There are two pathways for renewal: (1) automatic renewal, and (2) renewal packages. The law requires that the state attempt to renewal everyone automatically first. If the automatic process doesn’t work, then the state will send a renewal package to the most recent address on file – which is why it’s so important for DMAS to have your current address.  

• Automatic Renewal: The state will use the most recent information they have available to determine eligibility for any Medicaid program. It may use information from unemployment benefit certifications, applications for Temporary Assistance for Needy Families (TANF) or Supplemental Nutrition Assistance Program (SNAP) benefits, or other data already available to complete the automatic renewal. If they need more information or determine that you’re ineligible, then the state will send a renewal package to the most recent mailing address on file. If the information they have allows for an automatic renewal and determines that you’re eligible, then the state will issue a Notice of Action stating that you have been renewed, the effective date of your coverage, and your new renewal date. 
• Renewal Packages: The state will send a renewal package to anyone who does not have “recent” information that qualifies them for an automatic renewal, anyone who appears ineligible for Medicaid, or anyone whose Medicaid program eligibility is dependent on resources and assets (checking and savings account balances and certain other property values). Renewal packages should arrive with the information that the state has already filled in. For some larger families, renewal packets may be more than 20 pages long.  

• To complete a renewal package: review the information in the packet for any information that is outdated, incorrect, or incomplete. Cross out all errors and write the corrections in the space provided on the right-hand side. Return the package by mail, fax, or email to the Local DSS within 30 days of the date on the first page.  
• • Renewals can also be completed using a Commonhelp Online account, by calling CoverVA, or calling your local DSS. However, we recommend returning the packet by mail, fax, or email instead.

After returning a renewal package, you may be asked to submit verifications. Usually, this is a request for additional documentation such as proof of income or immigration status (Note: renewals are only permitted to seek information that is subject to change, so a verification request for immigration status or social security number if there is no reported change is not allowed.) 

You should submit verification documentation as soon as possible! You will be given a deadline to submit verification documents and information on how to and who to send the documents. 

After DSS determines eligibility, it will either issue a Notice of Action saying that your Medicaid has been renewed or a Termination Notice saying that your coverage will end. 

• Notice Granting Medicaid: This notice will say that the beneficiary has been renewed, the effective date of your coverage, and your new renewal date. 
• Termination Notice: This notice should be issued at minimum 11 days (10 days plus 1 day for mailing) in advance of the date that Medicaid coverage is scheduled to end. Coverage always ends on the last day of the month.  

• For example, if the notice is dated April 25, 2023, and coverage is scheduled to end on April 30, 2023 – that is not sufficient notice because it is less than 11 days. To terminate coverage in this situation, a notice must be mailed by April 19, 2023, to be sufficient.

I received a termination notice and I’m not eligible for Medicaid anymore. 

• You are likely eligible for health insurance on the Affordable Care Act Marketplace. Marketplace insurance is available to many people for low or no cost, depending on income level.  
• Your information should be automatically sent by the state to the Marketplace to assess your eligibility for plans, so you may get mail or emails directing you to the Marketplace to pick a new health plan. If you haven’t gotten that information yet, or don’t want to wait, you can enroll on your own.  
• You can complete your own Marketplace application here. You can also connect with a navigator through EnrollVA here or by calling (888) 392-5132 to get help finding the best plan for you. If you’re in one of our service areas, you may be connected with us! 
• There are special rules for this period to ensure that you have plenty of time to pick a Marketplace plan. If you have lost Medicaid during this period and it’s been several months, you are still able to pick a Marketplace plan using the Unwinding Special Enrollment Period up to July 31, 2024.  

I received a termination notice and I know that I am still eligible for Medicaid.  

You have several options to restore coverage, depending on the reason for your termination notice: 

• If you did not return the renewal package on time, you have 90-days from the date on the termination notice to return the renewal package. After returning the renewal package, the agency must determine your eligibility for any/all Medicaid programs and send you a new notice.  

• If you are approved, your coverage will back-date to the date that you lost coverage in the original termination notice. So, it will be like you never lost coverage.  
• You can request a Local Agency Conference. 

• A local agency conference is a request to speak with the local agency that made the decision to terminate your coverage and make your case about why you are still eligible. It is an informal process and is outside the formal appeal process.  
• If you request a conference, it must be scheduled within 10 business days.  
• You have a right to present evidence and a right to represent yourself or be represented by an authorized representative. You have a right to an explanation of the decision. 
• If the agency changes its decision, it must inform you in writing.  

• No one at the conference is allowed to discourage you from filing an appeal if you want to. 
• You can file an appeal.  

• Appeals must be filed within 30 days of receiving the termination notice. You can request an extension to that timeline for good cause, such as illness/hospitalization. If you already have coverage and think you still qualify, you can request that your existing coverage stays active while your appeal is pending. You must submit this request within 10 days of receiving the termination notice. Note: If you are denied, you may have to pay back any money spent on medical care during that time. If you are considering this option, reach out to us so we can help determine whether there is a risk of liability post-appeal.  
• See the below “Appeals” section for more information. 

I received a termination notice, and I don’t know if I’m still eligible for Medicaid. 

Contact us right away. If you’re still eligible for Medicaid, we can request that you still have access to your services within 10 days of receiving your notice while the appeal is pending. If you’re no longer eligible, we’ll help you figure out your next steps. Either way – we can help you figure it out! 

You have a right to appeal. You cannot be discouraged from filing an appeal from anyone processing the case, assisting with a case at a local agency, or by anyone working at DMAS or for the state. If anyone discourages you from filing an appeal, contact our office for legal advice.  

Appeals must be submitted within 30 days of receiving the termination notice. You can request an extension for good cause. An example of good cause is illness/hospitalization. 

Appeals are submitted using the using the Virginia Medicaid/FAMIS Appeal Request which is available from DMAS here. They can also be submitted via written letter or via phone. Here is the information on where to submit: 

Email: appeals@dmas.virginia.gov 

Fax: 804-452-5454 

By mail or in person to: Department of Medical Assistance Services Appeals Division 600 East Broad Street Richmond, Virginia 23219 

By Phone: 804-371-8488 

Because this is a formal appeal, you have due process protections: 

• You can request a hearing. The hearing time and date will be sent to you in writing. At the hearing, you have the right to present and submit your own evidence.  
• Appeals are “de novo.” This means that the hearing officer is required to look at all of the evidence fresh and not base their decision on what the local agency decided.  

• You can submit any new or relevant paperwork/documentation, say in the hearing anything that you think is relevant, ask questions at the hearing of anyone who had a part in making the decision, and have someone speak on your behalf, and correct any errors, or add any other information that might support the case.  

• You have the right to represent yourself or have an authorized representative assist you.  
• You have a right to an appeal summary.  

• The agency must prepare and send to you all documents submitted up to the time that the fair hearing was requested. It must also explain all facts, policy, and other relevant information to the determination that it made. The DMAS appeals division will set a deadline to send this packet.  
• If you have reason to believe that the summary that you received is incomplete – notify the hearing officer and local agency right away. 

I filed an appeal and my coverage was still denied. What do I do now?  

• State Fair Hearing decisions may be appealed to the Circuit Court using the two-step process described in Rules 2A:2 and 2A:4 in the Rules of the Supreme Court of Virginia. 
• More details about the process should be included in the hearing officer’s written decision. 
• You are likely eligible for health insurance on the Affordable Care Act Marketplace. Marketplace insurance is available to many people for low or no cost, depending on income level. You can complete your own Marketplace application here. You can also connect with a navigator through EnrollVA here or by calling (888) 392-5132 to get help finding the best plan for you. 

The hearing office will swear in participants who will be giving evidence, testimony, or any factual information. You and the local agency will both have the opportunity to give an opening statement, present your evidence and testimony, cross examine or question the other party’s evidence, and give a closing statement. The hearing officer will consider all of the evidence as though it is new. If you realize that something is missing from the record, you can request that the record is kept open for submission of evidence. That may mean that it takes longer for you to receive a decision.  

• Opening/Closing Statements: This is your chance to outline what the biggest problem is and summarize what all the evidence is going to say/did say.  
• Presenting Evidence/Testimony: This is your chance to make sure everything is clear/in the record. Use the opportunity to speak about the issue to clarify what is in the paper record. Repeat the things that are most important, but don’t just repeat what is in the paper record – explain it.  
• Cross Examination/Questioning: This is a chance to question the other party’s interpretation of information. Ask them questions about the data and information, and how they made the decisions that they made.  

Remember: Both you and the local agency are allowed to do each of these steps, so the other side may ask you questions, add their own testimony, or give a statement supporting their decision.  

Decisions should be issued within 90 days of requesting an appeal. Some things, such as rescheduling the hearing or keeping the record open may make that window open longer. You will receive the hearing officer’s decision in writing via mail. 

If at any point it appears that the hearing officer is considering the case based on the recommendation of the local agency rather than full considering all of the evidence as new, does not permit you to present your evidence or submit documentation – contact us right away for legal advice.