Jane Dotson
Virginia offers several free or low-cost health insurance programs for eligible applicants, including Medicaid and FAMIS (Family Access to Medical Insurance Security). Medicaid is a federal program that provides health coverage for eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. FAMIS, on the other hand, offers health coverage for pregnant women who are not eligible for Medicaid but have household incomes up to 205% of the poverty line. While eligibility criteria vary between states, Virginia allows individuals to have both Medicaid and private insurance in certain circumstances, such as for aged, blind, or disabled persons.
| Characteristics | Values |
|---|---|
| Can you have Medicaid and private insurance in Virginia? | Yes, it is possible to have both Medicaid and private insurance in Virginia. However, this may depend on the specific Medicaid program. |
| Medicaid eligibility in Virginia | - Low-income adults, children, pregnant women, elderly adults, and people with disabilities may be eligible for Medicaid in Virginia. |
- Full-benefit aliens, such as lawful permanent residents with five or more years of residency, may also be eligible for free or low-cost health coverage.
- Eligibility is determined by factors such as income, age, household size, and disability status. | | Applying for Medicaid in Virginia | - Individuals can apply for Medicaid in Virginia by filling out an online application, calling the Cover Virginia Call Center, or submitting a paper application to the local Department of Social Services office.
- A social security number is not required to apply, but proof may be needed for enrollment. | | Medicaid and other health benefits | - Individuals can receive VA health care benefits alongside Medicaid or private insurance.
- Having multiple forms of health coverage can provide more options for care and help with costs. |
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What You'll Learn
Medicaid eligibility in Virginia
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 across states, and eligibility does not transfer from one state to another.
In Virginia, Medicaid eligibility is based on several factors, including income, age, household size, tax-filing status, and disability. Adults under the age of 65 are eligible for Medicaid if their income is within 138% of the poverty level. Adults aged 65 and above, as well as those who are disabled or blind, may qualify for full Medicaid but must have income and resources within certain limits.
For children, the eligibility criteria for Medicaid in Virginia are more flexible. Children are eligible for Medicaid if their household income is up to 148% of the poverty level. Above this level, they may still qualify for the FAMIS program if their household income does not exceed 205% of the poverty level.
Virginia also offers FAMIS (Family Access to Medical Insurance Security), which provides health coverage for uninsured pregnant women who are not eligible for Medicaid but have household incomes up to 205% of the poverty level.
To apply for Medicaid in Virginia, individuals can fill out an online application, apply over the phone by calling the Cover Virginia Call Center, or complete and submit a paper application to their local Department of Social Services Office. An Eligibility Screening Tool is also available on CommonHelp to help individuals determine their potential eligibility for Medicaid or other health coverage options in Virginia.
It is important to note that having private insurance does not affect eligibility for VA health care benefits. Individuals can use VA health care benefits alongside other forms of health care coverage, including private insurance, Medicare, Medicaid, or TRICARE.
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Applying for Medicaid in Virginia
Virginia's Medicaid program offers health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. The criteria and coverage are unique to the state, and eligibility does not transfer from other states.
To apply for Medicaid in Virginia, you can:
- Apply online at www.commonhelp.virginia.gov or marketplace.virginia.gov.
- Apply over the phone by calling the Cover Virginia Call Center at 1-833-5CALLVA (1-833-522-5582) or 1-855-242-8282 (TDD: 1-888-221-1590).
- Complete and mail a paper application to your local Department of Social Services office. The application can be downloaded from the Cover Virginia website.
If you are over 65, blind, disabled, or have a special medical need, you may need to complete additional documents. You can also get a one-page supplement to the application if there are more than two people in your household.
Eligibility
Eligibility for Medicaid in Virginia is based on factors such as income, age, household size, tax-filing status, and disability. Adults under 65 are eligible if their income does not exceed 138% of the poverty level. Children are eligible if their household income is up to 148% of poverty, and above that level, they are eligible for the FAMIS program if the household income does not exceed 205% of the poverty level.
Pregnant women who are not eligible for Medicaid but have household incomes up to 205% of poverty can receive health coverage through the FAMIS program. Additionally, a full-benefit alien, such as a lawful permanent resident with five or more years of residency, may be eligible for free or low-cost health coverage from Virginia Medicaid.
Additional Information
If you are approved for Medicaid, you cannot cancel your coverage to receive a tax credit. If you are denied coverage, you have the right to appeal, and there is no limit to how many times you can apply.
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Medicaid and private 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 across states, and eligibility does not transfer from one state to another. In Virginia, there are several free or low-cost health insurance programs for those who qualify, including FAMIS (Family Access to Medical Insurance Security), which is Virginia's CHIP program. Adults under 65 are eligible for FAMIS if their income does not exceed 138% of the poverty level, while children are eligible if their household income is up to 148% of the poverty level.
Regarding having both Medicaid and private insurance, it depends on the specific Medicaid program. Some programs do not allow individuals to have both, while others, such as those for the aged, blind, or disabled, may permit it. Additionally, if you have other forms of healthcare coverage, such as private insurance, you can still use VA health care benefits alongside these plans. The VA will bill your private health insurance provider for any care, supplies, or medicine provided for non-service-connected conditions, and you won't be responsible for any unpaid balance.
It is important to note that federal regulations prohibit being enrolled in Medicaid and receiving a federal Advance Premium Tax Credit (APTC) for health insurance. If approved for Medicaid, you cannot cancel your coverage to receive a tax credit. Additionally, Medicaid eligibility is reviewed annually, and renewal can often be done without additional verifications.
In Virginia, individuals can apply for Medicaid through the Cover Virginia Call Center, online at www.commonhelp.virginia.gov, or by mailing or delivering a paper application to their local Department of Social Services Office.
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Medicaid and Medicare
In Virginia, individuals can apply for Medicaid through the Cover Virginia Call Center, by mailing a paper application, or by applying online or in person at their local Department of Social Services Office. Virginia also offers FAMIS (Family Access to Medical Insurance Security), which provides health coverage for uninsured pregnant women who are not eligible for Medicaid but have household incomes up to 205% of the poverty level. Adults under 65 are eligible for FAMIS if their income does not exceed 138% of the poverty level, while children from households with incomes up to 148% of the poverty level are eligible for Medicaid for Children (FAMIS Plus).
For those transitioning away from Medicaid, other coverage options may include an employer's plan, Medicare, or a plan purchased through the Virginia Insurance Marketplace.
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Losing Medicaid eligibility
- Understand the Reasons: Losing Medicaid eligibility can happen due to various factors, such as changes in income, household size, or other eligibility criteria. It's important to review the eligibility requirements and identify why you may no longer qualify.
- Appeal and Reapplication: If you believe you still meet the eligibility criteria, you have the right to appeal the decision. You can also reapply for Medicaid at any time, especially if your circumstances change. There is no limit to how many times you can apply.
- Transition to Other Coverage: If you are no longer eligible for Medicaid, you may be able to transition to other forms of health insurance. Depending on your circumstances, this could include an employer's health plan, Medicare, or a plan purchased through the Virginia Insurance Marketplace. Virginia also offers FAMIS (Family Access to Medical Insurance Security), which provides coverage for pregnant women and children who don't qualify for Medicaid but meet certain income thresholds.
- VA Health Care Benefits: If you are a veteran, you may be eligible for VA health care benefits, which can be used alongside other forms of health insurance, including private insurance, Medicare, or Medicaid. It's important to keep your VA doctor informed if you are receiving care outside the VA system.
- Stay Informed About Policy Changes: Keep yourself updated on any policy changes or proposals that may impact Medicaid eligibility in Virginia. For example, there have been debates and proposals to cut Medicaid funding, which could affect eligibility requirements and coverage. Staying informed will help you anticipate and navigate any changes.
- Seek Assistance: If you are unsure about your options or need help navigating the process, don't hesitate to seek assistance. You can contact the Cover Virginia Call Center, your local Department of Social Services, or a healthcare enrollee specialist to discuss your specific situation and explore alternative coverage options.
Remember, losing Medicaid eligibility doesn't mean you are left without options. Understanding the reasons for the change, exploring alternative coverage options, and staying informed about policy changes can help you navigate this challenging situation effectively.
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Frequently asked questions
Yes, you can have both Medicaid and private insurance in Virginia. However, Medicaid criteria and coverage vary from state to state, and eligibility does not transfer between states.
You can apply for Medicaid in Virginia by filling out an online application at www.commonhelp.virginia.gov or calling the Cover Virginia Call Center at 1-855-242-8282. You can also apply by mailing a paper application to your local Department of Social Services office.
Medicare is a federal program that offers health insurance to people aged 65 or older and those with certain disabilities. Medicaid is a federal program that offers health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.
No, federal regulations prohibit being enrolled in Medicaid and receiving an APTC. If you are approved for Medicaid, you cannot cancel your coverage to receive a tax credit.
