Health Law Daily FMAP and eFMAP rates for fiscal year 2021 released,
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Tuesday, December 3, 2019

FMAP and eFMAP rates for fiscal year 2021 released,

By Rebecca Mayo, J.D.

As required by the Social Security Act, HHS has calculated and published the Federal Medical Assistance Percentages rates for Fiscal Year 2021.

The Federal Medical Assistance Percentages (FMAP) rates will be used in determining the amount of Federal matching for Medicaid, Temporary Assistance for Needy Families (TANF) Contingency Funds, Child Support enforcement 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 enhanced FMAP (eFMAP) rates for the Children’s Health Insurance Program (CHIP) expenditures. Although HHS is not required to publish the eFMAP rates each year, HHS included them in the notice with the FMAP rates for the convenience of the states. The rates are effective from October 1, 2020 and ending September 30, 2021 (Notice, 84 FR 66204, December 3, 2019).

FMAP. The formula for calculating FMAPs as the Federal medical assistance percentage for any state is 100 per centum less the state percentage. The state percentage is the 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 and Hawaii. The Federal medical assistance percentage shall in no case be less than 50 per centum or more than 83 per centum.

Adjustments. The Patient Protection and Affordable Care Act provides for a significant increase in the FMAP for medical assistance expenditures for newly eligible individuals. The FMAP for the new adult group is 100 percent for calendar years 2014, 2015, and 2016, and gradually declining to 90 percent in 2020 where it will remain indefinitely. The Affordable Care Act also provides that 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. States recovering from a major disaster may also receive a special adjustment under the Affordable Care Act.

The FMAP can also be subject to an adjustment pursuant to the Children’s Health Insurance Program Reauthorization Act (CHIP) in two situations. If the state experienced no growth or positive growth in total personal income and an employer in that state has made a significantly disproportionate contribution to an employer pensions or insurance fund, the state’s FMAP must be adjusted. The adjustment must disregard the employer pension or insurance fund contribution in computing the per capita income for the state. If a state experiences negative growth in total personal income, the FMAP must be adjusted to disregard 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, when computing the per capital income for the state.

eFMAP for CHIP. The eFMAP rates are used in the CHIP program and in the Medicaid program for expenditures for medical assistance provided to certain children. The eFMAP for a state for a fiscal year is the FMAP for the state increased by a number of percentage points equal to 30 percent of the number of percentage points by which such FMAP for the state is less than 100 percent. In no case should the eFMAP for a state exceed 85 percent.

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