Written by a parent, not a doctor. Nothing here is medical advice.

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Virginia program

Free health insurance for your child (Virginia Medicaid)

Virginia's free Medicaid plan for children under 19. It can sit behind your work insurance.

What it is

Virginia's free Medicaid plan for children under 19. It can sit behind your work insurance.

A drop in pay can open this coverage while treatment continues. Virginia checks your child’s household and current income. Your work plan pays first if your child has both.

Eligibility rules
  • Your child must be under 19 and live in Virginia. The agency decides the tax household and which income counts.
  • Current monthly income is the test. A yearly figure divided by 12 is only an estimate.
  • The line is about $4,070 a month for four people and $3,370 for three, once the state's allowance is included.
  • The five-point income allowance applies when it changes the eligibility answer.
If your child has work insurance
  • The work plan is billed first. Medicaid can cover eligible care behind it.
  • Keeping both involves the work premium and two insurers to manage.
Before changing coverage
  • Your financial counselor can compare the exact Medicaid plan with the oncology team, hospital, pharmacy and treatment.
  • Your employer can explain what removing a child would save and when coverage could be added again.
What you get
  • No premium or copays for your child’s covered care.
  • Hospital care, cancer treatment, medicines and tests.
  • Rides to covered appointments, with a separate assessment for nursing at home.
What the rules cover
  • Your work plan is billed first. For covered care, the clinic cannot bill you the deductible or copay the work plan left, even when Medicaid pays nothing extra. If a bill arrives anyway, ask the financial counselor to check it before paying.
  • Nursing at home needs a separate care assessment. A cancer diagnosis alone does not establish nursing eligibility.
  • For illustration, suppose covered care has a $5,000 work-plan allowed amount and a $3,000 unmet deductible. The work plan pays $2,000. If Medicaid allows $1,200, its secondary payment can be $0 because the work plan already paid more. For the protected service described above, your child still owes $0. These assumed amounts illustrate the billing rule; they are not a fee schedule.
If you decide to apply
  1. Ask the hospital financial counselor for help with CommonHelp, using current income and insurance details.
  2. Bring earlier bills and the months they cover. Ask which Cardinal Care plans your oncology team accepts.

The local Department of Social Services decides; the state Department of Medical Assistance Services and the Cardinal Care health plan you pick run the coverage · Official page ↗

If you decide to apply
  • The published application decision standard is 45 calendar days, or 90 when a disability determination is needed. Those are processing standards, not the date care starts; urgent coverage is worth raising with the hospital rather than waiting.
  • A qualified participating hospital can assess temporary Medicaid using preliminary information. Without a full application by the end of the following month, temporary coverage normally ends then. With a timely full application, it lasts through the agency’s decision. Your financial counselor can confirm whether the hospital participates and the actual coverage dates.
  • Eligible bills from up to three months before the application month can be covered through 2026. Virginia publishes a two-month window for children from January 1, 2027.
  • Children generally keep coverage for 12 months once approved, subject to exceptions including turning 19.
Good to know

Your child can have Medicaid and work insurance together. The work plan is billed first.

Other details
  • Keeping both plans means keeping the work-plan premium and managing two insurers.
  • Before any coverage change, you can compare the exact plan with your child’s hospital, oncology team, pharmacy and treatment.

Federal background: Medicaid · Medicaid as second insurance

Official sources
Ask your social worker

“Could Medicaid lower our treatment bills while we keep work insurance? What would managing both involve, and could you help us apply if it makes sense?”

Why I’m asking: I want to understand which treatment bills Medicaid could cover and how two plans would work.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

An application uses current income, insurance details and earlier bills. The counselor can help compare plans accepted by the oncology team.

Your social worker

The oncology social worker or financial counsellor helps you file, asks the hospital about temporary Medicaid, and chases the decision.

The care team

Nothing for ordinary child Medicaid. Records are needed only for the waiver route.

Who decides
The local Department of Social Services checks income; the state runs the coverage through a Cardinal Care health plan.
Ask your social worker
“Could you help us decide whether to request Medicaid and a hospital assessment for temporary coverage?”

How to apply

First step: Your hospital social worker can discuss whether a CommonHelp application and temporary hospital coverage are useful, which income documents are needed and which earlier bills to include.

  1. Your hospital social worker can discuss whether a CommonHelp application and temporary hospital coverage are useful, which income documents are needed and which earlier bills to include.
  2. List the months that already have bills so the look-back covers the admission.
  3. Pick a Cardinal Care plan the hospital and the oncology group take.

Official application / program page ↗

Where it starts: CommonHelp and Cover Virginia at 1-855-242-8282 accept applications. Your hospital counselor can explain whether the hospital participates in temporary Medicaid assessments.

What to gather

  • Your child's birth certificate or identity document and Social Security number
  • A Virginia address
  • This month's income for each parent in the tax household
  • Insurance cards, if any
  • Hospital bills from the three months before you apply

How long: The manual gives 45 calendar days, or 90 when a disability decision is needed, and says long-term-care and emergent cases get priority. These are published standards, not measured waits.

What a yes looks like

A written notice with coverage dates and a choice of Cardinal Care health plan. Check the hospital and the oncology group are in that plan before choosing. Then 12 months of protected coverage.

What a no looks like, and the next move

Read whether the reason was income, a document or the covered group. If it is income, ask in the same application about FAMIS, and about the waiver route if your child needs hospital-level care at home. Appeal by the date on the notice.

Watch out

  • Virginia counts the tax household and this month's income, not last year's return.
  • Your child can keep work insurance with Medicaid. The counselor can compare premiums, treatment access and billing before any change.
  • Ask for the three months before the application month to be looked at; that window shrinks to two months in 2027.

Dates that change this

2026-01-13: The income limits are the 2026 guidelines dated January 13, 2026. The next Virginia update date was not published, so this is not a promised annual anniversary.

2027-01-01: Coverage reaches back up to three months before the month you apply. The state has published a cut to two months for applications from January 1, 2027.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full Medicaid with no premium and no child copays. For four people the limit is $3,933 a month, $4,070 on the column with the 5-point allowance.

  • $3,933/month — Income limit, home of 4, published base column
  • $4,070/month — Income limit, home of 4, published column that includes the 5-point allowance
  • $3,256/month — Income limit, home of 3, published base column
  • $3,370/month — Income limit, home of 3, with the allowance
  • $2,669/month — Income limit, home of 2, with the allowance
  • $4,771/month — Income limit, home of 5, with the allowance
  • $12 — Months of protected coverage once approved

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Anything medically necessary for a child under 21 (the children's benefit guarantee) · Private duty nursing and personal care when approved · Rides to appointments · Dental and vision

What it costs the family: No premium. No copays for a child.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
the published 143% of poverty monthly cell, with a 5-point disregard column the agency applies when it changes the answer; one limit for all three age bands
Insurance status condition
none: other insurance is billed first and Medicaid pays behind it
Residency
Virginia
Continuous eligibility
12 months
Retroactive months
3 now; the state has published 2 from 2027-01-01 for non-expansion groups
Processing standard
45 calendar days ordinarily, 90 when a disability determination is needed; long-term-care and emergent cases get priority

Decisions this site cannot make: Local Department of Social Services income determination · Hospital presumptive eligibility at an approved hospital

Expect friction on: Choosing a Cardinal Care health plan the oncology group takes

The trap: Your child can keep work insurance with Medicaid. The counselor can compare premiums, treatment access and billing before any change.

Where I read this

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