The 2010 Executive Budget Document
Department of Medical Assistance Services [ http://www.dmas.virginia.gov/ ]Mission Statement
To provide access to a comprehensive system of high quality and cost effective health care services to qualifying Virginians.Operating Budget Summary
|General Fund||Nongeneral Fund||Personnel Cost|
|2007 Appropriation||$ 2,408,455,441||$ 2,912,055,424||$ 25,396,531|
|2008 Appropriation||$ 2,567,180,009||$ 3,095,483,568||$ 25,505,817|
|2009 Appropriation||$ 2,338,073,401||$ 3,654,454,288||$ 29,227,820|
|2010 Appropriation||$ 2,442,581,997||$ 4,259,614,763||$ 31,152,633|
|2011 Base Budget||$ 2,442,581,997||$ 4,259,614,763||$ 31,152,633|
|2011 Addenda||$ 526,620,071||$ (14,279,558)||$ (610,242)|
|2011 Total||$ 2,969,202,068||$ 4,245,335,205||$ 30,542,391|
|2012 Base Budget||$ 2,442,581,997||$ 4,259,614,763||$ 31,152,633|
|2012 Addenda||$ 1,131,543,605||$ (123,699,430)||$ (610,242)|
|2012 Total||$ 3,574,125,602||$ 4,135,915,333||$ 30,542,391|
|General Fund||Nongeneral Fund||Total Positions|
|2011 Base Budget||169.02||190.98||360.00|
|2012 Base Budget||169.02||190.98||360.00|
Recommended Operating Budget Addenda
Distribute Central Appropriations amounts to agency budgetsAdjusts the agency budget to reflect amounts moved to or from Central Appropriations to cover the cost of items such as changes in retirement and other benefit contribution rates, as well as the distribution of other centrally funded items.
FY 2011 FY 2012 General Fund ($1,422,605) ($1,422,605) Nongeneral Fund ($1,422,605) ($1,422,605)
Increase federal appropriation for administrative programIncreases the federal appropriation in the agency's administrative program to reflect the actual level of spending the agency has incurred over the last few years. The federal administrative expenditures of the agency are somewhat variable, especially since certain expenditures are reimbursed at higher rates (information technology for example) and the level of spending in such activities can vary from year to year.
FY 2011 FY 2012 Nongeneral Fund $2,500,000 $2,500,000
Provide appropriation for nursing facility improvement grant programProvides additional special fund appropriation for the agency's new grant program to nursing facilities to help foster better work environments and reduce staff turnover. The funding is from nursing facility civil penalties, which are restricted by federal law to be used only for improving nursing facilities. The grant program begins in FY 2010 and will be issuing up to five grants totaling $250,000 each year.
FY 2011 FY 2012 Nongeneral Fund $250,000 $250,000
Distribute amounts for real estate fees to agency budgetsTransfers amounts for fees charged to agencies for central lease administration from the Department of General Services to agency budgets.
FY 2011 FY 2012 General Fund $22,786 $22,786 Nongeneral Fund $22,786 $22,786
Provide funding for payroll service bureau costsProvides funding to assist with mandated entry into the Payroll Service Bureau in the Department of Accounts.
FY 2011 FY 2012 General Fund $2,350 $2,350 Nongeneral Fund $2,350 $2,350
Fund Medicaid utilization and inflationProvides additional funding for the increase in the use of Medicaid services and the higher costs of those services. The current recession is impacting Medicaid enrollment significantly, especially among the non-disabled adult and children populations. This population grew by eight percent in FY 2009 and is projected to grow by over 12 percent in FY 2010. Medicaid expenditures are projected to increase 11.4 percent in FY 2011 and 8.1 percent in FY 2012.
FY 2011 FY 2012 General Fund $277,347,301 $500,386,662 Nongeneral Fund $511,374,489 $848,848,024
Add additional Medicaid coverage for pregnant women to comply with recent changes in federal lawExpands Medicaid coverage for pregnant women, with other insurance, with income between 133 percent and 185 percent of the federal poverty level (FPL). Under the federal Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009, states are allowed to cover pregnant women under their CHIP State Plan up to 300 percent FPL, but in order to do so must cover up to 185 percent FPL under Medicaid. CHIP coverage excludes individuals who have other insurance, whereas Medicaid does not. As such the federal government requires that Virginia must cover this underinsured group in order for the state to continue coverage under CHIP from 133 to 200 FPL through a continuing waiver.
FY 2011 FY 2012 General Fund $667,887 $659,221 Nongeneral Fund $727,887 $659,221
Backfill Medicaid program due to loss of federal stimulus matching fundsBackfills federal stimulus funding under the federal American Recovery and Reinvestment Act of 2009, which had increased the federal match rate for Medicaid, freeing up state dollars for fiscal relief. The enhanced federal match ends on December 31, 2010 and this funding reflects the additional state dollars needed to offset the loss in federal dollars for funding the Medicaid program.
FY 2011 FY 2012 General Fund $376,817,847 $814,675,984 Nongeneral Fund ($376,817,847) ($814,675,984)
Adjust funding for the Health Care FundProvides funding to reflect lower revenue estimates for the Health Care Fund. Tobacco tax revenues are expected to be about 10 percent lower than projected last year, mainly due to and expected decrease in demand as result of the April 1, 2009 increase in federal tobacco taxes. The fund is used as state match for the Medicaid program, so any decrease in revenue requires additional general fund support to fully fund Medicaid.
FY 2011 FY 2012 General Fund $17,396,739 $15,181,240 Nongeneral Fund ($17,396,739) ($15,181,240)
Provide additional funding for state mental health and mental retardation facility Medicaid costsProvides additional funding associated with the Medicaid costs of state mental retardation and mental health facilities. Medicaid funding for these facilities at the Department of Medical Assistance Services (DMAS) has been held static for many years. The Department of Behavioral Health and Developmental Services internally transfers money, when available, to DMAS to draw down additional federal Medicaid dollars to cover their full Medicaid costs. This action is necessary because the agency no longer has the internal resources to transfer. About $2.0 million of the cost in FY 2012 is a restoration of federal stimulus funding due to the higher federal Medicaid match that ends on December 31, 2010.
FY 2011 FY 2012 General Fund $0 $31,901,342 Nongeneral Fund $0 $28,098,658
Fund Family Access to Medical Insurance Security plan utilization and inflationProvides additional funding for the program to reflect higher costs, mainly as a result of increased rates paid to managed care organizations. Due to the recession more children are qualifying for Medicaid rather than the Family Access to Medical Insurance Security (FAMIS) program. In FY 2009 enrollment was up just over two percent and is growing slowly. FAMIS provides coverage of children under the age of 19 in families with income from 133 percent to 200 percent of the federal poverty level. The program receives an enhanced federal match of 65 percent.
FY 2011 FY 2012 General Fund $3,958,115 $8,066,485 Nongeneral Fund $7,350,283 $14,980,113
Fund medical services for involuntary mental commitmentsProvides funding for the hospital and physician services for persons subject to an involuntary mental commitment. The program's expenditures were up by 27 percent in FY 2009 and the current estimate reflects stable funding from FY 2010 going forward.
FY 2011 FY 2012 General Fund $3,064,074 $3,064,074
Fund medical assistance services for low-income children utilization and inflationAdds funding for the Commonwealth's Medicaid Children's Health Insurance Program. Enrollment in this program increased 10 percent in FY 2009 and has already increased by 7.5 percent in FY 2010 through just the end of October 2009. The recession is resulting in significant enrollment growth in this program similar to Medicaid. This program applies to children between the ages of 6 through 19 who fall within the income limit of 100 to 133 percent of the federal poverty level. The federal match rate for this group of children is 65 percent.
FY 2011 FY 2012 General Fund $10,148,749 $16,477,545 Nongeneral Fund $18,847,678 $30,601,156
Modify nursing facility field auditsReduces the number of nursing facility cost report field audits and patient fund account audits to focus on more productive audit areas.
FY 2011 FY 2012 General Fund ($119,500) ($123,000) Nongeneral Fund ($119,500) ($123,000)
Eliminate regular and assisted living programsEliminates funding for the regular and intensive living programs, which provides non-Medicaid funding of three dollars a day for regular assisted living recipients and six dollars a day for intensive assisted living recipients.
FY 2011 FY 2012 General Fund ($1,461,478) ($1,461,846)
Supplant funding for coverage of legal alien children with federal fundsCaptures cost savings by utilizing federal funds to cover a group of legal alien children under Medicaid who currently are covered by state dollars only. Legal alien children under the age of 19 who have been in the United States for less than five years were deemed ineligible for full Medicaid coverage under federal welfare reform in 1996. The state maintained coverage for those children with only state funding since federal funds were no longer available. Recent changes in federal law allow the state to claim federal funds for this legal alien group of children. This strategy captures those state dollars that will now be funded with federal dollars.
FY 2011 FY 2012 General Fund ($724,324) ($700,451) Nongeneral Fund $724,324 $700,451
Eliminate disease management contractEliminates the disease management program (Healthy Returns) in the Medicaid program. The contract for the program was not renewed in November 2009.
FY 2011 FY 2012 General Fund ($964,030) ($1,025,106) Nongeneral Fund ($1,120,473) ($1,069,039)
Capture savings from elimination of 200 Mental Retardation (MR) wavier slotsCaptures savings from the elimination of 200 Mental Retaration (MR) waiver slots. The 2009 General Assembly funded 200 MR waiver slots that would have been available on January 1, 2010.
FY 2011 FY 2012 General Fund ($5,494,508) ($6,223,500) Nongeneral Fund ($6,933,692) ($6,223,500)
Expand prior authorization and impose service limits affecting three dental servicesRequires prior authorization for gingivectomy and periodontal scaling services within the dental program. In addition, this strategy includes limiting the age of panoramic X-rays to children ages 6-20 and excluding coverage for ages 0-5.
FY 2011 FY 2012 General Fund ($229,422) ($241,775) Nongeneral Fund ($290,577) ($278,224)
Reduce residential psychiatric facility ratesCaptures savings from the reduction in rates paid to residential psychiatric facilities by one percent.
FY 2011 FY 2012 General Fund ($440,364) ($496,450) Nongeneral Fund ($537,525) ($507,548)
Reduce indigent care fundingReduces funding for indigent care services paid to the VCU and UVA academic health centers. About $219 million ($110 million general fund) a year is provided to the teaching hospitals to be used for indigent health care costs. Funding for indigent care has increased by 52 percent ($74.5 million) since FY 2006. From FY 2009 to FY 2010 the increase was 13.6 percent ($26.3 million). This strategy reduces the amount of funding by three percent each year. The hospitals will still be paid the full federal share of their indigent care costs.
FY 2011 FY 2012 General Fund ($7,191,959) ($7,855,994)
Eliminate unfilled part-time positionsEliminates funding for four vacant part-time positions.
FY 2011 FY 2012 General Fund ($103,522) ($103,522) Nongeneral Fund ($103,522) ($103,522)
Increase audits of intensive in-home servicesProvides funding for additional audits of intensive in-home services for children. Additional recoveries are expected from these increased audits to offset the additional costs, leaving a net savings for the Commonwealth. These services are the fastest growing of the mental health community rehabilitation services and increased audit efforts shall help to ensure proper utilization of these services.
FY 2011 FY 2012 General Fund ($750,000) ($750,000) Nongeneral Fund ($1,011,932) ($750,000)
Adjust Health Care Fund to reflect repeal of the dealer discount on tobacco taxesReflects additional revenue to the Virginia Health Care Fund as a result of the repeal of the dealer discount on tobacco taxes. This results in a general fund savings because the Health Care Fund is used as state match for Medicaid and any additional revenue reduces the general fund needed for Medicaid.
FY 2011 FY 2012 General Fund ($3,600,000) ($3,600,000) Nongeneral Fund $3,600,000 $3,600,000
Implement a provider assessment on Intermediate Care Facilities for the Mentally Retarded (ICF-MR)Implements a provider assessment that generates additional state dollars used as match to draw down federal Medicaid funds. This amendment imposes an assessment on the revenues of private and state ICF-MRs. This assessment increases the costs of ICF-MRs which can then be reimbursed by Medicaid.
FY 2011 FY 2012 General Fund ($4,168,066) ($8,486,183) Nongeneral Fund $4,121,767 $8,391,918
Add antidepressant, antianxiety and atypical antipsychotic drugs to the Preferred Drug List (PDL)Adds antidepressant, antianxiety and atypical antipsyhotic drugs to the Medicaid Preferred Drug List (PDL). The Preferred Drug List (PDL) is a list of preferred drugs that promotes the clinically appropriate utilization of drugs in a cost-effective manner.
FY 2011 FY 2012 General Fund ($989,396) ($1,119,227) Nongeneral Fund ($1,248,551) ($1,119,227)
Impose stricter requirements on Disproportionate Share Hospital payments to out-of-state hospitalsImposes a stricter qualification requirement on out-of-state hospitals to qualify for Disproportionate Share Hospital (DSH) payments. Currently, any hospital that exceeds the required Medicaid utilization rate qualifies for a DSH payment, regardless of how much of that utilization is from Virginia Medicaid clients. This new requirement adds that in addition to the initial qualification requirement, out-of-state hospitals must also meet a 12 percent Virginia Medicaid utilization requirement.
FY 2011 FY 2012 General Fund ($2,485,652) ($2,565,193) Nongeneral Fund ($2,485,652) ($2,565,193)
Reduce rates for intensive in-home servicesReflects savings from a reduction in the rate for intensive in-home services for children and adolescents from $70 to $60 per hour that is effective on February 1, 2010. This service provides interventions for children up to age 21 who are at-risk of being moved into an out-of-home placement or after being transitioned from an out-of-home placement due to a documented clinical need of the child.
FY 2011 FY 2012 General Fund ($9,300,759) ($10,521,220) Nongeneral Fund ($11,736,923) ($10,521,220)
Reduce number of hours allowed for respite careReduces the number of hours covered each year for respite care services in the home and community-based care waivers. Respite care services provided in any combined setting are limited to 720 hours per calendar year. This strategy reduces the limit to 240 hours per year, which translates into 30 eight-hour days of respite care per year.
FY 2011 FY 2012 General Fund ($5,195,132) ($21,238,946) Nongeneral Fund ($6,555,902) ($21,238,946)
Change eligibility requirements for Children's Mental Health demonstration waiverChanges the eligibility requirements for the waiver to allow children when they exit a Psychiatric Residential Treatment Facility (PRTF) to be counted as a family of one. Currently, when they return home their family's income results in them losing eligibility. As a result the program only has about 20 children enrolled versus a projected 300. This change will result in more children being enrolled in the waiver, saving the Commonwealth from having to pay the higher costs of a PRTF.
FY 2011 FY 2012 General Fund ($1,000,000) ($1,000,000) Nongeneral Fund ($1,000,000) ($1,000,000)
Change prior authorization requirement for Intensive In-Home servicesChanges the prior authorization requirement for intensive in-home services from 12 weeks to one week. Currently, prior authorization is not required until after 12 weeks of services have been provided. This change will help ensure the effective utilization of this service. Intensive in-home services provide interventions for children up to age 21 who are at-risk of being moved into an out-of-home placement or after being transitioned from an out-of-home placement due to a documented clinical need of the child.
FY 2011 FY 2012 General Fund ($307,312) ($347,638) Nongeneral Fund ($387,806) ($347,638)
Postpone mandated increase in annual Mental Retardation and Developmental Disability waiver slotsDelays the implementation of a new statutory requirement to add 400 Mental Retardation waiver and 67 Individual and Family Development Disabilities and Support Waiver slots per year in order to work toward to elimination of the waiting lists for those waivers. The 2009 General Assembly added this requirement and the funding was included in the forecast of Medicaid expenditures. This action captures the savings from not adding the slots.
FY 2011 FY 2012 General Fund ($12,134,798) ($27,065,000) Nongeneral Fund ($15,313,286) ($27,065,000)
Maintain reimbursement rates for freestanding psychiatric facilities at FY 2010 levelMaintains freestanding psychiatric hospital reimbursement rates into FY 2011 and FY 2012 at the FY 2010 level. No rebasing of rates in FY 2011 or inflationary adjustments are provided as specified in regulation.
FY 2011 FY 2012 General Fund ($264,182) ($420,167) Nongeneral Fund ($32,364) ($45,086)
Reduce reimbursement for long-stay hospitals to average Medicaid costsReduces payment rates to long-stay hospitals to their average Medicaid allowable costs. These hospitals were not incorporated into the prospective payment system as acute hospitals and are actually paid slightly more than their Medicaid costs under the older reimbursement system.
FY 2011 FY 2012 General Fund ($449,298) ($522,102) Nongeneral Fund ($566,983) ($522,102)
Withhold inflation adjustments from hospital operating ratesWithholds the annual inflation adjustments to operating rates for acute and rehabilitation hospitals in FY 2011 and FY 2012 as specified in regulation. This action does not impact the FY 2011 rebasing of operating rates for these hospitals.
FY 2011 FY 2012 General Fund ($29,399,447) ($46,554,639) Nongeneral Fund ($37,100,093) ($46,554,639)
Withhold inflation from Graduate Medical and Indirect Medical Education paymentsWithholds the normal inflation adjustments in FY 2011 and FY 2012 for Graduate Medical Education and Indirect Medical Education payments to acute and rehabilitation hospitals as specified in regulations.
FY 2011 FY 2012 General Fund ($2,060,826) ($2,750,809) Nongeneral Fund ($2,600,622) ($2,750,809)
Maintain Disproportionate Share Hospital payments at FY 2010 funding levelMaintains Disproportionate Share Hospital (DSH) payments for acute and rehabilitation hospitals at their FY 2010 levels through FY 2011 and FY 2012. This action withholds any inflation adjustments but does allow the FY 2011 rebasing of DSH payments (in a budget neutral calculation) as specified in regulation. In addition, the qualification requirement to receive DSH payments is reduced from 15 to 14 percent Medicaid utilization.
FY 2011 FY 2012 General Fund ($9,977,356) ($10,476,224) Nongeneral Fund ($9,977,356) ($10,476,224)
Maintain nursing facility rates at FY 2010 levelMaintains nursing facility operating rates in FY 2011 and FY 2012 at the same level as FY 2010. This action withholds the annual inflation adjustments and does not rebase rates in FY 2011 as specified in regulation.
FY 2011 FY 2012 General Fund ($11,154,710) ($18,327,952) Nongeneral Fund ($14,076,482) ($18,327,952)
Eliminate annual inflation adjustment for residential psychiatric facilitiesWithholds for FY 2011 and FY 2012 the typical inflation adjustments applied to residential psychiatric facility rates.
FY 2011 FY 2012 General Fund ($1,175,376) ($2,821,771) Nongeneral Fund ($1,483,245) ($2,821,771)
Eliminate annual inflation adjustment for home health agenciesWithholds for FY 2011 and FY 2012 the typical inflation adjustments applied to the rates for home health services.
FY 2011 FY 2012 General Fund ($182,916) ($402,131) Nongeneral Fund ($230,828) ($402,131)
Eliminate annual inflation adjustment for outpatient rehabilitation agenciesReflects savings from withholding in FY 2011 and FY 2012 the typical inflation adjustments applied to the rates of outpatient rehabilitation agencies.
FY 2011 FY 2012 General Fund ($68,139) ($165,496) Nongeneral Fund ($85,987) ($165,496)
Reduce rates for therapeutic behavioral servicesReflects the savings from a five percent reduction in therapeutic behavioral services (residential A and B services) for children provided in a residential setting. The reduction takes effect on February 1, 2010.
FY 2011 FY 2012 General Fund ($526,578) ($595,677) Nongeneral Fund ($664,507) ($595,677)
Reduce clinical laboratory ratesReflects savings from a five percent reduction in the Medicaid rates for clinical laboratory services which takes effect on February 1, 2010.
FY 2011 FY 2012 General Fund ($1,571,432) ($1,425,528) Nongeneral Fund ($1,983,040) ($1,425,528)
Freeze enrollment in the Home and Community-Based Care waivers beginning January 1, 2011Captures the savings from freezing enrollment in five of the Home and Community-Based Care (HSBC) waivers beginning January 1, 2011 and expiring on January 1, 2012. As a result after someone leaves the waiver, their slot will not be filled until the enrollment freeze ends. The HIV/AIDS and the Technology Assisted waivers are not included in the freeze. The waiver freeze may not take place if the federal government takes action to extend the Medicaid federal stimulus relief to states beyond the December 31, 2010 expiration date. Additional federal stimulus dollars, if made available, could be used to reverse this action.
FY 2011 FY 2012 General Fund ($3,745,802) ($13,310,010) Nongeneral Fund ($3,745,802) ($13,310,010)
Eliminate special Indirect Medical Education payments to hospitalsEliminates special Indirect Medical Education (IME) payments to three hospitals based on their number of Neonatal Intensive Care Unit (NICU) utilization or days. These special payments were originally provided to transition the hospitals due to a change in payment methodology that no longer included NICU data in the calculations.
FY 2011 FY 2012 General Fund ($884,200) ($1,000,000) Nongeneral Fund ($1,115,800) ($1,000,000)
Eliminate coverage of podiatry servicesEliminiates Medicaid coverage of podiatry services.
FY 2011 FY 2012 General Fund ($430,950) ($487,500) Nongeneral Fund ($543,830) ($487,500)
Limit annual visits for physical, occupational and speech therapiesImplements an annual limit for physical therapy, occupational therapy and speech therapy services. Currently, there is no maximum limit, only a requirement for prior authorization of additional visits after 24 in a year.
FY 2011 FY 2012 General Fund ($161,642) ($173,711) Nongeneral Fund ($203,982) ($173,711)
Reduce provider rates for Home and Community-Based waiver services by five percentReduces the rates paid to providers of Home and Community-Based Care waiver services by five percent beginning July 1, 2010. Skilled nursing services in the Technology Assisted waiver are exempt from this rate reduction.
FY 2011 FY 2012 General Fund ($18,154,159) ($17,961,285) Nongeneral Fund ($22,909,309) ($17,961,285)
Reduce income limits for optional 300 percent Supplemental Security Income eligibility groupReduces the income limit for an optional Medicaid eligibility group. Currently, certain Medicaid recipients in nursing facilities or long-term care waivers are eligible for Medicaid because they have income up to 300 percent of Supplemental Security Income (SSI), which is $2,022 per month. This action reduces the income limit to 275 percent of SSI, which is $1,854 a month. This income limit reduction may not take place if the federal government takes action to extend the Medicaid federal stimulus relief to states beyond the December 31, 2010 expiration date. If additional federal stimulus dollars become available, this action could be reversed.
FY 2011 FY 2012 General Fund ($16,870,746) ($36,440,811) Nongeneral Fund ($16,870,746) ($36,440,811)
Supplant general fund support for the Family Access to Medical Insurance Security program with nongeneral fund revenueDedicates 1.5 percent of the Master Settlement Agreement (MSA) with tobacco manufacturers to support children's health insurance efforts. Specifically, this funding will be used to support the state's Children's Health Insurance Program. The funding currently goes to the Virginia Tobacco Settlement Foundation, which receives a total of 10 percent of the MSA, for smoking cessation and obesity prevention efforts. This action redirects 15 percent of the foundation's funding to be used to support children's health.
FY 2011 FY 2012 General Fund ($1,979,124) ($2,004,563) Nongeneral Fund $1,979,124 $2,004,563
Implement pharmacy management savingsImplements the recommendations of a recent study to improve pharmacy management practices in the Medicaid program.
FY 2011 FY 2012 General Fund ($3,922,707) ($4,641,008) Nongeneral Fund ($4,950,189) ($4,641,008)
Eliminate coverage of optometry services for adultsEliminates Medicaid coverage of optometry services for adults. Children will still be eligible for optometry services as required by the Early Periodic Screening, Diagnosis, and Treatment program.
FY 2011 FY 2012 General Fund ($344,954) ($418,500) Nongeneral Fund ($391,856) ($418,500)
Modify durable medical equipment incontinence limitModifies the current limits on durable medical equipment incontinence supplies.
FY 2011 FY 2012 General Fund ($1,398,406) ($1,646,544) Nongeneral Fund ($1,764,693) ($1,646,544)
Change timeline for Medicaid expenditure reportChanges the monthly expenditure report of Medicaid expenditures from a monthly to a quarterly report. Medicaid expenditures are highly variable from month to month for numerous reasons. The variance in the numbers found in the monthly reports is often more misleading than informative, with the result that most of the narrative of the report is often devoted simply to explaining why the reported numbers do not mean what they appear to mean. This action is embedded in budget language.
Provide emergency regulatory authority to comply with the Children's Health Insurance Program Reauthorization ActProvides the Department of Medical Assistance Services with emergency regulatory authority to implement the mandatory provisions of the federal Children’s Health Insurance Program Reauthorization Act of 2009. This action is embedded in budget language.
Require Social Security numbers as part of application for the Family Access the Medical Insurance Security programAdds a requirement that social security numbers are required on the application for the Family Access to Medical Insurance Security (FAMIS) program. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requires states to verify citizenship and the identity of CHIP applicants and enrollees. In order to simplify this requirement, a data match of the person's Social Security Number (SSN) will be used to comply. No adverse impact is expected because 93 percent of applicants already provide their social security number. This action is embedded in budget language.