Louisiana Appropriately Claimed Most Balancing Incentive Payment Program Funds

The Medicaid ProgramThe Medicaid program provides medical assistance to low-income individuals and individuals with disabilities. The Federal and State Governments jointly fund and administer the Medicaid program. At the Federal level, CMS administers the program. Each State administers its Medicaid program in accordance with a CMS-approved State plan. In Louisiana, the State agency administers the Medicaid program. Although the State agency has considerable flexibility in designing and operating its Medicaid program, it must comply with applicable Federal requirements. The Federal Government pays its share of a State’s Medicaid expenditures based on the FMAP, which varies depending on the State’s relative per capita income (Social Security Act § 1903(a)(1) and 42 CFR § 433.10). The State agency’s regular FMAP was 65.51 percent for Federal fiscal year (FY) 2013, 62.11 percent for FY 2014, and 62.05 percent for FY 2015. Within 30 days after the end of each quarter, States report to CMS expenditures and the associated Federal share on the Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64 report). The amounts that States report must represent actual expenditures (42 CFR § 430.30(c)). The State agency uses line items on the CMS-64 report to split expenditures based on the type of services provided. For example, State agencies use line 12 to report home health services expenditures and line 19A to report home and community-based services expenditures.State Balancing Incentive Payments ProgramSection 10202 of the ACA established BIPP, which allowed eligible States to receive an increase in their FMAPs only for eligible Medicaid noninstitutional LTSS expenditures. States that spent less than 50 percent of their total Medicaid LTSS expenditures on noninstitutional LTSS prior to participating in the program were eligible for the BIPP. States that spent less than 25 percent were eligible for a 5-percent increase in their FMAPs; States that spent between 25 percent and 50 percent were eligible for a 2-percent increase in their FMAPs. The State agency received a 2-percent increase to its FMAP. States that received a 2-percent increase in their FMAPs had to spend at least 50 percent of their total Medicaid LTSS expenditures on noninstitutional LTSS by the end of the program. CMS identified specific CMS-64 report line items eligible for the increased FMAP.