Virginia AIDS Drug Assistance Program (ADAP)

The Virginia (VA) AIDS Drug Assistance Program (ADAP) provides access to life-saving medications for the treatment of HIV and related illnesses for low-income clients through the provision of medications or through assistance with insurance premiums and medication co-payments. The program is primarily supported with federal Ryan White (RW) Treatment Extension Act Part B grant funding, which is distributed by a formula based on living HIV and AIDS cases to all states and territories in the United States. VA ADAP provides insurance cost support or directly purchased medications through four service options: Direct ADAP, the Medicare Part D Assistance Program (MPAP), the Insurance Continuation Assistance Program (ICAP) and the Health Insurance Marketplace Assistance Program (HIMAP).


ADAP Enrollment Numbers (as of February 2019)

  • Direct ADAP: 1,922
  • Medicare Part D Assistance Program (MPAP): 719
  • Insurance Continuation Assistance Program (ICAP): 832
  • Health Insurance Marketplace Assistance Program (HIMAP, clients in ACA): 3,140
  • Medicaid Expected: 1,014
  • Medicaid Confirmed: 1,528

Hepatitis C/HIV Co-Infected Treatment Assistance Program Enrollment Numbers (as of April 2018)

  • Number of clients that have accessed program: 94
  • Number of clients that have completed treatment: 85
  • Number of clients in treatment: 3

Clinical Support and Policy Development

In 1996, an ADAP Advisory Committee was created. The committee is comprised of HIV/AIDS medical providers, a pharmacist, and consumers. The committee advises VDH on changes to the formulary, changes in eligibility criteria, adherence issues, and educational concerns. The committee reviews data on ADAP utilization and assess budgetary implications of trends and program changes.

For more information about the committee, please see the ADAP Advisory Committee Scope.


ADAP Quarterly Call

Schedule for the ADAP quarterly call, please see the 2019 Quarterly ADAP Call Schedule

Friday, April 19, 2019 - ADAP Quarterly Conference Call - Powerpoint Presentation Slides



Questions or comments?  Medication Eligibility Hotline 1-855-362-0658

 

Please read these updates and help us with the listed action steps. If you have any questions, please call the VDH Medication Hotline at 1-855-362-0658.


April 2019

Reminder: Annual Renewal Coming Soon!

Medicaid/FAMIS enrollees must renew their coverage annually. When possible, the local Department of Social Services (LDSS) will attempt to renew an enrollee without contacting the enrollee. This is called an ex parte renewal.

For some newly-enrolled adults, renewal may be right around the corner, even if their New Adult Coverage just began on January 1:

  • Adults who were automatically transitioned to the New Adult Coverage (from GAP or Plan First) will maintain the annual renewal date from their prior program. 
  • Adults who completed an Express Application (either as SNAP enrollees or as parents of a child enrolled in FAMIS Plus) will need to renew by their SNAP recertification date, or their child’s renewal date.
  • Adults who completed the full application should expect to get a renewal packet around 10 months after their coverage began. Many newly-eligible adults may find that their local DSS is able to complete their annual renewal ex parte, so they do not need to complete any paperwork at renewal time.

When LDSS renews an enrollee ex parte, s/he will get a Notice of Action that shows that his/her Medicaid/FAMIS coverage will continue for another year. If the LDSS cannot complete an enrollee’s renewal ex parte, s/he will get a prepopulated renewal form in the mail. S/he can then complete the renewal by:

  • Calling Cover Virginia at 1-855-242-8282
  • Going online to www.commonhelp.virginia.gov and “Associating” his/her case with his/her CommonHelp account (Note: The enrollee will need a Case Number and a Client ID number to do this). From there, s/he can select “Renew My Coverage” and complete the renewal online.
  • Correcting any information on the prepopulated renewal form, signing it, and mailing it to the LDSS.

Medicaid/FAMIS Enrollees Must Keep Information Up-to-Date

Medicaid/FAMIS enrollees must report any changes within 10 calendar days (especially changes in address, income, or household size). Failure to update information may result in a cancellation of coverage (for example, when mail from the DSS is returned, the enrollee’s coverage is automatically cancelled). When you help individuals and families apply, remind them to keep their address, income, and household information fully up-to-date with their LDSS or Cover Virginia.

A Medicaid/FAMIS enrollee can report changes by:

  • Calling Cover Virginia at 1-855-242-8282.
  • Going online to www.commonhelp.virginia.gov, and “Associating” his/her case with a CommonHelp account (Note: The enrollee will need a Case Number and a Client ID number). From there, s/he can select “Report my Changes” to update his/her information.
  • Completing a Change Request form and submitting it to the LDSS

Best Practices Once an Application is Submitted

  1. Be sure a client knows how to access his/her CommonHelp account. Write down the client’s tracking number (“T-number”), username, password, and answers to security questions and give to him/her for safe keeping. If the client gave you permission to follow up with the LDSS or Cover Virginia about an application on his/her behalf, you will need the T-number to get case status information, including the name of the worker processing the case from the Cover Virginia Call Center. The name of the worker managing a case is available from Cover Virginia about 2 weeks after the application was submitted.
  2. Submit verifications timely. Write client’s name and case number on each page of the verifications you submit.
  3. Advise the client to check the box giving the LDSS consent to verify information electronically for up to 5 years. This makes it possible for the LDSS to attempt to renew the person’s coverage ex parte. Remember, checking the box does not mean the LDSS can always find information electronically. The person may still have to complete a renewal form.
  4. Remind your client to open mail from any of the following: Cover Virginia, the Virginia Department of Medical Assistance Services (DMAS), LDSS, and his/her Managed Care Organization (MCO).
  5. Encourage your client to think about any providers s/he wishes to provide their healthcare. Help him/her figure out if those providers participate with a Virginia Medicaid MCO.

Managed Care Organizations (MCOs): What You Need to Know

An MCO is a health plan with a group of doctors and other healthcare providers who work together to give health services to the MCO’s members. MCOs have a specific network of providers, including doctors, pharmacies, hospitals, and specialists that an enrollee can go to for healthcare services. There are six MCOs that offer Medicaid coverage in Virginia: Anthem HealthKeepers Plus, Aetna Better Health, Magellan CompleteCare, Optima Health, UnitedHealthcare and Virginia Premier Elite. They all serve members across the entire state, enrolled in any Medicaid/FAMIS plan.

Choosing an MCO

Within the first two months of being approved for Medicaid/FAMIS coverage, most Medicaid/FAMIS enrollees are automatically enrolled in an MCO.

Enrollees who were automatically assigned to an MCO can change to a different MCO within the first 90 days of becoming enrolled in an MCO. After the first 90 days, Medicaid/FAMIS enrollees can only change their MCO once a year (unless special circumstances arise). The chart below summarizes when a Medicaid/FAMIS enrollee can change MCOs after the initial opportunity to change.
When choosing an MCO, it’s important to think about which providers an enrollee may want to provide his/her healthcare. It’s also important to make sure that the doctor an enrollee wants to care for him/her is accepting new patients.

Note: If a Medicaid/FAMIS enrollee has special or complex medical needs, s/he will be enrolled in an MCO program called Commonwealth Coordinated Care Plus (CCC Plus) that helps coordinate the enrollee’s care. Otherwise the person is enrolled in an MCO through the Medallion 4.0 program.

How to see which healthcare providers participate with a particular MCO

To look up whether a provider is in an MCO’s network, Medallion 4.0 enrollees can check out the Integrated Provider Search Tool on www.virginiamanagedcare.com. To get to the Integrated Provider Search Tool, hover over Choose (Find health plans and providers) on the homepage, and when the drop-down menu appears, select “Find a Provider.”

From there, search for a specific provider, or search within a radius to find a provider located convenient to the enrollee. The enrollee will be able to see which MCOs that provider accepts, whether the provider is taking new patients, and whether the provider can serve as the enrollee’s Primary Care Provider (PCP).

A CCC Plus enrollee must use the Integrated Provider Search tool on www.cccplusva.com. S/he should hover over Choose (Find health plans and providers) on the homepage, and select “Find a Provider” from the drop-down menu.

Note: Just because a provider is in a company’s CCC Plus network does not mean s/he will also be in that company’s Medallion 4.0 network, so it’s important to search using the correct website.

Choosing or Changing a Primary Care Provider (PCP)

Most MCOs require a member to choose a Primary Care Provider (PCP). If a newly-enrolled member does not select a PCP within the first 25 days of being enrolled, the MCO may assign that person a PCP. The enrollee can change his/her PCP at any time. After an enrollee changes his/her PCP, s/he will get a new MCO card with the new PCP’s name on it.

Things for Your Client to Consider When Picking a Dentist

Did you ever wonder why the dentist does a certain kind of treatment? Or why you sometimes need to make more than one appointment to fix your teeth?

Sometimes dentists explain what they are doing during your dental treatment, and sometimes they don’t. If they don’t, it’s okay to ask questions. Or if you are a parent, you can ask questions about your child’s treatment. Dentists will be happy to give you answers. It’s part of their job.

It is important to find a dentist you like and trust, because it makes asking questions easier. When you visit the same dental office over and over again, that office is called your dental home. The dentist and their staff welcome you to the office and get to know you and your family. If other members of your family visit the dentist, then it is their dental home too. We recommend that your family see the dentist every 6 months.

Smiles For Children is Virginia’s Medicaid and FAMIS dental program for children and adults. For information about Smiles For Children or to find a dentist in your area, call toll-free: 1-888-912-3456.

SignUpNow Milestones: 50 Workshops and 2,000 Trainees

On March 1, VHCF completed its 50th SignUpNow workshop and trained its 2,000th person since October 2018! We’re not done yet! Check out www.vhcf.org/workshops to find a SUN training near you!

SignUpNow teaches the “ins and outs” of the eligibility requirements, application procedures, and post-enrollment information for Virginia’s Medicaid and FAMIS programs:
  • New adult coverage
  • Programs for children and pregnant women
  • Plan First (family planning)
  • Low Income Families and Children (LIFC) program

SignUpNow participants will be able to provide hands-on assistance to individuals and families who want to apply for Medicaid or FAMIS.

Please share information about SignUpNow with colleagues, including those who work in non-healthcare organizations. More than 150,000 Virginians still need help applying for the New Adult Coverage and more than 59,000 Virginia children are eligible for coverage, but not enrolled.

Keep Track of New Adult Enrollments with the DMAS Expansion Dashboard

To stay current on the number of newly-eligible adults enrolled in Virginia’s New Health Coverage for Adults, check out the Virginia Department of Medical Assistance Services’ dashboard at www.dmas.virginia.gov/#/dashboard. The dashboard breaks down the number of new adult enrollees by locality, age, gender and income as a percentage of the Federal Poverty Level.

DMAS updates the dashboard every two weeks, so you can follow Virginia’s progress in enrolling newly-eligible adults. As of March 22 over 251,000 adults were enrolled!

What does the New Coverage Mean for Local/Regional Jails?

When the New Adult Coverage began in January 2019, many individuals who are incarcerated became eligible for Medicaid coverage for inpatient hospitalizations. Since these individuals have a specific set of needs, the Cover Virginia Inmate Unit (CVIU) was created to receive and process their applications. The CVIU will also manage their cases after enrollment.

Jail staff are encouraged to assist newly-eligible inmates with applying for Medicaid. It is recommended that jail staff make an appointment with Cover Virginia to help the inmate apply for coverage. Staff can call 833-818-8752 to schedule application appointments and help inmates apply.

A person is not automatically re-evaluated upon release, so it’s important to make sure a “Communication Form” is submitted 45 days before the person is scheduled to be released to ensure that s/he has full coverage upon leaving jail. The “Communication Form” lets the CVIU know to move the enrollee into full, “community” Medicaid (New Adult Coverage).

Thank you to our sponsors!

VHCF is grateful to the following organizations for supporting SignUpNow workshops and/or lunches to ensure that as many “helpers” as possible know how to assist Virginians in applying for Medicaid and FAMIS: Aetna Better Health of Virginia, Anthem HealthKeepers, Bob and Anna Lou Schaberg Fund, Bon Secours Richmond, Bon Secours Virginia Health System, Cameron Foundation, Carilion Clinic, Carilion Franklin Memorial Hospital, Community Foundation for a greater Richmond, Danville Regional Foundation, Families Forward, Inova Health System, Jenkins Foundation, Magellan Health, Martinsville-Henry County Coalition for Health and Wellness, Mary Washington Healthcare Foundation, Northern Virginia Health Foundation, Novant Health UVA Health System, Obici Healthcare Foundation, PATH Foundation, Potomac Health Foundation, Richmond Memorial Health Foundation, Robins Foundation, United HealthCare, United Way – Thomas Jefferson Area, Valley Health, VCU Health, Virginia Department of Medical Assistance Services (DMAS) and Williamsburg Health Foundation

Enrollment Update: As of April 1, 2019, there were:

255,592 adults enrolled in the New Adult Coverage
107,765 adults enrolled in Medicaid for Low-Income Families with Children (LIFC)
1,228 young adults enrolled in Medicaid for Former Foster Care Youth (FFC)* (*March 1 data)
40,909 adults enrolled in Plan First
575,760 children enrolled in FAMIS Plus
71,649 children enrolled in FAMIS
14,295 pregnant women enrolled in Medicaid for Pregnant Women (MPW)
1,278 pregnant women enrolled in FAMIS MOMS

VDH/DMAS Announcements

Medicaid Expansion Enrollment Updates

March 2019

If ADAP paid your Affordable Care Act (ACA) Marketplace Health Insurance Plan premiums and medication co-payments in 2018 and now you may have Medicaid, read carefully to learn more about how to get your medications in 2019. Contact the ADAP team at 1-855-362-0658 if you have questions

If you are newly enrolled in Virginia Medicaid, you need to go to Healthcare.gov at https://www.healthcare.gov/ or call 1-800-318-2596 (TTY: 1-855-889-4325) and stop your ACA Marketplace plan.  If you do not take this action, your ACA Marketplace plan may have been automatically renewed for 2019, but now you will not get help with costs.  ADAP stops paying your premiums and medication co-pays because you can get your medications using Medicaid.  Please send a copy of your Medicaid letter or card to Virginia Department of Health, James Madison Building, 1st floor, 109 Governor Street, Richmond, VA 23219 or fax to (804) 864-8050.  Call Benalytics at 855-483-4647 if you need help cancelling your ACA Marketplace plan.  Begin using your Medicaid insurance card to get your medications and health care services.

If you received a notice stating that your Medicaid application has been referred to Virginia for review, you are being evaluated for Medicaid benefits. Continue your ACA Marketplace plan until you receive a final decision from Virginia stating that you are eligible for Medicaid. ADAP keeps paying your premiums and medication co-pays until you are enrolled in Medicaid. Please mail a copy of your ACA Marketplace premium information and card to Virginia Department of Health, James Madison Building, 1st floor, 109 Governor Street, Richmond, VA 23219 or fax to (804) 864-8050.

If you have not received mail from Virginia Medicaid, or it has been misplaced, call the Cover Virginia Call Center at 1-855-242-8282 (TDD: 1-888-221-1590). Their hours are Mon - Fri: 8:00 am to 7:00 pm and Sat: 9:00 am to 12:00 pm.  They can answer any questions you may have about your plan status.  You can also go to their website at coverva.org.  If you are having a hard time accessing medications or medical services, reach out to your Medical Case Manager, Social Worker or other advocate for help.

If the final decision from Virginia is that, you are NOT eligible for Medicaid, continue your ACA Marketplace plan and update your Marketplace application with any changes (such as a change in your household size or income). If you already ended your ACA Marketplace plan, you may qualify for a Special Enrollment Period to enroll in ACA Marketplace coverage with financial assistance.  Go to Healthcare.gov at https://www.healthcare.gov/  or call 1-800-318-2596 (TTY: 1-855-889-4325) to update your Marketplace application or apply during a special enrollment period.  You have 60 days from the date of your denial of Medicaid eligibility to enroll using the Special Enrollment Period, if eligible.  Please mail a copy of your Marketplace premium information and card to Virginia Department of Health, James Madison Building, 1st floor, 109 Governor Street, Richmond, VA 23219 or fax to (804) 864-8050 so that ADAP can continue paying your premiums and medication co-pays.

For questions about Medicaid, call Cover Virginia Call Center at 1-855-242-8282 (TDD: 1-888-221-1590). Virginia Department of Social Services Enterprise Call Center at 1-855-635-4370 can also help with Medicaid and other benefits.

December 28, 2018

Are you ready for Medicaid Expansion?  Visit this page frequently for the latest enrollment updates.

Virginia Medicaid Expansion Enrollment Resources

The Department of Medical Assistance Services (DMAS) has posted the following informational updates regarding Medicaid Expansion:

  • December 19: Medicaid cards mailed to new members
  • December 26: Letters sent assigning new members to health plans, giving them 90 days from January 1 to decide whether to keep that plan or choose a different one
  • January 1, 2019: Coverage begins for newly eligible adults

November 21, 2018

You and your family might qualify for Virginia Medicaid’s new health insurance.  The new health benefits start on January 1, 2019.  Virginia Medicaid sent letters in yellow and white envelopes to people who will get this new insurance.  If you have Plan First and GAP, Medicaid will automatically enroll you.  If you have SNAP or are a Parent of a Child with Medicaid, you can answer three easy questions to sign up.  Cover Virginia can help you sign up online https://www.coverva.org/expansion or phone at 1-855-221-1590.  TDD users dial 1-888-221-1590.  If you got a letter from Medicaid but lost it, Cover Virginia can tell you whether Medicaid sent you a letter.  You can sign up for this new Medicaid insurance any time!

If you had Marketplace insurance last year, you might qualify for this new low to no-cost insurance that will cover your medicines, your doctor and lab visits, and other services.  Call Benalytics at 855-483-4647 and they can help you find out which insurance you can get and help you enroll.

Not sure which steps to take?  Call the ADAP Hotline at 1-855-362-0658.


Please read these updates and help us with the listed action steps. If you have any questions, please call the VDH Medication Hotline at 1-855-362-0658.


ACA Enrollment Updates

March 2019

If you have Anthem coverage, Anthem sent out new cards with a new Bank Identification Number/BIN (BIN 20099). This six-digit number tells the computer database at the pharmacy which health insurance provider is to receive the claim for your prescription. Several people are reporting that the new BIN not working. Anthem confirmed this may be true for some clients, and is working to fix it. Until this problem is fixed, the retail pharmacy should try both the old BIN 003858 and new BIN 020099. As Anthem updates VDH, we will post them to our website. If you are experiencing this issue, please call the medication access hotline at 1-855-362-0658. Clients who are not able to fill using both BIN numbers may qualify for a 30-day temporary fill.

VDH is getting a large volume of 2019 insurance billing statements for Medicaid-eligible clients for the 2019 open enrollment period. For VDH to pay premiums for ACA plans, the following action must be completed:

  • VDH must have an official Medicaid denial for that client, meaning you are determined to NOT be eligible for Medicaid. A lack of response resulting in loss of Medicaid coverage, or a request for withdrawal from Medicaid, are not acceptable substitutes for a denial of coverage.
  • If you are eligible for Medicaid and have lost it, you will need to reapply for Medicaid coverage. Case Managers and Certified Application Counselors can help with reapplication and completing applications correctly. You can also call the medication access hotline (1-855-362-0658) for additional information.

VDH is getting various insurance documents by fax that are hard to read and/or have no contact information listed from the sender. When faxing enrollment worksheets, billing statements, or insurance card copies, please do the following:

  • Include the name and telephone number of the person faxing documents just in case there are questions.
  • Ensure you scan the entire document and not cut any of it off.
  • Include information on the cover page if your fax machine produces poor quality documents.

The Medication Hotline is getting a large volume of calls, but your calls are important to us.  Please leave a message and include your name, contact number, and reason for the call.  Please allow for one business day for returned calls before calling again.

Inform VDH if there is a change in client information (Name, Address, Phone number, Income, etc.). Most VDH communication is by mail or phone and it is important client information is current and that we know information that may affect services from the program.


Client Letters on Open Enrollment

  • If you are a client that receives medication through insurance that VDH pays for, please read this letter (en español).
  • If you are a client that receives medication through a local health department or other approved VDH site, please read this letter (en español).

Open Enrollment Updates

Calls are held weekly for those assisting with open enrollment to ask questions.  Notes from weekly calls are posted below for reference.


December 28, 2018

The below information applies to CIGNA Health Plans only:

January premium payments will not be posted by January 1, 2019 for clients enrolled with Cigna.  The delays are being addressed by Cigna and the carrier notified VDH that all client accounts on the payment lists submitted to Cigna (i.e., enrollments received & approved by December 21) will be placed in a hold status to prevent termination of the coverage.  Clients that are new enrollees with Cigna for 2019 will not be able to use their coverage until these issues are resolved.  Some clients that re-enrolled with Cigna for 2019 may also experience access issues.

Based on the information provided by Cigna, January payments should be posted by January 15, 2019.  If an affected client needs medication before this date, please contact the medication hotline at 855-362-0658.  VDH will process a 30-day temporary approval for those clients to access medications through a local health department or other medication pick-up site.  VDH and Benalytics will also be conducting courtesy calls to clients to share this information.

November 21, 2018

2019 Open Enrollment period started November 1 and ends December 15.  For this year's enrollment, the ACA module in e2VA will not be used to collect insurance enrollment on clients.  The 2019 Insurance Enrollment Worksheet should be completed for each client enrollment.  This is a computer-friendly Word document that information can be entered directly into or it can be printed and filled in manually.  This is same form used during the prior open enrollment period with only three additional elements: household income, family size, and a Medicaid-eligibility question.  If possible, please send the following information with the enrollment worksheet:

  • proof of income
  • proof of residency in Virginia
  • copy of insurance premium data from the Marketplace application

If the enrollment site is a VDH contracted service provider and you have an SFTP (secured) invoice folder (not your SFTP data folder), you may submit documents to the folder.  For all others, please fax the documents to 804-864-8050.

In prior years, some enrollment sites recorded each insurance enrollment on an Insurance Enrollment Tracking Log.  Sites provide these logs to VDH on a weekly basis to confirm receipt of enrollments submitted.  You can still send these logs to VDH this year.

Remember, if clients had Marketplace insurance last year or even insurance through their employers, they might qualify for Virginia Medicaid’s new low to no-cost insurance that will cover medicines, doctor and lab visits, and other services.  Benalytics can help clients find out which insurance they can get and help enroll them.  Client should call Benalytics at 855-483-4647.

Contact the Medication Access Hotline with any questions about open enrollment at 1-855-362-0658.


Virginia Department of Health (VDH) Supported ACA Marketplace Insurance Plans for 2019