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Centers for Medicare and Medicaid Services, Department of Health and Human Services

AUTHORIZATION

Social Security Act, Title XIX, as amended; Public Laws 89-97, 90-248, and 91-56; 42 U.S.C. 1396 et seq., as amended; Public Law 92-223; Public Law 92-603; Public Law 93-66; Public Law 93-233; Public Law 96-499; Public Law 97-35; Public Law 97-248; Public Law 98-369; Public Law 99-272; Public Law 99-509; Public Law 100-93; Public Law 100-202; Public Law 100-203; Public Law 100-360; Public Law 100-436; Public Law 100-485; Public Law 100-647; Public Law 101-166; Public Law 101-234; Public Law 101-239; Public Law 101-508; Public Law 101-517; Public Law 102-234; Public Law 102-170; Public Law 102-394; Public Law 103-66; Public Law 103-112; Public Law 103-333; Public Law 104-91; Public Law 104-191; Public Law 104-193; Public Law 104-208,104-134; Balanced Budget Act of 1997, Public Law 105-33; Public Law 106-113; Public Law 106-554; Public Law 108-27; Public Law 108-173; Public Law 109-91; Public Law 109-171; Public Law 109-432; Public Law 110-28; Public Law 110-161; Public Law 111-3; Public Law 111-5.

OBJECTIVES

To provide financial assistance to States for payments of medical assistance on behalf of cash assistance recipients, children, pregnant women, and the aged who meet income and resource requirements, and other categorically-eligible groups. In certain States that elect to provide such coverage, medically-needy persons, who, except for income and resources, would be eligible for cash assistance, may be eligible for medical assistance payments under this program. Financial assistance is provided to States to pay for Medicare premiums, copayments and deductibles of qualified Medicare beneficiaries meeting certain income requirements. More limited financial assistance is available for certain Medicare beneficiaries with higher incomes.

TYPES OF ASSISTANCE

USES AND USE RESTRICTIONS

For the categorically needy, States must provide in-and-out patient hospital services; rural health clinic services; federally-qualified health center services; other laboratory and x-ray services; nursing facility services, home health services for persons over age 21; family planning services; physicians' services; early and periodic screening, diagnosis, and treatment for individuals under age 21; pediatric or family nurse practitioner services; and services furnished by a nurse-midwife as licensed by the States. For the medically needy, States are required to provide a minimum mix of services for which Federal financial participation is available (see section 1902(a)(10)(C)(iv) of the Social Security Act).

ELIGIBILITY REQUIREMENTS

Applicant Eligibility

State and local welfare agencies must operate under an HHS-approved Medicaid State Plan and comply with all Federal regulations governing aid and medical assistance to the needy.

Beneficiary Eligibility

Low-income persons who are over age 65, blind or disabled, members of families with dependent children, low- income children and pregnant women, certain Medicare beneficiaries and, in many States, medically-needy individuals may apply to a State or local welfare agency for medical assistance. Eligibility is determined by the State in accordance with Federal regulations.

Credentials/Documentation

Federal funds must go to a designated State Medicaid Agency. Individuals must meet State requirements. Administrative costs will be determined in accordance with OMB Circular No. A-87, 'Cost Principles for State and Local Governments.'. OMB Circular No. A-87 applies to this program.

APPLICATION AND AWARD PROCESS

Preapplication Coordination

Preapplication coordination is required. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.

Application Procedure

OMB Circular No. A-102 applies to this program. This program is excluded from coverage under OMB Circular No. A-110. Individuals needing medical assistance should apply directly to the State or local welfare agency. States should contact the Regional Administrator, CMS for application forms. (See Appendix IV of the Catalog for agency Regional Office addresses.)

Award Procedure

States are awarded funds quarterly based on their estimates of funds needed to provide medical assistance to the needy. Awards are made quarterly on a fiscal year basis as follows: October 1, January 1, April 1, and July 1. Individuals receive medical care from providers of medical care who are participating in the Medicaid program.

Deadlines

Nov 15, 2009 An individual needing medical assistance may apply to the State at any time. States must submit quarterly estimates of funds needed no later than August 15, November 15, February 15, and May 15, in order to receive a timely quarterly grant award for the following quarter.

Range of Approval/Disapproval Time

Up to 60 days. The States usually provide needy individuals with immediate medical assistance.

Appeals

Individuals denied medical assistance by the State or local welfare agency must be given a fair hearing on appeal (see 42 CFR, Subchapter C, Part 431, Subpart E). States have 60 days to resubmit revised applications.

Renewals

Recipients receive assistance as long as they are qualified under State requirements.

ASSISTANCE CONSIDERATION

Formula and Matching Requirements

Statutory Formula: Matching Requirements: Federal funds are available to match State expenditures for medical care. Under the Act, the Federal share for medical services may range from 50 percent to 83 percent. The statistical factors used for fund allocation are: (1) Medical assistance expenditures by State; and (2) per capita income by State based on a 3-year average (source, 'Personal Income,' Department of Commerce, Bureau of Economic Analysis). Statistical factors for eligibility do not apply to this program. This program has maintenance of effort (MOE) requirements, see funding agency for further details.This program has MOE requirements, see funding agency for further details.

Length and Time Phasing of Assistance

The needy receive medical assistance as necessary. States receive funds quarterly. The Electronic Transfer System will be used by States for monthly cash draws on the Federal Reserve Bank. Method of awarding/releasing assistance: lump sum.

POST ASSISTANCE REQUIREMENTS

Reports

No program reports are required. No cash reports are required. No progress reports are required. States must submit fiscal and statistical reports, as required, to the Centers for Medicare and Medicaid Services, Department of Health and Human Services. A Treasury Report TUS-5401 is required monthly. States must submit certified expenditure reports within 30 days after the end of each quarter. No performance monitoring is required.

Audits

In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003), 'Audits of States, Local Governments, and Non-Profit Organizations,' nonfederal entities that expend financial assistance of $500,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $500,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in Circular No. A-133.

Records

States must maintain records which substantiate direct and indirect costs charged to the grant award activity.

FINANCIAL INFORMATION

Account Identification

Obligations

(Formula Grants (Apportionments)) FY 08 $211,212,633,000; FY 09 est $262,389,063,000; FY 10 est $289,763,503,000

Range and Average of Financial Assistance

$6,600,000 TO $32,190,544,000.

Program Accomplishments

Fiscal Year 2009: No Current Data Available Fiscal Year 2010: It is estimated that there will be 53,300,000 Medicaid enrollees in fiscal year 2010. Fiscal Year 2011: No Current Data Available

Regulations, Guidelines, and Literature

42 CFR, Subchapter C.

INFORMATION CONTACTS

Regional or Local Office

See Regional Agency Offices. Contact the Associate Regional Administrator, Division of Medicaid, Centers for Medicare and Medicaid Services. (See Appendix IV of the Catalog for addresses and telephone numbers.).

Headquarters Office

Division of Medicaid 7500 Security Boulevard, Baltimore, Maryland 21244 Phone: 410-786-3870

93.778 Medical Assistance Program

(Medicaid; Title XIX)

FEDERAL AGENCY