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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 13 of 61 to title XXI funding limits and shortfalls.

Section 2105(d)(3) of the Act is not applicable to pregnant individuals enrolled under the FAMIS MOMS component of the demonstration.

V. BENEFITS

21. Demonstration Benefits. There are three distinct benefit packages offered under this demonstration:

a. FAMIS MOMS – Individuals enrolled in FAMIS MOMS as described in STC 17.a receive the same package of benefits as provided to pregnant individuals covered by Virginia’s Medicaid program. The benefit package includes comprehensive health and dental benefits, including orthodontics (orthodontics benefit is limited to individuals under the age of 21). All dental services must be received through the Commonwealth's contracted Smiles for Children service provider.

If changes are made in the benefit package that would cause FAMIS MOMS to no longer receive the same benefits provided to pregnant individuals under the Medicaid state plan, the Commonwealth must submit the proposed change to CMS for review and approval, as outlined in STC 7, before modifications can be implemented by the Commonwealth.

b. FAMIS Select Premium Assistance. For families with CHIP eligible children who choose to receive premium assistance for private or employer-sponsored health insurance coverage, benefits are limited to premium assistance subsidies and immunizations as described in STC 17.b.

Consistent with 2105(c)(3) of the Social Security Act, cost-effectiveness for the purchase of employer-sponsored insurance shall be determined relative to the amount of expenditures (determined on an individual or aggregate basis) under the state child health plan, including administrative expenditures, that the state would have made to provide comparable coverage to the targeted low-income child or family involved (as applicable).

c. Postpartum Extension – Individuals who are eligible for the 12-month extended postpartum coverage period as described in STC 17.c will receive full state plan benefits during the pregnancy and postpartum period.

22. Minimum Essential Coverage (MEC). In accordance with CMS’ February 12, 2016 correspondence to the Virginia Department of Medicaid Assistance Services' Director, Cynthia Jones, the Commonwealth's benefit package provided to uninsured pregnant individuals and newborn children under the FAMIS MOMS component of the demonstration is equivalent to CHIP state plan coverage. Accordingly, CMS has determined coverage provided to these individuals and children under this demonstration is recognized as MEC.