Your child qualifies for Medicaid in Virginia if they are under 19, live in the state, meet citizenship or immigration requirements, and your household income falls at or below the limit for their age group. If your income is a little too high for Medicaid but still at or below 200% of the federal poverty level, your child qualifies instead for FAMIS, Virginia’s version of the Children’s Health Insurance Program. Both programs cover doctor visits, hospital care, dental, vision, mental health, and prescriptions with no monthly premium.
The Requirements That Come Before Income
Three things have to be true before the state looks at what you earn.
Your child must be under 19. Coverage runs through the day before the 19th birthday, after which the child can move to adult Medicaid or Marketplace coverage.
Your child must live in Virginia. There is no minimum length of residency, but a caseworker may ask for a utility bill, lease, or similar document showing a Virginia address.
Your child must be a U.S. citizen or hold a qualifying immigration status, verified through federal databases. Lawfully present immigrants, including children with a Permanent Resident Card or an Employment Authorization Document, can qualify, though some categories face a five-year wait before full Medicaid is available. A child who doesn’t meet the immigration rules may still be eligible for emergency Medicaid, and a pregnant mother may qualify for FAMIS Prenatal coverage regardless of the child’s status.
Income Limits by Age and Program
Virginia uses the federal poverty level (FPL) to set the cutoffs, and the Medicaid ceiling moves with your child’s age. Younger children qualify at higher incomes.1Medicaid.gov. Virginia Medicaid and CHIP State Profile
- Infants under age 1 qualify for Medicaid if household income is at or below 148% of the FPL.
- Children ages 1 through 5 qualify at or below 143% of the FPL.
- Children ages 6 through 18 qualify at or below 133% of the FPL.
If your income runs above the Medicaid ceiling for your child’s age but at or below 200% of the FPL, your child qualifies for FAMIS. You don’t need to pick between the programs on your application. The state reviews your information and places your child in the correct one.
What That Means in Dollars for 2026
The federal poverty guideline for a family of four is $33,000 in 2026.2U.S. Department of Health and Human Services. 2026 Poverty Guidelines – 48 Contiguous States At 200% of the FPL, which is the FAMIS ceiling, the approximate annual household income limits are:
- Household of 2: $43,280
- Household of 3: $54,640
- Household of 4: $66,000
- Household of 5: $77,360
- Household of 6: $88,720
Medicaid itself cuts off lower. For a family of four, the Medicaid limit works out to roughly $43,890 per year for children ages 6 through 18, $47,190 for children ages 1 through 5, and $48,840 for infants.2U.S. Department of Health and Human Services. 2026 Poverty Guidelines – 48 Contiguous States Income between those Medicaid cutoffs and $66,000 puts a child in FAMIS.
How Virginia Counts Your Income
Virginia uses Modified Adjusted Gross Income (MAGI) to decide eligibility. MAGI looks at gross income before taxes and payroll deductions, not take-home pay.3Medicaid.gov. Eligibility Policy It counts income from everyone in the household, not just the parent applying.
Who Is in Your Household
If you file a federal tax return, your household includes you, your spouse if you live together, and anyone you claim as a dependent.4Centers for Medicare and Medicaid Services. MAGI-Based Household Income Eligibility Training Manual If you don’t file taxes, the household is you, your spouse if living together, and your children under 19 who live with you. For a child applying on their own, the household includes the child, any parents living with the child, and any siblings under 19 in the home.
What Doesn’t Count as Income
Several common sources of money are left out of MAGI:
- Child support you receive
- Supplemental Security Income (SSI)
- Veterans’ disability payments
- Workers’ compensation
- Gifts and loan proceeds
Because of these exclusions, your household may qualify even when your total cash flow looks higher than the FPL numbers suggest.5HealthCare.gov. What’s Included as Income
No Asset Test
MAGI-based eligibility for children’s coverage has no asset or resource test.3Medicaid.gov. Eligibility Policy The state will not ask about your savings, car, or home equity.
How to Apply
You can submit an application four ways:
- Online through the CommonHelp portal at commonhelp.virginia.gov
- By phone with Cover Virginia at 833-522-5582 (TDD 1-888-221-1590), Monday through Friday 8 a.m. to 7 p.m. and Saturday 9 a.m. to noon
- By mail using a paper application sent to the central processing unit
- In person at a local Department of Social Services office
Paper forms are available on the Cover Virginia website and at any local DSS office.6Department of Medical Assistance Services. Applying for Medicaid
Have these ready before you start: Social Security numbers and dates of birth for everyone in the household, recent pay stubs covering at least the last 30 days (or a tax return if self-employed), proof of a Virginia address, any immigration documents that apply, and details of any current health coverage your child has. Report wages and tips before deductions, and leave out the excluded income types listed above.
One caution if your child was recently covered by private insurance. Federal rules let states apply a waiting period of up to 90 days before FAMIS enrollment when a child voluntarily left employer group coverage.7Medicaid.gov. Waiting Periods in CHIP Exceptions apply when the loss was involuntary, such as a parent’s job loss or the employer dropping the plan. Report prior insurance accurately so the state can tell whether a waiting period applies.
What Happens After You Apply
Virginia must make an eligibility decision within 45 days of receiving your application.8eCFR. 42 CFR 435.912 – Timely Determination and Redetermination of Eligibility Many applications move faster. Nationally, about two-thirds of Medicaid and CHIP applications are processed within seven days. If the state asks for additional documents, respond quickly, because the clock can pause while the state waits on you. You’ll get the final decision by mail.
If your child had medical bills in the three months before you applied, Medicaid can cover them retroactively, as long as the child would have been eligible during that period.3Medicaid.gov. Eligibility Policy Mention any unpaid medical expenses from those earlier months when you apply.
Once enrolled, your child keeps coverage for a full 12 months regardless of income changes during that year. This continuous eligibility rule took effect in January 2024, so a raise or new job won’t push your child off coverage mid-year.9Medicaid.gov. Continuous Eligibility
At the 12-month mark, Virginia reviews eligibility.10eCFR. 42 CFR 435.916 – Regularly Scheduled Renewals of Medicaid Eligibility The state first tries to renew automatically using tax and wage records. If it can, coverage simply continues and you get a notice. If it can’t, you’ll receive a pre-filled renewal form with at least 30 days to correct and return it. If you miss the deadline and coverage ends, the state must treat a form returned within 90 days of termination as a new application and restore coverage without a fresh start.
If your child is denied, you have 30 days from the date on the denial notice, plus 5 days for mailing time, to appeal to the Department of Medical Assistance Services.11Department of Medical Assistance Services. Virginia Medicaid Client Appeals Process – At-A-Glance Appeals can be filed by mail, fax, phone, email, or in person, and the state may accept a late appeal for good cause. The appeal leads to a fair hearing where you can present evidence that your child qualifies.