DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
Center for Medicaid and CHIP Services
 
 
May 22, 2012 
 
Medicaid/CHIP Affordable Care Act Implementation 
Answers to Frequently Asked Questions 
 
FMAP 
Q1: How does CMS define the term Expansion State?  Which States are 
expansion States? 
A:  Under the Affordable Care Act, an Expansion State is one that had eligibility standards for 
parents and nonpregnant childless adults (under either the State plan or a demonstration project) 
to at least 100 percent of the FPL as of the date of enactment of the Affordable Care Act.  
Specifically, a State is an expansion State if, on March 23, 2010, the State offered health benefits 
coverage Statewide to parents and non-pregnant, childless adults whose income is at least 100 
percent of the poverty line, that includes inpatient hospital services, is not dependent on access to 
employer coverage, employer contribution, or employment and is not limited to premium 
assistance, hospital-only benefits, a high deductible health plan, or alternative benefits under a 
demonstration program authorized under section 1938 of the act.  A State that offers health 
benefits coverage to only parents or only non-pregnant childless adults described in preceding 
sentence will not be considered to be an expansion State;  both groups must have been covered 
as described above. 
 
The law established a special Federal medical assistance percentage (FMAP) for expansion 
States.  Expansion States are able to claim a special FMAP for the non-pregnant childless adults 
who are not newly eligible.  These States can also claim the enhanced FMAP for individuals 
who are newly eligible in 2014.  CMS is in the process of a 50-State review of State coverage 
as of March 23, 2010.   
 
Q2:  Can a State claim enhanced FMAP for parents in the new adult group?   
A:  Yes, in order to be eligible for enhanced FMAP for newly eligible individuals, an 
individual must be in the new adult group.  The adult group is comprised of individuals that 
could include parents.  Specifically, the group is comprised of individuals described in section 
1902(a)(10)(A)(i)(VIII) of the Act who beginning January 1, 2014: 
  Are under age 65 
  Are not pregnant 
  Not entitled to/enrolled for benefits under Medicare (Part A and B)  Page 2 
  Not described in the "(I) to (VII) Groups" (referring to individuals described in section 
1902(a)(10)(I) - (VII) of the Act) 
  Whose income is determined using MAGI and does not exceed 133% of the FPL 
     
This list does not preclude parents from being in the adult group, but whether the State can claim 
enhanced FMAP depends on whether the parents are considered newly eligible ; that is,   an 
individual who is not under 19 years of age (or higher age as the State may have elected) and 
who is not eligible under the State plan or under a waiver of the plan for full benefits or for 
benchmark coverage or benchmark equivalent coverage under State rules in effect as of 
December 2009, or is eligible but would not have been enrolled for such benefits or coverage 
through a waiver under the plan that has a capped or limited enrollment. 
 
Thus, for any parents who are in the adult group because, for example, their income is greater 
than the income standard for parents in the States parent/caretaker relative group in January 
2014, the State will be able to claim enhanced FMAP if they would not have been eligible under 
the eligibility criteria in effect under the plan or waiver as of December 1, 2009.   
 
Our proposed rules on this definition were issued in August 2011 (available at 
http://www.gpo.gov/fdsys/pkg/FR-2011-08-17/html/2011-20756.htm); final rules are 
forthcoming.  As discussed in the proposed rule, CMS intends to establish a methodology for 
States to claim enhanced FMAP without having to maintain and apply its December 1, 2009 
eligibility rules to each individual.