Virginia Department of Medical Assistance Services (DMAS) administers the state’s Medicaid and CHIP programs, playing an essential role in the Commonwealth’s health care system by offering lifesaving coverage.  One in four (599,640) children ages 0-19, and 38% of children with special healthcare needs are covered by Medicaid or Family Access to Medical Insurance Security (FAMIS), Virginia’s CHIP program.

Virginia’s Medicaid program covers approximately 1,870,000 individuals and is delivered to individuals through two models: fee-for-service (10% of enrollees) and managed care (90% of enrollees).

MEDICAID AND FAMIS PROGRAMS FOR CHILDREN AND PREGNANT INDIVIDUALS:

• FAMIS Plus, or children’s Medicaid - Coverage to low-income children (with family income 0-143% of the federal poverty limit) from birth up until age 19
• FAMIS, Virginia’s CHIP program - Coverage for uninsured children whose families are above the income cutoff for Medicaid but below 205% FPL, who cannot afford commercial coverage
• Medicaid for Pregnant Women - Comprehensive coverage for pregnant women up to 148% FPL
• FAMIS MOMS (CHIP for pregnant women) - Comprehensive coverage for uninsured pregnant women between 148 and 205% FPL
• Medicaid Waivers:
  • Developmental Disability Waivers (DDW): Virginia has three waivers for individuals with a developmental disability:  1. Building independence for individuals 18 and older; 2. Family & individual support; 3. Community living.  Virginia Medicaid administers DD Waivers jointly with the Virginia Department of Behavioral Health and Developmental Services. There is a waiting list, and slots are assigned based on urgency of need.
  • Commonwealth Coordinated Care (CCC) Plus Waiver: The CCC Plus Waiver serves all ages and does not have a waiting list. The waiver provides care in the home and community rather than in a nursing facility or other specialized care medical facility. The CCC Plus Waiver provides supports and service options for successful living, private duty nursing, personal care respite, assistive technology and environmental modifications.  DMAS oversees the Medicaid Long-term Services and Supports Screening Process in Virginia to evaluate what services may be available to an individual, including services through the CCC Plus waiver. 

BABYCARE PROGRAM:

Virginia’s BabyCare Program plays an essential role in providing health care to children and pregnant women.  The program provides behavioral risk screening, case management services, and expanded prenatal services for pregnant women in order to: (1) Reduce infant mortality and morbidity; (2) Ensure provision of comprehensive services to eligible pregnant women and infants up to age two; and, (3) Enable pregnant women and caretakers of infants to receive wrap-around services that improve their well-being.  Pregnant women not enrolled in Managed Care are eligible for BabyCare during pregnancy and through the end of the month of the 60th post-partum day, and infants are eligible up to age two. Each of the contracted health plans have similar programs and services for high-risk moms and infants up to age two.  Specifically, case management services are available to high-risk pregnant women and children up to age two.  “High Risk” needs can include any elements identified in the psychosocial, medical or nutritional domains of the screening tool administered by an RN or BSW/MSW.    The BabyCare Program is administered across the state in all of Virginia’s Local Health Departments, rural health clinics and FQHCs.  

MEDICAID EXPANSION UPDATES THAT IMPACT TITLE V POPULATION:

• MEDICAID EXPANSION:  In January 2019, new Virginia Medicaid expansion eligibility rules went into effect, resulting in a decrease of the overall uninsured rate from 12.3% to 11% between 2018 and 2019.  The reduction was more dramatic for adults ages 18-64 with incomes below 138% FPL, with the uninsured rate dropping from 28.1% to 23%.
• MEDICAID DENTAL BENEFITS EXPANSION: Effective July 1, 2021, Virginia’s nationally recognized SFC program will continue to provide dental benefits to children age 20 and below, and pregnant women but will now add coverage to adults in Medicaid. Dental coverage for adults enrolled in Medicaid will focus on overall oral health, prevention and restoration and will be similar to the coverage currently available to pregnant women.  There are no additional costs or co-payments for children, pregnant women or adults.                                                                                                      
• PRENATAL AND POSTPARTUM COVERAGE EXPANSIONS:
  • Starting 7/1/2021, Virginia offers new FAMIS Prenatal Coverage, a comprehensive coverage program for pregnant individuals who meet all other eligibility criteria, regardless of immigration status. Applicants do not need to provide immigration documents or have a Social Security number to qualify for FAMIS Prenatal. Applicants must still meet income and state residency requirements. 
  • In November 2020, Virginia’s General Assembly and Governor enacted legislation directing DMAS to extend coverage to 12 months postpartum for FAMIS MOMS and other pregnant populations who otherwise would not qualify for a full-benefit eligibility category beyond 60 days postpartum. Virginia submitted a Section 1115 waiver amendment application requesting this change to the federal government on March 31, 2021. Waiver negotiations are in progress; Virginia will implement the extended postpartum coverage upon federal approval. By ensuring coverage during the critical 12 months postpartum, Virginia aims to reduce maternal and infant morbidity and mortality, improve health outcomes, and advance health equity. 

MEDICAID COVID RESPONSE: 

In 2020, Virginia Medicaid responded to the COVID-19 pandemic state of emergency declaration with a comprehensive set of policies, including temporary changes providing flexibility in eligibility rules.  This resulted in an increase in Medicaid coverage for an additional 228,528 Virginians, including 72,286 children.  Additional COVID-related benefits and temporary emergency flexibilities for Medicaid recipients positively impacted the MCH community.  These included: 

1. Suspension of co-pays for Medicaid or FAMIS-covered services for the duration of the public health emergency
2. Outreach to high risk members to review critical needs
3. Expanded telehealth options
4. Routine prescriptions supplied at 90-day intervals
5. Safeguard for coverage lapse due to processing delay

In September 2019, Virginia Medicaid was awarded $4.6 million from Centers for Medicare and Medicaid Services (CMS) Section 1003 Substance Use Disorder (SUD) Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act Grant.  The grant’s goal is to increase provider capacity for addiction and recovery treatment, and has designated Medicaid members who are pregnant and parenting as a priority population. Grant activities included providing training to providers on best practices for treating pregnant and postpartum individuals for substance use disorders. The grant also supported Preferred Office-Based Opioid Treatment programs that target pregnant and parenting individuals, such as OB-Motivate through the Virginia Commonwealth University.

VDH TITLE V/DMAS COLLABORATIONS:                              

VDH Department of Family Health Services, and specifically Title V and CYSHCN Programs, have a strong and collaborative partnership with DMAS, prioritizing and aligning shared goals and joint policy-level decision making.

Current collaborations include:

1. Doula Reimbursement/Doula Certification:  DMAS is currently establishing a process for Doula enrollment and reimbursement, in collaboration with VDH’s work regarding establishing doula certification. 
2. BabyCare:  Five health districts have robust BabyCare programs through which Title V funding supports their efforts. 
3. National Academy for State Health Policy (NASHP): Maternal and Child Health Policy Innovation Program – DMAS applied for, and was awarded this funding, and subsequently invited Title V to participate in the following:  Cohort 1 (2019/2020) Program focused on substance abuse and mental health; Cohort 2 (starting March 2021) Program focus includes maternal mortality for Medicaid eligible population.
4. Care Connection and CCC Plus Managed Care (Care Coordination)-Training and education provided for Care Connection Care Coordination and MCO Care Coordinators on programs and roles to improve collaboration and the delivery system for children and youth with specialized health care needs.