People Who May Be Eligible For Medical Assistance. If someone is helping you fill out this application, you may need to complete Appendix C. • If you are applying for someone other than a spouse or family member.Under the Medicaid spousal impoverishment provisions, a certain amount of the couple's combined resources is protected for the spouse living in the community. You do not need to visit the DSS office to file an application. •. This is a comprehensive guide to divorce in Virginia. On this webpage, you will be able to view this packet or download this as a Word document below. Read Virginia Medicaid eligibility requirements for long term care for seniors including the income, assets and level of care requirements. With this application, you may apply for one or more of the following assistance programs: • Auxiliary Grants (AG). Download VA Form 21P-534a (PDF). Transfer has occurred, which triggers a penalty in the form of denial of Medicaid coverage of long-term care benefits for the institutionalized spouse.