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
Can a state decide to be its own MMIS systems integrator?
CMS encourages the use of an SI outside the state agency, but states can consider themselves in that role if they can support that effort and if that decision is made with consultation and agreement from CMS. For more information about the role of the SI, see Section 1.7 in part 01 of MECT Medicaid Enterprise Certification Life Cycle. https://www.medicaid.gov/medicaid/data-and-systems/mect/index.html
FAQ ID:94921
SHARE URLDoes CMS MMIS certification support non-traditional claims processing models, such as using an Administrative Services Organization or "claims processing as a service" approach?
Yes. The certification checklist defines a set of business and technical requirements that a particular Medicaid function must meet. The checklists and criteria are agnostic as to whether the requirements are met by a system built within the Medicaid Agency, a Software-as-a-Service model, a cloud-hosted model, or an ASO model.
FAQ ID:94461
SHARE URLIs MITA considered during milestone reviews?
Yes, our milestone review process is fully aligned with MITA. During each milestone review, CMS will verify that the state has considered MITA maturity during system definition, and whether the state is actively moving toward higher MITA maturity as defined in the state's latest MITA State Self-Assessment. Please see 42 CFR 433.112 (b)(11).
FAQ ID:94476
SHARE URLI am a vendor not currently in the Medicaid space, but interested in learning more about opportunities for MMIS and/or E&E modular solutions. Whom can I contact for more information?
CMS is looking for new innovators in the Medicaid IT space. Please direct inquiries to: mmis_mes_certification@cms.hhs.gov.
FAQ ID:94416
SHARE URLI am an existing MMIS vendor under contract with a state. Who do I contact with questions about the new certification process?
Please work with your state representatives, so that they can contact CMS regional offices for quick assistance with your questions. In addition, please review other FAQs related to this topic.
FAQ ID:94431
SHARE URLWill any individuals lose coverage as a result of the new MAGI-based income methodology?
No one loses coverage as a result of converting to MAGI rules, but, in states that don't adopt the new adult eligibility group, it is possible that some individuals will lose coverage.
The Affordable Care Act ensured that no one would lose health coverage--if they were not eligible under the new MAGI standards either they would be covered under the new Medicaid adult coverage group or they would be able to purchase insurance through the Marketplace with the benefit of a premium tax credit and likely cost sharing reductions. Following the Supreme Court's decision, the Medicaid expansion is voluntary for states, and in states that do not adopt the new coverage group some individuals may lose coverage at the time of their renewal when the new rules are applied.
FAQ ID:92501
SHARE URLIt looks like in some states CHIP has gotten smaller; do the new MAGI rules result in smaller CHIP programs?
No, the change to MAGI does not affect the size of CHIP Programs.
The number of children in CHIP does not change as a result of MAGI because the new standards have the same value as the old standards; they simply translate the state's pre-MAGI two-step policies into a simpler one-step calculation. For example, if the state under old rules covers children in Medicaid with incomes up to 150% of the Federal Poverty Limit (FPL) and CHIP from 150% to 200% of the FPL, and under MAGI the new Medicaid income standard is 160% of the FPL, that doesn't mean that children between 150% and 160% are losing CHIP coverage--it means that many children between 150% and 160% of the FPL using net income standards were already eligible for Medicaid because of the use of disregards.
FAQ ID:92506
SHARE URLDo the new MAGI standards mean that more children will move from CHIP to Medicaid?
No, the number of children moving from CHIP to Medicaid is not affected by the change to MAGI.
Under the law, those states that cover children ages 6-18 with incomes between 100% and 133% of the FPL in CHIP will be transitioning these children to Medicaid so that children under 133% of the FPL, regardless of their age, are eligible for the same coverage program (some states will continue to have different, higher income standards for younger children). The change to MAGI standards does not change the number of children who will move from CHIP to Medicaid.
FAQ ID:92511
SHARE URLWith regards to MAGI, can states that want to have one eligibility level for children, ages 1-18, do so?
Yes. The new converted standards are based on the state's current income eligibility standards and their pre-2014 disregards. So if children in different age groups have different effective eligibility levels under a state's pre-2014 rules, the children will have different converted standards. For example, if a state has been covering children aged 1-5 to 133% FPL and children aged 6-18 to 100% FPL, the state's MAGI eligibility standard in 2014 may be 139% FPL for children aged 1-5 and 133% FPL for older children.
FAQ ID:92516
SHARE URLWith regards to MAGI, can states that want to have a "rounded" number for their eligibility standards do so or must they stay with the converted standards?
Yes, states can adjust their standards within certain limits established by law.
States can adjust both their adult standards (e.g., for pregnant women) and their children standards, as long as they do not reduce eligibility levels below minimum standards established by the law. CMS can advise states of their options.
FAQ ID:92521
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