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Medicaid Expansion

Medicaid Expansion

About Medicaid Expansion

Virginia has changed its rules for Medicaid coverage, and thousands of adults across the state will be able to get quality, low-cost healthcare coverage. This may include those who have applied for Medicaid in the past but were denied. Under the new rules for Medicaid Expansion, you may now qualify if you did not before.

As of January 1, 2019 if you are a Virginia resident aged 19-64 and meet new income qualifications, you will be able to get the healthcare you need when you need it.

Benefits and Services

Members joining through Medicaid Expansion come to the program from many different health plans/insurance companies and state programs:

  • If you have been on a Medicaid plan before, you’ll get four more benefits with Medicaid Expansion:
    • Annual wellness exams
    • Vaccines or immunizations
    • Individual and group smoking cessation counseling
    • Nutritional counseling for individuals with obesity or chronic medical diseases
  • If you had other insurance, you may have already had these benefits.

When you sign up with Magellan Complete Care of Virginia (MCC of VA), we’ll work with you to explain any benefits you have questions about. And we’ll help you get the care and services you need.

Extra benefits

When you get Medicaid Expansion with MCC of VA, you get all of the extra benefits we offer for the Commonwealth Coordinated Care Plus (CCC Plus) or Medallion 4.0 programs.

Some of these benefits include:

  • Adult dental services
  • Adult vision services
  • CLICKOTINE™ program to quit smoking
  • Online therapy programs to help with emotional challenges
  • No-cost standard over-the-counter products with a doctor’s prescription
  • Smart phone with 1,000 free minutes and 1GB of data each month
  • And much more.

See our list of extra benefits for CCC Plus and for Medallion 4.0.

How do I find out if I’m eligible?

To qualify, you will need to:

  • Have an annual income of no more than $17,237 for an individual, or $29,436 for an adult in a household of three.
  • Not be currently enrolled in Medicare.

To find out if you qualify, visit the Medicaid Expansion page at CoverVA.org. There, you can answer the questions in the Eligibility Screening Tool to find out if you may be eligible. 

How will I know which state program I qualify for?

If you have had Medicaid benefits previously, The Department of Medical Assistance Services (DMAS) will use your medical history to decide whether you are medically complex. This means that you need extra help with your healthcare needs.

If you are signing up for Medicaid for the first time, you will fill out a health screening on your application that provides us with information about your medical background. If, on that screening, you say that you are medically complex, you will be enrolled in CCC Plus. If you tell us you are not medically complex, you will be enrolled in Medallion 4.0. We will assign you to the appropriate program based on what you tell us your needs are.

If you join MCC of VA through Medicaid Expansion, we may will contact you or your authorized representative to ask some questions about your health needs and social circumstances. This will happen within the first 120 days you are a member of MCC of VA. This will provide a few additional pieces of information to help us determine what kind of care you need.

How will I know which health plan I’m enrolled in?

DMAS will assign you to a health plan (also known as a Managed Care Organization (MCO). You will get a letter in the mail that tells you the name of your health plan. If you’ve been put in a different health plan and would like to enroll with MCC of VA, use the Cover Virginia Call Center at 1-855-242-8282 (TDD 1-888-221-1590), Monday-Friday, 8:00 a.m. – 7:00 p.m. and Saturday from 9:00 a.m. to noon. Or change your health plan online at CoverVA.org. You have the right to enroll with the plan of your choice.

After you’ve signed up with us, we’ll send you your ID card and other information to welcome you to our plan. We look forward to having you as a member!

Doctors and Medications

With MCC of VA, can I see the same doctor(s) I’m seeing now?

If your doctor is not in our network, you can keep seeing him or her for the first 30 days. You can also keep getting your approved services during this time or for 30 days after you first enroll. We will work to add your doctor into our network. If he or she hasn’t joined our network after your first 30 days in our plan, we will help you find another doctor in our network who meets your needs.

Which doctors and pharmacies are in the MCC of VA network?

We work with a large network of doctors and pharmacies across Virginia. Use our online search tool to find doctors and pharmacies that fit your needs. You can also call us at 1-800-424-4524 (TTY 711) for CCC Plus, or 1-800-424-4518 (TTY 711) for Medallion 4.0. If your doctor or pharmacy is not in our network, give us a call. We’ll reach out to them to join.

How can I find out if my medication is covered?

Look up your medication on our list of covered drugs. You can also read the list of over-the-counter medications. Or, call us at 1-800-424-4524 (TTY 711) for CCC Plus, or 1-800-424-4518 (TTY 711) for Medallion 4.0.

Apply today!

There are several ways you can apply for Medicaid Expansion:

  • Call the Cover Virginia Call Center at 1-855-242-8282 (TDD 1-888-221-1590) to apply on the phone Monday - Friday from 8:00 a.m. to 7:00 p.m. and Saturday from 9:00 a.m. to noon.
  • Complete an online application at Common Help: commonhelp.virginia.gov.
  • Complete an online application at The Health Insurance Marketplace: healthcare.gov.
  • Mail or drop off a paper application to your local Department of Social Services (mailing may take longer than other methods of applying). Find your nearest local Department of Social Services by visiting dss.virginia.gov/localagency.
  • Call the Virginia Department of Social Services Enterprise Call Center at 1-855-635-4370 (if you also want to apply for other benefits).

After applying, members will get a letter with a program assignment and information about how to choose a health plan.

  • To enroll in CCC Plus, visit cccplusva.com/enroll or call the CCC Plus Enrollment Helpline at 1-844-374-9159 (TTY 1-800-817-6608). This number is available Monday-Friday, 8:30 a.m. - 6 p.m.
  • To enroll in Medallion 4.0, visit VirginiaManagedCare.com or call the Medallion 4.0 Enrollment Helpline at 1-800-643-2273 (TTY 1-800-817-6608). This number is available Monday-Friday, 8:30 a.m. – 6 p.m.

Resources

Medicaid Expansion Member FAQ / (Spanish)

 

 

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