Virginia Nursing Home Medicaid pays for a nursing home once Medicare’s short rehabilitation benefit runs out — but only after the family clears an income test, an asset test and a level-of-care assessment. This Virginia nursing home medicaid guide gives the 2026 figures, what the spouse at home is allowed to keep, how the five-year look-back works, and where in Virginia the application actually goes.
Every dollar figure below comes from the state Medicaid agency, CMS or the statute cited, and each resets on its own calendar. Where Virginia has not published a current figure we say so instead of guessing.
In This Virginia Nursing Home Medicaid Guide:
Virginia Nursing Home Medicaid at a Glance (2026)
| Program | Virginia does not market nursing home coverage under a separate brand. The Department of Medical Assistance Services (DMAS) calls the benefit Medicaid Long-Term Services and Supports (LTSS), and the covered benefit itself is Nursing Facility Services. Families are formally applying for Medicaid for people who are Aged, Blind, or Disabled (ABD) with long-term care, which is the eligibility category the local caseworker will name on the notice. Virginia’s overall Medicaid program is now branded Cardinal Care, so approval letters, member cards and health plan mail may carry that name instead. |
| 2026 income limit (single applicant) | $2,982 |
| 2026 asset limit (single applicant) | $2,000 |
| Spouse at home may keep (assets) | $32,532 to $162,660 |
| Spouse at home income floor | $2,705 to $4,066.50 per month |
| Look-back period | 60 months |
| Penalty divisor | not published here yet — confirm with The application is taken and decided by the local department of social services (LDSS) in the city or county where the applicant lives, not by DMAS, which only writes the policy. Cover Virginia, the state’s Medicaid help line, can answer questions, mail an application, or take one by phone at 1-855-242-8282 (TDD 1-888-221-1590). You can find your own LDSS office through the Virginia Department of Social Services local agency directory at dss.virginia.gov/localagency. Nursing facility admissions or business office staff routinely help families assemble and deliver the paperwork to the LDSS. |
| Home equity limit (no spouse at home) | $752,000 (confirm with The application is taken and decided by the local department of social services (LDSS) in the city or county where the applicant lives, not by DMAS, which only writes the policy. Cover Virginia, the state’s Medicaid help line, can answer questions, mail an application, or take one by phone at 1-855-242-8282 (TDD 1-888-221-1590). You can find your own LDSS office through the Virginia Department of Social Services local agency directory at dss.virginia.gov/localagency. Nursing facility admissions or business office staff routinely help families assemble and deliver the paperwork to the LDSS.) |
| Over the income limit? | Medically-needy spend-down — no Miller trust |
Virginia Nursing Home Medicaid Income and Asset Limits
Two tests, both applied to the person entering the facility. The income test looks at gross monthly income from every source — Social Security, pensions, IRA withdrawals, annuities, rent. The asset test counts what can be turned into cash: bank accounts, investments, retirement accounts in most states, and any property other than the home.
Virginia is a medically-needy state. Being over the Virginia nursing home medicaid income figure does not end the application: the excess is spent down on the cost of care each month, and the nursing home bill itself usually absorbs it. No Miller trust is needed.
Virginia does not count the applicant’s home while a spouse, minor child, or disabled child lives there, and generally protects it while the applicant intends to return, subject to a federal home-equity ceiling. One vehicle is excluded regardless of value, as are ordinary household furnishings and personal belongings such as clothing, furniture and a wedding ring.
Irrevocable prepaid funeral arrangements and burial space items like a plot, casket, vault and marker are excluded, and a limited burial fund and certain life insurance may also be disregarded.
Virginia does not require a qualified income trust, Miller trust, or income-only trust, because it is a medically needy state rather than an income-cap state. Instead, an applicant whose income exceeds the long-term care standard qualifies through a spend-down: incurred medical expenses, including the nursing facility’s own charges and health insurance premiums, are subtracted from countable income until it reaches the allowed level.
Once approved, the resident contributes nearly all monthly income to the facility as a patient pay amount, keeping only a small personal needs allowance.
What the Spouse at Home Keeps Under Virginia Nursing Home Medicaid
Federal spousal impoverishment rules stop Virginia nursing home medicaid from bankrupting the husband or wife who stays home. The at-home spouse keeps a protected share of the couple’s assets — between $32,532 and $162,660 in 2026 — and is guaranteed a monthly income floor of at least $2,705, rising to $4,066.50 when housing costs are high. The house is fully exempt while the spouse lives in it.
Virginia applies the federal spousal impoverishment protections without unusual state twists. When the spouse enters a nursing facility, the couple can ask the local department of social services for a resource assessment as of the date institutional care began; that assessment fixes how much of the couple’s combined countable resources the at-home spouse may keep.
The at-home spouse may also receive a monthly maintenance income allowance out of the nursing home spouse’s income. Virginia uses the standard federal allowance figures, and a spouse who needs more may request a hearing.
The asset snapshot is taken on the first day of the continuous stay, not the application date. Families who spend down before asking for a resource assessment often spend money the spouse was entitled to keep.
The Look-Back Rule and Transfer Penalties
Virginia reviews every transfer made in the 60 months before the application. Money or property given away, or sold for less than it was worth, is added up and divided by the state’s penalty divisor — its average private-pay nursing home cost — to produce a period during which Virginia nursing home medicaid will not pay.
The divisor in Virginia is not published here yet — confirm with The application is taken and decided by the local department of social services (LDSS) in the city or county where the applicant lives, not by DMAS, which only writes the policy. Cover Virginia, the state’s Medicaid help line, can answer questions, mail an application, or take one by phone at 1-855-242-8282 (TDD 1-888-221-1590). You can find your own LDSS office through the Virginia Department of Social Services local agency directory at dss.virginia.gov/localagency.
Nursing facility admissions or business office staff routinely help families assemble and deliver the paperwork to the LDSS..
60 months, federal standard. The IRS annual gift exclusion has no bearing here: a gift that is tax-free can still trigger a Medicaid penalty. Transfers to a spouse, to a disabled child, or of the home to a child who lived there and provided care for two years are the main exceptions.
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How to Apply for Virginia Nursing Home Medicaid
Where: The application is taken and decided by the local department of social services (LDSS) in the city or county where the applicant lives, not by DMAS, which only writes the policy. Cover Virginia, the state’s Medicaid help line, can answer questions, mail an application, or take one by phone at 1-855-242-8282 (TDD 1-888-221-1590). You can find your own LDSS office through the Virginia Department of Social Services local agency directory at dss.virginia.gov/localagency. Nursing facility admissions or business office staff routinely help families assemble and deliver the paperwork to the LDSS. — start the application.
Virginia decides medical need through the Medicaid LTSS Screening, completed on the Virginia Uniform Assessment Instrument (UAI). For someone living at home, a Community-Based Team made up of a local department of social services worker and a local health department nurse performs it; hospital discharge staff screen patients admitted from a hospital, and nursing facilities may screen in limited situations.
The screening looks at help needed with activities of daily living, physical and mental health, ongoing medical or nursing needs, and risk of admission without services. Results are filed electronically with DMAS.
Bring five years of bank statements, deeds, vehicle titles, insurance policies, the Medicare and Social Security cards, and any trust or power of attorney documents. Missing paperwork is the most common reason a Virginia nursing home medicaid decision is delayed.
While the Application Is Pending
While the application is pending, the nursing facility usually admits the resident and either bills privately, holds the account, or accepts the family’s assurance that Medicaid is being sought; Medicaid pays the facility only after approval, and then covers the period back to the eligibility date.
Virginia allows retroactive coverage for a limited number of months before the application month if the person would have qualified then, so unpaid nursing home bills from that window can still be covered. Typical decision time in weeks: UNVERIFIED.
After approval, nearly all of the resident’s income goes to the facility each month as the patient share, minus a small personal needs allowance, health insurance premiums and the spouse’s allowance.
Denials, Appeals and What Comes After
Most Virginia denials are procedural rather than substantive: the family did not return bank statements, deed records, life insurance values, or other verifications the caseworker requested, or the LTSS screening was never completed and submitted. Others involve countable resources still above the limit or a penalty from uncompensated transfers found in the financial review.
Any applicant may request a State Fair Hearing with the DMAS Appeals Division; guidance is at https://www.dmas.virginia.gov/appeals/applicant-member-appeals-resources/ and the appeals office can be reached at 804-371-8488. Appeals may also be filed when no decision is issued.
One more thing families should know before they file: after the resident’s death, the state may seek repayment from the estate. That process — what it can reach and the exemptions — is covered in our guide to Virginia Medicaid estate recovery.
A Realistic Virginia Nursing Home Medicaid Timeline
Week one: the hospital or family calls the Medicaid office for the level-of-care assessment and starts gathering five years of statements. Weeks two to four: the assessment is done and the financial application is filed, usually with the facility’s admissions office helping. Weeks six to twelve: the caseworker verifies accounts and may ask for more documents; answer within the deadline on each request or the clock resets.
Approval, when it comes, is retroactive to the eligibility date, which is why filing early is the single most valuable thing a family can do.
Where to Get Help Free
Two free doors exist in every state: the Virginia SHIP counselor for the Medicare side and the state’s Aging and Disability Resource Center for the Medicaid side. Neither sells anything. For a Virginia nursing home medicaid question involving a house, a spouse at home or a recent gift, a local elder law attorney or legal aid office is the next call.
Key Takeaways: Virginia Nursing Home Medicaid
- Two tests, not one: Virginia nursing home medicaid checks income and assets separately, and passing one does not excuse the other.
- The spouse is protected: the at-home spouse keeps a share of assets and an income floor under Virginia nursing home medicaid before anything is spent down.
- The look-back is five years: any gift inside it is divided by the divisor and becomes months without Virginia nursing home medicaid coverage.
- The home usually does not count: while a spouse lives there, the house is exempt from the Virginia nursing home medicaid asset test.
- Apply as Medicaid pending: most facilities admit while Virginia nursing home medicaid is decided and the state pays back to the eligibility date.
- Assessment first: the level-of-care evaluation is what starts the Virginia nursing home medicaid clock, so request it on day one.
- Retirement accounts often count: IRAs and 401(k)s are countable in most states under Virginia nursing home medicaid unless in payout status.
- Income trust or spend-down: whether an over-income applicant needs a Miller trust is the first Virginia nursing home medicaid question to settle.
- The resource snapshot matters: Virginia nursing home medicaid measures the couple’s assets on the day the stay began, not the day you apply.
Official Sources
- Virginia does not market nursing home coverage under a separate brand. The Department of Medical Assistance Services (DMAS) calls the benefit Medicaid Long-Term Services and Supports (LTSS), and the covered benefit itself is Nursing Facility Services. Families are formally applying for Medicaid for people who are Aged, Blind, or Disabled (ABD) with long-term care, which is the eligibility category the local caseworker will name on the notice. Virginia’s overall Medicaid program is now branded Cardinal Care, so approval letters, member cards and health plan mail may carry that name instead. — Virginia Medicaid: https://coverva.dmas.virginia.gov/learn/coverage-for-adults/long-term-services-supports/
- The application is taken and decided by the local department of social services (LDSS) in the city or county where the applicant lives, not by DMAS, which only writes the policy. Cover Virginia, the state’s Medicaid help line, can answer questions, mail an application, or take one by phone at 1-855-242-8282 (TDD 1-888-221-1590). You can find your own LDSS office through the Virginia Department of Social Services local agency directory at dss.virginia.gov/localagency. Nursing facility admissions or business office staff routinely help families assemble and deliver the paperwork to the LDSS.
- Medicaid.gov spousal impoverishment standards: medicaid.gov
- Medicare.gov Medicare Savings Programs: medicare.gov
This Virginia nursing home medicaid guide was checked against the state Medicaid agency, CMS and the statute cited above in September 2026. Figures reset on their own calendars (most on January 1); if a number here disagrees with a notice you received, the notice wins — and please tell us. This page is general information, not legal, financial or medical advice.