Managed Care Organizations (MCOs)
Role and Responsibilities of the MCO
In Virginia’s Medicaid Managed Care program, people are members of a Managed Care Organization (MCO). An MCO is a health plan with a group of doctors and other providers working together to give health services to its members. An person’s MCO will cover all Medicaid services they receive now, including medical services, behavioral health services, nursing facility services and “waiver” services for community-based long term care. All MCOs meet Affordable Care Act (ACA) requirements.
An MCO can help people choose doctors, get rides to doctor visits, and get other medically necessary services. MCOs can help people learn about health topics such as diabetes or asthma. For questions, call the MCO and ask to speak to a nurse. For other questions, call the MCO member services number.
The MCO will assign a Care Coordinator to work with the person and their doctor to create a health care plan tailored to their needs. The Care Coordinator can answer questions about health benefits and help the person get the care they need. The Care Coordinator will:
- Be the main contact for questions about healthcare services.
- Ask questions about the person’s health.
- Work with the person to make a written plan to help them meet their health goals.
- Help make doctor appointments if needed.
- Help find transportation for doctor visits.
- Make sure the person has all preapprovals and referrals when needed.
- Help the person access community and social services.
- Talk with the person and their health care team to make sure their needs are met.
Care Coordination Helpline:
- Aetna Better Health: 1-800-279-1878
- Anthem Healthkeepers Plus: 1-800-901-4687
- Molina Complete Care (formally known as Magellan): 1-800-424-5418
- Sentara Health Plan (formally known as Optima Health): 757-552-7401
- United Healthcare Community Plan: 1-844-864-8848
- Change their health plan for any reason.
- Review the added benefits from all health plans to see what best meets their needs.
- Call the Enrollment Helpline to ask questions: 1-844-374-9159.
If the person likes their current plan, they do not need to do anything.
To learn more about open enrollment, click here.
Written materials are critical to obtaining services, including, at a minimum, provider directories, member handbooks, appeal and grievance notices, and denial and termination notices in English and other prevalent non-English languages spoken in Virginia. Each MCO is required to provide interpretation services.
To use interpretation services, select your MCO from the bulleted list below:
Managed Care HelpLine
- Toll-Free: 1-800-643-2273
- Can speak with you in other languages.
- TTY: 1-800-817-6608