Virginia Medicaid Planning: What Families Need to Know

Virginia Medicaid can pay for nursing-facility care when a person needs it and meets financial rules that the Virginia Department of Medical Assistance Services (DMAS) sets: a resource test, an income test tied to 300% of the SSI payment, a 60-month look-back at transfers, and spousal protections that in 2026 let a spouse at home keep resources up to $162,660. After death, DMAS may seek repayment from the estate.

Most people facing a nursing-home admission in Virginia come to this question suddenly: a hospital discharge planner mentions Medicaid, a parent in Roanoke can no longer live alone, or a husband in Northern Virginia needs more care than his wife can give at home. The family is weighing a monthly bill against savings built over decades, and wondering what happens to the house and to the spouse who stays in it. This page sets out how Virginia's own program answers those questions, and where the answer depends on facts or on rules that change.

How Virginia Medicaid Covers Long-Term Care

DMAS administers Virginia's medical assistance programs, Medicaid and CHIP (called FAMIS in Virginia), according to the DMAS member eligibility manual. Eligibility decisions are made by the local departments of social services and by the Cover Virginia Central Processing Unit, not by the nursing home.

Paying for long-term care runs on rules distinct from ordinary health coverage. DMAS keeps a separate chapter of its eligibility manual, Chapter M14: Long-Term Care, covering long-term services and supports. For a person in a facility who does not qualify in another full-benefit group, DMAS uses a "special income" group with its own method of counting income and resources. Virginia's income chart also lists allowances for community-based care (CBC), meaning care outside a facility; this page does not address the individual home- and community-based waiver programs.

Federal law sets the framework every state must follow, and Virginia runs its own program inside it. This page covers Medicaid for long-term care only; it does not cover Medicare, private long-term-care insurance or veterans' benefits.

Virginia Medicaid Eligibility: Assets, Income, and the Look-Back Period

Three tests decide eligibility: the person's care needs, their resources and their income. This page focuses on the two financial tests rather than on how DMAS assesses the need for a nursing-facility level of care.

Resources. A countable asset is one Medicaid adds up against the limit; an exempt asset is not counted. Virginia follows Social Security's SSI resource rules, adapted for state law, per Chapter M11: ABD Resources. That chapter lists a $2,000 limit for one person and $3,000 for a couple in the aged, blind and disabled group with income under 80% of the poverty level; the figure for a particular long-term-care group follows that group's own rules in the manual.

Income. The special income group uses a limit of 300% of the SSI payment for one person. The federal 2026 standards bulletin puts that cap at $2,982 a month, effective January 1, 2026. Under M14, a person above it is treated as medically needy and placed on a spenddown, met month by month after expenses are actually incurred. Virginia does not recognize Miller trusts (qualified income trusts), M11 states.

Look-back. The look-back period is the window in which DMAS reviews gifts and other transfers. M14 states it is 60 months, matching the federal rule for transfers on or after February 8, 2006, in 42 U.S.C. § 1396p(c)(1)(B)(i). A penalty period is a stretch of ineligibility caused by a transfer for less than fair value.

What Virginia Medicaid Counts — and Does Not Count — as an Asset

Bank accounts, investments and property beyond the home are the kinds of assets families usually ask about first, and M11 governs how each is treated. Virginia defines the home as property that serves as a person's principal place of residence; M11 also sets the conditions under which the home stays excluded while the applicant is in a facility.

Federal law adds a ceiling: under 42 U.S.C. § 1396p(f), long-term-care coverage is barred where home equity exceeds a set limit, unless a spouse, a child under 21 or a blind or disabled child lives in the home. Virginia's income chart lists that excess home equity figure as $752,000 from January 1, 2026; M14 lists $730,000 for 2025.

The treatment of a vehicle, prepaid burial arrangements and life insurance is set out in M11's resource rules.

Spend-down means reducing countable assets to the limit by paying for things of fair value, such as care bills, home repairs, medical equipment or a prepaid funeral. Each purchase is reported on the application, and M11 governs which purchases leave the family holding an exempt asset.

Spousal Protections: What the Community Spouse Keeps in Virginia

A wife in Hampton Roads whose husband has just entered a facility is, in Medicaid's terms, the community spouse: the spouse who remains at home. Under 42 U.S.C. § 1396r-5, the resources of both spouses are pooled when the institutionalized spouse applies, and the community spouse may keep a community spouse resource allowance (CSRA). Either spouse may ask the state to assess the couple's total resources when continuous institutionalization begins, and the notice must describe a right to a fair hearing.

Virginia's income chart sets these figures:

• Spousal resource standard (the CSRA floor): $32,532, from January 1, 2026
• Maximum spousal resource standard: $162,660, from January 1, 2026
• Maximum monthly maintenance needs allowance: $4,066.50, from January 1, 2026
• Minimum monthly maintenance needs allowance (MMMNA): $2,705, from July 1, 2026
• Excess shelter standard: $811.50, from July 1, 2026

The MMMNA is the minimum monthly income the at-home spouse is allowed to keep, drawn from the other spouse's income when needed. The nursing-facility personal needs allowance is $40.

The community spouse's own income is generally not counted as available to the spouse in care. A transfer to one's spouse carries no transfer penalty under 42 U.S.C. § 1396p(c)(2)(B)(i). Couples elsewhere can compare Illinois Medicaid planning.

Transfers, Gifts, and the Penalty Period: What Virginia Families Need to Understand

Many families in Virginia reasonably wonder whether helping a grandchild with tuition three years ago now counts against a parent. A transfer of a countable asset for less than its value inside the 60-month look-back can create a penalty period. Under 42 U.S.C. § 1396p(c)(1)(D)(ii), that penalty starts on the later of the month of the transfer and the date the person is otherwise eligible and would be receiving institutional-level care. A gift made four years before applying is penalized the same way as one made four months before.

Not every transfer is penalized. Federal law lists exceptions, including transfers to the person's spouse; whether another exception fits turns on the statute and the family's facts. M14 governs how DMAS calculates the length of a penalty, and it sets out some figures separately, by application date, for Northern Virginia localities: Alexandria, Arlington, Fairfax, Fairfax County, Falls Church, Loudoun County, Manassas, Manassas Park and Prince William County.

Every transfer is disclosed on the application. Whether a particular transfer creates a penalty turns on its date, its value, who received it and why.

Virginia Medicaid Planning Tools: Trusts, Annuities, and Spend-Down Strategies

Trusts are governed in Virginia by M11's rules for trusts an individual establishes on or after August 11, 1993. An irrevocable trust, one the person cannot revoke, can in some cases hold assets that are no longer counted, but funding it is a transfer, so the look-back and penalty rules apply. Whether a trust's assets count depends on its terms. M11 also addresses income placed in a trust for a disabled individual or a pooled trust.

An annuity converts a lump sum into a stream of payments. Whether DMAS treats an annuity as a countable asset, as income or as a transfer turns largely on its terms.

A caregiver agreement is a written contract paying a family member for personal care actually provided. Whether payments count as fair value turns on the contract's terms and the records kept.

Spend-down on exempt items, such as home repairs, medical equipment or a prepaid funeral, is the other common approach. None of these tools works the same way for every family, and none guarantees eligibility. Readers comparing states can see Texas Medicaid planning.

Virginia Estate Recovery: What Happens After a Medicaid Recipient Dies

Estate recovery is the state seeking repayment from a deceased recipient's estate for benefits it paid. Federal law, 42 U.S.C. § 1396p(b)(1), requires states to seek recovery for people who were 55 or older when they received nursing facility and related services. Virginia's estate-recovery statute directs DMAS to operate a recovery program for people whose nursing-facility care Medicaid financed, capped at total Medicaid payments made.

Virginia's estate-recovery regulation says DMAS gives notice of the program at application and seeks recovery from the estate of a person 55 or older, up to the total spent on items and services under the State Plan, with a protection for people eligible for both Medicaid and Medicare.

Recovery is deferred: under 42 U.S.C. § 1396p(b)(2) and the Virginia regulation, it can be made only after the surviving spouse's death and only when there is no surviving child under 21 or blind or disabled child. Deferral postpones the claim; it does not cancel it. States must also have procedures to waive recovery for undue hardship under 42 U.S.C. § 1396p(b)(3). In Virginia, anyone affected may apply for a hardship waiver, DMAS decides it, and recovery is waived when heirs are themselves Medicaid eligible. DMAS also sets a threshold below which it does not pursue recovery. Whether the home is reached, and whether Virginia's claim extends beyond the probate estate, depends on Virginia's current rules.

What a Virginia Medicaid Planning Attorney Does — and When to Involve One

Attorney involvement in Virginia usually starts with documents: account statements, deeds, five years of transfers, income records and the care setting. An attorney compares those facts against DMAS rules to see which options the rules allow, can assist with the application and its paperwork, and can represent a family in an appeal.

Crisis planning describes work that begins after a nursing-home admission. Options may still exist then, including the spousal allowances and permitted spend-down, though what is available depends on the facts. Advance planning begins before care is needed, when more of the 60-month look-back can pass before an application.

Medicaid Asset Protection Group is a website that provides information and facilitates inquiries; it is not a law firm. Rules differ by state, as Colorado Medicaid planning and North Dakota Medicaid planning show.

Virginia Regions and Where Cases Are Filed

DMAS runs one program statewide, but applications are handled locally. Inquiries go to the local department of social services where the applicant lives, to the Cover Virginia Call Center at 1-855-242-8282 or the Cover Virginia website. A family in Northern Virginia, the Richmond metro, Hampton Roads, Roanoke and Southwest Virginia, Charlottesville or the Shenandoah Valley follows the same rules through its own local office; only the Northern Virginia figures in M14 noted above differ.

The DMAS provider manual adds one limit: a provider's employee or contractor who stands to receive Medicaid payment may never file an application for a deceased individual.

Appeals. A notice of adverse action includes appeal rights to DMAS. Per the DMAS appeals summary, a client has 30 days, plus 5 days for mailing, from the date on the notice; an exception may be made for good cause. Appeals of a managed care organization's final decision must reach DMAS within 120 days, which cannot be extended. The member, an attorney or an authorized representative may appeal orally or in writing. The agency sends an appeal summary, a DMAS Appeals Division hearing officer holds the hearing by phone or in person, and a written decision follows. The process is the same in every region of the state.

Discussing Medicaid Planning in Virginia

Virginia's rules turn on details: when a transfer was made, which local office handles the application, how a couple's resources split on the date care began, and what the estate may owe later. A conversation with an attorney would cover the assets and their titles, five years of transfers, both spouses' income, the care setting and who lives in the home. This page cannot settle those facts, and it does not cover Medicare, veterans' benefits or private insurance.

To discuss a situation like this with an attorney, request a consultation about your family's Medicaid and long-term-care options through Medicaid Asset Protection Group.