What Makes You Eligible to be a Member?

When you apply for Medical Assistance, you are screened for all possible programs based on your age, income, and other information. To be eligible for a Medical Assistance Program, you must meet the financial and non-financial eligibility conditions for that program. Please visit the Virginia Department of Social Services’ (VDSS) Medicaid Program page for eligibility details and/or the VDSS Medicaid Forms and Applications page for an application or other Medicaid form details.

You are eligible for Managed Care when you have full Medicaid benefits, and meet one of the following categories:

  • Children under age 21
  • Foster Care or Adoption Assistance Child under age 26
  • Pregnant women including two months post-delivery
  • Parent Caretakers

Medicaid eligible persons who do not meet certain exclusion criteria must participate in the program. Enrollment is not a guarantee of continuing eligibility for services and benefits under the Virginia Medical Assistance Services Program.

Medicaid Expansion

Are you one of 400,000 Virginians newly eligible for Medicaid?

Beginning January 1, 2019, thousands of Virginians between the ages of 19-64 will be able to get the health care they need at little to no cost.

You may be eligible if:

  • You are a Virginia resident, age 19 to 64
  • You are enrolled in a low cost individual health insurance plan on the federal exchange, or
  • You meet the income requirements

We are referring to those covered by these new regulations as Optima Health Medicaid XP eligible. Optima Health Medicaid XP is not a health plan. Please check our Frequently Asked Questions for more information.

Open Enrollment

Open Enrollment in Optima Family Care is currently available for Medicaid Medallion 4.0 members in the following region(s):

  • Central region: April 19, 2019 – June 30, 2019
  • Northern region: June 19, 2019 – August 31, 2019

This is your chance to switch to Optima Family Care.

Get Started   Check Eligibility

Optima Family Care