CCMC introduces innovative member-centered care model with new health plans

In a pivotal meeting held on June 17, 2025, Virginia's Department of Medical Assistance Services (DMAS) unveiled significant updates to the Cardinal Care Managed Care (CCMC) Program, aimed at enhancing the Medicaid experience for its members. The session, characterized by a commitment to member-centered care, highlighted the program's focus on holistic health management and improved access to essential services.

At the heart of the CCMC initiative is a new model of care that prioritizes the needs of members, ensuring that both medical and non-medical requirements are addressed. This approach includes the introduction of a foster care specialty plan, designed specifically to cater to the unique health and behavioral needs of children and youth in foster care. The program aims to provide tailored support, fostering a nurturing environment for these vulnerable populations.

Key goals outlined during the meeting include strengthening provider access and availability, streamlining administrative processes, and enhancing case management for members with high-risk factors. The emphasis on innovation and operational excellence is expected to drive better health outcomes through value-based payment arrangements.

Importantly, the meeting reassured current members that there would be no reductions in services or benefits. Existing service authorizations will remain valid for at least 30 days, ensuring continuity of care during the transition to the new health plan, Humana Healthy Horizons of Virginia, which will replace Molina. Providers are encouraged to begin contracting with Humana immediately, as the new model is set to take effect on July 1, 2025.

Members will have the opportunity to compare and select new managed care organizations (MCOs) during a special enrollment period from June 19 to September 30, 2025. This flexibility allows individuals to choose the plan that best meets their needs, with the assurance that existing authorizations will be honored during the transition.

The CCMC's responsive model of care promotes collaboration among interdisciplinary care teams, ensuring that members receive comprehensive support tailored to their evolving needs. This includes health risk assessments and the development of personalized care plans that address both medical and social determinants of health, such as housing and food access.

As Virginia moves forward with these enhancements to its Medicaid program, the CCMC aims to create a more accessible, supportive, and effective healthcare environment for all its members, particularly those in foster care. The changes reflect a broader commitment to improving health outcomes and quality of life for some of the state's most vulnerable residents.