On July 1, 2025, the Department of Medical Assistance Services (DMAS) rebranded Virginia’s Medicaid program as Cardinal Care. All managed care and fee-for-service Medicaid members became part of Cardinal Care. Cardinal Care, Virginia’s Medicaid Program, continues to offer members the same health care services. No changes occurred to existing coverage.
Managed Care Organizations (MCOs)
In Virginia’s Medicaid Managed Care program, members are part of a Managed Care Organization (MCO). An MCO is a health plan with a group of doctors and other providers working together to give health services to its members. The MCO covers all Medicaid services, including medical services, behavioral health services, and long-term services and supports. All MCOs meet Affordable Care Act (ACA) requirements.
MCO Services
MCO can help members choose doctors, get rides to doctor visits, and get other medically necessary services, as well as provide information about health topics such as diabetes or asthma.
Well Care
Well care services are those designed to prevent illness and keep members healthy. Services provided include:
- Annual wellness exams for adults
- Services for pregnant women and new babies
- Well child checkups for children and teens
Primary Care Providers (PCPs)
Managed Care Organization (MCO), members may choose their own doctor, clinic or other health provider to manage their health care. The Primary Care Provider (PCP) selected serves as the point of care or coordinator for all of the members’ healthcare needs. As the PCP becomes familiar with the member’s medical history and healthcare needs, referrals to specialists, orders for tests, and other procedures become part of the plan of care, which the PCP coordinates with the patient, specialists, and other necessary individuals to provide medical care.
Emergencies
An emergency is an injury or illness that can cause death or permanent damage if help is not received right away. In an emergency, call 911 or go to the nearest hospital emergency room.
Do not go to the emergency room unless it is a true medical emergency.
Annual Enrollment Period
Annual open enrollment begin in October and are set in each region.
Foster Care Specialty Plan
FCSP members will stay in Anthem HealthKeepers Plus unless they move to fee-for-service Medicaid or qualify to choose a different health plan.
Care Coordination
All members can get help finding the proper health care or community resources by calling the Member Services number on the back of their ID card. Members can also call 24 hours a day, seven days a week to talk to an on-call nurse or other licensed health professional.
Care Management
If a member has significant health care needs, they will receive care management from their health plan. Care management enhances the coordination between different providers and the services they receive. With care management, a care manager is assigned to the health plan member to assist them in figuring out what they need from their plan. The care manager is an expert on the benefits of the program. They work closely with members, their doctors, other healthcare providers, family members, and caregivers to understand and support them in meeting their needs and achieving their healthcare goals.
What does “Dually Eligible” Mean?
Members who qualify for both Medicare and Medicaid, are dually eligible.
Medicare is health coverage for people ages 65 or older and those of any age who were found disabled under Social Security rules. Medicaid is health coverage for individuals and families who meet income limits and other rules based on financial need. People who qualify for both are usually older or disabled adults whose income is low.
What is a D-SNP?
Medicare and Medicaid have different rules. So, state and federal governments work together to coordinate healthcare and benefits for those who have both. Dual Eligible Special Needs Plan (D-SNP) is a plan to help members who have both find a plan that works best for them.
D-SNPs are Medicare Advantage (“Medicare Part C”) plans that private insurance companies offer for people who have both Medicare and Medicaid. For their Medicare coverage, many dual eligibles choose a D-SNP. The D-SNPs have healthcare coordinators who coordinate Medicare and Medicaid coverage. In Virginia, most people who are dually eligible get their Medicaid coverage from Cardinal Care Managed Care (Managed Care Organizations MCOs)
Why is it a good idea to join a D-SNP?
With a D-SNP:
- Medicare and Medicaid benefits are coordinated.
- Care coordination services help the members manage their healthcare.
- The member does not pay premiums.
- Depending on income, the member may not have co-pays for doctor or specialist visits; however, co-pays for prescriptions may still apply.
- Additional benefits not covered by Medicare or Medicaid are available.
- More focused care helps make sure the member gets the right help to manage their health.
Who qualifies for a D-SNP?
To qualify, the member must:
- Qualify for or have Medicare Part A (hospital coverage) and Part B (outpatient care).
- Qualify for or have full Medicaid.
- Be enrolled in Cardinal Care Managed Care for Medicaid coverage or be willing to enroll.
Where can you learn more or find a D-SNP?
- Call the member services number on the Cardinal Care Managed Care Medicaid ID card.
- Call the Virginia Insurance Counseling and Assistance Program (VICAP) at 1-800-552-3402. They offer free, confidential information about health coverage for those who have Medicare.
- Go to www.Medicare.gov. (Computers are available in libraries and senior centers if you don’t have one at home.)
- Learn about Medicare Advantage plans, D-SNPs, and Medicare Part D prescription drug plans on the Medicare Plan Finder at https://www.medicare.gov/plan-compare.
- Call 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048).
D-SNP health plans information:
Aetna Better Health of Virginia 1-855-463-0933 (TTY: 711)
Anthem HealthKeepers Plus 1-855-949-3321 (TTY: 711)
Humana Healthy Horizons in Virginia 1-844-881-4482 (TTY: 711)
Sentara Community Plan 1-855-434-3267 (TTY: 711)
United Healthcare 1-844-589-0514 (TTY: 711)
