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Virginia FAMIS MOMS and FAMIS Select Section 1115 Demonstration Demonstration Period: October 25, 2019 through June 30, 2029; Amended November 18, 2021 Page 10 of 61 (MCOs), and any other contracted entities. The Single State Medicaid Agency is responsible for the content and oversight of the quality strategies for the demonstration.

16. Common Rule Exemption. The Commonwealth must ensure that the only involvement of human subjects in research activities that may be authorized and/or required by this demonstration is for projects which are conducted by or subject to the approval of CMS, and that are designed to study, evaluate, or otherwise examine the Medicaid or CHIP program – including public benefit or service programs, procedures for obtaining Medicaid or CHIP benefits or services, possible changes in or alternatives to Medicaid or CHIP programs or procedures, or possible changes in methods or levels of payment for Medicaid benefits or services. CMS has determined that this demonstration as represented in these approved STCs meets the requirements for exemption from the human subject research provisions of the Common Rule set forth in 45 CFR 46.104(b)(5).

IV. ELIGIBILITY AND ENROLLMENT

17. Eligibility Groups Affected by the Demonstration. The following populations are eligible under this demonstration as described therein:

a. FAMIS MOMS. Coverage is provided to uninsured pregnant individuals in families with income up to and including 200 percent of the FPL who are not eligible for Medicaid, including lawfully present (CHIPRA 214) individuals. FAMIS MOMS coverage is also provided to pregnant individuals with access to state employee’s health benefit coverage (in accordance with the hardship exception as provided in section 2110(b)(6)(C) of the Act), thereby aligning the Commonwealth’s coverage of pregnant individuals with the expansion of CHIP coverage to children of state employees. FAMIS MOMS coverage is the same as that provided to pregnant individuals under the Medicaid state plan.

Under the demonstration, Virginia is also authorized to deem infants born to FAMIS MOMS to be eligible for Medicaid or CHIP coverage, as appropriate, consistent with 42 CFR 435.117 and 457.360. These infants are deemed eligible on the date of birth and remain eligible until attaining the age of 1.

b. FAMIS Select Premium Assistance. Children eligible for and enrolled in Virginia’s separate CHIP program, may elect to enroll in FAMIS Select and receive CHIP premium assistance payments to purchase private or employer sponsored health insurance coverage. Such enrollment is voluntary and based on informed choice regarding all implications of choosing premium assistance in lieu of direct CHIP state plan coverage, including the possibility of reduced benefits and increased cost-sharing, and that the CHIP cost-sharing limit of five percent on annual, aggregate cost sharing will not apply.

The Commonwealth will ensure that enrollees are annually notified that they may choose direct CHIP state plan coverage at any time. The Commonwealth will inform families that all age-appropriate immunizations in accordance with the