Gear Up for FMAP Push Next Week

Check your in-box Monday for an Action Alert on the FMAP extension. ANCOR members need Congress to address the bill (HR 4213) that contains the Recovery Act FMAP extension ASAP to help state budget efforts underway now. According to sources on Capitol Hill, there is no loss of political will to move the provision, it's a matter of money. The FMAP extension carries bipartisan support, but members are currently at an impasse over whether the provision should be offset or passed as an emergency measure.

Also circulating behind-the-scenes, under the leadership of Representative Lois Capps (D-CA), is a Dear Colleague letter with a deadline of next week for signatories. The letter to House leadership urges swift action on the FMAP provision in H.R. 4213 and to resolve differences between the House and Senate versions, so the final bill can go to the President for his signature. In addition to Representative Capps (D-CA), other cosponsors are Representatives Chellie Pingree (D-ME), Tammy Baldwin (D-WI), Gene Green (D-TX). ANCOR thanks these Congressional leaders for their support and action on this important issue.

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HHS Releases Second Quarter FMAP Rates

In today’s Federal Register, HHS announced the adjusted FMAP rates for the second quarter of FY 2010, as required in the Recovery Act (ARRA). See today’s Federal Register Notice for your state’s adjusted rate.
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President Signs Short Term Extension Bill; Negotiations Continue on Jobs Bill with FMAP

Congress this week concluded work on the Continuing Extension Act of 2010 (HR 4851), also referred to as the “extensions bill.” House passage came Thursday evening a few hours after the Senate passed an amended version of the bill, and the president signed it shortly after that.

In addition to extending expanded unemployment benefits through the end of May, the short-term legislation would extend COBRA health insurance subsidies for the unemployed and higher payments for physicians who treat Medicare patients. It also would extend a national flood insurance program and the use of 2009 poverty guidelines for federal programs.

The short-term extension package is designed to buy time for House and Senate negotiators to reach a deal on the American Workers, State and Business Relief Act of 2010 (HR 4213), which extends the unemployment benefits through the end of the year and the temporary FMAP increase originally passed as part of the Recovery Act through June 2011. ANCOR members are encouraged to call their members of Congress and encourage them to swiftly resolve the differences in HR 4213.
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Conferencing of “Tax Extenders Act” with FMAP Extension Likely After Health Reform

Last week the Senate passed the American Workers, State and Business Relief Act, also known as the Tax Extenders Act, which includes a six month extension of the temporary increase in states Federal Medical Assistance Percentage (FMAP) through June 10, 2011. Because there are differences between the Senate-passed measure and the version approved by the House in December that must be worked out, ANCOR staff learned this week that the bill will likely be “conferenced” after health reform legislation is wrapped up. At this time, neither chamber has appointed conferees. ANCOR is urging Congress to work quickly to seek agreement on a final bill to ensure the vital FMAP extension.
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Providers Should Press for State Protection of Services and Supports

CMS March 5th letter to Medicaid Directors affirms HHS announcement regarding additional Federal Relief to states due to ARRA FMAP application to state Medicaid “Clawback.” As ANCOR reported in past WIC’s Updates, HHS announced on February 18th that it would provide $4.3 billion in fiscal relief to states by applying ARRA increased FMAP to the so-called clawback payments states pay to the federal government as required by the Medicare Prescription Drug Improvement and Modernization Act of 2003 that added Medicare cost of assuming drug costs for dually eligible Medicare/Medicaid beneficiaries.The recalibrations mean decreased state contributions for the increased federal FMAP. Providers should take this opportunity to use the additional federal assistance to protect services, supports and rates for individuals with disabilities.
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Senate Continues Consideration of Large Jobs Bill with FMAP Extension--No Votes Until Tuesday March 9th

The Senate spent Thursday resuming consideration of H.R. 4213 disposing of a growing number of pending amendments. Majority Leader Reid considered bringing a motion to close debate. However, he announced that the Senate would continue consideration of the bill Friday and Monday with no roll call votes scheduled until Tuesday, March 9th.
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FMAP Extension Likely on Next Senate Jobs Bill

Senate Majority Leader Reid (D-NV) is following through on his commitment to extend federal FMAP assistance to states through June 31, 2011. Rumored to be in released draft language on a second jobs bill released Wednesday, Reid is including a number of must-pass "health care provisions"that were not included in the first-Senate jobs bill passed Tuesday. In addition to six-month FMAP extension, the next bill in the Senate's job agenda will include an extension of COBRA subsidies for ten months through December 31, 2010 for individuals who have lost employment, an extension of the current fix to Medicare physician rates through September 2010, a full-year extension of the Medicare therap cap exemption, and other Medicare provisions. Stayed tuned for future Alert on when the second jobs bill is introduced and scheduled for a Senate vote. Thanks to everyone who has already responded to ANCOR's previous February 12th alert on FMAP by contacting both of their Senators!
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Senate Passes $15 Billion Jobs Bill--First in Series of Job Creation Agenda

After waiving a Republican point of order, the Senate Wednesday morning  passed a $15 billion jobs bill, by a vote of 70-28. The bill which includes  payroll tax breaks, bond-financing for state and local infrastructure projects, a small-business expensing provision, and an extension of federal highway programs, will be sent to the House for a vote.  The House passed a more comprehensive $154 billion jobs bill in December which included a six-month extension of FMAP. 

Before leaving for their week-long President's Day recess, Majority Leader Reid (D-NV) scrapped a larger, bipartisan jobs bill draft by Senate Finance Chair Baucus (D-MT) and Ranking Member Grassley (R-IA) in favor of a series of smaller jobs bills.  Majority Leader Reid is working on several other jobs bills as part of a jobs creation agenda.  A six-month extension of FMAP, as well as extensions of unemployment insurance and COBRA, are being considered for the next jobs bill. However, timing has not been set for the series of bills or content.  Reid must first determine what items must be costed out under new "pay-go rules" and what combination in each package will bring sufficient support to muster a 60-vote cloture rule to end any filibuster efforts, before proceeding.

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Forty-Seven Governors Urge FMAP Extension

A bipartisan group of 42 governors of states and five governors of U.S. territories sent a letter on February 22 urging House and Senate leaders to extend for at least six months the enhanced federal match for Medicaid included in the American Recovery and Reinvestment Act of 2009. The following governors did not sign the letter: Janice Brewer (R-AZ), C. L. Otter (R-ID), Bobby Jindal (R-LA), Tim Pawlenty (R-MN), John Hoeven (R-ND), Mark Sanford (R-SC), Rick Perry (R-TX), and Gary Herbert (R-UT).
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Senate To Move on First Jobs Bill Week of February 8th

Provisions of a Senate $80 billion jobs bill expected in Thursday's Democratic press conference with Majority Leader Reid (D-NV), Durbin (D-IL) and Baucus (D-MT) were not forthcoming as Senators said details for a bill would be unveiled Friday or Monday. Reid expects to vote on the first jobs creation bill by end of next week before the Congressional week-long Presidents' Day recess that begins February 12th.

Senate leaders continued to negotiate a bipartisan package of tax incentives and safety-net spending for laid-off workers Thursday, but the must-pass nature of the bill meant it was beginning to attract unrelated legislative freight. The House-passed jobs bill costs $154 billion heavily focused on infrastructure and FMAP extension. However, the Senate jobs bill is to focus on tax credits and tax payroll relief for small businesses, highway funding, and possibly extension of unemployment insurance and COBRA. At this point, it is not expected to include FMAP extension. See related brief on Reid and Rockefeller bill and push to get FMAP in this jobs bill. Read more!

Reid and Rockefeller Introduce Senate Bill to Extend FMAP--Push Next Week to Avert More Job Losses Without FMAP Extension

Senate Majority Leader Reid (D-NV) and Senator Rockefeller (D-WV) introduced legislation Thursday to extend by six-months the temporary federal funding for FMAP in last year's Recovery Act (ARRA). With states expected aggregate budget shortfall at $180 billion and only $40 billion covered by ARRA's FMAP through 2010, the $140 billion expected shortfall would cost a job loss of 900,000 jobs nationally.

ANCOR sent a letter to all Senators Tuesday urging immediate extension of ARRA FMAP funding. In a meeting with Rockefeller's staff last night, ANCOR was told that the bill (yet to have a bill number) has 33 Democratic sponsors. ANCOR asked if the legislation mirrors the House provision included in its job bill passed in December. Senate Finance staff confirmed that it was the same except for adding a provision regarding county pass-throughs. Rockefeller staffer has confirmed that she will be a part of ANCOR's free audio conference on FMAP on Thursday, February 11th.

Senate staff from multiple offices expressed the urgency of immediately including an FMAP extension to avert deeper budget cuts that states are now planning in their 2011 budgets. The temporary extension would be through June 2011. The intention is to include the legislation immediately in the first jobs bill that the Senate is expected to take up next week. Both the National Governors Association and National Conference (NGA) on State Legislatures (NCSL) sent bipartisan letters this week to Congress urging immediate extension of ARRA FMAP funding. ANCOR will have an alert out early next week pending fact sheet being developed by Senate staffers today. Read more!

President Obama Includes FMAP Extension in Budget

President Barack Obama's FY 2011 Budget endorses and includes a $28 billion six month extension of Enhanced Medicaid (FMAP). Without this provision, states would have been expected to make dramatic budget cuts this session to make up for the sudden loss of federal revenue that had previously sustained earlier recession budgets.

The FMAP extension had earlier been passed twice (most recently in December 2009) by the U.S. House of Representatives, but was stalled in the Senate with the aftermath of the demise of the current Health Care Reform bill.
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50-State Survey Found that ARRA’s Increase in Medicaid FMAP Helped Many States Preserve and Even Expand Medicaid This Year—But Reversals May Come

The Kaiser Family Foundation warned in its December 8th release of its annual 50-state survey of Medicaid and the Children's Health Insurance Program states will face another crisis in Medicaid funding when the economic stimulus program ends next year (December 2010). Passed in February, the $787 billion economic recovery initiative provided $89 billion in extra Medicaid funding to states that maintained current eligibility and enrollment rules. The Kaiser foundation said that without another infusion states may scale back Medicaid to deal with budget shortfalls in the upcoming fiscal year. "If fiscal relief is not replenished and Medicaid eligibility is not protected," the report said, "many states are unlikely to withstand the pressure to make substantial cuts." Read more!

If ARRA Federal Increase in Medicaid FMAP Is Not Extended, States Will Be Faced with Tough Choices in 2011.

Federal Medicaid fiscal relief in the ARRA have been critical in helping states to address budget shortfalls, perserve eligibility, avoid or reduce provider cuts, and avoid or soften program cuts. See Kaiser’s October 2009 fact sheet: Medicaid and State Budgets: From Crunch to Cliff.
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NEWS FLASH: House Includes $23.5 Billion to Extend the ARRA FMAP Increase Through 2011 in Health Reform Bill

The Senate does not have this provision at this time. Details to follow early next week. Read more!

California Risks Losing Enhanced FMAP, Seeks $20 Billion Loan

California is in danger of losing billions of dollars in enhanced FMAP if it does not restore wage cuts to home healthcare workers. According to a May 5 opinion by CMS, the cuts, which were passed in February, violate provisions of the ARRA prohibiting states receiving enhanced FMAP from making certain changes to Medicaid programs. In the opinion, CMS determined that California’s proposed cuts to home healthcare workers violate ARRA maintenance of efforts rules by increasing the local government’s share of Medicaid costs. Governor Schwarzenegger sent a letter to HHS Secretary Sebelius urging the government to reconsider rescinding California’s $6.8 billion in FMAP. California will also need to borrow more than $20 billion dollars to close its budget deficit unless voters accept a budget ballot measure on May 19. Without loans and a budget overhaul, the state is expected to run out of cash in July but polls indicate that voters are likely to reject the budget ballot measure. Read more!

HHS Releases FMAP Rates for First Two Quarters of FY 2009 Recalculated Based on ARRA Increases

The Federal Medical Assistance Percentage (FMAP) released today in the Federal Register is for the first two quarters of FY 2009 (effective from October 1, 2008 through March 31, 2009). Rates are recalculated pursuant to the American Recovery and Reinvestment Act (ARRA) including 6.2 increase to every state, plus the unemployment adjustment. See ANCOR's National Issues FMAP page to find your state's adjustment.






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