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

STATE: Virginia Page 4-13

Effective Date: 07/01/05

13 Approval Date: _____________/06

Effective 08-01-03, enrollment is for 12 continuous months, unless one of the following events occurs before the annual renewal: 1) an increase in gross monthly income to above 200% FPL; 2) a child moves out of state; 3) a child turns age 19; 4) the family requests cancellation; or 5) the family applies for Medicaid and the child is determined eligible for Medicaid. Families must report the following changes before the annual renewal: 1) an increase in gross monthly income or change in family size resulting in a family income above 200% FPL; or 2) an enrolled child moving out of the Commonwealth of Virginia. If none of the above changes is reported, eligibility will be renewed annually.

4.1.9. ⌧ Other standards (identify and describe):

Children are not eligible for the Family Access to Medical Insurance Security Plan: (1) if they are a member of a family eligible for employer-sponsored dependent health insurance coverage under any Virginia State Employee Health Insurance Plan, (2) if they are inmates of public institutions, (3) if they are inpatients in an institution for mental disease, or (4) if their parent or other authorized representative does not meet the requirements on assignment of rights to benefits or cooperation with the agency in identifying and providing information to assist the Commonwealth in pursuing any liable third party.

4.2. The state assures that it has made the following findings with respect to the eligibility standards in its plan: (Section 2102)(b)(1)(B)) (42CFR 457.320(b))

4.2.1. ⌧ These standards do not discriminate on the basis of diagnosis. 4.2.2. ⌧ Within a defined group of covered targeted low-income children, these standards do not cover children of higher income families without covering children with a lower family income. 4.2.3. ⌧ These standards do not deny eligibility based on a child having a pre- existing medical condition.

4.3. Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) (42CFR 457.350)

Effective September 1, 2002, the State intensified efforts to enroll children in health care coverage through both its FAMIS and Medicaid programs. The Medicaid income limits for poverty level children were increased to 133% of the federal poverty level for children ages 6-19, thereby creating a single income limit for all poverty level children. A Title XIX State Plan