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entitled 'Recovery Act: Increased Medicaid Funds Aided Enrollment 
Growth, and Most States Reported Taking Steps to Sustain Their 
Programs' which was released on October 8, 2010. 

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Report to Congressional Requesters: 

United States Government Accountability Office:
GAO: 

October 2010: 

Recovery Act: 

Increased Medicaid Funds Aided Enrollment Growth, and Most States 
Reported Taking Steps to Sustain Their Programs: 

GAO-11-58: 

GAO Highlights: 

Highlights of GAO-11-58, a report to congressional requesters. 

Why GAO Did This Study: 

In February 2009, the American Recovery and Reinvestment Act of 2009 
(Recovery Act) initially provided states and the District of Columbia 
(the District) with an estimated $87 billion in increased Medicaid 
funds through December 2010, provided they met certain requirements. 
Funds were made available to states and the District through an 
increase in the Federal Medical Assistance Percentage (FMAP), the rate 
at which the federal government matches state expenditures for most 
Medicaid services. In March 2010, Congress passed the Patient 
Protection and Affordable Care Act (PPACA), which prohibits states 
from adopting certain changes to program eligibility in order to 
receive federal reimbursement, and in August 2010, extended increased 
FMAP rates through June 2011. GAO was asked to examine issues related 
to Medicaid funds under the Recovery Act. GAO examined (1) states’ and 
the District’s access to and use of increased FMAP funds, and (2) 
states' and the District’s plans to sustain their Medicaid programs 
once these funds are no longer available. 

To do this work, GAO surveyed state Medicaid officials in the 50 
states and the District in August 2009 and March 2010 about their 
program enrollment, uses of funds, program adjustments, and program 
sustainability. GAO obtained responses from all states and the 
District. GAO also reviewed CMS data and guidance and interviewed CMS 
and state officials. 

What GAO Found: 

States and the District are on pace to draw down about 94 percent—$82 
billion of the estimated $87 billion—in increased FMAP funds provided 
by the Recovery Act. Most states adjusted their Medicaid programs to 
comply with the act’s requirements, and nearly all states and the 
District reported using the increased FMAP to cover increased 
enrollment, which grew by 14.2 percent nationally between October 2007 
and February 2010. Enrollment growth across the states and the 
District ranged from about 1 percent to 38 percent, with 22 states and 
the District experiencing a 10 to less than 20 percent increase. 
Although most enrollment growth was attributable to children, the 
highest growth rate was among the nondisabled, nonaged adult population.
Forty-seven states and the District reported concern regarding the 
sustainability of their Medicaid programs without the increased FMAP, 
and 46 states took steps to address sustainability, including 
introducing financing arrangements, such as taxes on health care 
providers, or reducing provider payments. Most states and the District 
also reported proposed changes for the future. (See figure.) 

Figure: Certain Actions Most States and the District of Columbia 
Reported Implementing or Proposing to Address Medicaid Program 
Sustainability: 

[Refer to PDF for image: stacked horizontal bar graph] 

Action implemented or proposed: New taxes on health care providers; 
Number of states including the District implementing actions: 38; 
Number of states including the District proposing actions: 5. 

Action implemented or proposed: Reductions or freeze in provider 
payment rates; 
Number of states including the District implementing actions: 28; 
Number of states including the District proposing actions: 13. 

Action implemented or proposed: New or increased intergovernmental 
transfers of funds; 
Number of states including the District implementing actions: 35; 
Number of states including the District proposing actions: 2. 

Action implemented or proposed: Reductions in benefits and services; 
Number of states including the District implementing actions: 11; 
Number of states including the District proposing actions: 11. 

Source: GAO analysis of state-reported data. 

[End of figure] 

Congress passed legislation in August 2010 to extend the increased 
FMAP through June 2011, although at lower rates than provided by the 
Recovery Act. How the subsequent return to regular FMAP rates will 
affect states and the District will vary depending on their unique 
economic circumstances. GAO estimates that regular FMAP rates will be, 
on average, nearly 11 percentage points lower than increased FMAP 
rates available in December 2010. For future adjustments, states and 
the District will need to consider PPACA, which prohibits more 
restrictive eligibility standards, methods, or procedures until 2014, 
in order to receive federal Medicaid reimbursement. 
HHS provided technical comments to this report, which GAO incorporated 
as appropriate. 

View [hyperlink, http://www.gao.gov/products/GAO-11-58] or key 
components. For more information, contact Carolyn L. Yocom at (202) 
512-7114 or yocomc@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

States Have Accessed Most Available Funds and Used Them to Support 
Medicaid Enrollment Growth: 

Most States Reported Taking Actions to Sustain Their Medicaid 
Programs, but Federal Legislation Will Influence Future Program 
Adjustments: 

Agency Comments: 

Appendix I: Scope and Methodology: 

Appendix II: Regular and Preliminary Increased Fourth Quarter 2010 
FMAP Rates and Components of the Increase: 

Appendix III: Increased FMAP Grant Awards and Funds Drawn Down: 

Appendix IV: State-Reported Adjustments to Medicaid Programs and Uses 
of Funds Freed Up by the Increased FMAP: 

Appendix V: Medicaid Enrollment and Enrollment Changes by 
Subpopulation Group from October 2007 through February 2010: 

Appendix VI: Estimated Changes in States' FMAP Rates and Share of 
Medicaid Payments: 

Appendix VII: GAO Contact and Staff Acknowledgments: 

Tables: 

Table 1: Financing Arrangements Used by States to Generate the 
Nonfederal Share of Medicaid Payments and Limits Imposed on These 
Arrangements: 

Table 2: State-Reported Adjustments to Medicaid Programs to Meet 
Recovery Act Requirements: 

Table 3: State-Reported Uses of Freed-Up Funds for State Fiscal Year 
2009: 

Table 4: State-Reported Uses or Planned Uses of Freed-Up Funds for 
Federal Fiscal Year 2010 through First Quarter of Federal Fiscal Year 
2011: 

Table 5: Actions States Reported Implementing between October 2009 and 
February 2010 to Address Concerns about Medicaid Program 
Sustainability: 

Figures: 

Figure 1: Percentage Point Increase in States' FMAP for Fourth Quarter 
Federal Fiscal Year 2010: 

Figure 2: National Medicaid Enrollment Growth, October 2007 through 
February 2010: 

Figure 3: Percentage Increase in Medicaid Enrollment for All States, 
October 2007 through February 2010: 

Figure 4: Enrollment Increases by Medicaid Subpopulation Groups for 
All States, October 2007 through February 2010: 

Figure 5: Actions States Reported Implementing or Proposing to Address 
Medicaid Program Sustainability: 

Abbreviations: 

CHIP: State Children's Health Insurance Program: 

CMS: Centers for Medicare & Medicaid Services: 

CNMI: Commonwealth of the Northern Mariana Islands: 

CPE: certified public expenditure: 

FFY: federal fiscal year: 

FMAP: Federal Medical Assistance Percentage: 

FPL: federal poverty level: 

HHS: Department of Health and Human Services: 

IGT: intergovernmental transfer: 

PPACA: Patient Protection and Affordable Care Act: 

[End of section] 

United States Government Accountability Office:
Washington, DC 20548: 

October 8, 2010: 

The Honorable Tom Harkin: 
Chairman: 
Committee on Health, Education, Labor and Pensions: 
United States Senate: 

The Honorable Jack Reed: 
United States Senate: 

Since the winter of 2007, the nation has faced what is generally 
reported to be the most serious economic crisis since the Great 
Depression. From October 2007 to June 2010, the national unemployment 
rate more than doubled--from 4.7 to 9.5 percent. States' individual 
experiences varied, with unemployment rates in June 2010 at or above 9 
percent in about half the states and as high as 14.2 percent in 
Nevada.[Footnote 1] In addition to rising unemployment, the current 
economic crisis has also led to decreases in state tax revenues and 
increases in the number of individuals who are eligible for Medicaid, 
the joint federal-state health financing program for certain low-
income populations, which is administered by the Department of Health 
and Human Services' (HHS) Centers for Medicare & Medicaid Services 
(CMS). 

The American Recovery and Reinvestment Act of 2009 (Recovery Act) was 
enacted in February 2009 to promote economic recovery and investment 
during this time of economic crisis.[Footnote 2] Among its stated 
purposes are to provide fiscal relief to states and to maintain 
states' Medicaid programs so that Medicaid beneficiaries are assured 
continuity of services. The Recovery Act initially provided states 
with an estimated $87 billion in increased federal funds for Medicaid 
from February 2009 through December 2010, which states could access 
provided they met certain requirements, including ensuring that their 
program eligibility requirements are not more restrictive than July 
2008 standards.[Footnote 3] CMS makes Recovery Act funds available to 
states for state spending on Medicaid services through an increase in 
the rate at which the federal government matches state expenditures 
for these services. The federal government matches states' spending 
for Medicaid services according to a formula known as the Federal 
Medical Assistance Percentage (FMAP).[Footnote 4] Without the fiscal 
relief provided to state Medicaid programs by the Recovery Act, states 
reported that they would have faced difficulties maintaining their 
level of benefits and services to an increasing number of eligible 
Medicaid beneficiaries.[Footnote 5] 

Moreover, in March 2010, Congress passed the Patient Protection and 
Affordable Care Act (PPACA), which, among other provisions, prohibits 
states from adopting more restrictive Medicaid eligibility standards, 
methodologies, or procedures for adults until 2014 in order for states 
to receive any federal Medicaid funding.[Footnote 6] Although some 
economists have pointed to signs of economic improvement, the budget 
outlook for states continues to show signs of stress, including a 
collective $174.1 billion budget gap that states faced for fiscal year 
2010, as well as additional projected gaps in 2011 and 2012.[Footnote 
7] To help states address continuing budget gaps, federal legislation 
amending the Recovery Act was enacted on August 10, 2010, which 
provides for an extension of increased FMAP funding through June 30, 
2011, but at a lower level.[Footnote 8] In light of lingering fiscal 
pressures, it remains to be seen how states will respond to provisions 
within PPACA and the extension of the increased FMAP funding that will 
affect the financing of their Medicaid programs. 

You expressed interest in states' uses of the increased FMAP funds and 
concerns they may have once this funding is no longer available. In 
this report, we examine issues related to the federal Medicaid funds 
available to states under the Recovery Act, including (1) the extent 
to which states have accessed and used increased FMAP funds, and (2) 
how states plan to sustain their Medicaid programs once the increased 
FMAP funds are no longer available. 

To address our objectives, we administered a Web-based survey to the 
Medicaid directors or their designated contacts in all states in 
August 2009 and again in March 2010, and obtained response rates of 98 
and 100 percent, respectively.[Footnote 9] We reviewed states' 
responses to survey questions, which collected information on a 
variety of topics, including Medicaid enrollment, uses of increased 
FMAP funds, adjustments made in response to the Recovery Act's 
requirements, and the longer-term sustainability of their Medicaid 
programs. We also asked states about potential changes to their 
eligibility guidelines after Recovery Act funding is no longer 
available. However, states completed the survey prior to March 23, 
2010, the enactment date of PPACA, and prior to enactment of 
legislation extending Recovery Act funding, and therefore, could not 
have taken into account provisions of the law when responding. As 
needed, we followed up with Medicaid officials in selected states to 
clarify survey responses and to obtain additional information on their 
compliance with certain Recovery Act requirements. In addition, using 
a more limited survey, we contacted the five largest U.S. insular 
areas--American Samoa, Guam, the Commonwealth of the Northern Mariana 
Islands, Puerto Rico, and the U.S. Virgin Islands--to collect 
enrollment and other data and obtained responses from four of them. 
[Footnote 10] In addition, we reviewed data from CMS on federal 
Medicaid funds allotted under the Recovery Act for federal fiscal 
years (FFY) 2009 and 2010; interviewed CMS officials to discuss their 
oversight of the Medicaid funds provided under the Recovery Act; and 
reviewed data prepared by Federal Funds Information for States, an 
organization that tracks and reports on the fiscal impact of federal 
budget and policy decisions on state budgets and programs. We relied 
on the survey responses reported by the official identified as the 
primary contact for the state's Medicaid program and on federal 
Medicaid data provided by CMS. We did not independently verify these 
data. However, we reviewed all survey responses and federal Medicaid 
data for internal consistency and followed up with state officials and 
CMS for clarification when necessary. Based on these activities, we 
determined these data were sufficiently reliable for the purpose of 
our report. (See appendix I for additional information on the scope 
and methodology.) 

We conducted a performance audit for this review from December 2009 to 
August 2010 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings and conclusions based on our audit objectives. 

Background: 

Title XIX of the Social Security Act establishes Medicaid as a federal-
state partnership that finances health care for certain low-income 
individuals, including children, families, the aged, and the disabled. 
[Footnote 11] Within broad federal requirements, each state operates 
and administers its Medicaid program in accordance with a CMS- 
approved state Medicaid plan. These plans detail the populations 
served, the services covered, and the methods used to calculate 
payments to providers. All states must provide certain services, such 
as inpatient and outpatient hospital services, nursing facility 
services, and physician services, and may provide additional, optional 
services, such as prescription drugs, dental care, and certain home-
and community-based services. The federal government matches most 
state Medicaid expenditures for covered services according to the 
FMAP, which is based on a statutory formula drawing on each state's 
annual per capita income.[Footnote 12] To obtain federal matching 
funds for Medicaid, states file quarterly financial reports with CMS 
and draw down funds through an existing payment management system used 
by HHS. 

The Recovery Act initially provided eligible states with an increased 
FMAP for 27 months from October 1, 2008, to December 31, 2010. 
[Footnote 13] On August 10, 2010 federal legislation was enacted 
amending the Recovery Act and providing for an extension of increased 
FMAP funding through June 30, 2011, but at a lower level.[Footnote 14] 
Generally, for fiscal year 2009 through the third quarter of fiscal 
year 2011, the increased FMAP is calculated on a quarterly basis and 
is comprised of three components: (1) a "hold harmless" provision, 
which maintains states' regular FMAP rates at the highest rate of any 
fiscal year from 2008 to 2011; (2) a general across-the-board increase 
of 6.2 percentage points in states' regular FMAPs through the first 
quarter of fiscal year 2011, which will be reduced to regular FMAP by 
July 1, 2011; and (3) a further increase to the regular FMAPs for 
those states that have a qualifying increase in unemployment rates. 
[Footnote 15] Because the unemployment component of the increased FMAP 
is based on both the level of its regular FMAP and changes in a 
state's unemployment rate--versus its existing unemployment rate--it 
does not fully differentiate among states' economic circumstances 
prior to the downturn. States with comparatively high unemployment 
rates and higher regular FMAPs did not always receive the largest 
unemployment adjustment to their FMAPs.[Footnote 16] For example, 
Michigan had the highest pre-recession unemployment rate in the nation 
at 7.3 percent in October 2007, and in June 2010, continued to have 
one of the nation's highest unemployment rates at 13.2 percent. 
Although the state's unemployment rate increased by 5.9 percentage 
points over this time, the increased FMAP attributable to the 
unemployment component in the fourth quarter of FFY 2010 was 3.88 
percentage points. In contrast, New Hampshire received an unemployment 
adjustment of 5.39 percentage points for the same period, although 
growth in its unemployment rate was significantly lower, and in June 
2010, was less than half the unemployment rate in Michigan.[Footnote 
17] 

Following enactment of the Recovery Act, FMAP rates substantially 
increased in all states over the regular 2009 FMAP rates and have 
continued to increase, albeit at a slower rate, since that time. On 
average, increased FMAP rates nationally for the first and second 
quarters of FFY 2009 were 8.58 percentage points higher than regular 
FFY 2009 FMAP rates. By the fourth quarter of FFY 2010, the increased 
FMAP rates nationwide had increased by an average of 10.59 percentage 
points over the regular FFY 2010 FMAPs, with the increase ranging from 
6.94 percentage points in North Dakota to 13.87 percentage points in 
Louisiana.[Footnote 18] (See figure 1.) 

Figure 1: Percentage Point Increase in States' FMAP for Fourth Quarter 
Federal Fiscal Year 2010: 

[Refer to PDF for image: illustrated U.S. map] 

Percentage point increase in FMAP: 

6% to less than 10% (21): 
Alabama: 
Arkansas: 
District of Columbia: 
Georgia: 
Idaho: 
Indiana: 
Iowa: 
Kansas: 
Kentucky: 
Maine: 
Mississippi: 
Missouri: 
Nebraska: 
New Mexico: 
North Carolina: 
North Dakota: 
South Carolina: 
South Dakota: 
Tennessee: 
Utah: 
West Virginia: 

10% to less than 12% (23): 
Alaska: 
Arizona: 
California: 
Colorado: 
Connecticut: 
Delaware: 
Illinois: 
Maryland: 
Massachusetts: 
Michigan: 
Minnesota: 
Montana: 
New Hampshire: 
New Jersey: 
New York: 
Ohio: 
Oregon: 
Pennsylvania: 
Rhode Island: 
Vermont: 
Virginia: 
Wisconsin: 
Wyoming: 

12% to less than 14% (7): 
Florida:
Hawaii:
Louisiana: 
Nevada: 
Oklahoma: 
Texas: 
Washington: 

Sources: GAO analysis of HHS and Federal Funds Information for States 
data; Map Resources (map). 

Note: The increase is based on a comparison between preliminary 
increased FMAP rates for the fourth quarter fiscal year 2010, which 
were estimated on May 25, 2010, and the regular FMAP rates for 2010, 
which were published in the Federal Register on November 26, 2008. HHS 
calculates preliminary FMAP rates using Bureau of Labor Statistics 
unemployment estimates and adjusts these FMAP rates once the final 
unemployment numbers become available. Fiscal year refers to the 
federal fiscal year, which begins October 1 and ends September 30. 

[End of figure] 

For all states, the largest proportion of the increased FMAP was the 
component attributable to the across-the-board increase of 6.2 
percentage points. In addition, the "hold harmless" component 
contributed to the increase in 17 states, and all states except North 
Dakota received an increase to their regular FMAP rate based on 
qualifying increases in unemployment rates.[Footnote 19] (See appendix 
II for additional information on increased FMAP rates available to 
states under the Recovery Act.) 

For states to qualify for the increased FMAP, they must pay the 
state's share of Medicaid costs and comply with a number of 
requirements, including the following: 

* States generally may not apply eligibility standards, methodologies, 
or procedures that are more restrictive than those in effect under 
their state Medicaid programs on July 1, 2008.[Footnote 20] 

* States must comply with prompt payment requirements.[Footnote 21] 

* States cannot deposit or credit amounts attributable (either 
directly or indirectly) to certain elements of the increased FMAP in 
any reserve or rainy day fund of the state.[Footnote 22] 

* States with political subdivisions--such as cities and counties--
that contribute to the nonfederal share of Medicaid spending cannot 
require the subdivisions to pay a greater percentage of the nonfederal 
share than would have been required on September 30, 2008.[Footnote 23] 

In addition, states must separately track and report on increased FMAP 
funds. To help states comply with these requirements, CMS provided the 
increased FMAP funds to states through a separate account in the 
payment management system used by HHS, allowing the funds to be 
tracked separately from regular FMAP funds as required by the act. CMS 
also provided guidance in the form of state Medicaid director letters 
and written responses to frequently asked questions, and the agency 
continues to work with states individually to resolve any compliance 
issues that may arise.[Footnote 24] 

Despite these restrictions, however, states are able to make certain 
other adjustments to their Medicaid programs without risking their 
eligibility for increased FMAP funds. For example, the Recovery Act 
does not prohibit states from reducing optional services, or reducing 
provider payment rates. States also continue to have flexibility in 
how they finance the nonfederal share of Medicaid payments. 
Specifically, provided they comply with federal limits, states may 
rely on various financing arrangements, such as provider taxes, 
certified public expenditures (CPE), or intergovernmental transfers 
(IGT), to generate the nonfederal share of payments.[Footnote 25] (See 
table 1.) 

Table 1: Financing Arrangements Used by States to Generate the 
Nonfederal Share of Medicaid Payments and Limits Imposed on These 
Arrangements: 

Financing arrangement: Provider tax; 
Description: A tax, fee, assessment, or other mandatory payment 
imposed on health care services or providers. States may use resulting 
revenue to pay their nonfederal share of Medicaid payments under 
statutorily specified circumstances; 
Limits imposed on arrangements: States may receive federal matching 
funds for provider taxes only if such taxes are broad-based, uniformly 
imposed, and do not result in any taxpayers being held harmless (i.e., 
receiving state funds to reduce the net payment to the state to below 
the amount of the tax). 

Financing arrangement: Medicaid certified public expenditure (CPE); 
Description: A government provider, such as a county hospital, 
certifies to a state the amount of expenditures for a Medicaid-covered 
service provided to a Medicaid beneficiary. The state obtains federal 
Medicaid matching funds based on the amount of the payment; 
Limits imposed on arrangements: Medicaid law allows states to finance 
the nonfederal share of payments with CPEs as long as the funds are 
(1) derived from state or local tax revenue, and (2) certified by 
units of local or state government as eligible for federal 
reimbursement. 

Financing arrangement: Intergovernmental transfer (IGT); 
Description: Nonstate public revenue sources, such as local 
governments or other public entities, which provide the nonfederal 
share for Medicaid. 
Limits imposed on arrangements: CMS requires that (1) IGTs from 
providers to a state occur before Medicaid supplemental payments are 
made, and (2) the amount of an IGT not exceed the nonfederal share of 
the Medicaid payments. 

Source: GAO analysis of CMS data. 

Note: See GAO, Medicaid Financing: Federal Oversight Initiative Is 
Consistent with Medicaid Payment Principles but Needs Greater 
Transparency, GAO-07-214 (Washington, D.C.: Mar. 30, 2007). 

[End of table] 

States Have Accessed Most Available Funds and Used Them to Support 
Medicaid Enrollment Growth: 

States have accessed most of the increased FMAP funds available to 
them through the Recovery Act, despite most having to make adjustments 
to their Medicaid programs to become eligible for the funds. Nearly 
every state used the funds to cover increased Medicaid enrollment, 
which grew by over 14 percent nationally between October 2007 and 
February 2010. 

States Have Accessed Most Available Increased FMAP Funds and Made 
Program Adjustments to Comply with the Act: 

Through the end of the third quarter of FFY 2010, states had drawn 
down a total of $60.8 billion in increased FMAP funds--95 percent of 
the funds available at that point, or 70 percent of the total 
estimated $87 billion in increased FMAP that was provided through the 
Recovery Act.[Footnote 26] If current spending patterns continue, we 
estimate that the states will draw down $82 billion by December 31, 
2010--about 94 percent of the estimated total allocation of $87 
billion.[Footnote 27] CMS distributed the increased FMAP funds to 
states through an existing payment system, thereby providing states 
with timely access to the funds. Within 3 months of enactment, all but 
one state had drawn down the increased FMAP funds.[Footnote 28] 

Most states reported making at least one adjustment to their Medicaid 
programs in order to be eligible for the increased FMAP funds, and 25 
states reported making multiple adjustments. Twenty-nine states 
reported making adjustments to comply with the act's prompt payment 
requirement, and 26 states reported making adjustments to the act's 
maintenance of eligibility requirement. For example, several states 
reported that they were in the process of replacing antiquated claims 
payment systems or implementing programming changes to existing 
systems to be able to comply with the prompt payment requirement. 
Specifically, Hawaii and South Carolina adjusted their claims payment 
systems to identify claims on a daily basis and developed reporting 
mechanisms to monitor compliance with the act's prompt payment 
requirement. In terms of adjustments states made to comply with the 
maintenance of eligibility requirement, Vermont reported that it 
eliminated premium increases that it had imposed on certain 
beneficiaries, and Arizona reported reversing a policy that had 
increased the frequency at which it determined program eligibility. In 
addition, 13 states reported making adjustments to the act's 
requirement on contributions by political subdivisions, and 4 states 
reported making adjustments to comply with the act's requirement 
related to rainy day funds. 

When asked about the difficulty of complying with the act's 
requirements in order to access funds, states most frequently reported 
that meeting the prompt payment requirement posed a high level of 
difficulty. Nine states reported having not met the prompt payment 
requirement at some point since the Recovery Act was enacted, with the 
total number of days reported by a state ranging from 1 day to 48 
days. Eight states have either applied for or received a waiver from 
meeting the prompt payment requirement from CMS.[Footnote 29] (See 
appendix III for additional information on the increased FMAP grant 
awards and drawdown amounts for each state.) 

States Used Increased FMAP Funds to Maintain Their Programs in Light 
of Enrollment Growth: 

For FFY 2010 through the first quarter of FFY 2011, nearly all states 
reported using or planning to use funds freed up by the increased FMAP 
to cover increased Medicaid caseloads (45 states), maintain Medicaid 
eligibility (44 states), and to maintain Medicaid benefits and 
services (44 states). Additionally, the majority of states also 
reported using or planning to use these funds to help support general 
state budget needs, maintain institutional provider payment rates, and 
maintain practitioner payment rates.[Footnote 30] Despite the variety 
of purposes for which states used the increased FMAP funds, when asked 
about the sufficiency of the funds, fewer than half of states (18 
states) reported that the 2010 funds were sufficient for the stated 
purposes of the act--to provide fiscal relief to states and to 
maintain states' Medicaid programs. 

Nonetheless, 46 states reported that the increased FMAP was a major 
factor in their efforts to support Medicaid enrollment growth which, 
from October 2007 through February 2010, increased 14.2 percent 
nationally, which is significantly higher than in previous years. 
[Footnote 31] The rate of growth peaked between January 2009 and July 
2009, increasing by 5 percent during this 7-month period. (See figure 
2.) 

Figure 2: National Medicaid Enrollment Growth, October 2007 through 
February 2010: 

[Refer to PDF for image: line graph] 

Date: October 2007	
National enrollment: 44.4 million. 

Date: January 2008	
National enrollment: 44.6 million. 

Date: July 2008	
National enrollment: 45.5 million. 

Date: January 2009	
National enrollment: 46.8 million. 

[January 2009 to July 2009: 2.4 million new enrollees] 

Date: July 2009	
National enrollment: 49.1 million. 

Date: February 2010	
National enrollment: 50.7 million. 

Source: GAO analysis of state-reported data. 

[End of figure] 

Enrollment growth across the states varied considerably--ranging from 
about 1 percent in Tennessee and Texas to almost 38 percent in Nevada. 
[Footnote 32] Twenty-three states experienced a 10 to less than 20 
percent enrollment increase, with 16 states experiencing an enrollment 
increase of 20 percent or greater.[Footnote 33] (See figure 3.) While 
the magnitude of the enrollment increase across states was largely due 
to the economic downturn, program expansions and enrollment outreach 
initiatives implemented in some states prior to the economic downturn 
also contributed to enrollment growth. Despite states' declining 
revenues, however, the act's maintenance of eligibility requirement 
made the increased FMAP contingent on states not adopting more 
restrictive Medicaid eligibility standards, methodologies, or 
procedures than those that were in place on July 1, 2008. 

Figure 3: Percentage Increase in Medicaid Enrollment for All States, 
October 2007 through February 2010: 

[Refer to PDF for image: vertical bar graph] 

Enrollment percentage change: less than 10%; 
Number of states: 12. 

Enrollment percentage change: 10% to less than 15%; 
Number of states: 11 (nationally, Medicaid enrollment increased by 
14%). 

Enrollment percentage change: 15% to less than 20%; 
Number of states: 12. 

Enrollment percentage change: 20% to less than 25%; 
Number of states: 7. 

Enrollment percentage change: 25% or more; 
Number of states: 9. 

Source: GAO analysis of state-reported data. 

Note: These percentages are based on state-reported Medicaid 
enrollment data. For some states, the data reported are preliminary 
and subject to change. 

[End of figure] 

When examining regional variation in enrollment growth, states in the 
western region of the country most commonly had enrollment increases 
above the national increase of just over 14 percent (11 of 13 states), 
while states in the northeast region were least likely to have 
enrollment increases over the national increase (4 of 9 states). 
Various factors likely contributed to these regional variations. For 
example, when compared to national averages, most states in the 
western region experienced higher than average growth in unemployment 
(8 of 13 states) and poverty rates (7 of 13 states) during the 
recession, and higher rates of uninsurance prior to the recession (11 
of 13 states). Low enrollment growth in the northeast region may be 
due, in part, to the fact that many of these states have historically 
had higher Medicaid income-eligibility levels when compared to states 
in other regions. For example, in 2009, the majority of states in the 
northeast extended Medicaid coverage to parents with incomes over 150 
percent of the federal poverty level (FPL). In contrast, the majority 
of states in the southern and western regions generally limited 
program eligibility to parents under 75 percent of the FPL. 

Across the states, most enrollment growth was attributable to 
children, a population that comprises over half of total Medicaid 
enrollment, and is sensitive to economic downturns. However, the 
highest rate of increase during this period occurred among the 
nondisabled, nonaged adult population. Specifically, from October 2007 
through February 2010, enrollment among the nondisabled, nonaged adult 
population increased by nearly 30 percent, compared to an increase of 
nearly 15 percent for children.[Footnote 34] (See figure 4.) 

Figure 4: Enrollment Increases by Medicaid Subpopulation Groups for 
All States, October 2007 through February 2010: 

[Refer to PDF for image: vertical bar graph] 

Medicaid subpopulation groups (increase): Children (3,717,276); 
Percentage increase: 14.73%. 

Medicaid subpopulation groups (increase): Aged (351,121); 
Percentage increase: 7.14%. 

Medicaid subpopulation groups (increase): Disabled (324,631); 
Percentage increase: 4.89%. 

Medicaid subpopulation groups (increase): Adults (1,738,046); 
Percentage increase: 29.88%. 

Source: GAO analysis of state-reported data. 

Note: These percentages are based on state-reported Medicaid 
enrollment data. For some states, the data reported are preliminary 
and subject to change. 

[End of figure] 

Of the 29 states with readily available information on the geographic 
distribution of Medicaid enrollment increases, 21 states reported that 
the increase was generally distributed evenly across the state, and 8 
states reported that the increase was concentrated in certain urban or 
rural counties. For example, Arizona Medicaid officials reported that 
the largest enrollment increase occurred in Maricopa County--the 
state's largest county that includes Phoenix and Scottsdale. 
Pennsylvania officials reported that the concentration of enrollment 
growth was mixed between one rural county and two urban counties-- 
Montgomery and Cumberland. 

(See appendix IV for more information on adjustments made by states to 
comply with Recovery Act requirements and states' uses of funds freed- 
up by the increased FMAP. See appendix V for additional information on 
enrollment changes in the states and the largest U.S. insular areas.) 

Most States Reported Taking Actions to Sustain Their Medicaid 
Programs, but Federal Legislation Will Influence Future Program 
Adjustments: 

Most states are concerned about their ability to sustain their 
Medicaid programs once the increased FMAP funds are no longer 
available, and have taken actions or proposed actions to address 
program sustainability. However, states' efforts to make future 
program adjustments will be influenced by recent legislation, 
including PPACA, and the subsequent extension of the increased FMAP 
through June 2011. 

States' Actions to Address Program Sustainability Include New or 
Altered Financing Arrangements and Reductions to Provider Payments: 

Forty-eight states reported concerns regarding the sustainability of 
their Medicaid programs after Recovery Act funding is no longer 
available,[Footnote 35] with most states reporting that the factors 
driving their concerns included the increased share of the state's 
Medicaid payments in 2011, and the projection of the state's economy, 
tax revenues, and Medicaid enrollment growth for 2011.[Footnote 36] To 
address program sustainability, 46 states have taken actions--such as 
introducing new Medicaid financing arrangements and reducing or 
freezing practitioner payment rates--and 44 states reported 
implementing multiple actions. Most commonly, states implemented new 
financing arrangements or altered existing ones--such as provider 
taxes, IGTs, and CPEs--to generate additional revenues to help finance 
the nonfederal share of their Medicaid programs.[Footnote 37] In 
addition, most states also reported that they proposed making 
additional changes to their Medicaid programs for the remainder of 
fiscal year 2010 or for fiscal year 2011. (See figure 5.) 

Figure 5: Actions States Reported Implementing or Proposing to Address 
Medicaid Program Sustainability: 

[Refer to PDF for image: stacked horizontal bar graph] 

Action implemented or proposed: New taxes on health care providers: 
States implementing action: 38; 
States only proposing action: 5. 

Action implemented or proposed: Reductions or freeze in provider 
payment rates: 
States implementing action: 28; 
States only proposing action: 13. 

Action implemented or proposed: New or increased intergovernmental 
transfers of funds: 
States implementing action: 35; 
States only proposing action: 2. 

Action implemented or proposed: New certified public expenditures: 
States implementing action: 35; 
States only proposing action: 1. 

Action implemented or proposed: Reductions in benefits and services: 
States implementing action: 11; 
States only proposing action: 11. 

Action implemented or proposed: Increases to beneficiary co-payments 
or premiums: 
States implementing action: 6; 
States only proposing action: 13. 

Action implemented or proposed: Increases to existing taxes on health 
care providers: 
States implementing action: 3; 
States only proposing action: 13. 

Action implemented or proposed: Changes to prescription drug 
formularies: 
States implementing action: 9; 
States only proposing action: 9. 

Action implemented or proposed: No action taken: 
States implementing action: 5; 
States only proposing action: 0. 

Source: GAO analysis of state-reported data. 

[End of figure] 

Twenty-eight states reported that they reduced or froze Medicaid 
payment rates to certain Medicaid providers in response to concerns 
about program sustainability.[Footnote 38] For example, in December 
2009, Iowa implemented across-the-board rate reductions for most 
providers ranging from 2.5 to 5 percent, which will remain in effect 
until June 30, 2011. Similarly, Maryland reduced or froze payments for 
physicians and hospitals, and for long-term care services and home-and 
community-based services. States also reported reducing benefits and 
services, changing prescription drug formularies, or increasing 
beneficiary copayments or premiums. Four states--Florida, Illinois, 
Mississippi, and Texas--and the District of Columbia reported that 
they did not implement any changes in response to their concerns about 
program sustainability; however, Medicaid officials in most of those 
states and the District told us that they were considering future 
changes. 

In addition to these program changes, over half the states reported 
making administrative changes that could affect Medicaid application 
processing time, such as decreasing the number of staff or staff hours 
available for processing Medicaid applications, increasing furlough 
days, and decreasing the number of Medicaid intake facilities. Despite 
these actions, most states kept pace with the increasing number of 
applications they received. Specifically, of the 33 states reporting 
data, 25 processed on average at least 95 percent of applications they 
received each month. 

(See appendix IV for additional information on state actions to 
address program sustainability. Appendix VI provides more information 
on changes to states' share of Medicaid payments when increased FMAP 
is no longer available.) 

States' Efforts to Make Future Program Adjustments Will Be Influenced 
by Federal Legislation: 

States indicated that legislation to extend the increased FMAP funding 
would help address their concerns about program sustainability. At the 
time of our survey, legislation extending the increased FMAP had been 
proposed, but not enacted. Despite uncertainties about the 
availability of the increased FMAP beyond December 2010, however, 30 
states had assumed a 6-month extension of the increased FMAP in their 
fiscal year 2011 budgets without any changes to the way it is 
calculated as provided for under the Recovery Act, and only 9 of these 
states had contingency plans in place if such legislation was not 
enacted.[Footnote 39] 

On August 10, 2010, Congress passed legislation amending § 5001 of the 
Recovery Act to extend the increased FMAP through June 30, 2011, but 
at a lower level.[Footnote 40] Specifically, under the amendments to 
the Recovery Act, states' increased FMAP rates will decrease by at 
least 3 percentage points beginning on January 1, 2011, and continue 
to be phased down to their regular FMAP rates by July 1, 2011. For 
states that had assumed an unmodified extension of the increased FMAP, 
the available federal funds will be less than anticipated. However, 
without the extension, we estimate that states, on average, would have 
faced a nearly 11 percentage point decrease in their FMAP rates on 
January 1, 2011.[Footnote 41] The additional 6 months of increased 
FMAP funding will allow states more time to adjust as they return to 
their regular FMAP rates. How states will fare as they return to their 
regular FMAP rates will vary depending on each state's unique economic 
circumstances and the size of their Medicaid population.[Footnote 42] 
Officials from several states indicated that the loss of increased 
FMAP funds would distress their state's budget, requiring the state to 
make additional program reductions, as the following examples 
illustrate. 

* Wisconsin Medicaid officials reported that the state would need to 
reduce Medicaid expenses by $1 billion annually, or about 20 percent 
of the state's Medicaid budget, and are considering several options, 
including eliminating the state's prescription drug program for 
seniors and several rate reform initiatives.[Footnote 43] 

* Colorado Medicaid officials reported that the state would need to 
reduce Medicaid expenditures by an estimated $250 million, in addition 
to approximately $320 million the state has already cut. The state 
reported that the additional expenditure reduction would require 
drastic cuts to optional programs, benefits, and provider rates. 

In addition, the recently enacted PPACA includes several provisions 
that affect states' Medicaid programs, and states will need to take 
into account these provisions when considering additional adjustments 
to their programs. Specifically, the maintenance of eligibility 
requirement under PPACA precludes states from receiving federal 
Medicaid funding if they apply eligibility standards, methods, or 
procedures, under their plan or a waiver, that are more restrictive 
for adults than those in effect on the date of PPACA's enactment until 
the date the Secretary of HHS determines that a health insurance 
exchange established by the state is fully operational, which must be 
no later than January 1, 2014.[Footnote 44],[Footnote 45] 

PPACA also provides states with an opportunity to obtain additional 
Medicaid funds, either immediately or in the future. For example, 
PPACA requires states to cover all persons under 65 who are not 
already eligible under mandatory eligibility groups up to 133 percent 
of the FPL by 2014, but states have the option to expand eligibility 
immediately and to receive federal funds for these individuals. 
[Footnote 46] As of August 12, 2010, Connecticut and the District have 
obtained CMS approval to shift eligible low-income adults from 
existing state health care programs into Medicaid.[Footnote 47] The 
act also includes provisions to facilitate states' use of home-and 
community-based long-term care services.[Footnote 48] 

Agency Comments: 

In commenting on a draft of this report, HHS provided technical 
comments, which we incorporated as appropriate. HHS did not comment on 
our findings. 

We are sending copies of this report to the Secretary of HHS, the 
Administrator of the Centers for Medicare & Medicaid Services, and 
other interested parties. In addition, the report will be available at 
no charge on the GAO Web site at [hyperlink, http://www.gao.gov]. 

If you or your staff members have any questions, please contact me at 
(202) 512-7114 or yocomc@gao.gov. Contact points for our Offices of 
Congressional Relations and Public Affairs may be found on the last 
page of this report. Major contributors to this report are listed in 
appendix VII. 

Signed by: 

Carolyn L. Yocom: 
Acting Director, Health Care: 

[End of section] 

Appendix I: Scope and Methodology: 

To examine the extent to which states have accessed increased Federal 
Medical Assistance Percentage (FMAP) funds, we reviewed data provided 
by two divisions within the Department of Health and Human Services 
(HHS)--the Centers for Medicare & Medicaid Services (CMS) and the 
Office of the Assistant Secretary for Planning and Evaluation--on 
increased FMAP rates and Medicaid grant awards under the Recovery Act 
for federal fiscal years (FFY) 2009 and 2010. We analyzed data on 
increased FMAP rates to determine the proportion of each state's 
increase attributable to the three components prescribed in the act: 
the across-the-board component, the hold harmless component, and the 
unemployment component. We compared preliminary fourth quarter FFY 
2010 increased FMAP rates to the 2011 regular FMAP rates to estimate 
the percentage increase in states' share of Medicaid payments once the 
increased FMAP is no longer available. 

We also analyzed CMS data on increased FMAP funds to determine each 
state's total available grant award for FFYs 2009 and 2010 and the 
percentage each state had drawn from their available grants as of June 
30, 2010. Based on these drawdown rates, we projected the total amount 
of increased FMAP funds that states would draw down by December 31, 
2010. We interviewed CMS officials to understand how they compiled 
data on increased FMAP funds and to clarify anomalies we identified in 
the data. We also discussed CMS officials' oversight of the Medicaid 
funds provided under the Recovery Act and specifically addressed their 
oversight of states' actions to comply with the act's eligibility 
requirements for increased FMAP. We also reviewed relevant CMS 
guidance, including a sample of increased FMAP grant award letters, a 
fact sheet, frequently asked questions documents, and state Medicaid 
director letters related to the act. 

To examine how states used the increased FMAP funds and how states 
planned to sustain their Medicaid program once the increased FMAP 
funds are no longer available, we administered a Web-based survey to 
the Medicaid directors or their designated contacts in all states in 
August 2009 and in March 2010, and obtained a response rate of 98 and 
100 percent, respectively.[Footnote 49] The surveys asked states to 
provide information on a variety of topics, including their uses of 
increased FMAP funds, monthly Medicaid enrollment from October 2007 
through February 2010, adjustments made in response to the act's 
requirements, and any concerns they had about the longer-term 
sustainability of their Medicaid programs. We pretested the surveys 
with Medicaid officials from four states. We reviewed all survey 
responses, and where appropriate, included these responses in the 
report. As needed, we followed up with Medicaid officials in selected 
states to clarify responses, to request corrected enrollment data, or 
to obtain additional information on their compliance with certain 
Recovery Act requirements. 

We analyzed the Medicaid enrollment data obtained from the surveys to 
determine total enrollment growth and percentage change in enrollment 
for each state between October 2007 and February 2010. We also 
analyzed the enrollment data to determine the extent to which each 
Medicaid subpopulation--children, aged individuals, disabled 
individuals, and adults (nonaged, nondisabled)--contributed to overall 
enrollment growth during this period. We analyzed the survey data on 
Medicaid applications to determine any changes in states' processing 
volumes and rates over this period. We did not independently verify 
these data; however, we reviewed all survey responses and federal 
Medicaid data for internal consistency, validity, and reliability. 
[Footnote 50] Based on these activities, we determined these data were 
sufficiently reliable for the purpose of our report. 

In addition, we analyzed other state economic and fiscal data--such as 
poverty rates, unemployment rates, and Medicaid eligibility levels--to 
examine their relationship to overall Medicaid enrollment growth 
within states and regions.[Footnote 51] We also reviewed data prepared 
by Federal Funds Information for States, an organization that tracks 
and reports on the fiscal impact of federal budget and policy 
decisions on state budgets and programs. Finally, we reviewed relevant 
provisions of the Patient Protection and Affordable Care Act, and 
other legislation that affect states' Medicaid programs.[Footnote 52] 

We conducted a performance audit for this review from December 2009 to 
August 2010 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings and conclusions based on our audit objectives. 

[End of section] 

Appendix II: Regular and Preliminary Increased Fourth Quarter 2010 
FMAP Rates and Components of the Increase: 

State: Alabama; 
Regular FMAP, fiscal year 2010[A]: 68.01; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 77.53; 
Percentage point FMAP increase: 9.52; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 65; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 35; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Alaska; 
Regular FMAP, fiscal year 2010[A]: 51.53; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 62.46; 
Percentage point FMAP increase: 10.93; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 57; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 35; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 9. 

State: Arizona; 
Regular FMAP, fiscal year 2010[A]: 65.75; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 75.93; 
Percentage point FMAP increase: 10.18; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 61; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 35; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 4. 

State: Arkansas; 
Regular FMAP, fiscal year 2010[A]: 72.78; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 81.18; 
Percentage point FMAP increase: 8.40; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 74; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 24; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 2. 

State: California; 
Regular FMAP, fiscal year 2010[A]: 50.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.59; 
Percentage point FMAP increase: 11.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Colorado; 
Regular FMAP, fiscal year 2010[A]: 50.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.59; 
Percentage point FMAP increase: 11.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Connecticut; 
Regular FMAP, fiscal year 2010[A]: 50.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.59; 
Percentage point FMAP increase: 11.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Delaware; 
Regular FMAP, fiscal year 2010[A]: 50.21; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.78; 
Percentage point FMAP increase: 11.57; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 54; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 46; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: District of Columbia; 
Regular FMAP, fiscal year 2010[A]: 70.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 79.29; 
Percentage point FMAP increase: 9.29; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 67; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 33; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Florida; 
Regular FMAP, fiscal year 2010[A]: 54.98; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 67.64; 
Percentage point FMAP increase: 12.66; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 49; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 36; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 15. 

State: Georgia; 
Regular FMAP, fiscal year 2010[A]: 65.10; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 74.96; 
Percentage point FMAP increase: 9.86; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 63; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 37; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Hawaii; 
Regular FMAP, fiscal year 2010[A]: 54.24; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 67.35; 
Percentage point FMAP increase: 13.11; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 35; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 17. 

State: Idaho; 
Regular FMAP, fiscal year 2010[A]: 69.40; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 79.18; 
Percentage point FMAP increase: 9.78; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 63; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 32; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 5. 

State: Illinois; 
Regular FMAP, fiscal year 2010[A]: 50.17; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.88; 
Percentage point FMAP increase: 11.71; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 46; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 1. 

State: Indiana; 
Regular FMAP, fiscal year 2010[A]: 65.93; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 75.69; 
Percentage point FMAP increase: 9.76; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 64; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 36; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Iowa; 
Regular FMAP, fiscal year 2010[A]: 63.51; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 72.55; 
Percentage point FMAP increase: 9.04; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 69; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 31; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Kansas; 
Regular FMAP, fiscal year 2010[A]: 60.38; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 69.68; 
Percentage point FMAP increase: 9.30; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 67; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 33; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Kentucky; 
Regular FMAP, fiscal year 2010[A]: 70.96; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 80.14; 
Percentage point FMAP increase: 9.18; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 68; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 32; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Louisiana; 
Regular FMAP, fiscal year 2010[A]: 67.61; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 81.48; 
Percentage point FMAP increase: 13.87; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 45; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 20; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 35. 

State: Maine; 
Regular FMAP, fiscal year 2010[A]: 64.99; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 74.86; 
Percentage point FMAP increase: 9.87; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 63; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 37; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Maryland; 
Regular FMAP, fiscal year 2010[A]: 50.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.59; 
Percentage point FMAP increase: 11.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Massachusetts; 
Regular FMAP, fiscal year 2010[A]: 50.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.59; 
Percentage point FMAP increase: 11.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Michigan; 
Regular FMAP, fiscal year 2010[A]: 63.19; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 73.27; 
Percentage point FMAP increase: 10.08; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 62; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 38; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Minnesota; 
Regular FMAP, fiscal year 2010[A]: 50.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.59; 
Percentage point FMAP increase: 11.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Mississippi; 
Regular FMAP, fiscal year 2010[A]: 75.67; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 84.86; 
Percentage point FMAP increase: 9.19; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 67; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 26; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 7. 

State: Missouri; 
Regular FMAP, fiscal year 2010[A]: 64.51; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 74.43; 
Percentage point FMAP increase: 9.92; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 63; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 38; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Montana; 
Regular FMAP, fiscal year 2010[A]: 67.42; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 77.99; 
Percentage point FMAP increase: 10.57; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 59; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 31; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 11. 

State: Nebraska; 
Regular FMAP, fiscal year 2010[A]: 60.56; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 68.76; 
Percentage point FMAP increase: 8.20; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 76; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 24; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Nevada; 
Regular FMAP, fiscal year 2010[A]: 50.16; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 63.93; 
Percentage point FMAP increase: 13.77; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 45; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 37; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 18. 

State: New Hampshire; 
Regular FMAP, fiscal year 2010[A]: 50.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.59; 
Percentage point FMAP increase: 11.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: New Jersey; 
Regular FMAP, fiscal year 2010[A]: 50.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.59; 
Percentage point FMAP increase: 11.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: New Mexico; 
Regular FMAP, fiscal year 2010[A]: 71.35; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 80.49; 
Percentage point FMAP increase: 9.14; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 68; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 32; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: New York; 
Regular FMAP, fiscal year 2010[A]: 50.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.59; 
Percentage point FMAP increase: 11.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: North Carolina; 
Regular FMAP, fiscal year 2010[A]: 65.13; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 74.98; 
Percentage point FMAP increase: 9.85; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 63; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 37; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: North Dakota[D]; 
Regular FMAP, fiscal year 2010[A]: 63.01; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 69.95; 
Percentage point FMAP increase: 6.94; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 89; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 0; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 11. 

State: Ohio; 
Regular FMAP, fiscal year 2010[A]: 63.42; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 73.47; 
Percentage point FMAP increase: 10.05; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 62; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 38; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Oklahoma; 
Regular FMAP, fiscal year 2010[A]: 64.43; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 76.73; 
Percentage point FMAP increase: 12.30; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 50; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 28; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 22. 

State: Oregon; 
Regular FMAP, fiscal year 2010[A]: 62.74; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 72.87; 
Percentage point FMAP increase: 10.13; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 61; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 39; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Pennsylvania; 
Regular FMAP, fiscal year 2010[A]: 54.81; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 65.85; 
Percentage point FMAP increase: 11.04; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 56; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 44; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Rhode Island; 
Regular FMAP, fiscal year 2010[A]: 52.63; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 63.92; 
Percentage point FMAP increase: 11.29; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 55; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 45; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: South Carolina; 
Regular FMAP, fiscal year 2010[A]: 70.32; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 79.58; 
Percentage point FMAP increase: 9.26; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 67; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 33; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: South Dakota; 
Regular FMAP, fiscal year 2010[A]: 62.72; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 70.80; 
Percentage point FMAP increase: 8.08; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 77; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 23; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Tennessee; 
Regular FMAP, fiscal year 2010[A]: 65.57; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 75.37; 
Percentage point FMAP increase: 9.80; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 63; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 37; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Texas; 
Regular FMAP, fiscal year 2010[A]: 58.73; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 70.94; 
Percentage point FMAP increase: 12.21; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 51; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 34; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 15. 

State: Utah; 
Regular FMAP, fiscal year 2010[A]: 71.68; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 80.78; 
Percentage point FMAP increase: 9.10; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 68; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 32; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Vermont; 
Regular FMAP, fiscal year 2010[A]: 58.73; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 69.96; 
Percentage point FMAP increase: 11.23; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 55; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 38; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 6. 

State: Virginia; 
Regular FMAP, fiscal year 2010[A]: 50.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.59; 
Percentage point FMAP increase: 11.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Washington; 
Regular FMAP, fiscal year 2010[A]: 50.12; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 62.94; 
Percentage point FMAP increase: 12.82; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 48; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 41; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 11. 

State: West Virginia; 
Regular FMAP, fiscal year 2010[A]: 74.04; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 83.05; 
Percentage point FMAP increase: 9.01; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 69; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 29; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 2. 

State: Wisconsin; 
Regular FMAP, fiscal year 2010[A]: 60.21; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 70.63; 
Percentage point FMAP increase: 10.42; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 60; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 40; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: Wyoming; 
Regular FMAP, fiscal year 2010[A]: 50.00; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 61.59; 
Percentage point FMAP increase: 11.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 53; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 47; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 0. 

State: National (average); 
Regular FMAP, fiscal year 2010[A]: 60.13; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 70.72; 
Percentage point FMAP increase: 10.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 60; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 37; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 4. 

State: Midwest (average); 
Regular FMAP, fiscal year 2010[A]: 60.63; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 70.23; 
Percentage point FMAP increase: 9.59; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 66; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 33; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 1. 

State: Northeast (average); 
Regular FMAP, fiscal year 2010[A]: 53.46; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 64.73; 
Percentage point FMAP increase: 11.26; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 55; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 44; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 1. 

State: South (average); 
Regular FMAP, fiscal year 2010[A]: 64.33; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 74.86; 
Percentage point FMAP increase: 10.54; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 60; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 34; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 6. 

State: West (average); 
Regular FMAP, fiscal year 2010[A]: 58.80; 
Preliminary increased FMAP, fiscal year 2010, fourth quarter[A]: 69.90; 
Percentage point FMAP increase: 11.10; 
Component and its percentage contribution to the FMAP increase[B]: 
Across the board: 57; 
Component and its percentage contribution to the FMAP increase[B]: 
Unemployment increase[C]: 37; 
Component and its percentage contribution to the FMAP increase[B]: 
Hold-harmless: 6. 

Source: GAO analysis of HHS and Federal Funds Information for States 
data. 

Note: Fiscal year refers to the federal fiscal year (FFY), which 
begins October 1 and ends September 30. HHS calculates preliminary 
FMAP rates using Bureau of Labor Statistics unemployment estimates and 
adjusts these FMAP rates once the final unemployment numbers become 
available. 

[A] The regular FFY 2010 FMAP rates were published in the Federal 
Register on November 26, 2008. The fourth quarter FFY 2010 increased 
FMAP rates are preliminary and were published by Federal Funds 
Information for States on May 25, 2010. 

[B] Average percentage does not add to 100 percent due to rounding. 

[C] Under the Recovery Act, once a state qualifies for an unemployment 
increase, the increase is maintained through December 31, 2010. 

[D] North Dakota is the only state that did not receive an increase to 
its preliminary FMAP rate due to qualifying increases in the state's 
unemployment rate during the period. 

[End of table] 

[End of section] 

Appendix III: Increased FMAP Grant Awards and Funds Drawn Down: 

(Dollars in thousands): 

State: Alabama; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $638,953; 
Funds drawn down as of June 30, 2010: $631,364; 
Percentage of funds drawn down as of June 30, 2010: 99. 

State: Alaska; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $157,609; 
Funds drawn down as of June 30, 2010: $154,985; 
Percentage of funds drawn down as of June 30, 2010: 98. 

State: Arizona; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,447,964; 
Funds drawn down as of June 30, 2010: $1,396,738; 
Percentage of funds drawn down as of June 30, 2010: 96. 

State: Arkansas; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $469,834; 
Funds drawn down as of June 30, 2010: $469,834; 
Percentage of funds drawn down as of June 30, 2010: 100. 

State: California; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $8,161,837; 
Funds drawn down as of June 30, 2010: $7,351,033; 
Percentage of funds drawn down as of June 30, 2010: 90. 

State: Colorado; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $672,250; 
Funds drawn down as of June 30, 2010: $619,292; 
Percentage of funds drawn down as of June 30, 2010: 92. 

State: Connecticut; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $941,177; 
Funds drawn down as of June 30, 2010: $939,428; 
Percentage of funds drawn down as of June 30, 2010: 100. 

State: Delaware; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $239,691; 
Funds drawn down as of June 30, 2010: $239,053; 
Percentage of funds drawn down as of June 30, 2010: 100. 

State: District of Columbia; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $256,088; 
Funds drawn down as of June 30, 2010: $239,930; 
Percentage of funds drawn down as of June 30, 2010: 94. 

State: Florida; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $3,365,155; 
Funds drawn down as of June 30, 2010: $3,365,155; 
Percentage of funds drawn down as of June 30, 2010: 100. 

State: Georgia[A]; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,190,337; 
Funds drawn down as of June 30, 2010: $1,193,457; 
Percentage of funds drawn down as of June 30, 2010: 100. 

State: Hawaii; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $269,586; 
Funds drawn down as of June 30, 2010: $257,846; 
Percentage of funds drawn down as of June 30, 2010: 96. 

State: Idaho; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $214,118; 
Funds drawn down as of June 30, 2010: $205,630; 
Percentage of funds drawn down as of June 30, 2010: 96. 

State: Illinois; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $2,358,447; 
Funds drawn down as of June 30, 2010: $2,223,231; 
Percentage of funds drawn down as of June 30, 2010: 94. 

State: Indiana; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,167,154; 
Funds drawn down as of June 30, 2010: $958,449; 
Percentage of funds drawn down as of June 30, 2010: 82. 

State: Iowa; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $403,129; 
Funds drawn down as of June 30, 2010: $396,591; 
Percentage of funds drawn down as of June 30, 2010: 98. 

State: Kansas; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $344,657; 
Funds drawn down as of June 30, 2010: $338,804; 
Percentage of funds drawn down as of June 30, 2010: 98. 

State: Kentucky; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $814,502; 
Funds drawn down as of June 30, 2010: $777,703; 
Percentage of funds drawn down as of June 30, 2010: 95. 

State: Louisiana; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,054,562; 
Funds drawn down as of June 30, 2010: $1,042,376; 
Percentage of funds drawn down as of June 30, 2010: 99. 

State: Maine; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $411,781; 
Funds drawn down as of June 30, 2010: $397,339; 
Percentage of funds drawn down as of June 30, 2010: 96. 

State: Maryland; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,257,917; 
Funds drawn down as of June 30, 2010: $1,225,053; 
Percentage of funds drawn down as of June 30, 2010: 97. 

State: Massachusetts; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $2,317,095; 
Funds drawn down as of June 30, 2010: $2,175,125; 
Percentage of funds drawn down as of June 30, 2010: 94. 

State: Michigan; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,837,917; 
Funds drawn down as of June 30, 2010: $1,814,387; 
Percentage of funds drawn down as of June 30, 2010: 99. 

State: Minnesota; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,378,171; 
Funds drawn down as of June 30, 2010: $1,340,052; 
Percentage of funds drawn down as of June 30, 2010: 97. 

State: Mississippi; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $608,627; 
Funds drawn down as of June 30, 2010: $566,203; 
Percentage of funds drawn down as of June 30, 2010: 93. 

State: Missouri; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,164,170; 
Funds drawn down as of June 30, 2010: $1,134,237; 
Percentage of funds drawn down as of June 30, 2010: 97. 

State: Montana; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $143,761; 
Funds drawn down as of June 30, 2010: $140,898; 
Percentage of funds drawn down as of June 30, 2010: 98. 

State: Nebraska; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $215,324; 
Funds drawn down as of June 30, 2010: $196,639; 
Percentage of funds drawn down as of June 30, 2010: 91. 

State: Nevada; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $335,985; 
Funds drawn down as of June 30, 2010: $322,158; 
Percentage of funds drawn down as of June 30, 2010: 96. 

State: New Hampshire; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $190,083; 
Funds drawn down as of June 30, 2010: $182,005; 
Percentage of funds drawn down as of June 30, 2010: 96. 

State: New Jersey; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,613,002; 
Funds drawn down as of June 30, 2010: $1,568,194; 
Percentage of funds drawn down as of June 30, 2010: 97. 

State: New Mexico; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $459,972; 
Funds drawn down as of June 30, 2010: $446,452; 
Percentage of funds drawn down as of June 30, 2010: 97. 

State: New York; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $8,659,348; 
Funds drawn down as of June 30, 2010: $7,725,736; 
Percentage of funds drawn down as of June 30, 2010: 89. 

State: North Carolina; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,710,739; 
Funds drawn down as of June 30, 2010: $1,710,739; 
Percentage of funds drawn down as of June 30, 2010: 100. 

State: North Dakota; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $73,305; 
Funds drawn down as of June 30, 2010: $54,735; 
Percentage of funds drawn down as of June 30, 2010: 75. 

State: Ohio; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $2,279,147; 
Funds drawn down as of June 30, 2010: $2,164,154; 
Percentage of funds drawn down as of June 30, 2010: 95. 

State: Oklahoma; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $720,511; 
Funds drawn down as of June 30, 2010: $633,511; 
Percentage of funds drawn down as of June 30, 2010: 88. 

State: Oregon; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $654,847; 
Funds drawn down as of June 30, 2010: $623,060; 
Percentage of funds drawn down as of June 30, 2010: 95. 

State: Pennsylvania[A]; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $2,927,271; 
Funds drawn down as of June 30, 2010: $2,927,763; 
Percentage of funds drawn down as of June 30, 2010: 100. 

State: Rhode Island; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $349,968; 
Funds drawn down as of June 30, 2010: $348,336; 
Percentage of funds drawn down as of June 30, 2010: 100. 

State: South Carolina; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $679,978; 
Funds drawn down as of June 30, 2010: $658,052; 
Percentage of funds drawn down as of June 30, 2010: 97. 

State: South Dakota; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $91,604; 
Funds drawn down as of June 30, 2010: $91,163; 
Percentage of funds drawn down as of June 30, 2010: 100. 

State: Tennessee; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,142,763; 
Funds drawn down as of June 30, 2010: $1,120,362; 
Percentage of funds drawn down as of June 30, 2010: 98. 

State: Texas; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $4,189,789; 
Funds drawn down as of June 30, 2010: $4,164,967; 
Percentage of funds drawn down as of June 30, 2010: 99. 

State: Utah; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $249,728; 
Funds drawn down as of June 30, 2010: $201,441; 
Percentage of funds drawn down as of June 30, 2010: 81. 

State: Vermont; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $207,888; 
Funds drawn down as of June 30, 2010: $207,453; 
Percentage of funds drawn down as of June 30, 2010: 100. 

State: Virginia; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,111,452; 
Funds drawn down as of June 30, 2010: $1,103,904; 
Percentage of funds drawn down as of June 30, 2010: 99. 

State: Washington; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,435,402; 
Funds drawn down as of June 30, 2010: $1,228,353; 
Percentage of funds drawn down as of June 30, 2010: 86. 

State: West Virginia; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $342,068; 
Funds drawn down as of June 30, 2010: $340,742; 
Percentage of funds drawn down as of June 30, 2010: 100. 

State: Wisconsin; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $1,098,529; 
Funds drawn down as of June 30, 2010: $1,073,922; 
Percentage of funds drawn down as of June 30, 2010: 98. 

State: Wyoming; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $80,556; 
Funds drawn down as of June 30, 2010: $72,658; 
Percentage of funds drawn down as of June 30, 2010: 90. 

State: Total for states and the District; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $64,105,746; 
Funds drawn down as of June 30, 2010: $60,760,690; 
Percentage of funds drawn down as of June 30, 2010: 95. 

State: Insular area[B]: 

State: American Samoa; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $5,625; 
Funds drawn down as of June 30, 2010: $3,646; 
Percentage of funds drawn down as of June 30, 2010: 65. 

State: CNMI; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $3,089; 
Funds drawn down as of June 30, 2010: $1,517; 
Percentage of funds drawn down as of June 30, 2010: 49. 

State: Guam; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $8,550; 
Funds drawn down as of June 30, 2010: $1,400; 
Percentage of funds drawn down as of June 30, 2010: 16. 

State: Puerto Rico; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $190,433; 
Funds drawn down as of June 30, 2010: $93,799; 
Percentage of funds drawn down as of June 30, 2010: 49. 

State: U.S. Virgin Islands; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $8,857; 
Funds drawn down as of June 30, 2010: 0; 
Percentage of funds drawn down as of June 30, 2010: 0. 

State: Grand total; 
Increased FMAP grant award for FFY 2009 and first three quarters of 
FFY 2010: $64,322,299; 
Funds drawn down as of June 30, 2010: $60,861,053; 
Percentage of funds drawn down as of June 30, 2010: 95. 

Source: GAO analysis of HHS data, as of June 30, 2010. 

Note: All percentages are rounded. 

[A] These states have drawn down slightly more than is available 
through their increased FMAP grant and we rounded the percentage down 
to 100. CMS officials indicated that they recognize that these states 
have drawn down more than is available through the increased FMAP 
grant and that CMS is working with these states to resolve this issue. 

[B] Under the Recovery Act, insular areas initially had the option of 
choosing either an across-the-board increase of 6.2 percentage points 
to the FMAP rate in conjunction with a 15 percent increase in their 
federal Medicaid payment limits or a 30 percent increase in their 
federal Medicaid payment limits through December 31, 2010. See 
Recovery Act, div. B, title V, § 5001(b)(2),(d). All five insular 
areas opted for the 30 percent increase to the cap in their federal 
Medicaid allotment. After December 31, 2010, insular areas will 
receive the same FMAP adjustment as states do. See Pub. L. No. 111-
226, § 201, 124 Stat. at 2389. 

[End of table] 

[End of section] 

Appendix IV: State-Reported Adjustments to Medicaid Programs and Uses 
of Funds Freed Up by the Increased FMAP: 

Table 2: State-Reported Adjustments to Medicaid Programs to Meet 
Recovery Act Requirements: 

State: Alabama; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Alaska; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Arizona; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: Arkansas; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: California; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Colorado; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Connecticut; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Delaware; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: District of Columbia; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Florida; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Georgia; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Hawaii; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Idaho; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: Illinois; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: Indiana; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Iowa; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Kansas; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: Kentucky; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Louisiana; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Maine; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Maryland; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Massachusetts; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Michigan; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Minnesota; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Check]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: Mississippi; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Missouri; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: Montana; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Check]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: Nebraska; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Nevada; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: New Hampshire; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: New Jersey; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: New Mexico; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Check]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: New York; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: North Carolina; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: North Dakota; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Ohio; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Oklahoma; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Oregon; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: Pennsylvania; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Rhode Island; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: South Carolina; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: South Dakota; 
Recovery Act requirement: Maintenance of eligibility[A]: N/A; 
Recovery Act requirement: Prompt payment[B]: N/A; 
Recovery Act requirement: Rainy day funds[C]: N/A; 
Recovery Act requirement: Political subdivisions[D]: N/A. 

State: Tennessee; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Texas; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Utah; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Check]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: Vermont; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Virginia; 
Recovery Act requirement: Maintenance of eligibility[A]: [Check]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Washington; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: West Virginia; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Check]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Check]. 

State: Wisconsin; 
Recovery Act requirement: Maintenance of eligibility[A]: N/A; 
Recovery Act requirement: Prompt payment[B]: N/A; 
Recovery Act requirement: Rainy day funds[C]: N/A; 
Recovery Act requirement: Political subdivisions[D]: N/A. 

State: Wyoming; 
Recovery Act requirement: Maintenance of eligibility[A]: [Empty]; 
Recovery Act requirement: Prompt payment[B]: [Empty]; 
Recovery Act requirement: Rainy day funds[C]: [Empty]; 
Recovery Act requirement: Political subdivisions[D]: [Empty]. 

State: Total; 
Recovery Act requirement: Maintenance of eligibility[A]: 26; 
Recovery Act requirement: Prompt payment[B]: 29; 
Recovery Act requirement: Rainy day funds[C]: 4; 
Recovery Act requirement: Political subdivisions[D]: 13. 

Source: GAO analysis of state-reported data. 

Note: We asked states about adjustments to comply with the 
requirements specified in the Recovery Act in both surveys. South 
Dakota and Wisconsin did not provide responses to the August 2009 
survey. 

[A] States generally may not apply eligibility standards, 
methodologies, or procedures that are more restrictive than those in 
effect under their state Medicaid programs on July 1, 2008. See 
Recovery Act, div. B, title V, § 5001(f)(1)(A). 

[B] Under the Recovery Act, states are not eligible to receive the 
increased FMAP for certain claims for days during any period in which 
that state has failed to meet the prompt payment requirement under the 
Medicaid statute as applied to those claims. See Recovery Act, div. B, 
title V, § 5001(f)(2). Prompt payment requires states to pay 90 
percent of clean claims from health care practitioners and certain 
other providers within 30 days of receipt and 99 percent of these 
claims within 90 days of receipt. See 42 U.S.C. § 1396a(a)(37)(A). A 
clean claim is a claim that has no defect or impropriety (including 
any lack of any required substantiating documentation) or particular 
circumstance requiring special treatment that prevents timely payment 
from being made on the claim. See Social Security Act § 1816. 

[C] A state is not eligible for certain elements of increased FMAP if 
any amounts attributable directly or indirectly to them are deposited 
in or credited to a state reserve or rainy day fund. Recovery Act, 
div. B, title V, § 5001(f)(3). 

[D] States with political subdivisions--such as cities and counties-- 
that contribute to the nonfederal share of Medicaid spending cannot 
require the subdivisions to pay a greater percentage of the nonfederal 
share than would have been required on September 30, 2008. See 
Recovery Act, div. B, title V, § 5001(g)(2). 

[End of table] 

Table 5: State-Reported Uses of Freed-Up Funds for State Fiscal Year 
2009: 

State: Alabama; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Alaska; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services[A]: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: Arizona; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Arkansas; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: California; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Colorado[D]; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Connecticut; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services[A]: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Delaware; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services[A]: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: District of Columbia[D]; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services[A]: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Florida; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Georgia; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Hawaii; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Idaho; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Illinois; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check][C]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Indiana; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Iowa; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: Kansas; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Kentucky; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Check]; 
Finance general budget needs: [Check]. 

State: Louisiana; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: Maine; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Maryland; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [B]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [F]; 
Maintain Medicaid payment rates for practitioners: [C]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Check]; 
Finance general budget needs: [Check]. 

State: Massachusetts; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: Michigan; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Minnesota; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [B]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Check]; 
Finance general budget needs: [Check]. 

State: Mississippi; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Missouri; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Montana; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services[A]: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Nebraska; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: 
[Check][F]; 
Maintain Medicaid payment rates for practitioners: [Check][C]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: Nevada; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Check]; 
Finance general budget needs: [Check]. 

State: New Hampshire; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: New Jersey; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Check]; 
Finance general budget needs: [Check]. 

State: New Mexico; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: New York[D]; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services[A]: [Empty]; 
Maintain Medicaid payment rates for institutional providers: 
[Check][F]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: North Carolina; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services[A]: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: North Dakota[G,H]; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services[A]: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: Ohio; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services[A]: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Oklahoma; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services[A]: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Oregon; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Pennsylvania; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Rhode Island; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: South Carolina; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [F]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: South Dakota[E]; 
Cover increased Medicaid caseload: N/A; 
Maintain Medicaid eligibility levels: N/A; 
Maintain Medicaid benefits and services[A]: N/A; 
Maintain Medicaid payment rates for institutional providers: N/A; 
Maintain Medicaid payment rates for practitioners: N/A; 
Ensure prompt payment requirements are met: N/A; 
Finance State Children's Health Insurance Program (CHIP): N/A; 
Finance general budget needs: N/A. 

State: Tennessee[D]; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Texas; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: 
[Check][F]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: Utah; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Vermont; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: 
[Check][F]; 
Maintain Medicaid payment rates for practitioners: [Check][C]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Check]. 

State: Virginia; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance State Children's Health Insurance Program (CHIP): [Check]; 
Finance general budget needs: [Check]. 

State: Washington; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Check]; 
Finance general budget needs: [Check]. 

State: West Virginia; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Check]; 
Finance general budget needs: [Empty]. 

State: Wisconsin[E]; 
Cover increased Medicaid caseload: N/A; 
Maintain Medicaid eligibility levels: N/A; 
Maintain Medicaid benefits and services[A]: N/A; 
Maintain Medicaid payment rates for institutional providers: N/A; 
Maintain Medicaid payment rates for practitioners: N/A; 
Ensure prompt payment requirements are met: N/A; 
Finance State Children's Health Insurance Program (CHIP): N/A; 
Finance general budget needs: N/A. 

State: Wyoming; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services[A]: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance State Children's Health Insurance Program (CHIP): [Empty]; 
Finance general budget needs: [Empty]. 

State: Total; 
Cover increased Medicaid caseload: 39; 
Maintain Medicaid eligibility levels: 38; 
Maintain Medicaid benefits and services[A]: 39; 
Maintain Medicaid payment rates for institutional providers: 33; 
Maintain Medicaid payment rates for practitioners: 33; 
Ensure prompt payment requirements are met: 15; 
Finance State Children's Health Insurance Program (CHIP): 7; 
Finance general budget needs: 34. 

Source: GAO analysis of state-reported data. 

Note: While the increased FMAP funds available under the Recovery Act 
are for Medicaid services only, the receipt of these funds may reduce 
the funds that states would otherwise have to use for their Medicaid 
programs, and states have reported using these freed-up funds for a 
variety of purposes. We provided a list of uses from which states 
could select. We asked states to report uses or planned uses for 
increased FMAP funds for state fiscal year 2009. 

[A] We also asked states if they used funds to expand Medicaid 
benefits and services. No state reported using funds for this purpose. 

[B] State also reported using funds to expand Medicaid eligibility 
levels. 

[C] State also reported using funds to increase Medicaid payment rates 
for practitioners. 

[D] State reported using funds to finance local or state public health 
insurance programs other than Medicaid or CHIP. 

[E] State did not provide responses to this survey. 

[F] State also reported using funds to increase Medicaid payment rates 
for institutional providers. 

[G] State reported using funds to increase Medicaid payment rates for 
practitioners. 

[H] State reported using funds to increase Medicaid payment rates for 
institutional providers. 

[End of table] 

Table 6: State-Reported Uses or Planned Uses of Freed-Up Funds for 
Federal Fiscal Year 2010 through First Quarter of Federal Fiscal Year 
2011: 

State: Alabama; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Alaska; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Arizona; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Arkansas; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: California; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Colorado; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Connecticut; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Check]; 
Finance general budget needs: [Check]. 

State: Delaware; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: District of Columbia; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Florida; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Georgia; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Check]; 
Finance general budget needs: [Check]. 

State: Hawaii; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Idaho; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Illinois; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Indiana; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Iowa; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Kansas; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Kentucky; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Louisiana; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Maine; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Maryland[D]; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check][A]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Massachusetts; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Check]; 
Finance general budget needs: [Check]. 

State: Michigan; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Minnesota; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Check]; 
Finance general budget needs: [Check]. 

State: Mississippi; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Missouri; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Montana; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: 
[Check][D]; 
Maintain Medicaid payment rates for practitioners: [Check][B]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Nebraska; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: 
[Check][D]; 
Maintain Medicaid payment rates for practitioners: [Check][B]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Nevada; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: New Hampshire; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [F]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: New Jersey; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: New Mexico; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Check]; 
Finance general budget needs: [Check]. 

State: New York; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: North Carolina; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: North Dakota[C,E]; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Ohio; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Oklahoma; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Oregon; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check][B]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Check]; 
Finance general budget needs: [Empty]. 

State: Pennsylvania; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Rhode Island; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: South Carolina; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: 
[Check][D]; 
Maintain Medicaid payment rates for practitioners: [Check][B]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Check]; 
Finance general budget needs: [Check]. 

State: South Dakota; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Check]; 
Finance general budget needs: [Check]. 

State: Tennessee; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Texas; 
Cover increased Medicaid caseload: [Empty]; 
Maintain Medicaid eligibility levels: [Empty]; 
Maintain Medicaid benefits and services: [Empty]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Utah; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Vermont; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Virginia; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Check]; 
Finance general budget needs: [Check]. 

State: Washington; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: West Virginia; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Check]; 
Maintain Medicaid payment rates for practitioners: [Check]; 
Ensure prompt payment requirements are met: [Check]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Check]. 

State: Wisconsin; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Wyoming; 
Cover increased Medicaid caseload: [Check]; 
Maintain Medicaid eligibility levels: [Check]; 
Maintain Medicaid benefits and services: [Check]; 
Maintain Medicaid payment rates for institutional providers: [Empty]; 
Maintain Medicaid payment rates for practitioners: [Empty]; 
Ensure prompt payment requirements are met: [Empty]; 
Finance local public health programs or CHIP (programs other than 
Medicaid): [Empty]; 
Finance general budget needs: [Empty]. 

State: Total; 
Cover increased Medicaid caseload: 45; 
Maintain Medicaid eligibility levels: 44; 
Maintain Medicaid benefits and services: 44; 
Maintain Medicaid payment rates for institutional providers: 36; 
Maintain Medicaid payment rates for practitioners: 33; 
Ensure prompt payment requirements are met: 21; 
Finance local public health programs or CHIP (programs other than 
Medicaid): 10; 
Finance general budget needs: 36. 

Source: GAO analysis of state-reported data. 

Notes: While the increased FMAP funds available under the Recovery Act 
are for Medicaid services only, the receipt of these funds may reduce 
the funds that states would otherwise have to use for their Medicaid 
programs, and states have reported using these freed-up funds for a 
variety of purposes. We provided a list of uses from which states 
could select. We asked states to report uses or planned uses for 
increased FMAP funds for FFY 2010 and the first quarter of FFY 2011, 
and all states and the District of Columbia provided responses. 

[A] State also reported using or planning to use funds to expand 
Medicaid benefits and services. 

[B] State also reported using or planning to use funds to increase 
Medicaid payment rates for practitioners. 

[C] State reported using or planning to use funds to increase Medicaid 
payment rates for practitioners. 

[D] State also reported using or planning to use funds to increase 
Medicaid payment rates for institutional providers. 

[E] State also reported using or planning to use funds to increase 
Medicaid payment rates for institutional providers. 

[F] State also reported using funds to expand Medicaid eligibility 
levels. 

[End of table] 

Table 7: Actions States Reported Implementing between October 2009 and 
February 2010 to Address Concerns about Medicaid Program 
Sustainability: 

State: Alabama; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Alaska; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Arizona; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Check]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Arkansas; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: California; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Check]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Colorado; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Check]; 
Increase to co-pays or premiums: [Check]; 
Change to drug formulary: [Check]; 
No action taken: [Empty]. 

State: Connecticut; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Check]; 
No action taken: [Empty]]. 

State: Delaware; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: District of Columbia; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Check]. 

State: Florida; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Check]. 

State: Georgia; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Hawaii; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Idaho; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Check]; 
Increase to co-pays or premiums: [Check]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Illinois; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Check]. 

State: Indiana; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Iowa; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Kansas; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Check]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Kentucky; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Check]; 
No action taken: [Empty]. 

State: Louisiana; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Maine; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Maryland; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Check]; 
No action taken: [Empty]. 

State: Massachusetts; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Michigan; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Minnesota; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Mississippi; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Check]. 

State: Missouri; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Check]. 

State: Montana; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Nebraska; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Check]; 
No action taken: [Empty]. 

State: Nevada; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Check]; 
No action taken: [Empty]. 

State: New Hampshire; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Check]; 
Increase to co-pays or premiums: [Check]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: New Jersey; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Check]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Check]; 
No action taken: [Empty]. 

State: New Mexico; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: New York; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: North Carolina; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Check]; 
Increase to co-pays or premiums: [Check]; 
Change to drug formulary: [Check]; 
No action taken: [Empty]. 

State: North Dakota; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Ohio; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Oklahoma; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Check]; 
Increase to co-pays or premiums: [Check]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Oregon; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Check]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Check]; 
No action taken: [Empty]. 

State: Pennsylvania; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Rhode Island; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: South Carolina; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: South Dakota; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Tennessee; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Texas; 
New provider Tax: [Empty]; 
New or increased IGT[A]: [Empty]; 
New CPE[B]: [Empty]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Check]. 

State: Utah; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Vermont; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Check]; 
Increase to co-pays or premiums: [Check]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]]. 

State: Virginia; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Washington; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: West Virginia; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Empty]; 
Reduction or freeze in institutional payment rates: [Empty]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Wisconsin; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Wyoming; 
New provider Tax: [Check]; 
New or increased IGT[A]: [Check]; 
New CPE[B]: [Check]; 
Reduction or freeze in practitioner payment rates: [Check]; 
Reduction or freeze in institutional payment rates: [Check]; 
Reductions in benefits and services: [Empty]; 
Increase to co-pays or premiums: [Empty]; 
Change to drug formulary: [Empty]; 
No action taken: [Empty]. 

State: Total; 
New provider Tax: 38; 
New or increased IGT[A]: 35; 
New CPE[B]: 35; 
Reduction or freeze in practitioner payment rates: 25; 
Reduction or freeze in institutional payment rates: 19; 
Reductions in benefits and services: 11; 
Increase to co-pays or premiums: 6; 
Change to drug formulary: 9; 
No action taken: 5. 

Source: GAO analysis of state-reported data. 

Note: We asked states to consider actions implemented to address 
concerns over the sustainability of their Medicaid programs after 
increased FMAP funds were no longer available. 

[A] IGT = Intergovernmental transfer: 

[B] CPE = Certified public expenditure: 

[End of table] 

[End of section] 

Appendix V: Medicaid Enrollment and Enrollment Changes by 
Subpopulation Group from October 2007 through February 2010: 

State: Alabama; 
Total enrollment, February 2010: 835,136; 
Percentage change, October 2007 to February 2010: 
All populations: 11.89; 
Children: 19.53; 
Aged: -14.23; 
Disabled: 4.81; 
Adults: -0.68[A]. 

State: Alaska; 
Total enrollment, February 2010: 97,354; 
Percentage change, October 2007 to February 2010: 
All populations: 21.56; 
Children: 27.04; 
Aged: 0.61; 
Disabled: 9.45; 
Adults: 25.18. 

State: Arizona; 
Total enrollment, February 2010: 1,422,444; 
Percentage change, October 2007 to February 2010: 
All populations: 28.92; 
Children: 25.85; 
Aged: 13.76; 
Disabled: 5.51; 
Adults: 46.47. 

State: Arkansas; 
Total enrollment, February 2010: 582,246; 
Percentage change, October 2007 to February 2010: 
All populations: 5.51; 
Children: 7.14; 
Aged: -6.45; 
Disabled: 8.29; 
Adults: 0.86. 

State: California; 
Total enrollment, February 2010: 7,231,029; 
Percentage change, October 2007 to February 2010: 
All populations: 9.60; 
Children: 11.67; 
Aged: 6.33; 
Disabled: 4.64; 
Adults: -7.97. 

State: Colorado; 
Total enrollment, February 2010: 501,596; 
Percentage change, October 2007 to February 2010: 
All populations: 29.09; 
Children: 36.44; 
Aged: 6.45; 
Disabled: 7.58; 
Adults: 42.68. 

State: Connecticut; 
Total enrollment, February 2010: 485,993; 
Percentage change, October 2007 to February 2010: 
All populations: 19.35; 
Children: 10.73; 
Aged: 115.88; 
Disabled: -4.46; 
Adults: 26.05. 

State: Delaware; 
Total enrollment, February 2010: 173,987; 
Percentage change, October 2007 to February 2010: 
All populations: 15.39; 
Children: 11.02; 
Aged: 1.99; 
Disabled: 9.43; 
Adults: 26.09. 

State: District of Columbia; 
Total enrollment, February 2010: 151,331; 
Percentage change, October 2007 to February 2010: 
All populations: 11.88; 
Children: 10.68; 
Aged: 0.44; 
Disabled: 12.02; 
Adults: 11.83. 

State: Florida; 
Total enrollment, February 2010: 2,730,912; 
Percentage change, October 2007 to February 2010: 
All populations: 29.04; 
Children: 35.77; 
Aged: 14.43; 
Disabled: N/A; 
Adults: N/A. 

State: Georgia; 
Total enrollment, February 2010: 1,433,830; 
Percentage change, October 2007 to February 2010: 
All populations: 15.18; 
Children: 22.50; 
Aged: 8.22; 
Disabled: 3.04; 
Adults: 7.37. 

State: Hawaii; 
Total enrollment, February 2010: 252,820; 
Percentage change, October 2007 to February 2010: 
All populations: 22.30; 
Children: 17.57; 
Aged: 4.22; 
Disabled: 7.15; 
Adults: 41.81. 

State: Idaho; 
Total enrollment, February 2010: 185,916; 
Percentage change, October 2007 to February 2010: 
All populations: 23.67; 
Children: 20.57; 
Aged: 30.66; 
Disabled: 15.47; 
Adults: 89.81. 

State: Illinois; 
Total enrollment, February 2010: 2,392,106; 
Percentage change, October 2007 to February 2010: 
All populations: 25.06; 
Children: 15.11; 
Aged: 7.45; 
Disabled: 5.70; 
Adults: 79.92. 

State: Indiana; 
Total enrollment, February 2010: 973,084; 
Percentage change, October 2007 to February 2010: 
All populations: 20.70; 
Children: 18.40; 
Aged: 8.16; 
Disabled: 11.74; 
Adults: 9.83. 

State: Iowa; 
Total enrollment, February 2010: 436,373; 
Percentage change, October 2007 to February 2010: 
All populations: 22.32; 
Children: 27.53; 
Aged: 0.96; 
Disabled: 9.26; 
Adults: 35.36. 

State: Kansas; 
Total enrollment, February 2010: 280,406; 
Percentage change, October 2007 to February 2010: 
All populations: 6.79; 
Children: 6.55; 
Aged: -4.06; 
Disabled: 8.96; 
Adults: -5.05. 

State: Kentucky; 
Total enrollment, February 2010: 730,433; 
Percentage change, October 2007 to February 2010: 
All populations: 9.12; 
Children: 13.82; 
Aged: -8.88; 
Disabled: 4.38; 
Adults: 6.31. 

State: Louisiana; 
Total enrollment, February 2010: 1,023,728; 
Percentage change, October 2007 to February 2010: 
All populations: 16.60; 
Children: 14.74; 
Aged: 0.23; 
Disabled: 11.51; 
Adults: 16.66. 

State: Maine; 
Total enrollment, February 2010: 278,936; 
Percentage change, October 2007 to February 2010: 
All populations: 6.49; 
Children: 11.44; 
Aged: -1.13; 
Disabled: 4.00; 
Adults: 10.97. 

State: Maryland; 
Total enrollment, February 2010: 740,101; 
Percentage change, October 2007 to February 2010: 
All populations: 28.57; 
Children: 24.43; 
Aged: -0.45; 
Disabled: 7.30; 
Adults: 64.40. 

State: Massachusetts; 
Total enrollment, February 2010: 1,416,297; 
Percentage change, October 2007 to February 2010: 
All populations: 12.72; 
Children: 8.38; 
Aged: 2.54; 
Disabled: 7.85; 
Adults: 23.23. 

State: Michigan; 
Total enrollment, February 2010: 1,797,960; 
Percentage change, October 2007 to February 2010: 
All populations: 16.13; 
Children: 14.70; 
Aged: 36.73; 
Disabled: 0.55; 
Adults: 28.27. 

State: Minnesota; 
Total enrollment, February 2010: 645,905; 
Percentage change, October 2007 to February 2010: 
All populations: 11.48; 
Children: 10.61; 
Aged: -2.96; 
Disabled: 4.50; 
Adults: 25.95. 

State: Mississippi; 
Total enrollment, February 2010: 618,147; 
Percentage change, October 2007 to February 2010: 
All populations: 9.88; 
Children: 15.97; 
Aged: -4.27; 
Disabled: 8.38; 
Adults: 78.80. 

State: Missouri; 
Total enrollment, February 2010: 881,177; 
Percentage change, October 2007 to February 2010: 
All populations: 14.30; 
Children: 9.56; 
Aged: 9.18; 
Disabled: 23.03; 
Adults: 30.14. 

State: Montana; 
Total enrollment, February 2010: 97,816; 
Percentage change, October 2007 to February 2010: 
All populations: 15.08; 
Children: 23.62; 
Aged: 3.52; 
Disabled: -10.49; 
Adults: 24.42. 

State: Nebraska; 
Total enrollment, February 2010: 200,867; 
Percentage change, October 2007 to February 2010: 
All populations: 13.64; 
Children: 16.09; 
Aged: -2.23; 
Disabled: 8.94; 
Adults: 21.61. 

State: Nevada; 
Total enrollment, February 2010: 251,062; 
Percentage change, October 2007 to February 2010: 
All populations: 37.76; 
Children: 52.92; 
Aged: 9.57; 
Disabled: 7.98; 
Adults: 34.00. 

State: New Hampshire; 
Total enrollment, February 2010: 118,060; 
Percentage change, October 2007 to February 2010: 
All populations: 15.62; 
Children: 21.06; 
Aged: -0.35; 
Disabled: 34.62; 
Adults: -19.67. 

State: New Jersey; 
Total enrollment, February 2010: 827,928; 
Percentage change, October 2007 to February 2010: 
All populations: 10.68; 
Children: 16.44; 
Aged: 1.27; 
Disabled: 6.59; 
Adults: -3.83. 

State: New Mexico; 
Total enrollment, February 2010: 467,763; 
Percentage change, October 2007 to February 2010: 
All populations: 15.15; 
Children: 20.16; 
Aged: -7.20; 
Disabled: -18.28; 
Adults: 5.27. 

State: New York; 
Total enrollment, February 2010: 4,631,913; 
Percentage change, October 2007 to February 2010: 
All populations: 12.38; 
Children: 13.59; 
Aged: 6.92; 
Disabled: N/A; 
Adults: 65.40. 

State: North Carolina; 
Total enrollment, February 2010: 1,426,024; 
Percentage change, October 2007 to February 2010: 
All populations: 16.15; 
Children: 19.68; 
Aged: -3.64; 
Disabled: 7.15; 
Adults: 43.73. 

State: North Dakota; 
Total enrollment, February 2010: 61,456; 
Percentage change, October 2007 to February 2010: 
All populations: 21.79; 
Children: 36.37; 
Aged: 3.20; 
Disabled: 5.79; 
Adults: 8.31. 

State: Ohio; 
Total enrollment, February 2010: 1,899,388; 
Percentage change, October 2007 to February 2010: 
All populations: 16.46; 
Children: 17.26; 
Aged: 3.14; 
Disabled: 8.54; 
Adults: 27.81. 

State: Oklahoma; 
Total enrollment, February 2010: 616,018; 
Percentage change, October 2007 to February 2010: 
All populations: 13.01; 
Children: 16.01; 
Aged: 6.96; 
Disabled: N/A; 
Adults: 11.27. 

State: Oregon; 
Total enrollment, February 2010: 539,228; 
Percentage change, October 2007 to February 2010: 
All populations: 28.50; 
Children: 32.37; 
Aged: 15.14; 
Disabled: 19.67; 
Adults: 31.51. 

State: Pennsylvania; 
Total enrollment, February 2010: 2,073,245; 
Percentage change, October 2007 to February 2010: 
All populations: 8.60; 
Children: 6.86; 
Aged: 8.87; 
Disabled: 11.14; 
Adults: 17.45. 

State: Rhode Island; 
Total enrollment, February 2010: 186,317; 
Percentage change, October 2007 to February 2010: 
All populations: 15.03; 
Children: -2.11; 
Aged: -0.05; 
Disabled: 1.21; 
Adults: 31.96. 

State: South Carolina; 
Total enrollment, February 2010: 735,947; 
Percentage change, October 2007 to February 2010: 
All populations: 6.34; 
Children: 11.53; 
Aged: -3.85; 
Disabled: 2.99; 
Adults: 0.55. 

State: South Dakota; 
Total enrollment, February 2010: 99,248; 
Percentage change, October 2007 to February 2010: 
All populations: 9.28; 
Children: 11.57; 
Aged: -3.75; 
Disabled: 7.99; 
Adults: 9.72. 

State: Tennessee; 
Total enrollment, February 2010: 1,322,976; 
Percentage change, October 2007 to February 2010: 
All populations: 1.13; 
Children: 11.06; 
Aged: 13.93; 
Disabled: -33.80; 
Adults: 10.64. 

State: Texas; 
Total enrollment, February 2010: 3,162,057; 
Percentage change, October 2007 to February 2010: 
All populations: 0.64; 
Children: -2.09; 
Aged: 8.70; 
Disabled: 12.06; 
Adults: -10.61. 

State: Utah; 
Total enrollment, February 2010: 249,545; 
Percentage change, October 2007 to February 2010: 
All populations: 25.72; 
Children: 39.83; 
Aged: 9.30; 
Disabled: 15.94; 
Adults: 13.62. 

State: Vermont; 
Total enrollment, February 2010: 157,659; 
Percentage change, October 2007 to February 2010: 
All populations: 21.68; 
Children: 7.39; 
Aged: -3.47; 
Disabled: 7.31; 
Adults: 47.99. 

State: Virginia; 
Total enrollment, February 2010: 775,046; 
Percentage change, October 2007 to February 2010: 
All populations: 18.42; 
Children: 26.65; 
Aged: -1.07; 
Disabled: 9.54; 
Adults: 17.62. 

State: Washington; 
Total enrollment, February 2010: 1,068,572; 
Percentage change, October 2007 to February 2010: 
All populations: 13.54; 
Children: 18.31; 
Aged: 3.98; 
Disabled: 8.91; 
Adults: 6.31. 

State: West Virginia; 
Total enrollment, February 2010: 328,307; 
Percentage change, October 2007 to February 2010: 
All populations: 8.28; 
Children: 9.58; 
Aged: -1.58; 
Disabled: 7.59; 
Adults: 12.18. 

State: Wisconsin; 
Total enrollment, February 2010: 1,081,743; 
Percentage change, October 2007 to February 2010: 
All populations: 30.96; 
Children: 17.80; 
Aged: 5.09; 
Disabled: -2.66; 
Adults: 98.65. 

State: Wyoming; 
Total enrollment, February 2010: 66,505; 
Percentage change, October 2007 to February 2010: 
All populations: 14.84; 
Children: 18.04; 
Aged: 3.37; 
Disabled: 8.68; 
Adults: 14.71. 

State: Total for states; 
Total enrollment, February 2010: 50,743,937; 
Percentage change, October 2007 to February 2010: 
All populations: 14.21; 
Children: 14.73; 
Aged: 7.14; 
Disabled: 4.89; 
Adults: 29.88. 

Insular area[B]: 

Guam: 
Total enrollment, February 2010: 27,882; 
Percentage change, October 2007 to February 2010: 
All populations: 18.03; 
Children: 16.85; 
Aged: 3.15; 
Disabled: 19.89; 
Adults: 20.01. 

Puerto Rico: 
Total enrollment, February 2010: 1,565,746; 
Percentage change, October 2007 to February 2010: 
All populations: -0.31; 
Children: -4.92; 
Aged: 4.16; 
Disabled: 11.85; 
Adults: -7.91. 

U.S. Virgin Islands: 
Total enrollment, February 2010: 8,274; 
Percentage change, October 2007 to February 2010: 
All populations: 80.97; 
Children: [Empty]; 
Aged: [Empty]; 
Disabled: [Empty]; 
Adults: [Empty]. 

U.S. geographic region: 

Midwest: 
Total enrollment, February 2010: 10,749,713; 
Percentage change, October 2007 to February 2010: 
All populations: 19.29; 
Children: 15.44; 
Aged: 8.23; 
Disabled: 6.88; 
Adults: 43.70. 

Northeast: 
Total enrollment, February 2010: 10,176,348; 
Percentage change, October 2007 to February 2010: 
All populations: 11.85; 
Children: 11.22; 
Aged: 8.13; 
Disabled: 8.12; 
Adults: 39.89. 

South: 
Total enrollment, February 2010: 17,386,226; 
Percentage change, October 2007 to February 2010: 
All populations: 12.14; 
Children: 14.85; 
Aged: 5.64; 
Disabled: 2.14; 
Adults: 14.52. 

West: 
Total enrollment, February 2010: 12,431,650; 
Percentage change, October 2007 to February 2010: 
All populations: 14.92; 
Children: 16.39; 
Aged: 7.19; 
Disabled: 5.36; 
Adults: 25.51. 

Source: GAO analysis of state-reported and insular-area reported data. 

Note: For some states, the data reported are preliminary and subject 
to change. 

[A] Alabama indicated that it experienced a decrease in its adult 
enrollment due to terminations and denials resulting from the 
citizenship and identity documentation requirement, which the state 
began enforcing in April 2007. 

[B] Due to limitations in enrollment data reported by certain insular 
areas, we were unable to conduct complete analyses. 

[End of table] 

[End of section] 

Appendix VI: Estimated Changes in States' FMAP Rates and Share of 
Medicaid Payments: 

State: Alabama; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 77.53; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 74.53; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 72.53; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 68.54; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 8.99; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 40. 

State: Alaska; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 62.46; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 59.46; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 57.46; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 12.46; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 33. 

State: Arizona; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 75.93; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 72.93; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 70.93; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 65.85; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.08; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 42. 

State: Arkansas; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 81.18; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 78.18; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 76.18; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 71.37; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.81; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 52. 

State: California; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.59; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.59; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.59; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.59; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: Colorado; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.59; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.59; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.59; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.59; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: Connecticut; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.59; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.59; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.59; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.59; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: Delaware; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.78; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.78; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.78; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 53.15; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 8.63; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 23. 

State: District of Columbia; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 79.29; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 76.29; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 74.29; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 70.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.29; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 45. 

State: Florida; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 67.64; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 64.64; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 62.64; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 55.45; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 12.19; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 38. 

State: Georgia; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 74.96; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 71.96; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 69.96; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 65.33; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.63; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 38. 

State: Hawaii; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 67.35; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 64.35; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 62.35; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 51.79; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 15.56; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 48. 

State: Idaho; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 79.18; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 76.18; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 74.18; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 68.85; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.33; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 50. 

State: Illinois; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.88; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.88; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.88; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.20; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.68; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 31. 

State: Indiana; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 75.69; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 72.69; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 70.69; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 66.52; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.17; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 38. 

State: Iowa; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 72.55; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 69.55; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 67.55; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 62.63; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.92; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 36. 

State: Kansas; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 69.68; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 66.68; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 64.68; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 59.05; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.63; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 35. 

State: Kentucky; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 80.14; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 77.14; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 75.14; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 71.49; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 8.65; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 44. 

State: Louisiana[E]; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 81.48; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 78.48; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 76.48; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 63.61; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 17.87; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 96. 

State: Maine; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 74.86; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 71.86; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 69.86; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 63.80; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.06; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 44. 

State: Maryland; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.59; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.59; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.59; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.59; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: Massachusetts; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.59; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.59; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.59; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.59; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: Michigan; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 73.27; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 70.27; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 68.27; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 65.79; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 7.48; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 28. 

State: Minnesota; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.59; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.59; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.59; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.59; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: Mississippi; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 84.86; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 81.86; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 79.86; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 74.73; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.13; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 67. 

State: Missouri; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 74.43; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 71.43; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 69.43; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 63.29; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.14; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 44. 

State: Montana; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 77.99; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 74.99; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 72.99; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 66.81; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.18; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 51. 

State: Nebraska; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 68.76; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 65.76; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 63.76; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 58.44; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.32; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 33. 

State: Nevada; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 63.93; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 60.93; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 58.93; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 51.61; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 12.32; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 34. 

State: New Hampshire; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.59; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.59; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.59; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.59; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: New Jersey; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.59; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.59; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.59; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.59; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: New Mexico; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 80.49; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 77.49; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 75.49; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 69.78; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.71; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 55. 

State: New York; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.59; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.59; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.59; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.59; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: North Carolina; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 74.98; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 71.98; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 69.98; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 64.71; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.27; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 41. 

State: North Dakota; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 69.95; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 66.95; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 64.95; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 60.35; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.60; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 32. 

State: Ohio; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 73.47; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 70.47; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 68.47; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 63.69; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.78; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 37. 

State: Oklahoma; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 76.73; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 73.73; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 71.73; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 64.94; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.79; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 51. 

State: Oregon; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 72.87; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 69.87; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 67.87; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 62.85; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.02; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 37. 

State: Pennsylvania; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 65.85; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 62.85; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 60.85; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 55.64; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.21; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: Rhode Island; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 63.92; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 60.92; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 58.92; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 52.97; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.95; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: South Carolina; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 79.58; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 76.58; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 74.58; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 70.04; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.54; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 47. 

State: South Dakota; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 70.80; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 67.80; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 65.80; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 61.25; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.55; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 33. 

State: Tennessee; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 75.37; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 72.37; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 70.37; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 65.85; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.52; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 39. 

State: Texas; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 70.94; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 67.94; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 65.94; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 60.56; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.38; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 36. 

State: Utah; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 80.78; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 77.78; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 75.78; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 71.13; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.65; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 50. 

State: Vermont; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 69.96; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 66.96; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 64.96; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 58.71; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.25; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 37. 

State: Virginia; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.59; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.59; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.59; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.59; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: Washington; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 62.94; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 59.94; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 57.94; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 12.94; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 35. 

State: West Virginia; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 83.05; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 80.05; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 78.05; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 73.24; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 9.81; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 58. 

State: Wisconsin; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 70.63; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 67.63; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 65.63; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 60.16; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.47; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 36. 

State: Wyoming; 
Estimated increased FMAP for FFY 2011[A]: First quarter: 61.59; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 58.59; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 56.59; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 50.00; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 11.59; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 30. 

State: US (average); 
Estimated increased FMAP for FFY 2011[A]: First quarter: 70.72; 
Estimated increased FMAP for FFY 2011[A]: Second quarter: 67.72; 
Estimated increased FMAP for FFY 2011[A]: Third quarter: 65.72; 
Regular FMAP for FFY 2011[B]: Fourth quarter: 59.89; 
Change between first and fourth quarters FFY 2011: Percentage point 
decrease in FMAP rate[C]: 10.83; 
Change between first and fourth quarters FFY 2011: Percentage increase 
in state share of Medicaid payments[D]: 39.26. 

Source: GAO analysis of HHS and Federal Funds Information for States 
data. 

Note: Increased FMAP will no longer be available to states beginning 
on July 1, 2011. 

[A] We used preliminary fourth quarter FFY 2010 FMAP rates to estimate 
FMAP rates for the first three quarters of FFY 2011. The preliminary 
fourth quarter FFY 2010 FMAP rates were published by Federal Funds 
Information for States on May 25, 2010. 

[B] The fiscal year 2011 regular FMAP rates were published by HHS in 
the Federal Register on November 27, 2009. 

[C] Estimated FMAP percentage point decrease for each state between 
the first quarter FFY 2011 increased FMAP rate and the 2011 regular 
FMAP rate. 

[D] Estimated percentage increase in state share of Medicaid payments 
between the first quarter FFY 2011 increased FMAP rate and the 2011 
regular FMAP rate. 

[E] For the portion of federal fiscal year 2011 not in the Recovery 
Act recession adjustment period (i.e., after December 31, 2010), the 
Patient Protection and Affordable Care Act (PPACA) will provide 
Louisiana with an FMAP of 68.04 (rather than the current FMAP of 
63.61). 

[End of table] 

[End of section] 

Appendix VII: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Carolyn L. Yocom, (202) 512-7114 or yocomc@gao.gov: 

Acknowledgments: 

In addition to the contact name above, the following team members made 
key contributions to this report: Susan Anthony, Assistant Director; 
Emily Beller; Laura Brogan; Ted Burik; Julianne Flowers; Zachary 
Levinson; Drew Long; and Kevin Milne. 

[End of section] 

Footnotes: 

[1] Throughout this report, the term states refers to the 50 states 
and the District of Columbia. 

[2] Pub. L. No. 111-5, 123 Stat. 115. 

[3] See GAO, Estimated Temporary Medicaid Funding Allocations Related 
to Section 5001 of the American Recovery and Reinvestment Act, 
[hyperlink, http://www.gao.gov/products/GAO-09-364R] (Washington, 
D.C.: Feb. 4, 2009). 

[4] For purposes of this report, the term regular FMAP refers to the 
FMAP as defined in section 1905(b) of the Social Security Act. The 
term increased FMAP refers to the temporary FMAP calculated based on 
provisions of § 5001 of the Recovery Act, as amended by Pub. L. No. 
111-226, § 201. 

[5] See GAO, Recovery Act: One Year Later, States' and Localities' 
Uses of Funds and Opportunities to Strengthen Accountability, 
[hyperlink, http://www.gao.gov/products/GAO-10-437] (Washington, D.C.: 
March 2010). 

[6] This requirement will continue to apply to children until October 
1, 2019. The Patient Protection and Affordable Care Act, Pub. L. No. 
111-148, § 2001(b), 124 Stat. 119, 271 (2010), as amended by the 
Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-
152, expands eligibility for Medicaid to include most individuals 
under age 65 and establishes a national floor for Medicaid eligibility 
at 133 percent of the federal poverty level ($14,404 for an individual 
or $29,326 for a family of four in 2009) by January 1, 2014. The act 
allows states that expand Medicaid coverage to these individuals prior 
to that date to obtain federal reimbursement based on the regular FMAP. 

[7] States are projecting budget gaps of $83.9 billion and $72.1 
billion for state fiscal years 2011 and 2012, respectively. 

[8] See Pub. L. No. 111-226, § 201, 124 Stat. 2389 (2010). Under the 
legislation extending the increased FMAP financing, states will 
receive a general across-the-board increase of 3.2 percentage points 
in their regular FMAPs for the second quarter of federal fiscal year 
(FFY) 2011 and a 1.2 percentage point increase in their regular FMAP 
rates for the third quarter of FFY 2011. States will continue to be 
eligible for an unemployment adjustment to their regular FMAP rates. 

[9] As part of GAO's ongoing reports on states' uses of Recovery Act 
funds, we have collected similar information from a sample of states 
and the District of Columbia on a more frequent basis. For example, 
see GAO, Recovery Act: States' and Localities' Uses of Funds and 
Actions Needed to Address Implementation Challenges and Bolster 
Accountability, [hyperlink, http://www.gao.gov/products/GAO-10-604] 
(Washington, D.C.: May 2010). 

[10] We include information reported by the insular areas in appendix 
III and appendix V. 

[11] Medicaid programs are administered by the 50 states, the District 
of Columbia, and the 5 largest U.S. insular areas. 

[12] The federal share of a state's Medicaid payments may range from 
50 to 83 percent. For the insular areas, the FMAP is set by statute at 
50 percent. 

[13] Recovery Act, div. B, title V, § 5001, Pub. L. No. 111-5, 123 
Stat. at 496. CMS made increased FMAP funds available to states on 
February 25, 2009, and states could retroactively claim reimbursement 
for expenditures that occurred as of October 1, 2008. 

[14] See Pub. L. No. 111-226, § 201, 124 Stat. 2389 (2010). 

[15] Under the Recovery Act, insular areas initially had the option of 
choosing either an across-the-board increase of 6.2 percentage points 
to the FMAP rate in conjunction with a 15 percent increase in their 
federal Medicaid payment limits or a 30 percent increase in their 
federal Medicaid payment limits. See Recovery Act, Pub. L. No. 111-5, 
div. B, tit. V, § 5001(b), (d), 123 Stat. 115, 497-498 (2009). CMS 
officials reported that all five insular areas opted for the 30 
percent increase to their federal Medicaid payment limits. After 
December 31, 2010, insular areas will receive the same FMAP adjustment 
as states do. See Pub. L. No. 111-226, § 201, 124 Stat. at 2389. 

[16] The unemployment adjustment is generally determined using both 
changes in a state's unemployment rate and its regular FMAP rate. 
Specifically, the adjustment is calculated, in part, by comparing the 
unemployment rate during consecutive 3-month periods between December 
2009 and January 2011 to the lowest 3-month unemployment rate since 
January 1, 2006. The unemployment adjustment may vary depending on 
changes to the underlying regular FMAP rate and hold harmless 
adjustment in effect for a given quarter. See Pub. L. No. 111-226, § 
201, 124 Stat. at 2393. 

[17] New Hampshire's unemployment increased 2.5 percentage points 
during this period--from 3.4 to 5.9 percent. 

[18] HHS's Office of Inspector General found that HHS's Office of the 
Assistant Secretary of Planning and Evaluation and CMS correctly 
calculated the increased FMAP in accordance with applicable provisions 
of the Recovery Act. See HHS, Office of the Inspector General, Review 
of the Calculations of Temporary Increases in Federal Medical 
Assistance Percentages Under the American Recovery and Reinvestment 
Act, A-09-09-00075 (May 2009); and Review of the Calculation of 
Additional Medicaid Funding Awarded Under the American Recovery and 
Reinvestment Act, A-09-09-00080 (July 2009). 

[19] Under the Recovery Act, once a state qualifies for an 
unemployment increase, the increase is maintained through December 31, 
2010, regardless of subsequent changes in unemployment rates. 

[20] See Recovery Act, div. B, title V, § 5001(f)(1)(A). 

[21] Under the Recovery Act, states are not eligible to receive the 
increased FMAP for certain claims for days during any period in which 
that state has failed to meet the prompt payment requirement under the 
Medicaid statute as applied to those claims. See Recovery Act, div. B, 
title V, § 5001(f)(2). Prompt payment requires states to pay 90 
percent of clean claims from health care practitioners and certain 
other providers within 30 days of receipt and 99 percent of these 
claims within 90 days of receipt. See 42 U.S.C. § 1396a(a)(37)(A). A 
clean claim is a claim that has no defect or impropriety (including 
any lack of any required substantiating documentation) or particular 
circumstance requiring special treatment that prevents timely payment 
from being made on the claim. See Social Security Act § 1816. 

[22] A state is not eligible for certain elements of increased FMAP if 
any amounts attributable directly or indirectly to them are deposited 
in or credited to a state reserve or rainy day fund. Recovery Act, 
div. B, title V, § 5001(f)(3). 

[23] In some states, political subdivisions--such as cities and 
counties--may be required to help finance the state's share of 
Medicaid spending. Under the Recovery Act, a state that has such 
financing arrangements is not eligible for certain elements of the 
increased FMAP if it requires subdivisions to pay during a quarter of 
the recession adjustment period a greater percentage of the nonfederal 
share than the percentage that would have otherwise been required 
under the state plan on September 30, 2008. See Recovery Act, div. B, 
title V, § 5001(g)(2). The recession adjustment period is the period 
beginning October 1, 2008, and ending June 30, 2011. 

[24] For example, as of May 3, 2010, CMS's Web site included state 
Medicaid director letters related to the availability or use of 
increased FMAP funds. See [hyperlink, 
http://www.cms.hhs.gov/SMDL/SMD/list.asp?sortByDID=1a&submit=Go&filterTy
pe=none&filterByDID=-99&sortOrder=ascending&intNumPerPage=10] 
(accessed May 3, 2010). 

[25] GAO, Medicaid Financing: Federal Oversight Initiative Is 
Consistent with Medicaid Payment Principles but Needs Greater 
Transparency, [hyperlink, http://www.gao.gov/products/GAO-07-214] 
(Washington, D.C.: Mar. 30, 2007). In this report, we found that more 
than half the states ended certain Medicaid financing arrangements, 
which CMS determined to be inappropriate. 

[26] CMS officials indicated that states can continue to draw from 
their increased FMAP grant awards for the last three quarters of FFY 
2010 expenditures until CMS finalizes the grant awards for these 
quarters, a process the agency has not yet completed. 

[27] We based our estimate on funds drawn by states as of June 30, 
2010. 

[28] Hawaii first drew down funds on June 15, 2009, the date after 
which the state reversed recent changes to its income eligibility 
requirements that state officials believed would make them 
noncompliant with the act's maintenance of eligibility requirements. 

[29] States may obtain a waiver from the act's prompt payment 
requirements if the Secretary of HHS determines that there are exigent 
circumstances, including natural disasters, which would prevent a 
state from the timely processing of claims or compliance with 
reporting requirements. A CMS official told us that Maine, Maryland, 
Massachusetts, North Dakota, and Pennsylvania had received approval 
for a waiver from the act's prompt payment requirement. In addition, 
CMS reported that three states--Idaho, Michigan, and Wisconsin--have 
requested waivers that are under review, and Tennessee had withdrawn a 
request for a waiver. 

[30] Fewer than half the states reported using or planning to use 
these funds to ensure prompt pay requirements were met (21 states); to 
finance local public health insurance programs or the State Children's 
Health Insurance Program (CHIP) (10 states); and to increase Medicaid 
payment rates for certain providers (6 states). In addition, 1 state 
reported using funds to expand Medicaid eligibility levels and 1 state 
reported using funds to expand Medicaid benefits and services. 

[31] For example, the Henry J. Kaiser Family Foundation estimated that 
national Medicaid enrollment increased by about 1 percent from 
December 2004 through June 2007. See the Kaiser Commission on Medicaid 
and the Uninsured, Medicaid Enrollment in the 50 States June 2008 Data 
Update, Henry J. Kaiser Family Foundation (Washington, D.C., September 
2009), [hyperlink, http://www.kff.org/medicaid/upload/7606-04.pdf] 
(accessed Jan. 11, 2010). 

[32] The lower enrollment growth in Tennessee and Texas could be due 
to specific factors. For example, a January 2009 court ruling allowed 
Tennessee to redetermine eligibility for specific beneficiaries, 
resulting in a reduction of about 100,000 individuals from their 
Medicaid program. For Texas, the lower enrollment growth could be due, 
in part, to the fact that the state provided preliminary enrollment 
data for September 2009 through February 2010. 

[33] Three of the five largest insular areas also provided Medicaid 
enrollment data for this complete time period. Specifically, during 
this time, enrollment increased by slightly over 18 percent in Guam 
and nearly 81 percent in the U.S. Virgin Islands, and was largely 
unchanged in Puerto Rico. 

[34] During this period, Medicaid enrollment increased by about 7 
percent for aged populations and 5 percent for disabled populations. 

[35] States completed our survey in March 2010, at which time the 
Recovery Act provided that the increased FMAP rates would no longer be 
available to states beginning on January 1, 2011, and approximately 4 
months before legislation to extend the increased FMAP through June 
2011 was enacted. 

[36] As an indicator of the fiscal duress states have experienced over 
the past several years, 43 states cut their state fiscal year 2009 
enacted budgets and 40 states cut their state fiscal year 2010 budgets 
after enactment. By comparison, only 12 states cut their enacted 
budgets in state fiscal year 2008. In addition, only 4 states-- 
Delaware, Florida, Ohio, and Virginia--reported meeting their 2010 
revenues estimates. See Federal Funds Information for States, State 
Policy Reports 2010, Volume 28, Issue 10 (Washington D.C., July 2010.) 

[37] States reported implementing new taxes on private hospitals, 
intermediate care facilities for persons with mental retardation, and 
nursing facilities. 

[38] Fourteen states that reported reducing or freezing Medicaid 
practitioner or institutional provider payment rates also implemented 
new provider taxes. 

[39] See National Conference of State Legislature's May 6, 2010 letter 
to Congress: FMAP Extension and the Impact on States, Table 1. Six- 
Month FMAP Extension, [hyperlink, 
http://www.ncsl.org/default.aspx?TabId=20284] (accessed July 29, 2010). 

[40] See Pub. L. No. 111-226, § 201, 124 Stat. 2389. 

[41] We based our estimates on the most recently available increased 
FMAP rates and the 2011 regular FMAP rates, and assumed no change in 
states' unemployment adjustment. 

[42] When increased FMAP funds are no longer available, states' share 
of Medicaid payments will increase. 

[43] In terms of reform initiatives, Wisconsin reported adjusting 
provider payments based on outcomes and error rates, continuing a 
Medicaid quality improvement effort that included a managed care pay- 
for-performance initiative, and implementing care management and 
coordination strategies. 

[44] Pub. L. No. 111-148, § 2001(b)(2), 124 Stat. 118, 275. This 
requirement will continue to apply to children until October 1, 2019. 
Beginning on January 1, 2011, this provision may have limited 
applicability if a state certifies to the Secretary that it has a 
budget deficit or projects to have a budget deficit in the following 
fiscal year. Pub. L. No. 111-148, § 2001(b)(2). According to CMS 
officials, the agency is currently developing guidance on various 
PPACA provisions. 

[45] Prior to the enactment of PPACA, 10 states reported they were 
considering reducing eligibility once increased FMAP funds were no 
longer available. 

[46] See CMS, State Medicaid Director Letter #10-005, New Option for 
Coverage of Individuals under Medicaid (Apr. 9, 2010). 

[47] Five states provided coverage to working parents and seven states 
provided coverage to childless adults through state-funded programs in 
2009. 

[48] See, e.g., Pub. L. No. 111-148, § 2402, 10202. 

[49] In addition, using a more limited survey, we contacted the five 
largest U.S. insular areas--American Samoa, Guam, the Commonwealth of 
the Northern Mariana Islands (CNMI), Puerto Rico, and the U.S. Virgin 
Islands--to collect enrollment and other data and obtained responses 
from CNMI, Guam, Puerto Rico, and U.S. Virgin Islands. Information 
reported by the insular areas is included in appendix III and appendix 
V. 

[50] For example, some state-reported Medicaid enrollment data 
obtained through our survey were preliminary and subject to update. 

[51] We obtained poverty rates from the U.S. Census Bureau, 
unemployment rates from the Bureau of Labor Statistics, and Medicaid 
eligibility levels from the Henry J. Kaiser Family Foundation. 

[52] The Patient Protection and Affordable Care Act, Pub. L. No. 111- 
148, 124 Stat. 119, as amended by the Health Care and Education 
Reconciliation Act of 2010, Pub. L. No. 111-152. 

[End of section] 

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