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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 14 of 61

CMS also concluded that the Commonwealth’s coverage provided under the FAMIS Select component of the demonstration does not meet the comprehensive criteria for MEC. The FAMIS Select program does not provide premium assistance enrollees with wrap-around services or cost-sharing assistance that is comparable to CHIP state plan out-of-pocket limits, thus, this is a lesser benefit than coverage afforded to children who are eligible for CHIP state plan coverage. Accordingly, CMS has determined that the coverage provided to these children under the FAMIS Select demonstration component is not recognized as MEC.

For the 12-month postpartum extension, effective as of the date of these amended STCs, CMS also concluded that the Commonwealth’s benefit package provided to postpartum individuals is equivalent to Medicaid and CHIP state plan coverage. Accordingly, CMS has determined the postpartum coverage provided to these individuals under this demonstration is recognized as MEC.

VI. COST SHARING

23. Cost Sharing. The cost-sharing requirements for this demonstration are outlined below:

a. FAMIS MOMS - The cost-sharing requirements for the FAMIS MOMS component of the demonstration are consistent with those described in the Medicaid state plan. There are no monthly premiums or enrollment fees associated with participation in the demonstration.

Co-payments for services received by FAMIS MOMS are identical to co- payments required of pregnant individuals covered by Medicaid. By policy, there are no co-payments required for pregnancy related services or for medical conditions that may complicate the pregnancy, including dental services. Also, it is a contractual requirement that Managed Care Organization (MCO) not charge pregnant individuals co-payments for any services. Therefore, the only co- payments that may be charged to a pregnant individual receiving services through Medicaid or FAMIS MOMS would be for non-pregnancy related services delivered through fee-for-service.

b. Postpartum Extension – There is no cost-sharing requirement associated with services received during the 12-month extended postpartum coverage period.

c. FAMIS Select Premium Assistance. For families with CHIP eligible children who choose to receive premium assistance for private or employer-sponsored insurance and supplemental immunization benefits in lieu of receiving coverage under the CHIP state plan, cost-sharing requirements will continue to be set by their private or employer-sponsored insurance plan.

VII. DELIVERY SYSTEM