Table of Contents
State/Territory Name: IA
State Plan Amendment (SPA) #: 20-0003
This file contains the following documents in the order listed:
1) Approval Letter2) Summary Form (with 179-like data)3) Approved SPA Page
DEPARTMENTOFHEALTH & HUMANSERVICESCentersforMedicare & MedicaidServices601East12thStreet, Suite355KansasCity, Missouri64106-2898
MedicaidandCHIPOperationsGroup
June15, 2020
MichaelRandol, MedicaidDirectorDivisionofMedicalServicesDepartmentofHumanServicesIowaMedicaidEnterprise611FifthAvenueDesMoines, IA50309
DearMr. Randol:
TheCentersforMedicareandMedicaidServices (CMS) hascompleteditsreviewofIowa’sStatePlanAmendment (SPA) #20-0003, whichwassubmittedonMarch31, 2020. ThepurposeofSPA #20-0003istoincreasethepremiumsassessedtoindividualsenrolledintheeligibilitygroupundersection1902(a)(10)(A)(ii)(XIII) oftheSocialSecurityActbeginningonAugust1, 2020. Thisisanannualadjustment. CMSisapprovingthisSPAsubjecttocertainlimitations, whichareexplainedinfurtherdetailbelow.
OnMarch18, 2020, theFamiliesFirstCoronavirusResponseAct (FFCRA) wassignedintolawPub. L. 116-127). TheFFCRAauthorizesatemporary6.2percentagepointincreasetoeach
qualifyingstateFederalMedicalAssistancePercentage (FMAP) undersection1905(b) oftheSocialSecurityAct. StatesmayclaimthisenhancedFMAPforexpendituresbeginningJanuary1, 2020andextendingthroughthelastdayofthecalendarquarterinwhichthepublichealthemergencyisdeclaredbytheSecretaryofHealthandHumanServices.
InordertoqualifyfortheenhancedFMAP, statesneedtomeetcertainrequirementsinsection6008oftheFFCRA. Whilestatesmaycontinuetocollectpremiumsduringthepublichealthemergencyperiod, undersection6008(b)(2) oftheFFCRA, statesmaynotincreasepremiumstoanamounthigherthanthatassessedonJanuary1, 2020. Assuch, ifthepublichealthemergencyhasnotendedbyAugust1, 2020, thestatehasagreednottoimplementthepremiumincreaseauthorizedinSPA20-003inordertocomplywiththeFFCRA. Instead, thestatewillsuspendallpremiumsforthiseligibilitygroup, perthestate’sdisasterSPA, #20-0008. OnceCMSnotifiesthestatesthatthepublichealthemergencyhasendedandstatescannolongerclaimenhancedFMAP, thenthestatecanresumepremiumassessmentsforthiseligibilitygroupandincreasethepremiumspertheamendedscheduleafterthestate’srulemakingprocesshasclosed.
CMSapprovedthisSPAonMay21, 2020, withaneffectivedateofAugust1, 2020, pursuanttothelimitationsoutlinedabove. EnclosedisacopyoftheCMS-179summaryform, aswellastheapprovedpageforincorporationintotheIowaStatePlan.
Page2 – MichaelRandol, MedicaidDirector
Ifyouhaveanyquestionsaboutthisletterorrequireanyfurtherassistance, pleasecontactLauraD’Angeloat (816) 426-6425, [email protected].
Sincerely,
X JamesG. Scott, DirectorDivisionofProgramOperations
EFQBSUNFOU!PG!IFBMUI!BOE!IVNBO!TFSWJDFT! GPSN!BQQSPWFE! PNC!Op/!1:49.12:4! DFOUFST!GPS!NFEJDBSF!'!NFEJDBJE!TFSWJDFT!
3/TUBUF2/USBOTNJUUBM!OVNCFSUSBOTNJUUBM!BOE!OPUJDF!PG!BQQSPWBM!PG!
3 1114JPXBTUBUF!QMBO!NBUFSJBM!
4/QSPHSBN!JEFOUJGJDBUJPO;!UJUMF!YJY!PG!UIF!TPDJBMGPS;!DFOUFST!GPS!NFEJDBSF!'!NFEJDBJE!TFSWJDFT! TFDVSJUZ!BDU!)NFEJDBJE*
UP;!SFHJPOBM!BENJOJTUSBUPS! 5/QSPQPTFE!FGGFDUJWF!EBUFDFOUFST!GPS!NFEJDBSF!'!NFEJDBJE!TFSWJDFT!
Bvhvtu2-3131EFQBSUNFOU!PG!IFBMUI!BOE!IVNBO!TFSWJDFT!
6/UZQF!PG!QMBO!NBUFSJBM!
5OFX!TUBUF!QMBO! BNFOENFOU!UP!CF!DPOTJEFSFE!BT!OFX!QMBO! BNFOENFOU!
DPNQMFUF!CMPDLT!7!UISV!21!JG!UIJT!JT!BO!BNFOENFOU!
7/GFEFSBM!TUBUVUF0SFHVMBUJPO!DJUBUJPO8/GFEFSBM!CVEHFU!JNQBDU3131)= 211-111b/GGZ``````````````````!%!``````````````````
2:13)b*)21*)B*)jj*)YJJJ*pguifTTB 3132)= 211-111c/GGZ``````````````````!%!``````````````````
9/QBHF!OVNCFS!PG!UIF!QMBO!TFDUJPO!PS!BUUBDINFOU:/ QBHF!OVNCFS!PG!UIF!TVQFSTFEFE!QMBO!TFDUJPOPS!BUUBDINFOU!
Buubdinfou3/7.B-Qbhf23dBuubdinfou3/7.B-Qbhf23d
21/TVCKFDU!PG!BNFOENFOU
TQBbekvtutuifqsfnjvntdbmfqfs552JBD86/2)4:*c Uifnbyjnvnqsfnjvnbnpvoujtcbtfepouifbwh/tubuffnqmpzffifbmuijotvsbodfqsfnjvnxijdijt-gpsbtjohmfqfstpo-%93: fggfdujwfKbovbsz2-3131/Uifsfgpsf-uifnbyjnvnqsfnjvnnvtuopucfbcpwfuibubnpvou/
22/HPWFSOPSÉT!SFWJFX!
5 PUIFS-!BT!TQFDJGJFE! HPWFSOPSÉT!PGGJDF!SFQPSUFE!OP!DPNNFOU!
DPNNFOUT!PG!HPWFSOPSÉT!PGGJDF!FODMPTFE!
OP!SFQMZ!SFDFJWFE!XJUIJO!56!EBZT!PG!TVCNJUUBM!
27/SFUVSO!UP23/TJHOBUVSF!PG!TUBUF!BHFODZ!PGGJDJBM
NJDIBFMSBOEPMNFEJDBJEEJSFDUPS24/UZQFE!OBNF
NJDIBFMSBOEPM EFQBSUNFOUPGIVNBOTFSWJDFT7226UIBWFOVF
25/UJUMF EFTNPJOFTJB6141: NFEJDBJEEJSFDUPS
26/EBUF!TVCNJUUFE
GPS!SFHJPOBM!PGGJDF!VTF!POMZ!
28/EBUF!SFDFJWFE29/EBUF!BQQSPWFE
QMBO!BQQSPWFE!.!POF!DPQZ!BUUBDIFE!
2:/!FGGFDUJWF!EBUF!PG!BQQSPWFE!NBUFSJBM! 31/TJHOT!
32/UZQFE!OBNF33/UJUMF
34/SFNBSLT
GPSN!DNT.28:!)180:3*!
ATTACHMENT2.6-APage12c
State: Iowa
CitationConditionorRequirement
Thedefinitionof “family” forpurposesofthe250% familyincomeeligibilitytestincludes:
Fordisabledindividualsunder18andunmarried: theindividual, parentslivingwiththeindividual, unmarriedsiblingsunder18livingwiththeindividual, andchildrenoftheindividualwholivewiththeindividual.
Fordisabledindividuals18orolderormarried: theindividual, theindividual’sspouselivingwiththeindividual, andanyunmarriedchildrenunder18whoarelivingwiththeindividual.
Incomparingfamilyincometo250%, SSIincomedisregardsandexemptionsareapplied. Indeterminingwhetherthe250% familyincomeeligibilitytestismet, disregardtheamountofincomeequaltothesocialsecuritycost-of-livingadjustmentfortheyearuntilthefederalpovertylevelincreasegoesintoeffectfortheyear.
Premiumswillbechargedforrecipientswithgrossincomeinexcessof150% ofthefederalpovertylevelandwillbeadjustedannuallybasedonchangesintheaveragestateemployeehealthinsurancepremium. Thepremiumisdeterminedaccordingtoaslidingscalebasedonincome, withthemaximumpremium, basedontheaveragestateemployee’shealthinsurancepremium, chargedonlywhennotmorethan5% ofgrossincome.
MonthlypremiumamountsestablishedAugust1, 2020; beginat $35withgrossincomegreaterthan150% ofthefederalpovertylevelandincreasetoamaximumof $829withgrossincomegreaterthan1550% ofthefederalpovertylevel. Noothercost-sharingchargesapplytothisgroup, exceptforotherwiseapplicableIowaMedicaidco-payments, subjecttotheaggregatelimitsdescribedin42C.F.R. §447.56(f).
Indeterminingthemonthlypremiumamount, thegrossincomefigureusedincalculationofthemonthlypremiumwillnotincludethecost-of-livingadjustmentfortheyearuntilthefederalpovertylevelfortheyeargoesintoeffect.
TNNo. IA-20-003SupersedesApprovalDateEffectiveDateTNNo. IA-19-005