Medicaid for children
What services does Medicaid for children cover?
Medicaid for children covers these services:
- Dental care
- Doctor visits
- Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program for children (comprehensive preventive and treatment services)
- Emergency care
- Hospital visits
- Mental health care
- Prescription medicine
- Tests and X-rays
- Vaccinations
- Vision care
- Well-baby check-ups
- Well-child check-ups
Children with disabilities may qualify for additional Medicaid services. It can be hard for families to know how to get services for children with disabilities. In Virginia, most families get services for children from these state agencies:
- The local department of social services (DSS)
- The Department of Medical Assistance Services (Medicaid)
- The local Department of Health
The local Community Services Board (CSB) or local Department of Health screens the child. This screening helps you learn what Medicaid waiver services are right for your child.
To find out if a child qualifies for one of the Developmental Disability Waivers, ask your local CSB for a screening.
Remember:
- When a child is approved for waiver services, only the child’s income is counted. Parent income is never counted for Medicaid Waiver eligibility.
- The child’s Medicaid eligibility must be reviewed every 12 months.
- The child must have a disability determination completed by Disability Determination Services (Social Security) before age 18.
- The child’s level of care must be reviewed yearly to make sure the child still qualifies for waiver services.
What are the income limits?
| Household size | Yearly | Monthly |
|---|---|---|
| 1 | $22,289 | $1,858 |
| 2 | $30,252 | $2,521 |
| 3 | $38,214 | $3,185 |
| 4 | $46,176 | $3,848 |
| 5 | $54,139 | $4,512 |
| 6 | $62,101 | $5,176 |
| 7 | $70,064 | $5,839 |
| 8 | $78,026 | $6,503 |
| Each additional | $7,963 | $664 |
*Includes 5% FPL Disregard
2024 Income Guidelines as of January 17, 2024
*Children with higher income may still be eligible for FAMIS
Former Foster Care Youth – No Income Requirement
Medicaid coverage is available to eligible former foster care youth who were receiving Medicaid and foster care services at the time of their 18th birthday and are under age 26. The coverage has no income requirement
How do you apply?
If you think your children qualify, go to Apply.
For more eligibility assistance, use the screening tool at Am I Eligible? Eligibility for health coverage is based on income plus other factors. This tool screens for income only. You may qualify for coverage based on other things like age or disability. To get a full review, you need to apply.
Learn more about how to appeal a decision at Appeals.
Where to learn more about Medicaid for children
FAMIS Brochure
[PDF] English | Spanish | Arabic | Amharic | Urdu | Vietnamese
FAMIS Flyer
[PDF] English | Spanish | English/Spanish | Amharic | Arabic | Urdu | Vietnamese
Medicaid Members Handbook