Virginia Medicaid Definition
Medicaid is a jointly funded state and federal health care program for low-income persons of all ages. This page, however, 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 and assisted living services, Virginia Medicaid pays for many non-medical support services that help frail seniors remain living in their homes.
In Virginia, the Department of Medical Assistance Services (DMAS) administers the Medicaid program. One’s local Department of Social Services (DSS) determines eligibility.
Income & Asset Limits for Eligibility
There are several Medicaid long-term care programs for which Virginia seniors may be eligible. These programs have differing eligibility requirements, such as income, assets, and functional ability, as well as benefits. Further complicating eligibility is that the criteria vary with marital status and that Virginia offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – These are not entitlement programs; The number of participants is limited and wait 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 – This is an entitlement program; Persons who are eligible are guaranteed assistance. Various long-term care benefits, such as personal care assistance or adult day care, may be available.
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 the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Virginia. More.
|2022 Virginia Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,523 / month*||$2,000||Nursing Home||$5,046 / month*||$4,000||Nursing Home||$2,523 / month for applicant*||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,523 / month†||$2,000||Nursing Home or Hospital||$5,046 / month†||$4,000||Nursing Home or Hospital||$2,523 / month for applicant†||$2,000 for applicant & $137,400 for non-applicant||Nursing Home or Hospital|
|Regular Medicaid / Aged Blind and Disabled||$906 / month||$2,000||Help with ADLs||$1,221 / month||$3,000||Help with ADLs||$1,221 / month||$3,000||Help with ADLs|
†Based on one’s living setting, a beneficiary may not be able to keep monthly income up to this level.
What Defines “Income”
Any income that a Medicaid applicant receives is counted. This income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Covid-19 stimulus checks and Holocaust restitution payments are not counted as income, and therefore, do not impact eligibility.
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) 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 $2,288.75 (effective 7/1/22 – 6/30/23). If a non-applicant’s monthly income falls under $2,288.75, income can be transferred from their applicant spouse, bringing their income up to this level.
In Virginia, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $686.63 / month (effective 7/1/22 – 6/30/23). However, in 2022, a spousal income allowance cannot push a non-applicant’s income over $3,435 / month. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal income 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. More on how Medicaid counts income.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, IRAs, credit union, savings, and checking accounts, and real estate in which one does not reside. 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. For home exemption, the applicant must live in their home or have intent to return, and in 2022, their home equity interest cannot be more than $636,000. Equity interest is the amount of the home’s value owned by the applicant. The home is automatically exempt if the applicant has a spouse living in it.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. 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 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant.
Virginia has a 5-year Medicaid Look-Back Period that immediately precedes one’s Medicaid 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.
Qualifying When Over the Limits
For Virginia elderly residents, 65 and over, who do not meet the eligibility requirements in the table 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 7/1/22 – 6/30/23. For Group I, the income limit is $356.35 / month for an individual and $453.65 / month for a couple. Group II allows $411.18 / month for an individual and $506.31 / month for a couple. Group III allows $534.54 / month for an individual and $644.42 / month for a couple. The “spend-down” amount is the difference between one’s monthly income and the income limit in one’s geographic region. In VA, it is calculated for a 6-month period for persons living in the community. Once the “spend down” has been met, one will be Medicaid eligible for the remainder of the period. The asset limit is the same statewide and is $2,000 for an individual and $3,000 for a couple.
2) Asset Spend Down – Seniors who have assets over Medicaid’s limit can still become asset eligible by spending down extra assets. This can be done by spending “excess” 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 the look back rule was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income”, or “over-asset”, or both, 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. Read more or connect with a Medicaid planner.
Specific Virginia Medicaid Programs
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, “Cover Virginia Application for Health Coverage and 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.
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. For additional information about Medicaid planning click here and for more information about applying for long-term care Medicaid, click here.