CMS has issued operational guidance to states regarding how to implement H.R. 1’s Medicaid coverage restrictions for noncitizens, which take effect Oct. 1.
On April 8, the agency outlined how states must update eligibility systems, applications, verification processes and claims infrastructure before the deadline. Under H.R. 1, federal Medicaid and CHIP funding will be limited to U.S. citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and individuals lawfully residing under Compacts of Free Association. The provision effectively makes previously covered legal immigrants, including refugees, asylees, parolees and victims of trafficking, ineligible for Medicaid benefits.
Emergency medical coverage remains available under federal matching funds, as does the state option to cover lawfully residing children and pregnant women. States also must evaluate whether the eligibility changes require adjustments to capitation rates and ensure managed care contracts are updated to reflect the new federal funding limits.
CMS said it has already conducted financial oversight of eight states with noncitizen coverage programs, identifying $1.8 billion in expenditures related to services for noncitizens only eligible for emergency Medicaid benefits, and said it intends to continue those efforts.
CHIP state plan amendments must be submitted to CMS by Nov. 30 and Medicaid state plan amendments by Dec. 31.
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