Does Virginia Medicaid Pay for Assisted Living?

Assisted living provides seniors with housing, meals, personal care, and health services in a residential setting. It bridges the gap between independent living and nursing home care. But assisted living can be expensive, often costing between $3,000-$6,000 per month. Many seniors rely on Medicaid waivers to help pay these costs.

Does Virginia Medicare pay for assisted living? Virginia Medicaid does not directly cover the cost of room and board in assisted living facilities. However, it does offer financial assistance for personal care and health services provided in assisted living through specific Medicaid waiver programs, such as the Commonwealth Coordinated Care Plus (CCC Plus) Waiver and the Program of All-Inclusive Care for the Elderly (PACE).

What is Assisted Living and How Does it Work?

Assisted living communities provide housing, meals, personal care, and health services to seniors who need assistance with daily living activities.Residents live in private apartments or rooms and receive customized levels of care based on their needs. 

There are three main levels of care in assisted living:

• Basic Care – Includes housing, meals, laundry, cleaning, social activities, and 24/7 staffing. Residents at this level are generally independent.
• Personal Care – Provides assistance with activities like bathing, dressing, grooming, and medication management. 
• Memory Care – Secured units with specialized programming for seniors with Alzheimer’s and dementia. Extra safety supervision and therapeutic activities.

Residents pay a monthly fee that covers housing, meals, activities, and a baseline level of care. Additional personalized services are charged on an à la carte basis.

How is Assisted Living Funded Through Virginia Medicaid?

Virginia Medicaid does not cover room and board in assisted living. However, it does pay for personal care and health services through certain Medicaid waiver programs:

What are the Eligibility Requirements for Medicaid Waivers?

To qualify for a Medicaid waiver, applicants must:

• Be aged 65+ 
• Meet Virginia’s income and asset limits
• Require nursing home level of care
• Obtain doctor certification of needs

What are the Specific Medical and Nursing Needs that Qualify a Senior for a Medicaid Waiver?

A senior must need hands-on assistance with multiple daily living activitieslike bathing, dressing, eating, toileting, and transferring. Cognitive impairments like dementia and wandering risks may also qualify.

What are the Income and Asset Limits for Medicaid Waivers?

• Income: Typically $2,382/month for individuals, $4,764 for couples in 2022
• Assets: $2,000 for individuals, $3,000 for couples. Certain assets are exempt.

How Do I Apply for a Medicaid Waiver for Assisted Living?

• Contact your local Department of Social Services office 
• Complete an in-person screening and assessment 
• Submit medical records and financial documentation
• Be approved by the screening team 

What are the Documentation Requirements for Applying for a Medicaid Waiver?

You’ll need documents proving the senior’s:

• Identity
• Age 
• Income sources 
• Assets
• Virginia residency 
• Medical conditions and needs

What is the Commonwealth Coordinated Care Plus (CCC Plus) Waiver?

The CCC Plus waiver pays for personal care and medical services for seniors living in assisted living. 

What is the Waiting List for the CCC Plus Waiver?

There is currently no waiting list for the CCC Plus waiver in Virginia. All eligible applicants are approved.

What is the Program of All-Inclusive Care for the Elderly (PACE)?

PACE provides medical care and long-term services to frail seniors aged 55+ who qualify for nursing home care but wish to remain in the community. This includes assisted living.

What are the Costs of Assisted Living in Virginia?

Without Medicaid, seniors pay assisted living costs out-of-pocket.

What are the Average Monthly Costs of Assisted Living in Virginia?

According to Genworth’s 2021 Cost of Care Survey, the average assisted living costs in Virginia are:

• Basic Care: $3,750/month
• Personal Care: $4,138/month 
• Memory Care: $4,695/month

Costs in Northern Virginia are over $1,000/month higher on average.

What are the Benefits of Assisted Living?

Assisted living offers seniors many benefits that allow them to enjoy an enhanced quality of life. One of the biggest advantages is the ability to live in a residential, non-institutional setting that feels more like a normal home environment than a medical facility. Assisted living communities are designed to be comfortable, welcoming, and socially engaging.

Another key benefit is having access to 24/7 assistance with activities of daily living such as bathing, dressing, meals, medication management, and mobility. Trained staff are available around the clock to provide personalized care and services based on each resident’s needs. This assistance enables seniors to maintain independence while ensuring their health and safety.

Assisted living also provides easy access to medical and nursing services. Registered nurses are on-site to oversee medication regimens, coordinate doctor appointments, provide wound care, and monitor overall health changes. This medical support is tailored for each resident while allowing them to avoid hospital visits or relocations when possible.

Assisted living enables seniors to enjoy an active lifestyle with abundant amenities. Most communities offer fitness centers, social hours, educational classes, entertainment events, day trips, gardening, and more. These engaging opportunities create a sense of community while supporting physical and cognitive health.

Living in an assisted living facility allows seniors to stay close to their family and community. Loved ones can visit often, participate in activities or meals together, and help support the transition process. Maintaining these meaningful connections boosts emotional health and improves one’s overall quality of life.

Key benefits of assisted living include:

• Living in a residential, non-institutional setting
• Receiving 24/7 assistance with daily activities
• Accessing personalized medical and nursing care
• Enjoying an active lifestyle with amenities like fitness centers 
• Staying close to family and community

What are the Alternatives to Assisted Living?

If a senior does not qualify for Medicaid waiver programs, some alternatives include:

• Independent living communities
• In-home caregiving services
• Adult day health programs 
• Moving in with family 

What are the Different Types of Assisted Living Facilities in Virginia?

• Assisted living facilities – Provide housing, meals, personal care
• Residential care homes – Smaller, more intimate settings 
• Continuing care retirement communities – Offer various levels of care as needs change

In summary, Virginia Medicaid does help pay assisted living costs through certain long-term care waiver programs like CCC Plus. These programs make assisted living an affordable option for low-income seniors who require assistance with daily activities and medical care. Understanding the eligibility requirements and applying properly are key to accessing this essential support.

Frequently Asked Questions