RD26 - Family Access to Medical Insurance Security (FAMIS) Study

Executive Summary:

The provisions of the following resolution and bills were considered in completing this review of Family Access to Medical Insurance Security (FAMIS):

• SJR 90 requires review of regulatory, statutory, and administrative provisions
• SB 428/HB 1087 requires FAMIS coverage of mental health services of day health and rehabilitation services
• HB 332 requires FAMIS coverage of mental health services of intensive in-home services and 24-hour emergency response
• HB 1086 requires simplification of the application process
• HB 1088 limits the annual enrollment fee paid by FAMIS families
• HB 1089 provides for 12-month continuous eligibility for children enrolled in Medicaid or FAMIS.

A copy of the resolution and six bills are included in Appendix A.

Virginia's first State Children's Health Insurance Program (SCHIP) funded under Title XXI of the Social Security Act was the Children's Medical Security Insurance Plan (CMSIP). CMSIP which began accepting applications in October 1998 was a stand-alone program for children whose family incomes were
Virginia's second SCHIP Family Access to Medical Insurance Security or FAMIS was initiated on August 1, 2001. Legislation introduced in 2000 implemented a number of changes in the program. The most significant changes involved increasing family income levels from 185 to 200 percent of federal poverty guidelines and changing the benchmark for health benefits from Medicaid benefits to benefits provided by private, commercial managed-care organizations.

Virginia has failed to meet its own projections for SCHIP enrollment; as of 2001, 58 percent of the projected enrollment had been reached (36,740 of 63,200) and approximately $89 million of $210 million in federal funding had been expended.

Actions Taken by JCHC

A number of policy options were offered for consideration by the Joint Commission on Health Care regarding the provision of Child Health Insurance in Virginia. These policy options are listed on pages 39-42. A summary of public comments received regarding the proposed Options are included in Appendix D.

The Commission approved for introduction during the 2003 General Session an Omnibus bill and budget amendment to incorporate changes in eligibility and benefits (that should apply both to Medicaid coverage for children and to FAMIS whenever possible) to effectuate the following changes:

• Establish a single, umbrella program that incorporates both Medicaid for medically indigent children and FAMIS retaining the program name of FAMIS with the Medicaid portion being known as FAMIS Plus.

• Require use of a single application to determine eligibility for both Medicaid coverage for children and FAMIS. (This would put in statute what is current practice.)

• Include within FAMIS, coverage for the community-based mental health and mental retardation services provided for children enrolled in Medicaid (under State Plan Options).

• Reduce the waiting period from six to four months between the time that a child was covered by private health insurance and when eligibility for FAMIS can be established.

• Allow coverage for prenatal care and delivery for children within FAMIS using the wording that care will be provided for children from conception to birth.

• Amend the language that authorizes cost-sharing within the FAMIS Plan to require a $25 per year per family enrollment fee and specify that the co-payment amounts shall not be reduced below the copayment amounts required as of January 1, 2003.

(Approval of an Omnibus bill included accepting Options I, IV, VI, and VIII to recommend that none of the FAMIS-related bills carried over from the 2002 Session be reported.)