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Biden-Harris Administration Releases Medicaid and
CHIP Guidance Targeting Vaccination and Testing for COVID-19
Comprehensive suite
of tools will help states close health coverage gaps and provide funding to
boost COVID-19 vaccinations and school testing among hard-hit, low-income
families
As part of its
implementation of the American Rescue Plan Act of 2021 (ARP), the
Biden-Harris Administration is issuing guidance that provides essential
information to states as they navigate the options available to advance
COVID-19 vaccination and testing, and the Medicaid program’s broader aim of
providing much-needed health coverage for millions of eligible individuals.
To help states support families and communities and to continue to address
health disparities, the Centers for Medicare & Medicaid Services (CMS)
will provide guidance to states about additional ARP funding for states to
promote the importance of COVID-19 vaccination for eligible children and
adults enrolled in Medicaid.
Testing for COVID-19
is an essential component to keeping the country’s schools open, which is
why CMS’s new guidance highlights Medicaid and CHIP coverage for diagnostic
and screening COVID-19 testing in a variety of settings, including schools.
The guidance also reinforces that COVID-19 vaccines are available to nearly
all Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries
for free.
Under the ARP, states
can receive a temporary increase in the Federal Medical Assistance
Percentage (FMAP) if they newly extend Medicaid coverage to certain
low-income adults. Additionally, the ARP temporarily makes 100% federal
matching funds available for states’ Medicaid and CHIP expenditures for
COVID-19 vaccine administration. Also, state expenditures for Medicaid
services received through Urban Indian Organizations and certain Native
Hawaiian health care entities will receive a temporary match at 100% FMAP.
“The Biden-Harris
Administration continues to remind states that the fight against COVID-19
requires increased efforts to boost testing and vaccination,” U.S. Health
and Human Services (HHS) Secretary Xavier Becerra. “As families prepare
children to return to school, today’s guidance reaffirms our commitment to
provide free COVID vaccination and testing for all eligible Medicaid and
CHIP beneficiaries. I will continue to work with the states to get our
communities vaccinated and healthy across the country.”
“Today’s guidance
reinforces our commitment to providing low-income adults and children with
access to COVID-19 testing and vaccination, and I urge all eligible
enrollees to get vaccinated to protect themselves and their families,” said
CMS Administrator Chiquita Brooks-LaSure. “I also urge states to take
advantage of additional federal funds provided by the Biden-Harris
Administration and the American Rescue Plan Act by ensuring eligible
families have equal access to the essential and comprehensive health care
that they need.”
COVID-19 Testing
in Schools
In an effort to
implement the Biden-Harris Administration’s Build Back Better Agenda in
America’s classrooms and communities, CMS is reinforcing that Medicaid will
cover diagnostic and screening testing for COVID-19 when that testing is consistent
with Centers for Disease Control and Prevention (CDC) recommendations. For
families, this coverage will help ensure peace of mind while maintaining
access to education.
Coverage of
Habilitation Services
Children with
disabilities are uniquely impacted by the COVID-19 pandemic and
specifically those who receive Medicaid-covered services through schools.
CMS is committed to ensuring that children who are currently relying on
remote learning continue to have access to the same services that are available
and covered while attending school in person.
Enhancing Access
to COVID-19 Vaccinations
The ARP requires that
states cover COVID-19 vaccines and their administration for nearly all
Medicaid and CHIP beneficiaries with no cost sharing, thus ensuring that
cost is not a barrier to anyone who wants to get vaccinated. The guidance
provides information on the ARP’s temporary 100% federal match for state
expenditures on COVID-19 vaccines and vaccine administration for those with
Medicaid and CHIP. The temporary increase in federal matching funds provide
assurance to states that the federal government will continue to pay for
COVID-19 vaccination costs.
To help states build
awareness and address vaccine hesitancy, CMS is making federal
administrative matching funds available for states’ approved expenditures
on state-funded monetary incentives for beneficiaries to encourage
vaccinations against COVID-19 and the flu.
Incentive for
Expanding Medicaid
Under the ARP, CMS
will provide a temporary increase in federal funding to states that newly
elect to expand Medicaid coverage to certain low-income adults, by offering
a temporary five-percentage-point increase in federal matching funds for
certain Medicaid expenditures for a maximum of two years. Additionally,
these states will qualify for the 90% federal matching funds already
available through the Affordable Care Act (ACA) for medical services for
newly eligible Medicaid-expansion enrollees.
To date, 39 states,
including the District of Columbia, have expanded their Medicaid programs
to cover the ACA adult group. On July 1, 2021, Oklahoma became the first state
to do so and qualify for the temporary federal funding increase offered
through the ARP, helping as many as 190,000 Oklahomans qualify for
coverage, including a significant number of citizens from Tribal nations
located in Oklahoma. As a result of Medicaid expansion, these Oklahomans
now have access to Medicaid coverage of primary and preventive care,
emergency medical care, substance use disorder services, prescription
drugs, and other important health care services.
Twelve states have
yet to expand Medicaid coverage, which creates inequalities in coverage for
low-income individuals from one community to the next. Medicaid expansion
can reduce these inequalities and thereby bring America closer to ending
health disparities—a key priority for the Biden-Harris Administration and
communities across the U.S.
Reducing Health
Disparities
Addressing health
inequity and serving the needs of low-income Americans, including
individuals with disabilities and indigenous people of color who rely on
these essential health programs, is a top priority for CMS. American
Indians, Alaska Natives, and Native Hawaiians suffer health disparities at
higher rates compared to other U.S. racial and ethnic groups. Under the
ARP, state expenditures for Medicaid services received through Urban Indian
Organizations and certain Native Hawaiian health care entities will be
matched at 100% FMAP from April 1, 2021 through March 31, 2023.
To view the Testing
and Medicaid Coverage of Habilitation Services State Health Official
letter, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/sho-21-003.pdf
To view the FMAP
State Health Official letter, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/sho-21-004.pdf
To view the Medicaid
and CHIP Vaccine PowerPoint, please visit: https://www.medicaid.gov/state-resource-center/downloads/avail-flex-fund-oppo-addr-covid-19-vac-hesit.pdf
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