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Catalog of Federal Domestic Assistance

Program Descriptions

CATALOG OF FEDERAL DOMESTIC ASSISTANCE

93.778:  Medical Assistance Program (Medicaid)

Popular Name:  Medicaid; Title XIX

Objectives:  To provide financial assistance to States for payments of medical assistance on behalf of cash assistance recipients, children, pregnant women, and the aged who meet income and resource requirements, and other categorically-eligible groups. In certain States that elect to provide such coverage, medically-needy persons, who, except for income and resources, would be eligible for cash assistance, may be eligible for medical assistance payments under this program. Financial assistance is a provided to States to pay for Medicare premiums, copayments and deductibles of qualified Medicare beneficiaries meeting certain income requirements. More limited financial assistance is available for certain Medicare beneficiaries with higher incomes.

PROGRAM AND AWARD FINANCIAL AND INFORMATION CONTACTS
ELIGIBILITY REQUIREMENTS FINANCIAL AND ADMINISTRATIVE INFO.
APPLICATION AND AWARD PROCESS INFORMATION CONTACTS
RELATED PROGRAMS ASSISTANCE CONSIDERATIONS
PROGRAM ACCOMPLISHMENTS POST ASSISTANCE REQUIREMENTS


93.778 ELIGIBILITY REQUIREMENTS:

Applicant Eligibility:  State and local welfare agencies must operate under an HHS-approved Medicaid State Plan and comply with all Federal regulations governing aid and medical assistance to the needy.

Beneficiary Eligibility:  Low-income persons who are over age 65, blind or disabled, members of families with dependent children, low-income children and pregnant women, certain Medicare beneficiaries and, in many States, medically-needy individuals may apply to a State or local welfare agency for medical assistance. Eligibility is determined by the State in accordance with Federal regulations.

Credentials/Documentation:  Federal funds must go to a designated State Medicaid Agency. Individuals must meet State requirements. Administrative costs will be determined in accordance with OMB Circular No. A-87, "Cost Principles for State and Local Governments."

93.778 APPLICATION AND AWARD PROCESS:

Preapplication Coordination:  The standard application forms, as furnished by HHS and required by OMB Circular No. A-102, "Uniform Administrative Requirements for Grants-in-Aid to State and Local Governments," must be used for this program. States should contact the HHS Regional Office for application information. (See Appendix IV of the Catalog for agency Regional Office addresses.) This program is excluded from coverage under E.O. 12372.

Application Procedure:  Individuals needing medical assistance should apply directly to the State or local welfare agency. States should contact the Regional Administrator, HCFA for application forms. (See Appendix IV of the Catalog for agency Regional Office addresses.) This program is excluded from coverage under OMB Circular No. A-110.

Award Procedure:  States are awarded funds quarterly based on their estimates of funds needed to provide medical assistance to the needy. Awards are made quarterly on a fiscal year basis as follows: October 1, January 1, April 1, and July 1. Individuals receive medical care from providers of medical care who are participating in the Medicaid program.

Deadlines:  An individual needing medical assistance may apply to the State at any time. States must submit quarterly estimates of funds needed no later than August 15, November 15, February 15, and May 15, in order to receive a timely quarterly grant award for the following quarter.

Range of Approval/Disapproval Time:  Up to 60 days. The States usually provide needy individuals with immediate medical assistance.

Appeals:  Individuals denied medical assistance by the State or local welfare agency must be given a fair hearing on appeal (see 42 CFR, Subchapter C, Part 431, Subpart E). States have 60 days to resubmit revised applications.

Renewals:  Recipients receive assistance as long as they are qualified under State requirements.

Criteria for Selecting Proposals:  Not applicable.

Examples of Funded Projects:  Not applicable.

Range and Average of Financial Assistance:  (Fiscal year 1999) $1,785,000 to $14,286,733,000; 1,968,079,000. (Fiscal year 2000) $1,930,000 to $15,900,897,000; $2,046,254,000.

93.778 RELATED PROGRAMS:

  • 64.012 Veterans Prescription Service;
  • 64.013 Veterans Prosthetic Appliances;
  • 93.560 Family Support Payments to States: Assistance Payments (AFDC);
  • 93.110 Maternal and Child Health Federal Consolidated Programs;
  • 93.224 Community Health Centers;
  • 93.246 Health Centers Grants for Migrant and Seasonal Farmworkers;
  • 93.773 Medicare: Hospital Insurance;
  • 93.774 Medicare: Supplementary Medical Insurance;
  • 93.775 State Medicaid Fraud Control Units;
  • 93.777 State Survey and Certification of Health Care Providers and Suppliers;
  • 96.006 Supplemental Security Income (SSI).

93.778 PROGRAM ACCOMPLISHMENTS:

The number of Medicaid enrollees in fiscal year 1999 was 32,900,000. It is estimated that there will be 33,400,000 Medicaid enrollees in fiscal year 2000 and an estimated 33,900,000 Medicaid enrollees in fiscal year 2001.

93.778 FINANCIAL AND ADMINISTRATIVE INFO:

Federal Agency:  HEALTH CARE FINANCING ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Type of Assistance:  Formula Grants.

Obligations:  (Grants) FY 99 $111,141,671,000; FY 00 est $116,116,783,000; and FY 01 est $124,175,254,000.

Budget Account Number:  75-0512-0-1-551.

Authorization:  Social Security Act, Title XIX, as amended; Public Laws 89-97, 90-248, and 91-56, 42 U.S.C. 1396 et seq., as amended; Public Laws 92-223, 92-603, 93-66, 93-233, 96-499, 97-35, 97-248, 98-369, 99-272, 99-509, 100-93, 100-202, 100-203, 100-360, 100-436, 100-485, 100-647, 101-166, 101-234, 101-239, 101-508, 101-517, 102-234, 102-170, 102-394, 103-66, 103-112, 103-333, 104-91, 104-191, 104-193, 104-208,104-134; Balanced Budget Act of 1997, Public Law 105-33 and Public Law 106-113.

Regulations, Guidelines, and Literature:  42 CFR, Subchapter C.

93.778 INFO CONTACTS:

Regional or Local Office:  Contact the Associate Regional Administrator, Division of Medicaid, Health Care Financing Administration. (See Appendix IV of the Catalog for addresses and phone numbers.)

Headquarters Office:  Tim Westmoreland, Director, Center for Medicaid and State Operations, Health Care Financing Administration, Room C4-25-02, 7500 Security Blvd., Baltimore, MD 21244. Phone: (410) 786-3870. Use the same number for FTS.

(See Appendix IV for more contact info.)

93.778 ASSISTANCE CONSIDERATIONS:

Formula and Matching Requirements:  Federal funds are available to match State expenditures for medical care. Under the Act, the Federal share for medical services may range from 50 percent to 83 percent. The statistical factors used for fund allocation are: (1) medical assistance expenditures by State; and (2) per capita income by State based on a 3-year average (source, "Personal Income," Department of Commerce, Bureau of Economic Analysis). Statistical factors for eligibility do not apply to this program. This program has maintenance of effort (MOE) requirements, see funding agency for further details. [See FMAP.]

Length and Time Phasing of Assistance:  The needy receive medical assistance as necessary. States receive funds quarterly. The Electronic Transfer System will be used by States for monthly cash draws on the Federal Reserve Bank.

Uses and Use Restrictions:  For the categorically needy, States must provide in- and out-patient hospital services; rural health clinic services; federally-qualified health center services; other laboratory and x-ray services; nursing facility services, home health services for persons over age 21; family planning services; physicians' services; early and periodic screening, diagnosis, and treatment for individuals under age 21; pediatric or family nurse practitioner services; and services furnished by a nurse-midwife as licensed by the States. For the medically needy, States are required to provide a minimum mix of services for which Federal financial participation is available (see section 1902(a)(10)(C)(iv) of the Social Security Act).

93.778 POST ASSISTANCE REQUIREMENTS:

Reports:  States must submit fiscal and statistical reports, as required, to the Health Care Financing Administration, Department of Health and Human Services. A Treasury Report TUS-5401 is required monthly. States must submit certified expenditure reports within 30 days after the end of each quarter.

Audits:  In accordance with the provisions of OMB Circular No. A-133 (Revised, June 24, 1997), "Audits of States, Local Governments, and Non-Profit Organizations," nonfederal entities that receive financial assistance of $300,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $300,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in Circular No. A-133.

Records:  States must maintain records which substantiate direct and indirect costs charged to the grant award activity.

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Last Updated, November, 2000             Comments or Questions?           ©Grant Community.com 2000, All Rights Reserved