ARRA Medicaid

FFIS Reports

Issue Brief 10-44 Preliminary FY 2011 First Quarter ARRA FMAPs, October 25, 2010

Issue Brief 10-35 Final FY 2010 Fourth Quarter ARRA FMAPs, August 24, 2010

Issue Brief 10-33
New Law Extends ARRA FMAPs to June 2011, August 17, 2010

Issue Brief 10-22 Final FY 2010 Third Quarter ARRA FMAPs, May 25, 2010

Issue Brief 10-17 Preliminary FY 2010 Third Quarter ARRA FMAPs, April 27, 2010

Issue Brief 10-09 FY 2010 Second Quarter ARRA FMAPs; Related Medicaid Issues, March 16, 2010

Issue Brief 10-08 HHS to Allow Flexibility in Using Clawback Savings, February 25, 2010

Issue Brief 10-07 HHS Reverses ARRA Policy on Medicare Clawback,
February 23, 2010

Issue Brief 09-47
Final FY 2010 First Quarter ARRA FMAPs, December 1, 2009

Issue Brief 09-44 House Health Care Reform Bill Includes ARRA FMAP Extension, November 6, 2009

Issue Brief 09-39 Preliminary FY 2010 First Quarter ARRA FMAPs, October 26, 2009

Issue Brief 09-32 Final Fourth Quarter ARRA Bonus FMAPs, August 28, 2009

Issue Brief 09-28 New Methodology Increases ARRA FMAPs for Some States,
August 13, 2009

Issue Brief 09-22 Fourth Quarter Estimates of ARRA Bonus FMAPs, June 23, 2009

Issue Brief 09-14 Updated Estimates of ARRA Bonus FMAPs, April 8, 2009

Issue Brief 09-13 ARRA Guidance Issued on Transitional Medical Assistance, April 7, 2009

Issue Brief 09-05 Estimated Stimulus FMAP Increases, February 24, 2009

Agency Announcements

HEALTH AND HUMAN SERVICES
 

July 18, 2012: HHS OIG Report Finds States Inappropriately Retained Federal Funds for Medicaid Collections  A recent report from the HHS Office of Inspector General (OIG) finds that when CMS retroactively provided additional ARRA Medicaid funds for the first quarter of FY 2009, it did not address collections, which reduce a state‚Äôs expenditures. According to the report, 35 states did not appropriately recalculate the federal share for collections. The report recommends that CMS recoup the $25 million from the 35 states. The full report is available at: http://oig.hhs.gov/oas/reports/region6/61100064.asp

November 10, 2011: GAO Releases Report on New Medicaid Prototype Formula The Recovery Act mandated that the Government Accountability Office (GAO) provide recommendations for modifying the Federal Medical Assistance Percentage (FMAP) to make it more responsiveto state Medicaid programs needs during future economic downtowns. In its new report, GAO presents a prototype formula and evaluates its effect on the allocation of assistance to states. To view the report, click here: http://www.gao.gov/products/GAO-12-38

March 31, 2011: GAO Releases Reports on Medicaid and Impact of Economic Downturns on States
In response to a requirement in ARRA, GAO released a report that reviews how past recessions affected states' ability to fund Medicaid, examines the responsiveness of past increased Federal Medical Assistance Percentage (FMAP) assistance to state needs, and identifies options for adjusting the increased FMAP formula for use during future recessions. To view the report, click here: http://www.gao.gov/products/GAO-11-395

February 2, 2011: HHS Publishes Final ARRA FMAPs for First Quarter of FY 2011
HHS published a noticed in the Federal Register that provides the ARRA Federal Medical Assistance Percentages (FMAPs) for the first quarter of FY 2011. To view the notice, see: http://www.gpo.gov/fdsys/pkg/FR-2011-02-02/pdf/2011-2283.pdf

October 29, 2010: HHS Publishes Final ARRA FMAPs for Fourth Quarter of FY 2010
HHS published a noticed in the Federal Register that provides the ARRA FMAPs for the fourth quarter of FY 2010. To view the notice, see: http://edocket.access.gpo.gov/2010/pdf/2010-27412.pdf

October 25, 2010: Updated ARRA Medicaid Funding Table HHS posted updated state-by-state Medicaid grant funding information, as approved in Section 5001 of ARRA: http://www.hhs.gov/recovery/statefundsfmap-text.html

October 2010: GAO Releases Report on ARRA Medicaid Funds GAO released a report on Medicaid funds under ARRA, which examines how states have used the additional funds and state plans to sustain their Medicaid programs once the funds are no longer available. To access the full report, click here: http://www.gao.gov/new.items/d1158.pdf

August 20, 2010: Updated ARRA Medicaid Funding Table HHS posted updated state-by-state Medicaid grant funding information, as approved in Section 5001 of ARRA: http://transparency.cit.nih.gov/RecoveryGrants/grant.cfm?grant=Reinvestment

August 26, 2010: HHS Publishes ARRA FMAPs for Third Quarter of FY 2010 HHS published a noticed in the Federal Register that provides the ARRA FMAPs for the third quarter of FY 2010. To view the notice, see: http://edocket.access.gpo.gov/2010/pdf/2010-21235.pdf

June 21, 2010: CMS Issues Guidance on ARRA FMAPs Related to Political Subdivisions CMS provided clarification on the interpretation and application of the political subdivision requirement included in ARRA. To view the guidance, see:
http://www.cms.gov/smdl/downloads/SMD10010.pdf

June 9, 2010: OIG Releases Audit Reports on ARRA Medicaid Eligibility Requirements
HHS Office of Inspector General (OIG) released two reports on compliance with the Medicaid eligibility requirements in New Hampshire and Minnesota. To view the reports, go to: http://oig.hhs.gov/recovery/recovery_reports.asp

May 10, 2010: CMS Releases Letter on Clawback Calculation The Centers for Medicare and Medicaid Services (CMS) notified states of the clawback multipliers for the third quarter of FY 2010, based on the increased Medicaid matching rates under ARRA. The letter is available at: http://www.cms.gov/smdl/downloads/SMD10007.pdf

May 6, 2010: HHS Office of Disability Awards ARRA Funds for Data Collection Efforts  The HHS Office on Disability awarded $6 million under ARRA to establish a Center of Excellence in Research on Disability Services, Care Coordination and Integration. For more information, click here: http://www.hhs.gov/news/press/2010pres/05/20100506a.html

April 30, 2010: HHS Publishes ARRA FMAPs for Second Quarter of FY 2010 HHS published a noticed in the Federal Register that provides the ARRA Federal Medical Assistance Rates (FMAP) for the second quarter of FY 2010. To view the notice, see:
http://edocket.access.gpo.gov/2010/pdf/2010-10055.pdf


April 29, 2010: NCSL Releases Report on ARRA FMAP Extension and State Budget Impact The National Conference of State Legislatures (NCSL) released a report on the proposed six-month extension of the ARRA FMAPs. It includes information on whether states have budgeted on the assumption that Congress will approve the extension, how much states have budgeted for an extension, and whether states have developed any budget contingencies in the event that the FMAP is not extended. The full report is here: http://inside.ffis.org//ff/NALFO_Enhanced_FMAP_Extension.pdf

March 5, 2010: CMS Issues Guidance on Revised Clawback Calculations The Centers for Medicare and Medicaid Services (CMS) issued a letter to state Medicaid directors formally notifying states of a change in policy that relies on the increased Medicaid matching rates under ARRA when calculating the phased down state contribution for the Medicare Part D program-commonly known as the "clawback." The letter, which is attached, provides additional information about the policy, an explanation of how the new calculations will be applied, and how each state will be notified of the adjustments.

February 2, 2010: HHS Publishes ARRA Adjustments to FMAPs HHS published in the Federal Register the adjusted FMAP rates for the first quarter of FY 2010. To view the notice, see: http://edocket.access.gpo.gov/2010/pdf/2010-2177.pdf

January 22, 2010: CMS Releases ARRA Guidance The Centers for Medicare and Medicaid Services (CMS) sent a letter to state Medicaid directors containing guidance on the implementation of Section 5006 of ARRA, which includes protections for Indians in Medicaid and CHIP: http://www.cms.hhs.gov/smdl/downloads/SMD10001.PDF  

December 30, 2009: CMS Proposes Requirements for EHR Medicare and Medicaid Incentive Payment Programs The Centers for Medicare and Medicaid Services (CMS) announced a proposed rule to implement the provisions of ARRA that provide incentive payments to eligible professionals and hospitals participating in Medicare and Medicaid programs that adopt and meaningfully use certified electronic health record (EHR) technology. The rule includes a 60-day comment period. To view the proposed rule, see: http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf

The following fact sheet summarizes the provisions in the proposed rule affecting state Medicaid programs and Medicaid providers: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3562&intNumPerPage=10&checkDate=&checkKey=&srchType=
1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType
=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

The following fact sheet summarizes CMS's proposed definition of meaningful use: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3564&intNumPerPage=10&checkDate=&checkKey=&srchType=
1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType
=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

December 8, 2009: Federal Register Notice on ARRA FMAPs HHS published a notice in the Federal Register that finalizes the methodology for calculating the higher federal matching funds under ARRA and provides the final calculation of the adjusted Federal Medical Assistance Percentage (FMAP) rates for the third and fourth quarters of FY 2009. The methodology for calculating the FMAPs is the same as the one proposed in the August 4, 2009 notice (see FFIS Issue Brief 09-28 for more information). To view the Federal Register notice, go to: http://edocket.access.gpo.gov/2009/pdf/E9-29248.pdf  

September 1, 2009: HIT Provisions The Centers for Medicare and Medicaid Services (CMS) released a State Medicaid Director Letter on the Health Information Technology (HIT) provisions inARRA. ARRA allows for 100% federal financial participation (FFP) for state expenditures for Medicaid provider incentive payments to encourage electronic health record (EHR) technologyand for demonstrating meaningful use. According to the letter, upon receipt, states may immediately request the 90% FFP match for administrative planning activities. The letter also advises states to immediately contact their CMS regional office for further guidance and maintain ongoing communication while initiating planning activities. The guidance statesthat planning activities are for the purposes of administering the incentive payments to providers, ensuring their proper payments, auditing and monitoring of such payments, and participating in statewide efforts to promote interoperability and meaningful use of EHRs. CMS indicated the agency is developing rulemaking that will provide more detailed instruction on provider eligibility and rules for participation. The proposed rulemaking is expected by the end of this year. The letter is available at:
http://www.cms.hhs.gov/SMDL/SMD/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=1&sortOrder=descending&itemID=CMS1228276&intNumPerPage=1

August 28, 2009: Updated Funding Information for DSH HHS posted updated funding information on the Medicaid Disproportionate Share Hospital Program (DSH):
http://transparency.cit.nih.gov/RecoveryGrants/grant.cfm?grant=DSH

August 19, 2009: CMS ARRA Guidance The Centers for Medicare and Medicaid Services released another State Medicaid Director letter that provides guidance on ARRA, including the process for accessing the increased Federal Medical Assistance Percentage (FMAP), expenditures for which the increased FMAP is available, and the eligibility maintenance of effort (MOE) requirements. The letter can be found at:
http://www.cms.hhs.gov/SMDL/SMD/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=1&sortOrder=descending&itemID=
CMS1227962&intNumPerPage=10

August 4, 2009: Change in FMAP Calculations HHS will likely change the way it calculates the increased FMAP rates under ARRA. Initially, the methodology for the unemployment bonus relied on unemployment data for the most recent three-month period for which data are available prior to the beginning of the quarter for which the FMAP is being determined. This data included both preliminary and final data and the months used depended on the data available from the Bureau of Labor Statistics. It appears that HHS will now calculate preliminary quarterly FMAP rates at the time preliminary monthly data for the month prior to the start of the quarter is available (this data will not be available until after the start of the quarter). HHS will then calculate final quarterly FMAP rates at the time final monthly data for the month prior to the start of quarter is available. Attached is a notice describing this change and providing the ARRA adjustments to the FMAP for the third quarter of FY 2009. Because of the change in methodology, these rates differ from those estimated by FFIS. This notice can be found here in the Federal Register.

July 31, 2009: OIG Releases Report on ARRA Medicaid Funding The Office of Inspector General (OIG) released a report regarding its review of the Centers for Medicare and Medicaid Services' (CMS) calculation of additional Medicaid funding awarded under ARRA for the first two quarters of FY 2009. The report, available at http://oig.hhs.gov/oas/reports/region9/90900080.pdf, found that CMS calculated the amounts in accordance with federal law.

July 30, 2009: Centers for Medicare and Medicaid Services (CMS) Issues SMD CMS issued a Dear State Medicaid Director (SMD) Letter providing policy guidance to states on section 5001 of ARRA as it applies to prompt pay provisions. These requirements must be met to qualify for the increased FMAP and have been expanded to include hospital and nursing home claims (in addition to practitioner claims). The letter and technical appendix is available at:
http://www.cms.hhs.gov/smdl/downloads/SMD073009.pdf
http://www.cms.hhs.gov/smdl/downloads/SMD073009ATT.pdf 

July 7, 2009: CMS FAQ The Centers for Medicare and Medicaid Services (CMS) released an updated frequently asked questions document that covers the Making Work Pay credit, Temporary Increase of Medicaid FMAP, and Disproportionate Share Hospital Allotments. The updated document is attached.

June 17, 2009: CMS Releases Guidance on ARRA Implementation The Centers for Medicare and Medicaid Services (CMS) released a State Medicaid Director letter to provide guidance on the implementation of the ARRA. It summarizes the sections of ARRA that impact Medicaid and CHIP and provides detail on the sections specific to payments that should not be counted for purposes of determining eligibility. Below is a link to the letter and its attachments:
http://www.cms.hhs.gov/SMDL/downloads/SMD061709.pdf
http://www.cms.hhs.gov/SMDL/downloads/SMD061709att.pdf

May 22, 2009: OIG Reviews FMAP Calculation An Office of Inspector General (OIG) report found that the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) correctly calculated the temporary FMAP increases for the first and second quarters of FY 2009. As such, the report contains no recommendations. The complete report can be found at:
http://oig.hhs.gov/oas/reports/region9/90900075.pdf

May 1, 2009: Medicaid Regulations Rescinded HHS announced it would rescind three Medicaid regulations that were finalized over the past several years. The regulations are currently under moratoria until June 1, 2009. They would impact certain payments for outpatient hospital services, school-based administration and transportation claims, and targeted case management (TCM). Two of the regulations have not yet been implemented by the Centers for Medicare and Medicaid Services (CMS), and one, TCM, has been partially implemented. A regulation addressing the provider tax policy will be delayed for one year while more information is gathered. The notice, scheduled to be published in the Federal Register May 6, cites the adverse effects the regulations could have on beneficiaries and states. It is currently available at: http://edocket.access.gpo.gov/2009/pdf/E9-10494.pdf

April 24, 2009: Updated Q&A The Centers for Medicare and Medicaid Services updated the Qs and As for the ARRA FMAP guidance. The guidance is available at:
http://www.cms.hhs.gov/Recovery/Downloads/ARRA_FAQs.pdf

April 21, 2009: Recalculated FMAPs HHS has announced the Federal Medical Assistance Percentages (FMAPs) for the first two quarters of federal FY 2009, which have been recalculated pursuant to ARRA. These percentages will be effective from October 1, 2008, through March 31, 2009. The attached Federal Register notice announces the FMAPs for state medical assistance under Title XIX and Title IV-E. The table gives figures for each of the 50 states and the District of Columbia.

April 6, 2009: TMA Guidance Attached is a letter to state Medicaid directors regarding Transitional Medical Assistance changes in ARRA. Also attached is Supplement 12 to Attachment 2.6. FFIS Issue Brief 09-13 describes the changes.

March 25, 2009: FMAP Compliance Guidance HHS released guidance to states on compliance with the requirements for the enhanced Medicaid FMAP provisions that were included in ARRA. It is attached.