Virginia Medicaid Expansion: What It Means for Addiction Care

Virginia Medicaid Expansion: What It Means for Addiction Treatment

Virginia expanded Medicaid eligibility in January 2019, extending coverage to approximately 750,000 additional Virginians. The expansion had significant implications for addiction treatment access. People who previously earned too much to qualify for traditional Medicaid but too little to afford private insurance suddenly had comprehensive coverage of substance use disorder treatment. Virginia's Addiction and Recovery Treatment Services (ARTS) benefit provides broad coverage of the full continuum of addiction care.

This guide covers what Virginia Medicaid expansion actually means for addiction treatment access, who qualifies for expanded Medicaid, what services are covered under Cardinal Care, how to apply if you do not have coverage, Medicaid-approved treatment providers in Hampton Roads, and changes to mental health and SUD coverage under expansion.

What Virginia Medicaid Expansion Means for Addiction Treatment Access

Before expansion, Virginia Medicaid eligibility for adults was one of the most restrictive in the country. Non-disabled adults without dependent children generally could not qualify regardless of income. Parents of dependent children could qualify only at extremely low income levels. This left a significant population of low-income Virginians without coverage of addiction treatment.

Expansion extended eligibility to adults earning up to 138 percent of the federal poverty level. Key implications for addiction treatment:

• Approximately 750,000 additional Virginians gained coverage
• Non-disabled adults without children became eligible for the first time
• Working adults in low-wage jobs gained coverage
• Adults transitioning from incarceration gained coverage more easily
• Coverage of MAT for opioid use disorder became broadly accessible
• The 'Medicaid gap' (too much income for traditional Medicaid, too little for ACA subsidies) closed for people at or below 138 percent FPL

The impact on addiction treatment has been substantial. Providers report significant increases in the number of Medicaid-covered patients accessing treatment. The state's response to the opioid crisis was strengthened by expanded coverage of MAT and comprehensive substance use disorder services.

Who Qualifies for Expanded Medicaid in Virginia

Cardinal Care eligibility depends on multiple factors:

Income. Adults 19 to 64 qualify with household income at or below 138 percent of the federal poverty level. For 2024, this is approximately $20,783 annually for a single person and $35,632 for a family of three. Amounts adjust annually.

Household composition. Eligibility considers household size and relationships. Married couples, dependent children, and other household members affect the calculation.

Citizenship or immigration status. Coverage is generally available to U.S. citizens and certain qualified non-citizens. Undocumented individuals are not eligible except for limited emergency services.

Virginia residency. Applicants must live in Virginia. Homelessness does not disqualify applicants.

Not receiving Medicare. People receiving Medicare typically apply through different Medicaid categories. Dual eligibility for both Medicare and Medicaid is possible for people meeting both program's rules.

Additional eligibility pathways beyond expansion include:

• Pregnant women (higher income limits, expedited enrollment)
• Children in FAMIS or CHIP programs (up to 200% FPL)
• People with disabilities (SSI recipients typically qualify)
• Older adults 65+ meeting income and asset limits
• Foster care and former foster care youth

What Addiction Services Are Now Covered Under Expanded Medicaid

Virginia's ARTS benefit provides comprehensive addiction treatment coverage through Cardinal Care:

Screening and assessment. SBIRT (Screening, Brief Intervention, and Referral to Treatment) and comprehensive substance use assessment.

Medical detoxification. Inpatient and outpatient medical detox at licensed facilities.

Residential treatment. ASAM Level 3.1, 3.3, 3.5, and 3.7 residential care with prior authorization based on medical necessity.

Partial Hospitalization Program (PHP). ASAM Level 2.5 day treatment programs.

Intensive Outpatient Program (IOP). ASAM Level 2.1 intensive outpatient services.

Standard outpatient counseling. ASAM Level 1 individual, group, and family therapy.

Medication-Assisted Treatment (MAT). Coverage of buprenorphine (Suboxone), naltrexone (Vivitrol), and methadone treatment at Opioid Treatment Programs.

Peer recovery services. Coverage of certified peer recovery specialist services.

Care coordination. Case management services connecting patients with treatment, housing, and community resources.

Psychiatric services. Assessment, diagnosis, and medication management for co-occurring mental health conditions.

Withdrawal management. Ambulatory withdrawal management (Level 1-WM and 2-WM) and residential withdrawal management (Level 3.7-WM and 4-WM).

How to Apply for Virginia Medicaid If You Do Not Have Coverage

Application options:

Online. Apply at commonhelp.virginia.gov. The system supports Cardinal Care applications along with SNAP, TANF, and other benefit programs. Application takes 30 to 60 minutes if you have needed documents.

By phone. Call Cover Virginia at 1-855-242-8282. Application assistance in English and Spanish.

In person. Contact your local Department of Social Services. Find yours at dss.virginia.gov.

Through a certified enrollment assister. Community organizations, hospitals, and health centers often have certified assisters who help complete applications.

Through Cardinal Care Managed Care Organizations. MCOs help potential enrollees with applications.

Documents typically needed:

• Photo identification
• Proof of Virginia residency
• Proof of income (pay stubs, tax returns, unemployment benefits)
• Social Security numbers for all household members
• Immigration documents if not a U.S. citizen
• Information about other health coverage

Processing timeframes:

• Standard applications: 45 days
• Disability-based applications: 90 days
• Expedited processing available for pregnant women and other priority groups
• Once approved, coverage may be retroactive up to 3 months if medically necessary

Once enrolled, members receive a Medicaid card and choose a Managed Care Organization. Options vary by region. Hampton Roads options include Anthem HealthKeepers Plus, HealthKeepers Plus, Sentara Community Plan, Molina, Aetna Better Health, and UnitedHealthcare Community Plan.

Medicaid-Approved Treatment Providers in Hampton Roads

The Hampton Roads region has multiple Medicaid-approved treatment providers offering ARTS benefit services:

Norfolk Community Services Board. Public behavioral health provider serving Norfolk. Comprehensive addiction and mental health services on sliding scale including Medicaid-covered care.

Virginia Beach Community Services Board. Similar comprehensive services serving Virginia Beach.

Portsmouth Behavioral Healthcare Services. Community-based services in Portsmouth.

Colonial Behavioral Health. Serving Newport News, Hampton, York County, and surrounding areas.

Western Tidewater Community Services Board. Serving Suffolk, Franklin, Isle of Wight, and Southampton.

Chesapeake Integrated Behavioral Healthcare. Serving Chesapeake.

Private Medicaid-approved providers. Multiple licensed private treatment programs accept Cardinal Care coverage across the Hampton Roads region.

Changes to Mental Health and SUD Coverage Under Expansion

The 2019 expansion coincided with important changes in Virginia Medicaid's behavioral health coverage:

• ARTS benefit implementation broadened substance use disorder coverage significantly
• ASAM criteria adoption standardized level-of-care decisions
• Managed Care Organization structure administers behavioral health benefits
• Peer recovery specialist services became covered
• Integrated mental health and substance use disorder coverage supports dual diagnosis
• Coverage of MAT expanded significantly, addressing opioid crisis
• Care coordination services became covered, supporting complex cases
• Community-based service expansion (mobile crisis, community stabilization) supports acute needs

Your Next Step

If you do not currently have coverage and are considering addiction treatment, apply for Cardinal Care today. Application takes 30 to 60 minutes at commonhelp.virginia.gov. If you already have Cardinal Care coverage and are looking for treatment, call BeBold Recovery or your local Community Services Board for a free confidential assessment. Cardinal Care coverage of addiction treatment is broad, and multiple pathways to care exist across Hampton Roads.

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