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| Applying for Children's Health Insurance |
Download the
Families and Children Medicaid Application*
(Note: Use the Social Services Application for Benefits
to apply for Adult Medicaid or for other programs.)
Fill the application out completely, sign and date it, and remember to list the
parent/caretaker as "person 1". List everyone living in the home. If there are
more than four people in the household, print additional copies of the form and
remember to sign and date each copy. Answer the questions in the left margin
for each person listed. A signature is required on page two. By signing, you
agree to "assign medical support". This gives the
Virginia Department of Medical Assistance Services (DMAS) the right to
be reimbursed should you be eligible for other insurance payments or medical
claims.
Families
with too much household income to qualify for Medicaid may be eligible for
FAMIS (Family Access to Medical Insurance Security) Call Toll Free
1-877-86FAMIS to apply, or visit http://www.famis.org
for more information.
If you have questions you may request the Virginia Social Services Temporary
Assistance Programs Information Brochure, or call the City of Richmond
Department of Social Services at (804) 646-7212.
Submit Application With Appropriate Materials To:
City of Richmond Department of
Social Services
900 East Marshall Street
Richmond, Virginia 23219
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*Note:
In order to view and print these documents, your
computer must have the Adobe
Acrobat Reader utility installed; if this software
is not installed on your system, you can download it for
free from Adobe.
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