When Medicaid in Virginia Will Pay for a Nursing Home

Virginia's Medicaid program (also called "Cardinal Care") pays for nursing home stays for people without a lot of income who need help with activities of daily living. Nursing homes are expensive; in 2024, the average daily cost of a private room in a nursing home in Virginia was $335 (over $10,000 per month).

Private health insurance policies and Medicare don't cover long-term care. And few people purchase private long-term care (LTC) insurance policies.

In Virginia, like the rest of the nation, Medicaid is a very common source of funding for long-term care—especially for those who've already used up all their own assets to pay for care. About 62% of nursing home residents nationwide use Medicaid to pay their nursing home costs. Virginia is no exception.

You can become eligible for Virginia's Medicaid program in many ways. The state has specific eligibility rules for long-term care services, such as:

• nursing homes,
• assisted living facilities, and
• home health care.

Assisted living facilities and home health care services are generally more affordable than nursing home care, but still costly. Fortunately, if you're eligible, Virginia Medicaid can help you access the type of long-term care services you need.

Income Limits for Long-Term Care in Virginia

Virginians who are 65 or older, disabled, or blind can qualify for Medicaid if they meet certain income and asset limits. Most people who receive Supplemental Security Income (SSI)—a needs-based program—already qualify to receive Medicaid in Virginia.

Regular Medicaid Income Limit in Virginia

If you're not receiving SSI, you can qualify for regular Medicaid for the aged, blind, and disabled (ABD) in Virginia if your monthly income is less than 80% of the federal poverty level (FPL). (In 2025, 80% of the FPL is $1,043 per month for an individual.) Fortunately, the income limit for long-term care is higher than for ABD Medicaid (more on this below).

Virginia LTC Medicaid Income Limit

Cardinal Care has a higher income limit for many Virginians who need long-term care services, including people who are:

• 65 or older
• blind
• disabled
• pregnant
• under age 19, or
• a parent living with a child under 18.

If you fall into one of these groups, you can qualify for Medicaid for long-term care if your monthly income is no more than 300% of the SSI benefit amount for an individual, or $2,901 per month for 2025.

Qualifying for Medicaid Through Virginia's Medically Needy Program

If your income is above both the ABD and LTC Medicaid limits, you still might qualify for LTC Medicaid if you have a lot of medical expenses. Going through Virginia's Medically Needy Program, you can use your monthly medical bills to "spend down" your income and qualify for Medicaid.

The Medically Needy spend-down income limit is how much you'd have left after subtracting your monthly medical bills from your monthly income. It varies by geographic region. In 2025, Virginia's three regions have the following monthly income limits:

• Group 1: $401.69 for individuals and $511.35 for couples
• Group 2: $463.49 for individuals and $570.71 for couples, and
• Group 3: $602.54 for individuals and $726.39 for couples.

So, if you're single and in Group 3, for example, you'd need to show that paying your monthly medical expenses would lower your income to $602.54 or less. Once you meet that limit, you qualify for Medicaid coverage for the rest of that month. You don't actually have to pay the bills to qualify, just receive them.

Resource Limit for Long-Term Care Medicaid in Virginia

To qualify for Medicaid in Virginia, you must have no more than $2,000 in resources. Resources are assets like money and property. Some properties don't count toward the resource limit. In Virginia, for instance, exemptions include one car, personal items, and household goods.

The state follows complicated rules to decide whether or not your house is exempt. If you're still living in your home, the house and the lot it sits on are exempt.

But if you need Medicaid for long-term care, you can't have more than $730,000 in equity in your home in 2025. In addition, your home is only an exempt resource for the first six months that you're in an institution, unless you intend to return to your home. However, if certain family members live in your home, your home remains exempt indefinitely. Family members include your:

• spouse
• dependent child
• disabled adult child, or
• disabled parent.

If your income is below 80% of the FPL, your home can also remain exempt after six months if you intend to return to it or if selling it would cause undue hardship to a co-owner. (But it generally won't be exempt from Medicaid estate recovery.)

Any additional land you have that surrounds or is adjacent to your home might be exempt—depending on which Medicaid income qualifications you meet.

If your qualifying income is less than 80% of the FPL, all surrounding land is exempt. If you qualify for Medicaid by meeting the 300% FPL limit, only your home is exempt. The exemption of additional land surrounding your home depends on its value. If it's worth more than $5,000, it counts as a resource. (Va. Code § 32.1-325(A)(3).)

These rules can be confusing. It can be helpful to talk to an elder care lawyer if you need help determining if the equity in your home or additional land counts as a resource for Medicaid.

When Virginia Medicaid Considers a Nursing Home Medically Necessary

Medicaid will pay for a nursing home only when it's medically necessary. So, you must show that you require a "nursing home level of care," meaning that you have a physical or mental condition that requires nursing supervision and assistance with activities of daily living (ADLs). You must show that you can't care for yourself.

Before Medicaid will pay for nursing home care, you must have a "pre-admission screening." These screenings are usually done by a nurse or social worker who visits you wherever you're living when you apply for help. The screener uses a form, called the Virginia Uniform Assessment Instrument, to help evaluate whether you need help with certain daily activities. (22 Va. Admin. Code § 40-73-440.) The assessment evaluates your need for help with things like:

• bathing
• eating
• taking medication
• using the bathroom
• moving around, and
• dressing.

The screener will decide how much assistance you typically need to get those activities done. Whether you meet the nursing home level of care depends on the combination of the number of things you need help with and the level of help you 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 appropriate for you. In general, for a nursing home to be considered medically necessary, you must have a medical condition that's so serious that you need the level of nursing care only available in an institution.

Virginia's Personal Needs Allowance for Medicaid LTC Recipients

If you receive Medicaid and live in a nursing home, you'll be required to spend most of your income on your care. How much you can keep depends on whether you're receiving nursing home Medicaid or home and community-based waiver services (HCBS).

Virginia allows nursing home residents receiving Medicaid to keep only $40 per month as a personal needs allowance. If you receive Medicaid and get long-term support services through a Medicaid HCBS waiver, the personal needs allowance is 165% of the SSI benefit level ($1,595 per month in 2025).

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

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