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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 2 of 61

II. PROGRAM DESCRIPTION AND HISTORICAL CONTEXT

Demonstration Description

Virginia's FAMIS MOMS and FAMIS Select demonstration has three components.

The first component of the demonstration entitled, “FAMIS MOMS” provides coverage to uninsured pregnant individuals, including lawfully residing pregnant individuals, in families with income up to and including 200 percent of the federal poverty level (FPL) who are not otherwise eligible for Medicaid. “FAMIS MOMS” also provides coverage to pregnant individuals with access to state employees’ health benefit coverage (in accordance with the hardship exception as provided in section 2110(b)(6)(C) of the Social Security Act (the Act)); thereby aligning the Commonwealth’s coverage of pregnant individuals with the expansion of CHIP coverage to children of state employees. FAMIS MOMS coverage is the same as that provided to pregnant individuals 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, consistent with 42 CFR 435.117 and 457.360. These infants are deemed eligible on the date of birth and remain eligible until attaining the age of 1.

The second component of the demonstration entitled, the “FAMIS Select” program, provides premium assistance for private or employer-sponsored insurance to uninsured children, ages 0 through 18, in families with income up to and including 200 percent of the FPL, who are eligible for direct CHIP state plan coverage. These individuals are provided the option to receive premium assistance for private 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 at any time.

The third component of the demonstration, effective as of the date of these amended STCs, extends the postpartum eligibility period from the end of the month in which the 60th postpartum day occurs to the end of the 12th month following the end of the pregnancy, for the “FAMIS MOMS” population and pregnant individuals in any Medicaid state plan eligibility group. As described in STC 17, individuals who are within 12 months postpartum but whom are outside of the state plan 60-day postpartum coverage period (including those who were not enrolled in Virginia 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 may receive extended postpartum coverage.

Demonstration History

The Virginia FAMIS MOMS and FAMIS Select demonstration was initially approved on June 30, 2005 and implemented August 1, 2005.

FAMIS MOMS Virginia implemented the FAMIS MOMS program incrementally beginning August 1, 2005. The intent of this demonstration program component is to provide prenatal care to uninsured