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Molina members move to Humana Healthy Horizons July 1; plans, DMAS say prior authorizations and waivers honored during transition
Summary
Humana and DMAS said Molina Medicaid members will be assigned to Humana Healthy Horizons effective July 1, 2025. Humana and DMAS clarified a 60-day continuity-of-care period for existing authorizations; Molina will continue processing prior claims for dates of service before July 1.
Humana Healthy Horizons in Virginia will receive Molina Medicaid members and accept Molina-issued service authorizations during a continuity period, Humana and DMAS representatives said during a June provider Q&A.
Carrie Whitaker, Humana’s director of contract compliance, said Humana will automatically enroll Molina members to Humana effective July 1, 2025, and will provide a 60-day continuity-of-care period during which existing prior authorizations will be honored and members may continue to see existing providers. Humana said it has been exchanging information with Molina to support the transition and will work with providers if they wish to join Humana’s network after the continuity period.
DMAS staff and other speakers clarified the transition schedule: Molina members are expected to be enrolled into Humana with an effective date of July 1, and members moved to Humana will have 90 days from that effective date to make any plan changes before standard open-enrollment rules apply. A DMAS representative confirmed during the session that the continuity-of-care period for authorizations in this transition is 60 days; earlier slides in the presentation had stated 30 days but the Q&A clarified the longer period.
On claims handling, DMAS staff said claims for Molina members with dates of service prior to July 1, 2025, should be submitted to Molina within Molina’s current timely-filing requirements. Elizabeth Smith of DMAS’s integrated care division said Molina will continue to process Virginia Medicaid business after June 30 and will complete outstanding claims and business for dates of service before July 1.
Providers with outstanding Molina claims that remain unresolved were told they may contact DMAS escalation channels (the CCC Plus mailbox was referenced) if plan-level resolution is unsuccessful. Humana said eligibility and claims visibility for transferred members generally will become available in plan systems after June 19, when assignment in the eligibility system occurs.
