Virginia Medicaid, SCHIP, & Federal Authority

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Section 1115/HIFA Waiver – In June 2005, Virginia received approval from the Centers for Medicare and Medicaid Services (CMS) for a demonstration waiver entitled FAMIS MOMS and FAMIS Select.  The waiver allows the state to claim Title XXI funding for pregnant women with incomes between 133 percent and 200 percent of the federal poverty level (FPL).  Virginia has been incrementally phasing in this expansion: first covering pregnant women with incomes between 133 percent and 150 percent of the FPL, followed by women with incomes between 150 percent and 165 percent of the FPL in August 2006.  Virginia expanded eligibility again in October 2007 to women with incomes between 165 and 185 percent of the FPL.  Virginia is currently scheduled to complete the FAMIS MOMS expansion to 200 percent of the FPL beginning July 1, 2009.  The expansion is subject to the availability of state funds.

The waiver also includes an employer-sponsored insurance premium assistance option, called FAMIS Select, for children with family incomes below 200 percent of the FPL.  Families with children who choose to enroll in FAMIS Select may receive up to $100 per FAMIS Select enrolled child per month to help pay their family premium. In fiscal year 2007, a total of 857 women were enrolled in FAMIS MOMS, and 857 children were enrolled in FAMIS Select.

The Deficit Reduction Act of 2005 (DRA) – In March 2007, CMS approved Virginia’s submission of a benchmark state plan amendment under the DRA to offer Medicaid and disease management services to beneficiaries with certain chronic medical conditions. The program, entitled Healthy Returns, is open to categorically eligible individuals who have asthma, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, and/or diabetes.[1]  Enrollment in the program is voluntary. In addition to state plan services, enrollees receive condition-specific education; access to a 24-hour hotline; care coordination; and regularly-scheduled telephonic care management. All traditional Medicaid services will be administered on a fee-for-service basis, and a prepaid ambulatory health plan will provide the disease management.

Additionally, the Virginia Department of Medical Assistance Services recently sought and received authorization, through the DRA, to establish an optional “alternative benefits package” for MEDICAID WORKS program enrollees that includes personal assistance services in addition to the standard health care services available through Medicaid.  MEDICAID WORKS is Virginia’s Medicaid Buy-In program, which enables workers with disabilities to earn higher income and retain more in savings than is typically allowed by Medicaid while ensuring continued health care coverage.  With the addition of personal assistance services, sometimes called attendant care, individuals with disabilities can receive non-medical support in the home or the workplace in order to continue to live at home, maintain employment and participate in community activities.

[1]Individuals enrolled in managed care, dually eligible for Medicare and Medicaid, residing in institutions, or who have third party insurance are not eligible to enroll in Healthy Returns.