LEGAL NOTICE

COMMONWEALTH OF VIRGINIA

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES

NOTICE OF INTENT TO REQUEST 111 WAIVER

The Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to solicit public comment on the Department’s request for Section 1115 demonstration waiver for early implementation of the Modified Adjusted Gross Income (MAGI) provisions related to eligibility determinations for certain medical assistance programs (Medicaid and FAMIS).

The Patient Protection and Affordable Care Act of 2010 mandates significant changes in how eligibility is determined for medical assistance programs for children, parent/caretaker relatives and pregnant women beginning January 1, 2014. 

The change requires the use of IRS tax rules for determining income and household composition for these individuals and brings the determination of eligibility in line with determinations of eligibility for the Advance Premium Tax Credit (APTC) and cost-sharing subsidies for individuals through the Federally Facilitated Marketplace.  The Federally Facilitated Marketplace will begin use of these new rules in October 2013, when open enrollment for health insurance coverage begins.  In addition to making determinations of eligibility for the APTC and cost sharing subsidies, the Federally Facilitated Marketplace will also be assessing potential eligibility for medical assistance coverage using the same rules.  If an individual or family appears to meet Medicaid or FAMIS requirements using the new rules, the Marketplace will send the application electronically to local departments of social services for processing.  However, if the Virginia medical assistance programs are not using the same rules as the Marketplace, individuals assessed as being potentially eligible will be evaluated using a different set of rules, which could lead to a denial of coverage.  Using two sets of rules to evaluate the same population could lead to confusion on the part of the applicants as they will be informed by the Marketplace of their potential eligibility for medical assistance and lead to unnecessary transfers of information between the two entities.  

DMAS will hold two separate public hearings on this issue in July.  DMAS will publish the details regarding these two hearings on the Commonwealth Calendar.  This notice is intended to satisfy the requirements of the Center for Medicaid and CHIP Services State Health Official Letter #12-001 section 10201(i) of the Patient Protection and Affordable Care Act.   A copy of this notice is available for public review from Cindy Olson, Policy Division, DMAS, 600 Broad Street, Suite 1300, Richmond, VA  23219, and this notice is available for public review on the Regulatory Town Hall (www.townhall.com).   

The full public notice is available from the Department of Medical Assistance Services home page at http://dmas.virginia.gov/ through a link in the What’s New column.  Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Ms. Olson and such comments are available for review at the same address.