Medicaid for Persons Who are Elderly and Disabled

This is an overview of the Virginia Medicaid program for persons who are elderly or disabled. The information applies to older Americans and people with physical, cognitive, sensory, or mental impairments.

What is Medicaid?

Medicaid is a joint federal and state-funded health insurance program that is administered by the state. It covers individuals with low incomes who also meet certain citizenship requirements.

In Virginia, the program name for persons who are over 65 or disabled is Medicaid for Persons Who are Elderly and Disabled.

Types of Virginia Medicaid Programs

The federal government establishes basic Medicaid guidelines, but states have a certain amount of flexibility with regard to the actual eligibility requirements for their Medicaid programs. In Virginia, there are a variety of different medical programs, each with its own specific purpose, distinct name, and eligibility, income and assets, and citizenship requirements.

The various Virginia Medicaid programs are as follows:

1. Full Medicaid Coverage
2. Limited Medicaid coverage (Medicaid Savings Plans)
3. Long Term Care Medicaid
4. Emergency Medicaid
5. Spend Down Medicaid

Most of these Medicaid programs provide comprehensive coverage. Those that do not, are typically specialized programs that were created to fill certain gaps.

Who is Eligible for Medicaid in Virginia?

Essentially, if you are an individual who is 65 or older, or disabled according to the Medicaid Disability Unit’s definition, you are eligible for Full Medicaid in Virginia if you have an income of $851 or less and no more than $2000 in countable assets.

If your spouse is also over 65 or disabled, and if your combined income is below $1150 per month, and your combined countable assets are below $3000, both of you can be eligible for Medicaid.

Medicaid Citizenship Requirements

Most Virginia Medicaid programs have some requirements that you are either a US citizen or a qualified immigrant. Most non-citizens, with some exceptions, are ineligible for Medicaid benefits for the first 5 years they are in the United States.

Spend Down Medicaid

If you have too much income or too many assets to qualify for Medicaid in Virginia, you may be eligible to spend down your income and/or assets to qualify for Spend Down Medicaid. In this case, you would first have to apply for Medicaid and then be informed of how much of your income and/or assets you will need to spend down to the level that would make you eligible.

You can use unpaid medical bills and medical bills that you have already paid to meet your spend-down amount. Furthermore, you can also qualify for Medicaid, by paying your spend-down amount at the beginning of each month, much like a deductible.

Emergency Medicaid

If you do not qualify for regular Medicaid because of your immigration status, you may qualify for emergency Medicaid, which will pay for emergency hospitalization only.

Long Term Care Medicaid

Medicaid will also pay for long term care for individuals needing a nursing home level of care if your income and assets are below the state’s requirements. There are very strict income and assets rules for this type of Medicaid. These rules can also vary depending on whether or not you have a spouse who does not require nursing and will remain at home, whether you are already in a nursing home, and if you are receiving community-based care.

What’s more, there are also rules that prohibit you from giving your assets away in order for you or your spouse to become eligible to have Medicaid pay for the nursing home. If you anticipate that you or your spouse may need to apply for Medicaid to pay for a nursing home, you should consult with a qualified and experienced attorney.

How to Apply for Virginia Medicaid

If you are in a hospital, the social services department at the hospital can arrange for you to undergo a screening. Otherwise, you can apply for Medicaid in Virginia by:

1. Visiting Virginia Commonhelp online;
2. Contacting your local Department of Social Services (DSS) office to request an application; or
3. Calling Cover Virginia’s Call Center at 1-855-242-8282

To find out if you or a loved one is eligible for Medicaid in Virginia, contact an experienced Virginia elder care attorney who can explain Virginia Medicaid’s eligibility requirements to you in more detail and assist you through the application process. Please feel free to contact Speedwell Law, PLLC at (703) 553-2577 or [email protected] to arrange a consultation.

Click here to learn more about our Medicaid services and to schedule your free consultation.

The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site.