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HHS finalizes rule on funding payment rates for new Medicaid beneficiaries

April 1, 2013
by Patricia Sheehan, Editor-in-Chief
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The federal government last Friday announced a final rule that provides 100 percent payment of the cost of certain newly eligible adult Medicaid beneficiaries. These payments will be in effect January 1, 2014 through 2016, phasing down to a permanent 90 percent matching rate by 2020.

The Affordable Care Act (ACA) authorizes states to expand Medicaid to adult Americans under age 65 with income of up to 133 percent of the federal poverty level (approximately $15,000 for a single adult in 2012) and provides federal funding for these states.

The final rule describes the method states will use to claim the matching rate that is available for Medicaid expenditures of individuals with incomes up to 133 percent of poverty and who are defined as “newly eligible” and are enrolled in the new eligibility group. 

For states that had coverage expansions in effect prior to enactment of the ACA, the rule also provides information about the availability of an increased FMAP (Federal Medical Assistance Percentages) for certain adults who are not newly eligible.

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