State Medicaid Director's letters

This letter provides guidance to states on how the long-term services and supports-related rules, including the estate recovery rules, in section 1917 of the Social Security Act (the Act), and federal regulations at 42 C.F.R. 435.700, et seq., apply to individuals who are eligible for Medicaid under Modified Adjusted Gross Income (MAGI) eligibility rules (“MAGI individuals”) and receive coverage for long-term services and supports (LTSS).

CMS released a letter to State Medicaid Directors discussing mutual obligations and accountability of both state and federal governments for the integrity of the Medicaid program and the development, application, and improvement of safeguards vital to ensure proper and appropriate use of federal and state dollars. The letter also discusses a new requirement that states submit upper payment limit (UPL) demonstrations on an annual basis, and guidance on the format and method of UPL demonstration.

New guidance establishes a one percentage point increase in the federal medical assistance percentage (FMAP) for certain preventive services. States must cover their standard Medicaid benefit package, all recommended preventative services, administration, adult vaccines, and can not impose cost-sharing on these services in order to claim the one percentage point.

In our last update on HCBS quality (CMS Interim Procedural Guidance Update: May 28, 2004) we announced changes to the Interim Procedural Guidance (IPG) and offered further clarification of the review process. This communication announces additional changes to the IPG and the release of two technical assistance products.

The Centers for Medicare and Medicaid Services (CMS) is currently working with states to design and implement new models for integrating the benefits and financing of both programs. This website is designed as a resource for advocates, providing resources, background information and, most importantly, in the Advocate Tools section, concrete recommendations that advocates need to engage constructively with their states to ensure that new models improve care for dual eligibles.

Medicaid program integrity is among the highest priorities of the nation’s Medicaid Directors and is a key component of every initiative and program states conduct. Program integrity is about creating a culture where there are consistent incentives to provide better health outcomes within a context that avoids over-or underutilization of services. Directors seek to promote economy, efficiency, accountability, and integrity in the management and delivery of services.

Have you seen the new site sponsored by CMS? This space offers a resource center for states, up to date information about the affordable care act and additional federal policy guidance. The waiver section organizes information by state, program name, waiver authority and status of a application. This chart gives an overview of the four primary types of waivers and demonstration projects: Section 1115, Section 1915(b) Managed Care, Section 1915(c) HCBS, and Concurrent Section 1915(b) and 1915(c).

This site offers a wealth of information for anyone seeking clarification about the Balancing Incentive Program. It also provides numerous resources States will find useful when pursuing the benefits offered by the Program, including: The Program Application; The Implementation Manual; A user-friendly Work Plan; A user-friendly CSA/CDS crosswalk; Frequently Asked Questions; Webinars; Additional resources on the web; and beyond.

This policy brief provides information on Washington, DC and the 37 states that are planning to better integrate care for participants who are dually eligible for Medicare and Medicaid. The Center for Medicaid and Medicare Services (CMS) will allow states to select a capitated model, or a managed fee-for-service model, or they can use both models. Included is a chart explaining the main differences between the two models.