CMS Issues Guidance on Enhanced FMAP

The Centers for Medicare and Medicaid Services this week released FAQs addressing questions about the temporary 6.2 percentage point increase to each state’s Federal Medical Assistance Percentage (FMAP) included in the Families First Coronavirus Response Act (FFCRA). Section 6008 of FFCRA provides the FMAP bump under section 1905(b) of the Social Security Act effective beginning January 1, 2020 and extending through the last day of the calendar quarter in which the public health emergency declared by the Secretary of Health and Human Services for COVID-19 , including any extensions, terminates.

Section 6008(a) of the FFCRA states that the increased FMAP is available for each calendar quarter occurring during the public health emergency. As the public health emergency for COVID-19 was declared by the Secretary of Health and Human Services on January 31, 2020, the increased FMAP is available for qualifying expenditures that were incurred on or after January 1, 2020 and through the end of the quarter in which the public health emergency including any extensions, ends. The quarter in which the State makes a payment is the quarter in which the expenditure will be considered to be incurred, and the FMAP applicable to that quarter is the appropriate FMAP for that claim. States are not required to submit a SPA to be eligible for the FMAP increase.

CMS indicates that all states and territories are eligible for the increased FMAP, provided they meet the requirements of section 6008(b) and (c) of the Families First Coronavirus Response Act. These are:

(1) States must maintain eligibility standards, methodologies, or procedures equal or less restrictive than those in effect on January 1, 2020.

(2) States cannot raise any Medicaid premiums above those in effect on January 1,

2020.

(3) States must commit to not disenroll any beneficiary enrolled as of the date of enactment of this section or who enrolls for benefits during the emergency period, regardless of change in eligibility status (known as “continuous coverage”).  

(4) States must provide full coverage for any testing services and treatments for COVID–19, including vaccines, specialized equipment, and therapies.

The FAQs include clarification on each of these requirements, which became effective on March 18, 2020. While CMS has not conducted reviews for state compliance, the agency believes that “all states can take steps to be compliant and earn the enhanced funding, and CMS will provide technical assistance to states on this issue.” Regarding continuous coverage, CMS indicates that states that want to qualify for the increased FMAP should make a good faith effort to identify and reinstate individuals whose coverage was terminated on or after the date of enactment for reasons other than a voluntary request for termination or ineligibility due to residency. At a minimum, states are expected to inform individuals whose coverage was terminated after March 18, 2020 of their continued eligibility and encourage them to contact the state to reenroll. Where feasible, states should automatically reinstate coverage, back to the date of termination, for individuals terminated after March 18, 2020 and should suspend any terminations already scheduled to occur during the emergency period.

However, CMS indicates that under their interpretation of the statute, the 6.2 percentage point FMAP increase does not apply to all match rates. In general, the increased FMAP is “available for allowable Medicaid medical assistance expenditures for which federal matching is paid ordinarily at the state-specific FMAP rate defined in the first sentence of section 1905(b) of the Act.” The FAQs clarify that increased FMAP is available for services provided under waivers and section 1115 demonstrations if the expenditures are matched at the FMAP defined in the first sentence of 1905(b). However, CMS lists several Medicaid expenditures to which the enhancement does not apply, including:

• Community First Choice (CFC) 1915(k) service expenditures already eligible for a 6 percentage point in Federal match rate increase
• Medicaid administrative expenditures, for which the matching rate is not defined in section 1905(b)
• Adult group expenditures matched at the “newly eligible” FMAP specified in section 1905(y) of the Act
• Adult group expenditures matched at the “expansion state” FMAP specified in section 1905(z) of the Act
• Health home services under section 1945 of the Act when these are matched at 90%. After the initial enhanced FMAP period for these services, they will be matched at the state’s regular FMAP, which might be subject to the 6.2 percentage point increase.
• Any other expenditures not matched at the FMAP determined for each state that is defined in the first sentence of section 1905(b).

FMI: The guidance is available at https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-faqs.pdf?eType=EmailBlastContent&eId=ed2c8935-b8d6-404a-97d1-cf9d7eada13d.