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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.

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Based on CMS guidance, states may take up to 18 months to bring an IV&V contractor on board to perform certification tasks or align current IV&V contract to comply with CMS guidance pertaining to scope of services and financial independence. What must the state do if the IV&V contractor's start up is delayed?

IV&V contractor activities must still be performed such as checklist evaluation, artifact review and preparation of IV&V Progress Reports. The state should provide a plan and timeline for how these activities will be supported and performed until the proper IV&V contract can be either procured or aligned with updated CMS guidance on IV&V.

FAQ ID:94866

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Is IV&V required during operations and maintenance (O&M) for MMIS?

As contained in the MECT standard RFP/contract language required by CMS, CMS does not cover activities that the state may require of the IV&V contractor during ongoing O&M. However, as Medicaid is moving away from monolithic single applications, it is expected that states will continuously update and replace modules in their enterprise. Therefore, IV&V should always have a role to ensure successful integration and testing.

FAQ ID:94881

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What would preclude a company from being eligible to bid on the MMIS or E&E IV&V contract(s)?

If an organization is performing another role (such as systems integrator, PMO, quality assurance, etc.) on the MMIS or E&E project, it may not perform the IV&V function on the same project. A state may contract the same vendor to perform the IV&V role for both its E&E and MMIS projects.

FAQ ID:94886

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Why does the IV&V contractor need to sit outside the Medicaid agency?

To reduce potential conflict of interest, CMS is ensuring that states are arranging IV&V services through contracts that should be owned outside of the agency that owns the MMIS or E&E project. The oversight organization for the IV&V contractor should not be involved in oversight of the development effort, a stakeholder in the business implementation, or the DDI contractor. The IV&V contract monitor should be aware of system development problem solving, reporting, and contractor management. This contract oversight provides true independence between the IV&V contractor and system development teams. This requirement is consistent with other HHS agencies' practices and industry best practices.

FAQ ID:94891

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How does section 2001(a)(5)(B) of the Affordable Care Act impact states currently covering children 6-18 up to 133 percent of the FPL under a separate CHIP?

Section 2001(a)(5)(B) of the Affordable Care Act (implemented through regulations for the Medicaid program at section 435.118) increased the minimum income limit applicable to Medicaid eligibility for the mandatory group for poverty-level related children aged 6-18 from 100 to 133 percent of the FPL under section 1902(a)(10)(A)(i)(VII) of the Act. Therefore, if a state is currently covering uninsured children up to 133 percent of the FPL under a separate CHIP, these children must be transitioned to the Medicaid state plan under this children's group effective January 1, 2014. CMS is available to work with states individually on their transition plans for this population.

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FAQ ID:92606

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Are these children who are being transferred from CHIP to the Medicaid state plan considered optional targeted low-income children under section 1902(a)(10)(A)(ii)(XIV) of the Act?

No. For the purposes of eligibility, these children are considered a mandatory Medicaid group for poverty-level related children under section 1902(a)(10)(A)(i)(VII) of the Act. As described below, states will continue to receive the CHIP matching rate for this population.

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FAQ ID:92611

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Will new applicants/children ages 6-18 with incomes between 100 and 133 percent of the FPL with other health insurance qualify for coverage under the Medicaid state plan?

Yes. Under the Medicaid mandatory group for poverty-level related children under section 1902(a)(10)(A)(i)(VII) of the Act, insured children must be covered in addition to uninsured children (please also see applicable match rate questions below). This is different from the rules governing a separate CHIP program, which preclude coverage for insured children.

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FAQ ID:92616

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Does 2001(a)(5)(B) of the Affordable Care Act impact children eligible in a separate or Medicaid expansion that are currently covered at income levels above 133 percent of the FPL?

No. States continue to have the option to cover children above 133 percent of the FPL either under a Medicaid expansion or separate program. States must maintain CHIP "eligibility standards, methodologies, and procedures" for children that are no more restrictive than those in effect on March 23, 2010 as specified under the "maintenance of effort" provision at 2105(d)(3) of the Act. A parallel requirement in Medicaid can be found at sections 1902(a)(74) and 1902(gg) of the Act. These provisions are effective through September 30, 2019.

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FAQ ID:92621

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Will states continue to receive the CHIP enhanced FMAP for children currently enrolled in a separate CHIP up to 133 percent of the FPL after the transition to coverage of these children under the Medicaid mandatory group for poverty-level related children?

Yes. The 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) after these children transition to Medicaid. This includes children who previously qualified for CHIP in a separate program and uninsured children whose family incomes are up to 133 percent of the Federal poverty level, and therefore will be eligible for Medicaid in 2014. Regular Medicaid matching rates will apply for all other children covered under the mandatory group for children aged 6-18-children with income no more than 100 percent FPL and insured children with income above 100 percent to 133 percent FPL.

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FAQ ID:92626

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Will a Medicaid and/or CHIP SPA be necessary for States that are transitioning children from a separate CHIP to the Medicaid state plan under the mandatory group for poverty-level related children under section 1902(a)(10)(A)(i)(VII) of the Act?

Yes. States that are transitioning children from a separate CHIP to the Medicaid state plan under the mandatory group for poverty-level related children under section 1902(a)(10)(A)(i)(VII) of the Act (which will be part of the newly consolidated mandatory group for children at 42 CFR 435.118), will need to submit both a Medicaid and CHIP SPA. The Medicaid SPA will need to be approved prior to, or simultaneously with, the CHIP SPA.

In addition, states that currently cover uninsured children aged 6-18 with income above 100 percent to 133 percent FPL under the Medicaid eligibility group for optional targeted lowincome children at section 1902(a)(10)(A)(ii)(XIV) of the Act (42 CFR 435.229) will need a Medicaid SPA to transition these children to the mandatory group for poverty-level related children under section 1902(a)(10)(A)(i)(VII) of the Act under the mandatory children's consolidated group at 42 CFR 435.118 and must expand their coverage to include insured children.

The SPA templates are available at http://www.medicaid.gov/State-Resource-Center/Medicaidand-CHIP-Program-Portal/Medicaid-and-CHIP-Program-Portal.html and CMS is available to provide technical assistance to states as they work through this transition.

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FAQ ID:92631

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