For Members

Please visit the Appeals Resources section of our website help with Appeals.

Fee-for-Service: The Department of Medical Assistance Services traditional health care payment system in which physicians and other providers receive a payment for each unit of service they provide.  Virginia Medicaid is the state and federal funded government program administered by DMAS.  Eligibility requires limited income and resources and must be in a covered group.  The local DSS offices process the applications, determine eligibility, and enroll the members into Medicaid FFS.

Managed Care: A fully capitated, mandatory Medicaid managed care program in which qualified Medicaid members choose between 5 contracted Managed Care Organizations.  The contracted MCO receives a capitated payment that covers a comprehensive set of services.  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.  MCO assignment letters are sent to members, the letter identifies the assigned MCO for the member.  The letter also provides the time frame for the Medicaid member to call the MCO helpline to change their selection.  If the Medicaid member does not call to make a change, the assignment is effective as of the begin date in the letter.  The MCO Medicaid members have until the last business day of the month before the begin date and a 90-day window from initial enrollment without cause to make a change for any reason. 

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:
Aetna: 1-800-734-0430
Anthem: 1-855 325-7581
Molina: 1-833- 273-7416
Sentara: 1-877-892-3986
United Health: 1-844-604-2078  

Please visit the CoverVA website to update your information.

You can cancel your coverage by calling CoverVA at 1-855-242-8282 (TTY: 1-888-221-1590), or by notifying your local Department of Social Services

Cardinal Care will continue to offer members the same programs and services and will not reduce or change any existing coverage. Members will continue to receive the same benefits, see the same doctors and providers, and have access to the same health care services. 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 Change Your Health Plan (virginia.gov)

Or you can use the Cardinal Care App: Virginia Cardinal Care on the App Store (apple.com)

Please visit the Provider lookup page to find a provider.

Virginia Medicaid encourages everyone to report all suspected cases of Medicaid fraud and abuse. Our website provides more information. You can report suspected fraud cases in two ways:

• Call the Fraud and Abuse Referral Hotline at 1-866-486-1971.
• Email recipientfraud@dmas.virginia.gov.

a. I never received one.

You can contact Cover Virginia at 1-833-5CALLVA. Only full benefit Medicaid and FAMIS members will receive the 1095-B tax form.

b. I need a copy.

The Commonwealth of Virginia will mail the 1095-B forms by January 31 of each year. The Commonwealth will also send this information directly to the IRS. You should keep the 1095 form with your tax records.

c. I need to make a correction.

You can contact Cover Virginia at 1-833-5CALLVA to speak with someone about making a correction.

d. The information is incorrect and I need to file a complaint.

Cover Virginia can answer questions about your Virginia 1095-B form for Medicaid and FAMIS coverage.