[Federal Register Volume 82, Number 223 (Tuesday, November 21, 2017)]
[Notices]
[Pages 55383-55386]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-24953]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Federal Matching Shares for Medicaid, the Children's Health 
Insurance Program, and Aid to Needy Aged, Blind, or Disabled Persons 
for October 1, 2018 Through September 30, 2019

AGENCY: Office of the Secretary, DHHS.

ACTION: Notice.

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DATES: The percentages listed in Table 1 will be effective for each of 
the four quarter-year periods beginning October 1, 2018 and ending 
September 30, 2019.

FOR FURTHER INFORMATION CONTACT: Caryn Marks or Rose Chu, 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.

SUPPLEMENTARY INFORMATION: The Federal Medical Assistance Percentages 
(FMAP), Enhanced Federal Medical Assistance Percentages (eFMAP), and 
disaster-recovery FMAP adjustments for Fiscal Year 2019 have been 
calculated pursuant to the Social Security Act (the Act). These 
percentages will be effective from October 1, 2018 through September 
30, 2019. This notice announces the calculated FMAP rates, in 
accordance with sections 1101(a)(8) and 1905(b) of the Act, that the 
U.S. Department of Health and Human Services (HHS) will use in 
determining the amount of federal matching for state medical assistance 
(Medicaid), Temporary Assistance for Needy Families (TANF) Contingency 
Funds, Child Support Enforcement collections, Child Care Mandatory and 
Matching Funds of the Child Care and Development Fund, Title IV-E 
Foster Care Maintenance payments, Adoption Assistance payments and 
Kinship Guardianship Assistance payments, and the eFMAP rates for the 
Children's Health Insurance Program (CHIP) expenditures. Table 1 gives 
figures for each of the 50 states, the District of Columbia, Puerto 
Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of 
the Northern Mariana Islands. This notice reminds states of available 
disaster-recovery FMAP adjustments for qualifying states, and 
adjustments available for states meeting requirements for negative 
growth in total state personal income. At this time, no states qualify 
for such adjustments.
    This notice also contains the increased eFMAPs for CHIP as 
authorized under the Patient Protection and Affordable Care Act (PPACA) 
for fiscal years 2016 through 2019 (October 1, 2015 through September 
30, 2019).
    Programs under title XIX of the Act exist in each jurisdiction. 
Programs under titles I, X, and XIV operate only in Guam and the Virgin 
Islands. The percentages in this notice apply to state expenditures for 
most medical assistance and child health assistance, and assistance 
payments for certain social services. The Act provides

[[Page 55384]]

separately for federal matching of administrative costs. Sections 
1905(b) and 1101(a)(8)(B) of the Social Security Act (the Act) require 
the Secretary of HHS to publish the FMAP rates each year. The Secretary 
calculates the percentages, using formulas in sections 1905(b) and 
1101(a)(8), and calculations by the Department of Commerce of average 
income per person in each state and for the Nation as a whole. The 
percentages must fall within the upper and lower limits specified in 
section 1905(b) of the Act. The percentages for 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.

Federal Medical Assistance Percentage (FMAP)

    Section 1905(b) of the Act specifies the formula for calculating 
FMAPs 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 55 percent . . . .

Section 4725(b) 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 and XXI shall be 70 percent. For the District of 
Columbia, we note under Table 1 that other rates may apply in certain 
other programs. In addition, we note the rate that applies for Puerto 
Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of 
the Northern Mariana Islands in certain other programs pursuant to 
section 1118 of the Act. The rates for the States, District of Columbia 
and the territories are displayed in Table 1, Column 1.
    Section 1905(y) of the Act, as added by section 2001 of the Patient 
Protection and Affordable Care Act of 2010 (``Affordable Care Act''), 
provides for a significant increase in the FMAP for medical assistance 
expenditures for individuals determined eligible under the new adult 
group in the state and who will be considered to be ``newly eligible'' 
in 2014, as defined in section 1905(y)(2)(A) of the Act. This newly 
eligible FMAP is 100 percent for Calendar Years 2014, 2015, and 2016, 
gradually declining to 90 percent in 2020 where it remains 
indefinitely. In addition, section 1905(z) of the Act, as added by 
section 10201 of the Affordable Care Act, provides that states that had 
expanded substantial coverage to low-income parents and nonpregnant 
adults without children prior to the enactment of the Affordable Care 
Act, referred to as ``expansion states,'' shall receive an enhanced 
FMAP beginning in 2014 for medical assistance expenditures for 
nonpregnant childless adults who may be required to enroll in benchmark 
coverage. These provisions are discussed in more detail in the Medicaid 
Eligibility proposed rule published on August 17, 2011 (76 FR 51172) 
and the final rule published on March 23, 2012 (77 FR 17143). This 
notice is not intended to set forth the newly eligible or expansion 
state FMAP rates.

Other Adjustments to the FMAP

    For purposes of Title XIX (Medicaid) of the Social Security Act, 
the Federal Medical Assistance Percentage (FMAP), defined in section 
1905(b) of the Social Security Act, for each state beginning with 
fiscal year 2006 is subject to an adjustment pursuant to section 614 of 
the Children's Health Insurance Program Reauthorization Act of 2009 
(CHIPRA), Public Law 111-3. Section 614 of CHIPRA stipulates that a 
state's FMAP under Title XIX (Medicaid) must be adjusted in two 
situations.
    In the first situation, if a state experiences positive growth in 
total personal income and an employer in that state has made a 
significantly disproportionate contribution to a pension or insurance 
fund, the state's FMAP must be adjusted. Employer pension and insurance 
fund contributions are significantly disproportionate if the increase 
in contributions exceeds 25 percent of the increase in total personal 
income in that state. A Federal Register Notice with comment period was 
issued on June 7, 2010 (75 FR 32182) announcing the methodology for 
calculating this adjustment; a final notice was issued on October 15, 
2010 (75 FR 63480). A second situation arises if a state experiences 
negative growth in total personal income. Beginning with Fiscal Year 
2006, section 614(b)(3) of CHIPRA specifies that certain employer 
pension or insurance fund contributions shall be disregarded when 
computing the per capita income used to calculate the FMAP for states 
with negative growth in total personal income. In that instance, for 
the purposes of calculating the FMAP, for a calendar year in which a 
state's total personal income has declined, the portion of an employer 
pension and insurance fund contribution that exceeds 125 percent of the 
amount of the employer contribution in the previous calendar year shall 
be disregarded.
    We request that states follow the same methodology to determine 
potential FMAP adjustments for negative growth in total personal income 
that HHS employs to make adjustments to the FMAP for states 
experiencing significantly disproportionate pension or insurance 
contributions. See also the information described in the January 21, 
2014 Federal Register notice (79 FR 3385). This notice does not contain 
an FY 2019 adjustment for a major statewide disaster for any state 
(territories are not eligible for FMAP adjustments) because no state's 
FMAP decreased by at least three percentage points from FY 2018 to FY 
2019.

Enhanced Federal Medical Assistance Percentage (eFMAP) for CHIP

    Section 2105(b) of the Act specifies the formula for calculating 
the eFMAP rates 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.

    In addition, Section 2105(b) of the Social Security Act, as amended 
by Section 2101 of the Affordable Care Act, increases the eFMAP for 
states by 23 percentage points:

. . . during the period that begins on October 1, 2015, and ends on 
September 30, 2019, the enhanced FMAP determined for a state for a 
fiscal year (or for any portion of a fiscal year occurring during 
such period) shall be increased by 23 percentage points, but in no 
case shall exceed 100 percent.

The eFMAP rates are used in the 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 Act. There is no specific requirement to publish 
the eFMAP rates. We include them in this notice for the convenience of 
the states, and display both the normal eFMAP rates (Table 1, Column 2) 
and the Affordable Care Act's increased eFMAP

[[Page 55385]]

rates (Table 1, Column 3) for comparison.

(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 Title IV-E; 93.659: Adoption Assistance; 
93.769: Ticket-to-Work and Work Incentives Improvement Act (TWWIIA) 
Demonstrations to Maintain Independence and Employment; 93.778: 
Medical Assistance Program; 93.767: Children's Health Insurance 
Program)

    Dated: November 13, 2017.
Eric D. Hargan,
Acting Secretary.

 Table 1--Federal Medical Assistance Percentages and Enhanced Federal Medical Assistance Percentages, Effective
                                       October 1, 2018-September 30, 2019
                                               [Fiscal year 2019]
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                                                                                                Enhanced federal
                                                          Federal medical    Enhanced federal       medical
                                                             assistance          medical           assistance
                                                            percentages         assistance      percentages with
                                                                               percentages     ACA 23 Pt Inc ***
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Alabama................................................              71.88              80.32             100.00
Alaska.................................................              50.00              65.00              88.00
American Samoa *.......................................              55.00              68.50              91.50
Arizona................................................              69.81              78.87             100.00
Arkansas...............................................              70.51              79.36             100.00
California.............................................              50.00              65.00              88.00
Colorado...............................................              50.00              65.00              88.00
Connecticut............................................              50.00              65.00              88.00
Delaware...............................................              57.55              70.29              93.29
District of Columbia **................................              70.00              79.00             100.00
Florida................................................              60.87              72.61              95.61
Georgia................................................              67.62              77.33             100.00
Guam *.................................................              55.00              68.50              91.50
Hawaii.................................................              53.92              67.74              90.74
Idaho..................................................              71.13              79.79             100.00
Illinois...............................................              50.31              65.22              88.22
Indiana................................................              65.96              76.17              99.17
Iowa...................................................              59.93              71.95              94.95
Kansas.................................................              57.10              69.97              92.97
Kentucky...............................................              71.67              80.17             100.00
Louisiana..............................................              65.00              75.50              98.50
Maine..................................................              64.52              75.16              98.16
Maryland...............................................              50.00              65.00              88.00
Massachusetts..........................................              50.00              65.00              88.00
Michigan...............................................              64.45              75.12              98.12
Minnesota..............................................              50.00              65.00              88.00
Mississippi............................................              76.39              83.47             100.00
Missouri...............................................              65.40              75.78              98.78
Montana................................................              65.54              75.88              98.88
Nebraska...............................................              52.58              66.81              89.81
Nevada.................................................              64.87              75.41              98.41
New Hampshire..........................................              50.00              65.00              88.00
New Jersey.............................................              50.00              65.00              88.00
New Mexico.............................................              72.26              80.58             100.00
New York...............................................              50.00              65.00              88.00
North Carolina.........................................              67.16              77.01             100.00
North Dakota...........................................              50.00              65.00              88.00
Northern Mariana Islands *.............................              55.00              68.50              91.50
Ohio...................................................              63.09              74.16              97.16
Oklahoma...............................................              62.38              73.67              96.67
Oregon.................................................              62.56              73.79              96.79
Pennsylvania...........................................              52.25              66.58              89.58
Puerto Rico *..........................................              55.00              68.50              91.50
Rhode Island...........................................              52.57              66.80              89.80
South Carolina.........................................              71.22              79.85             100.00
South Dakota...........................................              56.71              69.70              92.70
Tennessee..............................................              65.87              76.11              99.11
Texas..................................................              58.19              70.73              93.73
Utah...................................................              69.71              78.80             100.00
Vermont................................................              53.89              67.72              90.72
Virgin Islands *.......................................              55.00              68.50              91.50
Virginia...............................................              50.00              65.00              88.00
Washington.............................................              50.00              65.00              88.00
West Virginia..........................................              74.34              82.04             100.00
Wisconsin..............................................              59.37              71.56              94.56
Wyoming................................................              50.00              65.00              88.00
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* For purposes of section 1118 of the Social Security Act, the percentage used under titles I, X, XIV, and XVI
  will be 75 per centum.

[[Page 55386]]

 
** The values for the District of Columbia in the table were set for the state plan under titles XIX and XXI and
  for capitation payments and DSH allotments under those titles. For other purposes, the percentage for DC is
  50.00, unless otherwise specified by law.
*** Section 2101(a) of the Affordable Care Act amended Section 2105(b) of the Social Security Act to increase
  the enhanced FMAP for states by 23 percentage points, but not to exceed 100 percent, for the period that
  begins on October 1, 2015 and ends on September 30, 2019 (fiscal years 2016 through 2019).

[FR Doc. 2017-24953 Filed 11-20-17; 8:45 am]
 BILLING CODE 4150-15-P