How To Get Medicaid In Virginia

Virginia's Medicaid program has fairly lenient income limits for qualifying for nursing home care coverage.

Virginia's Medicaid programme pays for nursing domicile 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 toll of a private room in a nursing home in Virginia was $280. Assisted living facilities and dwelling health care services are a bit more than affordable, but still costly. (For details, come across Nolo's commodity on when Virginia Medicaid will cover assisted living facilities and dwelling house health care.) Long-term intendance 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 upwardly all of their ain assets to pay for care. Approximately 70% of nursing home residents nationwide utilise Medicaid to pay for their nursing home intendance.

At that place are many different ways to become eligible for Virginia's Medicaid program, and in that location are specific eligibility rules for long-term intendance services like nursing homes, assisted living facilities, and habitation wellness care.

Income Limits for Long-Term Care in Virginia

Virginians who are 65 or older, disabled, or blind can authorize for Medicaid if they also run into income and nugget limits. Most people who receive SSI already qualify to receive Medicaid in Virginia. To qualify for basic Medicaid in Virginia (not long-term intendance), if you are elderly, bullheaded, or disabled and not receiving SSI, then your monthly income must be less than 80% of the federal poverty level (FPL). (In 2019, lxxx% of the FPL is $833 per calendar month for an individual. With Medicaid expansion effective in 2019, Medicaid is at present too bachelor to sure non-elderly Virginia residents earning up to 138% of the FPL, or $17,237 per year for an individual in 2019.)

Fortunately, in that location is a college income limit for seniors (and some others) who need long-term care services. If yous are 65 or older, blind, disabled, pregnant, under age nineteen, or a parent living with a child under 18, then you can qualify for Medicaid for long-term care equally long every bit your monthly income is no more than than 300% of the SSI amount for an private, or $ii,313 per month for 2019.

If your income is above the limit, you yet might be able to qualify for Medicaid for long-term intendance if yous have a lot of medical expenses. Going through Virginia'south Medically Needy Program, you can apply medical bills that you incur each month to "spend downwardly" your income and qualify for Medicaid.

The Medically Needy spend-down income limit varies depending on the canton in which you live. As a full general guideline, nonetheless, the spend-down limit is 47% of the FPL—in 2019, $489 per calendar month for a single person and $662 per month for a married couple—meaning that you must show that you lot have incurred medical expenses each calendar month that would go out y'all with no more than those amounts. In one case you prove that you take those expenses, you qualify for Medicaid coverage for the rest of that month. You do not actually take to pay the bills with your income, only incur them.

Resource Limit for Long-Term Care in Virginia

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

The state follows complicated rules to decide whether your house is exempt or non. If yous are living in your abode, it is exempt. If yous have land surrounding your home that is worth more than $5,000, that country is counted as a resource if you qualified for Medicaid by coming together the 300% FPL limit. If your qualifying income is less than 80% of the FPL, and so your home and all surrounding land is exempt.

If you demand 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 simply an exempt resources for the first six months that yous are in an establishment. 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 lxxx% of the FPL, your habitation can also remain exempt after six months if you intend to return to it or if selling it would crusade undue hardship to a co-possessor.

These rules are confusing; you lot should talk to an elder intendance lawyer if y'all need help determining if the disinterestedness in your habitation counts as a resource.

When a Nursing Home Is Medically Necessary

Medicaid will pay for a nursing home only when information technology is medically necessary. You lot must show that y'all require a "nursing home level of care," meaning that you lot have a concrete or mental condition that requires nursing supervision and assistance with activities of daily living (ADLs). You must show that you lot cannot care for yourself.

Before Medicaid will pay for nursing domicile care, you must accept a "pre-admission screening." These screenings are usually done by a nurse or social worker who visits you wherever you lot are living when you apply for help. The screener uses a class, called the Virginia Uniform Cess Instrument, to assist evaluate whether you lot need assist with certain activities, including bathing, eating, taking medication, using the bathroom, moving around, and dressing. The screener will decide how much aid you typically need to get those activities done. Whether you lot meet the nursing habitation level of intendance depends on the combination of the number of things you need aid with and the level of help you lot 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 advisable for you. In full general, for a nursing home to be considered medically necessary, you must have a medical status that is so serious that you demand the level of nursing care that is merely available in an institution.

Personal Needs Allowance for Nursing Home Residents

If you receive Medicaid and live in a nursing habitation, you will exist expected to spend most of your income on your care. Virginia allows nursing dwelling house residents receiving Medicaid to keep only $40 per month every bit a personal needs allowance. If you receive Medicaid and become dwelling house- and community-based Medicaid Waiver services (discussed on the next page), and then you are immune to proceed $one,272 per calendar month equally your personal needs assart.

Read on to find out when Virginia Medicaid will cover assisted living facilities and domicile health care.

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