Virginia Medicaid offers several low-cost and no-cost health coverage programs for eligible children, pregnant women and adults, including individuals with disabilities. To find out more about each program, follow the links below.
Monthly Income Eligibility by Program
You may qualify for health coverage from Virginia Medicaid if your household’s monthly income is at or below the following amounts.
|Household Size||Medicaid for Children Under Age 19 & Pregnant Women||Medicaid for Adults Age 19-64||FAMIS for Children Under 19, FAMIS MOMS for Pregnant Women & Plan First|
Coverage for Children
There are two health coverage programs available for qualifying children in Virginia. Both programs offer comprehensive benefits with no enrollment costs and no monthly premiums. Medicaid for children (also called FAMIS Plus) and the FAMIS program are for children up to age 19 whose family does not exceed income limits. Children under age 21 who are in foster care or subsidized adoptions, as well as infants born to a Medicaid or FAMIS MOMS-eligible mother may also qualify.
Coverage for Pregnant Women
Virginia offers two health coverage programs for qualifying pregnant women. Both programs provide full coverage benefits while a woman is pregnant and for two months following the birth of her baby. A pregnant woman may qualify for health care coverage from Virginia Medicaid or the FAMIS MOMS program if her family does not exceed income limits.
Medicaid for Adults Between 19 and 64 Years of Age
Health coverage programs for qualifying adults in Virginia are provided through Medicaid. There are no enrollment costs and no monthly premiums for individuals between the ages of 19-64 years of age who meet the eligibility qualifications and are within the income guidelines. They cannot be receiving Medicare, cannot be pregnant, and cannot be enrolled in Medicaid under a different category.
Individuals aged 19–64 years old who are parents or caretaker adult relatives living with a child under age 19 may be eligible for full coverage Medicaid if family income does not exceed the limits.
Medicaid for Aged, Blind, or Disabled (ABD) Individuals
Individuals who are age 65 or older, or who are disabled, or who are blind, may be eligible for full-Medicaid health coverage. People who are not eligible for full-Medicaid health coverage because their income is over the program limits may be placed on a Medically Needy Spenddown. Under a Medically Needy Spenddown, the person must have a certain amount of medical bills before Medicaid can be approved. The amount of the medical costs necessary to qualify is different depending on household size and income.
Medicare Savings Programs
The Medicare Savings Programs, also known as Medicare Buy-In, helps Medicare members with limited income to pay their Medicare premiums, and in some cases, deductibles and co-payments. The Medicare Savings Programs provide four different levels of assistance depending on an individual’s or couple’s income.
The Medicaid Works program is for individuals who are blind or disabled, and who are at least 16 but less than 65 years of age. These individuals are eligible to work and earn a higher income while still qualifying for Medicaid benefits.
Plan First is Virginia’s Family Planning Services Program for men and women who do not meet income requirements for full Medicaid benefits. Plan First is a limited benefit program that covers medical services such as annual family planning exams for men and women; pap tests; sexually transmitted infection testing; family planning education and counseling; tubal ligation and vasectomies; approved over-the-counter and prescribed contraceptives; and transportation to a family planning service.
- Plan First (a limited benefit family planning program for men and women)
Former Foster Care Individuals
Medicaid coverage is available to individuals who are between ages 18 to 26 and were in foster care and receiving Medicaid in any state at the time of their 18th birthday. There is no income limit for this program.
Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA)
Individuals who have been screened by the Virginia Department of Health’s Every Woman’s Life program or the Project Wish program and who have been diagnosed and need treatment for breast or cervical cancer may be eligible. Income eligibility for this program is determined by Virginia Department of Health’s Every Woman’s Life Program screeners.
Emergency Services for Non-Citizens
Individuals who meet the requirements for full Medicaid coverage but who do not meet citizenship requirements may be eligible for Medicaid coverage of limited emergency treatment.
If you think you may be eligible for one of the above programs, please apply.