Update to the Enrollment of Afghan Immigrants
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The purpose of this bulletin is to notify providers of an update to the Medicaid eligibility guidance for Afghan immigrants. Federal legislation has extended qualified immigration status for immediate Medicaid/CHIP eligibility to all Humanitarian Parolees, provided they meet all other factors.
Eligible Humanitarian Parolees are those who either:
- Were paroled into the United States between July 31, 2021, and September 30, 2022
- Are a qualifying relative of someone who received parole in that period, even if they receive parole after Sept 30, 2022.
A qualifying relative is a spouse, parent, or child of a parolee, or a legal guardian of a parolee who is determined to be an unaccompanied child.
This aligns eligibility among the three main immigration statuses assigned to Afghan refugees: Special Immigrant Visa (SIV), Special Immigrant Parolee (SIP), and Humanitarian Parolee. The exception to eligibility applies to non-pregnant adults that arrived prior to July 31, 2021. They are subject to the five year bar, but are eligible for payment of emergency services and Marketplace coverage.
For those individuals who attest to meeting all eligibility factors, enrollment in Hospital
Presumptive Eligibility (HPE) is typically a faster path to temporary enrollment, however, full
Medicaid applications are encouraged.
Please see the attached summary chart on the next page for updated eligibility information for the three main immigration statuses applied to the majority of Afghan evacuees, and their applicable eligibility.
DMAS Afghan Immigrant Status and Medicaid Eligibility
|
Eligibility Group → |
Hospital Presumptive Eligibility (HPE) |
Medicaid or CHIP (FAMIS) |
Refugee Medical Assistance (RMA) |
Emergency Services |
|
Application Type → Immigration Status ↓ |
HPE Application
|
Medicaid Application** |
Medicaid Application** |
Medicaid Application** |
|
Special Immigrant Visas (SIV) |
Yes* |
Yes |
Yes*** |
No |
|
Special Immigrant Parolees (SIP) |
Yes* |
Yes |
Yes*** |
No |
|
Humanitarian Parolees and/or their qualifying relatives# who are paroled into the United States between July 31, 2021, and September 30, 2022 |
Yes* |
Yes |
Yes*** |
No |
|
Humanitarian Parolees who are children under 19 or a pregnant individual who were paroled into the United States prior to July 31, 2021 |
Yes* |
Yes |
Yes*** |
No |
|
Humanitarian Parolees who were paroled into the United States prior to July 31, 2021 and are not pregnant or under 19 |
Yes, but only if they have resided in the US for at least five years |
Yes, but only if they have resided in the US for at least five years |
No |
Yes, but only if they have resided in the US for less than five years |
|
* HPE is time-limited enrollment that does not provide coverage for costs associated with labor and delivery. **Applications for Medicaid may be filed online (commonhelp.virginia.gov), by phone (833-5CALLVA), or by completing a paper application and returning it to the local Department of Social Services where the individual resides. Applicants must meet all eligibility factors prior to enrollment; this chart only refers to meeting an eligible immigration status. *** Individuals only meet eligibility for RMA if found not eligible for full-coverage (for example, if the individual has income in excess of the Medicaid or CHIP (FAMIS) income limits. RMA is limited to the first eight months of residency. # Qualifying relatives can be paroled later than September 30, 2022. |
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PROVIDER CONTACT INFORMATION & RESOURCES |
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Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
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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 |
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KEPRO Service authorization information for fee-for-service members.
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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. |
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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. |
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Medallion 4.0 |
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CCC Plus |
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PACE |
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Magellan Behavioral Health Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members. |
www.MagellanHealth.com/Provider For credentialing and behavioral health service information, visit: www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or Call: 1-800-424-4046 |
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Provider HELPLINE Monday–Friday 8:00 a.m.-5:00 p.m. For provider use only, have Medicaid Provider ID Number available. |
1-804-786-6273 1-800-552-8627 |
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Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-800-279-1878 |
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Anthem HealthKeepers Plus |
1-800-901-0020 |
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Magellan Complete Care of Virginia |
1-800-424-4518 (TTY 711) or 1-800-643-2273 |
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Optima Family Care |
1-800-881-2166 www.optimahealth.com/medicaid |
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United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
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Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |