Cover Virginia FAMIS — How to Apply for a Grandchild's Health Coverage

What FAMIS and Medicaid Cover

Virginia provides two programs for children's health coverage, both administered through Cover Virginia and the Department of Medical Assistance Services (DMAS):

Children's Medicaid (Cardinal Care): Covers children in households with income up to 143% of the Federal Poverty Level (including a standard 5% FPL disregard). Full medical, dental, vision, mental health, and prescription coverage with no co-payments or deductibles.

FAMIS: Covers children in households with income between 143% and 205% of the Federal Poverty Level. Same comprehensive coverage — medical, dental, vision — and also no co-payments or deductibles for pediatric care.

For a kinship caregiver, the practical difference between the two is just the income threshold. Cover Virginia determines which program the child qualifies for based on the application — you do not need to choose between them.

The Income Rule That Matters Most

Health coverage for children uses Modified Adjusted Gross Income (MAGI) rules, and household composition depends on tax filing status. Here is the key distinction for kinship caregivers:

If you do not claim the child as a tax dependent: The child is evaluated as a non-filer. Only the child's own personal income is counted. Your retirement income, wages, Social Security, and pension are excluded from the eligibility calculation. Since most children in kinship care have little or no personal income, most qualify for Children's Medicaid.

If you do claim the child as a tax dependent: Your income is included in the household under tax-filer rules. You may still qualify under FAMIS's higher income limit (205% FPL), but your financial picture matters.

For an informal caregiver who does not claim the child as a tax dependent, the child's own income is the key income figure under the non-filer rule. Eligibility still depends on the applicable income limit and the child's other program requirements.

How to Apply

Three pathways:

1. Online: CommonHelp at commonhelp.virginia.gov — you can apply for health coverage alongside TANF and SNAP in one submission
2. Phone: Cover Virginia Call Center at 1-855-242-8282. If you are applying for multiple benefit programs, you can also call the Enterprise Customer Service Center at 1-855-635-4370.
3. In person or by mail: Submit Form 032-03-1100-39 (Application for Benefits) to your local DSS office

You do not need a court custody order to apply for a child's health coverage. A relative caregiver providing full-time care can apply on behalf of the child using proof of relationship and proof that the child lives with you.

Enrolling the child in health coverage establishes insurance — it does not grant you medical consent authority. If you need the ability to authorize medical treatment, that requires a separate legal step (a Power of Attorney under § 20-166 or formal court custody).

Noncitizen Children

As of October 1, 2026, federal Medicaid rules changed for non-pregnant adults. But these changes do not affect children aged 18 and under. Legally residing noncitizen children remain fully eligible for both Medicaid and FAMIS based on standard household income limits. If a caseworker suggests otherwise, the DMAS noncitizen eligibility toolkit (published June 2026) confirms that pediatric eligibility is unchanged.

Retroactive Coverage

For Medicaid, Virginia's current rules allow retroactive coverage for up to three calendar months before the application month if the child met the eligibility rules in those months. Beginning January 1, 2027, the maximum becomes one month for Medicaid Expansion and two months for other Medicaid categories. Virginia does not provide retroactive coverage through FAMIS, except for newborns whose application is submitted within three months of birth. Ask Cover Virginia or your local DSS which coverage category applies before relying on reimbursement for earlier bills.

This matters if you have been paying out of pocket for the child's medical care before applying — those costs may be reimbursable.

Renewals

Health coverage must be renewed periodically, typically every 12 months. Cover Virginia or your local DSS will send a renewal packet. Respond before the deadline. If coverage closes after a missed renewal, read the notice and contact Cover Virginia or your local DSS promptly about the renewal or appeal steps for that case; do not assume you must start over with a new application.

For a complete walkthrough of FAMIS alongside every other financial benefit available to kinship caregivers in Virginia — TANF child-only, SNAP, childcare subsidies, and more — the Virginia kinship financial help guide covers each program with the documents you need and the specific agencies to contact.

See more Virginia guides →