Page 9

Virginia FAMIS MOMS and FAMIS Select Section 1115 Demonstration Demonstration Period: October 25, 2019 through June 30, 2029; Amended November 18, 2021 Page 3 of 61 individuals within the title XXI income range and likely to give birth to FAMIS-eligible (i.e., CHIP state plan) children. The first stage expanded eligibility to pregnant individuals with family income above the Medicaid limit of 133 percent of the FPL but less than or equal to 150 percent of the FPL. The second stage, implemented September 1, 2006, covered pregnant individuals with incomes through 166 percent of the FPL. Subsequent stages covered pregnant individuals through 185 percent of the FPL (July 1, 2007) and through 200 percent of the FPL (July 1, 2009). Effective July 1, 2010, CMS approved an amendment to eligibility requirements to allow enrollment of pregnant individuals with income below 133 percent of the FPL who do not meet eligibility requirements for full Medicaid coverage but do meet the FAMIS MOMS requirements.

During the period January 1, 2014 through November 30, 2014, this demonstration component was phased-out because the Virginia General Assembly adopted an amendment to the Commonwealth’s biennial budget directing the Commonwealth to phase-out and eliminate the FAMIS MOMS program when health insurance coverage under the Federally Facilitated Marketplace (FFM) became available on January 1, 2014. New applications for FAMIS MOMS coverage were not accepted after December 31, 2013. However, individuals enrolled in FAMIS MOMS on or prior to December 31, 2013 retained eligibility for the duration of their coverage period. Any application received for pregnancy coverage beginning January 1, 2014 through November 30, 2014, was screened for Medicaid under pregnant individuals eligibility and for CHIP. If the applicant was ineligible for Medicaid or CHIP, the application was transferred to the FFM. Beginning on December 1, 2014, enrollment was reopened and new applications accepted for uninsured pregnant individuals with income up to and including 200 percent of the FPL. This income eligibility threshold aligns with children’s coverage levels under the CHIP state plan.

On April 3, 2015, CMS approved a demonstration amendment to add coverage for dental services to the FAMIS MOMS program component, consistent with the addition of these benefits for pregnant individuals under Medicaid. This demonstration amendment also allowed eligibility to be expanded to include pregnant individuals with access to subsidized health insurance through state employee benefits.

The title XXI goals and objectives of the FAMIS MOMS program are as follows:

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

FAMIS Select Virginia implemented the FAMIS Select program beginning August 1, 2005. FAMIS Select replaced Virginia's former employer-sponsored health insurance program and provides an alternative for families with children enrolled in FAMIS (i.e., the CHIP state plan) and who have access to private or employer-sponsored coverage. The Commonwealth provides a set monthly premium assistance subsidy for health insurance coverage for children with family income up to 200 percent of the FPL who are eligible for direct coverage in FAMIS. All children are first enrolled in FAMIS. Parents may then choose the premium assistance subsidy in lieu of direct FAMIS coverage for their child(ren). Premium assistance payments are paid directly to the