Who is eligible for Medicaid?
Medicaid was created to assist people who have lower incomes, but coverage is dependent upon other criteria as well. Eligibility was primarily for individuals falling into particular categories, such as low-income children, pregnant women, the elderly, individuals with disabilities, and parents meeting specific income thresholds. Beginning January 1, 2019, many more Virginians will now be eligible for the new Medicaid Health Coverage for Adults. In Virginia, income and resource requirements vary by category.
Some groups covered by Medicaid are:
- Pregnant Women,
- Adults aged 19 to 64 meeting new income and other eligibility requirements,
- Individuals with disabilities,
- Individuals age 65 and older,
- Some parents and caregivers.
Medicaid has different levels of benefits:
- Full coverage - Provides the full range of benefits including doctor, hospital, and pharmacy services.
- Limited coverage - Men and women who have income 200% of the Federal Poverty Level (FPL) may be eligible for limited benefits (family planning services) through Plan First
Services covered by Medicaid
FAMIS Plus (Children's Medicaid)
- Doctor visits
- Well Baby Checkups
- Hospital visits
- Prescription medicine
- Tests and X-rays
- Dental care
- Emergency care
- Vision care
- Mental health care
- Well Child Checkups
- Early and Periodic Screening, Diagnosis, and Treatment program for children (EPSDT)
Information about FAMIS and FAMIS Plus is available in the following languages: [PDF] English, Spanish, Traditional Chinese, Simplified Chinese, Vietnamese, Arabic, Farsi, Korean, Russian, Hindi, Amharic, French, Kurdish, Urdu, and Somali
Medicaid for Pregnant Women
When you are enrolled in Medicaid for pregnancy, you get comprehensive health care benefits during your pregnancy and for two months following your baby’s birth. Medicaid may provide up to 3 months retroactive coverage. You also receive dental benefits during your pregnancy coverage. Dental services are administered through the Smiles For Children program. For assistance finding a dentist or for more information, please call Smiles for Children at 1-888-912-3456 or click on the [PDF] Guide to Dental Coverage.
If you are enrolled in Medicaid for pregnancy and you wish to breast feed your baby, you are covered for breast pumps and breast feeding support that can start during your pregnancy and continue after your baby is born. For more information, click on the [PDF] Breast Pumps Member Fact Sheet (English) [PDF] Breast Pumps Member Fact Sheet(Spanish).
Your health care services are provided through MCOs (managed care organizations). Please refer to the Health Plan Information page for more information about how members of the Medicaid programs receive their benefits. The MCOs all have a special program for women with high risk pregnancies. Call your MCO Member Services for more information.
Once your baby is born, he or she is automatically eligible for health insurance for the first year of life. Please let us know as soon as your baby is born so that we can determine whether the baby will be covered under FAMIS or FAMIS Plus. All we need is the baby’s name, date of birth, race and gender to get the infant enrolled immediately. You can enroll your newborn by calling Cover Virginia at 1-855-242-8282, or reporting the birth to your Eligibility Worker at your local Department of Social Services.
Note: At the end of the 60 day period following the birth of your baby, you may still qualify for health coverage. Call 1-855-242-8282 or check with your Eligibility Worker at your local Department of Social Services to find out.
Medicaid for Adults
For detailed information about certain Medicaid covered groups, see the handbooks below.
For information on how Medicaid members receive their benefits, visit the Health Plan Information page.
How Do I Apply?
To find out if you may qualify for Medicaid, answer the questions on the Screening Tool on the Am I Eligible? page.
If, after using the Screening Tool, you think you may qualify for Medicaid, FAMIS, or Plan First, follow the instructions on the Apply page.
For more information about how to appeal a decision, visit the Appeals page.
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