Many people with dementia will one day need help all day with bathing, dressing and staying safe. This is called long-term care. Medicare does not pay for it, and most health insurance does not either.¹ Many families pay out of pocket until the money runs low.

Medicaid is the program that steps in. It is run by each state with federal money. For people with limited income and savings, it can pay for nursing home care and for care at home.² This page explains how it works, with a focus on Virginia, where Medicaid is called Cardinal Care.

Key points

Medicare does not pay for long-term custodial care. Medicaid does, for people who meet strict money and care-need rules.^1,2
In Virginia, the CCC Plus Waiver pays for help at home, such as personal care aides, adult day health care and respite. It has no waiting list.^3,5
In 2026, a single person in Virginia can usually have no more than $2,000 in countable savings. The home is often not counted.^10,9
Gifts and transfers made in the 5 years before applying can delay coverage.¹²
A spouse who stays at home can keep part of the couple's savings and income. After death, the state may seek repayment from the estate.^9,14

Why Medicaid matters in dementia

Medicare does not pay for ongoing help with daily tasks when that is the main need.¹ See what Medicare covers and what dementia care costs. When savings run low, Medicaid can pay all or part of the cost.² Veterans may also qualify for VA benefits.

Medicaid can pay for care in two main places:

A nursing home. Medicaid can cover a long stay. But not every nursing home accepts Medicaid, so ask early.² See nursing homes.
Home and community. Most states, including Virginia, also pay for care at home through programs called waivers.^2,3

Cardinal Care: Virginia Medicaid's name

In Virginia, every Medicaid member is now part of Cardinal Care.⁸ Two older program names, CCC Plus and Medallion, were health plan programs that ended in 2023.⁸ Most members get their care through one of five health plans: Aetna Better Health, Anthem HealthKeepers Plus, Humana Healthy Horizons, Sentara Health Plans or UnitedHealthcare Community Plan (as of October 2026).⁸

The CCC Plus Waiver kept its name.⁴ It is a set of home and community services, not a health plan.

The CCC Plus Waiver: help at home in Virginia

The CCC Plus Waiver (Commonwealth Coordinated Care Plus Waiver) pays for care at home for people who would otherwise need a nursing home.⁴ It serves older adults and people with disabilities.⁴ It has no waiting list.^3,6

Services can include:⁵

Service	What it is	Limits (2025 fact sheet)
Personal care	An aide helps with bathing, dressing, eating, toileting and moving around	About 56 hours a week, with exceptions
Respite	A break for the family caregiver	480 hours a year (July to June)
Adult day health care	A day program with nursing and activities	Set by the care plan
Personal Emergency Response System (PERS)	A help button, with medicine reminders if needed	Set by the care plan
Home changes and equipment	Ramps, grab bars, assistive devices	Up to $5,000 each per year
Private duty nursing	Skilled nursing at home for complex needs	Up to 112 hours a week

Personal care and respite can be agency-directed, where an agency sends a trained aide. They can also be consumer-directed, where the person or a family representative hires and manages the aide.^4,5 Virginia has separate rules about when a family member can be the paid aide. Ask about them before you count on this.⁴

To learn more, see adult day care, in-home care and respite care.

PACE is another choice. PACE (Program of All-Inclusive Care for the Elderly) is for people 55 and older who meet nursing home level of care and live in a PACE service area. It combines medical care and long-term care in one program. People who qualify for the CCC Plus Waiver may choose PACE instead.¹¹ See PACE.

Two kinds of rules: care needs and money

To get Medicaid long-term care, a person must pass two tests. One is about care needs. The other is about income and savings.

The care-need test: the LTSS screening

Before Medicaid pays for a nursing home, the CCC Plus Waiver or PACE, the person must have a Long-Term Services and Supports (LTSS) screening.⁷ The screening looks at:⁷

How much help the person needs with daily activities, such as bathing, dressing, eating and walking
Their health and any ongoing medical or nursing needs
Whether they are at risk of going into a nursing home or hospital within 30 days without services

You ask for a screening through your local Department of Social Services. A team of a social worker and a health department nurse comes to meet with the person and, if possible, a family member.⁴ If the person is in the hospital, the discharge planner can do the screening.⁴

People with dementia often look more capable to a stranger than they are on a normal day. Before the screening, write down what help is needed with each daily task, how often, and any wandering, falls or nights awake. Have the main caregiver at the visit. A behavior diary can help.

The money test: income

In 2026, a person needing long-term care in Virginia can usually qualify with income up to $2,982 a month.⁹ This is 300% of the federal SSI payment.¹¹ If income is higher, the person may still qualify through a "spenddown." This means their medical bills must use up the extra income first.¹¹

Qualifying does not mean all income stays with the person. Most people must pay part of their income toward their care each month. This is called patient pay.^11,3 In a nursing home in Virginia, the person keeps a personal needs allowance of $40 a month.⁹ People getting waiver services at home keep more for rent, food and bills ($1,641 a month in 2026).⁹ A spouse at home may also receive part of the income (see below).¹³

The money test: savings and property

In 2026, Virginia's limit on countable resources (savings and property) is $2,000 for one person.¹⁰ Some things are usually not counted:¹⁰

The person's main home and the land under it. For long-term care, this is limited to home equity of $752,000 in 2026, unless a spouse or certain children live there.^9,12
Household goods and personal belongings
A burial plot and some burial funds or prepaid funeral plans, within limits

Bank accounts, stocks and second homes usually count. Ask your local Department of Social Services or an elder law attorney about the details.

The 5-year look-back period

When someone applies for Medicaid long-term care, the state looks back 60 months (5 years) at money and property given away or sold for less than it was worth.¹² This includes transfers by the person's spouse.¹²

If a transfer is found, Medicaid will not pay for long-term care for a period of time. This is called a penalty period. Its length is the value given away divided by the average monthly cost of a private-pay nursing home in the state.¹²

For example, with made-up numbers: if that average were $10,000 a month, a $50,000 gift would mean about 5 months without Medicaid payment for care.

The penalty does not start on the date of the gift. It starts when the person has applied, would otherwise qualify, and is getting long-term care.¹² So a gift can leave a family with large bills at the worst time.

Some transfers do not cause a penalty. Under federal law, these include:¹²

Transfers to a husband or wife
Transfers to a child who is blind or has a disability, or to a trust only for that child
Transferring the home to a child under 21, or to a brother or sister who co-owns the home and lived there for at least a year before the person entered care
Transferring the home to an adult child who lived there for at least 2 years and gave care that kept the parent out of a nursing home

The state may also waive a penalty if it would cause undue hardship, such as losing food or shelter.¹²

Do not give away money, sign over a house or buy a financial product to "qualify for Medicaid" without advice from an elder law attorney. Annuities and some trusts have special rules and can count as a transfer.^12,2 Be careful with sellers who offer quick Medicaid plans. See finding an elder law attorney.

Protections for the spouse at home

When one spouse needs long-term care, Medicaid has rules so the other spouse is not left poor. These are called spousal impoverishment protections.¹³ They apply to nursing home care and to home and community-based care.²

Savings. The state counts the couple's savings together. Then it sets aside a share for the spouse at home. In Virginia in 2026, this protected amount is at least $32,532 and at most $162,660.⁹ The person needing care must then meet the $2,000 limit with what is left.

Income. The spouse at home keeps their own income. If it is low, part of the other spouse's income can go to them each month.¹³ In Virginia, the target amount for the spouse at home is at least $2,705 a month (from July 1, 2026) and at most $4,066.50 a month in 2026.⁹

The home. The home equity limit does not apply while a spouse lives in the home.¹²

These rules are detailed. A couple can ask the local Department of Social Services for a resource assessment to see where they stand before applying.¹¹

Estate recovery: what happens after death

Federal law requires states to try to get back some Medicaid costs after a member dies. This is called estate recovery.¹⁴ For people who were 55 or older, states must seek repayment for nursing home care, home and community-based services, and related hospital and drug costs.¹⁴ In Virginia, the claim can include any Medicaid payments made for the person.¹⁵

There are important limits:^14,12

The state cannot recover while a husband or wife is still living.
It cannot recover while there is a child under 21, or a child of any age who is blind or has a disability.
States must have a way to waive recovery when it would cause undue hardship.

Assets protected by a qualified Long-Term Care Partnership insurance policy are also shielded from recovery, up to the amount protected when the person applied.¹⁵ See long-term care insurance.

Ask an elder law attorney how this affects the home and your wills and trusts.

How to apply in Virginia

Get legal papers in place early. The person with dementia may not be able to sign forms later. A durable power of attorney lets a trusted person apply and manage money for them.
Ask for an LTSS screening. Call your local Department of Social Services. If the person is in the hospital, ask the discharge planner.⁴
Apply for Medicaid. Apply online at CommonHelp (commonhelp.virginia.gov), by phone with Cover Virginia at 1-855-242-8282 (TTY 1-888-221-1590), or on paper through your local Department of Social Services.^3,4 Paper applications for long-term care need an extra form called Appendix D.⁴
Gather papers. Expect to show proof of income, bank and investment statements, property, insurance, and records of large gifts or sales in the past 5 years.^2,12
Choose services. Once approved, the screening team or health plan care coordinator helps you find providers.⁴
Keep up with renewals. Read every letter from Medicaid. Report changes and return renewal forms on time so coverage does not stop.³

Nursing homes that accept Medicaid often have staff who can help with the application.² For free or low-cost legal help, see finding an elder law attorney.

Common questions

Will Medicaid take our house?

Not while the person is alive and the home is protected. The home is usually not counted for eligibility, within the equity limit, and the limit does not apply when a spouse lives there.^10,12 After death, the state may seek repayment from the estate. It cannot do so while a spouse, a child under 21, or a blind or disabled child survives.¹⁴

Does Medicaid pay for assisted living or memory care?

Help with assisted living is more limited. Some people living in assisted living can join PACE if they meet its rules.¹¹ Virginia also has a state payment called the Auxiliary Grant for some people with low income who live in assisted living.¹¹ Ask the facility and your local Department of Social Services what help is available. See assisted living and memory care.

Can I get paid to care for my parent?

Possibly. With consumer direction in the CCC Plus Waiver, the person or family hires and manages the aide.⁴ Virginia has rules about which family members can be paid, so ask before you plan around it.⁴

When to get help

Get advice from an elder law attorney if you own a home, have more than a small amount of savings, are married, or gave away money in the past 5 years.² Get help quickly if a hospital is planning discharge to a nursing home, or if Medicaid denies coverage. Denial and change notices explain how to appeal and by when.

Caring for someone while sorting out Medicaid is stressful. See caregiver stress and burnout. If you feel hopeless or think about harming yourself, call or text 988. If someone is in danger right now, call 911.

Sources

Medicare.gov. Long-term care. Centers for Medicare & Medicaid Services, 2026. Medicare.gov
Alzheimer's Association. Medicaid. Alzheimer's Association, 2026. alz.org
Cover Virginia. Long-term services and supports. Virginia Department of Medical Assistance Services, 2026. Cover Virginia
Virginia Department of Medical Assistance Services. CCC Plus Waiver. DMAS, 2026. DMAS
Virginia Department of Medical Assistance Services. CCC Plus Waiver fact sheet. DMAS, 2025. PDF
Virginia Department of Medical Assistance Services. Waivers. DMAS, 2026. DMAS
Virginia Department of Medical Assistance Services. LTSS screening. DMAS, 2026. DMAS
Virginia Department of Medical Assistance Services. Cardinal Care members. DMAS, 2026. DMAS
Virginia Department of Medical Assistance Services. Medicaid Eligibility Manual, M00 appendix: income charts (July 2026). DMAS, 2026. PDF
Virginia Department of Medical Assistance Services. Medicaid Eligibility Manual, chapter M11: ABD resources. DMAS, 2026. PDF
Virginia Department of Medical Assistance Services. Medicaid Eligibility Manual, chapter M14: long-term care. DMAS, 2026. PDF
Social Security Administration. Social Security Act, section 1917: liens, adjustments and recoveries, and transfers of assets. SSA. SSA
Medicaid.gov. Spousal impoverishment. Centers for Medicare & Medicaid Services. Medicaid.gov
Medicaid.gov. Estate recovery. Centers for Medicare & Medicaid Services. Medicaid.gov
Virginia Department of Medical Assistance Services. Medicaid Eligibility Manual, chapter M17: Medicaid fraud and non-fraud recovery. DMAS. PDF

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.