Who is eligible for Medicaid?
Medicaid was created to assist people who have lower incomes, but coverage is dependent upon other criteria as well. Eligibility is primarily for individuals falling into particular categories, such as low-income children, pregnant women, the elderly, individuals with disabilities, and parents meeting specific income thresholds. In Virginia, income and resource requirements vary by category.
Some groups covered by Medicaid are:
FAMIS Plus (Children's Medicaid)
- Dental care
- Emergency care
- Vision care
- Mental health care
- Well Child Checkups
- Early and Periodic Screening, Diagnosis, and Treatment program for children (EPSDT)
Medicaid for Pregnant Women
When you are enrolled in Medicaid for pregnancy, you get comprehensive health care benefits during your pregnancy and for two months following the end of your pregnancy. There is also a special program for women with high risk pregnancies.
Beginning March 1, 2015, if you are enrolled in Medicaid for pregnancy, you will also receive dental benefits during your pregnancy and for 60 days following your baby’s birth. Services are administered through the Smiles For Children program and include: x-rays and examinations, cleanings, fillings, root canals, gum related treatment, crowns, bridges, partials and dentures, tooth extractions and other oral surgeries, and
other appropriate services. Braces are not included in this coverage for women age 21 or older. For assistance finding a dentist or for more information, please call Smiles for Children at 1-888-912-3456 or click on the Guide to Dental Coverage.
Once your baby is born, he or she is automatically eligible for health insurance for the first year of life. Please let us know as soon as your baby is born so that we can determine whether the baby will be covered under FAMIS or FAMIS Plus. All we need is the baby’s name, date of birth, race and gender to get the infant enrolled immediately. You can enroll your newborn by calling Cover Virginia at 1-855-242-8282, or reporting the birth to your Eligibility Worker at your local Department of Social Services.
Medicaid for Adults
Adult Medicaid includes individuals with disabilities, individuals age 65 and older and some parents and caregivers. For detailed information about all Medicaid covered groups, see the handbooks below.
For information on how Medicaid members receive their benefits, visit the Health Plan Information page.
How Do I Apply?
To find out if you may qualify for Medicaid, answer the questions on the Screening Tool on the Am I Eligible? page.