Benefits and Services

With your MCC of VA Medicaid benefits, you’ll get standard benefits like:

Primary care provider (PCP) and specialist visits

PCP visits – Your PCP will provide most of your basic healthcare. You will usually see your PCP for most of your routine healthcare needs like exams, regular check-ups, vaccinations and other treatments to keep you well. You should call your PCP whenever you have a medical question or concern. Your PCP can also refer you to the hospital or specialists when needed.

If you have a disabling condition or chronic illness, you can ask that your specialist be your PCP. Women may also choose an OB/GYN for women’s health issues. This includes check-ups, follow-up care if there is a problem, and regular care during a pregnancy. Women do not need a PCP referral to see an OB/GYN provider in our network.

Your PCP must be part of the MCC of VA provider network. If your PCP is not in our network, you will need to choose a new doctor. Read more information on how to choose a doctor.

Specialist visits – A specialist is a doctor who provides healthcare for a specific disease or part of the body. There are many kinds of specialists. If you need care that your PCP cannot give, your PCP may send you to a specialist. They will give you what is called a referral. This will let you see the specialist if they are in the MCC of VA provider network. If we do not have a specialist in the MCC of VA network to provide the care you need, we will get you the care you need from a specialist outside of the MCC of VA network. You must get approval from MCC of VA before seeing an out-of-network specialist.

If you have a disabling condition or chronic illness, you can ask that your specialist be your PCP.

Check your MCC of VA member handbook for more information on PCP and specialist visits

Annual wellness exams

As an MCC of VA member, you can get a physical exam from your PCP every year. This is also called an annual wellness exam. There is no cost to get this exam. Just call your PCP to set up an appointment to schedule an exam for you or your child.

Emergency services

An emergency is a sudden or unexpected illness, severe pain, accident or injury that could cause serious injury or death if it is not treated immediately. You are always covered for emergencies.

If you have an emergency, call 911 right away. You do not need to call MCC of VA first. You do not need an authorization or a referral for emergency services. Calling 911 will help you get to a hospital. You can use any hospital for emergency care, even if you are in another city or state.

Tell the hospital that you are a Magellan Complete Care of Virginia member. Ask them to call us at the number on the back of your member ID card.

What is a medical emergency?

This is when a person thinks he or she must act quickly to prevent serious health problems. It includes symptoms such as severe pain or serious injury. The condition is so serious that, if it doesn’t get immediate medical attention, you believe that it could cause:

  • Serious risk to your health
  • Serious harm to bodily functions
  • Serious dysfunction of any bodily organ or part

A medical emergency can also happen if a pregnant woman is in active labor and:

  • There is not enough time to safely transfer her to another hospital before delivery
  • The transfer may pose a threat to her health or safety or to that of the unborn child

What is a behavioral health emergency?

A behavioral health emergency is when a person thinks about or fears they might hurt themselves or hurt someone else in the near future. You or a family member can call our Behavioral Health Crisis Line any time you need help. You or a family member can also call this number if you or they think you’re experiencing a drug overdose.

Behavioral Health Crisis Line

If you have an emergency when you are away from home

You may have a medical or a behavioral health emergency away from home. You may be visiting someone outside Virginia. While traveling, your symptoms may suddenly get worse. If this happens, go to the closest hospital emergency room. You can use any hospital for emergency care. Show them your MCC of VA member ID card or tell them you are a Magellan Complete Care of Virginia member.

You can get emergency care whenever you need it, anywhere in the United States or its territories. You do not need prior authorization for emergency services. If you need an ambulance to get to the emergency room, our plan covers that. Tell your PCP and MCC of VA about the emergency as soon as you can (with 48 hours if possible). If you need follow-up care after your emergency to get better, MCC of VA will cover that.

Visit our “How do I?” page to read about where you should go for healthcare if you aren’t sure you have an emergency.

Read more about emergency care in your MCC of VA member handbook.

Addiction and Recovery Treatment Services (ARTS)

Many people struggle with using substances at some time in their lives. Most people with a substance use disorder can benefit from treatment, no matter how challenging the problem may seem.

MCC of VA provides benefits for the following services to help:

  • Inpatient and outpatient treatment
  • Community-based treatment
  • Medication-assisted treatment (MAT)
  • Peer support services
  • Case management
  • Referrals to opioid treatment providers (OTP)

Talk to your PCP or contact MCC of VA and request to speak to one of our ARTS Care Coordinators, to determine the best treatment option for you. Search for an ARTS provider in our online provider directory. You can also contact Member Services for help finding a provider who provides these services or a referral to one of our ARTS Care Coordinators.

More detail on ARTS benefits can be found in your member handbook.

Behavioral health services

If you live with a behavioral health challenge, we offer the following support to help you meet your recovery goals:

  • Inpatient and outpatient treatment options
  • Community Mental Health Rehabilitation Services (CMHRS), including:
    • Mental health case management
    • Therapeutic day treatment
    • Day treatment/partial hospitalization for adults
    • Intensive community treatment
    • Mental health skill-building services
    • Intensive In-Home
    • Psychosocial rehabilitation services
    • Behavioral therapy
    • Crisis Intervention and Stabilization
    • Peer support services
    • Residential treatment services

Some behavioral health services are covered through Magellan of Virginia, the Department of Medical Assistance Services (DMAS) Behavioral Health Services Administrator. If you need behavioral health services, call us and we’ll help you find a provider that can help.

You can find more information on behavioral health services in your member handbook.

Recovery Support (Peer) Navigation program

Recovery Support (Peer) Navigation is for members who are coping with mental health challenges or substance use issues. When you join this program you get a certified Recovery Support Navigator (RSN) who has lived experience with mental health or addiction issues who will work as a partner in your recovery. RSNs do many things to help you, like:

  • Teach you about recovery and support you with developing your own recovery and resiliency goals
  • Help you live successfully in your community
  • Help you identify and obtain information on community resources
  • Work with you in your community, your home, or your provider setting

This flyer tells more about our Peer Recovery Navigation program and how you can join:

Peer Recovery Navigation program (English)
Peer Recovery Navigation program (Spanish)

 

Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT)

Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT) is a program that provides comprehensive and preventive healthcare services for children under 21. This program tries to diagnose and treat health problems as early as possible.

If you have a child under age 21, EPSDT provides appropriate preventive, dental, behavioral health, developmental and specialty services. It includes coverage for immunizations, well child visits, lead investigations, private duty nursing, personal care and other services and therapies that treat or make a condition better. It will also cover services that keep your child’s condition from getting worse. EPSDT can provide coverage for medically necessary services even if these are not normally covered by Medicaid.

MCC of VA provides most EPSDT services (note: EPSDT services are not covered under FAMIS). However, there may be some EPSDT services, like pediatric dental care you’ll get through the Medicaid fee-for-service program. Read more about EPSDT in your member handbook. You can also call Member Services for help with these services.

Family planning services

Family planning services are included with your MCC of VA standard benefits. These services include:

  • Devices
  • Drugs (including long acting reversible contraception)
  • Supplies for the delay or prevention of pregnancy

You are free to choose your method for family planning through in-network or out-of-network providers. You do not need to get a service authorization or PCP referral for family planning services.

Long-term Services and Supports (LTSS) for CCC Plus members

MCC of VA provides LTSS coverage for CCC Plus or MCC of VA HMO SNP members. These services help older individuals and people living with disabilities meet their daily needs and maintain maximum independence. Your Care Coordinator will help you find and access services that let you live in your own home or other settings of your choice. They’re here to help you find options to improve your quality of life.

MCC of VA covers nursing facility care for CCC Plus members who meet the coverage criteria for that level of care. Some CCC Plus members who qualify for nursing facility levels of care may qualify for a waiver that allows them to stay in the community and get help with their daily needs, called activities of daily living (ADL). They may have a person regularly come into their home to give them healthcare services. MCC of VA Care Coordinators visit on-site at various nursing facilities. They can help you with getting nursing facility information, services, and facilitating approvals and authorizations.

Read more about Long-Term Services and Supports in your CCC Plus member handbook.

Other standard Medicaid benefits

Check your member handbook to see all the standard Medicaid benefits offered by CCC Plus and Medallion 4.0.

Extra benefits

As an MCC of VA member, you’ll get extra services that are generally not covered through Medicaid fee-for-service. These are known as “extra benefits”.

CCC Plus extra benefits (English)

CCC Plus extra benefits (Spanish)

Medallion 4.0 extra benefits (English)

Medallion 4.0 extra benefits (Spanish)

Benefits available on your smartphone (English)

Benefits available on your smartphone (Spanish)

Special Medallion 4.0 programs for pregnant women and children

Pregnant women and new moms

Our Mother-Baby Connections program will guide you through early prenatal care and what to do if you think you may be pregnant. If you’re pregnant, we’ll send text messages with health tips about each stage of pregnancy. They’ll tell you what to expect during your pregnancy, how to spot problems and how to prepare for delivery and parenthood.

Whether you’re a first-time mom or already have kids, you might have questions or concerns in between doctor visits or after your baby is born. We’ll educate and support you during your pregnancy and the first year of your newborn’s life to help you and your child be as healthy as possible.

Our CenteringPregnancy program offers a supportive environment for pregnant women to share and learn together. Meet regularly with your care provider and up to 12 other pregnant members to discuss your feelings and experiences. Doctors and nurses can teach you about nutrition, how to deal with stress, caring for your infant and more.

You’ll also get extra benefits, like:

  • Infant sleep sacks and diapers
  • An invitation to baby showers hosted by MCC of VA (hosted quarterly per region)
  • “What to Expect When Expecting” book
  • Rides to WIC appointments, Lamaze and parenting classes

Children

We’re here to help your kids grow into healthy young adults. To help them succeed, MCC of VA members get these extra benefits:

  • Annual sports physicals from a PCP for children ages 10-18
  • One bicycle helmet per year for children under 18
  • A backpack stocked with supplies and comfort items for children entering a new foster home

Please see your Medallion 4.0 member handbook for more information on these special programs.

Pharmacy Benefits

List of covered drugs

MCC of VA has a list of covered drugs that we select with the help of doctors and pharmacists. This is called a preferred drug list. This list of covered drugs also includes all the drugs on the DMAS Preferred Drug List (PDL). The list tells you which drugs are covered by us and if there are any rules or restrictions on any drugs, such as a limit on the amount you can get.

To get medicines on the list of covered drugs, you first need to get a prescription from your doctor. Take the prescription to a pharmacy in the MCC of VA network or have your doctor call it in.

MCC of VA pays for enhanced over-the-counter (OTC) products for all members with an active prescription from a participating provider. These products can include, but are not limited to:

  • Glucosamine with or without chondroitin
  • Fish oil
  • Saliva substitute
  • Skin or wound products
  • Psyllium
  • Fleet prep kits
  • Various vitamins or combinations not covered by the Commonwealth’s Pharmacy Manual and Covered Services

Please review this list to find out if your drugs are covered. If you would like a paper copy of the list of covered drugs, please call Member Services and we will mail you a copy. The list may change during the year.

If you are on a drug that is impacted by a change to the list of covered drugs, you will be notified in writing 30 days prior to the change taking effect.

If you have any questions about your medicine(s) or about your MCC of VA pharmacy benefits, please call our Member Services team.

List of covered drugs

 

Getting your medicines

For new medicines – When you get a prescription from your doctor, ask them to send it to a network pharmacy near you. You can find a list of pharmacies that work with MCC of VA in our online provider directory. You may also take the prescription to the pharmacy that works with MCC of VA and drop it off yourself.

For medicines you already take – If you already have medicines at a pharmacy that’s not on our list, you will need to pick a new in-network pharmacy. Once you do, simply ask the new pharmacy to get your prescription from your old pharmacy. Make sure you bring your Member ID card so you can show it to the pharmacist.

Drug recalls

This list will tell you which drugs have been recently recalled.

Specialty pharmacy program

MCC of VA wants to help you get the care you need. Maybe you need to take a specialty medicine. Specialty medicines can be oral, but many times they are injected, infused, or inhaled medicines. These may need special storage or handling. MCC of VA limits the amount of specialty drug fills to up to a 34-day supply.
Magellan Rx Specialty is our preferred specialty pharmacy. We’d like you to get your specialty medicine sent through the mail from Magellan Rx Specialty. Magellan Rx Specialty will work closely with you and your provider to give you what you need to help manage your condition.

Services and programs to support your needs
Magellan Rx Specialty pharmacy makes it easy for you to get your specialty medicine with services to help you including:

  • Coaching programs to help manage your condition
  • Free delivery to your home or another address within two days of ordering
  • Supplies such as syringes and needles at no cost
  • Highly trained pharmacists and nurses available to answer any questions
  • Insurance specialists to help you get the most out of your benefits
  • Online member portal where you can request refills and learn more

Get started today
If you have a new prescription or if you are requesting a refill from another pharmacy, please call Magellan Rx Specialty to get your medicine delivered to you at no cost. If you do not want to use Magellan Rx Specialty pharmacy, tell the pharmacy team member at the time of the call. They will make a change that will allow you to continue to get your specialty medicine at your current pharmacy.

Contact us
Have questions? Please call 1-866-554-2673 (TTY/TDD 1-800-424-0328). Our hours are Monday through Friday from 8 a.m. to 10 p.m. local time. The pharmacy is available 24 hours a day, seven days a week for emergencies.

Medicare and Medicaid services

If you have Medicare and Medicaid, some of your services will be covered by your Medicare plan and some will be covered by MCC of VA. We are your CCC Plus Medicaid plan.

Types of services under Medicare

  • Inpatient hospital care (medical and psychiatric)
  • Outpatient care (medical and psychiatric)
  • Physician and specialist services
  • X-ray, lab work and diagnostic tests
  • Skilled nursing facility care
  • Home health care
  • Hospice care
  • Prescription drugs
  • Durable medical equipment

Types of services under CCC Plus Medicaid

  • Medicare copayments
  • Hospital and skilled nursing when Medicare benefits are exhausted
  • Long-term nursing facility care (custodial)
  • Home and community-based waiver services, like personal care and respite care, environmental/home modifications and assistive technology services
  • Community behavioral health services
  • Medicare non-covered services, like some over the counter medicines, medical equipment and supplies, and incontinence products

For more information about these services, contact your Medicare plan, visit Medicare.gov, or call Medicare at 1-800-633-4227 (TTY 1-877-486-2048).

For detailed information about your benefits, please review your member handbook.

Safelink wireless phone

Some MCC of VA members are also eligible to receive SafeLink Wireless smartphones.

There are three easy ways to enroll in the SafeLink Wireless program:

  1. Visit www.safelink.com to apply online.
  2. Print and fill out the application and mail it in.
  3. Call SafeLink at 1-877-631-2550.

Transportation

Do you need a ride to your healthcare appointments? Call Veyo at the number below to schedule a ride. Visit our “How do I?” page to read more about how to set up a ride to your appointments.

Veyo