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Provides instructions for using a paper application form, including how to download, print, request by mail, or pick up forms from the local Department of Social Services (DSS). Lists required forms and appendices (A–F), additional person supplements, voter registration certification steps, and specialized appendices for disabilities, long-term care, medically needy spenddown, and everyday living assistance. Concludes with submission methods (mail, fax, in person) and a contact line for further questions.",{"@graph":63,"@context":122},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/applying-for-medical-assistance/306753/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/applying-for-medical-assistance/306753.png","ImageObject",442,249,{"name":88,"@type":89},"Mimi","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114,118],{"name":105,"@type":106,"acceptedAnswer":107},"How can I apply for Medical Assistance without using a paper form?","Question",{"text":108,"@type":109},"You can apply online through CommonHelp, or apply by telephone by calling Cover Virginia if your application includes a parent, child, and/or a pregnant woman.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"If I want Medical Assistance and other benefits, how do I submit my applications?",{"text":113,"@type":109},"You can apply for Medical Assistance and other benefits online at the same time on CommonHelp. If you prefer paper forms, use the Application for Benefits for non–Medical Assistance programs, then follow the separate steps for Medical Assistance.",{"name":115,"@type":106,"acceptedAnswer":116},"What paper forms and appendices are required for Medical Assistance?",{"text":117,"@type":109},"All applicants must complete the Cover Virginia Application for Health Coverage and Help Paying Costs, including Appendices A, B, and C. Additional people need a Cover Virginia Additional Person Supplement. Adults over 18 also complete the Voter Registration Agency Certification, and some situations require Appendix D (disabilities/age 65+), Appendix E (medically needy spenddown), or Appendix F (help with everyday activities).",{"name":119,"@type":106,"acceptedAnswer":120},"After I complete the forms, how do I send them in?",{"text":121,"@type":109},"Return the signed application to your local DSS office by mail, fax, or in person. You can find the fax number and local DSS contact details through the local agency website, and call for directions if needed.","https://schema.org",{"og:url":78,"og:type":124,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":126,"canonical":78},"index,follow",{"doc_id":128,"site_id":56},306753,1790196239,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":88,"user_avatar":133,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":139,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":61,"update_tm":143,"read_time":9},2336477974920,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","# Applying for Medical Assistance\n\n## Do I need a paper application form to apply for Medical Assistance?\n\nThere are easy ways to apply for Medical Assistance if you don't want to fillout a paper applicationform:  \n·You can use CommonHelp,Virginia's online application for assistance,to apply for MedicalAssistance,as well as other benefit programs at the same time.Anyone can apply for MedicalAssistance on CommonHelp.  \n·If you are only interested in applying for Medical Assistance and your application includes a parent,child and/or pregnant woman,you can also apply by telephone by calling Cover Virginia at1-855-242-8282.  \n## >What if I want to apply for other benefits too?Orjust for another benefit but not MedicalAssistance?\n\nYou can apply for Medical Assistance,the Supplemental Nutrition Assistance Program(SNAP—formerly Food Stamps),Temporary Assistance for Needy Families(TANF),and more help online usingCommonHelp.You can apply for any or all of these benefits at the same time on CommonHelp.  \nIf you prefer a paper application form,you can use the Application for Benefits to apply for assistanceprograms except Medical Assistance.If you also want to apply for Medical Assistance,you need tofollow the steps below to complete a separate application form.  \n## A paper application is best for me.How can I get a form?\n\nTo apply for Medical Assistance using a paper application form,you can download and print the formand supplements below.You can also call your local department of social services(DSS)and ask for aform to be mailed to you or pick one up at your local DSS office.You can find the address and phonenumber for your local DSS at http://www.dss.virginia.gov/localagency/.  \n## I want to print my own application.What do I need to print?\n\nYou may need to print and complete more than one form.Please read the steps below to find out whichforms you need.If you have any questions about which forms you need to fill out,please call CoverVirginia at 1-855-242-8282.  \n1.   All people applying for Medical Assistance need to complete the Cover Virginia Applicationfor Health Coverage and Help Paying Costs,including the attached Appendices A,B and C.You can apply for yourself and/or another person on this form.  \n2.   If you need to apply for more than two (2)people,print and complete a Cover VirginiaAdditional Person Supplement for each additional person who is applying.  \n3.   All applicants over age 18 also need to complete the Commonwealth of Virginia VoterRegistration Agency Certification.Each adult needs to complete and sign their own form.  \n4.   If you think that you or the person you are applying is blind or disabled,are age 65 and overand/or need Medicaid to cover nursing facility or community-based long-term care services,complete Appendix D-Adults over Age 19 with Disabilities and Other Adults Age 65 andOver,Including People Who Need Long-term Care Services.You do not need to fill out aseparate Voter Registration Certification if you complete Appendix D.It is part of the form.  \n5.   If you applied for health care coverage for someone who is medically needy (has incomegreater than the Medicaid limit)and would like to be evaluated for a spenddown based onincome,resources and medical expenses,complete Appendix E-(Medically NeedySpenddown)to the Application for Health Coverage and Help Paying Costs.You do notneed to fill out a separate Voter Registration Certification if you complete Appendix E.It ispart of the form.  \n6.  If you applied for health care coverage for someone who needs help with everyday things likebathing,dressing,walking or using the bathroom to live safely in the home or if a doctor ornurse told them that they have a physical disability or long term disease,mental or emotionalillness,or addiction problem,complete Appendix F.You do not need to fill out a separateVoter Registration Certification if you complete Appendix F.It is part of the form.  \n## What do I need to do after I have completed the forms?\n\nAfter you ","cbCaipu5loumfKSE","https://ap.wps.com/l/cbCaipu5loumfKSE","pdf",257982,"English","# Applying for Medical Assistance\n## Do I need a paper application form?\n## What if I want to apply for other benefits too?\n## A paper application is best for me. How can I get a form?\n## I want to print my own application. What do I need to print?\n## What do I need to do after I have completed the forms?\n## What if I still have questions about how to apply?","[{\"question\":\"How can I apply for Medical Assistance without using a paper form?\",\"answer\":\"You can apply online through CommonHelp, or apply by telephone by calling Cover Virginia if your application includes a parent, child, and/or a pregnant woman.\"},{\"question\":\"If I want Medical Assistance and other benefits, how do I submit my applications?\",\"answer\":\"You can apply for Medical Assistance and other benefits online at the same time on CommonHelp. If you prefer paper forms, use the Application for Benefits for non–Medical Assistance programs, then follow the separate steps for Medical Assistance.\"},{\"question\":\"What paper forms and appendices are required for Medical Assistance?\",\"answer\":\"All applicants must complete the Cover Virginia Application for Health Coverage and Help Paying Costs, including Appendices A, B, and C. Additional people need a Cover Virginia Additional Person Supplement. Adults over 18 also complete the Voter Registration Agency Certification, and some situations require Appendix D (disabilities/age 65+), Appendix E (medically needy spenddown), or Appendix F (help with everyday activities).\"},{\"question\":\"After I complete the forms, how do I send them in?\",\"answer\":\"Return the signed application to your local DSS office by mail, fax, or in person. You can find the fax number and local DSS contact details through the local agency website, and call for directions if needed.\"}]","Applying for Medical Assistance | PDF",1789840728]