CMS-64.21U Quarterly Medicaid Assistance Expenditures by Children’s

State: New Hampshire
Agency: CMS

CMS 64.21U
Quarterly Medical Assistance Expenditures
By Children's Health Insurance Program
Expenditures Categories

Type of Eligibility: U2 *

Total Computable

(A)
1A) Premiums: Up To 150% - Gross
Premiums Paid
1B) Premiums: Up To 150% - Cost Sharing
Offset
1C) Premiums: Over 150% - Gross Premiums
Paid
1D) Premiums: Over 150% - Cost Sharing
Offset
2) Inpatient Hospital Services - Reg.
Payments
2A) Inpatient Hospital Services - DSH
3) Inpatient Mental Health - Reg. Payment
3A) Inpatient Mental Health - DSH
3B) Certified Community Behavior Health
Clinic Payments
4) Nursing Care Services
5) Physician/Surgical
6) Outpatient Hospital Services
7) Outpatient Mental Health
8) Prescribed Drugs
8A1) Drug Rebate - National
8A2) Drug Rebate - State
8A3) MCO - National Agreement
8A4) MCO - State Sidebar Agreement
8A5) Increased ACA OFFSET - Fee for Service
- 100%
8A6) Increased ACA OFFSET - MCO - 100%
8A7) Drug Rebate Offset - Value Based
Purchasing
9) Dental Services
10) Vision Services
11) Other Practitioners
12) Clinic Services

___________________________.
Quarter/Year: Qtr 1st 2023
Quarter Ended: 12/31/2022
Federal
FMAP
66.30%
COVID FMAP
72.5% **
(B)

Share
CHIP
80.75%

(C)

Total Federal Share

(D)

13) Therapy Services
14) Laboratory/Radiological
15) Medical Equipment
16) Family Planning
17) Abortions No. 0
18) Screening Services
19) Home Health
20) Medicare Payments
21) Home And Community
21A) Home and Community-Based Services Regular Payment (WAIVER)
22) Hospice
23) Medical Transport
24) Case Management
26) ARP Section 9821 COVID
Vaccine/Vaccine Administration
31) Other Services
48) Total
** Lines are calculated at the COVID FMAP rate of 72.5%