{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-351.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-351.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-351.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-351.html"}],"law_id":86147,"edition_id":1,"section_id":86147,"structure_id":15498,"section_number":"32.1-351","catch_line":"Family Access to Medical Insurance Security Plan established","history":"1997, c. 679; 1999, c. 1034; 2000, cc. 824, 848; 2001, cc. 238, 735, 756; 2002, c. 640; 2003, cc. 66, 71, 521; 2005, c. 584; 2006, c. 428; 2007, c. 407; 2012, cc. 646, 689; 2014, cc. 9, 183; 2021, Sp. Sess. I, c. 245.","full_text":"A\n\nThe Department of Medical Assistance Services shall amend the Virginia Children’s Medical Security Insurance Plan to be renamed the Family Access to Medical Insurance Security (FAMIS) Plan. The Department of Medical Assistance Services shall provide coverage under the Family Access to Medical Insurance Security Plan for individuals under the age of 19 when such individuals (i) have family incomes at or below 200 percent of the federal poverty level or were enrolled on the date of federal approval of Virginia’s FAMIS Plan in the Children’s Medical Security Insurance Plan (CMSIP); such individuals shall continue to be enrolled in FAMIS for so long as they continue to meet the eligibility requirements of CMSIP; (ii) are not eligible for medical assistance services pursuant to Title XIX of the Social Security Act, as amended; (iii) are not covered under a group health plan or under health insurance coverage, as defined in § 2791 of the Public Health Service Act (42 U.S.C. § 300gg-91 (a) and (b)(1)); and (iv) meet both the requirements of Title XXI of the Social Security Act, as amended, and the Family Access to Medical Insurance Security Plan. Eligible children, residing in Virginia, whose family income does not exceed 200 percent of the federal poverty level during the enrollment period shall receive 12 continuous months of coverage as permitted by Title XXI of the Social Security Act.B\n\nThe Department of Medical Assistance Services shall also provide coverage for children and pregnant women who meet the criteria set forth in clauses (i) through (iv) of subsection A during the first five years of lawful residence in the United States, pursuant to § 214 of the Children’s Health Insurance Program Reauthorization Act of 2009 (P.L. 111-3).C\n\nFamily Access to Medical Insurance Security Plan participants shall participate in cost-sharing to the extent allowed under Title XXI of the Social Security Act, as amended, and as set forth in the Virginia Plan for Title XXI of the Social Security Act. The annual aggregate cost-sharing for all eligible children in a family above 150 percent of the federal poverty level shall not exceed five percent of the family’s gross income or as allowed by federal law and regulations. The annual aggregate cost-sharing for all eligible children in a family at or below 150 percent of the federal poverty level shall not exceed 2.5 percent of the family’s gross income. The nominal copayments for all eligible children in a family shall not be less than those in effect on January 1, 2003. Cost-sharing shall not be required for well-child and preventive services including age-appropriate child immunizations.D\n\nThe Family Access to Medical Insurance Security Plan shall provide comprehensive health care benefits to program participants, including well-child and preventive services, to the extent required to comply with federal requirements of Title XXI of the Social Security Act. These benefits shall include comprehensive medical, dental, vision, mental health, and substance abuse services, and physical therapy, occupational therapy, speech-language pathology, and skilled nursing services for special education students. The medical services required to be provided herein shall include dispensing or furnishing of up to a 12-month supply of hormonal contraceptives at one time, in accordance with subdivision A 27 of § 32.1-325. The mental health services required herein shall include intensive in-home services, case management services, day treatment, and 24-hour emergency response. The services shall be provided in the same manner and with the same coverage and service limitations as they are provided to children under the State Plan for Medical Assistance Services.E\n\nThe Virginia Plan for Title XXI of the Social Security Act shall include a provision that participants in the Family Access to Medical Insurance Security Plan who have access to employer-sponsored health insurance coverage, as defined in § 32.1-351.1, may, but shall not be required to, enroll in an employer’s health plan, and the Department of Medical Assistance Services or its designee shall make premium payments to such employer’s plan on behalf of eligible participants if the Department of Medical Assistance Services or its designee determines that such enrollment is cost-effective, as defined in § 32.1-351.1.F\n\nThe Family Access to Medical Insurance Security Plan shall ensure that coverage under this program does not substitute for private health insurance coverage.G\n\nThe health care benefits provided under the Family Access to Medical Insurance Security Plan shall be through existing Department of Medical Assistance Services’ contracts with health maintenance organizations and other providers, or through new contracts with health maintenance organizations, health insurance plans, other similarly licensed entities, or other entities as deemed appropriate by the Department of Medical Assistance Services, or through employer-sponsored health insurance. All eligible individuals, insofar as feasible, shall be enrolled in health maintenance organizations.H\n\nThe Department of Medical Assistance Services may establish a centralized processing site for the administration of the program to include responding to inquiries, distributing applications and program information, and receiving and processing applications. The Family Access to Medical Insurance Security Plan shall include a provision allowing a child’s application to be filed by a parent, legal guardian, authorized representative or any other adult caretaker relative with whom the child lives. The Department of Medical Assistance Services may contract with third-party administrators to provide any additional administrative services. Duties of the third-party administrators may include, but shall not be limited to, enrollment, outreach, eligibility determination, data collection, premium payment and collection, financial oversight and reporting, and such other services necessary for the administration of the Family Access to Medical Insurance Security Plan. Any centralized processing site shall determine a child’s eligibility for either Title XIX or Title XXI and shall enroll eligible children in Title XIX or Title XXI. A single application form shall be used to determine eligibility for Title XIX or Title XXI of the Social Security Act, as amended, and outreach, enrollment, re-enrollment and services delivery shall be coordinated with the FAMIS Plus program pursuant to § 32.1-325. In the event that an application is denied, the applicant shall be notified of any services available in his locality that can be accessed by contacting the local department of social services.I\n\nThe Virginia Plan for Title XXI of the Social Security Act, as amended, shall include a provision that, in addition to any centralized processing site, local social services agencies shall provide and accept applications for the Family Access to Medical Insurance Security Plan and shall assist families in the completion of applications. Contracting health plans, providers, and others may also provide applications for the Family Access to Medical Insurance Security Plan and may assist families in completion of the applications.J\n\nThe Department of Medical Assistance Services shall develop and submit to the federal Secretary of Health and Human Services an amended Title XXI plan for the Family Access to Medical Insurance Security Plan and may revise such plan as may be necessary. Such plan and any subsequent revisions shall comply with the requirements of federal law, this chapter, and any conditions set forth in the appropriation act. In addition, the plan shall provide for coordinated implementation of publicity, enrollment, and service delivery with existing local programs throughout the Commonwealth that provide health care services, educational services, and case management services to children. In developing and revising the plan, the Department of Medical Assistance Services shall advise and consult with the Joint Commission on Health Care.K\n\nFunding for the Family Access to Medical Insurance Security Plan shall be provided through state and federal appropriations and shall include appropriations of any funds that may be generated through the Virginia Family Access to Medical Insurance Security Plan Trust Fund.L\n\nThe Board of Medical Assistance Services, or the Director, as the case may be, shall adopt, promulgate, and enforce such regulations pursuant to the Administrative Process Act (§ 2.2-4000 et seq.) as may be necessary for the implementation and administration of the Family Access to Medical Insurance Security Plan.M\n\nChildren enrolled in the Virginia Plan for Title XXI of the Social Security Act prior to implementation of these amendments shall continue their eligibility under the Family Access to Medical Insurance Security Plan and shall be given reasonable notice of any changes in their benefit packages. Continuing eligibility in the Family Access to Medical Insurance Security Plan for children enrolled in the Virginia Plan for Title XXI of the Social Security Act prior to implementation of these amendments shall be determined in accordance with their regularly scheduled review dates or pursuant to changes in income status. Families may select among the options available pursuant to subsections D and F of this section.N\n\nThe provisions of Chapter 9 (§ 32.1-310 et seq.) of this title relating to the regulation of medical assistance shall apply, mutatis mutandis, to the Family Access to Medical Insurance Security Plan.O\n\nIn addition, in any case in which any provision set forth in Title 38.2 excludes, exempts or does not apply to the Virginia plan for medical assistance services established pursuant to Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (Medicaid), such exclusion, exemption or carve out of application to Title XIX of the Social Security Act (Medicaid) shall be deemed to subsume and thus to include the Family Access to Medical Insurance Security (FAMIS) Plan, established pursuant to Title XXI of the Social Security Act, upon approval of FAMIS by the federal Centers for Medicare & Medicaid Services as Virginia’s State Children’s Health Insurance Program.","order_by":null,"text":{"0":{"id":308580,"text":"The Department of Medical Assistance Services shall amend the Virginia Children’s Medical Security Insurance Plan to be renamed the Family Access to Medical Insurance Security (FAMIS) Plan. The Department of Medical Assistance Services shall provide coverage under the Family Access to Medical Insurance Security Plan for individuals under the age of 19 when such individuals (i) have family incomes at or below 200 percent of the federal poverty level or were enrolled on the date of federal approval of Virginia’s FAMIS Plan in the Children’s Medical Security Insurance Plan (CMSIP); such individuals shall continue to be enrolled in FAMIS for so long as they continue to meet the eligibility requirements of CMSIP; (ii) are not eligible for medical assistance services pursuant to Title XIX of the Social Security Act, as amended; (iii) are not covered under a group health plan or under health insurance coverage, as defined in § 2791 of the Public Health Service Act (42 U.S.C. § 300gg-91 (a) and (b)(1)); and (iv) meet both the requirements of Title XXI of the Social Security Act, as amended, and the Family Access to Medical Insurance Security Plan. Eligible children, residing in Virginia, whose family income does not exceed 200 percent of the federal poverty level during the enrollment period shall receive 12 continuous months of coverage as permitted by Title XXI of the Social Security Act.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":308581,"text":"The Department of Medical Assistance Services shall also provide coverage for children and pregnant women who meet the criteria set forth in clauses (i) through (iv) of subsection A during the first five years of lawful residence in the United States, pursuant to § 214 of the Children’s Health Insurance Program Reauthorization Act of 2009 (P.L. 111-3).","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":308582,"text":"Family Access to Medical Insurance Security Plan participants shall participate in cost-sharing to the extent allowed under Title XXI of the Social Security Act, as amended, and as set forth in the Virginia Plan for Title XXI of the Social Security Act. The annual aggregate cost-sharing for all eligible children in a family above 150 percent of the federal poverty level shall not exceed five percent of the family’s gross income or as allowed by federal law and regulations. The annual aggregate cost-sharing for all eligible children in a family at or below 150 percent of the federal poverty level shall not exceed 2.5 percent of the family’s gross income. The nominal copayments for all eligible children in a family shall not be less than those in effect on January 1, 2003. Cost-sharing shall not be required for well-child and preventive services including age-appropriate child immunizations.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":308583,"text":"The Family Access to Medical Insurance Security Plan shall provide comprehensive health care benefits to program participants, including well-child and preventive services, to the extent required to comply with federal requirements of Title XXI of the Social Security Act. These benefits shall include comprehensive medical, dental, vision, mental health, and substance abuse services, and physical therapy, occupational therapy, speech-language pathology, and skilled nursing services for special education students. The medical services required to be provided herein shall include dispensing or furnishing of up to a 12-month supply of hormonal contraceptives at one time, in accordance with subdivision A 27 of § 32.1-325. The mental health services required herein shall include intensive in-home services, case management services, day treatment, and 24-hour emergency response. The services shall be provided in the same manner and with the same coverage and service limitations as they are provided to children under the State Plan for Medical Assistance Services.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":308584,"text":"The Virginia Plan for Title XXI of the Social Security Act shall include a provision that participants in the Family Access to Medical Insurance Security Plan who have access to employer-sponsored health insurance coverage, as defined in § 32.1-351.1, may, but shall not be required to, enroll in an employer’s health plan, and the Department of Medical Assistance Services or its designee shall make premium payments to such employer’s plan on behalf of eligible participants if the Department of Medical Assistance Services or its designee determines that such enrollment is cost-effective, as defined in § 32.1-351.1.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"5":{"id":308585,"text":"The Family Access to Medical Insurance Security Plan shall ensure that coverage under this program does not substitute for private health insurance coverage.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E","next_prefix":"G"},"6":{"id":308586,"text":"The health care benefits provided under the Family Access to Medical Insurance Security Plan shall be through existing Department of Medical Assistance Services’ contracts with health maintenance organizations and other providers, or through new contracts with health maintenance organizations, health insurance plans, other similarly licensed entities, or other entities as deemed appropriate by the Department of Medical Assistance Services, or through employer-sponsored health insurance. All eligible individuals, insofar as feasible, shall be enrolled in health maintenance organizations.","type":"section","prefixes":["G"],"prefix":"G","entire_prefix":"G","prefix_anchor":"G","level":1,"prior_prefix":"F","next_prefix":"H"},"7":{"id":308587,"text":"The Department of Medical Assistance Services may establish a centralized processing site for the administration of the program to include responding to inquiries, distributing applications and program information, and receiving and processing applications. The Family Access to Medical Insurance Security Plan shall include a provision allowing a child’s application to be filed by a parent, legal guardian, authorized representative or any other adult caretaker relative with whom the child lives. The Department of Medical Assistance Services may contract with third-party administrators to provide any additional administrative services. Duties of the third-party administrators may include, but shall not be limited to, enrollment, outreach, eligibility determination, data collection, premium payment and collection, financial oversight and reporting, and such other services necessary for the administration of the Family Access to Medical Insurance Security Plan. Any centralized processing site shall determine a child’s eligibility for either Title XIX or Title XXI and shall enroll eligible children in Title XIX or Title XXI. A single application form shall be used to determine eligibility for Title XIX or Title XXI of the Social Security Act, as amended, and outreach, enrollment, re-enrollment and services delivery shall be coordinated with the FAMIS Plus program pursuant to § 32.1-325. In the event that an application is denied, the applicant shall be notified of any services available in his locality that can be accessed by contacting the local department of social services.","type":"section","prefixes":["H"],"prefix":"H","entire_prefix":"H","prefix_anchor":"H","level":1,"prior_prefix":"G","next_prefix":"I"},"8":{"id":308588,"text":"The Virginia Plan for Title XXI of the Social Security Act, as amended, shall include a provision that, in addition to any centralized processing site, local social services agencies shall provide and accept applications for the Family Access to Medical Insurance Security Plan and shall assist families in the completion of applications. Contracting health plans, providers, and others may also provide applications for the Family Access to Medical Insurance Security Plan and may assist families in completion of the applications.","type":"section","prefixes":["I"],"prefix":"I","entire_prefix":"I","prefix_anchor":"I","level":1,"prior_prefix":"H","next_prefix":"J"},"9":{"id":308589,"text":"The Department of Medical Assistance Services shall develop and submit to the federal Secretary of Health and Human Services an amended Title XXI plan for the Family Access to Medical Insurance Security Plan and may revise such plan as may be necessary. Such plan and any subsequent revisions shall comply with the requirements of federal law, this chapter, and any conditions set forth in the appropriation act. In addition, the plan shall provide for coordinated implementation of publicity, enrollment, and service delivery with existing local programs throughout the Commonwealth that provide health care services, educational services, and case management services to children. In developing and revising the plan, the Department of Medical Assistance Services shall advise and consult with the Joint Commission on Health Care.","type":"section","prefixes":["J"],"prefix":"J","entire_prefix":"J","prefix_anchor":"J","level":1,"prior_prefix":"I","next_prefix":"K"},"10":{"id":308590,"text":"Funding for the Family Access to Medical Insurance Security Plan shall be provided through state and federal appropriations and shall include appropriations of any funds that may be generated through the Virginia Family Access to Medical Insurance Security Plan Trust Fund.","type":"section","prefixes":["K"],"prefix":"K","entire_prefix":"K","prefix_anchor":"K","level":1,"prior_prefix":"J","next_prefix":"L"},"11":{"id":308591,"text":"The Board of Medical Assistance Services, or the Director, as the case may be, shall adopt, promulgate, and enforce such regulations pursuant to the Administrative Process Act (§ 2.2-4000 et seq.) as may be necessary for the implementation and administration of the Family Access to Medical Insurance Security Plan.","type":"section","prefixes":["L"],"prefix":"L","entire_prefix":"L","prefix_anchor":"L","level":1,"prior_prefix":"K","next_prefix":"M"},"12":{"id":308592,"text":"Children enrolled in the Virginia Plan for Title XXI of the Social Security Act prior to implementation of these amendments shall continue their eligibility under the Family Access to Medical Insurance Security Plan and shall be given reasonable notice of any changes in their benefit packages. Continuing eligibility in the Family Access to Medical Insurance Security Plan for children enrolled in the Virginia Plan for Title XXI of the Social Security Act prior to implementation of these amendments shall be determined in accordance with their regularly scheduled review dates or pursuant to changes in income status. Families may select among the options available pursuant to subsections D and F of this section.","type":"section","prefixes":["M"],"prefix":"M","entire_prefix":"M","prefix_anchor":"M","level":1,"prior_prefix":"L","next_prefix":"N"},"13":{"id":308593,"text":"The provisions of Chapter 9 (§ 32.1-310 et seq.) of this title relating to the regulation of medical assistance shall apply, mutatis mutandis, to the Family Access to Medical Insurance Security Plan.","type":"section","prefixes":["N"],"prefix":"N","entire_prefix":"N","prefix_anchor":"N","level":1,"prior_prefix":"M","next_prefix":"O"},"14":{"id":308594,"text":"In addition, in any case in which any provision set forth in Title 38.2 excludes, exempts or does not apply to the Virginia plan for medical assistance services established pursuant to Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (Medicaid), such exclusion, exemption or carve out of application to Title XIX of the Social Security Act (Medicaid) shall be deemed to subsume and thus to include the Family Access to Medical Insurance Security (FAMIS) Plan, established pursuant to Title XXI of the Social Security Act, upon approval of FAMIS by the federal Centers for Medicare & Medicaid Services as Virginia’s State Children’s Health Insurance Program.","type":"section","prefixes":["O"],"prefix":"O","entire_prefix":"O","prefix_anchor":"O","level":1,"prior_prefix":"N"}},"ancestry":[{"id":15498,"edition_id":1,"name":"Family Access to Medical Insurance Security Plan","identifier":"13","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:55:34","date_modified":"2026-06-26 03:55:34","permalink":{"id":201607,"object_type":"structure","relational_id":15498,"identifier":"13","token":"32.1\/13","url":"\/32.1\/13\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":86147,"structure_id":15498,"section_number":"32.1-351","catch_line":"Family Access to Medical Insurance Security Plan established","url":"\/32.1-351\/","token":"32.1\/13\/32.1-351","metadata":false},{"id":59066,"structure_id":15498,"section_number":"32.1-351.1","catch_line":"Assistance with employer-sponsored health insurance","url":"\/32.1-351.1\/","token":"32.1\/13\/32.1-351.1","metadata":false},{"id":75225,"structure_id":15498,"section_number":"32.1-351.2","catch_line":"Children's Health Insurance Program Advisory Committee; purpose; membership; etc","url":"\/32.1-351.2\/","token":"32.1\/13\/32.1-351.2","metadata":false},{"id":66737,"structure_id":15498,"section_number":"32.1-352","catch_line":"Virginia Family Access to Medical Insurance Security Plan Trust Fund","url":"\/32.1-352\/","token":"32.1\/13\/32.1-352","metadata":false},{"id":64145,"structure_id":15498,"section_number":"32.1-353","catch_line":"Rights and responsibilities","url":"\/32.1-353\/","token":"32.1\/13\/32.1-353","metadata":false}],"next_section":{"id":59066,"structure_id":15498,"section_number":"32.1-351.1","catch_line":"Assistance with employer-sponsored health insurance","url":"\/32.1-351.1\/","token":"32.1\/13\/32.1-351.1","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-351\/","history_text":"

This law was first created in 1997. The record of its establishment is cataloged in chapter 679<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. It has been modified 10 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1999, chapter 1034<\/a>; in 2000, chapters 824<\/a> and 848<\/a>; in 2001, chapters 238<\/a>, 735<\/a>, and 756<\/a>; in 2002, chapter 640<\/a>; in 2003, chapters 66<\/a>, 71<\/a>, and 521<\/a>; in 2005, chapter 584<\/a>; in 2006, chapter 428<\/a>; in 2007, chapter 407<\/a>; in 2012, chapters 646<\/a> and 689<\/a>; in 2014, chapters 9<\/a> and 183<\/a>.<\/p>","references":[{"id":70452,"section_number":"32.1-122.9","catch_line":"Conditional grants for certain dental students","order_by":null,"url":"\/32.1-122.9\/"},{"id":63285,"section_number":"32.1-122.9:1","catch_line":"Dentist Loan Repayment Program","order_by":null,"url":"\/32.1-122.9_1\/"},{"id":77747,"section_number":"32.1-325","catch_line":"Board to submit plan for medical assistance services to U.S. Secretary of Health and Human Services pursuant to federal law; administration of plan; contracts with health care providers","order_by":null,"url":"\/32.1-325\/"},{"id":63267,"section_number":"38.2-3541.2","catch_line":"Enrollment following change in eligibility status under assistance programs","order_by":null,"url":"\/38.2-3541.2\/"},{"id":74357,"section_number":"38.2-4320.1","catch_line":"Explanation of benefits for health maintenance organization enrollees who are recipients of medical assistance services or covered by the Family Access to Medical Insurance Security (FAMIS) Plan","order_by":null,"url":"\/38.2-4320.1\/"},{"id":75766,"section_number":"38.2-6500","catch_line":"Definitions","order_by":null,"url":"\/38.2-6500\/"},{"id":59512,"section_number":"63.2-1903","catch_line":"Authority to issue certain orders; civil penalty","order_by":null,"url":"\/63.2-1903\/"}],"refers_to":[{"id":86911,"section_number":"2.2-4000","catch_line":"Short title; purpose","order_by":null,"url":"\/2.2-4000\/"},{"id":85954,"section_number":"32.1-310","catch_line":"Declaration of purpose; authority to audit records; authority to review complaints of abuse or neglect","order_by":null,"url":"\/32.1-310\/"},{"id":77747,"section_number":"32.1-325","catch_line":"Board to submit plan for medical assistance services to U.S. Secretary of Health and Human Services pursuant to federal law; administration of plan; contracts with health care providers","order_by":null,"url":"\/32.1-325\/"},{"id":59066,"section_number":"32.1-351.1","catch_line":"Assistance with employer-sponsored health insurance","order_by":null,"url":"\/32.1-351.1\/"}],"permalink":{"id":201609,"object_type":"law","relational_id":86147,"identifier":"32.1-351","token":"32.1\/13\/32.1-351","url":"\/32.1-351\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-351\/","token":"32.1\/13\/32.1-351","dublin_core":{"Title":"Family Access to Medical Insurance Security Plan established","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-351","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> The Department<\/span> of Medical Assistance Services shall amend<\/span> the Virginia Children’s Medical Security Insurance Plan to be renamed the Family Access to Medical Insurance Security (FAMIS) Plan. The Department<\/span> of Medical Assistance Services shall provide coverage under the Family Access to Medical Insurance Security Plan for individuals under the age of 19 when such individuals (i) have family incomes at or below 200 percent of the federal poverty level or were enrolled on the date of federal approval of Virginia’s FAMIS Plan in the Children’s Medical Security Insurance Plan (CMSIP); such individuals shall continue to be enrolled in FAMIS for so long as they continue to meet the eligibility requirements of CMSIP; (ii) are not eligible for medical assistance services pursuant to Title XIX of the Social Security Act, as amended; (iii) are not covered under a group health plan or under health insurance coverage, as defined in § 2791 of the Public Health Service Act (42 U.S.C. § 300gg-91 (a) and (b)(1)); and (iv) meet both the requirements of Title XXI of the Social Security Act, as amended, and the Family Access to Medical Insurance Security Plan. Eligible children, residing in Virginia, whose family income does not exceed 200 percent of the federal poverty level during the enrollment period shall receive 12 continuous months of coverage as permitted by Title XXI of the Social Security Act. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The Department<\/span> of Medical Assistance Services shall also provide coverage for children and pregnant women who meet the criteria set forth in clauses (i) through (iv) of subsection A during the first five years of lawful residence in the United States, pursuant to § 214 of the Children’s Health Insurance Program Reauthorization Act of 2009 (P.L. 111-3). <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> Family Access to Medical Insurance Security Plan participants shall participate in cost-sharing to the extent allowed under Title XXI of the Social Security Act, as amended, and as set forth in the Virginia Plan for Title XXI of the Social Security Act. The annual aggregate cost-sharing for all eligible children in a family above 150 percent of the federal poverty level shall not exceed five percent of the family’s gross income or as allowed by federal law<\/span> and regulations. The annual aggregate cost-sharing for all eligible children in a family at or below 150 percent of the federal poverty level shall not exceed 2.5 percent of the family’s gross income. The nominal copayments for all eligible children in a family shall not be less than those in effect on January 1, 2003. Cost-sharing shall not be required for well-child and preventive services including age-appropriate child immunizations. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> The Family Access to Medical Insurance Security Plan shall provide comprehensive health care benefits to program participants, including well-child and preventive services, to the extent required to comply with federal requirements of Title XXI of the Social Security Act. These benefits shall include comprehensive medical, dental, vision, mental health, and substance abuse services, and physical therapy, occupational therapy, speech-language pathology, and skilled nursing services for special education students. The medical services required to be provided herein shall include dispensing or furnishing of up to a 12-month supply of hormonal contraceptives at one time, in accordance with subdivision A 27 of § 32.1-325<\/a>. The mental health services required herein shall include intensive in-home services, case management services, day treatment, and 24-hour emergency response. The services shall be provided in the same manner and with the same coverage and service limitations as they are provided to children under the State Plan for Medical Assistance Services. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> The Virginia Plan for Title XXI of the Social Security Act shall include a provision that participants in the Family Access to Medical Insurance Security Plan who have access to employer-sponsored health insurance coverage, as defined in § 32.1-351.1<\/a>, may, but shall not be required to, enroll in an employer’s health plan, and the Department<\/span> of Medical Assistance Services or its designee shall make premium payments to such employer’s plan on behalf of eligible participants if the Department<\/span> of Medical Assistance Services or its designee determines that such enrollment is cost-effective, as defined in § 32.1-351.1<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> The Family Access to Medical Insurance Security Plan shall ensure that coverage under this program does not substitute for private health insurance coverage. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

G.<\/span> The health care benefits provided under the Family Access to Medical Insurance Security Plan shall be through existing Department<\/span> of Medical Assistance Services’ contracts<\/span> with health maintenance organizations and other providers, or through new contracts<\/span> with health maintenance organizations, health insurance plans, other similarly licensed entities, or other entities as deemed appropriate by the Department<\/span> of Medical Assistance Services, or through employer-sponsored health insurance. All eligible individuals, insofar as feasible, shall be enrolled in health maintenance organizations. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

H.<\/span> The Department<\/span> of Medical Assistance Services may establish a centralized processing site for the administration of the program to include responding to inquiries, distributing applications and program information, and receiving and processing applications. The Family Access to Medical Insurance Security Plan shall include a provision allowing a child’s application to be filed by a parent, legal guardian, authorized representative or any other adult caretaker relative with whom the child lives. The Department<\/span> of Medical Assistance Services may contract<\/span> with third-party<\/span> administrators to provide any additional administrative services. Duties of the third-party<\/span> administrators may include, but shall not be limited to, enrollment, outreach, eligibility determination, data collection, premium payment and collection, financial oversight and reporting, and such other services necessary for the administration of the Family Access to Medical Insurance Security Plan. Any centralized processing site shall determine a child’s eligibility for either Title XIX or Title XXI and shall enroll eligible children in Title XIX or Title XXI. A single application form shall be used to determine eligibility for Title XIX or Title XXI of the Social Security Act, as amended, and outreach, enrollment, re-enrollment and services delivery shall be coordinated with the FAMIS Plus program pursuant to § 32.1-325<\/a>. In the event that an application is denied, the applicant shall be notified of any services available in his locality that can be accessed by contacting the local department<\/span> of social services. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

I.<\/span> The Virginia Plan for Title XXI of the Social Security Act, as amended, shall include a provision that, in addition to any centralized processing site, local social services agencies shall provide and accept applications for the Family Access to Medical Insurance Security Plan and shall assist families in the completion of applications. Contracting health plans, providers, and others may also provide applications for the Family Access to Medical Insurance Security Plan and may assist families in completion of the applications. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

J.<\/span> The Department<\/span> of Medical Assistance Services shall develop and submit to the federal Secretary of Health and Human Services an amended Title XXI plan for the Family Access to Medical Insurance Security Plan and may revise such plan as may be necessary. Such plan and any subsequent revisions shall comply with the requirements of federal law<\/span>, this chapter, and any conditions set forth in the appropriation act. In addition, the plan shall provide for coordinated implementation of publicity, enrollment, and service delivery with existing local programs throughout the Commonwealth that provide health care services, educational services, and case management services to children. In developing and revising the plan, the Department<\/span> of Medical Assistance Services shall advise and consult with the Joint Commission on Health Care. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

K.<\/span> Funding for the Family Access to Medical Insurance Security Plan shall be provided through state and federal appropriations and shall include appropriations of any funds that may be generated through the Virginia Family Access to Medical Insurance Security Plan Trust Fund. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

L.<\/span> The Board<\/span> of Medical Assistance Services, or the Director, as the case may be, shall adopt, promulgate, and enforce such regulations pursuant to the Administrative Process Act (§ 2.2-4000<\/a> et seq.) as may be necessary for the implementation and administration of the Family Access to Medical Insurance Security Plan. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

M.<\/span> Children enrolled in the Virginia Plan for Title XXI of the Social Security Act prior to implementation of these amendments shall continue their eligibility under the Family Access to Medical Insurance Security Plan and shall be given reasonable notice of any changes in their benefit packages. Continuing eligibility in the Family Access to Medical Insurance Security Plan for children enrolled in the Virginia Plan for Title XXI of the Social Security Act prior to implementation of these amendments shall be determined in accordance with their regularly scheduled review dates or pursuant to changes in income status. Families may select among the options available pursuant to subsections D and F of this section. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

N.<\/span> The provisions of Chapter 9 (§ 32.1-310<\/a> et seq.) of this title relating to the regulation of medical assistance shall apply, mutatis mutandis<\/span>, to the Family Access to Medical Insurance Security Plan. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

O.<\/span> In addition, in any case in which any provision set forth in Title 38.2 excludes, exempts or does not apply to the Virginia plan for medical assistance services established pursuant to Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (Medicaid), such exclusion, exemption or carve out of application to Title XIX of the Social Security Act (Medicaid) shall be deemed to subsume and thus to include the Family Access to Medical Insurance Security (FAMIS) Plan, established pursuant to Title XXI of the Social Security Act, upon approval of FAMIS by the federal Centers for Medicare & Medicaid Services as Virginia’s State Children’s Health Insurance Program. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nFAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN ESTABLISHED (\u00a7 32.1-351)\n\nA. The Department of Medical Assistance Services shall amend the Virginia\nChildren’s Medical Security Insurance Plan to be renamed the Family Access\nto Medical Insurance Security (FAMIS) Plan. The Department of Medical Assistance\nServices shall provide coverage under the Family Access to Medical Insurance\nSecurity Plan for individuals under the age of 19 when such individuals (i) have\nfamily incomes at or below 200 percent of the federal poverty level or were\nenrolled on the date of federal approval of Virginia’s FAMIS Plan in the\nChildren’s Medical Security Insurance Plan (CMSIP); such individuals shall\ncontinue to be enrolled in FAMIS for so long as they continue to meet the\neligibility requirements of CMSIP; (ii) are not eligible for medical assistance\nservices pursuant to Title XIX of the Social Security Act, as amended; (iii) are\nnot covered under a group health plan or under health insurance coverage, as\ndefined in § 2791 of the Public Health Service Act (42 U.S.C. §\n300gg-91 (a) and (b)(1)); and (iv) meet both the requirements of Title XXI of\nthe Social Security Act, as amended, and the Family Access to Medical Insurance\nSecurity Plan. Eligible children, residing in Virginia, whose family income does\nnot exceed 200 percent of the federal poverty level during the enrollment period\nshall receive 12 continuous months of coverage as permitted by Title XXI of the\nSocial Security Act.\n\nB. The Department of Medical Assistance Services shall also provide coverage for\nchildren and pregnant women who meet the criteria set forth in clauses (i)\nthrough (iv) of subsection A during the first five years of lawful residence in\nthe United States, pursuant to § 214 of the Children’s Health\nInsurance Program Reauthorization Act of 2009 (P.L. 111-3).\n\nC. Family Access to Medical Insurance Security Plan participants shall\nparticipate in cost-sharing to the extent allowed under Title XXI of the Social\nSecurity Act, as amended, and as set forth in the Virginia Plan for Title XXI of\nthe Social Security Act. The annual aggregate cost-sharing for all eligible\nchildren in a family above 150 percent of the federal poverty level shall not\nexceed five percent of the family’s gross income or as allowed by federal\nlaw and regulations. The annual aggregate cost-sharing for all eligible children\nin a family at or below 150 percent of the federal poverty level shall not\nexceed 2.5 percent of the family’s gross income. The nominal copayments\nfor all eligible children in a family shall not be less than those in effect on\nJanuary 1, 2003. Cost-sharing shall not be required for well-child and\npreventive services including age-appropriate child immunizations.\n\nD. The Family Access to Medical Insurance Security Plan shall provide\ncomprehensive health care benefits to program participants, including well-child\nand preventive services, to the extent required to comply with federal\nrequirements of Title XXI of the Social Security Act. These benefits shall\ninclude comprehensive medical, dental, vision, mental health, and substance\nabuse services, and physical therapy, occupational therapy, speech-language\npathology, and skilled nursing services for special education students. The\nmedical services required to be provided herein shall include dispensing or\nfurnishing of up to a 12-month supply of hormonal contraceptives at one time, in\naccordance with subdivision A 27 of § 32.1-325. The mental health services\nrequired herein shall include intensive in-home services, case management\nservices, day treatment, and 24-hour emergency response. The services shall be\nprovided in the same manner and with the same coverage and service limitations\nas they are provided to children under the State Plan for Medical Assistance\nServices.\n\nE. The Virginia Plan for Title XXI of the Social Security Act shall include a\nprovision that participants in the Family Access to Medical Insurance Security\nPlan who have access to employer-sponsored health insurance coverage, as defined\nin § 32.1-351.1, may, but shall not be required to, enroll in an\nemployer’s health plan, and the Department of Medical Assistance Services\nor its designee shall make premium payments to such employer’s plan on\nbehalf of eligible participants if the Department of Medical Assistance Services\nor its designee determines that such enrollment is cost-effective, as defined in\n§ 32.1-351.1.\n\nF. The Family Access to Medical Insurance Security Plan shall ensure that\ncoverage under this program does not substitute for private health insurance\ncoverage.\n\nG. The health care benefits provided under the Family Access to Medical\nInsurance Security Plan shall be through existing Department of Medical\nAssistance Services’ contracts with health maintenance organizations and\nother providers, or through new contracts with health maintenance organizations,\nhealth insurance plans, other similarly licensed entities, or other entities as\ndeemed appropriate by the Department of Medical Assistance Services, or through\nemployer-sponsored health insurance. All eligible individuals, insofar as\nfeasible, shall be enrolled in health maintenance organizations.\n\nH. The Department of Medical Assistance Services may establish a centralized\nprocessing site for the administration of the program to include responding to\ninquiries, distributing applications and program information, and receiving and\nprocessing applications. The Family Access to Medical Insurance Security Plan\nshall include a provision allowing a child’s application to be filed by a\nparent, legal guardian, authorized representative or any other adult caretaker\nrelative with whom the child lives. The Department of Medical Assistance\nServices may contract with third-party administrators to provide any additional\nadministrative services. Duties of the third-party administrators may include,\nbut shall not be limited to, enrollment, outreach, eligibility determination,\ndata collection, premium payment and collection, financial oversight and\nreporting, and such other services necessary for the administration of the\nFamily Access to Medical Insurance Security Plan. Any centralized processing\nsite shall determine a child’s eligibility for either Title XIX or Title\nXXI and shall enroll eligible children in Title XIX or Title XXI. A single\napplication form shall be used to determine eligibility for Title XIX or Title\nXXI of the Social Security Act, as amended, and outreach, enrollment,\nre-enrollment and services delivery shall be coordinated with the FAMIS Plus\nprogram pursuant to § 32.1-325. In the event that an application is denied,\nthe applicant shall be notified of any services available in his locality that\ncan be accessed by contacting the local department of social services.\n\nI. The Virginia Plan for Title XXI of the Social Security Act, as amended, shall\ninclude a provision that, in addition to any centralized processing site, local\nsocial services agencies shall provide and accept applications for the Family\nAccess to Medical Insurance Security Plan and shall assist families in the\ncompletion of applications. Contracting health plans, providers, and others may\nalso provide applications for the Family Access to Medical Insurance Security\nPlan and may assist families in completion of the applications.\n\nJ. The Department of Medical Assistance Services shall develop and submit to the\nfederal Secretary of Health and Human Services an amended Title XXI plan for the\nFamily Access to Medical Insurance Security Plan and may revise such plan as may\nbe necessary. Such plan and any subsequent revisions shall comply with the\nrequirements of federal law, this chapter, and any conditions set forth in the\nappropriation act. In addition, the plan shall provide for coordinated\nimplementation of publicity, enrollment, and service delivery with existing\nlocal programs throughout the Commonwealth that provide health care services,\neducational services, and case management services to children. In developing\nand revising the plan, the Department of Medical Assistance Services shall\nadvise and consult with the Joint Commission on Health Care.\n\nK. Funding for the Family Access to Medical Insurance Security Plan shall be\nprovided through state and federal appropriations and shall include\nappropriations of any funds that may be generated through the Virginia Family\nAccess to Medical Insurance Security Plan Trust Fund.\n\nL. The Board of Medical Assistance Services, or the Director, as the case may\nbe, shall adopt, promulgate, and enforce such regulations pursuant to the\nAdministrative Process Act (§ 2.2-4000 et seq.) as may be necessary for the\nimplementation and administration of the Family Access to Medical Insurance\nSecurity Plan.\n\nM. Children enrolled in the Virginia Plan for Title XXI of the Social Security\nAct prior to implementation of these amendments shall continue their eligibility\nunder the Family Access to Medical Insurance Security Plan and shall be given\nreasonable notice of any changes in their benefit packages. Continuing\neligibility in the Family Access to Medical Insurance Security Plan for children\nenrolled in the Virginia Plan for Title XXI of the Social Security Act prior to\nimplementation of these amendments shall be determined in accordance with their\nregularly scheduled review dates or pursuant to changes in income status.\nFamilies may select among the options available pursuant to subsections D and F\nof this section.\n\nN. The provisions of Chapter 9 (§ 32.1-310 et seq.) of this title relating\nto the regulation of medical assistance shall apply, mutatis mutandis, to the\nFamily Access to Medical Insurance Security Plan.\n\nO. In addition, in any case in which any provision set forth in Title 38.2\nexcludes, exempts or does not apply to the Virginia plan for medical assistance\nservices established pursuant to Title XIX of the Social Security Act, 42 U.S.C.\n§ 1396 et seq. (Medicaid), such exclusion, exemption or carve out of\napplication to Title XIX of the Social Security Act (Medicaid) shall be deemed\nto subsume and thus to include the Family Access to Medical Insurance Security\n(FAMIS) Plan, established pursuant to Title XXI of the Social Security Act, upon\napproval of FAMIS by the federal Centers for Medicare & Medicaid Services as\nVirginia’s State Children’s Health Insurance Program.\n\nHISTORY: 1997, c. 679; 1999, c. 1034; 2000, cc. 824, 848; 2001, cc. 238, 735,\n756; 2002, c. 640; 2003, cc. 66, 71, 521; 2005, c. 584; 2006, c. 428; 2007, c.\n407; 2012, cc. 646, 689; 2014, cc. 9, 183; 2021, Sp. Sess. I, c. 245.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}