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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 44 of 61 Demonstration Populations

The FAMIS MOMS and FAMIS Select demonstration populations include:

A. Demonstration Population I – FAMIS MOMS FAMIS MOMS provides coverage to uninsured pregnant women in families with income up to and including 200 percent (plus a five percent income disregard) of the federal poverty level (FPL) who are not otherwise eligible for Medicaid. FAMIS MOMS also provides coverage to lawfully residing pregnant women and pregnant women with access to state employee health benefit coverage (in accordance with the hardship exception as provided in section 2110(bX6XC) of the Social Security Act (the Act)), thereby aligning the Commonwealth’s coverage of pregnant women with the expansion of CHIP coverage to children of state employees. FAMIS MOMS coverage is the same as that provided to pregnant women 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. FAMIS MOMS beneficiaries receive health care services primarily through one of the managed care organizations (MCOs) contracted by the Commonwealth to provide Medicaid and FAMIS (CHIP state plan) benefits.

B. Demonstration Population II – FAMIS Select FAMIS Select provides premium assistance for private or employer-sponsored insurance to uninsured children, from birth through age 18, in families with income up to and including 200 percent (plus a five percent income disregard) of the FPL, who are eligible for direct CHIP coverage. These individuals are provided the option to receive premium assistance for private or employer-sponsored insurance and supplemental immunization benefits in lieu of receiving coverage under the CHIP state plan. However, these individuals still retain the right to elect to receive direct CHIP coverage instead at any time. FAMIS Select beneficiaries receive health care services through the private or employer-sponsored plan of choice.

Demonstration Objectives to be Evaluated

During the renewal period, the objectives of the demonstration to be evaluated are as follows:

FAMIS MOMS (Demonstration Population I):

• Facilitate access to prenatal care for FAMIS MOMS participants. • Improve selected birth outcomes of FAMIS MOMS participants and their newborns.

FAMIS Select (Demonstration Population II):

• Facilitate access to affordable private and employer-sponsored health insurance for low- income families through premium assistance. • Monitor and ensure member satisfaction with FAMIS Select program. • Assure the aggregate cost-effectiveness of the FAMIS Select program.