The Centers for Medicare & Medicaid Services (CMS) published a letter to state Medicaid directors with guidance on claiming methodologies for benefits that can receive a differential match rate in Medicaid managed care.
In general, states’ expenditures for medical assistance are matched at a state-specific federal medical assistance percentage (FMAP). However, some expenditures can be matched at an increased FMAP rate, or differential match rate. Examples of differential match rates include family planning services, Indian Health Services facility services, services provided to beneficiaries with breast or cervical cancer, and community-based mobile crisis intervention services.
To claim the differential match rate, states must develop a claiming methodology to identify the portion of the Medicaid managed care capitation rate attributable to a particular eligible benefit. CMS has developed a three-step guide for state Medicaid programs to ensure they claim expenditures for these services appropriately. The agency expects states to ensure that they have appropriate claiming methodologies in place by the quarter ending Dec. 31, 2024.
Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.
