MedicaidCoverageMedium impact
Continuity of Care (New)
Humana·VA·Medicaid
Effective date
Jul 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has introduced a new Continuity of Care policy for Virginia Medicaid members, allowing overrides of utilization management requirements (step therapy, prior authorization, non-preferred edits) for members stable on existing medications within their first 60 days of enrollment. This applies when members are stable on therapy, have compendia-supported diagnoses, and enrolled within the previous 60 days.
Action Required
By July 1, 2025: Billing team should review current Virginia Medicaid members who are within their first 60 days of enrollment and stable on existing medications. When prior authorization denials occur for these members, reference this Continuity of Care policy to request overrides for utilization management requirements. Ensure documentation shows member stability on medication, compendia support for diagnosis, and enrollment date within previous 60 days.