DHS Expands Medicaid Benefit Flexibilities for Members and Providers

The Virgin Islands Department of Human Services on St. Thomas. (Source photo by Bethaney Lee)

The Virgin Islands Department of Human Services (DHS) is working around the clock with its federal partners to ensure that Virgin Islanders have access to all provisions that will be of help during this crisis. DHS staff members are implementing changes in record time and working to ensure that the various programs can keep pace with the new surge in need and demand for critical cash, food, medical, childcare and energy assistance benefits.

DHS exists to advocate for the territory’s vulnerable populations and ensure that all Virgin Islanders have access to much needed resources.

The Medicaid Program (MAP), which is called Medical Assistance Program locally, is a critical government-sponsored program that aids with healthcare coverage to uninsured or under-insured people with low-incomes. Human Services employees are also on the front lines every day and serve the Virgin Islands community as essential employees in this time of national uncertainty and hardship.

MAP, funded by the federal government and administered at the state/territory level provides a variety of assistance services like doctor visits, long-term medical, custodial care costs, hospital stays and more.

Additional Member Benefit Flexibilities

To help in this time of COVID-19, the V.I. Department of Human Services administered Medicaid Program is currently offering the following member benefit flexibilities:

  1. Automatically extend all Medicaid/ Children’s Health Insurance Program (CHIP) recertification’s for six months, thus promoting social distancing, health and wellness for our clients and staff alike.
  2. Eliminate current requirements for members to get referrals for specialists and to get prior authorization. This means, during this time of hardship, MAP members will not have to get referrals from their primary doctors or public providers and a prior authorization (except for certain dental and durable medical equipment) from the DHS.

3011 Golden Rock • Christiansted, St. Croix, Virgin Islands 00820 • 718-2980 phone • 773-6121 fax

1303 Hospital Ground, Suite 1 • St. Thomas, Virgin Islands 00802-6722 • 774-1166 phone • 774-3466 fax

Schedule an appointment with a private provider or specialist first. This will enable our members to receive services from any enrolled Medicaid provider without any referral or prior authorization to extend presumptive eligibility already being performed in the hospitals, Federally Qualified Health Centers (FQHCs), and Department of Health clinics to pregnant women, the aged, blind and disabled populations.

DHS will extend the eligibility period for all Presumptive Eligibility applications for 90-days from the date of the application to support social distancing, while providing continuous eligibility for needed services.

Presumptive Eligibility (PE) provides Medicaid benefits for a limited time while a formal Medicaid eligibility determination is being made by DHS. The goal of the PE process is to offer immediate health care coverage to people likely to be Medicaid eligible before there has been a full Medicaid determination.

Medicaid Providers

For Medicaid providers, the DHS Medicaid Program will extend the following flexibilities:

  1. Postpone deadlines for revalidation of provider agreements for the duration of the COVID-19 Public Health Emergency. This is applicable for all providers currently enrolled in the Medical Assistance Program including off-island providers.
  2. Waive normal provider screenings and enrollment activities in those cases where a provider is already a participating Medicare provider or a participating Medicaid provider in another state or territory.
  3. Reimburse for hospital and other services rendered in an unlicensed facility that DHS can assess to reasonably meet minimum standards and expectations (including health, safety, and comfort for members and staff) consistent with the current COVID-19 Public Health Emergency guidelines for Medicaid members. This would apply in the event the hospitals became overwhelmed with patients.
  4. Provide clinically appropriate care using telehealth and telemedicine technology, primarily through DHS Department of Health Clinics, FQHCs and physicians.

Providers will be paid the same rate for providing telehealth and telemedicine appointments as they would for a face to face encounter.

DHS continues to work with its federal partner, Centers for Medicaid and Medicare Services (CMS), to ensure all the available flexibilities and authorities are implemented to allow DHS to provide quality health care services to the citizens of the U.S. Virgin Islands.

3011 Golden Rock • Christiansted, St. Croix, Virgin Islands 00820 • 718-2980 phone • 773-6121 fax

1303 Hospital Ground, Suite 1 • St. Thomas, Virgin Islands 00802-6722 • 774-1166 phone • 774-3466 fax

For more information, visit the Department of Human Services website: www.dhs.gov.vi or its Facebook page at https://www.facebook.com/usvidhs at U.S. Virgin Islands Department of Human Services. People can also email: [email protected] on St. Thomas or [email protected] on St. Croix with questions or to submit documentation. Please ensure that a working telephone number is on any application. Telephone interviews will be scheduled in lieu of face-to-face interactions.

Phone Contacts:

St. Croix:772-7117 or 772-7100 ext. 7006/ 7151/ 7120

St. Thomas: 774-0930 ext. 4308/ 4324/ 4318

Phone Contacts:

St. Croix: 772-7117 or 227-4686

St. Thomas: 725-5702

For more information on COVID-19, visit the V.I. Department of Health’s website: www.doh.vi.gov/coronavirus or text COVID19USVI to 888777. #COVID19USVI