If you are currently enrolled in Medicaid, FAMIS or Plan First, your health care coverage needs to be renewed annually. You will receive aform in the mail if you need to renew your health coverage.If you recently received a renewal application for these programs, you may have noticed that the application looks different than before.There’s a new process to renewing your coverage. The first time you use this new form to renew, it may take you longer than before to complete.However, you could be automatically renewed for up to 5 years without having to complete a renewal form if nothing has changed and you check abox at the end of the form that allows us to look at your electronic income data each year, including information from tax returns. Online: Through your account on, or;. By phone: Call Cover Virginia at 1-855-242-8282.
By mail: Complete the paper renewal form and return it to your local Department of Social Services.
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Medicaid pays for health and medical care for certain groups of people who have low income. Local Departments of Social Services take applications and make eligibility decisions. The Department of Medical Assistance Services (DMAS) pays the bills.
Medicaid is not a type of insurance, though Medicaid benefits may be provided to you through a chosen primary care physician or Health Maintenance Organization (HMO). Medicaid is available to people who fall into certain categories and who have limited finances. Effective January 1, 2019 adults earning up to 138% of the federal poverty level (MAGI), or less than $17,000 a year may also qualify. When am I required to report changes? The recipient has a responsibility to report any changes in his/her circumstances that may affect his/her eligibility within 10 days of the date the changed occurred.When are Medicaid Reviews required?
Medicaid reviews are required at least every 12 months. Reviews may also be done when changes are reported.What information is required for the review? Depending on the type of Medicaid you are receiving, you may be asked to complete a review form, provide verification of all gross monthly income, and provide verification of resources.
Your eligibility worker will contact you to request the information that is needed.What is Medallion? Medallion is a managed care organization (MCO) established to provide quality health care to Medicaid recipients.When should I expect to be enrolled in an MCO? If you are selected for managed care, you will receive an enrollment package in the mail 15 to 45 days after you have been approved for Medicaid. Complete this package in the time allotted and return the forms if you want to choose your MCO.
If you fail to return your forms and make a selection by the time indicated, an MCO will be chosen for you.If I have problems with my MCO, whom do I call? Call the MCO’s Hotline.
This number should be called first. If you are not satisfied with the response, call the general Medallion Hotline 1(800) 643-2273. Your eligibility worker should only be called as a last resort in MCO matters.What happens if I am disenrolled from Medallion? If you remain Medicaid eligible, you can receive Medicaid covered services from any approved Medicaid provider. If your Medicaid case is closed and then reopened and you are again eligible for managed care, your MCO enrollment will be reactivated in 30-60 days from the time your case is reopened.What is LIFC?
LIFC stands for Low Income Families with Children. This Medicaid coverage is for parents, caretaker-relatives, and persons essential to the well-being of a dependent child. These individuals must be living with the dependent child.What is a Spenddown?
A Medicaid spenddown is for people who meet all the Medicaid eligibility requirements except for income. People who have countable income higher than the medically needy income limit are placed on a spenddown.
A spenddown works like an insurance policy deductible. The amount of the deductible is called the “spenddown liability”. The spenddown is a 6-month period, although it can be shortened under certain conditions.What is Retro period? This is the 3- month period that is immediately before the application month. If you applied in April, your retro period is January, February, and March.
To be evaluated for this period, you will have to verify all income and resources the household had during this period.Will Medicaid cover bills earlier than 3 months prior (retro period) to the application month? No.What is SLH? SLH stands for State and Local Hospitalization. It covers In/Out patient services at a hospital, emergency room services, and Health Department Clinic visits. The certification period is for 6 months. The certification does not cover doctor visits.If I am not eligible for any state funded medical program, where can I get medical help?
You can go to the Virginia Beach Health Department located at 4452 Corporation Lane (telephone 518-2700) or the Beach Health Clinic located at 3396 Holland Rd., Suite 102, Virginia Beach, VA 23452 (telephone 428-5601).What about help with prescription costs? If you do not have prescription drug coverage through private insurance, Medicare or Medicaid, you may be eligible for obtain medicines at no cost or at a discount through prescription assistance programs. Additional information is available online at Disability Resources and the. Carrier installation manuals downloads. (These programs are not affiliated with our agency.)What is FAMIS? This is Family Access to Medical Insurance Security and is for uninsured low-income children from birth to age 19. The program is designed to provide comprehensive health care coverage for children whose family makes too much to qualify for Medicaid, but has income below 200% of the federal poverty level. To apply call 1(866) 87FAMIS.
If you have access to a computer, go to the for more information or to file an on-line application.What is FAMIS Plus? FAMIS Plus is another name for Medicaid children from birth to age 19 whose family unit has income within 133% of the federal poverty level (FPL).Does the Virginia Beach Department of Social Services Human Services maintain a list of doctors and dentists that accept Medicaid? It is up to the customer to locate a physician who accepts Virginia Medicaid. A Provider Search function is on the.Can anyone obtain case information on my Medicaid case?
Yes, but you have to authorize that individual to have access in writing before the agency can release the information.Does Sentara Family Care provide dental coverage for adults? Yes but only for 19 and 20 yr. For more information call 1-800-881-2166.Will Medicaid or Medallion pay for non-emergency transportation? You must call 1-866-386-8331 at least 48 hours (2 days) before service is needed.What is Income? Income is any money received by you such as SSI, Social Security, cash gifts, wages, etc.Is a bank account for my Social Security check considered a resource? Yes, and all resources including bank accounts must be verified. That includes accounts with zero and negative balances.What is the Patient Advocate Foundation Virginia Cares Uninsured Program?
This program helps uninsured adults diagnosed with a chronic, life-threatening, or debilitating disease find the healthcare they need. Call 1(800) 532-5274 or visit for more information.What is Plan First? Plan First pays for family planning services only for men and women ages 19 to 64 years of age.
Contact us at (757) 437-3200 or the Virginia (DMAS) for more information.What is Smiles for Children? This program provides dental coverage for children enrolled in Medicaid (FAMIS Plus) and It also covers limited oral surgery for adults enrolled in Medicaid. Call 1(888) 912-3456 for more information.Do you have to meet citizenship and identification requirements for Medicaid? Yes, citizens may be asked to provide proof of citizenship and identity. Contact our agency at (757) 437-3200 for more information. HIPP is a federal requirement that all Medicaid-eligible individuals able to enroll in a cost-effective private health insurance plan through their employer do so.
The HIPP program will pay the employee's share of the premium. Individuals who do not enroll will lose their Medicaid benefits.
The Department of Medical Assistance Services (DMAS) HIPP Unit will evaluate every plan offered to the employee to determine whether the plan is cost-effective; that is, if it would cost less to buy health insurance to cover medical care or to pay for the care with Medicaid funds. Applying for HIPPIf you or family members are employed and have access to group health insurance, you are required to complete a HIPP application. Your eligibility worker will forward the application to the Department of Medical Assistance Services (DMAS). You will also be given an Employer Insurance Verification Form, which you are required to give to your employer to complete.
The employer must return the completed form to the HIPP Unit at DMAS.Medicaid will still cover the Medicaid-eligible members of your family as a secondary plan. Medicaid will pay for some services not covered by the insurance including co-pays and deductibles. Employer Insurance versus MedicaidThe insurance may cover services not covered by Medicaid. Members of your family that are not covered by Medicaid may be covered under the employer's insurance plan. Continued enrollment in private health insurance can help meet your pre-existing waiting periods, deductibles, and out of pocket expenses for the time when you will no longer be covered by Medicaid. If you lose your Medicaid eligibility, you may pay the premiums yourself and keep the private insurance. Using private health insurance helps lower costs to the Medicaid program.
Your Responsibilities under HIPPAny changes in employment, insurance coverage, or household must be reported to DMAS immediately. Every month, you will be required to send DMAS a copy of your most recent paycheck showing the insurance premium deduction. Incorrect payments will be recovered.To report changes or if you have questions, call HIPP at (800) 432-5924.For additional information, contact Phillip White (757) 385-3603.
What is HIPP?HIPP is the Texas Medicaid program that helps families pay for employer-sponsored health insurance premiums. It is for families with at least 1 person who gets Medicaid.People enrolled in any Medicaid program, except for the Children's Health Insurance Program (CHIP) and STAR Health managed care program, are eligible to enroll in HIPP.There are no age restrictions in the HIPP program. The family member who has Medicaid and the family member who can get employer-sponsored health insurance can be any age. Who Can Get HIPP?If you can answer “Yes” to these questions, you should apply for HIPP:.
Does anyone in your family get Medicaid?. Can someone in your family get health insurance at work?You might be able to get HIPP if it costs Medicaid less to cover you or your family under employer-sponsored health insurance than it costs to cover family members who have Medicaid.Employer-sponsored health insurance is a group health plan you can get through your job. The family member who gets Medicaid must be able to get coverage on this plan. COBRA (Consolidated Omnibus Budget Reconciliation Act) is a type of health insurance you can get if you leave a job where you had insurance. If you have COBRA coverage, send us your COBRA rates.
We will look at the rates and let you know if you can join HIPP. How do I Apply for HIPP?To apply, you can either or call 800-440-0493. You also will need to submit the following required items:. Employer-sponsored health insurance plan’s rate sheet. Your employer can provide your insurance plan's rate sheet. A rate sheet is an informational document that shows the insurance premium amounts you pay each month. Proof of health insurance payment if you already are covered.
The date on the proof of health insurance payment must be the same month of submission. You can print HIPP forms by clicking the links below.Use this to apply to HIPP.Use this if you want another person to be able to talk to us about your family’s case.Use this if you want your premium reimbursement to go to your checking or savings account.Use this when reimbursement check was not received.Use this if your address has changed.Use this when allowing HIPP to speak to your employer on your behalf.This form is used to tell the HIPP program what the employer sponsored insurance paid for the Medicaid recipients in the past year.Use this when faxing anything to HIPP. Once You Start Getting HIPPOnce your HIPP program case is approved for renewal each year, you will need to continue submitting a proof of health insurance payment each month. In most cases, your employer will take the health insurance premium amount out of each paycheck. A proof of this payment must be submitted to HIPP, and HIPP will reimburse the employee’s portion of the health insurance premium amount.Please see “” for information about what can and can’t be used as proof of payment.It’s best to send HIPP your proof of payment the same month you pay your health insurance premium. However, you may submit your proof of payment within 3 months from the month of coverage. Proof of payment received after this will not be reimbursed.HIPP determines the month of reimbursement based on the latest date on the proof of payment.In most cases, HIPP processes reimbursements within 7 working days after receiving a valid proof of payment.
Reimbursements are normally sent out on Tuesdays and Thursdays. HIPP can reimburse you by mailing a check or direct depositing the amount into a savings or checking account.During HIPP enrollment or re-enrollment, it can take up to 30 working days from the time HIPP receives all required documentation to process your health insurance information. CheckIf you have not received your reimbursement check within two weeks after the date HIPP mailed your check, please fill out and submit the to HIPP. A new check will be sent to you after the completed Stop Payment Form has been received and processed.
Direct DepositWith direct deposit, HIPP deposits your health insurance premium payment straight into the checking or savings account you choose.To set up a direct deposit, send HIPP the following:. Completed. Voided check.