Virginia Medicaid
Cardinal Care connects members to the care that they need when they need it and reduces transitions between programs as their health care needs evolve. All managed care and fee-for-service Medicaid members are part of the Cardinal Care program. Effective July 1, 2025, we will be transforming the Virginia Medicaid's System to drive member-centric choices and care.
What’s new?
As of July 1, 2025, Virginia Medicaid will have 5 Managed Care Plans:
- Aetna Better Health of Virginia: Aetna Medicaid Virginia
- Anthem HealthKeepers Plus: Anthem
- NEW Humana Healthy Horizons of Virginia: Humana Healthy Horizons
- Sentara Health Plans: Sentara Health Plans
- United Healthcare of the Mid-Atlantic, Inc: UnitedHealthcare Community Plan
Medicaid Members who are currently in a Molina plan will be switched to the new Humana Healthy Horizons of Virginia plan effective July 1, 2025. FAMIS members can now make plan choices through the managed care enrollment broker. Members in foster care, former foster care or adoption assistance will receive benefits and services under the Anthem HealthKeepers Plus, the new Foster Care Specialty Plan.
What stays the same?
- Member benefits and services
- Providers are still required to enroll and periodically revalidate directly with DMAS through it's provider services solution (PRSS) portal
- Providers should check a member's eligibility before rendering any service by logging onto the Virginia Provider web portal
Key Actions for Providers and Provider Associations
Help your members by directing them to these resources for help:
- Virginia Cardinal Care Mobile App
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- www.virginiamanagedcare.com
- Managed Care Helpline at 1-800-643-2273
- (TTY 1-800-817-6608)
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- MCO provider representatives are available for specific questions.
- Providers must enroll with the State via PRSS and Contract with the Managed Care Plans individually.
Learn More
Attend a Virtual Cardinal Care Provider Education Session:
Watch a recording of the event or review a pdf of the presentation:
- Cardinal Care Provider Education Session Recording (YouTube Video)
- Cardinal Care Provider Education Session Presentation (pdf)
Submit questions to DMAS prior to the event. The Cardinal Care FAQ will also be updated with additional information based on the questions received.
Review the new Provider bulletin, "July 1, 2025 Implementation of New Cardinal Care Managed Care Contract"
New Cardinal Care ID Cards
The new Cardinal Care brand is visible on Medicaid, FAMIS and Plan First ID cards and MCO Medicaid and FAMIS ID cards. We've made available resources you can print to display in your office explaining the new Medicaid ID cards for members. Resources: Flyer or Poster.
The blue-and-white Medicaid and FAMIS ID cards, and green-and-white Plan First ID cards are still valid. Both the old and new cards enable claims processing. New Cardinal Care Plan First ID cards clearly reflect the program’s limited benefits coverage.
Checking Eligibility
There are three options to check the eligibility for a member:
- Use self-help service on the MES website. You can create an account if you don't have one by following the instructions on the page.
- Use the Virginia Medical Assistance MediCall System. (Learn how to use MediCall.) The MediCall System offers Medicaid providers 24/7 access to current member eligibility information, check status, claims status, prior authorization information, service limit information, pharmacy prescriber identification number cross reference, and information to access member eligibility and provider payment verification.
The telephone numbers are:-
- 1-800-772-9996 Toll-free throughout the United States
- 1-800-884-9730 Toll-free throughout the United States
- (804) 965-9732 Richmond and surrounding counties
- (804) 965-9733 Richmond and surrounding counties
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- For assistance with MediCall or other billing questions, call the Provider Helpline at (800) 552-8627
Health Plan Contact Information
| Aetna Better Health | https://www.aetnabetterhealth.com/virginia/providers/join-network.html Email: Aetnabetterhealth-VAProviderRelations@aetna.com |
| Anthem Healthkeepers | LTSS -VALTSSProviderEnrollment@anthem.com Providers with questions about their enrollment status should contact their assigned PR rep. Non-LTSS -https://www.anthem.com/provider/contact-us/ |
| Humana Healthy Horizons | Physical Health Providers: VirginiaProviderUpdates@humana.com Behavioral Health Providers: VA_BH_Medicaid@humana.com Home and Community-Based Services (HCBS) Providers: LTSSContracting@humana.com |
| Sentara Health Plans | Provider Network Management – 1-877-865-9075 Email: PrvRecruit@sentara.com |
| United Healthcare Community Plan | UHCprovider.comLivechatavailableatUHCprovider.com/contactus 1-844-284-0146 |
Cardinal Care Resources
- Cardinal Care Managed Care Resources, English | Spanish
- Cardinal Care Frequently Asked Questions, English | Spanish
- Sample Cardinal Care Member ID Cards, English | Spanish
- Cardinal Care Member Flyer, English | Spanish
- Cardinal Care Molina Member Flyer, English | Spanish
- Cardinal Care Foster Care Specialty Plan, Foster Care Member Flyer, English | Spanish
- Cardinal Care Foster Care Specialty Plan, Adoption Assistance Member Flyer, English |Spanish
- Cardinal Care Foster Care Specialty Plan, Former Foster Care Member Flyer, English | Spanish
Provider Resources
- Durable Medical Equipment (DME): View and download Appendix B files and access DME training.
- Medical Assistance Eligibility Manual: View and download chapters of the Eligibility Manual, which is used to determine a person's eligibility for Medicaid, Family Access to Medical Insurance Security Plan (FAMIS), children’s Medicaid and FAMIS Prenatal coverage.
- MES Provider Manuals Library is here.
- MES Memo/Bulletin Library
- MES Provider Section
- Procedure Fee Files & CPT Codes: Search CPT codes by service date, flag code or multiple CPT codes, and access other procedure fee files.
- Rate Setting: Find rate setting information for Medicaid reimbursement.
- MES Provider Training section: Training aids and videos for Providers using MES