Faster Processing for Many Applications
Have you noticed a faster turnaround time for new Medicaid/FAMIS applications recently? The Virginia Department of Medical Assistance Services ( DMAS) and the Virginia Department of Social Services ( VDSS) recently implemented new efforts to streamline the application process. These efforts helped to increase the number of applications that can receive a speedy eligibility determination. If you’ve helped a client apply online with CommonHelp, or by phone with the Cover Virginia Call Center, since late October 2019, you may have noticed eligibility results in as little as 15 minutes after applying!

Since these changes went into effect, nearly one quarter of applications have been able to receive an eligibility determination by “self-direct.” Clients whose applications are determined eligible by self-direct do not need to send documents to verify income, so their applications can be processed more quickly. Clients who do need to submit documents to verify income should still receive a Verification Check List ( VCL) from either Cover Virginia or their local Department of Social Services ( LDSS) by mail. The VCL will tell the client:
  1. What document(s) s/he needs to send,
  2. Where and how to submit documents, and
  3. The date by which documents need to be received to avoid a denial.

Since around 75% of those applying may still need to submit documents to show they are eligible for Medicaid/FAMIS, it is very important for clients to be on the lookout for a VCL after submitting an application.

Coming Soon: Managed Care Open Enrollment in Tidewater
Each year, children enrolled in FAMIS Plus, and adults enrolled in certain Medicaid categories ( including Low-Income Families with Children, Former Foster Care, and Medicaid for Pregnant Women) have the opportunity to change their Medicaid Managed Care Organization ( MCO) during the MCO Open Enrollment Period for their region. Click here for a handy chart of the value-add benefits each MCO offers Medicaid members.
  • For those who live in the Tidewater region, including Chesapeake, Gloucester, Hampton, Isle of Wight, James City, Newport News, Norfolk, Poquoson, Portsmouth, Suffolk, Virginia Beach, Williamsburg, and York, MCO Open Enrollment will take place from February 19 – April 30, 2020.

  • Those who live in other regions can view their 2020 Open Enrollment dates at Virginians enrolled in the new Medicaid health insurance for adults living in all areas of Virginia have the same MCO Open Enrollment Period (November 1 – December 31 for Medallion 4.0 members, and November 1 – December 18 for CCC+ members).

Coming Soon: NEW Medicaid/FAMIS Correspondence!
The Virginia Department of Medical Assistance Services ( DMAS ) and the Virginia Department of Social Services ( VDSS ) have been hard at work to make the correspondence received by Medicaid/FAMIS applicants and members more user-friendly. DMAS and VDSS gathered suggestions from patients and advocates and used them to develop the new, easy-to-read forms and notices.

Be on the lookout for a new Notice of Action ( approval or denial ), Verification Check List ( VCL ), and Notice of Temporary Approval this spring, and a new Renewal Form this summer!

Later in 2020, several pieces of important correspondence are scheduled to become available in 17 additional languages.

New “How to Apply” Videos Available!
The Virginia Department of Medical Assistance Services ( DMAS) has released a new marketing campaign aimed at increasing awareness of Virginia’s Medicaid/FAMIS programs. As part of this campaign, DMAS has created videos in Spanish and English letting folks know that there are several options to apply for Medicaid/FAMIS.
Click here for the video in English or here for the Spanish version. DMAS encourages nonprofits and others to include the videos on their website or to share them with clients.

For other resources that may be helpful in promoting the new adult Medicaid health insurance, go to Cover Virginia.

Healthy Birthday Virginia  Aims to Improve Maternal and Child Health
Governor Northam recently launched a new initiative to support healthy pregnancies and end racial disparity in the maternal mortality rate by 2025. As part of this initiative, the Northam administration conducted 10 Maternal Health Listening Sessions across the Commonwealth in September and October 2019 to hear from health care providers, parents, and community members about their experiences with maternal and infant health care. The administration is continuing this effort by conducting strategy sessions to develop a five-year plan to eliminate racial disparities in maternal mortality in Virginia.
Several strategies already in place focus on enrolling and retaining women in Medicaid/FAMIS MOMS, including:
  • Targeting outreach to pregnant women and encouraging them to apply for Medicaid/FAMIS MOMS coverage as early in their pregnancy as possible.

  • Automatically transitioning new moms between Medicaid eligibility categories to ensure uninterrupted coverage for women who qualify under expansion to retain health benefits beyond the standard 60-day postpartum cutoff (effective September 2019).

Governor Northam’s 2020 budget includes $22 million to reduce maternal and infant mortality by extending FAMIS MOMS coverage from 60 days to 12 months postpartum. This change will benefit women who do not qualify under Medicaid expansion. In addition, the proposed budget includes adding new services, such as home visiting program for at-risk pregnant and parenting women.

It is crucial for all pregnant Medicaid members to keep their household information up-to-date to help ensure new babies stay covered through their first birthday and to make it easier to renew coverage when the time comes. Members should report any changes to income, address, or household size within 10 days. New moms should also report the birth of their newborns within 30 days, and provide the newborn’s Social Security Number when it becomes available.
The baby’s birth, Social Security Number, or other household changes can be reported by:
  • Calling Cover Virginia (855-242-8282)
  • Logging into the member’s CommonHelp account
  • Calling or visiting your local Department of Social Services (LDSS)

Introducing: Cubre Virginia!
This fall, DMAS unveiled a full-service Spanish version of its Cover Virginia website!

All of Cover Virginia’s pages and internal links are now available in Spanish at .
Give a Child The Best Chance For Healthy Teeth: Seal Out Decay!
What Is A Sealant? A sealant is a thin plastic coating that is placed on the chewing surface of the back teeth. It keeps food and bacteria away from the grooves of these teeth, thus protecting the teeth from plaque and acids. Plaque can change the sugar and starch from food into harmful acids that attack the teeth and cause cavities.

Who Should Get Sealants? All children should have sealants placed on their back teeth as soon as the teeth erupt. Sealants can only be placed on teeth that do not have cavities. That is why it is important to take a child to the dentist every 6 months so that the sealants can be applied as soon as each back tooth erupts.

How Are Sealants Put Onto Teeth? Sealants are easy and painless to apply, and it only takes a few minutes for a dentist will place them on a child’s teeth. After cleaning the tooth, the sealant is painted onto the grooves of the back teeth and it hardens. Sometimes a special light is used to help harden the sealant.

Smiles For Children is Virginia’s Medicaid and FAMIS dental program for children and adults. For information about Smiles For Children or to find a dentist in your area, call toll-free: 1-888-912-3456.
How to Help a Client Find a Doctor
Medicaid Managed Care Organizations ( MCO) want to help make sure their members can find a medical provider that works for them. If your client needs help finding a provider, the best first step is to contact the MCO’s Member Services line:
  • Aetna Better Health: 1-800-279-1878
  • Anthem HealthKeepers Plus: 1-800-901-0020
  • Magellan Complete Care: 1-800-424-4518
  • Optima Family Care: 1-800-881-2166
  • UnitedHealthCare Community Plan: 1-844-752-9434
  • Virginia Premier:
  • Richmond/Central: 1-800-727-7536
  • Tidewater: 1-800-828-7953
  • Roanoke: 1-888-338-4579

If after calling, the member still cannot find a provider or get an appointment within a reasonable timeframe, s/he can submit a complaint to the MCO. If after submitting a complaint to the MCO, the member is still not able to get an appointment with a provider within a reasonable timeframe, s/he can send an email to to get help directly from DMAS with finding a provider.

Health Insurance Marketplace Open Enrollment Ends for 2020
The annual Open Enrollment Period to get health insurance through the Health Insurance Marketplace ended in mid-December. Folks can still get health insurance through the Marketplace outside of Open Enrollment in special circumstances if they qualify for a Special Enrollment Period ( SEP).

Many major life events might qualify someone to get a SEP through the Health Insurance Marketplace, including:
  • Loss of other insurance coverage
  • Permanent move
  • Marriage
  • Birth of a child
  • Adoption, placement for adoption, placement in foster care, or a child support or other court order
  • Receiving a denial for Medicaid

Folks who think they may qualify for a SEP should be prepared to submit documentation to prove that they are eligible for one. To find help enrolling in Health Insurance Marketplace coverage, check out, and select “Get Help with: Health Insurance Marketplace.”

January 2020 Enrollment in Medicaid/FAMIS
As of January 1, 2020, there were…
  • 372,098 adults enrolled in Virginia’s new Medicaid health insurance
  • 594,805 children enrolled in Medicaid (including the CHIP Medicaid Expansion)
  • 74,514 children enrolled in FAMIS
  • 1,747 women enrolled in FAMIS MOMS
  • 1,505 young adults enrolled in Medicaid for Former Foster Care youth
  • 13,306 pregnant women enrolled in Medicaid for Pregnant Women
  • 108,002 adults enrolled in Medicaid for Low-Income Families with Children (LIFC)
  • 44,232 adults enrolled in Plan First