The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.
Section 6201 of the Deficit Reduction Act of 2005 (DRA, Public Law 109-171) provides for $2 billion dollars in additional federal payments under Hurricane Katrina related multi-state section 1115 demonstrations. The legislation indiciated specific categories of expenditures for which these funds may be used. Initially, following enactment of the DRA, based on States' FY 2006 estimates of the DRA defined expenditure categories (from States with approved multi-state Hurricane Katrina demonstrations), we provided grant awards totaling $1.5 billion to 32 States. Although DRA provided for a total of $2 billion for Katrina relief, we initially held back $500 million with the intent of obtaining updated State estimates which would inform a subsequent disposition of such funds. Based on updated estimates, CMS determined that for 11 states their initial allocation (of the $1.5 billion) was not sufficient for their projected FY 2006 expenditures. We issued those states an additional $363,912,798 in grant authority in late September for total FY 2006 obligations of $1,863,912,798. The resulting unobligated carryover into FY 2007 was $136,087,202. Delayed state payment processing of Katrina-related relief provider claims through the fourth quarter of FY 2006 necessitates the issuance of additional grant authority to states for FY 2007. CMS plans to recove an an estimated $450 million from the approximately $1.9 billion originally obligated in FY 2006 by reconciling each state's FY 2006 grants with actual expenditures reported on the states'cumulative expenditures reports through the 4th quarter FY 2006. CMS will use the $450 million in estimated prior period recoveries and the FY 2006 unobligated carryover to provide FY 2007 grant authority to the states, as needed for payment of FY 2006 dates of service which are being paid in FY 2007. By reconciling each state's FY 2007 grants with actual expenditures through the 1st quarter FY 2007, we will be able to determine the further disposition of any remaining DRA funds.
Uses and Use Restrictions
Demonstration grants will be awarded to States for use in accordance with provisions of their approved Katrina Section 1115 demonstration projects for the nonfederal share or total uncompensated costs of medical care provided for eligible evacuees and affected individuals and associated administrative costs (Section 6201(a)(1)&(2) DRA 2005).
Under the demonstration projects, costs are reimbursable to the State for: the nonfederal share cost of services incurred by eligible individuals between August 24, 2005 and June 30, 2006; and the total uncompensated care pool (UCCP) costs for services incurred by eligible individuals between August 24, 2005 and January 31, 2006.
For Hurricane Katrina-related affected counties or parishes in Alabama, Louisiana and Mississippi, costs are also reimbursable to the State for the nonfederal share of expenditures, for medical care only, incurred by Title XIX and Title XXI individuals under existing State plans (i.e., not under a Katrina demonstration) beginning August 24, 2005 (Section 6201(a)(3) DRA 2005).
State: Katrina Section 1115 demonstration approved by CMS, Title XIX and Title XXI participant.
Evacuee/affected individual (i.e., displaced individual) status under the demonstrations is limited to parents, pregnant women, children under age 19, individuals with disabilities, low-income Medicare recipients, low-income individuals in need of long-term care with income levels simplified to reflect home State Title XIX and Title XXI eligibility rules. Evacuee/affected individual status under UCCP's varies by State with the approved UCCP methodology plan. Eligibility for medical costs of individuals under Section 6201(a)(3) DRA 2005, is based on the State's approved Title XIX or Title XXI plan.
Federal funds must go to a designated State Medicaid Agency with appropriate approved plans. Individuals must meet State requirements. Administrative costs will be determined in accordance with OMB Circular No. A-87 "Cost Principals for State and Local Governments."
Aplication and Award Process
States are encouraged to work with CMS in the development of their Section 1115 demonstration projects.
This program is excluded from coverage under E.O.
Submission of Section 1115 Katrina demonstration plan to CMS. No application required for Section 6201(a)(3).
Approved States will receive award funds quarterly based on estimates and reconciliations of prior period awards to reported approved nonfederal share and total expenditures, as applicable.
Section 1115 Katrina demonstration plan must be submitted to CMS by January 31 of each fiscal year.
Deficit Reduction Act of 2005 (DRA), Subtitle C-Katrina Relief, Section 6201, Additional Federal Payments Under Hurricane-Related Multi-State Section 1115 Demonstrations, Public Law 109-171.
Range of Approval/Disapproval Time
Formula and Matching Requirements
This program has no statutory formula or matching requirements. The nonfederal share paid under this Section shall not be regarded as Federal funds for purposes of Medicaid matching requirements, the effect of which is to provide fiscal relief to the State in which the Medicaid eligible individual originally resided.
Length and Time Phasing of Assistance
Project Period: No payments shall be made under Section 6201(a)(1)(A) or (a)(1)(C) of DRA 2005 for costs of health care provided to an eligible evacuee or affected individual for services for such individual incurred after June 30, 2006. No payments shall be made under Section 6201(a)(1)(B) or (a)(1)(D) of DRA 2005 for costs of health care incurred after January 31, 2006. No payments may be made under Section 6201(a)(1)(B)or (a)(1)(D) for an item or service that an evacuee or an affected individual has received from an individual or organization as part of a public or private hurricane relief effort. Budget Period: Appropriated funds are available until expended.
Post Assistance Requirements
States must submit fiscal and statistical reports, as required, to CMS.
The State will afford the Secretary access to any records or information relating to these plans for the purposes of review or audit.
Financial records, supporting documents, statistical records, and all other records pertinent to the demonstration shall be retained for at least three years or until resolution of any audit questions.
FY 07 $370,784,186; FY 08 $19,064,378; and FY 09 est not available.
Range and Average of Financial Assistance
No current data available.
Regulations, Guidelines, and Literature
Information regarding this program may be accessed through the world wide web at: www.cms.hhs.gov/emergency.
Regional or Local Office
Contact the Regional Administrator, Centers for Medicare and Medicaid Services (See Appendix IV of the Catalog for addresses and telephone numbers).
Contacts: Program questions--Cheryl Powell, Center for Medicaid and State Operations, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Mail Stop S2-01-16, Baltimore, MD 21244. Telephone: (410) 786-8693. Financial questions--Betsy Hanczaryk, Center for Medicaid and State Operations, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Mail Stop S3-13-15, Baltimore, MD 21244. Telephone: (410) 786-2013.
Criteria for Selecting Proposals