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DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850

November 18, 2021

Karen Kimsey Director Virginia Department of Medical Assistance Services 600 East Broad Street Richmond, VA 23219

Dear Ms. Kimsey:

The Centers for Medicare & Medicaid Services (CMS) is approving Virginia’s request to amend its section 1115 demonstration project entitled, “Virginia Family Access to Medical Insurance Security (FAMIS) MOMS and FAMIS Select” (Project Nos. 21-W-00058/3 and 11-W-00381/3), in accordance with section 1115(a) of the Social Security Act. Approval of this demonstration amendment will enable the Commonwealth to test the effects of providing state plan benefits to postpartum individuals in Medicaid and the Children’s Health Insurance Program (CHIP), with income up to and including 200 percent of the federal poverty level (FPL), for a total of 12 months. The Commonwealth will also provide continuous eligibility for these individuals during the entire postpartum period, ensuring continuity of coverage.

We have determined that this amendment will promote the objectives of Medicaid and CHIP by increasing and strengthening overall coverage and improving the health of mothers in Virginia, as well as reducing the rate of maternal mortality in the Commonwealth by addressing continuity of care for individuals postpartum. This approval is effective November 18, 2021 through June 30, 2029, except where otherwise noted in the expenditure authorities; and upon such date, unless extended or otherwise amended, all authorities granted to operate this demonstration will expire.

Consistent with CMS’s requirements for all section 1115 demonstrations, and as outlined in the Special Terms and Conditions (STCs), Virginia will be required to undertake systematic monitoring and a thorough evaluation of the demonstration. Throughout the life-cycle of the demonstration approval period, monitoring will support tracking the Commonwealth’s progress towards its demonstration goals, and we expect that such monitoring will accommodate new policy areas such as those approved with this amendment. Similarly, the Commonwealth will update the evaluation design to address this amendment component, to ensure a careful assessment of whether the demonstration initiatives, including those in the amendment, are effective in producing the desired outcomes for enrollees as well as for the CHIP and Medicaid programs overall.