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

STATE: Virginia Page 4-14

Effective Date: 07/01/05

14 Approval Date: _____________/06 Amendment effective September 1, 2002 was submitted to expand this income limit. Note: Children with income in excess of 100% FPL but equal to or less than 133% FPL who are currently enrolled in FAMIS became Medicaid eligible effective on this date. Families of these children were notified of this change, the different benefit package available to Medicaid recipients, and the fact that their children’s cases would be transferred to and maintained by the local department of social services in the locality where they reside.

Instead of having a separate application form for each program, Medicaid and FAMIS, a single child health insurance application form was implemented. The single application form is accepted at the FAMIS Central Processing Unit and at any local department of social services in the Commonwealth. In addition to the single application form, children in families who apply at local departments of social services for Medicaid using a multi-program application form and who are determined to be ineligible for Medicaid will also have their eligibility for FAMIS determined by the local department. A supplement has been developed for use with the multi-program application form to collect information not applicable to Medicaid but necessary to determine FAMIS eligibility.

The Commonwealth continues to contract with a private entity to operate a Central Processing Unit for receipt and review of applications, for conducting a screen for Medicaid eligibility and for making FAMIS eligibility determinations for those children who do not appear to be eligible for Medicaid. The Central site receives applications from numerous sources. Families are able to apply by mail, by phone or by fax. Contract staff at the Central Processing Unit review documentation and input data from the single application form into an automated system that screens the data for potential Medicaid eligibility. If a child appears potentially eligible for Medicaid, the contract staff transfers the application to Medicaid State staff co-located at the Central Processing Unit. State Medicaid staff reviews the case for Medicaid and determines if the child or his family has an active case with a local department of social services (Medicaid, Food Stamps or TANF). If the child or family has an active case, the State Medicaid staff transfers the application to the local department of social services in the city or county where the child resides for a complete eligibility determination and enrollment in the Medicaid program. If the child or family does not have an active case with a local department of social services, State Medicaid staff complete the Medicaid eligibility determination and enroll eligible children in the Medicaid program. Approved cases are then transferred to the local department of social services in the city or county where the child resides for on-going case maintenance.

Local departments of social services accept applications by mail, by fax or in person. Eligibility staff at the local agencies process child health applications received for Medicaid eligibility and, if eligible, enroll the child or children in the Medicaid program. If the child is found ineligible for Medicaid because of excess income, local departments of social services then complete a FAMIS eligibility determination. Children eligible for FAMIS are enrolled in the FAMIS program and their cases are transferred to the FAMIS Central Processing Unit for ongoing case maintenance. The family is not required to file a new application.