Frequently Asked Questions

Each federal agency has the authority to define use of its data. Therefore CMS defers to IRS, DHS and SSA who are partnering with us to provide data via the Federal data services hub. Please refer to the CMS Services Catalog to review the Business Service Description (BSD) for the verification of income service to identify the Federal tax information data elements and definitions that will be made available to states through the Federal data services hub.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 104.38 KB)

FAQ ID:93306

Enhanced Medicaid funding for Eligibility & Enrollment (E&E) activities is available from the approval of an Advanced Planning Document (APD). An ongoing Medicaid administrative match at the 50% rate is available for activities that take place prior to an approved E&E APD, as long as the activities fall within the purview of administering the Medicaid program (42 CFR 433.15). Funding is available ongoing, subject to APD approvals. More information is available in the State Medicaid Director Letter on Enhanced Funding dated March 31, 2016 (SMD# 16-004), to be found at https://www.medicaid.gov/federal-policy-guidance/federal-policy-guidance.html.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 104.38 KB)

FAQ ID:93321

The twenty-two standards and conditions are listed in the Medicaid Program; Mechanized Claims Processing and Information Retrieval Systems (90/10) rule issued on 12/4/2015. See https://www.federalregister.gov/documents/2015/12/04/2015-30591/medicaid-program-mechanized-claims-processing-and-information-retrieval-systems-9010.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 104.38 KB)

FAQ ID:93331

The requirements of Circular OMB-A-87 apply to the allocation of costs for design, development, and implementation (DDI) and maintenance and operations (M&O) of eligibility and enrollment (E&E) systems including the respective benefiting health insurance affordability programs: Medicaid, CHIP (for states that have separate Title XXI programs or for portions of separate CHIP programs in states that operate a combination CHIP/Medicaid program) and to CCIIO Grant Funding if the project will include functionality for Health Insurance Exchanges.

States can request the temporary exception to Circular OMB-A-87 requirements to use Medicaid enhanced funding for DDI costs of shared eligibility services that will benefit other human service programs (SNAP, TANF, childcare, and child welfare). The exception does not apply to M&O costs, and therefore states must cost allocate to benefiting programs for these costs. For more information, please see the State Medicaid Director Letter, dated July 20, 2015, at https://www.medicaid.gov/federal-policy-guidance/downloads/smd072015.pdf (PDF, 80.07 KB).

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 104.38 KB)

FAQ ID:93341

In zONE, states can find business process models, templates for concepts of operations, and other planning and development artifacts, business and technical requirements, Requests for Proposals (RFPs), Statements of Work (SOWs), system design documents, etc. CMS Eligibility & Enrollment (E&E) state leads are available to discuss and assist states in finding the right artifacts in the zONE collaboration spaces. Your SOTA team and your E&E state lead are available to answer specific questions about what might be available soon that is not already in the CALT.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 104.38 KB)

FAQ ID:93346

An assessment for IV&V analysis of a state's E&E system development effort will be required for APD projects that meet any of the criteria contained in federal regulations at 45 CFR 95.626(a). If CMS determines that the IV&V analysis is required for a state's system development effort, the provisions contained in federal regulations at 45 CFR 95.626(b) and (c) apply. Additional guidance is available in the Medicaid E&E Toolkit, available at https://www.medicaid.gov/medicaid/data-and-systems/meet/index.html.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 104.38 KB)

FAQ ID:93351

Medicaid Budget Expenditure System/Children's Budget Expenditure System (MBES/CBES) has been modified to add new Medicaid Eligibility Determination System lines to the 64.10 Form series beginning with Quarter Ending March 31, 2011:

• 28A - DDI of Medicaid E&E systems/cost of in house activities - 90% FFP
• 28B - DDI of Medicaid E&E systems cost of private sector contractors - 90% FFP
• 28C - Operation of an approved Medicaid E&E system/cost of in-house activities - 75 % FFP
• 28D - Operation of an approved Medicaid E&E system/cost private sector contractors- 75% FFP

FAQ ID:93361

No. As mentioned in the two letters that Secretary Sebelius sent to governors in November 2012, states have been and will continue to be partners in implementing the health care law and we are committed to providing states with the flexibility, resources and time they need to deliver the benefits of the health care law to the American people.

In response to various governors' requests for additional time, we extended the deadline for a Blueprint Application to operate a State-Based Exchange from November 16, 2012 to December 14, 2012. If a state is pursuing a State Partnership Exchange, we will accept Declaration Letters and Blueprint Applications and make approval determinations for State Partnership Exchanges on a rolling basis. A state that plans to operate the Exchange in its state in partnership with the federal government starting in 2014 will need to submit its Declaration Letter and Blueprint Application declaring what partnership role they would like to have by February 15, 2013.

Supplemental Links:

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

FAQ ID:94401

By law, states operating Exchanges in 2014 must ensure that their Exchanges are financially self-sustaining by January 1, 2015. The costs to states for establishing a State-Based Exchange and testing Exchange operations during 2014 may be funded by grants under section 1311(a). Additionally, grants under section 1311 may be awarded until December 31, 2014, for approved establishment activities that fund first year start-up activities (i.e., activities in 2014). It is also permissible that under a State Partnership Exchange, a state may receive grants for activities to establish and test functions that the state performs in support of a Federally-Facilitated Exchange. This applies whether or not a state is a State Partnership Exchange. Generally, states will not be required to repay funds, provided funds are used for activities approved in the grant and cooperative agreement awards.

Supplemental Links:

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

FAQ ID:94406

No. HHS is establishing a federally-managed data services hub to support information exchanges between states (Exchanges, Medicaid and CHIP agencies) and relevant federal agencies. In many cases, federal agencies other than HHS will be providing information through the hub. As stated in previous guidance, no charge will be imposed on states for use of the hub, nor for the required data accessed there.

Supplemental Links:

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

FAQ ID:94411