Medicaid for Senior Care in Virginia
What Medicaid Actually Covers for Senior Care
Virginia Medicaid, known as Cardinal Care, offers crucial support for seniors needing long-term care, primarily through two key programs: the Commonwealth Coordinated Care Plus (CCC Plus) Waiver and the Program of All-Inclusive Care for the Elderly (PACE).
The CCC Plus Waiver is designed to help seniors stay in their homes and communities rather than entering a nursing facility. It covers services like personal care assistance, adult day care, personal emergency response systems, home modifications for safety and accessibility, respite care, and private duty nursing. These services are for those who meet a nursing facility level of care. While comprehensive for in-home support, remember that this waiver focuses on services, not covering your basic room and board costs.
The Program of All-Inclusive Care for the Elderly (PACE) is for individuals age 55 and older who need a nursing home level of care but wish to remain at home. PACE provides a full spectrum of care, integrating all Medicare and Medicaid benefits. This includes physician visits, emergency care, medications, home health services, medical supplies, hospital and nursing home care when needed, meals, nutritional counseling, transportation, home modifications, and rehabilitation.
For those requiring institutional care, Nursing Home Medicaid covers the costs of care in a Medicaid-certified nursing facility.
Do You Qualify?
Navigating Virginia's Medicaid eligibility rules for 2026 can feel complex, but here's a straightforward look. For a single senior needing Nursing Home Medicaid or Home and Community Based Services (like the CCC Plus Waiver), your monthly income generally must be under $2,982. Your countable assets must be at or below $2,000.
If your income is higher, Virginia has a "Medically Needy" or "Spend-down" program. This allows you to become income-eligible by using your excess income for medical expenses, such as health insurance premiums, doctor visits, and prescription drugs.
For couples where both apply for Nursing Home Medicaid, the combined income limit is $5,964 per month and assets are limited to $4,000. If only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted towards the $2,982 limit. The non-applicant spouse can keep a significant amount of assets, up to $162,660, known as the Community Spouse Resource Allowance.
If your parent owns a home, their primary residence is generally not counted as an asset, especially if a spouse, minor child, or a blind or disabled child lives there. There is also a home equity limit of $752,000 in 2026. However, if the home becomes vacant and no qualifying family members reside there, it may be counted after six months unless there's a documented intent to return home or it's listed for sale. Pensions are considered income, and for those in a nursing home, most of that income, minus a small personal needs allowance (e.g., $40/month), will go towards the cost of care. Virginia also has a 5-year look-back period to review asset transfers before applying.
Waitlists & How to Apply
When you're ready to apply, it's good to know what to expect. The good news is that Virginia's CCC Plus Waiver generally does not have a waitlist, meaning services can begin once eligibility is confirmed. However, Developmental Disability (DD) Waivers do have waitlists, with priority given based on the urgency of need.
You can apply for Medicaid online at commonhelp.virginia.gov. Alternatively, you can call the Cover Virginia Call Center at 833-5CALLVA (1-833-522-5582) or visit your local Department of Social Services (DSS) office to submit a paper application. For seniors aged 65 and older seeking long-term care, you'll need to complete the "Cover Virginia Application for Health Coverage and Help Paying Costs" along with "Appendix D."
Be prepared with information such as Social Security numbers, income details (like paystubs or pension statements), and current health insurance policy numbers. Medicaid applications typically take up to 45 days for a determination. For the CCC Plus Waiver, the screening process itself can take around 30 days, with the full Medicaid approval following in 45-60 days.
Last updated: March 2026. Sources: CMS, state Medicaid agency, Genworth 2024.