Most Americans assume Medicaid is a single program. In Virginia, Medicaid is administered by DMAS, and long-term- care services are delivered through Commonwealth Coordinated Care Plus (CCC+) — a managed-long-term-services-and-supports program that contracts with private MCOs to coordinate care.1Understanding the architecture matters because the path from “applied” to “in care” runs through the MCO, not through DMAS directly.
What CCC+ covers
CCC+ delivers a comprehensive package of long-term-services- and-supports including:
- Nursing facility care. Room, board, and skilled care in a Medicaid-certified nursing home.
- Home and community-based services. Personal care, homemaker, respite, adult day health, home modifications, and related supports for recipients who choose to receive care at home or in community settings.
- Consumer Directed Services (CDS). The self-direction track that allows the recipient (or their designated employer of record) to hire and pay a personal-care attendant, often a family member.2
- Care coordination. Each CCC+ enrollee works with a care coordinator at their MCO who oversees service authorization, scheduling, and transitions.
Three eligibility tests, in order
1. Medical eligibility (level of care)
Before financial review, your parent needs a level-of-care determination establishing they meet nursing-facility level of care. Virginia uses standardized assessment tools through DMAS-contracted assessors or the local Department of Social Services. The assessment evaluates activities of daily living, cognitive status, medical needs, and the availability of informal supports. Wait times vary; allow 2-6 weeks.
2. Income
Virginia uses the federal SSI-based income cap of roughly $2,829/monthin 2026 (300% of the federal benefit rate). If your parent’s gross monthly income from all sources exceeds that cap, they’re not disqualified. They’ll need a Qualified Income Trust (QIT, sometimes called a Miller Trust).
3. Assets
The applicant’s countable assets must be at or below $2,000 at the moment of application.
Not counted (in most cases):
- The primary residence, up to ~$752,000 in equity (the federal home-equity ceiling)
- One vehicle of any value
- Personal effects and household goods
- A burial plot and a modest amount of pre-paid burial arrangements
- The cash value of certain small life-insurance policies
Counted:
- Checking, savings, money-market, and CD accounts
- Brokerage accounts and most retirement accounts in payout phase
- Cash surrender value of larger whole-life insurance
- Second properties, vacation homes, investment properties
- A second vehicle
The five-year look-back
Virginia applies the standard federal 60-month look-back. Any uncompensated transfer of assets — gifts to children, below-market sales, charitable contributions above modest levels — made in the 60 months before application generates a penalty period during which the applicant is otherwise eligible but Virginia Medicaid will not pay for nursing-home or CCC+ HCBS services.
The penalty math is straightforward: the value of the transfer divided by Virginia’s penalty divisor (set annually by DMAS and approximating the average private-pay nursing-home rate). A $100,000 gift becomes roughly a 10-to- 14 month penalty depending on the divisor. The clock on the penalty does not start until your parent is otherwise eligible— meaning they’ve spent down to $2,000 and are receiving (or have applied for) covered services. So the penalty hits exactly when the family needs Medicaid most.3
The MCOs and CCC+ enrollment
Once your parent is approved for CCC+, they enroll with one of the DMAS-contracted MCOs operating in their region of the Commonwealth. The MCO landscape includes several major national and regional plans — Anthem HealthKeepers Plus, Aetna Better Health, Molina Complete Care, Sentara, UnitedHealthcare, and others depending on the region.4
Switching MCOs is allowed at annual open enrollment or under qualifying circumstances. For most families, the most important MCO factors are: which one has contracts with your parent’s preferred nursing facility or home-care agency, and which one has the strongest care coordinators in your county.
The community-spouse situation
If one spouse needs care and the other doesn’t, the rules become more favorable. The well spouse (the “community spouse”) keeps:
- A monthly income allowance (MMMNA): ~$3,948 in 2026
- A protected asset amount (CSRA): up to ~$157,920 in 2026
- The homestead, vehicle, and personal effects as exempt
Most one-spouse-needs-care situations can be planned to a non-catastrophic outcome with 12–24 months of lead time. Talk to a Virginia elder-law attorney before doing anything — DIY in this scenario is where we’ve seen the most expensive mistakes.
Virginia’s estate recovery
Federal law (and Virginia’s implementing rules) require state Medicaid programs to attempt recovery from the estates of Medicaid LTC recipients after death. Virginia’s estate-recovery program seeks reimbursement from probate assets — meaning trust-held assets and assets passing by beneficiary designation are generally outside the recovery reach. For families that want to preserve assets for heirs, trust planning before Medicaid application is the standard tool. See the Virginia Legal & Financial guide.
What to do this month
- Gather the documents. Five years of bank statements, tax returns, real-estate records, brokerage statements, and life-insurance policies. DMAS and the MCO will ask for all of it.
- Stop any “creative” transfers. If gifting has happened recently, document it carefully; do not continue it.
- Talk to a Virginia elder-law attorney. The consultation typically runs $300–$500. Cheap insurance against a five- or six-figure mistake.
- Schedule the level-of-care assessment. Even if you’re not ready to file, the assessment needs to happen.
- Research the MCOs in your region. Particularly relevant if your parent has an established relationship with a specific facility or home-care agency.
For the broader context on Medicaid eligibility nationally, see our Medicaid pillar overview. For the Virginia-specific legal and estate-planning side, see Legal & Financial in Virginia.