Virginia Medicaid Long-Term Care

Last updated: August 21, 2026 Jurisdiction: Virginia

Virginia Medicaid calls long-term care LTSS

Virginia Medicaid uses the term Long-Term Services and Supports, or LTSS, for Medicaid-covered services delivered in a nursing facility or a community setting. DMAS policy explains that LTSS is for people whose physical or mental condition requires nursing supervision and help with activities of daily living. A screening or authorization is needed to decide the level of care and whether Medicaid will cover the service, while income and resources remain part of the eligibility determination (Cover Virginia LTSS overview).

DMAS is the Virginia Medicaid agency. Its consumer materials distinguish the financial Medicaid application from the clinical authorization: a person seeking nursing-facility care should request a pre-admission screening, and a person seeking community-based care must be screened and approved for the applicable waiver. The local Department of Social Services is a central application and screening contact point, although an inpatient hospital screening may be performed by a discharge planner (Virginia LTSS fact sheet; DMAS CCC Plus Waiver).

Institutional and community routes

For the long-term-care financial rules, the current manual generally treats a person as institutionalized after 30 consecutive days in a medical institution, Medicaid home- and community-based services, or a combination of the two. A signed hospice election in effect for 30 consecutive days also meets that definition. The manual says that LTSS authorization is required before Medicaid pays for nursing-facility care, waiver services, or PACE (DMAS Chapter M14).

Virginia's community alternative for older adults and people with physical disabilities is the Commonwealth Coordinated Care Plus Waiver. DMAS says that it serves older adults, people with physical disabilities, and people with chronic illness or severe impairment who otherwise would need a nursing facility, prolonged hospital stay, or specialized-care nursing facility. The program describes personal care, respite, assistive technology, environmental modifications, and consumer-directed or agency-directed care options (DMAS CCC Plus Waiver).

Patient pay and the practical application

Medicaid eligibility does not always mean that Medicaid pays every dollar without a member contribution. Virginia calls the contribution patient pay. Most LTSS recipients have a patient-pay calculation, while the state allows deductions and protections that can apply to basic needs and to some community spouses or children (Virginia LTSS fact sheet; DMAS Chapter M14).

Virginia starting point: Apply for Medicaid, obtain the required LTSS screening or authorization, and then make sure the financial review uses the correct LTSS pathway. A nursing-facility screen and a waiver screen are not interchangeable paperwork (Cover Virginia LTSS overview).

Families should preserve the screening outcome, application date, income records, resource records, and information about recent transfers. Those facts affect not just initial coverage but patient pay, spouse protections, and whether a transfer review applies. For broader strategy, see Medicaid (Baseline).

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Virginia Medicaid calls long-term care LTSS

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