Supporting Statement A

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SUPPORTING STATEMENT A
Generic Clearance for Medicaid and CHIP State Plan,
Waiver, and Program Submissions
CMS-10398, OMB 0938-1148

Background

The Centers for Medicare & Medicaid work in partnership with States to implement Medicaid and the Children’s Health Insurance Program (CHIP). Together these programs provide health coverage to millions of Americans. Medicaid and CHIP are based in Federal statute, associated regulations and policy guidance, and the approved State plan documents that serve as a contract between CMS and States about how Medicaid and CHIP will be operated in that State. When modifications or enhancements to the program are prescribed by Congress through legislation, each State’s program must be amended to comply. For example, in March 2010, Congress passed (and the President signed into law) the Affordable Care Act, which enacted comprehensive reform of the Medicaid program. CMS works collaboratively with States in the ongoing management of programs and policies, and CMS continues to develop implementing guidance and templates for States to use to elect new options available as a result of the Affordable Care Act or to comply with new statutory provisions. CMS also continues to work with States through other methods to further the goals of health reform, including program waivers and demonstrations, and other technical assistance initiatives.

As demonstrated below in section 15, this 2026 iteration requests OMB’s approval to raise our active burden ceiling by 1,112,707hours (from 450,000 to 1,562,707 hr) while extending our 0938-1148 control number for 3-years. The increase is mostly needed to account for the Working Families Tax Cut (WFTC) legislation (Pub. L. 119-21) and the implementing provisions in our June 3, 2026, Interim Final Rule with Comment Period (CMS-2454-IFC; RIN 0938-AV98) entitled, “Medicaid Program; Community Engagement Requirement for Certain Individuals.

A.	Justification

1.	Need and Legal Basis

Section 1901 of the Social Security Act (42 U.S.C. 1936) requires that States must establish a State plan for medical assistance that is approved by the Secretary to carry out the purpose of Title XIX. CHIP has a corresponding statutory requirement for a State plan outlined in Section 2101 to carry out the purpose of Title XXI. The State plan functions as a contract between the State and Federal government describing how the State will implement its program in accordance with Federal laws and regulations in order to secure Federal funding. 

The Act also provides the Secretary with some discretion in waiving program requirements when it does not have a negative financial impact (cost effectiveness, cost neutrality, and budget neutrality) and promotes the objectives of the program. For instance, Section 1915(b) allows for the waiver of Medicaid provisions to allow for the implementation of managed care programs. Additionally, Section 1115 of the Act provides the Secretary flexibility to waive program requirements in Section 1902 and provide Federal funding for costs that are otherwise unmatchable. Written applications from States are required for these programs that outline what the State proposes to do and the financial impact it will have.

2.	Information Users

State Medicaid and CHIP agencies are responsible for developing submissions to CMS, including State plan amendments and requests for waivers and program demonstrations. States use templates when they are available and submit the forms to CMS to review for consistency with statutory and regulatory requirements (or in the case of waivers and demonstrations whether the proposal is likely to promote the objectives of the Medicaid program).  If the requirements are met, CMS approves the State’s submission giving the State the authority to implement the flexibilities.  For a State to receive Medicaid Title XIX funding, there must be an approved Title XIX State plan.

The development of streamlined submission forms enhances the collaboration and partnership between States and CMS by documenting CMS policy for States to use as they are developing program changes. Streamlined forms improve efficiency of administration by creating a common and user-friendly understanding of the information needed by CMS to quickly process requests for State plan amendments, waivers, and demonstration, as well as ongoing reporting.

3.	Improved Information Technology

The forms for the States to use are available in electronic format. We expect every submittal to be forwarded to CMS using the electronic format. The forms create streamlined and structured data, decreasing the time required by States to develop their submissions to CMS.

4.	Duplication

There is no duplication of similar information.

5.	Small Business

There is no burden on small businesses.

6.	Less Frequent Collection

Under Medicaid and CHIP State plans, there is no need to resubmit information once it is approved, unless the State elects to change its program. For waiver and demonstration programs, renewals of the programs are required on cycles that vary across statutory authority from 2 – 5 years. However, within the approved waiver cycle, States are not asked to resubmit information once it is approved unless the State elects to change its program.  

7.	Special Circumstances

The implementation of these templates is often time sensitive and must be coordinated with the release of guidance documents such as regulations and policy letters. Additionally, some of the templates that would be approved under this collection must be available to States to implement the changes timely.

8.	Federal Register Notice/Prior Consultation

Serving as our 60-day notice, our Interim Final Rule with Comment Period (CMS-2454-IFC; RIN 0938-AV98) published in the Federal Register on June 3, 2026 (91 FR 33348).

For new and revised GenICs, we will continue to publish 14-day Federal Register notices that will provide interested parties with an opportunity to review and comment on the generic information collection request. Instructions for obtaining the GenIC’s documents and for submitting comments will be set out in each Federal Register notice.

However, new or revised GenICs that are affiliated with SMD (State Medicaid Director) or SHO (State Health Official) letters we may publish the 14-day Federal Register notice before, on, or after the issuance of the OMB’s approval of the generic collection of information request. Requests that are not tied to such letters must publish the 14-day  notice a minimum of 14 days prior to OMB’s approval.

For SMD and SHO letter-related GenICs, when the 14-day Federal Register notice’s comment period closes after OMB’s approval of the GenIC, CMS shall submit a subsequent GenIC that includes all public comments as well as CMS’ response to those comments. If the collection of information requirements and/or burden need to be revised, the subsequent GenIC must also address the proposed changes.

9.	Payment/Gift to Respondents

There is no payment or gift to respondents.

10.	Confidentiality

Program submissions to CMS from States are public information, and there is no personal identifying information collected in the documents.  No assurance of confidentiality is provided to respondents.

11.	Sensitive Questions

There are no questions of a sensitive nature.

12.	Burden Estimates

As demonstrated below in section 15 this 2026 iteration requests OMB’s approval to raise our active burden ceiling to 1,562,707 hours.

Cost estimates are dependent on our requirements and the respondent’s BLS Occupation Title and wage. Since this information will not be known until upcoming GenICs are developed, our cost estimates will be set out when each GenIC package is submitted to OMB for approval.

While this generic umbrella lays the groundwork for the content of the GenICs that fall under this umbrella, the GenICs specify the collection of information requirements and burden that are associated with those requirements. It also sets forth the collection’s reporting instruments (if any) and instructions.

13.	Capital Costs

There are no capital costs associated with this information collection.

14.	Costs to Federal Government

With respect to the PRA and the definition of “collection of information” under 5 CFR 1320.3(c), respondent labor-related costs are typically dependent on federal legislation, our implementing regulations, and current BLS occupation and wage data. Respondents may also have non-labor costs (postage is one example). Since this information will not be known until upcoming GenICs are developed, the Federal match or cost (if any) will be set out when each GenIC is submitted to OMB for approval.

15.	Program/Burden Changes

As demonstrated below, this 2026 iteration requests OMB’s approval to raise our active burden ceiling by 1,112.707 hours (from 450,000 to 1.562,707 hr) while extending our 0938-1148 control number for 3-years. The increase is mostly needed to account for the Working Families Tax Cut (WFTC) legislation (Pub. L. 119-21) and the implementing provisions in our June 3, 2026, Interim Final Rule with Comment Period (CMS-2454-IFC; RIN 0938-AV98) entitled, “Medicaid Program; Community Engagement Requirement for Certain Individuals.

The increase considers our currently approved burden ceiling, our active time estimates, time needed for CMS-2454-IFC, active time estimates that are no longer needed, our projected needs for 2026 – 2029, and the time needed for unanticipated GenICs.

15.1. Currently Approved Burden Ceiling 

450,000 hours (see attached NOA, dated July 29, 2026)

15.2. Currently Approved GenICs 

231,896 hours (see attached NOA, dated July 29, 2026)

For the GenICs that we propose to keep active, we are not making any program changes or adjustments.

15.3. Community Engagement Requirement for Certain Individuals (CMS-2454-IFC; RIN 0938-AV98)

The following changes that are associated with our June 3, 2026 IFC.

For details see the following table and attached generic collection of information requests.

Requirement
No. Respondents
Total Responses
Time per Response (hr)
Total Time (hr)
Wage ($/hr)
Total Cost ($)
Federal Share ($)
State Share ($)
GenIC #11 (MAGI-Based Eligibility Verification Plan)
Verification Plan
44 Jurisdictions
44 
124 
5,456 
Varies
505,226 
252,613 
252,613 
Verification Plan Updates
5 
5 
11 
55 
Varies
5,211 
2,606 
2,606 
Subtotal: GenIC #11
44 
49 
varies
5,511 
varies
510,437 
255,219 
255,219 
GenIC #35 (Eligibility and Enrollment Performance Indicators)
One-Time Burden for Monitoring Community Engagement (PI data)
44 
44 
162 
7,128 
Varies
797,350 
598,012 
199,338 
Annual Reporting for Monitoring Community Engagement (PI data)
44 
1,056 
4 
4,224 
Varies
488,907 
366,680 
122,227 
Subtotal: GenIC #35
44 
1,100 
varies
11,352 
varies
1,286,257 
964,692 
321,565 
GenIC #66 (Eligibility Processing Data Report)
One-Time Burden for Monitoring Community Engagement (EP data)
44 
44 
162 
7,128 
Varies
797,350 
598,012 
199,338 
Annual Reporting for Monitoring Community Engagement (EP data)
44 
1,056 
4 
4,224 
Varies
488,907 
366,680 
122,227 
Subtotal: GenIC #66
44 
1,100 
varies
11,352 
varies
1,286,257 
964,692 
321,565 
GenIC #100 (Medicaid Community Engagement: Good Faith Effort Exemptions and Quarterly Reporting)
Good Faith Effort Exemption Request and Workplan
10 
10 
28 
280 
Varies
26,125 
13,063 
13,063 
Good Faith Quarterly Reporting
2 
12 
13 
150 
Varies
13,371 
6,686 
6,686 
Subtotal: GenIC #100
10 
22 
varies
430 
varies
39,496 
19,749 
19,749 
GenIC #101 (Medicaid Community Engagement: Short-term Hardship Exception Requests)
Initial State Requirements to Establish and Document Short-Term Hardship Exceptions
44 
44 
116 
5,104 
Varies
479,931 
359,948 
119,983 
Initial State Requirements for Short-Term Hardship Exception Notices
44 
44 
Varies
4,928 
Varies
458,367 
343,775 
114,592 
Initial Mailing State Requirements for Short-Term Hardship Exception Notices: Total Labor Burden
44 
30,000,000 
0 
510,000 
39 
19,716,600 
9,858,300 
9,858,300 
Initial Mailing State Requirements for Short-Term Hardship Exception Notices: Total Non-Labor Burden
44 
30,000,000 
n/a
0 
n/a
24,060,000 
12,030,000 
12,030,000 
Annual State Maintenance Requirements for Short-Term Hardship Exception Notices
44 
44 
Varies
1,232 
Varies
114,592 
85,944 
28,648 
Ongoing State Requirements for Mailing Short-Term Hardship Exception Notices – Annual Updates: Total Labor Burden
44 
22,500,000 
39 
382,500 
Varies
14,787,450 
7,393,725 
7,393,725 
Ongoing State Requirements for Mailing Short-Term Hardship Exception Notices – Annual Updates: Total Non-Labor Burden
44 
22,500,000 
n/a
0 
n/a
18,045,000 
9,022,500 
9,022,500 
Short-Term Hardship Exception Notifications for Emergencies or Disasters
20 
20 
22 
440 
Varies
40,128 
20,064 
20,064 
Short-Term Hardship Exception Requests for Unemployment
20 
40 
104 
4,160 
Varies
370,560 
185,280 
185,280 
Beneficiary Burden for Short-Term hardship Exception Requests for Institution/ Inpatient Stays or Travel
300,000 
300,000 
1 
300,000 
13 
3,876,000 
0 
0 
Annual Mailing State Requirements for Expiration of a Short-Term Hardship Event Described in § 435.555(d)(2) and (3): Total Labor Burden
44 
18,200,000 
0 
309,400 
39 
11,961,404 
5,980,702 
5,980,702 
Annual Mailing State Requirements for Expiration of a Short-Term Hardship Event Described in § 435.555(d)(2) and (3): Total Non-Labor Burden
44 
18,200,000 
n/a
0 
n/a
14,596,400 
7,298,200 
7,298,200 
Subtotal: GenIC #101
300,044 
141,700,192 
varies
1,517,764 
varies
108,506,432 
52,578,438 
52,051,994 
TOTALTOTAL
600,810 
283,404,877 
varies
1,546,409 
varies
111,628,879 
54,782,790 
52,970,092 

15.4. Revised GenICs

Since the beginning of our current active iteration (October 3, 2024) we have added roughly 39,000 hours (38,946 hr) of revised burden. Given that was approximately 22 months ago we estimate an average of 1,773 hr of revisions per month (39,000 hr/22). For the upcoming 3-year approval period, we estimate an additional need of 63,828 hours (1,773 hr x 36 months).

15.5. Discontinued GenICs


Time (hr)
GenIC #71 (Reporting Requirements for State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services During the COVID–19 Emergency)
(640)
GenIC #81 (Improving Quality of Care and Outcomes Data for Pregnant Medicaid Beneficiaries and Newborn Infants through Linkage and Evaluation of VR, BC, DC, and TAF)
(104)
TOTAL
(744)

15.6. Projected GenICs

For the upcoming 3-year approval period (2026 - 2029), we estimate the time involved for completing a template is 20 hours for shorter/less complex templates and 40 hours for templates that are more comprehensive/complex. Under the above scenario, each State could spend 1,080 hours to produce 38 responses including 16 complex templates requiring 40 hours and 22 shorter templates requiring 20 hours (1,080 hours = [16 templates * 40 hours] + [22 templates * 20 hours]).  If all 56 respondents spent 1,080 hours over the 3-year period, the total 3-year burden would be 60,480 hours (1,080 hours * 56 States).

When considering GenICs #48 and #99, the total is 155,744 hours (60,480 hr + 94,984 hr + 280 hr).

Title
Target Rollout Date
Projected Time Per Response (hr)
Projected Time (hr)




GenIC #48 (Certified Behavioral Health Clinic Quality Data Reporting)
2026
224
94,984
GenIC #99 (Medicaid Certified Community Behavioral Health Clinic (CCBHC))
2026
5
280
ACA Sec 2001: Benchmark
TBD
40
2,240
ACA Sec 2003: Premium Assistance for ESI
TBD
20
1,120
ACA Sec 2202: Presumptive Eligibility by Hospitals
TBD
20
1,120
ACA Sec 2301: Coverage of Freestanding Birth Centers
TBD
20
1,120
ACA Sec 2302: Concurrent Hospice Care
TBD
20
1,120
ACA Sec 2303: Coverage of Family Planning Services
TBD
20
1,120
ACA Sec 2404: Spousal Impoverishment
TBD
20
1,120
ACA Sec 4106: Preventive Services for Adults
TBD
20
1,120
ACA Section 1312: Residency
TBD
40
2,240
ACA Section 1331:  Basic Health Plan
TBD
40
2,240
ACA Section 1411: Appeals Process
TBD
40
2,240
ACA Section 1413 /2201 HUB verification sources
TBD
20
1,120
ACA Section 1413: Alternative Streamlined Application Template (CMS)
TBD
20
1,120
ACA Section 1413: Verifications (Financial and non-Financial)
TBD
20
1,120
ACA Section 2002: Coordination with Exchange ( Medicaid and CHIP)
TBD
20
1,120
ACA Section 2004: Former Foster Care
TBD
20
1,120
ACA Section 2303:  Family Planning - Eligibility
TBD
40
2,240
Designation of Single State Agency
TBD
20
1,120
Election of Tax Credit Disregards
TBD
40
2,240
EQRO Protocols
TBD
20
1,120
Implementation of Asset Verification System
TBD
40
2,240
Implementation of MEQC data for PERM data
TBD
40
2,240
Implementation of Premium Assistance in Medicaid
TBD
40
2,240
Implementation of the Alignment of LIS and MSP Asset Tests
TBD
40
2,240
Implementation of the Public Assistance Reporting Information System (PARIS)
TBD
40
2,240
Medicaid and CHIP Statistical Enrollment Data System (SEDS)
TBD
40
2,240
Medicaid Eligibility Cards for Homeless Individuals
TBD
40
2,240
Medical Child Support Cooperation
TBD
40
2,240
Option to Cover Certain Children and Pregnant Women lawfully residing in the US
TBD
40
2,240
Performance Measures
TBD
40
2,240
Secretarial Certification of health plans in the Exchange
TBD
20
1,120
Secretarial Issue Streamlined Application (CCIIO-CMS)
TBD
20
1,120
Systematic Alien Verification for Entitlements
TBD
20
1,120
Tobacco cessation coverage
TBD
20
1,120
Transitional MA for Low Income Families
TBD
20
1,120
Tribal Consultation
TBD
20
1,120
Tuberculosis coverage
TBD
20
1,120
Medicaid Premiums
TBD
20
1,120
TOTAL
155,744

15.7. Unanticipated GenICs

We request 15,574 hours (155,744 x 0.10) of additional time for unanticipated informant collection requests. This figure accounts for a 10 percent margin of error with respect to our Projected GenIC time estimate for 2026 – 2029.

15.8. Summary of Burden Request

Burden Type
Time (hr)
Available Time
15.1. Currently Approved Burden Ceiling (A)
450,000
15.2. Currently Approved GenICs (B)

231,896
Subtotal: Available Time (C = A - B) 


218,104
Time Needed (3-Years)
15.3. Community Engagement Requirement for Certain Individuals  (CMS-2454-IFC; RIN 0938-AV98) (D)
1,546,409
15.4. Revised GenICs (E)
63,828
15.6. Projected New GenICs (F)


155,744
15.7. Unanticipated GenICs (G)

15,574
Subtotal: Burden Needed (H = D + E +F + G))

1,781,555
Time No Longer Needed
15.5. Discontinued GenICs
(744)
Subtotal: Burden No Longer Needed (J)
(744)
Requested Burden Ceiling  (H – [C + J])
1,562,707

16.	Publication and Tabulation Dates

There are no plans to publish the information for statistical use.

17.	Expiration Date

CMS seeks to continue our exemption from displaying the expiration date on our generic instruments.  The exemption would reduce work on replacing the expiration date every 3 years with the renewal of the Generic Umbrella package.  We currently have more than 50 approved GenICs.  Most of these may have multiple templates associated with them.

Moreover, in certain cases displaying the expiration date causes unnecessary burden and confusion, especially in instances where the expiration date is near the approval date. In one real example, a GenIC was approved on October 29, 2014, while the expiration date was a few days later, on October 31, 2014. It would be confusing to respondents to forward templates on Oct 29th with an expiration date of Oct 31st of the same year.  It would also be burdensome to produce and revise the expiration dates in such a short period of time.

18.	Certification Statement

There are no exceptions.

B.	Collection of Information Employing Statistical Methods

The use of statistical methods does not apply for purposes of this collection.