Virginia Medicaid Long Term Care Eligibility in 2025

Virginia Long Term Care

Programs for 2025:

Commonwealth Coordinated Care Plus Waiver (CCC+)
Program of All-Inclusive Care for the Elderly (PACE)
Medicaid Waivers for Home and Community-Based Services
Institutional / Nursing Home Medicaid
Regular Medicaid / Aged Blind and Disabled (ABD)

A pre-admission screening must be completed before an applicant can begin receiving Medicaid payments for care. Local health department nurses and social workers visit the applicant to determine if a nursing home level of care is required. If the applicant is already in a nursing home or hospital, this screening may be conducted by hospital staff.

Applicants who deplete personal funds after entering care facilities can apply for Medicaid without undergoing a pre-admission screening.

Eligibility in 2025:

1. Residency and Citizenship – The applicant must be a Virginia resident and a U.S. citizen or have proper immigration status.

2. Age/Disability – Applicants must be 65 or older, blind, or disabled. They must meet specific medical requirements consistent with the level of care requested.

3. Income Limitations – Single applicants must have an income under $2,901/month. Countable income includes wages, Social Security, pensions, veteran’s benefits, and other sources. Deductions are allowed for personal needs, spousal support, and certain expenses. Remaining income must be paid toward the cost of care as “patient pay.”

A personal needs allowance of $40/month is excluded from income calculations.

4. Asset Limitations – Countable assets must be under $2,000 for single applicants. Virginia allows certain assets to be excluded, including personal belongings, a home (with restrictions), and burial arrangements. A 60-month “look-back” period ensures no assets were sold or gifted below market value to qualify for Medicaid.

Exempt Assets in 2025 for an applicant in Virginia include:

Cash and countable assets under $2,000 for single applicants.
Primary residence (equity limit $730,000) if the applicant or spouse resides in it, or if there is intent to return home.
One automobile, regardless of equity value.
Burial plans up to $3,500 in value and burial space items like caskets and markers.
Term life insurance policies and whole life policies with cash values under $1,500.
Personal belongings, household items, and non-saleable property.

Spousal Rules in 2025:

Community Spouse Resource Allowance (CSRA): The non-applicant spouse can retain up to $157,920 in assets. If their share is under $31,584, additional assets from the applicant spouse can be transferred to meet this minimum.

Minimum Monthly Maintenance Needs Allowance (MMMNA): The non-applicant spouse can retain income from the applicant to meet the minimum of $2,555/month, up to a maximum of $3,948/month if additional housing costs exist.

Virginia Long Term Care Insurance Partnership:

Partnership policies match dollar-for-dollar asset protection. For instance, a policy with a $150,000 payout allows $150,000 in assets to be exempt when determining Medicaid eligibility. Both spouses must have individual policies.