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Glossary of Terms

  • Authorized Representative – A person who is authorized in writing to conduct the personal or financial affairs for an individual.
  • Cover Virginia Call Center – 1-855-242-8282 provides general program information and accepts applications over the phone for Medicaid and FAMIS programs. Also provides translation services and referral to CommonHelp or LDSS for other benefit programs.
  • DMAS – Department of Medical Assistance Services, the agency that administers the FAMIS and Medicaid programs in Virginia.
  • DSS – Department of Social Services, the agency responsible for determining eligibility for medical assistance and the provision of related social services. This includes the local Department of Social Services.
  • Eligibility Worker – Eligibility worker at the local Department of Social Services who reviews your application for Medicaid, FAMIS or Plan First to determine if you are eligible. This is the person you would contact regarding changes, such as your address or income, or problems, such as not receiving your Medicaid card.
  • FAMIS – Is a comprehensive health insurance program for uninsured children from birth through age 18. FAMIS is administered by the Virginia Department of Medical Assistance Services (DMAS) and is funded by the state and federal government.
  • FAMIS Plus – Is the Medicaid program for children.
  • FAMIS Select – Gives families of FAMIS-eligible children the opportunity to choose between coverage under FAMIS and coverage through a private or employer-sponsored health plan. Children enrolled in FAMIS Select access health insurance through their private or employer-sponsored health plan and will present the identification card of that plan for payment. Children enrolled in FAMIS Select do not have access to direct FAMIS coverage except if needed to cover childhood immunizations.
  • Managed Care- Delivery of health care services emphasizing the relationship between a primary care provider (PCP) and the Medicaid member (referred to as a “medical home”). The goal of managed care is to have a central point through which all medical care is coordinated. Managed care has proven to enhance access to care, promote patient compliance and responsibility when seeking medical care and services, provide for continuity of care, encourage preventive care, and produce better medical outcomes. Most Virginia Medicaid members are required to receive their medical care through managed care programs.
  • Managed Care Organization (MCO) – Is an organization that contracts with DMAS to provide, arrange for, deliver, pay for, or reimburse any of the costs of health care services for Medicaid enrollees.
  • Medicaid – An assistance program that helps pay for medical care for certain individuals and families with low incomes and resources, if applicable.
  • Primary Care Provider (PCP) – The doctor or clinic that provides most of your health care needs, gives you referrals to other health care providers when needed, and monitors your health. A PCP may be an internist, a pediatrician (children’s doctor), OB/GYN (women’s doctor), or certain clinics and health departments.
  • Smiles For Children – Is Virginia’s dental program for children enrolled in Medicaid, FAMIS and FAMIS Plus.