Many Virginians qualify for high-quality, no-cost health coverage through Medicaid. Do you? Find out if Virginia Medicaid is an option for you by viewing eligibility for adults, children, and pregnant women. Use the Screening Tool on the Cover Virginia website to check. Show
Screening Tool Apply Medicaid Eligibility for ChildrenYour child may be eligible for benefits if they:
Medicaid Eligibility for AdultsAdults may be eligible if you:
You are eligible for the Commonwealth Coordinated Care Plus (CCC Plus) program when you have full Medicaid benefits and meet one of the following conditions:
Medicaid Eligibility for Pregnant WomenYou may be eligible for pregnancy coverage if you:
You can Apply For Medicaid at Any TimeIf you are new to Medicaid, you can apply to enroll anytime of the year. You may apply on the Common Help website for health insurance and other benefits you may be eligible to receive. Apply Medicaid Eligibility for Children Not Eligible for Medicaid?Optima Health also offers affordable health plans for individuals and families. Shop and compare plans to determine if you are eligible for tax credits (financial assistance) to help pay for your health insurance plan. Optima Health offers a variety of health insurance plans both on and off the Health Insurance Marketplace. Explore Plans
A pre-admission screening must be completed before an applicant can begin receiving Medicaid payments for care. A nurse from the local health department and a service worker from the local department of social services visit the applicant at home to assess if the person needs a nursing home level of care. If the person is a patient in a hospital then the pre-admission screening process may be completed by hospital staff. Sometimes, people begin long term care and are able to pay for services out of pocket for a period, but after resources are depleted, need to apply for Medicaid to cover the cost of care. If this happens and the person is already in the nursing facility at the time of the Medicaid application, no pre-admission screening is needed. Eligibility in 2022:1. Residency and Citizenship – the applicant must be a resident of Virginia and a U.S. citizen or have proper immigration status. 2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. 3. Income Limitations – If single, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be less than 300% of the Supplemental Security Income (SSI) amount for an individual—$2,523 for 2018. People receiving Medicaid Long Term Care services must contribute some of their countable income toward the cost of care. Virginia calls this “patient pay.” Deductions are given for the person’s basic needs, the support of a child or spouse in the community, and other situations depending on the case. Once someone is found to be eligible, an eligibility worker determines the recipient’s “patient pay” amount and notifies the person of the figure. People who receive SSI payments with no other source of income do not have to contribute towards their cost of care.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt. Exempt Assets in 2022 for an applicant in Virginia include:i. $2,000 or less in cash/non-exempt assets if single. ii. The home and land surrounding it are exempt if the Medicaid applicant is residing there. For those with income under 80% federal poverty line (FPL), the home and all land adjoining the home lot are excluded. For those with income over 80% FPL, the home lot is excluded and the adjoining property is exempt to the extent the value of the adjoining property (not counting the home lot) is less than $5000 or is essential to the dwelling. For a married couple when only one spouse is in a nursing home, all the property adjoining the residence is excluded. If planning to return; a spouse; a child under 21; or a disabled person resides in the home; the house is exempt as well. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum. iii. One automobile, no equity amount specified. iv. Burial plans, not exceeding $3,500 in value. Burial space items are excluded regardless of value, including: casket, urn, crypt, grave markers, etc. Burial space items do not need to be stored at home, but rather an applicant should sign a contract with a burial provider. Any appreciation on burial funds, such as interest on a bank account, is also exempt v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted. vi. Term life insurance (no cash value) is exempt. Also, policies with a cash surrender value of $1,500 or less are exempt. Spousal Rules in 2022:Amount of assets community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $137,400. If the community spouse’s assets do not equal at least $27,480, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached. Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $2,177.50. The maximum amount of income that can be retained is $3,435.00 varying by case, depending on unique living expenses. Shelter costs that exceed a designated amount will increase the community spouse’s income allowance. Shelter costs include rent or mortgage, maintenance fees, taxes and insurance. Virginia is an “income first” state, meaning the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first. Virginia long term care insurance partnership for 2022:This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used you may apply for Medicaid with $155,000 worth of assets exempted. Further Reading:Virginia Department of Social Services: http://www.dss.virginia.gov/benefit/medical_assistance/ What is the maximum income for Medicaid in Virginia?Benefits.gov. View coronavirus (COVID-19) resources on Benefits.gov.
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Who is eligible for Virginia Medicaid?. What is the highest income to qualify for Medicaid?Federal Poverty Level thresholds to qualify for Medicaid
For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight. To calculate for larger households, you need to add $4,720 for each additional person in families with nine or more members.
Can adults get Medicaid in Virginia?Medicaid has health coverage programs for adults in Virginia who qualify. There are no enrollment costs and no monthly premiums for adults between 19-64 years old who qualify. Their income must be within the limits.
Does Virginia have expanded Medicaid coverage?The Virginia General Assembly approved Medicaid expansion as part of its FY 2019-2020 budget on May 30, 2018; Governor Northam signed the budget into law on June 7, 2018. Expansion coverage became effective under state plan amendment (SPA) authority on January 1, 2019 after enrollment began on November 1, 2018.
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