Federal Financial Participation in State Assistance Expenditures; Federal Matching Shares for Medicaid, the Children&apos;s Health Insurance Program, and Aid to Needy Aged, Blind, or Disabled Persons for October 1, 2024, Through September 30, 2025

Notice.

Citation: "88 FR 81090"

Page Number: "81090"

"Notices"

Agency: "Office of the Secretary, HHS."

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.

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 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                                                    

State                                                                                                                                                                                                    Federal                                         Enhanced                                        
                                                                                                                                                                                                         medical                                         federal                                         
                                                                                                                                                                                                         assistance                                      medical                                         
                                                                                                                                                                                                         percentages                                     assistance                                      
                                                                                                                                                                                                                                                         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.
** 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.