[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]
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Enhanced
Federal federal
State medical medical
assistance assistance
percentages percentages
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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
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* 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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