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 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.
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 (firstname.lastname@example.org). 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)
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)
Self Attestation Form (April 2020)
Self Attestation Form - Spanish (April 2020)
Medical Certification Form (April 2020)
VA MAP Enrollment Numbers (as of May 10, 2021)
- Direct Assistance: 2,061
- Medicare Prescription Assistance Program: 874
- Insurance Continuation Assistance Program: 782
- Health Insurance Marketplace Assistance Program (clients in ACA): 1,098
- Total VA MAP Clients: 4,815
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 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
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.
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|
2020 Income Guidelines as of January 17, 2020
For further information, please see Cover Virginia - Our Programs.
Cubre Virginia is Live!
CubreVirginia.org, a one-stop-shop for Spanish-speaking Virginians seeking information about low- and no-cost health coverage, was launched this month.
We have made incredible progress over the past year in our outreach to non-native English-speaking Virginians. The CubreVirginia website is an important step in our ongoing work to ensure that all eligible men, women and children have access to information about high-quality health coverage in their native language.
Like the English-language Cover Virginia website, coverva.org, cubrevirginia.org is a consumer-friendly source of information for visitors interested in learning who is eligible for FAMIS and Medicaid, what services are covered, and how they can apply for coverage. Additional languages are available through Google Translate.
Both websites feature an eligibility screening tool- a popular, easy-to-use online assessment to help users understand the income requirements to receive Medicaid coverage. The two websites also provide helpful information for individuals who are seeking to apply for coverage on the federal Marketplace. Open enrollment for the Marketplace began on November 1.
Cover Virginia has attracted more than 2 million views since its launch in 2013. The website is a recognized and trusted source of information for potentially eligible individuals, existing Medicaid members and health care advocates.
- Follow Cover Virginia on Facebook and Twitter for the latest Virginia Medicaid updates.
- Open Enrollment for the Federal Marketplace is happening until December 15. Cover Virginia has resources about the Marketplace available here. Remember, Virginians can apply for Medicaid at any time during the year.
- Medicaid coverage needs to be renewed every year. For more information, visit the Cover Virginia renewal page.
Medicaid Expansion Enrollment Updates
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.
Are you ready for Medicaid Expansion? Visit this page frequently for the latest enrollment updates.
Virginia Medicaid Expansion Enrollment Resources
- Medicaid Expansion Flyer for Marketplace Members
- Enrollment Pathways Toolkit
- Virginia Medicaid Expansion and 2019 ACA Open Enrollment
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
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.
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.
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
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
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
- Prescription Order Form
- Hurricane Preparedness for RWHAP Sub-recipients
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.
As of March 24, 2021, the following additions and changes were made to the VA MAP formulary.
- Delstrigo and Cabenuva were added
- 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/
Special Enrollment Period
The Special Enrollment Period (SEP) through the Federal Marketplace has been extended to August 15, 2021. Benalytics will continue to assist all eligible clients with enrollment into Marketplace plans and Medicaid enrollment. Benalytics will maintain the previously publicized Saturday hours from April 15 – May 15. Weekday hours will remain the same as previously posted. Please refer to the ACA Insurance Enrollment tab for more information.
Last Updated: January 15, 2021.