Medicaid = Cardinal Care

Did you know that CCC Plus and Medallion 4.0 will soon be called Cardinal Care?

First, some definitions:

CCC Plus – Commonwealth Coordinated Care Plus (CCC Plus) is a Medicaid managed long-term services and support program that serves over 260,000 individuals throughout the Commonwealth of Virginia. CCC Plus uses an integrated delivery model, across a comprehensive range of health services, to assist members with complex care needs. Enrollment in the program is required for qualifying individuals, who benefit from the person-centered care management program. CCC Plus strives to improve health care quality, access and efficiency for its members through contracted managed care organizations, also known as health plans. (https://www.dmas.virginia.gov/for-members/managed-care-programs/ccc-plus/)

Medallion 4.0 – The Medallion 4.0 is a statewide Medicaid program. The Medallion 4.0 program provides services to qualified members in the areas of maternity care, including early prenatal care, case management, and postpartum care; care for infants and children, including early intervention services, immunizations, screening, and preventive care; and wellness, behavioral health, community mental health services, behavioral therapy, family planning and chronic disease support for adults. (https://www.dmas.virginia.gov/for-members/managed-care-programs/medallion-40/)

Fee for Service (FFS) – People with Medicare or private health insurance, people receiving long-term care services, and children in foster care receive Medicaid coverage through a fee-for-service arrangement. The provider charges a fee for each service and receives payment from DMAS for each service. (https://www.dss.virginia.gov/files/division/bp/medical_assistance/intro_page/faq/about.pdf)

The transition to Cardinal Care is planned for July 2022 (if the state budget is approved by then).  Phase I is the merging of the products and rebranding, which won’t really affect providers.  Phase II will be implemented January 2023 and more changes will take place.

Changes in service due to transition:

  • When members transition between Medallion 4.0 and CCC plus, sometimes they are assigned FFS for about a month while the transition is going through.  This will not happen once the two are combined.
  • A regional open enrollment will be instituted rather than the entire state having open enrollment at the same time.
  • There will be unified contracts and accountability and oversight will be aligned
  • A Responsive Model of Care will be instituted.  More information on page 13: https://www.dmas.virginia.gov/media/3910/medicaid-managed-care-advisory-commitee-march-29-2021-final.pdf.  Those who have CCC Plus do have care coordinators already and after the transition, there will be determination on how much care coordination and care management a member receives based on an analytical tool that differs by MCO.
  • Providers may receive re-contracting information
  • You may have already experienced the change in system to MES.  If you have questions about that, contact admin@virginiaaba.org

What stays the same:

  • Access to care
  • No disruption to members or providers
  • Same 6 MCOs (Aetna, Anthem, Optima, Molina, United Healthcare, VA Premier)

Also, please note that the continuous coverage afforded to Medicaid recipients since March 2020 (due to the pandemic and under the Families First Coronavirus Response Act – FFCRA) will most likely expire in July 2022.  Continuous coverage means that people who were eligible for Medicaid in March of 2020 or later will remain on Medicaid  until the public health emergency (PHE) ends, even if they are no longer qualified for the service.  When the PHE ends, DMAS will redetermine eligibility for all Medicaid recipients and some may lose coverage.  It can take up to 12 months to complete the redetermination.  DMAS is working on “unwinding” in their anticipatory planning efforts. There are three phases of this unwinding – 1. Automation, 2. Staff Augmentation, 3. Outreach/Communication.

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