Limited Medicaid in Virginia for Adults
If you’re trying to understand limited Medicaid in Virginia for adults, this guide breaks it down in simple terms — who qualifies, what limited benefits mean, and how this differs from full Medicaid coverage in the Commonwealth of Virginia.
What Is Medicaid in Virginia?
Medicaid is a joint federal and state health insurance program for people with low incomes and limited resources. It helps cover many medical services like doctor visits, hospital care, prescriptions, and preventive care. In Virginia, Medicaid is managed by the Department of Medical Assistance Services (DMAS). (Virginia Medicaid)
Virginia expanded Medicaid under the Affordable Care Act, allowing more adults ages 19‑64 with low incomes to qualify for full health coverage. (Virginia Medicaid)
What Does “Limited Medicaid” Mean in Virginia?
“Limited Medicaid” refers to Medicaid programs that provide specific, partial benefits rather than full health coverage. It’s not full Medicaid — it covers only certain services and is designed for adults who don’t qualify for full Medicaid benefits due to income or other eligibility rules.
In Virginia, the primary limited Medicaid program is:
🔹 Plan First (Limited Family Planning Coverage)
Plan First is a limited benefit Medicaid program that provides family planning and reproductive health services to men and women who do not qualify for full Medicaid. (CoverVA)
What Plan First covers:
- Yearly family planning exams
- Pap tests & STI (sexually transmitted infection) testing
- Family planning education and counseling
- Approved contraceptives (both over‑the‑counter and prescription)
- Vasectomies and tubal ligations
- Transportation to family planning services
✨ Important: Plan First *does not cover general medical care, treatment for illnesses, emergency services, or prescription drugs unrelated to family planning. (Virginia Medicaid)
Think of Plan First as limited Medicaid health coverage focused only on reproductive and pregnancy planning services — it’s not a substitute for full Medicaid health benefits.
How Limited Medicaid Differs From Full Medicaid
| Feature | Full Medicaid | Limited Medicaid (Plan First) |
|---|---|---|
| Coverage | Comprehensive health services | Only family planning and related services |
| Who qualifies | Low‑income adults under 138% FPL, pregnant women, disabled or blind individuals | Adults who don’t meet full benefits criteria but need family planning services |
| Includes general medical care? | Yes | ❌No |
| Includes preventive care? | Yes | Only family planning |
Full Medicaid coverage is available to adults in Virginia with incomes below about 138% of the federal poverty level (FPL) — for example, in 2026, about $1,836 monthly for a single adult (with a 5% disregard). (CoverVA)
Plan First serves people with slightly higher or borderline incomes who don’t meet full eligibility but still need reproductive health services.
Who Qualifies for Limited Medicaid (Plan First) in Virginia?
To qualify for Plan First, you typically must:
- Be a U.S. citizen or lawfully present immigrant
- Live in Virginia
- Meet the specific income limits for your household size
- Not qualify for full Medicaid benefits under other categories
If you meet these criteria but your income is above the threshold for full adult Medicaid, you may still qualify for Plan First and receive family planning services. (CoverVA)
Why Limited Medicaid Exists
Limited Medicaid programs exist because:
✔ They provide essential preventive health services (like family planning) to those who wouldn’t otherwise qualify for full coverage. (KFF)
✔ They help reduce unintended pregnancies and support reproductive health through education and access to contraceptives. (KFF)
✔ They ensure that people who fall just outside full Medicaid income limits still have access to some crucial care. (CoverVA)
How to Apply for Limited Medicaid & Full Medicaid in Virginia
Many people apply for both programs using the same application. Eligible applicants will be screened automatically:
📍 Online: via CommonHelp
📍 Phone: Call Cover Virginia at 1‑855‑242‑8282
📍 In‑Person: Local Department of Social Services office
When you apply, the system evaluates your income and other eligibility factors to see whether you qualify for full Medicaid or limited benefits like Plan First. (CoverVA)
Final Takeaway
⚡ Limited Medicaid in Virginia — primarily through the Plan First program — gives adults with incomes above full Medicaid thresholds access to family planning and related health services.
⚡ It’s great for those who don’t qualify for full Medicaid but still need preventive reproductive care.
⚡ For any other medical needs, earning below the full Medicaid income limits opens the door to comprehensive Medicaid health coverage. (Virginia Medicaid)