[Federal Register Volume 88, Number 223 (Tuesday, November 21, 2023)]
[Notices]
[Pages 81090-81093]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-25636]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary


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, 2024, Through September 30, 2025

AGENCY: Office of the Secretary, HHS.

ACTION:  Notice.

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SUMMARY: The Federal Medical Assistance Percentages (FMAP), Enhanced 
Federal Medical Assistance Percentages (eFMAP), and disaster-recovery 
FMAP adjustments for fiscal year 2025 have been calculated pursuant to 
the Social Security Act (the Act). These percentages will be effective 
from October 1, 2024, through September 30, 2025. This notice announces 
the calculated FMAP rates, in accordance with 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 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 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.

DATES: The percentages listed in Table 1 will be effective for each of 
the four quarter-year periods beginning October 1, 2024, and ending 
September 30, 2025.

FOR FURTHER INFORMATION CONTACT: Amelia Whitman, 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) 578-1478.

SUPPLEMENTARY INFORMATION: Programs under titles IV, XIX and XXI of the 
Act exist in each jurisdiction. Programs under titles I, X, and XIV 
operate only in Guam and the Virgin Islands, and a program under title 
XVI (Aid to the Aged, Blind, or Disabled) operates only in Puerto Rico. 
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.

[[Page 81091]]

    However, section 5101(b) of the Consolidated Appropriations Act, 
2023 amended section 1905(ff) of the Act to provide that the FMAP for 
the Virgin Islands, Guam, the Northern Mariana Islands, and American 
Samoa shall be 83 percent permanently, and that the FMAP for Puerto 
Rico shall be 76 percent through September 30, 2027. 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. 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. 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. Section 
1905(c) of the Act was further amended by section 9814 of the American 
Rescue Plan of 2021 (Pub. L. 1117-2) to provide an eight- quarter 
increase of five percentage points in a qualifying state or territory's 
FMAP for a state or territory that begins to cover the new adult group 
after March 11, 2021. 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.

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).
    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 1905(aa) of the Social Security Act, as amended by section 
2006 of the Affordable Care Act, specifies that the annual FMAP rate 
shall be increased for a ``disaster-recovery FMAP adjustment state.'' 
The statute defines a ``disaster-recovery FMAP adjustment state'' as 
one of the 50 states or District of Columbia for which, at any time 
during the preceding 7 fiscal years, the President has declared a major 
disaster under section 401 of the Robert T. Stafford Disaster Relief 
and Emergency Assistance Act, under which every county or parish in the 
state is eligible for individual and public or public assistance from 
the Federal Government, and for which the FMAP as determined for the 
fiscal year is less than the FMAP for the preceding fiscal year by at 
least three percentage points. This notice does not contain disaster 
recovery adjustments since no state qualifies as a ``disaster-recovery 
FMAP adjustment state.'' See more 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).

(Catalog of Federal Domestic Assistance Program Nos. 93.558: TANF 
Contingency

[[Page 81092]]

Funds; 93.563: Child Support Services; 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, Department of Health and Human Services.

  Table 1--Federal Medical Assistance Percentages and Enhanced Federal
 Medical Assistance Percentages, Effective October 1, 2024-September 30,
                                  2025
                           [Fiscal Year 2025]
------------------------------------------------------------------------
                                                             Enhanced
                                              Federal         federal
                  State                       medical         medical
                                            assistance      assistance
                                            percentages     percentages
------------------------------------------------------------------------
Alabama.................................           72.84           80.99
Alaska..................................           51.54           66.08
American Samoa *........................           83.00           85.00
Arizona.................................           64.89           75.42
Arkansas................................           71.14           79.80
California..............................           50.00           65.00
Colorado................................           50.00           65.00
Connecticut.............................           50.00           65.00
Delaware................................           60.15           72.11
District of Columbia **.................           70.00           79.00
Florida.................................           57.17           70.02
Georgia.................................           66.04           76.23
Guam *..................................           83.00           85.00
Hawaii..................................           59.08           71.36
Idaho...................................           67.59           77.31
Illinois................................           51.38           65.97
Indiana.................................           64.90           75.43
Iowa....................................           63.25           74.28
Kansas..................................           61.87           73.31
Kentucky................................           71.48           80.04
Louisiana...............................           68.06           77.64
Maine...................................           62.06           73.44
Maryland................................           50.00           65.00
Massachusetts...........................           50.00           65.00
Michigan................................           65.13           75.59
Minnesota...............................           51.16           65.81
Mississippi.............................           76.90           83.83
Missouri................................           65.31           75.72
Montana.................................           62.37           73.66
Nebraska................................           57.52           70.26
Nevada..................................           60.22           72.15
New Hampshire...........................           50.00           65.00
New Jersey..............................           50.00           65.00
New Mexico..............................           71.68           80.18
New York................................           50.00           65.00
North Carolina..........................           65.06           75.54
North Dakota............................           50.97           65.68
Northern Mariana Islands *..............           83.00           85.00
Ohio....................................           64.60           75.22
Oklahoma................................           67.08           76.96
Oregon..................................           59.00           71.30
Pennsylvania............................           55.09           68.56
Puerto Rico *...........................           76.00           83.20
Rhode Island............................           56.31           69.42
South Carolina..........................           69.67           78.77
South Dakota............................           53.07           67.15
Tennessee...............................           64.81           75.37
Texas...................................           60.00           72.00
Utah....................................           64.36           75.05
Vermont.................................           58.19           70.73
Virgin Islands *........................           83.00           85.00
Virginia................................           50.99           65.69
Washington..............................           50.00           65.00
West Virginia...........................           73.84           81.69
Wisconsin...............................           60.43           72.30
Wyoming.................................           50.00           65.00
------------------------------------------------------------------------
* The Consolidated Appropriations Act, 2023 set the FMAP for American
  Samoa, Guam, Northern Marianas, and Virgin Islands permanently at 83
  percent and set the FMAP for Puerto Rico at 76 percent through FY
  2027. 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 81093]]

 
** 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 DC is 50.00, unless otherwise
  specified by law.

[FR Doc. 2023-25636 Filed 11-20-23; 8:45 am]
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