Over 500,000 Virginians Enrolled in New Health Coverage For Adults!
Virginia’s Department of Medical Assistance Services (DMAS) announced a huge milestone at the end of 2020: over 500,000 Virginians are enrolled in the New Health Coverage for Adults!
Exciting Changes Coming Soon to Medicaid/FAMIS!
Virginia’s Medicaid/FAMIS programs will see several exciting improvements in 2021, thanks to changes put in place by the Virginia General Assembly and Governor Northam.
Elimination of the “40-Quarter Rule” for Lawful Permanent Residents (LPRs, or “green-card-holders”)
Beginning in April 2021, adults who are LPRs will no longer be required to have 40 qualifying quarters of work in order to be eligible for Medicaid! For many years, Virginia’s “40-Quarter Rule” has prevented many otherwise-eligible green-card-holder adults from being able to enroll in Medicaid, even if they meet all other eligibility requirements (including having been lawfully present in the U.S. for 5 years or longer).
Individuals who may become eligible in April 2021 due to this change should be encouraged to apply or re-apply at that time, so that their eligibility can be re-determined. Keep in mind that some LPR Virginians who were ineligible for Medicaid because of the “40-Quarter Rule” may be enrolled in health insurance through the Health Insurance Marketplace, with financial help. Once these individuals become enrolled in Medicaid, it will be important for them to end their Marketplace plan, so they can avoid being billed for coverage they no longer need.
Addition of a Comprehensive Dental Benefit for Virginia Adults
The General Assembly has passed a new comprehensive Medicaid adult dental benefit effective July 1, 2021. Currently, the “core” dental benefit for adults (those 21 and over) enrolled in Medicaid has only consisted of medically-necessary extractions. (While several Managed Care Organizations (MCOs) have provided some dental benefits, these have been limited and have changed from year to year).
Extension of Postpartum Coverage for New Moms
In 2021, women enrolled in FAMIS MOMS or Medicaid for Pregnant Women (MPW) will get to remain covered in those programs for one full year postpartum! Currently, women in these programs are covered only for the duration of their pregnancy, and 60 days postpartum. Extending the coverage to the 12-month mark will enable women to receive essential services aimed at helping them and their newborns stay healthy.
Virginia has applied to the federal Centers for Medicare & Medicaid Services (CMS) to make this positive change to its Medicaid/FAMIS programs, and is awaiting approval. SignUpNow will share details about the rollout of extended postpartum coverage, including a “go-live” date, as they become available.
Preview of Other Coming Attractions
Be on the lookout for the Spring 2021 edition of SignUpNow Outreach, which will share additional details about the changes outlined above, changes coming to Cover Virginia, and increases in Medicaid payment to some types of providers.
Health Insurance Marketplace Updates
Open Enrollment for Private Health Insurance in the Federal Marketplace Has Ended!
As of January 12, over 261,000 Virginians had enrolled in or renewed their coverage through the Health Insurance Marketplace! While the Open Enrollment period for coverage through the Marketplace ended on December 15, many Virginians may qualify for a Special Enrollment Period (SEP) throughout the year.
Individuals may be able to get a SEP to enroll via the Marketplace outside the Open Enrollment Period if they:
- Applied for Medicaid during the Open Enrollment Period (November 1 – December 15, 2020), and received a Medicaid denial, even if the denial came after Open Enrollment ended on December 15.
- Lose job-based coverage, or lose eligibility for Medicaid or FAMIS, throughout the year.
- Were unable to enroll in coverage during the Open Enrollment Period due to COVID-19 (known as the “FEMA SEP”).
- Experience other life changes that may make them eligible for a SEP.
If you believe an individual or family might be eligible for a SEP, a Navigator or Certified Application Counselor (CAC
) can help! Go to coverva.org/assistance/
to find a Navigator or CAC near you.
For more information about SEPs that may be available to those losing jobs or income during COVID-19, check out this resource
from the Center on Budget and Policy Priorities.
Don’t forget: Virginians can apply for and enroll in Medicaid/FAMIS year-round!
Good News for Marketplace Enrollees Receiving Financial Help!
Each year, Virginians enrolled in coverage through the Health Insurance Marketplace must file a federal income tax return to keep receiving financial help to buy a plan. Due to delays in their tax returns being processed by the Internal Revenue Service (IRS), many Virginians who signed up for Marketplace coverage for 2021 may have been told that they could not receive financial help to buy a plan.
But, in December 2020, the Marketplace announced that it will continue to give financial help (Premium Tax Credits, or PTC
) to those who enrolled in a Marketplace plan for 2021, even if the Healthcare.gov system flagged them as having “failed to reconcile” their tax credits from the previous year. This is great news, since it means many folks will be able to keep their financial help until spring of 2021. If you or your client has questions about the Marketplace, or about PTC, a Navigator or Certified Application Counselor (CAC
) can help! Go to coverva.org/assistance/
to find a Navigator or CAC near you.
SignUpNow Workshops Available LIVE, and On-Demand
But, did you know that there is also an online, on-demand version of the SignUpNow training
? On-demand workshops can be completed when it’s convenient for you, wherever you are – one module at a time. The on-demand workshops
consist of the same content as the live trainings, broken down into 20-30-minute modules.
SignUpNow teaches the “ins and outs” of the eligibility requirements, application procedures, and post-enrollment information for Virginia’s Medicaid/FAMIS programs:
- New Adult Coverage
- Programs for children and pregnant women
- Plan First (family planning)
- Low Income Families and Children (LIFC) program
- Medicaid for Former Foster Care Youth
Have a question about Medicaid/FAMIS eligibility, or about SignUpNow
? Email firstname.lastname@example.org
, or call 804-828-6062. To register for a live, virtual workshop, go to vhcf.org/workshops
. Spaces will fill quickly, so register early!
DentaQuest Announces Virtual Monthly Member Forum
Beginning in December 2020, DentaQuest will host a LIVE Monthly Member Benefits Forum. Each Forum will review the Smiles For Children program, with an emphasis on pregnant member benefits.
During the Monthly Member Benefits Forums, members will be able to learn about their benefits and ask questions. Each forum will also include guest presenters from each Medicaid Managed Care Organization (MCO).
The LIVE Monthly Member Benefits Forums will take place on the following dates, from 12:00 – 1:00pm:
- January 26, 2021
- February 23, 2021
- March 23, 2021
- April 27, 2021
- May 25, 2021
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.
Public Health Emergency (PHE) Reminders
Because of the ongoing declaration of the Public Health Emergency (PHE) due to COVID-19, most Virginians enrolled in Medicaid will remain enrolled in coverage, even if they fail to complete a renewal or provide documentation.
During the PHE, Medicaid cases should not be closed unless a member:
- Moves permanently out of Virginia
- Requests his/her case be closed
- Is a FAMIS-enrolled child “aging out” of eligibility (i.e., turning 19).
- Is a FAMIS MOMS-enrolled woman who has reached 60 days postpartum (prior to the extension of postpartum coverage becoming effective).
- Is either a lawfully residing child turning 19, or lawfully residing pregnant woman who has reached 60 days postpartum (prior to the extension of postpartum coverage becoming effective).
A member’s local Department of Social Services should always assess the member for eligibility in another Medicaid/FAMIS category before terminating his/her coverage.
When an individual is no longer eligible for Medicaid/FAMIS, s/he is eligible for a Special Enrollment Period (SEP) to shop for private coverage on the Health Insurance Marketplace. Click here to find a Certified Application Counselor (CAC) or Navigator, who can help these folks enroll in Marketplace coverage.
The U.S. Department of Health and Human Services’ declaration of a PHE due to the COVID-19 pandemic is set to expire in late April, 2021, at the earliest. Changes to Medicaid/FAMIS enrollment and eligibility policy due to the PHE will continue until the end of April, including the policy dictating that no Medicaid cases should be closed due to a member’s failure to renew.
The Virginia Department of Social Services (VDSS) will continue to renew Medicaid/FAMIS members through the ex parte (automatic) process, when possible. Those who are aware of their renewal dates (or who receive a renewal packet by US mail) who can complete their renewals are encouraged to do so. Failing to renew will not cause their coverage to end during the PHE. Ex parte renewals are being completed and renewal packets are being processed to minimize backlogs and processing delays when the PHE ends.
As of January 1, 2021, there were:
- 511,119 Virginians enrolled in the New Health Coverage for Adults
- 157,103 children enrolled in FAMIS, and 585,629 children enrolled in FAMIS Plus
- 20,961 pregnant women enrolled in Medicaid for Pregnant Women, and 1,572 enrolled in FAMIS MOMS
- 132,417 parents or caretaker relatives enrolled in LIFC
- 1,883 young adults enrolled in Medicaid for Former Foster Care youth
- 45,743 adults enrolled in PlanFirst