DMAS Q&A details Cardinal Care rollout: Humana to replace Molina July 1; special enrollment runs June 19–Sept. 30

During a virtual provider Q&A session, the Virginia Department of Medical Assistance Services (DMAS) and the five Cardinal Care managed care organizations briefed providers on the July 1, 2025, transition that will enroll Molina members into Humana Healthy Horizons of Virginia and implement a statewide foster-care specialty plan with Anthem HealthKeepers Plus.

The change affects nearly 2 million Virginians covered by Medicaid, DMAS staff said, and will require providers to confirm enrollment steps, credentialing timelines and claim submission procedures ahead of the transition. DMAS emphasized that covered services and benefit levels will not be reduced under the new Cardinal Care contracts.

DMAS said the special Cardinal Care enrollment period runs June 19–Sept. 30, 2025, and that providers will be able to begin selecting Humana in the state provider portal (PRSS) starting June 16. DMAS staff and plan representatives repeatedly urged providers to use PRSS to enroll and to contact plans directly for plan-specific credentialing and claim problems.

Why this matters

The reprocurement consolidates managed care arrangements under the Cardinal Care contracts and adds a statewide foster-care specialty plan intended to deliver tailored supports to children and youth in foster care. Providers who do not complete contracting or credentialing with one or more plans risk being out of network for new admissions, though DMAS said members already in long-term care will remain at their facility and plans must pay out-of-network at the standard DMAS rate while the resident remains.

Key implementation details

- Effective date and enrollment window: The Cardinal Care contracts take effect July 1, 2025. DMAS said members will be able to compare and select MCOs between June 19 and Sept. 30, 2025; plan selections made before the 18th of a month become effective on the first of the following month.

- Molina-to-Humana transition: Humana Healthy Horizons of Virginia will replace Molina for affected members on 07/01/2025. Humana told providers that all existing Molina members will be automatically enrolled into Humana on that date and that Molina will continue to process claims for dates of service prior to 07/01/2025. As DMAS staff put it: “Molina will process claims for dates of service prior to 07/01/2025. Even though the plan is ending for enrollment with the members, they will continue to close out all Medicaid business,” (Elizabeth Smith, DMAS Integrated Care Division).

- Continuity of care and authorizations: The Cardinal Care contract requires a minimum 30-day continuity period for existing service authorizations. Humana said it will extend that to 60 days for Molina transitioning members, and Humana’s representative told providers they will “honor all existing service authorizations during that same 60-day time frame” (Carrie Whitaker, director of contract compliance, Humana Healthy Horizons of Virginia). UnitedHealthcare and other plans described 60-day continuity policies for transitions; UnitedHealthcare noted a 90-day continuity standard specifically for behavioral health in some circumstances.

- Provider enrollment and credentialing: Providers must remain enrolled with DMAS and revalidate through the PRSS portal. PRSS selections to join Humana will be available beginning June 16. Humana reported an average credentialing timeframe of about 30 days and said new provider contracts signed by Aug. 1, 2025, will be made retroactive to July 1. DMAS and plans advised providers to contact individual MCO provider relations teams for network-specific onboarding, credentialing, and contracting questions.

- Claims and member identifiers: Plans said their systems will accept members’ DMAS Medicaid ID numbers during the initial transition. Humana provided its payer ID as 61101 and said Humana-specific IDs (beginning with “H”) will also be used; Humana representatives said providers could submit claims with either the Medicaid ID or the Humana ID while systems are being updated.

- Foster care specialty plan: Anthem HealthKeepers Plus will operate the statewide foster-care specialty plan for children and youth in foster care, beneficiaries with former foster-care eligibility up to age 26, and those receiving adoption assistance. Anthem representatives said foster-care members will be auto-enrolled into the specialty plan unless they opt out; Anthem warned that opting out would forfeit some value-added benefits provided through the specialty plan (Maria Richardson, Anthem program manager for Medicaid foster care).

What plans told providers about operations and benefits

Each MCO summarized provider-facing tools and enhanced benefits. Examples given in the session included care management teams and interdisciplinary care teams, enhanced nonmedical supports (transportation, fresh food boxes, OTC allowances), value-based payment pilots, provider portals (Availity/Availity Essentials and other vendor portals), and training resources. Humana said its nonemergency transportation broker will be MotiveCare and that some utilization management reviews use an external medical-review vendor (NMR).

Questions and next steps

DMAS said it will publish FAQs, post session slides and the recording to the Cardinal Care provider page, and develop implementation escalation contacts for plan-specific issues. Providers should: (1) confirm PRSS enrollment and select plans in the June 19–Sept. 30 special enrollment window if needed; (2) contact MCOs directly to initiate credentialing and contracting; and (3) follow MCO appeals and reconsideration processes for claims and authorizations that are not implementation-related.

Ending

DMAS and plan representatives closed the session by reiterating that members’ covered services remain unchanged under Cardinal Care, that Molina will continue to close out pre-07/01/2025 claims, and that plan-specific contact information and recorded materials will be posted to DMAS’s provider Cardinal Care web page.