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Late News: HHS issues final rule on Medicaid beneficiaries

By Jonathan Block and Rich Daly
Posted: March 30, 2013 - 12:01 am ET

HHS delivered its final rule on the federal funding to cover the full cost of new Medicaid beneficiaries under the healthcare reform law, but the department is still accepting comments on the methodology states can use to determine whether a new beneficiary qualifies for the enhanced funding. That's important because anyone not deemed “newly eligible” doesn't qualify for that 100% federal match and would instead draw the lower rate for those already enrolled in Medicaid. The 104-page regulation describes the methods states will use to determine who is eligible for the 100% match rate, known as the federal medical assistance percentage (FMAP). Under the Patient Protection and Affordable Care Act, states that participate in the Medicaid expansion and enroll individuals whose annual income is up to 133% of the federal poverty level will have the costs of these new enrollees covered entirely by the federal government from 2014-16. After 2016, the federal contribution will gradually phase down, reaching 90% in 2020. “This is a great deal for states and great news for Americans,” HHS Secretary Kathleen Sebelius said in a news release. Lawmakers in several states remain unconvinced. Last week, Tennessee Gov. Bill Haslam said his state would decline to expand eligibility and forfeit the additional funding unless federal officials allow Tennessee to use the money to help the newly covered residents buy private health insurance. The increased FMAP becomes effective Jan. 1, 2014. The final rule incorporates comments received after the proposed rule was issued Aug. 17, 2011, and it includes details on the treatment of disability status and enrollment caps in states with certain demonstration projects.


Gov. Bill Haslam said Tennessee would decline expansion without changes.



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