Medicaid Administration

Template A2 – Organization and Administration

Statute: Section 1902(a)(4)

Regulation: 42 CFR 431.11

INTRODUCTION

In this template, the State provides a description of the organization and functions of the Medicaid agency, the medical assistance unit and the staff making eligibility decisions, if other than the Medicaid agency.

BACKGROUND

The designated State agency should have in place, an organizational structure and staffing sufficient to support the administration and operation of the State’s Medicaid program.

States are required to have a medical assistance unit within the Medicaid agency, staffed with a program director and other appropriate personnel who participate in the development, analysis, and evaluation of the Medicaid program.

TECHNICAL GUIDANCE

Template A2 consists of three sections

• Medicaid Agency Organization

• Medical Assistance Unit

• Eligibility Staffing

Medicaid Agency Organization

In this section, States must provide a description of the organization and functions of the Medicaid agency in the text box provided.

The State must then attach an organizational chart of the Medicaid agency via the upload function.

Medical Assistance Unit

In this section, the State must identify the entity designated as the medical assistance unit and provide a description of the organization and functions of the medical assistance unit in the text boxes provided.

The State must then attach an organizational chart of the Medicaid agency’s medical assistance unit via the upload function

Next the State must enter the kinds and numbers of professional medical personnel and supporting staff, in the Medicaid Agency, used in the administration of the plan and their responsibilities, in the text boxes provided.

Eligibility Staffing

This section of the template displays only for States which indicated in template A1 (Designation and Authority) that eligibility decisions are made by other than the Medicaid Agency or the Medicaid agency plus other agencies.

The system will display each entity checked in template A1 and for each agency, the State must enter a description of the staff designated by the agency and the functions they perform in carrying out their responsibilities, in the text boxes provided.

Note for CMS: Please provide guidance as to what may or may not be acceptable responses. For example, is there a minimum requirement as to credentials of staff making eligibility decisions, such as having a bachelor’s degree?