CMS Guidance on Enhanced FMAP Released

May 13, 2021

We received a copy of the CMS guidance earlier this afternoon and have had an hour or so to digest it.  With no assurance that we absorbed all of the details or nuances, the following are the big takeaways:


  • Federal funds attributed to the increased FMAP must be used to supplement existing state funds expended for HCBS in effect on 1 April, 2021, and
  • State funds equivalent to the amount of federal funds attributed to the increased FMAP must be used to implement or supplement one or more activities to enhance, expand or strengthen the HCBS program beyond what was available on 1 April, 2021;
  • Efforts may be both short-term and long-term in nature and will not impact the “cost-effectiveness” requirement of the Waiver;
  • Effective stakeholder engagement is expected in the planning process, however, as the memo details the use of the “State funds equivalent” it is nearly inevitable that this plan will need to be approved by the General Assembly when they come into Special Session this summer;
  • Services eligible include Case Management (a State Plan benefit), Section 1915(c) Waiver services (all of the DD Waiver services), MLTSS Services (MCO managed services which used to be in the EDCD Waiver);
  • Examples of activities which are COVID related include new or additional HCBS, increased rates for services (with the understanding that agencies will increase compensation for DSPs or add paid leave, a shift differential or hazard pay (not assumed in the rate setting methodology), or purchase PPE, recruit, train or pay incentives for staff, support families with supplies and equipment;
  • Examples of activities for building capacity by adding slots to reduce the waiting list, provide training for staff, updating critical incident management systems or provide new services.  Keep in mind that some of these (eg., adding slots) are risky investments using “one-time” money.

Section 2 of this memo also allows States to apply for an additional three 30-day periods of retainer payments (within calendar year  2021) which may be retroactive to January 1, 2021.