Persius/hicric huggingface dataset:
Secretary's Letter to Governors on Olmstead Decision - 1/14/00  
January 14, 2000  
Dear Governor:  
In recent years, we have made great strides in enabling individuals with disabilities to participate 
fully in our communities by removing barriers to access in employment, public accommodations, 
and state and local government programs. Many States have led the way in designing innovative 
and fiscally responsible ways to enable more persons with disabilities to receive necessary services 
in their communities instead of in institutions.  
Our country's progress in this regard reflects a shared belief that no person should have to live in a 
nursing home or other institution if he or she can live in his or her community. The recent Supreme 
Court decision in Olmstead v. L.C. affirms this shared value, by finding that unnecessary 
institutionalization of individuals with disabilities is discrimination under the Americans with 
Disabilities Act (ADA). In the decision, the Court explained that a State may be able to meet its 
obligation under the ADA by having comprehensive, effectively working plans ensuring that 
individuals with disabilities receive services in the most integrated setting appropriate to their 
needs.  
We encourage you to develop and implement such plans, and to involve individuals with 
disabilities and other stakeholders in the process of design and implementation. This Department 
stands ready to assist you in these efforts. To begin that process, attached is a letter from the 
Department of Health and Human Services to all State Medicaid Directors regarding the Olmstead 
decision. I want to also encourage you to share this letter with other state agencies operating 
programs affected by the Olmstead decision, since the ADA applies to all state programs.  
The Department is committed to continuing to work in partnership with you, individuals with 
disabilities and all other stakeholders to ensure that States have in place effective, fiscally 
responsible policies designed to increase access to community-based services. As you identify your 
priorities for the coming year, I hope you will continue to place substantial emphasis on developing 
programs and services for individuals with disabilities that will further our shared goal of 
integrating individuals with disabilities into the social mainstream, promoting equality of 
opportunity and maximizing individual choice.  
I deeply appreciate the leadership that you and your colleagues have provided, and I look 
forward to working with you as we continue to make progress in this important area.  
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Olmstead Decision - 1/14/00  
Sincerely,  /s/ 
Donna E. Shalala 
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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
 
CMCS Informational Bulletin 
 
  
DATE:  June 22, 2012 
 
FROM:  Cindy Mann, Director 
  Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:  Targeted Lead Screening Plans   
 
As announced in our Information Bulletin dated March 30, 2012, the Centers for Medicare & 
Medicaid Services (CMS) is revising its policy with respect to screening Medicaid eligible 
children for lead poisoning to align with the recommendations of the Centers for Disease Control 
and Prevention (CDC).  CDC encourages targeted screening in states that have sufficient data to 
demonstrate that universal screening is not the most effective method of identifying exposure to 
lead (see http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5809a1.htm).  
 
In addition to being consistent with CDCs recommendations, this change will allow states 
limited resources to be used for children most needing the screening.  A state may now request to 
include Medicaid eligible children in its targeted lead screening plan, rather than continuing to 
universally screen all Medicaid eligible children ages 1 and 2.   
 
To assist states with the process of determining their lead screening approach, CMS and CDC 
have developed detailed guidance for states that want to request to move to a targeted screening 
approach.  We invite State Medicaid Agencies to review the guidance and collaborate with their 
State Health Departments to determine if moving Medicaid eligible children to a targeted lead 
screening approach is appropriate for your state.  In addition, CMS and CDC have developed a 
process for states to submit requests to move to a targeted screening approach.  Both the 
guidance and process information are available at www.medicaid.gov/Medicaid-CHIP-Program-
Information/By-Topics/Benefits/Downloads/TargetedLeadScreening.pdf .   
 
For states that do not have sufficient data to allow targeted lead screening for Medicaid eligible 
children, the universal screening requirement for Medicaid eligible children ages 1 and 2 will 
remain in effect.  CMS strongly encourages State Medicaid agencies to work with their State 
Health Departments and provider organizations to ensure that children are receiving the 
necessary blood lead testing.  While primary prevention is the best way to avoid exposing young 
children to lead, lead screening is critically important for identifying children with elevated 
blood levels and referring them for a developmental assessment and educational services they are 
entitled to receive.   
  CMCS Informational Bulletin, Page 2 
We hope you will find this information helpful.  We will be hosting a call for states to discuss 
this new policy in the near future.  We will send more information about the call to the State 
Medicaid Agencies when the date has been finalized.  Questions regarding this issue may also be 
directed to Cindy Ruff at cynthia.ruff@cms.hhs.gov or 410-786-5916.
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:   January 29, 2015  
 
FROM:   Vikki Wachino  
Acting Director  
Center for Medicaid and CHIP Services 
 
SUBJECT:   2015 Federal Poverty Level Standards  
 
As required by Section 673(2) of the Omnibus Budget Reconciliation Act (OBRA) of 1981 (42 
U.S.C. 9902(2)), the Department of Health and Human Services (HHS) updates the poverty 
guidelines at least annually and by law these updates are applied to eligibility criterion for 
programs such as Medicaid and the Childrens Health Insurance Program (CHIP). These annual 
updates are accomplished by increasing the Census Bureaus current official poverty thresholds 
by the relevant percentage change in the Consumer Price Index for All Urban Consumers (CPI
U).  
 
The 2015 guidelines reflect the 1.6 percent price increase between calendar years 2013 and 2014. 
After this inflation adjustment, the guidelines are rounded and adjusted to standardize the 
differences between family and household sizes. For a family or household of 4 persons living in 
one of the 48 contiguous states or the District of Columbia, the poverty guideline for 2015 is 
$24,250. Separate poverty guideline figures are developed for Alaska and Hawaii, and different 
guidelines may apply to the Territories. The guidelines can be found at 
http://www.gpo.gov/fdsys/pkg/FR-2015-01-22/pdf/2015-01120.pdf.   
 
To determine eligibility for Medicaid, CHIP, and advance payments of the premium tax credit 
(APTC) and cost-sharing reductions (CSR) for the purchase of health coverage through the 
Marketplace, states and the federal government generally use a percentage multiple of the 
guidelines (for example, 133 percent or 185 percent of the guidelines) as allowed or mandated in 
relevant authorizing legislation or program regulations. The Federally-facilitated Marketplace 
(FFM) will begin using the 2015 FPLs for Medicaid and CHIP eligibility on February 1, 2015. 
In accordance with section 36B of the Internal Revenue Code, eligibility for APTC and CSR will 
continue to be determined using 2014 FPLs for all APTC and CSR for enrollment that is effective 
in 2015.  
 
Included with this informational bulletin is the 2015 Dual Eligible Standards chart that displays 
the new standards for the Medicare Savings Program categories. These standards are also 
available on Medicaid.gov at http://www.medicaid.gov/medicaid-chip-program-information/by-
population/medicare-medicaid-enrollees-dual-eligibles/seniors-and-medicare-and-medicaid-
enrollees.html. 
  CMCS Informational Bulletin  Page 2 
Please update your standards in accordance with this information. If you have any questions or 
need additional information, please contact Judith Cash, Director of the Division of Eligibility 
and Enrollment, at 410-786-4473 or Judith.Cash@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 
 
Center for Medicaid & State Operations 
 
CMSO Informational Bulletin CMS 
  
 
DATE:  January 29, 2010 
 
TO:  State Medicaid Directors 
 
CC:   Associate Regional Administrators 
   
FROM:  Cindy Mann, Director 
  Centers for Medicaid and State Operations (CMSO) 
 
SUBJECT:  Increase in States Qualifying Individuals (QI) Allotments for FY 2010 
 
CMSO CONTACT: Richard Strauss; (410) 786-2019;richard.Strauss@cms.hhs.gov    
 
We wanted to make you aware that on January 27, 2009 the President signed into law the 
"Emergency Aid to American Survivors of the Haiti Earthquake Act" (Haiti Earthquake Act).  
Section 3 of this legislation amends section 1933(g)(2)(M) of the Social Security Act (the Act) to 
effectively provide an additional $50 million in funding available for States' FY 2010 QI 
allotments.  Under the Qualifying Individuals (QI) program, Federal funds are available for 
States to pay the Medicare Part B monthly premiums for certain individuals (referred to as QIs) 
whose income is between 120% and 134% of the Federal poverty levels.  The amount of funds 
available to each State for this program is limited by the QI allotment for the State.  Prior to 
enactment of the Haiti Earthquake Act, there was only $562.5 million available for States' FY 
2010 QI allotments; with the enactment of this legislation, there is now a total of $612.5 million 
available for States' QI allotments in FY 2010.       
 
Prior to the enactment of the Haiti Earthquake Act, with only $562.5 million previously available 
for QI allotments in FY 2010, and based on States' estimates of QI expenditures for FY 2010 of 
about $603.2 million, there would have been a potential shortfall for the QI program in FY 2010 
of about $40.7 million ($603.2 million minus $562.5 million).  With the enactment of the Haiti 
Earthquake Act, the projected shortfall in the QI program for FY 2010 is eliminated. 
 
The Haiti Earthquake Act also added an additional $15 million for States' FY 2011 QI 
allotments; that brings the total funds available at this time for the QI program in FY 2011 to 
$165 million, increased from the previous $150 million.  As in the past, we anticipate that 
Congress will address the full funding for the QI program for FY 2011 at a later date. 
 
Your Regional Office will be contacting you regarding the revised FY 2010 QI allotment 
amounts.
DEPARTMENT OF HEALTH & 
HUMAN SERVICES Health Care 
Financing Administration  
Center for Medicaid and State 
Operations 7500 Security 
Boulevard Baltimore, MD 
21244-1850  
JUL 19 1999  
Dear State Medicaid Director:  
This letter is to transmit the revised Form HCFA-416, the annual reporting form 
for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services 
and accompanying instructions. This form was developed in consultation with the 
Medicaid Matemal and Child Health Technical Advisory Group and was 
approved by the Office of Management and Budget on June 30. As you know, 
section 1902(a)(43) requires states to report annually to the Health Care Financing 
Administration (HCFA) certain data about the delivery of EPSDT services. We 
believe this new form will assist HCFA and states to capture more reliable 
EPSDT data in both fee-for-service and managed care settings.  
The major changes to the form and instructions are:  
  the use of each state s individual periodicity schedule to determine their 
participation and screening ratios;  
  the use of specific CPT codes in counting EPSDT screens;  
  expanded data reporting on dental services; and  
  a new reporting element on the number of screening blood lead tests 
provided to children under the age of 6.  
 
The old Form HCFA-416 expired on March 31, 1998. This new form should be 
used for reporting data for the current fiscal year (October 1, 1998 through 
September 30, 1999), which is due April 1, 2000. We are in the process of revising 
the appropriate sections of the State Medicaid Manual. If you have any questions 
regarding this information please contact Teresa Gardner at (410) 786-3289 or 
Cindy Ruff at   (410) 786-5916. Thank you for your attention to this matter.  
David S. Cade Director Family and Children s Health Programs Group  
Enclosures  
cc:  
All HCFA Regional Administrators  
All 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 Senior Health Policy Analyst National Governors Association
SMD Letter - Policy Guidance on Medicaid for Persons with Limited English Proficiency   
August 31, 2000   
  
Dear State Medicaid Director:   
Over the past few years, States have made considerable progress in increasing access to health care 
coverage for low-income families through Medicaid and the State Children's Health Insurance 
Program (SCHIP). Problems persist, however, for individuals with limited English proficiency 
(LEP) in enrolling and accessing services because of their inability to communicate effectively with 
program staff and providers.   
The Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) 
has issued "Policy Guidance on the Title VI Prohibition against National Origin Discrimination As 
It Affects Persons with Limited English Proficiency", which discusses the responsibilities under 
Title VI of health and human services agencies and providers who receive Federal financial 
assistance from HHS. All entities which receive Federal Medicaid and/or SCHIP funds -- including 
State Medicaid agencies and State agencies or contractors administering SCHIP, as well as 
providers of Medicaid and SCHIP services -- are covered by the guidance.   
A copy of the guidance is enclosed for your review. While we encourage you to contact OCR 
about the details of the guidance, we would like to emphasize that under both the SCHIP and 
Medicaid programs, Federal matching funds are available for States' expenditures related to the 
provision of oral and written translation administrative activities and services provided for SCHIP 
or Medicaid recipients. Federal financial participation is available in State expenditures for such 
activities or services whether provided by staff interpreters, contract interpreters, or through a 
telephone service.   
A copy of this guidance has also been sent to your Governor and will be published as a notice in 
the Federal Register. If you have any questions or suggestions regarding this guidance, please 
contact the Office of Civil Rights or your HCFA regional office.   
Sincerely,   
/s/   
Timothy M. 
Westmoreland 
Director   
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Medicaid for Persons with Limited English Proficiency   
Enclosure   
cc:    All HCFA Regional Administrators All 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' Association   
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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 13, 2013  
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   Medicaid Disproportionate Share Hospital Allotment Payment Reductions 
 
 
Today, the Centers for Medicare & Medicaid Services (CMS) put on display at the Federal 
Register a Notice of Proposed Rulemaking titled Medicaid Disproportionate Share Hospital 
Allotment Payment Reductions (CMS-2367-P.)  The Affordable Care Act requires aggregate 
reductions to state Medicaid disproportionate share hospital (DSH) allotments annually from 
fiscal year (FY) 2014 through FY 2020, at the same time as the Marketplace and Medicaid 
provide increased coverage options that will likely reduce uncompensated care levels for 
hospitals.   The proposed rule includes a reduction methodology for FY 2014 and FY 2015 only.  
A CMS fact sheet describing the rule is available at 
http://www.cms.gov/apps/media/fact_sheets.asp. 
 
The rule is available at: https://www.federalregister.gov/public-inspection and will be published 
in the Federal Register on May 15, 2013.  Public comments are due July 12, 2013. Please refer to 
the Federal Register for information about how to submit comments.
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______________________________________________ 
 
CMCS Informational Bulletin 
  
 
DATE:  February 17, 2012 
     
FROM:  Cindy Mann, Director  
 
SUBJECT:  Essential Health Benefits FAQs 
 
Today the Department of Health and Human Services (HHS) issued a list of frequently asked 
questions (FAQs) to provide additional information on HHSs intended approach to defining 
essential health benefits (EHB).  The EHB definition will ensure that health insurance plans in 
the individual and small group markets, both inside and outside of the Affordable Insurance 
Exchanges, as well Medicaid alternative benefit plans defined under Section 1937 of the Social 
Security Act, offer a comprehensive package of service and items. 
 
These FAQs follow a December 16, 2011 bulletin released by HHS, which outlined proposed 
policies related to EHB that HHS plans to define in future rulemaking.  HHS is publishing the 
FAQs in order to be responsive to States and to give stakeholders timely information as they 
work towards establishing Affordable Insurance Exchanges and making decisions for 2014.  
 
Questions 20-22 in the FAQs relate specifically to Medicaid.  CMCS will be releasing future 
guidance on Medicaid benchmarks and essential health benefits.  In the meantime, please let 
us know your questions. 
 
The Frequently Asked Questions released today are available at: 
http://cciio.cms.gov/resources/files/Files2/02172012/ehb-faq-508.pdf  
 
To view the essential health benefits bulletin released by HHS on December 16, 2011, visit:  
http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits_bulletin.pdf  
 
Questions about essential health benefits (for Medicaid and more generally) can be sent to: 
EssentialHealthBenefits@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 5, 2016 
 
FROM:  Vikki Wachino, Director 
Center for Medicaid and CHIP Services 
   
SUBJECT:  Social Security Number Removal Initiative (SSNRI) 
 
The Centers for Medicare & Medicaid Services (CMS) is issuing this Informational Bulletin to inform 
states about the SSNRI.  Congress passed the Medicare Access and CHIP Reauthorization Act 
(MACRA) of 2015 (PL 114-10) on April 16, 2015.  Section 501 of MACRA requires CMS to remove 
Social Security Numbers from Medicare ID cards and replace existing Medicare Health Insurance 
Claim Numbers (HICNs) with a Medicare Beneficiary Identifier (MBI).  The MBI will be a randomly 
generated identifier that will not include a social security number or any personally identifiable 
information (PII).  This step is being taken to minimize the risk of identity theft for Medicare 
beneficiaries and reduce opportunities for fraud.  To comply with this statutory requirement, starting in 
early 2018, CMS will issue new Medicare cards with an MBI to approximately 60 million Medicare 
beneficiaries, including Dual Eligibles.  A HICN will still be assigned to each Medicare beneficiary 
will still be used for internal data exchanges between CMS and the states, but the new MBI must be 
used in all interactions with the beneficiary, the provider community and all external partners. 
 
In order for states to be fully compliant with this legislation and to continue critical data exchanges 
with CMS, state Medicaid business processes and systems must be examined and necessary changes 
identified,  developed, tested and implemented prior to CMS assigning MBIs and distributing the new 
Medicare ID cards.  To ensure a smooth implementation for the states, CMS has formed a bi-weekly 
All-State SSNRI Forum call which includes representatives from the Center for Medicare (CM), 
CMCS, each CMS Regional Office, and every state, territory and the District of Columbia.  These calls 
provide CMS the opportunity to promptly communicate important guidance and updates to the state 
Medicaid agencies (SMAs) and for SMAs and their invited key stakeholders to ask questions, share 
information and facilitate coordination. 
 
Questions regarding the SSNRI or the All State SSNRI Forum may be sent to 
SSNRISTATES@cms.hhs.gov.