Virginia’s State Plan for Medical Assistance

The Commonwealth of Virginia’s State Plan for medical assistance under Title XIX of the Social Security Act is available for public review and comment.

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Introduction to Virginia’s State Plan for Medical Assistance

The Virginia Department of Medical Assistance Services (DMAS) is the state agency that administers the Medicaid and Children’s health insurance Programs (CHIP) in Virginia.

The Medicaid Program is a federally funded program that provides Medical Assistance to eligible low-income individuals and families. CHIP is a state-funded program that provides health insurance coverage to eligible children who are not eligible for Medicaid.

DMAS is responsible for developing and operated Virginia’s State Plan for Medical Assistance. The State Plan describes how Virginia will administer its Medicaid and CHIP programs, including eligibility criteria, covered benefits, provider reimbursement rates, and other program rules and regulations.

The State Plan is updated every three years, in accordance with federal regulations. The current State Plan was approved by the Centers for Medicare & Medicaid Services (CMS) on July 1, 2019 and will be in effect through June 30, 2022.

Eligibility for Virginia’s State Plan for Medical Assistance

In order to be eligible for Virginia’s State Plan for Medical Assistance, an individual must meet the following criteria:
-Be a resident of Virginia
-Be a U.S. citizen or have legal immigration status
-Have income at or below 133% of the federal poverty level
-Not be eligible for Medicare
-Not have resources (such as savings or property) above certain limits

Coverage under Virginia’s State Plan for Medical Assistance

Virginia’s State Plan for Medical Assistance provides coverage for certain medical services to eligible low-income individuals and families. The services covered by the State Plan include, but are not limited to, physician services, inpatient and outpatient hospital care, laboratory and x-ray services, and nursing facility care.

How to Apply for Virginia’s State Plan for Medical Assistance

You may apply for the Virginia State Plan for Medical Assistance in one of three ways:
1. In person – You may go to any local social services office to apply. To find the office nearest you, please call 1-800-552-3431.
2. By mail – You may request an application by calling 1-800-552-3431 and have it mailed to you, or you may print an application from our website. The address to mail your completed application is:
3. Online – You may also apply online through https://commonhelp.virginia.gov/.

Renewing Coverage under Virginia’s State Plan for Medical Assistance

There are two ways to renew your medical assistance coverage under Virginia’s State Plan for Medical Assistance. You can either renew online or by mail.

If you choose to renew your coverage online, you will need to log in to your account on the Virginia Department of Social Services website. Once you have logged in, you will be able to access the renewal form and submit it electronically.

If you would prefer to renew your coverage by mail, you can request a renewal form from the Virginia Department of Social Services. Once you have received the form, you will need to fill it out and return it to the address specified.

What to do if your Coverage is Terminated under Virginia’s State Plan for Medical Assistance

If your coverage under Virginia’s State Plan for Medical Assistance is terminated, you have several options for continuing your coverage. You may be able to continue your coverage through another government program, or you may be able to purchase a private health insurance plan.

How to Appeal a Decision made by Virginia’s State Plan for Medical Assistance

If you disagree with a decision made by Virginia’s State Plan for Medical Assistance, you have the right to file an appeal. You must file your appeal within 90 days of the date on the notice of the action you are appealing.

To file an appeal, you may do any of the following:
-Submit a written request to the Department of Medical Assistance Services (DMAS). Your written request must include your name, address, and telephone number; your Medicaid ID number; and a description of the action you are appealing and the reason why you think the decision is wrong.
-Call 1-800-552-9963 to request an appeal form.
-Visit www.virginiamedicaid.dmas.virginia.gov/WBC/member/formspackets/forms/?view=AppealForms to download an appeal form.

Mail or fax your completed form to:
Department of Medical Assistance Services
Member Recovery Operations mailbox
600 East Main Street, Suite 300
Richmond, VA 23219
Fax: 804-819-4148

Virginia’s State Plan for Medical Assistance and Long-Term Care

The purpose of this document is to provide information about Virginia’s State Plan for Medical Assistance and Long-Term Care. This plan outlines the Commonwealth’s commitment to provide quality health care and long-term services and support to its most vulnerable citizens. The plan describes how the state will administer the program, how services will be delivered, and what benefits will be available to enrollees.

Virginia’s State Plan for Medical Assistance and Behavioral Health

The state plan is a comprehensive document that details how the Commonwealth of Virginia will provide medical assistance and behavioral health services to eligible low-income residents. The plan outlines the types of services that will be covered, how those services will be delivered, and how the state will ensure that quality care is provided.

Virginia’s State Plan for Medical Assistance and Substance Abuse

The Virginia Department of Medical Assistance Services (DMAS) is required by federal law to develop and maintain a State Plan for Medicaid. The State Plan describes how Virginia will administer its Medicaid program and how it will use federal Medicaid dollars. The State Plan is also required to address how the state will provide medical assistance to low-income residents and how it will ensure access to quality health care.

The state plan must also include a description of the state’s efforts to combat substance abuse, including date of plan submission, types of services included, provider qualifications, and mode of delivery.

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