New Health Coverage for Adult Virginians!
January 1, 2019 will bring new health coverage to Virginia for adults, ages 19 - 64, with household incomes up to 138% of the Federal Poverty Level (
$16,754 per year for an individual or $28,677 for a family of 3
)! Applicants must also meet citizenship or immigration and residency requirements. The new coverage will provide low- or no-cost health insurance to nearly 400,000 adults across the state.
The Department of Medical Assistance Services (
), Virginia Department of Social Services (
), and the Cover Virginia Call Center (
) are working hard to get ready and are making every effort to ease the application and enrollment process for the new coverage.
Pathways to New Coverage
There are a number of ways for adult Virginians to enroll in the new coverage. To streamline enrollment for as many Virginians as possible, DMAS has developed several strategies that are being implemented in September and October.
- GAP enrollees (Governor's Access Plan)
- Plan First enrollees (up to 138% FPL)
Individuals already enrolled in Virginia's limited-benefit Medicaid programs, GAP and Plan First, will be automatically enrolled in the new coverage. They will receive a letter from DMAS indicating that they will be enrolled in the new full-benefit coverage, effective January 1, 2019.
Plan First enrollees with incomes at or above 139% FPL to at or below 205% FPL will continue to be enrolled in Plan First.
- SNAP (Supplemental Nutrition Assistance Program) enrollees
- Parents of children currently enrolled in Medicaid
SNAP enrollees and parents of children enrolled in Medicaid will receive a letter and a 3-question Express Application in the mail. They can enroll in the new coverage by calling Cover Virginia (855.242.8282), going online to CommonHelp, or by returning the Express Application in the postage paid envelope included with the letter.
These individuals will need to act by the deadline (tentatively January 4, 2019) to be enrolled through the Express Application.
All other adult Virginians who may be eligible for the new coverage can apply any time, starting in late fall 2018, via:
- Cover Virginia Call Center (855.242.8282)
- VDSS Enterprise Call Center
- Paper application, which can be submitted via mail or hand delivered to the local Department of Social Services (LDSS)
- In person at the LDSS (an appointment is likely necessary)
Virginia Becomes a "Determination State!"
Starting November 1, applications for Medicaid and FAMIS, including the new adult coverage, can be evaluated for enrollment by the federal Health Insurance Marketplace (healthcare.gov), in addition to the LDSS and Cover Virginia Call Center.
When someone applies for health insurance in the Marketplace, if it is possible to verify income and citizenship electronically, the Marketplace can determine if a person is eligible for Medicaid, FAMIS, or Marketplace coverage. In some cases, the applicant could receive a decision in "real time." After the Marketplace determines a Virginian's eligibility for Medicaid or FAMIS, the case will be sent back to Virginia to be enrolled, and ongoing case maintenance will occur at the enrollee's LDSS.
Individuals who have health insurance from the Health Insurance Marketplace (
) and a household income up to 138% FPL should go to their Healthcare.gov account during the 2019 Open Enrollment Period (
November 1 - December
) to update their account. If the individual is eligible for and is then enrolled in Medicaid, he or she must cancel Marketplace coverage in order to avoid being billed for a January 2019 premium, since the Marketplace automatically renews enrollees' coverage annually if the enrollee doesn't make any changes to his/her account during Open Enrollment.
Individuals who continue to be eligible for coverage through the Marketplace should be certain their Healthcare.gov accounts reflect up-to-date income and household information during Open Enrollment.
For help with Marketplace applications, click here to find a Navigator or Certified Application Counselor near you.
Want to know more about the new coverage? Come to a SignUpNow training!
teaches the "ins and outs" of the eligibility requirements, application procedures, and post-enrollment information for Virginia's state-sponsored health insurance programs:
- New adult coverage
- Programs for children and pregnant women
- Plan First
- Low Income Families with Children (LIFC) program
Been to SignUpNow before? This year's workshops will cover important information about the new health coverage, as well as updates to other state-sponsored health insurance programs (Medicaid/FAMIS). Please, join us!
workshops are FREE. Seating is limited, so register early! Workshop specifics and online registration are available on the SignUpNow website,
Revised Question on the Application
The new Application for Health Coverage & Help Paying Costs includes a new question!
Question #9 (for "Person 1") or Question #10 (for "Person 2" and "Additional Person") asks applicants:
- Do you need help with everyday things like bathing, dressing, walking or using the bathroom to live safely in your home? or
- Has a doctor or nurse told you that you have a physical disability or long term disease, mental or emotional illness, or addiction problem?
If applicants answer YES to either question, they will be screened by their Medicaid managed care organization (MCO) to verify that they meet the medically complex requirements for Virginia's Commonwealth Coordinated Care Plus (CCC+) program. CCC+ provides special care coordination services for people with complex medical needs, in addition to the benefits available to all Medicaid enrollees through the Medallion 4.0 program. All Virginia Medicaid enrollees, including CCC+ participants, can choose from the same 6 managed care organizations (MCOs), each of which serves the entire state.
Medicaid Dental Services for Adults
Dental services for most adults are limited to medically necessary emergency procedures. Comprehensive dental benefits, including preventive services, are available through age 20. Pregnant women also qualify for comprehensive dental services, except for orthodontics. For a full list of the benefits being offered, including dental, please see the Medallion 4.0 comparison chart at
A side by side comparison chart showing the Medicaid dental benefits offered through the Smiles For Children program and enhanced dental benefits available for adults in Medallion 4 and the CCC Plus program will soon be available on the DMAS website located at
under Dental Members.
CCC Plus health plans all offer the added adult dental benefit of at least one exam, cleaning and one set of x-rays once a year. For details, please see the added benefits, limits and rules listed here:
DMAS Marks "100 Days to Coverage"
On September 21, DMAS convened stakeholder groups, community-based organizations and state agencies for an interactive strategy session to provide participants with the tools to become champions for and a trusted source of information about the new coverage.
The event featured national communication experts, who shared their on-the-ground Medicaid expansion experience from other states. Governor Ralph Northam led a call to action and there were also remarks by Secretary Daniel Carey, DMAS Director Jennifer Lee, and VDSS Commissioner Duke Storen. Interactive break-out sessions provided participants the opportunity to share strategies on how to effectively reach key groups of newly eligible Virginians, including those living in rural communities, those for whom English is a Second Language, individuals with behavioral health needs, individuals with disabilities, and young adults.
Virginia Governor Ralph S. Northam addresses attendees of the "100 Days to Coverage" event
1:1 Application Assistance
One-on-one application assistance is available through the Virginia Health Care Foundation's
Project Connect program and ENROLL Virginia!.
- Project Connect Outreach Workers can help individuals and families apply for state-sponsored health insurance (Medicaid and FAMIS, including new adult coverage).
- ENROLL Virginia! Navigators can help Virginians apply for coverage on the Health Insurance Marketplace (healthcare.gov) and state-sponsored health insurance (Medicaid and FAMIS, including new adult coverage).
These assisters are also available to partner with community organizations to maximize enrollment in state-sponsored health insurance and Marketplace coverage.
In late October, Virginia will submit to the federal government an application to change some features of its Medicaid program for the new adult group. The application, known as "Creating Opportunities for Medicaid Participants to Achieve Self-Sufficiency" (
), includes provisions to:
- Implement a work and community engagement program in which participation is a condition of Medicaid eligibility for certain adults with income up to 138% FPL;
- Effectuate premiums, co-payments for non-emergency use of the emergency department (ED), and health and wellness accounts (HWAs) for certain adults with income between 100% and 138% FPL; and
- Create a new housing and employment supports benefit for high-need populations.
It is important to remember that anyone enrolled in the new adult coverage before the changes are approved would not be subject to these changes until his/her annual renewal date.
Virginia is offering the opportunity for comment on this application until October 20. For details about the application, or information about where and how to submit comments, please go to
October Enrollment in State-Sponsored Health Insurance
As of October 1, there were...
- 565,796 children enrolled in Medicaid (including the CHIP Medicaid Expansion)
- 70,942 children enrolled in FAMIS
- 1,166 women enrolled in FAMIS MOMS
- 1,139 young adults enrolled in Medicaid for Former Foster Care youth
- 16,171 pregnant women enrolled in Medicaid for Pregnant Women
- 116,026 adults enrolled in Medicaid for Low-Income Families with Children (LIFC)
- 136,916 adults enrolled in Plan First