Medicaid Administration

Template CA1 – Designation and Authority

Statute: Section 1902(a)(5)

Regulation: 42 CFR 431.10

INTRODUCTION

Template CA2 must be completed by all States

In this template, the State names the single State agency authorized to administer and submit the State Plan for the State’s Medicaid program, and agrees to administer the program in accordance with the provisions of the State Plan, the requirements of title XI and XIX (as appropriate) of the Social Security Act, and all applicable Federal regulations and other official issuances.

BACKGROUND

States must designate a single State agency to administer or supervise the administration of the State’s Medicaid plan and provide certification by the State Attorney General, citing the legal authority for the single State agency to administer or supervise the administration of the Medicaid plan and to make rules and regulations that it follows in administering the plan or that are binding upon local agencies that administer the plan.

For families and children, Medicaid eligibility determinations may be made by the State Medicaid agency; and/or the State agency under Title IV-A (in the 50 states or the District of Columbia) or under Title I or XVI (in Guam, Puerto Rico, or the Virgin Islands); and/or a government-operated Exchange established under sections 1311(b)(1) or 1321(c)(1) of the Affordable Care Act.

For the aged, blind, and disabled, Medicaid eligibility determinations must be made by the State Medicaid agency; or the State agency under Title IV-A (in the 50 states or the District of Columbia) or under Title I or XVI (in Guam, Puerto Rico, or the Virgin Islands); or by the agency or agencies administering the supplemental security income program.

A State must implement and administer its Medicaid program in accordance with the approved State plan, any approved State plan amendments, the requirements of title XI and title XIX (as appropriate), and all applicable Federal regulations. CMS monitors the operation of the approved State plan and plan amendments to ensure compliance.

TECHNICAL GUIDANCE

Following the introductory statement, this template contains the following sections:

• Agency Type

• Single State Agency Responsibility

• Administration of the Plan

• Responsibility for Eligibility Determinations

Agency Type

The name of the Medicaid Agency is displayed at the top of this section and the State must then select the agency type that corresponds to the Agency named above. Only one option may be selected from the list provided.

If ‘Other’ is selected, the State must then enter the agency type in the text box provided.

Note for CMS: Need guidance as to types of State agencies which may be or not be acceptable.

This is followed by a statement that the named agency (the Medicaid agency name will be prefilled here) is the single State agency designated to administer or supervise the administration of Medicaid program under title XIX of the Social Security Act.

Single State Agency Responsibility

The state must select one of the two following options as to the administrative responsibility of the Medicaid agency:

• Administering the plan

• Supervising the administration of the plan by local political subdivisions

If ‘Administering the plan’ is selected, the State must then enter the statutory citation for the legal authority under which the agency administers the plan, in the text box provided.

If ‘Supervising the administration of the plan by local political subdivisions’ is selected, the State must then enter the statutory citations for both the legal authority under which the agency administers the plan on a statewide basis and under which the Medicaid agency has legal authority to make rules and regulations that are binding on the political subdivisions administrating the plan, in the text boxes provided.

This is followed by the State being asked to assure that ‘the certification signed by the State Attorney General identifying the single State agency and citing the legal authority under which it administers or supervises administration of the program has been provided’.

The State provides this affirmative assurance by checking the box next to the assurance statement. If the State does not check this box, the system will not accept this template for review and approval.

The State must then attach the certification via the Upload function.

Administration of the Plan

This section begins with a statement that ‘The State Plan may be administered solely by the Single State Agency, or some portions may be administered by other agencies’.

This is followed by a Y/N question for the State to indicate if the single State agency administers the entire State Plan under title XIX.

If the response is no, i.e., no other agency or organization administers any portion of it, the State selects one or both of the following options:

• The agency that administers or supervises the administration of the plan under Title X of the Act as of January 1, 1965, has been separately designated to administer or supervise the administration of that portion of this plan related to blind individuals.

• Waivers of the single State agency requirement have been granted under authority of the Intergovernmental Cooperation Act of 1968.

If the State selects ‘The agency that administers or supervises the administration of the plan under Title X….’, the following statement displays: The following designated state agency has a separate plan covering that portion of the State Plan under title XIX for which it is responsible. The State must then enter in the name and type of agency in the text boxes provided.

If the State selects ‘Waivers of the single State agency requirement….’, the State must then indicate by selecting Y/N as to whether the waivers are still in effect.

If the response is yes, i.e. the waivers are still in effect, then the State must provide the following information in the text boxes provided:

• Name of waiver;

• Name of state agency to which responsibilities have been delegated;

• Organizational arrangement authorized;

• Nature and extent of the responsibility for program administration delegated;

• Resources and/or services of the agency to be utilized in the administration of the plan

Note for CMS: Please provide guidance as to what may or may not be acceptable responses for ‘Nature and extent of the responsibility for program administration delegated’. That is, is there a level of delegation that the State cannot exceed?

Responsibility for Eligibility Determinations

This section has two parts:

• Entity or entities that have responsibility for all determinations of eligibility for families, adults, and for individuals under 21.

Here States must select one, two or all three options displayed.

• Entity that has responsibility for all determinations of eligibility for the aged, blind, and disabled

In this part, States must select only one of the three options listed. If the State selects ‘The Federal agency administering the SSI program’, the State must then ‘Indicate which agency determines eligibility for any groups whose eligibility is not determined by the Federal agency’ by selecting only one of the two options listed (Medicaid or title IV-A agency).