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

STATE: Virginia Page 4-16

Effective Date: 07/01/05

16 Approval Date: _____________/06 screened for completeness of information, the presence of other health insurance, verification of income, health coverage or access to the State Employee Health Insurance Plan, and Medicaid eligibility. If it appears that the child is Medicaid eligible, the case is referred for a Medicaid eligibility determination.

Applications received by the Central Processing site are screened for potential Medicaid eligibility first. If it appears that the child is Medicaid eligible, the case is referred for Medicaid eligibility determination. The State utilizes a screening process that consists of applying the Medicaid disregards to the gross family income and comparing the remainder to the Medicaid income limit for the family size. The single child health application collects all income and child care expense information needed to determine potential Medicaid eligibility. Individuals who are identified as potentially Medicaid eligible will not be enrolled in Title XXI without a full Medicaid determination and finding of ineligibility. Applications received at local departments of social services have full Medicaid eligibility determinations completed. If a child is determined ineligible for Medicaid, a FAMIS eligibility determination is then conducted.

At the time of a renewal of eligibility, the child’s insurance status and Medicaid eligibility is reviewed to ensure continued eligibility for enrollment in FAMIS.

4.4.2. The Medicaid application and enrollment process is initiated and facilitated for children found through the screening to be potentially eligible for medical assistance under the state Medicaid plan under Title XIX. (Section 2102)(b)(3)(B)) (42CFR 457.350(a)(2))

Child health applications received at the FAMIS Central Processing Unit are screened for Medicaid eligibility and, if found to be potentially eligible for Medicaid, are transferred directly by the FAMIS staff to Medicaid eligibility workers co-located at the FAMIS Central Processing Unit. In accordance with procedures described in §4.3 above, Medicaid workers, either at the Central Processing Unit, or at local departments of social services complete a Medicaid eligibility determination on all applications, those screened as potentially eligible for Medicaid by the FAMIS staff, as well as those received at local departments of social services directly from applicants.

The Commonwealth tracks applications that are referred by the Central Processing Unit for a Medicaid eligibility determination to monitor the accuracy of the Medicaid screening and the number of children enrolled in Medicaid through an application filed at the FAMIS Central Processing Unit.

4.4.3. The State is taking steps to assist in the enrollment in SCHIP of children determined ineligible for Medicaid. (Sections 2102(a)(1) and (2) and 2102(c)(2)) (42CFR