If a state submits a certification to the Secretary that it has (or projects) a budget deficit in a given fiscal year, the state may amend its State Plan and alter Medicaid eligibility requirements for adults with incomes above 133% of the federal poverty level, as long as the adults are not Medicaid-eligible on the basis of pregnancy or disability. However, the Q&As caution that states should be careful when considering eligibility changes prior to June 30, 2011, because the MOE provisions of the American Recovery and Reinvestment Act (Recovery Act) do not contain a similar budget deficit exception, and a violation could result in the loss of increased federal matching funds available through the Recovery Act.