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
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:
Date: November 18, 2012
Topics:
Affordable Care Act
Subtopics:
Enhanced Funding for Eligibility and Enrollment Systems
FAQ ID: 93246
The FFE's role is the same whether or not a state implements the Medicaid expansion for low-income adults. The FFE will still make MAGI-based determinations or assessments of eligibility for Medicaid and CHIP and will assess eligibility for premium tax credits and cost sharing. The FFE will apply the state's eligibility levels for Medicaid/CHIP when it makes the Medicaid determination or assessment. In addition, as established in the Exchange and Medicaid/CHIP eligibility final rules, the FFE will electronically transfer accounts for individuals who are either determined or assessed as eligible for Medicaid and CHIP (it is a state option whether to have the FFE determine or assess eligibility) for further evaluation/action.
Supplemental Links:
Date: November 18, 2012
Topics:
Affordable Care Act
Subtopics:
Enhanced Funding for Eligibility and Enrollment Systems
FAQ ID: 93256
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:
Date: November 18, 2012
Topics:
Affordable Care Act
Subtopics:
Enhanced Funding for Eligibility and Enrollment Systems
FAQ ID: 93261
The Federal data services hub will provide the following services on Day 1. CMS is also pursuing data sources for additional verifications through the Federal data services hub and will keep states updated as they are confirmed:
- Social Security Number (SSN) verification via the Social Security Administration (SSA)
- Citizenship verification via SSA or the Department of Homeland Security (DHS) when relevant
- Incarceration verification via SSA
- Title II benefit income information via SSA (monthly and annual amounts)
- Quarters of coverage information via SSA
- MAGI income information from the Internal Revenue Service (IRS)
- Max APTC from IRS
- Immigration status verification via DHS, as well as a translation to indicators for lawful presence, qualified non-citizen, and five year bar status.
- Public minimum essential coverage (MEC) verification from Federal agencies
Supplemental Links:
Date: November 18, 2012
Topics:
Affordable Care Act
Subtopics:
Enhanced Funding for Eligibility and Enrollment Systems
FAQ ID: 93266
No. We will not charge state-based exchanges (SBEs) or Medicaid/CHIP agencies for the Federal data hub services or underlying data.
Supplemental Links:
Date: November 18, 2012
Topics:
Affordable Care Act
Subtopics:
Enhanced Funding for Eligibility and Enrollment Systems
FAQ ID: 93271
Some services will be composite, and others atomic. For instance, it will be possible to invoke individual SSA services in a single composite service, although not all services in the composite will always need to be invoked. If the Exchange is seeking Title II income information for a member of a household who is not the applicant, then the citizenship and incarceration services would not be invoked. In contract, public MEC verification services will be separate, atomic services.
Supplemental Links:
Date: November 18, 2012
Topics:
Affordable Care Act
Subtopics:
Enhanced Funding for Eligibility and Enrollment Systems
FAQ ID: 93276
All transactional requests to the Federal data services hub shall be performed via web services. These services shall be invoked by State IT systems via application programming interfaces (API) or Web APIs that are accessed via secure Hypertext Transfer Protocol (HTTP) and shall be executed on the system hosting the requested services. The CMS web services shall accept request from trusted sources, perform the function based on the request, and return a response to the State system. CMS shall publish these web services in the CMS Service Catalog, which shall contain all services available to the states and the definitions of the standards that must be met to request the service and standard data format for the data provided when making the request and the data that shall be returned.
CMS is still determining the best mechanism for how batch and bulk data transactions will be designed and implemented. At this stage, CMS believes that there shall be a need to establish both web services and possibly alternate interfaces to meet batch and bulk data transaction requirements.
Supplemental Links:
Date: November 18, 2012
Topics:
Affordable Care Act
Subtopics:
Enhanced Funding for Eligibility and Enrollment Systems
FAQ ID: 93281
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:
Date: November 18, 2012
Topics:
Affordable Care Act
Subtopics:
Enhanced Funding for Eligibility and Enrollment Systems
FAQ ID: 93291
The Federal agencies involved in data verifications are currently involved in discussions of the overall approach to oversight and audits of safeguards. Certain agencies are expected to conduct their own independent audits.
Supplemental Links:
Date: November 18, 2012
Topics:
Affordable Care Act
Subtopics:
Enhanced Funding for Eligibility and Enrollment Systems
FAQ ID: 93296
The Federal data services hub is utilizing the same Department of Homeland Security (DHS) SAVE verification service currently available to states. States will receive both the verification data received from SAVE as well as the Federal data services hub-derived indicators of lawful presence, qualified non-citizen status, and whether the five year bar has been met where applicable.
Supplemental Links:
Date: November 18, 2012
Topics:
Affordable Care Act
Subtopics:
Enhanced Funding for Eligibility and Enrollment Systems
FAQ ID: 93301