Virginia Medicaid Eligibility For Seniors

Virginia Medicaid Expansion History

Gov. Terry McAuliffe took office in January 2014, and had long said that Medicaid expansion was one of his top priorities. It was a contentious issue between the Governor and the state legislature, with a government shut-down that loomed in the summer of 2014 because of budget disagreements pertaining to Medicaid expansion.

Various proposals to partially expand Medicaid, or expand coverage with modifications, were considered by lawmakers in 2014, 2015, and 2016, but none of them passed. In September 2016, Governor McAuliffe reiterated his point that Medicaid expansion would help to close the budget gap that Virginia was facing. McAuliffe left office in January 2018, with Medicaid expansion still on his wish list. But his successor, Governor Ralph Northam, had campaigned on the promise of expansion, and Virginia Democrats gained significant ground in the House of Delegates. But a tie-breaker win went to the Republicans, who held a 51-49 majority in 2018.

Legislation was introduced in the Virginia Senate in January 2018 to expand Medicaid , but a party-line vote in the Education and Health Committee killed it before the end of January. The following week, a House committee voted 14-3 in favor of HB 338, which would have imposed work requirements on some existing Medicaid enrollees in Virginia. HB338 passed in the house in February, with a 64 to 36 vote, but it did not advance in the Senate.

When A Nursing Home Is Medically Necessary

Medicaid will pay for a nursing home only when it is medically necessary. You must show that you require a “nursing home level of care,” meaning that you have a physical or mental condition that requires nursing supervision and assistance with activities of daily living . You must show that you cannot care for yourself.

Before Medicaid will pay for nursing home care, you must have a “pre-admission screening.” These screenings are usually done by a nurse or social worker who visits you wherever you are living when you apply for help. The screener uses a form, called the Virginia Uniform Assessment Instrument, to help evaluate whether you need help with certain activities, including bathing, eating, taking medication, using the bathroom, moving around, and dressing. The screener will decide how much assistance you typically need to get those activities done. Whether you meet the nursing home level of care depends on the combination of the number of things you need help with and the level of help you need.

Medicaid uses the information in your screening to decide whether you need a nursing home and, if so, what kind of nursing home is appropriate for you. In general, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is only available in an institution.

Medicare And Medicaid Assistance In Virginia

If you qualify for Medicare, we at Medicare Plan Finder can help you navigate your coverage options. If you qualify for both Medicare and Medicaid in Virginia, you can even get a DSNP , which combines the benefits of the two programs.

To speak with a licensed agent in your area, complete this form or call us at 833-438-3676.

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Comparing Medicare And Medicaid

Medicare is a federal health insurance program open to Americans aged 65 and older and disabled persons under 65. Medicaid is a state-specific insurance program for low income individuals with limited financial assets regardless of their age.

Medicare, generally speaking, offers the same benefits to all eligible participants. However, coverage is divided into Medicare Part A for inpatient care, Part B for outpatient care and Part D for prescription coverage. Medicaid is more comprehensive in its coverage but the benefits are specific to the age group. Children have different eligibility requirements and receive different benefits from low income adults and from the elderly or disabled persons.

Preparing For A Fair Hearing

If your Managed Care Organization has denied, revoked, or reduced coverage for a Medicaid service, and you have exhausted the MCOs internal appeals process, the next step if you wish to further appeal is to request a Fair Hearing through the Department of Medical Assistance Services Appeals Division. In this factsheet, we offer some tips for effectively preparing for your fair hearing.

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The Impact Of Medicaid Expansion In Virginia

An estimated 400,000 people were expected to become eligible for coverage under the expanded guidelines, but that number is higher now as a result of the COVID pandemic .

By early 2020, about 375,000 people had gained coverage under the expanded eligibility guidelines. By mid-2022, however, that number had grown to more than 671,000 people. When the COVID public health emergency ends and Medicaid eligibility redeterminations resume, some of those individuals will transition away from Medicaid.

About 138,000 people were previously in the coverage gap, not eligible for Medicaid in Virginia, and also not eligible for premium subsidies because their income was too low . The expansion of Medicaid made coverage realistically available to this group. And people with income between 100% and 138% of the poverty level, who were previously eligible for significant premium subsidies and cost-sharing reductions in the exchange, became eligible for Medicaid instead as of 2019, with far lower out-of-pocket costs.

According to Medicaid expansion advocates, Virginia had been missing out on $142 million in federal funding every month since the start of 2014, as a result of not expanding Medicaid. But that changed in 2019, when federal Medicaid expansion funding started to flow into the state. States pay 10% of the cost of Medicaid expansion, and the federal government pays 90%. This is a much more generous split than regular Medicaid funding.

Study: Virginia Medicaid Expansion Increased Financial Security For Enrollees

By: Meghan McIntyre– August 1, 2022 12:03 am

State social services workers signed up homeless residents for Medicaid at a resource fair in Richmond in 2018. Enrollment in the program has more than doubled since Medicaid expansion, leading to rising demand for mental health services.

Chesterfield resident Geneva Gordon was forced to file for bankruptcy after receiving a $21,000 hospital bill for a reconstructive wrist surgery while uninsured. Leaving her previous job left her without insurance, living paycheck to paycheck and constantly worrying about getting sick and adding to her growing medical debt.

Gordon has since enrolled in Medicaid, which she said has helped her tremendously in the three years shes had it.

Its 100% affordable, Gordon said. I havent really truly been limited on where I can go and who I can see.

Individuals like Gordon enrolled in Medicaid reported less financial stress and greater security for non-medical expenses such as housing and food, according to new research published this month in the journal Health Affairs.

The study focuses on people who were eligible for program enrollment following Virginias Medicaid expansion in 2019. Nearly 675,000 adults have enrolled in the states program since 2019, when Virginia lawmakers voted, after years of Republican opposition, to expand eligibility by increasing the income threshold to 138% of the federal poverty level and allowing individuals without children.

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Top Rated Assisted Living Communities By City

As of July 1, 2017, the Elderly or Disabled with Consumer Direction Medicaid Waiver and the Technology Assisted Medicaid Waiver were merged and became the Commonwealth Coordinated Care Plus Medicaid Waiver. This webpage is maintained only for historical purposes. To learn more about the CCC program, .

Resource Limit For Long

To qualify for Medicaid in Virginia, you must have no more than $2,000 in resources. Resources are assets like money and property. Some property does not count toward the resource limit for instance, in Virginia, one car is exempt, and household goods are exempt.

The state follows complicated rules to decide whether your house is exempt or not. If you are living in your home, it is exempt. If you have land surrounding your home that is worth more than $5,000, that land is counted as a resource if you qualified for Medicaid by meeting the 300% FPL limit. If your qualifying income is less than 80% of the FPL, then your home and all surrounding land is exempt.

If you need Medicaid for long-term care, then you cannot have more than $585,000 in equity in your home in 2019. In addition, your home is only an exempt resource for the first six months that you are in an institution. If your spouse, dependent child, disabled adult child, or disabled parent continues to live there, then your home is exempt indefinitely. If your income is below 80% of the FPL, your home can also remain exempt after six months if you intend to return to it or if selling it would cause undue hardship to a co-owner.

These rules are confusing you should talk to an elder care lawyer if you need help determining if the equity in your home counts as a resource.

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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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Compass Waiver Proposal Was Officially Withdrawn By Gov Northam In 2020

Virginia unveiled its waiver proposal for the Medicaid work requirement, premiums, and cost-sharing in September 2018. After a public comment period and public meetings, the final waiver proposal was submitted to CMS in November 2018. In early December 2019, a few weeks after Democrats swept the election in Virginia , Virginias Medicaid Director, Karen Kimsey, notified CMS that the state was formally delaying the negotiations for the work requirement. And during the budget approval process in the 2020 legislative session, lawmakers eliminated the COMPASS requirements , paving the way for Gov. Northam to officially withdraw the work requirement proposal in July 2020.

GOP lawmakers were already frustrated by the fact that although Medicaid expansion took effect in January 2019, it had appeared that it could be a year or two later before a work requirement took effect, just due to the protracted process of getting a waiver approved by the federal government. So it was not surprising that the decision to pause the negotiations over the work requirement was not well received by Republicans in Virginias legislature, who expressed dismay that what they had considered an ironclad promise had been broken.

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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.

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, physicians visits, prescription medication, medication management, mental health counseling, social activities and assistance with the Activities of Daily Living .

Some of the things that Virginia Medicaid wont cover in a nursing home are a private room, specialized food, comfort items not considered routine , 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 Waivers

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Effective Date Of Coverage

Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.

Medicaid Eligibility Income Chart By State Updated Jul 2022

The table below shows Medicaids monthly income limits by state for seniors. Income is not the only eligibility factor for Medicaid long term care there is also an asset limit and level of care requirements. Additionally, there are state-specific details. Click on the state name below to see that states complete Medicaid eligibility criteria.

The maximum income limits change dependent on the marital status of the applicant, whether a spouse is also applying for Medicaid, and the type of Medicaid for which they are applying. Nursing home Medicaid may have a different income limit than home and community based Medicaid services, and both of those may differ from the Aged, Blind and Disabled income limits.

Exceeding the income limits does not mean an individual cannot qualify for Medicaid. Most states have multiple pathways to Medicaid eligibility, such as a medically needy pathway. Furthermore, many states allow the use of Miller Trusts or Qualified Income Trusts to help person who cannot afford their care costs to become Medicaid eligible. There are also Medicaid planning professionals that employ other complicated techniques to help persons become eligible. Finally, candidates can take advantage of spousal protection laws that allow income to be allocated to a non-applicant spouse.

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Virginia Medicaid Eligibility For Seniors And Medicare Beneficiaries

Virginia holds one of the strictest Medicaid programs in the country, but that does not mean you dont qualify. For the most part, childless adults cannot qualify. Children and pregnant woman can qualify with an income at 133% of the federal poverty level or lower, elderly and disabled people can qualify at 80% of the federal poverty level or lower, and working parents can qualify at 30% of the federal poverty level or lower. The federal poverty level depends on your family size and yearly income and can change every year.

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

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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Virginia Medicaid Enrollment Numbers

By June 2016, total enrollment in Virginias Medicaid program was 968,666, which was 4% higher than it had been in late 2013. Enrollment growth hovered in the single digits until Medicaid was expanded, and then it grew substantially. By July 2020, total Medicaid and CHIP enrollment had grown to over 1.5 million, which was an increase of more than 50% increase since late 2013. Medicaid enrollment in Virginia, and in much of the nation, had a sharp increase in 2020 driven by the coronavirus pandemic.

As of November 2021, 1,926,548 Virginians are covered by Medicaid/CHIP programs.