Title of Regulation: 12VAC30-10. State Plan under Title XIX of the Social Security Act Medical Assistance Program; General Provisions (amending 12VAC30-10-60).

Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1315 and 42 USC § 1396 et seq.

Public Hearing Information: No public hearings are currently scheduled.

Public Comment Deadline: August 18, 2021.

Effective Date: September 2, 2021.

Agency Contact: Emily McClellan, Regulatory Supervisor, Policy Division, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-4300, FAX (804) 786-1680, or email emily.mcclellan@dmas.virginia.gov.

Basis: Section 32.1 325 of the Code of Virginia grants to the Board of Medical Assistance Services the authority to administer and amend the Plan for Medical Assistance and to promulgate regulations. Section 32.1-324 of the Code of Virginia authorizes the Director of the Department of Medical Assistance Services (DMAS) to administer and amend the Plan for Medical Assistance and to promulgate regulations according to the board's requirements.

Purpose: The regulation is essential to protect the health, safety, and welfare of citizens as it ensures continuity in Medicaid benefits for members using Supplemental Nutritional Assistance Program (SNAP) and streamlines services by significantly reducing duplication of effort for state agencies. Research has shown that SNAP households have at least one member that receives coverage under Medicaid, and there may be additional eligible members. Due to similar eligibility requirements in the programs, using SNAP income to determine Medicaid eligibility will reduce the need for Medicaid participants to frequently reapply for benefits.

Rationale for Using Fast-Track Rulemaking Process: This rulemaking is expected to be noncontroversial because it does not have any negative effect on Medicaid providers or Medicaid members. The changes will streamline the eligibility process to make eligibility determinations both easier and faster. This will benefit DMAS, the Department of Social Services, and Medicaid members. There are no changes in the number or outcome of eligibility determinations made as a result of these changes, and there are no costs associated with these changes.

Substance: The amendments conform the State Plan for Medical Assistance to Centers for Medicare and Medicaid Services requirement changes.

Issues: The primary advantage of this regulatory action is DMAS will be allowed to coordinate policies and processes with other state agencies to improve administration, customer service, and program participation. This change will also reduce the need for DMAS to request additional paperwork from members. There are no disadvantages to the public, the agency, or the Commonwealth as a result of this regulatory action.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. On behalf of the Board of Medical Assistance Services, the Department of Medical Assistance Services (DMAS) proposes to use verified income information provided by applicants for the Supplemental Nutritional Assistance Program (SNAP) as part of the Medicaid application process.¹ Since SNAP income thresholds are lower than Medicaid income thresholds, the proposed amendment would not change the income thresholds or other eligibility criteria for Medicaid. Rather, the proposed amendment would use verified income data already present in the Virginia Case Management System (VaCMS), an enterprise eligibility determination system used by the Department of Social Services (DSS), thereby reducing the paperwork burden for Medicaid-eligible SNAP enrollees.

Background. Applications for SNAP and Medicaid are processed by DSS staff, who use VaCMS for case management. Functionality in VaCMS supports the use of SNAP income in making Medicaid eligibility decisions by showing local DSS eligibility staff whether the applicant's case file has current, verified SNAP income information that can thus be used to make a Medicaid eligibility determination. Currently, ex parte eligibility renewals for Medicaid are completed using information that is already available in an applicant's case file. The proposed amendment would allow the same process to also be implemented for initial Medicaid applications. Without the proposed change, local DSS staff would have to request additional income verification from individuals applying for Medicaid. This additional step could result in a denial or loss of coverage if the individual does not provide the information in time, even if income information for that individual already exists in VaCMS.

In particular, DMAS proposes to add the following language into 12VAC30-10-60 Application; determination of eligibility and furnishing Medicaid: Supplemental Nutrition Assistance Program (SNAP) income will be used to support Medicaid eligibility determinations for individuals currently enrolled in SNAP. The Medicaid agency will not alter SNAP procedures while using the reported income to determine Medicaid eligibility using Medicaid rules. The Medicaid agency will obtain all information necessary for a Medicaid eligibility determination that is not in the case record for SNAP from the Medicaid eligibility application. This language has already been approved by the Centers for Medicare and Medicaid Services as part of a State Plan Amendment, with an effective date of October 1, 2019. Therefore, in practice, SNAP income is already in use for Medicaid eligibility determinations, and the proposed amendment would conform the regulation to current practice.

Estimated Benefits and Costs. The proposed amendment would directly benefit individuals applying for SNAP and Medicaid at the same time, or those applying for Medicaid who had previously been enrolled in SNAP, by reducing the number of times they have to provide the same income verification information. According to DMAS, DSS local eligibility workers would also benefit by the removal of unnecessary steps in the benefits determination process. Lastly, since the proposed amendment would not change the income thresholds or other eligibility criteria for either SNAP or Medicaid, it would not significantly affect enrollment rates for either program or have budget implications for the state's general fund allocations. While it is possible that some individuals who might have failed to provide income verification in a timely manner and thus be denied Medicaid would instead become enrolled, that marginal cost is likely negligible relative to overall Medicaid enrollment rates, and the benefit to those individuals from having health insurance likely outweighs the costs.

Businesses and Other Entities Affected. As mentioned previously, local DSS employees who conduct eligibility verifications would benefit from having a more streamlined process, and applicants for Medicaid who have also applied for SNAP would benefit from lower paperwork requirements. An estimate of the number of applicants for Medicaid who also apply for SNAP is not available.

Small Businesses² Affected. The proposed amendment would not affect any small businesses.

Localities³ Affected.⁴ The proposed amendment does not introduce new costs for local governments and is unlikely to affect any locality in particular, although some marginal savings in local DSS staff time may result.

Projected Impact on Employment. The proposed amendment is unlikely to affect employment.

Effects on the Use and Value of Private Property. The proposed regulation is unlikely to affect the use and value of private property. Real estate development costs are not affected.

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¹ "Medicaid" as used throughout the document includes other public health insurance programs that specifically cover pregnant women, mothers and children.

² Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

³ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

⁴ § 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency's Response to Economic Impact Analysis: The agency has reviewed the economic impact analysis prepared by the Department of Planning and Budget. The agency raises no issues with this analysis.

Summary:

The amendments allow the Department of Medical Assistance Services (DMAS) to use Supplemental Nutritional Assistance Program income to support Medicaid eligibility determinations at the time of Medicaid application.

12VAC30-10-60. Application; determination of eligibility and furnishing Medicaid.

A. The Medicaid agency meets all requirements of 42 CFR Part 435, Subpart J for processing applications, determining eligibility and furnishing Medicaid.

B. 1. Except as provided in subdivisions 2 and 3 of this subsection, individuals are entitled to Medicaid services under the plan during the three months preceding the month of application, if they were, or on application would have been, eligible. The effective date of prospective and retroactive eligibility is specified in 12VAC30-40-10.

2. For individuals who are eligible for Medicaid cost sharing expenses as qualified Medicare beneficiaries under § 1902(a)(10)(E)(i) of the Act, coverage is available for services furnished after the end of the month in which the individual is first determined to be a qualified Medicare beneficiary. 12VAC30-40-10 specifies the requirements for determination of eligibility for this group.

3. Pregnant women are not entitled to ambulatory prenatal care under the plan during a presumptive eligibility in accordance with § 1920 of the Act. 12VAC30-40-10 specifies the requirements for determination of eligibility of this group.

C. The Medicaid agency elects to enter into a risk contract with an HMO that is qualified under Title XIII of the Public Health Service Act or is provisionally qualified as an HMO pursuant to § 1903(m)(3) of the Social Security Act (42 USC § 1396(m)).

The Medicaid agency elects to enter into a risk contract with an HMO that is not federally qualified, but meets the requirements of 42 CFR 434.20(c) and is defined in 12VAC30-20-60.

D. The Medicaid agency has procedures to take applications, assist applicants, and perform initial processing of applications from those low income pregnant women, infants, and children under age 19, described in § 1902(a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), and (a)(10)(A)(ii)(IX) at locations other than those used by the Title IV-A program including FQHCs and disproportionate share hospitals. Such application forms do not include the ADFC form except as permitted by HCFA instructions.

E. Supplemental Nutrition Assistance Program (SNAP) income will be used to support Medicaid eligibility determinations for individuals currently enrolled in SNAP. The Medicaid agency will not alter SNAP procedures while using the reported income to determine Medicaid eligibility using Medicaid rules. The Medicaid agency will obtain all information necessary for a Medicaid eligibility determination that is not in the case record for SNAP from the Medicaid eligibility application.