Winter 2018 Issue
By Alexis Aplasca, MD
Virginia Department of Behavioral Health & Developmental Services
Beginning January 1, 2019, more Virginia adults will have access to quality, low- and no-cost health insurance through Medicaid expansion. These newly eligible Medicaid members include men and women working in retail, construction, childcare, landscaping, food service or other jobs that don’t offer health coverage.
Virginia began accepting applications under the new Medicaid expansion eligibility rules on November 1, 2018. Here are questions that providers may hear from their patients along with information from the Virginia Department of Medical Assistance Services to help them understand the new rules.
How many people will benefit from the new eligibility rules for Medicaid?
The new eligibility rules will give close to 400,000 Virginia adults access to health coverage. We want every eligible Virginia adult to have the opportunity for coverage and the ability to enjoy better health, greater success at work and a higher quality of life.
When can my patients apply for coverage under the new rules?
Virginia began accepting applications under the new rules on November 1, 2018. Coverage begins on January 1, 2019.
When does the enrollment period end?
Individuals can apply for Medicaid at any time.
How can my patients apply for coverage?
Our website at coverva.org describes all the ways to apply. Applications are accepted by phone, online or in person.
Contact the Cover Virginia call center at 1-855-242-8282 for application assistance.
Apply through the healthcare.gov website.
Fill out an online application at commonhelp.virginia.gov.
Visit the local social services agency in your community. You can search for the agency location in your community by visiting coverva.org.
Who can help my patients apply?
Staff at the Cover Virginia call center and staff at your local social services agencies can help.
There also are enrollment assisters based around the state. Some of them are Navigators, and others work in community health care centers. You can find information on assisters near you by visiting coverva.org.
Who is covered under the new eligibility rules?
Virginia adults are eligible for coverage if they are between the ages of 19 to 64, meet income requirements and are not eligible for Medicare.
Under the new guidelines, a single adult making at or below $16,750 annually may be eligible. A parent in a family of three with an annual household income at or below $28,700 may also qualify.
Will my patients be able to get health coverage if they have a pre-existing condition?
Yes, this health coverage is available to individuals with pre-existing conditions as long as they meet other qualifications.
How long does it take to review an application?
The federal time standard for processing these types of applications is up to 45 days.
What services are included in the coverage?
Are these services different from services available to existing members?
The services are essentially the same as those available to existing members.
Will my patients be able to keep their current providers?
With some limited exceptions, newly eligible adults will be asked to choose one of the six existing Medicaid Managed Care plans that will coordinate their care and reimburse doctors and other providers for services. New members should check with their doctors and other health care providers to find out whether they participate in one or more of these plans.
What health plans will be available?
Newly eligible adults will be able to choose from six plans. Information about those six choices will be shared with them once they are enrolled. The six plans include:
What is the process for becoming a Medicaid provider?
Most individuals enrolled in the Medicaid program have their services furnished through DMAS-contracted Managed Care Organizations (MCOs) and their network of providers. For providers to participate with one of the MCOs, in addition to enrolling with Virginia Medicaid, they must be credentialed by the MCO and contracted in the health plan’s network.
The credentialing process can take at least three months to complete. If you are not sure if you are contracted, have questions, or if you are interested in contracting with one or more of the MCOs, contact the MCO directly.
Contact information for contracting and credentialing for each MCO within the Medallion 4.0 and Commonwealth Coordinated Care Plus managed care programs is available in the chart following this response. If you are interested in enrolling as a Virginia Medicaid provider, contact the Virginia Medicaid Provider Enrollment Helpdesk (8am-5pm, Mon-Fri) Phone - 804-270-5105 or 888-829-5373.
Managed Care Credentialing Contact Information
Medallion 4.0 and CCC Plus Contact Information
Jannette Anderson, 804-527-6402, NetworkDevelopmentVAContact@aetna.com
Jamal Matthews, 804-354-2178, Jamal.Matthews@anthem.com
Kenya C. Onley, 804-366-6339, KCOnley@magellanhealth.com
Annie Beck, 877-865-9075, Option 4, OptimaContract@Sentara.com
Contact provider services at:
Tammy English, Tammy.English@vapremier.com
Web: www.virginiapremier.comand select: Providers>Join our Network
MLTSS (CCC Plus):
John “Huck” Blauvelt John.Blauvelt@vapremier.com,
Shannon Wilson Shannon.Wilson@vapremier.com
Web: www.virginiapremier.com and select: Providers>Join our Network
How do my patients select a plan?
New members will be randomly assigned to a plan to ensure that their coverage is available as quickly as possible. Once enrolled, they will receive information on how to change plans and a side-by-side comparison of their six choices. They will have 90 days to change plans if they would like to do so.
We encourage new members to compare plans and choose the one that is best for them. They should also ask their current health care providers which health plans they participate in.
How will providers know if our patients have coverage?
Once the program begins early next year, people enrolled in coverage will be mailed a healthcare card.
How can my office staff or I help others apply?
You can sign up for training through Sign Up Now, an initiative of the Virginia Health Care Foundation. Trainings are being offered throughout the state, so please visit here to learn about workshop dates and locations.
What are the important dates coming up for Medicaid expansion?
What is the plan for making sure Virginians receive coverage as soon as possible?
Virginia Medicaid has developed an outreach strategy that provides information about enrollment to specific groups of Virginia adults who are eligible or may be eligible for coverage.
First, individuals with serious mental illness who are in the Medicaid GAP program are now eligible for full benefits. They will be automatically enrolled in the new coverage that begins January 1, 2019, without having to apply again. Similarly, some individuals in the Plan First program will also be eligible and will be automatically enrolled as well without taking any additional steps. It’s important to know that not everyone in Plan First will meet the income requirements for full coverage. Those who are not eligible will continue to receive family planning benefits.
Second, we know that some SNAP beneficiaries and parents with children in the Medicaid program will qualify. We already have a significant amount of information on these individuals, so they will be asked to fill out a simple three-question application to complete the process.
Third, some individuals who purchased health insurance on the federal Marketplace will be eligible for Medicaid under the new rules. It is essential that these adults visit healthcare.gov during open enrollment, which began November 1. Healthcare.gov will process their application using Virginia’s new eligibility rules and determine if they now qualify for Medicaid.
And finally, there are many other uninsured Virginia adults who have no relationship with state agencies, and we will be working with community partners to reach them with this information.
What impact will the state’s 1115 waiver have on expansion?
The Virginia Medicaid agency remains focused on the work necessary to ensure that new health coverage for Virginia adults is available beginning on January 1, 2019. Developing a waiver is a separate, ongoing process, as described in the state budget.
The state budget clearly envisions that coverage will begin on January 1, 2019, when the waiver is still under development, and that sequence of events remains unchanged. We encourage our partners to remain focused on the immediate and urgent task of outreach and enrollment.
How can providers learn more about Medicaid expansion?
The DMAS website has a special page with resources for providers including a Medicaid expansion provider toolkit. These resources are available at http://www.dmas.virginia.gov/#/medexproviders.
How can my patients learn more about the new coverage?
The Cover VA website is a trusted source of information on health coverage that will serve as the hub for outreach to adults eligible for new coverage. Visitors to the coverva.org and dmas.virginia.gov websites can sign up to receive regular updates on the new coverage.
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