Qualifications for Medicaid in Virginia

What are the Medicaid application guidelines in regard to eligibility in Virginia? Since Medicaid benefits eligibility is determined at a state level, you must review the Virginia Medicaid requirements that pertain to you, as a patient and a resident of the state. Medicaid eligibility requirements must be met prior to enrolling in the state’s government-sponsored medical assistance program. What are the requirements for Medicaid, and more specifically, what are the income requirements for Medicaid in Virginia?

Review the below Medicaid eligibility topics, which discuss how to qualify for Medicaid:

  • Who is eligible for Medicaid in Virginia?

  • Medicaid requirements in Virginia

  • What are the income requirements for Medicaid in Virginia?

  • How to use the Medicaid eligibility screening tool

Who is eligible for Medicaid in Virginia?

What are the requirements for Medicaid eligibility in Virginia? Those who are eligible for Medicaid in Virginia must belong to a designated patient group. If you are not part of a specific group, then you cannot qualify for Medicaid benefits. Since Medicaid is regulated at a state level, note that who is eligible for Medicaid in VA may not apply to the Medicaid eligibility of another state. What are the Medicaid application guidelines for different groups of patients? If you live in Virginia, you meet Medicaid qualifications if you are:

A child – You may qualify for FAMIS (the children’s Medicaid program of Virginia) and for Medicaid.

A pregnant woman – You may be eligible for FAMIS MOMS and Medicaid.

A parent or a caretaker of a relative – You may receive Medicaid benefits or Plan First (limited-benefit Medicaid).

An adult 21 to 64 with mental illnesses – You may obtain limited Medicaid through Plan first or Governor’s Access Plan benefits.

Another qualifying adult – Depending on your circumstance, you may qualify for Medicaid benefits in a limited capacity through Plan First.

Former foster care children – You qualify for Medicaid if you are between the ages of 18 and 26.

Medicaid Requirements in Virginia

In order to qualify for Medicaid in VA, you must meet several non-negotiable requirements for Medicaid. Your eligibility for Medicaid benefits in Virginia is tailored to this state, alone. However, many states look to the following list when determining those who meet the application guidelines for Medicaid. These Medicaid qualifications are mandatory in Virginia:

You must be a resident of Virginia – In order to enroll in VA Medicaid benefits successfully, you must be able to prove that you currently reside in Virginia. Since the state monitors all government-sponsored health coverage, you cannot apply for Virginia Medicaid if you live outside of the state borders. Prepare to prove your residency in the state with an official form of identification, such as a state ID card or your valid driver’s license.

You must have a Social Security Number – Your Social Security Number is a federal identifier. And, since your annual income statements come into play when determining your Medicaid eligibility, supplying your Social Security Number assists with the verification process to ensure you meet the Medicaid eligibility requirements in Virginia.

You must have U.S. citizenship documents – If you are not a U.S. citizen, it is difficult to determine if you will, in fact, qualify for Medicaid. United States citizenship documents or papers that confirm your legal status in the country are required when you apply for Medicaid benefits in Virginia.

Additional documents of proof, if applicable – If you are disabled, are a mentally ill adult or are a former child that resided in foster care, you may be asked to show proof of these circumstances in order to decide your Medicaid eligibility. Be sure to have documentation to support your status if this applies to you.

What are the income requirements for Medicaid in Virginia?

What are the Medicaid application guidelines in terms of income limits? Income requirements for Medicaid in VA are determined through use of the Modified Adjusted Gross Income (MAGI) calculator. As in most states, the Medicaid income requirements take into account the different federal poverty levels, depending on eligibility group.

If you want to qualify for Medicaid or FAMIS Plus as a pregnant woman, the income limit is set at 143 percent of the federal poverty level in Virginia. For FAMIS (for children), FAMIS MOMS and Plan First (limited Medicaid benefits), you can earn no more than 200 percent of the federal poverty level. Children under 19 must live in households earning 143 percent of the federal poverty level. And, as a former child in foster care, you meet Medicaid qualifications in Virginia regardless of your income.

If you are blind, aged or disabled, you can earn no more than 80 percent of the federal poverty level to qualify for Medicaid in VA. To receive partial Medicaid through Plan First, you must fall within the 200 percentile of the federal poverty level. Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries and Qualified Individuals must remain within the limits of 100 percent, 120 percent and 135 percent of the federal poverty levels, respectively, in order to be eligible for Medicaid in VA.

How to Use the Medicaid Eligibility Screening Tool

Still unsure of how to qualify for Medicaid in Virginia? If you need to test your Medicaid eligibility further, there is a nifty online tool through Covered Virginia that can assist. Confirm if you are eligible for Medicaid in just a few moments. Prepare the information for the following Medicaid benefits eligibility questions, which cover the below topics:

  • How many people reside in your household?

  • How many household members are age 19 or older?

  • Are there any members in your household that are currently pregnant?

  • How many children live in your household who are 18 or younger?

  • What is your family’s monthly gross income before taxes are taken out?

  • Are you a former child of foster care between the ages of 18 and 26?

  • Are you (or any other member of your household) between 21 and 64 and are you currently diagnosed with a mental illness?

Answer the above questions to get an instant answer regarding your own personal Medicaid qualifications.

Once you have confirmed your Medicaid eligibility, proceed to the “How to Apply for Medicaid in Virginia” section, and review your available options.



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