Medicaid
Medicaid pays for health and medical care for certain groups of people who have low income. Local departments of Social Services collect applications and determine individual eligibility.
Eligibility for Medicaid is based on individual circumstances and determined after the application process has been completed.
Applications can be completed in one of three ways:
- Online at CommonHelp.Virginia.gov
- In person at our offices at 3432 Virginia Beach Blvd. or our satellite location at the Housing Resource Center, 104 N. Witchduck Rd., Suite 316.
- Over the phone at (855) 635-4370
- Call (757) 385-4306 and request a paper application be mailed to your home, then return the application to our offices 3432 Virginia Beach Blvd. or at the Housing Resource Center, 104 N. Witchduck Rd., Suite 316
Medicaid Programs
Individuals with low income who belong to one of the groups described below may be eligible for either full or limited Medicaid benefits.
- Adults between the ages of 19 and 64 who are not Medicare eligible with income less than 138% of the federal poverty level, (MAGI)
- Pregnant women - Once eligible for Medicaid, pregnant women remain eligible throughout the pregnancy and up to 60 days after the pregnancy ends OR 12 months postpartum
- Children younger than age 19
- Pregnant women or children under 19 who are under 200% of the federal poverty level may be eligible for FAMIS
- Children under age 21 who are in foster care or subsidized adoptions
- Infants born to Medicaid-eligible women may remain eligible until their first birthday
- Individuals who are 65 or older, blind or have been declared disabled by Social Security
- Individuals residing in Long Term Care Facilities, or receiving nursing care in their homes
- Hospice
There are several Medical Assistance Programs offered in Virginia. Each program covers different groups of people and each program has different eligibility requirements. When you apply for Medical Assistance, you are screened for all possible programs based on your age, income, financial resources, and other information.
To be eligible for a Medical Assistance Program, you must meet the financial and non-financial eligibility conditions for that program.
HIPP is a federal requirement that all Medicaid-eligible individuals able to enroll in a cost-effective private health insurance plan through their employer do so. The HIPP program will pay the employee's share of the premium. Individuals who do not enroll will lose their Medicaid benefits.
The Department of Medical Assistance Services (DMAS) HIPP Unit will evaluate every plan offered to the employee to determine whether the plan is cost-effective; that is, if it would cost less to buy health insurance to cover medical care or to pay for the care with Medicaid funds.
Applying for HIPP
If you or family members are employed and have access to group health insurance, you are required to complete a HIPP application. Your eligibility worker will forward the application to the Department of Medical Assistance Services (DMAS).
You will also be given an Employer Insurance Verification Form, which you are required to give to your employer to complete. The employer must return the completed form to the HIPP Unit at DMAS.
Medicaid will still cover the Medicaid-eligible members of your family as a secondary plan. Medicaid will pay for some services not covered by the insurance including co-pays and deductibles.
Employer Insurance versus Medicaid
The insurance may cover services not covered by Medicaid. Members of your family that are not covered by Medicaid may be covered under the employer's insurance plan. Continued enrollment in private health insurance can help meet your pre-existing waiting periods, deductibles, and out of pocket expenses for the time when you will no longer be covered by Medicaid.
If you lose your Medicaid eligibility, you may pay the premiums yourself and keep the private insurance. Using private health insurance helps lower costs to the Medicaid program.
Your Responsibilities under HIPP
Any changes in employment, insurance coverage, or household must be reported to DMAS immediately. Every month, you will be required to send DMAS a copy of your most recent paycheck showing the insurance premium deduction. Incorrect payments will be recovered.
To report changes or if you have questions, call HIPP at (800) 432-5924.
For additional information, contact Phillip White (757) 385-3603
Auxiliary Grants provide financial assistance for individuals receiving Supplemental Security Income and certain other aged, blind or disabled individuals who are entering or already living in certain licensed or approved facilities that accept auxiliary grant payments.
Who is eligible?
- Be 65 or over, blind or have another disability
- Reside in a licensed assisted living facility, supportive housing setting or approved adult foster care home
- Be a resident of Virginia for at least 90 days with the intent to remain in Virginia
- Be a citizen of the U.S. or an alien who meets specified criteria
- Have a monthly income less than the approved Auxiliary Grant rate
- Have assets of less than $2,000 for one person or $3,000 for a couple
- Have been assessed by an approved evaluator
For more information, please contact the Department of Human Services at (757) 385-4306.