When choosing an MCO, it’s important to think about which providers an enrollee may want to provide his/her healthcare. It’s also important to make sure that the doctor an enrollee wants to care for him/her is accepting new patients.
Note: If a Medicaid/FAMIS enrollee has special or complex medical needs, s/he will be enrolled in an MCO program called Commonwealth Coordinated Care Plus (
) that helps coordinate the enrollee’s care. Otherwise the person is enrolled in an MCO through the Medallion 4.0 program.
How to see which healthcare providers participate with a particular MCO
To look up whether a provider is in an MCO’s network, Medallion 4.0 enrollees can check out the Integrated Provider Search Tool on
. To get to the Integrated Provider Search Tool, hover over
Choose (Find health plans and providers)
on the homepage, and when the drop-down menu appears, select “Find a Provider.”
From there, search for a specific provider, or search within a radius to find a provider located convenient to the enrollee. The enrollee will be able to see which MCOs that provider accepts, whether the provider is taking new patients, and whether the provider can serve as the enrollee’s Primary Care Provider (
A CCC Plus enrollee must use the Integrated Provider Search tool on
. S/he should hover over
Choose (Find health plans and providers)
on the homepage, and select “Find a Provider” from the drop-down menu.
Note: Just because a provider is in a company’s CCC Plus network does not mean s/he will also be in that company’s Medallion 4.0 network, so it’s important to search using the correct website.
Choosing or Changing a Primary Care Provider (
Most MCOs require a member to choose a Primary Care Provider (
). If a newly-enrolled member does not select a PCP within the first 25 days of being enrolled, the MCO may assign that person a PCP. The enrollee can change his/her PCP at any time. After an enrollee changes his/her PCP, s/he will get a new MCO card with the new PCP’s name on it.
Things for Your Client to Consider When Picking a Dentist
Did you ever wonder why the dentist does a certain kind of treatment? Or why you sometimes need to make more than one appointment to fix your teeth?
Sometimes dentists explain what they are doing during your dental treatment, and sometimes they don’t. If they don’t, it’s okay to ask questions. Or if you are a parent, you can ask questions about your child’s treatment. Dentists will be happy to give you answers. It’s part of their job.
It is important to find a dentist you like and trust, because it makes asking questions easier. When you visit the same dental office over and over again, that office is called your
. The dentist and their staff welcome you to the office and get to know you and your family. If other members of your family visit the dentist, then it is their
too. We recommend that your family see the dentist every 6 months.
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.
Milestones: 50 Workshops and 2,000 Trainees
On March 1, VHCF completed its 50th
workshop and trained its 2,000th person since October 2018! We’re not done yet! Check out
to find a
training near you!
teaches the “ins and outs” of the eligibility requirements, application procedures, and post-enrollment information for Virginia’s Medicaid and FAMIS programs:
- New adult coverage
- Programs for children and pregnant women
- Plan First (family planning)
- Low Income Families and Children (LIFC) program
participants will be able to provide hands-on assistance to individuals and families who want to apply for Medicaid or FAMIS.
Please share information about
with colleagues, including those who work in non-healthcare organizations. More than 150,000 Virginians still need help applying for the New Adult Coverage and more than 59,000 Virginia children are eligible for coverage, but not enrolled.
Keep Track of New Adult Enrollments with the DMAS Expansion Dashboard
To stay current on the number of newly-eligible adults enrolled in Virginia’s New Health Coverage for Adults, check out the Virginia Department of Medical Assistance Services’ dashboard at
. The dashboard breaks down the number of new adult enrollees by locality, age, gender and income as a percentage of the Federal Poverty Level.
DMAS updates the dashboard every two weeks, so you can follow Virginia’s progress in enrolling newly-eligible adults. As of March 22 over 251,000 adults were enrolled!
What does the New Coverage Mean for Local/Regional Jails?
When the New Adult Coverage began in January 2019, many individuals who are incarcerated became eligible for Medicaid coverage for inpatient hospitalizations. Since these individuals have a specific set of needs, the Cover Virginia Inmate Unit (
) was created to receive and process their applications. The CVIU will also manage their cases after enrollment.
Jail staff are encouraged to assist newly-eligible inmates with applying for Medicaid. It is recommended that jail staff make an appointment with Cover Virginia to help the inmate apply for coverage. Staff can call
to schedule application appointments and help inmates apply.
A person is not automatically re-evaluated upon release, so it’s important to make sure a “Communication Form” is submitted 45 days before the person is scheduled to be released to ensure that s/he has full coverage upon leaving jail. The “Communication Form” lets the CVIU know to move the enrollee into full, “community” Medicaid (
New Adult Coverage
Thank you to our sponsors!
VHCF is grateful to the following organizations for supporting SignUpNow workshops and/or lunches to ensure that as many “helpers” as possible know how to assist Virginians in applying for Medicaid and FAMIS: Aetna Better Health of Virginia, Anthem HealthKeepers, Bob and Anna Lou Schaberg Fund, Bon Secours Richmond, Bon Secours Virginia Health System, Cameron Foundation, Carilion Clinic, Carilion Franklin Memorial Hospital, Community Foundation for a greater Richmond, Danville Regional Foundation, Families Forward, Inova Health System, Jenkins Foundation, Magellan Health, Martinsville-Henry County Coalition for Health and Wellness, Mary Washington Healthcare Foundation, Northern Virginia Health Foundation, Novant Health UVA Health System, Obici Healthcare Foundation, PATH Foundation, Potomac Health Foundation, Richmond Memorial Health Foundation, Robins Foundation, United HealthCare, United Way – Thomas Jefferson Area, Valley Health, VCU Health, Virginia Department of Medical Assistance Services (DMAS) and Williamsburg Health Foundation
Enrollment Update: As of April 1, 2019, there were:
255,592 adults enrolled in the New Adult Coverage
107,765 adults enrolled in Medicaid for Low-Income Families with Children (LIFC)
1,228 young adults enrolled in Medicaid for Former Foster Care Youth (FFC)* (
*March 1 data
40,909 adults enrolled in Plan First
575,760 children enrolled in FAMIS Plus
71,649 children enrolled in FAMIS
14,295 pregnant women enrolled in Medicaid for Pregnant Women (MPW)
1,278 pregnant women enrolled in FAMIS MOMS