What Makes You Eligible to be a Member?

When you apply for Medicaid health benefits through Virginia, either for yourself or your child, you will automatically be screened for all possible programs based on your age, income, and other criteria. The information below can help you determine whether or not you may be eligible.

Eligibility For Children

Your child may be eligible for Optima Family Care if they:

  • Live in Virginia
  • Are under age 19
  • Are United States citizens or lawfully residing immigrants
  • Live in a family meeting FAMIS income guidelines

To find out if your child qualifies for Optima Family Care, use the online screening tool.

If you think your child may qualify, you can submit their application by phone or online:

  1. Call Cover Virginia at 1-855-242-8282, or 
  2. Apply online at commonhelp.virginia.gov

Eligibility For Adults

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

You may be eligible for Optima Health Medicaid XP 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 make less than the income listed below based on your household size:

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

Eligibility For Pregnant Women

Pregnant women who are uninsured and do not meet the low-income requirements to qualify for Medicaid may still be eligible for benefits through Optima Family Care.

You may already be eligible for other Medicaid programs that offer limited benefits. Visit the Cover Virginia website to see if you qualify.

You Can Apply For Medicaid Any Time

If you are new to Medicaid, you can apply to enroll in Optima Family Care any time of the year. If you qualify, your benefits will start the first day of the month that you apply and enroll.

Open Enrollment

Open enrollment in Optima Family Care will be available for Medallion 4.0 Non-Expansion members in the following regions:

  • Central: April 19, 2021 – June 30, 2021
  • Northern/Winchester: June 19, 2021 – August 31, 2021

This is your chance to switch to Optima Family Care.

Get Started   Check Eligibility

Optima Family Care