[Federal Register Volume 86, Number 225 (Friday, November 26, 2021)]
[Notices]
[Pages 67479-67482]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-25798]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Federal Financial Participation in State Assistance Expenditures; 
Federal Matching Shares for Medicaid, the Children's Health Insurance 
Program, and Aid to Needy Aged, Blind, or Disabled Persons for October 
1, 2022 Through September 30, 2023

AGENCY: Office of the Secretary, DHHS.

ACTION: Notice.

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    The Federal Medical Assistance Percentages (FMAP), Enhanced Federal 
Medical Assistance Percentages (eFMAP), and disaster-recovery FMAP 
adjustments for Fiscal Year 2023 have been calculated pursuant to the 
Social Security Act (the Act). These percentages will be effective from 
October 1, 2022 through September 30, 2023. 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

[[Page 67480]]

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 adjustments available 
for states meeting requirements for disproportionate employer pension 
or insurance fund contributions and adjustments for disaster recovery. 
At this time, no state qualifies for such adjustments, and territories 
are not eligible.
    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 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 United States 
(meaning, for this purpose, the fifty states and the District of 
Columbia). 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. . . .''

    Section 1905(b) further specifies that the FMAP 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'') 
(Pub. L. 111-148), provides for a significant increase in the FMAP for 
medical assistance expenditures for newly eligible individuals 
described in section 1902(a)(10)(A)(i)(VIII) of the Act, as added by 
the Affordable Care Act (the new adult group); ``newly eligible'' is 
defined in section 1905(y)(2)(A) of the Act. The FMAP for the new adult 
group 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 offered substantial 
health coverage to certain low-income parents and nonpregnant, 
childless adults on the date of 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 
under section 1937 of the Act. These provisions are discussed in more 
detail in the Medicaid Program: Eligibility Changes Under the 
Affordable Care Act of 2010 proposed rule published on August 17, 2011 
(76 FR 51148, 51172) and the final rule published on March 23, 2012 (77 
FR 17144, 17194). This notice is not intended to set forth the matching 
rates for the new adult group as specified in section 1905(y) of the 
Act or the matching rates for nonpregnant, childless adults in 
expansion states as specified in section 1905(z) of the Act.
    Section 6008 of the Families First Coronavirus Response Act (FFCRA) 
(Pub. L. 116-127) as amended by section 3720 of the CARES Act (Pub. L. 
116-136), provides a temporary 6.2 percentage point FMAP increase to 
each qualifying state and territory's FMAP under section 1905(b) of the 
Act, effective January 1, 2020 and extending through the last day of 
the calendar quarter in which the public health emergency declared by 
the Secretary of HHS for COVID-19, including any extensions, 
terminates. The FY 2023 FMAP rates listed in Table 1 do not include the 
6.2 percentage point increase in the FMAP that qualifying states may 
receive under Section 6008 of the FFCRA (Pub. L. 116-127).

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, can be 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 no growth or 
positive growth in total personal income and an employer in that state 
has made a significantly disproportionate contribution to an employer 
pension or insurance fund, the state's FMAP must be adjusted. The 
adjustment involves disregarding the significantly disproportionate 
employer pension or insurance fund contribution in computing the per 
capita income for the state (but not in computing the per capita income 
for the United States). Employer pension and insurance fund 
contributions are significantly disproportionate if the increase in 
contributions exceeds 25 percent of the total increase in personal 
income in that state. A Federal Register Notice with comment period was 
published on June 7, 2010 (75 FR 32182) announcing the methodology for 
calculating this adjustment; a final notice was published on October 
15, 2010 (75 FR 63480).
    The 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, 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 or insurance fund 
contribution that exceeds 125 percent of the amount of such 
contribution in the previous calendar year shall be disregarded in 
computing the per capita income for the state (but not in computing the 
per capita income for the United States).

[[Page 67481]]

    No Federal source of reliable and timely data on pension and 
insurance contributions by individual employers and states is currently 
available. We request that states report employer pension or insurance 
fund contributions to help determine potential FMAP adjustments for 
states experiencing significantly disproportionate pension or insurance 
contributions and states experiencing a negative growth in total 
personal income. See also the information described in the January 21, 
2014 Federal Register notice (79 FR 3385).
    Section 2006 of the Affordable Care Act provides a special 
adjustment to the FMAP for certain states recovering from a major 
disaster. This notice does not contain an FY 2023 adjustment for a 
major statewide disaster for any state (territories are not eligible 
for FMAP adjustments) because no state had a recent major statewide 
disaster and had its FMAP decreased by at least three percentage points 
from FY 2021 to FY 2022. See information described in the December 22, 
2010 Federal Register notice (75 FR 80501).

Enhanced Federal Medical Assistance Percentage (eFMAP) for CHIP

    Section 2105(b) of the Act specifies the formula for calculating 
the eFMAP rates as follows:

    [T]he ``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 eFMAP rates are used in the Children's Health Insurance Program 
under Title XXI, and in the Medicaid program for expenditures for 
medical assistance provided to certain children as 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 (Table 1, Column 2).

DATES: The percentages listed in Table 1 will be applicable for each of 
the four quarter-year periods beginning October 1, 2022 and ending 
September 30, 2023.

FOR FURTHER INFORMATION CONTACT: Ann Conmy, 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 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)

Xavier Becerra,
Secretary.

  Table 1--Federal Medical Assistance Percentages and Enhanced Federal
 Medical Assistance Percentages, Effective October 1, 2022-September 30,
                                  2023
                           [Fiscal Year 2023]
------------------------------------------------------------------------
                                                             Enhanced
                                              Federal         federal
                  State                       medical         medical
                                            assistance      assistance
                                            percentages     percentages
------------------------------------------------------------------------
Alabama.................................           72.43           80.70
Alaska..................................           50.00           65.00
American Samoa *........................           55.00           68.50
Arizona.................................           69.56           78.69
Arkansas................................           71.31           79.92
California..............................           50.00           65.00
Colorado................................           50.00           65.00
Connecticut.............................           50.00           65.00
Delaware................................           58.49           70.94
District of Columbia **.................           70.00           79.00
Florida.................................           60.05           72.04
Georgia.................................           66.02           76.21
Guam *..................................           55.00           68.50
Hawaii..................................           56.06           69.24
Idaho...................................           70.11           79.08
Illinois................................           50.00           65.00
Indiana.................................           65.66           75.96
Iowa....................................           63.13           74.19
Kansas..................................           59.76           71.83
Kentucky................................           72.17           80.52
Louisiana...............................           67.28           77.10
Maine...................................           63.29           74.30
Maryland................................           50.00           65.00
Massachusetts...........................           50.00           65.00
Michigan................................           64.71           75.30
Minnesota...............................           50.79           65.55
Mississippi.............................           77.86           84.50
Missouri................................           65.81           76.07
Montana.................................           64.12           74.88
Nebraska................................           57.87           70.51
Nevada..................................           62.65           73.86
New Hampshire...........................           50.00           65.00
New Jersey..............................           50.00           65.00
New Mexico..............................           73.26           81.28
New York................................           50.00           65.00

[[Page 67482]]

 
North Carolina..........................           67.71           77.40
North Dakota............................           51.55           66.09
Northern Mariana Islands *..............           55.00           68.50
Ohio....................................           63.58           74.51
Oklahoma................................           67.36           77.15
Oregon..................................           60.32           72.22
Pennsylvania............................           52.00           66.40
Puerto Rico *...........................           55.00           68.50
Rhode Island............................           53.96           67.77
South Carolina..........................           70.58           79.41
South Dakota............................           56.74           69.72
Tennessee...............................           66.10           76.27
Texas...................................           59.87           71.91
Utah....................................           65.90           76.13
Vermont.................................           55.82           69.07
Virgin Islands *........................           55.00           68.50
Virginia................................           50.65           65.46
Washington..............................           50.00           65.00
West Virginia...........................           74.02           81.81
Wisconsin...............................           60.10           72.07
Wyoming.................................           50.00           65.00
------------------------------------------------------------------------
* 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.
** 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
  disproportionate share hospital (DSH) allotments under those titles.
  For other purposes, the percentage for D.C. is 50.00, unless otherwise
  specified by law.


[FR Doc. 2021-25798 Filed 11-24-21; 8:45 am]
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