Family Assistance Programs
VI Medicaid Program (Medical Assistance Program)
Medicaid was established by Congress in 1965 under Title XIX of the Social Security Act. Title XIX created the Medicaid program as partnership between the states, the territories, and the federal government to provide health care to certain low-income populations.
Click on link below to view required documents when applying for Medicaid in the U.S. Virgin Islands.
Click on link below to view USVI Access Monitoring Review Plan 2016
Call Center:(340) 715-6929 | Email: firstname.lastname@example.org
MMIS EDI HelpDesk:(855) 248-7536
(340) 774-0930x4352 St. Thomas
(340) 773-1311x6224 St. Croix
CMS requires ICD-10 codes on claims containing dates of service October 1, 2015 forward. For additional information please reference the Medicaid Program MMIS Provider WebPortal at: https://www.vimmis.com/Base%20Document%20Library/ICD-10%20Transition.aspx?PageView=Shared
All provider enrollment or re-enrollment into the USVI Medicaid program is handled by the VI Medicaid Program. Providers must contact the VI Medicaid Program directly so that the services and applicable rates/fees, and term of service, can be determined. A VI Medicaid Program Provider Agreement form will be prepared reflecting the applicable term, type of service, and applicable payment rate, and this form must be signed by the provider. This form must also be signed by the Commissioner of the VI Department of Human Services, and the Commissioner of the VI Department of Property and Procurement. Section 6401(a) of the Affordable Care Act as amended by section 10603 of the Affordable Care Act, amends section 1866(j) of the Social Security Act (the Act) adds a new paragraph for “(2) Provider Screening” and Federal regulations at 42 CFR §455.410 and §455.450 requires that all participating providers of medical or other items or services and suppliers under Medicare, Medicaid, and CHIP Section 1866(j)(2)(B) be screened according to their categorical risk level, upon initial enrollment and upon re-enrollment or revalidation of enrollment.
The required screening measures vary according to the provider’s categorical risk level of “limited,” “moderate” or “high.” State Medicaid agencies may rely on the results of screening performed by Medicare contractors, other State Medicaid agencies or other Children’s Health Insurance Program (CHIP) programs. Screening and credentialing is conducted by the VI Medicaid Program or its agent. Since there is no national enrollment database for Medicaid providers, in order to ensure that States do not complete unnecessary screening or collect application fees inappropriately, States should request information from providers as to whether they have submitted an application to enroll or if they are currently enrolled in another State’s Medicaid program or CHIP. If a provider informs the State that it is enrolled or has applied for enrollment in another State’s Medicaid program or CHIP, the State should contact the other State to confirm if the provider has been enrolled and therefore, screened, or if the provider is currently enrolling and/or if the State has collected an application fee. Federal Regulations at 42 CFR §455.460 require that only one application fee be collected for a Medicaid enrolling provider.
Upon the completion of the Provider Agreement, signed by the Department of Property and Procurement, a Government of the VI vendor number will be issued which is used in the data file when the government’s financial system (ERP) issues the payment to the provider. As part of the packet of information to be completed by the provider, and electronic fund transfer form is included. We encourage VI Medicaid Program providers of medical services, and vendors, to sign-up to receive payment via electronic funds transfer (EFT). However paper checks can be issued, but only one method can be recorded.
Once provider credentialing and the executed VI Medicaid Program Provider Agreement is complete a welcome letter is sent to the VI Medicaid Program enrolled provider with directions on how to access the VI Medicaid Program’s Medicaid Management Information System (MMIS) Provider Web Portal. VI Medicaid Program enrolled providers must complete a trading partner agreement in order to access secured information in the Web Portal. Our MMIS Web Portal can be found at www.vimmis.com.
Definition of Permanent and Total Disability
US Virgin Islands Medicaid Program
Individuals who are single childless adults, age 21-64 are presently not an eligible group under the VI Medicaid Program. However, and individual may complete an Application for Permanent and Total Disability (APTD), and if approved is considered disabled which is a covered group. Persons in this group must also meet the other standard eligibility criteria, such as income, resource, residency, and immigration status. “Permanent and Total Disability means that the individual has some physical or mental impairment disease or loss that substantially precludes the person from engaging in gainful occupations within individual competence such as holding a job or performing homemaking tasks. The impairment may be physical or mental organic of functional and of such degree as to interfere with the individual faculties such as senses reasoning mobility etc. It may exist from birth be acquired during the lifetime of the individual or result from an accident. It may be obvious such as loss of limb or it may be that it can be revealed only by medical examination. It may exist singly or in combinations and cannot be revised or corrected”.
Since DHS requires applicants for Medicaid to obtain appointments, please obtain an appointment at the time the application for permanent and total disability is started.