Administrative Code

Virginia Administrative Code
9/21/2021

Part VII. Medical Assistance Eligibility Resulting from Welfare Reform

Article 4
Income

12VAC30-110-1200. Definitions.

The following words and terms, when used in this part, shall have the following meanings unless the context indicates otherwise:

"Aid to Families with Dependent Children" or "AFDC" means the public assistance programs authorized in §§ 406 and 407 of the Social Security Act (42 USC §§ 606 and 607), and administered by the Virginia Department of Social Services. The term "AFDC" as used in this part includes Aid to Families with Dependent Children - Unemployed Parent (AFDC-UP).

"Assistance unit" means those persons who have been determined categorically and financially eligible to receive assistance as defined in the Virginia Department of Social Services' Virginia Independence Program regulations (22VAC40-35-5 et seq.).

"Caretaker-relative" means the natural or adoptive parent or other relative, as specified in 45 CFR 233.90(c)(1)(v), who is responsible for supervision and care of the needy child.

"Child" means an individual who would be considered a child under the AFDC State Plan.

"Family" means those individuals living in the household whose needs and income were included in determining the AFDC eligibility of the assistance unit at the time that the AFDC benefits were terminated and individuals under AFDC sanction whose income but not needs were included. It also includes those individuals whose needs and income would be taken into account in determining the AFDC eligibility of the caretaker-relative's assistance unit under the AFDC State Plan if the family were applying in the current month.

"Family income" means all the earned income, as defined in the AFDC State Plan, of all the members of the family without application of any disregards except the family's cost of child care necessary for the employment of the caretaker-relative or those disregards required by another federal statute.

"Transitional medical assistance" means extended medical assistance to participants in VIEW whose AFDC has been terminated voluntarily or involuntarily.

"Virginia Initiative for Employment not Welfare" or "VIEW" means the Job Opportunities and Basic Skills Training Program as implemented in the Commonwealth.

Statutory Authority

§§ 32.1-325 and 63.1-133.46 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 12, Issue 15, eff. June 1, 1996.

12VAC30-110-1210. (Repealed.)

Historical Notes

Derived from Virginia Register Volume 12, Issue 15, eff. June 1, 1996; repealed, Virginia Register Volume 19, Issue 18, eff. July 1, 2003.

12VAC30-110-1220. Scope of coverage.

A. Subject to subsection B of this section, during the 12-month extension period, the amount, duration, and scope of medical assistance made available to a family shall be the same as if the family were still receiving AFDC.

B. The Department of Medical Assistance Services (DMAS), at its option may, pursuant to the requirements of the Health Insurance Premium Payment Program (HIPP) in Part XII (12VAC30-130-740 et seq.) of 12VAC30-130, pay a family's expenses for premiums, deductibles, coinsurance, and similar costs for health insurance or other health care coverage offered by an employer of the caretaker-relative or by an employer of the absent parent of a dependent child. If an employer offers such coverage to the caretaker-relative:

1. To receive transitional medical assistance coverage for himself and his family, the caretaker-relative shall make application for such employer coverage, but only if:

a. The employer does not require the caretaker-relative to make financial contributions for the coverage (whether through payroll deduction, payment of deductibles, coinsurance, or similar costs, or otherwise); and

b. DMAS provides, directly or otherwise, payment of any of the premium amount, deductible, coinsurance, or similar expense that the employee is otherwise required to pay; and

2. DMAS treats the coverage under the employer plan as a third party liability (as of May 1, 1995, under § 1902(a)(25) of the Social Security Act) (42 USC § 1396a(a)(25)).

C. DMAS shall consider payments for premiums, deductibles, coinsurance, and similar expenses as payments for medical assistance.

Statutory Authority

§§ 32.1-325 and 63.1-133.46 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 12, Issue 15, eff. June 1, 1996.

12VAC30-110-1230. Written notice and reporting requirements.

A. Notices. During the third, sixth and ninth months of any transitional assistance DMAS shall notify the family of the reporting requirements.

B. Reporting requirements. To receive continued transitional medical assistance, a family shall report the following to the local department of social services, not later than the 21st day of the fourth, seventh, and tenth month in the period of transitional assistance: the family's gross monthly earnings and the family's costs for child care necessary for the employment of the caretaker-relative in each month of the preceding three-month period. The local department of social services may permit continued transitional medical assistance, notwithstanding a failure to report, if the family has established good cause for the failure to report on a timely basis.

C. Good cause. The local department of social services may grant an extension regarding the reporting requirements for good cause shown, pursuant to the Medicaid Client Appeals regulations at Part I (12VAC30-110-10 et seq.) of this chapter.

D. Frequency of reporting. A family receiving transitional assistance shall not be required to report more frequently than as required under subsection B of this section.

E. Notice before termination. No termination of assistance shall become effective until the local department of social services provides the family with notice of the grounds for the termination. No termination shall be effective earlier than 10 days after the date of mailing of the notice.

Statutory Authority

§§ 32.1-325 and 63.1-133.46 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 12, Issue 15, eff. June 1, 1996.

12VAC30-110-1240. Appeals.

All appeals regarding the provision of services under this part shall be conducted pursuant to the Medicaid Client Appeals regulations at Part I (12VAC30-110-10 et seq.) of this chapter.

Statutory Authority

§§ 32.1-325 and 63.1-133.46 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 12, Issue 15, eff. June 1, 1996.

12VAC30-110-1300. (Repealed.)

Statutory Authority

§§ 32.1-324 and 32.1-325 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 13, Issue 18, eff. July 1, 1997; repealed, Volume 27, Issue 9, eff. February 17, 2011; Errata, 27:10 VA.R. 964 January 17, 2011.

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