Page 12

STATE CHILD HEALTH PLAN UNDER TITLE XXI OF THE SOCIAL SECURITY ACT

STATE: Virginia Page 4-12

Effective Date: 07/01/05

12 Approval Date: _____________/06 The former Title XXI program, CMSIP, covered children up to 185% of the FPL and used the same income methodologies applied under the Virginia State Plan for Medical Assistance that are applied to children in the poverty income related groups.

Children who were enrolled in CMSIP on the date of FAMIS implementation, August 2001, were automatically enrolled in FAMIS. The income methodology for these children is protected. In the event that their gross family income exceeds the FAMIS limits, their eligibility will be determined using the income requirements of the CMSIP program for as long as they remain continuously eligible.

4.1.4. Resources (including any standards relating to spend downs and disposition of resources):

4.1.5. ⌧ Residency (so long as residency requirement is not based on length of time in state):

Eligible children must be Virginia residents.

4.1.6. Disability Status (so long as any standard relating to disability status does not restrict eligibility):

4.1.7. ⌧ Access to or coverage under other health coverage:

Any child covered under a group health plan or under health insurance coverage, as defined in § 2791 of the Public Health Service Act (42 U.S.C. § 300gg-91(a) and (b)(1)) shall not be eligible for the program.

4.1.8. ⌧ Duration of eligibility:

Children enrolled in FAMIS are eligible for coverage as of the first day of the month in which a signed application is received at either the local department of social services in the locality where the child resides or at the FAMIS Central Processing Unit. Effective 08-01-06, if a child enrolled in FAMIS is born within the three months prior to the month in which a signed application is received, coverage is effective retroactive to their date of birth if they would have met all eligibility criteria during that time.