Current Exceptions to Standard Federal Match Rates
| Statutory exception | Federal match rate | Social Security Act and other citations | Notes |
|---|---|---|---|
| Territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands) |
55 percent unless temporary enhanced FMAP in effect. Temporary FMAPs in effect for FY 2020 – FY 2021 = 76 for Puerto Rico, 83 percent for other territories (American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and the U.S. Virgin Islands ) |
1905(b); 1108(f), (g) | Subject to federal spending caps. Also applies for purposes of computing the CHIP E-FMAP. |
| District of Columbia | 70 percent | 1905(b) | Without this exception, would be at statutory minimum of 50 percent. Also applies for purposes of computing the CHIP E-FMAP. |
| Adjustment for disaster recovery | Varies | 1905(aa) | As of CY 2011, a disaster recovery FMAP adjustment is available for states that have experienced a federally-declared disaster and where the FMAP has declined by a specified amount. |
| Adjustment for certain employer contributions | Varies | P.L. 111-3 § 614; Federal Register 75, no. 199 (October 15): 63480 | As of FY 2006, significantly disproportionate employer pension and insurance fund contributions are excluded from calculation of Medicaid FMAPs.1 |
| Newly eligible individuals enrolled in new adult eligibility group through 138 percent FPL for states that expanded coverage to the new adult group before March 11, 2021 | CY 2020 and later = 90 percent | 1905(y) | As of CY 2014, applies to expenditures for the new eligibility group for non-elderly, non-pregnant adults with incomes at or below 133 percent FPL, who would not have been eligible for Medicaid in the state as of December 1, 2009 or were eligible under a waiver but not enrolled due to limits or caps on waiver enrollment. |
| Newly eligible individuals enrolled in new adult eligibility group through 138 percent FPL for states that expanded coverage to the new adult group after March 11, 2021 | 95 percent for first 8 quarters expansion is in effect; then 90 percent | 1905(ii) | Does not apply to states that implemented the Medicaid expansion prior to March 11, 2021 |
| Expansion state individuals enrolled in the new eligibility group through 133 percent FPL | CY 2020 and later = 90 percent | 1905(z)(2) | As of CY 2014, applies to expenditures for individuals who are enrolled in the new eligibility group for non-elderly, non-pregnant adults with incomes at or below 133 percent FPL in states that had already expanded eligibility to parents and non-pregnant childless adults at least through 100 percent FPL as of March 23, 2010 (when the ACA was enacted). |
| Certain women with breast or cervical cancer | Applicable state E-FMAP | 1905(b) | Applies to expenditures for an optional group of certain women with breast or cervical cancer who do not qualify for Medicaid under a mandatory eligibility pathway and are otherwise uninsured. |
| Individuals in the Qualifying Individuals program | 100 percent | 1933(d) | Applies to expenditures for Medicare Part B premiums for Medicare beneficiaries with incomes between 120 percent and 135 percent FPL and limited assets, up to a specified dollar allotment. |
| Indian Health Service facility services | 100 percent | 1905(b) | Applies to expenditures for services provided through an Indian Health Service facility. |
| Family planning services | 90 percent | 1903(a)(5) | Applies to expenditures for family planning services and supplies. |
| Certain preventive services and immunizations | FMAP plus 1 percentage point | 1905(b) | Applies to expenditures for certain clinical preventive services and certain adult immunizations in states that cover these services, beginning in CY 2013. |
| Smoking cessation services for pregnant women | FMAP plus 1 percentage point | 1905(b) | Applies to expenditures for smoking cessation services that are mandatory for pregnant women in states that cover certain clinical preventive services and certain adult immunizations, beginning in CY 2013. |
| Health homes | 90 percent | 1945(c)(1) | Applies to expenditures for optional health home and associated services for certain individuals with chronic conditions; available beginning in CY 2011 for the first eight quarters the health home option is in effect in the state. |
| Home and community-based attendant services and supports | FMAP plus 6 percentage points | 1915(k)(2) | Applies to expenditures for new optional home and community-based attendant services and supports for certain individuals with incomes at or below 150 percent FPL, or a higher income level applicable to those who require an institutional level of care. |
| COVID-19 vaccine and administration | 100 percent | 1905(hh) | Temporary increase in the FMAP for medical assistance for COVID-19 vaccine and administration. The increased FMAP begins on the first day of the first quarter beginning after the date of the enactment of 1905(a)(4)(E) [quarter beginning April 1, 2021] and ends on the last day of the first quarter that begins one year after the last day of the emergency period described in section 1135(g)(1)(B). |
| COVID-19 testing for uninsured individuals | 100 percent | 1905(b) | Applies to testing and testing-related services for uninsured individuals covered at state option during the public health emergency. |
| Services during the COVID-19 public health emergency | FMAP plus 6.2 percentage points | Section 6008 of the Families First Coronavirus Response Act (P.L. 116-127) | Increased FMAP is in effect until the last day of the calendar quarter in which the public health emergency ends. |
Notes: FY is fiscal year. CY is calendar year. FMAP is Federal Medical Assistance Percentage. E-FMAP is Enhanced Federal Medical Assistance Percentage. FPL is federal poverty level. ACA is Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended).
1Employer contributions to insurance and pension funds are among the components of state per capita personal income that HHS uses to calculate the FMAP. Other components of state per capita personal income include wages and salaries; dividends, interest, and rent; and government social benefits such as Social Security, Medicare, Medicaid, and state unemployment insurance.
Expired Exceptions to Standard Federal Match Rates
Congress created temporary exceptions for special situations, such as state fiscal relief, that have now expired. For example, the American Recovery and Reinvestment Act of 2009 (ARRA, P.L. 111-5) provided a temporary increase in each state’s FMAP from October 2008 through December 2010, that was later extended at lower levels through June 2011. Expired exceptions are described in the table below.
| Expired statutory exception | FMAP | Citations | Notes |
| Alaska | Varies | P.L. 105-33 § 4725(a); P.L. 106-554 Appendix F § 706; P.L. 109-171 § 6053(a) | From FY 1998–FY 2000 Alaska’s FMAP was set in statute at 59.8 percent, alternative formula used to calculate Alaska’s FMAP from FY 2001–FY 2005, and was held at the FY 2005 level for FY 2006–FY 2007. Also applied for purposes of computing the CHIP E-FMAP. |
| State fiscal relief, FY 2003–FY 2004 | FMAP plus 2.95 percentage points | P.L. 108-27 § 401(a) | FMAPs for the last two quarters of FY 2003 and the first three quarters of FY 2004 were not allowed to decline and were increased by 2.95 percentage points (did not apply to certain expenditures). |
| State fiscal relief, FY 2009–FY 2011 | FMAP plus 6.2, 3.2, or 1.2 percentage points | P.L. 111-5 § 5001, as amended by P.L. 111-226 § 201 | FMAPS were increased from the first quarter of FY 2009 through the third quarter of FY 2011. FMAPs were not allowed to decline and were increased by 6.2 percentage points until the last two quarters of the period, at which point they were increased by 3.2 percentage points and then 1.2 percentage points. Certain qualifying states received an additional unemployment-related increase. Territories received 30 percent increases in their spending caps in lieu of a percentage point increase in the FMAP and small increase in the spending cap. |
| Adjustment for Hurricane Katrina | Varies | P.L. 109-171 § 6053(b); Federal Register 72, no. 16 (January 25): 3391–3395 and Federal Register 72, no. 151 (August 7): 44146–44149 | Has not technically expired but the methodology does not allow for adjusting FMAPs after FY 2008. |
| Other expansion state individuals | FMAP plus 2.2 percentage points | 1905(z)(1) | During CY 2014 and CY 2015 expansion states that meet certain criteria could receive an FMAP increase of 2.2 percentage points for those who are not newly eligible individuals. |
| Primary care payment rates | 100 percent | P.L. 111-148, as amended by P.L. 111-152; SSA § 1902(a)(13)(C) | During CY 2013 and CY 2014 states were required to provide Medicaid payments at or above Medicare rates for primary care services furnished by certain types of primary care providers; 100 percent FMAP applied to any difference between the Medicaid payment rate in effect on July 1, 2009, and the Medicare payment rates for CY 2013 and CY 2014. |
| State balancing incentive payments | FMAP plus 5 percentage points | P.L. 111-148, as amended by P.L. 111-152, § 10202 | During FY 2011–FY 2015 qualifying states could receive a two to five percentage point increase in their FMAP for non-institutional long term services and supports for increasing the proportion of payments made for non-institutional long term services and supports to a specified target level. |
| Newly eligible individuals enrolled in new adult eligibility group through 138 percent FPL for states that expanded coverage to the new adult group before March 11, 2021 | CY 2014–CY 2016 = 100 percent CY 2017 = 95 percent CY 2018 = 94 percent CY 2019 = 93 percent |
1905(y) | As of CY 2014, applies to expenditures for the new eligibility group for non-elderly, non-pregnant adults with incomes at or below 138 percent FPL, who would not have been eligible for Medicaid in the state as of December 1, 2009 or were eligible under a waiver but not enrolled due to limits or caps on waiver enrollment. |
| Expansion state individuals enrolled in the new eligibility group through 138 percent FPL | CY 2014 = at least 75 percent CY 2015 = at least 80 percent CY 2016 = at least 85 percent CY 2017 = at least 86 percent CY 2018 = at least 90 percent CY 2019 = 93 percent |
1905(z)(2) | As of CY 2014, applies to expenditures for individuals who are enrolled in the new eligibility group for non-elderly, non-pregnant adults with incomes at or below 138 percent FPL in states that had already expanded eligibility to parents and non-pregnant childless adults at least through 100 percent FPL as of March 23, 2010 (when the ACA was enacted). |
