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.
Frequently Asked Questions
Yes. 1915 (c) waivers are optional programs that most States currently operate and can continue to operate. States interested in making changes to their 1915(c) waivers should contact their CMS Regional Office with specific questions.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Benefits and Delivery Systems
FAQ ID: 93056
Yes. 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), regardless of whether those children are enrolled in Medicaid or CHIP. This includes children who previously qualified for CHIP in a separate program and children whose family incomes are up to 133 percent of the Federal poverty level, and therefore will be newly eligible for Medicaid in 2014.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Children's Coverage
FAQ ID: 93061
Yes. Section 2101(f) of the Affordable Care Act provides that States maintain coverage under a separate CHIP program for children who lose Medicaid eligibility due to the elimination of income disregards as a result of the conversion to MAGI. We anticipate that this provision will directly impact a relatively small number of children, and are committed to helping States implement this provision in a manner that is not unduly burdensome or costly and still protects the continuity of coverage for these children as required by statute.
For States with only Medicaid Expansion CHIPs, one approach is to create a separate CHIP that is substantively identical to the existing program, thereby creating the greatest continuity of coverage for the child, the least confusion for the family, and the most efficient operation for the state. For States with existing separate CHIPs, a State plan amendment assuring that these children will be covered through that program for as long as they qualify should be sufficient.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Children's Coverage
FAQ ID: 93066
The process for making a MAGI-based eligibility determination is largely the same for all insurance affordability programs. The Affordable Care Act requires a single, streamlined application, accompanied by a similar set of business rules and verification processes, and an adjudication work flow that is largely identical between Exchanges, Medicaid and CHIP programs.
It is expected that State agencies that receive Federal funds from CMS to establish State-based Exchanges and provide for Medicaid and CHIP expansions coordinate efforts to produce a shared eligibility service or system that relies on a shared IT infrastructure and as such, cost allocate this service.
A shared eligibility service is not the same as one system. We define an eligibility service as a set of IT functions that produce an eligibility determination based upon MAGI. The service incorporates an application, a set of verifications (for citizenship, income, residency, etc.) and business rules that together determine how much financial assistance a consumer should receive to acquire affordable health insurance.
While policies codified in final regulations allow legal authority for eligibility determinations to remain with state Medicaid agencies (for Medicaid) and Exchanges (for premium tax credits and cost-sharing reductions), the underlying business rules and processes are nearly identical, and should, to the maximum extent practical, rely upon a shared IT service(s) and infrastructure.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Coordination with the Federally Facilitated Marketplace
FAQ ID: 93071
The agreement between Medicaid/CHIP agencies and Exchanges regarding coordination must be available to the Secretary upon request and will be subject to applicable disclosure laws, such as the Freedom of Information Act.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Coordination with the Federally Facilitated Marketplace
FAQ ID: 93076
States can work with the Federally-Facilitated Exchange (FFE) regarding Medicaid and CHIP eligibility determinations in one of two ways. The State may either establish an agreement whereby the FFE assesses applicants for Medicaid/CHIP eligibility based on MAGI and then transfers the applicants' electronic accounts to the State Medicaid or CHIP agency to complete the eligibility determination. Or the State may elect to accept MAGI-based eligibility determinations completed by the FFE as final determinations. Regardless of the approach, the process should be as seamless as possible for the applicant with most eligibility determinations completed in near real-time as specified in our eligibility final rule at 435.912.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Coordination with the Federally Facilitated Marketplace
FAQ ID: 93081
The Exchange will utilize the State's Medicaid and CHIP eligibility rules for conducting both eligibility determinations and eligibility assessments. This will include application of the State's MAGI income standards and related eligibility rules for the MAGI population. The Exchange will also rely on a robust verification protocol that is consistent with Medicaid and CHIP regulations but which might not be the same protocol the State is otherwise using.
If a State accepts assessments of eligibility from the Federally-Facilitated Exchange (FFE) and chooses to make the final eligibility determinations itself, once an individual has been assessed as Medicaid/CHIP eligible, their electronic account would be transferred to the State Medicaid or CHIP agency, which will complete the eligibility determination. This process will include any additional verification required by the State that is consistent with the Federal verification regulations.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Coordination with the Federally Facilitated Marketplace
FAQ ID: 93086
If the Marketplace is a government entity, States will have the option to enable their State-based Exchange to make Medicaid eligibility determinations for non-MAGI eligibility groups. Depending on the arrangements made in each State, such an Exchange can make all Medicaid eligibility determinations, only eligibility determinations based on MAGI, or assessments of eligibility based on MAGI. The FFE will not be making Medicaid eligibility determinations for non-MAGI groups; the FFE will either do final determinations or assessments for the MAGI eligibility groups.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Coordination with the Federally Facilitated Marketplace
FAQ ID: 93091
Yes. CMS is working with States to develop a model agreement, and it is one of the tools that the Coverage Expansion Learning Collaborative will be considering.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Coordination with the Federally Facilitated Marketplace
FAQ ID: 93096
The final rule specifies that Medicaid and CHIP agencies will establish their verification policies and procedures in a verification plan. This plan is not a required element of the Medicaid State plan but States suggested, and CMS agrees, that it will be helpful to have the each State's eligibility verification process established in a written plan. The verification plans will serve many purposes, including ensuring PERM reviews are mindful of the State's verification policies and also for promoting coordination with the Exchange. States' verification plans will be public and available upon request, but we are not establishing a Federal approval process. State verification policies must of course always be consistent with applicable Federal at section 435.940 - 435.956 of the eligibility final rule.
The verification plans will include information about the data sources the State will use to verify applicant information, define reasonable compatibility standards, and determine when self attestation will be accepted. CMS will provide a verification plan template for States to use.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Eligibility Policy
FAQ ID: 93176