Title V – Medicaid Memorandum of Understanding

Updated last in 2015, the Title V-Medicaid MOU (attached to this application) includes information on the responsibilities of both parties inherent to this collaboration.  In early 2022, members of both VDH and DMAS convened to review the current MOU sections related to maternal and child health and CYSHCN.  Efforts are currently underway to update and strengthen the agreement.

Virginia’s Medicaid Program

Virginia Department of Medical Assistance Services (DMAS) plays an essential role in the Commonwealth’s health care system by offering lifesaving healthcare coverage to approximately 2 million individuals and is delivered to individuals through two models: fee-for-service (10% of enrollees) and managed care (90% of enrollees).  Approximately 27% (527,901) of Virginian children ages 0-19,[1] and 36.4% of children with special healthcare needs[2] receive services through Virginia’s Medicaid program.   Virginia Medicaid covers a broad group of people and provides services beyond the minimum standards set in federal law, including expanding coverage to higher-income children through the CHIP Program, and covering long-term care in the home and community instead of an institutional setting.  In 2020, Virginia Medicaid covered approximately 37,300 births.[3] 

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. 

VDH and DMAS Coordination

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:  Virginia is the 4th state in the nation to offer community doula services as a benefit for Medicaid members.  Leaders from both DMAS and VDH collectively provided input and direction into both the state certification and reimbursement processes. Both initiatives went into full effect in early 2022.
2. National Academy for State National Academy for State Health Policy (NASHP) Maternal and Child Health Policy Innovation Program: DMAS applied for, and was awarded to work on a two-year policy academy which will advance innovative policy initiatives and build state capacity, 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 2021/2023) Program focused on addressing maternal mortality for Medicaid eligible pregnant and parenting women. More specifically, this program aimed to increase awareness of the community doula benefit and expansion of Postpartum Coverage to both members and providers.
3. CMS Affinity Group: The focus of this group is to Improve Maternal Health by Reducing Low-Risk Cesarean Delivery (LRCD). Slated to begin in September 2022, this group will be led by DMAS and VDH Title V will participate with other state partners to work on strategies to reduce LRCD and related issues.
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.
5. BabyCare Program:  Virginia’s BabyCare Program is Medicaid’s case management program that 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 postpartum 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. 

Medicaid expansion updates that impact Title V population 

MEDICAID EXPANSION:  In January 2019, new Virginia Medicaid expansion eligibility rules went into effect, with more than 500,000 new Medicaid members enrolled in health coverage.  During the first year of expansion (2018-2019) there was a decrease of the overall uninsured rate from 12.3% to 11%.  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% during the same time period. 

MEDICAID DENTAL BENEFITS EXPANSION: Effective July 1, 2021, Virginia’s nationally recognized Smiles For Children program added coverage to adults with Medicaid, in addition to  dental benefits to pregnant women and children age 20 and below.  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 July 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.

Virginia Medicaid Covid Response

The Families First Coronavirus Response Act (FFCRA) directed states to maintain Medicaid health coverage for individuals enrolled on or after March 18, 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:  Suspension of co-pays for Medicaid or FAMIS-covered services for the duration of the public health emergency; Outreach to high-risk members to review critical needs; Expanded telehealth options; Routine prescriptions supplied at 90-day intervals; Safeguard for coverage lapse due to processing delay.  

[1] ACS 2020 5 year estimate

[2] NSCH – 2019-2020

[3] BabySteps VA Maternal Health Annual Report 2021 - https://www.dmas.virginia.gov/media/4638/dmas-maternity-report-2021.pdf