Health Center Regulatory Issues

NACHC Files Comments on CMS Proposed Rule re: Medicaid Cost-Sharing and Benchmark Benefit Plans

On February 21, 2013, NACHC submitted comments to CMS on a Proposed Rule addressing Medicaid alternative benefit plans and Medicaid cost sharing requirements for the newly eligible adult group (a.k.a. Medicaid expansion group). Both alternative benefit plans and the alternative cost sharing authority will play an increasingly prominent role in Medicaid as the program expands to include the adult group. Members of the adult group, unless they fall within certain categories of medically frail individuals statutorily exempted from coverage under alternative benefit plans will receive medical assistance consisting of benchmark or benchmark-equivalent coverage. In addition, states will likely turn increasingly to the alternative cost sharing authority as the Medicaid program expands.

NACHC believes that CMS’s revisions of the alternative benefit plan and cost sharing provisions in the regulations, 42 C.F.R. Part 440, Subpart C and Part 447, Subpart A, should take into account the critical role that health centers play as primary care homes for the newly eligible adult group. NACHC suggests that, in the Final Rule, CMS should refine its Proposed Rule as follows: (1) to make clear that coverage under alternative benefit plans must include FQHC services; (2) to ensure that the new cost sharing flexibility afforded to state Medicaid programs through the Proposed Rule conforms to the statutory restrictions in Sections 1916 and 1916A of the Act; and (3) to take into account, in finalizing the cost sharing regulations, health centers’ role as safety net providers for the uninsured and their obligation to serve patients regardless of ability to pay. Read NACHC’s full comments here.

NACHC also requests that CMS clarify that nothing in the revised regulations authorizes states to require providers to condition the provision of services on a patient’s ability to pay the cost sharing, and we urge CMS to make clear that states may not impose on FQHCs, as Medicaid providers, obligations relating to cost sharing that conflict with an FQHC’s obligations under Section 330.

Questions? Contact Roger Schwartz at or 202-296-0158.