Medicaid FAQs
On April 13, CMS released
guidance to states on Medicaid-related COVID-19 issues. Although the guidance covers a range of topics, including implementation of coverage for COVID-related services for the uninsured and benefits and cost sharing for COVID-19-related testing and diagnostic services, below we have highlighted items important to long term care providers:
Treatment of Relief Payments in CARES Act
CMS clarifies that the relief payments eligible people receive from the CARES Act may not be counted as income when making Medicaid and CHIP eligibility determinations. In addition, these payments may not be counted as resources for 12 months (Question 54).
Eligibility Considerations for States to Receive Enhanced Federal Matching Rates
To continue to receive the temporary FMAP increase, the state must not cut eligibility for benefits during the public health emergency, even if that person no longer meets the existing eligibility criteria. Several questions in the FAQ document address targeted questions states have raised related to people using long term services and supports, or who become eligible for Medicare as well as Medicaid. These include:
- When a Person no Longer Meets Level of Care (LOC) or Other Requirements of a 1915(c) Waivers: If a person is participating in a 1915(c) home and community-based services (HCBS) waiver and they are determined to no longer meet the LOC requirements (or other requirements) for the waiver, the state should maintain an individual’s participation in a 1915(c) waiver for which the individual is enrolled during the emergency period, even if the individual is determined to no longer meet the LOC or other requirements for waiver participation (Question 25).
- When a Person’s Medicaid Eligibility Is Connected to Need for 1915(c) Waiver Services and They No Longer Meet LOC Requirements: If a person’s Medicaid eligibility is connected to their need for and receipt of 1915(c) waiver services, and they are determined to no longer meet the LOC requirements, to continue to receive the enhanced federal matching rate, the state must maintain the individual in this eligibility group and continue to provide coverage for 1915(c) services, unless they are now eligible for a different eligibility group that provides the same amount, duration, and scope of benefits (Question 26).
- Medicaid beneficiaries who become eligible for Medicare: If a person enrolled in Medicaid turns 65 and becomes eligible for Medicare during this time, CMS clarifies steps the state would have to take to ensure that their services are not reduced so that the state can continue to receive the 6.2% federal matching bump (Question27).
- Changes in SSI eligibility when this is the basis for Medicaid eligibility: If a person who is eligible for Medicaid based on their receipt of SSI benefits were to become ineligible for SSI during the public health emergency, they may not be terminated from Medicaid before the end of the month when the public health emergency ends. If the person is eligible for a different Medicaid eligible group that offers at least the same benefits available to SSI beneficiaries, the state is able to move them to that new group (Question 33).
- Moving between Medicare Savings Program (MSP) groups: During the public health emergency, states must maintain a person’s eligibility for at least the same amount, duration, and scope of benefits as are covered for the group in which the individual is enrolled. This includes paying for Medicare Part A and Part B premiums through MSPs and other Medicaid categories. This means that a person could not be moved to a different MSP group that offers less assistance with Medicare premiums and cost sharing during the emergency (Question 34).
1915(k) Clarification and EFMAP
CMS addressed an incorrect statement in a previous FAQ document, clarifying that Community First Choice 1915(k) service expenditures are in fact eligible for the enhanced federal matching rate of 6.2 percent under this public health emergency (Question 36).
