Kimberley Causey-Gomez
Commissioner

 

Michal Rhymer-Browne

Assistant Commissioner - St. Thomas

 

Carla Benjamin

Assistant Commissioner - St. Croix

U.S. Virgin Islands

Department of Human Services

Family Assistance Programs

VI Medicaid Program (Medical Assistance Program)

Medicaid is a government-sponsored program that provides assistance for health care coverage to people with low-incomes. The joint program, funded by the federal government and administered at the state level, varies. Patients receive assistance paying for things like doctor visits, long-term medical, custodial care costs, hospital stays, and more.

 

All of the services provided by CHIPs are free including doctor visits and check-ups, vaccinations, hospital care, dental and vision care, lab services, X-rays, prescriptions, and emergency services.

 

What is Medicaid?

  • Title XIX or Medicaid provides grants to States for Medical Assistance to the Needy.
  • Medicaid, which is also called Medical Assistance, is designed to make adequate health care available to children and adults who are unable to meet the cost of their medical needs.
  • It is a federally funded assistance program, operated according to the State Plan which was first approved by the US Department of Health and Human Services, July 1, 1966.
  • Medicaid also supplements the insurance plans provided under Title XVIII (Medicare).
  • Medicaid is the largest source of health insurance in the nation.

 

What is not Medicaid?

  • Medicaid is not Medicare.
  • Medicaid is an assistance program and does not require financial contributions from its recipients.
  • Medicaid, unlike Medicare, is a shared federal state/territory responsibility.

 

CHIP

The Children's Health Insurance Program (CHIP) is offered to parents of children under the age of 19 who make too much to qualify for Medicaid but can't afford regular health insurance. The income limits vary, as each state runs a variation of the program with different names and different eligibility requirements.

 

 

The main point of entry into the program is through an eligibility determination performed by the DHS.  Application processing times for Regular Cases should not exceed forty-five (45) days and Disability Cases should not exceed sixty (60) days. 

 

Clients applying under the permanent and total disability category are required to complete the Medicaid Application for Permanent and Total Disability (APTD) process unless they are already receiving Social Security Disability Benefits.

 

Person determined eligible are normally eligible for up to 12 months (unless their circumstances change) at which time a redetermination must be performed to continue eligibility.

 

The VI has also implemented Presumptive Eligibility (PE) as another door to enroll into Medicaid/CHIP Programs.  The PE Process allows uninsured individuals who need medical care to be temporarily determined eligible by certain providers when they appear at their facilities.  The PE Process allows the individuals to complete a brief PE application and self-attest to all information on that application and be immediately determined eligible if they qualify, and receive services immediately paid for by the Medicaid or CHIP Programs.  Note that PE eligibility is very limited and runs only to the end of the month following the month the PE application is completed and only one PE eligibility is permitted in any 12-month period.  PE Individuals must come into the DHS/MAP offices to complete a full Medicaid application to ensure continued eligibility and to ensure continuity of care.  Currently, PE is performed at the hospitals in the territory.

 

VI Enrollees do not have the freedom of choice (FOC) to go to any provider that they want to receive services as do Medicaid enrollees in the States.

 

Provider Enrollment

An eligible provider may be an individual, partnership, association, corporation, institution or public agency, meeting applicable requirements and standards for participation in the Medicaid Program.  A written agreement (Provider Agreement or Memorandum of Agreement for local clinics) must be signed between the provider of service and the USVI Medicaid Program. 

 

Please visit www.vimmis.com, reference materials or register as a user for enrollment application form.

 

Every contractual Agreement with the Government of the US Virgin Islands typically requires the following supporting documentation:

 

Group Providers/Corporations/Limited Liability Companies:

  • Current, valid business license for the entity;
  • Current, valid professional licenses for individual providers;
  • License Verification/Good Standing for individual providers, dated within the last year;
  • Current DEA Registration, if applicable;
  • Current Healthcare Professional Liability/Medical Malpractice;
  • Current Certificate of Government Insurance Coverage/Workers’ Compensation;
  • Current Certificate of Good Standing; note this expires June 30th each year;
  • Articles of Incorporation or Organization establishing the entity and any subsequent amendments;
  • Resolution authorizing the Agreement signatory to execute any agreement on behalf of the establishment.  This must be signed by the Corporate Secretary;
  • Current Tradename Certification, if applicable;
  • Sam.gov registration; and
  • Completed W-9 form.

Individual Providers:

  • Current, valid professional license;
  • Current Health Care Professional Liability/Medical Malpractice Insurance coverage (or Commercial General Liability and Automobile Liability Coverage for transportation services);
  • Licensure Verification/Good Standing dated within the last year;
  • Current DEA registration;
  • Current Certificate of Government Insurance Coverage/Workers Compensation;
  • Current Sam.gov registration;
  • Completed w-9 form; and
  • Current Tradename Registration, if applicable.

Hospitals, Laboratories and Federally Qualified Health Centers:

  • Current, valid business license for the entity/facility;
  • Current Healthcare Professional Liability/Medical Malpractice (or Commercial General Liability and Automobile Liability Coverage for transportation services);
  • Current Certificate of Government Insurance Coverage/Workers Compensation;
  • Current Certificate of Good Standing; note this expires June 30th each year;
  • Current Accreditation Certificate;
  • Articles of Incorporation or Organization establishing the entity and any subsequent amendments;
  • Resolution authorizing the Agreement signatory to execute any agreement on behalf of the establishment.  This must be signed by the Corporate Secretary;
  • Current SAM.gov registration;
  • Completed W-9 form; and
  • Current Tradename Registration, if applicable.

 

Call Center:(340) 715-6929 |Email:vimmis@dhs.vi.gov

 

MMIS EDI HelpDesk:(855) 248-7536

 

Email:VIEDIHelpdesk@MolinaHealthCare.com

 

Special Services:

(340) 774-0930x4352 St. Thomas

(340) 773-1311x6224 St. Croix