You can apply for Virginia Medicaid three ways: online through CommonHelp, by phone with Cover Virginia at 1-855-242-8282, or in person at your local Virginia DSS office. This guide walks through each channel, the documents to gather, what happens after you submit, how long a decision takes, and how to appeal a denial.

In This Guide

How to Apply for Virginia Medicaid Online Through CommonHelp

CommonHelp is Virginia's self-service portal for Medicaid and other benefits. Go to commonhelp.virginia.gov and select "Apply for Benefits." You can create an account, which lets you save your progress, upload documents, and check status later, or apply as a guest.

The online application asks about your household, income, assets, and any current health coverage. Once submitted, it routes to your local DSS for processing.

CommonHelp is the fastest path for community Medicaid, the coverage for adults and seniors who are not seeking nursing-facility or waiver care. Long-term care applicants can also start here, but the application then triggers the separate level-of-care screening described below.

Apply by Phone Through Cover Virginia

Cover Virginia is the state's central call center for Medicaid enrollment. Call 1-855-242-8282 and a representative can take your application over the phone, answer eligibility questions, and tell you which documents you will need. Phone is a good option if you would rather not fill out the online form yourself or if you have questions about which program fits your situation.

Cover Virginia can also help you check on an application already in progress and connect you to your local DSS.

How to Apply for Virginia Medicaid in Person at Your Local DSS

Every Virginia city and county runs a local Department of Social Services (DSS) office, where you can apply in person for Cardinal Care. Staff there process Medicaid applications and can help you complete the paperwork on the spot, including the long-term care application. Applying in person is often the most practical route for nursing-facility and waiver cases, where a caseworker can explain the asset, income, and transfer rules face to face.

To apply in person, bring the documents listed below. If you cannot get to the office, a family member or someone you authorize in writing can apply on your behalf.

What Happens After You Apply

Once your application reaches your local DSS, a caseworker reviews it in a set order.

1
Step 1

Financial determination

The caseworker verifies your income and countable assets against the program limits. For long-term care, a single applicant must have no more than $2,000 in countable assets in 2026, and a couple living in the same household is limited to $3,000. If one spouse enters a nursing facility while the other stays home, that couple limit does not apply: the case goes under Virginia's spousal impoverishment rules instead, which let the community spouse keep countable resources between $32,532 and $162,660. The home (up to the federal home-equity limit, which for 2026 is $752,000 unless the state elects a higher amount, up to $1,130,000), one vehicle, household goods, and a prepaid burial are exempt. If your income is over the $2,982 per month long-term care standard, Virginia's medically needy rules let you spend the excess down on medical and care costs, down to the state's medically needy income limit for one person: $421.94, $485.58, or $631.26 per month depending on your locality group, effective July 1, 2026. That spend-down route is available for nursing-facility care, the CCC Plus Waiver, and PACE, and not for the three developmental disability waivers. The caseworker also reviews any asset transfers in the 60-month look-back for gifts or below-market sales, which can create a penalty period.

2
Step 2

Level-of-care screening (long-term care only)

If you are applying for nursing-facility or waiver coverage, you must also meet a functional standard. A screening team assesses whether you need that level of care. This is separate from the financial review, and both have to clear before long-term care coverage starts.

3
Step 3

Managed care enrollment

Most Virginia Medicaid members receive care through Cardinal Care managed care plans. After approval, you are enrolled in a health plan, and in most cases you can choose among the available plans in your area.

4
Step 4

Personal needs allowance

A Medicaid-eligible nursing-facility resident contributes nearly all monthly income toward the cost of care but keeps a personal needs allowance of $40 per month for an aged, blind, or disabled individual ($60 for a couple), plus, for a married resident, a monthly income allowance for the community spouse.

How Long a Virginia Medicaid Application Takes

Federal Medicaid rules set the outside limit on how long the state can take to decide. Under 42 CFR 435.912, titled "Timely determination of eligibility," the determination may not exceed 45 days for most applicants and 90 days for applications based on disability. Read that as a ceiling on the agency rather than a guaranteed turnaround: it is the longest the state may take, not the date your answer arrives. The rule allows the state to exceed it in unusual circumstances, such as where the delay is caused by the applicant or an examining physician, or by an administrative or other emergency beyond the agency's control. Once the community engagement requirement is live, a third exception applies where the agency cannot meet the standard because an applicant who was sent a notice of noncompliance has a 30-calendar day period to respond.

In practice, a straightforward community Medicaid case is often decided well inside the 45-day window, while a long-term care application runs longer. Long-term care cases require both the financial determination and the separate level-of-care screening, and a request for a missing document pauses the clock until you respond. The single biggest lever you control is turning around any document request quickly: a delayed verification is the most common reason a decision slips past the federal window.

Eligibility decisions generally arrive by mail. If you have not heard back within the expected window, call Cover Virginia or your local DSS for a status update.

Why the Date You Apply Matters

Your application date sets the start of your coverage window, which is why you should apply as soon as you think you may qualify rather than waiting for a decision. Federal law requires Virginia Medicaid to cover eligible services furnished in the three months before the month you apply, if you would have qualified then, so unpaid medical and care bills from that window can be covered retroactively once you are approved.

That three-month window is about to shrink. Section 71112 of Public Law 119-21 shortens retroactive coverage for applications filed on or after January 1, 2027: at most two months before the application month for most enrollees, and one month for adults covered under the ACA expansion group. If you already have unpaid bills and you are close to filing, filing before the end of 2026 preserves the longer window.

This retroactive back-coverage is one reason not to delay a long-term care application while gathering paperwork. You can submit and supplement the file as documents come in, and the earlier application date preserves more of the back-coverage window.

If Your Virginia Medicaid Application Is Denied

A denial notice will state the reason and explain your appeal rights. If you disagree, you can request a fair hearing, which is an appeal. Federal rules cap how long a state's request window may run at 90 days from the date the notice is mailed. That 90 days is a ceiling on the state's window, not a deadline you are guaranteed, and a state may set a shorter one.

Virginia's deadline is 30 days, not 90. Under 12VAC30-110-160, a Request for Appeal must be filed with the DMAS Appeals Division within 30 days of your receipt of the notice of action or adverse determination. The trigger is receipt rather than mailing, and Virginia presumes you received the notice five days after the agency mailed it unless you show otherwise, so start from the mailing date printed on your notice, add five days, and count 30 from there. You can file through the AIMS portal, by email to appeals@dmas.virginia.gov, by fax to (804) 452-5454, by phone at (804) 371-8488, or by mail or in person to the Appeals Division, 600 E. Broad Street, Richmond, VA 23219.

Two other Virginia windows exist, and neither is your application-denial deadline. If you are already enrolled and a Cardinal Care managed care plan denied, reduced, or ended a service, you must exhaust that plan's one internal appeal first: 60 days from the date of the plan's adverse benefit determination notice to request it, then 120 days from receiving the plan's decision to request a DMAS fair hearing. And if you are appealing a termination or reduction of coverage you already have, filing before the effective date printed on the notice is what keeps your benefits running while the appeal is decided, a deadline that usually falls earlier than the 30-day filing window.

Common reasons for denial include income or assets over the limit, a transfer penalty from the look-back review, missing documents, or a missed verification deadline. Many denials are procedural rather than substantive, meaning the applicant did not return a requested document in time. If that is what happened, respond to the request right away and ask your DSS caseworker how to proceed.

At the hearing, you can present documents and explain your situation, and you may bring a representative or attorney. If the denial turned on a financial or transfer issue, an elder law attorney or your local Area Agency on Aging can tell you quickly whether the decision was correct.

Where to Apply and Get Help

Use whichever channel fits your situation. All three feed the same local DSS review.

Virginia CommonHelp Online self-service portal to apply, upload documents, and check status. commonhelp.virginia.gov
Cover Virginia Central call center that can take your application by phone and answer eligibility questions. 1-855-242-8282 coverva.dmas.virginia.gov
Your Local Department of Social Services Apply in person for Cardinal Care, including long-term care cases where a caseworker walks you through the paperwork. www.dss.virginia.gov
Virginia Department of Medical Assistance Services (DMAS) State Medicaid agency that oversees Cardinal Care and its managed care plans. www.dmas.virginia.gov

Documents to Gather Before You Apply

Having paperwork ready prevents the most common cause of delay. Gather these before you start any channel:

Identity and citizenship:

  • Your Social Security number
  • Proof of U.S. citizenship or qualifying immigration status (a passport or birth certificate works); already being on Medicare counts as proof of citizenship
  • A Virginia driver's license or state ID

Income:

  • An SSA-1099 or benefit award letter
  • Pension and retirement income statements
  • Recent pay stubs if anyone in the household is working

Assets:

  • Recent bank statements for all checking and savings accounts
  • Statements for retirement accounts, CDs, stocks, and bonds
  • Life insurance policies (face value and cash surrender value)

For long-term care applicants:

  • Records of any gifts or property transfers in the past five years, for the 60-month look-back review
  • Property deeds and recent tax bills
  • Prepaid burial or funeral contracts

Frequently Asked Questions

How do I apply for Virginia Medicaid long-term care?

Start an application online through CommonHelp, by phone with Cover Virginia at 1-855-242-8282, or in person at your local DSS. Long-term care applicants go through both a financial determination and a separate level-of-care screening, so applying in person at your DSS is often the most practical route for nursing-facility and waiver cases.

What are the income and asset limits to apply for Virginia Medicaid?

For long-term care in 2026, the income standard is $2,982 per month and the countable asset limit is $2,000 for one person and $3,000 for a couple living in the same household. If one spouse is entering a nursing facility and the other stays in the community, the couple limit does not apply and the spousal impoverishment rules govern instead. Virginia is a medically needy state, so an applicant over the income standard can still qualify by spending excess income down on medical and care costs, for nursing-facility care, the CCC Plus Waiver, or PACE.

Do I need a Miller Trust to qualify in Virginia?

Virginia's eligibility rules route an applicant whose income is over the cap to a medically needy spend-down rather than to a trust. You incur medical and care costs down to Virginia's medically needy income limit, which for one person is $421.94, $485.58, or $631.26 per month depending on your locality group, effective July 1, 2026. That route covers nursing-facility care, the CCC Plus Waiver, and PACE. Ask your DSS caseworker to confirm what applies to your case before you set up any trust.

How long does it take to get a decision?

Federal rules cap how long the agency may take at 45 days for most applicants and 90 days for applications based on disability, and that cap binds the agency rather than guaranteeing you a decision by then. Community Medicaid is generally decided faster than long-term care, which requires a level-of-care screening in addition to the financial review and can run longer if a document request pauses the clock.

Can someone else apply on my behalf?

Yes. A family member, friend, or an authorized representative you designate in writing can submit the application, provide documents, and follow up with your DSS or Cover Virginia. If you cannot sign because of incapacity, someone with legal authority such as a power of attorney or guardian can act for you.

Will Medicaid cover bills from before I applied?

It can. Federal law requires Virginia Medicaid to cover eligible services furnished in the three months before the month you apply, if you would have qualified then. For applications filed on or after January 1, 2027, that window shortens to two months for most enrollees and one month for adults in the ACA expansion group. That is why you should apply as soon as you think you may qualify, even before you have every document in hand.

Your next step Apply for Virginia Medicaid online through CommonHelp or call Cover Virginia at 1-855-242-8282.

Learn More

MedicaidHow to Apply for Medicaid by State: Steps, Documents, and Where to ApplyApplying for Medicaid follows the same federal steps everywhere; the agency and portal are your state's. What to gather, how long it takes, and where to apply. MedicaidVirginia Medicaid Programs OverviewVirginia Medicaid (Cardinal Care) covers long-term care through DMAS in 2026: eligibility, spend-down, CCC Plus waiver, MSPs, spousal rules, and how to apply. MedicaidVirginia Medicaid Eligibility and Income LimitsVirginia Medicaid income limits: $2,982/mo for long-term care with spend-down and no Miller Trust, plus 138% FPL for under-65 adults with no asset test. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house. MedicaidMedicaid Estate Recovery ExplainedMedicaid estate recovery explained: federal law, 51-state matrix, categorical protections, hardship waivers, and 2025-2026 reform updates. Verify before acting.

Find personalized help applying for Virginia Medicaid at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.