Orlando Harmon
Medicaid is a federal program that offers health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Eligibility criteria and coverage vary from state to state, and individuals with Medicaid in one state must reapply and meet the guidelines if they move to another. In Virginia, Medicaid provides low-cost and no-cost health coverage programs for children, pregnant women, and adults, including those with disabilities. The state's Health Insurance Flexibility and Accountability (HIPP) program requires all Medicaid-eligible individuals to enroll in a cost-effective private health insurance plan through their employer, if available. If an individual does not enroll, they will lose their Medicaid benefits. In this context, it is essential to understand the interplay between employer insurance and Medicaid in Virginia.
| Characteristics | Values |
|---|---|
| Medicaid in Virginia | Low-cost and no-cost health coverage programs for children, pregnant women, and adults, including those with disabilities |
| Medicaid eligibility | Determined by individual circumstances, including income, age, household size, tax-filing status, and disability |
| Applying for Medicaid in Virginia | Call the Cover Virginia Call Center or mail a paper application to the local Department of Social Services office |
| VA health care benefits | Can be used alongside other health insurance plans, including private insurance, Medicare, Medicaid, or TRICARE |
| VA health care eligibility | Not affected by whether or not an individual has other health insurance coverage |
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What You'll Learn
Eligibility for Medicaid in Virginia
Medicare-eligible individuals may also be eligible for a Medicare Savings Program (MSP), where Medicaid covers their Medicare premiums. MSPs have higher income and resource limits than full-benefit Medicaid. Virginia also offers Plan First, a family planning services program for individuals who do not meet the income requirements for full Medicaid. Plan First covers specific services, including yearly family planning exams, pap tests, sexually transmitted infection testing, family planning education and counselling, and tubal ligation and vasectomies.
Eligibility for Medicaid is determined on a case-by-case basis, and individuals are encouraged to apply for a full review of their eligibility. The Eligibility Screening Tool on CommonHelp can be used to screen for income eligibility, while applying through CoverVA.org or CubreVirginia.org provides a more comprehensive review, considering factors beyond income.
It is important to note that each state has its own requirements for Medicaid eligibility, and individuals should refer to their state's Medicaid agency for specific information. Virginia's open enrollment period for health insurance runs annually from November 1 through January 15, with special enrollment periods also available.
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Medicaid and employer insurance
Medicaid is a federal program that offers health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. However, Medicaid criteria and coverage vary from state to state, and eligibility does not transfer between states. For example, in Virginia, a full-benefit alien, such as a lawful permanent resident with five or more years of residency in the United States, may be eligible for free or low-cost health coverage from Virginia Medicaid.
In some cases, individuals may be eligible for both Medicaid and employer-sponsored insurance. The Health Insurance Premium Payment Program (HIPP) is a federal requirement that all Medicaid-eligible individuals who are able to enroll in a cost-effective private health insurance plan through their employer must do so. The HIPP program will pay the employee's share of the premium. If individuals do not enroll in the HIPP program, they will lose their Medicaid benefits.
If you have employer-sponsored insurance and are considering applying for Medicaid, you must report any changes in employment or insurance coverage to the Department of Medical Assistance Services (DMAS) immediately. Additionally, you may be required to complete a HIPP application and provide an Employer Insurance Verification Form to your employer.
It is important to note that Medicaid eligibility is based on individual circumstances and is determined after the application process. Therefore, if you are considering applying for Medicaid, you should review the specific eligibility criteria and application process for your state.
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Applying for Medicaid in Virginia
The application process itself can be done online, over the phone, or through a paper application. The online application can be submitted through CommonHelp, Virginia's Insurance Marketplace, or Cover Virginia. For those who prefer a phone call, the Cover Virginia Call Center is available during specified hours on weekdays, Saturdays, and even Sundays. The phone number and hours of operation for this service should be confirmed through the official channels. Alternatively, you may mail or submit a paper application in person to your local Department of Social Services (DSS).
When applying, you may be required to provide various forms of documentation. This includes employer and income information for all family members, such as pay stubs, W-2 forms, or wage and tax statements. If you are self-employed, specific information regarding self-employment expenses will be necessary. Additionally, you may need to prove your citizenship or immigration status after submitting your application.
It is worth noting that Virginia offers assistance for those who need help with the application process. Certified Application Counselors (CACs) and Application Assisters are available to guide you through the process and ensure your application is complete. This service is particularly useful if you are applying for someone who requires assistance with everyday tasks or has a physical disability, chronic disease, mental or emotional illness, or addiction disorder.
Finally, if you are a veteran, it is important to understand how Medicaid interacts with VA health care benefits. VA health care benefits can be used alongside other forms of health care coverage, including Medicaid. However, it is recommended to inform your VA doctor if you are receiving care outside of the VA to ensure proper coordination and meet your specific needs. Additionally, signing up for Medicare is encouraged to ensure more options for care. You can learn more about VA health benefits and their interaction with other insurance plans through the official VA website.
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Losing Medicaid eligibility
Medicaid, funded by both states and the federal government, provides healthcare coverage to about 72 million Americans, including low-income elderly residents, people with disabilities, and pregnant people with household incomes below a certain threshold. In Virginia, adults under 65 are eligible for Medicaid if their income does not exceed 138% of the poverty level due to Medicaid expansion, which the state implemented in 2019.
However, there are concerns about losing Medicaid eligibility due to potential cuts in funding and changes in eligibility requirements. In 2025, there was a debate in Congress about reducing Medicaid spending significantly as part of preserving tax cuts from President Donald Trump's previous term. The Republican-controlled House passed a bill proposing to cut federal spending by $880 billion over a decade, with Medicaid being a primary target. While there was opposition and calls for a more cautious approach, the specific details of the cuts and their impact on eligibility criteria were uncertain.
Virginia, with a high percentage of its population enrolled in Medicaid, estimated that about 300,000 residents would lose Medicaid coverage during the "unwinding" of the pandemic-era continuous coverage rules. While some transitioned to other coverage options, such as employer plans or the Virginia Insurance Marketplace, the total number of people who lost Medicaid exceeded initial projections. Procedural reasons, such as insufficient information to determine ongoing eligibility, also contributed to disenrollment.
Additionally, work requirements for Medicaid eligibility have been a point of discussion. While Virginia opted to skip the work requirement initially, the second Trump administration considered reinstating it, and there were proposals for a national work requirement for adult Medicaid recipients under 65. Work requirements can cause people to lose coverage and are administratively costly for states.
It is important to stay informed about eligibility criteria and coverage options. While there is uncertainty and potential for significant changes, staying aware of any updates and understanding alternative coverage options can help individuals navigate losing Medicaid eligibility and ensure they have access to the healthcare services they need.
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$39.95
Medicaid and VA health care benefits
Veterans Affairs (VA) health care benefits are available to veterans who meet the basic service and discharge requirements and were exposed to toxins and other hazards while serving. This includes veterans who served in the Vietnam War, Gulf War, Iraq, Afghanistan, or any other combat zone after 9/11. If you are separating from service due to a service-connected illness or injury, you may be eligible for VA health care benefits and certain TRICARE benefits.
VA health care benefits can be used alongside other forms of health care coverage, such as a private insurance plan, Medicare, Medicaid, or TRICARE. VA health care does not bill Medicare or Medicaid, but may bill Medicare supplemental health insurance for covered services. It is important to note that VA health care benefits do not cover veterans' family members.
To be eligible for enhanced eligibility status and placed in a higher priority group, veterans must meet the minimum active-duty service and discharge requirements and at least one of the following:
- Receive financial compensation from VA for a service-connected disability
- Were discharged for a disability resulting from service
- Are a combat veteran discharged on or after September 11, 2001
- Receive a VA pension
- Are a former prisoner of war (POW)
- Have received a Purple Heart or Medal of Honor
- Get or qualify for Medicaid benefits
Veterans can learn about and apply for VA health care benefits, as well as schedule their first VA medical appointment, with assistance from VA resources. It is recommended that veterans sign up for every health care benefit they are eligible for to ensure they have options in the future.
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Frequently asked questions
Yes, you can have both employer insurance and Medicaid in Virginia. However, Medicaid has specific eligibility criteria and coverage that varies from state to state. In Virginia, Medicaid is available to low-income elderly residents, people with disabilities, pregnant women, and children. Additionally, if you are eligible for Medicaid, you must enroll in a cost-effective private health insurance plan offered by your employer, as per the HIPP (Health Insurance Premium Payment Program) requirement.
You can apply for Medicaid in Virginia by calling the Cover Virginia Call Center at 1-833-522-5582 or by mailing a paper application to your local Department of Social Services office. You can also download and complete an application from the Cover Virginia website before submitting it to your local Department of Social Services.
Medicare is a federal program that provides health insurance to individuals aged 65 or older and those with specific disabilities. On the other hand, Medicaid is a federal program offering health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.
Eligibility for Medicaid in Virginia is determined by individual circumstances, including age, income, financial resources, and other factors. To be eligible, you must meet the financial and non-financial conditions specific to each program. Additionally, you must be a resident of Virginia, intending to remain in the state.
Yes, VA health care benefits can be used alongside other health care coverage, including private insurance plans, Medicare, Medicaid, or TRICARE. VA health care works in conjunction with these plans to provide comprehensive coverage for veterans.
