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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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