The Virginia Medicaid LTSS Screening: How to Get Approved for Home Care

If you have called your local Department of Social Services about getting help at home for your mom, dad, or spouse, someone probably told you that a screening has to happen first. You may have heard it called the LTSS screening, the Medicaid screening, the pre-admission screening, or "the UAI." It is all the same process — and in Virginia it is the door every family has to walk through before Medicaid will pay for personal care at home through the CCC Plus Waiver.

It is not a test you can study for, but it is absolutely something you can be ready for. Below is who conducts the screening, what the team is actually measuring, how to request one, and the mistakes we watch Northern Virginia families make while the nurse and social worker are sitting at the kitchen table.

What is the Virginia Medicaid LTSS screening?

LTSS stands for long-term services and supports — the ongoing, hands-on help someone needs to get through a day safely. The screening answers one question: does this person need a nursing facility level of care? If the answer is yes, Virginia Medicaid will pay for that care either in a nursing facility or, through a waiver, at home.

Under Virginia law, everyone requesting the CCC Plus Waiver, the Program of All-Inclusive Care for the Elderly (PACE), or Medicaid payment for nursing facility care has to be screened first. There is no way around it and no way to skip ahead — a waiver application without a completed screening simply stops. You can read the program details on DMAS's LTSS Screening page.

The screening is only half of the approval

This trips up almost everyone. There are two separate approvals, handled by two different processes:

• Functional eligibility — the LTSS screening. Does this person's condition meet nursing facility level of care?
• Financial eligibility — the Medicaid application, handled by your local Department of Social Services. Do this person's income and assets qualify under the long-term care rules?

You need both. A family can pass the screening beautifully and still wait months because nobody filed the Medicaid application, or the application went in without the long-term care appendix. If your loved one is not on Medicaid yet, start that application in parallel — you can apply online through CommonHelp, or call the Cover Virginia Call Center at 1‑833‑522‑5582 and specifically ask for Appendix D, the section for long-term services and supports. Our step-by-step CCC Plus Waiver application guide walks through the order these pieces go in.

Who performs the screening, and how do you request one?

If your loved one is at home

You request the screening through your local Department of Social Services. A Community-Based Screening Team — typically a social worker from DSS and a nurse from the local health department — will come out and meet with your loved one and, when possible, with the family caregiver. DMAS describes this team makeup directly on its CCC Plus Waiver page for members.

These teams are contracted with and reimbursed by DMAS, so the screening itself is not something your family gets billed for.

If your loved one is in the hospital or a nursing facility

Inpatients are screened by the hospital's team, usually through the discharge planner. This is often the fastest path a family will ever get, and it is the moment to speak up. If your father is being discharged after a fall or a stroke and you know he cannot be alone at home, tell the discharge planner you want an LTSS screening before he leaves. Waiting until he is home means starting over through DSS.

What if nobody calls you back?

Delays happen, and Virginia's regulations anticipate them: if the community-based team cannot complete a screening within 30 days of the request date, the rules allow a DMAS-designated screener to step in. If you are past that mark with no visit scheduled, it is completely fair to call DSS, reference the date you requested the screening, and ask what happens next.

What the screening team is actually measuring

The team documents what it observes on the Virginia Uniform Assessment Instrument (UAI), a standardized form covering physical health, functional ability, mental status, and social supports. Virginia's screening criteria have three components, spelled out in 12VAC30‑60‑303 of the Virginia Administrative Code:

1. Functional capacity

How much help does this person need with activities of daily living — bathing, dressing, toileting, transferring, eating, and moving around? The regulation defines specific qualifying combinations rather than a single cutoff. As an example, one path involves dependence in two or more activities of daily living combined with dependence in areas such as behavior and orientation along with joint motion or medication administration; other paths involve dependence in a larger number of daily activities together with mobility. The exact combinations matter, which is why the accuracy of what gets recorded matters so much.

2. Medical or nursing needs

This covers supervision or care beyond simple help with daily tasks — things like ongoing wound or catheter care, oxygen, dialysis, respiratory therapy, or a set of interrelated conditions that leaves someone at high risk of becoming medically unstable. Someone who needs monitoring but cannot reliably report their own symptoms falls here too, which is often the case with dementia.

3. Risk of nursing facility placement within 30 days

The team has to consider whether, without services, this person would be at risk of nursing facility admission in the near term. This is the piece families under-describe most. "We're managing" is a kind answer and often the wrong one — if you are managing only because you have not slept properly in four months, the team needs to hear that.

How to prepare for the screening visit

The screening is a snapshot of one afternoon, and older adults are famously good at rallying for company. Prepare so the snapshot is honest:

• Describe the hardest day, not the best one. Answer for what typically happens, including nights and bad weeks, not for how things look at 2:00 on a good Tuesday.
• Keep a one-week log first. Note every time you help with bathing, dressing, toileting, medications, transfers, and every night you are up. Concrete detail is far more useful than "she needs a lot of help."
• Have the paperwork ready. Medication list, diagnoses, recent hospital or rehab discharge summaries, and the names of treating physicians.
• Be in the room. DMAS expects the family caregiver to participate when available. Your loved one may minimize; you can gently and respectfully fill in the gaps.
• Do not coach or exaggerate. The goal is accuracy. Overstating needs damages your credibility and can complicate the plan of care later.
• Ask before they leave. What was the outcome, what happens next, who do I call, and what is the appeal process if this is denied?

Screeners now submit through Virginia's electronic Medicaid LTSS Screening system, which returns results immediately on submission — so you may know the outcome much sooner than families did a few years ago. If you want a rough sense of where you stand before the visit, our CCC Plus Waiver self-assessment takes about two minutes.

What happens after an approved screening

Once the screening is approved and Medicaid eligibility is in place, enrollment moves to your loved one's Cardinal Care health plan, where a care coordinator helps set up services and authorizations. The CCC Plus Waiver covers personal care and respite care, along with supports like a personal emergency response system, assistive technology, and environmental modifications.

Then comes the choice that shapes daily life the most: whether personal care is agency-directed or consumer-directed. Agency-directed means we recruit, train, supervise, and back up the caregiver. Consumer-directed means your family hires the attendant — often a relative — and manages them with support from a services facilitator. Our breakdown of agency-directed versus consumer-directed care compares both honestly, and if a family member wants to be the paid caregiver, see how to get paid to care for a family member in Virginia.

If the screening does not go your way, that is not necessarily the end. You have appeal rights, and deadlines apply — ask the screening team or DMAS about the process right away. A genuine change in condition, a hospitalization, or documentation the team did not have can also support requesting a new screening.

A note for Virginia families

Screening criteria, waiver rules, and program names in Virginia do change — the CCC Plus Waiver and Cardinal Care have both been reorganized in recent years. This information is for general guidance only and isn't legal or medical advice — program rules and figures change, so confirm current details with the official source or our team. For a fuller picture of the program itself, start with our guide to the CCC Plus Waiver in Virginia.

How Godaelli helps

We do this every week with families across Alexandria, Arlington, Fairfax, Loudoun, Prince William, and Stafford. We help you request the screening through the right office, tell you what to have written down before the team arrives, and explain in plain language what the outcome means. Once services are approved, we provide the personal care, companion care, and respite that the waiver authorizes — under either the agency-directed or consumer-directed model, whichever genuinely fits your family.

If you are stuck on where to start, or you are waiting on a screening and hearing nothing, reach out to our team. Call 703‑870‑0738 or email care@godaellihomecare.com, and we will walk you through the next step at no cost.