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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

Is the 100% federal matching rate (FMAP) available for individuals who are newly eligible under the former foster care group?

No. Under the law, the state's regular federal matching rate applies for individuals eligible under the former foster care group.

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FAQ ID:91851

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How did the Affordable Care Act (ACA) revise funding for the Children's Health Insurance Program (CHIP) under title XXI of the Social Security Act?

Section 2101(a) of the Affordable Care Act amended section 2104(a) of the Social Security Act to extend title XXI funding for states' CHIP fiscal year allotments through September 30, 2015, the end of federal fiscal year (FY) 2015. The new law also amended section 2105(b) of the Social Security Act to increase the enhanced Federal Medical Assistance Percentage (Enhanced FMAP) rate by 23 percent applicable for certain expenditures for the period FY 2016 through FY 2019, but in no case will the enhanced FMAP exceed 100 percent. In the absence of additional legislation, the FY 2015 allotments would continue to be available through September 30, 2016. The Secretary also has the authority to redistribute prior unexpended allotments to states experiencing shortfalls.

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FAQ ID:91861

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Will states have an opportunity to expand CHIP eligibility coverage levels above 200 percent of the Federal Poverty Level (FPL) not to exceed 300 percent of the FPL using block disregards before December 31, 2013, the date for which Modified Adjusted Gross Income (MAGI) applies?

Yes. States have a limited opportunity to expand CHIP eligibility without a section 1115 demonstration (through the use of a block of income disregard) that will then get incorporated into a MAGI converted eligibility level. Any state interested in expanding CHIP eligibility above 200 percent of the FPL must submit a state plan amendment (SPA) before Dec. 31, 2013. After such time, states could expand eligibility through a demonstration. (Of course, if a state has not already expanded eligibility to 50 percent points above the MAGI-converted Medicaid income level that was in effect in 1997, that option for expansion without demonstration authority will remain available after Dec. 31, 2013.)

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FAQ ID:91866

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Will the expenditures for children currently enrolled in a separate CHIP whose income is up to 133 percent of the FPL, who are transitioned to the Medicaid program beginning January 1, 2014 under the mandatory eligibility group for poverty-level related children required under section 1902(a)(10)(A)(i)(VII) of the Act, be eligible for the CHIP enhanced FMAP after such transition?

Yes. The CHIP enhanced FMAP will continue to be available for the expenditures for children shifted from CHIP to Medicaid, as long as their income is greater than the state's March 31, 1997 Medicaid income standard for children. In other words, if CHIP funding was available for this group of children when they were covered in a separate CHIP, it will continue to be available when the children are covered under Medicaid. The CHIP enhanced FMAP is available for uninsured children whose income exceeds that income standard, whether the children previously qualified for or were enrolled in a separate CHIP program or not.

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FAQ ID:91871

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Are states required to cover new applicants who have insurance under the mandatory coverage level for children ages 6-18 in Medicaid up to 133 percent FPL?

Yes, consistent with Medicaid coverage rules. States must cover children ages 6-18 in the new mandatory Medicaid group and Medicaid is the secondary payer to other insurance. All children must be covered without regard to their insurance status but title XIX funds must be used to cover such children who have creditable health insurance.

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FAQ ID:91876

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Will states be eligible to receive the enhanced CHIP FMAP for children who were previously eligible for CHIP but will now be enrolled in Medicaid as a result of the 5 percent disregard (applied to the Medicaid upper income threshold for children)?

Yes. As with children who move from a separate CHIP to Medicaid because of the change in Medicaid eligibility to 133 percent FPL, children moving from CHIP to Medicaid because of the application of the 5 percent disregard may also be funded through title XXI.

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FAQ ID:91881

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Will states be eligible to receive the enhanced CHIP FMAP for children who lose Medicaid eligibility due to the elimination of income disregards as a result of the conversion to MAGI under 2101(f)?

Yes. As stated in the Frequently Asked Questions pertaining to this provision posted on April 25, 2013, states may claim the enhanced match available under title XXI for children who lose Medicaid eligibility due to the elimination of income disregards as a result of the conversion to MAGI. These children now meet the definition of a targeted low-income child and will be enrolled in a separate CHIP in accordance with section 2101(f) of the ACA. If states choose the option to maintain Medicaid eligibility for such children title XIX funds and regular FMAP must be used to provide coverage.

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FAQ ID:91886

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Are states allowed to claim enhanced FMAP for enrollees whose family income is above 300 percent of the FPL?

Generally, no. Section 2105(c) (8) of the Social Security Act limits enhanced FMAP to the expenditures associated with children whose effective family income is at or below 300 percent FPL. Expenditures for children whose effective family income exceeds 300 percent of the FPL are matched at the regular Medicaid FMAP rate rather than the enhanced FMAP. However, the enhanced matching rate continues to be available for expenditures on populations whose income exceeds 300% FPL in states in which the income standard exceeds 300 percent as a result of MAGI conversion, as well as for states with approved income limits for CHIP above 300% of the FPL prior to the passage of the Children's Health Insurance Program Reauthorization Act (CHIPRA).

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FAQ ID:91891

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Will states be allowed to continue to cover parents and receive the enhanced CHIP FMAP for those expenditures?

States are no longer allowed to cover parents in CHIP after Sept. 30, 2013 and therefore, are no longer eligible to receive the enhanced CHIP FMAP for expenditures for parents.

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FAQ ID:91896

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What happens if there is a conflict between information in the flat file and information about the same individual that is already in the state's systems?

As applicant information is entered into state systems, there will be some applicants that will be known to the system, such as people who previously applied to or enrolled in Medicaid, family members of current beneficiaries, and possibly beneficiaries of other human services programs. If, based on this information known to the system, the state finds information that indicates the individual is unlikely to be eligible for Medicaid under MAGI rules, then the state may treat such information as an inconsistency. Just as states are not enrolling applicants on the flat file who have an inconsistency in their income or residency information based on FFM verification without further evaluation, states may also not enroll applicants based on the flat-file data for whom there are discrepancies based on state system information. We will work with states that would like to pursue other options for dealing with information found in state systems when entering individuals from the flat file.

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FAQ ID:91911

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