Virginia's Marketplace Open Enrollment Is Almost Here!

Open Enrollment on Virginia’s Insurance Marketplace runs from November 1, 2024 – January 15, 2025. During this time, Virginians can sign up for Marketplace health insurance coverage or change their existing coverage. Enhanced financial help is still available, meaning more people than ever qualify for free- or low-cost coverage through the Marketplace. ENROLL Virginia! Navigators provide free, local, 1:1 help with signing up for Marketplace coverage. You can find an ENROLL Virginia! Navigator near you by clicking here.

Virginia’s Insurance Marketplace also extended the Unwinding Special Enrollment Period (SEP) through December 31, 2024. This means that people who have lost Medicaid or FAMIS coverage during 2024 can still sign up for Marketplace coverage at any point through the end of the year. Beginning in January 2025, people losing Medicaid and FAMIS will have 90 days after losing that coverage to sign up for Marketplace coverage, rather than the shorter 60-day window given for other SEPs.

Medicaid Eligibility Updates

As of October 16, 2024, Medicaid and FAMIS eligibility redeterminations for pandemic-related coverage extensions were nearly complete (98.39%). The Department of Social Services is working to process remaining backlogged cases. As we fully “return to normal,” it is critical to continue messaging around renewals, which will now happen every year. Don’t forget to remind new Medicaid and FAMIS applicants and existing members to keep their contact information up to date, report all changes, and open any mail they receive about their coverage. Thank you for your tremendous collaboration and support throughout this process!

The Centers for Medicare & Medicaid Services (CMS) recently published two major final rules related to Medicaid eligibility, with provisions going into effect over the next three years. CMS Fact Sheets on the final rules can be found here and here. Virginia is already compliant with several aspects of these rules thanks to existing state policies and operational practices. One new policy effective July 1, 2024 is a removal of the requirement that individuals apply for other benefit programs, such as veteran’s or social security benefits, to be eligible for Medicaid. Look for more updates as each set of new provisions goes into effect!

Also effective July 1, 2024, lottery/gambling winnings are now counted as income under Modified Adjusted Gross Income (MAGI) rules. In general, winnings amounting to $80,000 or greater and received in a single payout are counted as income over a period of up to 120 months, and winnings less than $80,000 are counted in the month received. If received in installments, winnings are treated as other types of reoccurring income. 

Cardinal Care Smiles: What's Covered for Adults?

Brought to you by Cardinal Care Smiles

To align with the transition to Cardinal Care and better represent the populations served, Virginia Medicaid’s dental program, formerly known as Smiles For Children, transitioned to Cardinal Care Smiles in July 2024. The Cardinal Care Smiles program continues to provide comprehensive benefits for children, pregnant members, and adults. Virginia Medicaid’s dental program covers each of the dental specialties, including an array of preventive, diagnostic, and restorative services. It is important to note that orthodontics and bridges are not a covered benefit for adults. More information on the Cardinal Care Smiles program can be found here.

What does the program cover for adults and pregnant members? Adult and pregnant members with full Medicaid or FAMIS coverage can get their teeth cleaned, cavities filled, teeth extracted, root canals, and dentures and partials.

Can adults and pregnant members get help with dentures? What about tooth implants? If a member needs dentures, Cardinal Care Smiles will cover the cost. Members may be eligible for a replacement every 5 years. Cardinal Care Smiles will also cover the cost of repairs, relines, and replacing teeth after the member has had the prosthesis six (6) months. However, Cardinal Care Smiles does not pay for implants or bridges.

Is there a charge for any of these services? No, a member will not have to pay for services from a dentist in the network. However, a member might need to pay for services that are not covered or not medically necessary. If a member wants to receive services that are not covered, a member can choose to pay for them. Cardinal Care Smiles does not pay for services received from a dentist not in the network.

Welcome, Joanna!

The Virginia Health Care Foundation (VHCF) is delighted to welcome its new Director of Health Insurance Initiatives, Joanna Fowler. Joanna will lead Project Connect grantees and outreach workers who provide 1:1 application assistance throughout Virginia, partner with state agencies to improve systems and policies, and spearhead VHCF’s Medicaid/FAMIS training efforts. 

Joanna is an experienced health policy and operations analyst and has worked extensively on various initiatives related to coverage and access to care across several organizations. Her previous roles include Senior Advisor to the Director of the Virginia Department of Medical Assistance Services (DMAS) and Senior Advisor to the Director of the Center for Consumer Information & Insurance Oversight at the Centers for Medicare & Medicaid Services (CMS), the component of CMS that oversees health reform and the health insurance Marketplaces. 

Medicaid/FAMIS Enrollment

As of October 15, 2024, there were nearly 2 million Virginians enrolled in Medicaid/FAMIS. This includes:

• 757,572 adults enrolled in Medicaid Expansion (“New Adult Coverage”) and low-income parents/caretaker adults;
• 37,672 pregnant/postpartum enrollees in Medicaid for Pregnant Women (MPW), FAMIS MOMS, or FAMIS Prenatal Coverage;
• 776,861 children enrolled in FAMIS or FAMIS Plus;
• 226,559 individuals enrolled due to being Aged, Blind, or Disabled (ABD)