Medicaid.

Medicaid is a federal-state partnership with programs established in the federal Social Security Act and implemented at the state level with federal matching funds.  The Health Care Authority (HCA) administers the Medicaid program for health care for low-income state residents who meet certain eligibility criteria.  Washington's Medicaid program, known as Apple Health, offers a complete medical benefits package, including prescription drug coverage, to eligible families, children under age 19, low-income adults, certain disabled individuals, and pregnant women.  Apple Health provides coverage for emergency transportation services.

Supplemental Payments and Certified Public Expenditure Programs.

In addition to reimbursement for Medicaid services, states can make supplemental payments to certain medical service providers that are separate from and in addition to reimbursements made at standard payment rates.  Supplemental payments are eligible for federal matching dollars if aggregate payments to the providers receiving the supplemental payments are less than what Medicare would pay for the same services.

Certified public expenditure (CPE) programs allow public providers of medical services to certify their expenses as the non-federal share to receive Medicaid matching dollars, which means that the state does not have to contribute the matching share of these expenditures.  These CPE programs can be combined with supplemental payments to provide additional funding to public providers without incurring additional state costs.

Ground Emergency Medical Transportation Program.

The Ground Emergency Medical Transportation (GEMT) program is a voluntary program that makes supplemental payments to eligible GEMT providers who furnish qualifying emergency ground ambulance services to Medicaid clients.  The supplemental payments are funded using the CPE payment method.  Using the Centers for Medicare and Medicaid Services (CMS) approved cost report, eligible GEMT providers must certify to the state the total expenditures incurred for providing GEMT services to determine the supplemental payments.  The HCA only provides supplemental payments for the uncompensated and allowable direct and indirect costs incurred while providing GEMT services to Medicaid clients.  The supplemental payment covers the gap between the provider's actual cost per GEMT transport and the allowable amount received from Apple Health and any other sources of reimbursement.  Total reimbursements from Medicaid including the supplemental payment do not exceed 100 percent of actual costs.  The GEMT program must be implemented without any additional expenditure from the State General Fund.  As a condition of participation in the program, eligible providers must agree to reimburse the HCA for any costs associated with implementing the GEMT program.

To qualify for supplemental payments, eligible GEMT providers must meet the following criteria:

• be enrolled as a Medicaid provider for the period being claimed on their annual cost report;
• provide GEMT services to Medicaid enrollees; and
• be an organization owned or operated by the state, city, county, fire protection district, community services district, health care district, federally recognized Indian tribe, or any unit of government as defined by federal law.

Eligible public providers participating in the GEMT program may contract with a private provider for the provision of Medicaid ground emergency medical transportation services.  The eligible public provider may only claim supplemental reimbursement under the GEMT program for private provider contract costs attributed to providing ground emergency medical transportation services to Medicaid beneficiaries, billing costs, and the public provider's overhead costs allocated to the GEMT program, as allowed by the CMS.  The eligible public provider may not claim supplemental reimbursement for any other cost incurred by the contracted private provider.