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Medical Assistance Programs in Virginia

For many low-income households in Virginia, paying for medical coverage can be very difficult. An inability to pay for medical coverage is very serious, since even minor medical emergencies can cost several thousand dollars. For parents, it becomes even more of a concern, since they have to worry about medical coverage for both their children and themselves. Fortunately, Virginia has several different medical assistance programs available.

Eligibility for medical assistance programs in Virginia vary slightly depending on the program. However, two of the biggest contributing factors are the size of a household and the total income of a family. In addition, age can be a contributing factor for several medical assistance programs. Some of the more widely accessed programs, such as Medicaid and Chip, are federally-funded programs and administered in Virginia through various human services departments and health care clinics. The following is a list of the more popular medical assistance programs in Virginia and how to qualify for them.

Medicaid in Virginia

Medicaid is a federally-funded program, but each state has options on how Medicaid is run. The overall purpose of Medicaid is to provide medical assistance for low-income families in Virginia. Virginia did not accept the Medicaid expansion when it was offered through the Affordable Care Act in 2013. This decision impacts how much coverage is available in VA compared to other states.

The income requirements vary for Medicaid coverage in Virginia. Certain factors like whether an applicant is pregnant, has children, is younger than 21 years of age and in foster care, disabled or at least 65 years old can affect income limits.

Anyone who is eligible for Medicaid is accepted into the program without having to pay any type of enrollment fee or premium for services. However, some Medicaid services do have very small co-pays associated with them. For many low-income households, Medicaid is the only way they can meet the insurance requirements of the Affordable Care Act.

Medicare in Virginia

Due to the similar names, Medicare is often mistakenly confused with Medicaid. While both are medical assistance programs, they have very different purposes. Medicare is meant for beneficiaries that are at least 65 years old or beneficiaries with certain disabilities. Medicare is divided into four separate parts, known as Part A, B, C and D. Part A covers hospital insurance, Part B is for medical insurance, C is a mixture of the two previous plans and D is for prescription drugs.

Beneficiaries are allowed to have multiple plans based on their medical needs. Because of that, some of the parts share some crossover, since the government wants to ensure that beneficiaries receive basic coverage no matter which plan they choose. The costs vary with each plan, with Part A often being seen as the most affordable. Many beneficiaries receive Part A coverage for free, since it is available without cost for beneficiaries that have paid Medicare taxes for at least 10 years.

Virginia Children’s Health Insurance Program (CHIP)

CHIP is another federal medical assistance program. The program is available for both children and teenagers. CHIP is very important for parents who have their own insurance plan, but are unable to apply that insurance plan to their children and cannot afford a separate plan. It is not uncommon for parents to be ineligible for low-income medical assistance for themselves, but still able to get it for their children.

In most situations, parents will not have to pay anything for CHIP coverage. In some instances, there may be some small monthly costs depending on the financial situation of the applicant. CHIP coverage applies to beneficiaries until they turn 19.

Virginia FAMIS

FAMIS is a Virginia specific medical assistance program. FAMIS offers services similar to CHIP. This program is available to any applicants under the age of 19. State employees have the option of automatically enrolling their children into FAMIS. FAMIS uses slightly different income requirements compared to CHIP, and it is meant as an alternative for households that are not eligible for CHIP but still need medical assistance.

There is another variant of the program available, known as FAMIS MOMS. The MOMS variant is intended for pregnant women who do not have health insurance. While they are pregnant, beneficiaries receive insurance coverage for the medical services their pregnancies requires. This includes prenatal and delivery services as well. There are no monthly payments, and the co-pays are usually just a few dollars.

Virginia Newborn Child Under Age One

This medical assistance program is available to parents who were eligible for Medicaid coverage upon giving birth. As the name implies, the program provides insurance coverage for any newborn children, up until they turn one-year old. It may actually be possible to extend the coverage after the child has turned one, but it depends on the financial situation of his or her parents. Shortly before the child turns one, his or her parents will receive an application to continue the coverage.

Virginia Plan First

Plan First is another medical assistance program that is only available in Virginia. The program helps provide birth control as well as family planning services for applicants that are unable to qualify for Medicaid coverage.

Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) in Virginia

In Virginia, the BCCPTA is referred to as Every Woman’s Life. This medical assistance program offers long-term care for any beneficiaries that have breast or cervical cancer. It is important to note that BCCPTA only applies to applicants that have already been diagnosed with breast or cervical cancer. It is not a pre-screening program.