If a Virginia Medicaid renewal packet just arrived in your mailbox, do not set it aside: an unreturned renewal can end your coverage even if you still qualify. Federal law (42 CFR 435.916) requires the state to attempt an automatic renewal from data it already holds before it ever asks you for paperwork, but when a packet does reach you, it has to come back on time.

Renew online at CommonHelp · Call Cover Virginia: 1-855-242-8282

In This Guide

Recertification and renewal is a recurring requirement for keeping Virginia Medicaid. Eligibility is set once at initial application, but under 42 CFR 435.916 it is redetermined every 12 months thereafter, and a missed renewal can end coverage even for someone who still qualifies. When a renewal closes for procedural reasons, the person usually remained eligible and simply did not return the packet in time, which is exactly the situation the 90-day reconsideration window below is designed to fix.

Virginia runs its Medicaid program under the brand Cardinal Care. The Department of Medical Assistance Services (DMAS) is the single state Medicaid agency that sets policy, and your local Department of Social Services (LDSS) does the eligibility casework, including renewals. This guide covers how the Virginia Medicaid eligibility renewal cycle works in 2026, from the federal ex parte auto-renewal default and the 90-day reconsideration window to the short 30-day appeal deadline, long-term care and Commonwealth Coordinated Care (CCC) Plus waiver renewals, and the 2027 move to 6-month renewals for expansion adults. For the eligibility rules that decide whether you still qualify at renewal, see Virginia Medicaid income and asset limits.

How the Virginia Medicaid recertification and renewal cycle works

Under 42 CFR 435.916, the state Medicaid agency must redetermine eligibility at least every 12 months. That 12-month interval is also a ceiling for MAGI-based coverage, but for beneficiaries who qualify on the basis of age, blindness, disability, or long-term care it is only a floor: the state may redetermine more often. Your renewal month is set when you are first approved and stays the same calendar month every year. (One change is coming for Virginia's expansion adults, covered in the 2027 section below.)

Renewals split into two procedural paths depending on your eligibility category:

  • MAGI populations (children, pregnant women, parent and caretaker relatives, and the Affordable Care Act (ACA) expansion adult group Virginia covers): renewed using Modified Adjusted Gross Income methodology. Income is verified through federal electronic data sources, including Social Security Administration records and Internal Revenue Service tax data, plus other data available to DMAS. There is no asset test for MAGI groups, so these renewals clear automatically far more often.
  • Non-MAGI populations (Aged, Blind, and Disabled, long-term care, and CCC Plus waiver members): renewed under the non-MAGI framework, which includes an asset test. Virginia is a section 209(b) and medically needy state. Federal law requires every state to verify assets at renewal through an Asset Verification System (Section 1940 of the Social Security Act, 42 U.S.C. 1396w), so non-MAGI renewals seldom clear automatically and usually require the member to submit bank statements, retirement and life insurance documentation, and a signed AVS authorization.

For a non-MAGI renewal, the same financial rules that governed the original approval apply again: a single Aged, Blind, or Disabled applicant is limited to $2,000 in countable assets, and the long-term-care income standard is $2,982 a month for 2026 (300% of the Supplemental Security Income (SSI) federal benefit rate). An applicant over the income standard can still qualify through Virginia's medically needy spend-down rather than a Qualified Income Trust.

Ex parte renewal: the federal auto-renewal mandate

The ex parte default at 42 CFR 435.916(a)(2) is the federal rule that shapes modern Medicaid renewal. Before the state asks you for any information at renewal, it must make a redetermination without requiring information from you whenever it can do so from reliable information already in your account or otherwise available to the agency, including electronic data sources. Only when it cannot renew on that basis may it request information from you.

In Virginia, ex parte renewal draws on Social Security Administration earnings, retirement, and disability records; Internal Revenue Service tax filings; and other electronic data sources DMAS and your LDSS can reach. If those sources confirm you remain within the income threshold for your eligibility category and that your household and categorical circumstances have not changed, the renewal processes automatically. You receive a notice stating that coverage continues for another 12 months and no action is required.

When ex parte cannot confirm eligibility, the state must send a renewal form containing the information the agency already holds, and must give you at least 30 days from the date of the form (42 CFR 435.916(a)(3)) to respond, supply anything missing, and sign it. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Virginia may offer the same windows but is not required to, so ask your local Department of Social Services. Common reasons ex parte fails in Virginia:

  • Income the databases can't see: self-employment, gig, cash, or seasonal income that never appears in wage records
  • The asset test: ABD and CCC Plus waiver renewals need asset documentation that automated data rarely confirms
  • Household changes: a new baby, a spouse or adult child moving out, marriage, or divorce
  • Income near a threshold: even a small data mismatch triggers a manual review when reported income sits close to the cutoff

If you declare U.S. citizenship or a satisfactory immigration status and the state cannot promptly verify it, federal law requires a reasonable opportunity period: it ends at the earlier of verification or 90 days after the notice, and during it your benefits may not be delayed, denied, reduced, or terminated if the agency otherwise finds you eligible.

How to renew your Virginia Medicaid coverage

Under 42 CFR 435.916, a renewal may be submitted through any of the modes the agency offers, and the agency may not require an in-person interview to renew. In Virginia that means online through CommonHelp, by phone, by mail, and in person.

Channel Where Notes
Online commonhelp.virginia.gov Fastest; real-time confirmation, document upload, and address updates. Recommended.
Phone Cover Virginia Call Center, 1-855-242-8282 Statewide call center; can start or complete a renewal and request a packet.
Mail Return the signed packet to your local Department of Social Services Address is pre-printed on the packet; allow processing time after receipt.
In person Any local Department of Social Services office Your LDSS handles Virginia eligibility casework and renewals.

CommonHelp lets you view your case, update your address, upload documents, complete a renewal, and check the status of any pending action. If you created a CommonHelp account at initial application, use it. If not, create one with your name, date of birth, and Medicaid case number from any DMAS or LDSS notice.

The 90-day reconsideration window

If your coverage closed because you did not return the renewal form, you usually do not have to start over. Many families never learn this window exists before they reapply from scratch.

Under 42 CFR 435.916(a)(3)(iii), if you lose Medicaid for failure to return the renewal form (a procedural termination, not an eligibility-based one), the agency must reconsider your eligibility on the basis of the late-returned form if you submit it within 90 days of the termination, without requiring a new application. If the reconsideration finds you still eligible, your coverage is restored; whether that restoration reaches back to the termination date is state-dependent, and the rule does not itself promise it. That duty is federal for MAGI-based coverage and a state option on the non-MAGI pathways above, so ask your local Department of Social Services what applies to you.

Three distinctions decide whether the window applies:

  • Procedural termination: you did not return the renewal form, or returned it unsigned. The 90-day reconsideration applies (required for MAGI-based coverage; a state option otherwise).
  • Eligibility-based termination: DMAS determined you no longer meet income, residency, citizenship, or categorical requirements. Reconsideration does not apply, and you must file a new application (or appeal).
  • Timing: the 90-day clock starts on the termination date, not the date of the notice. Read your closure notice carefully.

To use the window, resubmit the renewal form through any channel above. If you no longer have it, call Cover Virginia at 1-855-242-8282 or use CommonHelp to request a new packet, and note the closure date so your LDSS routes the case correctly.

If your Virginia Medicaid renewal is denied: the 30-day appeal

If your renewal is denied or your coverage terminated for an eligibility reason, you have a federal right to a fair hearing under Section 1902(a)(3) of the Social Security Act and 42 CFR 431.220. Federal law caps the request window at 90 days from the date the notice is mailed, but a state may set a shorter operational window. Virginia's window is only 30 days. Under 12VAC30-110-160, a Request for Appeal must be filed within 30 days of your receipt of the notice, and you are presumed to have received it five days after DMAS mails it. Do not wait.

Appeals go to the DMAS Appeals Division, which you can reach through the online Appeals Information Management System (AIMS) portal, by email to appeals@dmas.virginia.gov, by fax to (804) 452-5454, by phone at (804) 371-8488, or by mail to Appeals Division, Department of Medical Assistance Services, 600 E. Broad Street, Richmond, VA 23219.

If the action you're challenging was taken by your Cardinal Care managed care plan rather than by the state, you must first exhaust the plan's one internal appeal (requested within 60 days of the plan's notice) before you can reach a DMAS state fair hearing (which you then request within 120 days of the plan's decision). For the full process, see Virginia Medicaid appeals and fair hearings.

Keeping coverage during the appeal. Federal law (42 CFR 431.230) continues your Medicaid during an appeal only if you request the hearing before the date the action takes effect, after the agency sends its advance notice. Because the agency must give at least a 10-day advance notice before terminating, requesting the appeal within that notice period preserves your coverage pending the decision. If the action is later upheld, the agency may recoup the cost of services provided only because benefits continued.

Children's 12-month continuous eligibility

Section 5112 of the Consolidated Appropriations Act, 2023 requires every state to give children under age 19 enrolled in Medicaid or CHIP (Family Access to Medical Insurance Security, or FAMIS, in Virginia) 12 months of continuous eligibility from the date of enrollment, effective January 1, 2024.

Once a child is enrolled, coverage is locked in for 12 months regardless of changes in family income. If a parent loses Medicaid mid-year because household income rose, the children stay covered until their next annual renewal. Limited exceptions allow mid-year termination: the child turns 19, moves out of Virginia, dies, the family voluntarily disenrolls, or there is fraud.

The practical takeaway: if you are a parent worried about income rising, report the change anyway. Reporting accurately protects you from later fraud allegations, and your children keep coverage through the rest of their 12-month period.

Pregnancy and 12-month postpartum coverage

A permanent state option, created by the American Rescue Plan Act of 2021 and made permanent by the Consolidated Appropriations Act, 2023, lets states extend Medicaid postpartum coverage to a full 12 months after the end of pregnancy, up from the historic 60-day window. Where a state has taken up the option, coverage continues through the end of the month in which the 12th postpartum month falls, regardless of income changes, and the annual renewal cycle resumes after that period ends. Confirm your current postpartum coverage period with Cover Virginia or your local Department of Social Services.

Long-term care and CCC Plus waiver renewals

If you receive Medicaid long-term care (nursing facility or the CCC Plus Waiver), your renewal has two independent parts, and both must stay current.

Financial redetermination. Your LDSS reviews income and assets on the annual 12-month cycle, including the asset test federal law requires the state to run through the Asset Verification System. It checks your income against the long-term-care standard of $2,982 a month (300% of the SSI federal benefit rate) and your countable assets against the $2,000 limit, applies the medically needy spend-down if your income is over the cap, and confirms the patient-pay amount, keeping a $40 monthly Personal Needs Allowance for a nursing-facility resident.

Level-of-care reassessment. Separately, an LTSS screening confirms you still meet a nursing-facility level of care. The CCC Plus Waiver, a 1915(c) waiver administered by DMAS, serves older adults and adults with disabilities who would otherwise need nursing-facility care, and unlike Virginia's developmental-disability waivers it has no waiting list. You can pass the financial redetermination and fail the level-of-care reassessment, or the reverse. If the level of care is no longer approved, waiver coverage ends, but you may continue on standard ABD Medicaid for non-waiver coverage if otherwise eligible.

For the full waiver framework, see Virginia Medicaid HCBS waivers.

Returned mail and your Cardinal Care plan

The federal rule that required an agency to search for a new address before acting on returned mail, 42 CFR 435.919, was removed effective July 31, 2026. Federal law now says only that the agency may act without advance notice when your whereabouts are unknown (42 CFR 431.213(d)), and that coverage must be reinstated if your whereabouts become known while you are still eligible (42 CFR 431.231(d)). Virginia may still have its own procedures, so if your packet came back as undeliverable, call Cover Virginia at 1-855-242-8282 and ask where your case stands.

Most members get coverage through Cardinal Care Managed Care. As of the contract implemented July 1, 2025, the five participating plans are Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia, Sentara Health Plans, and UnitedHealthcare of the Mid-Atlantic. To avoid a returned-mail delay:

  • Update your address in CommonHelp immediately after moving
  • Call Cover Virginia at 1-855-242-8282, or contact your LDSS
  • Update your address with your Cardinal Care plan too. The Cardinal Care Managed Care Helpline is 1-800-643-2273 (TTY 1-800-817-6608)
  • File a USPS change-of-address form

What changes in 2027: 6-month renewals for expansion adults

The COVID-19 continuous-enrollment requirement ended in 2023, and the unwinding redetermination ran through 2024. What matters for renewals now is a new federal change. Section 71107 of the 2025 budget-reconciliation law (H.R.1, Public Law 119-21) requires states to redetermine eligibility once every 6 months, rather than every 12, for the ACA expansion-adult population, for renewals scheduled on or after January 1, 2027. Its only exemption covers an Indian or Urban Indian as defined in the Indian Health Care Improvement Act, a California Indian, and anyone otherwise determined eligible as an Indian for the Indian Health Service. Other enrollees stay on the standard 12-month cycle.

This reaches Virginia directly. Virginia covers the ACA Medicaid expansion adult group (roughly 138% of the federal poverty level after the standard disregard), so those members will move from an annual renewal to a twice-a-year one.

The same 2025 law also shortens retroactive eligibility for applications filed on or after January 1, 2027, to two months before the application month for most enrollees and one month for the expansion group, down from the long-standing three-month default.

Common Virginia Medicaid recertification mistakes

  1. Ignoring the packet because the envelope looks like junk mail. Pull anything from DMAS, your local Department of Social Services, or Cover Virginia out of the pile and open it.
  2. Assuming ex parte will handle everything. Ex parte cannot renew Aged, Blind, and Disabled or waiver members, because their asset test rarely clears from automated data, so those members must return the packet by the deadline printed on it.
  3. Updating your address with Social Security or your health plan but not with your LDSS.
  4. Not knowing the 90-day reconsideration window exists. Return the form within 90 days of a procedural closure and your eligibility is reconsidered with no new application (required for MAGI-based coverage; a state option otherwise).
  5. Missing Virginia's 30-day appeal deadline. The federal ceiling is 90 days, but Virginia caps it at 30 days from receipt of the notice.
  6. Skipping the AVS signature for ABD or waiver renewals. Without your Asset Verification System authorization, your LDSS cannot run the bank-record check and the renewal stalls.
  7. Assuming children lose coverage when a parent does. Children under 19 keep coverage for their full 12-month continuous-eligibility period regardless of family income changes.

Frequently Asked Questions

How often do I have to renew Virginia Medicaid?

Once every 12 months for most beneficiaries. Your renewal month is the same each year and is tied to your initial approval date. Under 42 CFR 435.916 that is a minimum, not a cap, for aged, blind, disabled, and long-term-care beneficiaries. One change is coming: the ACA expansion-adult group moves to a 6-month cycle for renewals scheduled on or after January 1, 2027.

Where do I submit my Virginia Medicaid renewal?

The fastest method is online at commonhelp.virginia.gov (CommonHelp). You can also call the Cover Virginia Call Center at 1-855-242-8282, or mail or drop off the packet at your local Department of Social Services. Online submission gives real-time confirmation and document upload.

What happens if I miss my renewal deadline?

Your coverage closes at the end of your renewal month. If the closure was procedural (you did not return the renewal form), you have a 90-day reconsideration window to submit that form and have your eligibility reconsidered without a new application (required for MAGI-based coverage; a state option otherwise, so ask your local Department of Social Services). If you miss the 90 days, you must file a new application.

How long do I have to appeal a Virginia Medicaid denial?

Only 30 days from your receipt of the notice, under 12VAC30-110-160, and you are presumed to have received it five days after DMAS mails it. That is much shorter than the federal 90-day ceiling. If you request the appeal before the termination takes effect, your coverage continues pending the decision.

My child is on Medicaid. If my income goes up mid-year, does my child lose coverage?

No. Under federal continuous-eligibility rules, effective January 1, 2024, children under 19 have 12 months of continuous eligibility from enrollment. Even if your income rises above the threshold, your child keeps coverage until the next annual renewal. Exceptions: aging out at 19, moving out of Virginia, death, voluntary disenrollment, or fraud.

I'm on ABD Medicaid. Why does my renewal need bank statements?

ABD and long-term-care Medicaid have an asset limit, and federal law (Section 1940 of the Social Security Act) requires the state to verify your assets at renewal through an Asset Verification System, which automated income data cannot do on its own. Your LDSS reviews recent bank statements, retirement accounts, and life insurance to confirm you remain under the $2,000 limit, and the AVS needs your signed authorization.

My mail was returned. Will Virginia close my case automatically?

Federal law no longer answers that. The rule that required an agency to search for a new address before acting on returned mail, 42 CFR 435.919, was removed effective July 31, 2026, and Virginia may still have procedures of its own. Call Cover Virginia at 1-855-242-8282 to ask where your case stands, and update your address through CommonHelp as soon as you move.

Virginia Medicaid renewal: contacts and resources

These are the offices that handle a renewal, a reconsideration, or an appeal.

CommonHelp Renew online, upload documents, update your address, and check case status. commonhelp.virginia.gov
Cover Virginia Call Center Renewals by phone, packet requests, and application help. 1-855-242-8282https://secure.ssa.gov/poms.nsf/lnx/0501715020 coverva.dmas.virginia.gov
Local Department of Social Services Virginia eligibility casework and in-person renewals. Find your office through the DMAS or Cover Virginia website.
Cardinal Care Managed Care Helpline Compare or change your Cardinal Care health plan and update contact info. 1-800-643-2273 (TTY 1-800-817-6608)https://www.dmas.virginia.gov/for-members/cardinal-care-members/
DMAS Appeals Division File a Request for Appeal after a denial or termination. Email: appeals@dmas.virginia.gov (804) 371-8488https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-431/subpart-E/section-431.221
Virginia Insurance Counseling and Assistance Program (VICAP) Free Medicare and Medicare Savings Program counseling for Virginia seniors, through the Virginia Insurance Counseling and Assistance Program. vda.virginia.gov/vicap.htm

See all Brevy Medicaid guides.

Learn More

MedicaidHow to apply for Virginia MedicaidHow to apply for Virginia Medicaid in 2026 through CommonHelp, Cover Virginia, or your local DSS. Documents, the 45-day decision cap, screening, and appeals. MedicaidVirginia Medicaid appeals and fair hearingsIf Virginia Medicaid denied or ended your coverage, learn how to appeal to DMAS, keep your benefits during the appeal, and request a fair hearing in 30 days. MedicaidVirginia Medicaid income and asset 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. MedicaidVirginia Medicaid HCBS waiversVirginia Medicaid HCBS waivers explained: the CCC Plus Waiver pays for care at home for older adults and adults with disabilities, with no waiting list in 2026. MedicaidVirginia Medicare Savings ProgramsVirginia Medicare Savings Programs in 2026: QMB, SLMB, and QI income limits, Part B premium savings, Part D Extra Help, and how to apply through DMAS. MedicaidVirginia Medicaid hub

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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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