Great News from the Centers for Medicare and Medicaid Services and the Virginia General Assembly

The Centers for Medicare and Medicaid Services (CMS) further extended the unwinding section of 1902 waivers through June 30, 2025. DMAS can continue to allow verbal consent for Medicaid applications and partner with Managed Care Organizations (MCOs) for assistance with collecting member contact information, conducting outreach and assisting with renewals. Virginia will continue the 90-day reconsideration period and zero income strategy for renewals.

The Virginia General Assembly (GA) funded an additional 3,440 DD Waivers (Family and Individual Supports: 3,096 slots and Community Living: 344 slots) over the FY 2025-2026 biennium. The adopted state budget also includes a 3% increase for Medicaid dental reimbursement rates.

Virginia’s GA has directed DMAS to hire a Medicaid-eligibility consultant to assess all aspects of eligibility for Virginia Medicaid/Cardinal Care (eligibility determination, process design and information technology) performed by DMAS and local departments of social services. Findings and recommendations must be reported to the GA by December 15, 2024.

Lastly, the legislature is requiring a workgroup to study and make recommendations to improve the Medicaid Works program, a voluntary program that allows Medicaid members with disabilities (who are not on waivers) to earn up to $75,000/year and save up to $45,976 of their earnings.

Virginia Insurance Marketplace Updates

The Virginia Insurance Marketplace extended the Unwinding Special Enrollment Period (SEP). Virginians who lose Medicaid coverage between March 31st, 2023 and September 30th, 2024 are able to use the Unwinding SEP to enroll in Marketplace coverage at any point between these dates. 

The Virginia Insurance Marketplace also implemented the 150% Federal Poverty Level (FPL) SEP.  Any applicant with a household income under 150% FPL who does not qualify for full benefit Medicaid can now enroll in a Marketplace plan at any point in the year. The 150% FPL SEP may be particularly helpful to low-income legally residing noncitizens who do not qualify for Medicaid due to immigration status. Some may have immigration status to qualify for both Marketplace coverage and subsidies.

New federal regulations extend eligibility for Marketplace coverage and subsidies to specific groups of noncitizens, including Deferred Action for Childhood Arrivals (DACA) recipients. The new rule modifies who is considered “lawfully present” for the purposes of the Affordable Care Act. The regulations become effective November 1, 2024, facilitating enrollment during the 2025 Open Enrollment Period.

Medicaid Unwinding Update

As of June 12th, 2024, 94.33% of all unwinding redeterminations have been completed. Unwinding has been a major success in Virginia due to system and policy updates, increased data sharing and collaboration between the Virginia Department of Medical Services and Virginia Department of Social Services (VDSS), and support and outreach from external stakeholders. Kudos to everyone involved! More information from DMAS is available here.

Celebrating Excellence in Enrollment!

VHCF is proud of the 21 dedicated outreach workers that connect Virginians to health coverage. Hear personally about their enrollment assistance in this three minute video. And VHCF recently honored Miriam Kadhim with the “Excellence in Enrollment” award at its Cheers for Champions event. Miriam is the Medicaid Enrollment Specialist II with Neighborhood Health in Alexandria. Over the past 10 years, Miriam enrolled over 8,000 Virginians! Miriam demonstrated exemplary achievement, a solution-focused attitude and served as a mentor to peers. (Pictured below are Margaret G. Vanderhye, Virginia Health Care Foundation Chair, Miriam Kadhim, and Senator Barbara Favola, Virginia's 40th District.)

CMS Medicaid and Maternal Health Report

CMS released a report in May 2024 on Medicaid and CHIP members and maternal health. Nationally, the top underlying cause of pregnancy-related death for Hispanic/Latino and White individuals was behavioral health conditions. For Black members (whose maternal mortality rates are more than double other racial groups) cardiac and coronary conditions were the leading cause of pregnancy-related death. Preterm birth among Medicaid members was 12% compared to 10% with private insurance. For more information about access to care and other risk factors, please see the full report. 

Pregnancy and Oral Health

Brought to you by Smiles For Children

During pregnancy it is important to take care of your teeth and gums. Changes to your body during pregnancy can put you at higher risk of gum disease. Sore, swollen or bleeding gums are signs of a gum disease called gingivitis. Research shows that a pregnant individual with gum disease has a higher chance of having a baby too small. Gum disease is treatable by seeing your dentist.

Tips for Good Oral Health Care:

• Oral care is safe during pregnancy, and it is important to visit the dentist every six months or when you have concerns. Pregnant individuals should see a dentist at least once during pregnancy.
• Brush at least twice a day and replace your toothbrush every 3 to 4 months.
• Rinse every night with mouthwash that contains fluoride.
• If you vomit, it is important to rinse your mouth to stop the acid from damaging your teeth.
• Eat a variety of healthy foods such as fruits, vegetables, dairy products and whole grains.

Finding a Dentist

All Virginians with full health coverage through Medicaid or FAMIS have access to dental benefits including cleanings, exams, fillings, and crowns. Root canals, x-rays, and anesthesia are also covered. Members can call 1-888-912-3456 to find a dentist. For more information about Virginia’s Medicaid and FAMIS dental benefit, visit www.DentaQuest.com and www.dentaquest.com/en/find-a-dentist to find a dental provider.

Update on SignUpNow Workshops

The Virginia Health Care Foundation has announced Summer 2024 SignUpNow workshops to help you assist your clients with applying for and renewing their Medicaid/FAMIS. SignUpNow offers 2 types of training (Please Note: Workshops cover different material, please read carefully to ensure you are registering for the workshop you would like to attend.):

• SignUpNow – Medicaid/FAMIS workshops cover the “ins and outs” of the eligibility requirements, application procedures, and post-enrollment information for Virginia’s Medicaid/FAMIS programs for children and families (Medicaid, Medicaid Expansion, and the FAMIS programs). 
• SignUpNow – ABD workshops cover information for Virginia’s Aged, Blind, or Disabled (ABD) Medicaid covered groups, including ABD with Income ≤80% FPL; programs for Virginians who receive Supplemental Security Income (SSI), an Auxiliary Grant, or Long-Term Services and Supports (LTSS); and the Medicare Savings Programs. 

Register at vhcf.org/workshops/!

Medicaid/FAMIS Enrollment

As of June 1, 2024, there were 2 million Virginians enrolled in Medicaid/FAMIS. This includes:

• 789,989 adults enrolled in Medicaid Expansion (“New Adult Coverage”);
• 37,857 pregnant/postpartum enrollees in Medicaid for Pregnant Women (MPW), FAMIS MOMS, or FAMIS Prenatal Coverage;
• 794,484 children enrolled in FAMIS or FAMIS Plus;
• 228,481 individuals enrolled due to being Aged, Blind, or Disabled (ABD)