Virginia Medicaid Income Limits 2025: Program Requirements, Asset Tests, and Spend-Down Rules

Virginia Medicaid income limits in 2025 vary by program and household size. For most adults aged 19 to 64, the limit is 138% of the Federal Poverty Level, $1,732 per month for a single person. The program is administered by the Virginia Department of Medical Assistance Services (DMAS) under the Cardinal Care brand.

Figures reflect the 2026 FPL update effective January 13, 2026.

Key Takeaways

• Most adults aged 19 to 64 qualify for Virginia Medicaid if monthly income is at or below $1,732 for a single person, equal to 138% of the Federal Poverty Level.
• Long-term care Medicaid carries a separate, higher income limit of $2,901 per month. The aged, blind, and disabled (ABD) program uses a lower limit of $1,043 per month.
• No asset test applies to expansion adults, children, or pregnant women. A $2,000 asset limit applies to ABD and long-term care applicants only.

What Is the Income Limit for Medicaid in Virginia?

Virginia Medicaid does not carry a single universal income limit. The threshold that applies depends entirely on which program covers the applicant, expansion adults, children, pregnant women, the aged or disabled, or those needing long-term care each operate under a different rule.

For most adults aged 19 to 64, the limit is 138% of the Federal Poverty Level. Using the 2026 FPL figures that took effect January 13, 2026, that equals $1,732 per month for a single person.

Virginia expanded Medicaid under the Affordable Care Act in January 2019, adding coverage for adults who previously had no qualifying pathway. The program is administered by DMAS under the Cardinal Care brand, the unified name for Virginia’s full Medicaid system since October 2023.

MAGI-based programs, covering expansion of adults, children, and pregnant women, use gross income before deductions. Non-MAGI programs covering the aged, blind, disabled, and long-term care applicants apply different income counting rules with additional exclusions.

The distinction matters because the same gross income figure can produce different eligibility outcomes depending on which methodology applies.

The table below shows exactly how those thresholds break down across all five programs.

Virginia Medicaid Income Limits 2025: Program and Household Size

Five separate programs operate under Virginia Medicaid, each carrying a distinct income threshold. All five programs are compared side by side below, with monthly and annual figures included.

MAGI-program figures use the 2026 FPL effective January 13, 2026. The LTC figure equals 300% of the SSI benefit rate for 2025. Verify current figures at coverva.dmas.virginia.gov before applying.

Which program applies to an applicant determines not just the income threshold but the entire set of counting rules DSS uses to assess the application.

The 5 Percent Income Disregard: Why the Real Limit Is Higher Than the Headline Figure?

Virginia applies a 5% FPL Standard Disregard to all MAGI-based Medicaid programs. The practical effect is that the effective income threshold for a single expansion adult is 143% FPL, approximately $1,796 per month, not the 138% figure that appears in most published charts.

The disregard was introduced with the Affordable Care Act specifically to prevent a hard eligibility cliff between Medicaid and Marketplace insurance subsidies.

Without it, an applicant earning one dollar above the headline threshold would lose Medicaid eligibility entirely. DMAS applies the disregard automatically during eligibility determination, applicants do not need to calculate or claim it separately.

Four program groups fall under this disregard:

• Expansion adults aged 19 to 64
• Parents and caretaker relatives
• Pregnant women under both Medicaid and FAMIS MOMS
• Children under FAMIS Plus and FAMIS

The disregard does not apply to ABD or long-term care programs, which use non-MAGI income rules. A single adult earning up to $1,796 per month should submit an application and allow DSS to make the formal determination, not self-screen out based on the headline percentage.

For applicants unsure whether income falls within range, submitting an application is the correct step. How long does it take to get Medicaid covers the full timeline from submission to coverage start for Virginia applicants.

Virginia Medicaid Income Rules: What Counts and What Doesn’t

The income types that count toward Virginia Medicaid eligibility depend on which income methodology applies to the program. MAGI-based programs count gross income before any deductions.

Non-MAGI programs used for ABD and long-term care applicants apply a different set of counting rules that can reduce countable income below the gross figure.

Under MAGI rules, DSS counts these income sources:

1. Wages and salaries, measured as gross income before tax
2. Net self-employment income after allowable business deductions
3. Social Security benefits, including SSDI payments
4. Pension and retirement income
5. Unemployment compensation
6. Alimony received under agreements made before January 1, 2019

These sources fall outside MAGI rules and are not counted:

1. Child support payments received
2. Gifts and inheritances
3. Workers’ compensation in most cases
4. Veterans’ benefits that are needs-based
5. SSI payments

ABD Medicaid applies earned income exclusions that go further than MAGI rules, an applicant whose gross income appears to exceed the ABD limit may still qualify once DSS applies those deductions.

Nursing Home and Long-Term Care Medicaid Income Limits in Virginia

Virginia’s long-term care Medicaid income limit is $2,901 per month for an individual. This figure equals 300% of the federal SSI benefit rate and applies to both nursing home care and home and community-based services delivered through the Commonwealth Coordinated Care Plus waiver.

Residents approved for nursing home Medicaid must contribute most of their monthly income toward the cost of care, a calculation DSS calls patient pay.

Virginia allows nursing home residents to retain $40 per month as a personal needs allowance, one of the lower allowances among states. Residents receiving long-term support through a Medicaid HCBS waiver keep a higher amount: $1,595 per month, equal to 165% of the SSI benefit level for 2025.

Married applicants face additional rules. The community spouse, the partner living outside the facility, is protected by the Minimum Monthly Maintenance Needs Allowance.

Virginia’s MMMNA for 2025 is $2,555 per month. If the community spouse’s own income falls below this floor, a portion of the institutionalised spouse’s income can be redirected to them before the patient pay calculation is applied.

Applicants whose income exceeds $2,901 per month still have options. Virginia’s Medically Needy Program exists specifically for this situation and is covered in the next section.

The Medically Needy Program: Qualifying When Income Exceeds the Limit

Virginia’s Medically Needy Program allows applicants whose income exceeds the standard Medicaid threshold to qualify by spending down the excess against monthly medical bills. The spend-down amount shifts month to month, it is calculated fresh each calendar month against whatever medical bills the applicant presents.

The spend-down income threshold varies by geographic region. Virginia divides the state into three groups, each with a separate monthly income limit:

An applicant qualifies for that month when income minus documented medical expenses falls at or below the threshold for their region. DSS accepts bills from any licensed healthcare provider, specialists, therapists, pharmacies, and hospitals all count.

The bills do not need to be paid to qualify. They need only be received and presented to DSS. Once the threshold is met, Medicaid picks up covered healthcare costs for the rest of that calendar month.

Virginia’s Medically Needy spend-down allows applicants whose income exceeds standard Medicaid limits to qualify by presenting monthly medical bills to their local DSS office.

Bills from any licensed provider count toward the threshold, and do not need to be paid, only received. The income threshold varies by region, ranging from $602.54 to $684.17 per month for an individual.

For long-term care applicants, assets matter just as much as income during the eligibility review.

What is the 7-year look-back period for Medicaid explains how past asset transfers are reviewed during the Virginia eligibility process, a critical consideration for anyone transferring property or financial assets before applying.

How to Apply for Virginia Medicaid in 2025?

Applicants can submit a Virginia Medicaid application online at commonhelp.virginia.gov or in person at a local Department of Social Services office.

DSS handles eligibility determination, not DMAS directly, so any follow-up on application status or document requests goes to the local DSS office, not the state agency.

The application process runs in five steps:

1. Gather required documents before starting the application: proof of identity, proof of Virginia residency, income verification including recent pay stubs, tax returns, or benefit award letters, and immigration status documentation if applicable
2. Submit the application online at commonhelp.virginia.gov, by phone at 1-855-242-8282, by mail to the local DSS office, or in person
3. Respond promptly to any DSS request for additional documentation. Delays in response are the most common cause of extended processing timelines
4. If approved, select a Cardinal Care managed care plan from the available options in your area. If no selection is made within the enrollment window, a plan will be auto-assigned within 30 days
5. Coverage typically begins on the first day of the month following approval. Pregnant women and certain other groups may receive coverage effective the month of application

A complete first submission, with all documents included, avoids the back-and-forth that extends most DSS processing timelines.

Conclusion

The income limit that matters for a Virginia Medicaid applicant is always program-specific, the group an applicant falls into determines the threshold, the methodology, and the asset rules that apply.

The 5% FPL Standard Disregard means the effective threshold sits higher than most published charts show. Applying through commonhelp.virginia.gov and letting DSS run the numbers is always the better move over ruling out eligibility based on gross income alone.

FAQ

What are the income limits for Virginia Medicaid by household size?

Income limits vary by program. For expansion adults, the monthly limit is $1,732 for a household of one, $2,344 for two, and $3,568 for four. Children qualify at higher thresholds, up to 148% FPL for standard Medicaid and up to 205% FPL for FAMIS. The full breakdown by program appears in the table above.

Does Virginia Medicaid have an asset test?

No asset test applies to expansion adults, children, or pregnant women. A $2,000 asset limit does apply to ABD and long-term care applicants. Certain assets are exempt from the count, including one vehicle, personal belongings, and a primary residence provided the applicant intends to return to it.

Who qualifies for Medicaid in Virginia in 2025?

Virginia Medicaid covers five primary groups: adults aged 19 to 64 with income at or below 138% FPL, children under 19 at up to 205% FPL through FAMIS, pregnant women at up to 148% FPL, aged or disabled individuals meeting ABD rules, and those requiring nursing home or long-term care services. SSI recipients qualify automatically.

What is Cardinal Care Medicaid in Virginia?

Cardinal Care is the official brand name for Virginia’s full Medicaid program, launched in October 2023 when DMAS merged the Medallion 4.0 and CCC Plus programs into a single system. All Medicaid and FAMIS members are enrolled in Cardinal Care regardless of coverage type. Five managed care organizations currently operate under the Cardinal Care umbrella statewide.

Can you have too much income for Medicaid in Virginia?

Yes, but exceeding the standard limit does not end eligibility options. Virginia’s Medically Needy Program allows applicants above the income threshold to qualify by spending down monthly medical expenses to the regional threshold. Applicants whose income exceeds the limit should review the spend-down rules before concluding they are ineligible.

Disclaimer: The information presented in this article is for general educational purposes only; Virginia Medicaid policies, guidelines, and figures are subject to regular state updates and should be verified directly through official Cover Virginia or Department of Social Services portals prior to submission.