The Centers for Medicare & Medicaid Services (CMS) issued a final rule with request for comment to implement provisions of the Affordable Care Act on the increased Federal Medical Assistance Percentage (FMAP) for certain Medicaid beneficiaries in states. This rule codifies the increased FMAP rates that will be applicable beginning January 1, 2014 and outlines a methodology states will use to claim the appropriate matching rates. An increased FMAP rate is available for medical services provided to people defined as “newly eligible” who are enrolled in the new eligibility group for adults up to 133 percent of the poverty level. In general, individuals are “newly eligible” if they are enrolled in the new adult group and would not have been eligible for full benefits, benchmark benefits, or benchmark-equivalent benefits under the eligibility rules in that state in effect in December 2009. 

The rule also describes the increased FMAP available under the Affordable Care Act in a defined “expansion state” if the state had expanded coverage to the adult group prior to enactment of the Affordable Care Act. Based on public comments on the proposed rule and additional CMS analysis, the final rule selects the threshold methodology, one of the three methodologies described in the proposed rule, as the methodology that states will use to determine the appropriate FMAP related to “newly eligible” individuals. The threshold methodology would require states to convert their December 1, 2009 eligibility standards into the modified adjusted gross income (MAGI) format and then would use that measurement to assess the FMAP percentage.

Link(s): Final Rule