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Page 11 – CMCS Informational Bulletin 1) U.S. citizens and nationals, 2) LPRs,22 3) Cuban and Haitian entrants,23 and 4) Compacts of Free Association (COFA) migrants.24 We note that section 71109 does not amend PRWORA. The FFP limitations described in section 71109 do not apply to expenditures for: 1) care and services necessary for the treatment of an emergency medical condition as described in section 1903(v)(3) of the Act, authorized under section 1903(v)(2) of the Act (often referred to as “emergency Medicaid”);25 2) medical assistance to lawfully residing children and pregnant women under the CHIPRA 214 option authorized by section 1903(v)(4) of the Act;26 and 3) any state-designed Health Services Initiatives (HSIs) to improve the health of low-income children authorized under section 2105(a)(1)(D)(ii) of the Act.27 CMS is continuing to assess the implications of section 71109 on Medicaid and CHIP and expects to address any additional information in forthcoming guidance. Sections 1903(v)(5) and 2107(e)(1)(R) of the Act, as added by section 71109, are applicable to all states, the District of Columbia, and the territories. Section 71110. Expansion FMAP for Emergency Medicaid FFP is authorized for care and services necessary to treat an emergency medical condition (as described in section 1903(v)(3) of the Act) for certain noncitizens who do not have satisfactory immigration status for full Medicaid benefits, provided they otherwise meet a state’s Medicaid eligibility criteria (e.g., income, state residence),28 generally at the state’s regular Federal medical assistance percentage (FMAP) under section 1905(b) of the Act. Currently, if such a noncitizen meets the criteria in section 1902(a)(10)(A)(i)(VIII) of the Act for the Medicaid adult group, and the criteria in section 1905(y) or 1905(z) are met, a state can claim the associated 90 percent FMAP for its expenditures on services for an emergency medical condition for that noncitizen. Section 71110 adds a new subsection (kk) to section 1905 of the Act. Beginning October 1, 2026, new subsection 1905(kk) limits the FMAP for emergency Medicaid services provided to noncitizens to no greater than the FMAP determined under section 1905(b) of the Act for such 22 Section 1903(v)(5)(B)(ii) as added by section 71109(a) of the WFTC legislation, section 101(a)(15) and 101(a)(20) of the Immigration and Nationality Act (INA); an individual who is lawfully admitted for permanent residence under the INA (8 U.S.C. § 1101 et seq.); 8 U.S.C. § 1641(b)(1)). 23 Section 1903(v)(5)(B)(iii) as added by section 71109(a) of the WFTC legislation, section 501(e) of Refugee Education Assistance Act of 1980. See 8 U.S.C. §§ 1612(b)(2)(A)(iv), 1613(b)(1)(D), and 1641(b)(7). 24 Section 1903(v)(5)(B)(iv) as added by section 71109(a) of the WFTC legislation; see also Section 2107(e)(1)(R) (applying the same limitation to CHIP). See 8 U.S.C. §§ 1612(b)(2)(G), 1613(b)(3), and 1641(b)(8)). Coverage of COFA migrants under Medicaid is optional for territories. 25 Section 1903(v)(5) of the Act, added by section 71109(a) of the WFTC legislation; 8 U.S.C. 1611(b)(1)(A). 26 Section 1903(v)(5) of the Act, added by section 71109(a) of the WFTC legislation. The CHIPRA 214 option is applicable to CHIP through a cross-reference at section 2107(e)(1)(Q) of the Act to section 1903(v)(4) of the Act. 27 Section 2107(e)(1)(R) of the Act, added by section 71109(b) of the WFTC legislation. 28 8 U.S.C. § 1611(b)(1)(A) and sections 1903(v)(2) and (3) of the Act. See also section 1903(v)(5) of the Act, added by section 71109(a) of the WFTC legislation, which will apply beginning October 1, 2026, as discussed above.