FAQs
Q – What does the Emergency Period mean and what is the duration of this act?
A – The emergency period mentioned in section 319 of the Public Health Service Act states this act shall be active during the emergency period for a period of 90 days, unless further extended by the authorities.
Q – Does FFCRA change Medicaid Coverage?
A – FFCRA adds several new Medicaid eligibility groups for individuals that are uninsured during the COVID-19 pandemic. Extended coverage includes
- Retroactive eligibility period effective no earlier than March 18, 2020
- Eligible for the extended coverage receive limited services related to testing, diagnosis of COVID-19 provided during the emergency period.
Q – What is the eligibility criteria for this group?
A – Individual must be uninsured, meaning he/she must
- Not be eligible to receive coverage under a mandatory Medicaid eligibility group (state laws may differ)
- Not be enrolled in Medicaid coverage.
- Individuals receiving limited Medicaid coverage (TB, family planning, considered medically needy) would still be considered uninsured.
- Not be insured by another federally funded health care program, like CHIP, Basic Health Program, Medicare, TRICARE and Veterans Administration, and other federal employee health plans
- Not covered by any other group health plan or health insurance, examples of which are, employer-sponsored health insurance, retiree health plan etc.
Q – Are there any financial eligibility requirements for coverage under this newly eligible group?
A – No, there is no income or resource test for coverage. However, other eligibility requirements include
- Being a resident of the state
- SSN
- State agencies must help individuals who do not have an SSN
- For non-US citizens, or do not have a satisfactory immigration status Federal Financial Participation (FFP) is limited to payment for services necessary for treatment for an emergency medical condition.
Q – What services are covered?
A – Services provided no earlier than March 18, 2020 are covered including
- In vitro diagnostic testing (and administration of that test)
- COVID-19 testing-related services
Q – Does Medicaid also cover serological tests for optional COVID-19 testing eligible group?
A – Yes. Effective no earlier than March 18, 2020. FDA advises that serological tests for COVID-19 meet the definition of an in vitro diagnostic product for the detection of SARS-CoV-2 virus.
Q – What are COVID-19 testing-related services?
A – Services associated with and related to the administration of an in vitro diagnostic product, or to the evaluation for purposes of determining the need for such products, such as an X-ray
Q – What is the Federal Medical Assistance Percentage (FMAP) for the services provided for the COVID19 testing group?
A – The FMAP for services provided to an individual enrolled in the COVID-19 testing group is 100 percent. The 100 percent match is only available for the testing and testing-related services provided to beneficiaries enrolled in the new COVID-19 testing group (and for related administrative expenditures); the 100 percent match is not provided for COVID-19-related testing and diagnostic services provided to individuals covered under other Medicaid eligibility groups.
Q – What benefits were added for targeted low-income children and targeted low-income pregnant women covered by CHIP?
A – Coverage of in vitro diagnostic products for the detection of SARS-CoV-2 or diagnosis of COVID-19 are covered the same way they are covered in Medicaid. Coverage begun from March 18, 2020
Q – Are individuals covered through CHIP also exempt from cost sharing for testing related to COVID-19?
A – Yes. FFCRA exempts from cost sharing of
- Any in vitro diagnostic product described above
- Any other COVID-19 testing-related services.
For further queries, contact us at crm@claimsmedinc.com