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growth; which is the trend rate included in the President’s Medicaid Budget for

federal fiscal year 2022 for the same period of time that represents demonstration year 17 through demonstration year 24. The PMPM cost ceiling for each demonstration year represents the medical assistance payments for up to 12 months of continuous postpartum coverage for eligible individuals.

The budget limit for each demonstration year will be calculated using the below PMPM cost multiplied by the actual number of member months (as calculated in accordance with STC 54) and the Composite Federal Share.

Demonstration | Per Member Per | Demonstration Per Member Per Year (DY) Month (PMPM) Year (DY) Month (PMPM) Limit Limit DY17 $648.88 DY21 $794.50 DY18 $682.41 DY22 $835.81 DY19 $717.90 DY23 $879.27 DY20 $755.23 DY24 $924.99

56. Hypothetical Budget Neutrality Test. The title XIX (postpartum extension) component of the demonstration is structured as a “pass-through” or “hypothetical” expenditure test. Therefore, the Commonwealth may not accumulate or access budget neutrality “savings.” A prospective per capita cap on federal financial risk is established based on the costs that eligible individuals are expected to incur under the demonstration.

If total FFP for hypothetical expenditures should exceed the federal share of the Hypothetical Cap, the difference must be reported as a cost against the budget neutrality limit described in

STC 55.

57. Composite Federal Share Ratio. The Composite Federal Share is the ratio calculated by dividing the sum total of FFP received by the Commonwealth on actual demonstration expenditures during the approval period, as reported through the MBES/CBES and summarized on the Schedule C report, with consideration of additional allowable demonstration offsets such as, but not limited to, premium collections and pharmacy rebates, by total computable demonstration expenditures for the same period as reported on the same

forms.

58. Reporting Expenditures Subject to the Title XIX Budget Neutrality Agreement.

a. Tracking Expenditures. In order to track expenditures under this

demonstration, the Commonwealth must report demonstration expenditures through the Medicaid and Children’s Health Insurance Program Budget and Expenditure System (MBES/CBES), following routine CMS-64 reporting instructions outlined in section 2500 of the State Medicaid Manual. All demonstration expenditures claimed under the authority of title XIX of the Act and subject to the budget neutrality expenditure limit must be reported

Virginia FAMIS MOMS and FAMIS Select Section 1115 Demonstration Demonstration Period: October 25, 2019 through June 30, 2029; Amended November 18, 2021

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