Virginia FAMIS Program



Virginia’s health insurance program for children offers coverage for uninsured residents under age 19. The Family Access to Medical Insurance Security (FAMIS) program is for children whose income is above the eligibility level for Medicaid, though the same services are covered. When applying for public health coverage in the state of Virginia, you will be considered for both FAMIS and FAMIS Plus, which is Medicaid for children. Those who qualify for FAMIS will be required to pay a small copayment only for medical care, usually $2 or $5 for certain types of care.

FAMIS covers doctor’s office visits, hospital care, dental and vision care, and other services to its members. In order to qualify, children must live in Virginia, be under age 19, have U.S. citizenship or legal residency, and meet certain income requirements. Coverage is also available to pregnant women through FAMIS MOMS, following the same eligibility rules with the exception of no age requirement. Qualifying residents must also not have access to a state employee health plan or current coverage through an employer.

 

FAMIS Income Guidelines

 

If you meet the residency requirements and other eligibility criteria for FAMIS, the next most important factor in finding out whether you qualify is your household income. Additionally, children cannot have had health insurance for the past 4 months prior to application for FAMIS. Income must be over 133 percent of the Federal Poverty Level (FPL) and at or below 200 percent of FPL to qualify for benefits. Below is a chart of income limits for children and their family sizes according to the current FPL. Family size consists of the total number of children under age 19 and parents living in one household. The same limits qualify for pregnant women applicants for FAMIS MOMS, who including their unborn child, are considered a family of two.

 

 

Covered Benefits

FAMIS offers a comprehensive set of benefits to program members, which includes preventive care, check-ups, and major medical care and supplies. The most essential types of care to facilitate a child’s health and proper growth are all covered, also including vision and dental care. Other types of services for special needs are also available to children who need them, such as physical therapy. Below are many of the services available to members of FAMIS.

  • Doctor’s office visits
  • Babycare, including prenatal and maternity care
  • Well-child checkups
  • Clinic services
  • Inpatient and outpatient hospital care
  • Immunizations
  • Diagnostic laboratory and X-rays
  • Emergency care
  • Prescription medication
  • Dental care
  • Vision care, including eyeglasses
  • Mental health care
  • Durable Medical Equipment and Supplies
  • Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
  • Early intervention
  • Family Planning Services
  • Home health care
  • Podiatry
  • Organ transplants
  • Psychiatric or psychological services
  • Physical, occupational, and speech therapy

 

Costs

There are no monthly or annual fees for FAMIS, only a $2 or $5 copayment for certain medical services.

 

FAMIS Health Plans

FAMIS members can receive their medical coverage in two forms, either through managed care organizations (MCO) or fee-for-service (FFS). The majority of children who are on FAMIS have their benefits with a Virginia MCO health plan, though some may temporarily or permanently use the fee-for-service system. Fee-for-service care takes place for the first month or two after first enrolling in FAMIS. Before you choose an MCO and after you have been accepted for coverage, you will use the FFS system. During this period, children may use any doctor who accepts FAMIS.

MCOs vary based on the region of Virginia in which you live. The health insurance companies providing FAMIS coverage in different areas include:

  • Amerigroup
  • Anthem HealthKeepers Plus
  • Optima Family Care
  • MajestaCare
  • VirginiaPremier
  • CareNet

You can determine which of these are available near you by using the FAMIS Health Plan Listing.

 

Application & Renewal

FAMIS must be renewed every 12 months at the least. To apply for FAMIS and FAMIS Plus, individuals can call 866-87-FAMIS and speak with someone in their language of choice for assistance. You may also apply online through the FAMIS website, or at your local Department of Social Services. To complete your application, you must include one month’s proof of income for the most recent month, and proof of the child’s immigration status is the child was not born in the U.S. This is most effectively accomplished by providing a Social Security number.

Applying for and receiving FAMIS will not affect a families’ ability to obtain U.S. citizenship in any way.

 

Resources

FAMIS

Apply online for FAMIS benefits

Apply by phone: 866-87-FAMIS (877-873-2647)

TDD: 888-221-1590