Form CMS-10295 State Report on the Use of Increase FMAP Section 5001 of

State Report on the Use of Increased FMAP
Section 5001 of ARRA
I. Introduction
On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act
of 2009 (ARRA, P.L. 111-5) into law, representing approximately $87 billion in Federal funds to
help States, D.C. and Territories meet the health care needs for their Medicaid populations
during the recession period (October 1, 2008 thru December 31, 2011).
The purpose of this report is to identify how the: increased Federal dollars are used; and, the
States are meeting the conditions and requirements under section 5001 of ARRA.
II. State Information:
1. State:
XX
2. State Organizational Component:
3. State Contact Info:

Name:
Address:
E-Mail:
Telephone:

4. Date Submitted:
5. Report Period:

From (mm/dd/yyyy): mm/dd/20yy
To (mm/dd/yyyy): mm/dd/20yy

6.a. Attestation (signature):
6.b. Office of Governor Reviewer:
7. Did your State draw down increased Federal dollars as provided under the ARRA for the
reporting period?
Yes

No

If you marked "Yes", please complete the remaining questions.
8. If you marked "No", please provide a brief explanation why your State did not use the
increased Federal funds, and only complete those remaining questions that are still relevant.

FILE: ARRA-Sec-5001-State-Report-3.xlsx

Date: 8/20/2009
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State Report on the Use of Increased FMAP
Section 5001 of ARRA
State:

XX

Report Period:
From (mm/dd/yyyy): mm/dd/20yy
To (mm/dd/yyyy): mm/dd/20yy

III. State Plan Use of Increased FMAP
Please describe how the State is using the freed up State funds associated with the additional Federal funds related to the
increased FMAP available under the ARRA provision. For this purpose, the amount of "freed up State funds" is equivalent
to the difference between the amount of available Federal funds at the increased FMAP under ARRA and the amount of
the available Federal funds at the regular (non-increased) FMAP.
Indicate all that apply:
1. Uses related to the health care programs in the State:
A.

Medicaid
a) Cover increased caseload
b) Ensure prompt pay requirements are met
c) Maintain current populations and avoid cuts to eligibility
d) Maintain current benefits and avoid reductions in bebefits
e) Expand benefits and / or increase provider rates
f) Expand eligibility / coverage
g) Other. Please explain and provide any attachments if necessary

Estimated Amounts:
$
$
$
$
$
$
$
-

B.

Other Health Care Related (Non-Medicaid)
Describe:

Estimated Amounts:
$
-

2. Non-Health Care Related Uses
Describe:

Estimated Amounts:
$
-

3. Describe the funding process with respect to expenditures during the quarter in the Medicaid program including both
Federal funds related to the increased FMAP under ARRA and non-Federal funds. For this purpose, identify all of the
State funds and accounts which are involved in the funding process for the Medicaid program and into/through which the
increased Federal FMAP funds and the non-Federal share funds flow and/or are deposited.

3.A. Please provide the original estimates of general fund revenue collections used in developing the annual budget for
FY 2009 and your actual or preliminary actual general fund revenue collections

3.B. Please provide the original estimate of general fund revenue collections used in developing your FY 2010 budget
and your most recent updated estimate of collections. When available, please provide the final actual general fund
revenue collections.

4. Medicaid Program Funding Process. Please provide an explanation of the budget process in your state for funding the
Medicaid Program in FY 2009 and FY 2010.

4.A. Did your State reduce the share of State fund appropriations compared to Federal funds for the Medicaid Program,
due to the increased FMAP? If yes please explain.

4.B. Did your State maintain the share of State fund appropriations for the Medicaid Program, despite the increased
FMAP? If yes, please explain.

4.C. Please provide any other information that may help explain your State’s funding of Medicaid during these two fiscal
years.

5. Please include any other information/narrative not addressed in the questions above which would highlight the State's
use of FMAP stimulus funds:

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DRAFT - State Report on the Use of Increased FMAP - DRAFT
Section 5001 of ARRA
State:

Report Period:
From (mm/dd/yyyy): mm/dd/20yy
To (mm/dd/yyyy): mm/dd/20yy

XX

IV. Medicaid Enrollment
1. Please provide enrollment data for the reporting period by population:
Table 1: Medicaid Enrollment/Eligibility Data
1.a. Eligibility Group

Enrollment
9/30/2008 /1

1.b. Eligibility Group

Enrollment
In Report
Period /2
E

Eligibility
Months /3

Average Eligibility
Months
Col F ÷ 3
G
0.00
0.00
0.00
0.00
0.00
0.00

A
B
D
F
Aged (65 and Older)
Aged (65 and Older)
Disabled/Blind
Disabled/Blind
Pregnant Women
Pregnant Women
Children
Children
Other Adults
Other Adults
Total:
0.00
Total:
0.00
0.00
/1 Enrollment in Table 1.a. is equal to the baseline number of unduplicated individuals enrolled as of 9/30/08
/2 Enrollment in Table 1.b. is equal to the number of unduplicated individuals enrolled in report period (quarter)
/3 Eligibility Months in Table 1.b. is the total number of eligibility months during the report period (quarter)
2. Describe Significant Changes in Enrollment/Eligibility (+/- 5.0%)

2.a. Were there any policy changes that may have contributed to the increase/decrease? If yes, please explain below.

2.b. Which population(s) have decreased greater than 5%? Identify population(s) and indicate reason(s) for decrease.

Previous Q: (NASBO suggesting revising as above) 2.b. Which population(s) have decreased greater than 5%?
Identify population(s) and indicate reason(s) for decrease.

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State Report on the Use of Increased FMAP
Section 5001 of ARRA
State:

Report Period:
From (mm/dd/yyyy): mm/dd/20yy
To (mm/dd/yyyy): mm/dd/20yy

XX

V. Maintenance of Effort
1.A. Rainy Day/Reserve Funds. Please report the ending balance of the State's Rainy Day and/or Reserve Funds for each Report quarter. If there was an increase from the previous quarter, please explain
the source of funds and attach any additional information, as necessary.
Table 2. Rainy Day/Reserve Fund
Rainy Day/
Ending Balance
Reserve Fund*
9/30/2008

Ending Balance
Report Qtr

Change
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0

Total:
$0
$0
* Identify/List (If more space needed, include on attachment)

1.B. What are the constitutional and statutory provisions concerning the funding of your rainy day fund?"

1.C. Please describe the mechanism that your state uses to assure that increased FMAP funds are not deposited into your rainy day fund.

2a . Prompt Pay. In Table 3, please report on the number of days and amount of increased FMAP dollars lost as a result of the State's failure to meet the prompt payment requirements, if any. For this purpose,
Table 4 provides a running total for each quarter throught the Report Quarter; Do not complete for future quarters.
Table 3: Prompt Pay Violations
FFY
Quarter 1
Days
Amount
2009
2010
2011
Total:
0

Days

$0

Quarter 2
Amount

0

Days

$0

Quarter 3
Amount

0

Days

$0

Quarter 4
Amount

0

Total
Days

$0

Amount
0
0
0
0

$0
$0
$0
$0

2b. Indicate each date(s) of noncompliance for prompt pay during the Report Period/Quarter (mm/dd/yy):

3. Political Subdivisions. With respect to political subdivisions that are required to contribute to the non-Federal share of the State's Medicaid expenditures, please provide a list of each of political subdivisions
and required percentage of non-Federal share contribution on the percentage political subdivisions are required to contribute toward the non-federal share of Medicaid expenditures. If political subdivisions are
not required to contribute toward the non-Federal share of Medicaid expenditures, please indicate as such.
Table 4: Political Subdivisions Contribution Percentage
Political Subdivision *

Percentage Required
September 30, 2008 (x.x%)

Percentage Required
Report Quarter (x.x%)

* Identify/List (If more space needed, include on attachment)

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State Report on the Use of Increased FMAP
Section 5001 of ARRA

State:

Report Period:
From (mm/dd/yyyy): mm/dd/20yy
To (mm/dd/yyyy): mm/dd/20yy

XX

V. Maintenance of Effort (Cont'd)
4. Restrictive Eligibility. Please report any changes to the eligibility standards, methodologies and procedures that are more
restrictive than what was in effect on July 1, 2008. Provide a description of the changes(s), the effective date, and impact:

4b. Please complete the chart below indicating the increased FMAP dollar amounts lost as a result of such changes, if any:
Table 5: Eligibility Restrictions ($000s)
FFY
Quarter 1
Quarter 2
2009
2010
2011
Total:
$0
$0

Quarter 3

$0

Quarter 4

$0

Total
$0
$0
$0
$0

4c. Reinstatement of Eligiblity- If applicable, specify the date (and Quarter) that the state reinstated eligiblity standards,
methodologies, or procedures, respectively, under such plan (or waiver) as in effect on July 1, 2008.

4d. Reinstatement of Eligiblity- With respect to the eligibility provisions that were reinstated, indicate, by provision, the number of
unduplicated number of enrollees estimated to have retained eligibility, or have been able to be determined eligible, as a result of the
reinstated provision:
Table 6.

Number of enrollees during period that have retained or become eligible as a result of
reinstatement of eligibility provisions
Reinstated Provision (Describe)

No. of Individuals

5.a. Expanded Eligibility. Please report any changes under Title XIX, for medical assistance provided to individuals determined
eligible under eligibility standards that were higher than those in effect on July 1, 2008. Provide a description of the change, the
effective date and impact.

5b. New Eligibles. Please complete Table 7 below and list the number of new eligibles that are covered but excluded from increased
FMAP payments because the expansion is subject to eligiblity income standards that are higher than what was in effect on July 1, 2008.
Table 7.

Number of new elgible individuals during period that became eligible as a result of increased
income eligibility standards, and related lost FMAP
Increased Eligibility Income Standard (Describe)
No. of Individuals
Lost FMAP ($000s)

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State Report on the Use of Increased FMAP
Section 5001 of ARRA
State:

XX

Report Period:
From (mm/dd/yyyy): mm/dd/20yy
To (mm/dd/yyyy): mm/dd/20yy

VI. Comments

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