Having a baby in Virginia

Program

Cardinal Care (Virginia Medicaid)

Agency

Virginia Department of Medical Assistance Services

Medicaid limit

143% of the poverty level

CHIP for pregnant people

Up to 205%

CHIP unborn-child option

Up to 205%

12-month postpartum coverage since

November 18, 2021

Presumptive eligibility

Not for the pregnancy group, but hospitals can still make presumptive determinations.

Medicaid covers pregnancy up to 143% FPL and CHIP covers pregnant individuals up to 205% FPL. Virginia's 12-month postpartum coverage runs through a section 1115 waiver; the date shown is when the CMS approval took effect.

Hospitals in every state may make presumptive eligibility determinations.

Virginia passed paid family and medical leave in April 2026, but benefits don't start until December 1, 2028: up to 12 weeks a year at 80% of wages.

Program

Virginia Paid Family and Medical Leave Insurance Program (PFML), administered by the Virginia Employment Commission

Legal maximum, your own health

12 weeks

Benefits start

December 1, 2028

Pay

When benefits start Dec. 1, 2028: 80% of your average weekly wage (your full wage if you earn under $100/week), min $100/week, max equal to 100% of the state average weekly wage, set each year. The 2028 dollar cap hasn't been published. No benefits are paid in 2026.

Job protection

Yes, in the new law: if you've worked for your current employer at least 120 days before leave, you must be restored to your job or one with equivalent seniority, status, pay, benefits and service credits, and health coverage continues during leave. Retaliation, including immigration-status threats, is prohibited. Until benefits begin in Dec. 2028, only federal FMLA (50+ employees, 12 months/1,250 hours) gives job-protected leave.

Who qualifies

You'll need to meet Virginia's minimum earnings test for unemployment insurance (wages in your two highest base-period quarters at least the lowest amount in the UI benefit table, earned in at least 2 quarters) and be authorized to work in the U.S. Covers nearly all private and local-government employers, including small businesses (10 or fewer employees don't pay the employer share). State employees get equal or better leave through state HR policy instead. Self-employed people can opt in for at least 3 years.

Notes

Confirmed enacted: HB 1207 (2026 Va. Acts ch. 1093) and SB 2 (ch. 981) were both approved April 22, 2026, at the reconvened session with the Governor's substitute. They're codified at Va. Code 60.2-800 to 60.2-818, and VEC says Governor Spanberger and the General Assembly enacted the program April 22, 2026. Key dates (Va. Code 60.2-801 and VEC): program set up by Jan. 1, 2028; contribution rate set by Oct. 1, 2027; payroll contributions begin April 1, 2028; claims and benefits begin Dec. 1, 2028. Wage cap: contributions aren't due on wages above the Social Security contribution and benefit base (Va. Code 60.2-806(G)). Employers with more than 10 employees deduct up to 50% from pay and remit the full contribution; employers with 10 or fewer remit only the employee half. The benefit max is 100% of the state average weekly wage under Va. Code 65.2-500(B), adjusted by Sept. 30 each year for the next Jan. 1. Up to 12 weeks per benefit year for all reasons combined; 'serious health condition' expressly includes pregnancy and recovery from childbirth, so pregnancy recovery and bonding share the 12 weeks. Bonding must be in the child's first year. Safety leave is capped at 4 weeks. The earnings test is tied to Virginia's unemployment benefit table, so the 2028 dollar threshold isn't set yet. Older voluntary law: since 2022 (Acts cc. 131, 132; Va. Code 38.2-107.2), insurers may sell employers group 'family leave insurance' (renamed 'private family leave insurance' in 2026) as a rider or a separate policy. It's optional and the law sets no benefit level or duration, so it only helps if your employer bought it. Employers may use an approved private plan for the new program.

Checked October 2026. Amounts usually change January 1 and July 1, so confirm with the state before you plan.

In Virginia, Medicaid pays for up to three lactation sessions per provider a year with an IBCLC, billed through an enrolled doctor, midwife, clinic or health department.

Who can bill

physician; nurse practitioner; physician assistant; certified nurse-midwife; certified professional midwife; local health department; FQHC; RHC

Where

outpatient; clinic

Visit limits

3 sessions per member per provider per year

IBCLCs can enroll on their own

No

Since

January 1, 2016

Notes

Virginia Medicaid and FAMIS have paid for face-to-face lactation consultation (S9443, $72 per session) since January 1, 2016; the service must be delivered by an IBCLC but billed by an enrolled physician, NP, PA, nurse midwife, certified professional midwife, health department, FQHC or RHC. DMAS says its managed care plans also cover lactation consultation. The provider fact sheet dates from December 2015, but DMAS still links it, the December 2025 DME manual restates the coverage, and the current fee file still lists S9443 at $72.

Virginia Medicaid member information

Full-time provider prices before any subsidy, in 2022 dollars. The national median for center infant care was $12,647 a year. 133 county infant center prices were not surveyed in 2022; DOL estimated them from the price trend between other survey years.