U.S. flag

An official website of the United States government

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.

FAQ Library

Showing 41 to 50 of 768 results

Do Eligibility & Enrollment projects need to have Independent Validation and Verification (IV&V)?

An assessment for IV&V analysis of a state's E&E system development effort will be required for APD projects that meet any of the criteria contained in federal regulations at 45 CFR 95.626(a). If CMS determines that the IV&V analysis is required for a state's system development effort, the provisions contained in federal regulations at 45 CFR 95.626(b) and (c) apply. Additional guidance is available in the Medicaid E&E Toolkit, available at https://www.medicaid.gov/medicaid/data-and-systems/meet/index.html.

Supplemental Links:

FAQ ID:93351

How do I learn which data elements and definitions will be available for each Federal data hub service?

Information about the known data elements, definitions for the Federal data hub services are contained in Business Services Description (BSD) documents. The best way to access the BSDs and to avoid version control problems, is to request access to the CMS Service Catalog. States may do so by contacting dsh.support@qssinc.com and requesting the CMS Services Catalog User Intake Form. Please note that as the information published on the repository is quite technical in nature, state users should ideally have a technical background.

Supplemental Links:

FAQ ID:93291

How should States report expenditures in the CMS-64 for approved enhanced funding for Eligibility & Enrollment Advanced Planning Documents?

Medicaid Budget Expenditure System/Children's Budget Expenditure System (MBES/CBES) has been modified to add new Medicaid Eligibility Determination System lines to the 64.10 Form series beginning with Quarter Ending March 31, 2011:

  • 28A - DDI of Medicaid E&E systems/cost of in house activities - 90% FFP
  • 28B - DDI of Medicaid E&E systems cost of private sector contractors - 90% FFP
  • 28C - Operation of an approved Medicaid E&E system/cost of in-house activities - 75 % FFP
  • 28D - Operation of an approved Medicaid E&E system/cost private sector contractors- 75% FFP

FAQ ID:93361

How will the Supreme Court Decision affect CMS's ability to ensure other aspects of the law such as those affecting interactions with the Federally-facilitated Exchange? For example, if a state does not want to exchange electronic accounts with the FFE, what will be required and what, if any, penalties could be imposed?

As previously stated in a letter from the Secretary to the nation's governors, the Supreme Court held that a state may not lose federal funding for its existing Medicaid program if the state chooses not to participate in the expansion of Medicaid eligibility for low-income adults. The Court's decision did not affect other provisions of the law. State Medicaid and CHIP programs will need to coordinate with the Federally-facilitated Exchange, regardless of a state's decision to proceed with expansion. States will need to be part of the seamless system for people to apply for all coverage programs; and will need to coordinate eligibility with the new insurance affordability programs. These provisions have relevance regardless of whether a state chooses to participate in the expansion for low-income adults.

Supplemental Links:

FAQ ID:93246

How would a state's decision not to expand their Medicaid program's eligibility affect their ability to get information from the federal HUB under a state-based exchange model?

The federal hub will provide data verification services to any state-based exchange and to the Medicaid and CHIP program without regard to whether a state has adopted the low-income adult expansion. Consistent with the regulations issued on March 23, 2012, state Medicaid and CHIP programs must rely on the HUB for certain information; this provision applies without regard to whether a state has adopted the Medicaid expansion for low-income adults.

Supplemental Links:

FAQ ID:93261

What are the Standards and Conditions for Medicaid IT that are required for purposes of receiving the enhanced Medicaid funding?

The twenty-two standards and conditions are listed in the Medicaid Program; Mechanized Claims Processing and Information Retrieval Systems (90/10) rule issued on 12/4/2015. See https://www.federalregister.gov/documents/2015/12/04/2015-30591/medicaid-program-mechanized-claims-processing-and-information-retrieval-systems-9010.

Supplemental Links:

FAQ ID:93331

What cost allocation requirements apply to E&E projects and how can States use the temporary exception to OMB-A-87?

The requirements of Circular OMB-A-87 apply to the allocation of costs for design, development, and implementation (DDI) and maintenance and operations (M&O) of eligibility and enrollment (E&E) systems including the respective benefiting health insurance affordability programs: Medicaid, CHIP (for states that have separate Title XXI programs or for portions of separate CHIP programs in states that operate a combination CHIP/Medicaid program) and to CCIIO Grant Funding if the project will include functionality for Health Insurance Exchanges.

States can request the temporary exception to Circular OMB-A-87 requirements to use Medicaid enhanced funding for DDI costs of shared eligibility services that will benefit other human service programs (SNAP, TANF, childcare, and child welfare). The exception does not apply to M&O costs, and therefore states must cost allocate to benefiting programs for these costs. For more information, please see the State Medicaid Director Letter, dated July 20, 2015, at https://www.medicaid.gov/federal-policy-guidance/downloads/smd072015.pdf (PDF, 80.07 KB).

Supplemental Links:

FAQ ID:93341

What information is available for States to reuse and where can it be accessed?

In zONE, states can find business process models, templates for concepts of operations, and other planning and development artifacts, business and technical requirements, Requests for Proposals (RFPs), Statements of Work (SOWs), system design documents, etc. CMS Eligibility & Enrollment (E&E) state leads are available to discuss and assist states in finding the right artifacts in the zONE collaboration spaces. Your SOTA team and your E&E state lead are available to answer specific questions about what might be available soon that is not already in the CALT.

Supplemental Links:

FAQ ID:93346

What is the effective date for enhanced Medicaid funding and for how long is it available?

Enhanced Medicaid funding for Eligibility & Enrollment (E&E) activities is available from the approval of an Advanced Planning Document (APD). An ongoing Medicaid administrative match at the 50% rate is available for activities that take place prior to an approved E&E APD, as long as the activities fall within the purview of administering the Medicaid program (42 CFR 433.15). Funding is available ongoing, subject to APD approvals. More information is available in the State Medicaid Director Letter on Enhanced Funding dated March 31, 2016 (SMD# 16-004), to be found at https://www.medicaid.gov/federal-policy-guidance/federal-policy-guidance.html.

Supplemental Links:

FAQ ID:93321

What technical guidance and deliverables can CMS offer to states that are modernizing their eligibility and enrollment (E&E) systems?

CMS has developed the Medicaid Eligibility and Enrollment Toolkit (MEET) to provide guidance for states that are conducting E&E systems projects. The MEET is available at https://www.medicaid.gov/medicaid/data-and-systems/meet/index.html.

Also, various artifacts developed by states are posted in a shared environment for reuse by others. These artifacts can be used to help jump-start projects. More information on reuse, including access to the reuse repository, is available at https://www.medicaid.gov/medicaid/data-and-systems/reuse/index.html.

Supplemental Links:

FAQ ID:93226

Results per page