The Governor’s Access Plan (GAP) is a new Medicaid plan that will provide limited medical and behavioral healthcare coverage for mental health and substance use disorder services, medical doctor visits, medications, access to a 24-hour crisis line, recovery navigation services, and case management.
To get GAP benefits, you must meet ALL of the following criteria:
- Adult age 21 through 64 years old;
- U. S. Citizen or lawfully residing immigrant;
- Resident of Virginia;
- Household income that is below 80% of the Federal Poverty Level (FPL) (includes a 5% income disregard);
- Not otherwise eligible for any state or federal full benefits program including: Medicaid, FAMIS, Medicare, or Tricare;
- Not residing in a long term care facility, mental health facility, long-stay hospital or penal institution; and
- Screened and meet the criteria for GAP Serious Mental Illness (SMI).
GAP Income Guidelines
Qualifying for GAP also depends on household income and family size. For your family size, count the number of people included on your federal taxes. If you do not file taxes, count how many children and stepchildren under age 19 live in your home. Add yourself if you are the mother, father or stepparent of the children. Then add your husband or wife. For example, if you have 4 children and/or stepchildren under age 19 living in your home, plus yourself and your husband, your family size is 6. We determine eligibility based on monthly income. The current monthly income limit for a family of 6 is $2,308.
|GAP INCOME LIMITS* (GROSS INCOME) – EFFECTIVE JULY 1, 2016|
|Additional person add||$296||$3,536|
*includes 5% standard disregard
Applying for GAP is a two-step process. You can start at either step.
1. Completing a GAP application for financial/non-financial determination; and
2. Having a GAP SMI Screening done.
NRVCS can assist you with submitting a GAP application
To discuss your eligibility for the GAP program, or to schedule a screening, call NRVCS at 540.961.8400.
Individuals who meet the requirements are enrolled for a period of 12 continuous months. After 12 months, you will need to update your financial information; however, you will not need a new SMI Screening.
Services covered by the GAP Plan
There are three areas covered by the GAP Medicaid Plan: Outpatient Medical Services, Outpatient Behavioral Health Services, and Additional Services Covered by Magellan. Below is an overview of the services included:
– Primary & Specialty Care
– Diagnostic Services
– Physician’s Office
– Outpatient hospital coverage is limited to diagnostic ultrasound, diagnostic radiology (excluding PET scans), and EKG – including stress
– Diabetic Supplies
Behavioral Health Services
– GAP Case Management
– Psychiatric Evaluation, Management & Treatment
– Crisis Stabilization
– Crisis Intervention
– Psychosocial Rehabilitation
– Outpatient Psych & Substance Abuse Treatment Services
– Substance Abuse Intensive Outpatient (IOP)
– Methadone & Opioid Treatment
Magellan Only Services
– Care Coordination including Community Wellness and Community Connection
– Crisis Line available 24/7 and staffed by licensed mental health professionals
– Recovery Navigation Services, including a state-wide warm telephone line staffed by trained peers and limited, local, voluntary, in-person supports
Get more information
GAP members can call a Magellan care manager toll-free at 1-800-424-4279 or 1-800-424-GAP9. Magellan will have someone there 24 hours, 7 days per week to provide information about covered benefits, how to find a provider, and who to call for medical, pharmacy, and behavioral health needs.
GAP members can call the Magellan Recovery Navigation Line at 1-800-424-4520. This telephone number will be answered by a trained peer who has been through the mental health system who can help you navigate the system as well.
– GAP launches new “warm line” (posted 4/10/15)