Medicaid: The Federal Medical Assistance Percentage (FMAP)

^Pr^ep^ar^{ed f}^o^r^M^e^m^b^ers^an^d^Com^mⁱ^t^t^ees^of^C^ong^r^e^ss

Medicaid is a health insurance program jointly funded by the federal government and the states.
Generally, eligibility for Medicaid is limited to low-income children, pregnant women, parents of
dependent children, the elderly, and people with disabilities. The federal government’s share of a
state’s expenditures for most Medicaid services is called the federal medical assistance percentage
(FMAP).
Determined annually, the FMAP is designed so that the federal government pays a larger portion
of Medicaid costs in states with lower per capita income relative to the national average (and vice
versa for states with higher per capita incomes). For FY2008, FMAPs range from 50.00% to

76.29%. For FY2009, FMAPs range from 50.00% to 75.84%.

In recent years, the fiscal situation of the states has focused attention on Medicaid expenditures, ^th
as well as on changes in the federal share, or FMAP. In the 108 Congress, the Jobs and Growth
Tax Relief Reconciliation Act of 2003 (JGTRRA, P.L. 108-27) provided temporary fiscal relief
for states and local governments through a combination of FMAP increases and direct grants. In ^th
the 109 Congress, provisions to exclude certain Hurricane Katrina evacuees and their incomes
from FMAP calculations and prevent Alaska’s FY2006-FY2007 FMAPs from decreasing were
included in the Deficit Reduction Act of 2005 (P.L. 109-171).
In the 110^th Congress, a number of bills that would affect FMAPs have been introduced. Most
recently, debate has focused on the downturn in the U.S. economy and whether FMAP increases
should be included as part of a stimulus package. Stimulus bills containing a temporary increase
failed a motion to proceed in the Senate (S. 3604) and passed the House (H.R. 7110) in
September, and another was introduced in November (S. 3689). Over 10 years, the bills would
increase federal Medicaid spending by an estimated $19.6 billion, $14.7 billion, and $37.8 billion,
respectively. Additional legislation that would provide a temporary Medicaid FMAP increase was
introduced earlier in 2008 (S. 2586, H.R. 5268, S. 2620, S. 2819).
This report will be updated periodically.

Introduc tion ..................................................................................................................................... 1
The Federal Medical Assistance Percentage...................................................................................1
How FMAPs Are Calculated.....................................................................................................1
Statutory Exceptions.................................................................................................................4
Data Used to Calculate State FMAPs.......................................................................................5
Factors That Influence FMAPs.................................................................................................6
Recent Issues and Legislation.........................................................................................................7
Figure A-1. Largest Increase, Largest Decrease, and Average Change in State FMAPs,
FY1990-FY1991 to FY2005-FY2006........................................................................................12
Figure A-2. Median State FMAP, FY1990-FY2006......................................................................18
Table 1. FY2003-FY2010 FMAPs, by State...................................................................................2
Table A-1. Change in State FMAPs, FY1990-FY1991 to FY1997-FY1998.................................13
Table A-2. Change in State FMAPs, FY1998-FY1999 to FY2005-FY2006.................................15
Appendix. The Change in FMAPs Between FY2005 and FY2006...............................................10
Author Contact Information..........................................................................................................19

Medicaid is a health insurance program jointly funded by the federal government and the states.
Although states have considerable flexibility to design and administer their Medicaid programs,
certain groups of individuals must be covered for certain categories of services. Generally,
eligibility is limited to low-income children, pregnant women, parents of dependent children, the
elderly, and people with disabilities. The federal government’s share of Medicaid costs for most
services is determined by a formula established in statute; states must contribute the remaining ¹
portion of costs in order to qualify for federal funds.

The federal government’s share of most Medicaid service costs is determined by the federal
medical assistance percentage (FMAP), which varies by state and is determined by a formula set ²
in statute. Certain Medicaid services receive a higher federal match, including those provided
through an Indian Health Service facility, to certain women with breast or cervical cancer, for
family planning, or under the Qualifying Individuals program that pays Medicare Part B
premiums on behalf of certain Medicaid beneficiaries. For Medicaid administrative costs, the ³
federal share does not vary by state, and is generally 50%.
An enhanced FMAP—not discussed in this report—is provided for both services and
administration under the State Children’s Health Insurance Program (SCHIP), subject to the
availability of funds from a state’s federal allotment for SCHIP. When a state expands its
Medicaid program using SCHIP funds, the enhanced FMAP applies and is paid out of the state’s
federal allotment until it is exhausted, at which point the regular FMAP applies and is paid out of ⁴
federal Medicaid funds.
The FMAP formula compares each state’s per capita income relative to U.S. per capita income,
and 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 formula for a given state is:
FMAP^st^at^e = 1 - ( (Per capita income^st^at^e)²/(Per capita income^U.^S^.)² x 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 of 55% (i.e., state share of 45%). In addition, the

¹^For^a^br^oa^de^r^ov^e^r^vⁱ^ew^of^fⁱ^na^nc^ing^is^s^u^e^s^{, s}^e^e^C^R^S^R^e^por^{t R}^S²²⁸⁴⁹^,^M^e^dic^aⁱ^d^Fi^na^ncⁱⁿ^g^,^b^y^Ap^rⁱ^l^Gr^a^d^y.
²^T^h^{e F}^M^A^Pⁱ^s^al^so^u^s^edⁱⁿ^d^e^t^e^rmⁱⁿⁱⁿ^{g t}^h^{e f}^e^d^e^ral^sh^{are o}^f^cert^aⁱⁿ^chⁱ^l^d^sup^p^o^r^t^en^f^o^rcem^en^t^co^l^l^ectⁱ^oⁿ^s^,^T^e^m^p^o^r^ar^y
^A^s^sⁱ^s^t^aⁿ^c^e^f^o^{r N}^e^e^d^y^Fam^ilie^s^(TA^N^{F) c}^onting^e^nc^y^f^unds^{, a}^p^o^rti^o^{n of}^the^C^h^ild^Ca^re^a^{nd D}^e^v^e^lop^m^eⁿ^{t Fu}^nd
^(CCD^{F), a}ⁿ^d^f^o^s^t^e^r^c^a^r^e^a^{nd a}^d^o^p^tion^a^s^sⁱ^s^t^aⁿ^c^e^unde^{r T}^itle^I^V^-E^o^f^the^Socⁱ^a^l^Se^c^u^rity^A^c^t.
³^Se^e^C^R^S^R^e^por^{t R}^S²²¹⁰^1,^S^t^a^t^e^Medⁱ^caⁱ^d^P^r^og^ra^m^A^d^miⁿⁱ^st^ra^tⁱ^on^{: A}^B^rⁱ^e^f^Overvi^ew^,^b^y^Ap^rⁱ^l^Gr^a^d^y.
⁴^Se^e^C^R^S^R^e^por^{t R}^L³⁰⁴⁷³^,^St^a^t^e^Chⁱ^l^d^ren^’^{s Heal}^t^h^In^su^r^aⁿ^{ce P}^r^og^ra^{m (}^S^CHIP^{): A}^B^rⁱ^e^f^Overvi^ew^{, by}^Elic^ia^J^.^H^e^rz^,
^Ch^ri^{s L}^.^P^e^t^e^rsoⁿ^,^an^{d E}^v^el^yⁿ^{e P}^.^Bau^m^ru^cker.

formula’s squaring of income provides higher FMAPs to states with below-average incomes than ⁵
they would otherwise receive (and vice versa).
The Department of Health and Human Services (HHS) usually publishes FMAPs for an
upcoming fiscal year in the Federal Register in the preceding November. Thus, FMAPs for
FY2008 (the federal fiscal year that began on October 1, 2007) were calculated and published in
2006, and FMAPs for FY2009 were calculated and published in 2007. This time lag between
announcement and implementation provides an opportunity for states to adjust to FMAP changes,
but it also means that the per capita income amounts used to calculate FMAPs for a given fiscal
year are several years old by the time the FMAPs take effect.
Table 1 shows the FMAP for each state, the District of Columbia, and the territories for FY2003-
FY2009. It also shows the number of states with an FMAP decrease from the previous year,
which will fluctuate for reasons described in the Appendix at the end of this report.
Table 1. FY2003-FY2010 FMAPs, by State
^FY03^FY03^FY04^FY04
^{first 2}^{last 2}^{first 3}^last
^State^quarters^quarters^a^quarters^a^{quarter FY05}^FY06^FY07^FY08^FY09^FY10
^Alabama^70.6^{0 73.5}^{5 73.7}⁰^70.7⁵^70.8³^69.5¹^68.8⁵^67.6²^67.9⁸^68.0¹
^Alaska^b^58.2^{7 61.2}^{2 61.3}⁴^58.3⁹^57.5⁸^57.5⁸^57.5⁸^52.4⁸^50.5³^51.4³
^Arizona^67.2^{5 70.2}^{0 70.2}¹^67.2⁶^67.4⁵^66.9⁸^66.4⁷^66.2⁰^65.7⁷^65.7⁵
^Arkansas^74.2^{8 77.2}^{3 77.6}²^74.6⁷^74.7⁵^73.7⁷^73.3⁷^72.9⁴^72.8¹^72.7⁸
^California^50.0^{0 54.3}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^Colorad^o^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^Connecticut^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^Delaware^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.3⁸^50.0⁹^50.0⁰^50.0⁰^50.0⁰^50.2¹
^{District of}
^Columbia^70.0^{0 72.9}^{5 72.9}⁵^70.0⁰^70.0⁰^70.0⁰^70.0⁰^70.0⁰^70.0⁰^70.0⁰
^Florida^58.8^{3 61.7}^{8 61.8}⁸^58.9³^58.9⁰^58.8⁹^58.7⁶^56.8³^55.4⁰^54.9⁸
^Georgia^59.6^{0 62.5}^{5 62.5}⁵^59.5⁸^60.4⁴^60.6⁰^61.9⁷^63.1⁰^64.4⁹^65.1⁰
^Hawaii^58.7^{7 61.7}^{2 61.8}⁵^58.9⁰^58.4⁷^58.8¹^57.5⁵^56.5⁰^55.1¹^54.2⁴
^Idaho^70.9^{6 73.9}^{7 73.9}¹^70.4⁶^70.6²^69.9¹^70.3⁶^69.8⁷^69.7⁷^69.4⁰
^Illinois^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.3²^50.1⁷
^Indiana^61.9^{7 64.9}^{9 65.2}⁷^62.3²^62.7⁸^62.9⁸^62.6¹^62.6⁹^64.2⁶^65.9³
^Iowa^63.5^{0 66.4}^{5 66.8}⁸^63.9³^63.5⁵^63.6¹^61.9⁸^61.7³^62.6²^63.5¹
^Kansas^60.1^{5 63.1}^{5 63.7}⁷^60.8²^61.0¹^60.4¹^60.2⁵^59.4³^60.0⁸^60.3⁸

⁵^For^e^x^a^m^ple^,^{in s}^t^a^t^e^A^w^{ith a}ⁿ^a^bov^e^-^a^v^e^r^ag^e^pe^r^c^a^p^ita^inc^o^m^e^of^$42,⁰⁰^{0 c}^o^m^p^a^r^e^d^{to a}^U^.^S.^pe^r^c^a^p^ita^inc^o^m^e^of
^$⁴⁰^,⁰⁰⁰^,^t^h^e^F^M^A^P^f^o^rm^u^l^{a p}^r^odu^{ces an}^F^M^A^P^o^f⁵⁰^.³⁹^%^.^Iⁿ^st^at^{e B w}ⁱ^t^h^{a b}^e^l^o^w^-^aver^{age p}^e^{r cap}ⁱ^t^aⁱⁿ^co^m^e^o^f
^$38^,0^{00 c}^o^m^p^a^r^e^d^{to a}^U^.^S^.^pe^r^c^a^pita^inc^o^m^e^of^$40,⁰⁰^0,^the^F^M^A^P^f^o^r^m^ula^pr^oduc^e^s^aⁿ^F^M^A^P^o^f^59.3⁹^%^.^I^f^the
^f^o^r^m^ula^did^not^inc^l^ude^a^s^q^ua^rⁱⁿ^g^of^pe^r^c^a^p^ita^inc^o^m^e^{, it w}^{ould i}ⁿ^s^t^e^a^d^pr^od^uc^e^FMA^P^s^of^52.⁷⁵^%^f^o^r^s^t^a^t^e^A⁽^h^ig^he^r
^t^h^an^cu^rreⁿ^t^l^a^w⁾^an^d⁵⁷^.²⁵^%^f^o^r^st^at^{e B (l}^o^w^{er t}^h^an^cu^rren^t^l^a^w⁾^.

^FY03^FY03^FY04^FY04
^{first 2}^{last 2}^a^{first 3}^a^last
^State^quarters^quarters^quarters^{quarter FY05}^FY06^FY07^FY08^FY09^FY10
^Kentucky^69.8^{9 72.8}^{9 73.0}⁴^70.0⁹^69.6⁰^69.2⁶^69.5⁸^69.7⁸^70.1³^70.9⁶
^Louisiana^71.2^{8 74.2}^{3 74.5}⁸^71.6³^71.0⁴^69.7⁹^69.6⁹^72.4⁷^71.3¹^67.6¹
^Maine^66.2^{2 69.5}^{3 69.1}⁷^66.0¹^64.8⁹^62.9⁰^63.2⁷^63.3¹^64.4¹^64.9⁹
^Maryland^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^Massach^usetts^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^Michigan^55.4^{2 59.3}^{1 58.8}⁴^55.8⁹^56.7¹^56.5⁹^56.3⁸^58.1⁰^60.2⁷^63.1⁹
^Minnesota^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^Mississippi^76.6^{2 79.5}^{7 80.0}³^77.0⁸^77.0⁸^76.0⁰^75.8⁹^76.2⁹^75.8⁴^75.6⁷
^Missouri^61.2^{3 64.1}^{8 64.4}²^61.4⁷^61.1⁵^61.9³^61.6⁰^62.4²^63.1⁹^64.5¹
^Montana^72.9^{6 75.9}^{1 75.9}¹^72.8⁵^71.9⁰^70.5⁴^69.1¹^68.5³^68.0⁴^67.4²
^Nebras^ka^59.5^{2 62.5}^{0 62.8}⁴^59.8⁹^59.6⁴^59.6⁸^57.9³^58.0²^59.5⁴^60.5⁶
^Nevada^52.3^{9 55.3}^{4 57.8}⁸^54.9³^55.9⁰^54.7⁶^53.9³^52.6⁴^50.0⁰^50.1⁶
^New
^Hamps^hire^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^New^Jers^ey^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^New^Me^xico^74.5^{6 77.5}^{1 77.8}⁰^74.8⁵^74.3⁰^71.1⁵^71.9³^71.0⁴^70.8⁸^71.3⁵
^New^York^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^North
^Carolina^62.5^{6 65.5}^{1 65.8}⁰^62.8⁵^63.6³^63.4⁹^64.5²^64.0⁵^64.6⁰^65.1³
^North
^Dakota^68.3^{6 72.8}^{2 71.3}¹^68.3¹^67.4⁹^65.8⁵^64.7²^63.7⁵^63.1⁵^63.0¹
^Ohio^58.8^{3 61.7}^{8 62.1}⁸^59.2³^59.6⁸^59.8⁸^59.6⁶^60.7⁹^62.1⁴^63.4²
^Oklahoma^70.5^{6 73.5}^{1 73.5}¹^70.2⁴^70.1⁸^67.9¹^68.1⁴^67.1⁰^65.9⁰^64.4³
^Oregon^60.1^{6 63.1}^{1 63.7}⁶^60.8¹^61.1²^61.5⁷^61.0⁷^60.8⁶^62.4⁵^62.7⁴
^Pennsylvania^54.6^{9 57.6}^{4 57.7}¹^54.7⁶^53.8⁴^55.0⁵^54.3⁹^54.0⁸^54.5²^54.8¹
^Rhode^Island^55.4^{0 58.3}^{5 58.9}⁸^56.0³^55.3⁸^54.4⁵^52.3⁵^52.5¹^52.5⁹^52.6³
^South
^Carolina^69.8^{1 72.7}^{6 72.8}¹^69.8⁶^69.8⁹^69.3²^69.5⁴^69.7⁹^70.0⁷^70.3²
^South^Dakota^65.2^{9 68.8}^{8 68.6}²^65.6⁷^66.0³^65.0⁷^62.9²^60.0³^62.5⁵^62.7²
^Tennessee^64.5^{9 67.5}^{4 67.5}⁴^64.4⁰^64.8¹^63.9⁹^63.6⁵^63.7¹^64.2⁸^65.5⁷
^Texas^59.9^{9 63.1}^{2 63.1}⁷^60.2²^60.8⁷^60.6⁶^60.7⁸^60.5⁶^c^59.4⁴^58.7³
^Utah^71.2^{4 74.1}^{9 74.6}⁷^71.7²^72.1⁴^70.7⁶^70.1⁴^71.6³^70.7¹^71.6⁸
^Vermont^62.4^{1 66.0}^{1 65.3}⁶^61.3⁴^60.1¹^58.4⁹^58.9³^59.0³^59.4⁵^58.7³
^Virginia^50.5^{3 54.4}^{0 53.4}⁸^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^Washington^50.0^{0 53.3}^{2 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.1²^51.5²^50.9⁴^50.1²
^West^Virginia^75.0^{4 78.2}^{2 78.1}⁴^75.1⁹^74.6⁵^72.9⁹^72.8²^74.2⁵^73.7³^74.0⁴
^Wisconsin^58.4^{3 61.5}^{2 61.3}⁸^58.4¹^58.3²^57.6⁵^57.4⁷^57.6²^59.3⁸^60.2¹

^FY03^FY03^FY04^FY04
^{first 2}^{last 2}^a^{first 3}^a^last
^State^quarters^quarters^quarters^{quarter FY05}^FY06^FY07^FY08^FY09^FY10
^Wyoming^61.3^{2 64.9}^{2 64.2}⁷^59.7⁷^57.9⁰^54.2³^52.9¹^50.0⁰^50.0⁰^50.0⁰
^American
^Samoa^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^Guam^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^{N. Mariana}
^Islands^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^Puerto^Rico^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^Virgin^Islands^50.0^{0 52.9}^{5 52.9}⁵^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰^50.0⁰
^Number
^with
^decrease
^from
^previous
^{year 17}^—^a^—^a¹¹^d¹⁹^e²⁸²⁷²⁰¹⁷¹⁴
^Source:^Depart^{ment of}^{Health a}^{nd Huma}^{n Services (H}^{HS) notices pu}^{blished in the}^{Federal Register}^.
^a.^{The Jobs a}^{nd Growth}^{Tax Relief Reconciliat}^{ion Act of 20}^{03 (P.L. 1}^08-2^{7) tempora}^{rily increased Me}^dicaid
^{FMAPs to provide $1}^{0 billion in state fiscal relief. States also receiv}^{ed an additional $10 billion in dir}^ect
^grants.
^b.^{Alaska’s Medicaid FMAP used an alternative formula for FY2}⁰⁰^1-FY200^{5 (P.L. 106-}⁵⁵^{4) and did not decreas}^e
^{in FY200}^6-FY200⁷^becaus^{e of a p}^{rovision in the Deficit Reduction Act of 20}^{05 (DRA, P.L. 109-1}^71).^Prior
^{to DRA, A}^{laska had reverted to}^{using the}^{same FMAP calc}^{ulation as other states,}^{providing an FY2}⁰⁰⁶
^{FMAP of 50.1}^{6% a}^{nd FY20}^{07 FM}^{AP of 51.07}^%.
^c.^{This FY200}^{8 value of}^60.5^{6% was}^{provided by HHS im}^{plementation of a DRA provision related to}
^Hurrica^{ne Katrina (see discu}^{ssion under}^“Stat^{utory E}^xce^{ptions” in}^{this report). Using the}^reg^{ular FMAP}
^{formula, the state’s FY20}⁰⁸^value^{would have bee}^{n 6}^0.5^3%.
^d.^{Compared to regular FMAPs t}^hat^{applied in the first}^{two qua}^rters^{of FY200}^3.
^e.^{Compared to regular FMAPs t}^hat^{applied in the last}^quarte^{r of FY2}^004.
Although the FMAP is generally determined by a formula set in statute, there are exceptions
made for certain states and situations:
• As of FY1998, the District of Columbia’s Medicaid FMAP is set at 70%.⁶
• The territories (Puerto Rico, American Samoa, the Northern Mariana Islands,
Guam, and the Virgin Islands) have FMAPs set at 50% and, unlike the 50 states ⁷
and the District of Columbia, are subject to federal spending caps.

⁶^P^.^L^.¹⁰^5-³³⁽^B^a^l^aⁿ^c^e^d^B^udg^e^t^A^c^{t of}¹⁹⁹⁷⁾^{. T}^h^e^70%^a^l^s^o^a^p^plie^s^f^o^r^pur^pos^e^s^of^c^o^m^puting^aⁿ^eⁿ^ha^nc^e^d^FMA^P^f^o^r
^SCH^I^P.
⁷^For^m^o^r^e^inf^o^r^m^a^{tion, s}^e^e^G^o^v^e^rⁿ^m^e^{nt A}^c^c^ounta^b^ili^ty^Of^fⁱ^c^e^,^{U.S. Insul}^a^{r Are}^a^{s: M}^u^ltiple^Fac^t^{ors Affe}^c^t^Fe^de^ral
^H^e^{alth C}^a^r^e^Fu^ndi^ng^,^GA^O-06-7⁵^{, Oc}^to^be^{r 2}⁰⁰⁵^{, a}^t^htt^p^://w^ww^.^g^a^o^.g^ov^/ne^w^.ite^m^s^/^d⁰⁶⁷⁵^.p^df^.

• Alaska’s Medicaid FMAP was set in statute for FY1998-FY2000, used an
alternative formula for FY2001-FY2005, and was held at its FY2005 level for ⁸
FY2006-FY2007.
• The Deficit Reduction Act of 2005 (P.L. 109-171) provided that in computing
Medicaid FMAPs for any year after 2006 for a state that the Secretary of HHS
determines has a significant number of Hurricane Katrina evacuees as of October ⁹

1, 2005, the Secretary will disregard such evacuees and their incomes.

• Under the Jobs and Growth Tax Relief Reconciliation Act of 2003 (P.L. 108-27),
all states and territories received a temporary increase. Medicaid FMAPs for the
last two quarters of FY2003 and the first three quarters of FY2004 were held
harmless from annual declines and were increased by an additional 2.95 ¹⁰
percentage points.
• As noted earlier, the FMAP does not apply to certain Medicaid services that
receive a higher federal match (e.g., those provided through an Indian Health
Service facility).
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 most recent (FY2010) FMAP calculations,
HHS used state per capita personal income data for 2005, 2006, and 2007 that became available
from the Department of Commerce’s Bureau of Economic Analysis (BEA) in September 2008.
The use of a three-year average helps to moderate fluctuations in a state’s FMAP over time.
BEA revises its most recent estimates of state per capita personal income on an annual basis to ¹¹
incorporate revised and newly available source data on population and income. It also
undertakes a comprehensive data revision—reflecting methodological and other changes—every

⁸^P^.^L^.¹⁰^5-³³^s^e^{t A}^l^a^s^k^a^’^s^Me^dic^aⁱ^{d a}ⁿ^d^SC^H^I^P^FMA^P^s^f^o^r^FY¹⁹⁹⁸^-^F^Y²⁰^{00 a}^t⁵⁹^.8^0%^.^P^.^L^.¹^06-⁵⁵^{4 pr}^ov^ide^d^tha^t^its
^FMA^P^s^f^o^r^FY²⁰⁰¹^-^F^Y²⁰⁰^{5 w}^o^u^l^{d be}^c^a^l^c^u^la^te^d^usⁱⁿ^g^the^s^t^a^t^e^’^s^pe^r^c^a^p^ita^inc^o^m^e^def^l^a^t^e^d^by^{1.05 (}^t^he^r^e^by
^inc^r^e^a^s^ing^the^FMA^P^s⁾^.^P^.^L^.¹^09-¹⁷¹^pr^ov^ide^d^tha^t^its^FMA^P^s^f^o^r^FY²⁰^06-^FY²⁰^{07 w}^oul^d^not^f^a^{ll be}^low^the^s^t^a^t^e^’^s
^FY²⁰^{05 le}^v^e^l.
⁹^T^h^e^A^l^as^k^a^a^{nd K}^a^tr^ina^D^R^A^pr^ov^is^ions^a^l^s^o^a^pply^f^o^r^pur^pos^e^s^o^f^c^o^m^puting^e^nha^nc^e^d^FMA^P^s^f^o^r^SC^H^I^P^.
^A^lthoug^{h it w}^a^s^de^s^c^rⁱ^be^{d a}^s^a^“^h^old^ha^r^m^le^s^s^f^o^r^K^a^tr^ina^im^pa^c^t^”^{in D}^R^A^,^the^la^ng^ua^g^e^of^the^K^a^tr^ina^pr^ov^isⁱ^on
^req^uⁱ^{res evacu}^{ees t}^o^b^e^dⁱ^sregarded^evenⁱ^f^t^h^ei^{r i}ⁿ^cl^u^sⁱ^o^{n w}^o^u^l^dⁱⁿ^crea^se^{a st}^at^{e’s F}^M^A^P^.^Du^{e t}^o^l^a^{gs i}ⁿ^t^h^e
^a^v^a^ila^bility^o^f^da^ta^use^d^to^c^a^l^c^u^l^a^te^FMA^P^{s, FY2}⁰⁰⁸^is^th^e^fⁱ^{rst y}^e^a^r^f^o^r^w^h^ic^{h the}^prov^isio^{n a}^p^plie^{s. In}²⁰^07,^HHS
^pr^o^pos^e^d^aⁿ^{d t}^h^eⁿ^fⁱ^na^liz^e^d^a^m^e^thod^ol^og^y^f^o^rⁱ^m^ple^m^eⁿ^ta^tion^of^the^pr^ov^isⁱ^on^tha^t^w^oul^{d pr}^e^v^eⁿ^{t t}^h^e^low^e^rⁱ^ng^of^aⁿ^y
^FY²⁰⁰⁸^FMA^P^s^aⁿ^{d i}ⁿ^c^r^e^a^s^e^the^FY²⁰⁰⁸^FMA^P^f^o^r^one^s^t^a^t^e⁽^T^e^x^a^s⁾^.^T^h^e^m^e^thodol^og^y^tak^e^s^a^d^v^a^nta^g^e^of^a^da^ta
^tim^ing^is^s^u^e^tha^t^w^{ill not a}^pply^a^f^te^{r FY}²⁰^08.^A^lthoug^h^H^H^S^ha^{d i}ⁿ^itia^lly^e^x^pre^s^s^e^{d c}^onc^e^r^{n tha}^t^s^o^m^e^s^t^a^t^e^s^c^{ould s}^e^e
^low^e^r^FMA^P^s^{in la}^te^r^y^e^a^r^s^a^s^a^r^e^s^u^{lt of}^the^D^R^A^pr^ov^is^ion^,^t^h^e^fⁱ^na^{l m}^e^thodol^og^y^indic^a^t^e^s^tha^t^th^e^r^e^is^{no r}^e^lia^b^l^e
^w^a^{y t}^o^t^r^{ack t}^h^{e n}^u^m^b^e^{r an}^dⁱⁿ^{come o}^f^ev^acu^{ees o}ⁿ^an^on^goⁱⁿ^g^b^a^si^{s an}^d^t^h^eref^o^r^{e n}^o^b^a^si^{s f}^o^{r ad}^j^u^stⁱⁿ^{g F}^M^A^P^{s af}^t^e^r
^FY²⁰^08.^Se^e⁷²^Fe^de^ral^Re^giste^r³³⁹¹⁽^J^a^nua^r^y^{25, 2}⁰⁰⁷⁾^aⁿ^d⁷²^Fe^de^{ral Re}^giste^r⁴⁴¹⁴^{6 (}^A^ug^us^{t 7, 2}⁰⁰⁷⁾^.
¹⁰^A^lthoug^{h Me}^dic^aⁱ^d^dis^p^r^o^p^o^r^tio^na^te^s^h^a^r^e^hos^pita^{l (}^D^SH⁾^pa^y^m^ents⁽ⁱ^.e^.,^pa^y^m^eⁿ^ts^{to hos}^pita^ls^t^h^a^t^s^e^r^v^e^la^r^g^e
^num^be^r^s^of^low^-^inc^o^m^e^a^{nd Me}^di^c^aⁱ^{d pa}^tie^nts^aⁿ^{d a}^r^e^s^u^bje^c^t^to^f^e^de^r^a^{l s}^p^eⁿ^dⁱ^ng^c^a^p^s⁾^a^r^e^r^e^im^bur^s^e^{d us}^ing^t^h^e
^F^M^A^P^,^t^hⁱ^sⁱⁿ^{crease d}ⁱ^dⁿ^o^t^a^p^p^l^y^t^o^DS^H.^In^addⁱ^tⁱ^oⁿ^,^st^at^{es h}^a^d^t^o^m^eet^cert^aⁱⁿ^req^uⁱ^remen^t^{s i}ⁿ^o^r^d^e^{r t}^o^recei^{ve an}
^inc^r^e^a^s^e^(e^.g^{., the}^y^c^{ould n}^o^{t re}^strⁱ^c^t^e^lig^ibility^a^f^t^e^{r a}^c^e^r^ta^{in da}^te^).
¹¹^P^r^elⁱ^mⁱⁿ^ar^y^estⁱ^m^a^t^e^{s o}^f^st^at^{e p}^e^r^capⁱ^t^a^p^e^rsoⁿ^a^lⁱⁿ^co^m^e^f^o^{r t}^h^{e l}^a^t^e^st^avai^l^a^b^l^{e cal}^en^d^a^r^y^ear—^a^s^wel^l^{as revi}^sed
^estⁱ^m^a^t^e^s^f^o^{r t}^h^{e t}^w^o^p^r^ecedⁱⁿ^{g c}^a^l^eⁿ^d^a^{r y}^e^{ars—are rel}^e^asedⁱⁿ^A^p^ri^l^.^Revi^sed^estⁱ^m^at^e^s^f^o^{r al}^l^t^h^{ree years are rel}^e^ased
^{in Oc}^to^be^r.

few years that may result in upward and downward revisions to each of the component parts of
personal income (as defined in BEA’s national income and product accounts, or NIPA). These
components include
• 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 ¹²
Security, Medicare, Medicaid, state unemployment insurance, etc.).
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 will change over time. For example, the 2004
state per capita personal income data published by BEA in September 2006 (used in the
calculation of FY2008 FMAPs) differed from the 2004 state per capita personal income data
published in September 2007 (used in the calculation of FY2009 FMAPs).
It should be noted that the NIPA definition of personal income used by BEA is not the same as the
definition used for personal income tax purposes. Among other differences, NIPA 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.
Several factors influence state FMAPs. The first is the nature of the state economy and its ability
to respond to economic changes (i.e., downturns or upturns). The impact of a national economic
downturn or upturn will be related to the structure of the state economy and the business sectors
causing the upturn or downturn. For example, a national decline in automobile sales, while
having an impact on automobile sales and all state economies, will 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 to reflect state economies and
their response to economic changes in relation to the U.S. average per capita personal income.
The national economy is basically the sum of all 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 will be lower than the state declines because the
total decline has been offset by states with 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
small percentage change each year. 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
(which has very small changes each year). This comparison can result in significant state FMAP
changes.

¹²^Em^ploy^e^r^a^{nd e}^m^ploy^e^e^c^ontrⁱ^bu^tions^f^o^r^g^o^v^e^rⁿ^m^e^{nt s}^o^cⁱ^a^l^ins^u^r^a^nc^e⁽^e^.g^{., Soc}ⁱ^a^l^Se^c^u^r^ity^{, Me}^dic^a^r^e^,
^une^m^p^loy^m^eⁿ^{t ins}^u^r^a^nc^e^,^e^t^c^.⁾^a^r^e^e^x^c^l^ude^{d f}^r^om^pe^r^s^ona^{l inc}^o^m^e^{, a}^{nd e}^a^rⁿⁱ^ng^s^a^r^e^c^ounte^d^ba^s^e^d^oⁿ^r^e^sⁱ^de^nc^y⁽ⁱ^.e^.,
^f^o^r^indivⁱ^d^u^a^l^s^w^{ho liv}^eⁱⁿ^one^s^t^a^t^e^a^{nd w}^o^r^k^{in a}ⁿ^o^t^he^r^,^theⁱ^rⁱⁿ^c^o^m^e^is^c^ounte^dⁱⁿ^t^h^e^s^t^a^t^e^w^h^e^r^e^the^y^r^e^sⁱ^de⁾^.

In addition to annual revisions of per capita personal income data, comprehensive NIPA revisions
undertaken every four to five years may also influence FMAPs (for example, because of changes
in the definition of personal income). The impact on state FMAPs will depend on whether the
changes are broad (affecting all states) or more selective (affecting only certain states or
industries).
As noted earlier, statutory changes may also affect FMAPs.

In the 108^th Congress, the Jobs and Growth Tax Relief Reconciliation Act of 2003 (JGTRRA, P.L.
108-27) provided temporary fiscal relief for states and local governments through a combination
of $10 billion in FMAP increases and $10 billion in direct grants. Medicaid FMAPs for the last
two quarters of FY2003 and the first three quarters of FY2004 were held harmless from annual
declines and were increased by an additional 2.95 percentage points, so long as a state did not ¹³
restrict eligibility after a specified date (none did) and met certain other requirements. To
accommodate the FMAP increase, caps that apply to federal Medicaid spending in the territories
were raised by 5.9%. JGTRRA also provided states with an additional $10 billion in direct grants ¹⁴
based on population.
In the 109^th Congress, provisions to exclude certain Hurricane Katrina evacuees and their incomes
from FMAP calculations and prevent Alaska’s FY2006-FY2007 FMAPs from falling below the
state’s FY2005 level were included in the Deficit Reduction Act of 2005 (P.L. 109-171). Other
provisions that would have temporarily increased FMAPs for states affected by Hurricane
Katrina, limited FY2006 FMAP reductions for all states, and disregarded employer contributions
toward pensions in the calculation of FMAPs if they exceeded a certain threshold were debated ¹⁵
but not included in the final bill.
In the 110^th Congress, a number of bills that would affect Medicaid FMAPs have been introduced.
Most recently, debate has focused on the downturn in the U.S. economy and whether a temporary
FMAP increase should be included as part of a stimulus package. Stimulus bills containing a
temporary increase failed a motion to proceed in the Senate (S. 3604) and passed the House (H.R.

7110) in September, and another was introduced in November (S. 3689). Over 10 years, the bills ¹⁶¹⁷

would increase federal Medicaid spending by an estimated $19.6 billion, $14.7 billion, and ¹⁸
$37.8 billion, respectively. President Bush indicated that he would veto the bills considered in

¹³^F^o^{r a}^dⁱ^scu^ssi^on^o^f^req^uⁱ^r^em^en^t^sⁱⁿ^t^h^{e l}^a^w^,^{see Dep}^a^rt^men^t^o^f^Hea^l^t^h^and^Hu^m^aⁿ^S^e^rvi^ces,^Cen^t^{ers f}^o^{r M}^e^dⁱ^care
^a^{nd Me}^dⁱ^c^aⁱ^{d Se}^rv^ic^e^s^{, De}^a^r^Sta^t^e^Me^dic^aⁱ^{d Dire}^c^t^{or le}^t^t^e^r^{, Ju}^ne¹³^{, 2}⁰⁰³^{, a}^t^htt^p^://w^ww^.c^m^s^.hhs.g^ov^/sm^d^l/
^dow^nloa^ds^/^s^m^d0613^03.^pdf^.
¹⁴^Se^e^htt^p^://w^w^w^.trea^s^.g^ov^/^p^re^s^s^/^re^le^a^s^e^s^/^j^s^453.^htm^.
¹⁵^Se^e^C^R^S^R^e^por^{t R}^S²²³³^3,^B^u^d^g^e^{t Re}^c^onc^ilia^tio^{n FY}²⁰^06:^Prov^is^{ions A}^ffe^c^ting^the^M^e^dic^a^{id Fe}^de^{ral M}^e^dic^a^l
^Assistaⁿ^{ce Percen}^ta^g^e⁽^F^MAP)^,^b^y^Ap^rⁱ^l^Gr^a^d^y.
¹⁶^{U.S. C}^ong^re^{ss, Se}^na^te^Com^m^itte^e^{on A}^ppr^opria^ti^ons,^By^r^d^State^m^eⁿ^{t in}^S^u^p^por^t^{of Ec}^on^om^ic^Re^c^o^v^e^r^y^and^Stim^u^l^us
^Pac^k^age^{, Se}^pte^m^be^r^{26, 20}⁰⁸^,^a^t^http:^//a^p^p^r^o^pr^ia^tio^ns^.s^eⁿ^a^t^e^.^g^o^v^/ⁿ^e^w^s^.cf^m^.
¹⁷^C^ong^r^e^s^sⁱ^ona^{l B}^udg^e^t^O^f^fⁱ^ce^,^Es^tim^ate^d^C^o^s^t^o^f^H^.^R.⁷¹¹⁰^{, T}^h^e^J^o^{b C}^r^e^a^ti^on^an^{d U}ⁿ^e^m^p^l^oy^m^e^{nt R}^e^lie^{f Ac}^{t of}²⁰⁰⁸^,
^as^Iⁿ^tr^od^uc^e^d^oⁿ^Se^pte^m^be^r²⁶^,²⁰⁰⁸^{, a}^t^http^://c^b^o^.g^ov^/^f^tpdoc^s^/^98x^x^/^doc⁹⁸¹⁶^/^h^r71^10.^pdf^.
¹⁸^C^ong^r^e^s^sⁱ^ona^{l B}^udg^e^t^O^f^fⁱ^ce^{, le}^tte^r^{to t}^h^e^H^oⁿ^o^r^a^ble^R^obe^r^t^C^.^B^y^r^d^{, N}^o^v^e^m^b^e^r^18,²⁰^08,^a^t^ht^tp:/^/^w^w^w^.^c^bo.g^o^v^/
^f^t^pdoc^s^/^99x^x^/^doc⁹⁹^18/^Se^na^te^Sti^m^ulus^Iⁿ^f^r^a^s^tr^uc^tur^e^B^y^r^d^L^t^r^.^pdf^.

September.¹⁹ Additional legislation that would provide a temporary Medicaid FMAP increase was
introduced earlier in 2008 (S. 2586, H.R. 5268, S. 2620, S. 2819).
The recent House and Senate stimulus bills contain different Medicaid provisions:
• S. 3604 would hold all states harmless from any decline in their Medicaid
FMAPs for FY2009 and the first quarter of FY2010 (see Table 1 for scheduled
declines) and provide all states and territories with an additional increase of four
percentage points. S. 3689 is similar, except that it would provide an increase of
eight percentage points instead of four.
• H.R. 7110 would hold all states harmless for FY2009 and the first two months of
FY2010, provide all states and territories with an additional increase of one
percentage point, and provide qualifying states with an additional increase of up
to three percentage points based on employment, food stamp, and foreclosure
data.
• Although some details vary, all of the bills would apply the temporary FMAP ²⁰
increase to Medicaid only, temporarily raise federal Medicaid spending caps in
the territories, require states to maintain Medicaid eligibility as of a specified
date in order to be eligible for the increase, and require states to ensure that local
governments do not pay a larger percentage of nonfederal expenditures than ²¹
otherwise would have been required.
• The Senate bills would also prohibit states from using the additional federal
funds paid as a result of a temporary FMAP increase to increase any reserve or
rainy day fund that they maintain.
• Separate from the temporary Medicaid FMAP increase, the House bill includes a
provision that would exclude certain employer pension and insurance fund ²²
contributions in the calculation of Medicaid FMAPs beginning with FY2006.
FMAP increases would reduce the amount of state funding that is required to maintain a given
level of Medicaid services. For states that are contemplating cuts in order to slow the growth of or
reduce Medicaid spending (e.g., by lowering income eligibility, eliminating coverage of certain
benefits, freezing or reducing provider reimbursement rates, increasing cost-sharing or premiums ²³
for beneficiaries), increased federal funding could enable them to avoid those cuts. For others,
the state savings that result from an FMAP increase could be used for a variety of purposes that ²⁴
are not limited to Medicaid. In SFY2008 and SFY2009, many states have implemented or

¹⁹^E^x^ecu^tⁱ^v^{e O}^f^fⁱ^{ce o}^f^t^h^{e P}^r^esi^d^ent,^Of^fⁱ^{ce o}^f^M^aⁿ^a^g^e^m^eⁿ^t^an^d^B^udget^,^State^m^eⁿ^ts^{of A}^d^mⁱ^nis^t^r^a^tioⁿ^Polic^y^oⁿ^N^o^n-
^Appro^p^ria^tio^{ns a}ⁿ^d^Ap^pro^p^riati^o^{ns Bills}^,^a^t^htt^p^://w^w^w^.^w^hite^hous^e^.^g^o^v^/^om^b/^le^gⁱ^s^l^a^tiv^e^/^s^a^p/in^de^x^.^h^t^m^l^.
²⁰^E^x^cep^t^f^o^{r M}^e^dⁱ^cai^d^DS^H^p^a^ymeⁿ^t^s^,^w^hⁱ^c^h^{are su}^bj^ect^t^o^f^e^d^e^ral^sp^en^dⁱⁿ^g^cap^s.
²¹^S^o^m^e^st^at^{es req}^uⁱ^{re l}^o^cal^go^vern^men^t^{s t}^o^fⁱⁿ^aⁿ^{ce p}^a^rt^o^f^t^h^{e no}ⁿ^f^ed^eral⁽ⁱ^.^e^.^,^st^at^{e) sh}^are^o^f^M^e^dⁱ^cai^d^co^st^s.^Sⁱⁿ^{ce a}
^te^m^por^a^r^y^FM^A^Pⁱⁿ^c^r^e^a^s^e^w^ould^r^e^duc^e^a^s^t^a^t^e^’^s^nonf^e^d^e^r^a^l^s^h^a^r^e^,^a^loc^a^l^g^o^v^e^rⁿ^m^e^nt^w^hos^e^r^e^quir^e^{d c}^oⁿ^t^rⁱ^b^u^ti^on^is^a
^s^p^e^cⁱ^fⁱ^e^d^dolla^r^a^m^{ount (}^o^r^s^o^m^e^othe^r^a^m^ount^tha^t^is^no^{t a}^fⁱ^x^e^{d pe}^r^c^eⁿ^ta^g^e^o^f^the^no^nf^e^d^e^r^a^l^s^h^a^r^e⁾^c^oul^{d pa}^y^a^la^r^g^e^r
^pe^r^c^eⁿ^ta^g^e^of^the^nonf^e^d^e^r^a^l^s^h^a^r^e^thaⁿ^it^ot^he^r^w^is^e^w^ould^ha^v^e^wⁱ^tho^u^{t t}^h^e^FMA^P^inc^r^e^a^s^e^.
²²^Se^e^C^R^S^C^o^ng^r^e^s^sⁱ^ona^{l D}ⁱ^s^t^rⁱ^b^u^tⁱ^on^Me^m^o^r^a^ndum^,^Es^tim^ate^d^M^e^dic^aⁱ^d^FM^APs^Uⁿ^de^r^{a Pr}^op^os^al^{to D}ⁱ^s^r^e^gar^d
^C^e^r^t^{ain Em}^ploy^e^r^Pe^nsⁱ^on^an^{d I}ⁿ^s^u^r^anc^e^Fu^nd^C^o^ntrⁱ^b^u^ti^ons^,^by^A^p^r^{il G}^r^a^d^y⁽^a^v^a^ila^ble^upon^r^e^qu^e^s^t)^.
²³^T^h^e^N^a^tiona^{l A}^s^s^o^cⁱ^a^{tion of}^Sta^t^e^B^udg^e^t^O^f^fⁱ^c^e^r^s^a^{nd the}^N^a^tioⁿ^a^{l G}^o^v^e^r^nor^s^A^s^s^o^cⁱ^a^{tion j}^o^intly^pub^lis^{h a}^s^p^rⁱ^ng
^a^{nd f}^a^{ll surv}^e^y^of^sta^t^e^fⁱ^sc^a^l^c^onditio^{ns a}^t^http^://w^ww^.n^a^s^bo.org^/^p^ublic^a^tⁱ^ons.^p^h^p^{. T}^h^e^Ce^nte^r^{on B}^udg^e^t^aⁿ^d^P^o^lic^y
^P^rⁱ^o^ritie^s^a^l^s^o^pr^ov^ide^s^inf^o^rm^a^tⁱ^{on a}^t^htt^p^://w^w^w^.c^bpp.org^/^pubs^/^s^f^p^.htm^.
²⁴^For^e^x^a^m^ple^,^{27 s}^t^a^t^e^s^r^e^por^te^{d t}^h^a^t^the^y^us^e^d^f^unds^pr^ov^ide^d^by^the^FMA^P^inc^r^e^a^s^e^{in J}^G^T^R^R^A^to^a^v^{oid, m}ⁱ^nimⁱ^z^e^,
⁽^c^onti^nue^d.^..)

planned Medicaid expansions and enhancements. However, there is concern that states could
follow a pattern seen in the last economic downturn, when significant cuts to Medicaid did not ²⁵
come until later in the downturn.
The Congressional Budget Office has indicated that providing additional federal aid to states that
are facing fiscal pressures or a recession would probably stimulate the economy. However,
federal aid to states whose budgets are relatively healthy might provide little stimulus if it is used ²⁶
to build up rainy day funds, rather than increase spending or reduce taxes.

^(...c^on^tin^ue^d)
^o^r^po^st^poⁿ^e^M^e^dⁱ^cai^d^cut^s^o^r^f^r^eezes.^Ho^w^e^ver,^t^h^{e f}^unds^a^l^s^o^he^l^p^e^d^m^aⁿ^y^s^t^a^t^es^f^{ill s}^hortf^a^lls^{in th}^eⁱ^{r ov}^e^r^a^{ll g}^e^ne^ra^l
^f^{und b}^udg^e^t^s^.^Se^e^K^a^is^e^r^C^o^m^m^issⁱ^on^on^Me^dic^aⁱ^{d a}^nd^the^Uⁿ^ins^u^r^e^d,^Fi^na^nc^ing^the^M^e^dic^a^{id Pr}^og^r^a^m^:^The^I^m^pac^t
^{of Fe}^de^r^a^l^Fis^c^al^Re^lie^f^{, A}^p^{ril 2}⁰^{04, a}^t^htt^p^://k^f^f^.^org^/^m^e^dic^aⁱ^d/uplo^a^d/^Fina^nc^ing^-^the^-^Me^dic^aⁱ^d-^P^r^og^r^a^m^-^T^h^e^-^I^m^pa^c^t^-
^o^f^-F^ed^eral^-Fⁱ^s^cal^-Relⁱ^e^f^-^A^p^ri^l^-²⁰⁰⁴^.^p^d^f^an^d^V^e^rⁿ^on^S^mⁱ^t^h^et^al^.^,^St^ate^s^Re^s^p^o^nd^{to F}ⁱ^s^c^{al Pr}^e^s^s^u^r^e^:^{A 50-}^St^ate^U^p^date
^{of S}^t^ate^M^e^dic^aⁱ^d^Speⁿ^dⁱ^{ng G}^r^ow^{th a}ⁿ^d^C^o^s^t^C^ont^ai^nm^eⁿ^{t Ac}^ti^ons^,^Kai^s^{er Co}^mmⁱ^ssi^oⁿ^on^M^e^di^cai^{d an}^d^t^h^e
^Uⁿ^ins^u^r^e^{d, J}^aⁿ^u^a^r^y^{2004, a}^t^htt^p^:/^/w^w^w^.^k^f^f^.or^g^/m^e^d^ic^aⁱ^d/⁷⁰^01.c^f^m^.^For^a^not^he^r^a^s^s^e^s^s^m^e^{nt of}^how^Me^dic^aⁱ^{d w}^a^s
^t^r^eat^edⁱⁿ^F^Y²⁰⁰⁴ⁱⁿ^t^h^{e bu}^d^g^et^s^o^f^t^eⁿ^st^at^es,^{see Ja}^m^e^{s W}^.^F^o^sset^t^an^d^C^o^u^r^tⁿ^ey^E^.^Bu^rke,^M^e^dic^aⁱ^d^a^nd^St^ate
^B^u^dg^et^{s i}ⁿ^F^Y²⁰⁰⁴^:^Wh^{y Med}ⁱ^ca^id^I^s^So^Ha^r^d^to^C^u^t^{, Roc}^k^e^f^e^lle^{r I}ⁿ^s^titute^of^G^o^v^e^rn^m^e^{nt, J}^u^ly^{2004, a}^t
^http:^//w^w^w^.r^oc^kⁱ^ns^t.or^g^/^pdf^/^h^e^a^lth_c^a^r^e^/²⁰^04-^07-
^m^e^dic^aⁱ^d_a^nd^_s^ta^te^_b^udg^e^t^s^_ⁱⁿ^_^f^y^_2004^_w^h^y^_^m^e^d^ic^aⁱ^d_is^_ha^r^d^_to^_^c^u^t.^pdf^.
²⁵^V^e^rn^on^Sm^{ith e}^t^a^l^.,^H^e^a^d^e^d^f^o^r^{a C}^r^uⁿ^c^h^:^Aⁿ^U^p^date^on^M^e^dic^aⁱ^d^S^p^eⁿ^dⁱⁿ^g^{, C}^o^v^e^r^age^a^nd^Polic^y^H^e^adin^gⁱⁿ^t^o^aⁿ
^Ec^onom^ic^D^o^wⁿ^t^u^rⁿ^,^K^a^is^e^r^C^o^m^m^issⁱ^{on o}ⁿ^Me^dic^aⁱ^{d a}ⁿ^{d t}^h^e^Uⁿⁱⁿ^s^u^r^e^d,^Se^pte^m^be^r²⁰^08,^a^t^htt^p^://^w^w^w^.^k^f^f^.or^g^/
^m^e^dic^aⁱ^d/78^15.c^f^m^.
²⁶^S^t^at^em^en^t^o^f^P^e^t^e^{r R.}^Orszag,^Di^rect^o^r^,^Con^g^ressi^oⁿ^a^l^Bud^g^et^Offⁱ^ce,^b^e^f^o^{re t}^h^{e Co}^mmⁱ^t^t^{ee o}ⁿ^Fⁱⁿ^aⁿ^ce,^U.^S^.^S^eⁿ^a^t^e^,
^O^p^tio^ns^for^Re^s^p^o^ndi^ng^to^Sh^or^t-^Te^r^m^Ec^onom^ic^W^e^ak^ne^s^s^{, J}^a^nua^r^y^{22, 20}^08,^a^t^h^ttp:^//c^bo^.g^ov^/f^tpdoc^s^/^89x^x^/^doc⁸⁹^32/
^01-^22-^T^e^s^tim^on^y^E^c^onStim^ulus^.p^df^.

In most years, FMAPs will differ from the previous year for two reasons: annual revisions to per
capita personal income; and the replacement of the oldest year of data for per capita personal
income with the most recent year of data. For FY2006 FMAPs, there were three reasons for the
change from FY2005: (1) comprehensive NIPA revisions; (2) annual revisions to per capita
personal income (for years 2001 and 2002, which are in common for the calculations of FY2005
and FY2006); and (3) the replacement of the oldest year of data for per capita personal income
(2000) with the most recent year (2003).
Some states found that FMAP changes between FY2005 and FY2006 were larger than expected.
As a result, questions were raised about the cause(s) of the changes and about whether the
changes are unusual. An analysis of the change in state FMAPs over the years shows that the
range of FMAP changes between FY2005 and FY2006 is not unusual. Figure A-1 contains a
graphic representation of the annual change in FMAPs since FY1990, showing the largest
positive and negative changes and the average change in state FMAPs each year. While the range
of change in FMAPs was not unusually large, the -0.55 average change between FY2005 and
FY2006 represented the only time during the 16-year period that the average change exceeded
plus or minus one-half of a percentage point. Over the period, the average change in state FMAPs
was positive half of the time and negative half of the time. In addition, there were eight years
when the number of states with FMAP increases exceeded the number of states with FMAP
decreases, and eight years when the opposite was true. The pattern varies by state, with some
states having a negative annual change between years for all years, and other states having a
positive annual change for most years.
The most recent comprehensive NIPA revisions were undertaken in 1999 and 2003, and state
FMAPs for the first years calculated using this revised data (FY2002 and FY2006) show a larger
range of changes compared to other years. For example, state FMAP changes between FY2000
and FY2001 ranged from +2.84 to -1.13, with an average change of +0.12. State FMAP changes
between FY2001 and FY2002 (the first year calculated after the 1999 comprehensive NIPA
revision) ranged from +2.49 to -2.63, with an average change of -0.26. This indicates that recent
comprehensive NIPA revisions may have had an impact on state FMAPs. But the range of FMAP
changes associated with the latest (2003) comprehensive NIPA revision is not substantially
different from the range associated with the 1999 revision.
Another way to examine FMAPs over the 16-year period is through the median. The median
represents the FMAP at which half of the states have higher values and half of the states have
lower values. As shown in Figure A-2, during the FY1990-FY2006 period the median state
FMAP declined only slightly (by less than 1 percentage point), and the change between FY2005
and FY2006 was very small (two-tenths of a percentage point). In Figure A-2, the solid line
connects median state FMAPs for each year. The dotted line connects median state FMAPs
resulting from temporary increases granted by P.L. 108-27. The decline in the median state FMAP
since FY1990 is not a result of more states being subject to the statutory minimum FMAP of 50%
over time (in FY1990, there were two more states at the statutory minimum than in FY2006).
Instead, the decline in the median state FMAP reflects the decline in the number of states with
FMAPs of 70% or more (in FY1990, 12 states had an FMAP of 70% or more; by FY2006 only
five states had an FMAP of 70% or more).

As noted earlier, the NIPA definition of personal income includes transfer payments. This means
that all other things being equal, during an economic downturn, as more people in a state receive
transfer payments (e.g., unemployment or Medicaid benefits), the personal income in the state
increases. At the same time, since capital gains (or losses) are not included in personal income, if
a significant portion of the economic downturn is the result of declines in the equity (stock)
market, the capital losses do not result in a corresponding decline in personal income.
The economic downturn of 2001 has been attributed to the impact of the September 11^th attacks
and the decline in the equity (stock) market. As a result, states may have experienced a decline in
personal income tax revenues without a corresponding reduction in per capita personal income
(which is used to calculate FMAPs).
Population is also a major component in the calculation of per capita personal income. If, for
example, two states have the same aggregate personal income, the state with the largest
population will have the lowest per capita personal income and the highest FMAP of the two
states.
According to a published BEA document on the highlights of the 2003 NIPA revision,²⁷
measurement changes improved estimates of property-casualty insurance, services provided by
banks without charge, and investment in nonresidential structures. While these changes would
have an impact on personal income (for example, the changes for services provided by banks
without charge and property-casualty insurance would affect personal interest income), a larger
impact may be attributable to the use of updated and more comprehensive data sources. These
include updated BEA input-output tables, more recent annual surveys of business, government,
and the economy by the Census Bureau, tabulations of business returns for 2000 and 2001 by the
Internal Revenue Service, and tabulations of wages and salaries for 2001 and 2002.

²⁷^A^v^a^ila^ble^{on t}^h^e^B^E^A^w^e^bs^ite^a^t^http:^//w^w^w^.be^a^.^g^o^v^/^be^a^/^ne^w^s^r^e^l/²⁰⁰^3c^r^_^f^a^x^.^pdf^.

Figure A-1. Largest Increase, Largest Decrease, and Average Change in
State FMAPs, FY1990-FY1991 to FY2005-FY2006
ⁱ^{ki/CRS-RL32950}
^g/w
^s^.or
^le^ak
^://wiki
^h^ttp
^Source:^Figure^prepa^{red by}^the^{Congressional Research Service (}^CRS).

Table A-1. Change in State FMAPs, FY1990-FY1991 to FY1997-FY1998
^State¹⁹⁹^0-19^{91 199}^1-19^{92 199}^2-19^{93 199}^3-19⁹⁴¹⁹⁹^4-19^{95 199}^5-19^{96 199}^6-19⁹⁷¹⁹⁹^7-19⁹⁸
^Alabama^-0.48^{0.20 -1.48 -0.23}^{-0.77 -0.60 -0.31}^-0.22
^Alaska^{0.00 0.00 0.00 0.00}^{0.00 0.00 0.00}^a
^Arizona^{0.73 0.89 3.28 0.01}^0.50^-0.55^-0.32^-0.20
^Arkansas^0.54^{0.54 -1.25}^0.05^{-0.71 -0.14 -0.32}^-0.45
^California^{0.00 0.00 0.00 0.00}^{0.00 0.00 0.23}^1.00
^Colorad^o^1.48^{1.20 -0.37 -0.12}^{-1.20 -0.66 -0.12}^-0.35
^Connecticut^{0.00 0.00 0.00 0.00}^{0.00 0.00 0.00}^0.00
^Delaware^{0.00 0.00 0.00 0.00}^{0.00 0.33}^-0.33^0.00
^District^of^Columbia^{0.00 0.00 0.00 0.00}^{0.00 0.00 0.00}^a
^Florida^{-0.24 0.23 0.34}^-0.25^1.50^{-0.52 0.03}^-0.14
ⁱ^{ki/CRS-RL32950}^Georgia^{-0.75 0.44 0.30 0.39}^-0.24^-0.33^-0.38^-0.68
^g/w^Hawaii^{0.00 0.00 0.00 0.00}^{0.00 0.00 0.00}^0.00
^s^.or^Idaho^{0.33 -0.41 -2.04 -0.28}^{-0.78 -1.36 -0.81}^1.62
^le^ak
^Illinois^{0.00 0.00 0.00 0.00}^{0.00 0.00 0.00}^0.00
^://wiki^Indiana^-0.52^{0.61 -0.64}^0.28^{-0.46 -0.46 -0.99}^-0.17
^h^ttp^Iowa^{0.89 1.63}^{-2.30 0.59}^{-0.71 1.60}^-1.28^0.81
^Kansas^{1.28 1.88}^{-1.05 1.34}^{-0.62 0.14}^-0.17^0.84
^Kentucky^{0.01 -0.14 -1.13 -0.78}^-1.33^{0.72 -0.21}^0.28
^Louisiana^1.36^{0.96 -1.73 -0.22}^{-0.84 -0.76 -0.53}^-1.33
^Maine^-1.71^-1.09^{-0.59 0.15}^{1.34 0.02 0.40}^2.32
^Maryland^{0.00 0.00 0.00 0.00}^{0.00 0.00 0.00}^0.00
^Massach^usetts^{0.00 0.00 0.00 0.00}^{0.00 0.00 0.00}^0.00
^Michigan^{-0.37 1.24 0.43 0.53}^0.47^-0.07^-1.57^-1.62
^Minnesota^0.69^1.00^{0.50 -0.28}^{-0.38 -0.34 -0.33}^-1.46
^Mississippi^-0.24^{0.06 -0.98 -0.16}^{-0.27 -0.51 -0.85}^-0.13
^Missouri^{0.64 1.02}^{-0.58 0.38}^{-0.79 0.21}^-0.02^0.64

^State¹⁹⁹^0-19^{91 199}^1-19^{92 199}^2-19^{93 199}^3-19⁹⁴¹⁹⁹^4-19^{95 199}^5-19^{96 199}^6-19⁹⁷¹⁹⁹^7-19⁹⁸
^Montana^{0.38 -0.03 -0.78}^0.13^{-0.24 -1.43 -0.37}^1.55
^Nebras^ka^1.59^{1.79 -3.18}^0.66^{-1.58 -0.91 -0.36}^2.04
^Nevada^{0.00 0.00 2.28}^-1.97^{-0.31 0.00 0.00}^0.00
^New^Ham^pshire^{0.00 0.00 0.00 0.00}^{0.00 0.00 0.00}^0.00
^New^Jers^ey^{0.00 0.00 0.00 0.00}^{0.00 0.00 0.00}^0.00
^New^Me^xico^1.13^{0.95 -0.48}^0.32^{-0.86 -0.44 -0.21}^-0.05
^New^York^{0.00 0.00 0.00 0.00}^{0.00 0.00 0.00}^0.00
^North^Carolina^{-0.86 -0.08 -0.60 -0.78}^{-0.43 -0.12 -0.70}^-0.80
^North^Dakota^2.48^{2.75 -0.54 -1.08}^-2.40^{0.33 -1.33}^2.70
^Ohio^-0.04^{0.70 -0.38}^0.58^{-0.14 -0.52 -0.89}^-1.14
^Oklahoma^{1.36 1.09}^{-1.07 0.72}^-0.34^{-0.16 0.12}^0.50
ⁱ^{ki/CRS-RL32950}^Oregon^0.55^{0.05 -1.16 -0.27}^{0.24 -1.35 -0.49}^0.94
^g/w^Pennsylvania^-2.22^{0.20 -1.36 -0.87}^{-0.34 -1.34 -0.08}^0.54
^s^.or^Rhode^Island^-1.41^{-0.45 0.35 0.23}^1.62^{-1.65 0.06}^-0.73
^le^ak
^South^Carolina^-0.49^{0.08 -1.38 -0.20}^-0.37^{0.06 -0.34}^-0.20
^://wiki^South^Dakota^0.79^{0.90 -2.32 -0.77}^{-1.44 -1.40 -1.77}^2.86
^h^ttp^Tennessee^{-1.07 -0.16 -0.84 -0.42}^{-0.63 -0.88 -1.06}^-1.22
^Texas^{2.30 0.65 0.26}^-0.26^-0.87^{-1.01 0.26}^-0.28
^Utah^0.19^0.22^{0.18 -0.94}^{-0.87 -0.27 -0.88}^0.25
^Vermont^{-0.80 -0.60 -1.49 -0.33}^1.27^0.05^0.18^1.13
^Virginia^{0.00 0.00 0.00 0.00}^{0.00 1.37 0.08}^0.04
^Washington^{0.33 0.77 0.04}^-0.78^-2.27^{-1.78 0.33}^1.63
^West^Virginia^0.39^{0.68 -1.39 -0.57}^{-1.12 -1.34 -0.66}^1.07
^Wisconsin^{0.34 0.76 0.04 0.05}^-0.66^-0.14^-0.67^-0.16
^Wyoming^2.19^{0.96 -1.99 -1.48}^{-2.76 -3.18}^0.19^3.14

^Maximumⁱ^ncrease^{2.48 2.75 3.28 1.34}^{1.62 1.60 0.40}^3.14

^State¹⁹⁹^0-19^{91 199}^1-19^{92 199}^2-19^{93 199}^3-19⁹⁴¹⁹⁹^4-19^{95 199}^5-19^{96 199}^6-19⁹⁷¹⁹⁹^7-19⁹⁸
^Maximum^dec^rease^{-2.22 -1.09 -3.18 -1.97}^{-2.76 -3.18 -1.77}^-1.62
^Average^cha^nge^0.21^{0.42 -0.49 -0.13}^{-0.39 -0.38 -0.32}^0.29
^Num^ber^withⁱⁿ^crease^{23 29 11 16}^{7 10 10}²⁰
^Num^ber^with^dec^rease¹⁴^{8 27 22}^{31 29 30}¹⁹
^Source:^{Table pr}^epared^{by t}^he^{Congressional Research Service (}^CRS).
^a.^{Statutory change (}^{P.L. 105-33}⁾^{for Alask}^a^{and the Distri}^{ct of}^Columbia.
Table A-2. Change in State FMAPs, FY1998-FY1999 to FY2005-FY2006
^State¹⁹⁹^8-19^{99 199}^9-20^{00 200}^0-20^{01 200}^1-20⁰²²⁰⁰^2-20^{03 200}^3-20^{04 200}^4-20⁰⁵²⁰⁰^5-20⁰⁶
^Alabama^{-0.05 0.30 0.42}^0.46^{0.15 0.15 0.08}^-1.32
^{Alaska 0.00}^0.00^a^1.34^0.89^0.12^-0.81^b
ⁱ^{ki/CRS-RL32950}^Arizona^{0.17 0.42}^-0.15^-0.79^{2.27 0.01 0.19}^-0.47
^g/w^Arkansas^0.12^{-0.11 0.17}^-0.38^{1.64 0.39 0.08}^-0.98
^s^.or
^le^ak^California^{0.32 0.12}^-0.42^0.15^{-1.40 0.00 0.00}^0.00
^Colorad^o^-1.38^{-0.59 0.00}^0.00^{0.00 0.00 0.00}^0.00
^://wiki^Connecticut^{0.00 0.00 0.00}^0.00^{0.00 0.00 0.00}^0.00
^h^ttp
^Delaware^{0.00 0.00 0.00}^0.00^{0.00 0.00 0.38}^-0.29
^District^of^Columbia^{0.00 0.00 0.00}^0.00^{0.00 0.00 0.00}^0.00
^Florida^{0.17 0.80 0.00}^-0.19^{2.40 0.10}^-0.03^-0.01
^Georgia^{-0.37 -0.59 -0.21}^-0.67^{0.60 -0.02}^0.86^0.16
^Hawaii^{0.00 1.01 2.84}^2.49^{2.43 0.13}^-0.43^0.34
^Idaho^{0.26 0.30 0.61}^0.26^-0.06^{-0.50 0.16}^-0.71
^Illinois^{0.00 0.00 0.00}^0.00^{0.00 0.00 0.00}^0.00
^Indiana^{-0.40 0.73 0.30}^0.00^{-0.07 0.35 0.46}^0.20
^Iowa^{-0.43 -0.26 -0.39}^0.19^0.64^{0.43 -0.38}^0.06
^Kansas^{0.34 -0.02 -0.18}^0.35^-0.05^0.67^0.19^-0.60

^State¹⁹⁹^8-19^{99 199}^9-20^{00 200}^0-20^{01 200}^1-20⁰²²⁰⁰^2-20^{03 200}^3-20^{04 200}^4-20⁰⁵²⁰⁰^5-20⁰⁶
^Kentucky^{0.16 0.02}^-0.16^-0.45^{-0.05 0.20}^-0.49^-0.34
^Louisiana^0.34^{-0.05 0.21}^-0.23^{0.98 0.35}^-0.59^-1.25
^Maine^{0.36 -0.18 -0.10}^0.46^{-0.36 -0.21 -1.12}^-1.99
^Maryland^{0.00 0.00 0.00}^0.00^{0.00 0.00 0.00}^0.00
^Massach^usetts^{0.00 0.00 0.00}^0.00^{0.00 0.00 0.00}^0.00
^Michigan^{-0.86 2.39 1.07}^0.18^{-0.94 0.47 0.82}^-0.12
^Minnesota^{-0.64 -0.02 -0.37}^-1.11^0.00^0.00^0.00^0.00
^Mississippi^{-0.31 0.02 0.02}^-0.73^{0.53 0.46 0.00}^-1.08
^Missouri^{-0.44 0.27 0.52}^0.03^{0.17 0.24}^-0.32^0.78
^Montana^{1.17 0.57 0.74}^-0.21^0.13^-0.11^-0.95^-1.36
^Nebras^ka^{0.29 -0.58 -0.50}^-0.83^-0.03^{0.37 -0.25}^0.04
ⁱ^{ki/CRS-RL32950}^Nevada^{0.00 0.00 0.36}^-0.36^{2.39 2.54 0.97}^-1.14
^g/w^New^Ham^pshire^{0.00 0.00 0.00}^0.00^{0.00 0.00 0.00}^0.00
^s^.or^New^Jers^ey^{0.00 0.00 0.00}^0.00^{0.00 0.00 0.00}^0.00
^le^ak
^New^Me^xico^{0.37 0.34 0.48}^-0.76^{1.52 0.29}^-0.55^-3.15
^://wiki^New^York^{0.00 0.00 0.00}^0.00^{0.00 0.00 0.00}^0.00
^h^ttp^{North Carolina}^-0.02^-0.58^-0.02^-1.01^1.10^0.29^0.78^-0.14
^North^Dakota^-0.49^{0.48 -0.43}^-0.12^{-1.51 -0.05 -0.82}^-1.64
^Ohio^{0.12 0.41 0.36}^-0.25^{0.05 0.40 0.45}^0.20
^Oklahoma^{0.33 0.25 0.15}^-0.81^0.13^-0.32^-0.06^-2.27
^Oregon^-0.91^{-0.59 0.04}^-0.80^{0.96 0.65 0.31}^0.45
^Pennsylvania^{0.38 0.05}^-0.20^1.03^{0.04 0.07}^-0.92^1.21
^{Rhode Island}^0.88^-0.28^0.02^-1.34^2.95^0.63^-0.65^-0.93
^South^Carolina^{-0.38 0.10 0.49}^-1.10^{0.47 0.05 0.03}^-0.57
^South^Dakota^{0.41 0.56}^-0.41^-2.38^{-0.64 0.38 0.36}^-0.96
^Tennessee^{-0.27 0.01 0.69}^-0.15^0.95^{-0.19 0.41}^-0.82
^Texas^{0.17 -1.09 -0.79}^-0.40^-0.18^0.23^0.65^-0.21

^State¹⁹⁹^8-19^{99 199}^9-20^{00 200}^0-20^{01 200}^1-20⁰²²⁰⁰^2-20^{03 200}^3-20^{04 200}^4-20⁰⁵²⁰⁰^5-20⁰⁶
^Utah^{-0.80 -0.23 -0.11}^-1.44^1.24^0.48^0.42^-1.38
^Vermont^{-0.21 0.27 0.16}^0.66^-0.65^-1.07^-1.23^-1.62
^Virginia^{0.11 0.07 0.18}^-0.40^-0.92^{-0.53 0.00}^0.00
^Washington^{0.35 -0.67 -1.13}^-0.33^-0.37^0.00^0.00^0.00
^West^Virginia^{0.80 0.31 0.56}^-0.07^{-0.23 0.15}^-0.54^-1.66
^Wisconsin^{0.01 -0.07}^0.51^-0.72^{-0.14 -0.02 -0.09}^-0.67
^Wyoming^{1.06 -0.04}^0.56^-2.63^{-0.65 -1.55 -1.87}^-3.67

^Maximumⁱ^ncrease^{1.17 2.39 2.84}^2.49^{2.95 2.54 0.97}^1.21
^Maximum^dec^rease^{-1.38 -1.09 -1.13}^-2.63^{-1.51 -1.55 -1.87}^-3.67
^Average^cha^nge^{0.01 0.08 0.12}^-0.26^{0.32 0.12}^-0.09^-0.55
ⁱ^{ki/CRS-RL32950}^Num^ber^withⁱⁿ^crease^{23 23 23}¹²^{23 27 18}⁹
^g/w^Num^ber^with^dec^rease^{16 17 16}²⁸^{17 11 19}²⁸
^s^.or
^le^ak^Source:^{Table pr}^epared^{by t}^he^{Congressional Research Service (}^CRS).
^a.^{P.L. 106-5}⁵⁴^{sets an alternative}^{formula for A}^l^ask^a^{for FY2001-FY2005.}
^://wiki^b.^{Although Alaska had re}^{verted to}^usi^{ng the}^{same form}^{ula as other}^s^{tates whe}^{n FY20}^{06 F}^{MAPs were}^published^{by H}^{HS, the Deficit Reduction Act of 2}⁰⁰⁵^{(DRA, P.L.}
^h^ttp^109-¹⁷^{1) later p}^{rovided that Alaska’s FMAP would not fall below it}^{s FY200}^{5 level for FY20}^06-FY2⁰⁰^7.

Figure A-2. Median State FMAP, FY1990-FY2006
ⁱ^{ki/CRS-RL32950}
^g/w
^s^.or
^le^ak
^://wiki
^h^ttp
^Source:^Figure^prepa^{red by}^the^{Congressional Research Service (}^CRS).

^A^p^r^{il Gr}^ad^y
^Aⁿ^a^l^ystⁱⁿ^H^e^a^l^t^h^Ca^r^e^Fi^na^ncⁱ^ng
^ag^rad^y^@^c^r^s^.l^oc.g^ov^{, 7-}⁹⁵⁷⁸