Medicaid in Virginia is a joint federal and state program designed to provide health insurance to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. The program covers a wide range of health services, including doctor visits, hospital stays, preventive care, and long-term care services.
In recent years, Virginia expanded its Medicaid program under the Affordable Care Act (ACA), significantly increasing the number of Virginians eligible for coverage. This expansion aimed to cover adults who earn up to 138% of the federal poverty level, thereby reducing the uninsured rate across the state. Medicaid in Virginia is administered by the Department of Medical Assistance Services (DMAS), which oversees the program's operations and ensures compliance with federal and state regulations. The program is funded through a combination of federal and state funds, with the federal government providing a significant portion of the financing.
Medicaid in Virginia provides a comprehensive range of covered services to meet the healthcare needs of its enrollees. Below is a list of some key services covered, along with a brief description of each:
This list provides an overview of the broad spectrum of services covered under Medicaid in Virginia, designed to address a wide range of healthcare needs for its enrollees.
Medicaid eligibility in Virginia is determined based on income, age, and specific other health and family status criteria, with income levels set as a percentage of the Federal Poverty Level (FPL). Here are some specific eligibility categories and their corresponding income thresholds:
Parents and caretaker relatives living with a child under 19 can be eligible if their household income is up to 138% of the FPL.
Under the Medicaid expansion in Virginia, adults aged 19-64 without dependent children are eligible for Medicaid if their income is up to 138% of the FPL.
Individuals aged 65 or older, blind or disabled, may qualify for Medicaid based on income, resources (like savings and investments), and medical needs. The income limits for this group can be more complex, often set at a lower percentage of the FPL, and consideration of assets.
Eligibility includes income and asset tests for those needing long-term care in a facility or through home and community-based services. The income limit is typically set at 300% of the Social Security Income (SSI) monthly rate, but applicants must also meet specific medical necessity criteria and asset limits.
These income levels are adjusted annually based on changes to the Federal Poverty Level. Additionally, Virginia Medicaid considers various deductions and disregards when calculating income, meaning some people with incomes slightly above these thresholds may still qualify based on their net income after these adjustments.
Applicants are also assessed based on residency, U.S. citizenship (or qualified non-citizen status), and not being incarcerated or institutionalized. For the most accurate and up-to-date information regarding eligibility, individuals are encouraged to contact the Virginia Department of Social Services or visit their website, as regulations and thresholds may change.
Applying for Medicaid in Virginia is a straightforward process, and there are multiple ways to submit your application. Here's how you can apply:
CommonHelp: The easiest and quickest way to apply for Medicaid is through Virginia's CommonHelp website. The site also allows you to check your eligibility, apply for other benefits, and manage your account.
Local Department of Social Services (DSS): You can apply in person at your local DSS office. To find the nearest office, visit the Virginia Department of Social Services website and use the provided locator tool.
Cover Virginia Call Center: If you prefer to apply over the phone or have questions about the application process, call the Cover Virginia Call Center at 1-855-242-8282. Assistance is available in multiple languages.
You can download and print an application form from the Cover Virginia website. Once completed, please mail it to your local Department of Social Services. Addresses for each local office can be found on the DSS website.
When applying, be prepared to provide personal information and documents for all individuals applying for coverage, including:
Once you've submitted your application, the Department of Social Services will review it to determine your eligibility. You may be contacted for additional information or documentation. The decision process can take up to 45 days for regular Medicaid applications and up to 90 days for applications involving disability determinations.
Medicaid coverage needs to be renewed once a year. You will receive a notice from the Department of Medical Assistance Services (DMAS) or your local Department of Social Services (DSS) telling you it's time to renew your coverage.
There are several ways to complete your Medicaid renewal:
Be prepared to provide updated information about your income, household size, and any changes in your situation since your last application or renewal. This might include recent pay stubs, tax returns, or other documentation of income and assets.
After submitting your renewal, the Department of Social Services or DMAS will review your application to determine if you still qualify for Medicaid coverage. You will be notified of the decision by mail.
Renewing your Medicaid coverage on time ensures that you and your family can access essential healthcare services without interruption.
