MCC of Virginia Member Stories

Magellan Complete Care of Virginia’s Medallion 4.0, Commonwealth Coordinated Care Plus (CCCPlus) and Dual Special Needs Plan (D-SNP) members receive personalized, high-quality health care tailored to their medical, behavioral and social health needs.

Suzie’s Story

Suzie* is a forty-two year old female who joined MCC of VA in 2019 when Virginia expanded Medicaid to include childless adults and men. Suzie has a number of physical and behavioral health issues, including asthma and major depressive disorder. Unfortunately, her depression led to several suicide attempts, and she was living in a traumatic household, self-medicating with alcohol and drugs.

When Suzie first enrolled with us, we had a hard time reaching her. When she was admitted to the hospital, our care coordinator was finally able to speak her in person. She was in need of good, long-term residential treatment, so our care coordinator sprang into action, working with others at the health plan to find the right place for her.

After her residential treatment, Suzie returned to her mother’s home and lives there with her her children. She is clean from substance use and attends group therapy, is regularly seeing a psychiatrist and is engaging in medication management for her depression. She also returned to a health weight and regularly sees her physician to ensure that she is and stays healthy after years of alcohol and drug abuse. She is now working and has been attending and volunteering at church three times per week.

Suzie said none of this would be possible without the coverage and support from MCC of Virginia to reach her goals to be free of substance use and to have her mental health issues managed properly.

*Not her real name.

Mary’s Story

Mary* is a 47-year old female dual-eligible member who was hospitalized of congestive heart failure, which was exacerbated by her weight. Her stay in the hospital was difficult. She experienced multi-organ failure and required respiratory stabilization. Mary’s prognosis was grim; she was give 3 – 6 months to live and was placed on Hospice/Palliative Care. Despite her prognosis, she was determined to recover, and she did. She was no longer experiencing multi-organ failure, was losing weight  and was ready to go home. Unfortunately, that was challenging, because she still had complex needs that required significant care. She needed to be in a residential facility for a while.

A team at MCC of VA worked tirelessly with the facility social worker and others to keep the woman near her family. Unfortunately, after an exhaustive search, there was no facility within the state that was able to meet the complex needs of the member. The team then shifted focus and worked on a solution that would allow Mary to live in a community setting and still get the complex care she needed through the Technology wavier. The waiver required the community setting to be modified, among other things. Over the next several months, the MCC of VA team took charge to make everything happen. They:

  • Found a provider willing to take on Mary’s complex needs
  • Worked with the apartment complex to install accessible doors
  • Obtained durable medical equipment (DME) and supplies
  • Arranged for 24-hour in-home care by 2 caregivers each day
  • Trained family members in back-up care for the member’s breathing needs
  • Located providers who would conduct home visits
  • Provided transportation for Mary to visit providers who couldn’t come to her

After a year of significant collaboration and planning, Mary was finally able to transition from the community setting to her own home and live with her family. The MCC of VA team continues to work very closely with her and her care team to coordinate her care and ensure her complex needs are met.

*Not her real name.