Cardinal Care: How Virginia is Transforming Its Medicaid Programs

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The Virginia Department of Medical Assistance Services (DMAS) has introduced a significant policy change by consolidating the Medallion 4.0 and Commonwealth Coordinated Care Plus (CCC Plus) managed care programs into a single, unified program called “Cardinal Care.” This change aims to streamline services, improve continuity of care for members, and alleviate confusion among providers.

What you need to know about VA’s own Cardinal Care: Cardinal Care is a single brand encompassing all health coverage programs for all of Virginia’s Medicaid members.

Cardinal Care began its phased implementation on January 1, 2023, with the full “go-live” date set for July 1, 2023. This slow rollout is due to the pending approval by the Centers of Medicare and Medicaid Services which is anticipated to begin July 1st, 2023.

Both providers and members will not need to take any enrollment action as this function was adapted by Cardinal Care. Members in managed Care can stay with their same MCO (Managed Care Organization) and doctors.

Care and programs enrolled in by members will remain the same such as preventative care, behavioral health services and recovery treatment services.

What are the most prominent changes? Cardinal Care has taken many steps to ease transition for VA’s providers and members, however there are a few changes to note:

Open enrollment for members will resume for all MCO members, following a regional schedule based on the members location. Medicaid members will receive new ID cards, which The Department of Medical Assistance Services (DMAS) has started to rollout since January 1st, 2023, with the Cardinal Care logo. This change may cause confusion among providers, but it is part of the transition to the new program. Fee-for-service (FFS) members can continue to use their current blue-and-white cards. New Virginia Medicaid Cardinal Care fee-for-service cards will be issued for newly eligible members or as replacements for lost or damaged cards.

These changes also affect prior eligibility verification systems such as ARS, Medicall and 270/271 EDI (Electronic Data Interchange) Transactions. These systems will now reflect MCO or fee-for-service enrollment and no longer list CCC Plus or Medallion 4.0. Despite the transition, MCOs (Managed Care Organization) will still accept Medallion and CCC Plus service authorizations and claims through the previous submission process.

To round out the changes which The Department of Medical Assistance Services (DMAS) is updating its website and the enrollment broker websites. Until the updates are complete, all Managed Care members will continue to use the existing enrollment websites and helplines.

Continuity of Care Overhaul: Bridging the Gap

Despite this huge transition, Cardinal Care pledged to bridge the gap of continuity of care by ensuring members will no longer transition between two managed care programs, thus improving VA (Veterans Affairs) Medicaid’s care continuity. For example, Medallion members transitioning into hospice or long-term services and supports will no longer drop to fee-for-service before enrolling in managed care.

In summary, the new Cardinal Care program unifies the Medallion 4.0 and CCC Plus managed care programs to simplify and improve the overall Medicaid experience for members in Virginia. With streamlined services, enhanced continuity of care, and easier access to information, Cardinal Care aims to better serve the needs of the Medicaid population. The introduction of new ID cards and the rebranding under Optima signify the beginning of this transition. Providers are encouraged to familiarize themselves with the changes and seek assistance if needed, ensuring a successful transition for all parties involved.


Cardinal Care Fact Sheet:  

Department of Medical Assistance Services – Cardinal Care Transition
Virginia Medicaid Transitioning to Cardinal Care – An Overview for Providers and Stakeholders March 2023

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