Virginia Medicaid pays for nursing-facility LTSS once a person clears the nonfinancial, financial, and transfer-of-assets rules and has the necessary authorization. DMAS defines institutionalization for these purposes as 30 consecutive days of care in a medical institution, Medicaid HCBS, or some combination of the two — 30 consecutive days of elected hospice also qualifies. The manual requires authorization before Medicaid will pay for nursing-facility care, waiver services, or PACE (DMAS Chapter M14).
On the consumer side, Cover Virginia explains that the LTSS screening step is what decides both the level of care needed and whether Medicaid will cover the cost. Someone seeking nursing-facility coverage applies through the local Department of Social Services serving the locality where they last lived before admission, and requests a pre-admission screening — a clinical step that's kept distinct from the resource and income review (Cover Virginia LTSS overview; Virginia LTSS fact sheet).