Medicaid eligibility

Understanding Long-Term Medicaid Eligibility in Virginia

Determining Medicaid eligibility can be confusing. As our loved ones age, eventually they reach the point in life when they may need some help engaging with their day-to-day lives—help that spouses or adult children are unable to provide. It can be hard to accept, but even activities such as preparing meals, bathing, and dressing safely may at some point become too difficult for them. This is when Medicaid may need to become a part of their lives, providing the long-term assistance they need. The question becomes: as a Virginian, when might your elderly loved one be eligible for such aid?

 Medicaid rules differ among the states, but in each of them it provides for long-term care, which Medicaid describes as “health-related care and services (above the level of room and board) not available in the community, needed regularly due to a mental or physical condition.” Among the available options in this situation are coverage for the cost of certain certified Medicaid nursing facility services, and services or forms of support provided outside of an institution.

 In Virginia, the Department of Medical Assistance Services is responsible for administering the Medicaid program, while local Departments of Social Services perform determinations of Medicaid eligibility.

 For a resident of Virginia to be eligible for Medicaid long-term services, they must meet a number of requirements, which are affected by marital status and whether both spouses are applying at the same time. For our purposes, we will pretend your loved one is a single elder applying for Medicaid in Virginia. (If theirs is a different situation, please don’t hesitate to contact us for more information.)

 The elements that go into a determination of long-term service Medicaid eligibility can be broadly broken into those of the level of care your loved one may need, as well as their personal income and assets.

 In the situation we are assessing, it does not matter whether an elder needs to enter a nursing facility or is eligible to utilize Medicaid waivers for home or community-based services. (Though it must be said: there may be a wait list for non-facility services.) For both scenarios the income and asset requirements are the same.

First of all, an elder cannot be making more than $2,382 per month in income. This means income from any source, including Social Security payments, stock dividends, IRA withdrawals, pension payments, alimony payments, and so on—with the single limited exception of COVID-19 stimulus checks.

Secondly, they may not possess more than $2,000 in assets.  Luckily, a good number of things that might otherwise be considered assets are exempt from this calculation. But among those that are counted toward eligibility are real estate that is not their residence, checking accounts, savings accounts, cash, bonds, stocks, investments, and IRAs. Also important to note: Virginia has a “Medicaid Look-Back Period” of five years, during which your loved one can’t have sold any of these “eligible assets” for below market value, or given them away—including to their children—because if they have, it will be automatically assumed they did so for the purpose of lowering their assets to gain eligibility to Medicaid programs. This results in a punitive amount of time during which they will be considered ineligible for the program (and they still won’t have those assets they offloaded).

Let Us Help You With Medicaid Eligibility

Whether you need to assess your loved one’s situation vis-à-vis Medicaid eligibility or you are considering other ways to help them plan for the future, attend one of Promise Law’s free Medicaid workshops. These workshops provide a great foundation of information that everyone needs to be able to make good planning decisions. Moreover, if you attend a workshop you also get a complimentary one-on-one consultation with one of our attorneys.


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