NAMDsSCOTUSquestions

Submitted:July3,2012 ScopeofExpansion,Timelines,andFMAP CanCMSconfirmthatindividualswithincomebetween100133%oftheFPLwillbeeligible forcostsharingsubsidiesandtaxcreditstopurchasecoveragethroughtheExchange? Canstatesexpandeligibilityto100%FPLorotherlevelslessthan133%fortheoptionaladult group?Ifso,howdoesthisimpacttheFMAP?Thatis,willstatesbeeligiblefortheenhanced federalfundingperthecurrentschedule? WillincomedisregardsimpacttheMAGI/povertyleveldeterminationforeligibilitypurposes, effectivelymakingtheincomelevelsfortheoptionaleligibilityexpansions105%/138%? Canstatesphaseintheirexpansiontotheoptionaladultgroupbeyond2014?Ifso,how doesthisimpactstatesabilitytoreceivetheenhancedFMAPfortheoptionaladultgroup? Willstateshavetheoptiontoexpandtotheoptionaladultgroupafter2014?Ifso,howdoes thisimpactstatesabilitytoreceivetheenhancedFMAPfortheoptionaladultgroup? WillstatesthatpreviouslyexpandedMedicaideligibilitybeeligibleforenhancedFFPevenif theydecidenottoproceedwiththeMedicaidexpansiontotheoptionaladultgroup? HowwillCMSdefinenewlyeligibleindividualsforstatesthathavealreadyexpandedsome formofMedicaidcoveragetotheoptionaladultpopulationpriortotheimplementationof theACA?HowwillCMSdefinebenchmarkcoverageasitrelatestodeterminingthenumber ofnewlyeligibles?Willthesestatesqualifyforthefullincreaseinenhancedfederal funding?Willtheyqualifyforexpansionstatefunding? IfastatechoosesnottoexpandMedicaidtotheoptionaladultcategory,canastateuse MedicaidfundingtoassistindividualsinthisgroupandotherMedicaideligibleindividualsin purchasinghealthinsurancethroughtheExchange?Ifso,wouldstatesbeeligibletoreceive theenhancedFMAPaccordingtothestatute?CouldtheyalsouseMedicaidfundstoprovide wraparoundservices?Whatistheapprovalprocessforthisapproach? Process MuststatesproactivelysubmitaSPAforapprovaloftheexpansion?Alternatively,must statessubmitaSPAindicatingtheyarechoosingnottoexpandtotheoptionaladultgroup? o Ineitherscenario,willCMSdevelopatemplate? o Ifso,whendoesCMSexpecttomaketheseresourcesandprocessesavailable? o Whatistheexpectedtimelineforapprovalineithersituation? AretheredeadlinesfortheSPAsubmissions?
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WhatflexibilitywillCMSaffordstatesgiventhatlegislativeactionisrequiredinmanystates priortomovingforwardwiththeoptionalexpansiontotheadultgroup?Forexample,will CMStimelinesanddecisionsrelatedtotheexpansiontimelinesreflectthatsomestateshave bienniallegislativesessionsand/orthatthelegislaturemaynotmakedecisionsabout expansionfortheoptionaladultcategoryuntilwellintocalendaryear2013? Whatisthecontingencyplaniflegislatorsdonotactintimetomeetanydeadlines/timelines thatCMSmayestablishfortheoptionalexpansion? WillCMSworkwithstatestoincorporateexpansionstotheoptionaladultgroupinwaiver programs,includingunderSection1115waiverauthority?Whatistheprocessfordoingso? HowwillCMSensuretransparencyandaccountabilityaroundtimelinesforapproval processesbothforcurrentandprospectivewaiverandSPAsubmissionsrelatedtothe expansion?

Funding Ifastatehasalreadyexpendedmoneytoupgradetheireligibilitysystemsata90/10match rateandthestatesubsequentlychoosesnottoexpandMedicaidtotheoptionaladultgroup, isthestateliableforreturningthesefunds? What,ifany,impactisthereonfuture90/10fundingifastatechoosingnottoexpand?For earlyexpansionstates? Isthe90/10fundingtiedtotheExchangedesignandimplementation,regardlessofwhether astateexpandsMedicaideligibilitytotheoptionaladultgroup? CanMedicaidfundingbeusedtosupporttheNavigatorprogramevenifthestatedoesnot choosetoexpandMedicaidtotheoptionaladulteligibilitygroup? Subpopulationissues IstheexpansionofMedicaidtochildrenenrolledinfostercareoptional? IstheexpansionofMedicaidforchildrenfrom100133%oftheFPLoptional? IsthereanychangetotheCMSguidanceregardingthecollapsingofeligibilitycategories? RelatedACArequirements Priorto2014,arestatesstillsubjecttotheMOErequirementsrelatedtoeligibilitylevels, methods,andprocedures?What,ifany,penaltyistherefornoncompliance? WillstatesstillberequiredtoconverttheirincomecountingmethodologytoMAGIfor purposesofdeterminingeligibilityregardlessofwhethertheyexpandtotheoptionaladult group? InstatesthatdonotexpandeligibilitytotheoptionalMedicaidgroup,willtheDSHprogram fundingstillbereducedaccordingtotheschedulestipulatedintheACA?Indevelopingthe

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DSHreductionmethodology,willCMSconsiderwhetherastatetakesupinitsentiretyor partiallytheeligibilityexpansiontotheoptionaladultgroup? WhatisCMStimelineforissuingguidanceonalternativebenefitpackagesfortheoptional adultcategory? WhatisCMStimelineforreleasingthefinalruleregardingthetemporaryenhancedfederal fundingforprimarycarereimbursementrates? DoesCMSplantoissueguidancerelatedtohowstatesnotifyindividualsaboutthe applicationofthepenaltyfornotpurchasing/enrollinginhealthcoverage? WhatisthetimelineforCMSissuanceofguidanceontheBasicHealthPlanprogram?

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