Medicaid Requirements in Virginia

Medicaid is a medical assistance program that helps state residents cover medical expenses. In Virginia, the Medicaid Program is administered by the Department of Medical Assistance Programs. An individual's eligibility is determined by their local social services department under the administration of the State Department of Social Services. Limited income and resources are eligibility factors for Medicaid, as well as your inclusion in one of the groups covered by Medicaid.

Financial Eligibility Requirements

• Medicaid provides for those with limited income and resources.

  Medicaid coverage is intended to provide for state residents with limited income and resources. Your eligibility is determined in relation to Medicaid Resource Limits and Medicaid Income Limits. Your income and resource limits are calculated in relation to the people count in your Assistance Unit (whether you apply as an individual or as a member of a family). Also, limits are established to your relevant covered group type.

  For initial eligibility, the State Department of Social Services (DSS) considers your countable income which is your earned and unearned income remaining when you subtract various income exclusions from your gross income. This total must be less than 80 percent of the Federal Poverty Level or $8,664 for an individual or $17,640 for a family of four.

  Ongoing eligibility dictates that an individual's countable income limit for earned income is 200 percent of the Federal Poverty Level (FPL) or $21,660 for an individual or $44,100 for a family of four. Eligible individuals must keep their earned income and other financial resources in a "Work Incentive" account at their bank or financial institution. For unearned income, the countable income limit is 80 percent of the FPL.

Citizenship and Residency

• Proof of citizenship is required.

  You must provide proof of citizenship and proof of legal presence in the U.S.; your Social Security Number (SSN) or proof of application for a SSN unless the applicant is a child under the age of one or an illegal alien; and proof of residency in Virginia. You must confirm your status as a U.S. citizen or provide proof of alien status eligibility.

Due Diligence

• Because Medicaid is a "last pay" medical assistance program, you must apply for all other assistance programs for which you may be eligible first. You are required to take all steps needed to obtain every annuity, pension, disability benefit and retirement to which you may be entitled prior to applying for Medicaid.

Institutional Status

• You must meet institutional status requirements which means you cannot be an inmate of a public institution or a mental health patient in an institution unless you are under age 22 and undergoing inpatient psychiatric services.

Employed Persons

• If you are employed more than 30 hours per week and eligible for coverage in your employer's group health plan, you must apply to the Health Insurance Premium Payment Program (HIPP).

Covered Groups

• Pregnant women make up one of the eligible covered groups.

  You must belong to one of the groups covered by Medicaid such as pregnant women, children and the disabled. The first reference below provides a listing of covered groups.