Benefits & Services for Providers

Other Programs and Guidelines

DMAS Medicaid programs and guidelines, including Medicaid, Plan First, Breast Cancer, Foster Care and more.

Maternal and Child Health

Virginia’s Maternal and Child Health (MCH) programs, which include Family Access to Medical Insurance Security (FAMIS), Medicaid for Children, Medicaid for Pregnant Women, FAMIS MOMS, and FAMIS Prenatal Coverage.

Adult Preventative Services

Adult Medicaid members now receive coverage for preventive services as of July 1, 2022. Preventive services are defined as routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.

Cell and Gene Therapy (CGT) Access Model

The Department of Medical Assistance Services (DMAS) will participate in the federal Centers for Medicare and Medicaid Services’ (CMS) Cell and Gene Therapy (CGT) Access Model, effective October 1, 2026. The model aims to improve and streamline access to life-changing CGT medications for Medicaid members with rare and severe diseases across fee-for-service (FFS) and managed care. The initial focus is on cell and gene therapies approved to treat sickle cell disease (SCD).

Benefits & Services include:

• CGT medications for SCD
  • CASGEVY (Vertex Pharmaceuticals, Inc.)
  • LYFGENIA (bluebird bio, Inc.)

• Pre-treatment
• Inpatient care
• Follow-up care
  • After administration of Casgevy/Lyfgenia, for up to one year post treatment

• Case Management
• Fertility Preservation Services
•  Manufacturers cover up to three rounds of reproductive material collection and preservation and up to 15 years of storage for eligible members.

The model is expected to improve access, health outcomes, and quality of life for Medicaid members.

Additional Resources

• Cell and Gene Therapy (CGT) Access Model Overview Factsheet
• DMAS Cell Gene Therapy Access Model Implementation Update 
• Virginia Medicaid Appendix B: Physician Administered Drug (PAD) Criteria