Virginia Medicaid
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Overview

The Medicaid waivers are home and community based offering supports and services to a Medicaid individual, both children and adults. The waiver services will differ based on individual need and program criteria met.


In-Person Provider Visits

During the state public health emergency, personal care agencies and service facilitators had the choice to check on Medicaid members by telephone or other virtual tools. The state public health emergency has now ended, and your provider will start making in-person visits again.

These in-person visits are important because your provider can make sure that you have all of the support you need and that you are safe in your home. Providers are required to visit our Medicaid members every 90 days.

We understand that some members may have questions or concerns about the return to in-person visits because of COVID-19. We encourage providers to talk with members and come up with a plan for visits that works for everyone. Here are some tips to help you with those plans:

Before the visit:

Get your vaccine. Vaccines are the best way to be safe and prevent illness from COVID. You can get your free vaccine by calling 1-(877) 829-4682.

Make sure you and your provider review this list and answer “no” to all of the questions:

Have you had any of these health concerns in the last 48 hours?

  • Fever or chills
  • Cough
  • Shortness of breath or trouble breathing
  • Fatigue or tiredness
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
  • Have you tested positive for COVID-19 in the past 10 days?
  • Are you waiting for results from a COVID-19 test right now?
  • In the past 10 days, has a doctor, nurse, pharmacist, or other health care provider told you that you have COVID-19 or might have COVID-19?

During the visit:

You and your provider should wear masks and social distance. Washing your hands is also important. If possible, meet in a room with good air flow or even outside if you can. 

State leaders are closely following COVID trends. Virginia Medicaid will let you know if there are any changes affecting how you receive health services. If you have additional questions, please contact: cccpluswaiver@dmas.virginia.gov.


Update on HCBS Rate Increases

The Virginia Department of Medical Assistance Services (DMAS) values the important work of home and community-based care providers, including providers of services for physical and behavioral health needs. We understand the challenges they have faced over the past year as they continue to ensure our members have access to critical services during the COVID-19 pandemic. The budget passed during the August 2021 special session includes a 12.5% increase for community based service providers starting July 1, 2021. DMAS is currently assessing impacts across a variety of HCBS services and will issue guidance as soon as possible.


Public Comments on American Rescue Plan Act Funding for Home and Community-Based Services

The Virginia Medicaid agency requested public comments on how to invest federal funding through the American Rescue Plan Act into home and community-based services. We received 165 comments from June 11th until June 30th. Read a summary of the feedback from stakeholders.

Announcements

  • Attention Fee for Service (FFS) Medicaid Members: For Client Services Information on the DMAS website, including the Medicaid Works program, Medicaid Handbook, Appeals, and Transportation, feel free to access this link at: For Applicants
    If you are in a Medicaid Managed Care Health Plan, refer to your health plan materials.
  • Updated EM/AT and PERS Provider Lists - August 11, 2021 - See posted at the bottom of this Waiver website screen. Both lists are Fee for Service (FFS) provider lists only.
  • E-MAIL IN BOX - For Consumer Directed Services Questions related to time sheets and service authorizations for fee for service CCC Plus waiver members, submit your question to: cdsf@dmas.virginia.gov
  • E-MAIL IN BOX - For CCC Plus Waiver Questions related to program criteria and clarification of policy for fee for service members, submit your question to: cccpluswaiver@dmas.virginia.gov
    NOTE: For CCC Plus Waiver members participating in a managed care health plan, submit your question to: cccplus@dmas.virginia.gov

Consumer-Directed Care Services (CD)

Consumer-directed (CD) care is services provided when the consumer chooses to hire, train, and supervise their own personal care attendant. The Services Facilitator assists the waiver individual and their family/primary caregiver with the responsibilities of CD as they become the employer of record for the CD attendant. Agency-directed (AD) care is services provided by a personal care agency which offers personal care aides. The care needs may include the individual’s activities of daily living (such as bathing, dressing, toileting, feeding, and mobility needs) and may also include light housekeeping, meal preparation and laundry.


Notes

  • For waiver members participating in the CCC Plus Health Plans (except Magellan Complete Care), the F/EA remains Public Partnerships LLC (PPL) at: http://www.publicpartnerships.com/. For Magellan Complete Care waiver members, they will use the F/EA named ACES$ Financial Management Services - refer to: https://www.mycil.org/acess-virginia.html.
  • Effective January 1, 2019, the Consumer Direct Care Network (CDCN) will be the new Fiscal Employer Agent for Fee for Service CCC Plus Waiver members who opt for consumer directed attendant services. Visit the CDCN website at: http://www.consumerdirectva.com/
  • For waiver individuals in Aetna Health Plan, please contact your Aetna Care Coordinator for information on your FE/A.
  • Effective July 01, 2019, VA Premier Health Plan has changed their FE/A from PPL to CDCN. Please contact your VA Premier Care Coordinator for information on your FE/A.

Overview - Developmental Disability Waivers (DD)

Currently, the following are the Developmental Disabilities (DD) waivers available: Building Independence (BI) Waiver, Family and Individual Support (FIS) Waiver and the Community Living (CL) Waiver

The DD waivers are offered to both children and adults with various levels of intellectual and/or developmental disabilities. There are a multitude of services and supports offered under each waiver, depending on individualized needs and program criteria met.





Commonwealth Coordinated Care Plus Waiver (CCC Plus)

The CCC Plus Waiver (also known as the Commonwealth Coordinated Care Plus Waiver), is a combination of the formerly known waivers titled: EDCD (Elderly or Disabled with Consumer Direction) waiver and the Technology Assisted (Tech) waiver. All of the waivers offer CD or AD services depending on individualized needs and program criteria met.