What If Someone Doesn't Qualify for Medicaid in Virginia?

If you believe someone you're caring for does not qualify for Medicaid, do not assume that without checking the exact rules. Many families assume that they are ineligible before talking to an expert.

Medicaid eligibility in Virginia is based on:

• Income
• Bank accounts and assets
• Virginia residency

Common Situations That Cause Confusion

Income Seems Too High

Virginia has a rule called a spenddown. If income or assets are above the Medicaid limit, you may be eligible to receive full Medicaid coverage by proving your paid and unpaid medical expenses are high enough to qualify. Medical expenses may include:

• Doctor visits
• Prescriptions
• Health insurance premiums

Income that appears too high does not always mean eligibility is impossible. There are a number of ways your income and assets can be structured to legally qualify for Medicaid.

If the Person Is Married

If only one spouse is applying for long-term care services, the other spouse's income is not counted toward the applicant's income limit. Many families assume they are disqualified because the healthy spouse earns income. That income is not included when only one spouse applies.

Savings Are Above the Limit

If savings exceed the Medicaid limit, eligibility may not be available yet. As expenses are paid over time, savings may fall within the allowed amount. There are also strategies about how to legally arrange your assets to qualify.