How to Claim Medicaid in Virginia: Income Limits and Application Steps

To apply for Medicaid in Virginia, submit an application through the CommonHelp online portal, by phone to the Cover Virginia Call Center, by mail, or in person at your local Department of Social Services office. Virginia’s Medicaid program is branded statewide as Cardinal Care, and applying is free. A single adult earning up to $22,025 a year in 2026 qualifies under the state’s expansion rules, with higher limits for children, pregnant residents, and people who are aged, blind, or disabled.¹ If approved, coverage can reach back up to three months before the month you applied.

The Four Ways to Apply

Virginia accepts Medicaid applications through four channels, all free of charge:²

Online. Go to commonhelp.virginia.gov and complete the application there. The system gives you a confirmation and a tracking number so you can check status later.
By phone. Call the Cover Virginia Call Center at 1-833-5CALLVA (1-833-522-5582), Monday through Friday from 8 a.m. to 7 p.m. and Saturday from 9 a.m. to noon. TDD users can call 1-888-221-1590.³
By mail. Send a signed and dated paper application to your local Department of Social Services office. Mailing usually takes longer than the other options.
In person. Drop off a completed application at a local DSS office.

You can also chat with a Cover Virginia agent online during weekday business hours or email CoverVirginia@dmas.virginia.gov if you need help partway through.³

What to Gather Before You Start

Having your paperwork ready before you begin cuts down on delays. In most cases you will need:

Social Security numbers for each person in your household who is seeking coverage
Proof of Virginia residency, such as a state-issued ID or a utility bill with your current address
Proof of citizenship or immigration status, such as a birth certificate, passport, or immigration document
Income verification: recent pay stubs, W-2 forms, or your most recent tax return
Details on any employer-sponsored insurance available to anyone in your household

List every person living in your home on the application, even those who are not applying for coverage. Household size determines the income limit that applies to you, and leaving someone off can push you under a lower threshold and lead to a denial.

Do You Qualify? 2026 Income Limits by Category

Cardinal Care is Virginia’s single Medicaid program covering both managed care and fee-for-service members.⁴ For most applicants, eligibility runs off Modified Adjusted Gross Income (MAGI), which is roughly your adjusted gross income from your tax return. Each category has its own income ceiling, and some also have asset limits.

Adults Ages 19 to 64

Under Medicaid expansion, adults from 19 through 64 qualify if their household income is at or below 138 percent of the federal poverty level, with a built-in 5 percent income disregard. The 2026 limits are:¹

Household of 1: $22,025 per year ($1,836 per month)
Household of 2: $29,864 per year ($2,489 per month)
Household of 3: $37,702 per year ($3,142 per month)
Household of 4: $45,540 per year ($3,795 per month)

Each additional household member adds $7,839 per year to the limit. These are gross income figures, not take-home pay.

Children Under 19 and FAMIS

Virginia offers two coverage tiers for children. Medicaid for children covers families at somewhat higher income levels than adult Medicaid, and the Family Access to Medical Insurance Security (FAMIS) program fills the gap for families who earn too much for children’s Medicaid. Both are free. The 2026 limits for a family of four are:⁵

Medicaid for children: $48,840 per year ($4,070 per month)
FAMIS: $67,650 per year ($5,638 per month)

Children must be under 19, live in Virginia, and be U.S. citizens or lawfully residing immigrants.⁵

Pregnant Residents

Pregnant applicants qualify at higher income levels than other adults. Virginia also offers FAMIS Prenatal Coverage for pregnant individuals with income up to 200 percent of the federal poverty level.⁶ FAMIS Prenatal Coverage does not require immigration documents or a Social Security number, so pregnant residents can apply regardless of immigration status.⁷

Aged, Blind, or Disabled Applicants

If you are 65 or older, blind, or meet the Social Security Administration’s definition of disabled, you apply under the aged, blind, or disabled (ABD) category. ABD applicants also have to stay below resource limits of $2,000 for an individual or $3,000 for a couple.⁸ Countable resources include bank accounts, stocks, and similar assets. Your primary home and one vehicle are generally excluded.

Over the Income Limit? The Spend-Down Path

If your income is slightly above the Medicaid ceiling but you have high medical costs, Virginia’s medically needy spend-down program can still get you covered. You subtract qualifying medical expenses (premiums, copayments, deductibles, and bills for covered services) from your countable income, and if what remains is at or below Virginia’s medically needy income level, you qualify for time-limited coverage.⁹

To use spend-down, you must meet the $2,000 (individual) or $3,000 (couple) resource limit and fall into one of the covered groups: aged, blind, or disabled; under 18; pregnant or within 12 months of the end of a pregnancy; or certain individuals under 21 in foster care or state custody.⁹ A working-age adult over the income limit with no disability and no child in the home does not have a spend-down route.

Residency and Citizenship Rules Apply to Everyone

Whichever category you fall into, you must live in Virginia and provide a Social Security number, or proof you have applied for one. You also need to show U.S. citizenship or eligible immigration status, with exceptions for FAMIS Prenatal Coverage and emergency medical services. Green card holders with at least five years of U.S. residency may qualify for full Medicaid, and refugees and asylees can qualify through separate pathways.⁷

Need Care Right Now? Hospital Presumptive Eligibility

If you show up at a hospital needing care, certain Virginia hospitals can grant temporary Medicaid coverage on the spot through Hospital Presumptive Eligibility (HPE). Coverage starts the day the hospital determines you are likely eligible and lasts through the end of the following month. If you file a full Medicaid application before your HPE period ends, coverage continues while that application is processed.¹⁰

What Happens After You Apply

Processing Times and Start Date

Virginia has to process standard applications within 45 days. Applications that require a disability determination can take up to 90 days. You will get a letter called a Notice of Action with the decision.¹¹

If you are approved, coverage begins on the first day of the month you submitted your application, and a Cardinal Care card comes in the mail. A caseworker may call or write to verify income, residency, or other details. Responding quickly keeps your case moving within the processing window.¹¹

Bills From the Last Three Months

If you had medical expenses during the three months before the month you applied, Virginia can pay those bills retroactively, as long as you would have been eligible during that period. Report any unpaid medical expenses on your application so the state can evaluate backdated coverage.¹²

Picking a Managed Care Plan

Most Cardinal Care members get services through one of five managed care organizations:¹³

Aetna Better Health of Virginia
Anthem HealthKeepers Plus
Humana Healthy Horizons in Virginia
Sentara Community Plan
UnitedHealthcare Community Plan

You may be assigned to an MCO on approval, but you can switch plans within the first 90 days of enrollment or during the annual open enrollment period.¹¹

If You Are Denied

Your Notice of Action will explain why the application was denied and how to appeal. Under federal rules, you have up to 90 days from the date the notice is mailed to request a fair hearing.¹⁴

If you are already enrolled in a managed care plan and disagree with a decision about your services, you first go through the MCO’s internal appeal. After the MCO issues its final decision, you can request a state fair hearing from the DMAS Appeals Division by mail, fax, phone, email, or in person. To keep your benefits running while the appeal is pending, file within 10 calendar days of the date on the MCO’s final appeal letter.¹⁵

At the hearing you can represent yourself or bring a lawyer, family member, or other representative. You have the right to review your case file before and during the hearing, present evidence, call witnesses, and question the state’s evidence and witnesses.

Renewing Every 12 Months

Medicaid eligibility has to be renewed each year.¹⁶ Virginia will either confirm your eligibility automatically using available data or mail you a pre-filled renewal form. If a form arrives, you have at least 30 days to review it, correct anything wrong, and return it. Missing the deadline can end your coverage, so watch your mail and respond in time.

1
Department of Medical Assistance Services. Adults 19-64 Years Old
2
Department of Medical Assistance Services. Applying for Medicaid
3
Department of Medical Assistance Services. Contact CoverVA
4
Department of Medical Assistance Services. Cardinal Care Members
5
Department of Medical Assistance Services. Medicaid for Children and FAMIS
6
Department of Medical Assistance Services. FAMIS Prenatal Coverage Chapter M23
7
Department of Medical Assistance Services. Information for Noncitizens
8
Department of Medical Assistance Services. ABD Resources Manual Chapter M11
9
Department of Medical Assistance Services. Medically Needy Spenddown Fact Sheet
10
Department of Medical Assistance Services. Hospital Presumptive Eligibility Full Benefit Coverage
11
Virginia Medicaid. Commonly Asked Questions
12
Medicaid.gov. Eligibility Policy
13
Department of Medical Assistance Services. Health Plans
14
eCFR. Subpart E – Fair Hearings for Applicants and Beneficiaries
15
Virginia Code Commission. Virginia Administrative Code 12VAC30-120-640 – State Fair Hearing Process
16
eCFR. 42 CFR Part 435 Subpart J – Redeterminations of Medicaid Eligibility