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CMS Releases Q&A Document for ACA Implementation



This week in Washington—CMS releases an ACA implementation Q&A resource. You are tuning in to the National Association of Public Hospitals and Health Systems health policy update for the week of Feb. 11, 2013.

On Feb. 6, the federal Centers for Medicare & Medicaid Services (CMS) released an informational bulletin for states regarding Affordable Care Act (ACA) implementation. The bulletin directs states to the “Frequently Asked Questions” section of, which has been updated to address a number of questions CMS has received regarding provisions in the ACA. The updated Q&A focused on the basic health plan and the enhanced federal medical assistance percentages (FMAP) authorized by the ACA.

CMS clarifies that the basic health plan will not be an option until 2015. The rules regarding the basic health plan have been delayed and will likely not be settled until 2014. CMS noted that it would work with states in the interim to identify alternatives to covering low-income people until the basic health plan is finalized. In the new Q&A, CMS directs states to a previously released FAQ on health benefit exchanges that outlines options available for states to use Medicaid funds to purchase coverage through a Qualified Health Plan on the Marketplace for Medicaid beneficiaries until the basic health plan is available in 2015.

The new Q&A also addresses a number of questions regarding enhanced FMAP. Starting in 2014, states will see two types of enhanced FMAP for state expenditures for low-income individuals—one is for the newly eligible and the other is for expansion state FMAP. These rate increases, authorized by the ACA, will only be available to states that broaden their coverage to the new adult group that will be eligible under the ACA’s Medicaid expansion. CMS’ Q&A clarifies that the newly eligible FMAP rate is for those who would not have been eligible for full benefits, benchmark benefits, or benchmark-equivalent benefits under a state’s Medicaid program as of Dec. 1, 2009. Individuals will also be considered newly eligible if they were eligible for benefits but were not enrolled due to a waiver or demonstration limiting or capping enrollment as of Dec. 1, 2009. States will receive a 100 percent FMAP match in the first two years of implementation for the newly eligible population. The rate then decreases to 95 percent in calendar year 2017, 94 percent in calendar year 2018, 93 percent in calendar year 2019, and 90 percent in calendar years 2020 and beyond.

The expansion state FMAP, meanwhile, provides an alternative enhanced FMAP for those states that expanded their Medicaid coverage to childless adult populations prior to the ACA’s enactment. States interested in confirming their status as an expansion state should submit an analysis of their coverage provisions as of March 23, 2010, to CMS. For the expansion state FMAP, states will receive their regular FMAP rate increased by a transition percentage. The transition percentage will be a percentage of the difference between the regular Medicaid FMAP and the enhanced newly eligible FMAP, which can range from 50 to 100 percent. By 2019, the expansion state FMAP will be equal to the newly eligible FMAP. CMS also noted that, in determining the two new enhanced FMAPs for the newly eligible and expansion states, states will always receive the more favorable FMAP rate if two are applicable to a population.

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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