Virginia Pregnancy Medicaid: Do I Qualify? (2026)

Direct Answer: Does Virginia Medicaid Cover Pregnancy?

Yes. Virginia Medicaid for Pregnant Women covers households earning at or below 148% of the 2026 Federal Poverty Level, which equals $23,621 per year for a single-person household. The unborn child counts as a household member, so a pregnant individual with no other dependents is treated as a 2-person household (148% FPL threshold of $32,028). Virginia also offers FAMIS MOMS for households earning between 148% and 205% FPL. Both programs cover prenatal care, delivery, and 12 months of postpartum care.

Virginia Pregnancy Medicaid Income Limits by Household Size (2026)

Virginia Medicaid for Pregnant Women uses 148% of the 2026 Federal Poverty Level as its income cutoff. Virginia adopted updated 2026 FPL guidelines on January 13, 2026, which are now in effect at CoverVA. An important calculation rule: the unborn child counts as one household member. A pregnant woman with no other dependents applies as a 2-person household, meaning her 2026 income limit is $32,028 per year, not $23,621.

Virginia also offers FAMIS MOMS for households earning between 148% and 205% of the 2026 FPL. For a 2-person household, FAMIS MOMS covers incomes up to $44,362 per year in 2026. FAMIS MOMS applicants must be uninsured at the time of application. Both programs deliver care through Virginia's Cardinal Care managed care plans.

What Virginia Medicaid Covers for Pregnant Women (2026)

Virginia Medicaid for Pregnant Women provides comprehensive benefits with no cost-sharing for covered services. Prenatal care includes all required prenatal visits, lab tests (blood work, urine tests, gestational diabetes screening), ultrasounds, and specialist referrals. Labor and delivery are fully covered in any Virginia Medicaid-participating hospital, including cesarean section when medically indicated. Virginia also covers doula services for all enrolled pregnant and postpartum Medicaid members, a benefit that fewer than 15 states currently offer.

Virginia provides dental coverage for pregnant Medicaid members through the Smiles for Children program (contact: 1-888-912-3456). Dental care during pregnancy is especially important because hormonal changes increase the risk of periodontal disease, which is linked to preterm birth. Postpartum coverage continues for 12 full months after delivery, covering all standard Medicaid benefits regardless of any income changes the family experiences after the birth.

• Prenatal visits: all required appointments with an OB-GYN or certified midwife
• Labor and delivery: hospital admission, anesthesia, attending physician, newborn initial care
• Prenatal lab work: blood tests, urine analysis, Group B strep screening, gestational diabetes screening
• Ultrasounds: standard and high-risk pregnancy ultrasounds
• Dental care through Smiles for Children (call 1-888-912-3456 to find a participating dentist)
• Doula services: Virginia covers professional doula support during pregnancy and postpartum
• Postpartum visits: 12 months of continued coverage after delivery for the birthing parent
• Mental health services: screening and treatment for postpartum depression and anxiety

How to Apply for Virginia Medicaid for Pregnant Women

Virginia Medicaid accepts pregnancy applications year-round with no enrollment window. Pregnant applicants receive priority processing, typically completed within 10 business days. Emergency situations (for example, labor is imminent) can be expedited to 5 business days. Virginia also allows up to 3 months of retroactive coverage, meaning if you received prenatal care before applying, those earlier services may be covered.

Virginia Medicaid applications can be submitted online, by phone, or in person. The online portal at coverva.dmas.virginia.gov/apply is the fastest method and accepts applications 24 hours a day. You can also call Cover Virginia at 1-855-242-8282 to apply by phone or to request a paper application. In-person assistance is available at local Department of Social Services offices throughout Virginia.

FAMIS MOMS and FAMIS Prenatal: Higher-Income Pregnancy Options in Virginia

Virginia operates two additional pregnancy programs for individuals whose income exceeds the 148% FPL Medicaid threshold. FAMIS MOMS covers households earning between 148% and 205% of the 2026 Federal Poverty Level. For a 2-person household in 2026, that means annual income between $32,028 and $44,362 qualifies for FAMIS MOMS. Applicants must be uninsured at the time of application and must not currently have access to other comparable coverage.

FAMIS Prenatal is a more targeted option that covers prenatal care only (not full medical coverage) and has no immigration status requirement. FAMIS Prenatal serves individuals who are not eligible for full Medicaid or FAMIS MOMS due to immigration status but who are pregnant and reside in Virginia. Postpartum coverage for FAMIS Prenatal members is limited compared to full Medicaid and FAMIS MOMS. All three programs deliver services through Virginia's Cardinal Care managed care network.

• FAMIS MOMS: full pregnancy and 12-month postpartum coverage, income 148-205% FPL, must be uninsured
• FAMIS Prenatal: prenatal care only, no immigration status requirement, limited postpartum coverage
• Virginia Medicaid for Pregnant Women: full pregnancy plus 12-month postpartum, income at or below 148% FPL

Is Virginia a Medicaid Expansion State? (Expansion and the ACA Gap)

Yes. Virginia expanded Medicaid in January 2019, making it one of the 40 states plus the District of Columbia that have expanded coverage under the Affordable Care Act. Medicaid expansion in Virginia covers non-pregnant adults ages 19 to 64 with household income at or below 138% of the Federal Poverty Level ($22,025 per year for an individual in 2026). Virginia does not have the ACA coverage gap that affects non-expansion states.

The ACA coverage gap exists in the 10 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming), where adults earning between 100% and 138% FPL are too poor to qualify for ACA marketplace subsidies but do not qualify for traditional Medicaid. Virginia residents do not face this gap. Pregnant individuals in Virginia have separate, more generous income thresholds (148% FPL) regardless of expansion, and those thresholds apply to all Virginia residents who are pregnant.

Common Reasons Virginia Pregnancy Medicaid Applications Are Denied

Virginia DMAS must process all pregnancy Medicaid applications within 10 business days. If your application is denied, you will receive a written notice explaining the specific reason. Understanding the most common denial reasons helps applicants avoid delays.

Virginia residents have the right to appeal any denial or reduction of coverage. The appeal must be filed within 30 days of receiving the notice of adverse action (or up to 90 days if you have a good cause for the delay). Submit appeals to the DMAS Appeals Division by calling 804-371-8488, writing to DMAS Appeals Division at 600 E. Broad St., Richmond, VA 23219, or visiting coverva.dmas.virginia.gov/learn/appeals/. You can request that your current benefits continue during the appeal review.

• Income over 148% FPL: the most common reason. If you are over 148% FPL but below 205% FPL, apply immediately for FAMIS MOMS instead.
• Virginia residency not verified: applicants must demonstrate current Virginia residence, not just intent to move.
• Insufficient income documentation: incomplete pay stubs, missing W-2s, or failure to account for self-employment income.
• Pregnancy not confirmed: DMAS requires medical confirmation of pregnancy, not just a self-declaration.
• Immigration status disqualification: affects the standard Medicaid program, but FAMIS Prenatal covers prenatal-only services with no immigration status requirement.

What Counts as Income for Virginia Pregnancy Medicaid (MAGI Rules)

Virginia pregnancy Medicaid uses Modified Adjusted Gross Income (MAGI) to calculate household income, consistent with the federal Medicaid rules under the Affordable Care Act. MAGI is based on your federal tax filing income plus a few adjustments. For most pregnant individuals, MAGI equals the total income reported on your federal tax return, including wages, self-employment income, rental income, alimony received, and unemployment compensation.

Several income types are excluded from the MAGI calculation. Child support received is not counted as income. Supplemental Security Income (SSI) is excluded. Gifts and inheritances are not counted. Workers' compensation payments are excluded. Virginia also applies a 5% Federal Poverty Level standard income disregard to most programs, which effectively raises the usable income limit slightly. The household size calculation includes the unborn child as one person, which also increases the income threshold that applies.

• Counted as income under MAGI: wages, salaries, tips, self-employment net income, taxable interest and dividends, rental income, alimony received (for divorces finalized before January 1, 2019), Social Security benefits (taxable portion), unemployment compensation
• NOT counted as income under MAGI: child support received, SSI/SSDI, veterans benefits (non-taxable portion), gifts and inheritances, workers' compensation, TANF/SNAP benefits
• Household size and family size: includes the pregnant individual, all biological or adoptive children, the pregnant person's spouse (if filing jointly), and the unborn child (counts as 1 additional person). The family size determines which income row in the household-size table applies.

After Coverage: What Happens When Postpartum Coverage Ends in Virginia

Virginia provides 12 months of full Medicaid coverage after delivery for all individuals enrolled in Medicaid for Pregnant Women or FAMIS MOMS. This 12-month postpartum period is guaranteed regardless of any income changes that occur after the birth. After the 12-month postpartum period ends, DMAS reviews eligibility as a non-pregnant adult.

Individuals who remain income-eligible as non-pregnant adults (at or below 138% FPL) can transition to Virginia's standard Medicaid expansion coverage without interruption. Those who no longer qualify for Medicaid after postpartum coverage ends may be eligible for subsidized coverage through the ACA marketplace. Virginia's Insurance Marketplace accepts applications during Open Enrollment (November 1, 2025 through January 15, 2026 for 2026 coverage) and through Special Enrollment Periods triggered by the loss of Medicaid coverage.

What is the income limit for Virginia pregnancy Medicaid for a family of 4 in 2026?

For a family of 4 in 2026, the Virginia Medicaid for Pregnant Women income limit is $48,840 per year (148% FPL). If your family of 4 earns between $48,840 and $67,650 per year, you may qualify for FAMIS MOMS instead. Remember that the unborn child counts as one household member, so a pregnant woman with 2 other children and no spouse applies as a household of 4 (herself + 2 children + unborn child).

Does Virginia Medicaid cover prenatal care and hospital delivery?

Yes. Virginia Medicaid for Pregnant Women covers all prenatal visits, lab work, ultrasounds, labor and delivery (including cesarean section), hospital stays, anesthesia, and initial newborn care. There is no cost-sharing for these services. Virginia also covers doula services and dental care through the Smiles for Children program for enrolled pregnant members.

How long does Virginia Medicaid cover after birth in 2026?

Virginia provides 12 months of full Medicaid coverage after delivery. This 12-month postpartum period is guaranteed and does not end early if your income increases after birth. After 12 months, DMAS reviews your eligibility as a non-pregnant adult. If you remain at or below 138% FPL, you can continue on standard Virginia Medicaid expansion coverage.

What is FAMIS MOMS and how is it different from Virginia Medicaid for Pregnant Women?

FAMIS MOMS is Virginia's CHIP-based pregnancy program for individuals who earn too much for standard Medicaid (above 148% FPL) but below 205% FPL. For a 2-person household in 2026, that means income between $32,028 and $44,362 per year. FAMIS MOMS provides the same comprehensive prenatal and 12-month postpartum coverage as Medicaid for Pregnant Women. Applicants for FAMIS MOMS must be uninsured at the time of application.

Can undocumented immigrants get pregnancy Medicaid in Virginia?

Virginia offers FAMIS Prenatal for pregnant individuals regardless of immigration status. FAMIS Prenatal covers prenatal care only (not full medical coverage) and does not require immigration documents or a Social Security number. Standard Medicaid for Pregnant Women and FAMIS MOMS require U.S. citizenship or qualifying immigration status. Emergency Medicaid covers labor and delivery for all qualifying individuals regardless of immigration status.

What documents do I need to apply for Virginia pregnancy Medicaid?

You need proof of pregnancy (medical confirmation from a healthcare provider), identity documents (driver's license, birth certificate, or passport), Social Security numbers for household members, income proof (pay stubs from the last 30 days, W-2, or tax return), and proof of Virginia residency (utility bill or lease). Applications are accepted online at coverva.dmas.virginia.gov/apply or by calling 1-855-242-8282.

Is Virginia a Medicaid expansion state?

Yes. Virginia expanded Medicaid in January 2019. This means non-pregnant adults ages 19 to 64 earning at or below 138% FPL ($22,025 for an individual in 2026) qualify for Virginia Medicaid. Virginia does not have the ACA coverage gap that affects the 10 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming).

How long does it take to get approved for pregnancy Medicaid in Virginia?

Pregnant applicants receive priority processing and are typically approved within 10 business days. Emergency cases (for example, when labor is imminent) can be approved in 5 business days. Coverage starts from the date of application, and Virginia allows up to 3 months of retroactive coverage for services received before the application was submitted.