Virginia MedicaidState Plan
Medicaid State Plan
The Virginia Medicaid state plan is an agreement between Virginia and the Federal government describing how Virginia administers its Medicaid program. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in Virginia.
Children's Health Insurance Program (CHIP) State Plan
The CHIP State Plan is separate from the Medicaid State Plan. The CHIP State Plan is filed in accordance with Title XXI of the Social Security Act and describes how the state uses both state and federal funds to provide child health assistance to uninsured, low-income children. Virginia's programs administered by DMAS under CHIP State Plan authority are:
- Family Access to Medical Insurance Security (FAMIS) for children
- FAMIS Prenatal Coverage for eligible uninsured pregnant individuals regardless of immigration or citizenship status.
| Chapter / Section | Title | Date |
|---|---|---|
| CMS Electronic State Plan Sections - Eligibility and Enrollment | 05.01.2024 | |
| Preprint Pages from Front of State Plan | 08.29.2022 | |
| 1.1A | Designation and Authority | 07.31.2020 |
| 1.2A | Organization and Administration - Single State Agency | 07.31.2020 |
| 1.2B | Organization and Administration - Organizational Chart | 07.31.2020 |
| 1.2C | Organization and Administration - Professional and Medical Supporting Staff | 07.31.2020 |
| 1.2D | Organization and Administration - Central Processing Unit | 07.31.2020 |
| 2.1A | Definition of Medicaid Health Maintenance Organizations | 07.31.2020 |
| 2.1B | HMOs - Quality Control and Utilization Review | 07.31.2020 |
| 2.2A | Groups Covered and Agencies Responsible for Eligibility Determinations | 07.31.2020 |
| 2.2A S1 | Reasonable Classification of Individuals Under the Age of 21, 20, 19, and 18 | 07.31.2020 |
| 2.2A S2 | More Restrictive Categorical Eligibility Criteria | 07.31.2020 |
| 2.6A | Eligibility Conditions and Requirements | 07.31.2020 |
| 2.6A S1 | Income Eligibility Levels | 07.31.2020 |
| 2.6A S2 | Categorically Need Groups With Incomes Related to FPL | 07.31.2020 |
| 2.6A S3 | Limits on Amounts for Necessary Care Not Covered Under Medicaid | 07.31.2020 |
| 2.6A S5 | More Restrictive Methods of Treating Resources Than SSI Program | 07.31.2020 |
| 2.6A S6 | Standards for Optional State Supplementary Payments | 07.31.2020 |
| 2.6A S7 | Categorically Needs Covered Under Requirements More Restrictive than SSI | 07.31.2020 |
| 2.6A S8 | Resource Standards, More Liberal Income Disregards, More Liberal Methods of Treating Resources | 07.31.2020 |
| 2.6A S9 | Transfer of Resources | 07.31.2020 |
| 2.6A S10 | Consideration of Medicaid Qualifying Trust | 07.31.2020 |
| 2.6A S11 | Cost Effectiveness Methodology for COBRA Continuation | 07.31.2020 |
| 2.6A S12 | Variations from the Basic Personal Needs Allowance | 07.31.2020 |
| 2.6A S13 | Institutionalized Spouse | 07.31.2020 |
| 2.6A S14 | Eligibility Under Section 1931 of the Act | 07.31.2020 |
| 2.6A S16 | Asset Verification System | 07.31.2020 |
| 2.6A S18 | Adjustments to Newly Eligible Adult Population | 07.31.2020 |
| 2.6B | Standards for Optional State Supplementary Payments | 07.31.2020 |
| 2.8A | Requirements for Advance Directives | 07.31.2020 |
| 3.1A | Amount, Duration, and Scope - Categorically Needy | 04.07.2022 |
| 3.1A S7 | Medication Assisted Treatment | 10.14.2021 |
| 3.1A&B S1 | Amount, Duration, and Scope - Categorically and Medically Needy | 01.22.2024 |
| 3.1A&B S2 | Case Management Services | 11.22.2023 |
| 3.1A&B S3 | Requirements and Limits - Expanded Prenatal Care Services | 07.31.2020 |
| 3.1A&B S5 | Drugs or Drug Categories - Not Covered | 07.31.2020 |
| 3.1A&B S6 | Program of All-Inclusive Care for the Elderly | 04.27.2023 |
| 3.1B | Amount, Duration, and Scope - Medically Needy | 04.07.2022 |
| 3.1B S1 | Medication Assisted Treatment | 10.14.2021 |
| 3.1C | Standards Established and Methods Used to Assure High Quality | 12.14.2021 |
| 3.1C S1 | Nursing Facility Critera | 07.31.2020 |
| 3.1D | Methods of Providing Transportation | 03.07.2022 |
| 3.1E | Standards for the Coverage of Transplant Services | 07.31.2020 |
| 3.1F | Commonwealth Coordinated Care | 07.31.2020 |
| 3.1L 2 | Alternative Benefit Plan - Adult Expansion Group | 04.21.2022 |
| 3.1L 3 | Alternative Benefit Plan - Medicaid Works | 04.21.2022 |
| 3.2A | Coordination of Title XIX with Part A and B of Title XVIII | 07.31.2020 |
| 4.03A | Confidentiality and Disclosure of Information - Medicaid Applicants | 07.31.2020 |
| 4.11A | Standards - General & Special Hospitals, Convalescent & Nursing Homes | 07.31.2020 |
| 4.14G | Nursing Facility Resident Drug Utilization Review | 07.31.2020 |
| 4.16A | Cooperation with State Vocational Rehab Agency and Title V Agencies | 07.31.2020 |
| 4.17A | Lien Recoveries | 07.31.2020 |
| 4.17C | Estate Recoveries | 07.31.2020 |
| 4.18A | Cost Sharing - Categorically Needy & QMB | 07.31.2020 |
| 4.18C | Cost Sharing - Medically Needy & QMB | 07.31.2020 |
| 4.19A | Payment Rates - Inpatient Care - General | 12.06.2022 |
| 4.19A S2 | Payment Rates - Inpatient Care - Dispute Resolution for State-Operated Providers | 07.31.2020 |
| 4.19A S3 | Payment Rates - Inpatient Care - Per-Diem Methodology | 07.31.2020 |
| 4.19A S4 | Payment Rates - Inpatient Care - Outlier Payment Methodology | 07.31.2020 |
| 4.19B | Payment Rates - Other Types of Care - General | 03.05.2024 |
| 4.19B S2 | Payment Rates - Other Types of Care - Medicare Part A & B Deductible-Coinsurance | 07.31.2020 |
| 4.19B S3 | Payment Rates - Other Types of Care - Establishment of Rate Per Visit - Part 1 | 07.31.2020 |
| 4.19B S4 | Payment Rates - Other Types of Care - Establishment of Rate Per Visit - Part 2 | 03.13.2023 |
| 4.19B S5 | Payment Rates - Other Types of Care - Prospective Reimbursement for Rehab Agencies or CORFs | 07.31.2020 |
| 4.19B S6 | Payment Rates - Other Types of Care - Medicare Equivalent of Average Commercial Rate | 07.31.2020 |
| 4.19B S7 | Payment Rates - Other Types of Care - Primary Care Service Payment | 07.31.2020 |
| 4.19C | Reserving Beds During an Absence from an Inpatient Facility | 07.31.2020 |
| 4.19D | Establishing Payment Rates for Long-Term Care - Part 1 | 07.31.2020 |
| 4.19D S1 | Establishing Payment Rates for Long-Term Care - Part 2 | 11.08.2023 |
| 4.19E | Definition of a Claim by Service | 07.31.2020 |
| 4.22A | Third Party Liability - Identifying Liable Resources | 07.31.2020 |
| 4.22B | Third Party Liability - Payment of Claims | 07.26.2022 |
| 4.22C | Health Insurance Premium Payment for Kids Program | 07.31.2020 |
| 4.30 | Sanctions for Psychiatric Hospitals, MCOs, PCCMs | 07.31.2020 |
| 4.32A | System Procedure Requests to Other State Agencies | 07.31.2020 |
| 4.33A | Issuance of Medicaid Cards to Homeless Individuals | 07.31.2020 |
| 4.34A | Requirements for Advance Directives | 07.31.2020 |
| 4.35A-K | Enforcement of Compliance for Nursing Facilities | 07.31.2020 |
| 4.39 | Definition of Specialized Services | 07.31.2020 |
| 4.39A | Categorical Determinations | 07.31.2020 |
| 4.40A-E | Surveys by Department of Health | 07.31.2020 |
| 4.42A | Enforcement of False Claims Recovery Act | 07.31.2020 |
| 7.2A | Methods of Administration - Civil Rights | 07.31.2020 |
| 7.4 | Medicaid Disaster Relief for the COVID-19 National Emergency | 06.03.2022 |
| 7.5 | Provider Appeals | 07.31.2020 |
| Appendix 1 | Nursing Home Payment System Appendix 1 | 07.31.2020 |
| Appendix 2 | Nursing Home Payment System Appendix 2 | 07.31.2020 |
| Appendix 3 | Nursing Home Payment System Appendix 3 | 07.31.2020 |
| Appendix 4 | Nursing Home Payment System Appendix 4 | 07.31.2020 |
| Appendix 5 | Nursing Home Payment System Appendix 5 | 07.31.2020 |
| Appendix 6 | Nursing Home Payment System Appendix 6 | 07.31.2020 |
| Appendix 7 | Nursing Home Payment System Appendix 7 | 07.31.2020 |
| S10 | MAGI-Based Income Methodologies | 12.13.2013 |
| S59 | Individuals Eligible for Family Planning Services | 04.01.2015 |
| S88 | Non-Financial Eligibility - State Residency | 12.19.2013 |