Virginia Medicaid for Senior Care
Complete guide to Medicaid eligibility, coverage, and application process for nursing homes, assisted living, and home care in Virginia.
7.6 million Medicaid long-term care recipients nationwide
Virginia Department of Medical Assistance Services (DMAS)
Processing Time
30-45 days for standard Medicaid; EDCD Waiver applications take 60-90 days due to screening and enrollment processes
Virginia Medicaid Eligibility Requirements (2026)
To qualify for Medicaid long-term care in Virginia, applicants must meet both financial eligibility criteria (income and assets) and medical criteria (level of care needs). Virginia follows federal Medicaid guidelines with some state-specific variations.
Income Limits
Individual Applicant
$2,982/month
Married Couple (One Applying)
$5,964/month
Income includes Social Security, pensions, annuities, interest, dividends, and rental income.
Asset Limits
Individual Applicant
$2,000
Community Spouse (At-Home Spouse)
$3,000
Primary residence, one vehicle, personal belongings, and prepaid burial arrangements are exempt from asset limits.
5-Year Look-Back Period
Virginia Medicaid reviews all financial transactions for the 60 months prior to application. Asset transfers or gifts during this period can result in a penalty period of Medicaid ineligibility. The penalty is calculated by dividing the transferred amount by $8,822/month average (semi-private), $9,678/month (private) (the average monthly nursing home cost in Virginia).
Medical Eligibility
Applicants must demonstrate need for nursing facility level of care through a state assessment. This typically requires assistance with 2-3 Activities of Daily Living (bathing, dressing, toileting, transferring, eating) or cognitive impairment requiring supervision.
Assessments are performed by state-designated evaluators (nurses or social workers) and typically take 45-90 minutes. The assessment can occur at home, in a hospital, or at the care facility.
What Medicaid Covers in Virginia
Nursing Home Care
Medicaid pays 100% of nursing home costs in Virginia once eligibility is established. The average monthly cost is $8,822/month average (semi-private), $9,678/month (private). Recipients contribute most of their monthly income toward care costs, keeping only $50-75 for personal needs.
Coverage includes room, board, 24-hour nursing care, meals, medications, therapy services, and all medical care provided at the facility.
Assisted Living Coverage
EDCD Waiver and Auxiliary Grant Program: Virginia uses a combination approach for assisted living. The EDCD Waiver can provide personal care services to individuals in assisted living facilities. Additionally, Virginia's state-funded Auxiliary Grant program supplements SSI income to help seniors afford room and board in licensed assisted living facilities (approximately $1,600-1,700/month total income when combined with SSI). Medicaid covers care services through the waiver; room and board primarily covered through Auxiliary Grant supplement.
Note: This program covers personal care services but does not cover room and board costs. Residents need approximately $1,500-$2,500/month from Social Security or other income to cover housing expenses.
Home and Community-Based Services (HCBS) Waivers
Virginia offers 2 HCBS waiver programs that provide in-home care and community services as an alternative to nursing facility placement.
Elderly or Disabled with Consumer Direction (EDCD) Waiver
Serves individuals age 65+ or adults with disabilities who meet nursing facility level of care. Consumer-directed model allowing participants to hire and manage their own caregivers. Provides personal care, respite care, assistive technology, environmental modifications, home-delivered meals, adult day health care, and transition services. Approximately 17,000 participants statewide—one of Virginia's largest waiver programs.
Program Details →Technology Assisted Waiver
Serves individuals requiring ventilator or tracheostomy care who meet hospital or nursing facility level of care. Some elderly individuals with chronic respiratory conditions qualify.
Program Details →How to Apply for Medicaid in Virginia
Virginia Medicaid applications typically take 30-45 days for standard Medicaid; EDCD Waiver applications take 60-90 days due to screening and enrollment processes. Starting the process early and submitting complete documentation helps avoid delays.
Application Methods
You can apply for Medicaid in Virginia through:
- Online at CommonHelp.virginia.gov (Virginia's benefits portal)
- Phone: 1-855-242-8282 (Cover Virginia)
- Download application and mail to local Department of Social Services office
- In-person at local DSS office (120 local departments statewide)
Step 1: Gather Required Documents
Before starting your application, collect:
- •Birth certificate and Social Security card
- •Proof of citizenship (passport, naturalization)
- •5 years of bank statements
- •Investment and retirement account statements
- •Property deeds and mortgage statements
- •Life insurance policies
- •Social Security award letter
- •Pension benefit statements
- •Medicare card
- •Doctor's statement of care needs
Step 2: Submit Your Application
Complete and submit your application through one of the methods listed above. If applying online or by mail, keep copies of all submitted documents.
Step 3: Medical Assessment
A state assessor will evaluate level of care needs. This assessment typically takes 45-90 minutes and covers functional abilities, medical needs, cognitive status, and safety concerns.
Step 4: Financial Review
Medicaid staff review all financial documents and investigate any transfers or gifts made in the past 60 months. They may request additional documentation during this process.
Step 5: Receive Determination
You'll receive written notification of approval or denial. Approved applications include the effective date of coverage (often retroactive up to 3 months), patient responsibility amount, and covered services.
Get Free Application Help
Free Medicaid application assistance is available in Virginia from:
- •Area Agency on Aging: Call 1-800-677-1116 (Eldercare Locator) to find your local office
- •SHIP counselors: Free Medicare/Medicaid counseling
- •Nursing facility social workers: In-facility application support
- •Elder law attorneys: Paid help for complex financial situations ($2,000-$5,000)
Virginia-Specific Programs and Resources
Medicare Savings Programs (QMB/SLMB/QI)
QMB pays Medicare premiums, deductibles, and coinsurance. SLMB pays Part B premiums. QI pays Part B premiums (limited funding).
Learn MoreAuxiliary Grant (AG) Program
State-funded supplement to SSI (approximately $742/month in 2026) to help seniors afford assisted living facility room and board. Combined SSI + AG provides approximately $1,643/month total income.
Learn MoreCommonwealth Coordinated Care Plus (CCC Plus)
Virginia's managed care program integrating physical health, behavioral health, and long-term services for most Medicaid beneficiaries.
Learn MoreNeed Help with Virginia Medicaid?
Contact Virginia Department of Medical Assistance Services (DMAS) for specific questions about eligibility, application status, or covered services.
Main Office Phone
1-855-242-8282Application Helpline
1-855-242-8282