Virginia Medicaid covers a broad range of residents, from children and pregnant individuals to low-income adults and people with disabilities. Your eligibility depends primarily on your household income, age, and whether you fall into one of several specific categories. Virginia expanded Medicaid in 2019, opening coverage to adults aged 19 to 64 who earn up to 138% of the federal poverty level, which for a single person works out to roughly $22,025 per year.
Adults Aged 19 to 64
Thanks to Medicaid expansion, most low-income adults in Virginia can qualify based on income alone. You do not need to have a disability, be a parent, or meet any other special condition. You just need to live in Virginia, meet citizenship or qualifying immigration requirements, and have a household income within the limits below.
As of 2026 guidelines (effective January 2026, including the standard 5% federal poverty level disregard):
- 1 person: $22,025/year ($1,836/month)
- 2 people: $29,864/year ($2,489/month)
- 3 people: $37,702/year ($3,142/month)
- 4 people: $45,540/year ($3,795/month)
- 5 people: $53,379/year ($4,449/month)
- 6 people: $61,217/year ($5,102/month)
- 7 people: $69,056/year ($5,755/month)
- 8 people: $76,894/year ($6,408/month)
Each additional household member adds roughly $7,839 per year to the limit. These figures are based on Modified Adjusted Gross Income, which is essentially your tax return income before most deductions.
Children and FAMIS
Children in Virginia can qualify for Medicaid or the state’s FAMIS program (Family Access to Medical Insurance Security) at higher income levels than adults. To be eligible, a child must live in Virginia, be under 19, and be a U.S. citizen or lawfully residing immigrant. Notably, a parent’s immigration status is not considered when determining a child’s eligibility.
FAMIS covers children in families earning too much for standard Medicaid but still within roughly 200% of the federal poverty level. For a family of four, the FAMIS income limit is approximately $5,200 per month. FAMIS Plus, which covers children at slightly lower income levels, caps a family of four at about $3,718 per month. One important requirement for FAMIS specifically: the child must be uninsured at the time of application.
Income limits update annually, so checking CoverVA’s website for the current numbers is worth doing before you apply.
Pregnant Individuals
Virginia offers pregnancy coverage through multiple pathways, and the income limits are more generous than for standard adult Medicaid. There are two main options: Medicaid for Pregnant Women (and the related FAMIS MOMS program) and FAMIS Prenatal Coverage.
Medicaid for Pregnant Women and FAMIS MOMS both continue for a full year after the pregnancy ends, giving new parents an extended window of coverage during the postpartum period. FAMIS Prenatal Coverage, which has different eligibility rules, lasts for 60 days after the pregnancy ends.
FAMIS Prenatal Coverage is particularly accessible for immigrants. You do not need to meet immigration status rules, provide immigration documents, or have a Social Security number. You simply need to live in Virginia, meet income requirements, be uninsured, and provide your estimated delivery date and the number of children you’re expecting.
Aged, Blind, or Disabled Residents
Virginia has a separate Medicaid category for people who are aged (65 and older), blind, or disabled. Unlike the expansion group for working-age adults, this category looks at both your income and your resources (savings, investments, and other countable assets). The application process requires detailed financial information, and the income thresholds differ from the standard adult limits.
People in this group who earn slightly too much or have resources above the limit may still qualify for help paying Medicare premiums and cost-sharing through Medicare Savings Programs. These limited-benefit programs can significantly reduce out-of-pocket costs for Medicare beneficiaries even when full Medicaid coverage isn’t available.
Nursing Home and Long-Term Care
Qualifying for Medicaid-funded nursing home care involves two separate determinations. First, you need to meet financial eligibility, which includes strict income and asset limits. Second, you need to demonstrate that your level of care actually requires a nursing facility. A public health nurse and a family services specialist will visit your home to assess your medical needs and confirm that nursing home care is appropriate.
For people who need long-term support but want to stay at home, Virginia also offers home and community-based waiver programs. These waivers cover services like personal care, adult day programs, and home modifications, but they have their own eligibility criteria and often carry waiting lists.
The Spenddown Option for Higher Incomes
If your income is over the Medicaid limit but you face steep medical bills, Virginia’s medically needy spenddown program may help. It works like a deductible: the state calculates the gap between your income and the Medicaid limit (your “spenddown amount”), and once your medical expenses reach that amount, Medicaid kicks in for the rest of the coverage period.
How the timeline works depends on your situation. People receiving long-term services get one-month spenddown periods, and coverage starts on the first of the month when expenses meet the threshold. If you’re in a nursing facility or enrolled in a Program of All-Inclusive Care for the Elderly (PACE), projected expenses can count. For home and community-based services, only expenses you’ve already incurred apply.
Everyone else gets a six-month spenddown period. You accumulate qualifying medical expenses, including hospital bills, prescriptions, dental care, health insurance premiums (including Medicare premiums), and unpaid medical bills that haven’t been applied to a previous spenddown. Once your expenses hit the spenddown amount, coverage begins that day and runs through the end of the six-month period. Expenses you’ve already paid out of pocket can’t be counted, only bills that remain your responsibility.
Citizenship and Residency Rules
You must live in Virginia to qualify for Virginia Medicaid. U.S. citizens are eligible across all categories assuming they meet financial requirements. For noncitizens, the rules vary by program.
Green card holders who have had lawful permanent resident status for five or more years can qualify for full Medicaid coverage. The clock starts from the date permanent residency was granted, as shown on immigration documents. Refugees, asylees, and certain other qualified noncitizens may also be eligible without waiting five years. Legally residing children and pregnant individuals have broader access regardless of immigration status, and as noted above, FAMIS Prenatal Coverage has no immigration documentation requirement at all.
Noncitizens who don’t meet these criteria can still receive Medicaid coverage for emergency medical care.
How to Apply and What to Expect
You can apply for Virginia Medicaid online through CommonHelp (commonhelp.virginia.gov), by phone through Cover Virginia at 1-855-242-8282, or in person at your local Department of Social Services office. The state has 45 days to make a decision on a standard application, or 90 days if a disability determination is involved. Providing all requested documentation upfront can speed things up considerably.
To check your application status after submitting, log in to your CommonHelp account and use the “Check My Benefits” feature, or call Cover Virginia directly.