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State Medicaid and CHIP programs need funding to operate.
How does Medicaid and CHIP financing work?
The Medicaid program is jointly funded by the federal government and states/territories.
The federal government pays states and territories for a specific percentage of the program expenditures,
called the Federal Medical Assistance Percentage (FMAP) and
states and territories must fund their share of the program expenditures.
The federal government provides quarterly grant awards
to states and territories to cover the federal share for Medicaid.
The quarterly grants are based on information submitted by the states and territories
in quarterly estimate and expenditure reports, and other documents.
The Children's Health Insurance Program (CHIP) is also jointly funded by the federal government and states.
The federal government pays a percentage of a state's CHIP program expenditures
based on the state's enhanced FMAP (EFMAP)
and states must fund their share of the program expenditures.
The EFMAP rate for CHIP is greater than the regular FMAP for Medicaid.
States are provided CHIP Allotments annually which are determined based on a statutory formula.
Each quarter,
states and territories electronically report their estimated and actual Medicaid and CHIP expenditure data to CMS.
CMS reviews state and territory data for accuracy and allowability,
then uses this information to compute the amount of Federal Financial Participation
that is provided to the state to fund program operations.
CMS also stores this budget and expenditure data for record keeping, accounting, and data analysis purposes.
That's really helpful.
How is all the data collected, analyzed, and money sent to states?
The Medicaid and CHIP Financial System (MACFin) is a new integrated system
that will replace the Medicaid and CHIP Budget and Expenditure System (MBES/CBES)
for state and territory reporting and for CMS analysis of Medicaid and CHIP estimated and actual expenditures.
MACFin improves on the previous system by integrating the workflows
needed to make this happen and makes it easy to use and share data.
That sounds like progress.
Can you share more detail about what each part of MACFin does?
Sure.
MACFin has several modules, these include:
Budget Module –
The budget module collects states and territories quarterly budget estimates through
a file upload or manual entry
and allows CMS to review and determine the allowability of the states and territories estimates
and work with states to resolve any concerns on a quarterly basis.
Grants Module –
The grants module provides data and reports that will allow CMS to create and issue states'
initial and supplemental federal funding grant awards for medical assistance and administrative expenditures.
States and territories can access their grant awards through MACFin.
Expenditure Module –
The expenditure module is being developed now in MACFin
to make this process even better and structure in a way where the data and supporting documentation
can be easily submitted by states and territories and easily shared and verified.
CHIP Allotment Module –
The CHIP Allotment module automates and streamlines the CHIP allotment calculation process
for CMS and tracks projected and actual expenditures
in order to ensure states have their CHIP allotment grants when they need them.
State and CMS reviewers can use this data to track state spending against the available allotments.
IBNRS Module –
The Incurred But Not Reported Survey (IBNRS) module allows states and territories
to report expenditures that have been incurred but not yet reported.
DSH Module –
CMS calculates the disproportionate share hospital (DSH) allotment for each state and collects DSH audit data.
CMS then performs a completeness review in order to determine if there are issues with the audit submission.
Then the more in-depth content review is done
to determine that the state's DSH program is in compliance with federal requirements.
UPL Module –
The Upper Payment Limit (UPL) module
is used to collect and review provider level data from states relating to supplemental payments paid to providers.
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Who uses MACFin?
MACFin will replace the MBES/CBES and will be used by the current MBES/CBES users.
In addition, MACFin is intended to integrate and store all the Medicaid and CHIP financial data
received by CMS to be used by policy makers in the executive and legislative branches
of federal and state governments as well as by researchers and other interested stakeholders.
Are you still making changes and enhancements?
Yes!
We continually adapt to legislation changes and user needs.
Some areas we are working on now are:
Automation and process improvements –
includes the ability to submit template based data, integrated workflows for higher data quality.
Data availability, reporting and analytics –
enable better data integration and more opportunities for data-driven decision-making
by letting users access the data with visualizations to run custom analytics
and integrate data into other systems.
Better user experience –
user-focused design, easier access to data, more help and related information available within MACFin.
Data security –
protecting the integrity of the data, and secure it from outside threats.
All of this is great information to learn the basics on how MACFin works.
If you'd like to learn more, please email me at MACFin@dcca.com for me to follow up with you!
Talk to you soon.
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