cms-2t2-25-001_rev3.pdf

Notice of Funding Opportunity

Applications are due by 11:59 p.m. ET

Cohort 1: November 26, 2024

Cohort 2: April 18, 2025

Section 206 of the Consolidated Appropriations Act, 2024: State Planning Grants to Promote Continuity of Care for Medicaid and CHIP Beneficiaries Following Incarceration Opportunity number: CMS-2T2-25-001

Contents

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 7

Program description 9

Step 2: Get Ready to Apply 19

Get registered 20

Find the application package 20

Step 3: Prepare Your Application 21

Application contents and format 22

Step 4: Learn About Review and Award 29

Application review 30

Award notices 35

Step 5: Submit Your Application 36

Application submission and deadlines 37

Step 6: Learn What Happens After Award 40

Post-award requirements and administration 41

Contacts and Support 44

Before you begin 3

Endnotes 47

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks)

You must have an active account with SAM.gov. This includes having a Unique

Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days)

You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date

Applications are due by 11:59 p.m. Eastern Time:

• Cohort 1: November 26, 2024

• Cohort 2: April 18, 2025

To help you find what you need, this NOFO uses internal links. In Adobe

Reader, you can go back to where you were by pressing Alt + Left Arrow

(Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 7

Program description 9

Basic information Centers for Medicare & Medicaid Services (CMS)

Center for Medicaid and CHIP Services (CMCS)

Helping states promote continuity of care for people who have been incarcerated.

Have questions?

See Contacts and Support.

Key facts Opportunity name: State Planning Grants to Promote Continuity of Care for Medicaid and CHIP Beneficiaries Following Incarceration

Opportunity number:

CMS-2T2-25-001

Federal Assistance Listing:

93.694

Statutory authority number: Section 206 of Division G of the Consolidated Appropriations Act, 2024 (P.L. 118-42)

Key dates Application deadline:

• Cohort 1: November 26,

• Cohort 2: April 18, 2025

Optional notice of intent:

• Cohort 1: October 28, 2024

• Cohort 2: February 14, Expected award date:

• Cohort 1: February 15,

• Cohort 2: July 15, 2025

Expected start date:

• Cohort 1: March 1, 2025

• Cohort 2: August 1, 2025

Summary The Centers for Medicare & Medicaid Services (CMS) is seeking applications from eligible state Medicaid and CHIP agencies for planning grants to develop operational capabilities to promote continuity of care for individuals who meet both of the following criteria:

• Are inmates of a public institution, and

• Are eligible for medical assistance under the state Medicaid program or are eligible for child health assistance or pregnancy-related assistance under the state Children’s Health Insurance Program (CHIP).

These planning grants also support states with operationalizing requirements under section 205 of division G of the CAA, 2024 (P.L. 118-42), as well as the

CAA, 2023 (P.L. 117-328).

Funds may be used for addressing operational barriers and improving systems for continuity of care following incarceration in state-operated prisons, local, tribal, and county jails, and youth correctional or detention facilities.

CMS will fund cooperative agreements for a four-year period of performance.

Step 1: Review the Opportunity 5

Funding details Type: Cooperative Agreement, which means that you and CMS will have a role in the project. Throughout the life of your project, we (CMS) will be there to help and work with you.

Expected total funding for the program: $106,500,000, subject to availability of funds

Expected total awards: Up to 56

Anticipated funding range per applicant for the period of performance: $1 million to $5 million

We will provide funding in four budget period increments of 12 months each over a four-year period of performance.

Step 1: Review the Opportunity 6

Eligibility Who can apply

Eligible applicants The following types of government entities may apply:

• State Medicaid agencies: refers to the single state agency for medical assistance provided under Title XIX of the Social Security Act (the Act) for states, the District of Columbia, and U.S. Territories.

• State CHIP agencies: refers to the single state agency responsible for administering the state CHIP plan under Title XXI of the Act for states, the District of Columbia, and U.S. Territories.

Other eligibility criteria If a state administers its Medicaid and CHIP programs through separate agencies, as a condition for applying for funds under this NOFO both agencies must agree to work together and submit one application per state. For the purposes of this NOFO and to align efforts, states with separate Medicaid and

CHIP programs must include in their single application a letter of agreement identifying the Authorized Organizational Representative (AOR), the lead agency, and plans for collaboration.

A Tribal organization must come under the auspices of and work with the state Medicaid and CHIP agency (or agencies, if separate) in the implementation of this initiative.

Application cohorts This program has two separate application deadlines:

• Cohort 1: November 26, 2024, by 11:59 pm EST

• Cohort 2: April 18, 2025, by 11:59 pm EST

Half of the available funding will be available to the first cohort, and the remaining funding will be available for the second cohort. Cooperative agreements for each cohort cover a four-year period. State Medicaid or CHIP agencies may apply for either or both cohorts. However, state Medicaid and

CHIP agencies are eligible for a single award per state under this NOFO. If a state applies under the first cohort and is not awarded funds, the state may apply again during the second cohort using the same application or an updated application.

You may submit only one application under this NOFO per cohort deadline.

Step 1: Review the Opportunity 7

Eligibility limitations We will also consider the following criteria as potential reasons to disqualify applications:

• Incomplete application. A non-exhaustive list of circumstances that constitute an incomplete application includes:

◦ Failure to meet application requirements.

◦ Omission of required application elements.

• Insufficient supporting detail is provided in the application. We will not review applications that merely restate the text of the NOFO. You must detail your approach to achieving program goals and milestones.

Reviewers will note evidence of how effectively you address these elements in your application.

• Program integrity concerns. We may deny selection to an otherwise qualified applicant because of information found during a program integrity review regarding the organization, community partners, or any other relevant individuals or entities.

• Disregard of maximum page limits listed in the NOFO.

• Late submission of your application (see the application review section).

Cost sharing This program has no cost-sharing requirement. If you choose to include cost-sharing funds, we will not consider it during review. However, we will hold you accountable for any funds you add, including the requirements for grant reporting.

Step 1: Review the Opportunity 8

Program description Purpose CMS, through the Center for Medicaid and CHIP Services (CMCS), seeks applications from eligible state Medicaid and CHIP agencies for state planning grants for the purpose of developing operational capabilities to promote continuity of care for individuals who meet both of the following criteria:

• Are inmates of a public institution, and

• Are eligible for medical assistance under the state Medicaid program or are eligible for child health assistance or pregnancy-related assistance under the state CHIP.

Funding is available through section 206(a)(2) for activities and expenses related to complying with the statutory requirements under section 5121 of the CAA, 2023, and section 205 of division G of the CAA, 2024:

• A state shall provide certain Medicaid and CHIP services to eligible juveniles in the 30 days prior to release from incarceration, and targeted case managed for at least 30 days post release for eligible Medicaid juveniles post adjudication from their release from a public institution, effective January 1, 2025.

• A state shall not terminate eligibility for medical assistance for individuals who are inmates of a public institution, effective January 1, 2026.

This Funding is also available for activities and expenses related to:

• A state electing to implement state plan options under section 5122 of the

CAA, 2023, related to providing Medicaid services, CHIP services, and/or both for eligible juveniles pending disposition of charges.

• Promoting continuity of care for individuals who are inmates of a public institution and are eligible for medical assistance under the state

Medicaid program or for child health assistance or pregnancy-related assistance under CHIP, according to section 206(a)(2) of division G of the

CAA, 2024.

We encourage state Medicaid and CHIP agencies to form partnerships to assess state needs and determine the scope of their proposed projects.

Partners may include:

Step 1: Review the Opportunity 9

• Public institutions.

• State human services agencies.

• Medicaid and CHIP managed care plans.

• Community-based organizations.

• Other relevant parties

Background Research has shown that incarceration during adolescence and early adulthood is associated with an increased risk of adult incarceration, and poorer physical and mental health status later in adulthood.[1] Reports also indicate that people who are incarcerated face higher levels of health challenges such as chronic health conditions and infectious disease, making the need for medical coverage upon release essential.[2] Meeting the healthcare needs of those who are or have been incarcerated also can improve health equity, because people who are incarcerated are disproportionately from marginalized groups, such as racial and ethnic minorities, low-income individuals, people with disabilities, and those experiencing mental health and substance use disorders (SUD).[3]

Incarceration status is not a condition of eligibility for Medicaid and thus, does not make an individual ineligible for Medicaid coverage.[4] However, federal

Medicaid funds may not be used to pay for services for individuals who are held involuntarily in a public institution (for example, a prison, jail, or juvenile detention center), except when they are inpatients in a medical institution (for example, an inpatient hospital or nursing facility). This requirement, known as the inmate payment exclusion, is provided in paragraph (A) following the last numbered paragraph of section 1905(a) of the Act.

CHIP has an eligibility exclusion at section 2110(b)(2)(A) of the Act for inmates of a public institution. According to the Act, a child who is an inmate of a public institution is excluded from the definition of a targeted, low-income child for purposes of CHIP, and therefore is generally ineligible for enrollment in a separate CHIP program.[5] Such children would need to submit a new application for enrollment after release from a public institution to regain coverage, resulting in potential delays in accessing coverage and care.

Step 1: Review the Opportunity 10

The Consolidated Appropriations Act (CAA), 2023 and 2024 The CAA, 2023, signed into law on December 29, 2022,[6] included two provisions that amend the Medicaid inmate payment exclusion and the CHIP eligibility exclusion.[7] This is limited to certain circumstances for eligible juveniles.

The term “eligible juvenile” is defined in section 1902(nn) of the Act to include individuals under age 21, or former foster care children under age 26 who were determined eligible for Medicaid before becoming an inmate of a public institution or who are determined eligible for Medicaid while an inmate of a public institution, were in foster care under the responsibility of the state on the date of attaining 18 years of age (or higher age as the state has elected), and were enrolled in a state plan under Medicaid or under a waiver of such a plan while in foster care. This term also includes incarcerated youth under age

19 enrolled in CHIP who are eligible for services under section 2102(d)(2) of the Act.

Specifically, section 5121 of the CAA, 2023, modifies the Medicaid inmate payment exclusion and the CHIP eligibility exclusion to require states to provide the following services to eligible juveniles following adjudication of charges in both Medicaid and CHIP:

• For Early and Periodic Screening, Diagnostic and Treatment (EPSDT) eligible beneficiaries under the age of 21, this includes medically necessary screening and diagnostic services in accordance with the approved CHIP state plan or Medicaid requirements in the 30 days prior to release (or as soon as practicable).

• Targeted case management (TCM) services, including referrals to appropriate care and services, in the 30 days prior to release and, for

Medicaid beneficiaries, an additional period of at least 30 days following release.[8]

Section 5121(c) of the CAA, 2023, permits states to suspend, or continue providing services rather than terminate, CHIP coverage while the child is an inmate of a public institution, and imposes related requirements regarding redeterminations of eligibility prior to release.

Section 5122 of the CAA, 2023, affords states the option to remove the

Medicaid inmate payment or CHIP eligibility exclusion for eligible juveniles who are pending disposition of charges. States electing this option must provide all services under the Medicaid and CHIP state plans which eligible

Step 1: Review the Opportunity 11 juveniles would be entitled to in the absence of the Medicaid inmate payment or CHIP eligibility exclusion while the eligible juvenile is incarcerated pending disposition of charges. All provisions of sections 5121 and 5122 of the CAA, 2023, are effective January 1, 2025.

Section 205 of division G of the CAA, 2024, amends section 1902(a)(84)(A) of the Act to broaden the prohibition on termination of coverage for Medicaid beneficiaries who are incarcerated from eligible juveniles to all individuals who are inmates of a public institution. For CHIP, this statute amends section

2102(d)(1)(A) of the Act to prohibit the termination of targeted low-income pregnant women in CHIP who become incarcerated but allows the state to suspend their coverage. These changes are effective January 1, 2026.

Section 206(a) of division G of the CAA, 2024, authorized the Secretary to award and administer state planning grants to develop operational capabilities to promote continuity of care for individuals who are inmates of a public institution and are eligible for medical assistance under the state

Medicaid program or are eligible for child health assistance or pregnancy-related assistance under the state CHIP. This section further provided that states may use funds awarded under such grants for activities and expenses related to complying with the requirements of sections 1902(a)(84)(D) and

2102(d) of the Act, or adopting the state plan options described in the subdivision (A) following the last numbered paragraph of section 1905(a) and

2110(b)(7) of the Act, in accordance with the provisions of the CAA, 2023 and the CAA, 2024 discussed above.

This funding opportunity makes funds available to states to promote continuity of care for eligible individuals following incarceration and to comply with requirements of the CAA, 2023 and CAA, 2024.

Program requirements Overview Section 206(a) of division G of the CAA, 2024, authorizes the Secretary to award and administer state planning grants to develop operational capabilities to promote continuity of care for individuals who are inmates of a public institution and are eligible for medical assistance under the state

Medicaid program or are eligible for child health assistance or pregnancy-related assistance under the state CHIP. This section further provides that states may use funds awarded under such grants for activities and expenses related to complying with the requirements of sections 1902(a)(84)(D) and

2102(d) of the Act, or adopting the state plan options described in the subdivision (A) following the last numbered paragraph of section 1905(a) and

Step 1: Review the Opportunity 12

2110(b)(7) of the Act, in accordance with the provisions of the CAA, 2023, and the CAA, 2024, as outlined in the background section.

Permitted uses of funds The following are examples of allowable activities included in section

206(a)(2). You may propose other activities beyond the following:

• Identifying and addressing operational gaps with respect to complying with requirements or adopting state plan options, in collaboration with public institutions, state human services agencies, Medicaid managed care plans, providers, community-based organizations, and others.

• Establishing standardized processes and automated systems for activities that may include, but are not limited to:

◦ Determining whether an individual is enrolled in a state Medicaid program or state CHIP at the time such individual becomes an inmate of a public institution;

◦ Enrolling individuals who are inmates of a public institution;

◦ Facilitating the delivery of medical assistance under the state

Medicaid program or child health assistance or pregnancy-related assistance under the state CHIP to an individual who is eligible for such assistance while the individual is an inmate of a public institution, such as by establishing claims processing and prior authorization request protocols; and

◦ In the case of an eligible individual whose coverage under a state

Medicaid program or state CHIP was suspended while the individual was an inmate of a public institution, restoring coverage in advance to resume as of the individual’s release date from the public institution.

◦ Investing in information technology to:

▪ Enable bi-directional information sharing between public institutions, state Medicaid and CHIP agencies, and other entities such as managed care plans and providers (in a manner consistent with applicable state and Federal privacy laws) to support care transitions and coordination of treatment (including access to care in the community after release from a public institution); and[9]

▪ Develop indicators to ensure Federal financial participation for medical assistance furnished under a state Medicaid program or child health assistance or pregnancy-related assistance furnished under a state CHIP is available only for medical

Step 1: Review the Opportunity 13 assistance or child health assistance or pregnancy-related assistance for items and services for which such participation is permitted while an individual is an inmate of a public institution.

• Establishing oversight and monitoring processes to ensure public institutions and entities with which state Medicaid and CHIP agencies contract are compliant with any applicable Medicaid and CHIP requirements.

Prohibited uses of funds As noted in section 206(a)(3), planning grant funding may not be used to:

• Provide medical assistance under a state Medicaid program or child health assistance or pregnancy-related assistance under a state CHIP to an individual, or otherwise directly administer health care services for an individual.

• Build prisons, jails, or other carceral facilities, or pay for prison, jail, or other carceral facility-related improvements other than those improvements that are for the direct and primary purpose of meeting the health care needs of individuals who are incarcerated and eligible for medical assistance under the state Medicaid program or child health assistance or pregnancy-related assistance under the state CHIP. See

HHS Grants Policy Statement: Cost Considerations.

Requirements Applications must include all of the following elements, at a minimum. See the project narrative for full details of how to structure your application and what to include.

• The number of individuals in the state who were inmates of non-federal public institutions (such as state prisons, local and county jails, tribal jails, and youth correctional or detention facilities) and were eligible for medical assistance under a state Medicaid program at any time in calendar year 2022.[10]

• The number of non-federal public institutions in the state (such as state prisons, local and county jails, tribal jails, and youth correctional or detention facilities).

• The state’s current progress in developing, implementing, and operating initiatives to promote continuity of care for individuals who are inmates of a public institution and are eligible for medical assistance under the state

Medicaid program or child health assistance or pregnancy-related assistance under the state CHIP.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 14 https://www.hhs.gov/sites/default/files/hhs-grants-policy-statement-october-2024.pdf https://www.hhs.gov/sites/default/files/hhs-grants-policy-statement-october-2024.pdf

◦ Indicate progress and barriers to promoting continuity in care for such individuals.

◦ Provide an overview of all relevant funding sources for initiatives promoting continuity of care for beneficiaries following incarceration including through any Medicaid authorities such as section 1115 demonstration authority.

• A work plan and timeline describing the planning grant and how funds will be used.

See the continued eligibility section for additional details on post-award requirements and the application contents and format section for further application requirements.

Technical assistance and information for applicants CMS will host one informational webinar at least four weeks prior to each application deadline. Details about the webinars will be posted on the

Medicaid.gov website. For any questions regarding the information contained in this NOFO, please contact the Section 206 State Planning Grants mailbox at

PlanningGrantsPCC@cms.hhs.gov.

Cooperative agreement terms All awards under this NOFO will be structured as cooperative agreements.

Cooperative agreements require substantial CMS project involvement after an award is made. There are specific roles for both you and CMS. We may be in contact at least once a month, and more frequently when appropriate.

Your responsibilities

• Comply with the terms and conditions of the award.

• Ensure timely access to all CMS-required systems by key personnel.

• Attend and take part in CMS-sponsored onboarding, meetings, and technical assistance trainings.

• Collaborate with CMS staff to implement and monitor the project.

• Immediately notify CMS of needed or anticipated modifications to your approved project plans.

• Submit all required performance assessments, evaluations, and programmatic and financial reports included in the terms and conditions to CMS.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 15 mailto:PlanningGrantsPCC@cms.hhs.gov

• Attend and take part in routine monitoring calls with the CMS project officer or grants management specialist on progress and challenges. The meetings will include key personnel and the project officer.

Our responsibilities

• Monitor the project’s performance and progress.

• Collaborate with you and provide substantial project planning, implementation, and evaluation input.

• Provide substantial input in evaluation activities.

• Make recommendations for continuing the project.

• Review and approve website content before launch and updates.

• Review and approve all key personnel, such as the AOR and Project

Director (PD).[11]

• Maintain regular communication with you through at least monthly conference calls along with technical assistance and consultation.

• Review and provide feedback on all required performance assessment reports.

• Review and approve all required submitted data.

• Provide a structured approach to sharing, integrating, and actively applying improvement concepts, tactics, and lessons learned.

Substantial involvement relates to programmatic involvement, not administrative oversight.

Funding policies and limitations Limitations We do not allow the following costs:

• Pre-award costs.

• Meeting matching requirements for any other federal funds or local entities.

• Services, equipment, or supports that are the legal responsibility of another party under federal, state, or tribal law, such as vocational rehabilitation or education services, or under any civil rights laws, such as modifying a workplace or providing accommodations that are obligations under law.

• Goods or services not allocable to the project.

Step 1: Review the Opportunity 16

• Supplanting existing state, local, tribal, or private funding of infrastructure or services, such as staff salaries, etc.

• Construction.

• Capital expenditures for improvements to land, buildings, or equipment that materially increase their value or useful life as a direct cost, except with our prior written approval.

• The cost of independent research and development, including their proportionate share of indirect costs (see 45 CFR 75.476).

• Funds related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order.

• Certain telecommunications and video surveillance equipment (see 2 CFR

200.216).

• Meals, unless in limited circumstances such as:

◦ Subjects and patients under study.

◦ Where specifically approved as part of the project or program activity, such as in programs providing children’s services.

◦ Part of a per diem or subsistence allowance provided in conjunction with allowable travel.

• Costs that supplant funds for any other Notice of Funding Opportunity or

Financial Assistance Program.

Other than for normal and recognized executive-legislative relationships or participation by an agency or officer of a state, local, or tribal government in policymaking and administrative processes within the executive branch of that government, funding awarded under this NOFO may not be used for:

• Paying the salary or expenses of any grant recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before the Congress or any state government, state legislature, or local legislature or legislative body.

• Lobbying, but awardees can lobby at their own expense if they can segregate federal funds from other financial resources used for lobbying.

• Providing medical assistance under a state Medicaid program or child health assistance or pregnancy-related assistance under a state CHIP to an individual, or otherwise directly administering health care services for an individual.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 17 https://www.ecfr.gov/current/title-45/section-75.476 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-C/section-200.216 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-C/section-200.216

• Building prisons, jails, or other carceral facilities, or paying for prison, jail, or other carceral facility-related improvements other than those improvements that are for the direct and primary purpose of meeting the health care needs of individuals who are incarcerated and eligible for medical assistance under the state Medicaid program or child health assistance or pregnancy-related assistance under the state CHIP.

Indirect costs Indirect costs are those for a common or joint purpose across more than one project and that cannot be easily separated by project.

To charge indirect costs you can select one of two methods:

• Method 1 – Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency or a current cost allocation plan.

• Method 2 – De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you are awaiting approval of an indirect cost proposal you may also use the de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

Statutory authority Section 206(a) of division G of the CAA, 2024, authorizes the Secretary to issue state planning grants to address operational barriers to complying with requirements described in sections 1902(a)(84)(A) and 2102(d) of the Act (42

U.S.C. 1396a(a)(84)(A)-(D), 1397bb(d)), or adopting the state plan options described in the subdivision (A) following the last numbered paragraph of section 1905(a) and 2110(b)(7) of the Act, in accordance with the provisions of the CAA, 2023 and the CAA, 2024.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 18 https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1

Step 2:

Get Ready to Apply

In this step

Get registered 20

Find the application package 20

Get registered SAM.gov You must have an active account with SAM.gov. This includes having a Unique

Entity Identifier. SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and click Get Started. From the same page, you can also click on the Entity Registration Checklist for the information you will need to register.

Grants.gov You must also have an active account with Grants.gov.

Need Help? See Contacts and Support.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number

CMS-2T2-25-001.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 20 https://sam.gov/content/entity-registration https://grants.gov/applicants/applicant-registration https://www.grants.gov/search-grants

Step 3:

Prepare Your Application

In this step

Application contents and format 22

Application contents and format Applications include five main components. The following sections include guidance and instructions on the required format for each.

You can find all referenced forms within the funding opportunity’s application package on grants.gov.

Make sure you include each of these:

Component Submission format

Project abstract Use the Project Abstract Summary form.

Project narrative Use the Project Narrative Attachment form.

Budget narrative justification

Use the Budget Narrative Attachment form.

Attachments Insert each in the Other Attachments form.

Other required forms Upload using each required form.

We will provide instructions on document formats in the sections below.

Project abstract (required) Limit to one page. May be single spaced, but must otherwise follow other formatting requirements listed for the project narrative.

Write a one-page summary of your proposed project including the purpose and outcomes. Do not include any proprietary or confidential information. We will use this document for information sharing and public information requests if you are granted an award. You must include:

• The name of your organization.

• The names of any subrecipients or sub-awardee organizations, if applicable.

• Project goals.

• Total budget amount.

• A description of how you will use funds.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 22

Project narrative (required)

Required format for project narrative Page limit: 25, excluding attachments

File name: Project Narrative

Format: PDF (Do not compress or encrypt.)

Size: 12-point font or bigger

Footnotes and text in graphics may be 10-point.

Spacing for project abstract, tables, and footnotes: Single-spaced

Spacing for main content: Double-spaced

Margins: 1-inch

Page size: 8.5 x 11

Include consecutive page numbers throughout.

The project narrative is the most important part of your application and should clearly describe your proposed project. You must address the proposed goals, measurable objectives, and milestones in accordance with the instructions in the following sections.

See the merit review criteria to understand how reviewers will assess and score your project narrative.

Your project narrative should include the following sections.

Organizational capacity of applicant organization (required) You must demonstrate your capacity to organize and manage the planning grant and work collaboratively across key state agency partners.

The following information is required:

• Description of existing staff capacity. For example: job descriptions

(including for positions that are currently vacant) for all key staff that will be involved in the project.

• Identify the individual who will be the PD (primary lead and liaison to

CMS) and provide a resume or curriculum vitae (CV) for that person.

• Provide an organizational chart that identifies lines of authority and names the AOR.

Step 3: Prepare Your Application 23

• For states with separate Medicaid and CHIP agencies, describe collaboration and coordination between the organizations.

Individuals in public institutions (required) You must provide the following information:

• The number of individuals in the state who were inmates of non-federal public institutions (such as state prisons, local and county jails, tribal jails, and youth correctional or detention facilities) and were eligible for medical assistance under a state Medicaid program or child health assistance or pregnancy-related assistance under a state CHIP at any time in calendar year 2022.[12] When describing the information regarding your state’s Medicaid and CHIP beneficiaries in public institutions, please include the data source and the methodology for determining this population.

• The number of non-federal public institutions in the state (such as state prisons, local and county jails, tribal jails, and youth correctional or detention facilities). Include the data source for this number.

• An assessment of the state’s current progress in initiatives that promote continuity of care for Medicaid and CHIP beneficiaries who are inmates of public institutions. Provide an overview of all relevant funding sources for initiatives promoting continuity of care for beneficiaries following incarceration including through any Medicaid authorities such as section

1115 demonstration authority. Describe progress in and barriers to implementing these initiatives.

Program oversight (required) and subrecipients and contractors (if applicable) Describe the anticipated role of any subrecipients or contractors. In addition, describe your oversight and monitoring processes as well as your management controls for the program oversight of the planning grant.

• For the purposes of this award and to align efforts, states with separate

Medicaid and CHIP agencies must identify the AOR, the lead agency, and plans for collaboration. State Medicaid agencies and state CHIP agencies will administer funding awarded under this opportunity. CMS recommends state Medicaid agencies and state CHIP agencies collaborate with pertinent parties such as non-federal public institutions, state human services agencies, Medicaid managed care plans, providers, and community-based organizations. The narrative section should describe how funding will be used to promote the collaboration needed to address the new requirements for Medicaid and CHIP beneficiaries who

Step 3: Prepare Your Application 24 are inmates of public institutions and following incarceration, as described in the program requirements section.

• The narrative must include your oversight and monitoring processes to ensure public institutions and entities with which you subaward are compliant with any applicable Medicaid and CHIP requirements as well as

45 CFR 75.351 Subrecipient and contractor determinations and 45 CFR

75.352 Requirements for pass-through entities.

• Describe the management controls and coordination mechanisms that will be used to ensure the timely and successful execution and operation of the planning grant.

Work plan (required) The work plan should describe your goals, measurable objectives, activities, and milestones for this planning grant.

The work plan should also describe other activities to promote continuity of care for individuals who are inmates of a public institution and are eligible for medical assistance under the state Medicaid program or are eligible for child health assistance or pregnancy-related assistance under the state CHIP. This could include activities such as outreach and training for community providers.

The work plan should describe the amount, duration, and scope of the state planning grant activities, including target populations and plans and metrics for assessing progress in meeting work plan objectives. Include a timeline describing your measurable objectives.

Budget narrative (required) The budget narrative supports the information you provide in Standard Form

424-A. See other required forms. It includes added detail and justifies the costs you ask for. As you develop your budget, consider:

• If the costs are reasonable and consistent with your project’s purpose and activities.

• Restrictions on spending funds. See funding policies and limitations.

HHS now uses the definitions for equipment and supplies in 2 CFR 200.1. The new definitions change the threshold for equipment to the lesser of the recipient’s capitalization level or $10,000 and the threshold for supplies to below that amount.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 25 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Equipment) https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200#p-200.1(Supply)

In your budget narrative, you will:

• Provide an overall estimated budget for the entire four-year period of performance, that is, the total costs across all four years.

• Provide a detailed budget for the first 12-month budget period:

◦ Include breakdown of costs for each line item in your SF-424A.

◦ Describe the proposed costs for each activity or cost within the line item.

◦ Define the proportion of the requested funding designated for each activity.

◦ Justify the costs, including how you calculated them.

• Provide a high-level summary of budget costs for Years 2 through 4:

◦ Estimate the amount of funds you will request from CMS each year.

For example, $2 million in Year 2 and $2 million in Year 3.

• Explain how you separate costs and funding administered directly by you as the lead agency from funding you subaward to other consortium members.

• Be clear about how costs link to each activity and the goals of this program.

To create your SF-424A and budget narrative, see detailed instructions in

CMS Guidance for Preparing a Budget Request and Narrative on our website.

See merit review criteria to understand how reviewers will assess and score your budget narrative.

Required format for budget narrative Page limit: 10 pages

File name: Budget Narrative

File format: PDF (Do not compress or encrypt.)

Font Size: 12-point or bigger

Spacing: Single-spaced

Margins: 1-inch

Page Size: 8.5 x 11

Include consecutive page numbers throughout.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 26 https://www.cms.gov/about-cms/work-us/grants-cooperative-agreements/how-apply-cms-grants/budget-and-budget-narrative

Attachments You will upload attachments in Grants.gov using the Other Attachments Form.

Attachments do not count against application page limits.

Letters of support (optional) We encourage you to submit letters of support from relevant parties that this funding opportunity may impact. These letters are not required.

Letter of agreement (if applicable) For state government agencies where Medicaid and CHIP are administered separately, CMS requires a letter of agreement jointly signed by the state

Medicaid agency and the state CHIP agency to be submitted with the application. The letter should identify the AOR, the lead agency, and plans for collaboration.

Organizational chart (required) Clearly identify the reporting relationships of key personnel assigned to implementing the planning grant.

Indirect cost agreement (required) If you include indirect costs in your budget using an approved rate, include a copy of your current agreement approved by your cognizant agency or your cost allocation plan for indirect costs.

If you use the de minimis rate, you do not need to submit this attachment. See

CMS Guidance for Preparing a Budget Request and Narrative.

Resumes and job descriptions for key personnel (required) For key personnel, such as the AOR and principal investigator (PI/PD), attach resumes for positions that are filled. If a position isn’t filled, attach the job description with qualifications you plan to use for recruitment.

Business assessment of applicant organization (required) Maximum 12 pages, single-spaced.

We must assess your organization’s risk before we can make an award. This analysis includes your organization’s:

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 27 http://www.grants.gov/ https://www.ecfr.gov/current/title-45/part-75#p-75.2(Cognizant%20agency%20for%20indirect%20costs) https://www.ecfr.gov/current/title-45/part-75#p-75.2(Cognizant%20agency%20for%20indirect%20costs) https://www.cms.gov/about-cms/work-us/grants-cooperative-agreements/how-apply-cms-grants/budget-and-budget-narrative

• Financial stability.

• Quality of management systems.

• Internal controls.

• Ability to meet the management standards prescribed in 45 CFR Part 75.

For us to complete your assessment, you must review, answer, and attach the completed business assessment questions on our website at Business

Assessment of Applicant Organization.

Other required forms You will need to complete four other required forms. Submit the following required forms through Grants.gov. You can find the forms in the NOFO application package or review them and their instructions at Grants.gov

Forms.

Forms Submission Requirement

Application for Federal Assistance (SF-424) With the application. See extra instructions below.

Budget Information for Non-Construction

Programs (SF-424A)

With the application.

Disclosure of Lobbying Activities (SF-LLL) With the application.

Project/Performance Site Location(s) Form With the application.

Extra instructions for SF-424: Application for Federal Assistance Special instructions include:

• To write your Descriptive Title of Applicant’s Project in Item 15, see

Writing a Strong Descriptive Title on our website.

• Check No to item 19c. State review under Executive Order 12372 does not apply.

• Your authorized organization representative (AOR) must electronically sign this form. The AOR is the person who can make legally binding commitments for your organization. When the AOR authorizes an application, they agree to assume all award obligations.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 28 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.cms.gov/files/document/business-assessment-template-revised.pdf https://www.cms.gov/files/document/business-assessment-template-revised.pdf https://www.grants.gov/forms https://www.grants.gov/forms https://www.cms.gov/about-cms/work-us/grants-cooperative-agreements/how-apply-cms-grants#:~:text=Elements%20of%20a%20Strong%20Award%20Description https://www.cms.gov/about-cms/work-us/grants-cooperative-agreements/how-apply-cms-grants#:~:text=Authorized%20Organization%20Representative%20(AOR)

Step 4:

Learn About Review and Award

In this step

Application review 30

Award notices 35

Application review Initial review We review each application to make sure it is eligible, complete, and responsive. We won’t consider an application that:

• Is from an organization that doesn’t meet all eligibility criteria.

• Requests funding above the award ceiling.

• Is submitted after the deadline.

• Is not submitted through Grants.gov.

• Is not submitted by a state Medicaid or CHIP agency.

We will not review any pages that exceed the page limit.

According to HHS Grant Policy, the Division of Grants director or deputy director may choose to continue the review process for an ineligible application if it is in the best interests of the government to meet the objectives of the program.

Merit review A panel reviews all applications that pass the initial review. The panel members use the criteria below. For more information, see Merit Review and

Selection Process on our website.

Criterion Total number of points = 100

Project narrative 40 points

Work plan and timeline 40 points

Budget narrative 20 points

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 4: Learn About Review and Award 30 https://grants.gov/ https://www.cms.gov/about-cms/work-us/grants-cooperative-agreements/how-apply-cms-grants/merit-review https://www.cms.gov/about-cms/work-us/grants-cooperative-agreements/how-apply-cms-grants/merit-review

Criteria

Project narrative section 1: Organizational capacity of applicant organization Maximum points: 15

Description of the entity.

• Describe the entity that will perform the cooperative agreement activities under this funding opportunity.

• Include an organizational chart as an attachment clearly identifying the reporting relationships of key personnel assigned to implementing the planning grant.

Description of key personnel including identifying one individual to serve as PD.

• In your attachments, include a resume or curriculum vitae for each individual identified as key personnel in the organizational chart. If key personnel have not yet been hired, provide a hiring strategy and job descriptions.

Project narrative section 2: Individuals in public institutions Maximum points: 10

Description of Medicaid or CHIP-eligible individuals in public institutions and the current state of providing continuity of care to inmates of a public institution (include barriers and accomplishments).

• Provide the number of individuals in the state who were inmates of non-federal public institutions (such as state prisons, local and county jails, tribal jails, and youth correctional or detention facilities) and were eligible for medical assistance under a state Medicaid program at any time in calendar year 2022.

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When describing the information regarding your state’s Medicaid and CHIP beneficiaries in public institutions, please include the data source and methodology for determining this number.

• Provide the number of non-federal public institutions in the state (such as state prisons, local and county jails, tribal jails, and youth correctional or detention facilities). Reference the source of data for these figures.

• Provide an assessment of the state’s current progress in initiatives that promote continuity of care for Medicaid and CHIP beneficiaries who are inmates of public institutions. Describe progress in and barriers to implementing these initiatives.

Provide an overview of all relevant funding sources for initiatives promoting continuity of care for beneficiaries following incarceration including through any

Medicaid authorities such as section 1115 demonstration authority. Scoring preference will be given to states with less progress and those demonstrating higher need.

Step 4: Learn About Review and Award 31

Project narrative section 3: Program oversight and subrecipients and contractors Maximum points: 15

• Describe the management controls and coordination mechanisms that will be used to ensure the timely and successful execution and operation of the planning grant.

• Describe the anticipated role of any subrecipients or contractors, such as non-federal public institutions, state human services agencies, Medicaid managed care plans, providers, and community-based organizations. While state Medicaid and CHIP agencies will administer funding awarded under this opportunity, CMS recommends state Medicaid and CHIP agencies collaborate with pertinent parties such as those described above. Therefore, your narrative should also describe how you will use funding to promote the collaboration needed to address the new requirements for

Medicaid and CHIP beneficiaries in public institutions and following incarceration, as outlined in the program requirements section.

• Describe your oversight and monitoring processes to ensure public institutions and entities with which you contract are compliant with any applicable Medicaid and

CHIP requirements, as well as 45 CFR 75.351 subrecipient and contractor determinations and 45 CFR 75.352 Requirements for pass-through entities.

Step 4: Learn About Review and Award 32

Project narrative section 4: Work plan Maximum points:

• Provide the state’s plan for developing, implementing, and operating initiatives to promote continuity of care for individuals who are inmates of a public institution and are eligible for medical assistance under the state Medicaid program or are eligible for child health assistance or pregnancy-related assistance under the state CHIP.

• Describe your goals, measurable objectives, activities and milestones. 10

Describe the following:

• The amount, duration, and scope of planning grant activities.

• Target populations.

• A timeline for accomplishing objectives.

• Metrics for…