Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
 
Board
Board of Medical Assistance Services
 
chapter
Groups Covered and Agencies Responsible for Eligibility Determination [12 VAC 30 ‑ 30]
 
Guidance Documents
Chapter Information
Description This chapter contains all of the various categories of individuals who are eligible to receive Medicaid covered services. Categorically Needy groups are federally mandated groups which must be covered in all state Medicaid programs. Medically Needy groups are federal optional groups which may be covered at the discretion of the state.
State Authority COV 32.1-325 et seq .
Federal Authority Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
Text of Regulation Link to Virginia Administrative Code
Goals of Regulation None entered
Meetings

Contact Information
Name / Title: Emily McClellan  / Regulatory Supervisor
Address: Policy Division, DMAS
600 E. Broad Street, Suite 1300
Richmond, VA 23219
Email Address: Emily.McClellan@DMAS.Virginia.gov
Telephone: (804)371-4300    FAX: (804)786-1680    TDD: ()-
Current Actions
Action Title Latest Stage Status
12 Months Postpartum Emergency/NOIRA Attorney General review in progress.

Past Actions
Action Title Latest Stage Status
Medicaid Expansion: Hospital Presumptive Eligibility Fast-Track Stage complete. This regulation became effective on 09/02/2021.
Expansion-Related Changes - Expansion Group, FMAP, HIPP, Determination State Fast-Track Stage complete. This regulation became effective on 03/17/2022.
Former Out-of-State Foster Care Youth
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 06/15/2018.
Hospital Presumptive Eligibility Fast-Track Stage complete. This regulation became effective on 08/26/2016.
Modified Adjusted Gross Income (MAGI) Changes Fast-Track Stage withdrawn on 06/22/2015 prior to submitting for AG review.
Increase Resource Limits for Medicare Savings Program Groups
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 04/14/2010.
CHIPRA Deemed Newborns of FAMIS Enrollees
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 03/17/2010.
Clarify Requirements for Coverage as a Child Under Age 1
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/09/2009.
Medicaid Buy-In program Final Stage complete. This regulation became effective on 07/23/2009.
Medicare Prescription Drug Program (Part D) Final Stage complete. This regulation became effective on 03/07/2007.
Medicare Prescription Drug Program (Part D)
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage withdrawn on 11/08/2005 before Attorney General's office completed its review.
Aged, Blind, Disabled Individuals with Incomes at or below 80% of Federal Poverty Level
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2001.
Optional Groups other than the Medically Needy: Eligibility of Women with Breast/Cervical Cancer
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2001.
Technical Amendments: Medicaid Eligibility Requirements
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 04/11/2001.
Other Required Special Groups: Qualifying Individuals I and II
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 04/11/2001.

Withdrawn Actions
Action Title Latest Stage Status
Repeal of Out-of-Date and Unnecessary Regulations Fast-Track Stage withdrawn on 04/10/2024 before Attorney General's office completed its review.
Medicaid Buy-In Emergency/NOIRA Stage withdrawn on 03/06/2007 before the Secretary's office completed its review.
Medicaid Works, a Medicaid Buy-In Program Emergency/NOIRA Stage withdrawn on 01/16/2007 after Attorney General's review.