Definitions and abbreviations

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Activities of daily living (ADL): Personal care tasks such as bathing, dressing, toileting, transferring, and eating or feeding. A person’s degree of dependence in doing these activities helps decide the right level of care and service needs.

Appeal: Contesting (disagreeing with) an action from DMAS or a contractor. Examples of appealable issues include denials of eligibility, whole or partial denials of approval for medical services, payment denials, and audit findings.

Asset transfer: Medicaid applicants and members must be paid back in full for any transfers of money, property or other assets.

Authorized Representative: Person given written permission to manage someone’s personal or financial affairs.

Caseworker/Worker: Eligibility worker at the local department of social services (DSS) who processes the Medicaid application and manages the case. This is the person to contact about changes to address or income, or about problems such as not receiving a Medicaid card.

Certified Application Assistor: Volunteer trained by the government that you authorize to help you apply.

Co-insurance: The part of Medicare, Medicaid or other insurance charges that the patient pays.

Co-payment or co-pay: The part of Medicaid charges that a member must pay directly to the provider for certain services or procedures.

Cover Virginia Call Center: Call 833-5CALLVA to get program information, to apply by phone for Medicaid and FAMIS, and to get translation services and referrals to CommonHelp or your local social services agency for other benefit programs.

Department of Medical Assistance Services (DMAS): The agency that runs the Virginia Medicaid program.

Department of social services (DSS): The agency that determines eligibility for medical assistance and social services. This includes local departments of social services.

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT): Preventive health care and well-child checkups, tests, and immunizations (shots) for children and youth from birth to age 21. EPSDT may cover medically necessary services needed to correct or improve defects and physical or mental illnesses found in a screening, even if they are not covered by Medicaid.

Eligibility worker: Worker at the local department of social services who reviews your application for Medicaid, FAMIS or Plan First to find out if you qualify. This is the person to contact about changes to address or income, or problems such as not receiving your Medicaid card.

Family Access to Medical Insurance Security (FAMIS): Health coverage for uninsured children from birth through age 18. The Virginia Department of Medical Assistance Services (DMAS) runs FAMIS. The state and federal government funds FAMIS.

FAMIS Select: Lets families of FAMIS-eligible children choose between coverage in FAMIS or through a private or employer-sponsored health plan. Children in FAMIS Select get health coverage through their private or employer-sponsored health plan. They show their plan ID card for payment. They do not have direct FAMIS coverage, except if needed to cover childhood immunizations (shots).

Fraud: Deliberately withholding or hiding information or lying to get or try to get Medicaid.

Generic drugs: The Food and Drug Administration (FDA) requires generic drugs to have the same quality, strength, purity and stability as brand-name drugs. Generic drugs are less expensive than brand-name drugs.

Individualized Family Service Plan (IFSP): A plan for early intervention supports and services. A team writes the IFSP, with the child's family as the most important members. A good IFSP suits each child and family’s routines, activities, strengths and needs. It reflects the family’s priorities for the child’s development. In the IFSP, the family gets information about the child’s development, outcomes and goals, supports and services, and the transition plan to support the child and family as they leave the early intervention system.

Managed care: Most Virginia Medicaid members get medical care through managed care programs in which they are assigned to a health plan. They work with their primary care provider (PCP) to coordinate their medical care, ensure access to the right providers and promote preventive care to achieve positive health outcomes.

Managed care organization (MCO): A health plan contracted with Medicaid to provide medical services and coordinate health care services through a network (group) of providers.

Medicaid: Program that provides access to health care for one in five Virginians.

Medicaid for children: The Medicaid program for children.

Medically necessary: Services needed for the diagnosis or treatment of an illness or injury.

Patient pay: Share of the cost of long-term supports and services that persons with income may have to pay.

Primary care provider (PCP): The doctor or clinic that provides most personal health care needs, gives referrals to other health care providers when needed, and monitors Medicaid member health. The PCP may be an internist, a pediatrician (children’s doctor), OB/GYN (women’s doctor), or certain clinics and health departments.

Resources (assets): Includes money on hand and in a bank or safe deposit box, stocks, bonds, certificates of deposit, trusts, pre-paid burial plans, cars, boats, life insurance policies and real property.

Smiles for Children: Virginia’s dental program for children enrolled in Medicaid, FAMIS and Medicaid for children. Dental services will be available to adults in Medicaid starting July 2021.

Social Security Administration: The federal agency that runs the Social Security program for retirement, disability and survivors' benefits.

State plan: A Medicaid and CHIP state plan is an agreement between a state and the federal government that describes how that state runs its Medicaid and CHIP programs. It assures that a state will obey federal rules. It may claim federal matching funds for its program activities. The state plan shows who is covered, services provided, ways providers will be paid and administrative activities in the state.

Supplemental Security Income (SSI): A federal program that the Social Security Administration runs. SSI pays monthly benefits to persons who are disabled, blind or age 65 or older with limited income and resources. Children and adults who are blind or disabled can get SSI benefits.

Uniform Assessment Instrument (UAI): Pre-admission screening form to evaluate an applicants’ ability to complete activities of daily living.

Virginia's Insurance Marketplace: Online marketplace of private insurance plans. You can shop for health insurance, compare private plans and find out if you qualify for  help paying for coverage.

Waiver (or Medicaid Waiver): A Medicaid Waiver lets a state drop certain Medicaid program rules. This lets the state provide care for people who might not otherwise qualify for Medicaid. The Waiver must be approved by the federal government.

Abbreviations

An abbreviation formed from the first letters of other words.

Abbreviation	Definition
ABD Medicaid	Aged, Blind, or Disabled Medicaid
ACA	Patient Protection and Affordable Care Act (also called PPACA or Obamacare)
ADLs	Activities of daily living
ARTS	Addiction and Recovery Treatment Services
ALF	Assisted Living Facility
AR	Authorized Representative
AT	Asset Transfer or Assistive Technology
CCF	Common Core Formulary
CD	Consumer-Directed
CW	Caseworker
CAA	Certified Application Assister
CMS	Centers for Medicare and Medicaid Services
CCC	Commonwealth Coordinated Care
CCC Plus	Commonwealth Coordinated Care Plus
CCC Plus Waiver	Commonwealth Coordinated Care Plus Waiver (merged the Elderly or Disabled with Consumer Direction Waiver and Technology Assisted Waiver)
DBHDS	Department of Behavioral Health and Developmental Services
DMAS	Department of Medical Assistance Services
DME	Durable Medical Equipment
DD Waivers	Developmental Disability Waiver Services: (1) Building Independence (BI); (2) Community Living (CL); and (3) Family & Individual Supports (FIS)
DSS	Department of social services (sometimes called VDSS for Virginia Department of Social Services)
EM	Environmental Modification
EPSDT	Early and Periodic Screening, Diagnosis, and Treatment
EVV	Electronic Visit Verification
FAD	Final Agency Decision
FAMIS	Family Access to Medical Insurance Security
FQHC	Federally Qualified Health Center
GA	General Assembly
HHR	Health and Human Resources
ID	Intellectual Disability
IFSP	Individualized Family Service Plan
LTSS	Long-Term Supports & Services
MAC	Member Advisory Committee
Marketplace	Virginia's Insurance Marketplace
MC	Managed care
MCO	Managed care organization
MN	Medically necessary
M4	Medallion 4.0 program
NF	Nursing facility
OAG	Office of the Attorney General
OCMO	Office of the Chief Medical Officer
OTC	Over-the-counter medication
PDL	Preferred Drug List
POA	Power of Attorney
PP	Patient pay
PCP	Primary care provider
SNF	Skilled nursing facility
SSA	Social Security Administration
SSI	Supplemental Security Income
UAI	Uniform Assessment Instrument
VDH	Virginia Department of Health