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Renewals are Coming…and They will Keep Coming!
Virginia resumed conducting Medicaid/FAMIS eligibility renewals in March 2023. This kicked off a yearlong process during which all 2.2 million members will have their eligibility redetermined. More than 390,000 Virginians have already had their eligibility reviewed, and the rest will have theirs reviewed on a staggered basis from now through April 2024.
Here are answers to 10 frequently asked questions that will help you help your clients prepare for and complete a Medicaid/FAMIS renewal:
1. How do I help my client find his/her renewal date? This information can be found by using the Virginia Department of Medical Assistance Services (DMAS) online Medicaid portal (Medicaid Enterprise System, or MES), by calling the Cover Virginia Call Center, or by setting up an account on the CommonHelp website.
If the member’s renewal date from these sources is in the past, use this tool to find the member’s new renewal date.
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2. If my client’s renewal will not occur for several months, what can s/he do to prepare now? Even if a client’s renewal is months away, s/he can prepare now by ensuring that his/her mailing address and other contact information is up-to-date with Virginia Medicaid. This is especially important if your client has moved or changed phone numbers since 2019. S/he can report this change:
· To his/her Medicaid/FAMIS MCO,
· Online at commonhelp.virginia.gov,
· By contacting his/her local DSS, or
· By calling Virginia’s One Benefits line at 1-833-5CALLVA.
3. What does the renewal packet look like? A member’s renewal packet will come with an outer envelope addressed to the member, with his/her local DSS listed as the return address.
It will say “Open Immediately: Application Enclosed” on the outer envelope. It will also include an inner envelope (business-reply) to enable the member to submit the renewal by mail.
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4. What does the renewal form look like? A member’s renewal form should always come prepopulated with the information the state has on file about the member and his/her household. Its first page includes important information like the due date (found in a big bubble on the righthand side), and the member’s Case Number and Client ID.
As the form indicates, Virginians can submit a renewal by either correcting any incorrect information on the form and submitting it:
· To the local DSS, or
· Online at commonhelp.virginia.gov, using the Case Number and Client ID found on the renewal form to “Associate My Case” to a CommonHelp account, or
· Via the Cover Virginia Call Center at 1-855-242-8282 (TTY: 1-888-221-1590). (Note: it helps to have the requested information gathered and ready to give over the phone).
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5. What if my client is still eligible, but loses Medicaid because s/he didn’t turn in the renewal? The client should receive a 90-day “grace period” to complete the renewal and/or submit required documents. If s/he provides the requested information within the grace period and is found eligible, coverage will be reinstated back to the date of the termination.
6. What if my client needs help completing his/her renewal? The Virginia Health Care Foundation funds Project Connect Medicaid/FAMIS application assisters, who can help Virginians under 65 apply for or renew their Medicaid/FAMIS. If there is not a Project Connect assister in your community, you can find a local Navigator or Certified Application Counselor in most parts of Virginia.
7. What if my client is no longer eligible at renewal? If your client’s Medicaid/FAMIS is canceled, s/he will receive a Notice of Action via mail from the local DSS that indicates the date that coverage will end, and the reason for the termination. If a client is terminated due to no longer being eligible for Medicaid/FAMIS (e.g., having an income above the limit), s/he may be able to obtain health insurance through:
- His/her employer, or a spouse’s or parent’s employer. Most employers offer a 60-day window to sign up for coverage for someone who loses Medicaid/FAMIS.
The Marketplace has opened a Special Enrollment Period for those who lose Medicaid between March 2023 – July 2024. They simply need to attest to having lost Medicaid coverage during that window, and they will be allowed to apply and select a plan through the Marketplace at any time. They are not required to go to the Marketplace within 60 days of losing their Medicaid; they can apply at any time between March 2023 and July 2024.
Clients who lose Medicaid/FAMIS may also be eligible to receive care at a local free or charitable clinic or Federally Qualified Health Center (community health center).
8. What if my client is terminated inappropriately? Medicaid/FAMIS members and those who represent them may request to speak with their worker to request a reinstatement of coverage, and can file an appeal if they believe they were terminated inappropriately. Members can find out more about appeals on the Virginia Department of Medical Assistance Services website, and can even file their appeal online using the Appeals Information Management System (AIMS) Portal. Because of a special rule, members’ benefits can continue while an appeal is pending.
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9. Where can I find data about how many renewals Virginia has completed to-date? DMAS has developed an Eligibility Redetermination Tracker to help visualize the number of successful renewals, terminated members, and renewals still needing to be completed during the yearlong “return to normal” period.
10. Are there special concerns for clients who are enrolled in Medicaid due to being Aged, Blind, or Disabled (ABD), and/or receiving Medicaid-covered Long-Term Services and Supports (LTSS)? Yes. Most members who must meet countable resource limits should have certain pandemic-related resources excluded at renewal. These excluded resources include stimulus checks (IRS Economic Impact Payments), Pandemic-Related Unemployment Assistance, and other types of payments that the Social Security Administration has declared “disaster assistance.”
If someone receives Medicaid-covered LTSS, s/he can read more about special considerations involving Patient Pay in the DMAS Fact Sheet here.
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Learn More About Medicaid/FAMIS Eligibility and Renewals
The Virginia Health Care Foundation has announced Summer 2023 SignUpNow workshops to help you prepare your clients to renew their Medicaid/FAMIS. SignUpNow offers 2 training workshops (Please Note: Workshops cover different material, please read carefully to ensure you are registering for the workshop you would like to attend.):
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SignUpNow – Medicaid/FAMIS workshops cover the “ins and outs” of the eligibility requirements, application procedures, and post-enrollment information for Virginia’s Medicaid/FAMIS programs for children and families (Medicaid Expansion, and the FAMIS programs). Click here to register for a SignUpNow – Medicaid/FAMIS workshop.
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SignUpNow – ABD workshops cover information for Virginia’s Aged, Blind, or Disabled (ABD) Medicaid covered groups, including ABD with Income ≤80% FPL; programs for Virginians who receive Supplemental Security Income (SSI), an Auxiliary Grant, or Long-Term Services and Supports (LTSS); and the Medicare Savings Programs. Click here to register for a SignUpNow – ABD workshop.
Register today at vhcf.org/workshops/ to attend a workshop!
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Changes to Medicaid Managed Care Organizations (MCO)
Beginning this month, all Medicaid managed care enrollees will select their Cardinal Care Managed Care Organization (MCO, or Medicaid health plan) using the VirginiaManagedCare.com website, or the Enrollment Helpline at 1-800-643-2273 (TTY: 1-800-817-6608), M – F 8:30 am to 6 pm. This impacts those enrolled in Virginia’s Commonwealth Coordinated Care Plus (CCC Plus) programs, including members who are Aged, Blind, or Disabled (ABD).
Beginning July 1, two existing Medicaid/FAMIS MCOs, Optima Family Care and Virginia Premier, will join under a new name, Optima Health. Virginia Premier members will be automatically enrolled into Optima Health. They will receive new Optima Health Member ID cards this month. Former Virginia Premier members who wish to choose a different MCO can call the Enrollment Helpline, or go to VirginiaManagedCare.com.
A list of each Cardinal Care MCO’s extra benefits can be found here.
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Men’s Oral Health: A Key Piece of Overall Health
From the desk of Smiles For Children
June was Men's Health Month. Screenings, health fairs, and other health education and outreach activities were held across the country to boost the early detection and treatment of curable diseases among men. Did you know that oral health offers clues about whole health — or that problems in the mouth can shape the rest of a person’s health?
Oral health is an often-forgotten part of men's complete health. Men are likelier to have poorer oral hygiene habits and higher rates of periodontal disease, oral cancer, and dental trauma.
Fortunately, most oral health issues are avoidable, with good dental care habits, including:
- Brushing and flossing teeth twice daily;
- Using mouthwash after brushing to remove leftover food;
- Switching to a healthy diet and limiting sugary foods and drinks;
- Booking regular dental checkups and cleanings; and
- Avoiding tobacco use.
Taking care of oral health is a good investment in one's health. Medicaid/FAMIS members can call DentaQuest’s Smiles For Children call center at 1 (888) 912-3456 to get help finding an appointment with a local, in-network dentist. Uninsured residents can visit the Virginia Association of Free and Charitable Clinics or the Virginia Community Healthcare Association website to see clinics offering various health and dental services.
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Medicaid/FAMIS Enrollment
As of July 1, 2023, there were 2.19 million Virginians enrolled in Medicaid/FAMIS. This includes:
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739,643 adults enrolled in Medicaid Expansion (“New Adult Coverage”)
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38,745 pregnant people enrolled in Medicaid for Pregnant Women (MPW), FAMIS MOMS, or FAMIS Prenatal Coverage
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872,495 children enrolled in FAMIS or FAMIS Plus
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240,195 individuals enrolled due to being Aged, Blind, or Disabled (ABD)
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