March 2019

The Affordable Care Act
and Long-Term Care

In 2018 the Virginia General Assembly passed a bill that was signed into law by the Governor, for Virginia to adopt Medicaid expansion under the ACA. This created a new category of Medicaid eligible applicants in Virginia. Eligibility criteria for this new category are as follows:

  1. Age 19 or older and under age 65
  2. Not entitled to or enrolled in Medicare Part A or B
  3. Not eligible in another mandatory Medicaid category
  4. Household yearly income in 2019
    Family of one $16,754 or $1,397 monthly
    Family of two $22,715 or $1,894 monthly
    Family of three $28,677 or $2,391 monthly

People who meet the above criteria are eligible for physician and hospital care and prescription drugs for their medical needs. For this population there is no resource test and no co-payments. They need not be disabled but need only meet the above criteria for coverage.

These individuals are also eligible for long-term care services in a nursing facility or they can receive community based care under Medicaid. This is an important fact about the Affordable Care Act.

If someone under the age of 65 suddenly suffers a major stroke, loses their work income and finds themselves in a nursing facility, they could receive Medicaid coverage for long-term care even though they have more than $2,000 in savings. Basic resource limit for a single Medicaid recipient who is $2,000. This means they would not have to spend down their savings to pay for long-term care. Of course, they would lose this category of coverage once they become eligible for Medicare but social security disability requires a two year waiting period before Medicare coverage becomes available.

In the meantime, planning could be done to protect countable resources before the person loses their long-term care coverage under Medicaid. If a person has countable resources, they could create a first party special needs trust and transfer their countable assets into the first party trust and still retain Medicaid coverage to pay for their long-term nursing care.

This is not well known or understood. But it is a very important benefit under the Affordable Care Act.

Edward Zetlin Law is experienced in Elder Law and Special Needs Planning issues. Don't hesitate to call if you face such an issue or if you have additional questions. Edward Zetlin Law would be happy to discuss. Please contact us at 703-379-0442 or e-mail at

Community Presentations in March 2018. Langston-Brown - March 20th at 1:00 pm Difference between Revocable Trust versus Irrevocable Trust. Arlington Center 55+ at Langston-Brown Community Center, 2121 N Culpeper St, Arlington, VA 22207.

Contact us at (703)379-0442;

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