Provision for Married Recipients of Home and Community-Based Services

On November 9, 2018, the Centers for Medicare & Medicaid Services (CMS) published an Informational Bulletin advising states and stakeholders that the Patient Protection and Affordable Care Act’s spousal impoverishment-related provision was set to expire on December 31, 2018 (“Sunset of Section 2404 of the Affordable Care Act, Relating to the Spousal Impoverishment Rules for Certain Home and Community-Based Services Applicants and Recipient”). 

Today, CMS is issuing a new informational bulletin to provide information on the Medicaid Extenders Act of 2019, signed into law (P.L. 116-3) on January 24, 2019. The Medicaid Extenders Act of 2019 modifies section 2404 of the Affordable Care Act to require that state Medicaid agencies apply the spousal impoverishment rules to married applicants and beneficiaries eligible for home and community-based services (HCBS) through March 31, 2019.

The Medicaid Extenders Act of 2019 did not modify the terms of the Affordable Care Act spousal impoverishment-related provision beyond the extension of its sunset date. States should therefore continue to follow the guidance CMS published in SMDL #15-001 through March 31, 2019. 

The Medicaid Extenders Act of 2019, also alters several Medicaid programs and funding mechanisms:

• (Sec. 2) The bill makes appropriations for FY2019 for, the Money Follows the Person Rebalancing Demonstration Program. (Under this program, the Centers for Medicare & Medicaid Services must award grants to state Medicaid programs to assist states in increasing the use of home and community care for long-term care and decreasing the use of institutional care.)
• (Sec. 4) Asset Verification Requirement Penalties. Incrementally reduces a states’ FMAP beginning January 1, 2021 for non-compliance with asset verification requirements under section 1940 of the Social Security Act that apply to aged, blind and disabled (ABD) populations. The reductions begin at 0.12 percentage points for calendar years 2021 and 2022 and increase to 0.25 for percentage points for 2023, 0.35 percentage points for 2024 and 0.50 percent points for 2025 and thereafter.
• (Sec. 5) The bill also reduces funding available in the Medicaid Improvement Fund beginning in FY2021.

CMS may issue additional information about those provisions in the future.

Additional information and the bulletin is available here https://www.medicaid.gov/federal-policy-guidance/downloads/cib020819.pdf.