Cardinal Care Managed Care
Virginia’s Medicaid Managed Care program offers multiple options to enrollees. Individuals have a choice regarding the healthcare benefit they select based on their location and personal healthcare needs. Each plan offers a basic healthcare benefit plan plus extra benefits that might influence the selection. Selections in 2023 included six options, Aetna Better Health, Anthem HealthKeepers Plus, Molina Healthcare, Optima Community Care, UnitedHealthcare Community Plan, and Virginia Premier.
Virginia Medicaid offers several options for Virginians who wish to move into the post-COVID healthcare era. Following is a summary.
Adults 19-64 years old
Medicaid Expansion – Provides both medical and dental coverage to low or no-income individuals. May apply at any time. https://coverva.dmas.virginia.gov/learn/insurance-for-adults/adults-19-64-years-old
Former Foster Care Individuals – Adults aged 18 to 26 can get Medicaid if they were in foster care and had Medicaid in any state on their 18th birthday. There is no income limit for this Program.
Breast and Cervical Cancer Prevention and Treatment Act – Individuals screened by the Virginia Department of Health’s Every Woman’s Life program or the Project Wish program may qualify if diagnosed with and need breast or cervical cancer treatment. https://www.vdh.virginia.gov/every-womans-life/
Medicaid for persons who are aged, blind, or disabled (ABD)
Adults aged 65 or older or disabled or blind may qualify for full Medicaid. A person who does not qualify for full Medicaid because their income is over the limit may “spend down” their income limit on specific medical bills. They must have a certain amount in medical bills before being approved for Medicaid. The medical costs needed to qualify depend on household size and income.
Virginia Medicaid Waiver Programs
Developmental Disability Waivers Focuses on the needs of individuals diagnosed with developmental disabilities. The Program provides support and service options for successful living, learning, physical and behavioral health, employment, recreation, and community inclusion. Slots are allocated based on the urgency of need from a waiting list.
- Building Independence (BI) for individuals 18 and older
- Family & Individual Support (FIS)
- Community Living (CL)
Commonwealth Coordinated Care (CCC) Plus Waiver The CCC Plus Waiver provides support and services options for successful living, nursing, respite, assistive technology, and environmental modifications. It serves all ages and does not have a waiting list.
Medicare Savings Programs
Medicare Savings Programs help Medicare members with low income pay their Medicare premiums. In some cases, the programs also help pay deductibles and co-pays. The level depends on the person’s or couple’s income. The focus of the savings program includes the following medical expenses:
- Doctor or hospital bills
- Dentist bills
- Cost of prescription drugs and certain medical supplies
- Health insurance premiums
Medicaid Works is a work incentive opportunity offered by the Virginia Medicaid program for individuals with disabilities who are employed or want to work.
- Enables workers with disabilities to earn higher incomes while retaining more in savings and other resources and maintaining Medicaid coverage.
- A voluntary plan
- Enrollees earn up to $75,000 and save up to $46,340.
- Available to current and new Medicaid enrollees who are blind or disabled, have a total countable income of no more than $1677 per month, and resources of no more than $2,000 if single ($3,000 if a couple).
Plan First offers free yearly family planning exams, contraceptives, lab testing, family planning education, and more. In addition, if you get sick or need treatment for other medical conditions and do not qualify for full-benefit Medicaid, you can go to a Community Health Center. Based on your income, these centers have primary care on a sliding fee scale.
FAMIS, or Family Access to Medical Insurance Security Plan, is Virginia’s health insurance program for children. FAMIS covers all the medical care that growing children need to stay healthy. It also covers medical care if they get sick or hurt. There are no monthly premiums, co-payments, deductibles, or other costs for covered services to children enrolled in the FAMIS program.
Children may qualify if they:
- Live in Virginia
- Are uninsured
- Are under the age of 19
- Are U.S. citizens or lawfully residing immigrants
- Live in families that meet income rules
Former Foster Care Youth – No Income Requirement. Medicaid coverage is available to eligible former foster care youth who received Medicaid and foster care services on their 18th birthday and are under age 26. The coverage has no income requirement.