Reducing administrative burden for Medicaid

The 2nd COVID response bill ( Families First Coronavirus Response Act (FFCRA) (Pub. L. 116-127) ) has several big Medicaid components to it.  The biggest is an increased federal share of legacy Medicaid.  The FFCRA increases the federal payment by 6.2 percentage points for states that agree to certain conditions.  Those conditions are states can’t create administrative barriers to enrollment.

CMS has a guidance document that illustrates how administrative burden can’t be deployed to decrease enrollment during a crisis.

1. What must a state do to receive a 6.2 percentage point temporary increase to the
federal medical assistance percentage (FMAP)?
To qualify for the temporary FMAP increase, states must, through the end of the month when the public health emergency ends:
a. Maintain eligibility standards, methodologies, or procedures that are no more restrictive than what the state had in place as of January 1, 2020 (maintenance of effort requirement).
b. Not charge premiums that exceed those that were in place as of January 1, 2020
c. Cover, without impositions of any cost sharing, testing, services and treatments—including vaccines, specialized equipment, and therapies—related to COVID-19.
d. Not terminate individuals from Medicaid if such individuals were enrolled in the program as of the date of the beginning of the emergency period, or becomes enrolled during the emergency period, unless the individual voluntarily terminates eligibility or is no longer a resident of the state (continuous coverage requirement).
These requirements became effective on March 18, 2020. More information on these conditions is provided below.
2. What is the maintenance of effort (MOE) requirement in the FFCRA? What types of eligibility and enrollment changes can states make to respond to the current emergency and still receive temporary increased FMAP?
States may not impose eligibility standards, methodologies, or procedures that are more restrictive than those that were in place on January 1, 2020, in order to receive increased
FMAP during the emergency period. States may continue to make temporary or permanent eligibility and enrollment changes that are less restrictive…

Translating this out, it means that January 1, 2020 is the anchor for qualification criteria. States can loosen qualification and get the extra federal money but they can not tighten. Secondly, if a person is deemed eligible for Medicaid, they are going to remain eligible for Medicaid for the duration of the emergency except under very limited circumstances. Adminstrative burden of frequent redeterminations that require filling out 106 page applications won’t be able to reduce enrollment during the emergency period.

FFCRA is a major legislative change to Trump Administration policy of encouraging the deployment of administrative frictions to drive down Medicaid enrollment.