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

Virginia has several Medicaid and non-Medicaid programs that offer payment for home health care services. Home health care can consist of skilled nursing care, therapy services, medication management, and personal care aide services.

Who Is Eligible for Free Home Health Services in Virginia?

For Medicaid to pay for home or community-based health care services, you must be eligible for Medicaid under Virginia's long-term care rules. Virginia's Medicaid eligibility rules are more lenient for long-term care services than for doctor visits or hospital stays. To qualify for home health services, your income limit needs to be less than $2,901 per month for 2025. Family income doesn't count.

For more information about long-term care eligibility in general, including asset limits and the medically needy program, read our article on Medicaid eligibility for long-term care in Virginia.

You also need to be medically eligible for Medicaid-paid home health services. Virginia uses a long-term services and supports (LTSS) screening to determine who's eligible. You can request an LTSS Screening through the Department of Social Services. A social worker and nurse will meet with you to assess your need for home health services.

Medicaid Coverage of Home Health Services in Virginia

Virginia has several Medicaid and non-Medicaid programs that cover the cost of home health care services, such as:

• home aide services (help with the daily activities, like managing your medication or bathing and dressing yourself)
• skilled nursing care
• therapy services, and
• personal care aide services (help with household tasks like meal preparation or cleaning).

If you receive Medicaid, Virginia's Cardinal Care will pay for some limited home health care services. To be eligible for these Medicaid benefits under Cardinal Care, your doctor must have prescribed the services as part of a plan of care for a particular problem—with the goal of curing or rehabilitating you.

If you need ongoing home services to help you do activities of daily living or manage your medications, regular Medicaid for the aged, blind, and disabled (ABD Medicaid) won't cover it. But one of Virginia's Medicaid Home and Community Based Service Waiver (HCBS) programs or the state's Program for the All-Inclusive Care of the Elderly (PACE) might.

HCBS waivers and PACE both 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 for Virginia.

Virginia's Medicaid Waiver Programs

Virginia's Commonwealth Coordinated Care (CCC) Plus Waiver helps seniors and people with disabilities who need nursing home-level care to get the long-term care services they need at home and in their communities. This waiver allows these individuals to live at home instead of nursing homes or specialized care facilities.

CCC Plus Waiver services are for eligible individuals who are 65 or older or disabled, and certain others who are functionally dependent and have medical nursing needs. The program offers services like adult day health care, which provides medical and rehabilitative services in a group setting during the day. The program also offers services like:

• respite care
• personal care
• medication monitoring
• private-duty nursing
• environmental modification
• assistive technology
• emergency response systems, and
• case management.

Depending on your income, you might 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 attendants. If you choose the "consumer-directed" model, the state will assign a services facilitator to help you coordinate your care.

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

Does Virginia's Medicaid Program Pay for Assisted Living?

Cardinal Care doesn't pay for assisted living, and Virginia doesn't have any Medicaid waiver programs that pay for assisted living. But the CCC Plus Waiver discussed above can help finance assisted living. The CCC Plus Waiver can pay for certain services in assisted living centers instead of at home, including nursing, adult day care, personal care, medication monitoring, assistive technology, and case management. So while the waiver doesn't pay for room and board at assisted living facilities, it can take care of a lot of the costs of services provided at assisted living centers.

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. The PACE team coordinates individualized care and services to keep seniors in their own homes and communities as long as possible.

If you qualify for Medicaid, you can receive PACE services free of charge. To enroll in Virginia's PACE program, you must:

• be at least 55 years old
• meet the nursing home level of care, and
• be able to live safely in your home (or the community) with the help of PACE services.

You must also live in a PACE services area. If you're interested in a PACE program, apply directly to the one you're interested in, and the program staff will help determine your eligibility. Find the PACE programs serving your zip code on the Virginia PACE Alliance website.

Additional Help Available If You're Moving Out of a Nursing Home

If you enroll in the CCC Plus Waiver or PACE program after you've been in a nursing home for more than 90 days, you might be entitled to additional services aimed at transitioning you back to your home. These services are provided under Virginia's Money Follows the Person (MFP) program. MFP is a demonstration project administered by the Virginia Department of Medical Assistance Services (DMAS).

MFP provides transitional services if you're moving out of an institution. Services are available whether you're 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.

Virginia's MFP can help you make modifications to your house that will allow you to live there instead of in a nursing home. It also helps with temporary rental payments while home modifications are being completed.

Supportive Services for Virginians Who Don't Qualify for Medicaid

If you don't qualify for Medicaid and don't meet the nursing home level of care, you might still qualify for some personal assistance services if both of the following are true:

• you're physically disabled, and
• you need help with activities of daily living like eating, dressing, or bathing.

Virginia's Department for Aging and Rehabilitative Services offers personal assistance services (also called "attendant care") through the Personal Assistance Services (PAS) Program. Note that you can't participate in the PAS program if you qualify for any of Virginia's Medicaid waiver programs. To apply for PAS services, contact Virginia's PAS program.