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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 41 results

Our Inpatient Hospital Upper Payment Limit (UPL) demonstration is too large to send in one workbook, can we submit our demonstration to CMS in multiple workbooks? Alternatively, may states submit separate workbooks for each ownership category?

Yes, a state should submit multiple workbooks to CMS to provide a complete UPL demonstration for each service category subject to the UPL (Inpatient Hospital services (IPH), Outpatient Hospital services (OPH), Nursing Facility services (NF), Clinic, Institutions for Mental Disease (IMD), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Psychiatric Residential Treatment Facility (PRTF), and Qualified Practitioner supplemental payments). When submitting UPL demonstrations, the state should use the following naming convention: UPL_<UPL Demo Date Range>_<Service Type Abbreviation>_R<Region Number>_<State Abbreviation>_<Workbook Number>.xls. Here is an example of the naming convention: UPL_20170701-20180630_IP_R01_CT_01.xls.As well, states may submit one separate workbook for each ownership category (state government owned, non-state government owned, and private).

FAQ ID:92241

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Can a contractor that acts on behalf of the Medicaid agency submit the Upper Payment Limit (UPL) demonstrations to CMS?

No, the information must be submitted by the State Medicaid Director (or designated state official).

FAQ ID:92246

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Are states required to submit their Upper Payment Limit (UPL) demonstrations directly to the mailbox or should they continue to submit them to the CMS Regional Office?

States are requested to submit their UPL demonstrations to the UPL mailbox at MedicaidUPL@cms.hhs.gov, but should also send a copy of each demonstration to their CMS Regional Office, including the National Institutional Reimbursement Team (NIRT) and Non-Institutional Payment Team (NIPT) staff as appropriate, and addressed to the Associate Regional Administrator. UPL demonstrations should be submitted to meet the annual reporting requirement described in SMDL 13-003, as well as when proposing changes in payment through SPAs.

FAQ ID:92251

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Now that Upper Payment Limit (UPL) demonstrations are submitted to a central e-mailbox, will the CMS Regional Office still have a role in reviewing UPL demonstrations or will the review be performed by the Central Office?

The Regional Office will continue to review state UPL demonstrations and states will continue to work with the CMS Regional Offices as a first point of contact concerning their UPL demonstrations.

FAQ ID:92256

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Does Medicaid cover pregnancies, mental health, dental, nursing home, or long term care?

States are required to cover certain benefits and others are optional. To learn what your state covers, contact your state Medicaid agency. To learn more about the Federal rules around mandatory and optional services, visit the benefits page.

FAQ ID:95101

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My state has been affected by a natural disaster and/or a public health emergency has been declared. I am on Medicaid and my children are on CHIP. I have a question about our coverage. Who should I call?

Contact your state Medicaid agency. They can help answer your coverage questions and what to do when you have an access problem due to the declared emergency.

FAQ ID:95046

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I have a question about my Medicaid account. What is your phone number?

Contact your state Medicaid agency. They can help you get replacement cards and answer your questions about what services are covered, providers to use, and how to renew your eligibility.

FAQ ID:94571

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How do I apply for (or renew) Medicaid or CHIP?

Your state will determine if you qualify for Medicaid. Contact your state for renewal or application information.

FAQ ID:93381

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Who can tell me if I am eligible for Medicaid?

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Since Medicaid is administered by the Medicaid agency in your state, eligibility may vary from one state to another. Contact your state Medicaid Agency with questions, or see if you qualify by applying. CMS is the federal agency that works with state Medicaid agencies to make sure they comply with federal laws and regulations.

FAQ ID:94506

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I want to apply for Medicaid or get coverage for my child. Who do I contact?

Your state will determine if you qualify for Medicaid. Contact your state for renewal or application information.

FAQ ID:94516

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