Insurance & Virginia Managed Care Plans

Limitations

The existence of a Virginia Medicaid plan does not mean Eden is contracted or in-network with that plan. Contact Eden to verify current network participation for a specific member, service, and location. Eden educational resources are not a substitute for official Medicaid, waiver, or health-plan determinations. Rules vary by program, assessment, authorization, and plan. Confirm current details with DMAS, your MCO, and Eden intake.

Important definitions

Short definitions used on this page. Program manuals may phrase lists slightly differently.

• Cardinal Care: Virginia's Medicaid and FAMIS program brand. All Medicaid managed-care and fee-for-service members are part of Cardinal Care.
• Cardinal Care Managed Care (CCMC): Virginia's current Medicaid managed-care program, effective July 1, 2025. It combined the historic CCC Plus managed-care and Medallion 4.0 programs. Do not confuse CCMC with the CCC Plus Waiver.
• MCO: Managed Care Organization — the health plan that coordinates covered services for many Cardinal Care members.

Plain-English summary

Current Cardinal Care Managed Care roster, what each official plan is, and how to use member resources without ranking plans or inventing Eden contracts.

What Cardinal Care Managed Care is

CCMC is Virginia's current Medicaid managed-care program as of July 1, 2025. The health plan authorizes many services, coordinates care, and maintains a network. DMAS oversees the program.

Current plan roster

DMAS currently lists: Aetna Better Health of Virginia; Anthem HealthKeepers Plus; Humana Healthy Horizons of Virginia; Sentara Health Plans; UnitedHealthcare of the Mid-Atlantic, Inc. (UnitedHealthcare Community Plan). Anthem also administers a statewide Foster Care Specialty Plan. Molina is historical only.

Aetna Better Health of Virginia

Aetna Better Health of Virginia is one of the five health plans DMAS lists for Cardinal Care Managed Care statewide as of the July 1, 2025 program launch. Use the member ID card and the plan's official Virginia site for current member services numbers. Do not rely on a third-party blog for phone numbers. Personal care, respite, and other LTSS usually require the plan's service authorization process when the member is in managed care. Eden can help assemble documentation; the plan makes the coverage decision. If the plan denies, reduces, or ends a service, the notice should explain appeal and grievance rights. Deadlines come from that notice and official plan/DMAS rules — not from Eden. The existence of a Virginia Medicaid plan does not mean Eden is contracted or in-network with that plan. Contact Eden to verify current network participation for a specific member, service, and location.

Anthem HealthKeepers Plus

Anthem HealthKeepers Plus participates in Cardinal Care Managed Care. DMAS also awarded Anthem the statewide Foster Care Specialty Plan. Foster care, former foster care, and adoption-assistance members may have a specialty-plan enrollment path. Confirm the plan name printed on the member ID card. Authorization, care coordination, and LTSS workflows are plan-administered. Ask Anthem member services or an Eden coordinator to confirm the current process for the specific service. Appeal and grievance instructions are in the member handbook and on adverse-action notices. Eden does not represent members in legal proceedings. The existence of a Virginia Medicaid plan does not mean Eden is contracted or in-network with that plan. Contact Eden to verify current network participation for a specific member, service, and location.

Humana Healthy Horizons of Virginia

Humana Healthy Horizons of Virginia is the new Cardinal Care Managed Care plan as of July 1, 2025. DMAS automatically moved remaining Molina members to Humana on that date. If a family still has a Molina card, they should confirm current enrollment. Molina is not on the current DMAS CCMC roster. Continuity-of-care rules may apply after a plan change, but they are time-limited and plan-specific. Confirm remaining authorizations with Humana and DMAS — do not assume prior Molina approvals continue indefinitely. Use Humana's current member handbook and notices for appeals. Historical Molina documents are not current CCMC instructions. The existence of a Virginia Medicaid plan does not mean Eden is contracted or in-network with that plan. Contact Eden to verify current network participation for a specific member, service, and location.

Sentara Health Plans

Sentara Health Plans is listed by DMAS as a current Cardinal Care Managed Care plan. Member materials may still show a Community Plan product name — match the name on the ID card. Provider directories and member handbooks are published by the plan. Contact Sentara or Eden to verify whether a specific provider is in network for a specific service. LTSS authorizations, if required, are decided by the plan using the member's assessment and plan of care. Eden cannot approve hours. Grievances (complaints about service) are not the same as appeals (disputes of a coverage decision). Follow the official notice. The existence of a Virginia Medicaid plan does not mean Eden is contracted or in-network with that plan. Contact Eden to verify current network participation for a specific member, service, and location.

UnitedHealthcare of the Mid-Atlantic, Inc. (UnitedHealthcare Community Plan)

UnitedHealthcare of the Mid-Atlantic, Inc. participates in Cardinal Care Managed Care and is commonly described as UnitedHealthcare Community Plan in member materials. Confirm the legal plan name and member services number on the ID card. Community Plan branding does not by itself prove Eden is in network. Prior authorization and LTSS service authorization, when required, follow UnitedHealthcare's published processes. Timelines are not universal across all Virginia plans. Members generally have plan-level appeal rights and, in many cases, a path to a state fair hearing. Exact deadlines are on the notice. The existence of a Virginia Medicaid plan does not mean Eden is contracted or in-network with that plan. Contact Eden to verify current network participation for a specific member, service, and location.

Historical: Molina Healthcare of Virginia

HISTORICAL ONLY. Molina is not on the current DMAS Cardinal Care Managed Care roster. DMAS moved remaining Molina members to Humana Healthy Horizons of Virginia effective July 1, 2025. Do not treat Molina as a current Virginia Medicaid MCO. Families with old Molina cards should confirm current Cardinal Care Managed Care enrollment.

Continuity of care

When members change plans, continuity-of-care periods may apply. They are time-limited and defined by DMAS or plan rules. Confirm remaining authorizations with the active plan.

Eligibility and applicability

Program rules, assessments, and payer authorization decide what can start. Medicaid enrollment, waiver enrollment, service eligibility, service authorization, and authorized hours are not the same status.

Assessment and documentation

Depending on the program and service, an assessment and supporting documentation may be required. A nurse does not automatically visit first for every request.

Authorization and approval

When authorization is required, the payer or MCO reviews the requested service and hours. Outcomes can include approval, partial approval, a request for more information, or denial. Eden does not approve the benefit.

Hours and limits

Requested, assessed, authorized, scheduled, and EVV-verified hours can all differ. This site does not invent a universal hour number.

How services can interact

Personal care, respite, companion, adult day, and transportation follow separate rules. A plan may authorize one, more than one, or none.

Family caregiver implications

A parent or spouse is not automatically a paid caregiver. Virginia LRI rules apply only in defined relationships and only when the current official policy and authorization allow it.

Agency-directed vs consumer-directed

Agency-directed: a licensed agency is the employer. Consumer-directed: the member or representative is the employer of record, with services-facilitator support where the waiver allows. Eden's typical public role is agency-directed care.

Insurance and MCO implications

Managed-care members usually follow their plan's authorization and appeal process. Fee-for-service members follow DMAS processes. A plan existing on the official roster does not mean Eden is in-network.