Virginia Medicaid Office

Virginia Medicaid office (DMAS)

Virginia delivers Medicaid through the Department of Medical Assistance Services (DMAS), which covers more than one in five Virginians under the Cardinal Care brand. Cardinal Care covers over 2 million Virginians; the largest populations are low-income adults and children, with people with disabilities, older adults, and pregnant women rounding out the rolls.

Cardinal Care Managed Care

For more than two decades health care coverage in Virginia has been provided through managed care organizations. The managed care model covers more than 96% of members. DMAS released a request for proposals to reprocure the managed care system on August 31, 2023, for a regional implementation that began in fall 2024 — DMAS framed the procurement as prioritizing financial accountability, access to high-quality care, and support for targeted populations including behavioral and maternal health and members in the child welfare system.

How to reach DMAS and Cover Virginia

• Cover Virginia Call Center — 833-5CALLVA (TDD: 1-888-221-1590); hours Monday through Friday 8 a.m. to 7 p.m. and Saturday 9 a.m. to noon.
• CommonHelp portal — commonhelp.virginia.gov for applications, renewals, and document uploads, used by the Virginia Department of Social Services.
• DMAS website — dmas.virginia.gov for provider directories, policy bulletins, and Cardinal Care information.
• Cover Virginia website — coverva.dmas.virginia.gov for the consumer-facing application materials and forms.
• Local Department of Social Services (DSS) — every Virginia locality has a DSS; find yours at dss.virginia.gov/localagency.

DMAS works alongside the Virginia Department of Social Services (VDSS) and Local Departments of Social Services (LDSS) on eligibility and renewals; the agency frames itself as steward of about $23 billion in public funds that support Medicaid members.

Who qualifies for Virginia Medicaid?

Virginia organizes its Medicaid coverage into five adult-facing categories on Cover Virginia, with children covered through Medicaid and FAMIS (Family Access to Medical Insurance Security). The categories overlap by design — most members will qualify under one of them; some will qualify under more than one.

Adult coverage categories

• Adults 19–64 — More adults in Virginia can now get high-quality, low- or no-cost health insurance under this category.
• Medicaid for Aged, Blind, or Disabled (ABD) — adults who are age 65 or older or are disabled or blind may qualify for full Medicaid. Both income and resources determine eligibility, and limits depend on household size and category.
• Long-Term Services & Supports — for adults who need a higher level of care at home or in a facility.
• Plan First — Virginia's free family planning program for men and women.
• Medicare — for people 65 or older, and earlier for some adults with a disability, End-Stage Renal Disease (ESRD), or ALS.

ABD: spend-down and Medicaid Works

A person whose income is over the ABD limit but who has significant medical bills may "spenddown" excess income to qualify. The amount of medical bills needed depends on household size and income. Older adults whose income or resources are over the ABD limits may still qualify for help paying for Medicare through one of Virginia's Medicare Savings Programs.

Medicaid Works is a separate ABD pathway for people who are blind or disabled and are at least 16 but less than 65 years old. It lets a member work and earn a higher income while keeping Medicaid coverage. Both income and resource rules apply (the cap is higher than standard ABD).

Children's coverage and FAMIS

Children qualify for Virginia Medicaid or FAMIS depending on family income. The Maternal and Child Health page on DMAS describes both Virginia's children's Medicaid and FAMIS, which carry the same DMAS administration.

Virginia Medicaid income limits (2026 guidelines)

Virginia publishes 2026 income limits for its ABD-related programs as of January 13, 2026. The figures below come directly from Cover Virginia's ABD page; the limits include the FPL amount plus a standard $20 unearned income disregard. Each category also has its own resource limit. MAGI categories (adults 19–64, pregnant individuals, children, and FAMIS) use separate rules — confirm the current MAGI thresholds with Cover Virginia or your local DSS.

Medicaid for Aged, Blind, or Disabled (ABD)

ABD eligibility considers both income and resources. The home, one vehicle, and burial assets typically don't count toward the resource limit; ask your local DSS for the current resource thresholds and exemptions.

Medicare Savings Programs

Medicare Savings Programs help Medicare members with low income pay their Medicare premiums. In some cases the programs also help pay deductibles and copays. There are four levels of Medicare Savings Programs in Virginia; the level depends on income and resources.

Medicaid Works

Medicaid Works is for people who are blind or disabled and are at least 16 but less than 65 years old. The program lets a member work and earn higher income while keeping Medicaid coverage. Both income and resource limits apply.

These figures refresh annually as the federal poverty level updates; verify the current numbers at coverva.dmas.virginia.gov or by calling Cover Virginia at 833-5CALLVA before relying on a specific dollar amount for an eligibility decision.

How to apply for Virginia Medicaid

Virginia routes most Medicaid applications through CommonHelp — the statewide self-service portal — or through the Cover Virginia Call Center. The same application screens for Medicaid, FAMIS, and other state benefits when you ask for them.

Online: CommonHelp

Apply at commonhelp.virginia.gov. The portal accepts uploads (pay stubs, ID, proof of residence) and lets members check status, report changes, and renew. If you also want to apply for other benefits, you can apply online at commonhelp.virginia.gov or call the Virginia Department of Social Services Enterprise Call Center at 1-855-635-4370.

Through Virginia's Insurance Marketplace

You can also apply online at Virginia's Insurance Marketplace at marketplace.virginia.gov.

By phone

Call the Cover Virginia Call Center Monday through Friday, 8 a.m. to 7 p.m. and Saturday 9 a.m. to 12 p.m. at 833-5CALLVA (TDD: 1-888-221-1590).

By mail or in person at a local DSS

You can mail or drop off a paper application to your local Department of Social Services (mailing may take longer than other ways of applying). To find your local DSS, go to dss.virginia.gov/localagency. All application forms are available at coverva.dmas.virginia.gov/apply/applications/.

What you need to gather

• Full legal name
• Date of birth
• Social Security numbers (or document numbers for any legal immigrants who need insurance); you may be asked to prove citizenship or immigration status after you apply
• Employer and income information for everyone in your family (for example, from paystubs, W-2 forms, or wage and tax statements). If self-employed, the agency publishes a Self-employment Expenses Information document
• Policy numbers for any current health insurance
• Information about any job-related health insurance available to your family

Application Assisters

If you need help with your application, Cover Virginia maintains a directory of Application Assisters who can help in your area.

How to send documents we ask for

When DMAS sends a letter asking for more information, you can return it through any of these channels:

• Online — commonhelp.virginia.gov
• Email — verify_docs@coverva.org (scan, upload, attach, or photograph and attach; this address only receives information and will not reply)
• Mail — use the address on the letter
• Fax — 1-888-221-9402

Appeals and federal decision deadlines

DMAS publishes an Applicant/Member Appeals page describing how to appeal a decision. Federal Medicaid rules give the state up to 45 days to decide most applications and up to 90 days when the basis is disability. Retroactive coverage may run up to three months before the application month for qualifying medical bills.

What Virginia Medicaid covers

Virginia Medicaid covers a wide variety of inpatient and outpatient medical services. Benefits include behavioral health services, addiction and recovery treatment, dental services, and prescription medicines — the specific list a member can use depends on the coverage category and the managed care plan. Members can consult the Medical Assistance Handbook (published in English and Spanish on dmas.virginia.gov) for the details that apply to their case. Most coverage runs through the Cardinal Care managed care system, which covers more than 96% of members.

Core benefit categories

• Adult Preventive Services — adult Medicaid members now receive coverage for preventive services.
• Behavioral Health — DMAS focuses on proactive and preventive care for mental illness.
• Dental — coverage is now available for adults and children.
• School Based Services — physical, occupational, and speech therapy, audiology, psychological services, and more.
• Transportation Services — covered when you don't have another way to get to a doctor appointment or other Medicaid service.
• Maternal and Child Health — includes children's Medicaid and FAMIS (Family Access to Medical Insurance Security).
• Plan First — covers birth control and services to help prevent unplanned pregnancies for eligible men and women.

Prescription drug coverage

Virginia maintains separate prescription drug formularies for Medicaid Managed Care, Dual Special Needs Plans, and Virginia Medicaid Preferred Drug List (PDL) Fee-for-Service. Your formulary depends on how your benefits are delivered.

Long-term care

DMAS covers long-term care across several settings: Nursing Facilities, Specialized Care Nursing Facilities, Long-Stay Hospitals, and Home Health.

Waivers

Virginia's HCBS waiver programs cover Consumer Directed Services, Home and Community Based Services, and Developmental Disability supports. The DMAS Developmental Disabilities Waiver program provides supports with medical care, employment, community living, behavioral interventions, and other services that support employment.

Medicare and Medicaid programs (dual eligibles)

Members who have both Medicare and Medicaid may enroll in Virginia's Dual Eligible Special Needs Plans, accessed through Cardinal Care Managed Care.

Rights, responsibilities, and member handbooks

DMAS publishes a Rights and Responsibilities page describing what members are entitled to as participants in the Medicaid program. The Medical Assistance Handbook (English and Spanish) details covered services, plan information, and appeal rights — consult your handbook for the benefits that apply to your specific case.

Other state Medicaid pages