Frequently Asked Questions
Why am I being switched to Optima Health Community Care?
In order to better serve everyone in need of Medicaid services, the Department of Medical Assistance Services (DMAS) changed its Medicaid program. Some members who are covered through Medicaid are moved to the managed long-term services and supports program, called Commonwealth Coordinated Care Plus. This program includes dual-eligible (Medicaid and Medicare A and/or B) members and managed long-term services and supports recipients currently covered by fee-for-service programs; Medicaid waiver programs; and Virginia’s aged, blind, and disabled populations.
Does Optima Health Community Care replace Optima Family Care?
No, Optima Family Care is still a product of Optima Health; CCC Plus serves a separate and distinct population.
What is Optima Health Community Care?
Optima Health Community Care is the name for our program that serves Commonwealth Coordinated Care Plus (CCC Plus) members. CCC Plus is a new, statewide Medicaid managed long-term services and supports program for individuals with more complex care needs. CCC Plus focuses on improving quality, access, and efficiency. CCC Plus is launching August 2017 and enrollment into CCC Plus is required for qualifying populations.
The CCC Plus Program serves individuals who may:
- be dually eligible for Medicaid and Medicare (D-SNP),
- receive Medicaid-funded long-term services and supports (LTSS), or
- receive Medicaid and are over the age of 65 or disabled.
What is a Care Coordinator?
A Care Coordinator is an Optima Health clinical staff member dedicated to help members understand how their plan works, the benefits covered, and how to access services such as transportation to appointments and assistance with scheduling appointments. Your Care Coordinator will help members work with their doctor(s) and develop a health risk assessment and a personalized care plan specific to their healthcare needs. Members will receive a letter from their Care Coordinator with more information, including his/her office hours and contact information.
What is D-SNP?
D-SNP is a unique Medicare plan for those eligible for both Medicare and Medicaid. D-SNP-eligible CCC Plus members can choose the same health plan for Medicare and Medicaid coverage to help assure that they can receive the benefit of comprehensive care coordination. For simplicity, most people choose the same plan provider for both Medicare and Medicaid coverage.
What is ARTS?
Addiction and Recovery Treatment Services (ARTS) is the DMAS program for addiction and recovery treatment.
More information about the ARTS program, including participation criteria and covered services, can be found at http://www.dmas.virginia.gov/#/arts.
How can I find more information about DMAS programs?
Additional information is available on the DMAS website at: http://www.dmas.virginia.gov/#/index.
Can I switch insurance carrier?
Yes. Members can change their health plan during the first 90 days of enrollment for any reason. Members may change their plan carrier during open enrollment, which runs between October and December for a January 1 effective date. Members may also change their plan carrier under special circumstances, such as they move out of the service area or the doctor’s network is unable to accommodate their medical needs. For information on changing your health plan, please contact the CCC Plus hotline at 1-844-374-9159/TDD 1-800-817-6608, or visit cccplusva.com.
Will I get a new ID card?
Yes. Members will receive a member ID card that identifies them as an Optima Health Community Care member. In a separate mailing, they will also receive a new member handbook and information on accessing the provider directory. Members can expect to receive them closer to their coverage effective date.
Do I have to switch doctors?
For Medicare members, we (Member Services) or the Care Coordinator will make every attempt to coordinate care with the Medicare-assigned primary care provider (PCP), whether he/she is in the Optima Health Community Care network or not. If a member does not have Medicare, he/she may need to pick a PCP that is in the Optima Health Community Care network.
Members may change their PCP once every 30 days.
Will my services be covered by Optima Health Community Care?
All authorized services a member has in place today will remain for at least the first 90 days. The Care Coordinator will work with the Care team, which is made up of the providers and other people that help you. Together, you will decide what services are needed to make sure you stay safe and healthy.
Become an Optima Health member
To enroll, and for assistance with choosing the health plan that is best for you, call the CCC Plus Helpline at 1-844-374-9159 or TDD 1-800-817-6608, or visit cccplusva.com.
To learn more
To speak with a Customer Service Representative about Optima Health Community Care, call toll-free at 1-888-512-3171.