Medicaid’s Federal Medical Assistance Percentage (FMAP)




Medicaid’s Federal Medical Assistance
Percentage (FMAP)

Updated July 29, 2020
Congressional Research Service
https://crsreports.congress.gov
R43847




Medicaid’s Federal Medical Assistance Percentage (FMAP)

Summary
Medicaid is a means-tested entitlement program that finances the delivery of primary and acute
medical services as wel as long-term services and supports. Medicaid is jointly funded by the
federal government and the states. The federal government’s share of most Medicaid
expenditures is cal ed the federal medical assistance percentage (FMAP). The remainder is
referred to as the state share.
General y determined annual y, the FMAP formula is designed so that the federal government
pays a larger portion of Medicaid costs in states with lower per capita incomes relative to the
national average (and vice versa for states with higher per capita incomes). FMAP rates have a
statutory minimum of 50% and a statutory maximum of 83%. For FY2021, regular FMAP rates
range from 50.00% (13 states) to 77.76% (Mississippi).
The FMAP rate is used to reimburse states for the federal share of most Medicaid expenditures.
However, exceptions to the regular FMAP rate have been made for certain states (e.g., the District
of Columbia and the territories), situations (e.g., during economic downturns), populations (e.g.,
individuals covered by the Patient Protection and Affordable Care Act’s [P.L. 111-148, as
amended] Medicaid expansion and individuals with breast or cervical cancer), providers (e.g.,
Indian Health Service facilities), and services (e.g., family planning and home health services). In
addition, the federal share for most Medicaid administrative costs does not vary by state and is
general y 50%.
During the Coronavirus Disease 2019 (COVID-19) public health emergency period, the Family
First Coronavirus Response Act (FFCRA; P.L. 116-127) provides a 6.2-percentage-point increase
to the regular FMAP rates for al states, the District of Columbia, and the territories. The FFCRA
FMAP increase began on January 1, 2020 (the first day of the calendar quarter in which the
COVID-19 public health emergency period began), and the FFCRA FMAP increase is set to end
on the last day of the calendar quarter in which COVID-19 public health emergency period ends.
To receive the FFCRA FMAP increase, states, the District of Columbia, and the territories are
required to meet certain conditions. Such conditions include (1) maintaining Medicaid “eligibility
standards, methodologies, and procedures” that are no more restrictive than what was in effect on
January 1, 2020; (2) not imposing premiums exceeding the amounts in place as of January 1,
2020; (3) providing continuous coverage of Medicaid enrollees during the public health
emergency period; (4) providing coverage for testing services and treatments for COVID–19; and
(5) ensuring local governments are not required to contribute a larger percentage of the state’s
nonfederal Medicaid expenditures or Medicaid DSH payments than otherwise would have been
required on March 11, 2020.
The FFCRA FMAP increase does not apply to most FMAP exceptions. However, the FFCRA
FMAP increase does apply to a few FMAP exceptions, such as the FMAP exceptions for the
Community First Choice option, individuals eligible on the basis of breast and cervical cancer,
Certified Community Behavioral Health Clinics, and Money Follows the Person.
The Congressional Budget Office estimates the FFCRA FMAP increase wil increase federal
expenditures by about $50.0 bil ion from FY2020 to FY2022. However, the amount of the
increase in federal expenditures depends on the length of the COVID-19 public health emergency
period and states’ actual expenditures.

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Contents
Introduction ................................................................................................................... 1
The Federal Medical Assistance Percentage ........................................................................ 1

How FMAP Rates Are Calculated ................................................................................ 2
Data Used to Calculate State FMAP Rates ..................................................................... 2
Factors That Affect FMAP Rates.................................................................................. 3
FY2021 Regular FMAP Rates ..................................................................................... 4
FMAP Exceptions...................................................................................................... 6
Reduction to Regular FMAP Rates ............................................................................. 12
Territories ......................................................................................................... 13
Electronic Visit Verification Systems ..................................................................... 13
Asset Verification Programs ................................................................................. 13

FMAP Increase During the COVID-19 Public Health Emergency......................................... 14
Conclusion................................................................................................................... 15

Figures
Figure 1. State Distribution of Regular FMAP Rates............................................................. 5
Figure 2. FMAP Rate Changes for States from FY2020 to FY2021......................................... 6

Tables
Table 1. Current Exceptions to the Regular FMAP Rates for Medicaid .................................... 7

Table A-1. Regular FMAP Rates, by State, FY2016-FY2021 ............................................... 16
Table B-1. Past Exceptions to the Regular FMAP Rates for Medicaid.................................... 18

Appendixes
Appendix A. FMAP Rates for Medicaid, by State............................................................... 16
Appendix B. Past FMAP Rate Exceptions ......................................................................... 18

Contacts
Author Information ....................................................................................................... 20

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Introduction
Medicaid is a means-tested entitlement program that finances the delivery of primary and acute
medical services as wel as long-term services and supports.1 Medicaid is jointly funded by the
federal government and the states. Participation in Medicaid is voluntary for states, though al
states, the District of Columbia, and the territories choose to participate. Each state designs and
administers its own version of Medicaid under broad federal rules. While states that choose to
participate in Medicaid must comply with al federal mandated requirements, state variability is
the rule rather than the exception in terms of eligibility levels, covered services, and how those
services are reimbursed and delivered. The federal government pays a share of each state’s
Medicaid expenditures.2
This report describes the federal medical assistance percentage (FMAP) calculation used to
reimburse states for most Medicaid expenditures, and it lists the statutory exceptions to the
regular FMAP rate. In addition, this report provides a summary of the Family First Coronavirus
Response Act (FFCRA; P.L. 116-127) FMAP increase that states, the District of Columbia, and
the territories are receiving during the Coronavirus Disease 2019 (COVID-19) public health
emergency period.
The Federal Medical Assistance Percentage
The federal government’s share of most Medicaid service costs is determined by the FMAP rate,
which varies by state and is determined by a formula set in statute. The FMAP rate is used to
reimburse states for the federal share of most Medicaid expenditures, but exceptions to the
regular FMAP rate have been made for certain states, situations, populations, providers, and
services.3
The FMAP rate also is used to determine the phased-down state contribution (“clawback”) for
Medicare Part D and the federal share of other federal programs. For instance, the FMAP rate is
used to determine the federal share of spending for foster care maintenance, adoption assistance,
and guardianship assistance payments authorized by Title IV-E of the Social Security Act.4 The
FMAP rate also is used to determine the federal share of the “mandatory matching funds”
provided by the Child Care Entitlement to States.5 In addition, it determines the federal share of
funding under the Temporary Assistance for Needy Families Contingency Funds and the federal
share of collections under the Child Support Enforcement program.6

1 For more information about the Medicaid program, see CRS Report R43357, Medicaid: An Overview.
2 For a broader overview of financing issues, see CRS Report R42640, Medicaid Financing and Expenditures.
3 More detail about the exceptions to the regular federal medical assistance percentage (FMAP) rate is provided under
the heading “ FMAP Exceptions.”
4 For more information, see CRS Insight IN11297, Federal Medical Assistance Percentage (FMAP) Increase Available
for Title IV-E Foster Care and Perm anency Paym ents
, and CRS Report R42792, Child Welfare: A Detailed Overview
of Program Eligibility and Funding for Foster Care, Adoption Assistance and Kinship Guardianship Assistance under
Title IV-E of the Social Security Act
.
5 T he Child Care Entitlement to States is authorized in §418 of the Social Security Act (SSA). For more information,
see CRS In Focus IF10511, Child Care Entitlem ent to States.
6 For more information about the T emporary Assistance for Needy Families (T ANF) Contingency Funds, see CRS
Report RL32748, The Tem porary Assistance for Needy Fam ilies (TANF) Block Grant: A Prim er on TANF Financing
and Federal Requirem ents
.
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Medicaid’s Federal Medical Assistance Percentage (FMAP)

Separate from the regular FMAP rate, the enhanced FMAP (E-FMAP) rate is provided for both
services and administration under the State Children’s Health Insurance Program (CHIP), subject
to the availability of funds from a state’s federal al otment for CHIP. The E-FMAP rate is
calculated by reducing the state share under the regular FMAP rate by 30%.7
How FMAP Rates Are Calculated
The FMAP formula compares each state’s per capita income relative to U.S. per capita income.
The formula provides higher reimbursement to states with lower incomes (with a statutory
maximum of 83%) and lower reimbursement to states with higher incomes (with a statutory
minimum of 50%). The formula8 for a given state is:
FMAPstate = 1 - ((Per capita incomestate)2/(Per capita incomeU.S.)2 * 0.45)
The use of the 0.45 factor in the formula is designed to ensure that a state with per capita income
equal to the U.S. average receives an FMAP rate of 55% (i.e., state share of 45%). In addition, the
formula’s squaring of income provides higher FMAP rates to states with below -average incomes
(and vice versa, subject to the 50% minimum).9
The Department of Health & Human Services (HHS) usual y publishes FMAP rates for an
upcoming fiscal year in the Federal Register during the preceding November. This time lag
between announcement and implementation provides an opportunity for states to adjust to FMAP
rate changes.
Data Used to Calculate State FMAP Rates
The per capita income amounts used to calculate FMAP rates for a given fiscal year are several
years old by the time the FMAP rates take effect because, as specified in Section 1905(b) of the
Social Security Act, the per capita income amounts used in the FMAP formula are equal to the
average of the three most recent calendar years of data available from the Department of
Commerce. In its FY2021 FMAP calculations, HHS used state per capita personal income data
for 2016, 2017, and 2018 that became available from the Department of Commerce’s Bureau of
Economic Analysis (BEA) in September 2019. The use of a three-year average helps to moderate
fluctuations in a state’s FMAP rate over time.
BEA revises its most recent estimates of state per capita personal income on an annual basis to
incorporate revised and newly available source data on population and income.10 It also
undertakes a comprehensive data revision—reflecting methodological and other changes—every
few years that may result in upward and downward revisions to each of the component parts of
personal income. These components include the following:

7 For more information about CHIP, see CRS Report R43949, Federal Financing for the State Children’s Health
Insurance Program (CHIP)
.
8 SSA §1905(b).
9 For example, assume that U.S. per capita income is $40,000. In state A with an above-average per capita income of
$42,000, the FMAP formula produces an FMAP rate of 50.39%; if the formula did not include a squaring of per capita
income, it would instead produce a higher FMAP rate of 52.75%. In state B with a below-average per capita income of
$38,000, the FMAP formula produces an FMAP rate of 59.39%; if the formula did not include a squaring of per capita
income, it would instead produce a lower FMAP rate of 57.25%.
10 Preliminary estimates of state per capita personal income for the latest available calendar year —as well as revised
estimates for the two preceding calendar years—are released in April. Revised estimates for all three years are released
in September.
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Medicaid’s Federal Medical Assistance Percentage (FMAP)

 earnings (wages and salaries, employer contributions for employee pension and
insurance funds, and proprietors’ income);
 dividends, interest, and rent; and
 personal current transfer receipts (e.g., government social benefits such as Social
Security, Medicare, Medicaid, state unemployment insurance).11
As a result of these annual and comprehensive revisions, it is often the case that the value of a
state’s per capita personal income for a given year wil change over time. For example, the 2016
state per capita personal income data published by BEA in September 2017 (used in the
calculation of FY2019 FMAP rates) differed from the 2016 state per capita personal income data
published in September 2019 (used in the calculation of FY2021 FMAP rates).
In addition to these revisions, states’ per capita incomes are adjusted to reflect the population data
from the decennial census, which could affect states’ FMAP rates. BEA uses the Census Bureau’s
population data to calculate states’ per capita incomes. The FY2023 FMAP rates are to be
calculated using the population data from the 2020 census.
The definition of personal income used by BEA is not the same as the definition used for personal
income tax purposes. Among other differences, BEA’s personal income excludes capital gains (or
losses) and includes transfer receipts (e.g., government social benefits), while income for tax
purposes includes capital gains (or losses) and excludes most of these transfers.
Factors That Affect FMAP Rates
Several factors affect states’ FMAP rates. The first is the nature of the state economy and, to the
extent possible, a state’s ability to respond to economic changes (i.e., downturns or upturns). The
impact on a particular state of a national economic downturn or upturn wil be related to the
structure of the state economy and its business sectors. For example, a national decline in
automobile sales, while having an impact on al state economies, wil have a larger impact in
states that manufacture automobiles as production is reduced and workers are laid off.
Second, the FMAP formula relies on per capita personal income in relation to the U.S. average
per capita personal income
. The national economy is basical y the sum of al state economies. As
a result, the national response to an economic change is the sum of the state responses to
economic change. If more states (or larger states) experience an economic decline, the national
economy reflects this decline to some extent. However, the national decline wil be lower than
some states’ declines because the total decline has been offset by states with smal decreases or
even increases (i.e., states with growing economies). The U.S. per capita personal income,
because of this balancing of positive and negative, has only a smal percentage change each year.
Since the FMAP formula compares state changes in per capita personal income (which can have
large changes each year) to the U.S. per capita personal income, this comparison can result in
significant state FMAP rate changes.
In addition to annual revisions of per capita personal income data, comprehensive revisions
undertaken every four to five years may also influence regular FMAP rates (e.g., because of
changes in the definition of personal income). The impact on FMAP rates wil depend on whether
the changes are broad (affecting al states) or more selective (affecting only certain states or
industries).

11 Employer and employee contributions for government social insurance (e.g., Social Security, Medicare,
unemployment insurance) are excluded from personal income, and earnings are counted based on residency (i.e., for
individuals who live in one state and work in another, their income is counted in the state where they reside).
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FY2021 Regular FMAP Rates
Regular FMAP rates for FY2021 (the federal fiscal year that begins on October 1, 2020) were
published December 3, 2019, in the Federal Register.12 In the Appendix A to this report, Table
A-1
shows regular FMAP rates for each of the 50 states and the District of Columbia for FY2016
through FY2021.
Figure 1 shows the state distribution of regular FMAP rates for FY2021. Thirteen states are to
have the statutory minimum FMAP rate of 50.00%, and Mississippi is to have the highest FMAP
rate of 77.76%.

12 Department of Health and Human Services, “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, 2020 T hrough September 30, 2021 ,” 84 Federal Register 66204, December 3, 2019.
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Figure 1. State Distribution of Regular FMAP Rates
(FY2021)

Sources: Department of Health and Human Services, “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, 2020 Through September 30, 2021,” 84 Federal Register 66204,
December 3, 2019.
Note: State-by-state FY2021 regular FMAP rates are listed in Table A-1.
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Medicaid’s Federal Medical Assistance Percentage (FMAP)

As shown in Figure 2, from FY2020 to FY2021, the regular FMAP rates for 37 states are to
change, whereas the regular FMAP rates for the remaining 14 states (including the District of
Columbia) are to remain the same.13
Figure 2. FMAP Rate Changes for States from FY2020 to FY2021

Source: Prepared by the Congressional Research Service (CRS) using FY2020 and FY2021 regular FMAP rates.
Note: Specific FMAP rate changes for each state are listed in Table A-1.
For most of the states experiencing an FMAP rate change from FY2020 to FY2021, the change is
to be less than one percentage point. The regular FMAP rate for 20 states is to increase by as
much as one percentage point, and the FMAP rate for 13 states is to decrease by as much as one
percentage point.
For states with an FMAP rate change from FY2020 to FY2021, four states are to have an FMAP
rate increase of greater than one percentage point. North Dakota is to have the largest FMAP rate
increase of 2.35 percentage points, with the FMAP rate increasing from 50.05% to 52.40%. No
states are to experience an FMAP rate decrease of greater than one percentage point.
The District of Columbia’s FY2021 FMAP rate was not calculated according to the regular
FMAP formula because the FMAP rate for the District of Columbia has been set in statute at 70%
since 1998 for the purposes of Title XIX and XXI of the Social Security Act. However, for other
purposes, the FMAP rate for the District of Columbia is 50%, unless otherwise specified by law.
FMAP Exceptions
Although FMAP rates are general y determined by the formula described above, exceptions to the
regular FMAP rate have been made for certain states, situations, populations, providers, and
services. Some of these exceptions were included in the Social Security Amendments of 1965
(P.L. 89-97), which is the law that enacted the Medicaid program. Other exceptions have been

13 T hirteen of the states with no change to their regular FMAP rates from FY2020 to FY2021 receive the statutory
minimum FMAP rate of 50%, and the regular FMAP rate for the District of Columbia is statutorily set at 70%.
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added over the years. Table 1 lists examples of current exceptions to the FMAP in Medicaid
statute and regulations; past FMAP exceptions are listed in Table B-1. Many of the exceptions to
the FMAP rate are used as a means to incentivize states to cover certain services or populations or
conduct administrative activities. However, general administrative expenditures receive the
lowest federal matching rate for Medicaid of 50%.
Table 1. Current Exceptions to the Regular FMAP Rates for Medicaid
Exception
Description
Citations
Territories and Certain States
Temporary
For part of FY2020 (i.e., December 21, 2019, through
P.L. 116-94; SSA
Increase for
September 30, 2020) and FY2021, the FMAP rates for the
§1905(ff)
Territories
territories are increased from 55% to 83% for American
Samoa, CNMI, Guam, and the U.S. Virgin Islands and from
55% to 76% for Puerto Rico. (For more information about
the FMAP rate for the territories, see CRS In Focus
IF11012, Medicaid Financing for the Territories).
Territories
As of July 1, 2011, FMAP rates for the territories (Puerto
Most recently P.L.
Since July 1,
Rico, American Samoa, CNMI, Guam, and the U.S. Virgin
111-148, as
2011
Islands) were increased from 50% to 55%. Unlike the 50
amended by P.L.
states and the District of Columbia, the territories are
111-152; SSA
subject to federal spending caps. The 55% also applies for
§1905(b), 1108(f)
purposes of computing the E-FMAP rate for CHIP.
and (g)
However, for part of FY2019, FY2020, and FY2021, the
regular FMAP rates for the territories have been increased
temporarily, as discussed above in “Temporary Increase
for Territories” and in Table B-1. (For more information
about the FMAP rate for the territories, see CRS In Focus
IF11012, Medicaid Financing for the Territories).
District of
As of FY1998, the District of Columbia’s FMAP rate is set
P.L. 105-33; SSA
Columbia
at 70% (without this exception, it would be at the
§1905(b)
statutory minimum of 50%). The 70% also applies for
purposes of computing the E-FMAP rate for CHIP.
Special Situations
State Fiscal
A 6.2-percentage-point increase to the FMAP rates for al
P.L. 116-127, as
Relief
states, the District of Columbia, and the territories for
amended by P.L.
each calendar quarter occurring during the COVID-19
116-136 §3720
public health emergency period, beginning the first day of
calendar quarter in which the emergency period began
(i.e., January 1, 2020) and ending on the last day of the
calendar quarter in which the public health emergency
period ends.a States are required to meet certain
requirements to receive the increase. (For more
information about the FMAP increase, see “FMAP Increase
During the COVID-19 Public Health Emergency”
or CRS
Report R46346, Medicaid Recession-Related FMAP Increases).
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Exception
Description
Citations
Adjustment for Beginning in CY2011, a disaster-recovery FMAP
P.L. 111-148, as
Disaster
adjustment is available for states in which (1) during one of
amended by P.L.
Recovery
the preceding seven years, the President declared a major
111-152, P.L. 112-
disaster under the Stafford Act and every county in the
96 P.L, and P.L.
state warranted at least public assistance under that act
112-141; SSA
and (2) the regular FMAP rate declines by a specified
§1905(aa); 75
amount. To trigger the adjustment, a state’s regular FMAP
Federal Register
rate must be at least three percentage points less than
80501 (December
such state’s last year’s regular FMAP rate plus (if
22, 2010)
applicable) any hold harmless increase under P.L. 111-5;
the adjustment is an FMAP rate increase equal to 50% of
the difference between the two. To continue receiving the
adjustment, the state’s regular FMAP rate must be at least
three percentage points less than last year’s adjusted
FMAP rate; the adjustment is an FMAP rate increase equal
to 25% of the difference between the two. Louisiana is the
only state that was eligible for the disaster-recovery
adjusted FMAP from the fourth quarter of FY2011 (when
the adjustment was first available) through FY2014. No
state has met the requirements since FY2014.
Adjustment for As of FY2006, significantly disproportionate employer
P.L. 111-3; 75
Certain
pension and insurance fund contributions wil be excluded
Federal Register
Employer
from the calculation of Medicaid FMAP rates. This wil
63482 (October
Contributions
have the effect of reducing certain states’ per capita
15, 2010)
personal income relative to the national average, which in
turn could increase their Medicaid FMAP rates. Any
identifiable employer contributions towards pensions or
other employee insurance funds are considered to be
significantly disproportionate if the increase in the amount
of employer contributions accrued to residents of a state
exceeds 25% of the total increase in personal income in
that state for the year involved. To date, no state has
qualified for this adjustment.
Certain Populations
COVID-19
During the COVID-19 public health emergency period,a
P.L. 116-127, as
Testing for the
states have the option to extend COVID-19 testing,
amended by P.L.
Uninsured
testing-related state plan services, testing-related visits,
116-136; SSA
and the administration of the testing without cost sharing
§1902(a)(10)(XXIII)
to uninsured individuals under the Medicaid program. For
and (ss).
medical assistance and administrative costs associated with
uninsured individuals who are eligible for Medicaid under
this state option, states receive 100% federal
reimbursement (i.e., ful y federal y funded).
Children with
Beginning October 1, 2022, states have the option to
P.L. 116-16; SSA
Medical y
provide coordinated care through a health home for
§1945A
Complex
children with medical y complex conditions. During the
Conditions
first two fiscal year quarters that the option is in effect,
the FMAP rate is increased by 15 percentage points for
expenditures on the applicable health home services, but
in no case may the FMAP rate exceed 90%.
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Exception
Description
Citations
“Newly
Since January 1, 2014, states have had the option to
P.L. 111-148, as
Eligible”
expand Medicaid coverage to non-elderly, nonpregnant
amended by P.L.
Individuals
adults at or below 133% FPL (i.e., the ACA Medicaid
111-152; SSA
Enrol ed in
expansion). An increased federal matching rate is provided
§1905(y)
New Eligibility
for services rendered to “newly eligible” individuals in this
Group
group. The “newly eligible” are defined as those who
Through 133%
would not have been eligible for Medicaid in the state as of
FPL
December 1, 2009 or were eligible under a waiver but not
enrol ed because of limits or caps on waiver enrol ment.
The federal matching rates for “newly eligible” individuals
equal:
CY2014-CY2016 = 100%; CY2017 = 95%; CY2018 = 94%;
CY2019 = 93%; CY2020+ = 90%.
“Expansion
Prior to the ACA Medicaid expansion, some states
P.L. 111-148, as
State”
provided health coverage for al low-income individuals
amended by P.L.
Individuals
using Medicaid waivers. As a result, these states have few
111-152; SSA
Enrol ed in
or no individuals who qualify for the “newly eligible”
§1905(z)(2)
New Eligibility
federal matching rate. To address this issue, as of CY2014,
Group
an increased federal matching rate is available for
Through 133%
individuals in “expansion states” who were eligible for
FPL
Medicaid as of March 23, 2010 (P.L. 111-148’s enactment
date) in the new eligibility group for non-elderly,
nonpregnant adults at or below 133% FPL. “Expansion
states” are defined as those that, as of March 23, 2010,
offered health benefits coverage meeting certain criteria
statewide to parents and nonpregnant childless adults at
least through 100% FPL. The formula used to calculate
“expansion state” federal matching rates is [regular FMAP
+ (newly eligible federal matching rate – regular FMAP) *
transition percentage equal to 50% in CY2014, 60% in
CY2015, 70% in CY2016, 80% in CY2017, 90% in CY2018,
and 100% in CY2019+]. Since the formula for the
“expansion state” federal matching rate is based on the
regular FMAP rate, the “expansion state” federal matching
rates vary based on a states’ regular FMAP rates until
CY2019, at which point they are to equal the “newly
eligible” federal matching rates:
CY2014 = at least 75%; CY2015 = at least 80%; CY2016 =
at least 85%; CY2017 = at least 86%; CY2018 = at least
90%; CY2019 = 93%; CY2020+ = 90%.
Certain
For states that opt to cover certain women with breast or
P.L. 106-354, as
Women with
cervical cancer who do not qualify for Medicaid under a
amended by P.L.
Breast or
mandatory eligibility pathway and are otherwise uninsured,
107-121; SSA
Cervical
expenditures for these women are reimbursed using the
§1905(b)
Cancer
E-FMAP rate that applies to CHIP.
Qualifying
States are required to pay Medicare Part B premiums for
P.L. 105-33,
Individuals
Medicare beneficiaries with income between 120% and
permanently
Program
135% FPL and limited assets (referred to as “qualifying
extended via P.L.
individuals”), up to a specified dol ar al otment. They
114-10 ; SSA
receive 100% federal reimbursement for these costs,
§1933(d)
which are financed at the federal level by a transfer of
funds from Medicare to Medicaid.
Certain Providers
Indian Health
States receive 100% federal reimbursement for Medicaid
P.L. 94-437; SSA
Service Facility
services provided through an Indian Health Service facility.
§1905(b)
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Exception
Description
Citations
Certain Services
Certified
States receive the E-FMAP rate for services provided to
P.L. 113-93; 42
Community
Medicaid enrol ees who are not newly eligible under the
U.S.C. §1396a
Behavioral
ACA Medicaid expansion provided in a Certified
note.
Health Clinic
Community Behavioral Health Clinic.
Services

Certain
As of CY2013, states that opt to cover—with no cost
P.L. 111-148, as
Preventive
sharing—clinical preventive services recommended with a
amended by P.L.
Services and
grade of A or B by the United States Preventive Services
111-152; SSA
Immunizations
Task Force and adult immunizations recommended by the
§1905(b)
Advisory Committee on Immunization Practices receive a
one percentage point increase in their FMAP rate for
those services.
Smoking
As of CY2013, states that opt to cover USPSTF preventive
P.L. 111-148, as
Cessation for
services and ACIP adult immunizations as noted above
amended by P.L.
Pregnant
also receive a one percentage point increase in their FMAP 111-152; SSA
Women
rate for smoking cessation services that are mandatory for
§1905(b)
pregnant women.
Money Fol ows
States participating in the Money Fol ows the Person
P.L. 109-171; 42
the Person
Demonstration receive an enhanced federal matching rate
U.S.C. §1396a
Rebalancing
for home- and community-based services provided to
note.
Demonstration
support Medicaid enrol ees during their first year in the
community, after residing in an institution for 90
consecutive days or more. Specifical y, states receive a
federal matching rate ranging from 75% to 90%, which is
determined by increasing the regular FMAP rate by half
the state share (i.e., subtract regular FMAP rate from
100% and divide by two). This federal match is limited to
90%.
Family Planning States receive 90% federal reimbursement for family
P.L. 92-603; SSA
planning services and supplies.
§1903(a)(5)
Health Homes
As of CY2011, states have an option for providing “health
P.L. 111-148, as
home” and associated services to certain individuals with
amended by P.L.
chronic conditions. They receive 90% federal
111-152; SSA
reimbursement for these services for the first eight
§1945(c)(1)
quarters that the health home option is in effect in the
state.
Community
As of FY2011, states have an option for providing home
P.L. 111-148, as
First Choice
and community-based attendant services and supports for
amended by P.L.
Option
certain individuals at or below 150% FPL, or a higher
111-152; SSA
income level applicable to those who require an
§1915(k)(2)
institutional level of care. They receive a six percentage
point increase in their regular FMAP rate for these
services.
Administrative Activities
Electronic Visit
States receive 90% federal matching rate for the design,
P.L. 114-255; SSA
Verification
development, or instal ation of electronic visit verification
§1903(l)(6)(A)
System
systems for personal care and home health care services.
States receive 75% federal matching rate for the operation
and maintenance of these systems.
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Exception
Description
Citations
Prescription
For FY2019 and FY2020, states receive 100% federal
P.L. 115-271; SSA
Drug
matching rate (i.e., ful y federal y funded) for the design,
§1944(f)
Monitoring
development, or implementation of prescription drug
Programs
monitoring programs. To receive this increased federal
matching rate, states must have prescription drug
monitoring programs information-sharing agreements with
contiguous states.
Health
States receive 100% federal matching rate (i.e., ful y
P.L. 111-5; SSA
Information
federal y funded) for incentive payments to eligible
§1903(a)(3)(F)
Technology
Medicaid providers to adopt, implement, upgrade, and
meaningful y use certified EHR technology through 2021,
and states receive 90% federal matching rate for
administrative expenses related to the program.
Training of
States receive 75% federal matching rate for costs
P.L. 89-97; SSA
Medical
attributable to compensation or training of skil ed
§1903(a)(2)(A)&(B)
Personnel
professional medical personnel, and staff directly
supporting such personnel.
Citizenship
States receive 90% federal matching rate for the design,
P.L. 111-3; SSA
Verification
development, or instal ation of citizenship verification
§1903(a)(3)(H)
System
systems. States receive 75% federal matching rate for the
operation of these systems.
Immigration
States receive 100% federal reimbursement for the cost of
P.L. 99-603; SSA
Verification
implementation and operation of an immigration status
§1903(a)(4)
System
verification system.
Fraud Control
States receive 75% federal matching rate for state
P.L. 95-142; SSA
Unit
expenditures related to the operation of a state Medicaid
§1903(a)(6)
fraud control unit.
Preadmission
State expenditures attributable to preadmission screening
P.L. 100-203; SSA
Screening
and resident review for individuals with mental il ness or
§1903(a)(2)(C)
mental retardation who are admitted to a nursing facility
receive 75% federal matching rate.
Survey and
States receive 75% federal matching rate for state
P.L. 100-203; SSA
Certification
expenditures related to survey and certification of nursing
§1903(a)(2)(D)
facilities.
Managed Care
States receive 75% federal matching rate for state
P.L. 97-35; SSA
Review
expenditures related to performance of medical and
§1903(a)(3)(C)
Activities
utilization review activities or external independent review
of managed care activities.
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Exception
Description
Citations
Claims and
States receive 90% federal matching rate for the design,
P.L. 92-603; SSA
Eligibility
development, or instal ation of mechanized claims systems
§1903(a)(3)(A) and
Systems
and 75% federal matching rate for operating mechanized
(B); 80 Federal
claims systems. Both federal reimbursement percentages
Register 75819
are subject to certain criteria set by the Secretary of HHS,
(December 4,
which includes whether the activity is likely to provide
2015)
more efficient, economical, and effective administration of
claims processing. CMS published a final rule to
permanently amend the definition of Mechanized Claims
Processing and Information Retrieval systems to include
systems used for eligibility determination, enrol ment, and
eligibility reporting activities thereby making the 90%
federal matching rate available for the design, development
and instal ation or enhancement of eligibility determination
systems, and 75% federal matching rate for maintenance
and operations available for such systems.
Translation or
Administrative expenditures for translation or
P.L. 111-3; SSA
Interpretation
interpretation services in connection with the “enrol ment
§1903(a)(2)(E);
Services
of, retention of, and use of services” under Medicaid
State Medicaid
receive 75% federal matching rate. For CHIP, the
Director Letter,
increased match is 75%, or the state’s E-FMAP rate plus 5
State Health
percentage points, whichever is higher, and the CHIP
Official 10-007,
increased match is subject to the 10% cap on
CHIPRA 18, July 1,
administrative expenditures. The increased federal
2010.
matching rate for translation or interpretation services is
only available for eligible expenditures claimed as
administrative and not expenditures claimed as medical
assistance-related (which receive each state’s regular
FMAP rate).
General
Remaining state expenditures found necessary for proper
P.L. 89-97; SSA
Administration
and efficient administration of the state plan receive a 50%
§1903(a)(7)
federal matching rate.
Source: CRS, based on sources noted in the table.
Notes: Unless noted, exceptions do not apply for purposes of computing the E-FMAP rate for CHIP. ACA =
Patient Protection and Affordable Care Act (P.L. 111-148, as amended); CHIP = Children’s Health Insurance
Program; CHIPRA = Children’s Health Insurance Program Reauthorization Act (); CNMI = Commonwealth of
the Northern Mariana Islands; COVID-19 = Coronavirus Disease 2019; E-FMAP = enhanced federal medical
assistance percentage; EHR = electronic health record; FMAP = federal medical assistance percentage; FPL =
federal poverty level; SPA = state plan amendment; SSA = Social Security Act.
a. The public health emergency period is defined in paragraph (1)(B) of §1135(g) of the SSA as a public health
emergency declared by the Secretary of the Department of Health and Human Services (HHS) pursuant to
§319 of the Public Health Service Act. This refers to the public health emergency declared by the HHS
Secretary on January 31, 2020, with respect to the COVID-19 outbreak. An emergency determination
under §319 of the Public Health Service Act terminates after 90 days, unless terminated earlier by the HHS
Secretary, and is renewable for additional 90-day periods.
Reduction to Regular FMAP Rates
While many FMAP exceptions are used to incentivize states, the FMAP rate also can be used as a
means to penalize states through a reduction to the FMAP rate. There are FMAP reductions for
the territories, electronic visit verification systems, and asset verification programs.
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Medicaid’s Federal Medical Assistance Percentage (FMAP)

Territories
The FMAP rates for the territories could be reduced if the territories do not comply with certain
program integrity requirements. Puerto Rico’s FMAP reduction is different than the FMAP
reduction for American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and
the U.S. Virgin Islands.
American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S.
Virgin Islands are required to designate a program integrity lead by October 1, 2020. Starting in
FY2021, the FMAP rate for these four territories could be reduced if a program integrity lead has
not been designated. Specifical y, for each fiscal quarter in FY2021, the FMAP rate for a territory
without a program integrity lead could be reduced by 0.25 percentage points multiplied by the
total number of consecutive fiscal quarters the territory has not designated a program integrity
lead, not to exceed 5 percentage points.14
Puerto Rico also is required to designate a program integrity lead, but by June 20, 2020, instead
of by October 1, 2020. Puerto Rico has the following additional program integrity requirements:
(1) publish a plan to develop measures to satisfy the payment error rate measurement
requirements by June 20, 2021; (2) publish a contracting reform plan to combat fraudulent,
wasteful, or abusive Medicaid contracts by December 20, 2020; and (3) publish a plan to comply
with the Medicaid eligibility quality control requirements by June 20, 2021.
Starting January 1, 2020, through September 30, 2021, for each of the four program integrity
requirements (including requirements imposed under the terms of each plan) that Puerto Rico is
out of compliance, Puerto Rico’s FMAP rate is reduced by 0.25 percentage points multiplied by
the total number of consecutive fiscal quarters Puerto Rico has not been in compliance with the
requirement, not to exceed 2.5 percentage points.15 For Puerto Rico, there is an exception to the
FMAP reduction for extenuating circumstances that prevent Puerto Rico from satisfying the
requirements or if Puerto Rico has made reasonable progress toward satisfying the requirements.
Electronic Visit Verification Systems
For personal care services or home health care services requiring an in-home visit by a provider,
states’ FMAP rates are reduced for those services if the states do not have an electronic visit
verification system. For personal care services, the FMAP reductions could start in CY2020; for
home health care services, the FMAP reductions could start in CY2023. The FMAP reductions
could be 0.25 percentage points in the first year the reductions are in effect, 0.5 percentage points
for the second year, 0.75 percentage points for the third year, and 1 percentage point for
subsequent years.16
Asset Verification Programs
Section 1940 of the Social Security Act requires that states verify assets of individuals applying
for the aged, blind, or disabled Medicaid eligibility pathways using the states’ asset verification
programs. For states without an asset verification program, starting January 1, 2021, the regular
FMAP rate for the state could be reduced by

14 P.L. 116-94 §201; SSA §1108(g)(8)(B).
15 P.L. 116-94 §201; SSA §1108(g)(7)(B).
16 P.L. 114-255 §12006; SSA §1903(l)(6)(A).
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 0.12 percentage points for calendar quarters in 2021 and 2022;
 0.25 percentage points for calendar quarters in 2023;
 0.35 percentage points for calendar quarters in 2024; and
 0.50 percentage points for calendar quarters in 2025 and each year thereafter.17
FMAP Increase During the COVID-19 Public Health
Emergency
Since March 2020, various states’ stay-at-home orders due to COVID-19 have affected the
economy and led to massive layoffs, furloughs, and surges in unemployment claims. The job
losses have affected the Medicaid program because Medicaid is a countercyclical program, which
means the rate of growth for Medicaid enrollment tends to accelerate when the economy weakens
and tends to slow when the economy gains strength.
During recessions, growth in the unemployment rate results in an increase in the rate of growth
for Medicaid enrollment, which increases the rate of growth for Medicaid expenditures at the
same time that state revenues decline. Reduced state revenues can make it difficult for states to
continue financing their Medicaid programs, especial y with the recession-related growth in
Medicaid enrollment.
Federal fiscal relief to states is provided during recessions through adjustments to the FMAP rate,
because this process for getting federal Medicaid funding to states is already in place. In the past,
two temporary FMAP increases provided states with fiscal relief due to recessions through the
Jobs and Growth Tax Relief Reconciliation Act of 2003 (P.L. 108-27) and the American Recovery
and Reinvestment Act of 2009 (P.L. 111-5). To be eligible for these temporary FMAP increases,
states had to meet certain conditions.18
In response to the economic impact of the COVID-19 public health emergency, the Family First
Coronavirus Response Act (FFCRA; P.L. 116-127) provides a 6.2-percentage-point increase to
the FMAP rates for al states, the District of Columbia, and the territories, beginning on the first
day of the calendar quarter in which the COVID-19 public health emergency period began (i.e.,
January 1, 2020) and ending on the last day of the calendar quarter in which the COVID-19
public health emergency period ends.19
To receive this increased FMAP rate, states, the District of Columbia, and the territories are
required to (1) ensure their Medicaid “eligibility standards, methodologies, and procedures” are
no more restrictive than those that were in effect on January 1, 2020;20 (2) not impose premiums

17 P.L. 116-3 §4; SSA §1940(k)
18 For more information about these FMAP increases, see CRS Report R46346, Medicaid Recession-Related FMAP
Increases
.
19 T he public health emergency period is defined in paragraph (1)(B) of §1135(g) of the SSA as a public health
emergency declared by the Secretary of the Department of Health and Human Services (HHS) pursuant to §319 of the
Public Healt h Service Act. T his refers to the public health emergency declared by the HHS Secretary on January 31,
2020, with respect to the Coronavirus Disease 2019 (COVID-19) outbreak. An emergency determination under §319 of
the Public Health Service Act terminates after 90 days, unless terminated earlier by the HHS Secretary, and is
renewable for additional 90-day periods.
20 A similar provision was in place prior to the Family First Coronavirus Response Act (FFCRA; P.L. 116-127) for
Medicaid and CHIP children. Under SSA §1902(gg)(2) and SSA §2105(d)(3), states are required to maintain the
Medicaid and CHIP eligibility standards, methodologies, and procedures for children in place on the date of enactment
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Medicaid’s Federal Medical Assistance Percentage (FMAP)

exceeding the amounts in place as of January 1, 2020;21 (3) provide continuous coverage of
Medicaid enrollees during the COVID-19 public health emergency period;22 and (4) provide
coverage (without the imposition of cost sharing) for testing services and treatments for COVID–
19 (including vaccines, specialized equipment, and therapies).
Another condition to receive the FFCRA FMAP increase is that states, the District of Columbia,
and the territories cannot require local governments to fund a larger percentage of the state’s
nonfederal Medicaid expenditures for the Medicaid state plan or Medicaid DSH payments than
what was required on March 11, 2020.23
The FFCRA FMAP increase does not apply to most FMAP exceptions, including the FMAP
exceptions for the ACA Medicaid expansion, family planning, and home health services.
However, the FFCRA FMAP increase does apply to a few FMAP exceptions, such as the FMAP
exceptions for the Community First Choice option, individuals eligible on the basis of breast and
cervical cancer, Certified Community Behavioral Health Clinics, and Money Follows the
Person.24
Conclusion
The FMAP rate is used to reimburse states for the federal share of most Medicaid expenditures. In
FY2021, 13 states are to have the statutory minimum FMAP rate of 50% and Mississippi is to
have the highest FMAP rate of 77.76%. From FY2020 to FY2021, the regular FMAP rates for 37
states are to change, whereas the regular FMAP rates for the remaining 14 states (including the
District of Columbia) are to remain the same.
These regular FMAP rates for states, the District of Columbia, and the territories are temporarily
increased by 6.2 percentage points to provide some fiscal relief to states during the COVID-19
public health emergency period. The Congressional Budget Office estimates the FFCRA FMAP
increase wil increase federal expenditures by about $50.0 bil ion from FY2020 to FY2022.25
However, the amount of the increase in federal expenditures depends on the length of the
COVID-19 public health emergency period and states’ actual expenditures.


of the Patient Protection and Affordable Care Act (P.L. 111-148) through FY2027. T he penalty for states’
noncompliance with eit her the Medicaid or the CHIP maintenance of effort requirements for children would be the loss
of all federal Medicaid funds.
21 §3720 of the Coronavirus Aid, Relief, and Economic Security Act (P.L. 116-136) delays the application of the
premium requirement until 30 days after March 18, 2020 (i.e., the date of enactment for FFCRA).
22 Specifically, the continuous coverage requirement means that to receive the increased FMAP rate, states need to
maintain Medicaid eligibility for individuals enrolled in Medicaid on the date of enactment (i.e., March 18, 2020) or for
individuals who enroll during the public health emergency period through the end of the month in which the public
health emergency period ends (unless the individual requests a voluntary termination of eligibility or the individual
ceases to be a resident of the state).
23 See CRS In Focus IF10422, Medicaid Disproportionate Share Hospital (DSH) Reductions.
24 Center for Medicare & Medicaid Services, F”amilies First Coronavirus Response Act (FFCRA), P.L. 116-127
Coronavirus Aid, Relief, and Economic Security (CARES) Act, P.L. 116-136 Frequently Asked Questions (FAQs),”
April 13, 2020, at https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-CARES-
faqs.pdf..
25 Congressional Budget Office, H.R. 6201, Families First Coronavirus Response Act, April 2, 2020, at
https://www.cbo.gov/system/files/2020-04/HR6201.pdf.
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Appendix A. FMAP Rates for Medicaid, by State
Table A-1
shows regular FY2016-FY2021 FMAP rates calculated according to the formula
described in the text of the report (see “How FMAP Rates Are Calculated”). In FY2021, FMAP
rates range from 50% (13 states) to 77.76% (Mississippi). From FY2020 to FY2021, regular
FMAP rates are to decrease for 13 states, increase for 24 states, and remain the same for 14 states
(including the District of Columbia). Most of the states (13 states) for which the FMAP rates do
not change have the statutory minimum FMAP rate of 50%, and the FMAP rate for the District of
Columbia is statutorily set at 70%.
Table A-1. Regular FMAP Rates, by State, FY2016-FY2021
Change
FY2020 to
State
FY2016
FY2017
FY2018
FY2019
FY2020
FY2021
FY2021
Alabama
69.87
70.16
71.44
71.88
71.97
72.58
0.61
Alaska
50.00
50.00
50.00
50.00
50.00
50.00
0.00
Arizona
68.92
69.24
69.89
69.81
70.02
70.01
-0.01
Arkansas
70.00
69.69
70.87
70.51
71.42
71.23
-0.19
California
50.00
50.00
50.00
50.00
50.00
50.00
0.00
Colorado
50.72
50.02
50.00
50.00
50.00
50.00
0.00
Connecticut
50.00
50.00
50.00
50.00
50.00
50.00
0.00
Delaware
54.83
54.20
56.43
57.55
57.86
57.74
-0.12
District of Columbiaa
70.00
70.00
70.00
70.00
70.00
70.00
0.00
Florida
60.67
61.10
61.79
60.87
61.47
61.96
0.49
Georgia
67.55
67.89
68.50
67.62
67.30
67.03
-0.27
Hawai
53.98
54.93
54.78
53.92
53.47
53.02
-0.45
Idaho
71.24
71.51
71.17
71.13
70.34
70.41
0.07
Il inois
50.89
51.30
50.74
50.31
50.14
50.96
0.82
Indiana
66.60
66.74
65.59
65.96
65.84
65.83
-0.01
Iowa
54.91
56.74
58.48
59.93
61.20
61.75
0.55
Kansas
55.96
56.21
54.74
57.10
59.16
59.68
0.52
Kentucky
70.32
70.46
71.17
71.67
71.82
72.05
0.23
Louisiana
62.21
62.28
63.69
65.00
66.86
67.42
0.56
Maine
62.67
64.38
64.34
64.52
63.80
63.69
-0.11
Maryland
50.00
50.00
50.00
50.00
50.00
50.00
0.00
Massachusetts
50.00
50.00
50.00
50.00
50.00
50.00
0.00
Michigan
65.60
65.15
64.78
64.45
64.06
64.08
0.02
Minnesota
50.00
50.00
50.00
50.00
50.00
50.00
0.00
Mississippi
74.17
74.63
75.65
76.39
76.98
77.76
0.78
Missouri
63.28
63.21
64.61
65.40
65.65
64.96
-0.69
Montana
65.24
65.56
65.38
65.54
64.78
65.60
0.82
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Medicaid’s Federal Medical Assistance Percentage (FMAP)

Change
FY2020 to
State
FY2016
FY2017
FY2018
FY2019
FY2020
FY2021
FY2021
Nebraska
51.16
51.85
52.55
52.58
54.72
56.47
1.75
Nevada
64.93
64.67
65.75
64.87
63.93
63.30
-0.63
New Hampshire
50.00
50.00
50.00
50.00
50.00
50.00
0.00
New Jersey
50.00
50.00
50.00
50.00
50.00
50.00
0.00
New Mexico
70.37
71.13
72.16
72.26
72.71
73.46
0.75
New York
50.00
50.00
50.00
50.00
50.00
50.00
0.00
North Carolina
66.24
66.88
67.61
67.16
67.03
67.40
0.37
North Dakota
50.00
50.00
50.00
50.00
50.05
52.40
2.35
Ohio
62.47
62.32
62.78
63.09
63.02
63.63
0.61
Oklahoma
60.99
59.94
58.57
62.38
66.02
67.99
1.97
Oregon
64.38
64.47
63.62
62.56
61.23
60.84
-0.39
Pennsylvania
52.01
51.78
51.82
52.25
52.25
52.20
-0.05
Rhode Island
50.42
51.02
51.45
52.57
52.95
54.09
1.14
South Carolina
71.08
71.30
71.58
71.22
70.70
70.63
-0.07
South Dakota
51.61
54.94
55.34
56.71
57.62
58.28
0.66
Tennessee
65.05
64.96
65.82
65.87
65.21
66.10
0.89
Texas
57.13
56.18
56.88
58.19
60.89
61.81
0.92
Utah
70.24
69.90
70.26
69.71
68.19
67.52
-0.67
Vermont
53.90
54.46
53.47
53.89
53.86
54.57
0.71
Virginia
50.00
50.00
50.00
50.00
50.00
50.00
0.00
Washington
50.00
50.00
50.00
50.00
50.00
50.00
0.00
West Virginia
71.42
71.80
73.24
74.34
74.94
74.99
0.05
Wisconsin
58.23
58.51
58.77
59.37
59.36
59.37
0.01
Wyoming
50.00
50.00
50.00
50.00
50.00
50.00
0.00
Number with
increase from
22
25
25
23
19
24

previous year
Number stayed the
same from previous
12
13
13
14
15
14

year
Number with
decrease from
16
12
12
13
17
13

previous year
Source: Department of Health and Human Services, Annual Federal Register Notices.
Notes: Reflects FMAP rates calculated using the regular FMAP formula, with exceptions noted below.
a. Section 4725(b) of the Balanced Budget Act of 1997 amended Section 1905(b) to provide that the FMAP
rate for the District of Columbia shal be set at 70% for purposes of titles XIX and XXI and for capitation
payments and DSH al otments under those titles. For other purposes, the percentage for the District of
Columbia is 50%, unless otherwise specified by law.

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Appendix B. Past FMAP Rate Exceptions
Although FMAP rates are general y determined by the statutory formula described above, Table 1
lists current exceptions that have been added to the Medicaid statute and regulations over the
years, and Table B-1 lists past FMAP exceptions.
Table B-1. Past Exceptions to the Regular FMAP Rates for Medicaid
Exception
Description
Citations
Territories and Certain States
Territories
For November 22, 2019, through December 20, 2019, the FMAP
P.L. 116-69 §1302;
rate for the territories was increased from 55% to 100% (i.e., ful y
SSA §1905(ff)
federal y funded) for al territories. (For more information about the
FMAP rate for the territories, see CRS In Focus IF11012, Medicaid
Financing for the Territories
).
Territories
For October 1, 2019, through November 21, 2019, the FMAP rate
P.L. 116-59 §1302;
for the territories was increased from 55% to 100% (i.e., ful y
SSA §1905(ff)
federal y funded) for al territories. (For more information about the
FMAP rate for the territories, see CRS In Focus IF11012, Medicaid
Financing for the Territories
).
Territories
For the period of January 1, 2019, through September 30, 2019,
P.L. 116-20 §802;
CNMI received an additional $36 mil ion in federal Medicaid funding; SSA §1108(g)(5)
for this additional funding, the FMAP rate was increased from 55% to
100%.
Increased the FMAP rate from 55% to 100% for American Samoa
and Guam for the territories’ share of additional Medicaid federal
funding provided in the ACA that was available through September
30, 2019.
Territories
For the period of January 1, 2018, through September 30, 2019,
P.L. 115-123
Puerto Rico and the U.S. Virgin Islands received additional federal
§20301; SSA
Medicaid funding. The FMAP rate was increased from 55% to 100%
§1108(g)(5)
for this additional federal Medicaid funding.
Alaska
Alaska’s FMAP rate was set in statute for FY1998-FY2000 at 59.80%; P.L. 105-33
used an alternative formula for FY2001-FY2005 that reduced the
§4725(a); P.L. 106-
state’s per capita income by 5% (thereby increasing its FMAP rate);
554 Appendix F
and was held at its FY2005 level for FY2006-FY2007. These
§706; P.L. 109-171
provisions also applied for purposes of computing the E-FMAP rate
§6053(a)
for CHIP.
Special Situations
State Fiscal Relief,
FMAP rates were increased from the first quarter of FY2009
P.L. 111-5 §5001, as
FY2009-FY2011
through the third quarter of FY2011, providing states with more
amended by P.L.
than $100 bil ion (about $84 bil ion for the original provision and
111-226 §201
$16 bil ion for a six-month extension) in additional funds. Al states
received a hold harmless to prevent any decline in regular FMAP
rates and an across-the-board increase of 6.2 percentage points until
the last two quarters of the period, at which point the across-the-
board percentage point increase phased down to 3.2 and then 1.2;
qualifying states received an additional unemployment-related
increase. Each territory could choose between an FMAP increase of
6.2 percentage points along with a 15% increase in its spending cap,
or its regular FMAP rate along with a 30% increase in its cap; al
chose the latter. States were required to meet certain requirements
in order to receive the increase. (For more information about the
FMAP increase, see CRS Report R46346, Medicaid Recession-Related
FMAP Increases
).
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Medicaid’s Federal Medical Assistance Percentage (FMAP)

Exception
Description
Citations
Adjustment for
In computing FMAP rates for any year after 2006 for a state that the
P.L. 109-171; 72
Hurricane Katrina
Secretary of HHS determines has a significant number of Hurricane
Federal Register
Katrina evacuees as of October 1, 2005, the Secretary must
3391 (January 25,
disregard such evacuees and their incomes. Although it was labeled
2007) and 44146
as a “hold harmless for Katrina impact,” the provision language
(August 7, 2007)
required evacuees to be disregarded even if their inclusion would
increase a state’s FMAP rate. Due to lags in the availability of data
used to calculate FMAP rates, FY2008 was the first year to which
the provision applied. HHS proposed and finalized a methodology
that prevented the lowering of any FY2008 FMAP rates and
increased the FY2008 FMAP rate for one state (Texas). The
methodology took advantage of a data timing issue that does not
apply after FY2008. HHS had initial y expressed concern that some
states could see lower FMAP rates in later years as a result of the
provision, but the final methodology indicated that there is no
reliable way to track the number and income of evacuees on an
ongoing basis and therefore no basis for adjusting FMAP rates after
FY2008. The provision also applied for purposes of computing the
enhanced FMAP rate for CHIP.
State Fiscal Relief,
FMAP rates for the last two quarters of FY2003 and the first three
P.L. 108-27 §401(a)
FY2003-FY2004
quarters of FY2004 were not al owed to decline (i.e., were held
harmless) and were increased by an additional 2.95 percentage
points, providing states with about $10 bil ion in additional funds
(they also received $10 bil ion in direct grants). Although Medicaid
disproportionate share hospital (DSH) payments are reimbursed
using the FMAP rate, the increase did not apply to DSH. States had
to meet certain requirements in order to receive an increase (e.g.,
they could not restrict eligibility after a specified date). (For more
information about the FMAP increase, see CRS Report R46346,
Medicaid Recession-Related FMAP Increases).
Certain Populations
Certain “Expansion
During CY2014 and CY2015, an FMAP rate increase of 2.2
P.L. 111-148, as
States”
percentage points was available for “expansion states” that (1) the
amended by P.L.
Secretary of HHS determines did not receive any federal matching
111-152; SSA
rate increase for “newly eligible” individuals and (2) had not been
§1905(z)(1)
approved to divert Medicaid disproportionate share hospital funds
to pay for the cost of health coverage under a waiver in effect as of
July 2009. The FMAP rate increase applied to those who are not
“newly eligible” individuals as described in relation to the new
eligibility group for non-elderly, nonpregnant adults at or below
133% FPL.
Certain Providers
Primary Care
During CY2013 and CY2014, states were required to provide
P.L. 111-148, as
Payment Rates
Medicaid payments at or above the Medicare rates for primary care
amended by P.L.
services (defined as evaluation and management and certain
111-152; SSA
administration of immunizations) furnished by a physician with a
§1902(a)(13)(C); 77
primary specialty designation of family, general internal, or pediatric
Federal Register
medicine. States received 100% federal reimbursement for
66670.
expenditures attributable to the amount by which Medicare
exceeded their Medicaid payment rates in effect on July 1, 2009.
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Medicaid’s Federal Medical Assistance Percentage (FMAP)

Certain Services
State Balancing
During FY2011-FY2015, state balancing incentive payments were
P.L. 111-148, as
Incentive Payments
available under certain conditions for states in which less than 50%
amended by P.L.
of Medicaid expenditures for long-term services and supports (LTSS) 111-152, §10202
were noninstitutional. Qualifying states with less than 25%
noninstitutional LTSS had to plan to achieve a 25% target to receive
a five percentage point increase in their FMAP rate for
noninstitutional LTSS; those with less than 50% had to plan to
achieve a 50% target to receive a two percentage point increase.
Federal spending on these increased FMAP rates was limited to $3
bil ion during the period.
Source: Congressional Research Service, based on sources noted in table.
Notes: ACA = Patient Protection and Affordable Care Act (P.L. 111-148 as amended); CNMI = Commonwealth
of the Northern Mariana Islands; DSH = disproportionate share hospital; FMAP = federal medical assistance
percentage; FPL = federal poverty level.

Author Information

Alison Mitchell

Specialist in Health Care Financing





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Congressional Research Service
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