What is Cardinal Care? Understanding Virginia Medicaid’s New Program

Cardinal Care is Virginia’s streamlined approach to Medicaid managed care, designed to improve the healthcare experience for both members and providers. This unified program replaces the previous Medallion 4.0 and CCC Plus programs, aiming to create a simpler, more efficient system for accessing and delivering healthcare services within the Virginia Medicaid framework.

Cardinal Care Managed Care encompasses the full spectrum of services previously covered under Medicaid managed care, including essential long-term services and supports. These services are available based on established screening and coverage criteria, ensuring that individuals with significant health needs continue to receive comprehensive and coordinated care management. This commitment to comprehensive care means that members can expect continuity in the vital services they rely upon.

Streamlined Benefits for Medicaid Providers

For healthcare providers in Virginia, Cardinal Care brings significant improvements by simplifying administrative processes. The consolidation of Medallion 4.0 and CCC Plus into a single program means providers now operate under just one contract and credentialing process for each participating health plan. This reduction in administrative complexity allows providers to focus more on patient care and less on navigating multiple program requirements. This unified system ensures clarity and reduces the burden associated with managing different sets of rules and regulations.

Enhanced Experience for Medicaid Members

Members of Virginia Medicaid also benefit significantly from the Cardinal Care program. The single, unified managed care program is designed to reduce confusion and simplify the overall member experience. By eliminating the complexities of multiple programs, Cardinal Care aims to decrease enrollment churn between managed care and fee-for-service models. This stability in enrollment, coupled with a unified approach, leads to improved continuity of care as members’ health needs evolve over time. The goal is a more seamless and less fragmented healthcare journey for every Medicaid member in Virginia.

Continuity and Key Program Features

While Cardinal Care represents a significant step forward, it also maintains key elements of the existing Virginia Medicaid managed care system. The same Managed Care Organizations (MCOs) that administered Medallion 4.0 and CCC Plus continue to partner with Virginia Medicaid under Cardinal Care. This ensures a degree of familiarity and stability for both providers and members. Furthermore, essential tools and systems remain in place. Providers will continue to utilize 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, ensuring minimal disruption to established workflows.

The DMAS enrollment broker continues to support members in navigating the Cardinal Care program. Members retain the ability to select or change their MCO during open enrollment periods. This can be done conveniently through the Cardinal Care Managed Care enrollment website (https://www.virginiamanagedcare.com/) or by contacting the enrollment phone number at 800-643-2273 (TTY: 800-817-6608).

Understanding Your Medicaid ID Cards

It’s important to understand that the transition to Cardinal Care does not invalidate existing Medicaid ID cards. The blue-and-white Medicaid ID cards remain valid and should continue to be used. These cards, both old and new, facilitate claims processing. The updated cards include enhanced information to assist with claims processing and provide essential contact details for both members and providers. New Cardinal Care Plan First ID cards are also being issued and clearly indicate the program’s specific, limited benefits coverage. For managed care members, MCOs have issued new ID cards featuring the Cardinal Care logo, replacing the Medallion and CCC Plus program names, to reflect the unified program.

Staying Informed and Getting Help

To ensure a smooth transition, MCOs are committed to providing specific guidance regarding any Cardinal Care related updates to contracting, claims, and service authorization processes. Providers should expect to receive detailed information from their respective MCOs. For any general inquiries regarding the Cardinal Care Managed Care program, you can reach out to the dedicated contract inbox at [email protected]. Additionally, providers are encouraged to contact their managed care health plan directly for more specific information and support. Contact details for each participating MCO are readily available:

Cardinal Care Managed Care Plans Provider Services Contact Information

Cardinal Care represents Virginia’s commitment to simplifying and enhancing the Medicaid managed care experience. By unifying previous programs and maintaining essential services, Cardinal Care aims to provide a more streamlined, efficient, and user-friendly healthcare system for both Medicaid members and providers throughout Virginia.