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HHS Finalizes Medicaid Expansion Regulations

April 5, 2013—The Department of Health and Human Services (HHS) March 29 released a final rule, Medicaid Program; Increased Federal Medical Assistance Percentage Changes under the Affordable Care Act of 2010, which defines the “newly eligible” populations that qualify for 100 percent federal support under an Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) Medicaid expansion plan. On Jan. 1, 2014, the increased federal contribution, also known as the federal medical assistance percentage (FMAP) becomes effective.

Under the ACA, states that expand Medicaid coverage to “newly eligible” adults under age 65 with incomes up to 133 percent of the federal poverty level (FPL) will have 100 percent of those individuals’ health care costs covered by the federal government in calendar years 2014, 2015, and 2016 (i.e., a 100 percent FMAP).   After 2016, the FMAP is incrementally reduced on an annual basis until it is 90 percent in 2020 and subsequent years.

The final rule also defines “expansion states” (states that expanded Medicaid to parents and nonpregnant, childless adults up to 100 percent of the FPL before ACA passage), and identifies which populations in “expansion states” also are eligible for the 100 percent FMAP. The FMAP increase for expansion states will be phased-in, and will (by Jan. 1, 2019) equal FMAP level for newly eligible populations. Additionally, the final rule establishes eligibility criteria for a two-year, 2.2 percent FMAP increase for certain expansion states.

The final rule seeks comments on enrollment caps; the expansion state FMAP; the application of spend-down eligibility criteria; and the methodology states use to determine whether new beneficiaries qualify for an enhanced FMAP.


Christiane Mitchell
Senior Director Health Care Affairs
Telephone: 202-828-0461

Allison M. Cohen, J.D., LL.M.
Senior Policy and Regulatory Specialist
Telephone: 202-862-6085


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806