mmpc - National Indian Health Board

- I/T/U provider receives their all-inclusive or FQHC rate
(either directly from the plan or Medicaid makes up the
difference between plan payment and the I/T/U’s rate)
iii. There is not a specific date by which a state has to inform CMS
that it intends to expand Medicaid. The standard State Plan
Amendments procedures apply.
b. Other changes to Medicaid called for under the ACA are to be
implemented whether or not a state exercises the Medicaid expansion
option.
i. Application of a uniform definition of income using the new
definition of modified adjusted gross income (MAGI)
ii. No asset test for non-long term care service eligibility
iii. Maintenance of effort requirements on income eligibility continue
through 2019 for children and through 2014 for others
c. The ACA-directed study of a Navajo “single state agency for Medicaid”
was referenced several times by CMS and IHS.
i. The initial draft of the study is due from the contractor
Econometrica to CMS by October 2013.
ii. A final report is due to Congress from CMS by early 2014
d. Determining “Indian” for Exchange and IRS-related provisions.
i. In response to the question “How will AI/AN prove that they don’t
have to have insurance”, CMS staff responded “Exchange will
have to issue a letter or other document to an AI/AN so they have
proof.”
- It seems that this answer needs further clarification, if not
revision.
ii. A follow-up question was asked: “what documentation is required
by an AI/AN to provide to the Exchange to prove being an AI/AN”.
CMS staff responded: “CMS needs more input from tribes.”
e. Certification standards applied to Qualified Health Plans offered through
an Exchange.
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