[Federal Register Volume 75, Number 21 (Tuesday, February 2, 2010)]
[Notices]
[Pages 5325-5328]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-2177]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Implementation of Section 5001 of the American Recovery and 
Reinvestment Act of 2009 for Adjustments to the First Quarter of Fiscal 
Year 2010 Federal Medical Assistance Percentage Rates for Federal 
Matching Shares for Medicaid and Title IV-E Foster Care, Adoption 
Assistance and Guardianship Assistance Programs

AGENCY: Office of the Secretary, DHHS.

ACTION: Notice.

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SUMMARY: This notice provides the adjusted Federal Medical Assistance 
Percentage (FMAP) rates for the first quarter of Fiscal Year 2010 
(FY10) as required under Section 5001 of the American Recovery and 
Reinvestment Act of 2009 (ARRA). Section 5001 of the ARRA provides for 
temporary increases in the FMAP rates to provide fiscal relief to 
states and to protect and maintain state Medicaid and certain other 
assistance programs in a period of economic downturn. The increased 
FMAP rates apply during a recession adjustment period that is defined 
in ARRA as the period beginning October 1, 2008 and ending December 31, 
2010.

DATES Effective Date: These percentages are effective for the quarter 
beginning October 1, 2009 through December 31, 2009.

A. Background

    The FMAP is used to determine the amount of federal matching for 
specified state expenditures for assistance payments under programs 
under the Social Security Act. Sections 1905(b) and 1101(a)(8)(B) of 
the Social Security Act (``the Act'') require the Secretary of Health 
and Human Services to publish the FMAP rates each year. The Secretary 
calculates the percentages using formulas set forth in sections 1905(b) 
and 1101(a)(8)(B), and from the Department of Commerce's statistics of 
average income per person in each state and for the nation as a whole. 
The percentages must be 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 separately in the 
Act, and thus are not based on the statutory formula that determines 
the percentages for the 50 states.
    Section 1905(b) of the Act specifies the formula for calculating 
the FMAP as follows:

    The FMAP 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 FMAP shall in no case be less than 50 
per centum or more than 83 per centum, and (2) the FMAP 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 FMAP for the District of Columbia for 
purposes of titles XIX (Medicaid) and XXI (CHIP) shall be 70 percent. 
The Medicare Improvements for Patients and Providers Act of 2008 
(MIPPA) (Pub. L. 110-275) amended the FMAP applied to the District of 
Columbia for maintenance payments under title IV-E programs to make it 
consistent with the 70 percent Medicaid match rate.
    Section 5001 of Division B of the ARRA provides for a temporary 
increase in FMAP rates for Medicaid and title IV-E Foster Care, 
Adoption Assistance and Guardianship Assistance programs. The purpose 
of the increases to the FMAP rates is to provide fiscal relief to 
states and to protect and maintain State Medicaid and certain other 
assistance programs in a period of economic downturn, referred to as 
the ``recession adjustment period.'' The recession adjustment period is 
defined as the period beginning October 1, 2008 and ending December 31, 
2010.

B. Calculation of the Increased FMAP Rates Under ARRA

    Section 5001 of the ARRA specifies that the FMAP rates shall be 
temporarily increased for the following: (1) Maintenance of FMAP rates 
for FY09, FY10, and first quarter of FY11, so that the FMAP rate will 
not decrease from the prior year, determined by using as the FMAP rate 
for the current year the greater of any prior fiscal year FMAP rates 
between 2008-2010 or the rate calculated for the current fiscal year; 
(2) in addition to any maintenance increase, the application of an 
increase in each state's FMAP of 6.2 percentage

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points; and (3) an additional percentage point increase based on the 
state's increase in unemployment during the recession adjustment 
period. The resulting increased FMAP cannot exceed 100 percent. Each 
state's FMAP will be recalculated each fiscal quarter beginning October 
2008. Availability of certain components of the increased FMAP is 
conditioned on states meeting statutory programmatic requirements, such 
as the maintenance of effort requirement, which are not part of the 
calculation process.
    Expenditures for which the increased FMAP is not available under 
title XIX include expenditures for disproportionate share hospital 
payments, certain eligibility expansions, services received through an 
IHS or tribal facility (which are already paid at a rate of 100 percent 
and therefore not subject to increase), and expenditures that are paid 
at an enhanced FMAP rate. The increased FMAP is available for 
expenditures under part E of title IV (including Foster Care, Adoption 
Assistance and Guardianship Assistance programs) only to the extent of 
a maintenance increase (hold harmless), if any, and the 6.2 percentage 
point increase. The increased FMAP does not apply to other parts of 
title IV, including part D (Child Support Enforcement Program).
    For title XIX purposes only, for each qualifying state with an 
unemployment rate that has increased at a rate above the statutory 
threshold percentage, ARRA provides additional relief above the general 
6.2 percentage point increase in FMAP through application of a separate 
increase calculation. For those states, the FMAP for each qualifying 
state is increased by the number of percentage points equal to the 
product of the state matching percentage (as calculated under section 
1905(b) and adjusted if necessary for the maintenance of FMAP without 
reduction from the prior year, and after applying half of the 6.2 
percentage point general increase in the federal percentage) and the 
applicable percent determined from the state unemployment increase 
percentage for the quarter.
    The unemployment increase percentage for a calendar quarter is 
equal to the number of percentage points (if any) by which the average 
monthly unemployment rate for the state in the most recent previous 3-
consecutive-month period for which data are available exceeds the 
lowest average monthly unemployment rate for the state for any 3-
consecutive-month period beginning on or after January 1, 2006. A state 
qualifies for additional relief based on an increase in unemployment if 
that state's unemployment increase percentage is at least 1.5 
percentage points.
    The applicable percent is: (1) 5.5 percent if the state 
unemployment increase percentage is at least 1.5 percentage points but 
less than 2.5 percentage points; (2) 8.5 percent if the state 
unemployment increase percentage is at least 2.5 percentage points but 
less than 3.5 percentage points; and (3) 11.5 percent if the state 
unemployment increase percentage is at least 3.5 percentage points.
    If the state's applicable percent is less than the applicable 
percent for the preceding quarter, then the higher applicable percent 
shall continue in effect for any calendar quarter beginning on January 
1, 2009 and ending before July 1, 2010.
    Puerto Rico, the Virgin Islands, Guam, the Commonwealth of the 
Northern Mariana Islands, and America Samoa made a one-time election 
between (1) a 30 percent increase in their cap on Medicaid payments (as 
determined under subsections (f) and (g) of section 1108 of the Social 
Security Act), or (2) applying the increase of 6.2 percentage points in 
the FMAP plus a 15 percent increase in the cap on Medicaid payments. 
There is no quarterly unemployment adjustment for Territories. All 
territories and the Commonwealth of the Northern Mariana Islands 
elected the 30 percent increase in their spending cap on Medicaid 
payments; therefore there is no recalculation of their FMAP rate.

C. Adjusted FMAPs for the First Quarter of 2010

    ARRA adjustments to FMAPs are shown by state in the accompanying 
table. The hold harmless FY10 FMAP is the higher of the original FY08, 
FY09, or FY10 FMAP. The 6.2 percentage point increase is added to the 
hold harmless FY10 FMAP. The unemployment tier is determined by 
comparing the average unemployment rate for the three consecutive 
months preceding the start of each fiscal quarter to the lowest 
consecutive 3-month average unemployment rate beginning January 1, 
2006. The unemployment adjustment is calculated according to the 
unemployment tier and added to the hold harmless FY10 FMAP with the 6.2 
percentage point increase.

FOR FURTHER INFORMATION CONTACT: Carrie Shelton or Thomas Musco, 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. 93.558: TANF 
Contingency Funds; 93.563: Child Support Enforcement; 93-596: Child 
Care Mandatory and Matching Funds of the Child Care and Development 
Fund; 93.658: Foster Care; 93.659: Adoption Assistance; 93.090: 
Guardianship Assistance; 93.769: Ticket-to-Work and Work Incentives 
Improvement Act)

    Dated: December 22, 2009.
Kathleen Sebelius,
Secretary of Health and Human Services.

[[Page 5327]]



                                                                                ARRA Adjustments to FMAP Q1 FY10
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                                                                                                          Hold     3-month                                                     1st        1st
                                                                                                        harmless   average                                      Unemploy-    Quarter    Quarter
                                                              FY08       FY09       FY10       Hold    FY10 FMAP  unemploy-   Minimum    Unemploy-  Unemploy-     ment      FY10 FMAP  FY10 FMAP
                          State                             original   original   original   harmless  with 6.2%     ment    unemploy-     ment        ment    adjustment   unemploy-  unemploy-
                                                              FMAP       FMAP       FMAP       FY10      point      ending      ment    difference     tier      Q1 FY10      ment     ment hold
                                                                                                        increase  Sept 2009                                                adjustment   harmless
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Alabama..................................................      67.62      67.98      68.01      68.01      74.21       10.4        3.3         7.1       11.5        3.32       77.53      77.53
Alaska...................................................      52.48      50.53      51.43      52.48      58.68        8.2        6.0         2.2        5.5        2.44       61.12      61.12
Arizona..................................................      66.20      65.77      65.75      66.20      72.40        9.1        3.6         5.5       11.5        3.53       75.93      75.93
Arkansas.................................................      72.94      72.81      72.78      72.94      79.14        7.2        4.8         2.4        5.5        1.32       80.46      80.46
California...............................................      50.00      50.00      50.00      50.00      56.20       12.2        4.8         7.4       11.5        5.39       61.59      61.59
Colorado.................................................      50.00      50.00      50.00      50.00      56.20        7.4        3.6         3.8       11.5        5.39       61.59      61.59
Connecticut..............................................      50.00      50.00      50.00      50.00      56.20        8.1        4.3         3.8       11.5        5.39       61.59      61.59
Delaware.................................................      50.00      50.00      50.21      50.21      56.41        8.1        3.3         4.8       11.5        5.37       61.78      61.78
District of Columbia.....................................      70.00      70.00      70.00      70.00      76.20       11.0        5.4         5.6       11.5        3.09       79.29      79.29
Florida..................................................      56.83      55.40      54.98      56.83      63.03       10.9        3.3         7.6       11.5        4.61       67.64      67.64
Georgia..................................................      63.10      64.49      65.10      65.10      71.30       10.1        4.3         5.8       11.5        3.66       74.96      74.96
Hawaii...................................................      56.50      55.11      54.24      56.50      62.70        7.1        2.2         4.9       11.5        4.65       67.35      67.35
Idaho....................................................      69.87      69.77      69.40      69.87      76.07        8.8        2.8         6.0       11.5        3.11       79.18      79.18
Illinois.................................................      50.00      50.32      50.17      50.32      56.52       10.3        4.4         5.9       11.5        5.36       61.88      61.88
Indiana..................................................      62.69      64.26      65.93      65.93      72.13       10.0        4.4         5.6       11.5        3.56       75.69      75.69
Iowa.....................................................      61.73      62.62      63.51      63.51      69.71        6.6        3.7         2.9        8.5        2.84       72.55      72.55
Kansas...................................................      59.43      60.08      60.38      60.38      66.58        7.2        4.0         3.2        8.5        3.10       69.68      69.68
Kentucky.................................................      69.78      70.13      70.96      70.96      77.16       11.0        5.4         5.6       11.5        2.98       80.14      80.14
Louisiana................................................      72.47      71.31      67.61      72.47      78.67        7.5        3.5         4.0       11.5        2.81       81.48      81.48
Maine....................................................      63.31      64.41      64.99      64.99      71.19        8.5        4.4         4.1       11.5        3.67       74.86      74.86
Maryland.................................................      50.00      50.00      50.00      50.00      56.20        7.2        3.4         3.8       11.5        5.39       61.59      61.59
Massachusetts............................................      50.00      50.00      50.00      50.00      56.20        9.0        4.4         4.6       11.5        5.39       61.59      61.59
Michigan.................................................      58.10      60.27      63.19      63.19      69.39       15.2        6.7         8.5       11.5        3.88       73.27      73.27
Minnesota................................................      50.00      50.00      50.00      50.00      56.20        7.8        3.9         3.9       11.5        5.39       61.59      61.59
Mississippi..............................................      76.29      75.84      75.67      76.29      82.49        9.6        6.0         3.6       11.5        2.37       84.86      84.86
Missouri.................................................      62.42      63.19      64.51      64.51      70.71        9.4        4.7         4.7       11.5        3.72       74.43      74.43
Montana..................................................      68.53      68.04      67.42      68.53      74.73        6.7        3.2         3.5       11.5        3.26       77.99      77.99
Nebraska.................................................      58.02      59.54      60.56      60.56      66.76        5.0        2.8         2.2        5.5        2.00       68.76      68.76
Nevada...................................................      52.64      50.00      50.16      52.64      58.84       13.0        4.2         8.8       11.5        5.09       63.93      63.93
New Hampshire............................................      50.00      50.00      50.00      50.00      56.20        7.0        3.4         3.6       11.5        5.39       61.59      61.59
New Jersey...............................................      50.00      50.00      50.00      50.00      56.20        9.6        4.2         5.4       11.5        5.39       61.59      61.59
New Mexico...............................................      71.04      70.88      71.35      71.35      77.55        7.4        3.5         3.9       11.5        2.94       80.49      80.49
New York.................................................      50.00      50.00      50.00      50.00      56.20        8.8        4.3         4.5       11.5        5.39       61.59      61.59
North Carolina...........................................      64.05      64.60      65.13      65.13      71.33       10.9        4.5         6.4       11.5        3.65       74.98      74.98
North Dakota.............................................      63.75      63.15      63.01      63.75      69.95        4.2        3.0         1.2          0        0.00       69.95      69.95
Ohio.....................................................      60.79      62.14      63.42      63.42      69.62       10.7        5.3         5.4       11.5        3.85       73.47      73.47
Oklahoma.................................................      67.10      65.90      64.43      67.10      73.30        6.7        3.3         3.4        8.5        2.53       75.83      75.83
Oregon...................................................      60.86      62.45      62.74      62.74      68.94       11.7        5.0         6.7       11.5        3.93       72.87      72.87
Pennsylvania.............................................      54.08      54.52      54.81      54.81      61.01        8.6        4.3         4.3       11.5        4.84       65.85      65.85
Rhode Island.............................................      52.51      52.59      52.63      52.63      58.83       12.8        4.8         8.0       11.5        5.09       63.92      63.92
South Carolina...........................................      69.79      70.07      70.32      70.32      76.52       11.6        5.5         6.1       11.5        3.06       79.58      79.58
South Dakota.............................................      60.03      62.55      62.72      62.72      68.92        4.9        2.7         2.2        5.5        1.88       70.80      70.80
Tennessee................................................      63.71      64.28      65.57      65.57      71.77       10.7        4.5         6.2       11.5        3.60       75.37      75.37
Texas....................................................      60.56      59.44      58.73      60.56      66.76        8.0        4.4         3.6       11.5        4.18       70.94      70.94
Utah.....................................................      71.63      70.71      71.68      71.68      77.88        6.1        2.5         3.6       11.5        2.90       80.78      80.78
Vermont..................................................      59.03      59.45      58.73      59.45      65.65        6.8        3.5         3.3        8.5        3.18       68.83      69.96
Virginia.................................................      50.00      50.00      50.00      50.00      56.20        6.7        2.8         3.9       11.5        5.39       61.59      61.59
Washington...............................................      51.52      50.94      50.12      51.52      57.72        9.0        4.4         4.6       11.5        5.22       62.94      62.94
West Virginia............................................      74.25      73.73      74.04      74.25      80.45        8.9        4.2         4.7       11.5        2.60       83.05      83.05
Wisconsin................................................      57.62      59.38      60.21      60.21      66.41        8.7        4.4         4.3       11.5        4.22       70.63      70.63
Wyoming..................................................      50.00      50.00      50.00      50.00      56.20        6.6        2.8         3.8       11.5        5.39       61.59      61.59
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[FR Doc. 2010-2177 Filed 2-1-10; 8:45 am]
BILLING CODE 4150-05-P