[Federal Register Volume 63, Number 41 (Tuesday, March 3, 1998)]
[Notices]
[Pages 10400-10402]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-5385]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-2000-N]
RIN 0938-AI78


Medicaid Program; State Allotments for Additional Federal Funding 
of Emergency Health Services Furnished to Undocumented Aliens: Federal 
Fiscal Years 1998 Through 2001

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice.

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SUMMARY: This notice announces Federal fiscal year allotments that are 
available to certain States to furnish emergency health services under 
Medicaid to undocumented aliens. The 12 States having the highest 
number of undocumented aliens residing in the State will receive 
limited Federal funds for fiscal years 1998 through 2001 as additional 
compensation for providing emergency health services to the 
undocumented alien population. This notice also describes the 
methodology used to determine each State's allotment.
    This notice implements section 4723 of the Balanced Budget Act of 
1997, Public Law 105-33.

DATES: The allotments specified in this notice are available for 
approved expenditures for services furnished in each Federal fiscal 
year 1998 through 2001 (beginning October 1, 1997).

ADDRESSES: Copies: To order copies of the Federal Register containing 
this document, send your request to: New Orders, Superintendent of 
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[[Page 10401]]

many other public and academic libraries throughout the country that 
receive the Federal Register.
    This Federal Register document is also available from the Federal 
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password required).

FOR FURTHER INFORMATION CONTACT: Miles McDermott, (410) 786-3722.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 4723 of the Balanced Budget Act of 1997, Public Law 105-33, 
enacted August 5, 1997, provides for making available to certain 
States, through State allotments, additional Federal funding for 
emergency health services furnished to undocumented aliens. For those 
States eligible for the allotments, payments may be made for emergency 
medical services furnished to undocumented aliens who, except for their 
alien status, would otherwise qualify for Medicaid and for amounts paid 
for services furnished to aliens who do not meet the Medicaid 
eligibility requirements.
    The scope of emergency services under State Medicaid programs has 
been previously defined by the Social Security Act (the Act). Section 
1903(v)(2) of the Act provides that payment may be made only if the 
services are necessary for the treatment of an emergency medical 
condition of the alien, and the care and services do not involve 
procedures related to an organ transplant. Section 1903(v)(3) of the 
Act defines the term ``emergency medical services'' as a medical 
condition (including emergency labor and delivery) accompanied with 
severe symptoms (including severe pain) that require immediate 
attention and that if not given could result in seriously jeopardizing 
the patient's health; seriously impairing bodily functions; or 
seriously damaging bodily organs or parts. Implementing regulations for 
these statutory provisions are set forth at 42 CFR Part 440.
    Section 4723 of Public Law 105-33 provides for the distribution of 
additional Federal funding of $25 million, for each Federal fiscal year 
1998 through 2001, among the 12 States (which may include the District 
of Columbia) that are determined to have the greatest number of 
undocumented aliens. Section 4723 specifies that the number of 
undocumented aliens in a State will be determined based on estimates 
prepared by the Statistics Division of the Immigration and 
Naturalization Service (INS) as of October 1992 (or a later date if 
that date is at least one year before the beginning of the fiscal year 
involved). Section 4723 provides that the fiscal year allotments for 
each of these 12 States will also be determined based on the number of 
undocumented aliens in each specific State. In addition, any portion of 
an allotment to a State that is not paid out in a particular fiscal 
year will be available for payment during the next fiscal year.

II. Provisions of This Notice

    We are issuing this notice to announce the allotments for Federal 
fiscal years 1998 through 2001 that are available to the 12 States that 
we have determined to have the highest number of undocumented aliens 
for the furnishing of emergency health services to undocumented aliens. 
These 12 States will receive Federal funds up to each State's allotment 
in the amount that the State (or political subdivision of the State) 
demonstrates it paid for approved emergency services furnished to 
undocumented aliens. Therefore, for those States eligible for the 
allotments, they can recover the State share of the cost of treatment 
of emergency health services furnished to undocumented aliens who, 
except for their alien status, would otherwise qualify for Medicaid and 
also amounts paid for services to undocumented aliens who do not meet 
the Medicaid eligibility requirements. Once a State exhausts its 
allotment for a given fiscal year, the State will continue to receive 
its usual reimbursement rate and Federal funding will be based on the 
Federal medical assistance percentage (FMAP) calculations in which the 
rate of reimbursement will be between 50 and 83 percent. Any remaining 
portion of the allotment that is not paid to a State during the fiscal 
year will be available to the State the following fiscal year.
    Section 4723 of Public Law 105-33 sets forth the methodology for 
determining the allotment that each of the 12 States will receive. The 
amount of a State's allotment for a given fiscal year is based upon the 
State's percentage of undocumented aliens compared to that of the other 
11 eligible States. The undocumented alien population in a State is 
based on estimates calculated by the Statistics Division of the INS. 
The statute also indicates that more recent estimates could be used, if 
available, as long as these estimates are dated at least one year 
preceding the beginning of the fiscal year involved.
    Additional resources, along with new data from the United States 
Census Bureau, have allowed the INS to review and modify its original 
methodology for estimating the undocumented alien population and to 
update these estimates to reflect this population as of October 1996. 
The INS estimates refer to the population of immigrants that has 
established residence in the United States by remaining in the country 
for more than 12 months in an illegal status. According to the updated 
estimates of the INS, the total number of undocumented alien residents 
in the United States as of October 1996 was 5.0 million. This number 
represents approximately 1.9 percent of the total U.S. population. We 
have identified the following 12 States as having the greatest number 
of undocumented alien residents: California, Texas, New York, Florida, 
Illinois, New Jersey, Arizona, Massachusetts, Virginia, Washington, 
Colorado, and Maryland.
    The INS estimates of the undocumented alien population are updated 
approximately every 3 years. Thus, any new data may not be available 
until as early as October 1, 1999. Any updated data would have an 
impact on allotments in Federal fiscal year 2001, since the INS data 
must be compiled at least one year before the beginning of the fiscal 
year involved. Therefore, we have set forth in this notice, State 
allotments for Federal fiscal years 1998 through 2001. However, if the 
Statistics Branch of the INS generates updated estimates of the 
undocumented alien population by October 1, 1999, we will recalculate 
the State allotments for fiscal year 2001, and publish the new 
allotments in a Federal Register notice.
    The table below lists the 12 States entitled to an allotment, the 
per State undocumented alien population, the percentage of undocumented 
alien population to the total population among the top 12 States, and 
each State's allotment for Federal fiscal years 1998 through 2001.

[[Page 10402]]



                                                      Table                                                     
   [Allotments for State Emergency Health Services Furnished to Undocumented Aliens Under Section 4723 of the   
                      Balanced Budget Act of 1997: Federal Fiscal Years 1998 through 2001]                      
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                                                                                      Percent of                
             Ranking                             State               Population \1\   Population     Allotment  
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1................................  California......................       2,000,000        45.34     $11,335,298
2................................  Texas...........................         700,000        15.87       3,967,354
3................................  New York........................         540,000        12.24       3,060,530
4................................  Florida.........................         350,000         7.93       1,983,677
5................................  Illinois........................         290,000         6.57       1,643,618
6................................  New Jersey......................         135,000         3.06         765,133
7................................  Arizona.........................         115,000         2.61         651,780
8................................  Massachusetts...................          85,000         1.93         481,750
9................................  Virginia........................          55,000         1.25         311,721
10...............................  Washington......................          52,000         1.18         294,718
11...............................  Colorado........................          45,000         1.02         255,044
12...............................  Maryland........................          44,000         1.00         249,377
                                                                    --------------------------------------------
    Total........................  ................................       4,411,000       100.00     25,000,000 
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\1\ Source: INS, Statistics Branch, Demographic Statistics Section Estimated Resident Undocumented Population by
  State October, 1996.                                                                                          

    The following example illustrates the calculation of California's 
allotment:

    Example: California, the leading State of alien residence, has 
an estimated population of 2.0 million undocumented aliens. This 
figure represents 45 percent of the total undocumented alien 
population of 4,411,000. Since California has 45 percent of all 
undocumented aliens among the 12 eligible States, it is entitled to 
funds equal to 45 percent of the total funds available for that 
fiscal year (that is, 45 percent of $25,000,000). Thus California's 
total allotment is $11,335,298 for Federal fiscal year 1998.

III. Regulatory Impact Statement

    We have examined the impacts of this notice as required by 
Executive Order 12866 and the Regulatory Flexibility Act (RFA) (Pub. L. 
96-354). Executive Order 12866 directs agencies to assess all costs and 
benefits of available regulatory alternatives and, when regulation is 
necessary, to select regulatory approaches that maximize net benefits 
(including potential economic, environmental, public health and safety 
effects; distributive impacts; and equity). The RFA requires agencies 
to analyze options for regulatory relief for small businesses. For 
purposes of the RFA, States and individuals are not considered to be 
small entities.
    This notice implements the recently enacted provision of the 
Balanced Budget Act of 1997 that provides additional funding to certain 
States furnishing emergency health services to undocumented aliens for 
fiscal years 1998 through 2001. During each of the four fiscal years, 
$25 million is available to distribute among the 12 States having the 
highest number of undocumented aliens residing in their State. As 
specified in the law, we have used estimates of the undocumented alien 
population per State, prepared by the Statistics Division of the INS to 
determine the 12 highest States and to calculate the allotment each of 
the 12 States will receive. Any portion of the allotment that is not 
distributed to a State during the fiscal year will be available for 
that State the following fiscal year. These States will continue at the 
usual rate of reimbursement once allotments have been exhausted.
    This notice is expected to have a positive impact on States by 
providing additional payment to those 12 States determined to have the 
greatest number of undocumented aliens residing in the State. This 
funding will allow States to extend the emergency health services to a 
greater number of those undocumented aliens meeting the required 
criteria and providing some advantage over those States that are not 
entitled to these allotments.
    Also, section 1102(b) of the Social Security Act requires us to 
prepare a regulatory impact analysis for any notice that may have a 
significant impact on the operations of a substantial number of small 
rural hospitals. Such an analysis must conform to the provisions of 
section 603 of the RFA. For purposes of section 1102(b) of the Act, we 
define a small rural hospital as a hospital that is located outside a 
Metropolitan Statistical Area and has fewer than 50 beds.
    We are not preparing analyses for either the RFA or section 1102(b) 
of the Act because we have determined and certify that this notice will 
not have a significant economic impact on a substantial number of small 
entities or a significant impact on the operations of a substantial 
number of small rural hospitals.
    In accordance with the provisions of Executive Order 12866, this 
notice was reviewed by the Office of Management and Budget.

    Authority: Sections 1902(a)(62) and 1903(v) of the Social 
Security Act (42 U.S.C. 1396a(62) and 1396b(v)) and Section 4723 of 
Public Law 105-33.

    Dated: January 26, 1998.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.

    Dated: February 3, 1998.
Donna E. Shalala,
Secretary.
[FR Doc. 98-5385 Filed 3-2-98; 8:45 am]
BILLING CODE 4120-01-P