You qualify for Virginia Medicaid eligibility if you fit into one of the state’s covered categories and your household income (and, in some cases, your assets) falls below the limit for that category. For most adults aged 19 to 64, that limit is 138% of the Federal Poverty Level, roughly $22,025 a year for a single person in 2026. Children, pregnant applicants, and people who are aged, blind, or disabled follow different rules, and long-term care has its own eligibility test on top of the financial one.
Virginia Medicaid covers more than 1.8 million residents, including about 630,000 adults who gained access through the state’s 2019 expansion under the Affordable Care Act. The program is administered by the Department of Medical Assistance Services (DMAS). What you need to show, and the thresholds you need to stay under, depend entirely on which category you apply through.
The Four Eligibility Categories
Virginia sorts applicants into a handful of groups, each with its own rules.
Adults aged 19 to 64. This is the expansion population. If your household income is at or below 138% of the Federal Poverty Level, you can qualify regardless of disability status, parental status, or pregnancy.1Department of Medical Assistance Services. Adults Aged 19-64 No asset test applies.
Children under 19. Virginia’s Family Access to Medical Insurance Security (FAMIS) program provides no-cost coverage for children, with income limits that reach up to 205% of the FPL.2CoverVA. Medicaid for Children and FAMIS
Pregnant individuals. Pregnant applicants with income up to 205% FPL can enroll through FAMIS MOMS or Medicaid for Pregnant Women. Coverage starts the month you apply, runs through the pregnancy, and continues for 12 months after it ends. A separate FAMIS Prenatal Coverage option offers 60 days of postpartum coverage instead of 12 months.3CoverVA. Cardinal Care Pregnancy and Postpartum Coverage
Aged, blind, or disabled (ABD) adults. Adults 65 and older, people with documented disabilities, and those who are blind apply through the ABD programs. These use lower income thresholds tied to Supplemental Security Income standards and also impose an asset test.4CoverVA. Medicaid for Persons who are Aged, Blind, or Disabled One quirk worth knowing: because SSI thresholds are stricter than the expansion group’s, a disabled applicant under 65 whose income is modest but above SSI levels may find it easier to qualify through the MAGI-based expansion group.
2026 Income Limits in Dollars
Most adults and children are evaluated using Modified Adjusted Gross Income (MAGI), which is essentially your federal tax return income with a few adjustments.5Centers for Medicare & Medicaid Services. Income Eligibility Using MAGI Rules The 2026 Federal Poverty Level is $15,960 for a single person and $33,000 for a family of four.6HHS ASPE. 2026 Poverty Guidelines – 48 Contiguous States
For the expansion adult group, 138% of FPL works out to approximately $22,025 a year for an individual or $45,540 for a family of four.1Department of Medical Assistance Services. Adults Aged 19-64 For children through FAMIS and pregnant individuals through FAMIS MOMS, 205% of FPL translates to about $32,718 for a single-person household or $67,650 for a family of four.2CoverVA. Medicaid for Children and FAMIS
Asset Limits for Aged, Blind, or Disabled Applicants
ABD applicants face both income and asset tests. Countable resources generally cannot exceed $2,000 for a single person or $3,000 for a couple.4CoverVA. Medicaid for Persons who are Aged, Blind, or Disabled Countable resources include bank accounts, stocks, bonds, and secondary real estate. Your primary home and one vehicle are typically excluded, as are designated burial funds up to a set amount.
Protections for a Spouse Still at Home
When one spouse enters a nursing home and applies for Medicaid, federal law protects the spouse remaining at home. In 2026, the community spouse can keep assets up to a Community Spouse Resource Allowance of $162,660 and retain monthly income up to a Maximum Monthly Maintenance Needs Allowance of $4,066.50. These rules exist so that paying for one spouse’s long-term care does not impoverish the other.
If Your Income Is Just Too High: The Spend-Down
If your income exceeds the limit but you have significant medical expenses, Virginia offers a spend-down pathway. You subtract qualifying medical costs from your income until you reach the eligibility threshold. The program is open to ABD applicants and certain other groups who meet all non-financial requirements and have resources within the applicable limits.7Cover Virginia. Cardinal Care Fact Sheet – Medically Needy Spenddown
How it works depends on whether you receive long-term services and supports (LTSS). If you do, the state calculates your spend-down in one-month periods, and coverage begins on the first of the month you meet the threshold. If you are not receiving LTSS, the spend-down period is six months. You must incur enough medical expenses during that window to close the gap between your income and the eligibility limit. Coverage then begins on the exact date your accumulated expenses equal the spend-down amount and runs through the end of the six-month period.7Cover Virginia. Cardinal Care Fact Sheet – Medically Needy Spenddown
Qualifying expenses include hospital bills, prescription costs, doctor visits, behavioral health care, dental work, and health insurance premiums you pay out of pocket. Unpaid medical bills from earlier periods can also count, provided they were not already applied to a prior spend-down and you remain financially responsible for them.
How to Apply
You can apply through several channels:8Department of Medical Assistance Services. Applying for Medicaid
- Online through the CommonHelp portal at commonhelp.virginia.gov.9Virginia CommonHelp. Welcome to CommonHelp
- By phone at the Cover Virginia Call Center, 833-5CALLVA (833-522-5582), Monday through Friday 8 a.m. to 7 p.m. and Saturday 9 a.m. to noon.
- By mail or in person, using a paper application sent to or dropped off at your local Department of Social Services office.
Gather your documents before you start. You will need proof of U.S. citizenship or lawful immigration status such as a birth certificate, passport, or naturalization certificate.10Centers for Medicare & Medicaid Services. Medicaid Citizenship Guidelines Social Security numbers are required for every household member applying. You will also need to verify Virginia residency with utility bills, a lease, or similar mail, and provide income documentation such as recent pay stubs, W-2s, or tax returns. Self-employed applicants should prepare profit-and-loss statements or business records showing net income.
How Long the Decision Takes
Federal rules require Virginia to process most applications within 45 days. Applications that involve a disability determination can take up to 90 days.11Department of Medical Assistance Services. Commonly Asked Questions The clock starts when the state receives your application, and submitting complete documentation up front is the single best way to avoid delays.
You will receive a Notice of Action in the mail. If approved, it tells you your coverage start date. If denied, it explains the reason and how to appeal.
Keeping Your Coverage: Annual Renewal
Virginia Medicaid is not permanent. Eligibility is reviewed every year, and a surprising number of people who still qualify lose coverage simply because they missed paperwork.12CoverVA. Renew My Coverage
If your local Department of Social Services already has enough information on file, your renewal may be processed automatically and you will get a letter confirming continued coverage. Otherwise, a paper renewal form arrives in the mail. You can respond online through CommonHelp, by phone through Cover Virginia at 1-855-242-8282, or by mailing the completed form to your local DSS office.12CoverVA. Renew My Coverage If you are found no longer eligible, the notice will include your coverage end date, instructions for appealing, and a referral to the federal Marketplace.
Long-Term Care Eligibility Is Its Own Test
Virginia Medicaid pays for nursing home care and home-based alternatives, but qualifying for long-term care benefits is harder than qualifying for regular Medicaid. You must meet financial rules and also demonstrate medical need.
The medical test uses the Uniform Assessment Instrument (UAI), which evaluates your ability to perform daily activities like bathing, dressing, eating, and managing medications. The assessment also reviews your diagnoses, current medications, and whether your home environment can safely support your care.
The 60-Month Look-Back
When you apply for long-term care Medicaid, the state reviews every asset transfer you made in the 60 months before your application. Any assets you gave away or sold below fair market value during that window are presumed to have been transferred to qualify for Medicaid, and you carry the burden of proving otherwise.13Virginia Code Commission. 12VAC30-40-300 – Transfer of Resources
If the state finds a disqualifying transfer, it imposes a penalty period during which you are ineligible for long-term care benefits. The penalty length equals the value of the transferred assets divided by the average monthly cost of private nursing home care in Virginia. Give away $100,000 when the average monthly cost is $10,000, and you face roughly a 10-month penalty. An undue hardship waiver exists for cases where denying eligibility would cause severe financial harm, but these waivers are not easy to obtain.13Virginia Code Commission. 12VAC30-40-300 – Transfer of Resources
One more consideration shapes long-term care decisions: federal law requires Virginia to recover Medicaid costs from the estates of deceased members who received certain services after turning 55, primarily long-term care.14Virginia Department of Medical Assistance Services. Estate Recovery Fact Sheet The state cannot pursue a claim while a surviving spouse is alive or when there is a surviving child under 21 or a child who is blind or disabled.15Virginia Code Commission. 12VAC30-20-141 – Estate Recoveries If you held a qualified long-term care partnership insurance policy, Virginia will not seek recovery for costs the policy covered.