Last updated 2026-07-25
TL;DR
Virginia Medicaid pays for assisted living through the Commonwealth Coordinated Care Plus (CCC Plus) waiver, which covers personal care and services in licensed Assisted Living Facilities (ALFs) for people who meet nursing-facility level of care and financial limits. Medicaid does not pay room and board directly; the state's Auxiliary Grant program covers that gap for eligible residents.
What is assisted living?
Assisted living is a residential care setting for people who need help with daily activities like bathing, dressing, medication management, or meal preparation but don't need the round-the-clock skilled nursing care a hospital or nursing home provides. Residents typically have their own room or apartment, share common spaces, and get a mix of housing, meals, and personal care support from staff on site. In Virginia, the state licensing term is "assisted living facility" or ALF, and it's regulated under Title 22VAC40-73 of the Virginia Administrative Code, the Standards for Licensed Assisted Living Facilities [1]. The Virginia Department of Social Services (VDSS) is the licensing authority, not the health department, which surprises a lot of new operators coming from medical backgrounds. ALFs in Virginia are further split by the level of care they're licensed to provide: residential living care (for people who are mostly independent) and assisted living care (for people needing more hands-on help, including some with serious cognitive or physical limitations) [1]. A facility's license spells out which level it can serve. Admitting someone above that level without the right license is a real inspection finding, not a paperwork technicality.
What is a group home?
A group home is a smaller residential setting, usually a house in a regular neighborhood, where a handful of residents live together with staff support. The term gets used loosely, but in licensing language it usually refers to homes serving people with intellectual or developmental disabilities (IDD), mental illness, or those in behavioral health recovery, rather than the larger, more institutional assisted living model built around seniors and aging-related care needs. In Virginia, group homes for people with developmental disabilities are often licensed and funded through the Department of Behavioral Health and Developmental Services (DBHDS) and the DD Medicaid waivers, a different regulatory track than VDSS's assisted living rules. If you're researching "group homes" because you want to serve seniors specifically, you're almost certainly looking for an assisted living facility license instead. It's worth confirming which population and program you actually intend to serve before you pick a licensing category, because the paperwork, staffing ratios, and funding sources diverge quickly from there. For a broader walkthrough of how group home licensing works state by state, see assisted living facilities.
What is an assisted living facility?
An assisted living facility is a licensed residential program that provides housing, meals, supervision, and personal care services to adults who can't fully manage independently but don't need hospital-level medical care. Virginia's code defines an ALF as any facility offering "maintenance or care of four or more adults" that meets the licensing standards, and the exact scope of services depends on whether the facility is approved for residential or assisted living level of care [1]. ALFs are different from independent living communities (which offer little to no hands-on care) and from nursing facilities (which provide skilled nursing under a physician's orders). Most Virginia ALFs also handle medication administration, help with mobility, and coordinate with outside home health or hospice providers as a resident's needs change. Facilities must have a licensed administrator and follow specific staffing, training, and physical plant requirements laid out in 22VAC40-73 [1]. If you're comparing this term against related licensing categories, the article on assisted living facility breaks down how definitions shift from state to state. That matters if you're operating across multiple states or comparing Virginia's rules to a neighboring one.
What does assisted living provide?
Assisted living provides a bundle of housing and personal care services, typically: help with activities of daily living (bathing, dressing, toileting, transferring), medication management, meals, housekeeping, laundry, social and recreational activities, and 24-hour staff supervision. What it does not routinely provide is skilled nursing care, IV therapy, or the kind of intensive medical monitoring you'd get in a nursing facility, though some Virginia ALFs are licensed for specialized care levels that stretch closer to that line. Under Virginia's assisted living care standards, facilities must complete a Uniform Assessment Instrument (UAI) for every resident to determine their functional and cognitive status, which then drives the individualized service plan required by 22VAC40-73-450 [1]. That assessment also feeds into Medicaid waiver eligibility, since the state uses nursing-facility level of care criteria to decide who qualifies for the CCC Plus waiver's assisted living benefit [2]. What you won't typically get billed for separately in a well-run ALF: routine housekeeping, basic activities programming, and standard meals, since those are bundled into the daily or monthly rate. What often does get billed separately: incontinence supplies, specialized memory care add-ons, and transportation beyond a set number of trips. Ask for the fee schedule in writing before you assume something is included.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room and board or personal care costs of assisted living, in Virginia or anywhere else. CMS is explicit about this: Medicare Part A and Part B cover medical care, hospital stays, and limited skilled nursing under specific conditions, but "Medicare doesn't cover room and board when you get long-term care" and does not cover custodial or personal care as a standalone benefit [3]. What Medicare will sometimes cover, even for someone living in an ALF, is medically necessary services delivered there, like a physician visit, physical therapy following a qualifying hospital stay, or durable medical equipment. But the facility's monthly rate itself, the aide help with bathing and dressing, none of that is a Medicare-covered expense. This is the single most common point of confusion for families starting this search, and it's why Medicaid, not Medicare, is the relevant coverage question for anyone asking whether an ALF "accepts Medicaid."
How does Virginia Medicaid pay for assisted living?
Virginia Medicaid pays for assisted living services (not room and board) through the CCC Plus waiver, a Home and Community-Based Services waiver approved under Section 1915(c) of the Social Security Act, administered by the Virginia Department of Medical Assistance Services (DMAS) [2]. Under CCC Plus, Medicaid managed care plans reimburse licensed ALFs for personal care, medication oversight, and other services delivered to enrolled members who meet nursing-facility level of care. The critical detail: Medicaid waiver dollars cover the care component, but they don't cover the room and board portion of an ALF's monthly rate. That gap is filled, for financially eligible residents, by Virginia's Auxiliary Grant (AG) program, a state-and-local-funded supplement paid directly to the ALF on behalf of low-income aged, blind, or disabled residents [4]. In practice, a Medicaid-and-AG-eligible resident in an ALF typically has three funding streams stacked together: the CCC Plus waiver paying for personal care services, the Auxiliary Grant paying for room and board, and the resident's own income (mostly SSI or Social Security) applied toward their cost of care. Not every ALF participates in this arrangement. A facility has to be both VDSS-licensed and enrolled as an AG provider, and, separately, contracted with a CCC Plus managed care plan, to accept these payments. That's two different enrollment processes, run by two different agencies. A facility can be licensed without being enrolled in either funding program.
Who qualifies for Medicaid-funded assisted living in Virginia?
To get Medicaid-funded assisted living services in Virginia through CCC Plus, an applicant generally has to meet three tests: financial eligibility for Medicaid, a functional determination that they need nursing-facility level of care, and enrollment in an ALF that participates in the waiver and Auxiliary Grant program. DMAS uses the Uniform Assessment Instrument to make the level-of-care determination, the same tool referenced under the ALF service planning rules [1][2]. Financially, Medicaid long-term services and supports in Virginia follow federal and state income and asset limits for aged, blind, and disabled Medicaid categories. These limits change periodically and applicants should confirm current figures with their local Department of Social Services or DMAS, since the exact dollar thresholds are not fixed indefinitely and vary by household circumstances [2]. The Auxiliary Grant program has its own separate income limit tied to the SSI federal benefit rate plus a state supplement, and that number is set and adjusted by the Virginia General Assembly and DMAS, so again, confirm the current AG payment standard directly with DMAS rather than relying on an old figure [4]. A local Department of Social Services eligibility worker or a CCC Plus care coordinator is the most reliable first call for a specific applicant's numbers. These thresholds get updated, and a web search two years old can quote a stale figure.
How do I find an assisted living facility in Virginia that accepts Medicaid?
Start with the VDSS licensing database, which lists every licensed ALF in the state along with its license status and any recent violations, since that tells you the facility is legally allowed to operate before you ask about funding [1]. VDSS also publishes inspection reports for each licensed facility, and reading the two or three most recent ones is a faster way to judge quality than any marketing brochure. From there, ask the facility directly two questions: are you enrolled to accept the Auxiliary Grant, and do you contract with CCC Plus managed care plans? A facility can answer yes to the first and no to the second, or vice versa, and you need both pieces in place for the funding to work end to end. If a facility says it "takes Medicaid" without being able to explain the AG and CCC Plus distinction, that's worth a follow-up question. It suggests they may be less familiar with the actual mechanics than they're letting on. A local Area Agency on Aging or the CCC Plus managed care plan's member services line can also generate a list of participating facilities in a given region, which tends to be more current than a general online directory.
What is the difference between assisted living and a nursing home?
Assisted living and nursing homes differ mainly in the level of medical care provided and the regulatory framework behind them. Assisted living (ALFs in Virginia) is licensed by VDSS under 22VAC40-73 and focuses on housing plus personal care support, while nursing homes are licensed as health care facilities, regulated by the Virginia Department of Health, and staffed to provide skilled nursing care around the clock under a physician's orders [1]. A useful way to think about it: assisted living is the right setting for someone who needs help with daily tasks but is medically stable and doesn't require ongoing nursing intervention. A nursing home (also called a skilled nursing facility) is the right setting for someone who needs wound care, IV medications, rehabilitation therapy after a hospital stay, or continuous nursing oversight. Medicare's own coverage rules reflect this split: Medicare will cover a short skilled nursing facility stay under specific conditions after a qualifying hospital admission, but it does not cover an assisted living stay at all [3]. Cost structures differ too. Nursing home Medicaid coverage in Virginia runs through the regular Medicaid State Plan nursing facility benefit, which does cover room and board as part of the nursing facility per diem rate, unlike the ALF/CCC Plus arrangement where room and board is split off into the separate Auxiliary Grant. That's a real financial distinction families need to understand before assuming Medicaid works the same way in both settings.
Assisted living vs nursing home: side-by-side comparison
| Feature | Assisted Living Facility (ALF) | Nursing Home (Skilled Nursing Facility) | |
|---|---|---|---|
| Licensing agency in Virginia | Virginia Dept. of Social Services (VDSS) [1] | Virginia Dept. of Health | |
| Care level | Personal care, ADL support, medication management | Skilled nursing, rehab, 24-hr nursing oversight | |
| Medicare coverage | Not covered [3] | Short-term skilled stay covered under conditions [3] | |
| Medicaid coverage of room and board | Not covered by CCC Plus waiver; covered separately by Auxiliary Grant [4] | Covered as part of nursing facility per diem rate | |
| Medicaid coverage of care services | CCC Plus waiver (1915c HCBS waiver) [2] | Medicaid State Plan nursing facility benefit | |
| Typical resident profile | Needs help with ADLs, medically stable | Needs ongoing skilled nursing or rehab | This table is a simplification. Individual facility contracts, waiver rules, and state plan amendments can shift the details. Always confirm current coverage rules with DMAS or the facility's admissions office before assuming a specific service is included [2][4]. |
How do I start a group home or assisted living facility in Virginia?
Starting an assisted living facility in Virginia begins with VDSS licensing under 22VAC40-73, which covers everything from physical plant requirements to staffing ratios, training hours, admission and discharge policies, and the required Uniform Assessment Instrument process for every resident [1]. Before you touch the licensing application, you need to decide what level of care you're licensed to provide (residential living or assisted living care), because that decision drives your staffing plan, your physical building requirements, and which residents you can legally admit. A rough sequence most operators follow: confirm local zoning allows residential care use at your chosen property, secure a facility that meets VDSS's physical plant standards (room sizes, fire safety, accessibility), write policy and procedure manuals covering admission, medication management, emergency preparedness, and staff training, hire an administrator who meets VDSS's licensure or registration requirements, and then submit the formal application to VDSS along with the required fee (confirm current fee amounts directly with VDSS, since fee schedules are updated periodically). Only after state licensing is secured does it make sense to pursue Auxiliary Grant provider enrollment and CCC Plus managed care contracts. You can't bill either program without an active ALF license first. This is also where a lot of new operators underestimate the paperwork load. Virginia's licensing standards run to dozens of pages covering topics like staff-to-resident ratios by shift, required annual training hours, medication administration training for unlicensed staff, and specific emergency preparedness plan components [1]. Building all of that from scratch, in a format an inspector will actually accept, is the single biggest time sink in the whole process. That's the gap GroupHomePath's $299 State Group Home Licensing Kit is built to close: state-specific application checklists and policy manual templates so you're not starting from a blank page. You can start building your state-specific packet at /licensing-kit-builder. For a broader look at how this process compares across states, see assisted living and assisted living facilities.
What are the biggest mistakes people make when trying to get Medicaid to pay for assisted living in Virginia?
The most common mistake is assuming Medicaid pays for the whole monthly rate at an ALF the way it does at a nursing home. It doesn't. CCC Plus pays for personal care services; the Auxiliary Grant pays for room and board. If a facility isn't enrolled in the AG program, the resident or family is on the hook for the room and board portion out of pocket, even if the facility separately bills Medicaid for care services [2][4]. The second mistake is applying to a facility before confirming its actual license level. A residential living care license doesn't authorize a facility to admit someone with the physical or cognitive needs that assisted living care level requires. VDSS inspection findings around improper level-of-care admissions are common enough that it's worth double checking the facility's specific license classification, more than its marketing description, before signing anything [1]. The third mistake is waiting too long to start the financial eligibility paperwork. Medicaid financial eligibility determinations, especially ones involving asset transfers, spousal impoverishment rules, or estate recovery considerations, can take weeks to process through the local Department of Social Services. A facility move-in date shouldn't be scheduled around an assumption that eligibility will clear quickly.
Frequently asked questions
What is assisted living?
Assisted living is residential care for adults who need help with daily activities like bathing, dressing, or medication management but don't require the round-the-clock skilled nursing care of a nursing home. In Virginia, these are licensed as Assisted Living Facilities (ALFs) under 22VAC40-73, regulated by the Virginia Department of Social Services.
What is a group home?
A group home is a small residential setting, typically a house, where several residents live together with staff support. In Virginia, the term most often applies to homes serving people with intellectual/developmental disabilities or mental illness under DBHDS licensing, which is a different regulatory track than senior-focused assisted living facilities licensed by VDSS.
What is an assisted living facility?
An assisted living facility (ALF) is a licensed residential program providing housing, meals, supervision, and personal care to adults who need help with daily activities but not skilled nursing care. Virginia licenses ALFs under 22VAC40-73, dividing them into residential living care and assisted living care levels based on residents' functional needs.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room and board or personal care costs of assisted living. CMS states Medicare covers medically necessary services and doesn't pay for room and board in long-term care settings. Medicare may still cover a doctor visit or physical therapy delivered to someone living in an ALF, but not the facility's monthly rate itself.
How do I start a group home in Virginia?
Confirm zoning allows residential care use, secure a property meeting VDSS physical plant standards, write required policy manuals (admissions, medication management, emergency preparedness), hire a qualified administrator, and submit a licensing application to VDSS under 22VAC40-73. Only after licensing is active can you pursue Medicaid-related provider enrollments like the Auxiliary Grant or CCC Plus.
What is the difference between assisted living and a nursing home?
Assisted living provides housing and personal care for people who are medically stable but need help with daily tasks, licensed by VDSS. A nursing home provides skilled nursing care under a physician's orders, licensed by the Virginia Department of Health. Medicare covers short skilled nursing stays under conditions but never covers assisted living.
Does Virginia Medicaid pay for assisted living facilities?
Yes, but only for the care component, through the CCC Plus Medicaid waiver, which pays licensed ALFs for personal care services for members who meet nursing-facility level of care. Room and board is not covered by the waiver; it's covered separately, for financially eligible residents, by Virginia's Auxiliary Grant program.
What is the Auxiliary Grant program in Virginia?
The Auxiliary Grant (AG) is a Virginia state-and-local funded supplement that pays the room and board portion of an assisted living facility's rate for low-income aged, blind, or disabled residents. It works alongside, not instead of, Medicaid's CCC Plus waiver, which covers the personal care services portion of the bill.
How do I know if a specific ALF in Virginia accepts Medicaid?
Ask the facility directly whether it's enrolled as an Auxiliary Grant provider and whether it contracts with CCC Plus managed care plans, since both are needed for Medicaid funding to fully cover a resident's costs. You can also check the facility's license status and inspection history through the VDSS licensing database before asking about funding.
What does assisted living provide that a nursing home doesn't?
Assisted living typically offers a more home-like, less clinical environment with private or semi-private rooms, more independence, and services bundled around daily living support rather than medical treatment. It does not provide the skilled nursing, IV therapy, or intensive medical monitoring that a nursing home is staffed and licensed to deliver.
Can someone qualify for both Medicaid and the Auxiliary Grant at the same time in Virginia?
Yes, and in fact both are usually needed together to fully fund an ALF stay: Medicaid's CCC Plus waiver pays for personal care services while the Auxiliary Grant pays for room and board. Financial eligibility for each is determined separately by the local Department of Social Services and DMAS.
Are all assisted living facilities in Virginia licensed the same way?
No. VDSS licenses ALFs at different levels: residential living care for more independent residents and assisted living care for those needing more hands-on support, including some with cognitive impairment. A facility's specific license determines which residents it can legally admit, and licensing details should be confirmed directly with VDSS.
Sources
- Virginia Administrative Code, Standards for Licensed Assisted Living Facilities, 22VAC40-73: Virginia's licensing standards for assisted living facilities, level of care definitions, and service planning requirements
- Medicare.gov, Long-Term Care Coverage: Medicare does not cover room and board for long-term or custodial care, including assisted living
- Code of Virginia, Auxiliary Grants Program, Section 63.2-800: Auxiliary Grant is a state and local funded program covering room and board for eligible aged, blind, or disabled residents in assisted living
- 42 CFR 441.301, Home and Community-Based Services Waiver Requirements: Federal regulatory requirements governing 1915(c) HCBS waivers like CCC Plus, including person-centered service plans and level of care determinations
- Social Security Act Section 1915(c), 42 U.S.C. 1396n(c): Statutory authority allowing states to waive certain Medicaid requirements to cover home and community-based services as an alternative to institutional care
- Code of Virginia, Assisted Living Facilities Licensure, Section 63.2-1701: State statute establishing VDSS as the licensing authority for assisted living facilities in Virginia