Long-Term Care Medicaid in Virginia: 2026 Guide

In Virginia, Medicaid is run by the Department of Medical Assistance Services (DMAS), and eligibility is decided by your local Department of Social Services (DSS). Most Medicaid members, including people who need long-term care, get their coverage through Cardinal Care, Virginia’s Medicaid program and its managed care health plans. Long-Term Care Medicaid can pay for nursing home care and for care at home through the CCC Plus Waiver and PACE. This guide explains the 2026 rules in plain language.

At a glance: Virginia 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with the Virginia Department of Medical Assistance Services before relying on them.

What Long-Term Care Medicaid covers in Virginia

Nursing home care. Medicaid pays for care in a certified nursing facility. You pay most of your income toward the cost each month (your “patient pay”), and Medicaid pays the rest.

CCC Plus Waiver. This is Virginia’s main home and community-based waiver for older adults and adults with disabilities who need a nursing facility level of care. It can pay for personal care (agency-directed or consumer-directed, where you choose your own aide), respite, adult day health care, personal emergency response systems and help moving out of a nursing home. Services are arranged through your Cardinal Care health plan.

PACE (Program of All-Inclusive Care for the Elderly). For people 55 and older in a PACE service area who need a nursing facility level of care. A PACE team provides and coordinates all care, often at a PACE center.

Assisted living. Virginia Medicaid does not pay for room and board in assisted living facilities.

Who qualifies

A person generally must:

• be 65 or older, or blind or disabled;
• live in Virginia and be a U.S. citizen or qualified non-citizen;
• pass a long-term services and supports (LTSS) screening. The screening looks at your daily activities, medical and nursing needs, and risk of needing a nursing home. In the community, it is done by a team from the local DSS and the local health department. In a hospital, discharge planners can do it;
• meet the income and asset rules below, as decided by the local DSS.

Income rules

Virginia’s eligibility manual sets the income limit for the CCC Plus Waiver and PACE at 300% of the SSI payment rate for one person.

For nursing home care, Virginia’s manual also describes other ways to qualify for people whose income is higher, including a medically needy route.

Once you are on Medicaid in a nursing home, most of your income goes to the facility as patient pay. You keep a personal needs allowance of $40 a month, and money can be set aside for a spouse at home and for health insurance premiums.

Asset rules

In 2026, a single applicant can have up to $2,000 in countable resources. For a couple who both need care, the limit is $3,000.

Countable resources include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

• Your home (equity up to $752,000) if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Burial plots and limited burial funds, within DMAS rules

Spousal protections

• Assets: The spouse at home keeps a Community Spouse Resource Allowance of at least $32,532 and up to $162,660 in 2026, plus the home, one car and belongings.
• Income: The spouse at home keeps their own income. If it is below $2,705 a month (from July 1, 2026), part of the applicant’s income can go to them, plus extra for high housing costs, up to $4,066.50 a month.

Look-back and penalties

When you apply, Virginia looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($9,703 a month in Northern Virginia and $7,324 a month in all other localities).

Example: Outside Northern Virginia, a $50,000 gift divided by $7,324 is about 6.8 months without Medicaid payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Virginia

Virginia’s estate recovery program is run by DMAS.

• What is recovered: Medicaid paid for nursing facility care, home and community-based services and related hospital and prescription costs, for people 55 and older.
• When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: DMAS can waive or put off recovery in some situations. Ask DMAS for the current rules.
• Family members and executors can contact DMAS with questions.

How to apply

• Online: CommonHelp, Virginia’s benefits website
• By phone: through Cover Virginia (the number is on the official Cover Virginia website)
• In person or by mail: at your local Department of Social Services
• For the CCC Plus Waiver: ask your local DSS or health department for an LTSS screening. If you are in the hospital, ask the discharge planner.

After you apply. Your local DSS will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing. The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive, and report changes in income, assets or address when they happen.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Virginia

• DMAS, Cover Virginia and your local DSS: Medicaid applications and eligibility.
• Area Agencies on Aging and No Wrong Door: local information on long-term care options.
• VICAP (Virginia Insurance Counseling and Assistance Program): Virginia’s free Medicare counseling program (SHIP), offered through the Area Agencies on Aging.
• Virginia Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and assisted living, and for people receiving long-term care at home.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Virginia:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Virginia’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect Virginia’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• Virginia CCC Plus Waiver

Frequently asked questions

What is Cardinal Care? It is the name for Virginia’s Medicaid program. Most members, including people who need long-term care, get services through a Cardinal Care health plan.

What is the CCC Plus Waiver? It is Virginia’s program for long-term care at home. It can pay for personal care, respite, adult day health care and emergency response systems for people who pass the LTSS screening.

My income is above the limit. Can I still qualify? It depends on the program and your situation. The CCC Plus Waiver uses a limit tied to 300% of the SSI rate, and nursing home care can have other routes.

How much can my spouse keep? In 2026, at least $32,532 and up to $162,660 in assets, plus the home, a car and belongings, and income of at least $2,705 a month.

Why are there two penalty divisors? Nursing homes cost more in Northern Virginia, so Virginia uses $9,703 a month there and $7,324 a month in the rest of the state.

Will the state take my home after I die? DMAS can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with the Virginia Department of Medical Assistance Services before relying on them.

Sources

• DMAS, Medicaid Eligibility Manual Chapter M14, Long-Term Care
• DMAS, CCC Plus Waiver
• Cover Virginia, CCC Plus Waiver Fact Sheet 2026
• DMAS, LTSS Screening
• CommonHelp
• Cover Virginia
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.