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Key Virginia rules on Medicaid, naloxone, overdose Good Samaritan protection and the 988 crisis line. Each item links to its official source and shows the date it describes. Only items checked against an official source are shown.
Not legal advice. This page summarizes public policy information for general education. It is not legal or medical advice, and laws change. Check the linked official source, or ask a lawyer or health professional, before relying on it.
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Medicaid
Medicaid Expansion
Virginia has adopted and implemented the ACA Medicaid expansion, which covers nearly all adults with incomes up to 138% of the federal poverty level. KFF notes Virginia has a trigger law that would end expansion coverage, or require steps to offset higher state costs, if federal expansion funding is reduced.
Medicaid Work Requirements
The federal budget reconciliation law signed on July 4, 2025 (Public Law 119-21, section 71119) requires states that expanded Medicaid to make coverage for expansion adults conditional on work requirements beginning January 1, 2027. States may start sooner through waivers or state plan amendments, and CMS may grant good-faith exemptions that end no later than December 31, 2028.
Medicaid Coverage of Opioid Use Disorder Medications
Federal law requires every state Medicaid program to cover all FDA-approved medications for opioid use disorder, with related counseling and behavioral therapy. The requirement began on October 1, 2020 under section 1006(b) of the SUPPORT Act and was made permanent by the Consolidated Appropriations Act, 2024.
State Medicaid Substance Use Treatment Highlights
Virginia Medicaid must cover all three FDA-approved medications for opioid use disorder (methadone in opioid treatment programs, buprenorphine and naltrexone), and the state has a CMS-approved section 1115 substance use disorder demonstration (Building and Transforming Coverage, Services, and Supports for a Healthier Virginia). A 2023 KFF survey found at least one standard buprenorphine product available without prior authorization in fee-for-service Medicaid.
Naloxone (Narcan)
Over-the-Counter Naloxone
Narcan (naloxone hydrochloride 4 mg nasal spray) was approved by the FDA for sale without a prescription on March 29, 2023. This federal approval applies in every state.
State Naloxone Access Law
Virginia has a naloxone access law. These laws vary by state but generally make it easier to prescribe, dispense and carry naloxone, and protect people who give it in an emergency. PDAPS reports every state and DC had one by July 1, 2017.
Getting Naloxone from a Pharmacist Without a Prescription
Virginia's Department of Health has a statewide standing order, issued January 20, 2026 and effective for two years, that authorizes pharmacists to dispense naloxone and other opioid reversal agents following the Board of Pharmacy protocol. Narcan nasal spray is also sold over the counter nationwide.
Good Samaritan Overdose Law
Good Samaritan Overdose Protection
Virginia has a drug overdose Good Samaritan law that gives some legal protection to people who call for help during an overdose. The scope (protection from arrest, charge or prosecution, or only a defense in court) varies by state; read the statute for details.
988 Crisis Line
988 Suicide & Crisis Lifeline
Since July 16, 2022, calling or texting 988 anywhere in the United States connects to the 988 Suicide & Crisis Lifeline.
State 988 Funding
Virginia charges a monthly 988 charge of 12 cents on postpaid wireless lines and 8 cents per prepaid wireless purchase, enacted in 2021; the money goes to the state crisis call center fund.
Sources
- KFF: Status of State Medicaid Expansion Decisions
- CMS / Medicaid.gov: SHO #20-005: Mandatory Medicaid State Plan Coverage of Medication-Assisted Treatment
- CMS / Medicaid.gov: Substance Use Disorder Section 1115 Demonstration Opportunity (approved states)
- U.S. Food and Drug Administration: FDA Approves First Over-the-Counter Naloxone Nasal Spray
- PDAPS, Center for Public Health Law Research at Temple University: Naloxone Overdose Prevention Laws
- Virginia Department of Health: VDH Statewide Standing Order for Naloxone and Other Opioid Reversal Agents (2026)
- PDAPS, Center for Public Health Law Research at Temple University: Good Samaritan Overdose Prevention Laws
- Federal Communications Commission: 988 Suicide & Crisis Lifeline
- State of Virginia: Va. Code § 37.2-311.5; 2021 Acts, Sp. Sess. I, c. 248 (SB 1302)