Cardinal 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
  • • www.virginiamanagedcare.com
    • Managed Care Helpline at 1-800-643-2273
      • (TTY 1-800-817-6608)
• MCO provider representatives are available for specific questions.
• Providers must enroll with the State via PRSS and Contract with the Managed Care Plans individually.

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:

1. 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.
2. 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
3. For assistance with MediCall or other billing questions, call the Provider Helpline at (800) 552-8627