Virginia officially expanded Medicaid as it reached a resolution on its state budget in summer 2018. Anthem Blue Cross and Blue Shield, Cigna, and Aetna are the top three commercial carriers in Virginia, and all three have unveiled new PBM divisions as a result of mergers or new agreements. There have been several notable payer-provider agreements reached recently, including between Optima Health (owned by Sentara Healthcare) and Riverside Health System in the Norfolk market. Virginia continues to be a leader in telemedicine activity, and the state has been investigating blockchain capabilities to better help its cyber-security efforts. The Department of Medical Assistance Services selected six MCOs for Medallion 4.0, an update of the state's Medicaid program that serves more than 700,000 members. Seniors in Virginia should have numerous low-cost Medicare Advantage options from which to choose.