Nursing Homes in Virginia
Some seniors need comprehensive medical care to manage their health. It’s often difficult to get this level of care at home or in an assisted living facility, so these seniors may choose to move into a nursing home. These communities are also called skilled nursing facilities. They have licensed nurses on hand at all times to manage the complex needs of residents. Other medical professionals, such as doctors and physical therapists, also provide care in the facility. Additionally, seniors in nursing homes have access to a range of amenities, including meals, social activities and assistance with activities of daily living.
Virginia is home to more than 8.6 million people. People aged 65 and over make up 16.3% of the population and 25,650 residents live in nursing homes. There are 288 skilled nursing facilities across the state providing care to people.
This guide can help seniors and their families understand nursing home care in Virginia. It has information about different sources of funding for nursing home care and the rules and regulations that facilities must operate under.
Cost of Virginia Nursing Homes
The average cost of nursing homes in Virginia is $221 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in Virginia?
Institutional Medicaid covers the cost of nursing home care for people who meet the eligibility requirements. In Virginia, Medicaid is also known as Cardinal Care. It provides health insurance to low-income people throughout the state. There are different programs that help residents with varying needs, including those that require nursing home care. At the end of 2022, there were almost 2 million Virginians enrolled in Medicaid, including those in the Children’s Health Insurance Program. This has increased by 113% since the state expanded coverage.
Long-term services and support also include waivers that can provide care in the home. The Commonwealth Coordinated Care Plus Waiver is available to seniors who require a nursing home level of care but wish to remain living at home. The waiver covers personal care, skilled nursing, durable medical equipment and more. However, waivers have enrollment limits, so applicants may be put on a waiting list.
Eligibility for Medicaid in Virginia
Virginia Medicaid applicants must meet financial eligibility criteria made up of both income and asset limits. For single applicants and married people who have a spouse who isn’t applying, the income limit is $2,742 per month or $32,904 per year. The asset limit is $2,000, but a nonapplicant spouse can have assets of $148,620. For married couples, when both spouses are applying, the income limit is $5,484 per month or $65,808 per year, and the asset limit is $4,000.
Applicants should note that most of their income goes toward their nursing home care. Beneficiaries only keep a personal needs allowance of $40 per month, the cost of the Medicare premiums and a spousal allowance if it’s applicable. When calculating eligibility, certain assets aren’t counted toward the limit. This includes household furnishings, personal belongings and an automobile. As nursing home residents generally don’t intend to return to their home, it is counted toward their assets unless their spouse still lives there.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $32,904 | $2,000 |
| Two-Person Household | $65,808 | $4,000 |
*Per year
There are also nonfinancial eligibility criteria. Applicants must be:
- A resident of Virginia
- A U.S. national, citizen, permanent resident or legal alien
- Assessed as requiring a nursing home level of care
Applying for Medicaid in Virginia
Seniors applying for nursing home Medicaid must complete the Application for Health Coverage and Help Paying Costs, as well as Appendix D. Appendix D collects further information from people aged 65 and over. Both these forms can be found on the Cover Virginia website.
Seniors can use CommonHelp or the Health Insurance Marketplace to apply online. Phone applications can be made by calling (833) 522-5582. People who prefer to apply manually can print out the correct forms from the website and mail or drop them off to the local Department of Social Services (DSS).
What Information You Will Need
To process the application, the DSS may need to see:
- Proof of identity
- Proof of citizenship status and residency
- Social Security number
- Health insurance information
- Proof of income and assets
Additional Medicaid Support & Resources in Virginia
Virginia has government and nonprofit organizations dedicated to helping people apply for Medicaid. These resources can answer questions about eligibility, benefits and how to apply.
| Contact | Service | |
|---|---|---|
| CommonHelp | (855) 635-4370 | The CommonHelp website has information to help Virginians navigate benefits and apply for help. It has an eligibility check as well as detailed information about Medicaid. The call center is available to provide more personalized advice. |
| Application Assisters | Call local offices | Application Assisters provides help applying for Medicaid. Assistance is available in person or by phone from trained and certified team members. They can provide information about eligibility, benefits and how to apply. |
| Department of Social Services | Call local offices | The Department of Social Services has offices around the state. Staff can help applicants acquire the right forms, source the documentation needed and ensure applications are filled in correctly. |
| Virginia Health Care Foundation | (804) 828-5804 | Virginia Health Care Foundation helps uninsured Virginians access health care. It has an outreach and enrollment program to help people enroll in Medicaid. Projects in local communities provide information about Medicaid programs and how to sign up. |
Can You Use Medicare to Pay for Nursing Home Care in Virginia?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in Virginia
Seniors in Virginia can access a range of resources that help people apply for Medicare. There are both government and nonprofit organizations that provide Medicare counseling to the state’s older adults. Assistance available includes choosing the right plan, understanding benefits and finding additional help managing premiums.
| Contact | Service | |
|---|---|---|
| Virginia Insurance Counseling & Assistance Program (VICAP) | Call local officess | VICAP offers Medicare counseling through local Area Agencies on Aging. Seniors can get help finding the right plan, filing for benefits and avoiding fraud. VICAP also identifies when people are eligible for the Extra Help or Medicare Savings programs. |
| Enroll Virginia | (888) 392-5132 | Enroll Virginia has navigators and enrollment experts available to provide unbiased advice about health care. It holds events where people can start enrolling or get help with applications and has trained counselors available in person or over the phone. |
| Virginia Legal Aid | (866) 534-5243 | Virginia Legal Aid provides civil legal assistance to low-income people in the state. Its website has information about Medicare, including how to apply, the types of Medicare and answers to frequently asked questions. Local offices can also provide personalized assistance with Medicare issues. |
Other Financial Assistance Options for Nursing Home Care in Virginia
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in Virginia
| Licensing Requirements | All facilities must be licensed by the state by the Virginia Department of Health – Office of Licensure and Certification. Licenses and renewals are valid for 1 year. Each facility must have a separate license, even if they're operated under the same management. |
| Staffing Requirements | The facility must have enough qualified nurses and certified nurse aides on all shifts to meet the assessed needs of all residents. Staff can only be assigned duties that are consistent with their education, training and experience. |
| Staff Training Requirements | All staff must receive an orientation when they begin work. There must be annual in-service training for all resident care staff, and facilities must have a training program to develop and improve the skills of all personnel. |
| Admission Restrictions | Nursing homes may only admit a person if they can provide the appropriate level of care. |
| Care Planning Requirements | Facilities must conduct initial and periodic assessments of residents and develop a care plan. The care plan must include measurable objectives and a timetable to achieve them. The resident, their family or legal representative must have the opportunity to participate in care planning. |
| Dietary and Nutritional Services Requirements | Nursing homes must serve at least three meals each day and have nutritional snacks available upon request. Therapeutic diets must be available when prescribed by a physician. Menus must be developed by a dietitian to meet the recommended dietary allowances. |
| Specialized Rehabilitative Services | Specialized rehabilitative services include physical, speech and occupational therapy. Facilities must provide this care or arrange for it through a written agreement with outside providers. Services must be authorized by a physician and the relevant therapist and included in the resident’s plan of care. |
| Medication and Pharmaceutical Services | Nursing facilities must have an agreement with a qualified pharmacist to provide medication consultation. Medications can’t be administered without a valid order from a licensed professional. All medication orders must be reviewed at least every 60 days. |
| Activities Requirements | Activities must be provided on a regularly scheduled basis and tailored to meet the needs and interests of residents. Facilities must have a qualified staff member in charge of coordinating activities, and the program must make use of community social and recreational opportunities. |
| Infection Control Requirements | Facilities must have a written infection control program that addresses the surveillance, prevention and control of infections. It must include staff education regarding reducing infection risk. All reportable diseases must be reported promptly to the local health department. |
| Medicaid Coverage | Medicaid covers the cost of nursing home care for people who meet the financial and medical eligibility requirements. |
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