Virginia Medicaid has three main routes: standard Medicaid for low-income adults and families, Medicaid expansion for working-age adults earning up to 138% of the federal poverty line, and categorical programs for seniors and people with disabilities

Virginia expanded Medicaid in 2019, which opened coverage to more working-age adults than most states. The path you take depends on your age, income, and whether you have a disability or are caring for children. You will need to report your household income and size, and the state will determine which program fits your situation — or whether you do not meet income limits.

The application itself is free and takes 15 to 30 minutes. You can start online through the Virginia Department of Medical Assistance Services (DMAS), by mail, or in person at your local department of social services. Most people hear back within two to four weeks, though complex cases can take longer.

Key Takeaways

  • Virginia Medicaid expansion covers working-age adults with income up to 138% of the federal poverty line, which is roughly $1,900 per month for a single person (amounts vary yearly).
  • You must be a Virginia resident and a U.S. citizen or may have access to immigrant to enroll in any Virginia Medicaid program.
  • The online application through the Virginia DMAS website is the fastest route; you can also apply by mail or at your local department of social services.
  • Once approved, coverage typically begins the first day of the month after the state processes your application.
  • If your income or household changes, you must report it within 30 days to keep your coverage accurate.

Income limits and which program you may enter

Virginia has four main Medicaid pathways, and your income determines which one you can enter. Medicaid expansion covers adults aged 19 to 64 with income up to 138% of the federal poverty line. For 2024, that means roughly $1,900 per month for one person, $2,600 for two people, and $3,200 for three people — the exact amounts reset each year. This program does not require you to be disabled, pregnant, or caring for children.

Traditional Medicaid covers parents and caretakers of children, pregnant women, and children themselves, but the income limits are much lower — usually around 50% to 60% of the poverty line depending on your family structure. Medicaid for seniors and people with disabilities has higher income limits (up to around 100% of the poverty line) and is designed for people aged 65 and older or those receiving Supplemental Security Income (SSI). If you are already receiving SSI, you are usually enrolled in Medicaid automatically.

The state will ask for proof of your income: recent pay stubs, tax returns, or a letter from your employer. If you are self-employed, bring your last two years of tax returns. If your income varies month to month, report your expected annual income and explain the variation.

How to start your application

The fastest route is the online application through the Virginia DMAS website (dmas.virginia.gov). You will create an account, enter your household information, income, and citizenship status, and upload documents if the system asks for them. The site will tell you immediately whether you appear to meet income limits, though the final decision comes after a caseworker reviews everything.

If you do not have internet access or prefer to apply in person, visit your local department of social services — every county and city in Virginia has one. Staff there can help you fill out the paper form and answer questions about what documents to bring. You can also mail a completed application to your local office or to DMAS directly, though mail takes longer.

Have these items ready before you start: your Social Security number, proof of Virginia residency (a utility bill or lease), proof of citizenship (a birth certificate, passport, or naturalization papers), and recent income documentation. If you are applying for a child, you will need their Social Security number and birth certificate as well.

What happens after you submit your application

After you submit, DMAS sends you a confirmation number. You can check the status of your application online using that number, or call the DMAS customer service line. Most decisions come within two to four weeks, though if the state needs more information from you, the timeline extends.

If you are approved, your coverage begins on the first day of the month after approval. You do not have to wait for a physical card to arrive — coverage is active as soon as the decision is made. When your card does arrive (usually within one to two weeks), it will have your member ID number on it. You can use that number at the doctor or pharmacy before the card arrives.

If you are denied, the letter will explain why and tell you how to request a hearing to challenge the decision. You have 30 days from the denial letter to ask for a hearing. Common reasons for denial are income above the limit, failure to provide proof of citizenship, or not meeting residency requirements.

Reporting changes to your income or household

Once you are enrolled, you must report certain changes within 30 days. If your income increases, decreases, or your household size changes (a new baby, someone moving in or out, a job loss), contact DMAS or your local department of social services. You can report changes online, by phone, or in person.

If you do not report a change and your income actually exceeds the limit, the state may ask you to repay benefits you received while ineligible. If your income drops, reporting it quickly may move you into a different program with better benefits. Changes are free to report and take just a few minutes.

Your coverage renews once a year. The state will send you a renewal notice 30 days before your coverage ends. You will need to confirm your information and income again. If you do not respond to the renewal notice, your coverage will end, even if you still meet the income limit.

Coverage details and what Medicaid pays for in Virginia

Virginia Medicaid covers doctor visits, hospital care, prescription medications, mental health services, dental care for children and adults, vision care, and emergency services. Coverage for some services — like dental work for adults — varies depending on which Medicaid program you are in. Expansion Medicaid covers more services than traditional Medicaid in some cases.

You will have a copay for some services: usually $1 to $3 for a doctor visit or prescription, and $0 to $3 for an emergency room visit. Preventive care like vaccines and cancer screenings has no copay. If you cannot afford a copay, tell the provider — they may waive it.

You do not have to choose a specific plan; Virginia Medicaid is a single program, not a marketplace with options. You can see any doctor or hospital that accepts Medicaid. If you need a specialist, your primary care doctor can refer you, but you do not need a referral to see one.

If you do not meet income limits or citizenship requirements

If your income is above the Medicaid limit, you may be able to buy coverage through the Virginia Health Insurance Marketplace (the ACA marketplace). You might also be may be able to access for a tax credit that lowers your monthly premium. You can explore marketplace plans at healthcare.gov or through the Virginia Department of Insurance.

If you are not a U.S. citizen but are a may have access to immigrant (someone with a valid visa, green card, or certain other immigration status), you may still be able to enroll in Medicaid. Undocumented immigrants do not meet the citizenship requirement for standard Medicaid, but Virginia does offer emergency Medicaid for anyone who needs urgent care, regardless of immigration status.

If you are between jobs or waiting for your first paycheck, you can still apply. Report your expected income for the year, and the state will base your may be able to access on that. Once you start working and your actual income is different, report the change.

Frequently Asked Questions

How long does it take to get approved for Virginia Medicaid?

Most decisions come within two to four weeks of submitting a complete application. If the state needs more information from you, it may take longer. You can check your application status online using your confirmation number or by calling DMAS customer service.

Can I use Virginia Medicaid outside of Virginia?

Virginia Medicaid works in any state for emergency care. For non-emergency care, coverage depends on whether the provider is in the Medicaid network and whether the other state has a reciprocal agreement with Virginia. Call your Medicaid member services number before traveling to confirm coverage in the state you are visiting.

What if I lose my job while I have Medicaid?

Report the job loss to DMAS within 30 days. Your income will drop, which may make you may be able to access for a different Medicaid program or keep you in expansion Medicaid if you are still within the income limit. Your coverage will not end automatically — you must report the change for the state to update your case.

Do I have to pay back Medicaid if my income increases later?

No, you do not have to repay benefits you received while you were may be able to access. However, if you do not report an income increase and the state later discovers you were ineligible, you may be asked to repay the cost of services you received during the period you were over the limit. Reporting changes promptly protects you.

Can I have both Medicaid and Medicare?

Yes. If you are 65 or older or receive SSI, you may have both. People with both are called "dual may be able to access." Medicare is your primary insurance, and Medicaid covers costs Medicare does not, like copays and long-term care. Tell both programs about the other when you enroll.