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Building and Transforming Coverage, Services and Supports for a Healthier Virginia Approval Period: August 1, 2026 through December 31, 2031 Page 1 of 51
CENTERS FOR MEDICARE & MEDICAID SERVICES EXPENDITURE AUTHORITY
NUMBER: 11-W-00297/3
TITLE: Building and Transforming Coverage, Services, and Supports for a Healthier Virginia Section 1115(a) Demonstration
AWARDEE: Virginia Department of Medical Assistance Services (DMAS)
Under the authority of section 1115(a)(2) of the Social Security Act (“the Act”), expenditures made by Virginia for the items identified below, which are not otherwise included as expenditures under section 1903 of the Act shall, for the period from August 1, 2026 through December 31, 2031, unless otherwise specified, be regarded as expenditures under the state’s title XIX plan. All requirements of the Medicaid statute will be applicable to such expenditure authorities.
The following expenditures authorities may only be implemented consistent with the approved Special Terms and Conditions (STC) and shall enable Virginia to operate the above-identified section 1115(a) demonstration.
Title XIX Expenditure Authority
1. Residential and Inpatient Treatment for Individuals with Substance Use Disorder (SUD). Expenditures for Medicaid state plan services furnished to otherwise eligible individuals who are primarily receiving treatment and/or withdrawal management services for substance use disorder (SUD) who are short-term residents in facilities that meet the definition of an institution of mental diseases (IMD).
2. Residential and Inpatient Treatment for Individuals with Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED). Expenditures for Medicaid state plan services furnished to otherwise eligible individuals who are primarily receiving treatment for a serious mental illness (SMI) or serious emotional disturbance (SED) who are short- term residents in facilities that meet the definition of an institution for mental diseases (IMD).
3. Expenditures related to Former Foster Care Youth. Expenditures to extend eligibility for full Medicaid state plan benefits to former foster care youth (FFCY) who are under age 26, who turned 18 on or before December 31, 2022, who were in foster care under the responsibility of another state or tribe in such other state on the date of attaining 18 years of age (or such higher age as the state has elected for termination of Federal foster care assistance under title IV-E of the Act), were enrolled in Medicaid at any time during the foster care period in which they aged out of foster care, and are now applying for Medicaid in Virginia.