Yes, Virginia expanded Medicaid under the Affordable Care Act, with coverage taking effect in January 2019. The expansion raised income eligibility to 138% of the federal poverty level for adults aged 18 to 65, opening coverage to hundreds of thousands of residents who previously didn’t qualify. As of the most recent data from the Virginia House Appropriations Committee, roughly 490,754 people are enrolled through the expansion.
How Expansion Changed Eligibility
Before expansion, Virginia’s Medicaid program had strict limits. Childless adults generally couldn’t qualify at all, regardless of how little they earned. Parents had to meet very low income thresholds that left many working families without coverage.
The expansion removed those categorical restrictions. Now, any adult between 18 and 65 with a household income at or below 138% of the federal poverty level can qualify based on income alone. For a single person, that translates to roughly $20,783 per year (based on current federal poverty guidelines). Family size matters: a household of four qualifies at a higher dollar amount, but the 138% threshold stays the same. You don’t need to have children, a disability, or any other qualifying condition.
What the Expansion Covers
Virginia’s expansion population receives a comprehensive set of benefits. Coverage includes behavioral health services, addiction and recovery treatment, dental care for adults and children, and prescription medications. Preventive care, hospital visits, and lab work are also covered. The inclusion of dental and behavioral health benefits is notable because many states historically excluded or limited these services for adult Medicaid enrollees.
The Legislative Path
Virginia’s expansion had a long and politically contentious road. The state debated the issue for years after the ACA passed in 2010, with the General Assembly repeatedly blocking expansion efforts. The breakthrough came in 2018, when House Bill 5001 authorized the Department of Medical Assistance Services to amend the state Medicaid plan and begin covering newly eligible individuals. Coverage officially started on January 1, 2019, making Virginia the 33rd state (plus Washington, D.C.) to expand at that time.
Impact on Hospitals and Uninsured Rates
The effects showed up quickly in hospital data. During the first six months of 2019, the share of uninsured hospital admissions dropped sharply, falling to about 5% in rural areas and 6% in urban areas. Before expansion, hospitals absorbed significant costs treating uninsured patients who couldn’t pay, and rural hospitals were hit hardest.
Rural hospitals saw their share of Medicaid-covered admissions jump from 24% to 36%, a 49% increase in just six months. Critical Access Hospitals, the smallest and most financially vulnerable rural facilities, nearly doubled their Medicaid admissions from 13.7% to 25.6%. That shift matters because a hospital admission covered by Medicaid, even at lower reimbursement rates, is far better for a hospital’s bottom line than uncompensated care for an uninsured patient. Research from Virginia Commonwealth University found that these financially vulnerable hospitals still serve a disproportionately large share of uninsured patients compared to other hospitals, but expansion meaningfully reduced the strain.
How to Apply
Virginia offers several ways to apply for Medicaid coverage:
- Online: Apply at commonhelp.virginia.gov or through Virginia’s insurance marketplace at marketplace.virginia.gov.
- By phone: Call the Cover Virginia Call Center at 833-5CALLVA, available Monday through Friday from 8 a.m. to 7 p.m. and Saturday from 9 a.m. to noon.
- In person or by mail: Submit a paper application to your local Department of Social Services office, though this takes longer than other methods.
You’ll need your full legal name, date of birth, Social Security number, and employer and income information for everyone in your household. Pay stubs, W-2 forms, or wage statements all work as income documentation. If you have existing health insurance, bring those policy numbers as well. You may also be asked to verify citizenship or immigration status after submitting your application.