CENTERS
FOR MEDICARE AND MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
AUTHORIZATION:
Ticket-to-Work and Work
Incentives Improvement Act of 1999, Section 203, Public Law 106-170; Health
Insurance Portability and Accountability Act of 1996, as amended.
To
support State efforts to enhance employment options for people with
disabilities by building Medicaid infrastructure. Funding may be used to
develop a Medicaid buy-in, increase availability of Personal Assistance
Services, plan a Demonstration to Maintain the Independence and Employment
Program, or for State-to-State technical assistance.
TYPES OF ASSISTANCE:
Project Grants. Place Cursor Here for Definition
USES AND USE RESTRICTIONS:
While the proposals submitted by the States may vary, States participating in
this grant program will use the funds to remove the barriers to employment of
persons with disabilities by creating health systems change through the
Medicaid program. The development or enhancement of certain core Medicaid
components in each State would enable people with disabilities not only to
work, but to sustain adequate health coverage if they find they need to
relocate to another State for employment purposes. Continuity of health
coverage is an important principle which Congress has emphasized in other
legislation as well, such as the Health Insurance Portability and
Accountability Act (HIPAA). An adequate personal assistance services benefit
and a Medicaid buy-in for employed people with disabilities are, therefore,
significant components of the Ticket-to-Work and Work Incentives Improvement
Act. The infrastructure grants program provides money to the States to develop
these core elements. Funds may not be used for the direct provision of
services to people with disabilities except on a one-time, last resort,
emergency basis for the purpose of sustaining the individual's competitive
employment.
ELIGIBILITY REQUIREMENTS:
Applicant Eligibility: Either of the following may apply: (a) the
single state medicaid agency; or (b) any other agency or instrumentality of a
state(as determined under State law) in partnership, agreement and active
participation with the single state medicaid agency, the State Legislature, or
the office of the Governor.
Beneficiary Eligibility: There are two groups of potentially eligible
beneficiaries, as defined by the Ticket to Work and Work Incentives Improvement
Act of 1999. The first group consists of persons with disabilities between the
ages of 16 and 65 years old, employed, and meet income, asset, and resource
standards established by the State. The second group of potential beneficiaries
consists of persons between the ages of 16 and 65 years old, employed, and cease
to be eligible for Medical Assistance because of medical improvements determined
at the time of a regularly scheduled disability review, but who also continue to
have a severe medically determinable impairment.
Credentials/Documentation: Federal funds must go to a designated State
Medicaid Agency or its partner agencies or instrumentalities. Individuals must
meet State requirements. Administrative cost will be determined in accordance
with OMB Circular No. A-87, "Cost Principles for State and Local
Governments."
Pre-application Coordination: No
pre-applications are required. This
program is excluded from coverage under E.O. 12372.
Application Procedure: The standard application form SF-424 and
related forms, as furnished by CMS, must be used for this program. Application
forms are submitted to the Acquisition and Grants Group, CMS, 2-21-15 Central
Building, 7500 Security Boulevard, Baltimore, MD 21244-1850. This program is
subject to the provisions of OMB Circular No. A-102.
Award Procedure: Official notice of approved applications is made
through the issuance of a notice of cooperative agreement or grant award.
Deadlines: Established when program announcements are published in the
Federal Register or transmitted to States.
Range of Approval/Disapproval Time: The range is from 100 to 150 days.
Appeals: There are no formal appeals procedures. If an application is
disapproved, the reasons for disapproval will be fully stated.
Renewals: Extensions and continuations of projects are available if
formally applied for and approved. If a grant application is recommended for
approval for 2 or more years, the awardee must annually submit a formal request
for continuation accompanied by a progress report that will be evaluated prior
to a recommendation of continuation.
ASSISTANCE CONSIDERATIONS:
Formula and Matching Requirements: No State or local matching funds
are required for the infrastructure grants.
Length and Time Phasing of Assistance: CMS announced the first round
of infrastructure grant awards in October 2000. This grant program is authorized
for 11 years beginning in fiscal year 2001.
POST ASSISTANCE REQUIREMENTS:
Reports: Progress and expenditure reports are required on all
projects.
Audits: All fiscal transactions identifiable to Federal financial
assistance are subject to audit by the DHHS audit agency.
Records: Proper accounting records, identifiable by project number and
including all receipts and expenditures, must be maintained for 3 years.
Subsequent to audit, they must be maintained until all questions are resolved.
FINANCIAL INFORMATION:
Account Identification: 75-0516-0-1-551.
Obligations: (Grants) FY 01 $16,988,882; FY 02 est $25,000,000; and FY
03 est $25,000,000.
Range and Average of Financial Assistance: In FY 2001, from $529,117
to $1,250,000. Average: $679,555. In FY 2002 and FY 2003 est from $500,000 to
$1,500,000. The minimum grant award is $500,000 per fiscal year.
CMS awarded 25 grants in fiscal year 2001. An additional 13 more grants are
estimated to be awarded in fiscal year 2002. It is estimated that CMS will
award grants to at least 10 more States for fiscal year 2003. In fiscal year
2001, 5 grantee States implemented Medicaid buy-in programs and 6 grantee
States passed legislation to implement a buy-in program. Medicaid buy-in
implementation is the primary objective of this grant award.
REGULATIONS, GUIDELINES, AND LITERATURE:
Grants Administration policies (45 CFR 74 and 92) and application kits may be
obtained from the Office of Acquisition and Grants Group, Centers for Medicare
& Medicaid Services, Room C2-21-15, Central Building, 7500 Security
Boulevard, Baltimore, MD 21244-1850.
INFORMATION CONTACTS:
Regional or Local Office: Contact the appropriate CMS Regional
Administrator. (See Appendix IV for Regional Offices.)
Headquarters Office: Dennis Smith, Acting Director, Center for
Medicaid and State Operations, Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Room C5-21-17, Central Building, 7500
Security Boulevard, Baltimore, MD 21244-1850. Telephone: (410) 786-3870.
Web Site Address: http://www.cms.hhs.gov/contracts/.
EXAMPLES OF FUNDED PROJECTS:
For a description of State specific projects funded under this grant program.
Please see our website at www.hcfa.gov/medicaid/twwiia/twwiiahp.htm.
CRITERIA FOR SELECTING PROPOSALS:
The major elements in evaluating proposals include: understanding the
barriers that impede competitive employment of people with disabilities; the
extent to which the proposed infrastructure development will offer enduring and
significant improvement in the ability of the system to provide adequate health
coverage for people with disabilities and are competitively employed; provide
needed personal assistance and other supports, and/or remove other significant
employment barriers; the appropriateness of the methods, work plan, budget, and
timetable; the qualifications of key staff; and the State's plan for using its
grant experiences to identify different or better ways to improve its buy-in or
Medicaid services that support the competitive employment efforts of people with
disabilities.
