Virginia’s Medicaid Structure Features Cardinal Care

When most individuals think about needing financial assistance for medical needs, I believe they associate Medicare with the elderly and Medicaid with children and individuals with limited or no income. Both provide medical insurance coverage, but Medicaid helps with other needs besides medical costs. Previously within the Medicaid framework were programs supporting special needs groups, including disabilities, children, pregnant mothers, and the homeless. In 2023, Virginia restructured the Medicaid program. Before January 1, 2023, each special needs group had a separate track for receiving healthcare benefits. However, after that date, Virginia’s Medicaid Program featured Cardinal Care as the sole medical benefit structure available to all participants.

Participants who previously used Virginia Medicaid may find the new process confusing. The website uses the new naming system without referencing the old; therefore, it’s challenging to identify which new item is the same as the old.

The information on the previous “Virginia Medicaid” site is specific to healthcare providers. All the tabs listed are labeled with acronyms, making it complicated to figure out where to go for information. In addition, that site does not provide Medicaid eligibility information or say where to go to find it. I found it when I searched for Commonwealth Care and discovered the Program’s name had changed to “Cardinal Care, Virginia’s Medicaid Program.”

Cardinal Care replaced Virginia Medicaid’s managed care programs (Medallion 4.0 and Commonwealth Coordinate Care Plus (CCC Plus)) and became Cardinal Care Managed Care. Under the new Program, all Virginia members (children, adults, pregnant women, those with disabilities, and those needing long-term care services or support) receive care within the Cardinal Care Managed Care Program framework. Under Managed Care, participants may choose from several benefit plans with similar though slightly different options. In addition, Cardinal Care Medicaid covers medical, behavioral health, nursing facility, and “waiver” services for community-based long-term care.  

Medicaid Eligibility Requirement

Unlike Medicare, each state sets its guidelines for Medicaid benefits in that state. Virginia Medicaid requirements consider many factors, including but not limited to income, age, disability status, immigration status, resource availability, and other factors. Therefore, applying is the best way to determine if you qualify. Individuals interested in finding out if they are eligible can complete a preliminary screening at https://commonhelp.virginia.gov/access/accessController?id=0.44126806598280766.

Applying for Medicaid

It is easy to apply for Medicaid in Virginia. The Department of Medical Services oversees the Program and provides multiple ways.

• Apply online at https://commonhelp.virginia.gov/
• Call Cover Virginia’s call center M-F 8 a.m.- 7 p.m., or Saturday, 9 a.m. – 12 p.m. at 833-5CALLVA(TDD: 1-888-221-1590).

• Apply online at the Health Insurance Marketplace at healthcare.gov.
• Mail or drop off a paper application to your local Department of Social Services (DSS) (dss.virginia.gov/localagency)

When you apply, have the following information available:

• Full legal name
• Date of birth
• Social Security numbers (or document numbers for legal immigrants needing insurance).
• Employer and income information for everyone in your family (for example, from paystubs, W-2 forms, or wage and tax statements). Note: If self-employed, you can use these documents (Self-employment Expenses Information.)
• Policy numbers for any current health insurance
• Information about any job-related health insurance available to your family

If you mail your information, keep a copy of everything you send in case it gets lost! If you want to send the above electronically, send it using these addresses:

• Online: virginia.gov

• Mail: Use the address on the letter we send asking for information.
• Fax: 1-888-221-9402

For questions, call Cover Virginia at 833-5CALLVA.

Forms Needed for Each Application Type

• If you are applying for Medical Assistance, complete the Cover Virginia Application for Health Coverage and Help Paying Costs form, including Appendix A, B, and C.
• If you are applying for more than two people, you must include a Cover Virginia Additional Person Supplement form for each applicant.
• Anyone over eighteen needs to complete the Commonwealth of Virginia Voter Registration Agency Certification form (Note: You don’t have to register to vote).
• Applying for Medicaid for adults over age 19 with disabilities or older or anyone who needs long-term care. – Submit the Adults over 19 with Disabilities and Other Adults Aged 65 and Over, Including People Who Need Long-Term Care Services form. Appendix D. (ABD-LTC)
• The evaluation can consider income, resources, and medical expenses if you don’t qualify for Medicaid based on income but are Medically needy. Complete Appendix E (Medically Needy Spenddown) to the Application for Health Coverage and Help Paying Costs.
• If you applied for health care coverage for someone who needs help with everyday things like bathing, dressing, walking, or using the bathroom to live safely in the home or if a doctor or nurse told them that they have a physical disability or long-term disease, mental or emotional illness, or addiction problem, complete Appendix F.