Health plans

Members are first enrolled in fee-for-service for a short time until they are enrolled in one of the six health plans.

Most Medicaid and FAMIS members get care through a health plan. Each health plan has a network (group) of primary care providers (PCPs), specialists, hospitals, and other health care providers.

These are the health plans Medicaid and FAMIS members can choose:

• Aetna Better Health of Virginia
• Anthem HealthKeepers Plus
• Molina Complete Care of Virginia
• OptimaHealth Family Care
• UnitedHealthcare Community Plan
• Virginia Premier

Some people do not have to join a health plan. Read the list of [PDF] exclusions.

Choosing a health plan

Medicaid members

Members enrolled in Medicaid will get a letter asking them to choose a health plan. This “pre-assignment letter” will also list the health plan they will be enrolled in if they do not choose a health plan by the deadline. Members have 90 days from the date on the letter to choose their health plan.

All family members do not need to have the same health plan. To change your health plan, search for doctors, check your enrollment and more, go to the Medicaid Managed Care website.

To change your health plan online, select “Enroll” and then “Get Started.” If you want to change health plans by phone, call the Managed Care Helpline, Monday through Friday from 8:30 a.m. to 6 p.m. at 1-800-643-2273 (TDD 1-800-817-6608). Interpreter services are available. The Helpline can:

• Answer questions about health plans
• Find out if your doctor is in the health plan you want
• Help you choose the health plan that is right for you

For Medicaid members age 21 and older, there may be co-pays for some services. Read the Medicaid Member Handbook to learn more:

• [PDF] Medicaid Handbook (English)
• [PDF] Manual de Medicaid (Spanish)
  
  
  

FAMIS or FAMIS MOMS members

FAMIS or FAMIS MOMS members can choose their health plan when they apply. If they did not choose a plan when they applied, they can join a plan by calling Cover Virginia at 833-5CALLVA. If they do not choose a plan, one will be chosen for them.

Read about FAMIS health plan choices and covered services:

• [PDF] FAMIS MCO Choices and Covered Services (English)
• [PDF] FAMIS MCO Choices and Covered Services (Spanish)
  

Commonwealth Coordinated Care Plus members

Commonwealth Coordinated Care Plus (CCC Plus) members can learn more at cccplusva.com.

For help choosing a health plan, call the CCC Plus Helpline, Monday through Friday, 8 a.m. to 6 p.m. at 1-844-374-9159 (TTY: 1-800-817-6608).

Your Medicaid and FAMIS ID cards

Once you or your child are enrolled in Medicaid or FAMIS, you will get a Commonwealth of Virginia health insurance card from the Department of Medical Assistance Services (DMAS). Each enrolled person in your household will get a card.

If you need a replacement Medicaid ID card, call Cover Virginia at 833-5CALLVA to order a new one. You can also contact your local Department of Social Services (DSS). 

Members who are in a health plan will also get an ID card from the plan.

You must:

• Make sure the provider accepts Medicaid or FAMIS insurance and accepts your health plan, if you are in one
• Show your cards to the provider each time you get medical, dental, or other covered services
• Pay any required co-pays

If you need a replacement health plan card, call the Managed Care Organization (MCO) Helpline at 1-800-643-2273. Or contact your health plan to ask for a new card.

[PDF] DMAS ID Card

[PDF] FAMIS MCO ID Card

[PDF] Medicaid MCO ID Cards

Fee-for-service

When you are first enrolled in Medicaid or FAMIS, FAMIS MOMS, or Medicaid for children, you will get health care through fee-for-service. This means you can see any provider in the Medicaid or FAMIS fee-for-service network for covered services. Before you make an appointment or fill a prescription, ask the doctor, clinic, hospital, dentist, pharmacy, or mental health provider if they accept Medicaid or FAMIS fee-for-service. There are no co-pays for FAMIS members in fee-for-service.

For help finding a provider who accepts fee-for-service Medicaid or FAMIS, use the Department of Medical Assistance provider search.

After a short time, most Medicaid and FAMIS members will join a health plan. Some will stay in fee-for-service. All Plan First members will stay in fee-for-service. Some services are through fee-for-service even for members who are in health plans.

To learn about covered services provided to health plan members through fee-for-service, read your health plan’s member handbook and your Medicaid or FAMIS program handbook.