Virginia Medicaid
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Other Programs and Guidelines


Overview

DMAS administers Virginia’s Medicaid program, providing access to high quality, comprehensive health care services to Virginians who qualify.

 

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.

 

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.

Learn more at CoverVa.org or CubreVirginia.org.

 

Medicaid Works

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

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.