Medicaid: Legislation, Regulation and Guidance

  • State Health Official Letter, August 15, 2013. This letter describes Payment Error Rate Measurement (PERM) Eligibility reviews, Medicaid Eligibility Quality Control (MEQC) Program, and development of an interim approach for assessing payment error for eligibility.

CCF Comments on Interim Final Provisions of the Medicaid Rule

• Children’s Health Group Comments on Final Medicaid and Exchange Rules

  • Federal Register, 76: 51148-5199, August 12, 2011. The proposed rule implements sections of the ACA related to Medicaid and CHIP eligibility, enrollment simplification, and coordination.

CCF Comments on Proposed Medicaid and CHIP Eligibility Regulations

CCF addendum on immigrant and mixed status families by Dinah Wiley

  • Federal Register, 76: 21950-21975, April 19, 2011. This final rule revises the Medicaid regulations for Mechanized Claims Processing and Information Retrieval Systems. It also provides for an enhanced federal matching rate for the development of such systems.

Comments on the proposed federal regulations on federal funding for Medicaid eligibility and enrollment activities

  • State Health Official Letter, April 4, 2011. This letter provides initial guidance regarding the new option to receive federal matching funds for coverage of children of state employees through CHIP.
  • State Medicaid Director Letter, May 19, 2011. This letter provides further more detailed guidance on the State expenditures related to the development and sustaining of health information exchanges that may be eligible for the 90% match.

CMS Press Release

  • Federal Register, 76: 5862-5971, February 2, 2011. This proposed rule would implement provisions of the ACA that deal with allegations of fraud in Medicaid, CHIP, and Medicare.

CMS Informational Bulletin


  • Federal Register, 75: 56946-56961, November 16, 2010. This proposed rule would promote greater transparency in the review and approval of Section 1115 demonstration waivers.

Comments on the proposed federal regulations on public process for Medicaid and CHIP demonstration waivers

HHS Letter to States on Federal Support and Standards for Medicaid and Exchange Information Technology Systems

  • State Medicaid Director Letter, October 1, 2010. This letter provides guidance on section 6411 of the Affordable Care Act, Expansion of the Recovery Audit Contractor (RAC) Program.
  • State Health Official/State Medicaid Director Letter, September 28, 2010. This letter provides guidance on sections 2501 and 2502 of the ACA, which pertain to Medicaid prescription drug rebates, rebates for Medicaid managed care organization drugs, and the excluded drug provisions in Medicaid.
  • Federal Register, 75: 24470-24482, May 5, 2010. This interim final rule adopts the categories of information that will be collected and displayed as Web portal content, and the data we will require from issuers and request from States, associations, and high risk pools in order to create this content.

CCF Comments on the Web Portal Requirements

  • State Health Official/State Medicaid Director Letter, April 9, 2010. This letter provides guidance on section 2001 of the ACA, which establishes the option for states to begin providing Medicaid to the lowest income adults, without regard to categorical limitations, as of April 1, 2010.