Budget Neutrality Expenditure Limit. The following describes the method for calculating the budget neutrality expenditure limit for the Demonstration:
a) For each year of the budget neutrality agreement an annual budget neutrality expenditure limit is calculated for each EG described in paragraph 63 as follows:
i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the State under paragraph 52, for each EG, times the appropriate estimated PMPM costs from the table in subparagraph (iii) below.
ii. The PMPM costs in subparagraph (iii) below are net of premiums paid by Demonstration eligibles.
iii. The PMPM costs for the EGs used to calculate the annual budget neutrality expenditure limit for this Demonstration are specified below. 1) TANF-Urban $279.09 5.13% $293.42 5.13% $308.46 5.13% 2) TANF-Rural $283.08 5.13% $297.61 5.13% $312.87 5.13% 3) ABD-Urban $978.28 5.20% $1,029.15 5.20% $1,082.66 5.20% 4) ABD-Rural $779.61 5.20% $820.15 5.20% $862.79 5.20%
b) The overall budget neutrality expenditure limit for the three-year demonstration period is the sum of the annual budget neutrality expenditure limits calculated in subparagraph (a)(iii) above for each of the 3 years. The Federal share of the overall budget neutrality expenditure limit represents the maximum amount of FFP that the State may receive for expenditures on behalf of Demonstration populations and expenditures described in paragraph 51(a) during the Demonstration period.
Budget Neutrality Expenditure Limit. The following describes the method for calculating the budget neutrality expenditure limit for the Demonstration:
a) For each year of the budget neutrality agreement an annual budget neutrality expenditure limit is calculated for each EG described in STC 69 as follows:
i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the State in accordance with the requirements outlined in STC 60, for each EG, times the appropriate estimated per member per month (PMPM) costs from the table in subparagraph (iii) below. Should EGs 3 and 4 be incorporated into the budget neutrality expenditure limit, as outlined in STC 56, the PMPM costs may be revised.
ii. The PMPM costs in subparagraph (iii) below are net of any premiums paid by Demonstration eligibles.
iii. The PMPM costs for the calculation of the annual budget neutrality expenditure limit for the eligibility groups subject to the budget neutrality agreement under this Demonstration are specified below.
(1) To reflect the additional demonstration year that was authorized through temporary extensions (DY 12), the PMPM cost for each EG in Demonstration year 11 has been increased by the appropriate growth rate from the prior extension period. These figures are displayed below. Eligibility Group DY 11 (10/1/08 – 9/30/09) Trend Rate DY 12 (10/1/09 – 9/30/10) TANF Children under age 1 through 20 $549.19 6.7% $585.99 TANF Adults 21-64 $751.73 6.6% $801.34 FHPlus Adults with Children $586.82 6.6% $625.55 Note: Demonstration Populations 3 and 4 are no longer part of the calculation of the budget neutrality expenditure limit under this demonstration, but under demonstration 11-W-00234/2, The Federal-State Health Reform Partnership.
(2) For the current extension period, the PMPM cost for each EG in Demonstration year 12 has been increased by the appropriate growth rate included in the President‟s Federal fiscal year 2011 budget for DYs 13 through 16, as outlined below. In addition, because the Family Planning Expansion Adults are going to be treated as a “hypothetical state plan population” beginning in DY 13, a PMPM cost was constructed based on State expenditures in DY 10, and increased by the rate of growth in the medical care component of the Consumer Price Index between 2004 and 2008. Because DYs 16 and 17 combined are less than 12 months in duration, they are assigned the PMPM costs equal to what would have been calculated for the full year starting October 1, 2013 a...
Budget Neutrality Expenditure Limit. The following describes how the annual budget neutrality expenditure limits are determined, consistent with section 2111(a)(3)(C) of the Act.
Budget Neutrality Expenditure Limit. The following describes the method for calculating the budget neutrality expenditure limit for the Demonstration. Demonstration expenditures are defined under the following Medicaid Eligibility Groups (MEGs) as referenced in paragraph 64(d): a) MEG 1: SSI
Budget Neutrality Expenditure Limit. The following describes the method for calculating the budget neutrality expenditure limit for the demonstration. Demonstration expenditures are defined under the following Medicaid Eligibility Groups (MEGs) as referenced in paragraph 94(d):
a) MEG 1: SSI
b) MEG 2: TANF
c) MEG 3 : Low Income Pool For the purpose of calculating the overall PMPM expenditure limit for the demonstration, separate budget estimates will be calculated for each year on a demonstration year (DY) basis. The annual estimates will then be added together to obtain an expenditure estimate for the entire demonstration period. The federal share of this estimate will represent the maximum amount of FFP that the state may receive during the extension period for the types of Medicaid expenditures for the SSI and TANF MEGs. Budget neutrality calculations for both with and without waiver expenditures are applied on a statewide basis. For each DY, the federal share will be calculated using the FMAP rate(s) applicable to that year. For the purpose of monitoring budget neutrality, the $1 billion in annual LIP expenditures is considered as both with and without waiver expenditures.
Budget Neutrality Expenditure Limit. The following table gives the budget neutrality limit for each DY. The limits are expressed in terms of FFP (i.e., federal share).
Budget Neutrality Expenditure Limit. The cumulative budget neutrality expenditure limit of $9,402,053,590, which was in effect as of January 1, 2008, will remain in effect and unchanged for this Demonstration extension period (January 1, 2011 – December 31, 2015).
Budget Neutrality Expenditure Limit. The following describes the method for calculating the budget neutrality expenditure limit for the demonstration:
a) For each year of the budget neutrality agreement an annual budget neutrality expenditure limit is calculated for each EG described in STC 75 as follows:
i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the state under STC 74, for each EG, times the appropriate estimated PMPM costs from the table in subparagraph
Budget Neutrality Expenditure Limit. The following table gives the budget neutrality limit for each DY. The limits are expressed in terms of FFP (i.e., Federal share). DYs 1,2 and 3 Corresponding FFY DSH allotment DY 4 ¼ of the FFY 2014 FFY DSH allotment 51. Future Adjustments to the Budget Neutrality Expenditure Limit. CMS reserves the right to adjust the budget neutrality expenditure limit to be consistent with enforcement of impermissible provider payments, health care related taxes, new Federal statutes, or policy interpretations implemented through letters, memoranda, or regulations with respect to the provision of services covered under the Demonstration.
Budget Neutrality Expenditure Limit. The following describes the method for calculating the budget neutrality expenditure limit for the Demonstration.
a) For each year of the budget neutrality agreement an annual budget neutrality expenditure limit is calculated for the EG described in paragraph 44 as follows:
i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the State under paragraph 36, for each EG, times the appropriate estimated per member per month (PMPM) costs from the table in subparagraph (iii) below;
ii. The PMPM costs in subparagraph (iii) below are net of premiums paid by Demonstration eligibles; and
iii. The PMPM costs for the EG used to calculate the annual budget neutrality expenditure limit for this Demonstration are specified below. Eligibility Group 1 $634.08 6.6% $675.93 6.6% $720.54 6.6% Eligibility Group 2 $295.52 6.6% $315.02 6.6% $335.82 6.6% Eligibility Group 3 $883.76 6.6% $942.09 6.6% $1,004.27 6.6%
b) The overall budget neutrality expenditure limit for the 3-year Demonstration period is the sum of the annual budget neutrality expenditure limits calculated in subparagraph (a) (iii) above for each of the 3 years. The Federal share of the overall budget neutrality expenditure limit represents the maximum amount of FFP that the State may receive for expenditures on behalf of Participant populations and expenditures described in paragraph 35 during the Demonstration period.
