How To Get Medicaid In Va

The Cost Of West Virginia Medicaid

Some beneficiaries will be charged small co-payments for some services*. Pregnant women, kids under 21, and Native Americans are exempt from co-payments. There are no co-payments required for long-term care, hospice, family planning, breast and cervical cancer treatments, or emergency services. Co-payments will never exceed 5% of your household income. They usually range between $0 and $4 for doctor or specialist services and up to $75 for hospital services.

There are out-of-pocket maximums based on your income and the Federal Poverty Level :

• Tier 1: Up to 50% of the FPL Max $8 out-of-pocket
• Tier 2: 50-100% of the FPL Max $71 out-of-pocket
• Tier 3: At or above 100% of the FPL Max $143 out-of-pocket

*Co-payments for prescription drugs are the same for everybody and will range from $0 to $3.

Medicaid Expansion Beginning January 1 2019

The rules have changed. More people qualify. Beginning January 1, 2019, more adults living in Virginia will have access to quality, low-cost health insurance. Eligibility is based on income. For example, an adult without children whose annual income is at or below $16,754, or a family of three with annual income at or below $28,677, or a person living with a disability with an annual income at or below $16,754, qualifies for coverage. For more information, please visit .

If You Enlisted After September 7 1980 Or Entered Active Duty After October 16 1981

You must have served 24 continuous months or the full period for which you were called to active duty, unless any of the descriptions below are true for you.

This minimum duty requirement may not apply if any of these are true:

• You were discharged for a disability that was causedor made worseby your active-duty service, or
• You were discharged for a hardship or early out,or
• You served prior to September 7, 1980

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Is There Anything That Will Make Me More Likely To Get These Benefits

Yes. You may qualify for enhanced eligibility status if you meet at least one of these requirements. Enhanced eligibility means that well place you in a higher priority group. This makes you more likely to get benefits.

At least one of these must be true:

• You receive financial compensation from VA for a service-connected disability
• You were discharged for a disability resulting from something that happened to you in the line of duty
• You were discharged for a disability that got worse in the line of duty
• Youre a combat Veteran discharged or released on or after September 11, 2001
• You get a VA pension
• Youre a former prisoner of war
• You have received a Purple Heart
• You have received a Medal of Honor
• You get Medicaid benefits
• You served in Southwest Asia during the Gulf War between August 2, 1990, and November 11, 1998
• You served at least 30 days at Camp Lejeune between August 1, 1953, and December 31, 1987

Or, you must have served in any of these locations during the Vietnam War era:

If none of these descriptions apply to you, you may still qualify for care based on your income. Learn more about how the amount of money your family makes can affect whether you qualify for VA benefits.

How To Apply For Medicaid In In Virginia

If you want to apply for Virginia Medicaid, you will have to fill out an application and have the necessary documentation regarding your identity along with proof of income. If you are applying for your family or household, you will need the same documents for each member you are including.

Virginia Medicaid Application To download an application for Medicaid in Virginia, simply click here and download the application for the category you are applying for.

If you would like to apply for Medicaid online, you can do so through the Cover Virginia website. If you apply this way, you might still need to mail in documentation regarding residence, citizenship, and income. Once you have applied online, you will be able to check the status of your application using your Social Security Number and your login information. Medicaid forms shouldnt take any longer than 30 days to be fully processed.

Some people might prefer to apply in person and this can easily be done at the Department of Social Services office in your county. Once you get the application, fill it out completely and make sure that you have all of the necessary documentation with you. This will help to speed the process along. You can get the application in the Department of Social Services office or you can call them and have one sent to you in the mail.

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What To Do In An Emergency

If you receive emergency services, call your doctor to schedule a follow up visit as soon as possible. Please call us and let us know of the emergency care you received.

An emergency is a condition in which you think you have a serious medical condition, or not getting medical care right away will be a threat to your life, limb or sight.

You should call 911 if you are having a life-threatening behavioral health emergency. You can also go to a crisis center or the nearest emergency room.

You need to call Optum Behavioral Health at as soon as possible.

• PDF 1.62MB – Last Updated: 12/15/2021

Which Medicaid Plan Is Best In Virginia

The best Medicaid plan will be different from person to person based on their specific needs. There are a variety of plans to choose from. Not all of them are available in all areas, so check to see which ones are available to you before choosing one. You might also want to check with your doctors to see which plans they accept if you dont want to have to change doctors.

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Personal Needs Allowance For Nursing Home Residents

If you receive Medicaid and live in a nursing home, you will be expected to spend most of your income on your care. Virginia allows nursing home residents receiving Medicaid to keep only $40 per month as a personal needs allowance. If you receive Medicaid and get home- and community-based Medicaid Waiver services , then you are allowed to keep $1,272 per month as your personal needs allowance.

Read on to find out when Virginia Medicaid will cover assisted living facilities and home health care.

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Complete Your Medicaid Application

OnlineApply online at coverva.org.

By PhoneTo apply over the phone, call Cover Virginia at 1-855-242-8282, Monday through Friday, from 8 a.m. to 7 p.m. and Saturday from 9 a.m. to 12 p.m.

In Person Apply at your local Department of Social Services in the city or county where you live.

By Mail Print a paper application online from coverva.org and mail it to your local Department of Social Services.

In addition to completing your Medicaid application, you may be asked to provide additional documents such as:

• Proof of Identity/U.S. Citizenship or Immigration Status
• Proof of residency
• Household income

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West Virginia Medicaid Application

In 2014, Medicaid covered 29 percent of the people of West Virginias inhabitants. This figure was up from 21 percent in the prior year. In May 2013, Governor Earl Ray Tomblin chose to expand Medicaid, providing protection to approximately 91,500 working residents in the state. The movement to expand Medicaid cut the number of uninsured residents from 12 percent to 6 percent following the expansion.

West Virginia Medicaid gives low income residents the opportunity to seek medical attention through the use of a medical card supplied to them. In order to apply for Medicaid insurance coverage, residents may use the WVInRoads system. Under the Affordable Care Act, West Virginia received federal funding beginning in 2014 to pay for the costs of recently covered residents, many of which were functioning full-time, but without the alternative for employer-sponsored health insurance coverage.

Due to the new guidelines for eligibility, between 2013 and 2015, the state saw an increase in Medicaid enrollment of approximately 193,000 residents. In 2017, the state will begin paying some of the costs to provide medical benefits to its own residents, but this figure wont go over 10 percent.

As of April 2016, the total monthly Medicaid and CHIP enrollment reached 568,478 residents.

What is Covered Under Medicaid

Under West Virginia Medicaid, the following services are available for covered individuals and families:

Whos Covered Under Medicaid

Virginia Medicaid Income Limit

The Virginia Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.

To qualify, you must meet the Virginia Medicaid Income limits listed below.

Here is the Federal Poverty Level for 2021.

Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:

• Children up to age 1 with family income up to 143 percent of FPL
• Any child age 1-5 with a family income up to 143 percent of FPL
• Children ages 6- 18 with family income up to 143 percent of FPL
• CHIP for children with family income up to 200 percent of FPL
• Pregnant women with family income up to 143 percent of FPL
• Parents of minor children with family income up to 49 percent of FPL
• Individuals who are elderly, blind, and disabled with family income up to 81% of the FPL
• Adults without dependents under Medicaid expansion with income up to 133% of the FPL

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Does It Help Me In Any Way To Give Va My Health Insurance Information

Yes. Giving us your health insurance information helps you because:

• When your private health insurance provider pays us for your non-service-connected care, we may be able to use the funds to offset partor allof your VA copayment.
• Your private insurer may apply your VA health care charges toward your annual deductible .

Who Can Get Medicaid In Virginia

You should apply for Medicaid if your income is low and you match one of the descriptions below:

• You think you are pregnant
• The parent or caretaker of a child and/or teenager under the age of 19.
• You are a child or teenager age 18 or under.
• An adult age 65 or older.
• You are legally blind.
• Living with a disability or disabled.
• You are in need of nursing home care.

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West Virginia Consumer Assistance

West Virginia no longer operates a Consumer Assistance Program under the Affordable Care Act, however, the West Virginia Offices of the insurance Commissioner continues to provide assistance to consumers with health insurance questions or problems. You can contact them at 1-888-879-9842.

The agencies listed below can help you take advantage of some of these protections and benefits and they can answer your questions about different types of coverage.

If you need health insurance, be sure to check out HealthCare.govs Plan Finder. It will help you find and compare health care coverage options in your area.

If you have questions about insurance you bought for yourself and/or your family, or you have insurance provided by an employer who does business only in West Virginia, contact:

West Virginia Department of InsuranceWest Virginia Lottery Building

Virginia Medicaid Income Limit Charts

The Virginia Medicaid eligibility income limit charts are divided by groups.

For example, the first chart is focused on income limits for children who qualify for Medicaid.

Similarly, the second chart below focuses on the Medicaid income limits for adults in Virginia who qualify for Medicaid.

Virginia Medicaid Income Limit for Children

Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.

How to Read the Virginia Medicaid Income Limits Charts Above

You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.

Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.

For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 143% of the Federal Poverty Level which for a family of two is $24,911 as shown in the chart above.

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What Is West Virginia Medicaid Number

West Virginia Medicaid number where you can call and speak to West Virginia state health care agent regarding West Virginia Medicaid Application is .

West Virginia Medicaid hours of operation regarding West Virginia Medicaid Application are Monday through Friday, from 8:30 am to 4:30pm, closed on State holidays, but the best calling hours for West Virginia Medicaid to call regarding West Virginia Medicaid Application are 11:00 am to 3:00 pm.

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How Much Does Medicaid Cost In Virginia

Cost estimates will vary from person to person and the health services needed will also be a factor. If you have a copay, they are typically small and most of the time do not exceed $30. Visits to the clinic, doctor, or eye doctor cost as little as $1. Things like outpatient hospital visits, home health visits, or rehab cost as little as $3. If you are admitted to the hospital, the cost will be $100.

Cost and Coverage of Medicaid in Virginia Medicaid services that may be provided include care for babies, dental, durable medical equipment and supplies, early and periodic screening, diagnosis and treatment, family planning and birth control, long-term care, prescription drugs, clinic services, community-based residential services, and mental health services.

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Virginia Medicaid Phone Number

Heres how to contact the Virginia Medicaid Agency:

For Medicaid Applicant & Member Services

Cover Virginia also operates a statewide customer service call center for Medicaid and the FAMIS Programs:

The call center provides:

• Explanation of coverage and benefits
• Assistance in resolving application issues
• Assistance in submitting state-sponsored health insurance applications and
• renewals Records address, household, and income changes
• Enrolls individuals in their choice of managed care organization or assists
• them in changing their MCO

Dual Eligible Medicare And Medicaid Plans In West Virginia

If you are eligible for West Virginia Medicaid and are also over the age of 65, diagnosed with ALS or ESRD, or have been receiving SSDI for at least 25 months, you may be dual eligible. Dual eligibility means that you can obtain coverage from both Medicaid and West Virginia Medicare. Dual eligible beneficiaries usually qualify for a special enrollment period, which means you can enroll in a dual-eligible special needs plan during any time of year.

Dual eligible special needs plans, or DSNPs, are a form of Medicare Advantage, a type of Medicare plan that provides extra benefits like dental, vision, hearing, and more to those who qualify. Through a West Virginia DSNP plan, you can have all of the major benefits you need at little or no cost. To find out if you qualify and for help selecting a DSNP plan, contact Medicare Plan Finder at 833-438-3676.

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Expansion Under The Affordable Care Act

As of March 2022, 38 states and the District of Columbia have accepted the Affordable Care Act Medicaid extension 12 states have not. Among adults aged 18 to 64, states that expanded Medicaid had an uninsured rate of 7.3% in the first quarter of 2016, while non-expansion states had a 14.1% uninsured rate. Following a 2012 Supreme Court ruling, which held that states would not lose Medicaid funding if they did not expand Medicaid under ACA, several states rejected the option. Over half the national uninsured population lives in those states.

The Centers for Medicare and Medicaid Services estimated that the cost of expansion was $6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 to 10 million people had gained Medicaid coverage, mostly low-income adults. The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered in states that rejected the Medicaid expansion.

Studies of the impact of Medicaid expansion rejections calculated that up to 6.4 million people would have too much income for Medicaid but not qualify for exchange subsidies. Several states argued that they could not afford the 10% contribution in 2020. Some studies suggested that rejecting the expansion would cost more due to increased spending on uncompensated emergency care that otherwise would have been partially paid for by Medicaid coverage,

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Income Limits For Long

Virginians who are 65 or older, disabled, or blind can qualify for Medicaid if they also meet income and asset limits. Most people who receive SSI already qualify to receive Medicaid in Virginia. To qualify for basic Medicaid in Virginia , if you are elderly, blind, or disabled and not receiving SSI, then your monthly income must be less than 80% of the federal poverty level .

Fortunately, there is a higher income limit for seniors who need long-term care services. If you are 65 or older, blind, disabled, pregnant, under age 19, or a parent living with a child under 18, then you can qualify for Medicaid for long-term care as long as your monthly income is no more than 300% of the SSI amount for an individual, or $2,313 per month for 2019.

If your income is above the limit, you still might be able to qualify for Medicaid for long-term care if you have a lot of medical expenses. Going through Virginia’s Medically Needy Program, you can use medical bills that you incur each month to “spend down” your income and qualify for Medicaid.

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