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Eligibility of Pregnant Individuals at the End of their Postpartum Period

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Effective Date:

All Providers Participating in the Virginia Medicaid and FAMIS Programs and Managed Care Organizations
Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to serve as a reminder to providers delivering prenatal and postpartum care services to individuals of eligibility rules surrounding the end of the postpartum period for pregnant individuals. Most pregnant individuals are re-evaluated at the end of the 60-day postpartum period. Please see the below guidance for special processes during the COVID health emergency period.

During the COVID-19 Public Health Emergency (PHE):

  • Most members enrolled in Medicaid for Pregnant Women and postpartum members enrolled in non-pregnancy related coverage are protected by the COVID-19 Federal (PHE) Maintenance of Effort and will not have benefits reduced or terminated unless they are reported deceased, move permanently from the state, or request closure of their benefits.
  • Members enrolled in FAMIS MOMS, FAMIS Prenatal Care, or CHIPRA-214 individuals enrolled in Medicaid for Pregnant Women are re-evaluated at the end of their 60-day postpartum period for eligibility in other coverage groups and enrolled in ongoing eligibility or closed if no longer eligible as this population is not protected by the Maintenance of Effort.

Post COVID-19 PHE:

  • After the end of the COVID-19 Public Health Emergency, all members must have their eligibility reviewed before reduction or closure of benefits. When individuals are found eligible for ongoing coverage, they are moved to a new coverage group with no break in eligibility.

When members have their eligibility reviewed, they may remain eligible for full or limited coverage. Individuals who have provided all information necessary to review their eligibility and are not enrolled in Medicare who are found ineligible for full coverage are referred to the Federal Marketplace to be evaluated for a Qualified Health Plan or Advanced Premium Tax Credits. Thank you for continuing postpartum care to these individuals and all of Virginia’s members.




Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996


Service authorization information for fee-for-service members.


Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

Managed Care Programs

Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE).  In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider.  The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Medallion 4.0

CCC Plus


Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members.

For credentialing and behavioral health service information, visit:, email:,or

Call: 1-800-424-4046


Monday–Friday 8:00 a.m.-5:00 p.m.  For provider use only, have Medicaid Provider ID Number available.



Aetna Better Health of Virginia


Anthem HealthKeepers Plus


Magellan Complete Care of Virginia

 1-800-424-4518 (TTY 711) or 1-800-643-2273

Optima Family Care


United Healthcare


1-844-752-9434, TTY 711

Virginia Premier

1-800-727-7536 (TTY: 711),