Most Medicaid and FAMIS enrollees get their care through a Managed Care Organization (MCO). An MCO is an organization with a network of primary care providers (PCPs), specialists, hospitals and other health care providers. A PCP is the doctor you choose to provide and coordinate your or your child’s health care. Different MCOs are available in different areas of the state. Your choices are based on where you live. MCOs that provide health care to Medicaid and FAMIS enrollees include Aetna Better Health of Virginia, Anthem HealthKeepers Plus, INTotal Health, Kaiser Permanente, Optima Family Care, and Virginia Premier. Look at the Health Plan Listing by Locality to determine which MCOs are available in your area.
Once you or your child is enrolled in Medicaid or FAMIS, you will get a permanent Commonwealth of Virginia health insurance card from the Department of Medical Assistance Services (DMAS). Each enrolled person in your household will get a card. If that person is also enrolled in a managed care organization (MCO), he or she will also get a separate identification card from the MCO. You are responsible for:
Members enrolled in Medicaid, will receive a letter requesting that they select a plan and also indicating that they have been preassigned to a contracted MCO. Members living in a locality served by 2 or more MCOs, may select one of the contracted MCOs. The Medicaid member’s preassignment letter will indicate a plan in which they will be enrolled if they do not select an MCO within the designated time period.
For more information, please call the managed care helpline at 1-800-643-2273 (TDD: 1-800-817-6608).
FAMIS or FAMIS MOMS enrollees can choose their MCO when they apply. If they did not choose an MCO when they applied, they can call Cover Virginia at 1-855-242-8282 to enroll in an MCO.
FAMIS MCO Comparison Charts (below) for FAMIS enrollees only.
Co-pays apply for some FAMIS services. Please see your FAMIS member handbook or your MCO member handbook for more information about co-pays required for services.
Most Medicaid and FAMIS enrollees will be enrolled in an MCO, but some will remain in fee-for-service and some services are provided through fee-for-service even when enrolled in an MCO. For more information about covered services provided through fee-for-service to MCO enrollees, please review your MCO member handbook and your Medicaid or FAMIS program handbooks.
When first enrolled in Medicaid or FAMIS Plus (children’s Medicaid), the enrollee will be able to access health care through fee-for-service. This means they can see any provider in the Medicaid/FAMIS fee-for-service network for covered services. Before you schedule an appointment or before you get a prescription filled, ask the doctor, clinic, hospital, dentist, pharmacy or mental health provider if they accept Medicaid/FAMIS fee-for-service. All Plan First enrollees will remain in fee-for-service.
For Medicaid enrollees age 21 and older, there may be co-payments for some services. See the Medicaid Member Handbooks below for more information.
When a child or pregnant woman is first enrolled in FAMIS or FAMIS MOMS, the enrollee can access health care through the fee-for-service network. This means they can see any provider in the Medicaid/FAMIS fee-for-service network for covered services. Before you schedule an appointment or before you get a prescription filled, ask the doctor, clinic, hospital, dentist, pharmacy or mental health provider if they accept FAMIS. There are no co-payments for FAMIS enrollees in fee-for-service.
If you need help finding a provider who accepts fee-for-service Medicaid or FAMIS, check the Department of Medical Assistance Provider Search.