Virginia Medicaid Eligibility: Income Limits, Asset Rules & How to Apply

Virginia’s Medicaid program goes by two names depending on the context.

The state brands its Medicaid managed care system as Cardinal Care — the umbrella program through which most Virginia Medicaid recipients receive coverage.

The federal enrollment program is called Cover Virginia — the state’s Medicaid outreach and enrollment brand administered by DMAS.

What sets Virginia’s Medicaid system apart in this series:

No QIT required. Virginia is a Medically Needy spend-down state, like Vermont. Seniors with income above the long-term care limit deduct medical expenses instead of establishing a Qualified Income Trust.

CCC Plus with Consumer Direction. The Commonwealth Coordinated Care Plus Waiver allows eligible members to hire, train, and manage their own care attendants — including certain family members — giving them direct control over their in-home support.

FAMIS with multiple sub-programs. Virginia’s CHIP system (Family Access to Medical Insurance Security) is more differentiated than most states, with separate tracks for children at different income levels, pregnant women, immigrants needing prenatal care, and families with employer coverage.

The lowest Personal Needs Allowance outside South Dakota. At $40/month, Virginia nursing home residents retain less discretionary income than residents of every other state in this series except South Dakota ($30).

Virginia expanded Medicaid in 2019, with enrollment beginning November 2018. Over 595,000 Virginians have enrolled under expansion.

This guide covers every Virginia Medicaid program, 2026 income limits, CCC Plus consumer direction, the FAMIS system, the Medically Needy pathway, and how to apply. For a comparison to other states, see Medicaid income limits across all 50 states.

Virginia Medicaid Programs

Cardinal Care (Managed Care / ACA Expansion Adults) covers adults 19–64 earning up to 138% FPL through Virginia’s managed care system.

Expansion enrollment began November 1, 2018 for coverage effective January 1, 2019. Virginia was among the later states to implement ACA expansion. More than 595,000 Virginians are now enrolled under expansion rules.

FAMIS Plus (Children’s Medicaid) is Virginia’s Medicaid program for children with household incomes up to approximately 148% FPL.

FAMIS Plus provides full Medicaid benefits — medical, dental, behavioral health, and pharmacy — at no cost to enrolled families. Children receive 12 months of continuous enrollment once approved, meaning coverage cannot be terminated mid-year except in narrow circumstances (turning 19, permanently leaving Virginia, parent/guardian request, error, or fraud).

FAMIS Children (CHIP) covers children whose household income falls between approximately 148% FPL and 205% FPL — above standard Medicaid but below the FAMIS income ceiling.

FAMIS Children also carries no monthly premium and no copayments under current policy. Like FAMIS Plus, enrolled children receive 12 months of continuous coverage.

FAMIS MOMS covers pregnant women with household incomes between approximately 148% FPL and 194% FPL.

This is Virginia’s CHIP-based pregnancy program. Coverage extends 12 months postpartum — one of the more generous postpartum coverage windows in the region.

FAMIS Prenatal Coverage covers pregnant women who would otherwise qualify for Medicaid or FAMIS MOMS but don’t meet federal immigration status requirements.

Virginia state-funds prenatal care for immigrants who need it, regardless of documentation status. This is similar in concept to Vermont’s IHIP and Oregon’s OHP Plus immigration coverage, but specifically targets prenatal services. The benefit covers the same services as FAMIS MOMS.

FAMIS Select is Virginia’s premium assistance program for families with access to employer-sponsored coverage.

Rather than enrolling in the state Medicaid plan, FAMIS Select helps pay the family’s share of their employer health insurance premiums. Eligible families choose between direct Medicaid enrollment and premium assistance depending on which provides better coverage for their situation.

Nursing Home / Institutional Medicaid covers long-term care in Medicaid-certified nursing facilities and ICF/IID.

This is an entitlement — eligible applicants cannot be denied. Income limit: $2,901/month (single). Asset limit: $2,000 (single).

CCC Plus Waiver (Commonwealth Coordinated Care Plus) is Virginia’s primary HCBS program for seniors and disabled adults who need nursing home-level care but prefer to remain at home or in the community.

CCC Plus operates under the Cardinal Care managed care framework and includes adult day care, personal care assistance, personal emergency response systems, home modifications, assistive technology, respite care, and more.

Consumer-Directed Services (CDS) within CCC Plus allows eligible members to hire, train, and directly manage their own care attendants — including certain family members and other people of the member’s choosing.

Under CDS, the Medicaid member (or their representative) acts as the employer of record. A Services Facilitator helps with employer responsibilities. This self-direction option gives members more control than the traditional agency-managed model.

Regular Medicaid (Aged, Blind, and Disabled — ABD) covers low-income elderly, blind, or disabled Virginians who don’t need nursing home care.

Income limit: $967/month (single). Asset limit: $2,000 (single).

PACE (Program of All-Inclusive Care for the Elderly) serves dual-eligible seniors (Medicare and Medicaid) by combining both programs into a single coordinated plan.

Developmental Disability (DD) Waiver serves Virginians with intellectual or developmental disabilities who need HCBS supports in community settings.

Income Limits — 2026

All figures are monthly gross income. Note: Virginia applies a 5% FPL Standard Disregard to income-based programs, which effectively raises usable income limits slightly above the stated percentages.

Verify exact current thresholds at coverva.dmas.virginia.gov — Virginia adopted 2026 FPL figures on January 13, 2026.

Key Notes on Virginia’s Income Rules

$40/month Personal Needs Allowance — When a nursing home resident’s income exceeds $2,901/month, excess goes toward care costs. The resident retains $40/month for personal spending.

At $40/month, Virginia’s PNA is the second-lowest in this series — only South Dakota’s $30 is lower. For context: Vermont protects $79.93, Texas $75, South Carolina $65, Tennessee and Rhode Island $50, Pennsylvania and Utah $45. Virginia’s $40 is a significant planning consideration for families with loved ones in nursing facilities.

No QIT required. Like Vermont, Virginia uses the Medically Needy spend-down pathway for excess income. Seniors deduct qualifying medical expenses from countable income rather than establishing a Qualified Income Trust. This is simpler than the QIT structure required in most other states.

Nursing Home income: If income exceeds $2,901/month, the Medically Needy spend-down allows qualifying medical expenses to reduce countable income to the eligibility threshold.

Community Spouse Allowance: When one spouse applies for nursing home or CCC Plus care, the other may keep income up to $3,948/month as a Minimum Monthly Maintenance Needs Allowance — if housing and utility costs exceed $793.13/month (effective July 1, 2025 – June 30, 2026).

Children: 12-month continuous enrollment — Once a child is enrolled in FAMIS Plus or FAMIS, they retain coverage for a full 12 months regardless of income changes, unless they age out, permanently leave Virginia, or coverage is voluntarily ended.

Pregnant women: 12 months postpartum coverage regardless of income changes after delivery.

Federal Poverty Level Reference — 2026

Use the federal poverty level calculator to find the exact threshold for your household size.

Asset Rules

No asset test applies to ACA expansion adults, children, or pregnant women. Asset limits apply to nursing home, CCC Plus, and ABD programs.

Home equity limit: $730,000. Primary home is exempt while the applicant or spouse resides there or intends to return.

Pre-paid funeral contracts: Virginia exempts irrevocable pre-paid funeral contracts up to $3,500 from countable assets. This is less than South Carolina’s $15,000 cap but higher than the standard $1,500 life insurance face value exemption used in most states.

Exempt (Non-Countable) Assets

• Primary home (within the $730,000 cap)
• One vehicle
• Household goods and personal effects
• Irrevocable pre-paid funeral contracts (up to $3,500)
• Medicaid Compliant Annuities
• Life insurance with face value $1,500 or less

Virginia’s 60-Month Look-Back Period

Virginia enforces a 60-month (5-year) look-back for Nursing Home Medicaid and CCC Plus.

When you apply, DMAS and your local DSS office review all asset transfers from the 5 years before your application date. Transfers below fair market value trigger a penalty period of ineligibility.

Exempt transfers:

• Transfers to a spouse
• Transfers to a blind or disabled child
• Home transfer to a caregiver child who lived there at least 2 years before institutionalization and whose care delayed nursing home placement
• Transfer to a sibling with an equity interest who lived in the home at least 1 year before institutionalization

No look-back applies to ABD Regular Medicaid, expansion adults, children, or pregnant women.

Medical and Functional Requirements

To qualify for Nursing Home Medicaid or CCC Plus, applicants must demonstrate Nursing Facility Level of Care (NFLOC) through:

ADLs: Mobility, bathing, dressing, eating, and toileting.

IADLs: Cooking, shopping, managing finances, medication management.

Cognitive or behavioral issues: Alzheimer’s or dementia — diagnosis alone is not sufficient.

CCC Plus applicants undergo a Community Based Screening conducted by a team of a Social Worker and a Health Department Nurse. This screening can be initiated through your local DSS, or arranged through a hospital discharge planner if you are currently hospitalized.

For ABD Regular Medicaid, proof of disability (65+ age, blindness, or SSA-defined disability) is required — NFLOC is not necessary.

Medicaid Estate Recovery

Virginia’s Medicaid Estate Recovery Program seeks reimbursement for long-term care costs from a beneficiary’s estate after death.

Recovery most commonly targets the primary home when not protected through a surviving spouse, qualifying disabled child, or caregiver child exemption.

Options If You Exceed the Limits

Medically Needy Spend-Down: Virginia’s primary pathway for excess income — deduct qualifying medical expenses from countable income until it falls below the eligibility threshold.

No trust establishment required. Track medical bills carefully to demonstrate the spend-down in any given eligibility period.

Irrevocable Pre-Paid Funeral Contracts: Up to $3,500 pre-paid burial costs are exempt from asset limits.

Spend Down Assets: Convert countable assets into exempt ones — home improvements, vehicle, paying off debt.

Medicaid Compliant Annuities: Convert excess assets into an income stream.

Federal Policy Changes Coming to Virginia

Work Requirements (January 2027): Virginia has a prior history with Medicaid work requirements — the state pursued a work requirement waiver before the ACA expansion took full effect, though it was never implemented.

OBBBA work requirements apply to expansion adults 19–64 who are not seniors, disabled, pregnant, or otherwise exempt. Virginia’s experience with the earlier work requirement process suggests the state may navigate implementation strategically. For context on how these work across programs, see SNAP work requirements. Full federal policy context: how the One Big Beautiful Bill affects Medicaid and SNAP.

Reduced Retroactive Coverage (January 2027): Coverage will go back only 2 months from application date, down from 90 days.

Apply promptly if you believe you qualify.

More Frequent Renewals (December 2026): Renewals shift to every 6 months for most expansion enrollees.

Use CommonHelp at commonhelp.virginia.gov to renew online.

New Cost-Sharing (October 2028): Non-exempt enrollees may face up to $35 per specialist visit. Primary care and preventive services remain free. Seniors, children, pregnant women, and nursing facility residents are exempt.

Virginia Medicaid and SNAP

Virginia SNAP is administered by the Virginia Department of Social Services (VDSS) — the same agency whose local offices (LDSS) determine Medicaid eligibility.

The CommonHelp portal (commonhelp.virginia.gov) handles both SNAP and Medicaid applications, though SNAP eligibility is determined by VDSS and Medicaid by DMAS.

Virginia’s SNAP uses 200% FPL BBCE — the most permissive federal maximum. Virginia also has Fresh Match, an EBT matching program at farmers’ markets providing dollar-for-dollar matching on fresh produce up to $20 per visit.

Virginia’s 120+ local DSS offices (one per county and independent city) make in-person SNAP and Medicaid assistance widely available across the state.

Useful links for Virginia residents:

• Virginia SNAP benefits, income limits, and eligibility
• How to apply for SNAP in Virginia
• Virginia WIC income guidelines
• Whether seniors on Social Security can also qualify for food stamps

How to Apply for Virginia Medicaid

Online (Recommended): Apply through CommonHelp at commonhelp.virginia.gov.

CommonHelp covers Medicaid, FAMIS, SNAP, and other VDSS benefits through a single integrated application.

By Phone: Call Cover Virginia at 1-855-242-8282 (TTY: 1-888-221-1590). Available Monday–Friday 8 AM–7 PM and Saturday 9 AM–12 PM.

By Mail or In Person: Download a paper application from coverva.dmas.virginia.gov. Mail or deliver to your local DSS office.

Note on Virginia’s unique geography: Virginia has 38 independent cities (such as Alexandria, Richmond, Norfolk, Virginia Beach, and Chesapeake) that are administratively separate from counties. Each city and county has its own Local Department of Social Services (LDSS). This results in more than 120 LDSS offices statewide — more than most states of comparable size. Applying online through CommonHelp routes to the correct LDSS automatically.

For LTC / CCC Plus: Contact your local DSS to request the Appendix D supplemental form (required for ABD and LTC applications). A Community Based Screening by a Social Worker and Health Department Nurse is required before CCC Plus enrollment.

For CCC Plus Consumer-Directed Services: Contact your local DSS or CCC Plus managed care organization. A Services Facilitator will assist with employer setup.

For the complete step-by-step application guide: the Virginia Medicaid application guide.

Documents You’ll Need

• Virginia residency proof (utility bill, lease, or official mail)
• U.S. citizenship or qualifying immigration status documentation
• Income proof: pay stubs, SSA award letters, pension statements
• SSNs for all household members
• For LTC / ABD: bank statements, property records, 60 months of financial history
• For disability: SSA disability documentation or physician letter
• For pregnancy: physician verification

Processing Times

• Standard applications: Up to 45 days
• Disability-based / LTC applications: Up to 90 days
• Pregnant women / children (urgent): Expedited processing available; as fast as 5–10 days

Frequently Asked Questions

What is Cardinal Care and how does it relate to Virginia Medicaid?

Cardinal Care is Virginia’s managed care brand name for Medicaid delivery.

Most Virginia Medicaid recipients — including expansion adults, children through FAMIS, and CCC Plus waiver enrollees — receive their benefits through Cardinal Care managed care organizations (MCOs). The MCO coordinates their care across providers. The underlying program is Medicaid; Cardinal Care is how it’s operationally delivered.

What is the CCC Plus Consumer-Directed Services option?

Consumer-Directed Services (CDS) within the CCC Plus Waiver allows eligible members to act as their own employer for personal care and respite services.

The member (or their representative) hires, trains, manages, and if needed, terminates their own attendants — including certain family members. A Services Facilitator helps with administrative employer responsibilities. This is distinct from the agency-directed model where an MCO assigns caregivers. Contact DMAS or your local DSS to learn whether CDS is available for your specific waiver services.

What is FAMIS and how does it differ from standard Medicaid for children?

FAMIS (Family Access to Medical Insurance Security) is Virginia’s CHIP program — covering children and pregnant women whose incomes are above standard Medicaid but still low enough to need assistance.

The key distinction: children with household incomes up to approximately 148% FPL qualify for FAMIS Plus (full Medicaid benefits). Children from 148%–205% FPL qualify for FAMIS Children (CHIP-funded). Both programs provide the same benefits with no premiums or copays, and 12 months of continuous enrollment once approved.

What is FAMIS Prenatal Coverage and who is it for?

FAMIS Prenatal Coverage provides prenatal care to pregnant women who would qualify for Medicaid or FAMIS MOMS based on income but don’t meet federal immigration status requirements.

Virginia state-funds this program to ensure prenatal care access regardless of immigration documentation. The benefit covers the same services as FAMIS MOMS. This is similar to Vermont’s IHIP program but focused specifically on prenatal coverage.

Does Virginia require a QIT/Miller Trust for Medicaid?

No — Virginia is a Medically Needy spend-down state.

Instead of a Qualified Income Trust (required in Texas, Pennsylvania, Tennessee, and most other states), Virginia allows seniors with income above the nursing home limit to deduct qualifying medical expenses from their countable income. When documented medical expenses bring income below the threshold, Medicaid eligibility is restored for that period. No separate trust account is needed.

What is Virginia’s unique independent cities structure and why does it matter?

Virginia has 38 independent cities — like Alexandria, Richmond, Norfolk, and Virginia Beach — that exist separately from any county.

Each city and each of Virginia’s counties has its own Local Department of Social Services (LDSS), resulting in 120+ offices statewide. Your LDSS determines your Medicaid eligibility. Applying online through CommonHelp automatically routes to your correct LDSS based on your address, which is the easiest approach for most applicants.

Can I get both Virginia Medicaid and SNAP through CommonHelp?

Yes — both are available through the CommonHelp portal (commonhelp.virginia.gov).

However, SNAP eligibility is determined by VDSS and Medicaid by DMAS, even though both appear in the same portal. Processing timelines and required documentation may differ. Virginia SNAP uses 200% BBCE — making it more accessible than states at the 130% federal floor. See Virginia SNAP benefits and eligibility for income limits and details.

Last updated: 2026 | Sources: Virginia DMAS, Cover Virginia (coverva.dmas.virginia.gov), CommonHelp portal, medicaidplanningassistance.org, USDA FPL guidelines, CMS.gov. Verify current thresholds at coverva.dmas.virginia.gov or by calling Cover Virginia at 1-855-242-8282. This guide is for informational purposes only — eligibility is determined by DMAS and local DSS offices.