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Medicaid Service Adjustments Frequently Asked Questions (FAQs) Why are the PCA Program, Durable Medical Equipment, Adult Dental and Prescription Services, and Medical Escort Travel Programs Being Paused or Limited? We experienced an influx of clients after the storms of Irma and Maria, followed by the COVID-19 pandemic, and the numbers have never gone down. In the wake of these disasters, many individuals faced new health challenges and increased care needs, driving a surge in demand for these services to support daily living activities and overall well-being. This unprecedented increase in requests has led to unsustainable costs. Will the PCA Program Continue to be Available for Children? Yes. The PCA Program will continue to be available for children. Will the PCA Program Continue to be Available for Members who are Aged, Blind, or Disabled? Yes. The PCA Program will continue to be available for the aged, blind, and disabled on a temporary basis. During the time in which the service is limited, certain measures will be reimplemented to help ensure the proper utilization of resources. Prior authorizations for specific procedures will be reinstated to maintain the efficiency and effectiveness of our services. What If I Have a Need for The Services During This Time When They Are Paused or Limited? During the time services are paused you can still submit a request in writing to have your case reviewed by DHS and the medical review team who will review your request and make a determination on a case-by-case basis. For written service requests, please submit to: dhs.map@vi.giv What If I Have a Need for Prescription Drugs During This Time When They Are Paused or Limited? Critical and therapeutic medications will remain available and may require a prior authorization. Generic alternatives are also being reviewed and may be considered as a substitute to an existing prescription. Additionally, individuals should ask their pharmacist about prescription discount programs that may be available for prescriptions not being covered. When Can We Expect These Programs to Resume? We recognize the importance of these services and are working diligently to bring them back online. Efforts are underway to seek additional funding and resources to restore these services as soon as possible. What Can We Expect When These Programs Resume? Certain measures will be reimplemented to help ensure the proper utilization of resources. Prior authorizations for specific procedures will be reinstated to maintain the efficiency and effectiveness of our services. How Will DHS Continue to Make These Programs Sustainable? DHS is actively working on reassessing these programs to help ensure their continuation in a financially sustainable manner. We are committed to exploring avenues to minimize the impact of these changes. DHS is also exploring the potential implementation of copays for certain services in the future. This measure will help manage costs while maintaining access to care for those who need it most. These adjustments, though challenging, present opportunities for improving our services. By reassessing and restructuring, we can develop programs that are more efficient and less prone to misuse. Prioritizing essential services and implementing measures like prior authorizations will help ensure that resources are used effectively. We also value community input and welcome feedback on how we can best enhance our services The Department of Human Services (VIDHS) exists to provide social services to members in our community with diverse needs. In times of national uncertainty and hardship we act as a safety-net and exist to inspire hope and empower change through non-judgmental, quality delivery of needed services and resources. Please visit the Department of Human Services website, www.dhs.gov.vi or on Facebook (https://www.facebook.com/usvidhs).