Medicaid Covered Services 2025 Virginia

ADULT PREVENTATIVE SERVICES

Adult Medicaid members receive coverage for preventive services, including routine healthcare, such as screenings, check-ups, and patient counseling, to prevent illnesses, diseases, or other health problems. Preventive services can help people improve their health before they develop a more serious condition. Medicaid members schedule these services through their primary care doctor’s office.

The following preventive services are available at no cost to members:

• • Adult wellness exam
  • Individual and group smoking cessation and alcohol counseling
  • Recommended vaccines, such as tetanus and diphtheria, shingles, hepatitis A and B, influenza, and human papillomavirus
  • Mammography, prostate and other cancer screenings
  • Blood pressure and cholesterol screenings
  • Depression screenings
  • Nutritional Counseling

BEHAVIORAL HEALTH

To keep Virginians healthy and thriving in their communities, DMAS recognizes the need to focus on proactive and preventive care for mental illness. Services include:

• • Mobile crisis response teams
  • Short-term crisis supports
  • 23-hours of observation
  • Short-term intervention services
  • Partial hospitalization during daytime hours
  • Intense outpatient therapy and counseling a few times a week
  • Community-based team supports for adults experiencing serious mental illness

The following provides greater detail regarding some of the above service options:  

 Services for Youth (ages 11-18)

Multi-systemic Therapy: Youth get help with behavior, mood, and substance use needs while they stay in their home and in school. The therapy builds on a person’s support system, including family, school, and community partners. The goal of the program is to empower both youth and their parents and guardians.

Functional Family Therapy: Trained staff work with the family to address the behavioral or emotional needs of youth with behavioral and emotional challenges. The focus is on short-term goals to strengthen family ties and promote positive behaviors, while keeping young people in their homes, at school, and out of the hospital or justice system.

Services for Youth and Adults

 Mental Health Partial Hospitalization Program:

Adults and youth receive short-term, intensive services during daytime hours, five or six days a week, while continuing to live at home.

Mental Health Intensive Outpatient:

Adults and youth receive short-term, structured therapy and counseling, both individually and with members of their support system, two to three times weekly. These services are more intensive than traditional outpatient services and are designed to help members stay out of the hospital.

Mobile Crisis Response:

A team of providers visits the adult’s or youth’s location during a crisis to help keep them safe and refer them to local services, thereby avoiding a hospital stay.

Community Stabilization:

These short-term community services help stabilize an adult or youth after a mental health crisis. This service can also assist when members are waiting to start or connect with longer-term services.

23-Hour Crisis Stabilization:

This service is available 24 hours a day, 7 days a week, in a clinic-like setting where members can stay for up to 23 hours. Staff will evaluate adults or youth through this walk-in program and link members to other support services.

Residential Crisis Stabilization Unit:

Adults or youths experiencing a mental health or substance use crisis can get support from trained staff in a local residential crisis unit for a short-term, overnight stay to avoid hospital admission. This service is available 24 hours a day, 7 days a week.

 SERVICES FOR ADULTS

Assertive Community Treatment:

Adults with serious mental illness get care through a single team of providers who work closely together to support the individual in recovery and create a plan to build essential life skills. This service is available 24 hours a day, 7 days a week.

 ADDICTION AND RECOVERY TREATMENT SERVICES (ARTS)

Your Medicaid benefit covers several new treatment approaches, and we are here to help you understand the available options. Treatment options range from outpatient to inpatient services, including Medication Assisted Treatment (MAT) for prescription drugs or other opioids. You can talk with your primary care doctor about treatment options for substance or alcohol use. Your doctor and/or health care team will work with you to find the best program for you. Or you can:

• Contact the ARTS Care Coordinator at your Managed Care Organization
• Visit the DMAS ARTS Google Map at https://www.dmas.virginia.gov/for-providers/addiction-and-recovery-treatment-services/information-and-provider-map/for treatment options in your local area.

 DENTAL

Cardinal Care Smiles (CCS) is Virginia’s Medicaid and FAMIS dental program for adults and children. DentaQuest manages the Cardinal Care Smiles program. Contact DentaQuest at 1-888-912-3456 or search the DentaQuest website to find a listing.

There are no costs or co-payments for dental care services in the CCS program. On the day of the appointment, bring your Virginia Medicaid card and your managed care organization ID card (if you are enrolled in a health plan).

 Transportation services are available to Medicaid members for their dentist appointments. Visit the Virginia Medicaid website or contact your health plan for contact information to make a reservation.

 SCHOOL-BASED SERVICES

DMAS pays schools to cover the cost of the school health services they provide to students who are enrolled in FAMIS or Medicaid. Physical therapy, occupational therapy, speech therapy, audiology, nursing, psychological services, personal care services, and, in some circumstances, transportation are services that are covered.

TRANSPORTATION SERVICES

Transportation is covered by Medicaid when you do not have another way to get to your doctor appointment or other Medicaid services. It is available for Medicaid members who are part of our managed care health plans as well as members in our fee-for-service program. Your member ID card lists the phone number to call for transportation. Health plan and fee-for-service transportation telephone numbers for reservations and ride assistance are available here: 

• Transportation Contacts for Reservations and Ride Assist/Customer Service 
• https://dmas.virginia.gov/media/a53m3czx/transporatation-contacts-for-reservation-and-ride-assist-customer-service_07-01-2025-sp.pdf

Fee-for-Service (FFS) transportation assistance is managed and operated by ModivCare (formerly LogistiCare). If you are enrolled in a managed care health plan and are eligible for transportation, please contact your plan to arrange transportation.

 MEDICAID FOR AGED, BLIND, OR DISABLED (ABD) INDIVIDUALS

Individuals who are age 65 or older, or who are disabled, or who are blind, may be eligible for full-Medicaid health coverage. People who do not qualify for full Medicaid health coverage because their income is over the program limits may be placed on a Medically Needy Spenddown. Under a medically needy spenddown, the individual must incur a certain amount of medical expenses before Medicaid can be approved. The amount of medical costs required to qualify varies depending on household size and income. Others who are not eligible for full-benefit Medicaid because their income or resources exceed the limits may qualify for Medicaid assistance with the cost of Medicare. 

MEDICARE SAVINGS PROGRAMS

The Medicare Savings Programs, also known as Medicare Buy-In, helps Medicare members with limited income to pay their Medicare premiums, and in some cases, deductibles and co-payments. The Medicare Savings Programs provide four different levels of assistance depending on an individual’s or couple’s income.

MEDICAID WORKS

The Medicaid Works program is for individuals who are blind or disabled, and who are at least 16 but less than 65 years of age. These individuals are eligible to work and earn a higher income while still qualifying for Medicaid benefits.

• Medicaid Works (Medicaid Buy-In)
• Manual de asistencia médica

PLAN FIRST

Plan First is Virginia’s Family Planning Services Program for men and women who do not meet income requirements for full Medicaid benefits. Plan First is a limited benefit program that covers medical services such as annual family planning exams for men and women; pap tests; sexually transmitted infection testing; family planning education and counseling; tubal ligation and vasectomies; approved over-the-counter and prescribed contraceptives; and transportation to a family planning service.

• Plan First (a limited benefit family planning program for men and women)

FORMER FOSTER CARE INDIVIDUALS

Medicaid coverage is available to individuals who are between ages 18 to 26 and were in foster care and receiving Medicaid in any state at the time of their 18th birthday. There is no income limit for this program.

BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT ACT (BCCPTA)

Individuals who have been screened by the Virginia Department of Health’s Every Woman’s Life program or the Project Wish program and who have been diagnosed and need treatment for breast or cervical cancer may be eligible. Income eligibility for this program is determined by Virginia Department of Health’s Every Woman’s Life Program screeners.

EMERGENCY SERVICES FOR NON-CITIZENS

Individuals who meet the requirements for full Medicaid coverage but who do not meet citizenship requirements may be eligible for Medicaid coverage of limited emergency treatment.