New Cares Funding Available For Medicaid Providers

Published: June 12, 2020

by Jeanne L. Vance
Healthcare Legal Updates

On June 9, 2020, the U.S. Department of Health and Human Services (HHS) announced that it will allocate approximately $15 billion to providers who participate in state Medicaid program and Children’s Health Insurance Program (CHIP) and who did not receive payments from the initial $50 billion in general allocations from the Provider Relief Fund under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This funding is intended to provide relief to Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID‑19.

Eligibility:

To be eligible for the Medicaid and CHIP Distribution, healthcare providers must meet the following criteria:

  1. Did not receive payments from the $50 billion Provider Relief Fund general distribution;
  2. Have directly billed their state Medicaid program/CHIP or Medicaid managed care plans for healthcare-related services between January 1, 2018, to May 31, 2020;
  3. Have either filed a federal income tax return for fiscal years 2017, 2018 or 2019, or be an entity exempt from the requirements to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return (e.g., a state-owned hospital or healthcare clinic);
  4. Have provided patient care after January 31, 2020;
  5. Have not permanently ceased providing patient care directly, or indirectly through included subsidiaries;
  6. If the applicant is an individual, have gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee; and
  7. Must be on a TIN list submitted by a state to HHS or must be validated by HHS to receive these funds.

Expected Payments:

Eligible Medicaid and CHIP providers can expect to receive at least 2% of their reported gross revenue from Medicaid and CHIP care for CY 2017, 2018 or 2019. The final amount each provider receives is dependent on the provider’s submission of data to HHS through the enhanced Provider Relief Fund Payment Portal, including information on the number of Medicaid patients served.

Payments will be made by HHS on a rolling basis as information is validated so eligible providers should apply as early as possible.

Application Information:

Providers may apply for the Medicaid and CHIP Distribution by visiting the new enhanced Provider Relief Fund Payment Portal. Providers will be required to create a user name with Optum and attest as the program administrator in order to submit the application through the portal. Of note, providers will need to have the following documents ready when accessing the portal:

  1. The applicant’s most recent federal income tax return for 2017, 2018 or 2019 or a written statement explaining why the applicant is exempt from filing a federal income tax return;
  2. The applicant’s Employer’s Quarterly Federal Tax Return on IRS Form 941 for Q1 2020, Employer’s Annual Federal Unemployment (FUTA) Tax Return on IRS Form 940, or a statement explaining why the applicant is not required to submit either form;
  3. The applicant’s FTE Worksheet (provided by HHS);
  4. If required by Field 15, the applicant’s Gross Revenue Worksheet (provided by HHS).

Unlike applications for the Provider Relief Fund general distribution payments, providers are permitted to submit only one application. Therefore, providers may not edit or resubmit the application once it has been submitted.

To determine their eligibility for funding under Medicaid and CHIP Distribution, providers must submit their application between June 10, 2020 and July 20, 2020.

Sources:

  1. gov: HHS Announces Enhanced Provider Portal, Relief Fund Payments for Safety Net Hospitals, Medicaid & CHIP Providers (issued June 9, 2020).
  2. gov: CARES Act Provider Relief Fund (General Information).
    CARES Act Provider Relief Fund – Frequently Asked Questions