[Federal Register Volume 75, Number 83 (Friday, April 30, 2010)]
[Notices]
[Pages 22807-22809]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-10055]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Implementation of Section 5001 of the American Recovery and 
Reinvestment Act of 2009 (Pub. L. 111-5) for Adjustments to the Second 
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 second 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 January 1, 2010 through March 31, 2010.

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 (``the Act''). Sections 1905(b) and 
1101(a)(8)(B) of the Act require the Secretary of Health and Human 
Services to publish the FMAP rates each year. The Secretary calculates 
the percentages using formulas in sections 1905(b) and 1101(a)(8)(B), 
and statistics from the Department of Commerce 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 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

[[Page 22808]]

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.
    Under section 5001(b)(2) of ARRA, Puerto Rico, the Virgin Islands, 
Guam, the Commonwealth of the Northern Mariana Islands, and America 
Samoa were given the option to make a special 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 Act), 
or (2) applying the general 6.2 percentage point increase 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.

D. Adjusted FMAPs for the Second 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; 93.778: Medical Assistance Program)

    Dated: April 13, 2010.
Kathleen Sebelius,
Secretary.

                                                                                ARRA Adjustments to FMAP Q2 FY10
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                                                                                       Hold
                                                                                     harmless      3-month                                                             2nd quarter   2nd quarter
                                           FY08       FY09       FY10       Hold     FY10 FMAP     average       Minimum    Unemployment  Unemployment  Unemployment    FY10 FMAP     FY10 FMAP
                 State                   original   original   original   harmless   with 6.2%  unemployment  unemployment   difference       tier       adjustment   unemployment  unemployment
                                           FMAP       FMAP       FMAP       FY10       point     ending Dec                                                Q2 FY10     adjustment       hold
                                                                                     increase       2009                                                                              harmless
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Alabama...............................      67.62      67.98      68.01      68.01       74.21         10.9           3.3           7.6          11.5           3.32         77.53         77.53
Alaska................................      52.48      50.53      51.43      52.48       58.68          8.5           6.0           2.5           8.5           3.78         62.46         62.46
Arizona...............................      66.20      65.77      65.75      66.20       72.40          9.2           3.6           5.6          11.5           3.53         75.93         75.93
Arkansas..............................      72.94      72.81      72.78      72.94       79.14          7.6           4.8           2.8           8.5           2.04         81.18         81.18
California............................      50.00      50.00      50.00      50.00       56.20         12.3           4.8           7.5          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          8.7           4.3           4.4          11.5           5.39         61.59         61.59
Delaware..............................      50.00      50.00      50.21      50.21       56.41          8.6           3.3           5.3          11.5           5.37         61.78         61.78
Dist of Columbia......................      70.00      70.00      70.00      70.00       76.20         11.6           5.4           6.2          11.5           3.09         79.29         79.29
Florida...............................      56.83      55.40      54.98      56.83       63.03         11.6           3.3           8.3          11.5           4.61         67.64         67.64
Georgia...............................      63.10      64.49      65.10      65.10       71.30         10.2           4.3           5.9          11.5           3.66         74.96         74.96
Hawaii................................      56.50      55.11      54.24      56.50       62.70          6.9           2.2           4.7          11.5           4.65         67.35         67.35
Idaho.................................      69.87      69.77      69.40      69.87       76.07          9.0           2.8           6.2          11.5           3.11         79.18         79.18
Illinois..............................      50.00      50.32      50.17      50.32       56.52         10.9           4.4           6.5          11.5           5.36         61.88         61.88
Indiana...............................      62.69      64.26      65.93      65.93       72.13          9.8           4.4           5.4          11.5           3.56         75.69         75.69
Iowa..................................      61.73      62.62      63.51      63.51       69.71          6.5           3.7           2.8           8.5           2.84         72.55         72.55
Kansas................................      59.43      60.08      60.38      60.38       66.58          6.7           4.0           2.7           8.5           3.10         69.68         69.68
Kentucky..............................      69.78      70.13      70.96      70.96       77.16         10.7           5.4           5.3          11.5           2.98         80.14         80.14
Louisiana.............................      72.47      71.31      67.61      72.47       78.67          7.3           3.5           3.8          11.5           2.81         81.48         81.48
Maine.................................      63.31      64.41      64.99      64.99       71.19          8.1           4.4           3.7          11.5           3.67         74.86         74.86
Maryland..............................      50.00      50.00      50.00      50.00       56.20          7.3           3.4           3.9          11.5           5.39         61.59         61.59
Massachusetts.........................      50.00      50.00      50.00      50.00       56.20          9.2           4.4           4.8          11.5           5.39         61.59         61.59
Michigan..............................      58.10      60.27      63.19      63.19       69.39         14.4           6.7           7.7          11.5           3.88         73.27         73.27
Minnesota.............................      50.00      50.00      50.00      50.00       56.20          7.6           3.9           3.7          11.5           5.39         61.59         61.59
Mississippi...........................      76.29      75.84      75.67      76.29       82.49         10.4           6.0           4.4          11.5           2.37         84.86         84.86
Missouri..............................      62.42      63.19      64.51      64.51       70.71          9.6           4.7           4.9          11.5           3.72         74.43         74.43
Montana...............................      68.53      68.04      67.42      68.53       74.73          6.6           3.2           3.4           8.5           2.41         77.14         77.99
Nebraska..............................      58.02      59.54      60.56      60.56       66.76          4.6           2.8           1.8           5.5           2.00         68.76         68.76
Nevada................................      52.64      50.00      50.16      52.64       58.84         12.9           4.2           8.7          11.5           5.09         63.93         63.93
New Hampshire.........................      50.00      50.00      50.00      50.00       56.20          6.9           3.4           3.5          11.5           5.39         61.59         61.59
New Jersey............................      50.00      50.00      50.00      50.00       56.20          9.9           4.2           5.7          11.5           5.39         61.59         61.59
New Mexico............................      71.04      70.88      71.35      71.35       77.55          8.1           3.5           4.6          11.5           2.94         80.49         80.49
New York..............................      50.00      50.00      50.00      50.00       56.20          8.9           4.3           4.6          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          4.3           3.0           1.3             0           0.00         69.95         69.95
Ohio..................................      60.79      62.14      63.42      63.42       69.62         10.8           5.3           5.5          11.5           3.85         73.47         73.47
Oklahoma..............................      67.10      65.90      64.43      67.10       73.30          6.9           3.3           3.6          11.5           3.43         76.73         76.73
Oregon................................      60.86      62.45      62.74      62.74       68.94         10.7           5.0           5.7          11.5           3.93         72.87         72.87
Pennsylvania..........................      54.08      54.52      54.81      54.81       61.01          8.7           4.3           4.4          11.5           4.84         65.85         65.85
Rhode Island..........................      52.51      52.59      52.63      52.63       58.83         12.5           4.8           7.7          11.5           5.09         63.92         63.92

[[Page 22809]]

 
South Carolina........................      69.79      70.07      70.32      70.32       76.52         12.3           5.5           6.8          11.5           3.06         79.58         79.58
South Dakota..........................      60.03      62.55      62.72      62.72       68.92          4.7           2.7           2.0           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          8.2           4.4           3.8          11.5           4.18         70.94         70.94
Utah..................................      71.63      70.71      71.68      71.68       77.88          6.6           2.5           4.1          11.5           2.90         80.78         80.78
Vermont...............................      59.03      59.45      58.73      59.45       65.65          6.7           3.5           3.2           8.5           3.18         68.83         69.96
Virginia..............................      50.00      50.00      50.00      50.00       56.20          6.8           2.8           4.0          11.5           5.39         61.59         61.59
Washington............................      51.52      50.94      50.12      51.52       57.72          9.2           4.4           4.8          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          8.6           4.4           4.2          11.5           4.22         70.63         70.63
Wyoming...............................      50.00      50.00      50.00      50.00       56.20          7.5           2.8           4.7          11.5           5.39         61.59         61.59
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[FR Doc. 2010-10055 Filed 4-29-10; 8:45 am]
BILLING CODE 4150-05-P