Virginia's Children's Health Insurance Program is branded FAMIS, short for Family Access to Medical Insurance Security. FAMIS covers children from birth through age 18 whose families earn too much for Medicaid but cannot afford private insurance. In 2026, a family of four qualifies for FAMIS if annual household income is at or below $67,650, which is 205% of the Federal Poverty Level. Coverage is free: no monthly premiums, no copayments, and no deductibles for covered services.
Virginia also runs FAMIS Plus, the name for Medicaid for Children, which covers children in lower-income households at or below 148% FPL. Both FAMIS and FAMIS Plus are managed by Virginia's Department of Medical Assistance Services (DMAS) and applications go through the same portal. This guide explains who qualifies in Virginia, the 2026 income limits by household size, the FAMIS versus FAMIS Plus distinction, how to apply, what documents you need, and what to do if you are denied.
Quick Answer: Who Qualifies for FAMIS in Virginia (2026)
Yes, your child qualifies for FAMIS if: the child is under 19 years old, lives in Virginia, is a U.S. citizen or lawfully residing immigrant, and household income is at or below 205% FPL ($67,650 per year for a family of four in 2026). FAMIS has no waiting period, no enrollment deadline, and no premium or cost-sharing for covered services.
Children below 148% FPL qualify for FAMIS Plus, the Medicaid for Children track, which adds Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services and transportation assistance. Virginia routes applicants to the correct program automatically based on income. Families only need to submit one application.
FAMIS Income Limits by Household Size in Virginia 2026
Virginia's FAMIS income limits in 2026 are set at 205% of the Federal Poverty Level and include a 5% income disregard that effectively raises the standard FPL cutoff slightly. Virginia adopted the 2026 FPL guidelines on January 13, 2026, earlier than most states. The table at the top of this page shows the full income chart. A household of four can earn up to $67,650 per year, or $5,638 per month, and still qualify for FAMIS. Each additional household member above eight adds $11,644 per year to the income limit.
Virginia uses Modified Adjusted Gross Income (MAGI) rules to count income for FAMIS. MAGI counts wages, salaries, self-employment income, unemployment compensation, Social Security benefits (taxable and nontaxable), alimony received, and investment income. MAGI does NOT count child support received, veterans benefits, workers compensation, gifts, or the value of SNAP and housing assistance. Income is measured on an annual basis, but Virginia can also annualize monthly income if it fluctuates.
Virginia FAMIS vs FAMIS Plus (Medicaid for Children): 2026 income threshold comparison| Program | FPL Threshold | Household of 1 (2026) | Household of 4 (2026) | Key Extra Benefit |
|---|
| FAMIS Plus (Medicaid for Children) | Up to 148% FPL | $23,621/year | $48,840/year | EPSDT + transportation assistance |
| FAMIS (CHIP) | 148% to 205% FPL | $23,622 to $32,718/year | $48,841 to $67,650/year | Same core benefits; no EPSDT add-on |
| ACA Marketplace (subsidized) | Above 205% FPL | Above $32,718/year | Above $67,650/year | Premium tax credits available; not free |
Virginia uses 2026 FPL guidelines effective January 13, 2026. FAMIS and FAMIS Plus both have no premiums, copayments, or deductibles. FAMIS MOMS covers uninsured pregnant individuals up to 205% FPL who do not qualify for Medicaid.
Source: Virginia DMAS CoverVA, coverva.dmas.virginia.gov, January 2026
What FAMIS Covers in Virginia (2026)
Virginia's FAMIS program provides comprehensive coverage for enrolled children at no cost. Covered services include routine and sick doctor visits, emergency care and hospitalizations, behavioral health and mental health services, prescription drugs, vision care and glasses, dental care, vaccinations, lab tests and imaging, and well-child checkups. FAMIS covers the same core services as commercial children's health insurance, with the added benefit of no premiums or cost-sharing.
FAMIS Plus (Medicaid for Children) adds EPSDT, the federal Medicaid benefit for enrollees under 21 that requires states to cover any medically necessary service even if it is not in the standard benefit package. EPSDT is particularly important for children with developmental delays, autism spectrum disorder, or complex medical needs. FAMIS Plus also provides transportation assistance to and from medical appointments when no other transportation is available.
How to Apply for FAMIS in Virginia
Virginia's FAMIS and FAMIS Plus applications go through the same channel. The fastest way to apply is online at commonhelp.virginia.gov, available 24 hours a day, 7 days a week. Virginia also accepts applications by phone through Cover Virginia at 1-855-242-8282 (TTY: 1-888-221-1590), Monday through Friday 8 a.m. to 7 p.m. Families can also submit paper applications by mail or in person at any local Department of Social Services office. There is no enrollment period for FAMIS: apply any time of year.
After submitting, Virginia DMAS typically processes FAMIS applications within 45 days. If additional information is needed, DMAS sends a letter specifying what documents to submit. Families can respond by mail, fax, email, or in person at a DSS office. Once approved, children receive 12 months of continuous eligibility: coverage stays in place for a full year even if family income temporarily increases during that time. Virginia reviews eligibility annually at the 12-month mark.
Documents Needed to Apply for FAMIS in Virginia
Virginia collects the following information during the FAMIS application. Having these ready before starting speeds up the process. Parents who are not applying for coverage themselves do not need to provide their own Social Security Number, which removes a barrier for mixed-immigration-status families.
- Social Security Number for each child applying (parents not seeking coverage do not need to provide theirs)
- Proof of income: recent pay stubs (last 30 days), W-2 or 1099 forms, or a self-employment income statement
- Proof of Virginia residency: utility bill, lease or mortgage statement, bank statement with Virginia address, or school enrollment records
- Child's birth certificate or other proof of age and identity (passport, hospital birth record)
- Immigration documents if any household member is a non-citizen: green card (I-551), I-94, Employment Authorization Document (EAD), or visa
- Current health insurance policy information if the child already has other coverage
Is Virginia a Medicaid Expansion State? (CHIP Context)
Yes, Virginia expanded Medicaid under the ACA effective January 1, 2019. For children, expansion matters because it lowered the floor for Medicaid for Children (FAMIS Plus) to 148% FPL for adults and children. The 10 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming) do not have this expanded adult Medicaid floor, but all 50 states run CHIP programs for children and children's Medicaid coverage is broader than adult coverage in every state regardless of expansion status.
Virginia's expansion is relevant for FAMIS families where parents or caregivers may separately qualify for Medicaid. Adults in Virginia with household income at or below 138% FPL (about $22,025 for one adult in 2026) qualify for Medicaid. A household where the parent earns between 138% and 400% FPL and the child earns less than 205% FPL can have the child covered by FAMIS and the parent covered by Medicaid or marketplace coverage at the same time.
Common Reasons FAMIS Applications Are Denied in Virginia
Virginia DMAS denies FAMIS applications for several identifiable reasons. Understanding these ahead of time can help families prepare a stronger application or identify the correct appeal.
- Income above 205% FPL: the most frequent denial. Families above the FAMIS limit should check whether their child qualifies for subsidized marketplace coverage. ACA marketplace plans cover children with no upper income cap; premium tax credits help families with income between 100% and 400% FPL offset costs.
- Access to cost-effective employer-sponsored insurance: if a parent's employer offers family coverage and Virginia DMAS determines it is cost-effective (the state's share of FAMIS would cost more than the premium for employer coverage), FAMIS may be denied. Families can appeal this determination.
- Missing or incomplete documents: applications on hold for incomplete information are closed if families do not respond within the allotted time. Re-submitting with complete documents starts a new application.
- Residency outside Virginia: children must reside in Virginia. Temporary out-of-state placements (foster care, school) have special rules. Families should call Cover Virginia to clarify residency questions before applying.
- Immigration status not qualifying: children who are undocumented do not qualify for FAMIS. They may qualify for emergency Medicaid services (treatment for an emergency medical condition). Some locality-funded programs in Virginia provide limited primary care for uninsured children regardless of status.
How to Appeal a FAMIS Denial in Virginia
Virginia families have the right to appeal a FAMIS or FAMIS Plus denial or termination. The denial notice includes the specific reason and instructions for requesting a review. Virginia requires families to file an appeal within 30 days of the date on the denial notice. An informal agency conference must be held within 10 working days of the request. At that conference, families can present additional information, and the eligibility worker will either uphold the denial, request more information, or revise the decision.
If the agency conference does not resolve the issue, families can request a formal State Fair Hearing through the Virginia Department of Social Services. During a State Fair Hearing, an impartial hearing officer reviews the case. Families can request continuation of coverage while the appeal is pending if the appeal is filed promptly. Legal aid organizations such as the Virginia Poverty Law Center can assist families with FAMIS appeals at no cost.
FAMIS MOMS: Virginia CHIP Coverage for Pregnant Individuals
Virginia also runs FAMIS MOMS, which provides CHIP-funded prenatal and postpartum coverage for uninsured pregnant individuals with household income between the Medicaid floor and 205% FPL. FAMIS MOMS covers prenatal visits, labor and delivery, postpartum care, and newborn care. Coverage continues for 12 full months postpartum regardless of any income changes during that period. Undocumented immigrants are not eligible for FAMIS MOMS, but emergency Medicaid covers labor and delivery regardless of immigration status.
Frequently Asked Questions
What is the income limit for FAMIS in Virginia for a family of 4 in 2026?
A family of four can earn up to $67,650 per year ($5,638 per month) and qualify for FAMIS, Virginia's CHIP program, in 2026. This equals 205% of the Federal Poverty Level. If your family of four earns less than $48,840 per year, your child may qualify for the richer FAMIS Plus (Medicaid for Children) benefit package instead.
What is FAMIS in Virginia?
FAMIS stands for Family Access to Medical Insurance Security. It is Virginia's brand name for CHIP, the federal Children's Health Insurance Program. FAMIS covers children from birth through age 18 whose families earn too much for Medicaid for Children (FAMIS Plus) but cannot afford private insurance. FAMIS is free: no premiums, copayments, or deductibles.
What counts as income for FAMIS eligibility in Virginia?
Virginia uses MAGI (Modified Adjusted Gross Income) to determine FAMIS income. MAGI includes wages, self-employment income, unemployment benefits, Social Security income, alimony received, and investment income. MAGI does NOT count child support received, veterans benefits, workers compensation, SNAP, housing assistance, or gifts. Lump-sum income like an inheritance is counted in the month received.
What is the difference between FAMIS and FAMIS Plus in Virginia?
FAMIS Plus is Medicaid for Children, covering children in households at or below 148% FPL ($48,840 per year for a family of four in 2026). FAMIS is the CHIP tier, covering households between 148% and 205% FPL ($67,650 for a family of four). FAMIS Plus includes EPSDT, which guarantees coverage for any medically necessary service, and transportation assistance. Both are free with no premiums or copayments.
How long does FAMIS last once my child is enrolled in Virginia?
Virginia provides 12 months of continuous eligibility for all children enrolled in FAMIS and FAMIS Plus. Coverage stays in place for the full 12 months even if family income temporarily rises above the limit. Virginia reviews eligibility at the 12-month anniversary. Coverage ends early only if the child permanently leaves Virginia, the family requests termination, the child turns 19, or there was an error or fraud in the original enrollment.
Can undocumented immigrant children get FAMIS in Virginia?
No. FAMIS and FAMIS Plus require children to be U.S. citizens or lawfully residing immigrants. Undocumented children do not qualify for FAMIS. They may qualify for Virginia emergency Medicaid, which covers treatment for emergency medical conditions. Some locality-funded Virginia programs offer limited primary care to uninsured children regardless of immigration status. Parents who are undocumented do not need to provide their own Social Security Number when applying for their eligible citizen or legal-resident children.
How do I apply for FAMIS in Virginia?
Apply online at commonhelp.virginia.gov any time of year. You can also call Cover Virginia at 1-855-242-8282 (Monday through Friday, 8 a.m. to 7 p.m.) or submit a paper application at your local Department of Social Services. Have your child's Social Security Number, proof of income, proof of Virginia residency, and the child's birth certificate ready. Decisions typically take up to 45 days.
My child was denied FAMIS in Virginia. What can I do?
You can appeal. The denial notice will explain the reason and the steps to request a review. You have 30 days from the date on the notice to file an appeal. Request an informal agency conference first; it must be held within 10 working days. If that does not resolve it, request a formal State Fair Hearing. File promptly to request continuation of coverage during the appeal. Virginia Poverty Law Center can assist with appeals for free.
