Virginia Medicaid &
FAMIS Plus

Medicaid in Virginia*

"Medicaid and FAMIS Plus (Medicaid coverage for children) are programs that help pay for medical care. To be eligible for Medicaid or FAMIS Plus you must have limited income and resources (things that you or someone in your household own) and you must be in one of the groups of people covered by Medicaid. Some groups covered by Medicaid are: pregnant women, children, parents who have children under age 18 in the home, people with disabilities, and people age 65 and older. Each group has its own eligibility rules but all people within the same group are treated the same. Medicaid is not designed to help everyone with every medical expense. "
*source: Virginia Department Of Medical Assistance Services , Richmond, Virginia 23219

Children's Medicaid in Virginia

• brochure:
  Division of Benefit Programs
  
  source:Virginia Department of Social Services
  languages: English
  from the brochure:
  "...This pamphlet addresses the Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Medical Assistance Programs and Energy Assistance Program...."
  • also from Virginia Department of Social Services:
    form:
    About Virginia's Medical Assistance Programs
    languages: English
    
    from the form:
    "There are several Medical Assistance Programs offered in Virginia. Each program covers different groups of people and each program has different eligibility requirements. When you apply for Medical Assistance, you are screened for all possible programs based on your age, income, financial resources, and other information...."

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• web page:
  MEDICAID | Virginia
  
  source:healthinsuranceinfo.net - Georgetown University's Health Policy Institute
  languages: English
  from the webpage:
  "...Income eligibility levels for these categories are described below. Your assets and some expenses also may be taken into account, so you should contact the Virginia Department of Medical Assistance Services for more information..."
• web page:
  Key Medicaid Information for Virginia for 2010
  
  source:Elder Law Answers
  languages: English
  Explains important basics about Virginia Medicaid. Topics include protections for the community spouse, transfers, income, and estate recovery...

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• web page:
  Virginia Medicaid
  
  source:GovBenefits.gov - Your Benefits Connection
  languages: English
  from the web page:
  " In order to qualify for this benefit program, you must be a resident of the state of Virginia, a US national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, blind, have a disability or a family member in your household with a disability, or be 65 years of age or older..."

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• web page:
  Virginia & United States State Medicaid Fact Sheets
  
  source:Kaiser Family Foundation
  languages: English
  
  

• brochure:
  Frequently Asked Questions About Eligibility & the Application Process
  
  source:Virginia Department of Social Services
  languages: English
  from the brochure:
  Can I qualify for a Medical Assistance program...

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• web page:
  2011 HHS Poverty Guidelines
  
  source: Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
  languages: English
  from the web page:
  "...The poverty thresholds are the original version of the federal poverty measure... The poverty guidelines are the other version of the federal poverty measure.
  

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• web page:
  Medicaid Eligibility
  
  source: Centers for Medicare & Medicaid Services
  languages: English
  Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.

• brochure:
  Proof of U.S. Citizenship and Identity for Medicaid (2007)
  
  source:Virginia Department of Social Services
  languages: English
  from the brochure:
  "...Effective July 1, 2006, individuals who declare on a Medicaid application that they are United States citizens must provide proof of citizenship and identity. Individuals who are already enrolled in Medicaid must provide this documentation at the time of their next Medicaid renewal...."

• web page:
  Medicaid Forms/Applications
  
  source:Virginia Department of Social Services
  languages: English
  from the web page:
  
  • web page:
    ON LINE Application for Adult Medical Assistance
    languages: English
    
    from the web page:
    "This is an application for Medical Assistance services for adults age 19 years or older who are blind or disabled, as well as for adults who are 65 or older..."
  • form:
    APPLICATION FOR BENEFITS
    languages: English
    
    from the form:
    "With this application, you can apply for one or more of the following assistance programs. Refer to the fold-out page for instructions...."

• web page:
  Local Departments of Social Services
  
  source:Virginia Department of Social Services
  languages: English
  from the web page:
  local department of social services listings by county...

• web page:
  What is Virginia Medicaid Managed Care?
  
  source:Virginia Medicaid Managed Care, Department of Medical Assistance Services
  languages: English
  "...Virginia Medicaid Managed Care is a state program that helps people who have Medicaid get the health care services they need..."
  • also from Virginia Medicaid Managed Care:
    web page:
    Changing Managed Care Health Plans or Doctors
    languages: English
    
    from the web page:
    "...After you enroll, you can change your MCO or your MEDALLION PCP within the first 90 days...."
     

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• web page:
  Virginia Medicaid, FAMIS and FAMIS Plus Managed Care Programs. How you can enroll
  
  source:Anthem Insurance Companies
  languages: English
  "...Applying for FAMIS, FAMIS Plus and FAMIS MOMS is quick and easy. Just call toll-free 1-866-87FAMIS (1-866-873-2647). Interpreters are available. Our representatives will connect you with someone who speaks your preferred language..."

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• web page:
  Health Plan Information
  
  source:Family Access to Medical Insurance Security - FAMIS (Commonwealth of Virginia)
  languages: English
  "...FAMIS offers health benefits through two delivery systems, managed care organizations (MCO) and fee-for-service (FFS). Look at the Health Plan Listing by Locality to determine which program is available in your area..."
  • also from Family Access to Medical Insurance Security - FAMIS:
    brochure:
    FAMIS MCO Comparison Chart - An MCO is a Managed Care Organization (health plan)
    2 pages; languages: English
    
    from the brochure:
    "...This chart is provided to help you choose an MCO in your area. It contains information about the MCOs, the areas they serve and the hospitals they cover. If you do not choose an MCO, one will be selected for you. If there is no MCO available in your area, you will be covered through the FAMIS Fee-For-Service network...."
     
  • brochure:
    FAMIS Health Plan Listing
    languages: English
    "...Look at the Health Plan Listing by Locality to determine which program is available in your area..."

• web page:
  SEARCH SERVICES
  
  source:Department Of Medical Assistance Services
  languages: English, Spanish
  from the web page: "Search to locate Health Care Providers ...."
  notes: this page links to directories for Health Care Providers. Disclaimers: Call the Provider first to see if they are accepting new patients. (link to search application was broken on 11/10/2010)
  

• web page:
  General Information
  
  source:Family Access to Medical Insurance Security - FAMIS (Commonwealth of Virginia)
  languages: English
  from the web page:
  "FAMIS is Virginia's health insurance program for children. It makes health care affordable for children of eligible families. FAMIS covers all the medical care growing children need to avoid getting sick, plus the medical care that will help them get better if they do get sick or get hurt..."
  • also from Family Access to Medical Insurance Security - FAMIS (Commonwealth of Virginia):
    brochure:
    Family Access to Medical Insurance Security Plan (FAMIS) MEMBER HANDBOOK
    16 pages; languages: English
    from the brochure:
    "Welcome to Family Access to Medical Insurance Security (FAMIS). This is a comprehensive health insurance program for Virginia’s children. FAMIS is administered by the Virginia Department of Medical Assistance Services (DMAS) and is funded by the state and federal government. You should read this handbook from the beginning to the end...."

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• brochure:
  Medicaid and FAMIS Plus Covered Services
  
  source:Virginia Department of Medical Assistance Services
  11 pages; languages: English
  from the brochure:
  "...ATTACHMENT II - SUMMARY OF COVERED MEDALLION II and MEDICAID/FAMIS PLUS SERVICES This attachment is not intended to be a comprehensive list of benefits. All benefit limits should be verified through the appropriate DMAS Provider Manual..."
  • brochure:
    Children’s Mental Health Program Fact Sheet
    2 pages; languages: English
    from the brochure:
    "In December 2006, the Department of Medical Assistance Services (DMAS) applied for and was later awarded a demonstration grant to design a program that will allow states to offer home and community-based services for children who reside in a Psychiatric Residential Treatment Facility (PRTF)..."
     

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• brochure or publication:
  Virginia MEDICAID FACTS
  
  source:AMERICAN ACADEMY OF PEDIATRICS
  languages: English
  from the web page:
  "Twenty-three percent of Virginia’s children are enrolled in Medicaid.... It costs Virginia just $1,666 per year, on average, for each Medicaid-eligible child compared to the average costs per adult Medicaid enrollee of $7,265....."

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• web page:
  Virginia Family Access to Medical Insurance Security (FAMIS)
  
  source:GovBenefits.gov - Your Benefits Connection
  languages: English
  from the webpage:
  "...FAMIS covers all the medical services growing children need to avoid getting sick, plus the services that will help them make a speedy recovery if they do become ill or get hurt. Services covered by FAMIS include: Doctor visits, Well-baby checkups, Hospital visits, Vaccinations, Prescription medicine, Tests and x-rays, Dental care, Emergency care, Vision care and Mental Health benefits..."

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• bublication / brochure:
  Children’s Health Coverage Virginia
  
  source:Children's Defense Fund
  languages: English
  from the web page:

  "Applying for health insurance in Virginia... Virginia’s FAMIS program provides free and low-cost health care to children. If you are a family of four with income of $... or less, your child may be eligible. If you are a family of four with income of $... or less, your child may be eligible for FAMIS Plus (Medicaid)...."

  • also from Children's Defense Fund:
    brochure:
    Health Coverage for All Children: Virginia
    2 pages; languages: English
    from the brochure:
    "Health Coverage for Virginia’s Children..."
     

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• Medicaid brochure:
  Virginia Public Health Insurance for Children
  
  source:National Center for Children in Poverty (NCCP)
  languages: English, Spanish
  from the brochure:
  "...The two major federal funding sources for low-income children’s public health insurance are Medicaid and the State Children’s Health Insurance Program (SCHIP). States enjoy some flexibility in their Medicaid programs for children,..."
  • also from National Center for Children in Poverty (NCCP):
    web page:
    Virginia Public Health Insurance for Parents
    languages: English
    from the web page:
    "Most family plans are funded through Medicaid, but a handful of states have waivers to use State Children’s Health Insurance Program (SCHIP) funds to cover parents. ..."
     
  • web page:
    Virginia Demographics of Low-Income Children
    languages: English
    from the web page:
    "Research suggests that, on average, families need an income of about twice the federal poverty level to meet their most basic needs. Children living in families with incomes below this level—$40,000 for a family of four in 2006—are referred to as low income..."
     

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• web page:
  Virginia Medicaid, SCHIP, & Federal Authority
  
  source:State Coverage Initiatives
  languages: English
  from the web page:
  " In June 2005, Virginia received approval from the Centers for Medicare and Medicaid Services (CMS) for a demonstration waiver entitled FAMIS MOMS and FAMIS Select. The waiver allows the state to claim Title XXI funding for pregnant women with incomes ..."

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• web page:
  Virginia: CHIP Program Name and Type
  
  source:Kaiser Family Foundation statehealthfacts.org
  languages: English, Spanish
  from the web page:
  "Individual state profiles..."

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• web page:
  What services are offered under Medicaid?
  
  source:Fairfax County Department of Family Services
  languages: English
  from the web page:
  "If you are eligible for full Medicaid coverage, the following services are typically provided: •Payment of your Medicare premium •Inpatient hospital care •Outpatient hospital care ..."

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• web page:
  Medicaid has three levels of benefits:
  
  source:Virginia Health Information
  languages: English
  from the web page:
  "Full coverage... Time-limited coverage... Medicare-related coverage – Provides Medicaid payment of Medicare premiums; may also include payment of Medicare’s deductible and coinsurance, up to Medicaid’s maximum payments. .."

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• web page:
  Benefits by State: Virginia (October 2008)
  
  source:Medicaid Benefits: Online Database, Kaiser Family Foundation
  languages: English
  from the web page:
  "Acute Care Services ... Practitioner Services ... Prescription Drugs... Physical Therapy and Other Services... Products and Devices... Transportation Services... Other Services..."

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• brochure or publication:
  Women and Medicaid in Virginia
  
  source:National Women's Law Center
  3 pages; languages: English, Spanish
  from the brochure or publication:
  "Tens of thousands of women in Virginia receive health care coverage through Medicaid..."
  

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• brochure or publication:
  Mental Health and Substance Abuse Services in Medicaid and SCHIP in Virginia (2003)
  
  source: US Dep't of Health and Human Services, Substance Abuse and Mental Health Services Administration
  file size: 7 pg.; languages: English
  from the brochure:
  "As of July 2003, 572,898 people were covered under Virginia’s Medicaid and SCHIP programs. There were 540,766 enrolled in the Medicaid program (including 20,749 in the SCHIP Medicaid expansion program), and 32,132 in the separate SCHIP program. In state fiscal year 2002, Virginia spent $3.96 billion to provide Medicaid services..."
  

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• web page:
  FAMIS MOMS
  
  source:Family Access to Medical Insurance Security - FAMIS (Commonwealth of Virginia)
  languages: English
  from the web page:
  "The FAMIS MOMS program provides health care coverage for pregnant women. Good health care during pregnancy is important for you and the baby. FAMIS MOMS encourages pregnant women to get early and regular prenatal care to increase the likelihood for a healthy birth outcome..."
  • also from Family Access to Medical Insurance Security - FAMIS (Commonwealth of Virginia):
    brochure:
    FAMIS MOMS Member Handbook
    languages: English
    from the brochure:
    "make sure you get the prenatal and postpartum care that is important for you and your baby. It also provides information about how to get your baby covered by FAMIS after the birth so that your infant will receive the medical care he or she...."
    Spanish Version: MANUAL DEL AFILIADO  

• brochure:
  Virginia Medicaid Preferred Drug List (2009)
  
  source:Virginia Department of Medical Assistance Services
  4 pages; languages: English
  from the brochure:
  "Not all medications listed are covered by all DMAS programs. Check individual program coverage. For program drug coverage information, visit..."

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• web page:
  Medicare, Medicaid and Prescription Drug Assistance
  
  source:Senior Services of Southeastern Virginia
  languages: English
  from the web page:
  "Individuals who have Medicare, Medicaid or medical claims questions can call one of our volunteer Insurance Counselors for advice on everything from filing a claim, to comparing and understanding their coverage choices, to researching basic Medicaid information..."

• web page:
  Smiles For Children Dental Program
  
  source:Virginia Department of Medical Assistance Services
  languages: English
  from the web page:
  "...provides coverage for diagnostic, preventive, restorative/surgical procedures, as well as orthodontia services for Medicaid, FAMIS and FAMIS Plus children. The program also provides coverage for limited medically necessary oral surgery services for adults (age 21 and older)..."
  • also from Virginia Department of Medical Assistance Services:
    brochure:
    Dental Benefits for Medicaid Adults
    1 page; languages: English
    
    from the brochure:
    "Dental treatment for adults is covered under certain circumstances through Virginia’s dental program, Smiles For Children. Adult dental services are limited to medically necessary oral surgery and associated diagnostic services, such as X-rays..."
     

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• web page:
  Find an Oral Health Provider: Virginia Dental Providers
  
  source:InsureKidsNow.gov
  languages: English
  

• brochure:
  Virginia Health Care Options Matrix™ Guide
  
  source:Foundation for Health Coverage Education
  2 pages; languages: English, Spanish
  from the brochure: "...hand-held guide available that outlines your state’s (Virginia) public and private health care choices for individuals and groups in almost every demographic profile, as well as offers a reference list of phone numbers and Web sites..."

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• brochure:
  Consumer Guide for Getting and Keeping Health Insurance in Virginia.
  
  source:Georgetown University Health Policy Institute
  file size: 41 pg.; languages: English
  from the brochure:
  "...As a Virginia resident, you have rights under federal and state law that will protect you when you seek to buy, keep, or switch your health insurance, even if you have a serious health condition... This guide describes your protections as a Virginia resident...."

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• brochure:
  Virginia Health Center Fact Sheet
  
  source: National Association of Community Health Centers (NACHC)
  languages: English
  from the brochure:"Community, Migrant, and Homeless Health Centers are non-profit, community-directed providers that remove common barriers to care by serving communities who otherwise confront financial, geographic, language, cultural and other barriers."
  • also from National Association of Community Health Centers (NACHC):
    web page:
    Find a Health Center
    languages: English
    from the web page:
    "If you need affordable health care, a Community Health Center may be what you're looking for... Click here to find the health center closest to your address or to see a list of health centers in your state or county/parish..."

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• web page:
  Search for Health Centers by State or County
  
  source:U.S. Department of Health & Human Services
  languages: English
  from the brochure:

  "Federally-funded health centers care for you, even if you have no health insurance. You pay what you can afford, based on your income. Health centers provide •checkups when you're well •treatment when you're sick •complete care when you're pregnant •immunizations and checkups for your children •dental care and prescription drugs for your family •mental health and substance abuse care if you need it..."

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• web page:
  Pre-Existing Condition Insurance Plan: Virginia
  
  source:Patient Advocate Foundation's Virginia Cares Uninsured Program
  languages: English
  from the web site: "...On July 1, eligible residents of Virginia will be able to apply for coverage through the state's Pre-Existing Condition Insurance Plan program run by the U.S. Department of Health and Human Services..."
  

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• from the The Virginia Long Term Care Care Project:
  • Virginia Medicare Medicaid Nursing Homes Directory
    languages: English
    from the web page:
    "These are Virginia Nursing Homes in cities A - Z." In addition to the state directory described above, there are nursing home directories for principal Virginia cities. A few examples:
    
    • Richmond VA Nursing Homes
    • Roanoke Nursing Homes
    
    
  • Virginia Assisted Living
    languages: English
    from the web page:
    "A consumer's guide to information and help about assisted living in Virginia, with a directory of assisted living facilities..."
    
    • Arlington, Virginia Assisted Living
    • Richmond, Virginia Assisted Living
    
    
    
  • Virginia Home Health Care
    languages: English
    
    • Richmond, Virginia Home Health Care Providers
    
    
    
   

• web page:
  Medicaid's Spousal Impoverishment Figures for 2009
  
  source:Elder Law Answers
  languages: English
  from the web page:
  ""In 2009, the spouse of a Medicaid recipient living in a nursing home (called the "community spouse") may keep as much as $109,560 without jeopardizing the Medicaid eligibility of the spouse who is receiving long-term care. Called the "community spouse resource allowance," this is the most that a state may allow a community spouse to retain..."
  

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• web page:
  Spousal Impoverishment
  
  source:Centers for Medicare & Medicaid Services
  languages: English
  from the web page::
  "The expense of nursing home care, which ranges from $4,000 to $6,000 a month or more, can rapidly deplete the lifetime savings of elderly couples. In 1988, Congress enacted provisions to prevent what has come to be called "spousal impoverishment," ..."
  

Medicaid Community Waivers in Virginia

"Medicaid Waivers were developed to encourage people with disabilities and the elderly to access services in their homes and communities. Medicaid is a joint federal-state program. Medicaid Waivers provide funding to serve people who are eligible for long-term care in institutions such as hospitals, nursing facilities, and intermediate-care facilities. Through Medicaid Waivers, states can “waive” certain requirements including the requirement that individuals live in institutions in order to receive Medicaid funding... "
*source: Virginia Department of Medical Assistance Services, Richmond, Virginia 23219

• brochure:
  Virginia’s Medicaid Waivers for Persons with Disabilities, Their Parents, and Caregivers
  
  source:Virginia Department of Medical Assistance Services
  languages: English
  

• web page:
  Contact Info and Descriptions for all Virginia Medicaid 1915(c) HCBS Waivers, 2006
  
  source:Center for Personal Assistance Services
  languages: English
  from the web page: "The following is a list of all Virginia 1915(c) Waivers by name - complete with a description, contact information and web link..."

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• web page:
  (Virginia) Medicaid Waivers and Demonstrations List
  
  source:Centers for Medicare & Medicaid Services
  languages: English
  from the web page:
  "...This list contains information about state-specific Medicaid waiver and demonstration programs. Users can access fact sheets, copies of proposals, approval letters, and other documents related to specific programs..."
  

• web page:
  Medicaid Fraud Control Unit
  
  source:Attorney General of Virginia
  languages: English
  from the web page: "TThe Virginia MFCU works regularly with all federal and state law enforcement agencies, as well as private insurance companies operating within Virginia...."
• hotline:
  Medicaid Fraud Control and Elder Abuse Unit (MFCU)
  According to the Attorney General of Virginia: "1-800-371-0824"