[Federal Register Volume 72, Number 16 (Thursday, January 25, 2007)]
[Notices]
[Pages 3391-3395]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-1174]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary


Proposed Implementation of Section 6053(b) of the Deficit 
Reduction Act for Fiscal Year 2008 FMAP

AGENCY: Office of the Secretary, HHS.

ACTION: Notice with comment period.

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SUMMARY: This notice with comment period describes the procedure for 
implementing Section 6053(b) of the Deficit Reduction Act of 2005, 
Public Law 109-171 for fiscal year 2008. Section 6053(b) of the Deficit 
Reduction Act provides for a modification of the Federal Medical 
Assistance Percentages for any state which has a significant number of 
evacuees from Hurricane Katrina.

DATES: Comment Date: To be assured consideration, comment must be 
received at the address provided below, no later than 5 p.m. on 
February 26, 2007.

ADDRESSES: Because of staff and resource limitations, we can only 
accept comments by regular mail. You may mail written comments (one 
original and one copy) to the following address only: Department of 
Health and Human Services, Room 447D, Attention: FMAP Proposed Rule, 
200 Independence Ave., SW., Washington, DC 20201.
    Submitting Comments: We welcome comments from the public on all 
issues set forth in this rule with comment period to assist us in fully 
considering issues and developing policies. Please provide a reference 
to the section on which you choose to comment.

SUPPLEMENTARY INFORMATION:

A. Background: Federal Medical Assistance Percentages

    Federal Medical Assistance Percentages are used to determine the 
amount of Federal matching for state expenditures for assistance 
payments for certain social services such as Temporary Assistance for 
Needy Families (TANF) Contingency Funds, matching funds for the Child 
Care and Development Fund, Title IV-E Foster Care Maintenance payments, 
Adoption Assistance payments, and state medical and medical insurance 
expenditures for Medicaid and the State Children's Health Insurance 
Program (SCHIP).
    Sections 1905(b) and 1101(a)(8)(B) of the Social Security Act 
require the Secretary of Health and Human Services to publish the 
Federal Medical Assistance Percentages each year. The Secretary is to 
calculate the percentages, using formulas in sections 1905(b) and 
1101(a)(8)(B), from the Department of Commerce's statistics of average 
income per person in each state and for the Nation as a whole. The 
percentages are within the upper and lower limits given in section 
1905(b) of the Act. The percentages to be applied to the District of 
Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and 
the Northern Mariana Islands are specified in statute, and thus are not 
based on the statutory formula that determines the percentages for the 
50 states. The ``Federal Medical Assistance Percentages'' are for 
Medicaid.
    Section 1905(b) of the Social Security Act specifies the formula 
for calculating Federal Medical Assistance Percentages as follows:
    ``Federal medical assistance percentage'' for any state shall be 
100 per centum less the state percentage; and the state percentage 
shall be that percentage which bears the same ratio to 45 per centum as 
the square of the per capita income of such state bears to the square 
of the per capita income of the continental United States (including 
Alaska) and Hawaii; except that (1) the Federal medical assistance 
percentage shall in no case be less than 50 per centum or more than 83 
per centum, (2) the Federal medical assistance percentage for Puerto 
Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and 
American Samoa shall be 50 per centum.
    Section 4725 of the Balanced Budget Act of 1997 amended section 
1905(b) to provide that the Federal Medical Assistance Percentage for 
the District of Columbia for purposes of Title XIX and for the purposes 
of calculating the Enhanced Federal Medical Assistance Percentage under 
Title XXI shall be 70 percent. For the District of Columbia, we note 
under the table of Federal Medical Assistance Percentages the rate that 
applies in certain other programs calculated using the formula 
otherwise applicable, and the rate that applies in certain other 
programs pursuant to section 1118 of the Social Security Act. Section 
2105(b) of the Social Security Act specifies the formula for 
calculating the Enhanced Federal Medical Assistance Percentages as 
follows:
    The ``enhanced FMAP,'' for a state for a fiscal year, is equal to 
the Federal medical assistance percentage (as defined in the first 
sentence of section 1905(b)) for the state increased by a number of 
percentage points equal to 30 percent of the number of percentage 
points by which (1) such Federal medical assistance percentage for the 
state, is less than (2) 100 percent; but in no case shall the enhanced 
FMAP for a state exceed 85 percent.
    The ``Enhanced Federal Medical Assistance Percentages'' are for use 
in the State Children's Health Insurance Program under Title XXI, and 
in the Medicaid program for certain children for expenditures for 
medical assistance described in sections 1905(u)(2) and 1905(u)(3) of 
the Social Security Act.
    On November 30, 2006, at 71 FR 69209, we published the FMAP and 
Enhanced FMAP rates for each state for October 1, 2007 through 
September 30, 2008 (fiscal year 2008). This notice describes the 
procedure we would use to modify the fiscal year 2008 FMAP rates to 
comply with the requirements of section 6053(b) of the DRA, which we 
discuss more fully below.

B. Section 6053(b) of the Deficit Reduction Act

    Section 6053(b) of the Deficit Reduction Act (DRA) of 2005 requires 
that calculations used in computing the FMAPs disregard evacuees and 
any income attributable to them who were evacuated to and live in a 
state, other than their state of residence, as of October 1, 2005 as a 
result of Hurricane Katrina. The DRA defines ``evacuee'' as ``an 
affected individual who has been displaced to another state'' (Sec 
6201(b)(3)). This provision applies to any state that the Secretary of 
HHS

[[Page 3392]]

determines has a significant number of Katrina evacuees.
    The modification of the Federal Medical Assistance Percentages and 
the Enhanced Federal Medical Assistance Percentages under the Deficit 
Reduction Act affect only medical expenditure payments under Title XIX 
and expenditure payments for the State Children's Health Insurance 
Program under Title XXI. The Department believes that the percentages 
in this rule do not apply to payments under Title IV of the Social 
Security Act. In addition, the Title XIX statute provides separately 
for Federal matching of administrative costs, which is not affected by 
the subject Deficit Reduction Act provision.
    Section 6053(b) applies to calculations for FMAPs for any year 
after 2006. The underlying data that serve as the basis for the FMAP 
calculations are produced by the Department of Commerce's Bureau of 
Economic Analysis (BEA). Section 1101(a)(8)(B) requires FMAP 
calculations to be determined using data from the Department of 
Commerce. Therefore, the standard practice in the calculation of the 
FMAPs is to utilize the most up-to-date BEA state per capita income 
data. The Fiscal Year 2008 FMAPs, which were published on November 30, 
2006 use the state per capita income estimates for 2003-2005. The first 
year that the relevant data--state per capita personal income 
estimates--would show any impact related to Hurricane Katrina is 2005, 
since Hurricane Katrina occurred in August 2005. Therefore, this rule 
proposes to implement Section 6053 (b) of the DRA starting with the 
Fiscal Year 2008 FMAPs, since the 2008 FMAP calculation will be the 
first year that include 2005 data.
    We believe the likely Congressional intent of this provision was to 
assist any state that took in a large number of Katrina evacuees. The 
statute instructs HHS to remove Katrina evacuees and their income from 
the FMAP calculation for any such state. This adjustment would protect 
such a state from an adverse fluctuation in its FMAP based on Katrina 
evacuees. This adjustment would also, however, remove any positive 
fluctuation in the FMAP based on Katrina evacuees. It is not clear that 
this latter impact was intended by Congress.
    We believe that, because Katrina evacuees are likely to have lower 
income than the general population of the states to which they are 
evacuated, accurate data would probably result in no adverse 
fluctuation in FMAP for any state using the standard calculation 
methodology. Instead, there would probably be a positive fluctuation 
under the standard calculation that would be eliminated by the 
statutory adjustment. In other words, the statutory adjustment could 
result in that state having a higher per capita income (and lower FMAP) 
than if the adjustment was not made.
    In many instances, evacuees either had lower incomes before or lost 
their employment and means of support after Katrina. Evacuees' per 
capita income, therefore, would be less than the per capita income of 
the general population of the state(s) to which they were evacuated. 
Eliminating persons of lower per capita income from any affected state 
would raise overall state per capita income, thus lowering its 
respective Federal FMAP percentage.
    Moreover, the standard methodology used by BEA to calculate per 
capita income does not permit the attribution of all income sources to 
Katrina evacuees. That is, BEA does not possess the data necessary to 
count all sources of Katrina evacuees' income (see detailed discussion 
below), and as a result, we believe our approach offers the best 
possible calculation given the limited data available.
    We propose in this rule a methodology for the adjustment that would 
take advantage of the way in which state population is usually 
calculated to comply with our understanding of Congressional intent in 
the first year, and raise the FMAP slightly for any affected state. But 
we are concerned that this methodology would have the expected effect 
of lowering the FMAP in future years compared to the calculation 
methodology.
    We are also concerned that it will be more difficult to accurately 
disregard evacuee population and income in future years. It will also 
become increasingly difficult to isolate Katrina evacuees' income to 
adjust per capita state income calculations as BEA only captures 
aggregate state income, not evacuees' income.

C. Calculation of the Federal Medical Assistance Percentage

    The Federal Medical Assistance Percentage (FMAP) is based on the 
percentage of low-income persons residing in a given state. By statute, 
it is no lower than 50% and no higher than 83%. The key variable in 
calculating the FMAP is the estimate of state per capita personal 
income. The state per capita income estimates are then plugged into the 
statutory FMAP formula. There are two components to the state per 
capita personal income estimates. The denominator is the Annual 
Population Estimate; the numerator is State Personal Income.

1. Modification to Population Estimate

    The first adjustment that must take place under Section 6053(b) of 
the DRA is to the state population estimate. The state population 
estimate must be adjusted by removing all Katrina evacuees in each 
state that were evacuated across state lines.
    Because the state population estimates used in the 2005 Per Capita 
Personal Income estimates are from July 1, 2005, which is prior to 
Hurricane Katrina, these Katrina evacuees do not appear in the data 
that is the basis for the state population estimates for any state 
covered by this provision. Thus, while Section 6053(b) of the DRA 
requires it, no adjustment to this data is required to disregard 
Katrina evacuees.
    To ensure compliance with the statutory requirement to disregard 
Katrina evacuees, however, we explored the possibility of adjusting the 
population estimates to reflect the influx of evacuees, and then 
disregarding the actual number of Katrina evacuees. For this purpose, 
we used BEA estimates of the number of Katrina evacuees relocated to 
the various states based on FEMA data. We then used BEA's estimates of 
Katrina evacuees relocated to each state to adjust upward the 
population of those states to account for the influx of evacuees. We 
then considered whether the influx of evacuees may have displaced other 
individuals from the population of the affected state(s), but we found 
no evidence to support an adjustment based on this possibility. 
Following the requirements of Section 6053(b), we then would subtract 
these evacuees from their respective states to arrive at a state 
population prior to the effects of Hurricane Katrina. The resulting 
calculations arrive at the July 1, 2005 population figures reported by 
the Bureau of the Census for the time period just prior to Hurricane 
Katrina. This analysis confirmed that no adjustment is required to the 
population estimate used in the calculation of the state per capita 
personal income for 2005 to disregard Katrina evacuees.

2. Modification to State Personal Income Estimate

    The second adjustment that must take place under Section 6053(b) of 
the DRA is to state personal income. State personal income must be 
adjusted by removing all income that is attributed to Katrina evacuees, 
and HHS has consulted with BEA at length on how to do so.
    According to standard BEA methodology, state personal income 
consists of the sum of wages and

[[Page 3393]]

salaries, supplements to wages and salaries, proprietor's income, 
rental income, personal dividends, personal interest income, and 
transfer receipts less contributions for government social insurance. 
State personal income is the income that is received by, or on behalf 
of, all the persons living in a state. In addition, source data for 
wages and salaries, supplements to wages and salaries, and 
contributions for government social insurance (which are compiled on a 
place of work basis) are adjusted for persons who work in one state and 
live in another.
    BEA published these data in ``State Personal Income for the Fourth 
Quarter of 2005 and Per Capita Income for 2005,'' which appeared in the 
April 2006 Survey of Current Business, and subsequently revised in the 
October 2006 Survey of Current Business. In Table D of the April 2006 
article, BEA gives the adjustments it made to account for some of the 
economic effects of Hurricanes Katrina, Rita, and Wilma that are not 
reflected in the source data used to estimate state personal income for 
2005. We will use these data as the basis for making the adjustments to 
the FMAPs required by the Deficit Reduction Act.
    Implementing Section 6053(b) is complex because the data related to 
personal income are not detailed enough to fully conform to all of the 
provision's requirements. For example, BEA cannot isolate the fraction 
of a state's total wages and salaries that were paid to Katrina 
evacuees who moved there from another state. Therefore, HHS cannot 
remove income paid to Katrina evacuees for wages and salaries.
    Further, HHS can only estimate some of the ``interstate income'' 
attributable to Katrina evacuees. For purposes of this rule, interstate 
income is personal income that was paid to Katrina evacuees in a 
different state than the state they were living in before Hurricane 
Katrina. Included in our estimate of interstate income are governmental 
transfer receipts that were paid to evacuees who may have moved across 
state lines. Governmental transfer receipts consist of all transfer 
payments, such as TANF or Medicaid, as well as transfers from business, 
such as net insurance settlements. Transfers such as Medicare or 
Medicaid are government payments made directly or through 
intermediaries to vendors for the care provided to individuals.
    Below we discuss three types of transfer receipt adjustments 
included in Table D: FEMA disaster assistance, interstate population 
dispersal, and net insurance settlements.
a. FEMA Disaster Assistance
    FEMA disaster assistance is one type of transfer payment included 
in personal income. For FEMA disaster assistance, payments are recorded 
at the location where the recipients are residing at the time of 
payment. Therefore, if the evacuees receiving FEMA disaster assistance 
were evacuated to another state, the FEMA disaster assistance payment 
would be counted as income in the state that they were evacuated to.
    However, we can not know what proportion of the FEMA disaster 
assistance payments were made to interstate evacuees and what 
proportion were made to permanent residents of the states in question. 
For Texas, it is likely that the majority of the FEMA disaster 
assistance payments were made to interstate evacuees. For Alabama, the 
FEMA disaster assistance payments were likely made to both Alabama 
residents as well as interstate evacuees.
    Although we cannot determine the extent to which the FEMA disaster 
assistance payments represent income to interstate evacuees as opposed 
to permanent residents, we propose to include the entire FEMA disaster 
assistance adjustment in the estimate of interstate income. We make 
this decision because we believe it is best to include as much 
countable income of the evacuees as possible in order to comply with 
the intent of the statute, especially given that we can not count all 
sources of income for the evacuees.
b. Interstate Population Dispersal
    The interstate population dispersal adjustment is BEA's estimate of 
governmental transfer receipts that were paid to Hurricane Katrina 
evacuees while they were living in the states to which they had been 
evacuated. The transfer receipts included in the interstate population 
dispersal adjustment include payments such as Medicaid or TANF, as 
listed above. We propose to include the interstate population dispersal 
adjustment in our estimate of interstate income.
    According to Table D, some states gained income due to this 
adjustment and some states lost income. A positive interstate 
population dispersal adjustment, such as the adjustment for Alabama, 
means that the state was estimated to receive an increase in transfer 
income because evacuees moved into that state from another state, and 
received transfer payments in their new state. A negative interstate 
population dispersal adjustment, such as the adjustment for Louisiana, 
means that the state was estimated to receive a decrease in transfer 
income because evacuees moved out of that state to another state, and 
received transfer payments in their new state.
    BEA estimates these interstate population dispersal adjustments 
based on the evacuee population that moved across state lines after the 
hurricane, and the average transfer payment per evacuee. The evacuee 
population is based on the FEMA Current Location Report.
c. Net Insurance Settlements
    Net insurance settlements are income derived from insurance 
payments made based on claims for lost or damaged property. For net 
insurance settlements, BEA records the payments as income in the state 
where the homes were destroyed.
    Therefore, even if an evacuee received an insurance payment in a 
different state from where their property was damaged, it would be 
recorded as income in the state where the damage occurred. If an 
individual was evacuated from Louisiana to Texas because his or her 
home was destroyed in the hurricane, and he or she received an 
insurance payment while living in Texas, BEA would record this payment 
as income in the State of Louisiana, not the State of Texas.
    Therefore, we propose not to include the net insurance settlements 
adjustment in our estimate of interstate income, because the income has 
already been re-allocated to the state where the evacuees lived before 
Hurricane Katrina.
    The methodology described above details the FMAP adjustments that 
were made to accommodate the requirements of Section 6053(b) with the 
available data. The calculations this year result in a positive impact 
on any affected state, i.e., increasing FMAPs. As noted above, it is 
unclear what effect Section 6053 (b) will have on future years should 
this provision carry forward beyond fiscal year 2008. It is possible 
that any affected state will receive lower FMAP rates when updated data 
become available.

D. Affected States

    According to Section 6053(b), the Secretary of HHS must apply this 
provision to any state that the Secretary determines has a significant 
number of Katrina evacuees. However, the statute provides HHS no 
guidance on how to determine what number of evacuees constitutes a 
``significant number.'' As a result, HHS attempted to provide an 
objective means to determine a ``significant number'' of evacuees.
    HHS has chosen to determine significance by calculating the numbers 
of evacuees beyond two standard

[[Page 3394]]

deviations from the mean of all states' number of evacuees. Measures of 
significance generally involve how observations vary in their distance 
from the average of all observations in their particular group. In this 
case, the observations are the number of evacuees relocated to each of 
the respective states. A measure used frequently to determine 
significance is the standard deviation from the mean or average. We 
propose to use as the measure of a significantly affected state those 
that incurred an influx of evacuees greater than twice the standard 
deviation from the mean of all states.
    Using the BEA estimates for the number of evacuees relocated to 
each state (except as noted below for Louisiana) we calculated an 
average influx of evacuees for all states of 7,159. The distribution of 
evacuees into all states around this average produces a standard 
deviation of 22,375. Therefore, we propose to apply the provisions of 
Section 6053(b) to any state with an influx of evacuees greater than 
51,909 (the mean plus two standard deviations). This methodology 
specifies only Texas, with 154,018 evacuees, having such a significant 
influx of evacuees.
    Therefore, we propose to apply Section 6053(b) to Texas. Because 
the DRA defines ``evacuee'' as ``an affected individual who has been 
displaced to another state'' (section 6201 (b)(3)), we propose that 
Louisiana not be considered an affected state. Although there were 
intra-state evacuations within Louisiana, the provision is intended to 
apply only to any state that took in a significant number of evacuees 
from another state.
    BEA has made available on its Web site a version of Table D that 
includes adjustments for all states. The Web site address is: http://www.bea.gov/bea/regional/articles.cfm?section=articles and the section 
is: State Personal Income: Fourth Quarter of 2005 and Per Capita 
Personal Income for 2005, Additional Tables.

E. Projected Effect of the Provision

    Using the personal income estimates released by BEA, we have 
calculated FMAPs for 2008 and the revised FMAPs applying the 
methodology outlined above. The table below presents the 2008 FMAPs and 
the revised 2008 FMAPs with the proposed adjustment, and the 2008 
EFMAPs and the revised 2008 EFMAPs.

------------------------------------------------------------------------
                                                              2008 with
                    Texas                      Calculated     proposed
                                                  2008       adjustment
------------------------------------------------------------------------
FMAP........................................         60.53         60.56
EFMAP.......................................         72.37         72.39
------------------------------------------------------------------------

    As seen in the tables above, applying the proposed adjustment 
increases the FMAP and EFMAP for Texas.

F. Time Frame for the Adjustment

    The language of Section 6053(b) does not provide for a sunset of 
the FMAP adjustments. Therefore, the implication is that such 
adjustments would be made in perpetuity. Yet it seems unreasonable to 
assume that individuals who continue to reside in a state other than 
those directly impacted by Katrina would still be considered evacuees 
forever, even after they have established residency and obtained 
employment in their new state.
    As previously mentioned, it is possible that this provision will 
have a negative impact on a qualifying state's FMAP in future years. 
The magnitude of this negative impact is not known at this time.
    Additionally, it is technically difficult to perform the 
calculations for this provision because of numerous data limitations. 
Even under the calculation for FY 08, BEA was unable to completely 
account for all sources of income for evacuees. It is likely that BEA 
will continue to encounter these difficulties and produce limited 
income estimates in the future. Furthermore, BEA may also encounter 
difficulties in tracking evacuees, as it is uncertain whether such data 
will be available.
    For the above reasons, we are proposing to define evacuees narrowly 
to ensure that an adjustment is made only to the extent warranted to 
address the sudden influx directly resulting from Hurricane Katrina, 
and not permanent changes in population level for host states. While we 
believe the most straightforward definition of an evacuee would be to 
consider individuals to be evacuees fro a time-limited period following 
displacement to another state, we have listed three approaches to 
define evacuees, and are soliciting public comment on the issue.
    (1) The first alternative would establish a bright line test as to 
how long an individual would be considered an evacuee. Under this 
alternative, individuals would be considered to be Hurricane Katrina 
evacuees for up to 18 months following displacement to another state. 
This represents a substantial time frame during which the individual 
would likely have established residency in another state and become a 
functioning part of that state's economy.
    (2) A second alternative approach is that individuals would be 
considered to be Hurricane Katrina evacuees while receiving FEMA 
Hurricane Katrina assistance. FEMA assistance is an available data 
source to identify the individuals. Receipt of FEMA assistance is an 
indication that individuals are not fully integrated into the economy 
of a new state, and expect to return to homes that were destroyed by 
Hurricane Katrina.
    (3) The third alternative approach would be to consider individuals 
to be Hurricane Katrina evacuees while reliable data remains available 
and sufficient to identify evacuees and their income in order to carry 
out the provisions of the DRA. The statute does not authorize this 
Department to construct or develop its own data sources. Thus, we do 
not believe that Congress intended to require this adjustment to be 
made after reliable data is no longer available to support the 
adjustment.
    We invite comments on the adoption for the definition of evacuee 
discussed above, or an alternate approach, to ensure that the effect of 
section 6053(b) of the DRA is limited to addressing sudden population 
influxes directly resulting from Hurricane Katrina.

G. Regulatory Impact Statement

    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
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 
Regulatory Flexibility Act (RFA) requires agencies to analyze options 
for regulatory relief of small businesses. For purposes of the RFA, 
small entities include small businesses, nonprofit organizations, and 
government agencies. Section 202 of the Unfunded Mandates Reform Act of 
1995 (Pub. L. 104-4) also requires that agencies assess anticipated 
costs and benefits before issuing any rule whose mandates require 
spending in any one year of $100 million in 1995 dollars, updated 
annually for inflation. That threshold level is currently approximately 
$120 million. Executive Order 13132 establishes certain requirements 
that an agency must meet when it promulgates a final rule that imposes 
substantial direct requirement costs on state and local governments,

[[Page 3395]]

preempts state law, or otherwise has Federalism implications.
    This rule announces the provisions of section 6053(b) of the 
Deficit Reduction Act of 2005. We do not estimate this regulation will 
have any significant effect on the economy. Nevertheless, we estimate 
the impact of the provision, once implemented, to be minimal. Our 
analysis suggests that the modification to the FMAPs will only affect 
Texas. The effect will likely be a minimal decrease in State Medicaid 
and SCHIP spending and a corresponding minimal increase in federal 
Medicaid and SCHIP spending.
    In addition, the provisions only directly affect states. Therefore, 
there is no need to perform a regulatory flexibility analysis in 
accordance with section 603 of the Regulatory Flexibility Act.

H. Summary

    We propose to adjust the fiscal year 2008 FMAP rate only for the 
State of Texas, by reducing the income estimates used in the FMAP 
calculation through the application of adjustments to reflect 
interstate population dispersal income and FEMA disaster assistance 
income for evacuees. Because this is the only income that can be 
attributed to Katrina evacuees based on BEA data, this income will be 
subtracted from the 2005 state personal income as published by BEA in 
October 2006 to obtain a new state personal income for Texas. This 
state personal income will be divided by the state population as of 
July 2005 to get a revised per capita personal income for each state. 
This revised 2005 per capita personal income will replace the 2005 per 
capita personal income in calculating the 2008 FMAPs.
    Effective Dates: The percentages listed will be effective for each 
of the four (4) quarter-year periods in the period beginning October 1, 
2007 and ending September 30, 2008.

FOR FURTHER INFORMATION CONTACT: Thomas Musco or Robert Stewart, Office 
of Health Policy, Office of the Assistant Secretary for Planning and 
Evaluation, Room 447D--Hubert H. Humphrey Building, 200 Independence 
Avenue, SW., Washington, DC 20201, (202) 690-6870.

(Catalog of Federal Domestic Assistance Program Nos. 93.778: Medical 
Assistance Program; 93.767: State Children's Health Insurance 
Program)

    Dated: January 19, 2007.
Michael O. Leavitt,
Secretary of Health and Human Services.
 [FR Doc. E7-1174 Filed 1-24-07; 8:45 am]
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