Apply for Virginia Medicaid

Apply for Virginia's Medicaid health coverage program.

✓ coverva.dmas.virginia.govVA · stateEdition rev. 09/26/2025Verification pending

Complex — read carefully

We are not a government agency. We help you understand and prepare — you submit on the official site.

These are the form’s own words. We show where each answer goes.1 / 116

Your answers

A few details from the form

First name

Middle name

Last name

Suffix

Home address (Leave blank if you don’t have one.)

On the official form

Application for Health Coverage & Help Paying Costs (MAGI Standard)

First name

(blank)

Middle name

(blank)

Last name

(blank)

Suffix

(blank)

Home address (Leave blank if you don’t have one.)

(blank)

We map your answers to the official form fields. Answers stay in this browser tab and are gone when you close it — nothing is sent to us.