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SUN Spring Newsletter

  • CoverVirginia Call Center and New Central Processing Unit
  • Recent Changes to CommonHelp
  • Dental Services for Pregnant Women
  • FAMIS Coverage for State Employees
  • FAMIS Marketing and Outreach
  • SignUpNow Trainings in June
  • Enrollment Numbers

The CoverVirginia Call Center and New Central Processing Unit
In 2014, the CoverVirginia (CVA) call center received over 500,000 calls and accepted 67,000 new telephonic applications and 4,000 telephonic renewal applications. It's new Central Processing Unit (CPU) processed and determined eligibility for over 53,000 applications that were sent down from the Federally Facilitated Marketplace (or to the state as "likely eligible" for a state insurance program (FAMIS or Medicaid). Additionally, the CPU performed expedited enrollments for over 13,000 deemed newborns submitted by hospitals and 1,400 Hospital Presumptive Eligibility enrollments.


The CVACPU will begin processing all telephonic applications in mid- April. If these applications are approved and enrolled by the CPU, they will be transferred to the enrollee's local Department of Social Services for ongoing case maintenance. Any new applications received via CommonHelp and annual renewals of coverage will still be processed by the local DSS.   


Recent Changes CommonHelp 

On March 29th, the Department of Social Services unveiled an updated CommonHelp website. The new home page clearly shows two separate paths for applying for benefits - Health Care Only (for Medicaid, FAMIS or Private Insurance via the Federal Healthcare Marketplace) or All Benefits Programs (for all DSS programs, including health care). The two paths allow for a faster, tailored experience for those applying for Health Care Only.

Major improvements to the website impacting Health Care Only applicants are the MMIS Check and Identity Proofing.  During the application process, once the customer has provided the information about themselves and any other household members on the "People in Your Home" page, CommonHelp will check the Medicaid Management Information System or MMIS (using Name, SSN, and DOB) to determine if any individuals are already covered. If a family member is already enrolled, the applicant will be reminded that they do not need to reapply for that person. This check should reduce the incidence of duplicate applications. ID Proofing is an added layer of consumer protections that may allow DSS to verify more application information electronically and thus may result in near-real time disposition of the case.


Dental Services for Pregnant Women
Until now, only emergency dental care was available for pregnant women.  Medically appropriate dental coverage is now available for pregnant women enrolled in Medicaid and FAMIS MOMS. It is provided via the Smiles For Children program, which is administered by DentaQuest. Covered services include: examinations, cleanings, fillings, root canals, gum related treatment, crowns, bridges, partials, dentures, x-rays, extractions and other oral surgeries, and other appropriate services. Note: braces are not included in dental coverage for women age 21 and older.   Pregnant members who are under 21 years old can get full benefits through Virginia's Smiles For Children dental program, including braces.  


State officials estimate about 45,000 pregnant women will be eligible for these services. Medicaid for Pregnant Women and FAMIS MOMS cover low-income women during pregnancy and for two months after giving birth. Pregnant moms on Medicaid and FAMIS MOMS in need of assistance finding a dentist to provide these services should call 888-912-3456 for help. The call center is available Monday-Friday from 8AM to 6PM. A new informational one pager is available for enrollees. Click here to view.  


FAMIS coverage for State Employees

On January 1st FAMIS became a new coverage option for the children of lower income state employees. Previously, dependents of state employees who were eligible for subsidized participation (where part of the insurance premium is paid by the state) in the state's health plan could not receive coverage through FAMIS. This restriction was removed as part of the Governor's Healthy Virginia Plan. Additionally, a waiver amendment has been approved by the Centers for Medicaid and Medicare Services (CMS) to allow state employees and their dependents to also enroll in the FAMIS MOMS program. This applies to state employees and their dependents who are eligible to get subsidized health insurance. 


Eligible uninsured children of new state employees, meaning they meet all the financial and nonfinancial requirements, can now be enrolled in the FAMIS programs. Upon hiring, the employee will be given information about this option for his/her children. 


DMAS is currently working with the Virginia Department of Human Resource Management (DHRM) to inform state employees whose children are insured through the state employee health plan that they may be able to drop that coverage and enroll their children in FAMIS during Open Enrollment in May 2015 for a July 1 start date. Starting April 20 through May 15, 2015 anyone considering this option can call Cover Virginia at 1-855-242-8282 and select Option 8 for special assistance for state employees. State employees should be sure to contact Cover Virginia for a full assessment of their child's eligibility for FAMIS before taking action at Open Enrollment.  If they remove their child from state health coverage and they do not qualify for FAMIS, they must wait until the next annual Open Enrollment or a qualifying mid-year event (QME) which would allow them to re-enroll their child in a state employee health plan. Calling Cover Virginia is the only way to get an expedited determination of FAMIS eligibility. Employees should have income verifications on hand for themselves and their spouse when they call. 


It is worth noting that part-time state employees who do not qualify for subsidized health insurance are already able to participate in FAMIS and FAMIS MOMS, if they otherwise meet eligibility requirements.


FAMIS Marketing and Outreach

A new full page FAMIS flyer has been designed and is now available for online order via the CoverVirginia Website (click on "Partners" in the upper right corner of the site, then click on "Materials" and a listing of all items available for order and print-as-you-go items will appear.) In addition, a new marketing campaign for the FAMIS Programs will be unveiled in time for Back to School.

Spring SignUpNow

VHCF has scheduled 7 SignUpNow State-Sponsored Health Insurance for Children and Pregnant Women trainings around the Commonwealth in June. Between June 3rd and June 23rd, we will be in Abingdon, Alexandria, Fredericksburg, Hampton, Harrisonburg, Roanoke and Richmond.  Online registration links and informational flyers on each location can be found here


FAMIS Program Enrollment as of April 1, 2015 (most recent data available):
  • 59,975 children are enrolled in FAMIS (including 168 in FAMIS Select);
  • 532,695 children are enrolled in FAMIS Plus (including 47,763 in the CHIP Medicaid Expansion);
  • 680 pregnant women are enrolled in FAMIS MOMS;
  • 16,663 pregnant women are enrolled in Medicaid for Pregnant Women; and
  • 92,697 men and women are enrolled in Plan First.
  • 512 former foster care youth are enrolled in Medicaid.