CMS letter to State Medicaid Directors: The Affordable Care Act Maintenance of Effort (MOE)

This letter provides guidance on state flexibility to make changes to their home and community-based services (HCBS) programs while complying with the maintenance of effort (MOE) provision of the Affordable Care Act. Letter recommends that States contact CMS for technical assistance if they are interested in pursuing any changes to their long-term care policies. The accompanying Q&As provide guidance on the MOE provisions in the Patient Protection and Affordable Care Act.