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

STATE: Virginia Page 2-5

Effective Date: 07/01/05

5 Approval Date: _____________/06 DMAS assumes that insured/uninsured individuals are evenly distributed by age below 100% of poverty. Above 100% of poverty more of the uninsured are ages 6-18. Virginia Medicaid covers children 0 through 5 up to 133% and covers children ages 6 through 18 up to 100% of poverty. Effective 9/01/02, Virginia’s Medicaid Program was expanded through Title XXI to cover additional targeted low-income children ages 6 through 18 with family income equal to or less than 133% of FPL.

2.2. Describe the current state efforts to provide or obtain creditable health coverage for uncovered children by addressing: (Section 2102)(a)(2) (42CFR 457.80(b))

2.2.1. The steps the state is currently taking to identify and enroll all uncovered children who are eligible to participate in public health insurance programs (i.e. Medicaid and state-only child health insurance):

In Virginia, determinations of eligibility for Medicaid (Title XIX) are made by the local Departments of Social Services and by Medicaid State agency staff co-located at the Title XXI Central Processing Unit. Applicants have the option of mailing in both their application for assistance and needed verifications, so that no face-to-face interview is required. Virginia also has eligibility workers outstationed in selected hospital sites and local health departments to identify potentially eligible and enroll eligible Medicaid (Title XIX) participants.

Determinations of eligibility for the state child health insurance program, The Family Access to Medical Insurance Security (FAMIS) Plan (Title XXI), are completed at a Central Processing Unit or Local Department of Social Services (LDSS). The Central Processing Unit screens applicants for Medicaid eligibility prior to completing a FAMIS eligibility determination. LDSS determines eligibility for Medicaid first and then determines FAMIS eligibility for children denied Medicaid due to excess income. Families may apply by mail, by phone or by fax; there is no requirement for a face-to- face interview.

In addition, many community groups have trained volunteers to help parents of potential Medicaid (Title XIX) and FAMIS (Title XXI) eligible individuals by answering questions and helping to complete applications and gather verifications needed to process cases.

Virginia’s Title XXI program is known as the Family Access to Medical Insurance Security Plan (FAMIS). The FAMIS program replaced Virginia’s original Title XXI program in August 2001. FAMIS was designed to simplify and speed-up the eligibility determination and enrollment process, and increase access to a broader array of providers through private-sector health insurance programs. These actions were taken to improve public perception and acceptance of the program, thereby increasing enrollment. In