Persius/hicric huggingface dataset:
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
 
 
CMCS Informational Bulletin 
 
DATE:   July 31, 2017 
 
FROM:  Brian Neale, Director 
Center for Medicaid and CHIP Services 
 
SUBJECT:   Promoting Access in Medicaid and CHIP Managed Care: Strategies for 
Ensuring Provider Network Adequacy and Service Availability 
CMS believes that states are in the best position to develop meaningful and appropriate network 
adequacy and service availability standards that reflect the scope of their programs, the 
populations served, and the unique demographics and characteristics of each state.  To assist 
states in developing their network adequacy and service availability standards, CMS formed a 
working group of states to discuss common access challenges and goals, as well as to create a 
forum for states to present their successful techniques for establishing and monitoring network 
adequacy in their programs.  The product of this groups efforts is a compilation of effective and 
promising network adequacy and service availability strategies and analysis techniques, as well 
as valuable data sources that states are using to develop and assess the availability of providers 
and services in their states.  Promoting Access in Medicaid and CHIP Managed Care: A 
Toolkit for Ensuring Provider Network Adequacy and Service Availability provides detailed 
descriptions of state access strategies and techniques that states can easily replicate, or states can 
customize the strategies and techniques to produce measures that address unique access 
challenges in their Medicaid and CHIP programs. 
The Toolkit is not intended to be an exhaustive list of approaches; it describes various standards 
and approaches that may offer states new and reasonable ways to promote access to care.  CMS 
understands that state Medicaid and CHIP agencies play a crucial role in setting goals, standards, 
and incentives to promote timely access, as well as work with managed care plans, providers, 
consumers, and other stakeholders to address barriers to care.  The Toolkit is intended to provide 
guidance and resources to help states fulfill these important responsibilities. 
Technical Assistance 
 
CMS remains committed to providing technical assistance to states and other stakeholders in 
understanding the Medicaid managed care regulatory provisions.  If you have questions or would 
like to request technical assistance related to the guidance in this informational bulletin, please 
send an email to ManagedCareRule@cms.hhs.gov.  We look forward to continuing our 
partnership to deliver on our shared goals of providing high quality, sustainable healthcare to 
those who need it most.
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Health Care Financing Administration  
 Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
August 17, 1998  
Dear State Medicaid Director:  
I am writing to inform you that a final regulation with comment was published in the Federal Register on August 7, 1998 
that gives States increased flexibility to coordinate TANF and Medicaid eligibility for low income families under section 
1931 of the Social Security Act. A copy of the regulation is attached to this letter.  
Prior regulations allowed States to provide Medicaid coverage to single parent families regardless of the number of hours 
that the parent was working but did not allow States to provide Medicaid coverage to two parent families in which the 
principal wage earner was working more than 100 hours per month. The regulation removes this 100 hour limitation.  
The only exception to this limit had been for States which had received an AFDC waiver which could then be carried over 
to Medicaid. With this regulatory change, all States will be able to provide health care coverage under Medicaid to 
virtually all TANF recipients and to continue that health coverage after a parent has found employment.  
This past June, the Administrator of HCFA and the Assistant Secretary for Children and Families wrote you and TANF 
Administrators urging you to seek out innovative ways to coordinate the administration of and eligibility for your TANF 
and Medicaid programs. This regulatory change provides another tool that you can use to more effectively coordinate 
these two programs. We urge you once again to invest every possible effort in reaching our to low-income families and in 
facilitating the enrollment of all eligible children.  
Sincerely,   
/s/   
Sally K. Richardson   
Director  
cc:  
Nolan Jones, National Governors' Association   
Lee Partridge, American Public Human Services Association   
Joy Wilson, National Conference of State Legislatures
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
 
 
CMCS Informational Bulletin 
 
DATE:  November 20, 2020 
 
FROM:  Anne Marie Costello, Acting Deputy Administrator and Director 
Center for Medicaid & CHIP Services  
 
SUBJECT:  2021 SSI and Spousal Impoverishment Standards   
 
This CMCS informational bulletin is to provide an update on the 2021 Supplemental Security 
Income (SSI) and Spousal Impoverishment Standards. 
 
Certain Medicaid income and resource standards are adjusted beginning each January in 
accordance with changes in the SSI federal benefit rate (FBR) and the Consumer Price Index 
(CPI). Many states offer, for example, categorical eligibility to individuals who are not receiving 
SSI but who meet the financial eligibility requirements of the program, as authorized by 
1902(a)(10)(A)(ii)(I) of the Social Security Act (the Act). Similarly, most states have adopted 
the special income level institutional eligibility category authorized under Section 
1902(a)(10)(A)(ii)(V) of the Act, the maximum income standard for which is 300% of the SSI 
FBR. Additionally, certain eligibility standards relating to coverage of long-term services and 
supports, including the home equity limitation in Section 1917(f) of the Act and elements of the 
spousal impoverishment statute in Section 1924, are increased each year based on increases in 
the CPI for All Urban Consumers (CPI-U). 
 
Included with this informational bulletin is the 2021 SSI and Spousal Impoverishment Standards 
chart that displays the new standards. These standards are also available on Medicaid.gov at 
https://www.medicaid.gov/medicaid/eligibility/spousal-impoverishment/index.html. Please 
update your standards in accordance with this information for the provisions that become 
effective on January 1, 2021. 
 
If you have any questions or need additional information, please contact Gene Coffey at 
410-786-2234 or Gene.Coffey@cms.hhs.gov.
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
CMCS Informational Bulletin 
 
DATE:  May 31, 2016 
 
FROM:  Vikki Wachino, Director                                                                                       
Center for Medicaid and CHIP Services 
SUBJECT:  Updated 2016 Spousal Impoverishment Standards 
 
Certain Medicaid income and resource standards are adjusted annually in accordance with 
changes in the Supplemental Security Income (SSI) federal benefit rate and the Consumer Price 
Index (CPI).  These include some of the standards described in section 1924 of the Social 
Security Act (the Act), which describes the financial eligibility rules (the spousal 
impoverishment rules) that apply when married individuals seek coverage of certain long-term 
services and supports. 
 
While some of the spousal impoverishment standards, such as the maximum community spouse 
income maintenance allowance and community spouse minimum and maximum resource 
allowances, are adjusted each January, section 1924 of the Act directs that the community 
spouses minimum monthly maintenance allowance (MMMNA) be adjusted, in accordance with 
changes to the federal poverty level, effective July 1st of each year.  Additionally, as the 
community spouses monthly housing allowance (which is the basis for determining if the 
community spouse may have an excess shelter allowance) is calculated based on a percentage of 
the MMMNA, the excess shelter allowance is adjusted each July 1st as well.  
Included with this informational bulletin is the revised 2016 SSI and Spousal Impoverishment 
Standards chart that displays the updated MMMNA and Community Spouse Monthly Housing 
Allowances.  These standards are also available on Medicaid.gov at 
http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Spousal-
Impoverishment-Page.html.  
 
Please update your standards in accordance with this information. 
 
If you have any questions or need additional information, please contact Gene Coffey at 410-
786-2234 or Gene.Coffey@cms.hhs.gov.
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Health Care Financing Administration  
 Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
October 26, 1998  
Dear State Medicaid Director:  
Enclosed is the Medicaid and Medicare Immunization Resource Guide which was developed to facilitate State Medicaid 
and HCFA collaboration on a value based, quality-focused purchasing project on immunization. This Guide is the first 
product of the Value Based Purchasing (VBP) Workgroup (5x5) comprised of five State Medicaid Directors and five 
members of HCFA's senior staff. The workgroup chose to focus its first major initiative on immunization purchasing 
strategies for children and dual eligibles.  
Individual chapters in Volume I of the guide provide information on the use of specific childhood immunization 
purchasing strategies and the extent to which they are evidence-based. The final chapter explores opportunities to 
collaborate with Medicare on flu and pneumococcal projects that are designed to raise immunization coverage levels 
among dual eligibles. Volume II serves as an Appendix and includes a broad array of background materials on 
immunization. The information that is presented was obtained with the support of the staff of the Centers for Disease 
Control.  
I hope that you will find it useful and interesting. If you have any questions or comments, please feel free to contact 
Barbara Greenberg by e-mail (bgreenberg1@hcfa.gov) or telephone (410-786-0435).  
Sincerely,  
 /s/   
Sally K. Richardson   
Director  
 
Attachments  
 
**(To obtain a copy of the Resource Guide, please contact Barbara Greenberg as indicated in the above letter).  
 
cc:  All HCFA Regional Administrators  All HCFA Associate Regional Administrators for Medicaid and State Operations  
All State Medicaid Directors  Lee Partridge - American Public Human Services Association  Joy Wilson - National 
Conference of State Legislators  Nolan Jones - National Governors Association  Cheryl Beversdorf - Association of State 
and Territorial Health Officials
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
 
 
CMCS Informational Bulletin 
 
DATE:  November 20, 2015  
 
FROM:  Vikki Wachino, Director 
Center for Medicaid and CHIP Services 
 
SUBJECT:  2016 SSI and Spousal Impoverishment Standards  
 
Certain Medicaid income and resource standards are adjusted beginning each January in 
accordance with changes in the Supplemental Security Income (SSI) federal benefit rate (FBR) 
and the Consumer Price Index (CPI). Many states offer, for example, categorical eligibility to 
individuals who are not receiving SSI but who meet the financial eligibility requirements of the 
program, as authorized by 1902(a)(10)(A)(ii)(I) of the Social Security Act (the Act). Similarly, 
most states have adopted the special income level institutional eligibility category authorized 
under Section 1902(a)(10)(A)(ii)(V) of the Act, the maximum income standard for which is 
300% of the SSI FBR. Additionally, certain eligibility standards relating to coverage of long-
term services and supports, including the home equity limitation in Section 1917(f) of the Act 
and elements of the spousal impoverishment statute in Section 1924, are increased each year 
based on increases in the CPI for All Urban Consumers (CPI-U).  
 
Included with this informational bulletin is the 2016 SSI and Spousal Impoverishment Standards 
chart that displays the new standards. Most of these standards remain the same compared to the 
2015 standards, because there were no increases in the CPI for Urban Wage Earners and Clerical 
Workers (CPI-W) (which is the index for the SSI FBR), or the Consumer Price Index for All 
Urban Consumers (CPI-U) (which, as noted above, is the index for the home equity limit and 
certain spousal impoverishment standards).  
 
These standards are also available on Medicaid.gov at http://medicaid.gov/Medicaid-CHIP-
Program-Information/By-Topics/Eligibility/Spousal-Impoverishment-Page.html. Please update 
your standards in accordance with this information for the provisions that become effective on 
January 1, 2016.  
 
If you have any questions or need additional information, please contact Gene Coffey at  
410-786-2234 or Gene.Coffey@cms.hhs.gov.
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
 
CMCS Informational Bulletin 
 
 
DATE:   December 21, 2012   
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   Increased Medicaid Payment for Primary Care Questions and Answers 
 
 
Today CMS is pleased to announce the release of important information for states on the 
implementation of the Affordable Care Acts provisions to raise payments for services furnished 
by certain primary care physicians in calendar years 2013 and 2014. 
 
Since the publication of the final rule on November 6, 2012, CMS has received questions from 
states and other stakeholders about this provision.  CMS has developed two Question and 
Answer documents to address many of the questions we have received to date, one document 
related to fee-for-service implementation issues and a second on managed care delivery system 
implementation issues. We hope this information will be helpful. 
 
The Questions and Answers may be accessed at: http://www.medicaid.gov/State-Resource-
Center/Frequently-Asked-Questions/CMCS-Ask-Questions.html 
 
Under the provisions of the regulation, states are required to amend their Medicaid state plans to 
increase payment rates; therefore, CMS has issued a state plan preprint for this purpose. The 
preprint Reimbursement Template -Physician Services, Increased Primary Care Service 
Payment 42 CFR 447.405, 447.410, 447.415, may be accessed 
at: http://www.medicaid.gov/AffordableCareAct/Provisions/Provider-Payments.html
March 13, 2001 
 
Dear State Medicaid Director: 
 
The purpose of this letter is to address continuing questions regarding the 
implementation of the January 12, 2001, final rule on the Revision to Medicaid Upper 
Payment Limit (UPL) Requirements. 
 
There have been questions as to whether the effective date of the UPL 
regulation has been delayed. The rule, in fact, became effective today, March 13, 2001. 
All state plan amendments submitted on or after March 13, 2001, are immediately subject 
to this rule, and therefore there is no transition period for such amendments. Any state 
plan amendment that is submitted on or after March 13, 2001, including modifications to 
existing state plans, that proposes to use federal funds under the Upper Payment 
Limitation authority that does not conform with the new upper payment limitations will 
be disapproved and Federal financial participation will not be available. Any federal 
funds that a state draws down for a state plan amendment submitted after March 13 that is 
pending federal review will be disallowed if the amendment does not meet the 
requirements of the new rule. 
 
While the new rule is an important step in limiting the practice of using 
these funds to gain extra federal matching payments, the Administration remains 
concerned about excessive payments that are not associated with the efficient delivery of 
health care to Medicaid beneficiaries. 
 
I hope this information provides the necessary clarification on this 
issue. 
 
Sincerely, 
 
/s/ 
 
Penny R. Thompson 
Acting Director 
 
cc: 
 
HCFA Regional Administrators 
 
HCFA Associate Regional Administrators for Medicaid and State Operations 
 
Lee Partridge, Director, Health Policy Unit - American Public Human Services 
Association 
 
Joy Wilson, Director, Health Committee - National Conference of State 
Legislatures 
 
Matt Salo, Director of Health Legislation - National Governors&#39; 
Association 
 
Brent Ewig - Association of State and Territorial Health Officials
DEPARTMENT OF HEALTH & HUMAN SERVICES 
                                                                                                  Health Care Financing Administration 
___________________________________________________________________________________
 ____ 
                                                                                                       Center for Medicaid and State Operations 
                                                                                                                                    7500 Security Boulevard 
                                                                                                                                Baltimore, MD 21244-1850 
 
NOV  2 1998 
 
 
Dear State Medicaid Director: 
 
Last June we notified you of our plans to add a new Medicaid feature to the Health Care 
Financing Administration (HCFA) Home Page. This new feature provides summary information 
on the different types of Medicaid Eligibility Quality Control (MEQC) projects operated by 
States. We are pleased to report that this information is now available on the Internet. 
 
This new HCFA website is a good resource for States to access information on the innovative methods 
many States are using to reduce erroneous expenditures and to improve the administration of their 
Medicaid programs. States can obtain descriptions of MEQC projects such as focused studies, special 
reviews and program surveys conducted by States under either a MEQC pilot or a section 1115 waiver. 
Anyone interested in developing a pilot project can access the website to determine if another State has 
conducted a similar project. They can contact that State to obtain specific materials used for that project 
such as copies of data collection instruments, review protocols and guides. In addition, States can use the 
information from the website to communicate with each other on a variety of subjects such as the 
effectiveness of projects in reducing errors. 
 
The Internet address for MEQC pilots provided on the HCFA Home Page is: 
http://www.hcfa.gov/medicaid/regions/mqchmpg.htm. 
 
Information about State MEQC pilots will be updated in March and September of each year. We invite 
you to visit this new website and use this information to your advantage in ensuring Medicaid payment 
accuracy.   States not having access to the Internet can contact their regional office for a hard copy of the 
information 
 
Sincerely, 
 
 
 
Sally K. Richardson U 
Director  Page 2 
cc:  All HCFA Regional Administrators 
 
All HCFA Associate Regional Administrators for Medicaid and State Operations 
 
Lee Partridge 
American Public Human Services Association 
 
Joy Wilson 
National Conference of State Legislatures 
 
Nolan Jones 
National Governors' Association
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Health Care Financing Administration  
 Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
June 24, 1998   
Dear State Medicaid Director:   
 A policy concern relating to certain contract requirements on managed care organizations (MCOs) or prepaid 
health plans (PHPs) has been undergoing Administration review. This is to inform you how we have 
considered this issue and what decision we have reached.   
 Some States have required in their contracts with MCOs or PHPs that any savings within their capitated 
payment, minus an allowed profit, if any, be used to provide health services to persons who are not eligible for 
Medicaid.   
 We view this practice as an inappropriate subsidy for services for the uninsured. (See section 1903(m)(2) 
(A)(iii) of the Social Security Act, which states that capitated programs are intended for Medicaid recipients.)   
 However, we recognize that when a capitated payment is made to an MCO or a PHP, the entity is required to 
meet its contractual obligations to serve Medicaid beneficiaries within the money provided, and that except for 
limits that may be set on allowed profits (in for-profit entities), the MCO or PHP can use its savings as it 
wishes. In effect, it is no longer "Medicaid money." In fact, should an MCO or PHP voluntarily choose to serve 
people who are not Medicaid eligible, it is free to do so. However, we believe it is not appropriate for the State 
Medicaid agency to require in its contract with an MCO or PHP that savings from capitated payments be used 
to provide health services to individuals not otherwise eligible for Medicaid.   
 Therefore, for any new or pending section 1915(b) or 1115 waivers (including applications for renewals) or any 
other Medicaid managed care situation (e.g., State plan option under the Balanced Budget Act), as a matter of 
policy, we will not approve any State Medicaid agency waiver application that contains a requirement for 
MCOs or PHPs to use savings under the capitation rate for non-Medicaid eligibles. Furthermore, in our normal 
review of waivers, Requests for Proposals, and contracts, we will also ascertain whether or not States are in 
compliance with this policy directive.   
If you have any questions about this policy, please contact Wayne Smith at (410) 786-6762.   
 
Sincerely,   
/s/ 
Sally K. Richardson,  
Director   
 
cc:  
All HCFA Regional Administrators  
All HCFA Associate Regional Administrators for Medicaid and State Operations  
Lee Partridge American Public Welfare Association  
Joy Wilson National Conference of State Legislatures  
Jennifer Baxendell National Governors' Association