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Update for Lawful Permanent Residents: 40 Work Quarter Requirement Removed

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Effective Date:

All Medicaid Providers and MCOs
Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to alert Medicaid providers to a change in a Virginia healthcare coverage (Medicaid) policy that was made in the 2020 Appropriations Act, which could impact patients who are residing in the United States as lawful permanent residents (LPRs). In the past, LPRs who had met the five-year federal residency rule were also required to show proof of at least 40 quarters of employment for which Social Security taxes were paid prior to meeting Medicaid eligibility requirements.

In accordance with Item 313.XXX of the Act, as of April 1, 2021, LPRs who entered the U.S. on or after August 26, 1996 and have five years of residency may now be eligible for healthcare coverage with no requirement to have accumulated work quarters. All other Medicaid eligibility requirements must still be met.

Individuals who have been denied Medicaid coverage in the past due to the lack of work quarters and LPRs with at least five years of residence in the U.S. are encouraged to apply for Medicaid through one of the following ways:

How to Apply for Health Insurance Programs in Virginia

Apply online at CommonHelp

Go to


Call 1-855-242-8282 (toll free).

Translation and interpreter services are available.



Through their local department of social services.

Go to for contact information.

For an individual’s eligibility to be accurately determined, a full eligibility determination must be completed. Anyone needing healthcare coverage is strongly encouraged to apply using one of the ways listed above.



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.


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),