When Virginia's Medicaid Program Will Pay for Home Health Care

Virginia has limited coverage for home health care through its Medicaid program.

Virginia has several Medicaid and non-Medicaid programs that offer payment for home health care services. Home health care can consist home aide services like medication management or bathing assistance, skilled nursing care, therapy services, and even personal care aide services like meal preparation or cleaning. For Medicaid to pay for home or community-based health care services, you must be eligible for Medicaid under Virginia's rules. Virginia's Medicaid eligibility rules are more lenient for long-term care services than for doctor visits or hospital stays. For more information, see Nolo's article that discusses Medicaid eligibility for long-term care in Virginia. Note that Virginia no longer has an Alzheimer's Assisted Living Waiver program.

Medicaid Coverage of Home Health Services

If you receive Medicaid, the program will pay for some limited home health care services. The services must be prescribed by your doctor as part of a plan of care for a particular problem, and the services must be directed at curing or rehabilitating you.

If you need ongoing home services to help you do activities of daily living or manage your medications, Medicaid will not cover that type of help. Instead, you should consider whether you qualify for any of Virginia’s several Medicaid Home and Community Based Care Waiver (CBC) programs or its Program for the All-Inclusive Care of the Elderly (PACE) that provide home and community-based care services to low-income residents. To qualify for most of Virginia’s waiver programs for home care, you must meet the nursing home level of care, as discussed in Nolo's article on when Virginia's Medicaid program pays for nursing homes.

Virginia’s Medicaid Waiver Programs

Virginia’s Commonwealth Coordinated Care (CCC) Plus Waiver, a combination of the waivers formerly known as the Elderly and Disabled with Consumer Direction (EDCD) Waiver and the Technology Assisted Waiver (Tech) Waiver, helps seniors and disabled individuals receive long-term care services in the community.

The CCC Plus Waiver program provides care in the home and community, rather than in a nursing or other specialized care facility, to those who require a hospital or nursing home level of care. To eligible individuals who are 65 or older or disabled, and certain others who are functionally dependent and have medical nursing needs, the CCC Plus Waiver program offers services like adult day health care, respite care, personal care, medication monitoring, private-duty nursing, environmental modification, assistive technology, emergency response systems, and case management for those who live at home. (Adult day health care provides medical and rehabilitative services in a group setting during the day.) Depending on your income, you may have to pay a portion of the cost of your services under this program. In this program, you can choose to either have an agency hire and supervise your personal care attendants, or you can choose to hire and supervise your own. If you choose the “consumer-directed” model, the state will assign a services facilitator to help you coordinate your own care.

Other waiver Programs are available for Virginians with intellectual or developmental disabilities. For more information about those, contact your local Community Services Board.

Virginia’s PACE Program

Virginia offers a Program for All-Inclusive Care for the Elderly (PACE). PACE is only available in certain locations in the state. PACE participants receive their services from an interdisciplinary team of professionals like physicians, nurses, and social workers, whose role is to coordinate individualized care and services to keep seniors in their own homes and communities. PACE participants must be at least 55 years old, meet the nursing home level of care, and be able to reside safely in the community with the help of PACE services. If you are interested in a PACE program, apply directly to the one you are interested in, and the program staff will help determine your eligibility.

Additional Help Available If You Are Moving Out of a Nursing Home

If you enroll in one of the above waiver or PACE programs after you have been in a nursing home for more than 90 days, then you may be entitled to additional services aimed at transitioning you back to your home. You can get assistance making modifications to your house and with temporary rental payments while home modifications are being completed. These services are provided under Virginia’s Money Follows the Person (MFP) program, a demonstration project administered by the Virginia Department of Medical Assistance Services. You can get these services if you are moving into your own home or apartment, your family’s home or apartment, or a small community-based group home containing no more than four unrelated people.

Supportive Services for Virginians Who Do Not Qualify for Medicaid

If you do not qualify for Medicaid and do not meet the nursing home level of care, you may still qualify for some personal assistance services if you are physically disabled and need help with activities of daily living like eating, dressing, or bathing. Virginia’s Department for Aging and Rehabilitative Services offers personal assistance services through the Personal Assistance Services (PAS) Program. Note that you cannot participate in the PAS program if you qualify for any of Virginia’s Medicaid waiver programs. To apply, contact Virginia’s PAS program.

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