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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsMarch 2014

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42 CFR 433.206, Threshold Methodology
Newly Eligible FMAP – The rule describes the increased FMAP available to states that expand to 133 percent of the federal poverty level under the Affordable Care Act for the expenditures of the “newly eligible” individuals enrolled in the new adult group created by the Affordable Care Act. The newly eligible FMAP is 100 percent in calendar years 2014-2016, 95 percent in calendar year 2017, 94 percent in calendar year 2018, 93 percent in calendar year 2019, and 90 percent in calendar years 2020 and beyond.
Expansion State FMAP – The rule describes an increased FMAP for expenditures for nonpregnant, childless individuals in the new adult eligibility group in a defined “expansion state.” The expansion state FMAP is the regular FMAP rate increased by the number of percentage points equal to a "transition percentage" (that ranges from 50-100 percent) of the gap between the regular Medicaid FMAP and the increased “newly eligible” FMAP.   In 2019 and beyond, the expansion state FMAP will be equal to the newly eligible FMAP, which means it will be 93 percent in 2019 and 90 percent in 2020 and thereafter.
NOTE: Consistent with federal law and the Medicaid State Plan, DMMA provided notice to the public regarding the proposed FMAP rates state plan amendment in the December 19, 2013 issue of the News Journal and the Delaware State News, respectively.
State: Delaware
TN: DE SPA #14-001 Approval Date: _____________ Effective Date: January 1, 2014
For individuals eligible in the adult group, the state will make an individual income-based determination for purposes of the adult group FMAP methodology by comparing individual income to the relevant converted income eligibility standards in effect on December 1, 2009, and included in the MAGI Conversion Plan (Part 2) approved by CMS on July 31, 2013. In general, and subject to any adjustments described in this SPA, under the adult group FMAP methodology, the expenditures of individuals with incomes below the relevant converted income standards for the applicable subgroup are considered as those for which the newly eligible FMAP is not available.The relevant MAGI-converted standards for each population group in the new adult group are described in Table 1.
Table 1: Adult Group Eligibility Standards and FMAP Methodology Features
X Does NOT apply a resource proxy adjustment (Skip items 2 through 3 and go to Section B).
X An enrollment cap adjustment is not applied by the state (skip items 2 through 4 and go to Section C).
C. Special Circumstances (42 CFR 433.206(g)) and Other Adjustments to the Adult Group FMAP Methodology
X Does not apply a special circumstances adjustment.
X Does not apply any additional adjustment(s) to the adult group FMAP methodology (skip item 3 and go to Part 3).
X Individuals previously eligible for Medicaid coverage through a section 1115 demonstration program or a mandatory or optional state plan eligibility category will be transitioned to the new adult group described in 42 CFR 435.119 in accordance with a CMS-approved transition plan and/or a section 1902(e)(14)(A) waiver. For purposes of claiming federal funding at the appropriate FMAP for the populations transitioned to new adult group, the adult group FMAP methodology is applied pursuant to and as described in Attachment E, and where applicable, is subject to any special circumstances or other adjustments described in Attachment D.
A. Expansion State Designation
Does NOT meet the definition of expansion state in 42 CFR 433.204(b). (Skip section B and go to Part 5)
X Meets the definition of expansion state as defined in 42 CFR 433.204(b), determined in accordance with the CMS letter confirming expansion state status, dated October 23, 2013.
X Does NOT qualify for temporary 2.2 percentage point increase in FMAP under 42 CFR 433.10(c) (7).
Qualifies for temporary 2.2 percentage point increase in FMAP under 42 CFR 433.10(c)(7), determined in accordance with the CMS letter confirming eligibility for the temporary FMAP increase, dated __________ The state will not claim any federal funding for individuals determined eligible under 42 CFR 435.119 at the FMAP rate described in 42 CFR 433.10(c)(6).
X Attachment A – Conversion Plan Standards Referenced in Table 1
Attachment D – Special Circumstances Adjustment and Other Adjustments to the Adult Group FMAP Methodology
X Attachment E – Transition Methodologies
Last Updated: December 31 1969 19:00:00.
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