Partnership Plan Revised STCs - January 2014

CENTERS FOR MEDICARE & MEDICAID SERVICES
EXPENDITURE AUTHORITY LIST

NUMBER:        11-W-00114/2

TITLE:              Partnership Plan Medicaid Section 1115 Demonstration

AWARDEE:      New York State Department of Health

Under the authority of section 1115(a)(2) of the Social Security Act (the Act), expenditures made by New York for the items identified below, which are not otherwise included as expenditures under section 1903 of the Act shall, for the period beginning January 1, 2014, until the ending date specified for each authority, be regarded as expenditures under the state's title XIX plan.

The following expenditure authorities shall enable New York to implement the approved Special Terms and Conditions (STCs) for the New York Partnership Plan Medicaid Section 1115 demonstration.

  1. Demonstration-Eligible Populations. Expenditures for health-care related costs for the following populations that are not otherwise eligible under the Medicaid State Plan. (End Date: March 31, 2014.)
    1. Demonstration Population 9 (HCBS Expansion). Medically needy individuals who are receiving HCBS, and who are medically needy after application of community spouse and spousal impoverishment eligibility and post-eligibility rules under Section 1924 of the Act are applied.
    2. Demonstration Population 10 (Individuals Moved from Institutional Settings to Community Settings for Long Term Care Services). Expenditures for health-care related costs for individuals moved from institutional nursing facility settings to community settings for long-term services and supports who would not otherwise be eligible based on income, but whose income does not exceed a more liberal income standard, and who receive services through the managed long term care program under this demonstration.
  2. Twelve-Month Continuous Eligibility Period. Expenditures for health-care related costs for individuals who have been determined eligible under groups specified in Table 1 of STC 19(a) for continued benefits during any periods within a twelve-month eligibility period when these individuals would be found ineligible if subject to redetermination (End Date: March 31, 2014)
  3. Facilitated Enrollment Services. Expenditures for enrollment assistance services provided by organizations that do not meet the requirements of section 1903(b)(4) of the Act, as interpreted by 42CFR 438.810(b)(1) and (2). Inasmuch as these services may be rendered by MCOs and therefore included in the MCOs' capitation payments, no expenditures other than these payments may be submitted for FFP. (End Date: March 31, 2014.)
  4. Designated State Health Programs Funding. Expenditures for the designated state health programs specified in STC 57(a)-(l) which provide health care services to low-income or uninsured New Yorkers in an amount not to exceed $477.2 million over the demonstration period. (End Date: December 31, 2014.)
  5. Designated State Health Programs Funding. Expenditures for the designated state health programs specified in STC 63 which provides services to low-income or uninsured New Yorkers enrolled in community support services, residential services and prevention and treatment programs under the Office of Mental Health, Office for People with Developmental Disabilities, and Office of Alcoholism and Substance Abuse Service in an amount not to exceed $250 million for the period of April 1, 2013 through March 31, 2014.
  6. Designated State Health Programs Funding. Expenditures for the designated state health program specified in STC 57(n) which provides transitional Family Health Plus benefits to parents and caretaker relatives with incomes up to 150 percent of the FPL. This authority expires April 30, 2014.
  7. Designated State Health Programs Funding. Expenditures for the designated state health program specified in STC 57(m) which provides premium subsidies to FHPlus individuals and new applicants between 133 percent and 150 percent FPL sent to the Marketplace. This authority expires December 31, 2014.