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
States can work with the Federally-Facilitated Exchange (FFE) regarding Medicaid and CHIP eligibility determinations in one of two ways. The State may either establish an agreement whereby the FFE assesses applicants for Medicaid/CHIP eligibility based on MAGI and then transfers the applicants' electronic accounts to the State Medicaid or CHIP agency to complete the eligibility determination. Or the State may elect to accept MAGI-based eligibility determinations completed by the FFE as final determinations. Regardless of the approach, the process should be as seamless as possible for the applicant with most eligibility determinations completed in near real-time as specified in our eligibility final rule at 435.912.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Coordination with the Federally Facilitated Marketplace
FAQ ID: 93081
The Exchange will utilize the State's Medicaid and CHIP eligibility rules for conducting both eligibility determinations and eligibility assessments. This will include application of the State's MAGI income standards and related eligibility rules for the MAGI population. The Exchange will also rely on a robust verification protocol that is consistent with Medicaid and CHIP regulations but which might not be the same protocol the State is otherwise using.
If a State accepts assessments of eligibility from the Federally-Facilitated Exchange (FFE) and chooses to make the final eligibility determinations itself, once an individual has been assessed as Medicaid/CHIP eligible, their electronic account would be transferred to the State Medicaid or CHIP agency, which will complete the eligibility determination. This process will include any additional verification required by the State that is consistent with the Federal verification regulations.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Coordination with the Federally Facilitated Marketplace
FAQ ID: 93086
If the Marketplace is a government entity, States will have the option to enable their State-based Exchange to make Medicaid eligibility determinations for non-MAGI eligibility groups. Depending on the arrangements made in each State, such an Exchange can make all Medicaid eligibility determinations, only eligibility determinations based on MAGI, or assessments of eligibility based on MAGI. The FFE will not be making Medicaid eligibility determinations for non-MAGI groups; the FFE will either do final determinations or assessments for the MAGI eligibility groups.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Coordination with the Federally Facilitated Marketplace
FAQ ID: 93091
Yes. CMS is working with States to develop a model agreement, and it is one of the tools that the Coverage Expansion Learning Collaborative will be considering.
Supplemental Links:
Date: May 21, 2012
Topics:
Affordable Care Act
Subtopics:
Coordination with the Federally Facilitated Marketplace
FAQ ID: 93096
Use our dentist locator to find a dentist that accepts Medicaid.
Date: No FAQ Date
Topics:
Medicaid & You
FAQ ID: 94526
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
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
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