What is Cardinal Care Virginia Medicaid Program?

Cardinal Care is Virginia’s unified Medicaid managed care program, designed to streamline and improve the healthcare experience for both Medicaid members and healthcare providers in the state. This program integrates the previous Medallion 4.0 and CCC Plus programs into a single, comprehensive system, aiming to reduce confusion and enhance the continuity of care.

Cardinal Care covers a full spectrum of Medicaid managed care services. This includes long-term services and supports, all within established screening and coverage criteria. Importantly, it continues the commitment to providing comprehensive care management for individuals with significant health needs, ensuring that vulnerable populations receive the attention and resources they require.

One of the major benefits of Cardinal Care is the simplification it brings to administrative processes, particularly for healthcare providers. Instead of navigating multiple contracts and credentialing processes under the former Medallion 4.0 and CCC Plus systems, providers now operate under a single contract and credentialing framework for each participating health plan. This consolidation reduces administrative burden, allowing providers to focus more on patient care and less on paperwork.

For Medicaid members, Cardinal Care offers a more user-friendly and less confusing experience. The unified program reduces the likelihood of enrollment churn between managed care and fee-for-service systems. This stability in enrollment ensures better continuity of care as members’ health needs evolve over time. Members can expect a more seamless experience when accessing the healthcare services they need.

Despite the changes, several key aspects of Virginia Medicaid managed care remain consistent under Cardinal Care. The program continues to partner with the same Managed Care Organizations (MCOs) that were involved in the Medallion 4.0 and CCC Plus programs. This ensures a degree of familiarity and stability within the provider network. Furthermore, providers will continue to utilize existing systems like the DMAS web-based Automated Response System (ARS), the Medicall telephonic system, and 270/271 eligibility transactions to verify member eligibility and managed care enrollment. These familiar tools help maintain efficiency and minimize disruption for providers.

The DMAS enrollment broker continues to support the Cardinal Care program. Medicaid members have the option to select or change their MCO during open enrollment periods. This can be done through the dedicated Cardinal Care Managed Care enrollment website or by contacting the provided phone number. This ensures members retain control over their healthcare choices within the managed care system.

It’s important to note that while the program transitions to Cardinal Care, existing blue-and-white Medicaid ID cards remain valid for fee-for-service claims processing. New Cardinal Care Plan First ID cards are also being issued, reflecting the program’s specific, limited benefits coverage where applicable. MCOs have also issued updated ID cards featuring the Cardinal Care logo to replace the previous Medallion and CCC Plus program names.

For any questions or further information regarding Cardinal Care Managed Care, individuals and providers can reach out via email to the dedicated contract inbox at [email protected]. Additionally, providers are encouraged to contact their specific managed care health plan for more detailed information and guidance. Contact details for each participating MCO are readily available, ensuring that all stakeholders have access to the support and information they need to navigate the Cardinal Care program effectively. These resources ensure a smooth transition and ongoing support for both members and providers within the Virginia Medicaid system.