New Adult Group. Adults eligible for Medicaid as the group defined in section 1902(a)(10)(A)(i)(VIII) of the Act are included in this demonstration, and in the budget neutrality. The state will not be allowed to obtain budget neutrality “savings” from this population. Therefore, a separate expenditure cap is established for this group, to be known as Supplemental Budget Neutrality Test 2. The MEG listed in the table below is included in Supplemental Budget Neutrality Test 2. MEG Trend Rate DY20 – PMPM DY21 – PMPM DY22 – PMPM DY23– PMPM DY24 - PMPM DY25 - PMPM New Adult Group 4.7% $907.68 $950.34 $995.01 $1,041.77 $1,090.74 $1,142.00
New Adult Group. CAPITATION RATES ODM implemented the Affordable Care Act’s Medicaid expansion on January 1, 2014. As of July 2017, approximately 630,000 individuals receive Medicaid benefits through MCPs under ODM’s expansion population, known as the ‘Extension’ population.
New Adult Group. Report for all expenditures for the Affordable Care Act new adult group, described in 1902(a)(10)(A)(i)(VIII) and 42 CFR 435.119
New Adult Group. Adults eligible for Medicaid as the group defined in section 1902(a)(10)(A)(i)(VIII) of the Act are included in this demonstration, and in the budget neutrality. The state will not be allowed to obtain budget neutrality “savings” from this population. Therefore, a separate expenditure cap is established for this group, to be known as Supplemental Budget Neutrality Test. The EG listed in the table below is included in Supplemental Budget Neutrality Test. Eligibility Group (EG) Trend Rate DY 21 PMPM (SFY 2018) DY 22 PMPM (SFY 2019) DY 23 PMPM (SFY 2020) DY 24 PMPM (SFY 2021) DY 25 PMPM (SFY 2022) New Adult Group 4.3% $561.68 $585.83 $611.02 $637.29 $664.70 If the state’s experience of the take up rate for the New Adult Group and other factors that affect the costs of this population indicates that the PMPM limit described above in paragraph (a) may underestimate the actual costs of medical assistance for the New Adult Group, the state may submit an adjustment to paragraph (a) for CMS review without submitting an amendment. Adjustments to the PMPM limit for a demonstration year must be submitted to CMS by no later than April 30 of the demonstration year for which the adjustment would take effect. The Supplemental Budget Neutrality Test is calculated by taking the PMPM cost projection for the New Adult Group in each DY, times the number of eligible member months for that group and DY, and adding the products together across groups and DYs. The federal share of the Supplemental Cap is obtained by multiplying total computable Supplemental Cap by the Composite Federal Share described in STC 127. The Supplemental Budget Neutrality Test is a comparison between the federal share of the Supplemental Cap and total FFP reported by the State for the New Adult Group. If total FFP for the New Adult Group should exceed the federal share of the Supplemental Budget Neutrality Test after any adjustments made to the budget neutrality limit as described in paragraph (b), the difference must be reported as a cost against the budget neutrality limit described in STC 122. Hypothetical Budget Neutrality Test 4: SMI/SED Services (see Expenditure Authority #16). As part of the SMI/SED program, the state may receive FFP for otherwise covered services, including the continuum of services to treat SMI/SED provided to Medicaid enrollees who are short- term residents in an IMD, as specified in the SMI/SED expenditure authority #16. These are state plan services that would otherwise be eli...
