Cardinal Care, Virginia's Medicaid managed-care program administered by the Department of Medical Assistance Services (DMAS), covers roughly 2 million Virginians. Losing Cardinal Care coverage can happen for several reasons: income increased above the 138% Federal Poverty Level threshold, an annual redetermination went unresponded, a reporting error by the state, or changes in household composition. Whatever the reason, the loss of Cardinal Care is a qualifying life event that opens a 90-day Special Enrollment Period on Virginia's Insurance Marketplace at marketplace.virginia.gov. Virginia's 90-day SEP for Medicaid loss is more generous than the standard 60-day federal SEP, and you can apply up to 60 days before your coverage terminates to ensure no gap between your Cardinal Care end date and your new plan's start date. Knowing your options and acting quickly are the two most important things you can do right now. The ACA subsidy cliff returned for 2026 after enhanced premium tax credits expired on January 1, 2026, meaning subsidy calculations are now back to the pre-2021 formula based on 100% to 400% FPL. Even so, most Virginians who recently lost Cardinal Care land in income ranges where subsidies are substantial, often bringing Silver plan premiums to $10 to $150 per month.
Virginia expanded Medicaid in January 2019, making it one of the 40 states plus DC that have adopted ACA expansion. That expansion means any adult age 19 to 64 with household income at or below 138% FPL qualifies for Cardinal Care regardless of disability, pregnancy, or parental status. For 2026, 138% FPL equals $22,025 for a single person or $45,540 for a family of four, based on HHS ASPE 2026 Poverty Guidelines. If your income has risen above those thresholds, or if DMAS determined you no longer qualify, the Virginia Medicaid loss SEP is your bridge to affordable private coverage. Virginia's Insurance Marketplace operates as a state-based exchange under the ACA and is the only place where Virginia residents can access federal premium tax credits. FAMIS, Virginia's CHIP program for children under 19, covers families with incomes up to 205% FPL and operates on year-round enrollment separate from the adult Marketplace SEP. This guide covers all three pathways: Cardinal Care re-application, FAMIS enrollment for children, and Virginia Marketplace SEP enrollment with subsidy calculations. Check your Medicaid income limits or ACA income limits using the links below before starting an application.
6 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The costliest mistakes Virginians make after losing Cardinal Care coverage in 2026:
- Waiting past the 90-day window. Virginia's Medicaid-loss SEP is 90 days from termination, but many people wait too long. After 90 days, the only option is the next Open Enrollment Period (November 1, 2026). Apply within the first two weeks of termination to maximize plan start date flexibility.
- Not appealing a Cardinal Care procedural termination. Over half of all Medicaid terminations during Virginia's unwinding were procedural, meaning coverage was lost not because of ineligibility but because of missing paperwork. You have 60 days to appeal with DMAS. Call 1-833-5CALLVA immediately.
- Using last year's income for subsidy calculations. Virginia's Insurance Marketplace calculates premium tax credits based on projected 2026 income, not 2025 income. If your income dropped significantly, report the lower projected amount to maximize your 2026 subsidy.
- Skipping FAMIS for children. Even if adult household members no longer qualify for Cardinal Care, children under 19 with family income up to 205% FPL still qualify for FAMIS year-round. FAMIS enrollment does not require an SEP and is not time-limited.
- Applying to the wrong marketplace. Virginia operates its own state-based exchange at marketplace.virginia.gov, not the federal healthcare.gov. Only Virginia's Insurance Marketplace can apply state premium tax credits to Virginia plans. Applying through healthcare.gov may redirect you, but start at marketplace.virginia.gov to be certain.
- Choosing a Bronze plan when a Silver plan with CSR is available. For incomes between 100% and 250% FPL, Silver plans with Cost-Sharing Reductions dramatically lower deductibles and copays, often making Silver cheaper overall than Bronze despite the higher listed premium.
Marketplace Plan vs Reapplying for Cardinal Care: Which Should You Choose in Virginia?
Cardinal Care re-enrollment is the right first move for any Virginia adult whose income is at or below 138% FPL in 2026 ($22,025 for a single person, $45,540 for a family of four, per HHS ASPE 2026 Poverty Guidelines). Cardinal Care is free, covers comprehensive benefits including vision and dental for adults, and enrollment is year-round with no penalty for waiting. The decision tree for Virginians is: Cardinal Care first (free, if income qualifies); then FAMIS for children (if kids are under 19 and household income is under 205% FPL); then Virginia's Insurance Marketplace with subsidies for adults not qualifying for Cardinal Care. Marketplace plans are the right choice for Virginia adults with income above 138% FPL, because premium tax credits typically bring Silver plan monthly costs to $10 to $200 per month for incomes in the 139% to 300% FPL range. Virginia's average subsidized premium in the 2026 plan year was $124 per month after credits, per Virginia SCC data.
Virginia's Insurance Marketplace became a state-based exchange in 2023, replacing the federal healthcare.gov portal for Virginia residents. Marketplace plans are the only way Virginia residents can access federal premium tax credits. COBRA continuation coverage is rarely the right answer for Virginians transitioning off Cardinal Care, because COBRA applies only to job-based coverage (not Medicaid transitions) and costs 102% of the full group premium, often $400 to $900 per month for an individual. If you had employer coverage before Medicaid and lost that job-based plan as well, COBRA may bridge a short gap while you await Marketplace enrollment, but the 2026 subsidized Marketplace plans are almost always cheaper once premium tax credits are applied. Always compare your actual after-subsidy Marketplace cost versus COBRA before electing COBRA.
How to Appeal a Virginia Cardinal Care Termination in 2026
Virginia Medicaid termination notices from DMAS include the specific reason for termination and your appeal rights. Procedural terminations, where coverage was lost because annual renewal paperwork was not returned in time, are the most common and most reversible type. Virginia Medicaid members have 60 days from the date of the termination notice to request an appeal hearing by calling 1-833-5CALLVA or writing to DMAS at the address listed on the notice. Requesting an appeal before your coverage ends (a timely appeal) allows DMAS to continue your Cardinal Care coverage while the appeal is pending, which means you do not need to enroll in a Marketplace plan while the appeal is in progress.
Documentation that can support a Virginia Cardinal Care appeal includes: proof that renewal paperwork was submitted (postal tracking, fax confirmation, or online submission confirmation), evidence that you still meet income eligibility (recent pay stubs, bank statements, or a current employer letter), and proof of current Virginia residency (utility bill, lease agreement, or government mail). Even if your appeal is denied, the 90-day Medicaid-loss SEP on Virginia's Insurance Marketplace remains open from your original Cardinal Care termination date, so you are not penalized for attempting an appeal. The Cardinal Care appeals process is administered by DMAS under Virginia Code Section 32.1-325.
Virginia Medicaid Income Limits and FAMIS Eligibility for 2026
Virginia is a full Medicaid expansion state, meaning Cardinal Care covers all adults aged 19 to 64 with household income at or below 138% of the Federal Poverty Level, with no asset test and no work requirement. For 2026, Virginia adopted the HHS ASPE Federal Poverty Guidelines on January 13, 2026. Cardinal Care income thresholds for adults: $22,025 per year for a household of 1; $29,863 for a household of 2; $37,702 for a household of 3; $45,540 for a household of 4. Children under 19 qualify for Cardinal Care Medicaid up to 148% FPL and FAMIS (Virginia's CHIP program) up to 205% FPL. Pregnant individuals qualify for coverage up to 148% FPL, with postpartum coverage continuing for 12 months. The household-size income lookup table below shows the 2026 thresholds for Cardinal Care (138% FPL) and the ACA subsidy ceiling (400% FPL) so you can immediately identify your pathway.
Virginia Medicaid (Cardinal Care) and ACA Subsidy Income Limits, 2026| Household size | 138% FPL (Cardinal Care limit) | 400% FPL (ACA subsidy ceiling) |
|---|
| 1 | $22,025 | $63,840 |
| 2 | $29,863 | $86,560 |
| 3 | $37,702 | $109,280 |
| 4 | $45,540 | $132,000 |
| 5 | $53,378 | $154,720 |
| 6 | $61,217 | $177,440 |
| 7 | $69,055 | $200,160 |
| 8 | $76,894 | $222,880 |
| Each additional person | + $7,838 | + $22,720 |
Virginia adopted 2026 FPL figures on January 13, 2026, earlier than most states. The 400% FPL subsidy cliff returned for 2026 after enhanced PTCs expired January 1, 2026. Households with income between 139% and 400% FPL who do not qualify for Cardinal Care should apply for a subsidized Marketplace plan through Virginia's Insurance Marketplace at marketplace.virginia.gov.
Source: HHS ASPE 2026 Poverty Guidelines; dmas.virginia.gov; marketplace.virginia.gov
Documents You Will Need to Enroll After Losing Virginia Medicaid
Virginia's Insurance Marketplace and DMAS both require documentation to verify identity, income, and residency. Gathering these documents before you start your application reduces processing time and helps avoid a gap in coverage. Your Cardinal Care termination notice is the single most important document: it confirms the qualifying life event that triggers the 90-day Medicaid-loss SEP and must be uploaded to the Virginia Marketplace application. Pay stubs or an income estimate letter for 2026 establish your projected income for subsidy calculations. Social Security numbers are required for all household members applying for coverage, though some immigrant categories may use Individual Taxpayer Identification Numbers (ITINs). Virginia residency documents include a current utility bill, lease agreement, or government-issued mail showing your Virginia address. Birth certificates are needed for any dependent children being added to coverage. For FAMIS enrollment, the same documents apply, and you can submit them through CoverVA.dmas.virginia.gov.
Frequently Asked Questions
How long do I have to get new coverage after losing Virginia Medicaid?
Virginia's Medicaid-loss Special Enrollment Period gives you 90 days from your Cardinal Care termination date to select and enroll in a new plan through Virginia's Insurance Marketplace at marketplace.virginia.gov. This is more generous than the federal standard 60-day SEP. You can also apply up to 60 days before your Cardinal Care ends to have your new Marketplace plan start the day after your Medicaid terminates, preventing any gap in coverage. If you miss the 90-day window, you must wait until ACA Open Enrollment starting November 1, 2026.
Can I re-apply for Virginia Medicaid (Cardinal Care) after losing it?
Yes. Cardinal Care enrollment is year-round in Virginia for adults aged 19 to 64 with income at or below 138% FPL ($22,025 for a single person, $45,540 for a family of four, in 2026). If your income dropped after the termination, or if the termination was procedural, you can reapply at any time through coverva.dmas.virginia.gov or by calling Cover Virginia at 1-833-5CALLVA. A procedural termination appeal must be filed within 60 days of the termination notice. If appealing in time, Cardinal Care can continue during the appeal process.
What is Cardinal Care and how is it different from regular Medicaid?
Cardinal Care is the brand name for Virginia Medicaid managed care, administered by the Virginia Department of Medical Assistance Services (DMAS). Under Cardinal Care, Medicaid benefits are delivered through private managed care organizations (MCOs) contracted by DMAS. Virginia expanded Medicaid in January 2019 under the ACA, so Cardinal Care now covers all eligible adults aged 19 to 64 with income up to 138% FPL, regardless of disability status or family structure. Cardinal Care covers hospital, physician, prescription drug, mental health, dental, and vision services with no premium for most members.
What documents do I need to enroll in Virginia's Insurance Marketplace after losing Cardinal Care?
The most important document is your Cardinal Care termination notice from DMAS, which confirms the qualifying life event triggering the 90-day SEP. You also need proof of 2026 projected income (recent pay stubs or employer letter), Social Security numbers for all household members, and proof of Virginia residency such as a utility bill or lease. If adding children, bring birth certificates. Upload these documents during your marketplace.virginia.gov application to avoid delays. Virginia's Marketplace is a state-based exchange, so applications must be submitted at marketplace.virginia.gov, not healthcare.gov.
Do my children qualify for FAMIS even if I lose Cardinal Care?
Yes. FAMIS (Family Access to Medical Insurance Security), Virginia's CHIP program, covers children under 19 with household income up to 205% FPL on a year-round basis, separate from the adult Medicaid or Marketplace SEP timelines. Children under 19 with household income up to 148% FPL qualify for free Medicaid under Cardinal Care. Children with household income between 148% and 205% FPL qualify for FAMIS with small cost-sharing. FAMIS enrollment has no deadline and is not affected by the parent losing Cardinal Care. Apply at coverva.dmas.virginia.gov.
What if I miss the 90-day SEP window after losing Virginia Medicaid?
Missing the 90-day window without another qualifying life event means you must wait until the next ACA Open Enrollment Period (November 1, 2026, through January 30, 2027, for 2027 Marketplace coverage) to enroll in a subsidized plan. However, Cardinal Care re-enrollment is year-round: if your income drops back below 138% FPL at any point, you can reapply for Cardinal Care at any time through coverva.dmas.virginia.gov. Children can still enroll in FAMIS year-round. Emergency Medicaid covers emergency-only services for residents who do not qualify for full Medicaid.
What is the ACA subsidy situation for Virginia residents in 2026?
The enhanced premium tax credits from the American Rescue Plan Act and Inflation Reduction Act expired on January 1, 2026, so the original ACA subsidy structure applies in 2026 for Virginia residents. Premium tax credits are available for households with income between 100% and 400% FPL ($22,025 to $63,840 for a single person in 2026). Households above 400% FPL pay full unsubsidized premiums. Virginia's Insurance Marketplace averaged $461 per month in premium subsidies in the 2026 plan year, reducing average net premiums to $124 per month. Use marketplace.virginia.gov to see your exact 2026 credit based on your household size and income.
How do I appeal a Virginia Cardinal Care termination?
You have 60 days from the date of the termination notice to appeal a Cardinal Care decision. Call Cover Virginia at 1-833-5CALLVA or submit a written appeal to DMAS at the address on your notice. A timely appeal (filed before coverage ends) can result in Cardinal Care continuing while DMAS reviews your case. Gather documentation including proof that paperwork was submitted, proof of current income, and proof of Virginia residency. Even if your appeal is denied, the 90-day Medicaid-loss SEP on Virginia's Insurance Marketplace remains open from your original termination date, so you do not lose Marketplace eligibility by attempting an appeal.
