CoverVAApplications
Applying for Cardinal Care
Virginia Cardinal Care (Medicaid and FAMIS) Application
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The Cardinal Care Application collects the information about you and your family that is needed to determine if you are eligible for Medicaid or FAMIS. Depending on your circumstances, you may need to include additional information with your application using one or more of the forms below.
Answering all questions and submitting the additional forms that are needed can help your application get processed more quickly. Application supplements and appendices are not standalone applications and must be submitted with a Virginia Cardinal Care Application.
Applying for More than Two People
Additional Person Single Page Supplement
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Submit an Additional Person Supplement with your Cardinal Care Application if have more than two people in your household. Information about all household members is needed, even if they are not applying for coverage. You cannot use this form by itself.
Applying for Someone with a Disability, Age 65 or Older, or Who Needs Long-Term Services and Supports
ABD-LTC Application – Appendix D
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Appendix D must be included with your application if someone applying for coverage is 65 or older, is eligible for Medicare, or has a disability. It is also needed when someone is applying for Medicaid coverage of Long-Term Services and Supports (also called Long-Term Care) and is 65 or older or Medicare eligible.
Nursing or Community Based Care – Appendix F
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Appendix F must be included with your application when someone applying for Medicaid coverage of Long-Term Services and Supports is between the ages of 19 and 64 and not yet Medicare eligible.
Applying for Medically Needy Coverage
Medically Needy Spenddown – Appendix E
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Individuals with income over the Medicaid limit, but who meet all other Medicaid requirements, may be eligible for time limited Medically Needy coverage. If an applicant is not eligible for full-benefit Medicaid and appears to meet the criteria for Medically Needy coverage, they will be asked to complete the Appendix E.
Help Collecting Information about Health Coverage from a Job
Employer Coverage Tool
[PDF] English | Spanish
This tool collects information about health coverage offered through a job. It can be given to any employer that offers health coverage to you or someone else in your household. Once completed, you should use the information to fill out Appendix A of your Application or Renewal. Only individuals who are able to enroll in health coverage through their a job need to complete Appendix A.
Already Enrolled in Medicaid or FAMIS and Applying for Help Paying Private Health Insurance Premiums
HIPP Application
[PDF] English
FAMIS Select Application
[PDF] English | Spanish
The Medicaid Health Insurance Premium Payment (HIPP) and FAMIS Select programs help families pay for employer health insurance. Eligible families can choose between these premium assistance programs and enrollment in full Medicaid or FAMIS. Families with an offer of employer-sponsored health insurance who would like premium assistance can complete the HIPP application (if enrolled in Medicaid) or the FAMIS Select application (if enrolled in FAMIS). Learn more Premium Assistance Programs at Premium Assistance | CoverVA.