DMAS unveils updates to Virginia's Cardinal Care Managed Care program and health plans

On June 10, 2025, the Virginia Department of Medical Assistance Services (DMAS) hosted an Evening Virtual Cardinal Care Member Education session, aimed at informing Medicaid providers and members about significant changes and enhancements to the Cardinal Care Managed Care program. This meeting was crucial as it outlined the transition to new health plans and the overall structure of Virginia's Medicaid system.

The session began with an overview of Cardinal Care, which encompasses all Medicaid members served through managed care and fee-for-service delivery systems. Notably, over 94% of Virginia's Medicaid members are enrolled in managed care, highlighting the program's importance in providing healthcare services. The meeting emphasized that eligibility rules would remain unchanged, ensuring continuity for current members.

A key focus of the discussion was the introduction of new health plans effective July 1, 2025. Humana Healthy Horizons of Virginia will join returning plans such as Aetna Better Health, Anthem Health Keepers, Sentara Health Plans, and UnitedHealthcare of the Mid Atlantic. This expansion aims to enhance member choice and access to care, with open enrollment periods allowing members to review and select their preferred health plans.

The meeting also addressed the enhanced care coordination model that will be available to all Cardinal Care members. This model is designed to adapt to individual needs, providing both medical and non-medical support, such as assistance with housing and food access. The introduction of a Dual Eligible Special Needs Plan was another significant topic, aimed at individuals eligible for both Medicare and Medicaid, ensuring they receive comprehensive care.

Participants were encouraged to utilize the Virginia Cardinal Care mobile app and the Cardinal Care Enrollment Broker for assistance in comparing health plans and provider networks. The session concluded with a commitment to ongoing support for members as they navigate these changes, emphasizing the importance of community resources and advocacy.

Overall, the meeting underscored DMAS's efforts to improve the Medicaid managed care system in Virginia, aiming to provide better services and support for its members. As the transition approaches, stakeholders are encouraged to stay informed and engaged with the upcoming changes to ensure a smooth enrollment process and continued access to necessary healthcare services.