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

STATE: Virginia Page 4-15

Effective Date: 07/01/05

15 Approval Date: _____________/06

FAMIS eligibility staff and eligibility workers at the local departments of social services evaluate applications for children determined not to be Medicaid eligible and having family income at or below 200% of the FPL and notify applicants of their eligibility. Children determined to be FAMIS-eligible have their cases maintained at the central site. Children determined to be Medicaid-eligible have their cases maintained at the local department of social services in their locality of residence. FAMIS cases are reviewed annually to determine continued eligibility. 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 annual renewal: 1) an increase in gross monthly income or change in family size that results in family income above 200% FPL; or 2) an enrolled child moves out of the Commonwealth of Virginia. Medicaid cases are reviewed in accordance with established Medicaid policy. At the time of redetermination and/or renewal, a child found ineligible for either Medicaid or FAMIS will have his eligibility automatically determined in the other program.

No Entitlement: In accordance with § 2102(b)(4) of the Social Security Act and § 32.1-353 of the Code of Virginia, the Family Access to Medical Insurance Security Plan shall not create any individual entitlement for payment of medical services or any right or entitlement to participation.

4.3.1 Describe the state’s policies governing enrollment caps and waiting lists (if any). (Section 2106(b)(7)) (42CFR 457.305(b))

⌧ Check here if this section does not apply to your state.

4.4. Describe the procedures that assure that:

4.4.1. Through the screening procedures used at intake and follow-up eligibility determination, including any periodic redetermination, that only targeted low- income children who are ineligible for Medicaid or not covered under a group health plan or health insurance coverage (including access to a state health benefits plan) are furnished child health assistance under the state child health plan. (Sections 2102(b)(3)(A) and 2110(b)(2)(B)) (42 CFR 457.310(b) (42CFR 457.350(a)(1)) 457.80(c)(3))

The child health insurance application asks for employer information and whether children currently have health insurance. Children with health coverage or those who have access to the State Employee Insurance Plan are ineligible for FAMIS.

As described in § 4.3 above, all applications for child health insurance coverage are