Cardinal Care Virginia Medicaid — What Families Need to Know in 2026

Your parent just qualified for Virginia Medicaid, and suddenly every piece of mail mentions "Cardinal Care" and a managed care organization you have never heard of. The terminology is confusing because the state restructured how it delivers long-term services, and most online guides still reference the old program names.

Here is what actually matters for your family right now.

What Cardinal Care Replaced

Virginia used to split Medicaid into separate managed care contracts for acute health care and long-term services and supports (LTSS). Cardinal Care unified everything under a single managed care framework administered by the Department of Medical Assistance Services (DMAS). Every Medicaid member — including those receiving nursing home care, CCC Plus waiver services, and assisted living Auxiliary Grant benefits — is now enrolled in a Cardinal Care managed care organization (MCO).

The MCO coordinates all of your parent's benefits: doctor visits, prescriptions, hospital stays, and long-term care services like personal care aides and adult day programs.

Which Health Plans Are in Cardinal Care

As of 2026, five MCOs operate in the Cardinal Care program:

• Aetna Better Health of Virginia
• Anthem HealthKeepers Plus
• Humana Healthy Horizons of Virginia
• Sentara Health Plans
• UnitedHealthcare Community Plan

The big change in July 2025 was Molina Healthcare exiting Virginia entirely. Members who were with Molina were automatically transitioned to Humana Healthy Horizons with a 60-day continuity-of-care window to keep existing providers. If your parent was affected by that transition and is still having billing issues with old providers, contact Humana's member services line directly — the continuity window has closed, but credentialing disputes from the transition are still being resolved.

How to Switch MCOs

Your parent can switch their Cardinal Care MCO during an annual open enrollment period or within 90 days of any qualifying event (new enrollment, plan assignment, or involuntary transition). Call the Cover Virginia helpline at 1-833-522-5582 to request a switch.

Before switching, check whether your parent's nursing facility, home health agency, or specialist accepts the new MCO. Not all providers contract with every plan, and a switch can disrupt an existing care team.

Why This Matters for Long-Term Care

The MCO is the entity that authorizes your parent's care hours under the CCC Plus waiver, approves nursing facility stays, and coordinates discharge planning. If your parent needs more personal care aide hours or a different level of service, the request goes through the MCO's care coordinator — not directly to DMAS.

Understanding which MCO your parent is enrolled with, who the assigned care coordinator is, and how to escalate authorization denials saves weeks of frustration when care needs change.

What Families Should Do First

Pull your parent's latest Cardinal Care enrollment letter and note the MCO name, member ID, and care coordinator contact. If you cannot find it, log into the Cover Virginia portal or call 1-833-522-5582. Having this information on hand before any hospital visit or care transition prevents the single most common delay families report — spending days figuring out which plan to call while a discharge clock is ticking.

For a complete walkthrough of Virginia's Medicaid long-term care system — including eligibility thresholds, spend-down rules, and asset protection strategies — the Virginia Medicaid Long-Term Care & Asset Protection Guide covers every step from initial screening through post-approval patient pay calculations.

See more Virginia guides →