Eligibility for Medicaid in Virginia


Some residents may wonder, “What are the requirements for Medicaid in Virginia?” when reviewing affordable health care programs. To meet Medicaid benefits eligibility requirements and obtain medical assistance, applicants must be financially needy and meet residency, income, age or disability requirements. However, Medicaid eligibility requirements and income limits often vary by household size. Furthermore, Medicaid eligibility is not based solely on an applicant’s need for medical care or current state of health. If applicants do not meet these medical assistance eligibility requirements due to income restrictions, they may apply for coverage under the Children’s Health Insurance Program (CHIP) if they are uninsured and pregnant or younger than 19 years of age. To meet CHIP medical assistance requirements, however, applicants must also meet income restrictions. However, these income restrictions are higher than that of Medicaid. Learning how to qualify for Medicaid insurance helps all potential applicants complete the Medicaid application process correctly and easily. To learn more about who is eligible for Medicaid in Virginia or who does not qualify for medical assistance, applicants can review the sections below.

Virginia Medicaid Benefits Eligibility Requirements

“What are the Medicaid application guidelines in Virginia?” is a common question asked by state residents learning how to apply for medical assistance. To be eligible for Medicaid, sometimes known as medical assistance, applicants must be financially needy, meet income limits, be a U.S. citizen, legal immigrant or permanent resident and reside in the state of Virginia. To meet Medicaid eligibility requirements under the Virginia Department of Medical Assistance Services (DMAS), applicants must also have a valid Social Security Number (SSN), meet the additional qualifications of their specific covered group and present an assignment of rights to medical benefits, if necessary. For instance, applicants may qualify for Medicaid if they meet the eligibility requirements of their covered group. These groups include low-income pregnant women or financially-needy caretakers of dependent children. Covered groups who may be eligible for medical assistance in VA include the following:

  • Applicants who are older than 65 or younger than 19 years of age
  • Residents who are younger than 21 years of age and residing in foster care
  • Former foster care residents who are younger than 26 and began receiving Medicaid benefits at 18 years of age
  • Claimants who are blind or disabled
  • Residents who are pregnant, regardless of marital status
  • Claimants who are caretaker relatives of dependent children
  • Certain patients who require treatment for cervical or breast cancer

To meet VA Medicaid benefits eligibility requirements, applicants must also demonstrate proof of legal presence as part of the application process. To qualify for medical assistance, applicants must present a Social Security card, a Resident Alien Card, a refugee or temporary protected status credential or many other types of documents to provide proof of citizenship or legal presence.

To learn more about Medicaid application guidelines for eligibility, download our comprehensive guide.

What are the income requirements for Medicaid in Virginia?

The income requirements for Medicaid in Virginia vary by household size, coverage type and covered group. These medical assistance income requirements refer to earned revenue, self-employment wages, Social Security and veteran’s disability benefits, alimony, retirement pensions and other types of income that petitioners must list during the Medicaid application process. However, Medicaid eligibility income requirements vary by household size. As such, Medicaid income limits are much higher for households of eight or more than that of families of one or two.

Furthermore, Medicaid eligibility requirements in Virginia also vary by covered group and coverage type. In some cases, Medicaid benefits eligibility requirements also vary depending on the city or county in which applicants reside. If applicants do not qualify for Medicaid based on their income, they may be placed on a spenddown, which is similar to a medical deductible. With a spenddown, residents may receive Medicaid benefits for a limited amount of time if their healthcare expenses exceed the amount of the spenddown. Also known as time-limited coverage, spenddown Medicaid insurance begins once claimants meet the spenddown amount, and benefits continue until the end of the set period. When learning how to qualify for Medicaid in VA, applicants should also get more information on the costs and coverage for Medicaid to see if they qualify for benefits.

Who does not meet Virginia Medicaid eligibility requirements?

Not all residents meet Medicaid benefits eligibility requirements, especially if their income exceeds the guidelines for their specific covered group or they cannot present proof of US citizenship. Additionally, applicants may not qualify for medical assistance if they do not fall under a specific covered group. However, other applicants are ineligible for Medicaid in VA as well, including the following:

  • Recipients of General Relief (GR) maintenance who do not fall under a specific covered group
  • The husbands or wives of aged, blind or disabled claimants (unless spouses themselves fall under a covered group)
  • Claimants who commit Medicaid fraud
  • Applicants who do not apply for or provide a Social Security Number

Those applicants who do not meet requirements for Medicaid in Virginia may be eligible at a different application period if their situation or household income changes and meets eligibility requirements.

To learn more about who is eligible for Medicaid in VA, download our detailed guide.

Virginia Department of Social Services