You have the right to...
- File an application for assistance.
- Receive written information about specific eligibility policies.
- Have a decision made promptly (within the limits set by state and federal rules).
- Receive a written notice of the decision.
- Have your personal and health information kept private.
- Receive advance notice of actions that end or reduce your coverage.
- Appeal any action, such as:
- any decision denying, terminating or reducing Medicaid eligibility;
- any unreasonable period of time taken to decide if you are eligible;
- any decision denying, terminating or reducing Medicaid-covered medical services.
You have the responsibility to...
- Complete the application and renewal forms accurately and truthfully to the best of your knowledge. False and untrue information may be subject to penalties under federal law.
- Supply requested information, or inform your eligibility worker about any problems you may have in getting the necessary information.
- Inform your eligibility worker of any other medical insurance that may cover some of your bills.
- Immediately report changes in your circumstances such as:
You can report changes at www.commonhelp.virginia.gov or by calling your worker at your local Department of Social Services. A change in your circumstances could affect the eligibility of member(s) of your household.
- Change in address, birth of a child, death of a family member, marriage, new employment, adding or dropping other health insurance or any change in household arrangements.
- The early termination or loss of pregnancy.
- Changes in your financial condition (which includes both earned and unearned income such as Social Security, SSI, going to work, changes in employment, transfers of assets or inheriting).
- Any medical insurance that may cover some of your bills.
- Filing a personal injury claim due to an accident.
- Keep scheduled appointments.
- Show your medical provider your plastic medical card(s) when you go for care.
Enrollment in Managed Care
Once you or a family member is enrolled in managed care, a premium is paid each month to the managed care organization (MCO) for the person’s coverage. If the individual, child or pregnant woman is not eligible for FAMIS, FAMIS Plus, FAMIS MOMS, or Medicaid because you did not report truthful information or failed to report required changes in your family size or income, you may have to repay the monthly premiums paid to the MCO. You may have to repay these premiums even if no medical services were received during those months.
You must confirm that no one applying for health insurance on the application is incarcerated (detained or jailed). You must state the name of any person incarcerated.
We need your correct information
If you choose to apply, we’ll check your answers using information in our electronic databases and databases from the Internal Revenue Service (IRS), Social Security, the Department of Homeland Security, and/or a consumer reporting agency. If the information doesn’t match, we may ask you to send us proof.
Renewal of coverage in future years
To make it easier to determine your eligibility for help paying for health coverage in future years, you can choose to allow the Medicaid or FAMIS programs or the Marketplace to use income data, including information from tax returns. You will receive notification of the outcome of your renewal. You have the right to opt out at any time.
If you agree, we will renew your eligibility automatically for the next 5 years (the maximum number of years allowed), or for a shorter number of years: 4 years, 3 years, 2 years, or 1 year. If you do not agree, we will not use information from tax returns to renew your coverage.
Other Health Insurance
If anyone on the application is eligible for Medicaid, you give the Medicaid agency rights to pursue and get any money from other health insurance, legal settlements, or other third parties. You also give to the Medicaid agency rights to pursue and get medical support from a spouse or parent.
Absent Parent Support
If any child on the application has a parent living outside of the home, you will be asked to cooperate with the agency that collects medical support from an absent parent. If you think that cooperating to collect medical support will harm you or your children, you can tell Medicaid and you may not have to cooperate.
As a citizen of the Commonwealth of Virginia, we are required to provide you with the opportunity to register to vote when applying for benefits. If you are not already registered and you want to register to vote, you can complete a voter registration form at vote.elections.virginia.gov/VoterInformation.