OK SPA 22-0042 Pregnancy-Related Federal Poverty Limit Increase, Postpartum Coverage Extension, and Proxy Methodology
The Oklahoma Health Care Authority (OHCA) will seek approval of Title XIX Medicaid State Plan authority to raise the income standard for the pregnancy-related category, extend postpartum coverage, and establish an enhanced Federal Matching Aid Percentage (FMAP) proxy methodology for certain individuals receiving postpartum services.
With an implementation date of January 1, 2023, the Federal Poverty Level (FPL) used to determine the maximum income allowable for Title XIX pregnancy-related eligibility group will increase from 133% to 185% (equivalent to 210% FPL after conversion to Modified Adjusted Gross Income (MAGI) methodology and applicable disregards). The State Plan Amendment will also seek to extend Medicaid postpartum coverage from 60 days to 12 months, implementing a provision of the American Rescue Plan Act effective until March 31, 2027. Lastly, the amendment will request to implement a proxy methodology ensuring the State receives the enhanced FMAP for postpartum services provided to members eligible as expansion adults.
Please view the draft SPA pages here: OK SPA 22-0042, and submit feedback via the comment box below.
60-day Tribal Consultation Period: 10/25/2022 – 12/24/2022
Tribal Consultation: 11/1/2022
Circulation Date: 11/1/2022
Comment Due Date: 12/1/2022
Proposed Effective Date: 1/1/2023
Comments
Dianna Berry:
Once the postpartum extension is approved, eligible members are entitled to the extension and are not required to cooperate with child support services (CSS) as a condition of receiving the extended coverage. Correct?
OHCA Response:
Pregnant women are required to comply with child support at the time of application and during a time of renewal. American Indian/Alaskan Native beneficiaries are exempted from the child support cooperation requirement, pursuant to state rules (OAC 317:35-5-44) and federal regulation (42 CFR 433.152).
Dianna Berry:
Per Section 1902(l)(1)(A) of the Social Security Act, poverty-level pregnant women (which includes the postpartum period) are eligible for Medicaid services as a mandatory group. Per section 1912(a)(1)(B) of the Act and 42 CFR 433.147(a)(1), poverty level pregnant women, are exempt from cooperating with the state in establishing paternity and in obtaining medical support and payments. Therefore, the state cannot condition eligibility for medical services on such cooperation.
OHCA Response:
You are correct; our initial interpretation was mistaken. However this State Plan Amendment will not change any current policy or practice in relation to child support compliance.
Steven Goldman:
Page 7 of this file refers to "Attachments D and E"
......are these available?
Thank you
OHCA Response:
Attachment D is on page 8 of this file. The exact methodology to be used is still in progress and will be part of the submission package as delivered to CMS for final approval.
Attachment E is unchanged by this State Plan Amendment, and is available in the current version of the State Plan on page 554 of the document.
The Oklahoma Medicaid State Plan can be found here.
Steven Goldman:
As follow-up to the O"OHCA Response" below...page 8 is essentially blank at this time. When will the full text of "Attachment D" be posted, so comments can be submitted by 12/1/22? Thank you.
OHCA Response:
Thank you for your comment. A new version of the SPA is available with the proposed proxy methodology available on Attachment D (page 8).
