State 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
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	09.25.2023
3.1A&B S2	Case Management Services	05.16.2022
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
3.2A	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	09.25.2023
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	12.06.2022
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
7.5	Provider Appeals	07.31.2020
	CMS Electronic State Plan Sections - Eligibility and Enrollment	01.09.2023
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
	Preprint Pages from Front of State Plan	08.29.2022
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
7.4	Medicaid Disaster Relief for the COVID-19 National Emergency	06.03.2022
3.1L 2	Alternative Benefit Plan - Adult Expansion Group	04.21.2022
3.1L 3	Alternative Benefit Plan - Medicaid Works	04.21.2022
7.7A	COVID Vaccines, Testing, and Treatment	11.30.2022