Virginia Medicaid
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Overview

The Medicaid waivers are home and community based offering supports and services to a Medicaid individual, both children and adults. The waiver services will differ based on individual need and program criteria met.

For anyone interested in applying for one of the DD (Developmental Disability) waivers, contact your local Community Services Board to inquire further.

For anyone interested in obtaining the CCC Plus waiver, the following action steps must occur:

  1. The individual may request a LTSS Screening through their local Dept. of Social Services. A Community Based Screening Team (i.e.: Social Worker and Health Dept. Nurse), will meet with the individual and a family member/caregiver, if available, to assess the individual’s need for the CCC Plus waiver. If an individual is hospitalized and needs a screening, this can be done in the hospital by a discharge planner; and
  2. The individual must be eligible for Medicaid in order to receive and have waiver services paid by Medicaid.
  3. The individual may:
    • Complete a Medicaid electronic application online at CommonHelp.virginia.gov,
    • Call the Cover Virginia Call Center at 1-833-5CALLVA (1-833-522-5582, TDD: 1-888-221-1590) to complete the application over the phone, or
    • Contact their local Dept. of Social Services agency to request a Medicaid paper application and request the Appendix D, which is specific to the long-term services and supports.

Once approved for Medicaid eligibility, screened and approved for the CCC Plus waiver, the individual may choose the desired waiver services. The screening team will assist the individual with locating providers in their area.


Announcements

  • DMAS is in the process of developing a targeted case management service for individuals with severe traumatic brain injury and has convened a workgroup with relevant stakeholders to develop program structures and cost estimates for implementing a continuum of treatment and supports for individuals with brain injury and neuro-cognitive disorders; including waiver and facility based neurorehabilitation and neurobehavioral services.
  • Out for Public Comment: "Overview of Companion and Residential Services." To make a comment, visit the Virginia Regulatory Town Hall website or email ddwaiver@dmas.virginia.gov
  • Billing Instructions for $1,000 COVID Relief Payment
  • FAQ for $1,000 COVID Relief Payment
  • Attention Fee for Service (FFS) Medicaid Members: For Client Services Information on the DMAS website, including the Medicaid Works program, Medicaid Handbook, Appeals, and Transportation, feel free to access this link at: For Applicants
    If you are in a Medicaid Managed Care Health Plan, refer to your health plan materials.
  • Updated EM/AT and PERS Provider Lists - October 12, 2022 - See posted at the bottom of this Waiver website screen. Both lists are Fee for Service (FFS) provider lists only.
  • E-MAIL IN BOX - For Consumer Directed Services Questions related to time sheets and service authorizations for fee for service CCC Plus waiver members, submit your question to: cdsf@dmas.virginia.gov
  • E-MAIL IN BOX - For CCC Plus Waiver Questions related to program criteria and clarification of policy for fee for service members, submit your question to: cccpluswaiver@dmas.virginia.gov
    NOTE: For CCC Plus Waiver members participating in a managed care health plan, submit your question to: cccplus@dmas.virginia.gov

Consumer-Directed Care Services (CD)

Consumer-directed (CD) services is a model of service delivery that empowers the member receiving services to employ an attendant to provide care. The member or their designated representative performs all of the employer responsibilities including hiring, training, managing, and if necessary, terminating the attendant. The Services Facilitator provides information and assists the member and their family/primary caregiver with learning the responsibilities of a CD employer of record. Services that can be directed by the member are personal care/personal assistance, respite services, and companion services.

Traditional services or Agency-directed (AD) care is services that are provided by a personal care agency. Waiver members may choose either consumer-directed or agency-directed care, or both.

Notes

  • For CCC Plus waiver members who opt for consumer directed services and who are participating in the CCC Plus MCO Health Plans of Aetna, Anthem, Optima and United Health Care, the Fiscal Employer Agent (F/EA) is Public Partnerships LLC (PPL) located at: http://www.publicpartnerships.com/.  For Aetna, they use both PPL and CDCN as the F/EA.  For Molina, the F/EA is named ACES$ Financial Management Services - refer to: https://www.mycil.org/acess-virginia.html for more information.  Va. Premier uses CDCN as the F/EA.
  • Since January 1, 2019, the Consumer Direct Care Network (CDCN) remains the Fiscal Employer Agent (F/EA) for Fee for Service (i.e.: not in a MCO health plan) CCC Plus waiver members who opt for consumer directed services. Visit the CDCN website at: http://www.consumerdirectva.com/ for more information.


Overview - Developmental Disability Waivers (DD)

Currently, the following are the Developmental Disabilities (DD) waivers available: Building Independence (BI) Waiver, Family and Individual Support (FIS) Waiver and the Community Living (CL) Waiver

The DD waivers are offered to both children and adults with various levels of intellectual and/or developmental disabilities. There are a multitude of services and supports offered under each waiver, depending on individualized needs and program criteria met.





Commonwealth Coordinated Care Plus Waiver (CCC Plus)

The CCC Plus Waiver (also known as the Commonwealth Coordinated Care Plus Waiver), provides home and community based care for individuals who would otherwise need care in a nursing facility or other specialized care medical facility. The waiver serves all ages and does not have a waiting list. The CCC Plus Waiver provides supports and service options such as personal care, respite, private duty nursing, adult day health care, assistive technology and environmental modifications.