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Virginia · Cardinal Care

Cardinal Care long-term care,
in plain English.

Penalty divisor $7,324/mo. CSRA up to $162,660. Home-equity limit $752,000. Estate recovery: aggressive (reaches non-probate assets).

A warm impressionist landscape evoking Virginia

How does Medicaid long-term-care planning work in Virginia?

Virginia's Medicaid program is Cardinal Care, with Cardinal Care Managed Care (CCMC) delivering long-term services and supports. The penalty divisor is $7,324/month, paired with federal-maximum CSRA (up to $162,660), aggressive (reaches non-probate assets) estate recovery, and a $752,000 home-equity limit. The 5-year lookback applies to every asset transfer — planning before a crisis always outperforms planning during one.

The numbers that matter in Virginia

  • Penalty divisor (2026): $7,324/month — every $7,324 in gifted assets during the 5-year lookback = 1 month of Medicaid ineligibility.
  • Nursing-home cost (2026, semi-private): ~$9,247/month = $110,964/year.
  • CSRA ceiling: $162,660 (community-spouse resource allowance).
  • MMMNA band: $2,643.75 to $4,066.50/month (minimum monthly maintenance needs allowance).
  • Home equity limit: $752,000.
  • Applicant asset cap: $2,000 (non-exempt).
  • Applicant income cap: $2,901/month (state-federal common threshold, 2026).
  • Managed long-term care: Yes — enrollment required after eligibility.
  • Estate recovery posture: Aggressive (broader than federal baseline).

Programs and acronyms in Virginia

If you're searching for help with long-term-care Medicaid in Virginia, these are the names and acronyms you'll encounter on state-agency forms, in elder-law conversations, and in nursing-facility paperwork.

  • Cardinal Care — Virginia Medicaid. The state's Medicaid program brand.
  • Virginia Department of Medical Assistance Services (DMAS) — administers Cardinal Care and processes long-term-care eligibility decisions.
  • Cardinal Care Managed Care (CCMC) — Virginia's unified MLTSS — capitated MCOs cover nursing-facility, HCBS, and acute care for adults 65+ and adults with disabilities. Replaced Medallion 4.0 + CCC Plus 2023.
  • Commonwealth Coordinated Care Plus (CCC Plus) — Operating sub-program within Cardinal Care for dual-eligibles needing nursing-facility level of care.
  • Building Independence Waiver — HCBS waiver for Virginians with developmental disabilities living independently in the community.
  • Family and Individual Supports Waiver — HCBS waiver providing in-home supports to Virginians with developmental disabilities living with family.
  • Community Living Waiver — HCBS waiver for Virginians with significant developmental disabilities needing 24-hour residential supports.
  • CommonHelp — Virginia's online Medicaid application portal: commonhelp.virginia.gov/
  • CoverVA — Virginia's Medicaid information portal (coverva.dmas.virginia.gov).
  • DSS — Local Department of Social Services (County eligibility intake).
  • EDCD — Elderly or Disabled with Consumer-Direction Waiver (now part of CCC Plus) (Legacy waiver name still in use).

The Virginia planning levers

Every Medicaid plan in Virginia pulls some combination of five levers: (1) community-spouse asset re-allocation inside the CSRA ceiling, (2) spend-down on exempt assets (home improvements, new car for the community spouse, pre-paid funeral), (3) irrevocable trust transfer outside the 5-year window, (4) caregiver-child exception or disabled-child exception on the home, and (5) personal-service contracts paying a family member for documented caregiving hours.

Which lever fits depends on the specific assets, the crisis timeline, and — critically — whether the applicant is already in a facility. If a family member is already admitted, the playbook narrows to levers (1), (2), and (5) only.

What planning looks like, by timeline

5+ years out: full menu available. Irrevocable-trust transfers, gifting, long-term-care insurance — all work if executed cleanly. Time is the most valuable asset in Medicaid planning.

1–5 years out: half-menu. Transfers still trigger the lookback but a known penalty period can be absorbed by private pay. Community-spouse re-allocation is still a big lever.

Already in a facility: crisis planning. Most gifting is off the table. Spend-down, community-spouse allowance, personal-service contracts, and exempt-asset purchases become primary. See the crisis playbook.

Virginia's Medicaid program is Cardinal Care (Virginia Medicaid). It's administered by Virginia Department of Medical Assistance Services (DMAS). Long-term-care Medicaid applicants apply through Cardinal Care (Virginia Medicaid) just like any other Medicaid benefit, but eligibility is governed by the LTC-specific asset, income, and lookback rules detailed below.
Cardinal Care (Virginia Medicaid)'s 2026 penalty divisor is approximately $7,324/month. Every $7,324 of uncompensated transfers during the 5-year lookback produces one month of Medicaid ineligibility. The divisor roughly tracks Virginia's private-pay nursing-home cost.
Virginia uses federal-maximum CSRA (up to $162,660). The federal 2026 CSRA ceiling is $162,660; the floor is $32,532. The non-applicant spouse can retain assets inside the state's cap without affecting the applicant's eligibility.
A primary residence is exempt while you or your spouse lives there. Virginia's 2026 home-equity limit is $752,000; equity above that disqualifies the applicant. After the applicant's death, Virginia pursues aggressive (reaches non-probate assets) estate recovery.
Yes. Virginia's managed LTC program is Cardinal Care Managed Care (CCMC). Virginia's unified MLTSS — capitated MCOs cover nursing-facility, HCBS, and acute care for adults 65+ and adults with disabilities. Replaced Medallion 4.0 + CCC Plus 2023. Applicants enroll in a plan after eligibility is established, which affects both the application timeline and the set of providers available.
Semi-private nursing-home rooms in Virginia run approximately $9,247/month ($110,964/year) in 2026. Private rooms add 10-25%. This figure drives the state's Medicaid penalty divisor and also signals how quickly private-pay assets deplete.
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