Virginia Medicaid Guide 2026: Cardinal Care Programs

Virginia Medicaid (Cardinal Care) pays for nursing and home care through a medically needy spend-down, so applicants over the 2026 income limit of $2,982/month qualify without a Miller Trust.

Virginia Medicaid is administered by the Virginia Department of Medical Assistance Services (DMAS), with applications taken at the local Department of Social Services. This guide maps every key question about Virginia Medicaid to the dedicated article that answers it.1

What Virginia Medicaid Covers

Virginia Medicaid operates under the Cardinal Care umbrella. DMAS covers the mandatory federal benefit categories plus a set of state-elected optional services:

• Hospital care: Inpatient and outpatient services
• Physician, clinic, and specialist visits
• Prescription drugs through managed care formularies
• Behavioral health: Mental health and substance use disorder services
• Home health and private duty nursing
• Long-term care: Nursing facility coverage and home- and community-based services (HCBS) through the CCC Plus Waiver
• Medicare Savings Programs (MSPs): Premium and cost-sharing assistance for dual-eligible beneficiaries
• Non-emergency medical transportation (NEMT)

For older adults and people with disabilities, long-term care coverage is the most financially significant benefit. In Virginia, a semi-private nursing home room runs about $123,005 per year and a private room about $140,160, according to the CareScout 2025 Cost of Care Survey. Medicaid covers the full cost once a resident meets financial and clinical eligibility standards.3

Who Qualifies for Virginia Medicaid

Virginia Medicaid Eligibility Overview

Virginia covers several population groups under Medicaid. For seniors and people with disabilities needing long-term services, eligibility runs through the aged, blind, and disabled (ABD) track. The key financial parameters in 2026:1

• Asset limit: $2,000 for a single applicant; $4,000 for a couple (both applying). Countable assets exclude the primary home, one vehicle, household goods, and prepaid burial.
• Income standard: $2,982/month, equal to 300% of the 2026 SSI Federal Benefit Rate of $994. Virginia is a section 209(b) state, meaning it uses eligibility rules that differ from SSI in certain respects.
• Home equity limit: $752,000 for 2026, the federal minimum. The primary residence is exempt while the applicant, a spouse, or a dependent lives there or the applicant intends to return.4
• No Miller Trust required: Virginia is a medically needy state, not an income-cap state. An applicant whose income exceeds the $2,982 standard can still qualify by spending down the excess on incurred medical and care costs.

Under the medically needy spend-down, an over-income applicant incurs medical costs down to Virginia's ABD medically needy income limit, which is regionalized into three locality groups: $421.94/month (Group I), $485.58/month (Group II), and $631.26/month (Group III) for an individual, effective July 1, 2026. This is a significant advantage over income-cap states, where an over-limit applicant must establish a Qualified Income Trust (Miller Trust).1

For full details on income limits, asset rules, and all eligibility categories, see Virginia Medicaid Eligibility and Income Limits.

Virginia Medicaid Long-Term Care

Nursing Facility Coverage

Virginia Medicaid pays for nursing facility care for ABD recipients who meet the nursing facility level-of-care (NF LOC) standard. Once financially and clinically eligible, Medicaid covers the cost of care. The resident contributes nearly all monthly income toward the nursing facility cost, keeping only the $40 Personal Needs Allowance ($60 for a couple), plus deductions for a community spouse allowance and certain health-insurance premiums.1

CCC Plus Waiver: Home and Community-Based Services

The CCC Plus Waiver provides home- and community-based services as an alternative to nursing facility placement. Services include personal care, respite, adult day health, assistive technology, environmental modifications, and more. Waiver applicants must meet the same NF LOC clinical threshold, and the same $2,000 asset limit and $2,982 income standard apply.1

The 5-Year Lookback and Transfer Penalties

Virginia applies a 60-month (five-year) lookback to asset transfers made for less than fair market value before a long-term care application, following the federal rule under 42 U.S.C. § 1396p(c). Uncompensated transfers within that window generate a penalty period of Medicaid ineligibility for nursing facility care.4

Estate Recovery

After the death of a Medicaid member who was age 55 or older when they received medical assistance, DMAS pursues federally mandated estate recovery under Code of Virginia § 32.1-326.1 and 12VAC30-20-141. Recovery is not limited to nursing facility or long-term care costs. Virginia seeks recovery of all medical assistance correctly paid on the member's behalf at age 55 or older under the State Plan, including the capitation payments made to a managed care organization on the member's behalf. Virginia also uses an expanded estate definition, not a probate-only estate: recovery can reach all real and personal property, and any asset in which the deceased held a legal title or interest at death, and may include the home even when the home was exempt for eligibility purposes. DMAS may collect up to the amount of the Medicaid payments made or the value of the estate, whichever is less. There is no recovery where the member is survived by a spouse who has not been a Medicaid member, by a child under age 21, or by a child who is blind or disabled, and an undue-hardship waiver is available.5

See Virginia Medicaid Estate Recovery for the full rules, exemptions, and hardship process.

Virginia Medicare Savings Programs

Virginia Medicaid administers four Medicare Savings Programs (MSPs) for low-income Medicare beneficiaries:6

• Qualified Medicare Beneficiary (QMB): Pays Part A and Part B premiums plus all Medicare cost-sharing (deductibles, coinsurance, copays).
• Specified Low-Income Medicare Beneficiary (SLMB): Pays the Part B premium only.
• Qualifying Individual (QI): Pays the Part B premium; slots are allocated annually, and you must apply again every year to stay in QI.
• Qualified Disabled and Working Individual (QDWI): Pays the Part A premium for certain working disabled individuals.

QMB enrollees are automatically deemed eligible for Part D Extra Help (Low-Income Subsidy), and federal law bars providers from billing a QMB enrollee for any Medicare cost-sharing.6

See Virginia Medicare Savings Programs for current income and asset limits and how to apply.

Spousal Impoverishment Protections

When one spouse applies for Virginia Medicaid long-term care coverage, federal spousal impoverishment protections keep the community spouse from losing all of their shared resources.7

Key 2026 figures:

• Community Spouse Resource Allowance (CSRA): Up to $162,660 in countable assets (the federal maximum), with a floor of $32,532.7
• Minimum Monthly Maintenance Needs Allowance (MMMNA): Up to $4,066.50/month in income the community spouse may keep, with a floor of $2,705.00. If the community spouse's own income falls short of the MMMNA, income from the institutionalized spouse can be diverted to make up the difference.7
• Home: Exempt from the eligibility calculation while the community spouse lives there.

These protections are applied at the initial eligibility determination. See Virginia Medicaid Spousal Impoverishment Protections for how the snapshot process, CSRA calculation, and income diversion work.

How to Apply for Virginia Medicaid

Applying for Virginia long-term care Medicaid follows a defined sequence. Gather your paperwork first, then submit through one of the agency pathways.

See How to Apply for Virginia Medicaid for a full walkthrough, the complete document checklist, and what to expect after submission.

If Virginia Medicaid Denies or Cuts Your Coverage

A denial is not the end of the road, and the deadline to challenge it is usually shorter than people expect.

Federal law guarantees every Medicaid applicant and beneficiary the right to a fair hearing before the state agency, whether the dispute is about eligibility or about a specific service being reduced or ended.8 A state must allow you a reasonable time to ask for that hearing, and federal law caps that window at 90 days from the date the notice of action was mailed.2 Read that as a ceiling, not a guarantee: 90 days is the most a state may give you, and a state is free to set a shorter deadline that binds you just as firmly.

Virginia's deadline is 30 days, not 90. Under 12VAC30-110-160, a Request for Appeal must be filed with the DMAS Appeals Division within 30 days of your receipt of the notice of action or adverse determination. Receipt, not mailing, is the trigger, and Virginia presumes you received the notice five days after the agency mailed it unless you show otherwise. So take the mailing date printed on your notice, add five days, and count 30 from there. You can file through the AIMS portal, by email to appeals@dmas.virginia.gov, by fax to (804) 452-5454, by phone at (804) 371-8488, or by mail or in person to the Appeals Division, 600 E. Broad Street, Richmond, VA 23219.2

Most Virginia members get care through a Cardinal Care managed care plan, and if the plan is what denied, reduced, or ended a service, a different pair of deadlines applies. You must exhaust that plan's one internal appeal first: 60 days from the date of the plan's adverse benefit determination notice to request it, then 120 days from receiving the plan's decision to request a DMAS fair hearing.2 That route is for plan service decisions; a state eligibility denial still runs on the 30-day window above.

There is a second, earlier deadline that matters more if you are already enrolled. If you request the hearing before the date the action takes effect, your benefits generally continue while the appeal is decided.9 Virginia carries that into 12VAC30-120-420 and 12VAC30-110-100: a grievance, plan internal appeal, or DMAS appeal filed before the effective date of the adverse benefit determination holds your coverage at its current level for anything the appeal covers.2 That date usually falls earlier than the 30-day filing deadline, so miss it and you may still appeal, but coverage can stop in the meantime.

When an adverse notice arrives, find the effective date and request the hearing in writing before it. See Virginia Medicaid Appeals and Fair Hearings for how to file, what the hearing itself involves, and what happens after a decision.

Keeping Virginia Medicaid Once You Have It

Eligibility is re-checked on a recurring cycle, and missing that step is one of the most common ways people lose coverage they still qualify for.

Before it can ask you for anything, Virginia Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot.10 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date of the form to return it. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Virginia may offer the same windows but is not required to, so ask DMAS what applies to you.10

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise).10

Keep your address current, open anything from Virginia Medicaid, and return a renewal form the week it arrives. See Virginia Medicaid Recertification and Renewal for the full cycle and how to recover coverage that has already closed.

Where to Get Help

Virginia Medicaid FAQ

Learn More

Find personalized help with Virginia Medicaid and Cardinal Care programs at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.