Medicaid, Va. Auxiliary Grant, LTC Insurance Resources & 2017 Congress

 2017 Congress and the Repeal of Entitlements

Google’s State of Play: Various Congressional Plans and their likely consequences.

Medicaid Application and Other Forms Online

CMS: Centers for Medicare and Medicaid Services:  To learn about the Medicaid program in your state see pages inside this link.
List of State Medicaid Program Websites
Contact Information for State Medicaid Offices
Virginia Department of Medical Assistance Services (Medicaid)  Resources for Virginia Medicaid issues.
Virginia Medicaid Manual and Updates



Entire Medicaid Manual (Combined by RSM):  Downloaded 12-7-2017


The Medicaid Eligibility Manual contains the policy and procedures used by eligibility workers to determine eligibility for the Medicaid program in Virginia.


The Medicaid Manual (in Adobe .pdf) maintained by the DMAS is the top link on the left.  Beneath this official publication link is the writer’s combined (“stitched”) Manual, incorporating in order the official separate chapter links, as of the date stated in the link.

This is helpful for global searches.

Here are specific links to targeted policy often involved in our long term care / worker compensation / personal injury proceeds protection practice:




Medicaid and FAMIS Income Limits for 2017 (effective January 1, 2017)
Medicaid ABD and FPL Income Limits for 2017 (effective April 1, 2017 – includes ABD and 80% FPL)



Most Recently Published Updates

DMAS-3 (January 1, 2017)
DMAS-4 (April 1, 2017)

Virginia “Spring Cleaning” Slideshow (4-30-2015) (by Virginia DMAS Staff Experts)
Virginia Medicaid

Provider Manuals (Generally)

Virginia Medicaid Nursing Home Manual

Appeal Summaries Selected appeal decisions in Medicaid eligibility cases. (Note: the “Agency” box should be completed with “DSS” for Medicaid eligibility decisions)
Centralized Common Help Benefit Application CommonHelp is an electronic application for multiple programs.  By establishing an account, it allows an applicant or recipient to check and benefits, link a private account to a case record (in the Department of Social Services), report changes in circumstances, and update an case record.
Medicaid Application Official Medicaid Application.

Basic Application

Long-Term Care Application

All Medicaid Forms

Undue Hardship Claim Form Asset Transfer Undue Hardship Claim
Pre-Screening Assessments A Screeners’ Reference Guide for Long-Term Care Services in Virginia

The Long Term Care Assessment Instrument Form

The Long Term Care Assessment Manual (2015, DSS – APS)

Virginia Medicaid Waivers Virginia offers seven waiver programs.  Five are administered by the Department of Medical Assistance Services. DMAS staff develop, oversee, and review quality in these programs.  They are responsible, among other things, for prior authorization services, and technical assistance to providers Overview of Virginia Waiver Services and Waiver Rates  authorized by Virginia for present year.

Authorized participants (“slots”) and waiting lists.

Medicaid Waiver Services Guide.   A useful guide published by the disAbility Resource Center of the Rappahannock Area, Inc.  The link is presently non-functional but we’ve asked for a replacement.

Life Tables Life Expectancy – Virginia Medicaid Table as of 1/1/2010
(See M1450, Appendix 2, “LIFE EXPECTANCY TABLE”)(Compare: United States SSA Table Life Expectancy.)
Entitlement Limits (2017) Medicaid Spousal and SSI Pubic Entitlement Tables, SGA, income and resource limitations.  Updated 2017.
Current Official Virginia Medicaid Position The official web page of the Virginia Department of Medical Assistance Services. Links to the FOE officer for DMAS.

See the CMS “State Medicaid Manual” for the Federal perspective on what Medicaid policy should be.

Virginia DMAS Medicaid Plan Virginia  Administrative Code Regulations constituting the official Virginia Medical Assistance Plan.
Medicaid Resources Current Medicaid Planning Outlines Income and Resource Guidelines Links       

 Centers for Medicare & Medicaid Services

Spousal Impoverishment

Federal Statute
Virginia Rules

Transfer of Assets

Federal Rules

Virginia Rules

Failure of Widow(er) To Claim The Elective Share Treated As A Transfer of Assets – Va. Code § 64.1-13 et seq

Miller v. Kansas Department of Social Services

Annuity Regulations

Medicaid Manual M 1450.400 F.

Testamentary Trust Established by Spouse Does Not Violate the Medicaid TOA Rule

Short Term Annuities and the Zahner case

Federal – Virginia Medicaid Estate Recovery

Think it won’t happen to you? Click here, here, and here.

Virginia Statute Prohibiting Medicaid Liens, Va. Code §63.2-409.

Virginia Regulation Governing Estate Recovery

Virginia Regulation Prohibiting Liens

Revocable Transfers of Real Estate – Virginia’s “Lady Bird” Deed Statute

Filial Responsibility: From Medieval to Modern, Going Around and Coming Around

What happens when Medicaid can’t (or won’t) pay for Mom and Dad’s medical and nursing care? Kids, meet Uncle Filial Responsibility, then, now and tomorrow?

Personal Injury Lien Reduction

Good Faith Lien Waiver Negotiation Guidelines

Special Needs Trusts

Virginia Department of Social Services Letter Regarding Pooled Income Trusts and Transfer of Assets Policy Related to FUNDING Such Trusts

Auxiliary Grant The Virginia Auxiliary Grant supplements income for Supplemental Security Income (SSI) and some other aged, blind, or disabled individuals living licensed assisted living facilities, or certain adult foster care homes. The Grant is “to maintain a standard of living that meets a basic level of need.”

This link contains the Virginia AG Manual and a listing of all facilities which accept the AG, arrayed by jurisdiction.

Detailed information about the facilities (licensure, inspection reports, etc.) is available here.

Long Term Care Insurance (LTCI) Generally.

National Association of State Insurance Commissioners LTCI Links

Virginia Insurance Bureau, LTCI Division:


Personal Worksheet
, which suggests that “[i]f you are buying this policy to protect your assets and your assets are less than $30,000, you may wish to consider other options for financing your long-term care.”

2015 Virginia State Corporation Commission Report
, stating at page 40 (Adobe .pdf page 43) that “[a]s various filings made in this docket have demonstrated, significant premium rate increases have continued to impact long-term care insurance policyholders in Virginia. The Commission has sought over the last several years to identify more clearly the drivers of these increases and to clarify if, and to what extent, the current regulatory framework applicable to long-term care insurance rate review may have become insufficient to address effectively the numerous consumer complaints the Bureau has received. The Commission recognizes the extremely difficult nature of this issue and the need to consider
numerous factors – including the significant premium rate increases experienced by long-term care insurance policyholders, the ability of the insurers issuing long-term care insurance policies to pay claims in the future and meet their contractual obligations, the equitable and fair treatment of all policyholders, both new and existing, and the sustainability of the long-term care insurance market in Virginia – in adopting changes to the current regulatory framework.

The Commission finds that the amendments proposed by the Bureau address many of the concerns expressed not only by consumers, but by the
Commission as well, regarding long-term care insurance premium rate increases in Virginia. These proposed amendments, which are discussed in more
detail in the Bureau’s Response and Reply and attached as Exhibit A, strive to both protect consumers and place heightened scrutiny on long-term care insurers seeking to raise premium rates. In addition, as discussed above, the Bureau’s proposed amendments to the Rules are substantially similar to certain revisions to the NAIC Model Regulation or contained in the NAIC Model Bulletin,P28F9P which the NAIC spent a considerable amount of time and effort developing based on extensive national discussion and collaboration with a broad set of stakeholders, including state insurance regulators, industry groups and consumer groups. The Commission finds that while the Bureau’s proposed amendments to the Rules will not eliminate long-term care insurance premium rate increases, such proposed amendments adopt a more conservative approach for the initial pricing of long-term care policies, require insurers to take a more active role in managing long-term care insurance rates, and provide additional and necessary protections to long-term care insurance
policyholders in Virginia.”

Virginia Code Provisions

Virginia Administrative Regulations

LTCI Shut Down By Pennsylvania State Insurance Commission: – Does Everyone Lose Everything In Their Policies?