Magellan Health

For Members

Governor's Access Program (GAP)

Governor’s Access Plan Information for Members, Family and Advocates

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.

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
  • Live in Virginia
  • Be a U.S. Citizen or lawfully residing immigrant
  • Have a household income that is below 80% of the Federal Poverty Level
  • 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:

  1. Complete a GAP application

To do this go to the Cover Virginia website

OR call Cover Virginia at 855-869-8190 / TDD 888-221-1590

2. Get a GAP SMI Screening

To do this visit your local Community Service Board OR

Find where you can get this screening by calling 1-800-424-GAP9

Once you have GAP Medicaid coverage, behavioral health services may be covered

  • Psychosocial Rehabilitation Services 
    • Join groups to learn social skills and other 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 or substance use 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 
  • Crisis Services 
    • Get quick support to help you stay out of the hospital and feel better 

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
    • To get help understanding your insurance or find services call 1-800-424-4279
  • Recovery Navigation

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) website

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


GAP Basics 

GAP Flyer - Eligibility Information

GAP handout for potential GAP members

 

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Contact Us

Magellan Members
Toll-free:1-800-424-4046
TDD: 1-800-424-4048
TTY: 711
Email

Magellan Providers
For questions about credentialing, contracting, provider website issues or general provider concerns, please contact us or call 1-800-424-4536.

For claim, authorization, discharges or clinical questions: email or call 1-800-424-4046.

Fraud and Abuse
1-800-755-0850
Special Investigations Unit Email: SIU@magellanhealth.com.

For quality of care concerns, general questions or comments, please call:
Toll-free: 1-800-424-4046