Virginia delivers most Medicaid coverage through Cardinal Care, a single, unified managed care program covering acute care, behavioral health, and most long-term services and supports together under one set of statewide MCO contracts, with a small remaining share of the caseload served fee-for-service. Cardinal Care combines what were previously two separate managed care programs, one built around acute care and one built around long-term services and supports, into a single program and MCO contract structure, with Developmental Disability waiver services the one benefit still carved out to fee-for-service. Virginia adopted the Affordable Care Act's Medicaid expansion effective January 1, 2019, extending eligibility to adults with incomes up to 138 percent of the federal poverty level. Per CMS's most recent managed care enrollment data, report year 2024, Virginia's Medicaid managed care plans covered approximately 1.81 million members.
Per CMS's most recent managed care enrollment data, report year 2024, Virginia's Medicaid managed care plans covered approximately 1.81 million members, including a Program of All-Inclusive Care for the Elderly (PACE) population served through 13 separate PACE organizations statewide. Five managed care organizations currently hold statewide contracts under Cardinal Care, each covering acute care, behavioral health, and most long-term services and supports for the same enrolled population rather than splitting acute care and long-term care into separate plans.
Long-term services and supports are integrated into Cardinal Care rather than carved out to a separate plan. Members needing LTSS get a functional eligibility screening through their local Department of Social Services, but once enrolled, their own MCO coordinates the actual care, including home and community-based waiver services. The one exception is Developmental Disability waivers (Building Independence, Family and Individual Support, and Community Living), which remain carved out and paid fee-for-service regardless of a member's MCO enrollment.
Integrated into managed care
Behavioral health is generally covered through Cardinal Care MCOs rather than carved out to a single statewide vendor; each MCO covers and coordinates behavioral health services for its own enrolled members. Certain non-traditional and residential behavioral health services remain carved out and paid fee-for-service, administered for that population by Magellan of Virginia, the state's Behavioral Health Services Administrator, which also coordinates those carved-out benefits with the MCOs on the rest of a member's care. Addiction and Recovery Treatment Services (ARTS), covering the full continuum of substance use disorder care including residential and inpatient detoxification, is available to Medicaid, FAMIS, and FAMIS MOMS members regardless of delivery model.
Carved in
Dental care is carved out of Cardinal Care managed care statewide and delivered fee-for-service rather than through the MCOs, for both Medicaid and FAMIS members. DentaQuest administers the program, branded Cardinal Care Smiles. Coverage includes comprehensive dental services for children and youth under 21 and a comprehensive adult dental benefit for members 21 and older, including pregnant members enrolled in FAMIS MOMS.
Pharmacy benefits for Cardinal Care MCO enrollees are provided directly through their own health plan, each of which maintains its own formulary within state parameters. Magellan Medicaid Administration serves as the pharmacy benefit administrator for the fee-for-service population, administering the statewide Preferred Drug List (Common Core Formulary) and processing fee-for-service pharmacy claims.
Non-emergency medical transportation is split by delivery model rather than run through one statewide arrangement. Fee-for-service members use ModivCare, which schedules trips and pays providers directly. Cardinal Care MCO members instead arrange non-emergency medical transportation through their own health plan, which covers it as part of its capitated benefit rather than through ModivCare.
Virginia's Medicaid Enterprise System is modular rather than single-vendor: Conduent operates the core Medicaid Management Information System, handling claims processing and member eligibility, while Gainwell Technologies separately operates Provider Enrollment Services as its own module.
Last updated: Oct 2, 2026
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