94746 Federal Register / Vol. 89, No. 230 / Friday, November 29, 2024 / Notices 

[FR Doc. 2024–27910 Filed 11–27–24; 8:45 am] 

BILLING CODE 4150–15–P 

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 quarteryear 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 ‘‘disasterrecovery 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 


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Federal Register / Vol. 89, No. 230 / Friday, November 29, 2024 / Notices 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/covid19-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 disasterrecovery 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 disasterrecovery 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. 


khammond on DSK9W7S144PROD with NOTICES
94748 Federal Register / Vol. 89, No. 230 / Friday, November 29, 2024 / Notices 

TABLE 1—FISCAL YEAR 2024 DISASTER-RECOVERY ADJUSTED FMAP RATES

State Fiscal year 

2023 FMAP 

Fiscal year 

2024 regular 

FMAP 

(unadjusted) 

Decrease 

in FMAP 

Disaster-recovery 

adjustment * 

Disaster-recovery 

adjusted 

FMAP 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

State Fiscal year 

2024 FMAP * 

Fiscal year 

2025 regular 

FMAP 

(unadjusted) 

Decrease 

in FMAP 

Disaster-recovery 

adjustment ** 

Disaster-recovery 

adjusted 

FMAP 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 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Meetings of the Presidential Advisory 

Council on Combating AntibioticResistant Bacteria 

AGENCY: Office of the Assistant 

Secretary for Health, Office of the 

Secretary, Department of Health and 

Human Services. 

ACTION: Notice. 

SUMMARY: As stipulated by the Federal 

Advisory Committee Act, the 

Department of Health and Human 

Services (HHS) is hereby giving notice 

that an in-person meeting is scheduled 

to be held for the Presidential Advisory 

Council on Combating AntibioticResistant Bacteria (PACCARB); the main 

focus of the meeting is to solicit 

feedback from invited presenters and 

members of the public on the 2025– 

2020 National Action Plan on 

Combating Antibiotic Resistant Bacteria. 

The meeting will be open to the public 

as well as streamed live on hhs.gov/live. 

A pre-registered public comment and 

innovation spotlight session will be 

held during the meeting. Pre-registration 

is required for members of the public 

who wish to present their comments or 

innovations live during the meeting. 

DATES: The meeting is scheduled to be 

held on January 28–29, 2025, from 9 

a.m. to 5 p.m. ET (times are tentative 

and subject to change). The confirmed 

times and agenda items for the meeting 

will be posted on the website for the 

PACCARB at https://www.hhs.gov/ 

paccarb when this information becomes 

available. Pre-registration for attending 

the meeting is strongly suggested and 

should be completed no later than 

January 24, 2025. 

ADDRESSES: The meeting will be held inperson at The Ritz-Carlton, Pentagon 

City, 1250 S. Hayes St., Arlington, VA 

22202. The meeting will also be live 

streamed and can be accessed through a 

live webcast on the day of the meeting. 

Additional instructions regarding 

attending this meeting virtually will be 

posted at least one week prior to the 

meeting at: https://www.hhs.gov/ 

paccarb. 

Individuals who wish to send in their 

written public comment should submit 

it via email to CARB@hhs.gov. 

Registration information is available on 

the website https://www.hhs.gov/ 

paccarb and must be completed by 

January 24, 2025, to attend the January 

28–29, 2025, public meeting or by 

January 21, 2025, to provide public 

comment or innovation spotlight at the 

meeting. Additional information about 

registering for the meeting and 

providing public comment can be 

obtained at https://www.hhs.gov/ 

paccarb on the Upcoming Meetings 

page. 

FOR FURTHER INFORMATION CONTACT: 

Jomana Musmar, M.S., Ph.D., 

Designated Federal Officer, Presidential 

Advisory Council on Combating 

Antibiotic-Resistant Bacteria, Office of 

the Assistant Secretary for Health, U.S. 

Department of Health and Human 

Services, 1101 Wootton Parkway, 

Rockville, MD 20852. Phone: 202–746– 

1512; Email: CARB@hhs.gov. 

SUPPLEMENTARY INFORMATION: The 

Presidential Advisory Council on 

Combating Antibiotic-Resistant Bacteria 

(PACCARB), established by Executive 

Order 13676, is continued by section 

505 of Public Law 116–22, the 

Pandemic and All-Hazards 

Preparedness and Advancing Innovation 

Act of 2019 (PAHPAIA). Activities and 

duties of the PACCARB are governed by 

the provisions of the Federal Advisory 

Committee Act (FACA), Public Law 92– 

463, as amended (5 U.S.C. app.), which 

sets forth standards for the formation 

and use of Federal advisory committees. 

The PACCARB shall advise and 

provide information and 

recommendations to the Secretary of 

Health and Human Services (Secretary) 

regarding programs and policies 

intended to reduce or combat antibioticresistant bacteria that may present a 

public health threat and improve 

capabilities to prevent, diagnose, 

mitigate, or treat such resistance. The 

PACCARB shall function solely for 

advisory purposes. 

Such advice, information, and 

recommendations may be related to 

improving: the effectiveness of 

antibiotics; research and advanced 

research on, and the development of, 

improved and innovative methods for 

combating or reducing antibiotic 

resistance, including new treatments, 

rapid point-of-care diagnostics, 

alternatives to antibiotics, including 

alternatives to animal antibiotics, and 

antimicrobial stewardship activities; 

surveillance of antibiotic-resistant 

bacterial infections, including publicly 

available and up-to-date information on 

resistance to antibiotics; education for 

health care providers and the public 

with respect to up-to-date information 

on antibiotic resistance and ways to 

reduce or combat such resistance to 

antibiotics related to humans and 

animals; methods to prevent or reduce 


khammond on DSK9W7S144PROD with NOTICES