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CMS Issues Rule on Matching Rate for Medicaid Expansion



This week in Washington—CMS issues the final rule on enhanced federal matching rate for ACA Medicaid expansion and releases an FAQ on premium assistance. You are tuning in to the National Association of Public Hospitals and Health Systems health policy update for the week of April 1, 2013.

On March 29, the federal Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period and related fact sheet that defines the methodology for implementing the enhanced federal matching rate for Medicaid expansion populations under the Affordable Care Act (ACA). Under the ACA, states will receive increased matching rates for Medicaid expenditures for the “newly eligible”—those beneficiaries who would not have been eligible for Medicaid under the state’s standards as of Dec. 1, 2009. CMS selected what it is calling a “threshold methodology” to determine the newly eligible populations and their expenditures. This “threshold methodology” was one of three proposed methodologies under consideration. States will determine on an individual basis whether a person who qualifies for the adult expansion group would not have been eligible under a simplified version of the state’s Dec. 1, 2009 eligibility standards, and therefore should be treated as “newly eligible.” While the rule was issued in final form, CMS will accept comments on the selected threshold methodology through June 3.

Also on March 29, CMS issued frequently asked questions (FAQs) for states that are considering providing coverage for their Medicaid expansion populations through the state-based health insurance exchanges, rather than an expansion of their existing Medicaid programs. States have the option, provided in the Medicaid statute, to use premium assistance to pay premiums for adults and children to purchase private coverage, as long as it is cost effective. Creation of FAQs document was prompted by recent interest in Arkansas’ proposal to use premium assistance to expand Medicaid as part of an 1115 waiver. The premium assistance option is available to states under current law through a state plan amendment process, as well as through Medicaid waivers.

Thanks for listening to another edition of This Week in Washington. I’m Zina Gontscharow; join us next week for another update.



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