[Federal Register Volume 74, Number 148 (Tuesday, August 4, 2009)]
[Notices]
[Pages 38630-38633]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-18544]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
Implementation of Section 5001 of the American Recovery and
Reinvestment Act of 2009 (ARRA) for Adjustments to the Third Quarter of
Fiscal Year 2009 Federal Medical Assistance Percentage (FMAP) Rates for
Federal Matching Shares for Medicaid and Foster Care and Adoption
Assistance
AGENCY: Office of the Secretary, DHHS.
ACTION: Notice with comment period.
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SUMMARY: This notice with comment period describes the methodology for
calculating the higher federal matching funding that is made available
under Section 5001 of the American Recovery and Reinvestment Act of
2009 (ARRA). Section 5001 of the ARRA provides for temporary increases
in the Federal Medical Assistance Percentage (FMAP) rates to provide
fiscal relief to States and to protect and maintain State Medicaid
programs in a period of economic downturn. The increased FMAP rates
apply during a recession adjustment period that is defined as the
period beginning on October 1, 2008 and ending on December 31, 2010.
[[Page 38631]]
Effective Date: The percentages listed are for the third quarter of
Fiscal Year 2009 beginning April 1, 2009 and ending June 30, 2009.
Comment Date: To be assured consideration, comments must be
received at the address provided below, no later than 5 p.m. on August
19, 2009.
ADDRESSES: Because of staff and resource limitations, we can only
accept comments by regular mail. You may mail written comments (one
original and one copy) to the following address only: Department of
Health and Human Services, Room 447D, Attention: FMAP Notice--ARRA, 200
Independence Ave., SW., Washington, DC 20201.
Submitting Comments: We welcome comments from the public on the
calculation methodology set forth in this notice with comment period to
assist us in fully considering issues and developing policies. Please
provide a reference to the section on which you choose to comment.
A. Background
The Federal Medical Assistance Percentage (FMAP) is used to
determine the amount of Federal matching for specified State
expenditures for assistance payments under programs under the Social
Security Act. Sections 1905(b) and 1101(a)(8)(B) of the Social Security
Act (``the Act'') require the Secretary of Health and Human Services to
publish the FMAP rates each year. The Secretary calculates the
percentages, using formulas set forth in sections 1905(b) and
1101(a)(8)(B), from the Department of Commerce's statistics 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 in statute, and thus are not
based on the statutory formula that determines the percentages for the
50 States.
Section 1905(b) of the Social Security Act specifies the formula
for calculating 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.
Section 5001 of Division B of the American Recovery and
Reinvestment Act of 2009 (ARRA) provides for a temporary increase in
FMAP rates for Medicaid, Foster Care and Adoption Assistance programs.
The purposes of the increases to the FMAP rates are to provide fiscal
relief to States and to protect and maintain State Medicaid programs in
a period of economic downturn, referred to as the ``recession
adjustment period.'' The recession adjustment period is defined as the
period beginning on October 1, 2008 and ending on 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 fiscal year 2009, fiscal year 2010, and first quarter of fiscal
year 2011, 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 maintenance of effort requirements, 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
which is not subject to increase), and expenditures that are paid at an
enhanced FMAP rate. The increased FMAP is also not available for
payments under title XXI. The increased FMAP is available for
expenditures under part E of title IV (Foster Care Maintenance
payments) only to the extent of maintenance increase, if any, and the
6.2 percentage point increase.
For each qualifying State with an unemployment rate that has
increased at a rate above a statutory threshold percentage, ARRA
provides additional relief above the general 6.2 percentage point
increase in FMAP through application of a different 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, in addition to the 6.2 percentage point increase.
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 and
preceding the most recent previous 3-consecutive-month period. 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 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.
Puerto Rico, the Virgin Islands, Guam, the Commonwealth of the
Northern Mariana Islands, and America Samoa can make a 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 Social Security Act), or (2)
[[Page 38632]]
applying the increase of 6.2 percentage points in the FMAP plus a 15
percent increase in the cap on Medicaid payments. There is no quarterly
unemployment adjustment for Territories. As a result, we are not
addressing the Territories or Commonwealth in this document, and will
instead work with them separately and individually.
C. Methodology Utilized in the Calculation of Increased FMAP Rates for
the Third Quarter of Fiscal Year 2009 and Subsequent Quarters During
the Recession Adjustment Period
This notice sets forth increased FMAP rates for the third quarter
of Fiscal Year 2009 that have been calculated pursuant to the ARRA and
are set forth in the table at the end of the notice. The rates set
forth in this notice are effective from April 1, 2009 through June 30,
2009. The table gives figures for each of the 50 States and the
District of Columbia. Adjusted figures are not shown for Puerto Rico,
the Virgin Islands, Guam, American Samoa, and the Commonwealth of the
Northern Mariana Islands. Under ARRA, the application of an increased
FMAP calculation for the Territories and Commonwealth depends upon a
one-time election of a higher FMAP and 15 percent increase in their cap
on federal Medicaid payments, or a 30 percent increase in their cap.
Moreover, there is no quarterly unemployment adjustment for the
Territories or Commonwealth. As a result, we will instead work with the
Territories and Commonwealth separately and individually.
The maintenance of FMAP calculation and the general 6.2 percentage
point increase are non-discretionary calculations, and were included in
a prior notice issued April 21, 2009, at 74 FR 18235. This notice
specifically adjusts FMAP rates for States qualifying for additional
increase based on currently available information on unemployment rates
in the States as obtained from the Department of Labor's Bureau of
Labor Statistics, and describes the methodology we intend to use
throughout the recession adjustment period.
The methodology that we have used to calculate the unemployment
adjustment is to utilize the final unemployment rate for the most
recent previous 3-month period for which data are available prior to
each quarter to calculate that quarter's FMAP. The unemployment rate
for the most recent previous 3-month period includes final unemployment
rates for all three months.
The timing of the availability of final State unemployment data for
the month just prior to the start of the fiscal quarter prevents the
publication of the FMAP rates until after the fiscal quarter has begun.
For example, State unemployment data for the month of March, the month
just prior to the start of the fiscal quarter beginning April 1,
becomes available during the month of April on a preliminary basis.
State unemployment data for March does not become final until May with
the release of preliminary April state unemployment data and so forth
for subsequent months and quarters.
Because States rely on timely publication of the percentages for
their use in budget planning activities, HHS will calculate preliminary
quarterly FMAP rates at the time preliminary monthly data for the month
prior to the start of the quarter is available. HHS will provide these
rates to the Centers for Medicare and Medicaid Services (CMS) for the
purpose of calculating preliminary quarterly adjustments, as specified
by ARRA, for States' federal matching amounts. HHS will calculate final
quarterly FMAP rates at the time final monthly data for the month prior
to the start of the fiscal quarter is available. HHS will provide these
rates to CMS for the purpose of calculating the final quarterly
adjustments, as specified by ARRA, for States' final quarterly federal
matching amounts and publish these final quarterly rates in a Federal
Register notice.
As an example of the methodology, HHS will calculate preliminary
FMAP rates for the fiscal quarter beginning April 1, using State
unemployment data from final January, final February, and preliminary
March unemployment rates, in April when preliminary March data become
available, and supply these to CMS. HHS will calculate final FMAP rates
for the fiscal quarter beginning April 1, using State unemployment data
from final January, final February, and final March unemployment rates,
in May when final March data become available and supply these to CMS
and publish these final quarterly rates in a Federal Register notice.
The methodology and timing for the calculations and their release will
proceed similarly for subsequent quarters during the recession
adjustment period.
We intend to utilize annual updates to the historical BLS data to
make changes in the States' lowest unemployment rate. Revised
historical unemployment rates are part of the currently available data
used at the time of calculating third quarter FMAP rates each year.
These revisions to the historical data will remain current until the
following third quarter FMAP rate is calculated, when new historical
data becomes available.
Using data for the final State unemployment rates for the 3-
consecutive-month period prior to the start of the fiscal quarter
beginning April 1, 2009 and historical periods of each 3-consecutive-
months beginning on or after January 1, 2006, differences in States'
unemployment rates were calculated to determine if a State qualifies
for an adjustment in its FMAP due to changes in its unemployment rate.
For the third quarter of fiscal year 2009, we compared each State's
final unemployment rate for the 3-month period ending in March 2009 to
the lowest average unemployment rate for the State for any 3-
consecutive-month period from January 1, 2006 through February 2009. A
State received an additional FMAP increase if the State's unemployment
increase percentage was at least 1.5 percentage points.
ARRA adjustments to FMAP are shown by State in the accompanying
table. The hold harmless FY09 FMAP is the higher of the original FY08
or FY09 FMAP. The 6.2 percentage point increase is added to the hold
harmless FY09 FMAP. The unemployment tier is determined from the
comparison of the 3-month average unemployment rate ending March 2009
and the lowest 3-month unemployment rate during January 2006 to
February 2009. The unemployment adjustment is calculated according to
the unemployment tier and added to the hold harmless FY09 FMAP with the
6.2 percentage point increase.
We are requesting public comment on the calculation methodology
described above, which we have used in developing the third quarter
increased FMAP rates. We will address any public comments in the next
quarterly notice of increased FMAP rates.
FOR FURTHER INFORMATION CONTACT: Thomas Musco 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.
(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: 93.659: Adoption Assistance; 93.769: Ticket-to-Work
and Work Incentives Improvement Act (TWWIIA) Demonstrations to
Maintain Independence and Employment)
Dated: July 27, 2009.
Kathleen Sebelius,
Secretary.
[[Page 38633]]
ARRA Adjustments to FMAP Q3 FY09
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Hold
harmless 1st and 2nd 3-Month 3nd quarter
FY08 FY09 Hold FY09 quarter FY09 average Minimum Unemploy- Unemploy- FY09 FMAP
State original original harmless FMAP FMAP Adjust unemploy- unemploy- ment Unemploy- ment adjust (incl
FMAP FMAP FY 09 with (incl HH-6.2- ment ment difference ment tier adjustment HH-6.2-
6.2%pt unemploy-ment) ending Q3 FY09 unemploy-ment)
increase Mar 2009
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Alabama........................................................ 67.62 67.98 67.98 74.18 76.64 8.4 3.3 5.1 11.5 3.33 77.51
Alaska......................................................... 52.48 50.53 52.48 58.68 58.68 8.0 6.0 2.0 5.5 2.44 61.12
Arizona........................................................ 66.20 65.77 66.20 72.40 75.01 7.4 3.6 3.8 11.5 3.53 75.93
Arkansas....................................................... 72.94 72.81 72.94 79.14 79.14 6.4 4.8 1.6 5.5 1.32 80.46
California..................................................... 50.00 50.00 50.00 56.20 61.59 10.6 4.8 5.8 11.5 5.39 61.59
Colorado....................................................... 50.00 50.00 50.00 56.20 58.78 7.1 3.6 3.5 11.5 5.39 61.59
Connecticut.................................................... 50.00 50.00 50.00 56.20 60.19 7.4 4.3 3.1 8.5 3.99 60.19
Delaware....................................................... 50.00 50.00 50.00 56.20 60.19 7.2 3.3 3.9 11.5 5.39 61.59
District of Columbia........................................... 70.00 70.00 70.00 76.20 77.68 9.6 5.4 4.2 11.5 3.09 79.29
Florida........................................................ 56.83 55.40 56.83 63.03 67.64 9.4 3.3 6.1 11.5 4.61 67.64
Georgia........................................................ 63.10 64.49 64.49 70.69 73.44 8.9 4.3 4.6 11.5 3.73 74.42
Hawaii......................................................... 56.50 55.11 56.50 62.70 66.13 6.6 2.2 4.4 11.5 4.65 67.35
Idaho.......................................................... 69.87 69.77 69.87 76.07 78.37 6.8 2.8 4.0 11.5 3.11 79.18
Illinois....................................................... 50.00 50.32 50.32 56.52 60.48 8.5 4.4 4.1 11.5 5.36 61.88
Indiana........................................................ 62.69 64.26 64.26 70.46 73.23 9.6 4.4 5.2 11.5 3.75 74.21
Iowa........................................................... 61.73 62.62 62.62 68.82 68.82 5.0 3.7 1.3 0.0 0.00 68.82
Kansas......................................................... 59.43 60.08 60.08 66.28 66.28 5.9 4.0 1.9 5.5 2.03 68.31
Kentucky....................................................... 69.78 70.13 70.13 76.33 77.80 9.3 5.4 3.9 11.5 3.08 79.41
Louisiana...................................................... 72.47 71.31 72.47 78.67 80.01 5.6 3.5 2.1 5.5 1.34 80.01
Maine.......................................................... 63.31 64.41 64.41 70.61 72.40 7.9 4.4 3.5 11.5 3.74 74.35
Maryland....................................................... 50.00 50.00 50.00 56.20 58.78 6.6 3.4 3.2 8.5 3.99 60.19
Massachusetts.................................................. 50.00 50.00 50.00 56.20 58.78 7.6 4.4 3.2 8.5 3.99 60.19
Michigan....................................................... 58.10 60.27 60.27 66.47 69.58 12.1 6.7 5.4 11.5 4.21 70.68
Minnesota...................................................... 50.00 50.00 50.00 56.20 60.19 7.9 3.9 4.0 11.5 5.39 61.59
Mississippi.................................................... 76.29 75.84 76.29 82.49 83.62 9.1 6.0 3.1 8.5 1.75 84.24
Missouri....................................................... 62.42 63.19 63.19 69.39 71.24 8.4 4.7 3.7 11.5 3.88 73.27
Montana........................................................ 68.53 68.04 68.53 74.73 76.29 5.9 3.2 2.7 8.5 2.41 77.14
Nebraska....................................................... 58.02 59.54 59.54 65.74 65.74 4.5 2.8 1.7 5.5 2.05 67.79
Nevada......................................................... 52.64 50.00 52.64 58.84 63.93 10.0 4.2 5.8 11.5 5.09 63.93
New Hampshire.................................................. 50.00 50.00 50.00 56.20 56.20 5.7 3.4 2.3 5.5 2.58 58.78
New Jersey..................................................... 50.00 50.00 50.00 56.20 58.78 7.9 4.2 3.7 11.5 5.39 61.59
New Mexico..................................................... 71.04 70.88 71.04 77.24 77.24 5.5 3.5 2.0 5.5 1.42 78.66
New York....................................................... 50.00 50.00 50.00 56.20 58.78 7.5 4.3 3.2 8.5 3.99 60.19
North Carolina................................................. 64.05 64.60 64.60 70.80 73.55 10.4 4.5 5.9 11.5 3.71 74.51
North Dakota................................................... 63.75 63.15 63.75 69.95 69.95 4.2 3.0 1.2 0.0 0.00 69.95
Ohio........................................................... 60.79 62.14 62.14 68.34 70.25 9.3 5.3 4.0 11.5 4.00 72.34
Oklahoma....................................................... 67.10 65.90 67.10 73.30 74.94 5.5 3.3 2.2 5.5 1.64 74.94
Oregon......................................................... 60.86 62.45 62.45 68.65 71.58 10.8 5.0 5.8 11.5 3.96 72.61
Pennsylvania................................................... 54.08 54.52 54.52 60.72 63.05 7.5 4.3 3.2 8.5 3.60 64.32
Rhode Island................................................... 52.51 52.59 52.59 58.79 63.89 10.4 4.8 5.6 11.5 5.10 63.89
South Carolina................................................. 69.79 70.07 70.07 76.27 78.55 10.9 5.5 5.4 11.5 3.09 79.36
South Dakota................................................... 60.03 62.55 62.55 68.75 68.75 4.6 2.7 1.9 5.5 1.89 70.64
Tennessee...................................................... 63.71 64.28 64.28 70.48 73.25 9.1 4.5 4.6 11.5 3.75 74.23
Texas.......................................................... 60.56 59.44 60.56 66.76 68.76 6.5 4.4 2.1 5.5 2.00 68.76
Utah........................................................... 71.63 70.71 71.63 77.83 77.83 5.0 2.5 2.5 8.5 2.15 79.98
Vermont........................................................ 59.03 59.45 59.45 65.65 67.71 7.0 3.5 3.5 11.5 4.31 69.96
Virginia....................................................... 50.00 50.00 50.00 56.20 58.78 6.4 2.8 3.6 11.5 5.39 61.59
Washington..................................................... 51.52 50.94 51.52 57.72 60.22 8.4 4.4 4.0 11.5 5.22 62.94
West Virginia.................................................. 74.25 73.73 74.25 80.45 80.45 6.0 4.2 1.8 5.5 1.25 81.70
Wisconsin...................................................... 57.62 59.38 59.38 65.58 65.58 7.8 4.4 3.4 8.5 3.19 68.77
Wyoming........................................................ 50.00 50.00 50.00 56.20 56.20 4.0 2.8 1.2 0.0 0.00 56.20
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[FR Doc. E9-18544 Filed 7-31-09; 11:15 am]
BILLING CODE 4210-01-P