Notice2024-27938
Adjustments for Disaster-Recovery States to the Fiscal Year 2024 and Fiscal Year 2025 Federal Medical Assistance Percentage (FMAP) Rates for Federal Matching Shares for Medicaid and Title IV-E Foster Care, Adoption Assistance, and Guardianship Assistance Programs
Primary source
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Published
November 29, 2024
Effective
October 1, 2023
Issuing agencies
Health and Human Services Department
Abstract
This notice announces the adjusted Federal Medical Assistance Percentage (FMAP) rates for the Fiscal Year 2024 and Fiscal Year 2025 for disaster-recovery FMAP adjustment States made available under the Social Security Act (the "Act"), as enacted in section 2006 of the Patient Protection and Affordable Care Act of 2010 ("Affordable Care Act"). The Social Security Act adjusts the regular FMAP rate for qualifying states that have experienced a major, statewide disaster. The percentages listed are for Fiscal Year 2024, retroactively effective from October 1, 2023 through September 30, 2024, and for Fiscal Year 2025, effective October 1, 2024 through September 30, 2025. Table 1 gives the Fiscal Year 2024 Disaster-Recovery Adjusted FMAP Rates and Table 2 gives the Fiscal Year 2025 Disaster-Recovery Adjusted FMAP Rates.
Full Text
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<title>Federal Register, Volume 89 Issue 230 (Friday, November 29, 2024)</title>
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[Federal Register Volume 89, Number 230 (Friday, November 29, 2024)]
[Notices]
[Pages 94746-94748]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-27938]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
Adjustments for Disaster-Recovery States to the Fiscal Year 2024
and Fiscal Year 2025 Federal Medical Assistance Percentage (FMAP) Rates
for Federal Matching Shares for Medicaid and Title IV-E Foster Care,
Adoption Assistance, and Guardianship Assistance Programs
AGENCY: Office of the Secretary, HHS.
ACTION: Notice.
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SUMMARY: This notice announces the adjusted Federal Medical Assistance
Percentage (FMAP) rates for the Fiscal Year 2024 and Fiscal Year 2025
for disaster-recovery FMAP adjustment States made available under the
Social Security Act (the ``Act''), as enacted in section 2006 of the
Patient Protection and Affordable Care Act of 2010 (``Affordable Care
Act''). The Social Security Act adjusts the regular FMAP rate for
qualifying states that have experienced a major, statewide disaster.
The percentages listed are for Fiscal Year 2024, retroactively
effective from October 1, 2023 through September 30, 2024, and for
Fiscal Year 2025, effective October 1, 2024 through September 30, 2025.
Table 1 gives the Fiscal Year 2024 Disaster-Recovery Adjusted FMAP
Rates and Table 2 gives the Fiscal Year 2025 Disaster-Recovery Adjusted
FMAP Rates.
DATES: The percentages listed in Table 1 will be effective for each of
the four quarter-year periods beginning October 1, 2023, and ending
September 30, 2024; The percentages listed in Table 2 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 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) of
the Act, 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). 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 (CAA, 2023) (Pub. L. 117-328) 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 that the rate
that applies for Puerto Rico, the Virgin Islands, and Guam in certain
other programs pursuant to section 1118 of the Act is 75 percent.
Section 4725(b) of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105-
33) amended section 1905(b) of the Act to provide that the FMAP for the
District of Columbia, for purposes of titles XIX and XXI, shall be 70
percent.
Section 1905(y) of the Act, as added by section 2001 of the
Affordable Care Act, 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 (i.e., the adult group); ``newly eligible'' is
defined in section 1905(y)(2)(A) of the Act. The FMAP for the 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 of the Act was further amended by section 9814 of the American
Rescue Plan of 2021 (Pub. L. 117-2) 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 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 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.
Disaster-Recovery Adjustments to the FMAP
Section 1905(aa) of the Act, as amended by section 2006 of the
Affordable Care Act, specifies that, notwithstanding section 1905(b) of
the Act, the FMAP for a ``disaster-recovery FMAP adjustment state'' is
adjusted as described in section 1905(aa)(1) of the Act. 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 (the ``Stafford Act''), under which every
county or parish in
[[Page 94747]]
the state warrant individual and public or public assistance from the
Federal Government, and for which the state's regular FMAP (as defined
by section 1905(aa)(3) of the Act) as determined for the fiscal year is
less than the FMAP for the preceding fiscal year by at least three
percentage points, as outlined in sections 1905(aa)(2)(A) and
(aa)(2)(B) of the Act. Section 1905(aa)(3) of the Act defines a state's
``regular FMAP'' to be the FMAP that would otherwise apply to the state
for the fiscal year, as determined under 1905(b) and without regard to
section 1905(aa), (y), (z), and section 10202 of the Patient Protection
and Affordable Care Act.
HHS did not consider the temporary FMAP increase available to
qualifying states under section 6008 of the Families First Coronavirus
Response Act (FFCRA) (Pub. L. 116-127) (as amended by the Consolidated
Appropriations Act, 2023, Pub. L. 117-328) from January 1, 2020 through
December 31, 2023 when determining whether a state is a disaster-
recovery FMAP adjustment State, or when determining the amount of such
a state's disaster-recovery FMAP adjustment (the calculation of that
adjustment is discussed below). HHS interprets the FFCRA FMAP increase
to apply only to the state-specific FMAP defined in the first sentence
of section 1905(b) of the Act. See CMS, COVID-19 FAQs, January 6, 2021,
at <a href="https://www.medicaid.gov/state-resource-center/downloads/covid-19-faqs.pdf">https://www.medicaid.gov/state-resource-center/downloads/covid-19-faqs.pdf</a>, IV.F.7. The first sentence of section 1905(b) of the Act
provides that the state-specific FMAP defined in that section is
``subject to'' certain other provisions of section 1905 of the Act that
contain language indicating that the FMAP described in the provision
replaces the FMAP in the first sentence of section 1905(b) entirely, in
which case the FFCRA FMAP increase does not apply. That is the case for
section 1905(aa) of the Act. Specifically, the word notwithstanding in
section 1905(aa)(1) of the Act and the word otherwise in section
1905(aa)(3) of the Act indicate that the FFCRA FMAP increase is neither
applied to the adjusted FMAP for a disaster-recovery FMAP adjustment
state, nor taken into account when determining the regular FMAP which
is used to determine the amount of the adjustment and whether a state
qualifies for it. Additionally, section 1905(aa)(2)(A) of the Act
specifies that the preceding year's FMAP against which the state's
regular FMAP is compared for purposes of determining whether a state
might qualify for an initial-year disaster-recovery FMAP adjustment
should be the FMAP determined for the state after the application of
only section 5001(a) of Public Law 111-5--there is no reference to the
FFCRA FMAP increase. Because the FFCRA FMAP increase does not affect
eligibility for or calculation of the disaster-recovery FMAP adjustment
for the first fiscal year a state receives it, the FFCRA FMAP increase
also does not affect the determinations for the second and subsequent
fiscal years a state receives an adjustment under section 1905(aa) of
the Act.
The increased FMAP (with disaster-recovery adjustment) is available
for state medical assistance (Medicaid) and for title IV-E Foster Care,
Adoption Assistance and Guardianship Assistance programs. Expenditures
for which the increased FMAP is not available under title XIX include
expenditures for disproportionate share hospital (DSH) payments and
expenditures that are paid at an enhanced FMAP rate, as well as any
payments made under Title XXI (the Children's Health Insurance
Program).
Calculation of the Increased FMAP Rates for Disaster-Recovery FMAP
Adjustment States
Generally, per section 1905(aa)(1) of the Act, the FMAP for
disaster-recovery FMAP adjustment States is calculated by increasing
the state's regular FMAP by a percentage of the amount by which it had
decreased across the relevant years. For the first year in which a
state qualifies for the disaster-recovery FMAP adjustment, the FMAP
shall be equal to the regular FMAP as determined for the fiscal year,
plus 50 percent of the number of percentage points by which the regular
FMAP is less than the FMAP determined for the state for the preceding
fiscal year after the application of only subsection (a) of section
5001 of Public Law 111-5 (if applicable to the preceding fiscal year)
and without regard to subsections 1905(aa), (y), (z), and subsections
(b) and (c) of section 5001 of Public Law 111-5. In year two or any
succeeding fiscal year in the qualifying 7 year period, the state's
regular FMAP for such fiscal year shall be increased by 25 percent of
the number of percentage points by which the state's regular FMAP for
such fiscal year is less than the FMAP received by the state during the
preceding fiscal year.
Disaster-recovery FMAP adjustments are included in the annual
publication of the FMAP rates for the succeeding fiscal year. An
additional notice for the changes discussed above is necessary because
for Fiscal Year 2024 and Fiscal Year 2025 disaster-recovery adjustments
to the FMAP rates were identified after publication of the FMAP rates
for those years.
Disaster-Recovery FMAP Adjustments for Fiscal Year 2024 and Fiscal Year
2025
All states and the District of Columbia had a presidential major
disaster declaration in Fiscal Year 2020 for COVID-19 under section 401
of the Stafford Act, under which every county or parish in the state
was eligible for individual and public or public assistance from the
federal government, and will meet the requirement related to the
declaration of a major disaster through Fiscal Year 2027. For Fiscal
Year 2024, one state, Arizona, meets the requirement that its regular
FMAP for such year is less than the previous year FMAP (i.e., Fiscal
Year 2023) by at least three percentage points. Therefore, this notice
provides a disaster-recovery FMAP adjustment for the state of Arizona
for Fiscal Year 2024, as shown in Table 1. With the Fiscal Year 2024
disaster-recovery adjustment, Arizona meets the requirement that the
regular FMAP as determined for Fiscal Year 2025 is less than the
previous year FMAP, including any applicable disaster-recovery
adjustment (i.e., the amount required under section 1905(aa)(2)(A) for
a state's first fiscal year that section 1905(aa) applies to the
state), by at least three percentage points. Therefore, this notice
provides a disaster-recovery FMAP adjustment for the state of Arizona
for Fiscal Year 2025, as shown in Table 2. See more information
described in the December 22, 2010 Federal Register notice (75 FR
80501).
(Catalog of Federal Domestic Assistance Program Nos. 93.658: Foster
Care Title IV-E; 93.659: Adoption Assistance; 93.090: Guardianship
Assistance; 93.778: Medical Assistance Program)
Dated: November 22, 2024.
Xavier Becerra,
Secretary, Department of Health and Human Services.
[[Page 94748]]
Table 1--Fiscal Year 2024 Disaster-Recovery Adjusted FMAP Rates
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Fiscal year
Fiscal year 2024 regular Decrease in Disaster-recovery Disaster-recovery
State 2023 FMAP FMAP FMAP adjustment * adjusted FMAP
(unadjusted) fiscal year 2024
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Arizona.................................................. 69.56 66.29 3.27 1.64 67.93
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* In the first year, the Disaster-Recovery Adjustment is 50 percent of the percentage point decrease between the regular FMAP for such fiscal year and
the FMAP from the preceding fiscal year.
Table 2--Fiscal Year 2025 Disaster-Recovery Adjusted FMAP Rates
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Fiscal year
Fiscal year 2025 regular Decrease in Disaster-recovery Disaster-recovery
State 2024 FMAP * FMAP FMAP adjustment ** adjusted FMAP
(unadjusted) fiscal year 2025
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Arizona.................................................. 67.93 64.89 3.04 0.76 65.65
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* Includes applicable Disaster-Recovery Adjustment made for Fiscal Year 2024 (See Table 1).
** In year two or any succeeding fiscal year in the qualifying seven-year period, the Disaster-Recovery Adjustment is 25 percent of the percentage point
decrease between the regular FMAP for such fiscal year and the FMAP from the preceding fiscal year, including any disaster-recovery adjustments.
[FR Doc. 2024-27938 Filed 11-27-24; 8:45 am]
BILLING CODE 4150-15-P
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