Page 17

Virginia FAMIS MOMS and FAMIS Select Section 1115 Demonstration Demonstration Period: October 25, 2019 through June 30, 2029; Amended November 18, 2021 Page 11 of 61 recommendations of the Advisory Committee on Immunization Practices (ACIP) are covered by CHIP if their private or employer sponsored health insurance coverage does not provide for such immunizations. Families will continue to be told that this coverage is a factor to consider in choosing premium assistance in lieu of direct CHIP state plan coverage. The Commonwealth shall provide information as to where children may receive immunizations, well-baby, and well-child services in the event these services are not covered in the private or employer-sponsored health plan in which they are enrolled. In the case where title XXI eligibles are enrolled in private or employer-sponsored health insurance that does not include immunizations, the Commonwealth has an established mechanism in effect to reimburse providers for the cost of immunizations.

c. Postpartum Extension. The Commonwealth will extend continuous postpartum coverage for Medicaid and CHIP pregnant individuals from the end of the state plan 60-day postpartum benefit period to the end of the 12th month following the end of the pregnancy (including individuals enrolled while pregnant during a period of retroactive eligibility and/or for individuals who did not have enrollment in Medicaid or CHIP while pregnant). Eligible populations will be provided 12- month continuous extended postpartum coverage as follows:

i. Individuals enrolled in the “FAMIS MOMS” population as described in subparagraph a, with exception for individuals whose program eligibility is derived by section 1903(v)(4) or 2107(e)(l)(O) of the Act as described in subpart c.iv below.

ii. Pregnant and postpartum individuals in any Medicaid state plan eligibility group, with exception for individuals whose program eligibility is derived by section 1903(v)(4) or 2107(e)(l)(O) of the Act as described in subpart c.iv below.

iii. Individuals who are within 12 months postpartum but beyond the state plan 60-day postpartum coverage period (including those who were not enrolled in Medicaid or CHIP while pregnant), have household income up to and including 200 percent of the FPL, and meet all other Medicaid or CHIP eligibility criteria, with exception for individuals whose program eligibility is derived by section 1903(v)(4) or 2107(e)(l)(O) of the Act as described in subpart c.iv below.

iv. Lawfully present (CHIPRA 214) Individuals – Individuals determined to be “lawfully residing” in the United States for the purpose of establishing Medicaid or CHIP eligibility in accordance with section 1903(v)(4) or 2107(e)(l)(O) of the Act are only eligible for continuous 12-month postpartum coverage in accordance with sections 9812 and 9822 of the American Rescue Plan Act of 2021 (ARP) (Pub. L. 117-2), for a five-year period starting April 1, 2022 through March 31, 2027. During this time- limited 5-year coverage period, lawfully present pregnant individuals are