```

[Federal Register Volume 89, Number 230 (Friday, November 29, 2024)]
[Notices]
[Pages 94746-94748]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-27938]

-----------------------------------------------------------------------

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.

-----------------------------------------------------------------------

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 https://www.medicaid.gov/state-resource-center/downloads/covid-19-faqs.pdf, 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
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                              Fiscal year
                                                             Fiscal year      2024 regular     Decrease  in     Disaster-recovery     Disaster-recovery
                          State                               2023 FMAP           FMAP             FMAP           adjustment *         adjusted  FMAP
                                                                              (unadjusted)                                            fiscal  year 2024
--------------------------------------------------------------------------------------------------------------------------------------------------------
Arizona..................................................           69.56            66.29             3.27                  1.64                 67.93
--------------------------------------------------------------------------------------------------------------------------------------------------------
* 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
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                              Fiscal year
                                                             Fiscal year      2025 regular     Decrease  in     Disaster-recovery     Disaster-recovery
                          State                              2024 FMAP *          FMAP             FMAP           adjustment **        adjusted  FMAP
                                                                              (unadjusted)                                            fiscal  year 2025
--------------------------------------------------------------------------------------------------------------------------------------------------------
Arizona..................................................           67.93            64.89             3.04                  0.76                 65.65
--------------------------------------------------------------------------------------------------------------------------------------------------------
* 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
```