Medicaid Rules in Virginia

Learn about Medicaid rules in Virginia

Medicaid is a joint initiative between the Federal and States governments. This program serves to provide assistance to those who would otherwise be unable to afford medical care. Medicaid, which began as part of the Social Security Act of 1965, to date provides financial assistance to over 46 million people in the United States. Whether or not a person is eligible to receive Medicaid assistance is a matter left largely up to individual states. While the federal government provides broad eligibility guidelines, it is left up to each state to create their own rules regarding eligibility, payment rates, and scope of medical services provided. Thus, while people may be eligible for Medicaid in Maryland, they may find themselves ineligible in neighboring Virginia. In Virginia, the Medicaid program is managed by the Department of Medical Assistance Services.

National Guidelines

National guidelines for eligibility (rules that all states must abide by in order to receive federal funds for Medicaid) dictate that Medicaid must be provided for certain groups that fall below the Federal Poverty Line (income of less than $22,050 per year for a family of four). These groups include children and pregnant women. Virginia rules thus must abide by these national guidelines. However, once these federal guidelines are met, it is left to the states to determine further eligibility.

Reporting Requirements

When applying for Medicaid in Virginia the rules stipulate that individuals submitting applications must report all of their income and assets. This includes earned income (job wages), unearned income (Social Security benefits, retirement pensions, child support), and owned assets (savings, bonds, stocks, life insurance policies). This income is then added up and compared to the number of people in the applicant's household. If the total income falls below the threshold set by the federal government, than the applicant may be considered eligible. Assets transferred or sold in order to bring your asset level below value may cause an individual to become automatically ineligible.

Spousal Impoverishment Protection

Spousal impoverishment protection is a special rule in Virginia for Medicaid patients. This special rule may apply to couples in which one spouse needs long-term care (hospital or nursing home) and the other does not. In cases such as this, a review of income and assets is conducted to determine how much the healthy spouse gets to keep and how much is taken by Medicaid to cover costs of long-term care.

Eligibility Review

In Virginia, eligibility is reviewed every 12 months by the VA Department of Medical Assistance Services. This means you must report income and assets every year to ensure continued eligibility.

References

• Work World: Medicaid Overview
• DMAS.Virginia.gov: Medicaid Applicant Handbook