Medicaid Long Term Care Virginia


Income Limits For Long

Elder Law Report: Look-Back Periods – LTC Medicaid & VA

Virginians who are 65 or older, disabled, or blind can qualify for Medicaid if they also meet income and asset limits. Most people who receive SSI already qualify to receive Medicaid in Virginia. To qualify for basic Medicaid in Virginia , if you are elderly, blind, or disabled and not receiving SSI, then your monthly income must be less than 80% of the federal poverty level .

Fortunately, there is a higher income limit for seniors who need long-term care services. If you are 65 or older, blind, disabled, pregnant, under age 19, or a parent living with a child under 18, then you can qualify for Medicaid for long-term care as long as your monthly income is no more than 300% of the SSI amount for an individual, or $2,313 per month for 2019.

If your income is above the limit, you still might be able to qualify for Medicaid for long-term care if you have a lot of medical expenses. Going through Virginia’s Medically Needy Program, you can use medical bills that you incur each month to “spend down” your income and qualify for Medicaid.

Right To Appeal Action Related To Home

If you have applied for, or are receiving home-based services, and disagree with an action taken by the local department of social services, you can request an appeal. You must request the appeal within thirty days of receiving written notification of the action with which you disagree.




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Virginia’s Medicaid Program Has Fairly Lenient Income Limits For Qualifying For Nursing Home Care Coverage

By Douglas Witten

Virginia’s Medicaid program pays for nursing home stays for those without a lot of income who need help with activities of daily living. Nursing homes are expensive in 2018, the average daily cost of a private room in a nursing home in Virginia was $280. Assisted living facilities and home health care services are a bit more affordable, but still costly. Long-term care isn’t covered by private health insurance policies or Medicare, and few people purchase private LTC insurance policies.

In Virginia, Medicaid is a very common source of funding for long-term care, particularly when people have already used up all of their own assets to pay for care. Approximately 70% of nursing home residents nationwide use Medicaid to pay for their nursing home care.

There are many different ways to become eligible for Virginia’s Medicaid program, and there are specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care.

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Treatment Of The Primary Residence

For Medicaid payment of nursing home long-term care, the applicant’s principal residence is excluded from countable resources only for the first six months of continuous institutionalization, provided the applicant intends to return home and provided the equity in the home property does not exceed the home equity limit stated above. Regardless of the amount of home equity, after six months of continuous institutionalization, the nursing home resident’s home will become a countable resource, unless the home is occupied by a spouse, dependent child under age 21, or a blind or disabled child. However, as a practical matter, there are numerous ways in Virginia to protect the home, as well as other real estate, by using an experienced Elder Law Attorney.

Relevant Federal And State Statutes Regulations And Rules

Three State Paths to Improve Medicaid Managed Long
  • Social Security Act Title XIX, 42 USC § 1396 et seq.

  • 42 USC § 1396p .

  • 42 USC § 1396r-5 .

  • Deficit Reduction Act of 2005, Pub. L. No. 109-171 , signed into law on February 8, 2006. The provisions of DRA dealing with the changes to eligibility for Medicaid long-term care are contained at §§ 6011 – 6021, and 6036 of the DRA.

  • 42 CFR 430 et seq.

  • Virginias Medicaid Rules are set forth in the Virginia Administrative Code at 12VAC30-20 et seq. and the Virginia Medicaid Manual, accessible online at .

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    Sudden Changes And Big Decisions

    Change is lifes only constant. Sometimes these changes strike without warning. If you or a loved one has experienced a sudden illness or serious accident, you understand how abruptly everything can change. Are you or a loved one suddenly in need of nursing home care? Finding and affording quality care on short notice can be stressful and draining. The Nance Law Firm can help you determine the best options for care and how to qualify for Virginia Medicaid to help finance them.

    Medicaid Options For Care

    Medicaid pays for individuals to receive long-term care in nursing facilities. Similar services in the community may be funded by Medicaid if they can be provided safely and at a lower cost. You may hear this called Medicaid Waiver or Waiver services. Individuals who meet criteria may choose a nursing home or one of the following community based options.

    Personal Care Aidesprovide non-medical services in your home. An aide can assist you with Activities of Daily Living including dressing, bathing, eating and toileting. They may also provide assistance with Instrumental Activities of daily Living including light housekeeping, laundry and meal preparation. Personal care can be agency directed or consumer directed.

    • Agency Directedservicesare provided by and controlled by an agency of your choice that will hire & train staff to assistance an individual who needs services. For Agency Directed Personal Care Services you must choose an agency on the DMAS list and confirm the agency is available to work in your area.
    • Consumer Directed services are controlled by the client or by someone acting on his or her behalf. The consumer hires and trains his or her own personal attendant, supervises services provided and signs off the timesheets. To use Consumer Directed Personal Attendant Services you must choose a facilitator, from the DMAS approved provider list, for assistance with starting services and ongoing support.

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    Federal Requirements Specify That Each Nf Must Provide At Least:

    • Nursing and related services
    • Specialized rehabilitative services
    • Medically-related social services
    • Pharmaceutical services
    • Dietary services individualized to the needs of each resident
    • Professionally directed program of activities to meet the interests and needs for well being of each resident
    • Emergency dental services
    • Room and bed maintenance services
    • Routine personal hygiene items and services

    When Will Medicaid In Virginia Pay For A Nursing Home

    Overview of the VA and Long-Term Care Services

    For most American seniors, nursing home care becomes necessary at some point in time and for some length of time as they age. Unfortunately, most seniors are unable to pay the high cost of nursing home care for any extended amount of time. In Virginia, the cost of a private room in a nursing home was $270 per day in 2019. During the same year, the average stay in a nursing home was about 25 months.

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    Services Included In The Nf Benefit

    A NF participating in Medicaid must provide, or arrange for, nursing or related services and specialized rehabilitative services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.

    There is no exhaustive list of services a NF must provide, in that unique resident needs may require particular care or services in order to reach the highest practicable level of well being. The services needed to attain this level of well-being are established in the individual’s plan of care.

    Specific to each state, the general or usual responsibilities of the NF are shaped by the definition of NF service in the state’s Medicaid state plan, which may also specify certain types of limitations to each service. States may also devise levels of service or payment methodologies by acuity or specialization of the nursing facilities.

    Long Term Services And Supports

    All plans cover LTSS if you are on a home and community based waiver or in a nursing facility. LTSS can help you live in your own home or other setting of your choice.

    LTSS includes:

    • Nursing facility or long stay hospital
    • Personal care and respite care
    • Personal emergency response system
    • Help for members moving to the community from a nursing facility

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    What Are The Medicaid Income Limits For 2022

    Finding out if you are eligible for Medicaid can be quite a headache. Since Medicaid is jointly funded by federal and state governments, there are different eligibility criteria for each state! One of the biggest factors for Medicaid eligibility are the income limits.

    If you are trying to learn more about whether your income is within the Medicaid income limit for your state of residence, then you are reading the right article!

    I will be explaining which sources of monthly incoming money are considered income, how each state decides their income limit, and providing an easy-to-use list of each states income limits for the year 2022.

    Read on to learn more about Medicaid income limits and determine if your income would be considered within the limit set by your state of residence!

    Reverse Mortgages In Virginia

    Continuing Education: Helping Patients and Residents ...

    Reverse mortgages are available in Virginia. A reverse mortgage is a home equity loan where the borrower does not have to make payments.

    This type of mortgage can increase monthly income, eliminate mortgage payments, and even fund Long-Term Care Insurance. However, there are many rules in Virginia on these products, and you should seek the help of a qualified and licensed mortgage broker.

    If you have significant equity in your home and you and your spouse are at least 62 years old, you can get a reverse mortgage to turn your equity into funding long-term health care, pay for an LTC Insurance policy, pay bills and add to your retirement lifestyle.

    The home must be the principal residence without any tax liens.

    Learn more about reverse mortgages by .

    *The federal government sets a new minimum and maximum amounts each year, but states can set their own minimum requirements at any level between the federal limits. This information is based on the best available sources.

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    Contact An Experienced Virginia Elder Law Attorney

    Medicaid rules are complicated. But, by consulting with a qualified elder law attorney regarding your eligibility for Medicaid to pay for nursing home care, you can save yourself and your family a considerable amount of money not have to deplete all of your lifes savings.

    Even if you are a high net worth individual, you can still qualify for Medicaid to pay for nursing home care. You should preferably engage in Medicaid planning before you need care. It is rarely too late to preserve assets. Call us today to learn more.

    To learn more about Medicaid and long-term care and how we can help you qualify, please feel free to contact Speedwell Law, PLLC at 553-2577 or to arrange a consultation.

    The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.

    Virginia Long Term Care

    • Elderly and Disabled with Consumer Direction
    • Waiver Intellectual Disabilities/Mental Retardation
    • Waiver Day Support Waiver
    • Individual and Family Developmental Disabilities 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.

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    Residents May Be Charged For:

    • Private room, unless medically needed
    • Specially prepared food, beyond that generally prepared by the facility
    • Telephone, television, radio
    • Personal comfort items including tobacco products and confections
    • Cosmetic and grooming items and services in excess of those included in the basic service
    • Personal clothing
    • Gifts purchased on behalf of a resident
    • Flowers and plants
    • Social events and activities beyond the activity program
    • Special care services not included in the facility’s Medicaid payment

    Other Financial Options For Care

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    In addition to the state specific options that help pay for elderly care, there are many non-profit and federal options that are also available. To find the best program for your situation, make sure to use our Resource Locator Tool to find other programs that help pay for or reduce the cost of care. There are also programs that help veterans with assisted living and there are eldercare loans available in Virginia.

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    Personal Needs Allowance For Nursing Home Residents

    If you receive Medicaid and live in a nursing home, you will be expected to spend most of your income on your care. Virginia allows nursing home residents receiving Medicaid to keep only $40 per month as a personal needs allowance. If you receive Medicaid and get home- and community-based Medicaid Waiver services , then you are allowed to keep $1,272 per month as your personal needs allowance.

    Read on to find out when Virginia Medicaid will cover assisted living facilities and home health care.

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    Long Term Services & Support

    Long Term Services and Support should be started as soon as possible after receiving your letter:

    • Medicaid – Please keep in mind, you must be approved for Medicaid benefits to start receiving care.
    • After six months – If services have not started, an update must be completed by the health department. A telephone update may be scheduled by calling 804-751-4908.
    • After one year – Your screening has expired. You no longer have Long Term Care services. If you still want services, a new screening must be requested. You may request a new screening by calling the Chesterfield-Colonial Heights Department of Social Services at 804-748-1100, select option 5 for Adult Services/Adult Protective Services.
    • Breaks in service – If you have started services and will be in the hospital or in rehab for three weeks or more, speak with a hospital case manager, social worker, or discharge planner to request a new screening before you are discharged.

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    Your Costs Under Medicaid

    Based on your income, you may be eligible for Medicaid coverage of some portion of your Medicare premiums/copays. Your state may also require you to pay for some of your Medicaid covered services, if you have enough income to do so. This varies by state. Talk with your local Medicaid office to find out how this works in your state.

    Who May Receive Nursing Facility Services

    Long Term Care

    NF services for are required to be provided by state Medicaid programs for individuals age 21 or older who need them. States may not limit access to the service, or make it subject to waiting lists, as they may for home and community based services. Therefore, in some cases NF services may be more immediately available than other long-term care options. NF residents and their families should investigate other long-term care options in order to transition back to the community as quickly as possible.

    Need for nursing facility services is defined by states, all of whom have established NF level of care criteria. State level of care requirements must provide access to individuals who meet the coverage criteria defined in federal law and regulation. Individuals with serious mental illness or intellectual disability must also be evaluated by the state’s Preadmission Screening and Resident Review program to determine if NF admission is needed and appropriate.

    Nursing facility services for individuals under age 21 is a separate Medicaid service, optional for states to provide. However, all states provide the service, and in practice there is no distinction between the services.

    In some states individuals applying for NF residence may be eligible for Medicaid under higher eligibility limits used for residents of an institution. See your state Medicaid agency for more information.

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