Quick Answer: Pregnant Virginians in 2026 have three main coverage paths: (1) Virginia Cardinal Care Medicaid (free, year-round, up to 148% FPL, which equals about $32,028 for a 2-person household since the expected baby counts), (2) FAMIS MOMS (Virginia CHIP for pregnant women, up to 205% FPL, about $44,362 for a 2-person household), or (3) Virginia Insurance Marketplace private plan using the new pregnancy-specific Special Enrollment Period available anytime during pregnancy. All three paths cover prenatal care, labor and delivery, and 12 months of postpartum coverage. Apply through CommonHelp at commonhelp.virginia.gov or Virginia's Insurance Marketplace at marketplace.virginia.gov.
Pregnancy in Virginia triggers immediate access to health coverage options that are available year-round, unlike most other life events that impose strict 60-day deadlines. Virginia Cardinal Care is the state's Medicaid program administered by the Virginia Department of Medical Assistance Services (DMAS). Cardinal Care for pregnant women covers prenatal visits, labor and delivery, postpartum care, and prescription drugs at no cost for Virginians whose household income falls at or below 148% of the 2026 Federal Poverty Level. A pregnant woman counts as two people when calculating household size for this program, so the actual income threshold for a pregnant woman with no other dependents is $32,028 per year (148% FPL at household size 2 under 2026 guidelines). Presumptive eligibility through Cardinal Care means that a qualified provider such as an OB-GYN or certified nurse-midwife can enroll you on the spot for immediate prenatal coverage while your formal Medicaid application is reviewed. Apply online at commonhelp.virginia.gov, through the CoverVA portal at coverva.dmas.virginia.gov, or by calling Virginia DMAS at 1-855-242-8282.
FAMIS MOMS is Virginia's separate CHIP program for pregnant women whose income exceeds the Medicaid limit. FAMIS MOMS covers income up to 205% of the 2026 Federal Poverty Level, which equals $44,362 per year for a 2-person household (pregnant woman plus expected child) or $56,006 for a 3-person household. FAMIS MOMS coverage includes the same prenatal, delivery, and postpartum benefits as Cardinal Care but with a small premium or cost-sharing for higher-income enrollees. A third option became available effective January 31, 2026: a new pregnancy-specific Special Enrollment Period for Virginia's state-based Insurance Marketplace. This SEP allows any qualifying pregnant Virginian who is not already enrolled in Marketplace coverage to enroll in a private plan at any point during pregnancy. The Marketplace SEP requires the enrollee to initiate enrollment within the pregnancy and then complete it within 60 days of starting. Premium Tax Credits are available for Marketplace plans if household income falls between 100% and 400% of FPL. All three programs, which are Cardinal Care Medicaid, FAMIS MOMS, and the Marketplace pregnancy SEP, extend postpartum coverage for 12 months after delivery regardless of income changes. Babies born to Medicaid-enrolled mothers are automatically enrolled in Medicaid at birth under the deemed newborn rule.
7 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most costly mistakes pregnant Virginians make when navigating coverage in 2026:
- Not counting the expected baby in household size. Virginia Medicaid and FAMIS MOMS count the expected baby as a household member, making the income threshold higher than most people expect. A pregnant woman alone is a 2-person household for these programs.
- Waiting too long to apply. Virginia offers presumptive eligibility for prenatal care, so coverage can begin the same day a qualified healthcare provider screens you. Delaying application means paying out-of-pocket for early prenatal visits that should be free.
- Assuming the federal healthcare.gov Marketplace is where to enroll. Virginia operates its own state-based Insurance Marketplace at marketplace.virginia.gov. The 2026 pregnancy SEP is a Virginia-specific benefit not available in all states.
- Enrolling in COBRA without checking Medicaid and FAMIS MOMS first. COBRA continuation charges 102% of the full employer premium, often $500 to $2,000 per month. Cardinal Care Medicaid covers the same prenatal care at zero cost if income qualifies, and FAMIS MOMS keeps costs very low.
- Not knowing about the 12-month postpartum coverage guarantee. Virginia Medicaid and FAMIS MOMS coverage continues for exactly 12 months after the end of pregnancy regardless of income changes. Some enrollees wrongly believe coverage ends at delivery or 60 days postpartum.
- Missing the baby's Medicaid enrollment window if the mother is not on Medicaid at delivery. Newborns born to Medicaid-enrolled mothers are auto-enrolled. But if the mother transitions to a Marketplace plan before delivery, the newborn triggers a 60-day SEP and must be enrolled separately within that window.
Virginia Pregnancy Medicaid Income Limits by Household Size, 2026
Virginia Cardinal Care Medicaid for pregnant women uses 148% of the Federal Poverty Level as its income threshold. Virginia FAMIS MOMS (CHIP for pregnant women) uses 205% FPL. For both programs, a pregnant woman counts as two people because the expected baby is included in the household size. The table below shows the 2026 annual income limits for each household size, based on 2026 HHS ASPE poverty guidelines adopted by Virginia DMAS effective January 13, 2026. Families expecting twins count one more person per additional expected child.
Virginia Pregnancy Medicaid and FAMIS MOMS Income Limits by Household Size, 2026| Household size (including expected baby) | Cardinal Care Medicaid (148% FPL, 2026) | FAMIS MOMS CHIP (205% FPL, 2026) |
|---|
| 2 (pregnant woman + 1 expected baby) | $32,028/year | $44,362/year |
| 3 (pregnant woman + 1 child + 1 expected baby) | $40,434/year | $56,006/year |
| 4 (pregnant woman + 2 children + 1 expected baby) | $48,840/year | $67,650/year |
| 5 (pregnant woman + 3 children + 1 expected baby) | $57,247/year | $79,294/year |
| 6 | $65,653/year | $90,938/year |
| 7 | $74,060/year | $102,582/year |
| 8 | $82,466/year | $114,226/year |
| Each additional person | + $8,407/year | + $11,644/year |
Calculated from 2026 HHS ASPE FPL: $15,960 (household of 1), +$5,680 per additional person (48 states + DC). Virginia DMAS adopted 2026 FPL figures effective January 13, 2026. Pregnant woman counts as 2 household members (3 for twins). For households above 205% FPL, the Virginia Insurance Marketplace pregnancy SEP and Premium Tax Credits (for income 100%-400% FPL) are the next options.
Source: HHS ASPE 2026 Poverty Guidelines; Virginia DMAS coverva.dmas.virginia.gov
Virginia's New Pregnancy SEP for the Insurance Marketplace (Effective January 31, 2026)
Virginia's Insurance Marketplace at marketplace.virginia.gov is a state-run exchange separate from the federal healthcare.gov that most other states use. Virginia debuted its own state-based Marketplace in the fall of 2023, and all Virginia residents shop for private ACA plans through marketplace.virginia.gov, not healthcare.gov. Effective January 31, 2026, a new state law led by Delegate Irene Shin created a pregnancy-specific Special Enrollment Period for Virginia's Marketplace. Before this law, becoming pregnant was not a qualifying life event under federal ACA rules, meaning that a pregnant Virginian who missed Open Enrollment and did not have another qualifying life event (such as job loss or marriage) could be locked out of Marketplace coverage for the entire year. The new Virginia pregnancy SEP changes this by allowing any qualifying pregnant person who is not already enrolled in a Marketplace plan to start enrollment at any point during the pregnancy. Once enrollment is started, the applicant has 60 days to complete it and select a plan. The SEP is not available to individuals who are already enrolled in a Marketplace plan (they cannot use it to switch plans mid-year). Maternity care and childbirth are essential health benefits covered by all Virginia Marketplace plans, and coverage applies even if pregnancy began before the enrollment date. Premium Tax Credits are available to reduce monthly premiums for households with income between 100% and 400% of the 2026 Federal Poverty Level. The 400% FPL subsidy cliff returned for 2026 after the enhanced premium tax credits from the Inflation Reduction Act expired on January 1, 2026.
What Documents Pregnant Virginians Need to Apply for Coverage in 2026
Cardinal Care Medicaid and FAMIS MOMS applications require standard identity, residency, income, and pregnancy verification documents. Gathering these before starting the online application at commonhelp.virginia.gov significantly reduces processing delays. Most applications are processed within 45 days, but presumptive eligibility provides coverage immediately if a qualified provider determines likely eligibility during a prenatal visit. For the Virginia Insurance Marketplace pregnancy SEP at marketplace.virginia.gov, documentation requirements are similar to standard ACA enrollment but include pregnancy verification to trigger the SEP. Virginia DMAS and the Marketplace both accept digital copies of documents uploaded through the online portal.
Cardinal Care vs FAMIS MOMS vs Marketplace: Which Virginia Coverage Should You Choose?
Three programs serve pregnant Virginians in 2026 and the decision flows logically from income. Cardinal Care Medicaid is the first check: if household income (counting the expected baby) falls at or below 148% FPL ($32,028 for a 2-person household in 2026), Cardinal Care is free, covers everything, and should be the automatic choice. FAMIS MOMS is the bridge program for income between 148% and 205% FPL ($32,028 to $44,362 for a 2-person household): coverage is nearly as comprehensive as Cardinal Care with small cost-sharing amounts, and it remains the lowest-cost option for this income band. Virginia's Insurance Marketplace pregnancy SEP is the path for income above 205% FPL or for those who strongly prefer to keep an existing private network of providers. Marketplace Silver plans with Premium Tax Credits (income 100% to 400% FPL) can run $50 to $300 per month after credits, but out-of-pocket costs for prenatal and delivery care under a Marketplace plan can reach the 2026 ACA maximum out-of-pocket limit of $10,600 for an individual versus $0 under Cardinal Care. COBRA is almost never the right choice for pregnant Virginians who qualify for Medicaid or FAMIS MOMS, since COBRA charges 102% of the full premium (often $500 to $2,000 per month) for the same prenatal benefits Virginia provides free or at very low cost.
Frequently Asked Questions
What is the income limit for pregnancy Medicaid in Virginia in 2026?
Virginia Cardinal Care Medicaid for pregnant women covers income up to 148% of the 2026 Federal Poverty Level. A pregnant woman counts as two people (she plus the expected baby), so the 2026 income limit is $32,028 per year for a household of two, $40,434 for a household of three, and $48,840 for a household of four. FAMIS MOMS (Virginia CHIP for pregnant women) extends coverage to 205% FPL: $44,362 for a 2-person household and $56,006 for a 3-person household. Both programs accept applications year-round through commonhelp.virginia.gov or coverva.dmas.virginia.gov.
How do I apply for pregnancy Medicaid in Virginia in 2026?
Apply online at commonhelp.virginia.gov, through the CoverVA portal at coverva.dmas.virginia.gov, or by calling Virginia DMAS at 1-855-242-8282. You can also apply in person at your local Virginia Department of Social Services office. Gather proof of identity (Virginia ID or passport), proof of Virginia residency (utility bill or lease), proof of pregnancy (healthcare provider's note or prenatal records), and documentation of all income sources for everyone in your household. Most applications are processed within 45 days. Ask your prenatal provider about presumptive eligibility to start coverage immediately during the review period.
What is the Virginia pregnancy SEP for the Marketplace in 2026?
Virginia created a new pregnancy-specific Special Enrollment Period for its state-based Insurance Marketplace effective January 31, 2026. Before this law, becoming pregnant was not a qualifying life event under federal ACA rules. The new Virginia pregnancy SEP lets any qualifying pregnant person who is not already enrolled in a Marketplace plan enroll in a private plan at any point during pregnancy. Once you start the enrollment process at marketplace.virginia.gov, you have 60 days to select and finalize a plan. The SEP is only available to new Marketplace enrollees, not to those already enrolled who want to switch plans.
How long does pregnancy Medicaid coverage last in Virginia?
Virginia Medicaid for pregnant women covers prenatal care, labor and delivery, and then continues for 12 full months after the end of pregnancy. This 12-month postpartum extension became permanent in Virginia under the American Rescue Plan Act provisions and cannot be terminated due to income changes during that postpartum year. FAMIS MOMS follows the same 12-month postpartum rule. After the postpartum year ends, standard Virginia Cardinal Care Medicaid is available for adults at up to 138% FPL if your income qualifies. If not, you may transition to a Marketplace plan using a qualifying life event SEP.
What happens to my baby's health insurance after birth in Virginia?
Babies born to Cardinal Care Medicaid-enrolled mothers are automatically enrolled in Virginia Medicaid at birth under the deemed newborn rule, with coverage retroactive to the date of birth. The hospital typically handles this enrollment. The baby remains enrolled for 12 months of continuous coverage regardless of income changes. If the mother is on FAMIS MOMS rather than Cardinal Care, the newborn may enroll in FAMIS (Virginia CHIP for children up to 205% FPL) or Cardinal Care for children (up to 148% FPL). If the mother is on a Marketplace or COBRA plan at delivery, the birth triggers a 60-day Special Enrollment Period to add the newborn to coverage.
Is COBRA worth it for pregnant women in Virginia?
Almost never, if you qualify for Virginia Cardinal Care Medicaid or FAMIS MOMS. COBRA charges 102% of the full employer premium, typically $500 to $2,000 per month for individual coverage. Cardinal Care provides the same comprehensive prenatal and delivery coverage at zero cost for income up to 148% FPL, and FAMIS MOMS provides near-zero-cost coverage to 205% FPL. The only scenario where COBRA might make sense is if your income is well above 205% FPL and you need to maintain coverage with a specific high-risk obstetric specialist who is not in the Virginia Marketplace network. Even then, compare the COBRA monthly cost against a Marketplace Silver plan with Premium Tax Credits before deciding.
Does Cardinal Care Medicaid cover prenatal care even if my pregnancy started before I enrolled?
Yes. Virginia Cardinal Care and FAMIS MOMS cover prenatal care from the application date or presumptive eligibility determination date, regardless of when the pregnancy began. Additionally, Virginia Medicaid may provide retroactive coverage for up to 3 months prior to the application month in some cases, which means prenatal care received before you applied may be covered retroactively. Ask your DMAS case worker at 1-855-242-8282 about retroactive eligibility when you apply. The Virginia Insurance Marketplace pregnancy SEP similarly covers maternity care and childbirth as essential health benefits even if the pregnancy began before the Marketplace enrollment start date.
What state-specific Virginia programs exist beyond standard Medicaid for pregnant women?
Virginia offers several programs that go beyond standard federal Medicaid. FAMIS MOMS extends coverage to 205% FPL for pregnant women who exceed the 148% Cardinal Care threshold. Presumptive eligibility lets qualified healthcare providers authorize immediate prenatal coverage before a formal Medicaid determination. The 12-month postpartum extension is now permanent in Virginia, going further than the 60-day federal floor. Virginia's own state-based Insurance Marketplace at marketplace.virginia.gov (separate from healthcare.gov) hosts the new pregnancy-specific SEP effective January 31, 2026, a benefit not federally required and not available in all states. Virginia FAMIS covers children up to 205% FPL with year-round enrollment and 12-month continuous coverage protection.
