UNITED STATES VIRGIN ISLANDS 
DEPARTMENT OF HUMAN SERVICES MEDICAL ASSISTANCE PROGRAM 
 
PUBLIC NOTICE 
 
NOTICE OF INTENT TO SUBMIT MEDICAID STATE PLAN AMENDMENT 
RELATED TO AN ALTERNATIVE BENEFIT PLAN FOR THE MEDICAID 
COVERAGE GROUP FOR LOW-INCOME ADULTS 
 
In accordance with 42 C.F.R. § 440.386, the United States Virgin Islands Department of Human 
Services (“Department”) hereby gives notice of its intent to seek approval from the United States 
Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), 
for a state plan amendment (SPA) to establish an alternative benefit plan (ABP) effective May 1, 
2015 in accordance with Sections 1902(k)(1) and 1937 of the Social Security Act.  The purpose 
of this notice is to describe the ABP and solicit public comment regarding the plan.  The 
Department intends to submit the state plan amendment regarding the ABP to CMS on or before 
May 1, 2015. 
 
The ABP is the benefit package that will be provided to beneficiaries in the Medicaid low-
income adult population under Section 1902(a)(10)(A)(i)(VIII) of the Social Security Act.  The 
United States Virgin Islands intends to continue providing the full array of Medicaid state plan 
services to this population; the alternative benefit plan will align with the existing state plan 
coverage.    
Effective May 1, 2015, the United States Virgin Islands will expand Medicaid eligibility to 
adults with incomes up to and including 133% of the United States Virgin Islands poverty level.  
Effective on that date the 133% of the United States Virgin Islands poverty level is equal to 75% 
of the United States federal poverty level. This expansion constitutes the fourth phase of 
Medicaid expansion in the United States Virgin Islands (Expansion IV). 
Effective May 1, 2015, the United States Virgin Islands must also offer assurances that the 
services provided to the low-income adult population provides the essential health benefits 
(EHB) described in Section 1302(b) of the Patient Protection and Affordable Care Act (ACA).  
The ABP SPA will demonstrate to CMS that the current Medicaid state plan includes services 
that are equal to or exceed services in the 10 EHB categories in the selected base benchmark 
plan. The base benchmark plan selected for this purpose is the Basic Option provided to federal 
employees by Blue Cross and Blue Shield. 
In addition to providing all state plan services, the ABP will provide full access to EPSDT 
services to beneficiaries under 21 years of age.  This will include informing these individuals that 
EPSDT services are available and of the need for age-appropriate immunizations.  The ABP will 
also provide or arrange for the provision of screening services for all children and for corrective 
treatment as determined by child health screenings.  EPSDT clients will also be able to receive 
any additional health care services that are coverable under the Medicaid program and found to 
be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless 
of whether the service is covered in the United States Virgin Islands Medicaid State Plan. 
The ABP will also offer access to non-emergency medical transportation services. The ABP will 
provide habilitative and rehabilitative services through a variety of therapies.  The ABP will also 
meet requirements of the federal Mental Health Parity and Addiction Equity Act.   
 
The ABP does not include limits on services, other than the requirement that services provided 
outside the clinics operated by the Department of Health, the federally qualified health centers, 
and the hospitals operated by the United States Virgin Islands Hospital and Health Facilities 
Corporation require authorization by the clinic that serves as the primary care provider for the 
patient, or by the Medical Assistance Program at the Department of Human Services. This 
requirement is the same requirement that applies to all coverage groups covered under the United 
States Virgin Islands Medicaid State Plan.  
 
There will be no cost sharing for the services provided under the ABP, or for any individual or 
service covered under the United States Virgin islands Medicaid State Plan.  The United States 
Virgin Islands does not currently impose cost sharing on Medicaid beneficiaries.   
As there are currently no Indian Health Programs or Urban Indian Organizations in the United 
States Virgin Islands, the consultation requirements in Section 5006(e) of the American 
Recovery and Reinvestment Act of 2009 do not apply to the United States Virgin Islands.  
Attached to this notice is the list of the state plan services aligned with the 10 EHB categories. 
Comments or inquiries must be submitted in writing by mail, e-mail, or fax within 30 days of the 
publication date of this notice to:  
Ms. Renée Joseph Rhymer, MSW 
Medicaid Program 
Department of Human Services 
1303 Hospital Ground 
Knud Hansen Complex, Building A 
St. Thomas, USVI 00802 
Phone: (340) 774-0930x 4353/4398 
Fax: (340) 774-4918