Virginia Medicaid Long Term Care Programs, Benefits & Eligibility Requirements
Summary
Medicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. This article focuses on Virginia Medicaid Long Term Care, which is different from regular Medicaid. Medicaid will help pay for long-term care for Virginia residents in a nursing home, in their home and in other residential settings through one of three programs – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.
Virginia Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
Virginia Medicaid will cover the cost of long term care in a nursing home for eligible Virginia residents through its Nursing Home / Institutional Medicaid. This includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physician’s visits, prescription medication, medication management, mental health counseling, social activities and assistance with the Activities of Daily Living (eating, bathing, moving, dressing, toileting).
Some of the things that Virginia Medicaid won’t cover in a nursing home are a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example), personal reading items, plants, flowers, and any care services not considered medically necessary.
Any Virginia Medicaid beneficiary who receives Nursing Home Medicaid coverage must give most of their income to the state to help pay for the cost of the nursing home. They are only allowed to keep a “personal needs allowance” of $40 / month. This can be spent on personal items such as clothes, snacks, books, haircuts, cell phones, etc. It cannot be spent on any item that Medicaid covers, including hygiene basics like a toothbrush, soap, deodorant, razors and incontinence supplies, unless the Medicaid beneficiary wants a specific brand that is not covered by Virginia Medicaid. In this case, they could spend their personal needs allowance on the item.
Home and Community Based Service (HCBS) Waivers
Home and Community Based Service (HCBS) Waivers will pay for long-term care services and supports that help Virginia Medicaid recipients who require a Nursing Facility Level of Care, or a hospital level of care, but choose to remain living “in the community” instead of moving to a nursing home. Virginia uses its Uniform Assessment Instrument (UAI) to determine if this level of care is required, and living “in the community” in Virginia can mean living in their home or the home of a loved one. HCBS Waivers in Virginia will not cover services for individuals living in an adult foster care home or an assisted living residence.
Virginia recently consolidated its Waiver options into one program, the Commonwealth Coordinated Care Plus Waiver (CCC+). Long-term CCC+ benefits include adult day care, private day nursing, home modifications, personal emergency response systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Program participants receive all of their CCC+ benefits through a single Medicaid plan delivered by a managed care organization, which has a network of care providers. In addition to using the in-network care providers, CCC+ beneficiaries can choose their own caregiver for some of these services (like personal care assistance) including family members. They can hire adult children, adult grandchildren, siblings, nieces and nephews, but spouses cannot be hired as caregivers.
Aged Blind and Disabled / Regular Medicaid
Virginia’s Aged Blind and Disabled (ABD) Medicaid, also known as Regular Medicaid, provides healthcare and personal service benefits to low-income Virginia residents who are aged (age 65+) or disabled and live “in the community.” Living “in the community” can mean living in their home, the home of a loved one, an adult foster care home or an assisted living residence. While ABD Medicaid will cover services in all of those settings, it will not cover room and board costs.
ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait. This includes a variety of long-term care benefits such as adult day care, doctor’s visits, skilled nursing care, in-home personal care, prescription assistance and transportation. ABD Medicaid beneficiaries qualify for these benefits and services one at a time, which is different from Nursing Home Medicaid, which makes all of its services immediately available for anyone who qualifies. Instead, ABD Medicaid recipients will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.
Program of All-Inclusive Care for the Elderly (PACE)
Elderly (age 65+) Virginia residents who have Aged Blind and Disabled (ABD) Medicaid can coordinate their medical, social service and non-medical personal needs into one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE is intended to help Virginia residents who need a Nursing Facility Level of Care but want to keep residing and receiving care in their home or somewhere else in the community. This program can be used by people who are “dual eligible” for Medicaid and Medicare and will help them coordinate the care from those two programs. The National PACE Association can also help locate a PACE program near you.
Eligibility Criteria For Virginia Medicaid’s Long Term Care Programs
To be eligible for Virginia Medicaid, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid / Regular Medicaid.
Virginia Medicaid Nursing Home Medicaid Eligibility Criteria
Financial Requirements
Virginia residents have to meet an asset limit and an income limit in order to be financially eligible for Nursing Home Medicaid. For a single applicant in 2022, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2022 income limit for a single applicant is $2,523 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Nursing Home Medicaid recipients are only allowed to keep $40 / month of their income as a “personal needs allowance” and must give the state the rest to help offset nursing home costs.
For married applicants with both spouses applying, the 2022 asset limit for Nursing Home Medicaid through Virginia Medicaid is $4,000 combined, and the income limit is $5,046 / month combined. For a married applicant with just one spouse applying, the 2022 asset limit is $2,000 for the applicant spouse and $137,400 for the non-applicant spouse, and the income limit is $2,523 / month for the applicant. The income of the non-applicant spouse is not counted.
Virginia Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Virginia Medicaid has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Nursing Home Medicaid in Virginia is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. Virginia uses its Uniform Assessment Instrument (UAI) to determine if this level of care is needed.
Virginia Home and Community Based Service (HCBS) Waivers Eligibility Criteria
Financial Requirements
Virginia residents have to meet an an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2022, the asset limit for HCBS Waivers in Virginia is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2022 income limit for a single applicant is $2,523 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying, the 2022 asset limit for HCBS Waivers in Virginia is $4,000 combined, and the income limit is $2,523 / month per spouse. For a married applicant with just one spouse applying, the 2022 asset limit is $2,000 for the applicant spouse and $137,400 for the non-applicant spouse, and the income limit is $2,523 / month for the applicant. The income of the non-applicant spouse is not counted.
Virginia Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Virginia Medicaid has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers in Virginia is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home, or a hospital level of care. Virginia uses its Uniform Assessment Instrument (UAI) to determine if this level of care is needed.
Virginia Aged Blind and Disabled Medicaid Eligibility Criteria
Financial Requirements
Virginia residents have to meet an asset limit and an income limit in order to be financially eligible for Aged Blind and Disabled (ABD) Medicaid / Regular Medicaid. For a single applicant in 2022, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2022 income limit for a single applicant is $906 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants, the 2022 asset limit for Virginia ABD Medicaid is $3,000 combined between the two applicants/spouses, and the income limit is a combined $1,221 / month. These limits are used for both married couples with both spouses applying for ABD Medicaid and married couples with only one spouse applying.
Virginia Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Virginia Medicaid has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional requirements for Virginia Aged Blind and Disabled (ABD) Medicaid are being disabled, blind or aged (65 or over). Virginia Medicaid will conduct an assessment of ABD Medicaid applicants and their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) to determine the kind of long-term care services the beneficiary needs and the state will cover.
One’s home is often their most valuable asset, and if counted toward Virginia’s Medicaid asset limit, it would likely cause them to be over the limit for eligibility. However, in some situations the home is not counted against the asset limit. If the applicant lives in their home and the home equity interest is less than $636,000 (as of 2022), then the home is exempt from the asset limit. Home equity interest is portion of the home’s equity value that the applicant owns, and the home’s equity value is the current value of the home minus any outstanding mortgage / debt against the home. If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives. If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $636,000. These rules apply to all three types of Medicaid.
Applying For Virginia Medicaid Long Term Care Programs
The first step in applying for a Virginia Medicaid Long Term Care program is deciding which of the three programs discussed above you or your loved one wants to apply for – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid / Regular Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Virginia Medicaid when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Virginia Medicaid applicant. These documents will be needed for the official Virginia Medicaid application. Necessary documents include five years of quarterly bank statements from all accounts; the most recent monthly or quarterly statements from all investments, IRAs, 401Ks, annuities and any other financial accounts; a letter from the Social Security Administration showing the applicant’s gross Social security income and deductions; tax forms to verify income streams including wages, pensions, royalties and interest; lists of items of any trusts; proof life insurance (if the applicant has any) and a list of beneficiaries; Power of Attorney documentation.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Virginia residents can apply for Medicaid online at CommonHelp. They can also call Cover Virginia at 855-242-8282. Another option is printing out the necessary applications from this webpage, filling them out and returning them to the applicant’s local Department of Social Services office. Applicants age 65 and older who need long term care should be aware that in addition to the “Cover Virginia Application for Health Coverage and Help Paying Costs,” they will also need the Appendix D form.
Choosing a Virginia Medicaid Nursing Home
After an applicant has been approved for Nursing Home Medicaid through Virginia Medicaid, they need to choose which Medicaid-approved nursing home they will live in. Even though Nursing Home Medicaid is an entitlement, Virginia Medicaid will only cover stays and care in approved nursing homes. Virginia residents can find and compare nursing homes using this Virginia Health Care Association Facility Locator. They can also use Nursing Home Compare, which is a federal government website that has information about more than 15,000 nursing homes across the country. All of the nursing homes on this site are either Medicaid- or Medicare-approved.