Virginia Medicaid Eligibility for Seniors

Getting Medicaid coverage for seniors in Virginia and understanding the various specifications can be overwhelming. It shouldn’t be. At Senior Planning, our team is here to guide you every step of the way, ensuring this process is as smooth and stress-free as possible.

Medicaid Coverage Eligibility Requirements for Seniors in Virginia

To qualify for Medicaid, applicants must meet Medicaid qualifications in Virginia related to residency, income, assets, and medical necessity, such as needing nursing home-level care or help with daily activities. 

Virginia Medicaid Asset Limits

One of the most important factors in Medicaid eligibility is the presence of assets. These limits vary according to the program type and whether the applicant is single or married.

Some of the assets included in the Medicaid limit are bank accounts, stocks, bonds, mutual funds, and secondary properties. These assets are considered to be owned by both spouses in a marriage, whether one or both are applying.

The limits may change from year to year.

It is important to note that Virginia Medicaid has a 5-year look-back period, where all transfers made in the 60 months prior to applying are assessed. This ensures that no assets were gifted or sold in the interest of meeting the Medicaid asset limit. 

The 5-year look-back rule applies to institutions/nursing home Medicaid, and home and community-based services, but not to regular Medicaid. 

Virginia Medicaid Income Limits (2025)

Another key eligibility factor is the applicant's income. Income that is counted in this limit includes social security benefits, pensions, IRA withdrawals, and employment wages. 

What are the income limits for Medicaid in Virginia? The Virginia Medicaid eligibility income chart below breaks down the income limits for the various Medicaid programs for single and married applicants:

In cases where only one spouse is applying for Institutional Medicaid or Medicaid Waivers, only the applicant's income is counted in the limit mentioned in the table above. The non-applicant’s income is disregarded, and they may also be entitled to a Spousal Income Allowance from their applicant spouse. 

Strategies for Exceeding Income and Asset Limits

If the applicant’s income or assets exceed the Virginia Medicaid requirements, there are ways to still qualify. 

• Medically Needy Pathway: Also known as a spend-down program, this program may allow applicants to spend the majority of their income on medical expenses so that they meet the income limit. 

• Asset Spend Down: Medicaid spend down rules in Virginia allow applicants exceeding the Medicaid asset limit to spend down on non-countable assets, such as home modifications, prepaying funeral and burial expenses, and paying off mortgage or credit card debts. You may wish to consult with an attorney concerning your Medicaid application, since Senior Planning Services does not provide any legal advice or services.

• Qualified Income Trusts (QITs / Miller Trusts): Excess income above the Medicaid limit can be deposited into a trust to pay for care costs. Any remaining funds in the trust after the beneficiary’s death are typically used to reimburse the state for Medicaid benefits paid.

Applying for Medicaid in Virginia for Seniors

The Virginia Medicaid long-term care application process can feel complex, but understanding what it involves makes it more manageable. Here are the general steps for applying for Medicaid nursing home eligibility in Virginia:

• Clarifying Program Options: Virginia Medicaid offers several pathways, including Nursing Home Medicaid, Home and Community-Based Services (HCBS) waivers, and Regular Medicaid.

• Eligibility Requirements: Each program has its own income and asset limits. Reviewing these guidelines helps determine whether an applicant is likely to qualify.

• Gathering Required Documents: You’ll need to provide paperwork that proves your eligibility. For a detailed breakdown of documentation required for Medicaid in Virginia, see our Medicaid document checklist.

• Application: Applications may be completed online or submitted in paper version.

• Processing and Review: Complete and accurate submissions reduce the risk of delays or denials during the state’s review process.

Choosing a Nursing Home Covered by Medicaid in Virginia

Medicaid covers nursing home care; however, not every facility accepts Medicaid, and space is sometimes limited. 

1. Verify Medicaid Acceptance: Does the nursing home of your choice accept Medicaid?

2. Evaluate Location and Services: Is the nursing home located close to family and friends? Does it offer specialized care? How well does the facility rate in terms of quality of care, staff, cleanliness, and environment?  

3. Check Availability: Not all nursing homes in Virginia have availability, so it’s important to contact facilities directly to ask about Medicaid bed availability. 

4. Review Payment Details: What costs are Medicaid covering, and what do you need to pay for? Medicaid pays for most costs in approved homes, but private rooms or non-essential services may require extra payment. 

Assisted Living in Virginia

Medicaid in Virginia can help seniors who need support in assisted living settings. This option is designed for those who require some assistance but do not need the round-the-clock medical care provided in nursing homes. Assisted living allows individuals to remain at home or in a community residence with the help of a caregiver who can assist with daily activities, such as light housekeeping, meal preparation, or companionship.

Coverage for assisted living may be available through Home and Community-Based Services (HCBS) or the Aged, Blind, and Disabled Medicaid program. To qualify, applicants must meet both the financial and functional eligibility requirements of these programs.

Get Approved: Virginia Medicaid Eligibility for Seniors Made Easy

The Virginia Medicaid system provides support for seniors and their families. While the various rules and limits feel daunting, Senior Planning helps you understand income limits, asset thresholds, spending-down options, and choosing a nursing home that's best for you. 

Reach out to Senior Planning for a free consultation. Our experienced team will guide you along the Medicaid application process, ensuring you receive the long-term care and support you need when you need it. 

Frequently Asked Questions about Virginia Medicaid

Does Medicaid require residency in Virginia?

Yes. To be eligible, applicants must be residents of Virginia and provide proof of residency. You must also be a U.S. citizen or qualified non-citizen to receive Medicaid benefits in the state.

What are the Medicaid look-back rules in Virginia?

Virginia enforces a 5-year Medicaid look-back period for nursing home and long-term care Medicaid. This means the state reviews financial transactions from the previous 60 months to ensure assets weren’t given away or transferred below market value to meet eligibility requirements. The rules can be complicated, so it’s a good idea to consult with one of the Medicaid planning experts at Senior Planning Services who are familiar with the rules.

Can Medicaid in Virginia help pay for assisted living or home care?

Yes. Medicaid may cover care services in assisted living or at home through the CCC Plus Waiver, though it doesn’t pay for room and board.

Will Medicaid cover both spouses if only one needs long-term care in Virginia?

No. Medicaid only covers the applicant, but spousal rules allow the healthy spouse to keep part of the income and assets.

Can you keep your home and still qualify for Medicaid in Virginia?

Yes. You can keep your primary home and qualify, but Virginia may recover costs from the estate after death. Reach out to Senior Planning Services to learn more.

What are Medicaid payback rules in Virginia?

Virginia’s payback rules are part of the estate recovery process. Virginia may recover Medicaid costs from an estate after death for members 55+ who received long-term care. Exceptions apply to certain surviving family. Contact the Senior Planning Services team for more guidance.