Virginia Medicaid Long Term Care Eligibility
Virginia Long Term Care
- Elderly and Disabled with Consumer Direction (EDCD)
- Waiver Intellectual Disabilities/Mental Retardation (ID/MR)
- Waiver Day Support (DS) Waiver
- Individual and Family Developmental Disabilities (DD) Support Waiver
- Technology-assisted Individuals Waiver
A pre-admission screening must be completed before an applicant can begin receiving Medicaid payments for care. A nurse from the local health department and a service worker from the local department of social services visit the applicant at home to assess if the person needs a nursing home level of care. If the person is a patient in a hospital then the pre-admission screening process may be completed by hospital staff.
Sometimes, people begin long term care and are able to pay for services out of pocket for a period, but after resources are depleted, need to apply for Medicaid to cover the cost of care. If this happens and the person is already in the nursing facility at the time of the Medicaid application, no pre-admission screening is needed.
1. Residency and Citizenship – the applicant must be a resident of Virginia and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested.
3. Income Limitations – If single, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be less than 300% of the Supplemental Security Income (SSI) amount for an individual—$2,199 for 2015. People receiving Medicaid Long Term Care services must contribute some of their countable income toward the cost of care. Virginia calls this “patient pay.” Deductions are given for the person’s basic needs, the support of a child or spouse in the community, and other situations depending on the case. Once someone is found to be eligible, an eligibility worker determines the recipient’s “patient pay” amount and notifies the person of the figure. People who receive SSI payments with no other source of income do not have to contribute towards their cost of care.
- A personal needs allowance of $30.00/month is disregarded from the total countable income.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Exempt Assets for an applicant in Virginia include:
i. $2,000 or less in cash/non-exempt assets if single.
ii. The home and land surrounding it are exempt if the Medicaid applicant is residing there. For those with income under 80% federal poverty line (FPL), the home and all land adjoining the home lot are excluded. For those with income over 80% FPL, the home lot is excluded and the adjoining property is exempt to the extent the value of the adjoining property (not counting the home lot) is less than $5000 or is essential to the dwelling. For a married couple when only one spouse is in a nursing home, all the property adjoining the residence is excluded. If planning to return; a spouse; a child under 21; or a disabled person resides in the home; the house is exempt as well. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
iii. One automobile, no equity amount specified.
iv. Burial plans, not exceeding $3,500 in value. Burial space items are excluded regardless of value, including: casket, urn, crypt, grave markers, etc. Burial space items do not need to be stored at home, but rather an applicant should sign a contract with a burial provider. Any appreciation on burial funds, such as interest on a bank account, is also exempt
v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
vi. Term life insurance (no cash value) is exempt. Also, policies with a cash surrender value of $1,500 or less are exempt.
Amount of assets community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $119,220. If the community spouse’s assets do not equal at least $23,844, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $1,966.25. The maximum amount of income that can be retained is $2,980.50 varying by case, depending on unique living expenses. Shelter costs that exceed a designated amount will increase the community spouse’s income allowance. Shelter costs include rent or mortgage, maintenance fees, taxes and insurance. Virginia is an “income first” state, meaning the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first.
Virginia long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used you may apply for Medicaid with $155,000 worth of assets exempted.
Virginia Department of Social Services: http://www.dss.virginia.gov/benefit/medical_assistance/
Medicaid forms and applications: http://www.dss.virginia.gov/benefit/medical_assistance/forms.cgi
Long Term Care and Waiver Services: http://www.dmas.virginia.gov/Content_pgs/ltc-home.aspx