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

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Virginia program

Free coverage for an uninsured child (FAMIS)

FAMIS covers children whose families earn too much for ordinary Medicaid and who have no insurance.

What it is

FAMIS covers children whose families earn too much for ordinary Medicaid and who have no insurance.

The same CommonHelp application checks Medicaid before FAMIS. FAMIS is free for covered care. Having an offer of work insurance is different from already having coverage.

Eligibility rules
  • Children qualify from birth through age 18. An employer offer alone does not count as existing insurance.
  • Effective January 13, 2026, the published FAMIS monthly columns are $5,500 before the allowance and $5,638 with it for four people; for three they are $4,554 and $4,668. There is no premium tier above this ceiling.
  • The published ceiling is 200% of poverty before the five-point allowance.
What you get
  • No premiums, copays or deductibles for covered services.
  • Health coverage for an eligible uninsured child.
What the rules cover
  • Children in managed-care FAMIS do not receive the full Medicaid EPSDT benefit guarantee. Temporary fee-for-service FAMIS has different EPSDT rules.
If you decide to apply
  1. Ask the hospital financial counselor to help with CommonHelp and screening for both child programs.
  2. Have current income and any insurance end dates ready, and check which plans your oncology team accepts.

The local Department of Social Services, after the Medicaid screen · Official page ↗

If you decide to apply
  • There is no waiting period for a child who was uninsured. Once approved, coverage lasts 12 months.
  • Retroactive FAMIS coverage is limited to newborns born in the three months before the application month. Virginia publishes two months from January 2027.
Good to know

FAMIS generally cannot sit beside other insurance your child already has.

Other details
  • There is no paid tier above the FAMIS line. FAMIS Select is a different option for a child already found eligible: the state pays toward a work plan instead. FAMIS does not cover bills from before you applied.

Federal background: CHIP

Official sources
Ask your social worker

“If Medicaid is not available, could FAMIS cover our child? How would it affect treatment access, and could you help with the same application?”

Why I’m asking: I want to understand the next coverage option without creating a gap in treatment.

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

Use the same application as Medicaid and say the child has no insurance.

Your social worker

The social worker checks the child was screened for Medicaid first, because Medicaid gives more.

The care team

Records and letters when the application asks for them.

Who decides
The local Department of Social Services
Ask your social worker
“Our child has no insurance. Can the one application screen for Medicaid first and then for the state child plan, and can you tell me which health plan the oncology group takes?”

How to apply

First step: File the same CommonHelp application as Medicaid and state that the child has no insurance.

  1. File the one CommonHelp application; it screens Medicaid first and this next.
  2. Say plainly that the child has no insurance.

Official application / program page ↗

Where it starts: The same CommonHelp application as Medicaid. Ask for the child to be screened for both.

What to gather

  • Your child's identity document and Social Security number
  • This month's income
  • Proof that any old insurance ended and when

How long: The same agency standards as Medicaid: 45 calendar days ordinarily.

What a yes looks like

An enrolment notice and a health plan card, with 12 months of protected coverage. Check the oncology group is in that plan.

What a no looks like, and the next move

If the reason is that the child has insurance, ask what happens when that plan ends. If the reason is income, ask about the medically needy spend-down route for a child under 18.

Watch out

  • Being offered a work plan is not the same as having one; an offer alone does not shut this door.
  • A child in the managed-care version does not get the Medicaid children's benefit guarantee; a child on temporary fee-for-service does. Ask which one your child is in.
  • Nothing was published about buying in above the ceiling, so do not count on it.

The numbers and the rules

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

What it is worth

Free cover with no premiums, copayments or deductibles for covered services. Limit $5,500 a month for four, $5,638 on the column with the allowance.

  • $5,500/month — Income limit, home of 4, published base column
  • $5,638/month — Income limit, home of 4, with the allowance
  • $4,554/month — Income limit, home of 3, published base column
  • $4,668/month — Income limit, home of 3, with the allowance
  • $0/month — Monthly premiums, copayments and deductibles for covered services

Covers: Doctor and hospital care · Chemotherapy and prescriptions · Dental and vision · Rides to appointments through the health plan

What it costs the family: None for covered services.

The eligibility facts, as published

Age
birth through 18
Age max exclusive
19
Income
above the Medicaid line and at or below the published 200% of poverty cell, with a 5-point disregard column
Insurance status condition
only an uninsured child is eligible; an employer offer alone is not coverage
Waiting period
none since July 3, 2014
Continuous eligibility
12 months
Retroactive
newborn only (a child born in the three months before the application month); the state has published a cut to two months in 2027

Decisions this site cannot make: Local Department of Social Services determination after the Medicaid screen

The trap: An offer of a work plan is not the same as being covered by one. A child who is offered but not enrolled can still be an uninsured child for this programme.

Where I read this

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