FAMIS MOMS and FAMIS Select Title XXI Section 1115 Demonstration Renewal

Pursuant to 42 CFR §431.408, DMAS is providing a follow-up notice of intent to submit to the federal Centers for Medicare and Medicaid Services (CMS) a request to extend for five years its Title XXI Section 1115 Demonstration for the FAMIS MOMS and FAMIS Select programs with no changes. The FAMIS MOMS and FAMIS Select demonstration is currently set to expire on June 30, 2019.

DMAS provided an initial opportunity to review and provide input on the FAMIS MOMS and FAMIS Select Section 1115 Demonstration Extension on November 13 through December 13, 2018. During that initial public notice period, two public hearings were held on November 30 and December 6, 2018. DMAS is now providing a second opportunity for the public to review and provide input on the FAMIS MOMS and FAMIS Select Section 1115 Demonstration Extension, which has been modified to provide additional information and clarity on how demonstration objectives have been met, how the demonstration will be evaluated for continued success, and actual and projected program enrollment and costs.  This public comment period will be open from March 4 through April 4, 2019.

Virginia’s Title XXI Children’s Health Insurance Program (CHIP) covers children with family income from 143% to 200% of the federal poverty level (FPL) under a separate child health plan known as the Family Access to Medical Insurance Security (FAMIS) Plan. Virginia’s Title XXI Section 1115 Demonstration has two components. First, it expands Title XXI coverage to uninsured pregnant women with family income up to 200% of the federal poverty level (FPL) who are not eligible for Medicaid, through a program known as FAMIS MOMS. Second, it uses Title XXI funds to support a health insurance premium assistance program known as FAMIS Select. Children must first be found eligible and enroll in FAMIS before electing to receive coverage through FAMIS Select.

The goals of Virginia’s Title XXI HIFA Demonstration are as follows:

For FAMIS MOMS:

• Facilitate access to prenatal, obstetric, and postpartum care for a vulnerable population that does not otherwise qualify for public insurance;
• Improve selected birth outcomes of FAMIS MOMS participants and their newborns;
• Facilitate access to recommended pediatric primary care for newborns of FAMIS MOMS participants.

For FAMIS Select:

• Facilitate access to affordable private and employer-sponsored health insurance for low-income families through premium assistance;
• Ensure that access to and use of health care services available to children participating in FAMIS Select is comparable to that of children participating in FAMIS;
• Assure the aggregate cost-effectiveness of the FAMIS Select program.

To read the FAMIS MOMS and FAMIS Select Demonstration’s full Public Notice, and to view the draft FAMIS MOMS and FAMIS Select Demonstration renewal application, please visit the DMAS website at http://www.dmas.virginia.gov/#/hifawaiver.

To read the most recent Prenatal Care and Birth Outcomes Focused Study reports from DMAS’ External Quality Review Organization (EQRO), please visit http://www.dmas.virginia.gov/#/med3studies.

Public Comment

The 30-day public comment period for the demonstration is from March 4 through April 4, 2019. All comments must be received by 11:59 p.m. (Eastern Time) on Thursday, April 4, 2019. Public comments may be submitted by e-mail to hope.richardson@dmas.virginia.gov or by regular mail or in person at the address below.

Virginia Department of Medical Assistance Services
FAMIS MOMS and FAMIS Select Demonstration Renewal
Attn: Hope Richardson
600 East Broad Street
Richmond, VA 23219

After considering public comments about the proposed demonstration renewal application, DMAS will make final decisions about the demonstration and submit a revised application to CMS. The summary of comments, as well as copies of written comments received, will be posted for public viewing on the DMAS website along with the demonstration extension application when it is submitted to CMS.

Information regarding the FAMIS MOMS and FAMIS Select Demonstration Renewal Application can be found on the DMAS website at http://www.dmas.virginia.gov/#/hifawaiver. DMAS will update this website throughout the public comment and application process.

For more information about the FAMIS MOMS and FAMIS Select Demonstration, which the Commonwealth is seeking to extend, please visit the CMS website at https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/?entry=8648.

Section 1115 of the Social Security Act gives the U.S. Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of Medicaid and the Children’s Health Insurance Program (CHIP). Under this authority, the Secretary may waive certain provisions of Medicaid or CHIP to give states additional flexibility to design and improve their programs. To learn more about Section 1115 demonstrations, please visit the CMS website at https://www.medicaid.gov/medicaid/section-1115-demo/index.html.