Frequently Asked Questions
1. What is FAMIS?
Family Access to Medical Insurance Security Plan (FAMIS) is a federal/state program that provides low-cost health insurance for children in families that earn too much for FAMIS Plus (Medicaid) but do not have private health insurance.
2. What is FAMIS Plus?
FAMIS Plus is Virginia's name for children's Medicaid. FAMIS Plus also provides great benefits. It covers children in families with lower or no income. When you apply for coverage your children will be considered for both FAMIS and FAMIS Plus. If they are eligible, you will be notified about which program they have qualified for.
3. Who is eligible for FAMIS?
Children are eligible for FAMIS if they:
- Live in Virginia
- Are under age 19
- Don't have health insurance now and haven't had it in the past 4 months (some exceptions apply - see below)
- Are not eligible for the Virginia state employee health insurance plan
- Are not eligible for FAMIS Plus (also known as Medicaid)
- Live in families meeting FAMIS income guidelines
- Are United States citizens or qualified aliens (Other children may be eligible, please call us to find out more. A parent's citizenship is not considered.)
4. Who is not eligible for FAMIS?
Children are NOT eligible for FAMIS if:
- They are currently covered by FAMIS Plus,
- Their parent or guardian is employed by a public agency and is eligible for State Employee Health Insurance,
- They are inmates of a public institution or inpatients in an institution for mental illness, or
- They have dropped insurance coverage without "good cause" during the four months prior to FAMIS application.
5. Is my child considered “insured”?
Depending on the type of insurance, your child may or may not be considered insured. The child is not considered to be insured now
if the insurance:
- Is through Medicare or the state/local hospitalization program.
- Does not have doctors in the area where the child lives.
- Is an accident-only policy.
- Only covers dental or vision.
- Only covers a specific disease such as cancer.
- Is a disability policy.
- Only covers hospitalization.
- Is a long-term care policy.
- Is a Workers’ Compensation policy.
- Is an auto policy that covers medical expenses.
6. When does the four month waiting period apply?
If the child was covered by a health insurance plan any time in the four months before applying for FAMIS, the child may not qualify for FAMIS. A waiting period of four months from the month the health insurance stopped may apply. A four month waiting period will not apply
if any one of the following is true:
- The parent or stepparent who had insurance for the child changed jobs or stopped working and no other parent’s employer pays part of the cost for family health insurance.
- The employer providing the health insurance stopped paying part of the cost for family coverage and no other parent's employer pays part of the cost for family health insurance.
- The child's insurance was cancelled by an insurance company for a reason which is not related to unpaid or late payments. For example: The child has used up lifetime benefits. A copy of the letter from the insurance company is required.
- The child’s insurance was dropped by a parent or stepparent who was paying the full insurance payment under a COBRA policy and no other parent's employer pays part of the cost for family health insurance.
- The child’s insurance was dropped by a family member other than the parent or stepparent living in the home with the child. For example: A parent not living in the home with the child, a grandparent, aunt, uncle, or godmother paid for health insurance for the child and later dropped it.
- The child’s insurance was dropped because the cost is more than 10% of the family's current gross monthly income or was more than 10% of the family's gross monthly income at the time the insurance was dropped. Some additional documents are required.
- The child’s prior health insurance was through Medicaid, HIPP, FAMIS, or FAMIS Select.
- The prior health insurance did not have doctors in the area where the child lives.
- The child is pregnant at the time the family applies for FAMIS.
7. How is eligibility determined?
Eligibility is determined by gross monthly income. To prove eligibility, applicants must show proof of income for the previous month by showing paycheck stubs or a letter from their employer.
8. What is the Income Guideline for FAMIS?
Income guidelines are based on the Federal Poverty Level (FPL) which is adjusted annually. The FAMIS income limit is 200% of the FPL. For example, a family of four can make up to $47,100 a year and still be eligible for FAMIS.
9. How long will my FAMIS coverage last?
FAMIS provides twelve months of continuous coverage (beginning with the month the child was enrolled) UNLESS:
- Your family's gross monthly income goes over the income limit for your family size.
- The child moves out of Virginia
- You apply for FAMIS Plus and the child is found eligible for that program
- The child turns 19 during the enrollment period, or
- You request, in writing, that the FAMIS coverage be stopped
You will be required every year to renew your child's coverage.
10. What does FAMIS cover?
FAMIS benefits are based on the state employee health insurance benefit package. Coverage includes:
- Doctor visits
- Well-baby and well-child checkups
- Hospital visits
- Prescription medicines
- Tests and x-rays
- Dental care
- Emergency care
- Vision care
- Mental health care
- And much more....
11. Will I have to pay a monthly or annual premium payment for FAMIS?
There is no premium payment for FAMIS.
12. Will I have to make a co-payment for medical services?
All families are required to make nominal co-payments for medical services and prescriptions. The amount of co-payment a family pays is based on the family's size and income. Most co-payments are $2 - $5. Some medical services will not require co-payments. For example, visits to the doctor for well-baby or well-child checkups are free.
13. How does a family apply for FAMIS?
Applying for FAMIS is quick and easy. There are three ways to apply.
Families wishing to enroll in FAMIS can do so by calling the FAMIS Central Processing Unit. By dialing the toll free number, 1-866-87FAMIS (1-866-873-2647), families can speak with a representative who will begin the enrollment process over the phone. Mailed or faxed Health Insurance Applications for Children and Pregnant Women are also acceptable. Faxed applications can be sent to 1-888-221-9402. Mailed applications can be sent to P.O. Box 1820, Richmond, VA 23218-1820. Families may also apply for FAMIS and FAMIS Plus through their local Department of Social Services.
You can submit an application online. Click here
for more information.
Some families may also have the option of applying for FAMIS and FAMIS Plus with the assistance of a community outreach project. Click here
for the listing of Local Outreach Assistance Projects.
Families found eligible for FAMIS may qualify for FAMIS Select
. To find out more call 1-888-802-5437 or 1-888-802-KIDS.
14. Can I apply for FAMIS at my local Department of Social Services (DSS)?
Yes, families can apply for FAMIS by contacting their local DSS (in addition to the option of calling the FAMIS Central Processing Unit). No face to face interview is required!
15. Where do I call if I have questions concerning my FAMIS eligibility?
Families may call the FAMIS Central Processing Unit (1-866-873-2647), their local DSS, or a Local Outreach Assistance Project for questions pertaining to FAMIS eligibility. To check on the status of a FAMIS application, families should contact the place at which they applied.
16. Where do I call if I have questions concerning the medical services available under FAMIS?
Families may call the Managed Care Organization (MCO) that they have chosen to deliver health services. There are six participating MCO's:
- Anthem 1-800-901-0020
- Coventry Cares 1-800-279-1878
- INTotal Health 1-855-323-5588
- MajestaCare 1-866-996-9140
- Optima 1-800-881-2166
- VA Premier 1-800-289-4970(Richmond); 1-800-828-7953 (Tidewater); 1-888-338-4579 (Roanoke)
For families that are enrolled with FAMIS and receive their health services through the fee-for service program, they may call the Department of Medical Assistance Services' Recipient Helpline: 1-804-786-6145.
17. How is FAMIS funded?
FAMIS is funded through a combination of Federal and State funds.
18. Who manages FAMIS?
FAMIS is administered and managed by the Department of Medical Assistance Services (DMAS).
19. What is the CPU?
CPU stands for Central Processing Unit. The CPU runs the toll free customer service line and processes the FAMIS applications.
20. What are the call center hours?
You can speak to a FAMIS representative between the hours of 8:00 am and 7:00 pm, Monday through Friday, and 9:00 am to 12:00 noon on Saturdays. We also have an after-hours voicemail system on which you can leave messages after these times and a representative will return your call the next business day at a time which is convenient to you if you specify.
21. What can I expect when I call the toll free number?
When you call the FAMIS toll free number, you may ask the representative general questions about the program, start an application, or check on the status of your application.
If you choose to start an application, a representative will help you fill out the application over the phone. He or she will ask you a few questions about your family, children, and health care coverage. It should take only about 5 minutes.
By calling the toll free number, families have not applied for the program as yet. The FAMIS help line will complete your application for you with as much information as you can provide over the phone. Then they will mail the pre-filled application to you to review and sign. You will be instructed to return the signed application and copies of your pay stubs or income verification for the previous month in the self-addressed, postage-paid envelope provided.
You will also be given a unique Family ID#, which will be assigned to your case. If you have additional questions at a later time, you can call back and provide this number and the representative can quickly look at your case.
22. After I return my application, how long does it take for a decision?
You have 30 days to return your pre-filled application. Once the CPU receives your application, it will be reveiwed for additional information needed. If your application has all documentation required, it will be processed within 12 days of receipt and a letter will be mailed to you the next business day.
23. What if I don't speak English?
The FAMIS call center is staffed with both English and Spanish speaking representatives. In addition, if your primary language is other than English or Spanish, they will provide a Tele-interpreter on the line to translate your call.