Partner Points Newsletter July 2024
Important Member Information
Our partners play a crucial role in helping Medicaid members, including by answering questions about coverage, eligibility, services, and more! This month’s Partner Points includes a member FAQ to help you answer those questions and provide members with key resources. The DMAS website is a great source of information for anyone looking to learn more about Medicaid.
Frequently Asked Questions
Question (Q): How do I file an appeal or determine my appeal status?
Answer (A): First, visit our website (https://www.dmas.virginia.gov) and under the “Appeals” section on the home page, click “Applicant/Member Appeals Resources.” There will be various PDFs and forms to look over and complete when looking to file an appeal or determine an appeal status.
Q: How do I know if I am in FFS or Managed Care?
A: For Fee-for-Service (FFS), eligibility requires limited income and resources and must be in a covered group. The local DSS office process the applications, determine eligibility and enroll members.
For Managed Care, the Enrollment Broker MCO helpline conducts all enrollment and education activities for Medicaid managed care eligible members. The Managed Care eligible Medicaid members are assigned to a MCO by the Enrollment Broker. For newly eligible Medicaid members, this occurs within 30 days after Medicaid eligibility is entered into VaMMIS. Prior to managed care plan assignment, the member is in FFS.
Q: How do I schedule Transportation?
A: Fee-for-Service Medicaid members who arrange their transportation will have to call Modivcare at 866-386-8331 between hours of 6:00 am and 8:00 pm to schedule their transportation for routine appointments covered by VA Medicaid, five business days before the day of the appointment. In certain cases, transportation can be provided with less than a 5-day notice. If member is enrolled in a MCO plan and eligible for transportation, they will contact their MCO plan for transportation arrangements.
Reservation Line:
Anthem: 1-855-325-7581
Sentara: 1-877-892-3986
United Health: 1-844-604-2078
Q: How do I update my member information?
A: To update member information, visit the CoverVa website (https://coverva.dmas.virginia.gov) and under the “Members” section on the home page, click the “Update your Information” tab. There, it will provide information/resources on how to report a change in contact information, how to create an account at Common Help, and how to apply for coverage for a family member.
Q: How do I cancel my coverage?
A: To cancel your Medicaid or Family Access to Medical Insurance Security (FAMIS) coverage, submit a request in writing to your local Department of Social Services (DSS). To find your local DSS office, please visit https://www.dss.virginia.gov/localagency/index.cgi
Q: How do I change my healthcare plan?
A: Members may stay with their same health plan and will continue to have the option to change their health plan once a year during open enrollment. To change your health care plan, please visit the enrollment website for help changing your health plan at https://www.dmas.virginia.gov. Under “Members” on the home page, click the “Cardinal Care” tab. To the right under “For Members,” click “Managed Care Programs” and then “Change Your Health Plan.” It will then direct you to the enrollment website.
You can also use the Cardinal Care App (Virginia Cardinal Care on the App Store) to change a health care plan.