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Enclosure

Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), P.L. 110-275, is a broad piece of legislation having impacts in many areas of Medicaid. This enclosure for the State Medicaid Director Letter on certain provisions of MIPPA is designed to provide further detail to the MIPPA provisions in the letter. Most of the provisions within this enclosure relate to changes regarding one or more of the Medicare Savings Programs (MSPs).

Section 111: Extension of the Qualifying Individual (QI) Program

Section 111 of MIPPA extended the QI program from the end of the third quarter of Federal fiscal year (FY) 2008 (June 30, 2008) to the end of the first quarter of FY 2010 (December 31, 2009); it also provided for an additional $100 million in funding for the QI program in FY 2008 (bringing the total funding for that fiscal year to $400 million), $450 million in total funding for FY 2009, and $150 million in funding for the first quarter of FY 2010.

Subsequent to the enactment of MIPPA, other legislation, the QI Program Supplemental Funding Act of 2008 (P.L. 110-379), and the American Recovery and Reinvestment Act of 2009 (P.L. 111-5), extended and appropriated additional funding for the QI program through the end of the first quarter of FY 2011 (December 31, 2010). Most recently, P.L. 111-127 increased the funding available for the second through the fourth quarters of FY 2010, and for the first quarter of FY 2011. The following are the funding levels appropriated by the Congress, representing all legislative initiatives extending the QI program since the beginning of FY 2008:

October 1, 2007 - December 31, 2007 (first quarter of FY 2008): $100 million January 1, 2008 - September 30, 2008 (second through fourth quarters FY 2008): $315 million October 1, 2008 - December 31, 2008 (first quarter of FY 2009): $130 million January 1, 2009 - September 30, 2009 (second through fourth quarters FY 2009): $350 million October 1, 2009 - December 31, 2009 (first quarter of FY 2010): $150 million January 1, 2010 - September 30, 2010 (second through fourth quarters FY 2010): $462.5 million October 1, 2010 - December 31, 2010 (first quarter of FY 2011): $165 million

Beneficiary Impact: As indicated, total funding for the QI program is limited nationally. Each State is provided an allotment for each fiscal year, determined in accordance with the methodology specified in 42 CFR 433.10(c)(5). Each State must control enrollment in its QI program based on the available Federal funding; accordingly, enrollment may need to be limited or closed.