Frequently Asked Questions

Consistent with the guidance provided above with respect to demonstrations available under the regular and the enhanced matching rates, CMS will work with states on their proposals and review them consistent with the statutory standard of furthering the interests of the program.

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• This FAQ was released as part of a larger set. View the full set. (PDF, 359.41 KB)

FAQ ID:94616

The section 1115 waiver authority continues and whether a particular waiver continues will vary by State. CMS has been working with States individually to determine the appropriate waivers and expenditure authorities that will be extended beyond December 31, 2013. For example, States that have utilized demonstrations to expand eligibility to the childless adult population will no longer need the expenditure authority because this population will become a mandatory State plan population under the Affordable Care Act's Medicaid eligibility expansion. On the other hand, States that have utilized demonstrations to undertake delivery system reforms may still require waivers and/or expenditure authorities to execute those reforms beyond December 31, 2013.

CMS will work with States to develop and submit the transition plans that are required by the Special Terms and Conditions of each demonstration. These transition plans will serve as a vehicle for discussion of the various options that States will have in 2014 and beyond, including for populations with incomes above 133 percent of the Federal poverty level (FPL). CMS will engage with States during State Operations and Technical Assistance (SOTA) calls to work through State-specific transition issues.

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FAQ ID:93016

The SOTA calls cannot replace the submission of a transition plan, as the plan is a required deliverable under the State's Special Terms and Conditions. However, we expect to use the SOTA calls as a platform for transition planning discussions. We are also available for additional calls with States as needed. We can accept as the State's required early deliverable, a summary of the issues that the State needs to address in the transition plan, given the specific features of its waiver and plans for 2014. We will work with States in subsequent months to fully develop the transition plan to ensure it is in place in time for 2014.

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FAQ ID:93026

Yes. CMS will continue to consider section 1115 demonstration extension requests. However, the State's proposal must include a plan to address changes in its demonstration that would need to take place to ensure readiness for 2014. Please also note that extension requests are subject to the recently issued transparency final rule (http://www.gpo.gov/fdsys/pkg/FR- 2012-02-27/html/2012-4354.htm )and corresponding State Health Officials letter (http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SHO-12-001.pdf (PDF, 136.08 KB) (PDF 0 bytes)), which outlines the new public notice comment and process requirements.

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• This FAQ was released as part of a larger set. View the full set. (PDF, 55.99 KB)

FAQ ID:93031

The Medicaid eligibility final rule at 435.110, 435.116 and 435.118 set forth the mechanism for consolidating certain federal eligibility categories into four main groupings: adults, children, pregnant women and parents/caretaker relatives. The table provided below lays out the consolidation of mandatory and optional eligibility groups (a version of this table was also included as part of the preamble to the proposed rule).

Realignment of Medicaid Eligibility Groups

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FAQ ID:93131

States are not required to track the pregnant status of women enrolled through the new adult group. Women who enroll in the adult group who later become pregnant will have the option of either staying enrolled in the adult group, or requesting that the State move them to a pregnancy-related eligibility group. This is most likely to occur if women need specific benefits that are not available under the adult group benchmark benefit package.

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FAQ ID:93136

If a woman indicates on the application that she is pregnant, she should be enrolled in Medicaid coverage as a pregnant woman. The Affordable Care Act specifies that pregnant women are not eligible for the new adult group. As mentioned above, if a woman enrolled in the adult group later becomes pregnant, she will have the option to stay enrolled in the adult group or request that the State move her to a pregnancy-related eligibility group.

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FAQ ID:93141

Yes, the breast and cervical cancer group and the eligibility group for working disabled individuals will remain optional eligibility groups which States may elect. The Affordable Care Act did not alter the financial or non-financial requirements or methodologies used to determine eligibility for these groups, both of which are exempt from the application of Modified Adjusted Gross Income (MAGI) methodology for determining income.

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FAQ ID:93151

Coverage under section 1931 of the Act was not repealed with the ACA and will remain in effect in 2014. As noted in the table above, eligibility for parents and caretaker relatives under section 1931 is implemented at section 435.110 of the regulations; eligibility for pregnant women under section 1931 is implemented at section 435.116 and eligibility for children at section 435.118. TMA under section 1925 of the Act will sunset on December 31, 2012, unless extended by Congress. If Congress elects to extend section 1925 of the Act beyond December 31, 2013, States will need to provide TMA to eligible individuals as set forth in their approved State plans. Note that the 4-month extension for individuals losing eligibility under section 1931 of the Act due to increased earnings or hours of work (see sections 1902(e)(1)(A) and 1931(c)(2) of the Act), and the 4-month extension of eligibility for individuals losing eligibility due to increased spousal support (see section 1931(c)(1) of the Act) do not have a sunset date and would therefore still apply in 2014 unless repealed by Congress. The extension of eligibility for individuals losing coverage under section 1931 due to increased child support will no longer be relevant in 2014, as child support is not counted as income under MAGI-based methodologies.

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FAQ ID:93156

Yes. People with disabilities or who need long term care services and supports may qualify under the new adult group in 2014 if they meet the MAGI-based eligibility standards for that group. In addition, under the final eligibility and enrollment rule, eligibility for the new adult group based on MAGI does not preclude eligibility for coverage under an optional group that might be otherwise excepted from MAGI methods. Individuals with MAGI-based income up to 133% of the federal poverty level who meet the criteria for the adult group but who need long term services and supports, can choose to enroll in an optional group that better meets their needs, and they can move from the adult group to the optional eligibility group at any time, if eligible. Individuals found eligible for the new adult group based on MAGI, but who appear on the application to be potentially eligible for Medicaid on a basis other than MAGI, will be offered a more thorough eligibility determination so that they can have this option.

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FAQ ID:93161