1.Automatic increase in the
Federal medical assistance percentage during periods of national economic
downturn
(a)National
Economic Downturn Assistance FMAP
(1)Section 1905 of the Social Security Act (42 U.S.C. 1396d)
is amended—
(A)in subsection
(b), in the first sentence—
(i)by
striking and (4)
and inserting (4)
; and
(ii)by
inserting and (5) with respect to each fiscal year quarter other than
the first quarter of a national economic downturn assistance period described
in subsection (y)(1), the Federal medical assistance percentage for any State
described in subsection (y)(2) shall be equal to the national economic downturn
assistance FMAP determined for the State for the quarter under subsection
(y)(3)
before the period; and
(B)by adding at the
end the following:
(y)National
Economic Downturn Assistance FMAPFor purposes of clause (5) of
the first sentence of subsection (b):
(1)National
economic downturn assistance periodA national economic downturn
assistance period described in this paragraph—
(A)begins with the
first fiscal year quarter for which the Secretary determines that for at least
23 States, the rolling average unemployment rate for that quarter has increased
by at least 10 percent over the corresponding quarter for the most recent
preceding 12-month period for which data are available (in this subsection
referred to as the trigger quarter
); and
(B)ends with the
first succeeding fiscal year quarter for which the Secretary determines that
less than 23 States have a rolling average unemployment rate for that quarter
with an increase of at least 10 percent over the corresponding quarter for the
most recent preceding 12-month period for which data are available.
(2)A State described in this paragraph is a State for which
the Secretary determines that the rolling average unemployment rate for the
State for any quarter occurring during a national economic downturn assistance
period described in paragraph (1) has increased over the corresponding quarter
for the most recent preceding 12-month period for which data are
available.
(3)Determination
of national economic downturn assistance fmap
(A)The national economic downturn assistance FMAP for a
fiscal year quarter determined with respect to a State under this paragraph is
equal to the Federal medical assistance percentage for the State for that
quarter increased by the number of percentage points determined by—
(i)dividing—
(I)the Medicaid
additional unemployed increased cost amount determined under subparagraph (B)
for the quarter; by
(II)the State's
total Medicaid quarterly spending amount determined under subparagraph (C) for
the quarter; and
(ii)multiplying the
quotient determined under clause (i) by 100.
(B)Medicaid
additional unemployed increased cost amountFor purposes of
subparagraph (A)(i)(I), the Medicaid additional unemployed increased cost
amount determined under this subparagraph with respect to a State and a quarter
is the product of the following:
(i)State increase
in rolling average number of unemployed individuals from the base quarter of
unemployment
(I)The amount determined by subtracting the rolling average
number of unemployed individuals in the State for the base unemployment quarter
for the State determined under subclause (II) from the rolling average number
of unemployed individuals in the State for the quarter.
(II)Base
unemployment quarter defined
- (aa)For purposes of subclause (I), except as provided in item
(bb), the base quarter for a State is the quarter with the lowest rolling
average number of unemployed individuals in the State in the 12-month period
preceding the trigger quarter for a national economic downturn assistance
period described in paragraph (1).
- (bb)If
the rolling average number of unemployed individuals in a State for a quarter
occurring during a national economic downturn assistance period described in
paragraph (1) is less than the rolling average number of unemployed individuals
in the State for the base quarter determined under item (aa), that quarter
shall be treated as the base quarter for the State for such national economic
downturn assistance period.
(ii)National
average amount of additional federal medicaid spending per additional
unemployed individualIn the case of—
(I)a calendar
quarter occurring in fiscal year 2012, $350; and
(II)a calendar
quarter occurring in any succeeding fiscal year, the amount applicable under
this clause for calendar quarters occurring during the preceding fiscal year,
increased by the annual percentage increase in the medical care component of
the consumer price index for all urban consumers (U.S. city average), as
rounded up in an appropriate manner.
(iii)State
nondisabled, nonelderly adults and children medicaid spending index
(I)With respect to a State, the quotient (not to exceed
1.00) of—
- (aa)the State
expenditure per person in poverty amount determined under subclause (II);
divided by—
- (bb)the National
expenditure per person in poverty amount determined under subclause
(III).
(II)State
expenditure per person in poverty amountFor purposes of
subclause (I)(aa), the State expenditure per person in poverty amount is the
quotient of—
- (aa)the total amount
of annual expenditures by the State for providing medical assistance under the
State plan to nondisabled, nonelderly adults and children; divided by
- (bb)the total number
of nonelderly adults and children in poverty who reside in the State, as
determined under paragraph (4)(A).
(III)National
expenditure per person in poverty amountFor purposes of
subclause (I)(bb), the National expenditure per person in poverty amount is the
quotient of—
- (aa)the sum of the
total amounts determined under subclause (II)(aa) for all States; divided
by
- (bb)the sum of the
total amounts determined under subclause (II)(bb) for all States.
(C)State's total
Medicaid quarterly spending amountFor purposes of subparagraph
(A)(i)(II), the State's total Medicaid quarterly spending amount determined
under this subparagraph with respect to a State and a quarter is the amount
equal to—
(i)the total amount
of expenditures by the State for providing medical assistance under the State
plan to all individuals enrolled in the plan for the most recent fiscal year
for which data is available; divided by
(ii)4.
(4)In
making the determinations required under this subsection, the Secretary shall
use, in addition to the most recent available data from the Bureau of Labor
Statistics Local Area Unemployment Statistics for each State referred to in
paragraph (5), the most recently available—
(A)data from the
Bureau of the Census with respect to the number of nonelderly adults and
children who reside in a State described in paragraph (2) with family income
below the poverty line (as defined in section 2110(c)(5)) applicable to a
family of the size involved (or, if the Secretary determines it appropriate, a
multiyear average of such data);
(B)data reported to
the Secretary by a State described in paragraph (2) with respect to
expenditures for medical assistance under the State plan under this title for
nondisabled, nonelderly adults and children; and
(C)econometric
studies of the responsiveness of Medicaid enrollments and spending to changes
in rolling average unemployment rates and other factors, including State
spending on certain Medicaid populations.
(5)Definition of
rolling average number of unemployed individuals, rolling
average unemployment rateIn this subsection, the
term—
(A)rolling
average number of unemployed individuals means, with respect to a
calendar quarter and a State, the average of the 12 most recent months of
seasonally adjusted unemployment data for each State;
(B)rolling
average unemployment rate means, with respect to a calendar quarter and
a State, the average of the 12 most recent monthly unemployment rates for the
State; and
(C)monthly
unemployment rate means, with respect to a State, the quotient
of—
(i)the monthly
seasonally adjusted number of unemployed individuals for the State; divided
by
(ii)the monthly
seasonally adjusted number of the labor force for the State,
using the
most recent data available from the Bureau of Labor Statistics Local Area
Unemployment Statistics for each State.(6)Increase in cap
on payments to territoriesWith respect to any fiscal year
quarter for which the national economic downturn assistance Federal medical
assistance percentage applies to Puerto Rico, the Virgin Islands, Guam, the
Northern Mariana Islands, or American Samoa, the amounts otherwise determined
for such commonwealth or territory under subsections (f) and (g) of section
1108 shall be increased by such percentage of such amounts as the Secretary
determines is equal to twice the average increase in the national economic
downturn assistance FMAP determined for all States described in paragraph (2)
for the quarter.
(7)The national economic downturn assistance FMAP shall
only apply for purposes of payments under section 1903 for a quarter and shall
not apply with respect to—
(A)disproportionate
share hospital payments described in section 1923;
(B)payments under
title IV or XXI; or
(C)any payments
under this title that are based on the enhanced FMAP described in section
2105(b).
(8)Additional requirement for certain
statesIn the case of a State described in paragraph (2) that
requires political subdivisions within the State to contribute toward the
non-Federal share of expenditures required under section 1902(a)(2), the State
shall not require that such political subdivisions pay for any fiscal year
quarters occurring during a national economic downturn assistance period a
greater percentage of the non-Federal share of such expenditures, or a greater
percentage of the non-Federal share of payments under section 1923, than the
respective percentage that would have been required by the State under State
law in effect on the first day of the fiscal year quarter occurring immediately
prior to the trigger quarter for the
period.
.
(2)Effective date;
no retroactive applicationThe amendments made by paragraph (1)
take effect on January 1, 2012. In no event may a State receive a payment on
the basis of the national economic downturn assistance Federal medical
assistance percentage determined for the State under section 1905(y)(3) of the
Social Security Act for amounts expended by the State prior to January 1,
2012.
(b)
(1)The
Comptroller General of the United States shall analyze the previous periods of
national economic downturn, including the most recent such period in effect as
of the date of enactment of this Act, and the past and projected effects of
temporary increases in the Federal medical assistance percentage under the
Medicaid program with respect to such periods.
(2)Not
later than April 1, 2011, the Comptroller General of the United States shall
submit a report to Congress on the results of the analysis conducted under
paragraph (1). Such report shall include such recommendations as the
Comptroller General determines appropriate for modifying the national economic
downturn assistance FMAP established under section 1905(y) of the Social
Security Act (as added by subsection (a)) to improve the effectiveness of the
application of such percentage in addressing the needs of States during periods
of national economic downturn, including recommendations for—
(A)improvements to
the factors that begin and end the application of such percentage;
(B)how the
determination of such percentage could be adjusted to address State and
regional economic variations during such periods; and
(C)how the
determination of such percentage could be adjusted to be more responsive to
actual Medicaid costs incurred by States during such periods, as well as to the
effects of any other specific economic indicators that the Comptroller General
determines appropriate.