Cardinal Care Income Limits in Virginia (2026)

Cardinal Care is the official brand for Virginia's Medicaid program, launched in October 2023 when the Department of Medical Assistance Services (DMAS) merged two legacy managed-care programs, Medallion 4.0 and Commonwealth Coordinated Care Plus (CCC Plus), into a single unified program. Cardinal Care serves more than 1.7 million Virginians including children, pregnant women, parents, seniors, and people with disabilities. Virginia adopted the 2026 Federal Poverty Level guidelines on January 13, 2026, earlier than most states. The 2026 FPL base is $15,960 for a single person in the 48 contiguous states, with a household increment of $5,680 per additional person, per the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (HHS ASPE). Cardinal Care applies the standard 5% FPL disregard on most MAGI-based calculations, meaning the effective threshold for children and pregnant women is approximately 148% FPL even though the stated program limit is 143% FPL without the disregard.

Virginia expanded Medicaid under the Affordable Care Act on January 1, 2019, after years of legislative debate. Expansion made Cardinal Care available to adults ages 19 to 64 with incomes at or below 138% FPL, adding more than 595,000 Virginians to coverage. Before expansion, childless adults and non-disabled parents with incomes above very low thresholds had no path to Medicaid regardless of income. Today, Cardinal Care covers four major population groups: expansion adults (138% FPL), children (148% FPL under Cardinal Care Medicaid, and up to 205% FPL via FAMIS, Virginia's CHIP program), pregnant women (148% FPL under Cardinal Care, with FAMIS MOMS extending coverage to 205% FPL), and aged, blind, and disabled Virginians under SSI-related rules with both income and asset tests. Virginia also administers three Medicare Savings Programs (QMB, SLMB, and QI) for low-income Medicare beneficiaries who may qualify for dual enrollment.

Cardinal Care uses a managed-care delivery model. Once enrolled, most members are assigned to one of several managed care organizations (MCOs) that coordinate and deliver services. The program covers a comprehensive benefit package including medical visits, hospitalization, behavioral health, prescription drugs, dental, and vision for most enrollees. Postpartum coverage extends for 12 months after the end of a pregnancy under federal rules effective since 2022, which Virginia implemented. Children enrolled in Cardinal Care receive 12 months of continuous eligibility under the federal mandate effective January 2024, meaning coverage does not end mid-year simply because a family's income temporarily rises. Starting in January 2027, Virginia plans to introduce community engagement requirements for expansion adults ages 19 to 64, so applicants should confirm current rules at dmas.virginia.gov when applying.

Cardinal Care (Virginia Medicaid) income limits by household size (2026)

Cardinal Care (Virginia Medicaid) income limits for 2026, based on the 2026 Federal Poverty Level for the 48 contiguous states. The Adult column shows the 138% FPL expansion threshold. The Children and Pregnant columns reflect the 148% FPL threshold (138% FPL plus the standard 5% disregard) that Virginia applies to those groups. FAMIS (Virginia CHIP) covers children and pregnant individuals between 148% and 205% FPL and is not reflected in this table. Annual figures are rounded to the nearest dollar.

Cardinal Care (Virginia Medicaid) eligibility requirements (non-income)

Cardinal Care eligibility in Virginia requires meeting both income and non-income criteria. Beyond the income thresholds shown in the table above, applicants must satisfy residency, citizenship or immigration status, and population-group requirements. Non-MAGI categories (aged, blind, disabled, and long-term care) carry additional asset tests.

• Virginia residency: Applicants must live in Virginia with the intent to remain. There is no minimum residency period. Homeless individuals may use the address of a shelter, social services office, or caseworker.
• U.S. citizenship or qualifying immigration status: Cardinal Care covers U.S. citizens, lawful permanent residents, and certain qualified aliens. Lawful permanent residents who entered the country on or after August 22, 1996 face a federal five-year bar before they can access most Medicaid benefits (pregnant women and children have exceptions). Emergency services are available to undocumented Virginians through the Emergency Medical Assistance program regardless of immigration status.
• Social Security Number: Applicants must provide a Social Security Number for each household member seeking coverage, or apply for an SSN if one has not been issued. Virginia will verify SSNs electronically through the Social Security Administration.
• Age and population-group criteria: Adults ages 19 to 64 qualify under the ACA expansion category at 138% FPL. Children under 19 qualify under the children's Medicaid category at 148% FPL (or FAMIS at up to 205% FPL). Pregnant individuals qualify at 148% FPL under Cardinal Care. Adults 65 and older, or those who are blind or disabled, qualify under SSI-related categories with income limits near the SSI federal benefit rate ($967 per month for an individual in 2026) and asset tests.
• Asset test (MAGI categories): Cardinal Care expansion adults, children, and pregnant women are MAGI-based categories and have no asset test. Applicants do not need to liquidate savings accounts, retirement funds, or property to qualify in these groups.
• Asset test (non-MAGI categories): Aged, blind, and disabled Virginians applying for SSI-related Medicaid face a $2,000 asset limit for single applicants and $3,000 for married couples. Long-term care Medicaid has stricter rules: income must be under $2,982 per month (2026) and countable assets under $2,000 for a single applicant, with a 60-month lookback period for asset transfers. A non-applicant spouse may retain up to $162,660 in assets under the Community Spouse Resource Allowance.
• No other disqualifying coverage: Applicants with access to affordable employer-sponsored insurance (ESI) offering minimum value coverage may be directed to enroll in that plan instead. Cardinal Care will often pay the employee premium contribution if the employer plan is cost-effective (the Premium Assistance program).

What income counts for Cardinal Care (Virginia Medicaid)

Cardinal Care uses Modified Adjusted Gross Income (MAGI) to determine eligibility for most applicants, including expansion adults, children, and pregnant women. MAGI is based on the federal tax definition of adjusted gross income with a few modifications specified by the Affordable Care Act. Virginia adopted the 2026 federal poverty guidelines effective January 13, 2026 and applies the standard 5% FPL disregard to children's and pregnancy Medicaid categories. MAGI rules do not apply to aged, blind, or disabled applicants, who use SSI-related income counting rules instead.

Income sources included

• Wages, salaries, and tips (W-2 income) from employment.
• Net self-employment income (gross receipts minus ordinary business expenses), reported on Schedule C or Schedule F for farm income.
• Social Security retirement and survivor benefits (the taxable portion counts as MAGI income).
• Social Security Disability Insurance (SSDI) benefits (the taxable portion counts).
• Unemployment compensation (fully counted as MAGI income).
• Pension and retirement account distributions (401(k), IRA, pension plan payments).
• Interest, dividends, and capital gains from investments.
• Rental income (gross rents minus allowable rental expenses).
• Alimony received under divorce or separation agreements executed before January 1, 2019 (pre-TCJA agreements only).

Income sources excluded

• Supplemental Security Income (SSI) payments are fully excluded from MAGI income (note: SSDI is different from SSI and IS counted).
• Child support payments received by the household.
• Veterans Administration (VA) disability compensation, pension payments, and GI Bill education benefits.
• Workers' compensation payments for job-related injury or illness.
• Gifts, inheritances, and one-time windfalls (not regular income).
• TANF (Temporary Assistance for Needy Families) cash assistance payments.
• Foster care and adoption assistance payments for foster children in the home.
• Loan proceeds (student loans, personal loans, home equity lines of credit) because loans are not income.

How to apply for Cardinal Care (Virginia Medicaid) in Virginia

Cardinal Care applications in Virginia go through CommonHelp, the statewide online benefits portal operated jointly by the Virginia Department of Social Services (VDSS) and DMAS. CommonHelp handles Cardinal Care, FAMIS, SNAP, and TANF applications in one place. Virginians can also apply by calling Cover Virginia at 1-855-242-8282 (Monday through Friday, 8 a.m. to 7 p.m.), by mailing a paper application to the Cardinal Care Correspondence Center, or by visiting a local Department of Social Services office. Once enrolled, members manage their coverage through CommonHelp and can report income changes, update household members, and renew coverage online.

1. 1. Gather required documents before starting: photo ID, Social Security Numbers for each household member, proof of Virginia residency (utility bill, lease, or mail with your address), proof of income (pay stubs from the last 30 days, most recent tax return, or business records if self-employed), and immigration documents if applicable.
2. 2. Go to commonhelp.virginia.gov and create an account or log in. Select 'Apply for Benefits' and choose Cardinal Care/Medicaid. The online application takes approximately 60 minutes for a household with multiple members. You can save your progress and return later.
3. 3. Complete all sections of the application: list every person in the household, report all sources of income for each person, and provide information about any existing health coverage (Medicare, employer plan, etc.).
4. 4. Submit your application electronically through CommonHelp. You will receive a confirmation number. Save this number to track your application status. If DMAS or VDSS needs additional documentation, a letter will be sent requesting specific items within a defined response window.
5. 5. Respond promptly to any request for additional information. Documents can be submitted through CommonHelp, by email to verify_docs@coverva.org, by fax to 1-888-221-9402, by mail, or in person at your local DSS office. Missing a documentation deadline is one of the most common reasons applications are denied.
6. 6. Wait for the eligibility determination. Most standard Cardinal Care applications are decided within 45 days. Pregnancy applications are processed within 15 days under federal expedited-processing rules. Once approved, you will receive a Cardinal Care member card and information about choosing an MCO plan in your area.

Official portal: commonhelp.virginia.gov

Documents needed

• Photo ID for the head of household (Virginia driver's license, state ID card, U.S. passport, or military ID).
• Social Security Numbers or Social Security cards for each household member applying for coverage.
• Proof of Virginia residency: a utility bill, rental lease, mortgage statement, or recent piece of official mail showing your current Virginia address.
• Proof of income for the most recent 30 days: pay stubs (all jobs), most recent federal tax return, or a signed self-employment statement with business records if self-employed.
• Citizenship or immigration status documentation: U.S. birth certificate, U.S. passport, Certificate of Naturalization, Permanent Resident Card (Green Card), or other qualifying immigration document.
• Proof of pregnancy if applying for Cardinal Care maternity benefits (a letter from your doctor, midwife, or clinic confirming pregnancy and estimated due date).

Processing timeline: Standard Cardinal Care applications are decided within 45 days of submission. Pregnancy applications are decided within 15 days under federal expedited-processing requirements. Applications involving a disability determination can take 60 to 90 days because they require a separate medical review by the Disability Determination Services unit. Virginia processes most applications faster than the federal 45-day maximum; applicants who applied online through CommonHelp can check status in real time.

Common reasons applications get denied

• Income above the applicable threshold for the applicant's population group (the most common single reason). Verify that all countable income is correctly reported under MAGI rules before reapplying.
• Failure to respond to a request for additional documentation within the required timeframe. Always respond to DMAS or VDSS document requests promptly; a missed deadline can result in denial even if you otherwise qualify.
• Virginia residency not verified (no document showing a current Virginia address in the applicant's name).
• Federal five-year bar for certain lawfully-present immigrants who entered the United States on or after August 22, 1996.
• Applicant already enrolled in minimum value employer-sponsored insurance and the employer plan is determined cost-effective for the state.

If your child's household income exceeds the Cardinal Care Medicaid limit

FAMIS (Family Access to Medical Insurance Security) is Virginia's Children's Health Insurance Program (CHIP), administered alongside Cardinal Care by DMAS. FAMIS covers children from birth through age 18 in households earning between 148% and 205% FPL, providing comprehensive coverage similar to Cardinal Care at low or no cost. For a family of four in 2026, FAMIS covers children with household income up to approximately $67,650 per year (205% FPL). Virginia also offers FAMIS MOMS, which covers pregnant individuals with household income between 148% and 205% FPL. Both FAMIS and FAMIS MOMS are applied for through the same CommonHelp portal at commonhelp.virginia.gov. Virginia is exploring expanding FAMIS coverage up to 300% FPL through future legislative action, which would further reduce uninsured children in higher-income working families.

Compare CHIP and Medicaid income limits across all 50 states

If you are 65 or older with limited income: Cardinal Care Medicare Savings Programs

Virginia administers three Medicare Savings Programs (MSPs) under Cardinal Care for Virginians who are enrolled in Medicare and have limited income. These programs help pay Medicare premiums, deductibles, and copayments. The Qualified Medicare Beneficiary (QMB) program covers Part A and Part B premiums, deductibles, and copayments for individuals with monthly income at or below $1,350 ($1,824 for married couples) using the 2026 federal guidelines. The Specified Low-Income Medicare Beneficiary (SLMB) program pays the Medicare Part B premium for individuals with monthly income between $1,351 and $1,616 ($1,825 to $2,184 for couples). The Qualifying Individual (QI) program pays the Part B premium for individuals with monthly income between $1,617 and $1,816 ($2,185 to $2,455 for couples). Virginia uses the federal asset limits for all MSPs: $9,660 for a single person and $14,470 for a married couple in 2026. Apply for all three programs through CommonHelp or by calling Cover Virginia at 1-855-242-8282. Approximately 12 million Americans are dual-eligible for both Medicare and Medicaid nationwide.

Read the full Medicare eligibility guide

Frequently Asked Questions