State Medicaid Director's letters

Guidance on the implementation of Section 2001 of the Affordable Care Act: Medicaid Coverage for the Lowest Income Populations is provided. This legislation establishes a new eligibility group and the option for states to begin providing medical assistance to eligible individuals as of April 1, 2010. To implement the 1902(k)(2) option to cover this group, states must submit an amendment to their State Medicaid plans.

This letter provides clarification on the receipt of Federal funds under the SSA Ticket to Work program and encourages utilization of the program’s flexible funding offers. Policy clarifications regarding State Medicaid providers’ acceptance and the treatment of SSA ticket payments are included, as well as clarification regarding the prohibition of using Ticket Outcome and Milestone payments as the State share of financial participation.

Guidance is offered on the implementation of section 6087 of the Deficit Reduction Act of 2005 (DRA) Public Law Number 109-171. Section 6087, the “Optional Choice of Self-Directed Personal Assistance Services (PAS) (Cash and Counseling)” amended section 1915 of the Social Security Act by adding subsection (j). Guidance also applies to section 1915(c) HCBS waiver programs when states offer the self-direction opportunity and permit participants to purchase “individual directed goods and services.”

This letter is another in a series of State Medicaid Director correspondence that provides guidance on the implementation of the American Recovery and Reinvestment Act of 2009 (the Recovery Act), Public Law 111-5. This letter provides guidance on the process for accessing the increased Federal Medical Assistance Percentage (FMAP), expenditures for which the increased FMAP is available, and the eligibility “maintenance of effort” (MOE) requirements under section 5001(f) of the Recovery Act.

One of a series designed to provide guidance on the implementation of the American Recovery and Reinvestment Act of 2009, this letter addresses the “prompt pay” requirements contained in section 5001(f)(2). States must comply with timely claims processing requirements in the Medicaid program, or potentially lose their eligibility for the increased Federal medical assistance percentage (FMAP) for certain expenditures. More detailed technical guidance is attached to this letter.

Guidance is offered for states in interpreting the sections of ARRA that impact Medicaid and CHIP. Program elements affected include tax credits, income used to calculate benefit levels, Federal Medical Assistance Percentage, Transitional Medical Assistance, protections for Native Americans, and transfers of assets. The attachment lays out program changes organized by ARRA section.

CMS offers guidance to states on how to avoid payments to excluded entities and the consequences of failing to prevent these payments. The letter stresses that it is the states’ responsibility to clearly communicate to providers that it is their obligation to screen employees and contractors for exclusion prior to hiring or contracting. It also provides the location of the List of Excluded Individuals/Entities which can be used to prevent improper payment.

This letter is another in a series of CMS communications that support state efforts to improve the quality of services and supports provided through the Medicaid Home and Community-based Services waiver program. This communication announces three new items designed to assist states in enhancing oversight and operations: GAO Mortality Study in Developmental Disabilities, HCBS Quality Requirements Grid: A Technical Assistance Tool and the National HCBS Quality Enterprise award to Thomson Reuters.

Attached is an initial guide for use by States regarding current CMS case-management policy in light of the moratorium. This document does not represent a comprehensive list of all relevant Medicaid policy issuances, but is designed to assist States in assessing the impact of the exception included in the CMS 2237-IFC moratorium. The Supplemental Appropriations Act, 2008, was signed into law on June 30, 2008. State Medicaid Director (SMD) Letters are included as reference.

This letter is one of a series providing guidance on the implementation of section 6087 of the Deficit Reduction Act of 2005, Public Law Number 109-171. Effective 1/1/07, Section 6087, (Cash & Counseling), adds subsection 1915(j) to the Social Security Act. States have the option to provide self-directed PAS to beneficiaries, without regard to the Medicaid requirements of comparability or statewideness. A State plan amendment (SPA) pre-print is enclosed to assist you in submitting an amendment.