Virginia MedicaidThe Virginia Medicaid agency pays providers directly for services to fee-for-service members. Most Medicaid members are only in fee-for-service for a short time until they get a managed care health plan. In managed care, a health plan helps members find providers and get the services they need.
Our mission is to improve the health and well-being of Virginians through access to high-quality health care coverage.
In 2019, Virginia Medicaid celebrated its 50th anniversary and successfully oversaw the largest expansion in its history. New eligibility rules expanded membership to more than 1.5 million Virginians. Agency leaders responded to these historic changes by adopting data-driven, member-focused innovations including a Medicaid Member Advisory Committee to provide feedback and ideas for current and future initiatives.
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Commonly Asked Questions and Answers about Coverage
What is the difference between fee-for-service and managed care?
What services does Medicaid cover? What is not covered?
Your coverage includes inpatient, outpatient and emergency medical services. Medicaid also covers preventive care, behavioral health, addiction and recovery treatment, prescription medicines, dental, and more. Your member handbook explains all of the benefits and services that are covered or not covered. Medicaid managed care members also receive a member handbook from their managed care organization, which outlines additional benefits that you may receive.
What are Managed Care Organizations and why do I need one?
A managed care organization (MCO) is a health plan with a group of doctors and other providers working together to give health services to its members. Your MCO will cover all Medicaid services you get now, including medical services, behavioral health services, nursing facility services and long-term services and supports for community-based long-term care.
What determines my eligibility for different health plans?
If you are eligible for Medicaid managed care, you can pick your own MCO from any of the six health plans that work with Virginia Medicaid.
What health plan am I enrolled in?
Medicaid will automatically enroll you into a managed care health plan. You will then have 90 days to choose a different plan if you want to switch. You will get an ID card from your health plan and some basic information about your health care.
Who is my Primary Care Provider?
You are able to select a primary care provider who participates with your health plan. You can call the Member Services phone number listed on the back of your member ID card to speak with someone who can help you select a provider.
What will happen to my coverage when Cardinal Care launches?
Your Medicaid coverage will not change when we launch Cardinal Care. You will still receive the same benefits, visit your same doctors and have the same coverage.
What do I need to do to prepare for the Cardinal Care launch?
You do not need to do anything to prepare for Cardinal Care. Your transition to Cardinal Care will be automatic, as long as you are a current, eligible Medicaid member.
What kind of support/resources do I have as a Fee-for-Service member?
Regular fee-for-service members can call the member helpline at 804-786-6145 for help with or questions about claims, complex billing and covered services.
Will I be able to continue to see my same provider under this coverage?
You may continue to see your current providers as long as they accept Virginia Medicaid and participate with the health plan that you selected if you are in managed care.