Governor's Access Plan (GAP)

Governor's Access Plan (GAP)

Serious Mental Illness (SMI) and co-occurring disorders and conditions are highly treatable.

Having healthcare coverage allows access to behavioral and health services.  Having this coverage can help members live, work, parent, learn, recover and be part of the community.

In September 2014, former Governor McAuliffe took a huge step in providing health insurance to uninsured Virginians by establishing the Governor’s Access Plan (GAP). GAP is a Medicaid plan that provides limited medical and behavioral health care coverage for low income individuals with serious mental illness.

We fully believe and recognize that serious mental illness is a highly treatable condition and with health coverage such as GAP, individuals have access to behavioral, substance use, and health services. In addition, members with this coverage are able to achieve successful recovery, wellness, resiliency, and increase positive participation in their community.

GAP Information for GAP Members and potential GAP members

Magellan along with the Department of Medical Assistance Services (DMAS) is excited to announce recent changes to the Governors Access Plan (GAP) that will expand services to GAP members. The GAP regulations were revised to account for program changes mandated by the 2017 General Assembly.

Effective October 1, 2017- For individuals applying for GAP coverage, the eligibility limits for a household income has increased from 80% to 100% (with an additional 5% disregard) of the federal poverty level.

Also, effective October 1, 2017- GAP insurance now covers additional Addiction and Recovery Treatment Services (ARTS) including Partial Hospitalization Services (ASAM Level 2.5) and Residential treatment (ASAM Levels 3.1 through 3.7) for members who have substance use disorders. For more information on ARTS services, GAP members can visit the Department of Medical Assistance Services’ (DMAS) Addiction and Recovery Treatment Services (ARTS) website or call Magellan of Virginia at 1-800-424-4046. 

Recovery Navigation Flier

GAP Flier 2017

ARTS one-pager for Peer Support

Mental Health one-pager for Peer Support 

Getting GAP Medicaid

To be eligible for GAP, you must:

  • Be between 21 and 64 years old
  • Not have other health insurance of any kind
  • Not eligible for any existing entitlement program (Medicaid, TriCare, Medicare)
  • Live in Virginia
  • Be a U.S. Citizen or lawfully residing immigrant
  • Have a household income that is below 100%* of the Federal Poverty Level (*100% +5% disregard)
  • Not live in a long-term care facility, mental health facility, or penal institution
  • Be screened and meet the criteria for GAP SMI (step 2 below)

Applying for GAP Medicaid is a 2 step process:

  • Complete a GAP application
  • Get a GAP SMI Screening
    • To do this visit your local Community Service Board (CSB) or a participating Federally Qualified Health Center (FQHC); or
    • Find where you can get this screening by calling 1-800-424-GAP9

Once you have GAP Medicaid coverage, behavioral, substance use, and health services may be covered:

  • Psychosocial Rehabilitation Services
    • Join groups to learn social and life skills to help you live on your own and enjoy your life 
  • Outpatient Therapy
    • Receive one on one, family or group therapy in a private location for mental health concerns
  • Substance Abuse Intensive Outpatient Program
    • Join groups to help you learn skills to not use alcohol or drugs
  • Opioid Treatment
    • Receive Methadone or Suboxone treatment
  • Psychiatric Evaluation
    • Talk to a doctor to see if medication would help you feel better
  • GAP Case Management
    • Get help solving problems, get assistance with what you need, and help finding other supports in your community
  • Crisis Services
    • Get quick support to help you stay out of the hospital and feel better
  • Residential Services for Substance Use
    • Stay in a safe environment for a short period of time while getting help and learning skills to stay alcohol or drug free
  • Peer Support Services
    • Work with peer specialists who can share their lived experience of overcoming mental health and drug usage challenges

Medical services may also be covered:

  • Primary Doctor and Medical Office Visits
    • Your primary care provider can help you stay healthy and help with many other problems
  • Specialty Care
    • Go to a doctor for problems that need additional care and attention. This can include a cardiologist, dermatologist, and other specialty doctors
  • Outpatient Diagnostic Services
    • This includes ultrasounds, CAT scans, MRIs, radiology, and EKGs that are performed in a doctor’s office
  • Laboratory
    • Help getting blood or other tests done to find problems in your body
  • Medical Equipment and Supplies
    • For assistance with diabetic medical equipment needed to maintain your health
  • Pharmacy
    • Have your prescription medications covered

GAP Coverage DOES NOT cover:

  • Transportation
  • Vision
  • Dental
  • Inpatient Services
    • Going to an ER or staying in a hospital is not covered

Magellan Services for GAP Medicaid Members

  • Care Coordination
    • Work with a GAP care manager in order to help you get connected to services that can assist in your journey to recovery, wellness, and resiliency.  
    • To reach a GAP care manager, call 1-800-424-4279.
  • Recovery Navigation
    • Get support from someone who has gone through things like you are going through.
    • You can reach Recovery Navigators by calling 1-800-424-4279.
    • Read more about Recovery Navigation
  • GAP Warm Line
    • Call the when you just want to talk to someone who will listen to you.
    • The call is toll-free and is only for GAP-members.
    • The phone number for the GAP warm line is: 1-800-424-4520.
      • The warm line is open seven days each week, except for major holidays like Thanksgiving, Christmas, etc. 
      • The hours for the warm line:
        Monday through Friday                             Saturday and Sunday
        4 p.m.—10 p.m.                                             10 a.m.—11 p.m.

Getting More Information

General Questions? Call Magellan to speak to a GAP Care Manager: 1-800-424-4279

Questions about an eligibility application? Call Cover Virginia: 1-855-242-8282

Want to know more? Visit the Department of Medical Assistance Services (DMAS) GAP webpage

Contact DMAS by email at: BridgetheGAP@dmas.virginia.gov

 

 

The Adobe Reader is required to view PDF files.