Grants to States for Medicaid

B1: This FY 2021 advance appropriation is enacted by Public Law 116-260.

B2: Total budgetary resources available in the OMB Action column differs from the Agency Request column by $3 million to account for the corrected display of the Vaccines for Children transfer. HHS confirmed the revised amount in writing.

A1: Amounts will be automatically adjusted for any downward changes in transfers to the VFC allocation account apportionment.

A3: Available only for quarterly obligation for Grants to States consistent with section 1903(d) of the Social Security Act; provided, however, that grants to the following States may continue to be made on an annual basis: IN, LA, NE, VA, WI, WA.

A4: Consistent with the policy letter of March 31, 1984 as updated for inflation, OMB should be advised in advance of granting a waiver unless total expenditures under the waiver are less than $2 million and fewer than 300 beneficiaries are affected, and funds available for waivers of State fiscal liability associated with erroneous payments, only where OMB is advised in writing 30 days in advance of approval, together with an analysis of short- and long-term budgetary effects. In cases with long-term net costs, the Department is expected to provide alternative offsets.

A6: The cumulative amount of CMS approved ACA Section 2703 planning grants will be reported on each apportionment request after the amount of approved planning grants reaches $20 million. Approved ACA section 2703 planning grants will not exceed $25 million.

A8: During a lapse in appropriations, prior-year recoveries from funds provided in the first paragraph of prior year appropriations for Grants to States for Medicaid are available for obligation for carrying out title XIX of the Social Security Act, including administrative costs, without further action by OMB. After the lapse in appropriations has ended, CMS must report within 30 calendar days to OMB the amount of funds that were obligated for administrative costs.

A6: The cumulative amount of CMS approved ACA Section 2703 planning grants will be reported on each apportionment request after the amount of approved planning grants reaches $20 million. Approved ACA section 2703 planning grants will not exceed $25 million.

A2: Adjustments are permitted between the Medical Assistance Payments category (line 6011) and another category B line where OMB receives written notification at least 10 days in advance and where the total of any adjustments does not increase the receiving category by more than 10 percent of the apportioned amount. Any existing legal limitation on total budget authority for Balancing Incentive Payments (line 6016) and Increased ACA funding for territories (line 6017) still applies.

A5: Details on attachments are not subject to 31 USC 1517. The term "attachments" includes but is not limited to the worksheets in this excel file that accompany the SF 132 and this footnote worksheet.

A7: Carryover amounts are available for allotment only after actual amounts are apportioned and known, and recoveries are available for allotment only after recoveries are apportioned and realized.