Virginia Medicaid

Last verified: June 2026

What is Virginia Medicaid, and who administers it?

Virginia Medicaid is the Commonwealth's joint federal-state health coverage program for people with low to moderate incomes. The Department of Medical Assistance Services (DMAS) administers the program from Richmond. Virginia expanded Medicaid under the Affordable Care Act effective January 1, 2019 — one of the later expansion states, making approximately 400,000 additional adults newly eligible at the time of expansion. As of 2025, roughly 2 million Virginians are enrolled, per DMAS.

DMAS covers medical services for qualifying children, pregnant women, parents, adults, and individuals with disabilities. The federal government pays about 50–65% of Virginia Medicaid costs depending on the program and year; the Commonwealth funds the rest.

Virginia Medicaid has no asset test for MAGI-based coverage — the program covering most adults, children, and pregnant individuals. Bank accounts, a car, and a home are not counted. Long-term care and disability programs have separate financial rules.

Cardinal Care: how Virginia Medicaid is delivered

Nearly all Virginia Medicaid and FAMIS members receive coverage through Cardinal Care Managed Care, Virginia's comprehensive managed care program. Cardinal Care replaced the previous CCC Plus and Medallion 4.0 programs, which ended in 2023. As of July 1, 2025, DMAS updated the Cardinal Care program with new plan options and enhancements. Members now choose from five health plans:

Members who were previously enrolled with Molina Healthcare were automatically moved to Humana Healthy Horizons effective July 1, 2025. Per DMAS, this change did not reduce current programs or services for eligible members.

To compare plans or switch health plans, use the Cardinal Care Enrollment Broker at virginiamanagedcare.com or call 1-800-643-2273 (Monday–Friday, 8:30 a.m.–6:00 p.m.). A free Cardinal Care mobile app is also available for Apple and Android devices.

Who qualifies for Virginia Medicaid?

Virginia covers several distinct groups. Income limits differ by category. The primary adult expansion group — adults ages 19–64 who are not otherwise eligible for Medicare — qualifies at or below 138% of the Federal Poverty Level. Other groups include:

• Adults ages 19–64: at or below 138% FPL — approximately $21,597/year for a single person (2025 FPL base)
• Children ages 0–18: covered through Medicaid (FAMIS Plus) and CHIP (FAMIS) up to 200% FPL
• Pregnant women: up to 205% FPL for full Medicaid coverage during and after pregnancy
• Parents and caretaker relatives: income-based, generally at or below 138% FPL post-expansion
• People receiving Supplemental Security Income (SSI): automatic Medicaid eligibility
• Adults with disabilities: various programs including the EDCD waiver for community-based care
• Individuals needing long-term care: separate financial and functional eligibility requirements

Source: DMAS eligibility guidelines, CoverVirginia. Income figures reflect the 2025 HHS Federal Poverty Level applied at the stated percentages. Verify current limits at coverva.dmas.virginia.gov.

FAMIS and FAMIS Plus: coverage for children and pregnant women

Virginia operates two programs for children under the Medicaid umbrella. FAMIS Plus is standard Medicaid for children up to 133% FPL. FAMIS (Family Access to Medical Insurance Security) is Virginia's CHIP program for children in families who earn too much for FAMIS Plus but up to 200% FPL. Both programs cover doctor visits, dental care, vision, prescriptions, and behavioral health services. FAMIS has small monthly premiums for households above certain income levels; FAMIS Plus has none.

Apply for FAMIS or FAMIS Plus through CommonHelp at the same time as applying for adult Medicaid — one application covers all household members.

Virginia Medicaid topics

What does Virginia Medicaid cover?

Medicaid covers a broad range of health services. Federal law mandates certain benefits — inpatient and outpatient hospital care, physician services, lab work, X-rays, and nursing facility services, among others. States add optional services on top of those. Dental, vision, and long-term home care coverage vary by state.

The national benefits overview lists required and commonly optional services. Check the Virginia Medicaid website for the current state-specific benefit package.

How to apply

Most people can apply online through Virginia's Medicaid portal, by phone, or in person at a local eligibility office. The how to apply page walks through each method, what documents you'll need, and what to expect during the review period.

Under 42 CFR 435.912, states must process most standard Medicaid applications within 45 days (90 days for disability-based applications). Virginia must follow that federal timeline.