What is Virginia Medicaid Managed Care?
Virginia Medicaid Managed Care is a state program that helps people who have Medicaid get the health care services they need.
In managed care, you are a member of a managed care organization (MCO) or you are in the state's MEDALLION program.
- A managed care organization (MCO) is a health plan with a group of doctors and other providers working together to give health services to its members.
- MEDALLION is a state program that works like an MCO. In MEDALLION you choose a primary care provider to manage your health care. Your primary care provider helps find other health services and specialists when you need them. See a brochure called Welcome to MEDALLION.
Your own doctor
When you are in an MCO or MEDALLION, you will choose your own doctor (or clinic or other health provider) to manage your health care. This is your primary care provider (PCP). Your PCP will get to know you and your health care needs and will refer you to specialists when needed. When you are sick or want a checkup, you can call your PCP to make an appointment.
Extra MCO services
If you are in an MCO, the MCO can help you choose doctors, get rides to doctor visits, and get other medically necessary services. MCOs can help you learn about health topics such as diabetes or asthma.
When you are in an MCO:
- If you have medical questions, you can call your MCO and ask to speak to a nurse.
- If you have other questions, call your MCO member services number.
- MCO phone numbers are on this website or on your MCO card.
Well care
Your MCO doctor or your MEDALLION doctor will offer well care programs to help you and your family stay healthy, such as:
- services for pregnant women and new babies
- well child checkups for children and teens
Seeing specialists
If you need to see a medical specialist, your PCP will give you a referral (permission) to see one. When you have a referral, you can make an appointment to see the specialist.
If you see a specialist without a referral, you may be billed for the visit.
Emergencies
An emergency is an injury or illness that if it is not taken care of immediately, could cause death or permanent damage to health. In an emergency,
- Call your PCP if you have time, or
- Call 911, or
- Go to the nearest hospital emergency room.
Do not use the emergency room when there is no emergency.
More about what managed care plans offer
To learn more, see the brochures and charts you got in the mail from Virginia Medicaid Managed Care. You can also print these or read them online (Brochures and charts will open in a new window):
- You and Your Medicaid Managed Care Organization
- Lists of MCO benefits
- Welcome to MEDALLION (large file, will download slowly)
- You and Your Primary Care Provider
 |
You need Adobe Acrobat Reader to view these files. If you don't have this program, you can download it for free. |