The Virginia (VA) Medication Assistance Program (MAP) 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 MAP provides insurance cost support or directly purchased medications through four service options: Direct Medication Assistance Program; the Medicare Prescription Assistance Program; the Insurance Continuation Assistance Program; and the Health Insurance Marketplace Assistance Program.
- VA MAP
- Medicaid Expansion Enrollment
- ACA Insurance Enrollment
- Emergency Preparedness
- Recent Announcements
VA MAP UPDATES, PER THE COVID-19 PANDEMIC
VA MAP, in continuously keeping abreast of the ongoing COVID-19 situation, is ensuring that clients, throughout all VA MAP programs, are able to maintain continuity of needed services. Below is regularly updated information regarding any updates to VA MAP programs, as well as what is being done to maintain complete and continued assistance.
UPDATE - SHIPPING MEDICATIONS TO HOME
October 13, 2020
Shipping medications to home may be an option for VDH clinical services/programs for which medications that can be self-administered are prescribed and then filled by the Division of Pharmacy Services (DPS). Some self-administered medications may not be eligible for this ship to home option. Please refer to the policy documents listed below for further information.
Request Form - Alternate Delivery of Medication(s) Ship to Home
Presentation Slides from the October 2, 2020 VA MAP Quarterly Call
UPDATES FOR PROVIDERS REGARDING VA MAP OPERATIONS AMID COVID-19
The Virginia Medication Assistance Program (VA MAP) requests that if you have not yet set up access to the Secure File Transfer Protocol (SFTP) folders (Cerberus), please contact Cristina Gorman (cristina.gorman@vdh.virginia.gov). The STFP folders are a secure method to send VA MAP eligibility applications, as well as any supporting documentation (Proof of Residency, Income, Insurance cards, etc.). VA MAP will be using this secure folder structure going forward until it is replaced by VDH’s new client level data system that will permit direct upload of applications and supportive documentation. While many sub-recipients have gained SFTP folder access, VA MAP is still receiving faxes, rather than STFP uploads. VA MAP requests that everyone begin submitting all eligibility documents using their assigned STFP Folder. For sub-recipients that have a complex agency structure that does not easily accommodate or allow SFTP folders, we understand you will need to continue to fax documentation until the new client level data system is available or we are eventually able to establish secure folders for your agency.
In addition to not receiving applications using the STFP folders, VA MAP is also receiving a high percentage of incomplete applications. We know everyone is extremely busy, but receiving completed applications is vital to VA MAP staff’s ability to enroll clients into the appropriate program within 14 days or less. And, filling our race and ethnicity data for clients on applications is needed for our ADAP report to HRSA. Please be sure to complete each section of the VA MAP application, including all insurance questions and provide legible and complete proofs of income and residency. If you have questions about how to complete an application, please contact the VA MAP Hotline at 855-362-0658 (toll free). Also, if a client is eligible for Medicaid based on income, please collaborate with your Case Managers to help clients apply for coverage, ensuring compliance with the Ryan White payer of last resort requirement.
Assistance for Clients Who Have Employer Based Coverage - Letter (April 29, 2020)
Assistance for Clients Who Have Employer Based Coverage - Letter - Spanish (May 4, 2020)
Information regarding RWHAP B Services For Eligible Clients Who Have Lost or Have Higher Costs For Employer Insurance Due to COVID-19 (April 24, 2020)
COVID-19 RESPONSE FOR VA MAP
March 12, 2020
For more information about coronavirus in Virginia, please use this link to the Virginia Department of Health, www.vdh.virginia.gov/coronavirus. Up-to-date information on the status of the virus outbreak is available from the Centers for Disease Control and Prevention (CDC).
For other medication access concerns or questions related to eligibility, contact the VA MAP hotline toll free at 1-855-362-0658.
If you are a medication access site and have any questions related to placing medication orders for clients on the Direct Medication Assistance Program (Direct MAP), please call Central Pharmacy at 804-786-4326.
If you are a Ryan White Part B provider and have questions about services other than medication access, please contact your HIV Services Coordinator.
Updated VA MAP Application Forms in Response to COVID-19
For PDF Applications, Recertifications, and Medical Certification Forms - after download, click the "Fill & Sign" option in order to fill out and save the complete form to your desktop.
VA MAP Application Form (December 2020)
VA MAP Application Form - Spanish (December 2020)
Recertification Application (April 2020)
Recertification Application - Spanish (December 2020)
Medical Certification Form (April 2020)
Additional 30-day Medication Request Form
VA MAP Enrollment Numbers (as of August 16, 2021)
- Direct Assistance: 2,112
- Medicare Prescription Assistance Program: 888
- Insurance Continuation Assistance Program: 824
- Health Insurance Marketplace Assistance Program (clients in ACA): 1,193
- Total VA MAP Clients: 5,017
Clinical Support and Policy Development
In 1996, an VA MAP (ADAP from 1996 to 2019) 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 VA MAP utilization and assess budgetary implications of trends and program changes.
For more information about the committee, please see the VA MAP Advisory Committee Scope.
VA MAP Quarterly Call
Schedule for all 2021 VA MAP Quarterly Calls
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.
August 13, 2021
Check out our Improved Website
We are thrilled to announce that we have launched a new version of CoverVA.org. The new website includes a chat feature, which allows you to chat with a real person about your Medicaid questions. You can learn more about eligibility, how to submit an application, or how to file an appeal. Help is available in both English and Spanish.
The new website also features:
- Simpler navigation
- Improved display on mobile devices
- Better search options
Explore the new CoverVA.org to learn more about Virginians’ Medicaid options and find health coverage choices for you and your family.
Visit Our New Site
February 2020
Virginia Medicaid offers several low-cost and no-cost health coverage programs for eligible children, pregnant women and adults, including individuals with disabilities. To find out more about each program, follow the links below.
Monthly Eligibility by Program
You may qualify for health coverage from Virginia Medicaid if your household’s monthly income is at or below the following amounts.
| HOUSEHOLD SIZE | MEDICAID FOR CHILDREN UNDER AGE 19 & PREGNANT WOMEN | MEDICAID FOR ADULTS AGE 19-64 | FAMIS FOR CHILDREN UNDER 19, FAMIS MOMS FOR PREGNANT WOMEN & PLAN FIRST | ||
|---|---|---|---|---|---|
| 1 | $1,575 | $1,469 | $2,181 | $851 | $1,436 |
| 2 | $2,127 | $1,983 | $2,946 | $1,150 | $1,940 |
| 3 | $2,680 | $2,499 | $3,711 | - | - |
| 4 | $3,233 | $3,014 | $4,477 | - | - |
| 5 | $3,785 | $3,529 | $5,242 | - | - |
| 6 | $4,337 | $4,044 | $6,007 | - | - |
| 7 | $4,890 | $4,560 | $6,773 | - | - |
| 8 | $5,442 | $5,074 | $7,538 | - | - |
| Each additional | $553 | $516 | $766 | - | - |
2020 Income Guidelines as of January 17, 2020
For further information, please see Cover Virginia - Our Programs.
2021 ACA Enrollment Information
February 16, 2021
2021 Special Enrollment Period (SEP)
Beginning February 15, 2021 a new SEP will be available to all Marketplace-eligible consumers who are uninsured or underinsured. This SEP period will continue through August 15, 2021. During this time eligible Virginia Medication Assistance Program (VA MAP) clients may be able to enroll into an insurance plan through the Marketplace. VA MAP has identified clients within its records that may be eligible for this SEP. VA MAP’s contracted insurance enrollment assister, Benalytics, will complete all Marketplace enrollments during this SEP and will continue to enroll eligible clients into Medicaid. Please see the additional information below.
2021 Special Enrollment Period (SEP) - Further Information
Special Enrollment Period and Medicaid Data Exchange
December 7, 2020
Open Enrollment Check-In Sessions
The Virginia Medication Assistance Program (VA MAP) is conducting the 3rd open enrollment check-in on Tuesday, December 8, 2020 from 10:30a.m. - 11:30 a.m. This will be an opportunity for enrollment assisters to ask questions about the enrollment process. VA MAP will also provide feedback on how enrollment is progressing, including challenges and successes. Please use the following information to connect to the check-in session.
- Dial: 1-866-845-1266
- PIN: 37681298
Please note that the above information is a change from what was previously posted for this session. Due to many participants experiencing challenges with connecting on the Google platform for the last enrollment call, we are using one of our conference lines for this session.
November 16, 2020
The Virginia Medication Assistance Program (VA MAP) partners with Benalytics to help eligible clients enroll in insurance coverage. This partnership has developed an enrollment website to assist clients with enrollment options. The My VA MAP website is officially live at this link www.MyVAMap.com.
2021 Enrollment Documents
The Virginia Medication Assistance Program is providing the following documents to assist community partners and clients with the open enrollment process. Updated documents and other information will be posted to the website as needed.
- 2021 Insurance Carrier Plan Chart
- 2021 Insurance Enrollment Cover Sheet - Use when sending enrollment documents to VA MAP
- 2021 ACA Enrollment Form (Downloadable and Fillable PDF)
- 2021 ACA Enrollment Form (Word)
Benalytics, VA MAP's enrollment assister, is available to assist clients with enrollment into Marketplace (ACA) plans, Medicaid and Medicare prescription drug plans.
Open Enrollment Hours: Mon-Fri, 8 am-7 pm and Sat, 9 am-2 pm
Communications
Open Enrollment Communications to Clients
- 2021 Open Enrollment Letter to Clients - English
- 2021 Open Enrollment Letter to Clients - Spanish
- 2021 Open Enrollment Announcement
Open Enrollment Communications to Providers/Community Partners
Emergency Preparedness
In preparation for the hurricane season, June 1 through November 30, the Virginia Ryan White HIV/AIDS Part B (RWHAP B) program asks all of its partners and consumers to be prepared ahead of time. To assure adequate medication supplies, we ask all providers and consumers to assess medication refill needs before any storm affects Virginia. If consumers access medications at local health departments, mail order, or retail pharmacies, encourage and help them have peace of mind and get refills now. People Living with HIV (PLWH) may be displaced within Virginia if a region is impacted (particularly those in eastern and central regions), and others may be from out-of-state if they evacuate to Virginia. To help everyone be prepared, VDH has created new tabs on the Ryan White program sites for "Hurricane/Emergency Preparedness." You will find information, policies, procedures, and forms to help PLWH who need emergency services during such events. If you need to provide emergency services to clients during or after a hurricane, the information you need is in a convenient location on this page, as well as the HIV Care Services web page. Stay safe and please reach out to the RWHAP B team if you have any question or need additional information.
It is important for each of us to be prepared to protect ourselves as well as our loved ones during this hurricane season. VDH has created Social Media Took Kits for Hurricane Preparedness.
Click on the following link for pre- and post-event information on severe weather preparedness and safety information.
Virginia's Department of Emergency Management has a prepared a list of needed terminology and information in the event of a hurricane in Virginia - VDEM - Hurricanes.
VA MAP and VA Ryan White HIV/AIDS Programs Part B Clients
Health Departments and Sub-recipients
- Fax Cover Sheet - Hurricane Preparedness for Health Departments with VA MAP Clients
- RWHAP B Services Tracking for Out of State Clients (Excel)
- Prescription Order Form
- Hurricane Preparedness for RWHAP Sub-recipients
Emergency Enrollment
Recent Announcements
September 8, 2021
VA MAP has updated its policies regarding applicants with Low Income Subsidy (LIS) assistance. Applicants with LIS who meet eligibility criteria will be provided cost sharing assistance, regardless of the amount of their subsidy (i.e., partial or full). Please read the policy below for more details.
August 27, 2021
PROVIDE System - Phase 1 Go-Live - August 30, 2021
On Monday, August 30, VA MAP & Groupware Technologies (GTI) will launch the Phase 1 implementation of the PROVIDE system. This new system provides an avenue for clients and/or their providers to submit VA MAP eligibility assessments (i.e., new applications and recertifications) electronically. Click the link below for additional information.
August 23, 2021
The Virginia Medication Assistance Program (VA MAP) has posted policy and procedure documents for accessing Cabenuva, the first FDA-approved long-acting injectable antiretroviral (LARV) medication. Please review the documents below.
- Long-Acting Injectable Antiretroviral (LARV) General Policy
- Cabenuva Specific Policy
- Administrative Log - Rilpivirine
- Administrative Log - Cabotegravir
Please direct any additional questions or concerns not answered in the general LARV or specific Cabenuva policies and procedures to Jasmine Christine Ford, HIV Care Services Clinical Coordinator in the Department of Disease Prevention, at jasmine.ford@vdh.virginia.gov.
May 11, 2021
Medicaid Enrollment Updates
As of April 1, 2021, the 40 Quarters Rule, which required Green Card holders (lawful permanent residents) to prove that they or members of their household had at least a 10 year work history in order to qualify for Virginia Medicaid, has been removed. Green Card holders (lawful permanent residents) with five years or more of residency in the United States may now be eligible for free or low-cost health coverage from Virginia Medicaid. Previous applicants must reapply. Additional information can be found using the link and letter listed below.
Beginning July 1, 2021, Virginia’s nationally recognized Smiles For Children (SFC) program will expand to provide comprehensive dental coverage for adults in full-benefit Medicaid covered groups. Dental coverage will continue for children and pregnant women. The new dental coverage for adults will focus on overall oral health, prevention, and restoration and will be similar to the coverage currently available to pregnant women. The program name will remain SFC with a new tag line, “Improving Dental Care for Children and Adults.”
As of March 24, 2021, the following additions and changes were made to the VA MAP formulary.
- Delstrigo and Cabenuva were added
- **Even though Cabenuva has been added to the formulary, VA MAP specific procedures for accessing Cabenuva are not yet available. Please check this website for updates.
- The medical exception requirement was removed from Edurant (rilpivirine)
The updated VA MAP formulary can be found at: https://www.vdh.virginia.gov/disease-prevention/formulary/
Last Updated: September 15, 2021.