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[Federal Register Volume 89, Number 230 (Friday, November 29, 2024)]
[Notices]
[Pages 94742-94746]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-27910]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary

Federal Financial Participation in State Assistance Expenditures; 
Federal Matching Shares for Medicaid, the Children's Health Insurance 
Program, and Aid to Needy Aged, Blind, or Disabled Persons for October 
1, 2025, Through September 30, 2026

AGENCY: Office of the Secretary, HHS.

ACTION: Notice.

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SUMMARY: The Federal Medical Assistance Percentages (FMAP), Enhanced 
Federal Medical Assistance Percentages (eFMAP), and disaster-recovery 
FMAP adjustments for fiscal year 2026 have been calculated pursuant to 
the Social Security Act (the Act). These percentages will be effective 
from October 1, 2025, through September 30, 2026. 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. 
Based on the criteria for a qualifying state, one state meets the 
requirements for an adjustment for disaster recovery.

DATES: The percentages listed in Table 1 will be effective for each of 
the four quarter-year periods beginning October 1, 2025, and ending 
September 30, 2026.

[[Page 94743]]

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: The Secretary of HHS manages programs under 
titles IV, XIX and XXI of the Act in each jurisdiction of the United 
States. Programs under titles I, X, and XIV of the Act operate only in 
Guam and the Virgin Islands, and a program under title XVI of the Act 
(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 provided under these titles. The Act provides 
separate terms 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 set out in sections 1905(b) and 
1101(a)(8), and calculations from 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 final percentages are subject to 
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:
    ``Subject to [statutory qualifications], the term `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 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 
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, the District 
of Columbia, and the territories are set out in Table 1, Column 1.
    Section 1905(y) of the Act, as added by section 2001(a)(3) 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 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. Some of these 
provisions are discussed in more detail in the proposed rule, 
``Medicaid Program; Eligibility Changes Under the Affordable Care Act 
of 2010'', published on August 17, 2011 (76 FR 51148, 51172) and the 
final rule and interim final rule published on March 23, 2012 (77 FR 
17144, 17194). This notice does not 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.

Other Adjustments to the FMAP

    For purposes of Title XIX (Medicaid) of the Act, the Federal 
Medical Assistance Percentage (FMAP), defined in section 1905(b) of the 
Act, for each state beginning with fiscal year 2006, may 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.
    First, the FMAP is adjusted 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 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

[[Page 94744]]

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 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, under which every county or parish in the 
state warrant individual and public or public assistance from the 
Federal Government, and for which the regular FMAP as determined for 
the fiscal year is less than the FMAP for the preceding fiscal year by 
an amount outlined under sections 1905(aa)(2)(A) and (aa)(2)(B) of the 
Act. All states and the District of Columbia had a presidential 
disaster declaration that applies to all counties and parishes within 
the state in the preceding 7 fiscal years. 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 
section 1905(b) and without regard to section 1905(aa), (y), and (z), 
and section 10202 of the Affordable Care Act. One state, Nebraska, 
meets the requirement that its regular FMAP as determined for Fiscal 
Year 2026 is less than the previous year FMAP by at least three 
percentage points (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). Therefore, this notice provides a disaster-
recovery FMAP adjustment for the state of Nebraska for Fiscal Year 
2026, as shown in Table 2. See more information described in the 
December 22, 2010 Federal Register notice (75 FR 80501).
    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 payments 
and expenditures that are paid at an enhanced FMAP rate, as well as any 
payments made under Title XXI.

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)

    Dated: November 22, 2024.
Xavier Becerra,
Secretary, Department of Health and Human Services.

  Table 1--Federal Medical Assistance Percentages and Enhanced Federal
 Medical Assistance Percentages, Effective October 1, 2025-September 30,
                                  2026
                           [Fiscal year 2026]
------------------------------------------------------------------------
                                    Federal medical    Enhanced Federal
              State                   assistance      medical assistance
                                      percentages         percentages
------------------------------------------------------------------------
Alabama.........................               72.63               80.84
Alaska..........................               52.42               66.69
American Samoa *................               83.00               85.00
Arizona.........................               64.34               75.04
Arkansas........................               69.23               78.46
California......................               50.00               65.00
Colorado........................               50.00               65.00
Connecticut.....................               50.00               65.00
Delaware........................               59.41               71.59
District of Columbia **.........               70.00               79.00
Florida.........................               57.22               70.05
Georgia.........................               66.40               76.48
Guam*...........................               83.00               85.00
Hawaii..........................               59.68               71.78
Idaho...........................               66.91               76.84
Illinois........................               51.82               66.27
Indiana.........................               64.74               75.32
Iowa............................               62.70               73.89
Kansas..........................               60.67               72.47
Kentucky........................               71.41               79.99
Louisiana.......................               67.83               77.48
Maine...........................               61.29               72.90
Maryland........................               50.00               65.00
Massachusetts...................               50.00               65.00
Michigan........................               65.30               75.71

[[Page 94745]]

 
Minnesota.......................               50.68               65.48
Mississippi.....................               76.90               83.83
Missouri........................               64.44               75.11
Montana.........................               61.47               73.03
Nebraska ***....................               55.94               68.05
Nevada..........................               59.80               71.86
New Hampshire...................               50.00               65.00
New Jersey......................               50.00               65.00
New Mexico......................               71.66               80.16
New York........................               50.00               65.00
North Carolina..................               64.62               75.23
North Dakota....................               50.99               65.69
Northern Mariana Islands *......               83.00               85.00
Ohio............................               64.85               75.40
Oklahoma........................               66.47               76.53
Oregon..........................               57.75               70.43
Pennsylvania....................               56.06               69.24
Puerto Rico *...................               76.00               83.20
Rhode Island....................               57.50               70.25
South Carolina..................               69.53               78.67
South Dakota....................               51.01               65.71
Tennessee.......................               64.16               74.91
Texas...........................               59.83               71.88
Utah............................               62.46               73.72
Vermont.........................               59.01               71.31
Virgin Islands *................               83.00               85.00
Virginia........................               50.39               65.27
Washington......................               50.00               65.00
West Virginia...................               74.22               81.95
Wisconsin.......................               60.68               72.48
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 Fiscal
  Year 2027. For purposes of section 1118 of the Act, the percentage
  used under titles I, X, XIV, and XVI will be 75 per centum for Puerto
  Rico, the Virgin Islands, and Guam.
** The values for the District of Columbia (DC) 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.
*** Nebraska received the FMAP for a disaster-recovery FMAP adjustment
  State.

                                             Table 2--Fiscal Year 2026 Disaster-Recovery Adjusted FMAP Rates
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                                                                                                                                            Disaster-
                                                                                      FY 2026 regular    Decrease in       Disaster-         recovery
                               State                                   FY 2025 FMAP         FMAP             FMAP           recovery      adjusted FMAP
                                                                                                                          adjustment *       FY 2026
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Nebraska...........................................................           57.52            54.36             3.16             1.58            55.94
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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.

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[FR Doc. 2024-27910 Filed 11-27-24; 8:45 am]
BILLING CODE 4150-15-P
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