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• On August 30, 2002, Virginia submitted its fourth amendment to establish a SCHIP Medicaid expansion program, in addition to the existing separate child health program. Children ages 6 through 18 with family income equal to or less than 133 percent of the FPL moved from the separate child health program into the Medicaid expansion program. This move makes all children below 133 percent of the FPL eligible for Medicaid and allows all of the children in one family to be covered in the same program. This amendment also increased dental, vision, and other services in the state employee health plan benefit package, eliminated premiums from cost-sharing requirements, changed procedures to improve coordination with Medicaid on eligibility determination for FAMIS, and added additional good cause exceptions to the 6-month waiting period requirement.

• Virginia submitted its sixth amendment on June 29, 2004. The amendment requested the addition of new school based health services to the State’s SCHIP (FAMIS) benefit package. This Amendment was disapproved. In the absence of a response from the State, it was not possible to ascertain whether the amendment met the statutory and regulatory requirements of the State Children’s Health Insurance Program (SCHIP), including the definition of “child health assistance” at section 2110(a) of the Act, the coverage requirements under section 2103 of the Act, and Section 2101(a), which requires the provision of child health assistance in an effective and efficient manner. Therefore the SPA was disapproved.

• This seventh amendment was submitted on July 3, 2006 with additional changes made on August 7, 2006. It made the following changes to the State plan: • Excludes the State’s four-month period of uninsurance if an applicant is pregnant at the time of application; • Permits 90-day retroactive coverage for newborns; • Adds disease management to the benefit package provided to enrollees in the fee-for- service delivery system; and • Removes all references to its previously approved SCHIP state plan premium assistance program, since the State currently operates its premium assistance program through an SCHIP Section 1115 demonstration.

Children Covered Under Program

• The State reported that 65,536 children were ever enrolled in the Medicaid expansion and 71,646 children were ever enrolled in the separate child health program in FFY 2006.

Administration

• Virginia's Department of Medical Assistance Services administers both the FAMIS and Medicaid programs.

Health Care Delivery System

• Enrollees in the Medicaid expansion program receive services through the established Medicaid delivery system, which includes mandatory managed care plans in certain geographic areas and PCCM in others.