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

STATE: Virginia Page 8-58

Effective Date: 07/01/05

58 Approval Date: _____________/06 Poverty Levels *100% 135% 150% 175% 200%

2.5% ≤ 150% of FPL 5% > 150% at FPL

$ $233

$314

$698

$815

$931

*Used for comparative purposes only.

* Figures in this column are for illustration purposes and are rounded.

Families are required to submit documentation to DMAS or its contractor, showing that the co- payment is met for the year. Once the cap is met, the managed care organization will issue a new card excluding families from paying additional co-pays.

Finally, Title XXI requires that cost-sharing for families with incomes below 150 percent of FPL not exceed an amount that is “nominal” under Medicaid law, with appropriate adjustment for inflation or other reasons as the Secretary determines to be reasonable. The maximum co- payments for a service costing over $50 is $3 under Medicaid law and was established in 1978. Virginia’s co-payment for families under 150% of FPL is $2, which is well below the $3 federal cap.

8.6 Describe the procedures the state will use to ensure American Indian (as defined by the Indian Health Care Improvement Act of 1976) and Alaska Native children will be excluded from cost-sharing. (Section 2103(b)(3)(D)) (42CFR 457.535)

No cost-sharing will be charged to American Indians and Alaska Natives. The application form requests racial information on each child for whom application for child health insurance is made. No cost-sharing is imposed on those children who are reported to be Native American or Alaska Native. The applicant’s statement on the application form is sufficient to exempt the child from any cost-sharing obligations. The FAMIS automated eligibility determination system codes the case records for children listed on the application form as Alaska Natives or American Indians and the automated record will exempt such children from any cost-sharing obligations.

Virginia has no federally recognized Indian tribes; however, ongoing communication will occur with Indian tribes in Virginia to ensure that Indian families understand the program and can access the provider network to secure covered services.

8.7 Please provide a description of the consequences for an enrollee or applicant who does not pay a charge. (42CFR 457.570 and 457.505(c))

Not applicable.