Virginia Medicaid covers low-income adults, children, pregnant women, and people with disabilities through a managed care system called Cardinal Care. The program is run by the Virginia Department of Medical Assistance Services (DMAS), and most members choose a private health plan that coordinates their care. Here’s how eligibility, enrollment, benefits, and renewals work in practice.
Who Qualifies for Virginia Medicaid
Virginia expanded Medicaid in 2019, which opened coverage to a much larger group of adults. If you’re between 19 and 64, don’t have Medicare, and your household income falls below 138% of the federal poverty level, you likely qualify. For a single person, that means earning roughly $22,025 a year or $1,836 a month. For a family of four, the cutoff is about $45,540 a year or $3,795 a month. These figures are based on 2026 guidelines and include a built-in 5% income disregard.
Children and teens have higher income thresholds through a separate program called FAMIS (Family Access to Medical Insurance Security). A family of four can earn up to $63,960 a year, or $5,330 a month, and still qualify their children. FAMIS covers kids who earn too much for standard Medicaid but still need affordable coverage. Pregnant women, people over 65, and individuals with disabilities each have their own eligibility pathways with different income rules.
Income is calculated based on gross earnings before taxes and deductions. Virginia uses Modified Adjusted Gross Income (MAGI) for most applicants, which is essentially your tax return income plus a few adjustments.
How to Apply
You can apply for Virginia Medicaid in several ways. The fastest option is online through CommonHelp at commonhelp.virginia.gov. You can also call the Cover Virginia Call Center at 833-5CALLVA (833-522-5582), which is open Monday through Friday from 8 a.m. to 7 p.m. and Saturday from 9 a.m. to noon. If you prefer paper, you can mail or drop off an application at your local Department of Social Services office.
Virginia also has its own state-based health insurance marketplace at marketplace.virginia.gov. If you apply there and your income qualifies you for Medicaid instead of a marketplace plan, your application gets routed accordingly.
When you apply, you’ll need to provide:
- Full legal names, dates of birth, and Social Security numbers for everyone in the household
- Employer and income information (paystubs, W-2s, or tax statements)
- Policy numbers for any current health insurance
- Details about any job-related insurance available to your family
- Document numbers for legal immigrants who need coverage
You may be asked to verify citizenship or immigration status after submitting your application. Self-employed applicants should be prepared to document business expenses separately.
How Cardinal Care Managed Care Works
Nearly all Virginia Medicaid members are enrolled in Cardinal Care, the state’s managed care program. Rather than the state paying doctors directly for each visit, Cardinal Care assigns you to a private health plan that manages your benefits, builds a provider network, and coordinates your care. The idea is to give you a single point of contact for everything from primary care to specialists to prescriptions.
As of July 2025, you can choose from five health plans:
- Aetna Better Health of Virginia
- Anthem HealthKeepers Plus
- Humana Healthy Horizons of Virginia
- Sentara Health Plans
- UnitedHealthcare Community Plan
If you don’t choose a plan, one will be assigned to you. You can use the Cardinal Care Enrollment Broker to compare plans, look up which doctors are in each network, and switch if your current plan isn’t working. FAMIS members now have access to this same enrollment broker, which was previously limited to Medicaid members.
Members in foster care, receiving adoption assistance, or who aged out of foster care and are under 26 get additional support through a dedicated Foster Care Specialty Plan administered by Anthem HealthKeepers Plus. One recent change to be aware of: Molina Healthcare left the program, and its members were automatically moved to Humana as of July 1, 2025. If you were previously with Molina and didn’t select a new plan, check that your providers are in Humana’s network.
What Virginia Medicaid Covers
Virginia Medicaid covers a broad set of services with no monthly premiums for most members. Core benefits include doctor visits, hospital stays, emergency care, lab work, prescription drugs, and preventive screenings. Mental health and substance use treatment are covered as well, including therapy, psychiatry, and crisis services.
Dental care for adults is a relatively recent addition. The program, called Cardinal Care Smiles, provides dental benefits for both adults and children through DentaQuest. Previously, adult dental coverage was extremely limited, so this is a meaningful expansion. You can find dentists and manage your dental benefits through the DentaQuest website.
Vision care, hearing services, and durable medical equipment (wheelchairs, oxygen supplies) are also covered. Children on Medicaid and FAMIS receive a particularly comprehensive set of benefits that includes regular well-child checkups, immunizations, and developmental screenings.
Behavioral Health Services
Virginia Medicaid covers an unusually detailed range of mental health and substance use services through its Project BRAVO initiative. This goes well beyond standard outpatient therapy. Covered services include intensive outpatient programs, partial hospitalization for mental health, mobile crisis response teams that come to you during a psychiatric emergency, and 23-hour crisis stabilization for situations that need immediate support but not full hospitalization. Residential crisis stabilization, community stabilization services, and applied behavior analysis for autism spectrum disorder are also included. For families, the program covers specialized approaches like multisystemic therapy and functional family therapy, which are evidence-based treatments designed for youth with serious behavioral challenges.
Long-Term Care and Home-Based Services
If you or a family member needs ongoing daily assistance, Virginia Medicaid offers long-term services and supports (LTSS) through home and community-based waivers. These waivers allow people to receive care at home or in a community setting instead of a nursing facility, which is what most people prefer.
To qualify, you must meet both a financial test and a functional test. The financial side follows Medicaid income and asset rules. The functional requirement is that you need a nursing-facility level of care, meaning you require substantial help with daily activities like bathing, dressing, eating, or managing medications. Specifically, you must be someone who would be eligible for admission to a nursing facility within 30 days.
For waiver participants who have income, the program deducts a maintenance allowance (set at 165% of the federal SSI income limit) before calculating any cost-sharing. This means you keep a portion of your income for personal needs, and only the remainder goes toward your care costs.
How Annual Renewals Work
Virginia Medicaid requires you to renew your coverage every year. This is not optional. If you don’t complete your renewal, you will lose coverage.
In many cases, your local Department of Social Services can verify your information automatically using tax records and other data sources. If that happens, you’ll get a letter in the mail confirming your coverage continues for another year, and you don’t need to do anything.
If your renewal can’t be completed automatically, you’ll receive a paper renewal form in the mail. At that point, you need to act. You have three options for completing it:
- Online: Log in to commonhelp.virginia.gov and select “Renew my benefits”
- By phone: Call Cover Virginia at 1-855-242-8282
- By mail or in person: Fill out the paper form and return it to your local DSS office
If the state requests additional documents, you can upload them through CommonHelp or email scanned copies to [email protected]. The most important thing is to watch your mail carefully during your renewal period. Missing a deadline means a gap in coverage, and getting re-enrolled after a lapse means starting the application process over again. Keep your mailing address current with DMAS so renewal notices actually reach you.