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CMS Issues Disappointing Letter on Medicaid MOE Guidance

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CMS Issues Disappointing Letter on Medicaid MOE Guidance

August 12, 2011

While the maintenance of effort (MOE) provisions of the Affordable Care Act require that states maintain eligibility standards, methodologies and procedures, an August 5 Centers for Medicare and Medicaid Services (CMS) letter to State Medicaid Directors states that “the MOE provisions do not affect a State’s ability to manage waiver costs by modifying waiver benefits, rates or introducing new waiver service-specific medical necessity criteria or utilization controls which do not affect individuals’ eligibility for Medicaid.”


CMS does note that changes in services could affect the ability of individuals to live in the community and carry implications regarding the Americans with Disabilities Act and the Olmstead decision.Other disappointing provisions include CMS allowing states to adjust the level of care criteria for institutional placement—making it harder to qualify for alternative home and community-based service (HCBS) options—and discontinue HCBS waivers when the approval period expires.