the administering agency. Eligibility is determined by one’s local Department of Social Services (DSS).

Income & Asset Limits for Eligibility

The categories of Medicaid long-term care programs have differing eligibility requirements (i.e., income, assets, functional need). Further complicating financial eligibility is that the criteria changes annually, varies with marital status, and Virginia offers multiple pathways towards eligibility.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a Virginia Medicaid program. Alternatively, one may take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Virginia. More.

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in VA, the VA Aid & Attendance Allowance, which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple
When only one spouse of a married couple applies for Institutional Medicaid or a Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of their spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) / Spousal Income Allowance from their applicant spouse. The MMMNA is the minimum amount of income a non-applicant spouse is said to require to avoid spousal impoverishment.

In VA, the MMMNA is $2,465 (eff. 7/1/23 – 6/30/24). If a non-applicant’s monthly income falls under this amount, income can be transferred to them from their applicant spouse, bringing their income up to $2,465. A non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $739.50 / month (eff. 7/1/23 – 6/30/24). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s total income over $3,853.50 / month. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how this allowance is calculated.

Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; the income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Spousal Income Allowance for a non-applicant spouse. More on how Medicaid counts income.

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
The value of countable assets are added together and counted towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In Virginia, IRAs are also counted. Medicaid also considers many assets to be exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This holds true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. However, a Spousal Impoverishment Rule permits the non-applicant spouse of a Medicaid nursing home or Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2024, the CSRA allows the community spouse (the non-applicant spouse) to retain 50% of the couple’s assets, up to a maximum of $154,140. If the non-applicant’s portion of the assets falls under $30,828, 100% of the assets, up to $30,828 can be retained by the non-applicant. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.

Medicaid’s Look-Back Rule
Virginia has a 5-year Medicaid Look-Back Period that immediately precedes one’s Nursing Home Medicaid or Waiver application date. During this period, Medicaid checks to ensure no assets were sold for less than fair market value or given away. If this has been done, Medicaid assumes it was to meet Medicaid’s asset limit. Violating the Look-Back Rule results in a Penalty Period of long-term care Medicaid ineligibility. There is no Medicaid Look-Back Rule for Regular Medicaid.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows individuals to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.

Virginia Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home after subtracting any outstanding debt against it. Equity interest is the amount of home equity owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. After 6 months, even with Intent to Return, a single Medicaid beneficiary might be required to sell their home. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.

While one’s home is usually exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Virginia’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

Medical / Functional Need Requirements

An applicant must have a functional need for long-term Medicaid. For Medicaid nursing home care and Waiver services, this equates to a Nursing Home Level of Care (NHLOC). Furthermore, some program benefits may require additional eligibility criteria be met. As an example, for Medicaid to pay for home modifications, an inability to live at home without modifying the home might be necessary. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NHLOC is not necessarily required.

Qualifying When Over the Limits

For Virginia elderly residents, aged 65 and over, who do not meet the financial eligibility requirements above, there are other ways to qualify for Medicaid.

1) Medically Needy Pathway – Virginia has a Medically Needy Program for seniors who have income over Medicaid’s limit. Also called a “Spend-down” program, persons can become income-eligible for Medicaid services by spending the majority of their income on medical bills. This includes health insurance premiums, physician visits, hospital bills, and prescription drugs. The program’s income limits vary based on the geographic region of the state in which one resides and are effective 7/1/23 – 6/30/24. For Group I, the income limit is $387.36 / month for an individual and $493.11 / month for a couple. Group II allows $446.95 / month for an individual and $550.35 / month for a couple. Group III allows $581.04 / month for an individual and $700.47 / month for a couple. The “spend-down” amount is the difference between one’s monthly income and the medically needy income limit in one’s geographic region.

2) Asset Spend Down – Seniors who have assets over Medicaid’s limit can still become asset-eligible by spending down extra assets on ones that are not counted towards eligibility. This includes making home modifications (wheelchair ramps, chair lift, grab bars, etc.), prepaying funeral and burial expenses, and paying off mortgage or credit card debt. Remember, assets cannot be gifted or sold under fair market value, as doing so violates the Look-Back Rule. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid-eligible, as well as to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.

Specific Virginia Medicaid Programs

In addition to paying for nursing home care, Medicaid in Virginia offers the following programs that help seniors to live at home or in the community.

1) Commonwealth Coordinated Care Plus Waiver (CCC+) – This is a managed care program through which VA residents receive their Medicaid benefits. The state recently re-designed its “home and community based services” or HCBS Waivers, consolidating the old Elderly or Disabled Waiver and the Technology Assisted Waiver into the CCC+ Waiver. Benefits, such as adult day care, home care, and financial support to make home modifications that help residents remain living in their homes, is available. Unfortunately, unlike Nursing Home Medicaid, which is an entitlement, HCBS through CCC+ is not an entitlement. This means there is limited enrollment and waiting lists can exist.

2) Program of All-Inclusive Care for the Elderly (PACE) – This program combines the benefits of Medicaid, including long-term care services, and Medicare into one program. This may include services in an assisted living residence or memory care unit. Additional benefits, such as dental and eye care, may be available.

How to Apply for Virginia Medicaid

Seniors can apply for VA Medicaid online at CommonHelp or by calling Cover Virginia’s Call Center at 855-242-8282. Persons can also complete and submit a paper application, Application for Health Coverage & Help Paying Costs, which can be downloaded and printed from this webpage. Seniors should be aware that supplement forms may need to be submitted with the application. For adults over 65 years of age or persons who need long term care, Appendix D: ABD, LTC Application, is required, which can be found on this webpage. Alternatively, persons can call their local Department of Social Services (DSS) office to request that paper applications and additional forms be mailed to their home. Completed applications should be returned to one’s local Department of Social Services office. For questions about applying for Medicaid, seniors should contact their local DSS office. The application process may vary based on the program for which one is applying.

Prior to submitting an application for Medicaid benefits in Virginia, elderly applicants should be certain that all eligibility requirements (discussed above) for the program for which they are applying are met. Having income and / or assets over the limit(s) can result in a denial of benefits without Medicaid Planning. Learn more about Medicaid Planning and the application process for long-term care Medicaid.