Long-Term Care Costs in Virginia

Virginia's long-term care costs are above national averages in most categories — assisted living averages $6,945 per month, approximately 12% above the national average, while nursing home care averages $10,250 per month, roughly 7% above the national average of $9,581. Home care averages $6,673 per month, in line with the national rate. Virginia Medicaid is called Cardinal Care, administered by the Department of Medical Assistance Services (DMAS), with eligibility determined by local Departments of Social Services (DSS). Home and community-based services are provided through the Commonwealth Coordinated Care Plus (CCC+) managed care program. The income limit for Nursing Home Medicaid and HCBS is $2,982 per month. Virginia uses a Medically Needy/Spenddown pathway with geographically varying income limits rather than Miller Trusts. Virginia expanded Medicaid under the ACA. This guide covers what care costs in Virginia, how to qualify for Cardinal Care, and what options exist for veterans and family caregivers in Richmond, Virginia Beach, Fairfax, Arlington, and across the Commonwealth.

Virginia's Aging Population: The Numbers Behind the Need

Virginia has approximately 1.5 million residents aged 65 or older — roughly 17% of the state's total population. The senior population is concentrated in Northern Virginia (Fairfax, Loudoun, Prince William, and Arlington Counties), the Hampton Roads region (Virginia Beach, Norfolk, Newport News, Chesapeake), Richmond (Henrico and Chesterfield Counties), and the Roanoke Valley. Growing retirement communities also exist in Charlottesville, Fredericksburg, Lynchburg, Williamsburg, and Winchester.

Virginia's geography — from the wealthy Northern Virginia suburbs of Washington, D.C. to the rural Appalachian communities of Southwest Virginia — creates dramatic disparities in long-term care access and cost. Many counties in Southwest Virginia, the Shenandoah Valley, and the Southside region have limited facility options, making home and community-based services essential for keeping seniors near their families and support networks.

Unpaid Caregivers in Virginia: Scale and Impact

An estimated 1.2 million unpaid family caregivers in Virginia provide care to aging relatives and adults with disabilities. According to AARP research, family caregivers nationwide spend an average of $7,242 per year in out-of-pocket costs related to caregiving.

Virginia's CCC+ Waiver program provides support for unpaid caregivers through personal care visits, adult day services, respite care, and personal emergency response systems. The program helps families sustain caregiving while delaying or preventing nursing home placement.

What Long-Term Care Costs in Virginia

Virginia's care costs vary by type of care:

• Assisted Living: $6,945 per month — approximately 12% above the national average of $6,200
• Nursing Home (semi-private room): $10,250 per month — approximately 7% above the national average of $9,581
• Home Care (home health aide): $6,673 per month — in line with the national average of $6,673
• Adult Day Care: $1,750 per month — approximately 15% below the national average of $2,058

At these rates, a three-year nursing home stay in Virginia costs approximately $369,000 — while home care totals roughly $240,000 over the same period. Assisted living, at $6,945/month, represents approximately $250,000 over three years. Virginia's home care costs being at the national average make home-based care a comparatively cost-effective alternative to facility care. For a detailed breakdown of care costs by type and how Virginia compares to other states, visit our Virginia Care Costs page.

How to Qualify for Cardinal Care Medicaid in Virginia: Eligibility Rules for 2026

Virginia Medicaid is called Cardinal Care, administered by the Department of Medical Assistance Services (DMAS). Eligibility is determined by one's local Department of Social Services (DSS). In addition to nursing home care, Virginia Medicaid pays for many non-medical support services that help frail seniors remain living at home. Virginia expanded Medicaid under the Affordable Care Act. Consulting with a Virginia elder law attorney or Certified Medicaid Planner early can help families avoid costly mistakes. Eligibility rules vary by program type:

• Nursing Home Medicaid (Institutional): Income limit of $2,982/month. All of a beneficiary's monthly income, with the exception of a $40/month Personal Needs Allowance, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must go toward nursing home costs (Patient Liability). Asset limit of $2,000 (single) or $4,000 (married couple, both applying). When only one spouse applies, the non-applicant spouse may retain up to $162,660 in assets. This is an entitlement.
• Medicaid Waivers / HCBS (CCC+): Income limit of $2,982/month. Asset limit of $2,000 (single). Requires Nursing Home Level of Care or Hospital level of care. This is not an entitlement — enrollment is limited and waiting lists may exist.
• Regular Medicaid / Aged, Blind and Disabled (ABD): Income limit of $1,064/month (single) or $1,442.66/month (couple); asset limit of $2,000 (single) or $3,000 (couple). This is an entitlement.

Virginia applies a 60-month (5-year) look-back period for Nursing Home Medicaid and HCBS Waiver applications. Asset transfers during this period can trigger a penalty period of Medicaid ineligibility. However, Virginia has a unique exception: if one has documentation establishing a pattern of gifting (e.g., birthdays or holidays) for at least 3 years, up to $4,000/year can be gifted without penalty. The federal $19,000 Gift Tax exclusion (2026) does NOT otherwise apply to Medicaid's look-back rules. There is no look-back period for Regular Medicaid. For the full Virginia Medicaid eligibility breakdown, see our Virginia Medicaid Guide.

Spousal Protections and Community Spouse Resource Allowance

When one spouse applies for Nursing Home Medicaid or CCC+ in Virginia, only the applicant spouse's income is counted. The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain up to $162,660 in countable assets. The minimum CSRA is $32,532. If the community spouse's half of the couple's assets is under $32,532, up to $32,532 can be retained.

The Minimum Monthly Maintenance Needs Allowance (MMMNA) in Virginia is $2,643.75 per month (eff. 7/1/25 – 6/30/26). If the non-applicant spouse's income falls below this amount, income can be transferred from the applicant spouse. A non-applicant spouse can increase their allowance if housing/utility costs exceed the shelter standard of $793.13/month. The Maximum MMMNA is $4,066.50. For Regular Medicaid, both spouses' income is counted and there is no MMMNA or CSRA.

Virginia Medicaid Programs: CCC+ and PACE

Virginia offers Medicaid-funded long-term care through its managed care system:

• Commonwealth Coordinated Care Plus (CCC+) Waiver: Virginia's primary HCBS program, operating under the Cardinal Care Managed Care (CCMC) program. Benefits include adult day care, personal care assistance, personal emergency response systems, home modifications, respite care, and more. CCC+ is not an entitlement — enrollment is limited and waiting lists can exist.
• Program of All-Inclusive Care for the Elderly (PACE): Combines Medicaid long-term care services and Medicare benefits into one program. May include services in assisted living or memory care settings. Additional benefits such as dental and eye care may be available. Available in select Virginia regions.

Qualifying When Over the Limits: Spenddown and Asset Strategies

Virginia offers several pathways for applicants who exceed the income or asset limits. Virginia does not use Miller Trusts (Qualified Income Trusts) — instead, the state uses a Medically Needy/Spenddown pathway with geographically varying income limits:

• Medically Needy Pathway (Spenddown): Virginia's Medically Needy Income Limits (MNIL) vary by geographic region (eff. 7/1/25 – 6/30/26): Group I: $410.05/month (individual), $522.01/month (couple). Group II: $473.14/month (individual), $582.55/month (couple). Group III: $615.08/month (individual), $741.53/month (couple). The "spenddown" is the difference between monthly income and the MNIL. Applicants meet their spenddown by paying health insurance premiums, physician visits, hospital bills, and prescription drugs. Once met, the applicant is income-eligible for the remainder of the month.
• Asset Spend-Down: Reduce countable assets by spending on exempt items — home modifications (wheelchair ramps, stair lifts, grab bars), prepaying funeral and burial expenses (irrevocable burial trusts), and paying off mortgage or credit card debt. Assets cannot be gifted or sold under fair market value within the 5-year Look-Back Period — keep documentation.
• Medicaid Planning: Work with a Certified Medicaid Planner or Virginia elder law attorney to employ legal strategies for eligibility and protect your home from Estate Recovery.

Asset Rules: What Counts and What Doesn't

Countable assets in Virginia include cash, stocks, bonds, investments, cryptocurrency, bank accounts (money market, savings, checking), and real estate in which one does not reside. In Virginia, IRAs are counted as assets — they are NOT exempt regardless of payout status. Non-countable (exempt) assets include personal belongings, household furnishings, one automobile, irrevocable burial trusts, and generally one's primary home (subject to the home equity limit).

All assets of a married couple are considered jointly owned. The CSRA allows the non-applicant spouse to retain 50% of the couple's assets, up to $162,660. There is no CSRA for Regular Medicaid. Nationally, Holocaust restitution payments are not counted as income. In Virginia, VA Aid & Attendance Allowance (above Basic VA Pension) does NOT count as income for Medicaid eligibility purposes.

Veterans and Long-Term Care in Virginia

Virginia has approximately 700,000 veterans — one of the largest veteran populations in the country, driven by proximity to the Pentagon, military installations, and the defense sector. Major installations include Fort Gregg-Adams (formerly Fort Lee, near Petersburg), Joint Base Langley-Eustis (Hampton), Naval Station Norfolk (the world's largest naval station), Marine Corps Base Quantico, and the Pentagon (Arlington). The Hunter Holmes McGuire VA Medical Center in Richmond, the Hampton VA Medical Center, and the Salem VA Medical Center serve veterans across the state. Virginia operates two State Veterans Care Centers in Richmond and Roanoke.

The VA Aid & Attendance benefit provides additional monthly income to veterans and surviving spouses who require assistance with activities of daily living. In Virginia, VA Aid & Attendance does NOT count as income for Medicaid eligibility purposes, allowing veterans to potentially qualify for both benefits simultaneously. For a comprehensive overview of veteran long-term care benefits, see our Veterans Long-Term Care Guide.

Planning Ahead: How to Pay for Nursing Home Care in Virginia

Understanding how to pay for nursing home care in Virginia — or any long-term care setting — requires evaluating multiple funding sources. With nursing home costs at $10,250/month, a 60-month look-back period, and a $2,982/month income limit, advance planning is essential. Virginia long-term care insurance policies, personal savings, veterans benefits, and Cardinal Care each play a role. Key steps include:

• Understanding your current financial position relative to Virginia Medicaid eligibility thresholds
• Knowing that Virginia's income limit is $2,982/month for Nursing Home Medicaid and CCC+ — with a Medically Needy/Spenddown pathway for those over the limit
• Recognizing that in Virginia, IRAs are counted as assets — not exempt — which significantly affects financial planning strategies
• Taking advantage of Virginia's unique documented gifting exception — up to $4,000/year can be gifted without penalty if a 3-year pattern is established
• Being aware that after 6 months, even with Intent to Return, a single beneficiary might be required to sell their home — a more aggressive home policy than many states
• Understanding that Virginia's Medically Needy limits vary by geographic region — your location affects your spenddown amount
• Researching Virginia long-term care insurance options while still healthy enough to qualify
• Exploring veterans benefits if the care recipient or spouse served during wartime — Virginia's large veteran population often underutilizes these benefits
• Consulting with a Virginia elder law attorney or Certified Medicaid Planner to protect assets and avoid look-back penalties

Estate Recovery: Protecting Your Home in Virginia

Virginia operates a Medicaid Estate Recovery Program (MERP), which allows the state to seek reimbursement from a deceased Medicaid beneficiary's estate for long-term care costs paid by Cardinal Care. This can include the family home if proper protections are not in place. The primary home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.

If no qualifying family member lives in the home, there is a home equity interest limit of $752,000 (in 2026). Home equity is the value of the home after subtracting outstanding debt. If neither the applicant nor qualifying family live in the home, the applicant must demonstrate Intent to Return. Important: After 6 months, even with Intent to Return, a single Medicaid beneficiary might be required to sell their home. There is no home equity limit for Regular Medicaid. The home is NOT exempt from estate recovery — families should consult a Virginia elder law attorney to explore legal protections including irrevocable trusts, the caretaker child exemption, and the sibling equity interest exemption.

Regional Cost Variations Across Virginia

Long-term care costs in Virginia vary dramatically by region. Northern Virginia (Fairfax, Loudoun, Arlington, Prince William Counties) has the highest costs in the state — driven by proximity to Washington, D.C., high cost of living, and strong demand. Alexandria and McLean see premium pricing for assisted living and memory care. Hampton Roads (Virginia Beach, Norfolk, Chesapeake, Newport News) represents a moderate cost market. Richmond (Henrico, Chesterfield) offers mid-range pricing. Charlottesville has rising costs driven by population growth. Southwest Virginia (Roanoke, Lynchburg, Bristol, Abingdon) and Southside Virginia (Danville, Martinsville) generally have lower costs but significantly fewer available facilities and home care providers.

Application Timeline and Process

Virginia Medicaid applications can be submitted through several channels:

• Apply online at CommonHelp (commonhelp.virginia.gov)
• Call Cover Virginia's Call Center at 855-242-8282
• Download and submit a paper application from the Cover Virginia website — adults over 65 or those needing long-term care must include Appendix D: ABD, LTC Application
• Contact your local Department of Social Services (DSS) to request paper applications be mailed
• Return completed applications to your local DSS office

It is vital that applicants are confident they meet all eligibility criteria before submitting a Medicaid application. For seniors who don't meet the requirements, Medicaid Planning is recommended. Processing times vary but typically take 45–90 days. The application process may vary based on the program for which one is applying.

Federal Policy Update: One Big Beautiful Bill Act (OBBBA)

The One Big Beautiful Bill Act (OBBBA) includes approximately $1 trillion in Medicaid cuts over 10 years. While Nursing Home Medicaid is largely protected from future funding reductions, Home and Community Based Services (HCBS) — including Virginia's CCC+ Waiver — are likely targets for cuts. Virginia expanded Medicaid under the ACA, and the initial cuts on January 1, 2026, eliminated a 2-year temporary financial incentive for expansion states. This law is still facing legal challenges. Families relying on or planning to use CCC+ should monitor developments and consider applying early.

Last updated: September 2026. Data sources: Virginia Department of Medical Assistance Services (DMAS), CareScout 2025 care cost survey (updated March 2026). All Medicaid figures reflect 2026 eligibility thresholds. This guide is for informational purposes only and does not constitute legal or financial advice.