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The purpose of this bulletin is to notify providers of the planned implementation of Medicaid Managed Care contracts associated with the reprocurement of the new Cardinal Care Managed Care (CCMC) Program under RFP 13330.

On December 30, 2024, The Department of Medical Assistance Services (DMAS) posted the Notice of Award (NOA) announcing statewide contracts for CCMC, awarded to the following Managed Care Organizations (MCOs):

• Anthem HealthKeepers Plus Inc.

• Aetna Better Health of Virginia

• Humana Healthy Horizons of Virginia

• Sentara Health Plans

• United Healthcare of the Mid-Atlantic, Inc.

Additionally, Anthem HealthKeepers Plus Inc. was selected to administer the Foster Care Specialty Plan (FCSP) statewide program.

Implementation is planned for July 1, 2025 and this bulletin provides information and resources for Members and Providers.

All members enrolled in managed care will be receiving information in the mail soon and will have the choice to change their health plan during a special enrollment period June 19– September 30, 2025 (see details below.) The Virginia Managed Care website will help Members find which health plans participate with their doctors and other medical providers, compare health plans and their added benefits, and select the health plan they wish to change to. This will be particularly important for those who are currently enrolled with Molina, see further instructions below.

Key Changes Under the New CCMC Program

• New MCO: Humana Healthy Horizons of Virginia will join CCMC as an MCO starting July 1, 2025.

• Molina Healthcare Exit: Molina Healthcare will no longer be a CCMC MCO after June 30, 2025.
  • Molina members will be enrolled in Humana Healthy Horizons of Virginia, effective July 1, 2025, with a 90-day window (until September 30^th) to change plans if they do not want to stay with Humana.

• FAMIS Plan Choices: FAMIS Members can now select health plans through the health plan enrollment broker.

• Special Enrollment Period for CCMC:
  • Medicaid and FAMIS members may stay with their current health plan or switch during the transition.

  • Enrollment period: June 19 – September 30, 2025.

  • Effective dates based on date of selection:
    • If selected on or before the 18th of the month, the change will be effective on the 1st of the next month.

    • If selected after the 18th, it will be effective on the 1st of the following month.

  • After September 30, 2025, members must wait for their next Managed Care Open Enrollment Period in 2026 to change plans.

Provider Guidance

Providers should begin contracting with Humana immediately to prevent disruptions in services for Molina members and provide services to other Medicaid members. Humana Healthy Horizons in Virginia: Provider information. Providers should also ensure their demographic and all license and certification information is current in PRSS to avoid any payment delays from DMAS or the MCOs. 

Foster Care Specialty Plan (FCSP) 

Anthem HealthKeepers Plus Inc. will administer FCSP, enrolling all eligible members who are in Foster Care, Adoption Assistance, and Former Foster Care

• Tidewater & Central Virginia regions and those members enrolled in Molina Healthcare: Automatic enrollment in FCSP on July 1, 2025.

• All other regions: Automatic enrollment in FCSP on August 1, 2025.

• Extra benefits include:
  • Dedicated Foster Care Specialty Support Line (Active upon enrollment: Mon–Fri, 8 AM – 5 PM | 833-838-2605)

  •  Care Management support with child welfare system expertise

  • Additional resources such as academic rewards, travel assistance, Chromebooks for learning, clothing support, and employment-related incentives

Opportunities to Learn More. 

Virtual Q&A 

DMAS and its MCOs will host Virtual Question & Answer Sessions for both members and providers to address inquiries and discuss implementation details.

Prior to attending the Virtual Q&A providers should view the DMAS Recorded Educational Presentations for Providers and Members available at:
🔗 DMAS Website

For Members- Virtual Q&A Sessions (no registration required)

• Tuesday, June 10, 2025 | 10:00 AM – 12:00 PM | [Click Here to Join the Microsoft Teams Meeting]

• Tuesday, June 10, 2025 | 4:30 PM – 6:30 PM | [Click Here to Join the Microsoft Teams Meeting]

For Providers- Virtual Q&A Sessions (no registration required)

• Friday, June 13, 2025 | 10:00 AM – 12:00 PM | [Click Here to Join the Microsoft Teams Meeting]

• Friday, June 13, 2025 | 2:00 PM – 4:00 PM | [Click Here to Join the Microsoft Teams Meeting]

Questions?

Below is a link to a Question Submission Form for the Virtual Member and Provider Q & A Sessions. After viewing the recorded presentation, you may submit your questions in advance of the Virtual Q & A to help ensure detailed and comprehensive responses. https://forms.cloud.microsoft/g/k5t1sgzSwd

For further information, please visit the DMAS website or contact CCMC@dmas.virginia.gov

To avoid disruption to claims payment through FFS and the MCOs providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions.  Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest.