DISCLAIMER: CoC (Continuum of Care) is an alternative term for LTSS (Long Term Services and Support). Please note that not all instances of LTSS have been transitioned to the new designation.
100% FMAP for CoC Services — Educate Your State
Receiving 100% Federal Medical Assistance Percentage (FMAP) for CoC services provided to eligible patients through IHS or tribal programs can help tribes and states alike.
Access more federal funding through 100% FMAP
Medicaid is a federal program that covers many long-term care services for eligible people. States manage Medicaid programs and share the costs of these programs with the federal government. CMS reimburses each state for a percentage of its total Medicaid expenditures. This percentage, which varies by state, is called the Federal Medical Assistance Percentage (FMAP).
FMAP varies by state, based on the state’s per capita income. States with lower per capita income typically have a higher FMAP. See published FMAP rates for your region.
Some services for some AI/AN patients are eligible for 100% FMAP
In all states, eligible services provided to Medicaid-eligible AI/AN patients in IHS or tribal facilities can be reimbursed at 100% FMAP. Non-Indians served at your facility are reimbursed at the state’s usual FMAP, not at 100% FMAP.
How does 100% FMAP benefit tribal programs?
Since CMS reimburses these expenses fully, eligible services provided to Medicaid-eligible AI/AN patients in IHS or tribal facilities cost your state nothing.
Because the state achieves these savings, states can often afford to reimburse tribes for tribally provided Medicaid services at an enhanced rate that is higher than 100%. Receiving an enhanced reimbursement rate from your state provides your tribe with more resources for CoC services.
How to become eligible for 100% FMAP
To be eligible for 100% FMAP, your program must meet several requirements:
- LTSS must be explicitly included in a tribe’s P.L. 638 contract or compact with IHS.
- The tribal health department must either provide or oversee CoC services. You can either:
- Have your tribal health department set up a funding agreement with the tribal aging program or department to provide CoC services, or
- Move your CoC program under the tribal health department
- The health department must bill the state Medicaid office for LTSS.
Working with your state for an enhanced reimbursement rate
If your program meets the requirements for 100% FMAP eligibility, you can work with your state to try to negotiate an enhanced rate. Meet with state representatives to discuss how an enhanced rate can benefit both parties:
- The state saves money because it doesn’t have to pay its normal share for Medicaid services provided to these patients
- The tribal CoC program will receive more funds to enhance its capacity to provide services to tribal citizens and others it may serve
Real-Life Example
See how the Oneida Nation successfully negotiated with the state of Wisconsin to provide better care for tribal citizens.
All content on this page was originally posted on the CMS.gov website here.
