This is the accessible text file for GAO report number GAO-09-371R entitled 'Estimated Adjusted Medicaid Funding Allocations Related to the Proposed American Recovery and Reinvestment Act' which was released on February 5, 2009. This text file was formatted by the U.S. Government Accountability Office (GAO) to be accessible to users with visual impairments, as part of a longer term project to improve GAO products' accessibility. Every attempt has been made to maintain the structural and data integrity of the original printed product. Accessibility features, such as text descriptions of tables, consecutively numbered footnotes placed at the end of the file, and the text of agency comment letters, are provided but may not exactly duplicate the presentation or format of the printed version. The portable document format (PDF) file is an exact electronic replica of the printed version. We welcome your feedback. Please E-mail your comments regarding the contents or accessibility features of this document to Webmaster@gao.gov. This is a work of the U.S. government and is not subject to copyright protection in the United States. It may be reproduced and distributed in its entirety without further permission from GAO. Because this work may contain copyrighted images or other material, permission from the copyright holder may be necessary if you wish to reproduce this material separately. United States Government Accountability Office: Washington, DC 20548: February 5, 2009: The Honorable Charles E. Grassley: Ranking Member: Committee on Finance: United States Senate: Subject: Estimated Adjusted Medicaid Funding Allocations Related to the Proposed American Recovery and Reinvestment Act: Dear Senator Grassley, You asked us to estimate the state allocations that would likely occur if an across-the-board percentage point increase in the Federal Medical Assistance Percentage (FMAP) replaced Section 5001 of the proposed American Recovery and Reinvestment Act of 2009, while maintaining the same funding level that the Congressional Budget Office estimated for this section.[Footnote 1] The following information responds to your request for state-by-state, quarter-by-quarter estimates of the Medicaid funding states would receive with such an across-the-board increase. To provide you with technical assistance, we developed an estimate of state-by-state Medicaid allocations for the Recession Adjustment Period defined in the proposed legislation. We used Medicaid data from the Centers for Medicare & Medicaid Services (CMS) to estimate states' funding allocations. States submit these data to CMS and they represent states' anticipated Medicaid funding requirements for the current and next fiscal year. These data may or may not correspond to future Medicaid expenditures. See Enclosure 1 for estimates of each state's approximate Medicaid allocation. We are sending copies of this letter to interested congressional committees. We will also make copies available to others upon request. In addition, the letter will be available at no charge on GAO's Web site at [hyperlink, http://www.gao.gov]. If you or your staff has any questions about this letter, please contact Stanley J. Czerwinski, Director, Strategic Issues, who can be reached at (202) 512-6806 or czerwinskis@gao.gov, or Thomas J. McCool, Director, Center for Economics, who can be reached at (202) 512-2700 or mccoolt@gao.gov. Sincerely yours, Signed by: Stanley J. Czerwinski: Director, Strategic Issues: Signed by: Thomas J. McCool: Director, Center for Economics: Enclosures: [End of section] Enclosure I: Estimated Medicaid Assistance Projected to be Provided to States by Replacing Section 5001 of the Proposed American Recovery and Reinvestment Act with an Across-the-board FMAP Percentage Point Increase (Dollars in Billions): Alabama; 2009 Q1: $0.101; 2009 Q2: $0.101; 2009 Q3: $0.101; 2009 Q4: $0.101; 2010 Q1: $0.106; 2010 Q2: $0.106; 2010 Q3: $0.106; 2010 Q4: $0.106; 2011 Q1: $0.106; Total for 9 quarters: $0.932. Alaska; 2009 Q1: $0.032; 2009 Q2: $0.032; 2009 Q3: $0.032; 2009 Q4: $0.032; 2010 Q1: $0.030; 2010 Q2: $0.030; 2010 Q3: $0.030; 2010 Q4: $0.030; 2011 Q1: $0.030; Total for 9 quarters: $0.278. Arizona; 2009 Q1: $0.223; 2009 Q2: $0.223; 2009 Q3: $0.223; 2009 Q4: $0.223; 2010 Q1: $0.239; 2010 Q2: $0.239; 2010 Q3: $0.239; 2010 Q4: $0.239; 2011 Q1: $0.239; Total for 9 quarters: $2.089. Arkansas; 2009 Q1: $0.096; 2009 Q2: $0.096; 2009 Q3: $0.096; 2009 Q4: $0.096; 2010 Q1: $0.105; 2010 Q2: $0.105; 2010 Q3: $0.105; 2010 Q4: $0.105; 2011 Q1: $0.105; Total for 9 quarters: $0.905. California; 2009 Q1: $1.070; 2009 Q2: $1.070; 2009 Q3: $1.070; 2009 Q4: $1.070; 2010 Q1: $1.097; 2010 Q2: $1.097; 2010 Q3: $1.097; 2010 Q4: $1.097; 2011 Q1: $1.097; Total for 9 quarters: $9.763. Colorado; 2009 Q1: $0.090; 2009 Q2: $0.090; 2009 Q3: $0.090; 2009 Q4: $0.090; 2010 Q1: $0.092; 2010 Q2: $0.092; 2010 Q3: $0.092; 2010 Q4: $0.092; 2011 Q1: $0.092; Total for 9 quarters: $0.819. Connecticut; 2009 Q1: $0.132; 2009 Q2: $0.132; 2009 Q3: $0.132; 2009 Q4: $0.132; 2010 Q1: $0.133; 2010 Q2: $0.133; 2010 Q3: $0.133; 2010 Q4: $0.133; 2011 Q1: $0.133; Total for 9 quarters: $1.194. Delaware; 2009 Q1: $0.031; 2009 Q2: $0.031; 2009 Q3: $0.031; 2009 Q4: $0.031; 2010 Q1: $0.036; 2010 Q2: $0.036; 2010 Q3: $0.036; 2010 Q4: $0.036; 2011 Q1: $0.036; Total for 9 quarters: $0.304. District of Columbia; 2009 Q1: $0.039; 2009 Q2: $0.039; 2009 Q3: $0.039; 2009 Q4: $0.039; 2010 Q1: $0.040; 2010 Q2: $0.040; 2010 Q3: $0.040; 2010 Q4: $0.040; 2011 Q1: $0.040; Total for 9 quarters: $0.359. Florida; 2009 Q1: $0.457; 2009 Q2: $0.457; 2009 Q3: $0.457; 2009 Q4: $0.457; 2010 Q1: $0.466; 2010 Q2: $0.466; 2010 Q3: $0.466; 2010 Q4: $0.466; 2011 Q1: $0.466; Total for 9 quarters: $4.160. Georgia; 2009 Q1: $0.192; 2009 Q2: $0.192; 2009 Q3: $0.192; 2009 Q4: $0.192; 2010 Q1: $0.206; 2010 Q2: $0.206; 2010 Q3: $0.206; 2010 Q4: $0.206; 2011 Q1: $0.206; Total for 9 quarters: $1.797. Hawaii; 2009 Q1: $0.039; 2009 Q2: $0.039; 2009 Q3: $0.039; 2009 Q4: $0.039; 2010 Q1: $0.040; 2010 Q2: $0.040; 2010 Q3: $0.040; 2010 Q4: $0.040; 2011 Q1: $0.040; Total for 9 quarters: $0.356. Idaho; 2009 Q1: $0.034; 2009 Q2: $0.034; 2009 Q3: $0.034; 2009 Q4: $0.034; 2010 Q1: $0.039; 2010 Q2: $0.039; 2010 Q3: $0.039; 2010 Q4: $0.039; 2011 Q1: $0.039; Total for 9 quarters: $0.329. Illinois; 2009 Q1: $0.277; 2009 Q2: $0.277; 2009 Q3: $0.277; 2009 Q4: $0.277; 2010 Q1: $0.298; 2010 Q2: $0.298; 2010 Q3: $0.298; 2010 Q4: $0.298; 2011 Q1: $0.298; Total for 9 quarters: $2.597. Indiana; 2009 Q1: $0.160; 2009 Q2: $0.160; 2009 Q3: $0.160; 2009 Q4: $0.160; 2010 Q1: $0.172; 2010 Q2: $0.172; 2010 Q3: $0.172; 2010 Q4: $0.172; 2011 Q1: $0.172; Total for 9 quarters: $1.502. Iowa; 2009 Q1: $0.079; 2009 Q2: $0.079; 2009 Q3: $0.079; 2009 Q4: $0.079; 2010 Q1: $0.084; 2010 Q2: $0.084; 2010 Q3: $0.084; 2010 Q4: $0.084; 2011 Q1: $0.084; Total for 9 quarters: $0.735. Kansas; 2009 Q1: $0.060; 2009 Q2: $0.060; 2009 Q3: $0.060; 2009 Q4: $0.060; 2010 Q1: $0.060; 2010 Q2: $0.060; 2010 Q3: $0.060; 2010 Q4: $0.060; 2011 Q1: $0.060; Total for 9 quarters: $0.541. Kentucky; 2009 Q1: $0.132; 2009 Q2: $0.132; 2009 Q3: $0.132; 2009 Q4: $0.132; 2010 Q1: $0.133; 2010 Q2: $0.133; 2010 Q3: $0.133; 2010 Q4: $0.133; 2011 Q1: $0.133; Total for 9 quarters: $1.193. Louisiana; 2009 Q1: $0.163; 2009 Q2: $0.163; 2009 Q3: $0.163; 2009 Q4: $0.163; 2010 Q1: $0.250; 2010 Q2: $0.250; 2010 Q3: $0.250; 2010 Q4: $0.250; 2011 Q1: $0.250; Total for 9 quarters: $1.900. Maine; 2009 Q1: $0.058; 2009 Q2: $0.058; 2009 Q3: $0.058; 2009 Q4: $0.058; 2010 Q1: $0.056; 2010 Q2: $0.056; 2010 Q3: $0.056; 2010 Q4: $0.056; 2011 Q1: $0.056; Total for 9 quarters: $0.513. Maryland; 2009 Q1: $0.169; 2009 Q2: $0.169; 2009 Q3: $0.169; 2009 Q4: $0.169; 2010 Q1: $0.178; 2010 Q2: $0.178; 2010 Q3: $0.178; 2010 Q4: $0.178; 2011 Q1: $0.178; Total for 9 quarters: $1.565. Massachusetts; 2009 Q1: $0.332; 2009 Q2: $0.332; 2009 Q3: $0.332; 2009 Q4: $0.332; 2010 Q1: $0.312; 2010 Q2: $0.312; 2010 Q3: $0.312; 2010 Q4: $0.312; 2011 Q1: $0.312; Total for 9 quarters: $2.885. Michigan; 2009 Q1: $0.251; 2009 Q2: $0.251; 2009 Q3: $0.251; 2009 Q4: $0.251; 2010 Q1: $0.258; 2010 Q2: $0.258; 2010 Q3: $0.258; 2010 Q4: $0.258; 2011 Q1: $0.258; Total for 9 quarters: $2.294. Minnesota; 2009 Q1: $0.194; 2009 Q2: $0.194; 2009 Q3: $0.194; 2009 Q4: $0.194; 2010 Q1: $0.207; 2010 Q2: $0.207; 2010 Q3: $0.207; 2010 Q4: $0.207; 2011 Q1: $0.207; Total for 9 quarters: $1.813. Mississippi; 2009 Q1: $0.102; 2009 Q2: $0.102; 2009 Q3: $0.102; 2009 Q4: $0.102; 2010 Q1: $0.111; 2010 Q2: $0.111; 2010 Q3: $0.111; 2010 Q4: $0.111; 2011 Q1: $0.111; Total for 9 quarters: $0.963. Missouri; 2009 Q1: $0.181; 2009 Q2: $0.181; 2009 Q3: $0.181; 2009 Q4: $0.181; 2010 Q1: $0.197; 2010 Q2: $0.197; 2010 Q3: $0.197; 2010 Q4: $0.197; 2011 Q1: $0.197; Total for 9 quarters: $1.706. Montana; 2009 Q1: $0.023; 2009 Q2: $0.023; 2009 Q3: $0.023; 2009 Q4: $0.023; 2010 Q1: $0.025; 2010 Q2: $0.025; 2010 Q3: $0.025; 2010 Q4: $0.025; 2011 Q1: $0.025; Total for 9 quarters: $0.214. Nebraska; 2009 Q1: $0.042; 2009 Q2: $0.042; 2009 Q3: $0.042; 2009 Q4: $0.042; 2010 Q1: $0.044; 2010 Q2: $0.044; 2010 Q3: $0.044; 2010 Q4: $0.044; 2011 Q1: $0.044; Total for 9 quarters: $0.389. Nevada; 2009 Q1: $0.044; 2009 Q2: $0.044; 2009 Q3: $0.044; 2009 Q4: $0.044; 2010 Q1: $0.047; 2010 Q2: $0.047; 2010 Q3: $0.047; 2010 Q4: $0.047; 2011 Q1: $0.047; Total for 9 quarters: $0.414. New Hampshire; 2009 Q1: $0.030; 2009 Q2: $0.030; 2009 Q3: $0.030; 2009 Q4: $0.030; 2010 Q1: $0.033; 2010 Q2: $0.033; 2010 Q3: $0.033; 2010 Q4: $0.033; 2011 Q1: $0.033; Total for 9 quarters: $0.282. New Jersey; 2009 Q1: $0.219; 2009 Q2: $0.219; 2009 Q3: $0.219; 2009 Q4: $0.219; 2010 Q1: $0.237; 2010 Q2: $0.237; 2010 Q3: $0.237; 2010 Q4: $0.237; 2011 Q1: $0.237; Total for 9 quarters: $2.060. New Mexico; 2009 Q1: $0.084; 2009 Q2: $0.084; 2009 Q3: $0.084; 2009 Q4: $0.084; 2010 Q1: $0.089; 2010 Q2: $0.089; 2010 Q3: $0.089; 2010 Q4: $0.089; 2011 Q1: $0.089; Total for 9 quarters: $0.781. New York; 2009 Q1: $1.237; 2009 Q2: $1.237; 2009 Q3: $1.237; 2009 Q4: $1.237; 2010 Q1: $1.335; 2010 Q2: $1.335; 2010 Q3: $1.335; 2010 Q4: $1.335; 2011 Q1: $1.335; Total for 9 quarters: $1.768. North Carolina; 2009 Q1: $0.262; 2009 Q2: $0.262; 2009 Q3: $0.262; 2009 Q4: $0.262; 2010 Q1: $0.280; 2010 Q2: $0.280; 2010 Q3: $0.280; 2010 Q4: $0.280; 2011 Q1: $0.280; Total for 9 quarters: $2.450. North Dakota; 2009 Q1: $0.016; 2009 Q2: $0.016; 2009 Q3: $0.016; 2009 Q4: $0.016; 2010 Q1: $0.017; 2010 Q2: $0.017; 2010 Q3: $0.017; 2010 Q4: $0.017; 2011 Q1: $0.017; Total for 9 quarters: $0.148. Ohio; 2009 Q1: $0.345; 2009 Q2: $0.345; 2009 Q3: $0.345; 2009 Q4: $0.345; 2010 Q1: $0.359; 2010 Q2: $0.359; 2010 Q3: $0.359; 2010 Q4: $0.359; 2011 Q1: $0.359; Total for 9 quarters: $3.175. Oklahoma; 2009 Q1: $0.115; 2009 Q2: $0.115; 2009 Q3: $0.115; 2009 Q4: $0.115; 2010 Q1: $0.131; 2010 Q2: $0.131; 2010 Q3: $0.131; 2010 Q4: $0.131; 2011 Q1: $0.131; Total for 9 quarters: $1.111. Oregon; 2009 Q1: $0.093; 2009 Q2: $0.093; 2009 Q3: $0.093; 2009 Q4: $0.093; 2010 Q1: $0.095; 2010 Q2: $0.095; 2010 Q3: $0.095; 2010 Q4: $0.095; 2011 Q1: $0.095; Total for 9 quarters: $0.844. Pennsylvania; 2009 Q1: $0.433; 2009 Q2: $0.433; 2009 Q3: $0.433; 2009 Q4: $0.433; 2010 Q1: $0.456; 2010 Q2: $0.456; 2010 Q3: $0.456; 2010 Q4: $0.456; 2011 Q1: $0.456; Total for 9 quarters: $4.011. Rhode Island; 2009 Q1: $0.046; 2009 Q2: $0.046; 2009 Q3: $0.046; 2009 Q4: $0.046; 2010 Q1: $0.047; 2010 Q2: $0.047; 2010 Q3: $0.047; 2010 Q4: $0.047; 2011 Q1: $0.047; Total for 9 quarters: $0.417. South Carolina; 2009 Q1: $0.107; 2009 Q2: $0.107; 2009 Q3: $0.107; 2009 Q4: $0.107; 2010 Q1: $0.106; 2010 Q2: $0.106; 2010 Q3: $0.106; 2010 Q4: $0.106; 2011 Q1: $0.106; Total for 9 quarters: $0.955. South Dakota; 2009 Q1: $0.018; 2009 Q2: $0.018; 2009 Q3: $0.018; 2009 Q4: $0.018; 2010 Q1: $0.018; 2010 Q2: $0.018; 2010 Q3: $0.018; 2010 Q4: $0.018; 2011 Q1: $0.018; Total for 9 quarters: $0.158. Tennessee; 2009 Q1: $0.184; 2009 Q2: $0.184; 2009 Q3: $0.184; 2009 Q4: $0.184; 2010 Q1: $0.190; 2010 Q2: $0.190; 2010 Q3: $0.190; 2010 Q4: $0.190; 2011 Q1: $0.190; Total for 9 quarters: $1.688. Texas; 2009 Q1: $0.633; 2009 Q2: $0.633; 2009 Q3: $0.633; 2009 Q4: $0.633; 2010 Q1: $0.710; 2010 Q2: $0.710; 2010 Q3: $0.710; 2010 Q4: $0.710; 2011 Q1: $0.710; Total for 9 quarters: $6.080. Utah; 2009 Q1: $0.046; 2009 Q2: $0.046; 2009 Q3: $0.046; 2009 Q4: $0.046; 2010 Q1: $0.045; 2010 Q2: $0.045; 2010 Q3: $0.045; 2010 Q4: $0.045; 2011 Q1: $0.045; Total for 9 quarters: $0.413. Vermont; 2009 Q1: $0.029; 2009 Q2: $0.029; 2009 Q3: $0.029; 2009 Q4: $0.029; 2010 Q1: $0.033; 2010 Q2: $0.033; 2010 Q3: $0.033; 2010 Q4: $0.033; 2011 Q1: $0.033; Total for 9 quarters: $0.282. Virginia; 2009 Q1: $0.150; 2009 Q2: $0.150; 2009 Q3: $0.150; 2009 Q4: $0.150; 2010 Q1: $0.161; 2010 Q2: $0.161; 2010 Q3: $0.161; 2010 Q4: $0.161; 2011 Q1: $0.161; Total for 9 quarters: $1.407. Washington; 2009 Q1: $0.200; 2009 Q2: $0.200; 2009 Q3: $0.200; 2009 Q4: $0.200; 2010 Q1: $0.233; 2010 Q2: $0.233; 2010 Q3: $0.233; 2010 Q4: $0.233; 2011 Q1: $0.233; Total for 9 quarters: $1.966. West Virginia; 2009 Q1: $0.065; 2009 Q2: $0.065; 2009 Q3: $0.065; 2009 Q4: $0.065; 2010 Q1: $0.066; 2010 Q2: $0.066; 2010 Q3: $0.066; 2010 Q4: $0.066; 2011 Q1: $0.066; Total for 9 quarters: $0.589. Wisconsin; 2009 Q1: $0.150; 2009 Q2: $0.150; 2009 Q3: $0.150; 2009 Q4: $0.150; 2010 Q1: $0.154; 2010 Q2: $0.154; 2010 Q3: $0.154; 2010 Q4: $0.154; 2011 Q1: $0.154; Total for 9 quarters: $1.370. Wyoming; 2009 Q1: $0.013; 2009 Q2: $0.013; 2009 Q3: $0.013; 2009 Q4: $0.013; 2010 Q1: $0.015; 2010 Q2: $0.015; 2010 Q3: $0.015; 2010 Q4: $0.015; 2011 Q1: $0.015; Total for 9 quarters: $0.130. Total; 2009 Q1: $9.311; 2009 Q2: $9.311; 2009 Q3: $9.311; 2009 Q4: $9.311; 2010 Q1: $9.869; 2010 Q2: $9.869; 2010 Q3: $9.869; 2010 Q4: $9.869; 2011 Q1: $9.869; Total for 9 quarters: $86.593. Source: Data from Bureau of Labor Statistics (BLS), Centers for Medicare & Medicaid Services (CMS), IHS Global Insight, and GAO analysis. Note: GAO calculations based on actual Federal Medical Assistance Percentage (FMAP) rates for 2008 through 2010. Years shown are federal fiscal years. Medicaid data are from the CMS Form 37. The CMS Form 37 is used to estimate federal Medicaid allocations. CMS Form 37 data are not available for fiscal year 2011. We used CMS Form 37 data for the fourth quarter of fiscal year 2010 as a proxy for the first quarter of fiscal year 2011. Data for the territories are not included in this analysis. We relied on the methodology outlined in our 2006 report on strategies to help states address increased Medicaid expenditures during economic downturns to guide the development of these estimates. See GAO, Medicaid: Strategies to Help States Address Increased Expenditures during Economic Downturns, GAO-07-97 (Washington, D.C.: Oct. 18, 2006). [End of table] [End of enclosure] Enclosure II: GAO Contacts and Staff Acknowledgments: For information about this letter, please contact Stanley J. Czerwinski, Director, Strategic Issues, who can be reached at (202) 512- 6806 or czerwinskis@gao.gov, or Thomas J. McCool, Director, Center for Economics, at (202) 512-2700 or mccoolt@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this letter. Individuals making key contributions to this letter and related products include: Robert Dinkelmeyer, Greg Dybalski, Susan J. Irving, Thomas James, Michelle Sager, Max Sawicky, Michael Springer, and Carolyn L. Yocom. [End of enclosure] Footnote: [1] CBO, Congressional Budget Office Cost Estimate, H.R. 1, American Recovery and Reinvestment Act of 2009, An amendment in the nature of a substitute, as introduced by Senators Inouye and Baucus on January 31, 2009 (Washington, D.C.: February 2, 2009). 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