• Innovation in Action

Jun 11, 2020

CMS Providing Additional Relief Funds to Medicaid and CHIP Providers


The Centers for Medicare & Medicaid Services (CMS) announced on June 9 it will provide additional targeted relief funds to Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID-19. The funding is being made available to providers who have NOT received payments from the Provider Relief Fund General Distribution.

Health care providers must have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for health care-related services between January 1, 2018 and May 31, 2020 to be eligible for this funding. Providers also must report to the Department of Health and Human Services (HHS) via the Enhanced Provider Relief Fund Portal the number of Medicaid patients served and annual patient revenue , which will be used as a factor in determining their Provider Relief Fund payment. Each payment will be at least 2 percent of the provider’s reported gross revenue from Medicaid/CHIP patient care, with the final amount to be determined after the data is submitted. Note that by receiving funds, providers agree to HHS publicly disclosing the payment received via the Relief Fund.

Examples of providers serving Medicaid/CHIP beneficiaries who may be eligible for funding include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and behavioral health providers, assisted living facilities and other home and community-based services providers.

HQIN advises payment recipients maintain a record to include the amount received and documentation of the costs to prevent, prepare for, and respond to the Coronavirus (COVID-19), as well as health care-related expenses or lost revenues attributable to COVID-19. This ensures compliance with the terms and conditions of the payment in the event of an audit. Care does not have to be specific to treating COVID-19 as HHS broadly views every patient as a possible case of COVID-19.

Unlike the CMS Accelerated and Advance Payment Program, which is a loan, Provider Relief Fund Payments do not need to be repaid.

For more information, view the HHS announcement, CARES Act Provider Relief Fund General Information, Medicaid Relief Fund Terms and Conditions, and Provider Relief Fund Attestation Portal.