Commonly Asked Questions
View commonly asked questions and answers for Virginia Medicaid applicants.
The federal and state governments share the costs to provide low-cost health coverage to eligible Virginians. Individuals can apply at any time to see if they are eligible for Medicaid health coverage. Most Medicaid members get services through a managed care health plan, and members have the right to pick the plan that works best for them.
Medicare is a federal program that offers health insurance to people who are age 65 or older and those with certain disabilities. Moving to another state does not affect eligibility.
Medicaid is a federal program that offers health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. However, Medicaid criteria and coverage is unique to each state and eligibility does not transfer from one state to another. If you received Medicaid in another state, you must reapply and meet the guidelines for Virginia Medicaid.
It depends. Some Medicaid programs will not allow an individual to have both, while it is allowable for other programs, such as those for an aged, blind or disabled person.
Eligibility may be based on many different factors, such as your income, age, household size, tax-filing status, a disability and more. You can check your eligibility by visiting Cover Virginia.
A full-benefit alien, such as a lawful permanent resident with five years or more of residency in the United States, may be eligible for free or low-cost health coverage from Virginia Medicaid. The five-year period starts from the date when you became a permanent resident, as shown on your immigration documents, such as an I-551 form (green card). Other aliens such as asylees, refugees, legally residing children and pregnant women may be eligible without meeting a residency period.
Other immigrants and those non-qualified citizens, including undocumented individuals who are in need of emergency care, may also receive coverage. It is important to apply to see if you qualify.
A criminal record is not a factor when determining your eligibility to receive Virginia Medicaid. An incarcerated individual may also apply for limited coverage.
You must be a Virginia resident to be eligible for Medicaid. You are considered a resident if you are located in Virginia with the intention to remain in the state. If you have Medicaid in another state, it does not transfer to Virginia and you must apply in Virginia.
You can apply for Virginia Medicaid in one of three ways and all are efficient:
- Apply online at commonhelp.virginia.gov
- Apply by calling the Cover Virginia Call Center at 1-833-5CALLVA (1-833-522-5582) (TDD: 1-888-221-1590), Monday – Friday, 8 a.m. to 7 p.m., and Saturday, 9 a.m. to noon.
- Apply by mailing a paper application to your local Department of Social Services office. You can download an application from the Cover Virginia website. You may complete and return the application to your local Department of Social Services.
You will need the following information in order to apply:
- Full legal name
- Date of birth
- Information on everyone in your household
- Income information (paystubs, W-2 forms or wage/tax statements)
- Current health insurance and information about any job-related health insurance available to you and your family
A social security number is not a requirement to apply, however proof may be needed in order to enroll (some exceptions apply).
Federal policy states an application must be determined within 45 days (90 days if a disability determination is needed). It may take less time to process if the applicant has provided all the necessary information. Pay attention to any requests for additional information or documents that are needed in order to complete your application.
Virginia Medicaid accepts applications for health coverage year-round. You can apply at any time throughout the year.
Yes. Call CoverVA at 1-855-242-8282 to speak with someone who can help you apply or answer questions you may have about an application. You can also find in-person application assistance at no charge by visiting your local Department of Social Services office.
A Medicaid eligibility worker will process your application and send you a letter called a Notice of Action. This letter will let you know if you are eligible for Medicaid health coverage. It may take up to 45 days to get a decision on your application. To check your status, you can log in to your account at commonhelp.virginia.gov by clicking the Check My Benefits button or call Cover Virginia at 1-855-242-8282 (TDD: 1-888-221-1590).
No. Virginia has a large number of Medicaid programs and approval is based on your circumstances. Eligibility is determined on a number of factors, but if you are approved, your coverage will be “the longest and strongest” available to you.
If you are approved for full coverage Medicaid, your benefits will begin on the first day of the month when your application was submitted (or up to three months prior to application if you reported medical expenses for that time period).
Virginia Medicaid covers many inpatient and outpatient health services, such as preventive care, doctor visits, emergency services, mental health services, prescription drugs, maternal health services, addiction and recovery treatment, dental and more.
Medicaid may also be able to cover costs while in a nursing facility or if receiving home/ community based services if the individual is medically-approved for services in addition to the financial evaluation.
Virginia Medicaid delivers the majority of services through six managed care organizations (MCO). If you are approved, you may be assigned to an MCO but would have the opportunity to make a change within the first 90 days of eligibility, or once a year during the open enrollment period.
There is Medicaid coverage that will allow for emergency services for certain individuals. A person must still apply and otherwise be eligible for Medicaid except for their alien status.
No. Federal regulations prohibit being enrolled in Medicaid and receiving an APTC. If you are approved for Medicaid, you cannot cancel coverage in order to receive a tax credit.
You can withdraw your application by calling CoverVA at 1-855-242-8282 (TTY: 1-888-221-1590), or by calling your local Department of Social Services.
If you have been denied Medicaid coverage you have the right to an appeal. There is not a limit to how many times you can apply. We request that you only submit one application at a time (unless there is a change in your circumstances after you apply).
Medicaid eligibility is reviewed for most individuals once a year. We are able to use a number of electronic sources, and often a worker can renew a member’s coverage without additional verifications. If more information is needed, we may ask you to complete a Verification Checklist.
You can only have active Medicaid coverage in one state at a time. If you are moving out of state, please notify your local Department of Social Services or call CoverVA at 1-855-242-8282 to cancel your coverage.
You can cancel your coverage by calling CoverVA at 1-855-242-8282 (TTY: 1-888-221-1590), or by notifying your local Department of Social Services.
The most common reason a person is denied Medicaid is because they did not return documents or provide information when requested. When information is requested, make sure to provide it in a timely fashion.