Virginia Medicaid Eligibility


 

Virginia Medicaid Income Guidelines

Low-income residents of Virginia without health insurance can use the Medicaid program to have access to free or low cost medical services. Families, pregnant women, and children are the primary audience for Medicaid, though it also provides care to disabled, blind, and elderly individuals. In some states, you can be an adult without children and qualify for Medicaid, but Virginia requires adults under 65 without disabilities to be parents in order to be eligible for the program. Uninsured children whose household income is too high for Medicaid can qualify for CHIP for health insurance.

Services provided by Medicaid are comprehensive and administered through HMOs or at public health clinics. Many major health insurance companies are providers of Medicaid services, giving Medicaid members the ability to use the organization of an established insurer and a select network of Medicaid providers. Preventative care is included for no cost, and various services such as doctor’s office visits, hospitalization, and outpatient care are covered by Medicaid. Below is the eligibility criteria for Medicaid in Virginia based on a family’s income in relation to the Federal Poverty Level (FPL).

 

Group                                       Income (percent of FPL)

Infant                                                    133%

Child age 1-5                                        133%

Child age 6-19                                      100%

Parent (unemployed)                            25%

Parent (employed)                                31%

Pregnant Women                                  133%

Single Aged/Blind/Disabled                    80%

*$2,000 asset limit

Aged/Blind/Disabled Couple                   80%

*$3,000 asset limit

Federal Poverty Level 2012

Other Eligible Groups

  • Temporary Assistance for Needy Families (TANF) recipients
  • Supplemental Security Income (SSI) beneficiaries
  • Disabled individuals who no longer qualify for SSI benefits
  • Qualified Medicare Beneficiary (QMB): Medicaid pays your Medicare monthly premium, deductibles, and coinsurance if your income is below the poverty level.
  • Specified Low-Income Medicare Beneficiary (SLMB): Medicaid pays your monthly premiums only if your income is below 120% FPL.
  • Medically Needy: Medicaid for those who have high medical expenses that when subtracted from your income deem you eligible for Medicaid.

 

Resources

Virginia Department of Social Services: Medical Assistance Programs

Virginia Medicaid Managed Care

Applications for Medicaid