Notice of Intent to Submit State Plan Amendment Modifying Alternative Benefits Plan
(This modification does not change any benefits currently offered—it is only a procedural change required by the Affordable Care Act.)
Pursuant to 42 CFR 440.305(d), the Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to solicit public comment on the Department’s proposal to seek approval from the Centers for Medicare and Medicaid Services (CMS) of a state plan amendment to modify the Alternative Benefit Plan (ABP) authorized under section 1937 of the Social Security Act for individuals who are eligible for the MEDICAID WORKS program.
MEDICAID WORKS is Virginia’s Medicaid Buy-In program, a work incentive opportunity for individuals with disabilities. Established in January 2007, this voluntary plan option enables workers with disabilities to earn higher income and retain more in savings than is typically allowed by Medicaid while ensuring continued health care coverage. MEDICAID WORKS helps enrollees gain greater independence from public assistance programs and enables their contribution to the tax base of the community and to its economic growth.
In 2008, DMAS received authorization to establish an optional alternative benefit plan for program enrollees to include personal assistance services, in addition to the standard health care services available through Medicaid. Personal assistance services, sometimes called attendant care, provide individuals with disabilities non-medical support in the home or the workplace in order that they may continue to live at home, maintain employment and participate in community activities.
The Affordable Care Act (ACA) requires that, as of January 1, 2014, all ABPs provide services in ten Essential Health Benefit (EHB) categories (ambulatory services, emergency services hospitalization, maternity and newborn care, mental health and substance use disorder services, rehabilitation and habilitative services, prescription drugs, laboratory, preventive services, and pediatric services). This modification to the existing ABP for the MEDICAID WORKS program will ensure that this ABP includes all of the required services under each of the EHB categories, as well as all other services authorized under Virginia’s Medicaid State Plan, and the personal assistance services mentioned above.
Any service limits or cost sharing currently authorized under the approved Medicaid State Plan will apply to the ABP. The ABP will include the full range of Early Periodic Screening, Diagnoses, and Treatment (EPSDT) program benefits for individuals under the age of 21.
Note: A separate communication will be issued to individuals enrolled in the program regarding the increase in the income limit which will be allowed under a forthcoming regulation.
Comments or inquiries on DMAS’ proposed state plan amendment to modify the ABP for the MEDICAID WORKS program may be sent, in writing, within 14 days of this notice publication to Jack Quigley, Policy and Research Division, Department of Medical Assistance Services, 600 East Broad Street, Richmond, VA 23219. Such comments are available for review at the same address.