StateMedicaid directors are advised that the increased federal medical percentage (FMAP) available under the American Recovery and Reinvestment Act of 2009 ( PubLNo 111-5 ) will be accessed through separate grant awards under the Payment Management System (PMS). Each time a state agency draws funds from the account, the agency director is deemed to have made five attestations: (1) all expenditures for which the funds are drawn are eligible for the increased FMAP; (2) no amounts attributable to the increase will be deposited or credited into any state reserve fund or rainy day account; (3) the agency does not require political subdivisions to increase their contributions to the nonfederal share of Medicaid expenditures over its requirements as of September 30, 2008; (4) the state has complied with maintenance of effort requirements, i.e. , no standards or procedures for determining eligibility are more restrictive than those in effect on July 1, 2008; and (5) the expenditures for which the funds are drawn are not claims of practitioners, nursing homes or hospitals received on a day when the state was out of compliance with the prompt payment requirement. The expenditures that are ineligible for increased FMAP include: (1) disproportionate share hospital payments; (2) services for expansion populations, individuals who became eligible because of an increased income or resource limit or a new category based on the federal poverty level; and (3) payments to Indian Health Service providers, which already receive 100 percent FMAP. Changes in eligibility standards or procedures are more restrictive if their application would cause an otherwise eligible applicant to be ineligible; examples include new or increased premiums or enrollment fees, reduction or elimination of slots in waiver programs, more frequent redeterminations of eligibility or more stringent institutionalization requirements.
CMS Letter to State Medicaid Directors, No. SMD-09-05, Aug. 19, 2009, ¶52,981
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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