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– Partner Points Newsletter January 2023 –
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Medicaid Eligibility Renewal Process Resumes in March
The normal renewal process for all Medicaid members will resume in spring 2023, after more than two years of continuous health coverage for all enrolled Medicaid members regardless of changes in circumstances. Some Virginia Medicaid members will receive renewal information in the mail as early as March 18, 2023, with closures starting no earlier than April 30, 2023. This return to normal renewal process for all 2.1 million Medicaid members is a tremendous effort that requires your attention and assistance.
How Advocates Can Help
You can assist Medicaid members to understand the renewal process, also known as unwinding, and complete any actions required as soon as possible. Members will receive a letter in the mail with a request to complete paperwork as needed to review their Medicaid eligibility. Some Medicaid members may receive a letter stating that their eligibility is automatically renewed, and nothing further is needed.
Members should complete the following steps to prepare for this effort and minimize gaps in their coverage:
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Update their contact information – Members should update their contact information as soon as possible to ensure they receive this important paperwork by going online at http://www.commonhelp.virginia.gov, by calling Cover Virginia at 1-855-242-8282, or by visiting their local Department of Social Services Office.
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Check their mail – Members will receive a letter about their Medicaid or Children’s Health Insurance Program (CHIP) coverage. This letter will also indicate if they need to complete a renewal form to see if they still qualify for Medicaid.
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Complete the renewal form (if they get one) – Members should fill out the form and return it right away to help avoid a gap in their Medicaid health coverage.
For more information about the return to normal enrollment process, visit: https://www.coverva.org/en/phe-planning. You may also use these resources in the CoverVA Toolkits to share fact sheets and FAQs in different languages with Virginia Medicaid members.
How Providers Can Help
Virginia Medicaid providers can assist their Medicaid patients by confirming their eligibility and coverage beginning in April 2023. Visit the Virginia Medicaid Provider Manual, chapter 1, for more information on how to confirm a member’s eligibility.
If a member no longer has coverage, you can encourage them to contact Enroll Virginia at 888-392-5132 to find new coverage. Individuals and families can also sign up for coverage on the Federal Marketplace at Healthcare.gov within 60 days of losing health coverage.
For more information about the renewal process, and for materials to share with your patients, visit https://www.coverva.org/en/phe-planning.
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Cardinal Care: What this Means for Providers
On January 1, 2023, Virginia Medicaid launched the new Cardinal Care brand for all health coverage programs for its 2 million members. This rebranding combines the fee-for-service, the managed care, and the Family Access to Medical Insurance Security (FAMIS) programs into one to help strengthen the Department’s ability to provide high quality care. While some aspects of Cardinal Care are in place, other aspects will follow a phased approach with completion scheduled for July 1, 2023.
Providers and members do not need to take any action to enroll in Cardinal Care. Providers may notice some changes because of the new Cardinal Care name. Providers will use the same service authorization and billing processes for fee-for-service and managed care organizations (MCOs). Providers will also use the same web-based automated response system (ARS), the Medicall telephonic system, and the 270/271 eligibility transactions to verify member eligibility and managed care enrollment. However, the eligibility verification system will simply reflect the member’s fee-for-service or MCO enrollment and will no longer display the program names Medallion and CCC Plus. For MCO members, eligibility verification systems will also include the member’s MCO name, provider ID and phone number, and the member’s MCO enrollment dates. Sample ARS eligibility verification screen captures are available on the DMAS Cardinal Care Transition page, under presentations.
Providers can learn more about the multi-phased Cardinal Care initiative in the Cardinal Care Stakeholder Fact Sheet on the DMAS website.
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New Open Enrollment Dates for Some Members
A benefit of Cardinal Care is a simplified open enrollment schedule for the managed care programs. Beginning January 1, 2023, open enrollment for all Virginia Medicaid managed care members will follow a regional timeline based on where the member lives. Previously, the dates of open enrollment were dependent upon the member’s health coverage program. CCC Plus members and Medicaid Expansion members whose open enrollment period ended Dec 31, 2022, will be allowed to change health plans again during their regional open enrollment in 2023. The new open enrollment schedule by region for all Virginia Medicaid managed care members is as follows:
For details about the specific counties located in each region, please visit www.cccplusva.com/open-enrollment.
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