Virginia Administrative Code
Title 12 - HEALTH
Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN
Part VII - Famis Moms
Section 12VAC30-141-740 - General conditions of eligibility
Universal Citation: 2 VA Admin Code 30-141-740
Current through Register Vol. 41, No. 3, September 23, 2024
A. This section shall be used to determine eligibility of pregnant women for FAMIS MOMS.
B. FAMIS MOMS shall be in effect statewide.
C. Eligible pregnant women must:
1. Be determined ineligible for
Medicaid due to excess income by LDSS, by DMAS, or by the CPU;
2. Be a pregnant woman at the time of
application;
3. Be a resident of
the Commonwealth as described in
12VAC30-141-100
E;
4. Be either a United States
citizen, United States national, lawfully residing, or a qualified noncitizen
as described in
12VAC30-141-100
E;
5. Be uninsured, that is, not
have creditable health insurance coverage; and
6. Not be an inpatient in an institution for
mental diseases, or an inmate in a public institution that is not a medical
facility.
"Lawfully residing" means the individual is lawfully present in the United States and meets state residency requirements. "Creditable health insurance coverage" means coverage that meets the definition at 42 CFR 457.10.
D. Financial eligibility.
1. Screening. All applications for FAMIS MOMS
coverage shall have a Medicaid income eligibility screen completed. Pregnant
women determined to be ineligible for Medicaid due to excess income shall have
their eligibility for FAMIS MOMS determined.
2. Standards. Income standards for FAMIS MOMS
are the same as those described at
12VAC30-141-100
F 2, applied to pregnant women. For purposes of income determination, the
family size of the pregnant woman will count the unborn child.
3. Spenddown. DMAS does not apply a spenddown
process for FAMIS MOMS where household income exceeds the income eligibility
limit for FAMIS MOMS.
E. Coverage under other health plans.
1. Any
pregnant woman covered under a group health plan or under health insurance
coverage, as defined in § 2791 of the Public Health Services Act (
42
USC §
300gg-91(a) and
(b)(1)) , shall not be eligible for FAMIS
MOMS.
2. FAMIS MOMS shall not be a
substitution for private insurance.
a. Only
uninsured pregnant women shall be eligible for FAMIS MOMS. A pregnant woman is
not considered to be insured if the health insurance plan covering the pregnant
woman does not have a network of providers in the area where the pregnant woman
resides. Each application for FAMIS MOMS coverage shall include an inquiry
about health insurance the pregnant woman has at the time of
application.
b. Health insurance
does not include Medicare, Medicaid, FAMIS or insurance for which DMAS paid
premiums under Title XIX through the Health Insurance Premium Payment (HIPP)
Program or under Title XXI through the SCHIP premium assistance
program.
Statutory Authority: § 32.1-351 of the Code of Virginia; 42 USC § 1396 et seq.
Disclaimer: These regulations may not be the most recent version. Virginia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
