Medicaid Eligibility in Virginia

Eligibility Team
Researcher & Writer
December 12, 2017

Virginia  Medicaid is something that is provided by the federal government in  conjunction with the state. It was created so that Virginians who are  eligible can get healthcare at a low cost or even free.

Virginia’s Requirements for Medicaid Qualification

Eligibility requirements for Medicaid have to be met before you can  qualify for the program. To be eligible for Medicaid in Virginia, you  have to belong to one of the designated patient groups. Without this  qualification, you will not be eligible for the program. Those medical  groups are:

  • Children
  • Pregnant women
  • Parents or caretakers of relatives
  • Adults between the ages of 21 and 64 who suffer from a mental illness
  • Other adults who qualify
  • Adults between the ages of 18 and 26 who are former foster children

You must also be a resident of Virginia who has a valid state ID. You  will also need to provide your Social Security number and have  documents proving that you are a US citizen. Aside from these things, if  you are a former foster child, suffering from a disability or mental  illness, you will need to provide documentation regarding these things.

How to Apply for Medicaid in in Virginia

If you want to apply for Virginia Medicaid, you will have to fill out  an application and have the necessary documentation regarding your  identity along with proof of income. If you are applying for your family  or household, you will need the same documents for each member you are  including.

Virginia Medicaid Application – To download an application for Medicaid in Virginia, simply click here and download the application for the category you are applying for.

If you would like to apply for Medicaid online, you can do so through the Cover Virginia website.  If you apply this way, you might still need to mail in documentation  regarding residence, citizenship, and income. Once you have applied  online, you will be able to check the status of your application using  your Social Security Number and your login information. Medicaid forms  shouldn’t take any longer than 30 days to be fully processed.

Some people might prefer to apply in person and this can easily be  done at the Department of Social Services office in your county. Once  you get the application, fill it out completely and make sure that you  have all of the necessary documentation with you. This will help to  speed the process along. You can get the application in the Department  of Social Services office or you can call them and have one sent to you  in the mail.

If you would like to complete the process by mail, that is also an  option. Once you have filled out the application, simply mail it back to  your local DSS office. Be advised that you might be called or receive a  piece of certified mail requesting any documents you failed to send in  with the application.

If you can’t file online, in person, or through the mail, you can  always file an application on the phone. Simply call 855-242-8282  between the hours of 8 AM and 7 PM Monday through Friday or on Saturdays  between 9 AM and noon.

What Does Medicaid Cover in Virginia?

Medicaid in Virginia has three levels of benefits.

Full coverage provides members with the complete range of benefits.  This includes pharmacy, hospital, and doctor services for qualified  individuals.

Time-limited coverage is for people who meet the spend-down or women  who get 24 months of services regarding family planning once the  Medicaid coverage they had expires at the end of their pregnancy.

Medicare-related coverage is where Medicaid will pay for Medicare  premiums. This might also include payments for Medicare coinsurance and  deductible.

Income Requirements for Virginia Medicaid

If you would like to be able to qualify for one of the Medicaid  programs in Virginia, you will have to fall into the income bracket for  the program you think you should be in. Pregnant women who might be in  the FAMIS Plus program or Medicaid can make no more than 143% of the FPL  (Federal Poverty Level) as determined by the MAGI (Modified Adjusted  Gross Income). For the children’s FAMIS program, MOMS, or Plan First,  you can’t earn more than 200% of the FPL. Children who are not yet 19  have to be in households that earn less than 143% of the FPL.

You can click here to find out more about the income limits for each household size.

How Much Does Medicaid Cost in Virginia?

Cost estimates will vary from person to person and the health  services needed will also be a factor. If you have a copay, they are  typically small and most of the time do not exceed $30. Visits to the  clinic, doctor, or eye doctor cost as little as $1. Things like  outpatient hospital visits, home health visits, or rehab cost as little  as $3. If you are admitted to the hospital, the cost will be $100.

Cost and Coverage of Medicaid in Virginia – Medicaid services that  may be provided include care for babies, dental, durable medical  equipment and supplies, early and periodic screening, diagnosis and  treatment, family planning and birth control, long-term care,  prescription drugs, clinic services, community-based residential  services, and mental health services.

Prescription Drugs with Medicaid in Virginia?

Yes, prescription drugs are covered in Virginia as long as they are  in the formulary. This might include supplies and equipment as well  depending on the type of Medicaid the patient has. Prescriptions might  be free or provided at a low cost.

Which Medicaid plan is best in Virginia?

The best Medicaid plan will be different from person to person based on their specific needs. There are a variety of plans to choose from. Not all of them are available in all areas, so check to  see which ones are available to you before choosing one. You might also  want to check with your doctors to see which plans they accept if you  don’t want to have to change doctors.

Eligibility Team
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Eligibility Team
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