The Centers for Medicare and Medicaid
Services (CMS) issued a final rule
Friday implementing provisions of the Affordable Care Act (ACA) on increased Federal Medical Assistance Percentage (FMAP), or matching, rates for certain Medicaid
beneficiaries in states. This rule codifies the increased FMAP rates that will
be applicable beginning January 1, 2014.
An increased FMAP rate is available
for medical services provided to people defined as "newly eligible"
who are enrolled in the new eligibility group for adults up to 133% of the poverty
level. In general, individuals are "newly eligible" if they are
enrolled in the new adult group and would not have been eligible for full
benefits, benchmark benefits, or benchmark-equivalent benefits under the
eligibility rules in that state in effect in December 2009. The newly
eligible FMAP is 100% in calendar years 2014-2016, 95% in calendar year 2017,
94% in calendar year 2018, 93% in calendar year 2019, and 90% in calendar years
2020 and beyond.
CMS also establishes an increased
FMAP for expenditures for nonpregnant, childless individuals in the new adult
eligibility group in a defined "expansion state." The expansion
state FMAP is the regular FMAP rate increased by the number of percentage
points equal to a "transition percentage" (that ranges from 50%-100%)
of the gap between the regular Medicaid FMAP and the increased "newly
eligible" FMAP. In 2019 and beyond, the expansion state FMAP will be equal
to the newly eligible FMAP, which means it will be 93% in 2019 and 90% in 2020
The final rule also describes the
threshold methodology that states will use to claim the new FMAP rates.
CMS is seeking comment on selected
provisions of this final rule through June 3 so that the agency can determine
whether additional clarification would assist states to implement these aspects
of the threshold methodology more effectively.
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