Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements and is jointly funded by states and the federal government. Virginia’s Medicaid program is known as Medallion Medicaid.
Enrollment
More than 46,000 Kaiser Permanente members are enrolled in Cardinal Care through our partnership with Sentara Health Plan. 46% are children and 54% are adults.
Participation
Kaiser Permanente currently participates as a Cardinal Care provider in 7 counties and in the 5 cities of Alexandria, Fairfax, Falls Church, Manassas, and Manassas Park. Kaiser Permanente is a delegated subcontractor to with Sentara to provide care on a capitated basis (meaning a fixed payment per member, per month).
State Program Spotlight
Kaiser Permanente provides several Medicaid benefits that help address social needs and improve outcomes for our members, especially those with the most complex needs. Key benefits include:
Behavioral Health Integration
To support our members’ mental health and wellness, we offer primary care, specialty medical and behavioral health care, substance use disorder treatment, and emergency care for acute crises. We partner with community mental health and rehabilitation providers to execute on the state’s behavioral health integration efforts. Our integrated model allows care to start wherever the member appears for treatment and includes both mental health and substance use disorder services for children and adults.
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
Our pediatric members have access to critical EPSDT services which provide comprehensive and preventive health care services for children under age 21. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, mental health and specialty services.
- Early: Assessing and identifying problems early
- Periodic: Checking children’s health at periodic, age-appropriate intervals
- Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems
- Diagnostic: Performing diagnostic tests to follow up when a risk is identified, and
- Treatment: Control, correct or reduce health problems found
Medicaid Tailored Model of Care (the Model)
In 2024, Kaiser Permanente launched enhanced case management services within a Medicaid tailored model of care for Virginia Medicaid members. The Model ensures all members have access to equitable, high-quality care and provides care coordination and care management services that are responsive to their needs and risks as they evolve. The Model prioritizes continuity of care and seamless transitions for members across the full continuum of physical health, behavioral health, pharmacy, and social service needs. The Model enables opportunities for members to engage with dedicated case managers focused on comprehensive proactive care planning and prevention of crisis and emergency services.
Social Health
Many Kaiser Permanente members struggle with inadequate housing, hunger, financial stress, and other circumstances that create barriers to good health, particularly members enrolled in Medicaid. Kaiser Permanente works proactively to identify our members with these and other adverse social needs and to connect them to community-based programs and government assistance programs that can support their well-being.
Safety-Net Partnerships
Kaiser Permanente is committed to building partnerships with the health care “safety net” — institutions that play a critical role in delivering health care for the uninsured and underserved. Through grants, training, and technical assistance, we work with safety-net hospitals and health centers to help these institutions reach those who are low-income, uninsured, or under-resourced in our communities, and move the needle in eliminating health disparities. We do this by investing in quality improvement and other support efforts that aim to transform care and improve health access for those most in need.
Social Health Screening and Identification
Kaiser Permanente uses standard social health screening questions and data analytics to identify members vulnerable to food- insecurity, homelessness, financial strain, and other adverse social factors. By expanding social health screenings across an increasing number of clinical settings and member services touchpoints, with a focus on high-risk populations, Kaiser Permanente is steadily increasing the number of members screened for social needs. We screened nearly 3 million members for social needs in 2024, including 32% of our Medicaid members. These screenings and other data sources helped us identify over 1 million members with social needs and connect nearly 500,000 members to public benefits and community-based programs that support overall health.
The Kaiser Permanente Community Support Hub™
The Kaiser Permanente Community Support Hub™ is dedicated to helping people meet their basic needs. The hub operates proactively, using text, email, and phone calls to encourage members to complete social health screenings and to offer help finding and enrolling in community-based resources and government assistance programs that support overall health. The Hub also provides on-demand services, including an online directory of resources that anyone can use to search for local programs that help with housing, food, paying utility bills, and more.
Medical Legal Partnerships
Working with local legal aid organizations in our communities, our care teams help patients facing housing-insecurity receive legal help at no cost. These medical-legal partnership programs build the capacity of the legal services sector and increase access to legal services to prevent people and families from losing their homes. This program targets low- income members and patients with housing related legal needs. In 2024, legal consultation was provided to over 1,000 patients across our national footprint.