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12-Month Continuous Eligibility (CE) for Children – Implementation of Mandated Provision of the Consolidated Appropriations Act of 2023

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Effective Date:

All Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
Cheryl J. Roberts, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to notify providers and Managed Care Organizations (MCOs) that, effective January 1, 2024, DMAS will implement 12-month continuous eligibility (CE) for children under age 19 in Medicaid and Family Access to Medical Insurance Security (FAMIS), in accordance with federal mandate.

Section 5112 of the Consolidated Appropriations Act (CAA) 2023 amended sections 1902(e)(12) and 2107(e)(1) of the Social Security Act to make it mandatory for states to provide 12 months of continuous eligibility for children under age 19 in Medicaid and the Children’s Health Insurance Program (CHIP) (called FAMIS in Virginia), with limited exceptions. Continuous eligibility means the child remains enrolled for a protected 12-month period, during which their coverage cannot be reduced or terminated regardless of changes in circumstance. Changes in circumstance that will no longer impact eligibility until the end of the child’s CE period include, but are not limited to, an increase in household income, loss of SSI, or a FAMIS-enrolled child obtaining other qualifying health coverage.

There are limited exceptions to the CE requirement. Those that apply to Virginia are listed below.

  • Aging out: Coverage under a children’s eligibility group will end at the end of the calendar month in which the individual turns 19. The individual will be evaluated for ongoing coverage as an adult and enrolled, if eligible.

  • Moving out of state: Coverage ends at the end of the month in which the child ceases to be a Virginia resident.

  • Death of the enrolled child.

  • The child or their representative requests termination of the child’s coverage.

  • The agency determines that eligibility was erroneously granted at the most recent determination, redetermination, or renewal of eligibility because of agency error or fraud, abuse, or perjury attributed to the child or the child's representative.

Medicaid-enrolled children may not be moved into FAMIS during a CE period as this is a reduction in coverage. FAMIS-enrolled children may be moved into Medicaid during a CE period but must remain in Medicaid for the duration of the 12-month CE period or be given a new 12-month CE period when the change occurs.

For additional details regarding the 12-month continuous eligibility for children requirement, please refer to the Virginia Medicaid Eligibility Manual.



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