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. A State is not required to select the same EHB benchmark reference plan for Medicaid section 1937 plans that it selects for the individual and small group market, and it could have more than one EHB benchmark reference plan for Medicaid (for example, if the State were to develop more than one benefit plan under section 1937).
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Benefits and Delivery Systems
FAQ ID: 93041
Yes. A State could propose its traditional Medicaid benefit package as a section 1937 alternate benefit plan under the Secretary-approved option available under section 1937 of the Social Security Act. The State would have to ensure that the ten statutory categories of EHB are covered, either through that benefit plan or as a supplement to that plan.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Benefits and Delivery Systems
FAQ ID: 93046
The managed care regulations apply to all benefits delivered through a managed care delivery system, regardless of the authority under which the benefits are provided or enrollment is required. Thus, any State which uses a managed care organization to deliver benefits under the authority of section 1937 of the Act must comply with the managed care regulations at 42 CFR 438.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Benefits and Delivery Systems
FAQ ID: 93051
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
No. Under section 438.356 of the Final Rule, states can contract with one or more EQROs to conduct EQR activities and other related tasks (such as production of the EQR report).
Supplemental Links:
Date: No FAQ Date
Subtopics:
Final Rule
FAQ ID: 94661
Verification services that are conducted as part of the eligibility determination process or to validate a client's attestation, after an eligibility record has been entered into the system, will be eligible for 75 percent FFP.
Those verifications performed post eligibility and normally initiated as part of a sampling approach, including audits, PERM or MEQC activities would be considered program integrity activity and eligible for the 50 percent FFP.
Supplemental Links:
Date: No FAQ Date
Topics:
Affordable Care Act
Subtopics:
Enhanced Funding for Eligibility and Enrollment Systems
FAQ ID: 93716
Use our dentist locator to find a dentist that accepts Medicaid.
Date: No FAQ Date
Topics:
Medicaid & You
FAQ ID: 94526
The ASD-related services for EPSDT eligible individuals (under age 21) must be provided under the Medicaid state plan and not under the 1915(c) waiver. When the state submits the home and community-based services waiver for renewal or amendment, the state should include a restriction under the "limits" section for that specific service indicating that EPSDT-aged individuals are excluded as the services are fully covered in the state plan. ASD-related services for individuals over age 21 may continue to be provided under the 1915(c) waiver.
Supplemental Links:
Date: No FAQ Date
Topics:
Benefits
Subtopics:
Autism
FAQ ID: 93411
Alignment with the state's system development life cycle happens during the Project Initiation phase, specifically during Activity 1: Consult with CMS. The state should incorporate CMS milestone reviews into the state's project schedule. The flexibility is in scheduling, not whether milestone reviews are performed. Decisions made between the state and CMS are documented in the Project Partnership Understanding document and can be updated as needed throughout the life cycle.
Date: December 12, 0017
Topics:
Eligibility and Enrollment Systems
Subtopics:
MMIS
FAQ ID: 95051
At a minimum, quarterly. Depending on the risk of project activity, the state and CMS may agree that more frequent reporting is appropriate. Any frequency greater than quarterly should be captured in the Project Partnership Understanding document.
Date: December 12, 0017
Topics:
Eligibility and Enrollment Systems
Subtopics:
MMIS
FAQ ID: 95071