Frequently Asked Questions for Medicaid Planning Attorneys

Your parent or spouse needs long-term care, and the monthly cost is larger than most families can absorb. A hospital social worker may have mentioned Medicaid, a facility may be asking about payment, or you may have just learned that Medicare will not cover ongoing custodial care.

That moment can make every financial decision feel urgent. A bank transfer, home sale, gift to a child, or incomplete application can affect eligibility. The rules for Medicaid in Virginia look at income, assets, medical need, marital status, and in many cases, five years of financial history.

East Coast Elder Law helps Virginia families with long-term care planning, Medicaid eligibility, asset protection planning, and crisis applications under current rules. Led by Shannon Laymon-Pecoraro, a Certified Elder Law Attorney with more than a decade of experience in elder law and special needs planning, our firm gives families a clearer way to understand what Medicaid is, what it covers, and what decisions may come next.

What Is Medicaid in Virginia and How Does It Work?

Medicaid is a joint federal-state health coverage program. In Virginia, the Department of Medical Assistance Services, or DMAS, administers the program. Virginia’s Medicaid program is now called Cardinal Care.

Medicaid serves several groups of Virginians, including:

• Low-income adults.
• Children.
• Pregnant women.
• Adults age 65 and older.
• People with disabilities.
• People who need certain long-term services and supports.

Medicaid is not the same as Medicare. Medicare is a federal health insurance program tied mainly to age or disability status. It may cover hospital care, doctor visits, and short-term skilled nursing rehabilitation when specific requirements are met. It does not pay for ongoing custodial care in a nursing facility.

Custodial care usually means help with Activities of Daily Living, or ADLs, such as:

• Bathing.
• Dressing.
• Toileting.
• Transferring to or from a bed or chair.
• Walking.
• Eating.

Medicaid is different because it is means-tested. Eligibility depends on income, countable resources, medical need, and the type of Medicaid coverage requested. That is why Medicaid planning often matters before a family files an application or spends down assets.

Who Qualifies for Medicaid in Virginia?

Virginia Medicaid eligibility depends on the program. The rules for a child, pregnant adult, working adult, or person receiving regular Aged, Blind, and Disabled Medicaid are not the same as the rules for nursing facility Medicaid.

For long-term care Medicaid, two tests usually matter most:

• Financial eligibility, which looks at income and countable resources.
• Functional eligibility, which looks at medical need and level of care.

A person may meet the financial rules but still need screening before Medicaid pays for long-term care. A person may also need nursing facility care but have too much income or too many countable resources without planning.

Income and Asset Limits in 2026

For many Virginia long-term care Medicaid applicants, the 2026 countable income limit is $2,982 per month, which reflects 300% of the Supplemental Security Income amount. Countable resources must generally be reduced to $2,000 or below. People with income over the limit may still have options when the private cost of long-term care is greater than their income.

Note: The income limit does not apply when an individual is in the nursing home. Additionally, you may be able to go on a month-to-month income spenddown for in-home care services.

These figures do not mean every asset must be spent before a person can qualify. Some assets may be exempt from the countable resource calculation, depending on the facts.

Common exempt assets may include:

• The applicant’s primary residence, if the home equity rules are met.
• One vehicle.
• Household goods.
• Personal belongings.
• Certain prepaid funeral or burial arrangements.

For 2026, Virginia’s home equity limit is listed at $752,000. A nursing facility Medicaid recipient in Virginia also keeps a $40 monthly personal needs allowance. Most remaining income is usually paid toward the cost of care after allowed deductions.

Some families also hear the phrase “Medicaid spend down.” A spend-down is not simply giving money away or emptying accounts. It may involve using funds for allowable expenses, paying valid debts, purchasing exempt items, or addressing medical costs. The correct approach depends on the applicant’s income, assets, marital status, care setting, and timing.

How Married Couples Are Treated Differently

When one spouse needs nursing facility care and the other spouse remains at home, Medicaid applies spousal impoverishment protections. These rules are meant to keep the spouse at home from being left without enough resources or income to live.

In 2026, the Community Spouse Resource Allowance in Virginia follows the federal range:

• Minimum Community Spouse Resource Allowance: $32,532.
• Maximum Community Spouse Resource Allowance: $162,660.

The spouse at home may also receive income protection through the Minimum Monthly Maintenance Needs Allowance. If the community spouse’s own income falls below the allowed amount, part of the nursing facility spouse’s income may be redirected to the spouse at home instead of being applied to care costs.

Joint ownership does not automatically protect an asset. Medicaid generally reviews the couple’s countable resources together, then applies the spousal protection rules. This is one reason married couples should seek advice before retitling property, moving money, or filing a Virginia Medicaid application.

Does Medicaid Cover Nursing Home Care in Virginia?

Yes. Medicaid is one of the main public funding sources for long-term nursing facility care in Virginia. Coverage is not automatic.

To receive Medicaid-funded nursing facility care, the applicant usually must:

• Meet the financial eligibility rules.
• Meet the required level of care.
• Complete the required long-term services and supports screening.
• Receive care from a facility that accepts Medicaid.
• Have a Medicaid bed available at that facility.

Virginia requires screening for people requesting Medicaid support for long-term services and supports in a nursing facility, CCC Plus Waiver services, or PACE. The screening evaluates support needs with ADLs, physical health, ongoing medical or nursing needs, and whether the person is at risk for nursing facility admission or hospitalization without services.

Facility choice can also affect the process. Some nursing facilities accept Medicaid, while others do not. A facility that accepts Medicaid may still have limited Medicaid-funded beds. Families facing a hospital discharge timeline should ask direct questions about Medicaid participation, bed availability, and whether the facility can meet the person’s care needs.

Virginia also offers the CCC Plus Waiver, a home and community-based services waiver. The waiver may help eligible people receive care outside a nursing facility if they meet Medicaid eligibility and level-of-care requirements. Waiver services may include personal care, respite care, adult day health care, personal emergency response systems, private duty nursing, assistive technology, environmental modifications, and transition services when program rules are met.

Regular Aged, Blind, and Disabled Medicaid is different from nursing facility Medicaid and the CCC Plus Waiver. It has separate income rules, resource rules, and coverage limits. Knowing which program applies is a threshold decision.

How the Five-Year Look-Back Works

When someone applies for nursing facility Medicaid or certain home and community-based waiver services, Medicaid reviews transfers made during the 60 months before the application date. This is commonly called the five-year look-back period.

A transfer for less than fair market value can create a penalty period. During that period, Medicaid may refuse to pay for certain long-term care services, even if the applicant otherwise meets the financial and medical rules.

Transfers that can create problems include:

• Giving money to children or other relatives.
• Retitling real estate without receiving fair market value.
• Selling property for less than it is worth.
• Forgiving debts owed to the applicant.
• Moving assets out of the applicant’s name shortly before applying.

The five-year look-back is one of the most misunderstood parts of Medicaid planning in Virginia. Families sometimes believe that the annual federal gift tax exclusion protects gifts from Medicaid review. It does not. Gift tax rules and Medicaid eligibility rules are separate. A gift can be allowed for tax purposes and still create a Medicaid penalty.

Some spend-down steps may be proper when handled correctly, such as:

• Paying valid debts.
• Making necessary home repairs.
• Purchasing exempt household or personal items.
• Establishing certain prepaid funeral or burial arrangements.
• Using a Medicaid-compliant annuity in the right situation.

These decisions require careful timing and documentation. Before transferring assets, selling property, or applying for Medicaid in Virginia, families should understand how the look-back period may apply.

What Happens to My Spouse and Our Home?

Many families come to this issue with the same fear: they worry that qualifying for Medicaid means losing everything.

Virginia’s rules are more measured than that. A spouse who remains at home may have important income and resource protections. The home is not automatically taken simply because someone enters a nursing facility or qualifies for Medicaid. Still, the house can raise different questions while the Medicaid recipient is living and after their death.

Community Spouse Protections

When one spouse receives nursing facility Medicaid and the other spouse remains at home, the community spouse may keep a protected share of the couple’s countable resources through the Community Spouse Resource Allowance.

The community spouse generally keeps their own income. In some cases, the community spouse may also receive part of the nursing facility spouse’s income if the community spouse’s income is below the allowed maintenance amount.

These protections can make a meaningful difference, but they are not automatic in the way families often expect. The amount the community spouse may keep depends on the couple’s resources, the Medicaid rules in effect, and how the application is handled.

Virginia Estate Recovery After Death

The family home may be exempt while a Medicaid recipient is living, especially when a spouse remains in the home or the recipient has a reasonable expectation of returning home. That lifetime protection is separate from estate recovery.

Virginia operates a Medicaid Estate Recovery Program. After a Medicaid recipient dies, the state may seek reimbursement from the recipient’s estate for medical assistance payments correctly paid on behalf of certain recipients, including individuals age 55 or older under the state plan.

Recovery can occur only after the death of the recipient’s surviving spouse, if any, and only when the recipient has no surviving child under 21 or blind or disabled child as defined by law.

Virginia’s estate recovery rules may include recovery from assets that pass through probate and certain other assets in which the recipient had a legal interest at death. The state may also seek recovery for managed care capitation payments made on the recipient’s behalf.

Why Choose East Coast Elder Law for Medicaid Planning

Medicaid planning is not only about forms. It is about timing, documentation, family structure, assets, income, care needs, and the pressure families feel when facility bills are already arriving.

East Coast Elder Law is led by Shannon Laymon-Pecoraro, a Certified Elder Law Attorney with more than a decade of experience in elder law and special needs planning. She works with Virginia families on Medicaid eligibility, long-term care planning, public benefits protection, and crisis applications.

Our firm helps families evaluate:

• Whether nursing facility Medicaid or a waiver program may apply.
• What income and resources count.
• Which assets may be exempt.
• How prior transfers may affect eligibility.
• How spousal protections may apply.
• What records the Virginia Medicaid application may require.
• Whether a spend-down plan is available under current rules.

East Coast Elder Law also assists eligible veterans and surviving spouses with VA pension planning. The firm does not handle VA disability compensation claims or VA disability appeals.

During active crises, we understand that care decisions do not always fit neatly inside regular business hours. We work with families in Hampton Roads, Virginia Beach, Norfolk, Chesapeake, Williamsburg, the Eastern Shore of Virginia, and nearby communities to bring structure to the Medicaid process before avoidable mistakes become harder to correct.

Client Testimonials

“When navigating long term care options and the Medicaid application process, it’s easy to get overwhelmed and confused by what you can or should do to best benefit your loved one. Shannon was instrumental in ensuring my grandfather got the necessary long term care until he passed away. A check-up doctors appointment turned into an ER visit, which put him into the hospital and into a rehab facility, that ended with long term care, where he passed. Shannon worked with our family and fought hard to keep him in the best facility for his care, while helping us navigate the Medicaid process. Shannon’s knowledge of elder law and constant drive were crucial for ensuring my grandfather was taken care of. She worked closely with me after normal working hours and maintained constant contact throughout the entire process. Her passion and dedication for those who need it most is truly admirable. Shannon is top notch! Truly the best!!” — Barbara D.

“In our case, this was a legal need that showed up out of nowhere, and needed to be handled as soon as possible. They worked to make sure appointments were available to fit our schedule. They answered every question we had, and several that we had not realized we should ask. When life was somewhat chaotic, I really appreciated that the legal details were being taken care of by someone I trusted from the initial consultation. Would definitely recommend East Coast Elder Law.” — Katherine S.

Frequently Asked Questions About Medicaid in Virginia

How Long Does It Take to Get Approved for Medicaid in Virginia?

Virginia Medicaid applications are generally subject to a 45-day processing standard, or 90 days if a disability determination is needed. Long-term care applications can take longer in practice because they often involve financial review, long-term services and supports screening, facility coordination, and document requests. Missing bank statements, transfer records, or income verification can delay approval.

What Is the Difference Between Medicare and Medicaid in Virginia?

Medicare is federal health insurance for people age 65 and older and certain younger people with disabilities. It may cover short-term skilled nursing rehabilitation under specific conditions. Medicaid is a means-tested program that may pay for long-term nursing facility care or certain home and community-based services once eligibility is established.

Can I Give Money to My Children to Qualify for Medicaid?

Gifts made within the five-year look-back period can create a Medicaid penalty for nursing facility care or certain waiver services. The federal gift tax exclusion does not protect transfers from Medicaid review. Speak with a Virginia elder law attorney before giving away money, retitling property, or moving assets.

Does Medicaid Pay for Assisted Living in Virginia?

Standard nursing facility Medicaid does not pay for assisted living room and board in Virginia. Some eligible Virginians may receive certain services through the CCC Plus Waiver or separate assistance programs, but coverage is limited and program-specific. Eligibility depends on medical need, income, resources, residence, and available services.

What Is Cardinal Care?

Cardinal Care is the name of Virginia’s Medicaid program. It includes managed care and fee-for-service Medicaid coverage. Many Medicaid members receive benefits through a Cardinal Care managed care organization, while some remain in fee-for-service coverage depending on their program, eligibility category, and circumstances.

Get Help With Medicaid Planning Before Costly Mistakes Happen

When long-term care enters the picture, the financial questions do not wait for the family to feel ready. A parent may already be in a facility. A spouse may need more care than the home can safely provide. The records Medicaid needs may stretch across years.

East Coast Elder Law helps Virginia families understand Medicaid eligibility, long-term care planning, spousal protections, spend-down issues, and crisis applications under current rules. We meet the moment with calm guidance and Virginia-specific planning.

Call 757-734-7584 or use our contact form to schedule a consultation.