FAQs

Medicaid is a federal and state program that provides health care coverage to residents of Virginia who meet eligibility requirements. The Virginia Department of Medical Assistance Services (DMAS) administers both the Medicaid and CHIP programs (which is Virginia's program for children who meet certain eligibility criteria).

You must be eligible for Medicaid and live in a county where Sentara Health with Kaiser Permanente is available as a Managed Care Organization (MCO). We must also be accepting new Medicaid members at the time you apply for Medicaid.

If you think you qualify for Medicaid, visit https://coverva.org/ to start your application process.

Learn more about the Medicaid application process.

You can apply any time during the year – there is no deadline.

Learn more about the Medicaid enrollment process.

Check the status of your application online through https://coverva.org/.

Once you are determined eligible for Medicaid, you’ll get a plastic DMAS ID card and can begin using your benefits.

If you’ve been turned down for Medicaid, you have 10 days to appeal your ineligibility by contacting your local Department of Social Services office. If you’re still not eligible for Medicaid, DSS will determine if you’re eligible for federal financial assistance.

Visit https://healthcare.gov/ to choose health coverage that meets your family’s needs.

Most individuals who qualify for Medicaid or FAMIS will have no monthly premium, no copay, and no out-of-pocket cost. For some individuals, a small monthly premium or copay may apply.

Medicaid and Healthcare.gov both offer health coverage, but Healthcare.gov offers federally subsidized health plans, whereas Medicaid coverage is jointly funded by the federal government and the states. Income eligibility is lower for Medicaid than for Healthcare.gov health plans. If you qualify for Medicaid, your health care will be free or low-cost to you and your family and you are not eligible to get financial assistance on a Healthcare.gov health plan.

Yes, you can choose your own primary care doctor from our wide network of doctors. You can also switch to a new Kaiser Permanente doctor at any time.

All of our available doctors take our Medicaid members. Simply visit kp.org/chooseyourdoctor.

You can find information on medical facility locations, departments, and care here. You can also call Member Services at 1-855-249-5025, or 711 (TTY), Monday through Friday, from 7:30 a.m. to 9 p.m. (closed holidays).

Your Medicaid Member Handbook will give you complete benefit information.

If you are eligible for Medicaid and choose to receive your care from Sentara Health with Kaiser Permanente, you are covered for drugs included in our approved list. To check if your medication is covered, click the link above or contact Member Services at 1-855-249-5025, or 711 (TTY), Monday through Friday, from 7:30 a.m. to 9 p.m. (except holidays).

To speak with a pharmacy representative who can help you transfer your prescription(s), call Member Services at 1-855-249-5025, or 711 (TTY), Monday through Friday, from 7:30 a.m. to 9 p.m. (closed holidays).

When you call, please have your prescription number(s) and the name and phone number of the pharmacy where you wish to transfer them from ready. We’ll handle the rest.

You can also visit New Member Prescription Transfer for information on how to transfer your prescriptions.

If you want to transfer a prescription from another pharmacy to a Kaiser Permanente medical center pharmacy, call the Kaiser Permanente pharmacy location of your choice and provide the following information:

• Your name and Sentara Health/Kaiser Permanente member ID number
• Name and telephone number of the other pharmacy
• Name of the prescribed medication
• Prescription number of the prescribed medication
• Name and phone number of the doctor who prescribed the medication

If you want to transfer a prescription from a Kaiser Permanente medical center or mail order pharmacy to another participating pharmacy, you must contact that participating pharmacy.

Your Medicaid benefits will stay active for up to 12 months if you have no change in circumstances (such as income, moving, adding family member, divorce). The state will send you a renewal application in the mail saying you need to reapply for Medicaid.

Learn more about the annual renewal process.

If you no longer qualify for Medicaid, you’ll have a limited amount of time to act to get other coverage before your Special Enrollment Period ends. You should quickly see if you are eligible for financial assistance from the government by visiting https://healthcare.gov/. You may be able to stay with Kaiser Permanente. We offer a range of plans to fit your needs and budget. Visit continuecoverage.kaiserpermanente.org to find a Kaiser Permanente plan for you and your family.

Losing health coverage such as Medicaid is considered a qualifying event that would trigger a Special Enrollment Period. You are eligible to enroll within 60 days of that event.