Medicaid Maintenance of Eligibility (MOE) Requirements: Issues to Watch
Issue Brief
CMS, Families First Coronavirus Response Act, Coronavirus Aid, Relief, and Economic Security Act Frequently Asked Questions, question 23, https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-CARES-faqs.pdf.
Except that a state could receive the enhanced funds from March 18 through April 17, 2020 if a premium in effect during that period was higher than those in effect on January 1, 2020. This provided a 30-day grace period for states to restore premiums to the amount required on January 1, 2020. CMS, Families First Coronavirus Response Act, Coronavirus Aid, Relief, and Economic Security Act Frequently Asked Questions, question 23, https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-CARES-faqs.pdf.
States also cannot collect any premiums that were due but unpaid during the continuous eligibility period after the MOE ends. CMS, Families First Coronavirus Response Act, Coronavirus Aid, Relief, and Economic Security Act Frequently Asked Questions, question 24, https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-CARES-faqs.pdf.
CMS, Families First Coronavirus Response Act – Increased FMAP FAQs, question B.1 https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-faqs.pdf.
CMS, Families First Coronavirus Response Act – Increased FMAP FAQs, question B.12 https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-faqs.pdf.
Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency, 85 Fed. Reg. 71142 (Nov. 6, 2020), https://www.federalregister.gov/documents/2020/11/06/2020-24332/additional-policy-and-regulatory-revisions-in-response-to-the-covid-19-public-health-emergency.
CMS, All-State Call, (October 29, 2020), https://www.cms.gov/files/audio/covid19allstatecall10292020.mp3.
This applies only to cost-sharing, such as copayments; states may still not increase or impose new premiums throughout the duration of the MOE period as required by the separate MOE provision at Families First Coronavirus Response Act, Section 6008 (b)(2).
“Minimum essential coverage” (MEC) describes the health insurance that individuals must maintain to comply with the ACA’s individual mandate. IRS regulations and CMS guidance provide that most Medicaid benefit packages generally qualify as MEC and specify when certain limited benefit packages, such as family planning services, tuberculosis services and pregnancy-related services, do not qualify as MEC. CMS, State Health Official Letter: Minimum Essential Coverage, (November 7, 2014), https://www.medicaid.gov/federal-policy-guidance/downloads/sho-14-002.pdf.
The rule separately provides that states that opt to cover lawfully present children and pregnant women who otherwise would be subject to the 5-year bar must move those enrollees to emergency Medicaid if they no longer meet lawfully present criteria.
CMS, All-State Call, (November 24, 2020), https://www.cms.gov/files/audio/covid19allstatecall11242020.mp3.
This provision applies only when there is a Public Assistance Reporting Information System (PARIS) data match showing potential residency in another state, the individual does not respond to a state request for information to verify residency, and the state takes “all reasonably available measures to attempt to verify residency.” Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency, 85 Fed. Reg. 71142 (Nov. 6, 2020), https://www.federalregister.gov/documents/2020/11/06/2020-24332/additional-policy-and-regulatory-revisions-in-response-to-the-covid-19-public-health-emergency; CMS, All-State Call, (December 1, 2020), https://www.cms.gov/files/audio/covid19allstatecall12012020.mp3.
CMS, Families First Coronavirus Response Act – Increased FMAP FAQs, question D.3, https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-faqs.pdf.
Id. at question D.1.
Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency, 85 Fed. Reg. 71142 (Nov. 6, 2020), https://www.federalregister.gov/documents/2020/11/06/2020-24332/additional-policy-and-regulatory-revisions-in-response-to-the-covid-19-public-health-emergency.
42 U.S.C. § 247d (a).
Most states have opted to send prepopulated renewal forms and/or offer reconsideration periods for non-MAGI populations. KFF, Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey, (June 2019), https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-issue-brief/.
42 CFR § 435.916 (a)-(f).
42 CFR § 435.916 (f).
See 42 C.F.R. § § 435.917, 431.206–431.214, 431.220 (a).
CMS, All-State Call, (December 1, 2020), https://www.cms.gov/files/audio/covid19allstatecall12012020.mp3.
CMS, Facilitating Medicaid and CHIP Enrollment and Renewal in 2014 (May 17, 2013), https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/SHO-13-003_0.pdf.
CMS, Answers to Frequently Asked Questions: Telephonic Applications, Medicaid and CHIP Eligibility Policy and 75/25 Federal Matching Rate (August 9, 2013), https://www.medicaid.gov/federal-policy-guidance/downloads/faq-08-09-2013.pdf.
42 C.F.R. § 435.948.
KFF, Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2020: Findings from a 50-State Survey, (March 2020), https://www.kff.org/report-section/medicaid-and-chip-eligibility-enrollment-and-cost-sharing-policies-as-of-january-2020-findings-from-a-50-state-survey-enrollment-and-renewal-processes/.
Id.