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Page 2 – State Health Official Letter Contents Background .............................................................................................................................................3 Overview of Section 71109 of the WFTC Legislation ...........................................................................3 Implementation Date for Section 71109 of the WFTC Legislation ....................................................5 Interaction between Section 71109 of the WFTC Legislation and PRWORA ...................................5 Impact on Noncitizens Dually Eligible for Medicare and Medicaid ..................................................7 Implementation Requirements at Application and for Current Medicaid and CHIP Beneficiaries ........8 Considerations for Applicants and Current Beneficiaries who are Not FFP-Eligible Noncitizens ..10 Operational Considerations for States and Territories .......................................................................... 11 Updates to Applications, Renewal Forms, and Other Materials for Medicaid and CHIP ................12 Verification of Immigration Status or Category ................................................................................13 Considerations for Medicaid Managed Care Programs ....................................................................16 Medicaid and CHIP Information Technology (IT) Systems Costs and Upgrades ................................16 Financial Systems and Proper Claiming ...........................................................................................18 Transformed-Medicaid Statistical Information System (T-MSIS) ...................................................18 Federal Medical Assistance Percentage (FMAP) .................................................................................19 FMAP for Full Medicaid and CHIP Benefits (including under the CHIPRA 214 Option) ..............19 FMAP for Emergency Medicaid .......................................................................................................19 State Plan Amendment (SPA) Submission ............................................................................................20 Territory Considerations .......................................................................................................................21 Closing .................................................................................................................................................22 APPENDIX A - Details Regarding Qualified Noncitizen Coverage in Medicaid and CHIP Before and After Implementation of Section 71109 of the WFTC Legislation ................................................23 APPENDIX B - Summary of Hub Changes in Accordance with Section 71109 of the WFTC Legislation.............................................................................................................................................29