Persius/hicric huggingface dataset:
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland 21244-1850 
Center for Medicaid and State Operations 
SMDL #02-020 
December 20, 2002 
Dear State Medicaid Director: 
In our April 18, 2000 State Medicaid Director letter, we stated that the Balanced Budget Act 
requires that a Medicaid managed care enrollee be permitted to obtain emergency services 
immediately at the nearest provider when the need arises. We further stated that when the 
prudent layperson standard is met, no restriction may be placed on access to emergency care. 
Therefore, managed care organizations (MCOs) and primary care case managers (PCCMs) could 
not place visit limitations on Medicaid enrollee presentations to the emergency room. 
Consistent with the policy set forth in the April 18, 2000, State Medicaid Director letter, we also 
required States, (as payers for PCCM programs), and MCOs to cover inpatient days for 
emergency services for managed care enrollees beyond any state plan-defined limits. 
This letter is to inform you that CMS is removing both of these requirements on MCOs, PCCMs, 
prepaid inpatient health plans (PIHPs), and prepaid ambulatory health plans (PAHPs). Upon 
further review, we believe that the limitations on amount, duration, and scope regarding 
emergency services in the state plan will apply to managed care enrollees as well as all other 
beneficiaries. States occasionally amend their state plans to place limits on coverage of 
emergency services, to the extent appropriate, to facilitate more appropriate use of preventive 
and primary care in outpatient settings. 
The Social Security Act makes no distinction in the definition of covered Medicaid services 
based on the system of delivery (see section 1905(a)), nor do state plans distinguish coverage 
requirements or limitations based on the delivery system. Therefore, the definition of state plan 
covered emergency services, including any limitations, should be applied uniformly to 
beneficiaries in fee for service and enrollees in managed care programs. We will assist you in 
amending your state plan, or any other applicable documents, in order to help you implement 
these changes. 
If you have any questions, please call Richard Chambers at (410) 786-5647. 
Sincerely, 
/s/ 
Dennis G. Smith 
Director  Page 2 - State Medicaid Director 
cc: 
CMS Regional Administrators 
CMS 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 

Brent Ewig 

Senior Director, Access Policy 

Association of State and Territorial Health Officials 

Trudi Matthews 

Senior Health Policy Analyst 

Council of State Governments 

Jim Forgue 

Acting Director, Health and Human Services Task Force 

American Legislative Exchange Council
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 28, 2012   
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   Modified Adjusted Gross Income (MAGI) Conversion Guidance 
 
 
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the availability of 
new guidance today to help states as they begin to plan converting current net income eligibility 
thresholds to equivalent modified adjusted gross income (MAGI) thresholds in the Medicaid 
program and Children's Health Insurance Program (CHIP).  The guidance outlines the 
conversion methodology and process, and the timeframes for executing the conversions.  
 
Currently state methodologies for determining Medicaid and CHIP income eligibility generally 
encompass the use of income disregards, and those methods vary widely across states and 
eligibility groups.  Effective January 1, 2014, a methodology for determining income based on 
MAGI will apply to both Medicaid and CHIP eligibility for most enrollees, including pregnant 
women, children, parents and other caretaker relatives, and the new adult group (as applicable in 
a state).   This new methodology is aligned with the one that will be used to determine eligibility 
for the premium tax credits and cost sharing reductions available to certain individuals 
purchasing coverage on the Exchange.   
 
To complete the transition to the MAGI-based methodology, states will develop MAGI-based 
income eligibility standards for the applicable eligibility groups that are not less than the 
effective income levels that were used to determine Medicaid and CHIP income eligibility as of 
the enactment of the Affordable Care Act.   
 
The State Health Official letter may be accessed at http://www.medicaid.gov/Federal-Policy-
Guidance/Federal-Policy-Guidance.html
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 
  
 
DATE:  February 4, 2010 
 
TO:  State Health Officials 
  State Medicaid Directors 
  NASMD 
  NASHP 
 
CC:   CMSO Staff 
  Associate Regional Administrators - Medicaid 
 
FROM:  Cindy Mann, Director 
  Centers for Medicaid and State Operations (CMSO) 
 
SUBJECT:  Childrens Health Insurance Program Reauthorization Act (CHIPRA) Anniversary 
 
 
I am pleased to share with you that in celebration of the anniversary of President Obama's signing 
of the CHIPRA legislation, HHS released the attached report today, "CHIPRA One Year Later:  
Connecting Kids to Coverage," that highlights the progress that States have made over the past 
year to expand and improve their Medicaid and CHIP programs and our ongoing federal efforts to 
work with States to implement CHIPRA.  Secretary Sebelius has issued a challenge today to all of 
us at the State, federal and community level to identify and enroll the estimated 5 million children 
who are already eligible Medicaid or CHIP but are not enrolled over the next five years. 
  
The report includes the most recent enrollment data for children in Medicaid and CHIP.  
Enrollment increased by 2.6 million children during the last federal fiscal year; nearly 40 million 
children were served by Medicaid and CHIP in FY 2009.  This data is based on information 
reported by the States through the SEDS system that was developed at the time that CHIP was 
created in 1998.  We will be relying more and more on State information to monitor progress in 
enrolling eligible children and as always, we appreciate our partnership with the States in 
administering these critical programs.  
The report is available on the Insure Kids Now website at www.insurekidsnow.gov/chip/report.html.
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 
 
SHO # 09-001 
February 6, 2009 
Dear State Health Official: 
On February 4, 2009, President Barack Obama signed Public Law 111-3, The Childrens 
Health Insurance Program Reauthorization Act of 2009, and issued a Presidential 
Memorandum directing the Secretary of Health and Human Services to withdraw the 
August 17, 2007, and May 07, 2008, letters issued to State Health Officials.  Therefore, 
the Centers for Medicare & Medicaid Services is withdrawing these letters and will no 
longer apply the policies in those letters when reviewing Childrens Health Insurance 
Program State plan amendments or section 1115 demonstration waivers. 
If you have any questions regarding this letter, please contact Ms. Dianne Heffron, 
Acting Director, Family and Childrens Health Programs, who may be reached at 
(410) 786-3247. 
  Sincerely, 
  /s/ 
  Jackie Garner 
  Acting Director, Center for Medicaid and State Operations 
cc: 
CMS Regional Administrators 
CMS Associate Regional Administrators, 
Division of Medicaid and Childrens Health 
Ann C. Kohler 
NASMD Executive Director 
American Public Human Services Association  Page 2  State Health Official 
Joy Wilson 
Director, Health Committee 
National Conference of State Legislatures 
Matt Salo 
Director of Health Legislation 
National Governors Association 
Debra Miller 
Directory for Health Policy 
Council of State Governments 
Christie Raniszewski Herrera 
Director, Health and Human Services Task Force 
American Legislative Council 
Barbara W. Levine 
Chief, Government Relations and Legal Affairs 
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 
February 3, 1999   
INFORMATION   
Dear State Medicaid Director:   
The purpose of this communication is to share with you a copy of a letter (attached) from HCFA's Administrator, Nancy-
Ann Min DeParle, that has been sent to all Medicare providers regarding the Year 2000 computer problem. Because many 
of them also provide services to Medicaid beneficiaries, many of the providers you rely on for the provision of care to 
your beneficiaries are likely to also receive the attached letter. We wanted to make certain that you were aware of this 
important communication. In it, we convey HCFA's readiness to process acceptable claims, and to urge all providers to 
make sure their systems are also Y2K compliant. A "Sample Provider Y2K Readiness Checklist" is included with the 
Administrator's letter to assist them in their assessment of their systems' readiness.   
In addition, we're enclosing several documents that we developed for educating providers, physicians, suppliers and 
other Medicare and Medicaid partners regarding Y2K.   
Finally, we are also including a listing of Y2K websites that you may find useful on this subject.   
If you have any questions, please contact Denise Bazemore or Rick Friedman of my staff for further information. 
Denise can be reached at tel: 410-786-4449, or DBazemore@hcfa.gov. Rick's number is 410-786-4451; 
RFriedman2@ hcfa.gov.   
Sincerely,   
/s/   
Sally K. Richardson Director   
Attachments   
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 Nolan Jones, Director, Human Resources Group, National Governors' Association John Thomas Flynn, 
President, National Association of State Information Resource Executives
Dear Colleague Letter - Childhood Lead Poisoning (4/28/00)  
April 28, 2000  
Dear Colleague:  
Childhood lead poisoning is a serious health threat to many of our Nation's children. We estimate 
that nearly one million children in the United States have elevated blood lead levels. A recent 
General Accounting Office report stated that three-fourths of all children, ages 1 through 5 years 
and found to have elevated blood lead levels, were enrolled in Medicaid and other health care 
subsidy programs. This equates to nearly 700,000 children nationwide. Children enrolled in 
Medicaid programs are nearly five times more likely to have harmful blood lead levels than other 
children. It is critical that we focus our efforts to identify and reach these high-risk children. 
Accordingly, we are sending you this information to bring your attention to the need for better 
coordination at Federal, State and local levels to ensure that Medicaid-enrolled children receive 
appropriate screening tests and treatment services, and to encourage the sharing of data between 
State and local health departments and State Medicaid Agencies to accomplish this goal.  
Within the Department of Health and Human Services (HHS), the Health Care Financing 
Administration (HCFA), the Centers for Disease Control and Prevention (CDC), the Health 
Resources and Services Administration (HRSA), and the Administration for Children and Families 
(ACF) are working together to address this public health issue. One of the goals of our effort is to 
increase the number of Medicaid-enrolled children who are screened for lead poisoning.  
HCFA recently sent the enclosed letter to all State Medicaid Directors to:  
  clarify the requirements for lead screening for children enrolled in Medicaid;  
  update States on HHS activities to address this serious public health problem; outline the 
 
goals of the Departmental Initiative on Lead Screening; and 
  encourage State Medicaid Agencies to work with their State and local public health 
departments to accomplish this goal.  
 
Please join us in taking whatever steps are necessary to provide leadership in addressing this 
important health care issue.  
Sincerely,  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd042800.asp (1 of 2)4/11/2006 4:54:35 PM Dear Colleague Letter - Childhood 
Lead Poisoning (4/28/00)  
_______/s/_______________________ Timothy M. Westmoreland Director Center for Medicaid 
and State Operations Health Care Financing Administration  
______/s/___________________ Jeffrey P. Koplan Director Centers for Disease Control and 
Prevention   __________/s/____________________ Claude Earl Fox, M.D., M.P.H. Secretary Health Services 
and Resources for Children and Families Administration  
______/s/___________________ Olivia A. Golden Administrator Assistant Health Services and 
Resources for Children and Families Administration  
Enclosure 
<% 'Sitewide navigation info / do NOT edit %>  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd042800.asp (2 of 2)4/11/2006 4:54:35 PM
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Health Care Financing Administration  
 Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
October 6, 1997  
Dear State Medicaid Director:  
This letter is one of several providing policy guidance and clarification for the recent legislative changes under the 
Balanced Budget Act (BBA) of 1997. Specifically, the purpose of this letter is to inform you that Section 4709 of the 
Balanced Budget Act of 1997 made changes to the 6 months guaranteed eligibility for individuals enrolled in managed 
care. Previously, States could elect to cover individuals who have become ineligible for Medicaid for up to 6 months if 
they are enrolled in: 1) an HMO that is qualified under title XIII of the Public Health Service Act, 2) an entity described in 
section 1903(m)(2)(B)(iii), (2)(E), (2)(G), or (6) under a contract described in section 1903(m)(2)(A), or 3) a Competitive 
Medical Plan (CMP) with current Medicare contracts.  
The legislation has expanded the States' option to guarantee up to 6 months eligibility in two ways: 1) it expands the types 
of HMOs whose members may have guaranteed eligibility in that now it includes anyone who is enrolled with a Medicaid 
managed care organization as defined in section 1903(m)(1)(A), and 2) it expands the option to include those enrolled 
with a primary care case manager as defined in section 1905(t) of the Social Security Act. These changes are effective 
October 1, 1997.  
Finally, note that as a result of these expansions, States may need to amend their State plans. If a State previously elected 
the 6 months guaranteed eligibility option, it should amend its State plan to reflect the BBA changes. If a State now wants 
to elect this option, it will also need to amend its State plan to do so. Your HCFA regional office will be glad to work with 
you to develop appropriate plan amendment pages pending publication by HCFA of final preprint pages.  
If your staff have questions about this letter, please have them contact your HCFA regional office.  
 
Sincerely,  
/s/ 
Sally K. Richardson   
Director   
Center for Medicaid and State Operations   
 
 
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 Legislature  Jennifer 
Baxendell - National Governors' Association
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:   May 24, 2018  
 
FROM:   Timothy Hill, Acting Director 
Center for Medicaid and CHIP Services  
 
SUBJECT:  Updated 2018 Spousal Impoverishment Standards  
 
This CMCS informational bulletin provides an update to the 2018 Supplemental Security Income 
(SSI) and Spousal Impoverishment Standards.  
 
Certain Medicaid income and resource standards are adjusted annually in accordance with 
changes in the SSI federal benefit rate (FBR) 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 needs 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 housing allowance is adjusted each July 1st as well. 
  
Included with this informational bulletin is the revised 2018 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 
https://www.medicaid.gov/medicaid/eligibility/spousal-impoverishment/index.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 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard 
Baltimore, Maryland 21244-1850 
 
Center for Medicaid and State Operations 
                    SMDL #02-016 
                   
              November 6, 2002       
                       
 
Dear State Medicaid Director: 
 
This is to advise you of recent legislative changes relating to Medicaid coverage of Medicare 
cost-sharing for Qualifying Individuals (QIs), described in section 1933 of the Social Security 
Act.  These are persons with incomes of 120-175 percent of the official Federal poverty line, 
whom Medicaid assists in paying all or part of the monthly Medicare Part B premium.  Authority 
for benefits for these persons had been scheduled to expire on December 31, 2002. 
 
A Continuing Resolution (Pub. L. No. 107-229, as amended by Pub. L. Nos. 107-240 and 107-
244) has been enacted that extends, at current funding levels, the QI-1 benefit through January 
21, 2003.  QI-1s have incomes from 120-135 percent of poverty and receive Medicaid for the 
full Medicare Part B premium.  Do not take any action to notify or terminate QI-1s at this time. 
 
The Continuing Resolution did not extend the expiration date for QI-2s. The QI-2s have income 
from 135-175 percent of poverty.   Therefore, effective January 1, 2003, the QI-2 benefit is no 
longer authorized and states should provide notice to the QI-2 beneficiaries of the termination 
action to be taken, consistent with the rules on advance notice at 42 CFR 431.211.  You are 
currently required to pay $3.91 per month toward the Medicare Part B premiums for QI-2s 
through December 31, 2002.  
 
We request that in the notice, you inform beneficiaries that the termination of their benefit of 
$3.91 per month toward their Medicare Part B premium, on December 31, 2002, was caused by 
Federal law. You should also advise the beneficiaries that if their income has changed, they may 
be eligible for other programs, such as the Qualified Medicare Beneficiary (QMB) or Specified 
Low-income Medicare Beneficiary (SLMB) programs, and should contact the state to get 
additional information.  Your letter may also choose to point out that since the QI-2 benefit 
terminated because of Federal law, the state need not grant affected individuals an opportunity 
for a hearing.   
 
We will keep you informed as we learn more information about the QI-1 program.     
 
Sincerely, 
 
          /s/   
         
Dennis G. Smith 
Director   
 
   
 
cc: 
CMS Regional Administrators 
 
CMS 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 
 
Brent Ewig 
Senior Director, Access Policy 
Association of State and Territorial Health Officials 
 
Jim Frogue 
Acting Director, Health and Human Services Task Force 
American Legislative Exchange Council 
 
Trudi Matthews 
Senior Health Policy Analyst 
Council of State Governments