Note.

Quote: “86 FR 67479”

Page number: “67479”

“Hints”

Agency: “Secretary’s Office, DHHS.”

SUMMARY:

Section 1905 (b) further states that the FMAP should be 55 percent for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. Section 4725 (b) of the Balanced Budget Act of 1997 amended Section 1905 (b) to provide that the FMAP for the District of Columbia is 70 percent for the purposes of Titles XIX and XXI. For the District of Columbia, please note in Table 1 that other tariffs may apply to certain other programs. Additionally, we note the rate that applies to Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands in certain other programs under Section 1118 of the Act. The rates for the state, District of Columbia, and Territories are listed in Table 1, Column 1.

Section 1905 (y) of the Act, 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 expenses 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 entitled” is defined in Section 1905 (y) (2) (A) of the Act. The FMAP for the new adult group is 100 percent for the 2014, 2015, and 2016 calendar years and gradually decreases 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 provided certain low-income parents and non-pregnant, childless adults with substantial health coverage at the time the Affordable Care Act came into effect, referred to as “Enlargement States”, will receive an expanded FMAP from 2014 for medical assistance expenses for non-pregnant childless adults who may need to apply for benchmark coverage under Section 1937 of the Act. These provisions are further elaborated in the Medicaid program: Changes to Eligibility under the Affordable Care Act of 2010, Proposed Regulation, published August 17, 2011 (76 FR 51148, 51172) and Final Regulation, published March 23, 2012 (77 FR 17144.), 17194). This announcement is not intended to provide the matching rates for the new adult group under Section 1905 (y) of the Act or the matching rates for non-pregnant, childless adults in expanding states under 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 for a temporary increase in FMAP of 6.2 percentage points for anyone prior to qualifying FMAP of a state and territory under Section 1905 (b) of the Act, effective January 1, 2020 and through the last day of the calendar quarter in which the health emergency was declared for COVID-19 by the Secretary of HHS, including all Extensions, ended. Fiscal 2023 FMAP rates listed in Table 1 do not include the 6.2 percentage point increase in FMAP that Eligible States may receive under Section 6008 of the FFCRA (Pub. L. 116-127).

Other adjustments to the FMAP

For the purposes of Title XIX (Medicaid) of the Social Insurance Act, the Federal Medical Assistance Percentage (FMAP) defined in Section 1905 (b) of the Social Insurance Act may, for each state, be subject to an adjustment in accordance with Section 614 Children’s Health Insurance Program Re-Admission Act 2009 (CHIPRA), Public Law 111-3. Section 614 of CHIPRA requires that a state’s FMAP must be adjusted under Title XIX (Medicaid) in two situations.

In the first situation, the state’s FMAP must be adjusted if a state has no growth or positive growth in total personal income and an employer in that state has made a significantly disproportionate contribution to an employer’s pension or insurance. The adjustment includes neglecting the significantly disproportionate employer contribution to the pension or insurance fund when calculating per capita income for the state (but not when calculating per capita income for the United States). The employer’s contributions to the pension and insurance fund are considerably disproportionate if the increase in contributions exceeds 25 percent of the total increase in personal income in that state. On June 7, 2010 (75 FR 32182) a Federal Register Notice with a deadline for comment was published in which the methodology for calculating this adjustment is disclosed; a final notice was published on October 15, 2010 (75 FR 63480).

The second situation arises when a state experiences negative growth in total personal income. Starting with the 2006 financial year, Section 614 (b) (3) of CHIPRA stipulates that for the purposes of calculating the FMAP for a calendar year in which the total personal income of a country has declined, the proportion of the employer’s pension or the insurance contribution is 125 percent exceeds the amount of any such contribution in the previous calendar year will not be included in the calculation of income per capita for the state (but not in the calculation of income per capita for the United States).

There is currently no state source of reliable, up-to-date data on pension and insurance contributions by individual employers and states. We encourage states to report employer pension or insurance fund contributions to identify potential FMAP adjustments for states with significantly disproportionate pension or insurance contributions and states with negative growth in total personal income. See also the information in the notification from the Federal Register of January 21, 2014 (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 release does not include an adjustment for FY 2023 for a major statewide disaster for any state (areas are not eligible for FMAP adjustments) because no state has recently had a major statewide disaster and its FMAP has decreased by at least three percentage points from FY 2021 FY 2022. See the information in the Federal Register notice dated December 22, 2010 (75 FR 80501).

Enhanced Federal Medical Assistance Percentage (eFMAP) for CHIP

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

[T]The “extended FMAP” for a state for a financial year corresponds to the percentage of federal medical care (as defined in Section 1905 (b) sentence 1) for the state increased by a number of percentage points equal to 30 percent of the number of percentage points, where (1) that percentage of federal medical coverage is less than (2) 100 percent; but in no case may the extended FMAP for any state exceed 85 percent.