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Frequently Asked Questions

Frequently Asked Questions are used to provide additional information and/or statutory guidance not found in State Medicaid Director Letters, State Health Official Letters, or CMCS Informational Bulletins. The different sets of FAQs as originally released can be accessed below.

Showing 31 to 40 of 58 results

How do I create a correspondence log/ How do I update the correspondence log?

The Correspondence Log is the official record for the package. The Correspondence Log can be used as a communication tool, where CMS provides information to the state and the state can respond. Only the SPOC and the CMS Point of Contact can write in the correspondence log, but others may view the correspondence log in a package for reference.

  1. Log in to MACPro as the CMS Point of Contact.
  2. Select the "Records" tab from the upper tool bar, and then select "Submission Packages" for your state.
  3. Next, select your Package ID.
  4. You will be taken to the Summary screen of your package. Select "Related Actions" from the left panel.
  5. Next, select "Create Correspondence Log"
  6. Enter in your information and then select "Create Correspondence Log"
  7. If you should need to add an entry, follow steps 1 through 4 and then select "Add Entry to Correspondence Log".
  8. On the next screen, fill in your entry and then select "Add Entry to Correspondence Log".
  9. You may also add an entry to the correspondence log by selecting "Correspondence Log" from the left panel instead of "Related Actions" shown in Step 4. Please note that this link will only appear after you have created a correspondence log.
  10. Select "Add Entry to Correspondence" in the top right corner.
  11. Fill in your entry information and then select "Add Entry to Correspondence".

FAQ ID:93006

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How do I view approved State Plan Content with current, previous, or future effective dates?

Under the "Records" tab, select "Medicaid State Plan". Next, search for a state using the search feature in the left panel. Select the blue link for your State Plan. On the next screen you will be able to see past, current and future Health Homes Programs.

FAQ ID:92856

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What main functions can my role perform?

Primary Role Definition
CMS Package Disapprover (PD)
  • Disapproves packages
  • This role is for Central Office users
Office of Strategic Operations & Regulatory Affairs (OSORA)
  • Coordinates communication for disapproval process between CMS Offices
  • Informs CMS Point of Contact and CMS Point of Contact Admin of package clearance and documentation completion
CMS Senior Management (SrMGR)
  • Evaluates recommended disposition
  • Reviews recommended disposition of disapproval and disapproval justification
CMS Package Approver (PA)
  • Approves Medicaid SPA Packages
  • Each user with this role can be associated to one Regional Office at a time or to Central Office
CMS Point of Contact Administrator (POC Admin)
  • Oversees the submission package through the CMS senior management review process for recommended disapprovals
  • Tailors disapproval notices
Subject Matter Expert (SME)
  • Provides SME input to Review Team, upon request (offline or as SRT member)
Submission Review Team (SRT)
  • Receives package review assignments
  • Provides section assessments through the Review Tool
  • Reviews and submits notes and comments for Official and Draft Submissions
  • Provides recommendations for RAI, Approval, and Disapproval
CMS Point of Contact (CPOC)
  • Oversees the review of Official and Draft Submissions
  • Maintains the composition of the review team (selects review team members within MACPro)
  • Documents and Reviews correspondence log entries
  • Reviews team feedback within the Review Tool
  • Recommends a disposition for a submission package
  • Requests clarifications and initiates a request for additional information (RAI) from the state
  • Tailors approval notice to the state
  • Sets and manages internal milestones and reminders for SRT and Sr. Managers
  • Oversees the submission package through the CMS senior management review process for recommended approvals
  • CMS users may choose to be CPOCs for specific states within their program and authority
Report Administrator (RA)
  • Views reports and submission packages on behalf of CMS Review Team Administrators (POC Admin)
Subscriber (SUB)
  • Subscribes to specific states of interest
  • CMS users may choose to be subscribers for specific states within a program and authority

FAQ ID:92861

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What does it mean if the State allows CMS to view?

The State has the option to allow CMS to view the information in a submission package prior to submission informally by using the "Allow CMS to View" functionality. The CMS Point of Contact, Submission Review Team, and Subject Matter Expert have the ability to view these submission packages once the state has initiated the function. Please Note: This option will permit the CMS review team to see the screens in this submission package as they appear currently. It does not cause the package to be submitted as Draft or Official, and does not start a CMS review clock. Validation of the screens is not required. States must notify their CMS contact that viewing is available; MACPro does not notify CMS staff. States can deselect this option at any time

To access the submission package, go to the "Records" tab and then select "Submission Packages". Next select the link to the submission package and then in the left panel, select "Reviewable Units". You may then select the blue links to each Reviewable Unit to view the data entered by the state.

FAQ ID:92866

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How does section 2001(a)(5)(B) of the Affordable Care Act impact states currently covering children 6-18 up to 133 percent of the FPL under a separate CHIP?

Section 2001(a)(5)(B) of the Affordable Care Act (implemented through regulations for the Medicaid program at section 435.118) increased the minimum income limit applicable to Medicaid eligibility for the mandatory group for poverty-level related children aged 6-18 from 100 to 133 percent of the FPL under section 1902(a)(10)(A)(i)(VII) of the Act. Therefore, if a state is currently covering uninsured children up to 133 percent of the FPL under a separate CHIP, these children must be transitioned to the Medicaid state plan under this children's group effective January 1, 2014. CMS is available to work with states individually on their transition plans for this population.

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FAQ ID:92606

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Are these children who are being transferred from CHIP to the Medicaid state plan considered optional targeted low-income children under section 1902(a)(10)(A)(ii)(XIV) of the Act?

No. For the purposes of eligibility, these children are considered a mandatory Medicaid group for poverty-level related children under section 1902(a)(10)(A)(i)(VII) of the Act. As described below, states will continue to receive the CHIP matching rate for this population.

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FAQ ID:92611

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Will new applicants/children ages 6-18 with incomes between 100 and 133 percent of the FPL with other health insurance qualify for coverage under the Medicaid state plan?

Yes. Under the Medicaid mandatory group for poverty-level related children under section 1902(a)(10)(A)(i)(VII) of the Act, insured children must be covered in addition to uninsured children (please also see applicable match rate questions below). This is different from the rules governing a separate CHIP program, which preclude coverage for insured children.

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FAQ ID:92616

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Does 2001(a)(5)(B) of the Affordable Care Act impact children eligible in a separate or Medicaid expansion that are currently covered at income levels above 133 percent of the FPL?

No. States continue to have the option to cover children above 133 percent of the FPL either under a Medicaid expansion or separate program. States must maintain CHIP "eligibility standards, methodologies, and procedures" for children that are no more restrictive than those in effect on March 23, 2010 as specified under the "maintenance of effort" provision at 2105(d)(3) of the Act. A parallel requirement in Medicaid can be found at sections 1902(a)(74) and 1902(gg) of the Act. These provisions are effective through September 30, 2019.

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FAQ ID:92621

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Will states continue to receive the CHIP enhanced FMAP for children currently enrolled in a separate CHIP up to 133 percent of the FPL after the transition to coverage of these children under the Medicaid mandatory group for poverty-level related children?

Yes. The CHIP enhanced FMAP will continue to be available for children whose income is greater than the Medicaid applicable income level (defined in section 457.301 and based on the 1997 Medicaid income standard for children) after these children transition to Medicaid. This includes children who previously qualified for CHIP in a separate program and uninsured children whose family incomes are up to 133 percent of the Federal poverty level, and therefore will be eligible for Medicaid in 2014. Regular Medicaid matching rates will apply for all other children covered under the mandatory group for children aged 6-18-children with income no more than 100 percent FPL and insured children with income above 100 percent to 133 percent FPL.

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FAQ ID:92626

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Will a Medicaid and/or CHIP SPA be necessary for States that are transitioning children from a separate CHIP to the Medicaid state plan under the mandatory group for poverty-level related children under section 1902(a)(10)(A)(i)(VII) of the Act?

Yes. States that are transitioning children from a separate CHIP to the Medicaid state plan under the mandatory group for poverty-level related children under section 1902(a)(10)(A)(i)(VII) of the Act (which will be part of the newly consolidated mandatory group for children at 42 CFR 435.118), will need to submit both a Medicaid and CHIP SPA. The Medicaid SPA will need to be approved prior to, or simultaneously with, the CHIP SPA.

In addition, states that currently cover uninsured children aged 6-18 with income above 100 percent to 133 percent FPL under the Medicaid eligibility group for optional targeted lowincome children at section 1902(a)(10)(A)(ii)(XIV) of the Act (42 CFR 435.229) will need a Medicaid SPA to transition these children to the mandatory group for poverty-level related children under section 1902(a)(10)(A)(i)(VII) of the Act under the mandatory children's consolidated group at 42 CFR 435.118 and must expand their coverage to include insured children.

The SPA templates are available at http://www.medicaid.gov/State-Resource-Center/Medicaidand-CHIP-Program-Portal/Medicaid-and-CHIP-Program-Portal.html and CMS is available to provide technical assistance to states as they work through this transition.

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FAQ ID:92631

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