Managed Care Organizations (MCO)
Most Medicaid and FAMIS enrollees get their care through a Managed Care Organization (MCO). An MCO (also known as a health plan) is an organization with a network of primary care providers (PCPs), specialists, hospitals and other health care providers. A PCP is the doctor you choose to provide and coordinate your or your child's health care. MCOs that provide health care to Medicaid and FAMIS enrollees include Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Magellan Complete Care of Virginia, OptimaHealth Family Care, UnitedHealthcare Community Plan, and Virginia Premier.
Your Medicaid and FAMIS ID CardsOnce you or your child is enrolled in Medicaid or FAMIS, you will get a permanent Commonwealth of Virginia health insurance card from the Department of Medical Assistance Services (DMAS). Each enrolled person in your household will get a card. If that person is also enrolled in a managed care organization (MCO), he or she will also get a separate identification card from the MCO. You are responsible for:
- Making sure the provider accepts Medicaid or FAMIS insurance and your MCO (if you are also enrolled in an MCO),
- Showing your card/s to the provider each time you get medical, dental, or other covered services, and
- Paying any required co-pays.
When first enrolled in Medicaid or FAMIS (including FAMIS MOMS and FAMIS Plus - children's Medicaid), you will be able to access health care through fee-for-service. This means you can see any provider in the Medicaid/FAMIS fee-for-service network for covered services. Before you schedule an appointment or before you get a prescription filled, ask the doctor, clinic, hospital, dentist, pharmacy or mental health provider if they accept Medicaid/FAMIS fee-for-service.
There are no co-payments for FAMIS enrollees in fee-for-service.
If you need help finding a provider who accepts fee-for-service Medicaid or FAMIS, check the Department of Medical Assistance Provider Search.
After a short period of time, most Medicaid and FAMIS members will be enrolled in an MCO, but some will remain in fee-for-service and some services are provided through fee-for-service even when enrolled in an MCO. For more information about covered services provided through fee-for-service to MCO enrollees, please review your MCO member handbook and your Medicaid or FAMIS program handbooks.
All Plan First enrollees will remain in fee-for-service.
Members enrolled in Medicaid, will receive a letter requesting that they select a health plan The Medicaid member's pre-assignment letter will also say which plan they will be enrolled in if they do not select an MCO within the designated time period. Members have 90 days to change their MCO health plan selection from the date when they receive the letter.
All family members do not need to be enrolled in the same MCO. To change your MCO, search for doctors, check your enrollment and more, go to Medicaid Managed Care Website. To change your MCO online click on "Enroll" then, "Get Started". If you want to speak to a live person to change plans, call the Managed Care Helpline at 1-800-643-2273 (TDD 1-800-817-6608). The helpline is available Monday through Friday from 8:30 am to 6:00 pm (Translation Services Available) to assist you with:
- Answering any questions you have about MCOs
- Finding out if your doctor is in the MCO you want
- Choosing the MCO you want for your medical coverage
For Medicaid enrollees age 21 and older, there may be co-payments for some services. See the Medicaid Member Handbooks below for more information.
- [PDF] Medicaid Handbook for Families and Children (English)
- [PDF] Medicaid Handbook for Families and Children (Spanish)
- [PDF] Medicaid Handbook for Aged, Blind and Disabled (English)
- [PDF] Medicaid Handbook for Aged, Blind and Disabled (Spanish)
For more information, please call the managed care helpline at 1-800-643-2273 (TDD: 1-800-817-6608) or visit the Medicaid Managed Care Website.
FAMIS or FAMIS MOMS enrollees can choose their MCO when they apply. If they did not choose an MCO when they applied, they can call Cover Virginia at 1-855-242-8282 to enroll in an MCO.See below for FAMIS MCO choices and a list of covered services.
Co-pays apply for some FAMIS services. Please see your FAMIS member handbook or your MCO member handbook for more information about co-pays required for services.
- [PDF] FAMIS Member Handbook (English)
- [PDF] FAMIS Member Handbook (Spanish)
- [PDF] FAMIS MOMS Member Handbook (English)
- [PDF] FAMIS MOMS Member Handbook (Spanish)
Commonwealth Coordinated Care Plus
Commonwealth Coordinated Care Plus (CCC Plus) members can get more information at www.cccplusva.com
For help choosing a health plan, call the CCC Plus Helpline. Toll-free number: 1-844-374-9159
TTY: 1-800-817-6608. Hours of operation: Monday - Friday, 8:30 a.m. - 6:00 p.m.
Download Acrobat Reader