Medicaid is a government-sponsored program that provides health care coverage assistance for people with low-incomes. The joint program, funded by the federal government and administered at the state level, varies. Patients receive assistance with paying for doctor visits, long-term medical, custodial care costs, hospital stays, and more.
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The Children’s Health Insurance Program (CHIP) is offered to parents with children under the age of 19, whose incomes are too high to qualify for Medicaid but can’t afford regular health insurance. Income limits vary, as each state runs a variation of CHIPs under different names and eligibility requirements.
All services provided by the Children’s Health Insurance Program (CHIP) are free for eligible applicants including doctor visits and check-ups, vaccinations, hospital care, dental and vision care, lab services, X-rays, prescriptions, and emergency services.
Medicaid covers members of the following groups that meet income, asset, USVI residency, and citizenship criteria:
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 the 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.
Unlike Medicaid enrollees in the States, VI Enrollees do not have the freedom of choice (FOC) to select their preferred medical providers.
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:
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