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FAQs

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We're here to help you understand your health care choices!

These Frequently Asked Questions (FAQs) answer some questions you may have.

If you have other questions, call the Managed Care HelpLine at 1-800-643-2273 (TTY: 1-800-817-6608).

Who does Medicaid cover?

Medicaid coverage is usually available to Virginians who are:

  • Children in low-income families
  • Pregnant women
  • The elderly
  • People with disabilities
  • Parents who make less than a certain income

All states must follow federal guidelines about who is covered by Medicaid. States set their own income and asset eligibility rules. Virginia’s eligibility rules are among the strictest in the nation.

What is a Managed Care Organization (MCO)?

An MCO is a health plan. It is made up doctors, hospitals and other providers working together to give you the health care and services you need.

Who can enroll in an MCO?

Most people in Medicaid must enroll in an MCO. People with other insurance or in a nursing home may not have to enroll.

What if I don’t choose an MCO?

When you qualify for Medicaid, Virginia’s Medicaid Managed Care program will send you a letter. The letter will ask you to call to choose an MCO . If you don’t call when the letter tells you to, the program will choose an MCO for you.

When is open enrollment?

It depends on where you live. Different regions have different open enrollment periods. To learn when open enrollment happens where you live, click here.

What happens after I enroll?

To check your enrollment, go to Check My Case.

Once you are enrolled, your new MCO will send you an ID card and information telling you when you can start using services.

Can I change my MCO?

You can only change your MCO at certain times. To find out when, call the Managed Care HelpLine at 1-800-643-2273 (TTY: 1-800-817-6608). To change your MCO, go to the Verify/Login page. After you log in, click "Choose a Plan."

What is a Primary Care Provider (PCP)?

Your PCP is the doctor, clinic or other health provider you choose to manage your health care. Your PCP will get to know you and your health care needs. Your PCP will see you when you are sick or need a checkup and refer you to specialists when you need them.

Can I change my PCP?

Yes. To change your PCP, call your MCO at the telephone number on your medical card.