Children’s 12-Month Continuous Coverage
Children in Medicaid and FAMIS get a continuous 12-month period of protected coverage, or continuous coverage, from the date of their enrollment. At the end of the 12-month period, the state will review the child’s eligibility and grant another 12-month period of coverage if they are still eligible.
What does this mean?
A child’s Medicaid or FAMIS coverage cannot be reduced or ended while they are in a continuous coverage period, with limited exceptions (see below). This is true even if they experience a change that previously would have resulted in a loss of coverage, such as an increase in household income above the eligibility limit, the loss of Supplemental Security Income (SSI), or a FAMIS-enrolled child gaining other health insurance.
Are there exceptions to the 12-month continuous coverage requirement?
There are limited exceptions that allow coverage to end before the full 12-month continuous coverage period is over.
- Turning age 19 (a member’s eligibility will be re-evaluated when they turn 19, even if they enrolled or renewed less than 12 months ago)
- A permanent move out of state
- Death of the child
- Child’s representative requests to end the coverage
- Child was enrolled in coverage due to an error or fraud
What happens at the end of the 12-month period?
The state will review the child’s eligibility through the annual renewal process. If the child is still eligible for Medicaid or FAMIS, they will be given a new 12-month period of continuous coverage. If they are no longer eligible, their coverage will be ended and they may be referred to the Virginia Insurance Marketplace (VIM) for possible enrollment in a Qualified Health Plan.
Should I still report changes?
Yes! It is important to continue to report changes in your household.
- Changes may impact the eligibility of adults in the household.
- Having to the most up-to-date information makes the renewal process simpler and easier.
- Reporting address and contact information changes is important so you continue to receive all state communications about your Medicaid or FAMIS coverage.
How do I get help if I have questions?
For questions, additional help, or language assistance services or large-print, Medicaid and FAMIS members are encouraged to call Cover Virginia at 833-5CALLVA (TDD: 1-888-221-1590).
12-Month Continuous Coverage Member Flyer
12-Month Continuous Coverage Stakeholder Flyer