This Week's Highlights
- How Cardinal Care is transforming Virginia's Medicaid system
- What's happening around the Commonwealth
- And more...
 If you are using a screen reader, the text of this flyer can be found here: Cardinal Care Managed Care Announcement Flyer (text)
How Does the Transition to Humana Work?
For members:
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Molina members will be enrolled in Humana Healthy Horizons of Virginia with an effective date of July 1, 2025 and will have 90 days from that effective date to make a change.
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After this period, members will have to wait until their next Managed Care Open Enrollment Period to change health plans.
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Existing service authorizations will be honored for a minimum of 30 days.
For providers:
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Medical providers should begin contracting with Humana now to provide services to Medicaid members and to avoid a disruption in services for their Molina members.
- No action is required for dental providers, as dental contracting will continue through DentaQuest.
- In order to be a Medicaid provider in an MCO's network, providers must
- Enroll through PRSS
- Contact the MCO(s) you wish to participate in to ensure each MCO’s requirements are satisfied.
Provider Readiness for Cardinal Care Managed Care (CCMC)
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Providers should begin contracting with Humana now to provide services to Medicaid members and to avoid a disruption in services for their Molina members.
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Check eligibility before you render any service: Member eligibility can be checked in a number of ways:
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Enroll and Periodically Revalidate directly through DMAS PRSS Portal:
- The 21st Century Cures Act requires all providers to enroll and periodically revalidate directly with DMAS through PRSS. Learn more about revalidation
10 Top Goals of Cardinal Care
Ensure Virginians covered by Medicaid have appropriate access to quality health care in every community.
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Focus on behavioral health services and outcomes for members through integrated health care targeting prevention, treatment, crisis, and recovery as part of the Right Help. Right Now. initiative.
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Enhance maternal and child health outcomes through strategic initiatives that increase member engagement and provide appropriate and timely access to services across geographic regions and for all populations.
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Strengthen provider access, adequacy, and availability through streamlined administrative and payment processes, training, and monitoring.
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Support members with high risk factors through case management and other resources to support health-related social needs in the community.
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Provide support to children and youth in foster care with a dedicated health plan and services to meet their medical and behavioral health needs.
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Improve access to appropriate services and supports for members receiving LTSS to enable them to live in the setting of their choice and promote their wellbeing and quality of life.
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Drive innovation and operational excellence with a focus on value-based payment arrangements and improved outcomes.
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Increase Virginia’s financial protections through quality driven withholds and tighter limits on MCO profits.
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Expand the use of data analytics, compliance monitoring and oversight for increased accountability.
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Stay Connected with Us
Virginia Medicaid employees are passionate about serving our Members, Providers, and Advocacy Groups daily.
This week's DMAS Employee Highlight is Bryan!
Bryan is a TPL Manager who has been working at DMAS since 2019.
What Bryan loves most about working at DMAS is the people he works with, who he describes as "positive, up-beat, and always willing to chip in and assist."
"Working at DMAS means 'impact' to me. Working at the agency allows me to have access to the levers that can change the way our safety net system works and improve the health and overall well-being of the members that we serve."
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What's Happening Around the Commonwealth
Governor Youngkin marks the start of 2025 hurricane season, urges preparedness
June 1st marks the start of the Atlantic hurricane season, and Governor Glenn Youngkin urges residents and businesses across the Commonwealth to take the necessary steps to prepare now.
To ensure that the Virginia Emergency Support Team is prepared to respond and coordinate resources should we see impacts from storms, government agencies, first responders, community organizations, and private sector partners continue regular training and collaboration to ensure a coordinated effort.
Below are a few critical steps to ensure you and your patients' safety:
Check your insurance coverage. Now is the time to review your insurance coverage and contact your insurance agent for any changes. If you are not insured against floods, talk to your insurance agent, shop for private flood insurance, or visit floodsmart.gov.
Know your zone. An evacuation may become necessary depending on the track and severity of the storm. Review Virginia’s evacuation zones at KnowYourZoneVA.org. Users can enter their physical address in the search bar of the website to view and confirm their designated evacuation zone.
Complete a family communication plan. Prepare for how you will assemble and communicate with your family and loved ones. Identify meeting locations and anticipate where you will go. The Federal Emergency Management Agency guidance on family communications plans is available here.
Make an emergency kit. Assemble an emergency kit that includes nonperishable food, water, medication, sanitary supplies, radios, extra batteries, and important documents. Learn more about building an emergency supply kit here.
Stay informed. Identify where to go for trusted sources of information during emergencies. Check with your local emergency management office to sign up for alerts that go directly to your phone or email. Be sure to monitor local news for watches and warnings in your area and follow the directions of local officials.
Learn more about preparing your family and your property against hurricane threats (and other disasters) by visiting the link below.
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