Virginia’s FAMIS program provides free health coverage for children in families that earn too much to qualify for Medicaid but not enough to comfortably buy private insurance. For 2026, a family of four can qualify with gross annual income up to $67,650. There are no premiums, no copayments, and no deductibles, and the coverage includes doctor visits, hospital care, prescriptions, dental, vision, and mental health services.
Who Qualifies for FAMIS
A child qualifies when all of the following are true:
- Under 19 years old.
- Lives in Virginia.
- A U.S. citizen or lawfully residing immigrant.
- Currently uninsured. A child with access to affordable employer-sponsored insurance through a parent generally does not qualify.
- Household income falls within the FAMIS range: above the Medicaid children’s threshold of roughly 148% of the Federal Poverty Level and at or below about 200% of FPL.
Virginia has elected the federal option that lets lawfully residing immigrant children enroll without waiting five years after obtaining legal status.1Medicaid.gov. Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women
If your household income falls below the Medicaid threshold, your child will likely be enrolled in Medicaid instead, which offers similar benefits. The state evaluates both programs from the same application, so you don’t need to guess which one to apply for.
2026 Income Limits
These figures are gross household income before taxes or deductions. The published limits already include a standard 5% federal disregard.2Department of Medical Assistance Services. Medicaid for Children and FAMIS
- Family of 1: $32,718 per year ($2,727 per month)
- Family of 2: $44,362 per year ($3,697 per month)
- Family of 3: $56,006 per year ($4,668 per month)
- Family of 4: $67,650 per year ($5,638 per month)
- Family of 5: $79,294 per year ($6,608 per month)
- Family of 6: $90,938 per year ($7,579 per month)
- Family of 7: $102,582 per year ($8,549 per month)
- Family of 8: $114,226 per year ($9,519 per month)
- Each additional person: add $11,644 per year ($971 per month)
The Waiting Period After Losing Other Coverage
Virginia generally requires a four-month waiting period after a child loses other health insurance before FAMIS can begin. The rule is meant to discourage families from dropping affordable employer coverage to switch to the state program. It doesn’t apply in several common situations, including when a parent changed jobs or stopped working, when the employer stopped contributing to the cost of family coverage, when the insurance company canceled the policy for a reason unrelated to nonpayment, or when the prior coverage cost more than 10% of the family’s gross monthly income. Children transitioning from Medicaid or another state program are also exempt.
If your child was already uninsured and hasn’t had coverage recently, the waiting period doesn’t apply at all.
What FAMIS Covers
Coverage rivals what many employer plans offer. Care is delivered through Virginia’s contracted managed care organizations: your child is assigned to an MCO and chooses a primary care provider inside that network.3Virginia Department of Medical Assistance Services. FAMIS 2019 Summary of FAMIS Covered Services The core benefits:4Virginia Department of Medical Assistance Services. FAMIS
- Doctor visits for illness, injury, and routine checkups.
- Inpatient hospital care up to 365 days per confinement, including intensive care, plus outpatient surgical and diagnostic services.
- Emergency room treatment when symptoms suggest a genuine emergency.
- Well-baby and well-child checkups on the American Academy of Pediatrics schedule, plus age-appropriate immunizations.
- All medically necessary prescription medications.
- Pediatric dental services through the Smiles for Children program, administered separately from the medical plan.
- Eye exams at least once every two years, plus one pair of glasses or medically necessary contact lenses.
- Physical, speech, and occupational therapy when medically necessary.
Mental and Behavioral Health
Federal parity law requires FAMIS to cover mental health and substance use disorder treatment at the same level as medical care. Copays, visit limits, and approval criteria can’t be more restrictive for behavioral health than for physical health services.5Medicaid.gov. Parity
In practice, FAMIS covers inpatient psychiatric care in general hospital psychiatric units, outpatient individual and group therapy, family counseling, and substance abuse treatment. The state also directly covers certain intensive services outside the managed care contract, including crisis intervention, intensive in-home services, and therapeutic day treatment for children with serious emotional disturbances.3Virginia Department of Medical Assistance Services. FAMIS 2019 Summary of FAMIS Covered Services
What FAMIS Costs
Nothing. FAMIS has no premiums, no copayments, no deductibles, and no other out-of-pocket costs for covered services.6CoverVA. FAMIS Select Virginia removed premiums in 2002 and eliminated all remaining copayments for both Medicaid and FAMIS enrollees on April 1, 2022.7Virginia Department of Medical Assistance Services. Removal of Co-Payments for Medicaid and FAMIS Enrollees If a provider tries to charge your child a copay, that’s an error worth reporting to your MCO.
How to Apply
Before starting, gather the following for everyone in your household:8Cover Virginia. How to Apply
- Social Security numbers for each child applying. Adults who are not applying don’t have to provide theirs.
- Income documentation: recent pay stubs, W-2s, or wage and tax statements for every working adult. Self-employed applicants need records of income and expenses.
- Employer name and contact information for each working adult.
- Details about any health coverage the child currently has or recently lost.
Household size includes the applicant and all tax dependents living in the home. Calculate gross monthly income by totaling all earnings before deductions for taxes, retirement, or insurance premiums. Inaccurate income figures or missing insurance details are the fastest way to trigger delays or a denial.
You can submit in three ways:9Virginia Department of Medical Assistance Services. Applying for Medicaid
- Online at commonhelp.virginia.gov.
- By phone at the Cover Virginia call center, (855) 242-8282.
- On paper, downloaded from the Cover Virginia website and mailed or dropped off at your local Department of Social Services office.
The same application covers both Medicaid and FAMIS.
What Happens After You Apply
Virginia generally processes applications within 45 calendar days. The state may verify your income electronically during that window. If more documentation is needed, you’ll receive a letter, and failing to respond can result in denial, so watch your mail closely.8Cover Virginia. How to Apply
Once approved, you’ll receive a formal notice and a health insurance card with a member ID. You’ll also be assigned to a managed care organization and asked to select a primary care provider.
Twelve-Month Continuous Eligibility and Renewals
Federal law now requires Virginia to give children 12 months of continuous eligibility. Once your child is approved, coverage stays in place for the full 12-month period regardless of changes in your household income or circumstances.10Medicaid.gov. Continuous Eligibility A mid-year raise won’t cause your child to lose coverage before the renewal date.
Coverage can end before the 12 months are up only in narrow cases:11Virginia Department of Medical Assistance Services. 12-Month Continuous Eligibility for Children
- The child turns 19.
- The family moves out of Virginia.
- The child or their representative requests termination.
- The state discovers the child was enrolled due to fraud or agency error.
Near the end of each 12-month period, the state sends a renewal packet. You have at least 30 days from the date of that notice to return the form or provide requested information.12Medicaid.gov. Overview – Medicaid and CHIP Eligibility Renewals If your child still qualifies, a new 12-month period begins. If not, coverage ends and the family may be referred to the Virginia Insurance Marketplace for other options.13CoverVA. Children’s 12-Month Continuous Coverage
Reporting Changes During the Year
Because of continuous eligibility, most changes during the 12-month period won’t affect your child’s enrollment. You’re required to report an income increase only if gross monthly income rises above 200% of the Federal Poverty Level for your family size. Increases that stay at or below that threshold don’t need to be reported.
Always report a change of address or phone number so the state can reach you at renewal. Report a move out of Virginia, because residency is an ongoing requirement. Contact Cover Virginia if you want to add a new child, especially a newborn. To report a change, log in at commonhelp.virginia.gov or call (855) 242-8282.
Appealing a Denial or Termination
If your child’s application is denied or coverage is terminated, you have the right to appeal. The process begins with an internal review by the managed care organization. If you disagree with the MCO’s final decision, you can request a state fair hearing with the Appeals Division within 120 days of that decision.14Legal Information Institute. 12 Virginia Administrative Code 30-120-650 – Appeal Timeframes
If your child is already enrolled and coverage is being reduced or terminated, filing promptly matters. Under federal rules, if you file before the effective date of the termination, your child’s coverage may continue until a decision is reached. The notice you receive will list the effective date and filing instructions, so read it carefully.
A Note on Pregnancy Coverage
FAMIS itself covers children. Pregnant women who are uninsured and meet income guidelines are served through a related program, FAMIS MOMS, which covers medical care, dental services, and special services for high-risk pregnancies through the pregnancy and for 60 days after it ends, with no premiums, enrollment fees, or copayments for pregnancy-related services.15CoverVA. FAMIS MOMS Flyer Applications for a newborn whose mother was not enrolled in FAMIS MOMS must be received within three months of the birth.