MedicaidReimbursementHigh impact
Waiver Rate Updates Effective July 1, 2026
Virginia Medicaid - DMAS·VA · Geriatrics·Claims & Billing
Effective date
Jul 1, 2026
We identified it
Sep 11, 2026
Summary
Virginia Medicaid has updated reimbursement rates effective July 1, 2026, for select services under the Developmental Disabilities (DD) Waiver and Commonwealth Coordinated Care Plus (CCC+) Waiver, plus revised the billing unit for Adult Day Healthcare. Managed Care Organizations (MCOs) require 30-60 days to update their systems and will automatically reprocess claims paid at old rates. Providers may bill immediately at old rates or wait for MCO system updates.
Action Required
By July 1, 2026: Billing team must begin monitoring the DMAS provider portal (PRSS) for rate sheet updates at https://www.dmas.virginia.gov/for-providers/rates-and-rate-setting/. Verify provider enrollment, contact information, and license information in PRSS for all service locations to ensure claims are not denied. Download and review the official SFY 2027 rate sheet once posted. Update billing software with new DD Waiver, CCC+ Waiver, and Adult Day Healthcare rates. Coordinate with each MCO (Cardinal Care, Aetna, Anthem, Humana, Sentara, United Healthcare, Acentra) regarding their system update timeline (30-60 days post-rate posting). Billing team may elect to bill MCOs immediately under old rates or delay billing until MCO systems are updated—document this decision. Track claim reprocessing timelines: DMAS will auto-reprocess FFS claims within ~30 days of system update; MCOs will auto-reprocess within ~30 days of their system completion. If rate errors are identified, file appeals with DMAS Appeals Division within 30 days of rate publication via https://www.dmas.virginia.gov/appeals/ or contact (804) 452-5454. Call provider helpline at 1-800-552-8627 with rate questions. Failure to update provider enrollment in PRSS will result in claim denials from MCOs and DMAS.