1. Medicaid Expansion: New health coverage for Virginia adults OCTOBER 26, Jennifer Lee, MD Director, Department of Medical Assistance Services

2. Who Qualifies for Virginia Medicaid Now?
Not all low-income Virginians are eligible
205% FPL ($42,599)
Children 0-18
(family of 3)
205% FPL ($42,599)
Pregnant Women
(family of 3)
80% FPL ($9,712)
Person With Disability
33% FPL ($6,924)
Parents
(Family of 3)
Not Eligible
Childless Adults

3. Who Qualifies for Virginia Medicaid Under Expansion?
Medicaid expansion will provide quality, low- and no-cost coverage to up to 400,000 Virginians
Adults ages 19 – 64, not Medicare eligible
Income from 0% to 138% Federal Poverty Level
*Percent income may vary by locality

4. Overview of New Health Coverage for Adults
Apply for new adult coverage beginning November 1, 2018
Up to 400,000 more Virginia adults will enroll in quality, low- and no-cost health coverage beginning January 1, 2019
People working in retail, construction, childcare, landscaping, food service or other jobs that do not offer health insurance may be eligible

5. Who Are Virginia’s Uninsured?
Recent focus groups with uninsured adults in Virginia who have incomes below 138% FPL offered key findings:
Cost has been the main barrier to coverage as well as working in jobs or for employers that do not offer coverage
Most have been putting off getting health care services, paying out of pocket at a clinic when sick, or going to ERs when they become seriously ill
The new adult population has a strong interest in enrolling in Medicaid and many say they will apply
Most are unaware that Virginia will expand Medicaid
Many fear “rejection” if they apply, as they have been unsuccessful in the past

6. Overview of Medicaid Expansion Requirements
The 2018 Appropriations Act directs DMAS to implement new coverage for adults and transform coverage
State Plan Amendments, contracts, or other policy changes
Implement new coverage for adults with incomes up to 138% FPL and implement early reforms for newly eligible individuals
§ 1115 Demonstration Waiver
Implement required reforms that transform the Medicaid program for certain individuals
DMAS is working in parallel and will submit a § Waiver while awaiting CMS approval of State Plan Amendments

7. Delivery System Will Use Current Managed Care Plans
Coverage will be provided for 96% of Medicaid enrollees through the Medallion 4.0 and Commonwealth Coordinated Care Plus (CCC Plus) managed care programs
Medicaid Delivery Systems
Aetna Better Health of Virginia
Anthem HealthKeepers Plus
Magellan Complete Care of Virginia
Optima Health
United Healthcare
Virginia Premier Health Plan
6 Health Plans Contracted Statewide
Commonwealth Coordinated Care Plus (CCC Plus) will serve populations who are medically complex (individuals with a complex behavioral or medical condition and functional impairment)
Medallion 4.0 will serve populations other than those who are medically complex
Fee for Service will serve populations until they are enrolled in an MCO and the populations and services that are excluded from managed care 7
Governor’s Working Papers; Pre-decisional; Not for public release

8. What Services are Covered?
New enrollees will receive coverage for all Medicaid covered services including evidence-based, preventive services
Doctor, hospital and emergency services, including primary and specialty care
Prescription drugs 
Laboratory and X-ray services 
Maternity and newborn care 
Home health services 
Behavioral health services, including addiction & recovery treatment services (ARTS)
Rehabilitative services, including physical, occupational and speech therapies 
Family planning services 
Medical equipment and supplies 
Preventive and wellness services, including annual wellness exams, immunizations, smoking cessation and nutritional counseling 
Managed Care Organization case management/care coordination services
Transportation to Medicaid-covered services when no alternatives are available
And more

9. State Law Requires Waiver Changes
Work and Community Engagement
Premiums, Co-Payments, Health and Wellness Accounts
Housing and Employment Supports Benefit
Source: 2018 Virginia Acts of Assembly Chapter 2

10. Enrollment Pathways Auto-Transition to Full Benefit Medicaid Express
The new adult population will enroll in coverage through a variety of enrollment pathways, including streamlined enrollment processes
Auto-Transition to
Full Benefit Medicaid
Limited Benefit Programs
GAP (Governor’s Access Plan) Adults 21 to 64 years of age with Severe Mental Illness (SMI)
Plan First Family planning services ≤ 138% FPL
Express
Application
SNAP beneficiaries Supplemental Nutrition Assistance Program formerly know as Food Stamps
Parents of Child(ren) enrolled in Medicaid
Transition from HealthCare.gov to
Virginia Medicaid
Individuals currently enrolled in a qualified health plan (QHP) from the Federally-facilitated Exchange (FFE), also known as the Marketplace or Healthcare.gov
Priority
Populations
Uninsured individuals served through other systems of care
General
Public
Newly eligible adults not captured in Streamlined Enrollment groups

11. Enrollment Plan for Priority Populations
DMAS will use a targeted approach to support enrollment of uninsured populations served through other systems of care
POPULATION
TARGETED APPROACH
Community Service Boards (CSBs)
Targeted training on Common Help for application submission
Potential data share agreement for targeted assistance
DMAS and CSB Executives will have a series of meetings, including one meeting with health plans
Designated DMAS Contact for CSB questions:
Donna Boyce,
Department of Corrections (DOC) and local and regional jails
Centralized Cover Virginia Unit for DOC Case Management and local and regional jails
Begin telephonic applications 11/1/2018
Virginia Department of Health- Ryan White Grantees
Targeted training on streamlined enrollment and QHP transition
Hospital Indigent Care Programs
Targeted training on streamlined enrollment
Targeted training and coordination with other entities supports enrollment of these priority populations

12. Enrollment Pathways Enrollment Communications Timeline
9/10/2018 & 9/12/2018
GAP – First GAP Heads Up Letter sent to inform current GAP members that GAP will be closing
11/15/2018
01/01/2019
Second GAP Heads Up Letter sent
Expanded Coverage Begins for the newly eligible adults
Early October
Healthcare.gov sends notice to current Marketplace plan members that the Medicaid rules have changed
01/04/2019
Last day to submit SNAP & Parents express application
10/25/2018
Plan First Heads Up Letter
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
JANUARY
Marketplace– Open Enrollment 11/1 – 12/ 15
Late-December**
First mailing: Managed care health plan Assignment Letter mailed from DMAS.
Second mailing: Managed care health plan ID Card & Welcome Packet mailed (from managed care health plans).
10/29/2018
SNAP & Parents - Express Application mailed
Applicant receives notification by mail if enrolled in new adult coverage.
**If enrolled by 12/18, members will receive their Medicaid ID and Managed care health plan ID before January 1, 2019.
Mid-December**
Medicaid ID card mailed to those that received notice of eligibility for the new adult coverage
Revised ; subject to additional changes

13. Governor’s Access Plan (GAP) Members
Auto-Transition to
Full Benefit Medicaid
Limited Benefit Programs
Eligible Population: Adults age 21 to 64 with a Serious Mental Illness (SMI)
LETTER
DATE
GAP “Heads Up Letter:” Letter informing GAP members that the GAP program will be ending in 2019
Sent on 9/10/2018 and 9/12/2018
2. Medicaid ID Card
Mid- December
3. Managed Care Health Plan ID Card and Welcome Packet
No later than 01/01/2019
GAP members do not need to take any action to enroll in full Medicaid benefits.
GAP members will remain in their current enrollment status until 12/31/2018 and will have full Medicaid benefits starting 1/1/2019.

14. GAP - Heads Up Letter *Letter is printed on white paper in a white envelope

15. Plan First Members
Auto-Transition to
Full Benefit Medicaid
Limited Benefit Programs
Eligible Population: General family planning services for adults, age with incomes ≤ 138% Federal Poverty Line (FPL) will transition to full benefit Medicaid
LETTER
DATE
Plan First “Heads Up Letter:” Letter informing Plan First members that they will be transitioning to full benefit Medicaid effective 1/1/2019
By 10/25/2018
Medicaid ID Card
Mid- December
Managed Care Health Plan ID Card and Welcome Packet
No later than 01/01/2019
Plan First members do not need to take any action to enroll in full Medicaid benefits.

16. Plan First - Heads Up Letter
Plan First - Heads Up Letter * Letter is printed on green paper in a yellow envelope

17. SNAP Beneficiaries Express Application
Eligible Population: Individuals receiving SNAP benefits, age 19-64, and have income ≤ 138% FPL; no self-employment income; not eligible for Medicare
LETTER
DATE
SNAP letter & Express Application
by 10/29/2018
Medicaid ID Card
Mid- December
Managed Care Health Plan ID Card and Welcome Packet
No later than 01/01/2019
Members must respond to the Express Application by 01/04/19 for expedited enrollment
Encourage individuals to return Express Application via phone, mail, or online to expedite enrollment
If Enrolled by 12/18 – Members will receive their Medicaid ID and health plan ID no later than 01/01/2019

18. SNAP Beneficiaries Letter - Includes Express Application
SNAP Beneficiaries Letter - Includes Express Application * Letter is printed on Blue paper in a yellow envelope

19. SNAP Beneficiaries Letter - Includes Express Application
SNAP Beneficiaries Letter - Includes Express Application * Letter is printed on Blue paper in a yellow envelope
Q1 RESPONSE TIPS –
This helps determine your household size
Q2 RESPONSE TIPS –
Has your income increased since you applied for SNAP benefits?
Q3 RESPONSE TIPS –
This is an optional question, so your response will not change your eligibility status.
If you need additional support or care coordination, please select ‘Yes’

20. Parents of Child(ren) Enrolled in Medicaid
Express
Application
Eligible Population: Parents of children who are enrolled in Medicaid; age with household income ≤ 138% FPL; Not eligible for Medicare
LETTER
DATE
Parents of Enrolled Child(ren) letter & Express Application
By 10/29/2018
Medicaid ID Card
Mid- December
Managed Care Health Plan ID Card and Welcome Packet
No later than 01/01/2019
Members must respond to the Express Application by 01/04/19 for expedited enrollment
Encourage individuals to return Express Application via phone, mail, or online to expedite enrollment
If Enrolled by 12/18 – Members will receive their Medicaid ID and health plan ID no later than 01/01/2019

21. Parents of Enrolled Child(ren) Letter – Includes Express Application
Parents of Enrolled Child(ren) Letter – Includes Express Application *Letter is printed on Pink paper in yellow envelope

22. Parents of Enrolled Child(ren) Letter – Includes Express Application
Parents of Enrolled Child(ren) Letter – Includes Express Application *Letter is printed on Pink paper in yellow envelope
Q1 RESPONSE TIPS –
Please provide your Social Security number
Q2 RESPONSE TIPS –
If you are not a U.S. citizen, you may still be eligible!
Inform us if you are a U.S. citizen or not.
If not a U.S. citizen – please provide your immigration document information.
Respond to all sections in this question
Q3 RESPONSE TIPS –
This is an optional question, so your response will not change your eligibility status.
If you need additional support or care coordination, please select ‘Yes’

23. The Marketplace/Healthcare.gov
Transition from HealthCare.gov to
Virginia Medicaid
Eligible Population: Individuals who currently have a Qualified Health Plan (QHP) from the Marketplace or Federally-facilitated Exchange (FFE) and meet the new eligibility requirements.
LETTER
DATE
Letter from FFE/ Healthcare.gov notifying individuals to update their account on HealthCare.gov
Early October
Medicaid ID Card
Mid- December
Managed Care Health Plan ID Card and Welcome Packet
No later than 01/01/2019
KEY STEPS TO TAKE:
Log in to your HealthCare.gov account and select your 2019 application.
Update your application with any changes for 2019 and submit it.
If eligible for Virginia Medicaid, please ensure you do not automatically enroll into Marketplace coverage for 2019.
Your information will automatically be transferred to Virginia Medicaid.
Please ensure that you terminate your coverage. You can take steps to end Marketplace coverage by calling or in your Marketplace account under “Application Details” and “My Plans & Programs”
Open Enrollment for 2019 Coverage Year: November 1 – December 15

24. Marketplace QHP Enrollee Letter – Sent from the Federally-facilitated Exchange (FFE)

25. Summary of Streamlined Enrollment Letters
Group
Letter
Action Needed to Expedite Enrollment
GAP Members
No action needed to enroll in full Medicaid benefits
Auto-Transition to
Full Benefit Medicaid
Plan First Members
No action needed to enroll in full Medicaid benefits
Auto-Transition to
Full Benefit Medicaid
SNAP Beneficiaries
Submit Express Application (via phone or mail) by 01/04/19 for expedited enrollment
Submit
Express
Application
Submit Express Application (via phone or mail) by 01/04/19 for expedited enrollment
Parents of Enrolled Children
Submit
Express
Application
Log into your healthcare.gov account, then update and submit your 2019 application between Nov. 1 and Dec. 15
Notice from HealthCare.gov
Marketplace Plan Member
Transition from HealthCare.gov to
Virginia Medicaid

26. Help Support the Streamlined Enrollment Process
Encourage members to look out for the YELLOW envelope mailing from DMAS or Virginia Medicaid
Help members complete and submit Express Applications by January 4th through any of these methods:
Mail
Call Cover Virginia: (TDD: )
Visit CommonHelp online:
What if an individual believes he/she received a letter, but may have lost it?
CALL COVER VIRGINIA ( ) to verify
Recipients of Express Applications (i.e. SNAP & Parents of Child(ren) Enrolled in Medicaid) are selected based on eligibility requirements

27. How to Apply for Medicaid Coverage
General Public
Individuals not captured in the streamlined enrollment groups may still apply for Medicaid coverage, including the new adult coverage, through any of the following:
Call the Cover Virginia Call Center at (TDD: )
Complete an online application at Common Help:
Complete an online application at The Health Insurance Marketplace:
Mail or drop off a paper application to your local Department of Social Services (mailing may take longer than other methods of applying.)
Find your nearest local Department of Social Services by visiting:
Call the Virginia Department of Social Services Enterprise Call Center
at (if you also want to apply for other benefits)
Individuals may apply for the new adult coverage beginning November 1st !

28. Outreach and Communications Strategic Communications Plan
A comprehensive strategic communications plan drives stakeholder engagement
KEY STAKEHOLDER ENGAGEMENT ACTIVITIES
Fall Advertising Campaign
Provider Events, including “Medicaid Expansion: What Providers Need to Know”
State Agency Workshops, Live Webinars, and Speakers Bureau
Providing information about the new adult coverage through out-of-home, radio, and digital advertisements
Engage with providers through a series of provider outreach events in regions across Virginia
Supporting intensive, continuing outreach to state agencies, newly eligible adults, and other stakeholders
Visit to access advocate resources, information on provider outreach events, a recorded webinar, and more!

29. Outreach and Communications Fall Advertising Campaign
What About You? Digital Banner 300x600
Digital banners are just one of many mediums for reaching the newly eligible adults this fall

30. Outreach and Communications “Medicaid Expansion: What Providers Need to Know”
Visit for event details and to register to attend (required)

31. Outreach and Communications How Can I Help People Apply?
Participate in SignUpNow
SignUpNow is a 4+ hour training for people interested in helping individuals and families apply for Medicaid and FAMIS, including new coverage for adults.
Trainings will be offered throughout the state, starting in November 2018
To receive workshop dates and locations, please sign up at .

32. Apply for the new adult coverage beginning November 1st
Regular Updates
Visit the Cover VA Website at or Call for information and regular updates
Apply for the new adult coverage beginning November 1st

33. Sign up on the Cover Virginia Website to Receive Updates. www. coverva
Sign up on the Cover Virginia Website to Receive Updates!