Virginia ABD Medicaid & Long-Term Care Planning
The questions families ask most (and the facts behind them)
Many Virginia seniors and their families delay calling a lawyer because they’re afraid of the cost. That fear is real. But when long-term care is on the table, waiting can cost far more than the legal fee—through avoidable denials, months of unnecessary private pay, or financial moves that accidentally trigger penalties. ABD Medicaid (Aged, Blind, or Disabled) and Virginia long-term care Medicaid are technical programs with strict rules, but those same rules can also create lawful opportunities to protect a spouse and preserve assets for children and grandchildren, including family members with special needs. If you want to start with Virginia’s official program explanations, you can read the Virginia DMAS overview of ABD Medicaid and the VA guide to ABD Medicaid coverage and eligibility.
Does Medicaid pay for the nursing home entirely, allowing you to keep your regular income?
Not exactly. In Virginia long-term care Medicaid, most monthly income is typically applied toward the cost of care (often called “patient pay”), and Medicaid pays the remaining approved amount under the program rules.
It also helps to know there are common exceptions. Residents are typically allowed to keep a small personal needs allowance, and Virginia Medicaid guidance addressing resident funds and allowances. Depending on the household, there may also be deductions tied to protecting a spouse at home under Virginia’s community spouse rules.
Will Medicare pay for all nursing home costs?
No—not for long-term custodial care. Medicare may cover a limited stay in a skilled nursing facility under specific conditions, but it generally does not cover ongoing nursing home residency when the primary need is help with daily activities rather than skilled nursing or rehabilitation.
Can Medicaid planning be done before going into a nursing home?
Yes, and earlier planning usually means more choices. Planning can help families organize finances in a way that supports eligibility, avoid documentation gaps that stall applications, and reduce the risk of transfer penalties that can delay coverage. Virginia’s overview of long-term services and supports is a helpful starting point: VA’s long-term services and supports.
Do I need an elder law attorney for Medicaid planning if the facility has a social worker?
Facility social workers can be helpful, but they cannot provide legal advice or design an asset-protection strategy tailored to your family’s goals and timeline. Medicaid planning often turns on detailed eligibility rules, documentation requirements, and timing issues that can be difficult to correct once a denial or penalty is triggered. When a spouse is involved, the rules are especially technical, and Virginia publishes the framework in the Virginia Administrative Code’s community spouse rules.
If I put money in my spouse’s name, will it ensure I qualify for Medicaid?
Not automatically. Virginia long-term care Medicaid rules include protections designed to prevent the spouse at home (the community spouse) from becoming impoverished, but the protections require correct classification, documentation, and timing, and eligibility analysis may consider marital resources even when accounts are titled in one name.
Is it true that only impoverished people qualify for Medicaid?
No. Some people qualify because they already meet program rules, while others qualify after using lawful planning tools and properly structuring finances under the rules. Medicaid eligibility is based on program requirements (including income and resource limits), not moral judgment.
Is it true you can’t receive Medicaid benefits until five years after transferring assets?
Sometimes a five-year rule applies, but the details matter. Virginia long-term care Medicaid includes a 60-month look-back for certain transfers, and improper transfers can create a penalty period during which Medicaid will not pay for long-term care services even if the person is otherwise eligible.
Are assets in a living trust protected from nursing home costs?
Usually, no—not simply because they are in a revocable living trust. Many families assume “trust equals protected,” but Medicaid treatment depends on the type of trust and the level of control retained. Certain irrevocable trusts created well in advance can sometimes be part of a lawful plan, but timing is sensitive.
If you enter a nursing home paying out-of-pocket, will you have to wait for a “Medicaid bed” later?
Not necessarily. If a facility is Medicaid-certified and accepts Medicaid residents, many people transition from private pay to Medicaid once eligibility is approved. However, facility policies and availability can vary, so it’s smart to ask the facility—in writing—how it handles a private-pay-to-Medicaid conversion for the same resident.
Are hiding assets an appropriate way to qualify for Medicaid?
No. You should never hide assets. Trying to conceal assets can lead to denial, repayment claims, or even allegations of fraud. The right strategy is lawful planning, using the rules as intended and fully disclosing required financial information.
Contact our Virginia ABD Medicaid planning team
If your family is facing long-term care decisions—especially if you’re trying to protect a spouse, avoid unnecessary private pay, or prevent a denial—getting clarity early can save money and stress. The Legacy Elder Law Center helps families pursue strong Medicaid outcomes while protecting what matters most: stability for the spouse at home, a plan that doesn’t implode mid-process, and a path forward that feels manageable.
This article is general information and not legal advice. Medicaid rules and outcomes depend on individual facts, and program limits change over time.
Frequently Asked Questions: Virginia ABD Medicaid & Long-Term Care Medicaid
Q: What is ABD Medicaid in Virginia?
ABD Medicaid is Virginia Medicaid coverage for people who are Aged (65+), Blind, or Disabled who meet financial and non-financial eligibility rules.
Q: Is ABD Medicaid the same thing as nursing home Medicaid in Virginia?
Not always. ABD refers to an eligibility group, while nursing home coverage is tied to long-term services and supports (LTSS). Many people pursuing nursing home Medicaid qualify through ABD pathways, but LTSS has its own screening and coverage structure.
Q: Does Medicaid pay the full nursing home bill in Virginia?
Medicaid generally pays the remaining approved amount after a resident’s required contribution (often called “patient pay”) is applied. Most monthly income is typically applied toward the cost of care, with limited deductions allowed.
Q: Can a person keep any of their income while on nursing home Medicaid?
Usually yes, but only limited amounts. Many residents can keep a small personal needs allowance and may be able to deduct certain expenses such as health insurance premiums before the rest is applied as patient pay.
Q: Will Medicare pay for long-term nursing home care?
Generally no. Medicare may cover a limited skilled nursing facility stay under specific conditions, but it does not cover ongoing custodial nursing home care. Medicare explains what is covered on Medicare.gov’s skilled nursing facility page.
Q: What is the “community spouse” rule in Virginia?
Community spouse rules are designed to protect a spouse at home from becoming impoverished when the other spouse needs long-term care. The protections exist, but they are technical and require correct documentation and timing.
Q: If I move assets into my spouse’s name, does that automatically make me eligible?
No. Titling assets in one spouse’s name does not automatically change how eligibility is analyzed. Virginia’s spousal and community spouse rules govern how resources and income are treated.
Q: What is the five-year look-back rule in Virginia?
For long-term care Medicaid, Virginia reviews certain transfers made within the 60 months before application/eligibility. Some transfers can trigger a penalty period where Medicaid will not pay for long-term care services even if the applicant is otherwise eligible.
Q: Does “five-year look-back” mean you must wait five years no matter what?
Not necessarily. The look-back rule means transfers may be reviewed and may cause a penalty—it doesn’t automatically mean everyone must wait five years. The details depend on the type of transfer, timing, and whether an exemption applies.
Q: Does a revocable living trust protect assets from nursing home costs?
Usually not by itself. A standard revocable living trust—where the creator keeps control and can revoke it—typically does not create Medicaid protection on its own. Certain irrevocable planning trusts may play a role when done correctly and early enough, but the rules are timing-sensitive and technical.
Q: If someone starts paying privately, can they switch to Medicaid later without moving?
Often yes, if the facility is Medicaid-certified and the resident becomes eligible. However, policies and availability can vary by facility, so it’s important to confirm how the facility handles a private-pay-to-Medicaid conversion.
