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The benefits for ND Medicaid Expansion, as required by the Affordable Care Act and section 1937 of the Social Security Act, are provided through an Alternative Benefit Plan (ABP). Effective for dates of service on or after July 1, 2023, ND Medicaid will be submitting a state plan amendment which will clarify language for existing benefits, specifically as they related to those under the age of 21.
To assure compliance with 42 CFR 440.345, ND Medicaid compared the benefits available under the ABP to those available under Traditional Medicaid fee-for-service. The results of this comparison showed that the ABP benefits include Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for those enrolled with ND Medicaid Expansion who are under age 21 that are consistent with the current ND Medicaid state plan regarding the delivery of these services with minimal changes.
Specific changes in this section include:
Medication Therapy Management (MTM) – changed to a maximum of four (4) MTM encounters per 365 days. Limit can be exceeded if medically necessary. Language was added to update this.
Family Planning – removal of Long-Acting Reversable Contraceptives is now a covered service.
1915(i) – Language was added to clarify services, removal of reference citation that was incorrect.
Medicaid expenditures for the Medicaid Expansion population are expected to be minimal for a 12-month period.
Date posted: November 14, 2023