By Rebecca Mayo, J.D.
HHS has released the Federal Medical Assistance Percentages (FMAP), Enhanced Federal Medical Assistance Percentages (eFMAP), and disaster-recovery FMAP adjustments for Fiscal Year 2020. These percentages will be effective from October 1, 2019 through September 30, 2020 and will be used to determine the amount of federal matching for state medical assistance programs. (Notice, 81 FR 12345, July 20, 2016).
FMAP. Each year, as required the by the Social Security Act (the Act), HHS calculates and publishes the FMAP rates using the formulas prescribed in the Act and calculations by the Department of Commerce of average income per person in each state and for the United States. The percentage is calculated using the per capita income of the state and the per capita income of the continental United States. The Patient Protection and Affordable Care Act of 2010 (ACA) also provided for a significant increase in the FMAP for medical assistance expenditures for newly eligible individuals as added by the ACA, and for expansion states. The ACA also provides for a special adjustment to the FMAP for certain states recovering from a major disaster, however this does not apply to this year’s changes as no states qualified.
The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) also stipulates that a state’s FMAP under Medicaid must be 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 because these things impact the per capital income for the state. CHIPRA also stipulates an adjustment when a state experiences negative growth in total personal income.
eFMAP. The eFMAP increases the FMAP and are used in the Children’s Health Insurance Program (CHIP) and in the Medicaid program for expenditures for medical assistance provided to certain children as described in the Act. HHS is not required to publish the eFMAP rates, however they are included in the notice.
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