Update for Lawful Permanent Residents: 40 Work Quarter Requirement Removed
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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 https://commonhelp.virginia.gov.
OR
Call 1-855-242-8282 (toll free).
Translation and interpreter services are available.
OR
OR
Through their local department of social services.
Go to https://www.dss.virginia.gov/localagency/index.cgi 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.
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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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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 |
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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 |