Virginia

What is Virginia Medicaid Long-Term Care?

Virginia Medicaid, also known as Cardinal Care, is a health coverage program for low-income individuals, including seniors aged 65 and older. It helps pay for nursing home care, in-home services, and community-based supports that assist frail seniors in continuing to live independently.

What types of long-term care Medicaid programs are available in Virginia?

What is Institutional / Nursing Home Medicaid?

This is an entitlement program, meaning all who qualify will receive services. It only covers care provided in nursing home facilities.

What are Medicaid Waivers / Home and Community Based Services?

These are not entitlements—there are limited enrollment slots and potential waitlists. Services are offered to delay or avoid nursing home placement and are provided at home or in adult day care settings.

What is Regular Medicaid for the Aged, Blind, and Disabled (ABD)?

This entitlement program offers long-term care supports like personal care or adult day care for eligible seniors with a functional need. It does not require nursing home placement.

What are the income and asset limits for Virginia long-term care Medicaid in 2025?

Eligibility requirements differ by program and marital status. The table below outlines the simplified financial criteria.

What are the 2025 income and asset limits for seniors?

*Most of a nursing home resident’s income must go toward care costs, minus allowances for personal needs, Medicare premiums, and a spouse’s income needs. †Some waiver recipients may not retain this full income amount.

How does Virginia define income for Medicaid purposes?

What types of income are counted?

All income—such as wages, pensions, Social Security, IRA withdrawals—is counted unless specifically excluded. Holocaust restitution and VA Aid & Attendance payments are not counted in Virginia.

How is income treated for married couples?

For Nursing Home Medicaid or Waivers, only the applicant’s income is considered. The non-applicant spouse may receive a Spousal Income Allowance if their income is below $2,643.75. However, their total income cannot exceed $3,948/month. For Regular Medicaid, both spouses’ incomes are counted, and no spousal allowance is available.

How are assets evaluated for Medicaid in Virginia?

What are countable and non-countable assets?

Countable assets include cash, investments, bank accounts, and real estate (not including the home one lives in). Exempt assets include personal belongings, one vehicle, burial trusts, and the primary residence (if certain conditions are met).

What are the asset rules for married couples?

Married couples’ assets are combined. For Nursing Home Medicaid or Waivers, the non-applicant spouse may keep up to $157,920 (or $31,584 if assets are low). There is no asset allowance for Regular Medicaid.

What is the Medicaid Look-Back Period in Virginia?

Virginia has a 5-year look-back period for Nursing Home Medicaid and Waivers. Gifting or selling assets for less than market value during this time can trigger a penalty period. Small gifts, like $4,000/year with a documented pattern, may be allowed.

Is the home exempt from Medicaid asset rules?

A home is exempt if the applicant or their spouse lives there, or if the applicant intends to return. However, equity must be under $730,000 if there’s no spouse living there. After death, Medicaid may seek reimbursement from the estate, including the home.

What are the functional or medical criteria to qualify?

Applicants must require a Nursing Home Level of Care (NHLOC) for Nursing Home Medicaid or Waivers. For Regular Medicaid, needing help with Activities of Daily Living (ADLs) may suffice. Additional needs may be required for specific benefits like home modifications.

Can seniors qualify for Medicaid if they exceed financial limits?

What is the Medically Needy Spend-Down Pathway?

Seniors with income over the limit may qualify by spending excess income on medical costs. Limits vary by region: Group I – $410.05, Group II – $473.14, Group III – $741.53 for individuals.

What is an Asset Spend Down?

Applicants may spend excess assets on exempt items like home improvements, funeral arrangements, or debt repayment to become asset-eligible. Gifts or undervalued sales within 5 years may lead to a penalty.

What is Medicaid Planning?

Those who are “over-income” or “over-asset” but still can’t afford care may benefit from Medicaid planning. Certified planners can help families qualify and protect assets like the home from estate recovery.

What Medicaid programs help seniors live at home in Virginia?

CCC+ Waiver

The Commonwealth Coordinated Care Plus Waiver combines older waiver programs and offers services like adult day care and home modifications. It is not an entitlement—slots are limited.

PACE

The Program of All-Inclusive Care for the Elderly combines Medicaid and Medicare services into one program, including long-term care, assisted living, and additional benefits like dental or vision care.

How can seniors apply for Medicaid in Virginia?

Applications can be submitted online at CommonHelp or by calling 855-242-8282. Paper forms are also available. Seniors aged 65+ must include Appendix D: ABD, LTC Application. Applications should be submitted to the local DSS office.

Before applying, applicants should ensure they meet all financial and medical criteria. Medicaid planning can assist those who are over the limits.