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Background:

• On June 15, 1998, Virginia submitted a proposal for a separate child health program, known as the Virginia Children's Medical Security Insurance Plan (VCMSIP).

• The initially approved plan covered children up to age 19 with family incomes up to 185 percent of the Federal poverty level (FPL).

Amendments

• Virginia submitted its first amendment on June 23, 2000, to change the name of the title XXI program to the Family Access to Medical Insurance Security Plan (FAMIS). The program covers children from birth through age 18 with family incomes up to 200 percent of the FPL. This amendment also made the following changes:

• Changed the benefit package from Medicaid look-alike to coverage based upon the state employee health plan, with the addition of physical therapy, occupational therapy, speech language pathology, and skilled nursing services for special needs children.

• Established a premium assistance program for children in families that meet FAMIS eligibility requirements and who have access to health insurance coverage through their parent's employer. Under the program, the State may pay the employee's share of the premium for dependent coverage if certain requirements are met. (The State no longer has approval to operate its premium assistance program through its State plan. See Amendment # 7).

• Incorporated cost sharing in the form of premiums and co-payments.

• Virginia submitted its second amendment on November 15, 2001, to allow the State to offer two different benefits packages to FAMIS enrollees based upon their geographic location in the State. Enrollees obtaining care through a managed care entity receive an enhanced benefit package based upon the State employee health plan. Enrollees in geographic areas of the State where there is not yet a contract with a managed care entity continue to obtain services through the Primary Care Case Management (PCCM) program and receive a Medicaid look-alike package, until such time as a contract with a managed care entity is implemented. This amendment also allowed the State to exempt children receiving services through the PCCM program from paying co-payments.

• On June 28, 2002, Virginia submitted its third amendment to update and amend the SCHIP State plan to indicate the State's compliance with the final SCHIP regulations. This amendment also suspended premiums and added case management and hospice services to the State plan for the benefit package modeled on the state employee health plan. These services were always included in the benefit package and provided to enrollees but were inadvertently omitted from earlier SCHIP State plan amendments.