DMAS details Cardinal Care managed‑care transition, special enrollment and Anthem foster‑care specialty plan

The Virginia Department of Medical Assistance Services (DMAS) hosted a virtual member education session explaining changes to Cardinal Care Managed Care that go into effect July 1, 2025, including the addition of Humana Healthy Horizons of Virginia and a statewide foster‑care specialty plan administered by Anthem HealthKeepers. DMAS officials and representatives of Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons, Centerra Health Plans (Sentara), and UnitedHealthcare Community Plan answered member questions and summarized benefits, enrollment rules and continuity‑of‑care protections.

DMAS said the Cardinal Care Managed Care (CCMC) reprocurement follows the program’s January 2023 launch and is intended to consolidate and improve Medicaid and FAMIS managed care. The agency told members that eligibility rules are not changing and that most Cardinal Care members already receive benefits through managed care plans rather than fee‑for‑service arrangements.

Why it matters: The transition affects plan contracts, which MCO delivers certain specialty supports (including a new Anthem foster‑care specialty plan), and when members can change plans. DMAS emphasized member choice and described tools and timelines members can use to compare plans and switch coverage during the special selection period.

Key details

- Effective date and vendors: DMAS said new CCMC contracts take effect July 1, 2025. The plans presented were Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia, Centerra Health Plans (Sentara Health Plans), and UnitedHealthcare of the Mid‑Atlantic. Anthem will administer a single statewide foster‑care specialty plan covering foster, former foster and adoption‑assistance populations.

- Special health‑plan selection window: DMAS described a special selection period from June 15 through Sept. 30, 2025, during which all Cardinal Care members may review and choose a health plan. DMAS explained that if a member selects a new plan on or before the 18th of a month, coverage begins the first day of the following month; selections made after the 18th take effect on the first day two months later. Members who do not select a plan by Sept. 30, 2025, must wait until the 2026 managed‑care open enrollment to change plans.

- Continuity of care and prior authorizations: DMAS showed a standard continuity‑of‑care protection that requires a newly selected plan to allow members to continue to see existing providers for up to 30 days. Several MCOs described additional transition support: Humana representatives said they will honor Molina prior authorizations and extend transition‑of‑care protections to 60 days, explaining, “we will honor the Molina prior authorizations, and our transition of care to allow them to see their existing provider is 60 days.”

- Foster‑care specialty plan enrollment: Shanice Gangadine, director of foster care at Anthem, said, “the transfer into Anthem's foster care specialty plan will be automatic” for eligible foster, former foster and adoption assistance members on July 1. She added that local departments of social services may opt a child out of the specialty plan, but an opt‑out moves the child into fee‑for‑service rather than another MCO.

- Transition of Molina members: Humana and DMAS staff said current Molina Healthcare members will be transitioned to Humana Healthy Horizons on July 1, 2025, and that Humana will work with members and providers to avoid care interruption.

- Dual Eligible Special Needs Plans (D‑SNPs): DMAS explained an alignment rule effective Jan. 1, 2025: when a member enrolls in a D‑SNP, the D‑SNP and the member’s Medicaid MCO must be administered by the same company. DMAS staff advised members who want Medicare and Medicaid plans to be aligned to first choose the Medicare plan and then ensure Medicaid enrollment aligns.

- Appeals and fair hearings: DMAS reminded members that MCO appeal processes must be exhausted before requesting a state fair hearing with DMAS. The agency described its two‑level fair hearing appeal process for MCO members.

- Retroactive coverage and FAMIS: DMAS said Medicaid eligibility may be retroactive up to three months before an application month if coverage is requested and eligibility is met for those months; retroactive claims must be submitted through the fee‑for‑service process. DMAS clarified that FAMIS coverage is not eligible for retroactive coverage.

- Care coordination and value‑added benefits: Each MCO described care management, care coordination, and enhanced benefits (for example, vision, transportation, educational supports, and postpartum/maternity programs). MCOs said they assign care managers or care coordinators for members with complex needs and outlined programs for maternity, pediatrics, behavioral health and long‑term services and supports (LTSS).

- Provider networks and single‑case agreements: MCOs advised members to use plan provider‑search tools (including the Virginia Cardinal Care mobile app and plan directories). Plans said they will try to contract providers into networks and may use single‑case agreements or temporary continuation-of‑care arrangements when clinically necessary.

- Transportation and mileage reimbursement: Several plans said they use MotiveCare for nonemergency transportation and offer mileage reimbursement or social‑trip allowances. Anthem specified mileage reimbursement at $0.70 per mile and additional nonmedical trip allowances; other plans described similar vendor arrangements and social‑trip benefits.

Member resources and next steps

DMAS and the MCOs told members that enrollment help is available via the Virginia Cardinal Care mobile app, the Virginia managed‑care website (managed by the Cardinal Care enrollment broker Maximus), and by calling plan member services. DMAS said members will receive mailed notices with plan assignments and special‑enrollment instructions and that a FAQ document will be posted after the sessions. DMAS also announced provider‑focused sessions for providers with designated times and urged providers to use provider‑specific sessions for technical questions about enrollment and billing.

Ending

DMAS closed the session by encouraging members to use the comparison tools, review plan materials, and submit outstanding questions through the virtual Q&A form by the posted deadline so DMAS can update the FAQ materials and continue outreach through the transition period.