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  • Final Rule Establishes Matching Rates for Medicaid Beneficiaries

    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 and thereafter.

    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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