[Federal Register Volume 75, Number 209 (Friday, October 29, 2010)]
[Notices]
[Pages 66763-66766]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-27412]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Implementation of Section 5001 of the American Recovery and
Reinvestment Act of 2009 (Pub. L. 111-5) for Adjustments to the Fourth
Quarter of Fiscal Year 2010 Federal Medical Assistance Percentage Rates
for Federal Matching Shares for Medicaid and Title IV-E Foster Care,
Adoption Assistance and Guardianship Assistance Programs
AGENCY: Office of the Secretary, DHHS.
ACTION: Notice.
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SUMMARY: This notice provides the adjusted Federal Medical Assistance
Percentage (FMAP) rate for the fourth quarter of Fiscal Year 2010
(FY10) as required under Section 5001 of the American Recovery and
Reinvestment Act of 2009 (ARRA). Section 5001 of the ARRA provides for
temporary increases in the FMAP rates to provide fiscal relief to
States and to protect and maintain State Medicaid and certain other
assistance programs in a period of economic downturn. The increased
FMAP rates apply during a recession adjustment period that was
originally defined in ARRA as the period beginning October 1, 2008 and
ending December 31, 2010. Public Law 111-226 amended ARRA to extend the
recession adjustment period to June 30, 2011 and to extend the hold
harmless provision that prevents a State's FMAP rate from decreasing
due to a lower unemployment rate from the calendar quarter ending
before July 1, 2010 to the calendar quarter ending before January 1,
2011. Public Law 111-226 also provided for a phase-down of the general
FMAP increase in the last two quarters of the extended recession
adjustment period, and changed the methodology for calculating the
unemployment adjustment for those quarters.
DATES: Effective Date: The percentages listed are for the fourth
quarter of FY10 beginning July 1, 2010 through September 30, 2010.
A. Background
The FMAP is used to determine the amount of Federal matching for
specified State expenditures for assistance payments under programs
under the Social Security Act (``the Act''). Sections 1905(b) and
1101(a)(8)(B) of the Act require the Secretary of Health and Human
Services to publish the FMAP rates each year. The Secretary calculates
the percentages using formulas in sections 1905(b) and 1101(a)(8)(B),
and statistics from the Department of Commerce 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 separately in the Act, and thus are not
based on the statutory formula that determines the percentages for the
50 States.
Section 1905(b) of the Act specifies the formula for calculating
the 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
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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.
The Medicare Improvements for Patients and Providers Act of 2008
(MIPPA) (Pub. L. 110-275) amended the FMAP applied to the District of
Columbia for maintenance payments under title IV-E programs to make it
consistent with the 70 percent Medicaid match rate.
Section 5001 of Division B of the ARRA provides for a temporary
increase in FMAP rates for Medicaid and title IV-E Foster Care,
Adoption Assistance and Guardianship Assistance programs. The purpose
of the increases to the FMAP rates is to provide fiscal relief to
States and to protect and maintain State Medicaid and certain other
assistance programs in a period of economic downturn, referred to as
the ``recession adjustment period.'' The recession adjustment period is
defined as the period beginning October 1, 2008 and ending December 31,
2010. Public Law 111-226 extends the recession adjustment period to
June 30, 2011.
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 FY09, FY10, and the first three calendar quarters of FY11, 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 a general percentage point increase in each State's FMAP
of 6.2 percentage points (decreasing during the last two quarters of
the extended recession adjustment period); 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 the maintenance of effort
requirement, 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
and therefore not subject to increase), and expenditures that are paid
at an enhanced FMAP rate. The increased FMAP is available for
expenditures under part E of title IV (including Foster Care, Adoption
Assistance and Guardianship Assistance programs) only to the extent of
a maintenance increase (hold harmless), if any, and the general
percentage point increase. The increased FMAP does not apply to other
parts of title IV, including part D (Child Support Enforcement
Program).
For title XIX purposes only, for each qualifying State with an
unemployment rate that has increased at a rate above the statutory
threshold percentage, ARRA provides additional relief above the general
percentage point increase in FMAP through application of a separate
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 general
percentage point increase in the Federal percentage) and the applicable
percent determined from the State unemployment increase percentage for
the quarter.
The unemployment increase percentage for calendar quarters other
than the last two quarters of the recession adjustment period 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.
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. A different but related methodology for an
unemployment adjustment applies for the last two quarters of the
recession adjustment period.
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 or after
January 1, 2009 and ending before January 1, 2011, as amended by Public
Law 111-226. This hold harmless provision is not in effect from January
1, 2011 to June 30, 2011.
Under section 5001(b)(2) of ARRA, Puerto Rico, the Virgin Islands,
Guam, the Commonwealth of the Northern Mariana Islands, and America
Samoa were given the option to make a special 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 Act),
or (2) applying the general 6.2 percentage point increase in the FMAP
plus a 15 percent increase in the cap on Medicaid payments. There is no
quarterly unemployment adjustment for territories. All territories and
the Commonwealth of the Northern Mariana Islands elected the 30 percent
increase in their spending cap on Medicaid payments; therefore there is
no recalculation of their FMAP rate.
D. Adjusted FMAPs for the Fourth Quarter of FY2010
ARRA adjustments to FMAPs are shown by State in the accompanying
table. The hold harmless FY10 FMAP is the higher of the original FY08,
FY09, or FY10 FMAP. The 6.2 percentage point increase is added to the
hold harmless FY10 FMAP. The unemployment adjustment is calculated
according to the unemployment tier and added to the hold harmless FY10
FMAP with the 6.2 percentage point increase.
For the fourth quarter of FY10, the unemployment tier is determined
by comparing the average unemployment rate for the three consecutive
months preceding the start of the fiscal quarter to the lowest
consecutive 3-month average unemployment rate beginning January 1,
2006. If the State's applicable percent is less than the applicable
percent for the third quarter of FY10, then the higher applicable
percent shall continue for the fourth quarter of FY10.
As indicated in the August 4, 2009 Federal Register Notice that
proposed the methodology for the FMAP unemployment adjustment
calculations (74 FR 38630), we utilize annual updates to the historical
Bureau of
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Labor Statistics (BLS) data to make changes to the States' lowest
unemployment rate beginning with the fourth quarter FMAP rate
adjustment calculation each year. As such, the rates calculated and
presented in the accompanying table are based on updates to the
historical BLS data used to determine the States' average lowest
unemployment rate for any 3 consecutive months beginning January 1,
2006.
FOR FURTHER INFORMATION CONTACT: Carrie Shelton or Thomas Musco, 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. 93.778: Medical
Assistance Program; 93.658: Foster Care; 93.659: Adoption
Assistance; 93.090: Guardianship Assistance)
Dated: September 22, 2010.
Kathleen Sebelius,
Secretary.
ARRA Adjustments to FMAP Q4 FY10
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Hold harmless 4th Quarter 4th Quarter 4th Quarter 4th Quarter
Hold harmless FY10 FMAP with FY10 FY10 FY10 FMAP FY10 FMAP
State FY10 6.2% pt unemployment unemployment unemployment unemployment
increase tier adjustment adjustment hold harmless
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Alabama................................................. 68.01 74.21 11.5 3.32 77.53 77.53
Alaska.................................................. 52.48 58.68 5.5 2.44 61.12 62.46
Arizona................................................. 66.20 72.40 11.5 3.53 75.93 75.93
Arkansas................................................ 72.94 79.14 8.5 2.04 81.18 81.18
California.............................................. 50.00 56.20 11.5 5.39 61.59 61.59
Colorado................................................ 50.00 56.20 11.5 5.39 61.59 61.59
Connecticut............................................. 50.00 56.20 11.5 5.39 61.59 61.59
Delaware................................................ 50.21 56.41 11.5 5.37 61.78 61.78
Dist. of Columbia....................................... 70.00 76.20 11.5 3.09 79.29 79.29
Florida................................................. 56.83 63.03 11.5 4.61 67.64 67.64
Georgia................................................. 65.10 71.30 11.5 3.66 74.96 74.96
Hawaii.................................................. 56.50 62.70 11.5 4.65 67.35 67.35
Idaho................................................... 69.87 76.07 11.5 3.11 79.18 79.18
Illinois................................................ 50.32 56.52 11.5 5.36 61.88 61.88
Indiana................................................. 65.93 72.13 11.5 3.56 75.69 75.69
Iowa.................................................... 63.51 69.71 8.5 2.84 72.55 72.55
Kansas.................................................. 60.38 66.58 8.5 3.10 69.68 69.68
Kentucky................................................ 70.96 77.16 11.5 2.98 80.14 80.14
Louisiana............................................... 72.47 78.67 8.5 2.08 80.75 81.48
Maine................................................... 64.99 71.19 11.5 3.67 74.86 74.86
Maryland................................................ 50.00 56.20 11.5 5.39 61.59 61.59
Massachusetts........................................... 50.00 56.20 11.5 5.39 61.59 61.59
Michigan................................................ 63.19 69.39 11.5 3.88 73.27 73.27
Minnesota............................................... 50.00 56.20 8.5 3.99 60.19 61.59
Mississippi............................................. 76.29 82.49 11.5 2.37 84.86 84.86
Missouri................................................ 64.51 70.71 11.5 3.72 74.43 74.43
Montana................................................. 68.53 74.73 11.5 3.26 77.99 77.99
Nebraska................................................ 60.56 66.76 5.5 2.00 68.76 68.76
Nevada.................................................. 52.64 58.84 11.5 5.09 63.93 63.93
New Hampshire........................................... 50.00 56.20 8.5 3.99 60.19 61.59
New Jersey.............................................. 50.00 56.20 11.5 5.39 61.59 61.59
New Mexico.............................................. 71.35 77.55 11.5 2.94 80.49 80.49
New York................................................ 50.00 56.20 11.5 5.39 61.59 61.59
North Carolina.......................................... 65.13 71.33 11.5 3.65 74.98 74.98
North Dakota............................................ 63.75 69.95 0 0.00 69.95 69.95
Ohio.................................................... 63.42 69.62 11.5 3.85 73.47 73.47
Oklahoma................................................ 67.10 73.30 11.5 3.43 76.73 76.73
Oregon.................................................. 62.74 68.94 11.5 3.93 72.87 72.87
Pennsylvania............................................ 54.81 61.01 11.5 4.84 65.85 65.85
Rhode Island............................................ 52.63 58.83 11.5 5.09 63.92 63.92
South Carolina.......................................... 70.32 76.52 11.5 3.06 79.58 79.58
South Dakota............................................ 62.72 68.92 5.5 1.88 70.80 70.80
Tennessee............................................... 65.57 71.77 11.5 3.60 75.37 75.37
Texas................................................... 60.56 66.76 11.5 4.18 70.94 70.94
Utah.................................................... 71.68 77.88 11.5 2.90 80.78 80.78
Vermont................................................. 59.45 65.65 8.5 3.18 68.83 69.96
Virginia................................................ 50.00 56.20 11.5 5.39 61.59 61.59
Washington.............................................. 51.52 57.72 11.5 5.22 62.94 62.94
West Virginia........................................... 74.25 80.45 11.5 2.60 83.05 83.05
Wisconsin............................................... 60.21 66.41 11.5 4.22 70.63 70.63
Wyoming................................................. 50.00 56.20 11.5 5.39 61.59 61.59
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[FR Doc. 2010-27412 Filed 10-28-10; 8:45 am]
BILLING CODE 4150-05-P