Don’t Delay. Medicaid and CHIP Relief Fund Process Can Be Lengthy
By Amy Lynn Sorrel


Although the deadline for physicians who treat Medicaid and Children’s Health Insurance Program (CHIP) patients to apply for federal Provider Relief Funds has been extended to Aug. 28, health officials encourage physicians to apply as soon as possible because it may take longer than they expect.

Each practice's Taxpayer Identification Number (TIN) must be validated, if it hasn't been already, before an application can progress. That process can take up to 10 days.

If the application is pending at 10:59 CST on Aug. 28, but the TIN has not been validated, the application will not move forward.

The U.S. Department of Health and Human Services (HHS) in June made $15 billion in funds available to Medicaid and CHIP physicians and providers, part of the second round of emergency grants Congress allocated from the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Provider Relief Fund payments “will be at least 2 percent of reported gross revenue from patient care,” HHS has said.

For phase two distribution of these funds, the Centers for Medicare & Medicaid Services (CMS) made important changes to the eligibility criteria, including opening funds to Medicaid and CHIP-participating physicians and providers who had previously been excluded for receiving any prior federal provider relief payments. Additionally, more Medicare-participating physicians are now eligible.

Specifically, physicians must:

  • have billed either Medicare fee-for-service between Jan. 1 and Dec. 31, 2019 or Medicaid or CHIP between Jan. 1, 2018 and Dec. 31, 2019; and
  • meet all of the following requirements:
    • Filed a federal income tax return for fiscal years 2017, 2018, 2019; or be exempt from filing a return;
    • Provided patient care after Jan. 31, 2020 (Note: patient care includes health care, services, and support, as provided in a medical setting, at home, or in the community);
    • Did not permanently cease providing patient care directly or indirectly;
    • Did not receive a previous payment totaling approximately 2% of annual patient revenue; and
    • For individuals, reported on Form 1040 (or other tax form) gross receipts or sales from providing patient care.

In July, Gov. Greg Abbott and the Texas Health and Human Services Commission (HHSC) urged physicians to apply, saying that, at the time, less than 5% of the state’s 27,351 eligible Medicaid and CHIP participating health care professionals had applied for funds.

To help you make informed decisions for your practice during the pandemic, TMA has published a Practice Viability Toolkit that provides up-to-date information and resources. The toolkit includes a section on cash flow, including loan assistance, lines of credit, payment deferrals, loan refinancing, and loans from private banks.


Last Updated On

August 17, 2020

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