Medicaid Long-Term Care Guide in Virginia
Long-term care eligibility, benefits, and how to apply through the Department of Medical Assistance Services (DMAS); eligibility determined by local Department of Social Services (DSS).
What makes Virginia Medicaid different
Virginia Medicaid, also called Cardinal Care, provides long-term care through nursing homes and home and community based services via the Commonwealth Coordinated Care Plus (CCC+) Waiver under the Cardinal Care Managed Care (CCMC) Program. Virginia uses a Medically Needy Pathway with geographically varying income limits across three regional groups. Unique features include a $40/month Personal Needs Allowance (among the lowest nationally), a documented gifting exception of up to $4,000/year, and a 6-month home sale requirement for single beneficiaries. Virginia expanded Medicaid under the Affordable Care Act.
Administered by the Department of Medical Assistance Services (DMAS); eligibility determined by local Department of Social Services (DSS).
Program Types
Institutional / Nursing Home Medicaid
An entitlement program providing care in Medicaid-certified nursing home facilities
Level of care: Nursing Home Level of Care (NHLOC)
Medicaid Waivers / HCBS
Home and Community Based Services with limited participant slots and potential waiting lists
Level of care: Nursing Home Level of Care (NHLOC) or Hospital Level of Care
Regular Medicaid / Aged Blind and Disabled
Aged Blind and Disabled Medicaid with some long-term care benefits like personal care assistance
Level of care: Help with ADLs (not NHLOC)
2026 Virginia Medicaid Long-Term Care Eligibility for Seniors
Institutional / Nursing Home Medicaid
Medicaid Waivers / HCBS
Regular Medicaid / Aged Blind and Disabled
*All of a beneficiary's monthly income, with the exception of a Personal Needs Allowance of $40/month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must go towards nursing home costs (Patient Liability).
†Based on one's living setting, a beneficiary may not be able to keep monthly income up to this level.
Explore Virginia Medicaid Programs
Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to Virginia.
Long-term care Medicaid guide
Eligibility · Caregiver pay · How to apply · 2026 data
Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.
Compare Medicaid Programs — Virginia
How the main LTC programs available in Virginia compare side by side.
| Program | Pay | Pay type | Tax-free? | Spouse OK? | Waitlist? |
|---|---|---|---|---|---|
| Consumer-directed HCBS | $15–18/hr | Hourly wage | No | Usually no | Often |
| Structured Family Caregiving (SFC) | Not in Virginia | Daily stipend | Yes | Usually no | Often |
| Personal Care Agreement | Market rate (from assets) | Private pay | No | Yes | No |
| VA Aid & Attendance | Up to $2,874/mo | Monthly pension | Yes | Yes | No |
Virginia Medicaid programs
Commonwealth Coordinated Care Plus (CCC+)
Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.
How Family Caregivers Get Paid Through Medicaid in Virginia
If you're a family member providing care, you may be able to get paid through Medicaid — often at rates comparable to a home care agency.
Consumer-directed care — hourly pay
Available in VirginiaHow it works: The person receiving care becomes the "employer" — they hire you and a fiscal intermediary handles payroll, taxes, and paperwork on their behalf. You receive a paycheck just like a regular job.
How to apply: DMAS · dmas.virginia.gov
Personal Care Agreement — private pay from assets
Available to any familySources: KFF Medicaid Home Care Survey 2025 (Jan 2026), Careforth FAQ (Jan 2026), IRS Notice 2014-7.
How to Apply for Medicaid Long-Term Care in Virginia
What to expect when applying for LTC Medicaid and getting family caregiver pay set up in Virginia. The process typically takes 45–90 days from application to first paycheck.
Apply in Virginia: DMAS · dmas.virginia.gov
Medicaid Eligibility Screener — Virginia
Answer 7 quick questions — we'll check the financial and care requirements for Virginia and explain what each one means.
What is the marital status of the person who needs care?
Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.
Sources
- CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
- CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
- Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
- CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
- CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
- IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.
Key Rules at a Glance
- Nearly all income counts: employment wages, alimony, pensions, Social Security (including SSDI), IRA withdrawals, and stock dividends
- Nationally, Holocaust restitution payments are NOT counted
- Virginia: VA Aid & Attendance Allowance (above Basic VA Pension) does NOT count as income
- Married couples (Nursing Home/Waiver): Only applicant's income is counted; non-applicant spouse income is disregarded
- Married couples (Regular Medicaid): Both spouses' income is counted toward eligibility limit
- Countable assets: cash, stocks, bonds, investments, cryptocurrency, bank accounts, and non-residential real estate
- Exempt assets: personal belongings, household furnishings, one automobile, irrevocable burial trusts, primary home (with conditions)
- IRAs: Counted as assets (NOT exempt)
- Married couples: All assets considered jointly owned regardless of which spouse applies
- Home automatically exempt if applicant's spouse, child under 21, or blind/disabled child (any age) lives in it
- Home equity interest limit: $713,000 (2026)
- If above family members don't live in home, applicant must have 'Intent to Return'
- IMPORTANT: After 6 months, even with Intent to Return, a single Medicaid beneficiary might be required to sell their home
- Regular Medicaid: No home equity interest limit applies
- Home equity = home value minus outstanding debt; equity interest = portion of equity owned by applicant
- Estate Recovery: Home is NOT exempt from Medicaid's Estate Recovery Program—state may seek reimbursement from deceased's estate
- Virginia has a 5-year (60-month) Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers
- Medicaid reviews all asset transfers during the 60 months immediately before application date
- Gifting assets or selling for under fair market value triggers a Penalty Period of ineligibility
- EXCEPTION: If documented pattern of gifting exists for at least 3 years (e.g., birthdays or holidays), up to $4,000/year can be gifted without penalty
- U.S. Federal Gift Tax Rule (up to $19,000/recipient in 2026) does NOT protect transfers from Medicaid's Look-Back
- Regular Medicaid: No Look-Back Period applies
- Keep documentation of all asset transfers and expenditures to prove compliance
- MMMNA: $2,643.75/mo · CSRA: $162,660 · CSRA Min: $32,532
- Minimum Monthly Maintenance Needs Allowance (MMMNA): Non-applicant spouse can receive income from applicant spouse up to $2,643.75/month (eff. 7/1/25 – 6/30/26)
- If non-applicant's housing and utility costs exceed 'shelter standard' of $793.13/month, Spousal Income Allowance can be increased
- Maximum MMMNA: Spousal Income Allowance cannot push non-applicant's total income over $4,066.50/month
- Community Spouse Resource Allowance (CSRA): Non-applicant spouse can retain 50% of couple's assets, up to $162,660 (2026)
- CSRA minimum: If non-applicant's portion is under $32,532, they can keep 100% of assets up to $32,532
- Spousal protections apply only to Nursing Home Medicaid and Medicaid Waivers, NOT Regular Medicaid
- Medically Needy Pathway / Spend-Down Program: For applicants over income limit with high medical expenses—income limits vary by geographic region (eff. 7/1/25–6/30/26)
- Regional medically needy income limits: Group I: $410.05/mo (individual), $522.01/mo (couple) | Group II: $473.14/mo (individual), $582.55/mo (couple) | Group III: $615.08/mo (individual), $741.53/mo (couple)
- Spend-down amount (deductible) is the difference between monthly income and one's regional MNIL—can be met by paying health insurance premiums, physician visits, hospital bills, and prescription drugs
- Medically needy asset limits: $2,000 for individuals, $3,000 for couples
- Asset Spend-Down: Reduce countable assets by spending on exempt items—home modifications (wheelchair ramps, chair lifts, grab bars)
- Additional spend-down options: Prepay funeral/burial expenses, pay off mortgage or credit card debt
- CRITICAL: Never gift assets or sell below fair market value within 60-month Look-Back Period (exception: documented pattern of gifting up to $4,000/year for 3+ years)
- Medicaid Planning: Work with a Certified Medicaid Planner to employ legal strategies for eligibility and home protection from Estate Recovery
Virginia Medicaid Programs
Commonwealth Coordinated Care Plus Waiver (CCC+)
Operates under Virginia's Cardinal Care Managed Care (CCMC) Program. HCBS benefits include adult day care, personal care assistance, personal emergency response systems, home modifications, respite care, and more. Limited enrollment with potential waiting lists.
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 units. Additional benefits like dental and eye care may be available.
How to Apply
- Online at CommonHelp
- Call Cover Virginia's Call Center at 855-242-8282
- Download and submit paper Application for Health Coverage & Help Paying Costs
- For adults over 65 or persons needing long-term care: Appendix D (ABD, LTC Application) is required
- Call local Department of Social Services (DSS) office to request mailed applications
- Submit completed applications to local DSS office
Application process varies by program. Contact local DSS office for questions. Supplemental forms may be required. Ensure all eligibility requirements are met—consider Medicaid Planning if over income/asset limits.
More Virginia Long-Term Care Resources
Take the Next Step for Virginia Medicaid
Find out if you qualify or see how Medicaid fits into your overall long-term care plan.
Sources & references
Verified May 2026- Centers for Medicare & Medicaid Services — Long-Term Services & Supports
- Administration for Community Living — State Medicaid Agencies
- Centers for Medicare & Medicaid Services — Medicaid Eligibility
- American Council on Aging — About Medicaid Planning Assistance
- Department of Medical Assistance Services (DMAS); eligibility determined by local Department of Social Services (DSS) — Virginia Medicaid — Official site