Choosing Optima Family Care

You have the right to choose your Optima Family Care as your preferred Medicaid plan from one of the six participating plan providers, within 90 days of being assigned to Virginia Medicaid by the Department of Medical Assistance Services (DMAS).

If you need to find out if you qualify for a Virginia Medicaid program, visit or call 1-866-873-2647.

Program Details

DMAS will send you a letter that will include your assignment to a health plan.

  • You may be assigned to the same health plan you have now, or you may be assigned to a new health plan.
  • If you choose to stay with the health plan to which you are assigned, there is nothing you need to do. You will receive further information from that health plan.
  • If you would like to switch to Optima Family Care, call the Virginia Managed Care Helpline toll-free at 1-800-643-2273, or by enrolling through the Virginia Managed Care website.
  • If you would like to learn more about Optima Family Care and the Medicaid changes in Virginia, call Optima Health Customer Service toll free at 1-800-881-2166.

Automatic Re-enrollment

If your enrollment ends with us and you regain eligibility for the program within 60 days or less, you will automatically be re-enrolled with Optima Family Care. You will be sent a re-enrollment letter from the Department of Medical Assistance Services (DMAS).

Enrollment for Newborns

If you have a baby, you will need to report the birth of your child as quickly as possible to enroll your baby for Medicaid. You can do this by:

  • Calling the Cover Virginia Call Center at 1-855-242-8282 to report the birth of your child over the phone, or
  • Contacting your local Department of Social Services to report the birth of your child.

You will be asked to provide your information and your newborn's:

  • Name
  • Date of Birth
  • Race
  • Sex
  • The newborn’s mother’s name and Medicaid ID number

Optima Family Care will provide coverage for your newborn for the entire birth month plus two additional consecutive months regardless of whether the newborn receives a Medicaid ID number. If you change the newborn’s enrollment during the “birth month plus two” period, then the new Managed Care Organization (MCO) will provide coverage for your newborn. In such cases, the former MCO is not responsible once the newborn is enrolled into another MCO.

Coverage for your newborn for the “birth month plus two” period is not contingent on the mother’s continued enrollment with Optima Family Care. Optima Family Care will cover the newborn even if the mother does not remain enrolled after the MCO newborn’s date of birth.

What is the Optima Family Care Difference?

Open Enrollment

Open Enrollment in Optima Family Care is currently available for Medicaid Medallion 4.0 members in the following region(s):

  • Northern region: June 19, 2019 – August 31, 2019

This is your chance to switch to Optima Family Care.

Get Started   Check Eligibility

Optima Family Care