2013-17965. Medicaid Program; Disproportionate Share Hospital Allotments and Institutions for Mental Diseases Disproportionate Share Hospital Limits for FY 2012, and Preliminary FY 2013 Disproportionate Share Hospital Allotments and Limits

AGENCY:

Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION:

Notice.

SUMMARY:

This notice announces the final federal share disproportionate share hospital (DSH) allotments for federal fiscal year (FY) 2012 and the preliminary federal share DSH allotments for FY 2013. This notice also announces the final FY 2012 and the preliminary FY 2013 limits on aggregate DSH payments that states may make to institutions for mental diseases (IMDs) and other mental health facilities. This notice also includes background information describing the methodology for determining the amounts of states' FY DSH allotments and IMD DSH limits.

DATES:

Effective Date: This notice is effective on August 26, 2013. The final allotments and limitations set forth in this notice are effective for the fiscal years specified.

FOR FURTHER INFORMATION CONTACT:

Richard Strauss, [phone].

SUPPLEMENTARY INFORMATION:

I. Background

In general, in accordance with the methodology specified under section 1923(f)(3) of the Social Security Act (the Act), a state's federal fiscal year (FY) disproportionate share hospital (DSH) allotment is calculated by increasing the amount of its DSH allotment for the preceding FY by the percentage change in the Consumer Price Index for all Urban Consumers (CPI-U) for the previous FY. Also in accordance with section 1923(f)(3) of the Act, a state's DSH allotment for a FY is subject to the limitation that an increase to a state's DSH allotment for a FY cannot result in the DSH allotment exceeding the greater of the state's DSH allotment for the previous FY or 12 percent of the state's total medical assistance expenditures for the allotment year (this is referred to as the 12 percent limit).

Furthermore, under section 1923(h) of the Act, federal financial participation (FFP) for DSH payments to institutions for mental diseases (IMDs) and other mental health facilities is limited to state-specific aggregate amounts determined in accordance with the methodology specified under such section. Under this provision, the aggregate limit for DSH payments to IMDs and other mental health facilities is the lesser of a state's FY 1995 total computable (state and federal share) IMD and other mental health facility DSH expenditures applicable to the state's FY 1995 DSH allotment (as reported on the Form CMS-64 as of January 1, 1997), or the amount equal to the product of the state's current year total computable DSH allotment and the applicable percentage specified in section 1902(h) of the Act (the applicable percentage is the IMD share of DSH total computable expenditures as of FY 1995).

In general, we determine states' DSH allotments and IMD DSH limits for a FY using the most recent available estimates of or actual medical assistance expenditures, including DSH expenditures in their Medicaid programs and the most recent available change in the CPI-U used for the FY in accordance with the methodology prescribed in statute. The indicated estimated or actual expenditures are obtained from states for each relevant FY from the most recent available quarterly Medicaid budget reports (Form CMS-37) or quarterly Medicaid expenditure reports (Form CMS-64), respectively, submitted by the states. For example, as part of the initial determination of a state's FY DSH allotment (referred to as the preliminary DSH allotments) that is determined before the beginning of the FY for which the DSH allotments and IMD DSH limits are being determined, we use estimated expenditures for the FY obtained from the August submission of the CMS-37 submitted by states prior to the beginning of the FY; such estimated expenditures are subject to update and revision during the FY before such actual expenditure data become available. We also use the most recent available estimated CPI-U percentage change that is available before the beginning of the FY for determining the states' preliminary FY DSH allotments; such estimated CPI-U percentage change is subject to update and revision during the FY before the actual CPI-U percentage change becomes available. In determining the final DSH allotments and IMD DSH limits for a FY we use the actual expenditures for the FY and actual CPI-U percentage change for the previous FY.

II. Provisions of the Notice

A. Calculation of the Final FY 2012 Federal Share State DSH Allotments, and the Preliminary FY 2013 Federal Share State DSH Allotments

1. Final FY 2012 Federal Share State DSH Allotments

Chart 1 of the Addendum to this notice provides the states' final FY 2012 DSH allotments determined in accordance with section 1923(f)(3) of the Act. As described in the background section, in general, the DSH allotment for a FY is calculated by increasing the FY DSH allotment for the preceding FY by the CPI-U increase for the previous fiscal year. For purposes of calculating the states' final FY 2012 DSH allotments, the preceding final fiscal year DSH allotments (for FY 2011) were contained in the Federal Register published on July 24, 2012 (77 FR 43301). For purposes of calculating the states' final FY 2012 DSH allotments we are using the actual Medicaid expenditures for FY 2012. Finally, for purposes of calculating the states' final FY 2012 DSH allotments, the applicable historical percentage change in the CPI-U for the previous FY (FY 2011) was 2.6 percent; we note that this is an increase from the estimated 2.4 percentage change in the CPI-U for FY 2011 that was available and used in the calculation of the preliminary FY 2012 DSH allotments which were published in the July 24, 2012 Federal Register (77 FR 43301).

2. Calculation of the Preliminary FY 2013 Federal Share State DSH Allotments

Chart 2 of the Addendum to this notice provides the preliminary FY 2013 DSH allotments determined in accordance with section 1923(f)(3) of the Act. The preliminary FY 2013 DSH allotments contained in this notice were determined based on the most recent available estimates from states of their FY 2013 total computable Medicaid expenditures. Also, the preliminary FY 2013 allotments contained in this notice were determined by increasing the final FY 2012 DSH allotments as contained in this notice (and described in section II.A.1. above) by 2.4 percent, representing the most recent available estimate of the percentage increase in the CPI-U for FY 2012 (the previous FY to FY 2013). In this regard, we note that in September of 2012 for purposes of calculating preliminary FY 2013 DSH allotments for states (which at that time was prior to the beginning FY 2013), we calculated such preliminary FY 2013 allotments by increasing states' preliminary FY 2012 allotments by 2.5 percent, representing the estimate of the percentage change in the CPI-U for FY 2012 available at that time. Again, we note that the preliminary FY 2013 allotments contained in this notice were determined using the final FY 2012 DSH allotments contained in this notice, the most recent available estimates of FY 2013 Medicaid expenditures, and the most recent available estimate of the percentage change in the CPI-U for FY 2012.

States' final FY 2013 DSH allotments will be published in future rulemaking based on the states' four quarterly Medicaid expenditure reports (Form CMS-64) for FY 2013 available following the end of FY 2013 and the actual change in the CPI-U for FY 2012.

B. Calculation of the Final FY 2012 and the Preliminary FY 2013 IMD DSH Limits

Section 1923(h) of the Act specifies the methodology to be used to establish the limits on the amount of DSH payments that a state can make to IMDs and other mental health facilities. FFP is not available for IMD or DSH payments that exceed the IMD limits. In this notice, we are publishing the final FY 2012 and the preliminary FY 2013 IMD DSH Limits determined in accordance with the provisions discussed above.

Charts 3 and 4 of the “Addendum” to this notice detail each state's final FY 2012 and preliminary FY 2013 IMD DSH Limit, respectively, determined in accordance with section 1923(h) of the Act

III. Collection of Information Requirements

This notice does not impose any new or revised information collection or recordkeeping requirements. The requirements and burden associated with Form CMS-37 (OMB No. 0938-0101), and Form CMS-64 (OMB No. 0938-0067) are unaffected by this notice. Consequently, this notice, the Form CMS-37, and Form CMS-64 are not subject to Office of Management and Budget review under the authority of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.).

IV. Regulatory Impact Statement

We have examined the impact of this notice as required by Executive Order 12866 on Regulatory Planning and Review (September 1993), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), section 1102(b) of the Act, section 202 of the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104-4), Executive Order 13132 on Federalism (August 4, 1999) and the Congressional Review Act (5 U.S.C. 804(2)).

Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). This notice reaches the $100 million economic threshold and thus is considered a major rule under the Congressional Review Act.

The final FY 2012 DSH allotments being published in this notice are approximately $20 million more than the preliminary FY 2012 DSH allotments published in the July 24, 2012 Federal Register (77 FR 43301). The increase in the final FY 2012 DSH allotments is due to the difference between the actual percentage change in the CPI-U for FY 2011 used in the calculation of the final FY 2012 allotments [2.6 percent) as compared to the estimated percentage change in the CPI-U for FY 2011 used in the calculation of the preliminary FY 2012 allotments (2.4 percent). The final FY 2012 IMD DSH limits being published in this notice are approximately $1 million more than the preliminary FY 2012 IMD DSH limits published in the July 24, 2012 Federal Register (77 FR 43301). The increases in the IMD DSH limits are because the DSH allotment for a FY is a factor in the determination of the IMD DSH limit for the FY. Since the final FY 2012 DSH allotments were increased as compared to the preliminary FY 2012 DSH allotments, the associated FY 2012 IMD DSH limits for some states were also increased.

The preliminary FY 2013 DSH allotments being published in this notice are about $182 million more than the final FY 2012 DSH allotments being published in this notice. The increase in the DSH allotments is due to the application of the statutory formula for calculating DSH allotments under which the prior fiscal year allotments are increased by the percentage increase in the CPI-U for the prior fiscal year. The preliminary FY 2013 IMD DSH limits being published in this notice are about $13 million more than the final FY 2012 IMD DSH limits being published in this notice. The increase in the IMD DSH limits is because the DSH allotment for a FY is a factor in the determination of the IMD DSH limit for the FY. Since the preliminary FY 2013 DSH allotments are greater than the final FY 2012 DSH allotments, the associated preliminary FY 2013 IMD DSH limits for some states also increased.

The RFA requires agencies to analyze options for regulatory relief of small businesses, if a rule has a significant impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of less than $7.0 million to $34.5 million in any one year. Individuals and states are not included in the definition of a small entity. We are not preparing an analysis for the RFA because the Secretary has determined that this notice will not have significant economic impact on a substantial number of small entities. Specifically, any impact on providers is due to the effect of the various controlling statutes; providers are not impacted as a result of the independent regulatory action in publishing this notice. The purpose of the notice is to announce the latest distributions as required by the statute.

In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Core-Based Statistical Area for Medicaid payment regulations and has fewer than 100 beds. We are not preparing analysis for section 1102(b) of the Act because the Secretary has determined that this notice will not have a significant impact on the operations of a substantial number of small rural hospitals.

The Medicaid statute specifies the methodology for determining the amounts of states' DSH allotments and IMD DSH limits; and as described previously, the application of the methodology specified in statute results in the decreases or increases in states' DSH allotments and IMD DSH limits for the applicable FYs. The statute applicable to these allotments and limits does not apply to the determination of the amounts of DSH payments made to specific DSH hospitals; rather, these allotments and limits represent an overall limit on the total of such DSH payments. In this regard, we do not believe that this notice will have a significant economic impact on a substantial number of small entities.

Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. In 2013, that threshold is approximately $141 million. This notice will have no consequential effect on state, local, or tribal governments, in the aggregate, or on the private sector.

Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on state and local governments, preempts state law, or otherwise has Federalism implications. Since this notice does not impose any costs on state or local governments, the requirements of E.O. 13132 are not applicable.

Alternatives Considered

The methodologies for determining the states' fiscal year DSH allotments and IMD DSH Limits, as reflected in this notice, were established in accordance with the methodologies and formula for determining states' allotments as specified in statute. This notice does not put forward any further discretionary administrative policies for determining such allotments.

Accounting Statement

As required by OMB Circular A-4 (available at http://www.whitehouse.gov/​omb/​circulars/​a004/​a-4.pdf), in the Table 1, we have prepared an accounting statement showing the classification of the estimated expenditures associated with the provisions of this notice. Table 1 provides our best estimate of the change (decrease) in the federal share of states' Medicaid DSH payments resulting from the application of the provisions of the Medicaid statute relating to the calculation of states' FY DSH allotments and the increase in the FY DSH allotments from FY 2012 to FY 2013.

Table 1—Accounting Statement: Classification of Estimated Expenditures, from the FY 2012 to FY 2013

[in Millions]

Category	Transfers
Annualized Monetized Transfers	$182
From Whom To Whom?	Federal Government to States.

Congressional Review Act

This proposed regulation is subject to the Congressional Review Act provisions of the Small Business Regulatory Enforcement Fairness Act of 1996 (5 U.S.C. 801 et seq.) and has been transmitted to the Congress and the Comptroller General for review.

In accordance with the provisions of Executive Order 12866, this notice was reviewed by the Office of Management and Budget.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical Assistance Program)

Dated: June 20, 2013.

Marilyn Tavenner,

Administrator, Centers for Medicare & Medicaid Services.

Dated: July 19, 2013.

Kathleen Sebelius,

Secretary, Department of Health and Human Services.

Addendum

This addendum contains the charts 1 through 4 (preceded by associated keys) that are referred to in the preamble of this notice.

Key to Chart 1. Final DSH Allotments for FY 2012

Key to Chart 1—Final DSH Allotments for FY 2012.

[The Final FY 2012 DSH allotments for the non-low DSH States are presented in the top section of this chart, and the final FY 2012 DSH allotments for the low-DSH States are presented in the bottom section of this chart]

Column	Description
Column A	State.
Column B	FY 2012 FMAPs. This column contains the states' FY 2012 Federal Medical Assistance Percentages.
Column C	Prior FY (2011) DSH Allotments. This column contains the states' prior FY 2011 DSH Allotments as would be determined without the application of section 5002 of ARRA.
Column D	Prior Fiscal Year (FY 2011) Allotment x (100% + Percentage Increase in CPI-U): 102.6%. This column contains the amount in Column D increased by 1 plus the percentage increase in the CPI-U for the prior FY (2.6 percent).
Column E	FY 2012 TC MAP Exp. Including DSH.This column contains the amount of the states' FY 2012 total computable (TC) medical assistance expenditures including DSH expenditures.
Column F	FY 2012 TC DSH Expenditures. This column contains the amount of the states' FY 2012 total computable DSH expenditures.
Column G	FY 2012 TC MAP Exp. Net of DSH. This column contains the amount of the states' projected FY 2012 total computable medical assistance expenditures net of DSH expenditures, calculated as the amount in Column E minus the amount in Column F.
Column H	12% Amount. This column contains the amount of the “12 percent limit” in federal share for the fiscal year, determined in accordance with the provisions of section 1923(f)(3) of the Act.
Column I	Greater of FY 2011 Allotment or 12% Limit. This column contains the greater of the state's prior FY (FY 2011) DSH allotment or the amount of the 12% Limit, determined as the maximum of the amount in Column C or Column I.
Column J	FY 2012 DSH Allotment. This column contains the states' final FY 2012 DSH allotments, determined as the minimum of the amount in Column I or Column D.
	For states with “na” in Columns I or D, refer to the footnotes in the chart.

Chart 1—Final DSH Allotments for Fiscal Year: 2012

State	FY 2012 FMAPs (percent)	Prior FY (2011) allotments	Prior Fiscal Year (FY 2011) Allotment (Col C × 100% + Pct Increases in CPIU:	FY 2012 TC MAP Exp. Including DSH	FY 2012 TC DSH Expenditures	FY 2012 TC MAP Exp. Net of DSH Col E-F	“12% Amount” =Col G × .12/(1-.12/ B)* (In FS)	Greater of Col H OR Col C (12% Limit, FY2011 Allotment)	2012 FY 2012 DSH Allotment MIN Col D, Col I
			102.6%
A	B	C	D	E	F	G	H	I	J
ALABAMA	68.62%	$307,525,116	$315,520,769	$4,980,627,414	$458,470,904	$4,522,156,510	$657,669,473	$657,669,473	$315,520,769
ARIZONA	67.30	101,258,270	103,890,985	7,902,936,657	194,651,219	7,708,285,438	1,125,716,333	1,125,716,333	103,890,985
CALIFORNIA	50.00	1,096,339,537	1,124,844,365	48,965,395,434	2,101,502,957	46,863,892,477	7,399,561,970	7,399,561,970	1,124,844,365
COLORADO	50.00	92,507,555	94,912,751	4,686,399,553	189,455,472	4,496,944,081	710,043,802	710,043,802	94,912,751
CONNECTICUT	50.00	200,016,335	205,216,760	6,463,271,670	478,109,955	5,985,161,715	945,025,534	945,025,534	205,216,760
DISTRICT OF COLUMBIA	70.00	61,255,002	62,847,632	2,099,098,380	61,103,120	2,037,995,260	295,157,934	295,157,934	62,847,632
FLORIDA	56.04	200,016,335	205,216,760	17,794,004,730	365,483,097	17,428,521,633	2,661,292,513	2,661,292,513	205,216,760
GEORGIA	66.16	268,771,950	275,760,021	8,299,066,366	415,817,421	7,883,248,945	1,155,588,811	1,155,588,811	275,760,021
HAWAII/1	na	na	na	na	na	na	na	na	10,000,000
ILLINOIS	50.00	215,017,560	220,608,017	13,216,199,698	443,954,241	12,772,245,457	2,016,670,335	2,016,670,335	220,608,017
INDIANA	66.96	213,767,459	219,325,413	7,450,053,558	-1,293,679	7,451,347,237	1,089,393,474	1,089,393,474	219,325,413
KANSAS	56.91	41,253,369	42,325,957	2,633,525,501	74,168,771	2,559,356,730	389,186,350	389,186,350	42,325,957
KENTUCKY	71.18	145,011,843	148,782,151	5,564,881,723	208,470,796	5,356,410,927	773,104,420	773,104,420	148,782,151
LOUISIANA/2	na	na	na	na	na	na	na	na	731,960,000
MAINE	63.27	105,008,576	107,738,799	2,369,701,164	41,241,661	2,328,459,503	344,813,652	344,813,652	107,738,799
MARYLAND	50.00	76,256,228	78,238,890	7,564,182,204	36,324,863	7,527,857,341	1,188,609,054	1,188,609,054	78,238,890
MASSACHUSETTS	50.00	305,024,911	312,955,559	12,660,753,340	0	12,660,753,340	1,999,066,317	1,999,066,317	312,955,559
MICHIGAN	66.14	265,021,644	271,912,207	12,377,302,267	276,022,328	12,101,279,939	1,774,019,923	1,774,019,923	271,912,207
MISSISSIPPI	74.18	152,512,455	156,477,779	4,432,068,902	210,532,157	4,221,536,745	604,349,172	604,349,172	156,477,779
MISSOURI	63.45	473,788,694	486,107,200	8,620,708,926	755,588,598	7,865,120,328	1,163,946,087	1,163,946,087	486,107,200
NEVADA	56.20	46,253,777	47,456,375	1,730,509,323	85,540,193	1,644,969,130	250,988,050	250,988,050	47,456,375
NEW HAMPSHIRE	50.00	160,111,598	164,274,500	1,174,440,051	41,992,778	1,132,447,273	178,807,464	178,807,464	164,274,500
NEW JERSEY	50.00	643,802,579	660,541,446	10,263,014,973	1,242,812,460	9,020,202,513	1,424,242,502	1,424,242,502	660,541,446
NEW YORK	50.00	1,606,381,192	1,648,147,103	51,477,488,275	3,250,438,690	48,227,049,585	7,614,797,303	7,614,797,303	1,648,147,103
NORTH CAROLINA	65.28	295,024,095	302,694,721	12,074,012,547	310,365,066	11,763,647,481	1,729,574,116	1,729,574,116	302,694,721
OHIO	64.15	406,283,181	416,846,544	16,241,807,775	544,474,576	15,697,333,199	2,317,125,042	2,317,125,042	416,846,544
PENNSYLVANIA	55.07	561,295,840	575,889,532	20,215,741,634	1,161,609,171	19,054,132,463	2,923,550,707	2,923,550,707	575,889,532
RHODE ISLAND	52.12	65,005,309	66,695,447	1,841,508,177	127,714,099	1,713,794,078	267,167,340	267,167,340	66,695,447
SOUTH CAROLINA	70.24	327,526,749	336,042,444	4,611,047,760	457,157,861	4,153,889,899	601,172,857	601,172,857	336,042,444
TENNESSEE/1	na	na	na	na	na	na	na	na	123,562,982
TEXAS	58.22	956,328,103	981,192,634	27,523,481,436	1,515,965,665	26,007,515,771	3,931,174,993	3,931,174,993	981,192,634
VERMONT	57.58	22,501,838	23,086,886	1,332,991,907	37,448,781	1,295,543,126	196,395,015	196,395,015	23,086,886
VIRGINIA	50.00	87,614,730	89,892,713	6,806,627,571	214,541,182	6,592,086,389	1,040,855,746	1,040,855,746	89,892,713
WASHINGTON	50.00	185,015,110	189,825,503	7,452,641,090	392,480,601	7,060,160,489	1,114,762,182	1,114,762,182	189,825,503
WEST VIRGINIA	72.62	67,505,513	69,260,656	2,772,398,537	75,461,531	2,696,937,006	387,696,929	387,696,929	69,260,656
TOTAL		9,751,002,453	10,004,528,517	343,597,888,543	15,767,606,535	327,830,282,008	50,271,525,401	50,271,525,401	10,870,051,501
LOW DSH STATES
ALASKA	50.00	20,371,357	20,901,012	1,323,188,957	19,859,459	1,303,329,498	205,788,868	205,788,868	20,901,012
ARKANSAS	70.71	43,141,306	44,262,980	4,105,082,591	61,447,395	4,043,635,196	584,415,830	584,415,830	44,262,980
DELAWARE	54.17	9,053,936	9,289,338	1,484,381,209	12,647,971	1,471,733,238	226,863,997	226,863,997	9,289,338
IDAHO	70.23	16,438,844	16,866,254	1,420,520,599	23,407,154	1,397,113,445	202,203,559	202,203,559	16,866,254
IOWA	60.71	39,384,356	40,408,349	3,416,666,341	51,985,041	3,364,681,300	503,230,881	503,230,881	40,408,349
MINNESOTA	50.00	74,694,976	76,637,045	8,661,424,765	47,645,449	8,613,779,316	1,360,070,418	1,360,070,418	76,637,045
MONTANA	66.11	11,351,703	11,646,847	965,777,404	17,086,812	948,690,592	139,089,858	139,089,858	11,646,847
NEBRASKA	56.64	28,300,533	29,036,347	1,675,943,349	41,928,603	1,634,014,746	248,791,923	248,791,923	29,036,347
NEW MEXICO	69.36	20,371,357	20,901,012	3,420,434,313	56,394,276	3,364,040,037	488,137,692	488,137,692	20,901,012
NORTH DAKOTA	55.40	9,552,761	9,801,133	732,046,343	1,163,524	730,882,819	111,956,428	111,956,428	9,801,133
OKLAHOMA	63.88	36,215,744	37,157,353	4,397,686,300	36,151,183	4,361,535,117	644,444,557	644,444,557	37,157,353
OREGON	62.91	45,269,681	46,446,693	4,542,895,184	69,278,705	4,473,616,479	663,371,155	663,371,155	46,446,693
SOUTH DAKOTA	59.13	11,045,549	11,332,733	740,258,203	751,299	739,506,904	111,335,565	111,335,565	11,332,733
UTAH	70.99	19,619,586	20,129,695	1,870,691,982	32,876,938	1,837,815,044	265,400,556	265,400,556	20,129,695
WISCONSIN	60.53	94,540,543	96,998,597	6,978,470,509	101,257	6,978,369,252	1,044,469,048	1,044,469,048	96,998,597
WYOMING	50.00	226,348	232,233	518,211,253	452,696	517,758,557	81,751,351	81,751,351	232,233
TOTAL LOW DSH STATES		$479,578,580	$492,047,623	$46,253,679,302	$473,177,762	$45,780,501,540	$6,881,321,686	$6,881,321,686	$492,047,621
TOTAL		$10,230,581,033	$10,496,576,140	$389,851,567,845	$16,240,784,297	$373,610,783,548	$57,152,847,088	$57,152,847,088	$11,362,099,122
1 Hawaii and Tennessee DSH allotments are determined under section 1923(f)(6) of the Act. Under this provision, for FY 2012, Tennessee's DSH payments are limited to $70,108,895 and Hawaii's DSH allotment is limited to $10,000,000.
2 FY 2012 DSH allotment for Louisiana determined under the provisions of section 1903(f)(3)(C) and (D) of the Act.

Key to Chart 2. Preliminary DSH Allotments for FY 2013

Key to Chart 2—Preliminary DSH Allotments for Fiscal Year: 2013

[The Preliminary FY 2013 DSH allotments for the non-low DSH States are presented in the top section of this chart, and the preliminary FY 2013 DSH allotments for the low-DSH States are presented in the bottom section of this chart]

Column	Description
Column A	State.
Column B	FY 2013 FMAPs. This column contains the States' FY 2013 Federal Medical Assistance Percentages.
Column C	Prior FY (2012) DSH Allotments. This column contains the States' prior FY 2012 DSH Allotments.
Column D	Prior FY (2012) DSH Allotments (Col C) × (100% + Percentage Increase in CPIU): 102.4%. This column contains the amount in Column D increased by 1 plus the estimated percentage increase in the CPI-U for the prior FY (102.4 percent).
Column E	FY 2013 TC MAP Exp. Including DSH. This column contains the amount of the States' projected FY 2013 total computable (TC) medical assistance expenditures including DSH expenditures.
Column F	FY 2013 TC DSH Expenditures. This column contains the amount of the States' projected FY 2013 total computable DSH expenditures.
Column G	FY 2013 TC MAP Exp. Net of DSH. This column contains the amount of the States' projected FY 2013 total computable medical assistance expenditures net of DSH expenditures, calculated as the amount in Column E minus the amount in Column F.
Column H	12% Amount. This column contains the amount of the “12 percent limit” in Federal share, determined in accordance with the provisions of section 1923(f)(3) of the Act.
Column I	Greater of FY 2012 Allotment or 12% Limit. This column contains the greater of the State's prior FY (FY 2012) DSH allotment or the amount of the 12% Limit, determined as the maximum of the amount in Column C or Column H.
Column J	FY 2013 DSH Allotment. This column contains the States' preliminary FY 2013 DSH allotments, determined as the minimum of the amount in Column I or Column D.
	For states with “na” in Columns I or D, refer to the footnotes in the chart.

Chart 2—Preliminary DSH Allotments for Fiscal Year: 2013

State	FY 2013 FMAPs	Prior FY (2012) DSH allotments	Prior FY (2012) DSH allotment (Col C) × 100% + Pct Increase in CPIU:	FY 2013 TC MAP Exp. including DSH	FY 2013 TC DSH Expenditures	FY 2013 TC MAP EXP. Net Of DSH (Col E − F)	“12% Amouunt” = Col G × .12/(1 − 12/Col B)* (In FS)	Greater of Col H Or Col C 12% Limit, FY 2012 Allotment)	2013 FY 2013 DSH Allotment MIN Col I, Col D
			102.4%
A	B	C	D	E	F	G	H	I	J
ALABAMA	68.53%	$315,520,769	$323,093,267	$5,329,850,000	$471,003,000	$4,858,847,000	$706,832,022	$706,832,022	$323,093,267
ARIZONA	65.68	103,890,985	106,384,369	8,671,536,000	213,742,000	8,457,794,000	1,241,820,961	1,241,820,961	106,384,369
CALIFORNIA	50.00	1,124,844,365	1,151,840,630	66,298,257,000	919,513,000	65,378,744,000	10,322,959,579	10,322,959,579	1,151,840,630
COLORADO	50.00	94,912,751	97,190,657	5,051,411,000	192,614,000	4,858,797,000	767,178,474	767,178,474	97,190,657
CONNECTICUT	50.00	205,216,760	210,141,962	6,431,510,000	290,445,000	6,141,065,000	969,641,842	969,641,842	210,141,962
DISTRICT OF COLUMBIA	70.00	62,847,632	64,355,975	2,263,613,000	57,226,000	2,206,387,000	319,545,703	319,545,703	64,355,975
FLORIDA	58.08	205,216,760	210,141,962	19,230,077,000	383,399,000	18,846,678,000	2,850,560,048	2,850,560,048	210,141,962
GEORGIA	65.56	275,760,021	282,378,262	8,369,129,000	415,995,000	7,953,134,000	1,168,201,938	1,168,201,938	282,378,262
ILLINOIS	50.00	220,608,017	225,902,609	15,891,835,000	492,771,000	15,399,064,000	2,431,431,158	2,431,431,158	225,902,609
INDIANA	67.16	219,325,413	224,589,223	8,205,160,000	296,676,000	7,908,484,000	1,155,475,965	1,155,475,965	224,589,223
KANSAS	56.51	42,325,957	43,341,780	2,631,311,000	75,425,000	2,555,886,000	389,395,061	389,395,061	43,341,780
KENTUCKY	70.55	148,782,151	152,352,923	6,003,011,000	207,429,000	5,795,582,000	838,008,492	838,008,492	152,352,923
LOUISIANA/3	na	na	na	na	na	na	na	na	731,960,000
MAINE	62.57	107,738,799	110,324,530	2,411,890,000	38,474,000	2,373,416,000	352,393,844	352,393,844	110,324,530
MARYLAND	50.00	78,238,890	80,116,623	7,990,885,000	28,789,000	7,962,096,000	1,257,173,053	1,257,173,053	80,116,623
MASSACHUSETTS	50.00	312,955,559	320,466,492	14,457,969,000	0	14,457,969,000	2,282,837,211	2,282,837,211	320,466,492
MICHIGAN	66.39	271,912,207	278,438,100	13,054,597,000	489,458,000	12,565,139,000	1,840,484,453	1,840,484,453	278,438,100
MISSISSIPPI	73.43	156,477,779	160,233,246	4,938,125,000	306,480,000	4,631,645,000	664,369,251	664,369,251	160,233,246
MISSOURI	61.37	486,107,200	497,773,773	9,167,121,000	731,848,000	8,435,273,000	1,258,268,675	1,258,268,675	497,773,773
NEVADA	59.74	47,456,375	48,595,328	1,788,469,000	81,265,000	1,707,204,000	256,359,532	256,359,532	48,595,328
NEW HAMPSHIRE	50.00	164,274,500	168,217,088	1,194,634,000	76,100,000	1,118,534,000	176,610,632	176,610,632	168,217,088
NEW JERSEY	50.00	660,541,446	676,394,441	10,885,937,000	1,285,149,000	9,600,788,000	1,515,913,895	1,515,913,895	676,394,441
NEW YORK	50.00	1,648,147,103	1,687,702,633	60,543,793,000	3,138,550,000	57,405,243,000	9,063,985,737	9,063,985,737	1,687,702,633
NORTH CAROLINA	65.51	302,694,721	309,959,394	12,152,941,000	348,212,000	11,804,729,000	1,734,242,863	1,734,242,863	309,959,394
OHIO	63.58	416,846,544	426,850,861	17,759,856,000	0	17,759,856,000	2,626,998,785	2,626,998,785	426,850,861
PENNSYLVANIA	54.28	575,889,532	589,710,881	21,684,533,000	811,678,000	20,872,855,000	3,215,644,000	3,215,644,000	589,710,881
RHODE ISLAND	51.26	66,695,447	68,296,138	2,138,378,000	133,105,000	2,005,273,000	314,183,272	314,183,272	68,296,138
SOUTH CAROLINA	70.43	336,042,444	344,107,463	4,819,642,000	488,104,000	4,331,538,000	626,534,769	626,534,769	344,107,463
TENNESSEE/2	na	na	na	na	na	na	na	na	53,100,000
TEXAS	59.30	981,192,634	1,004,741,257	30,522,421,000	2,362,443,000	28,159,978,000	4,236,499,016	4,236,499,016	1,004,741,257
VERMONT	56.04	23,086,886	23,640,971	1,453,569,000	37,449,000	1,416,120,000	216,238,051	216,238,051	23,640,971
VIRGINIA	50.00	89,892,713	92,050,138	7,614,317,000	292,128,000	7,322,189,000	1,156,135,105	1,156,135,105	92,050,138
WASHINGTON	50.00	189,825,503	194,381,315	7,263,797,000	408,769,000	6,855,028,000	1,082,372,842	1,082,372,842	194,381,315
WEST VIRGINIA	72.04	69,260,656	70,922,912	3,049,170,000	70,185,000	2,978,985,000	428,926,208	428,926,208	70,922,912
TOTAL	0.00	10,004,528,519	10,244,637,203	389,268,744,000	15,144,424,000	374,124,320,000	57,467,222,436	57,467,222,436	11,029,697,203
LOW DSH STATES
ALASKA	50.00	20,901,012	21,402,636	4,345,689,000	43,820,000	4,301,869,000	679,242,473.68	679,242,474	21,402,636
ARKANSAS	70.17	44,262,980	45,325,292	1,580,616,000	16,393,000	1,564,223,000	226,429,145	226,429,145	45,325,292
DELAWARE	55.67	9,289,338	9,512,282	1,656,878,000	19,283,000	1,637,595,000	250,510,411	250,510,411	9,512,282
HAWAII/1	51.86	10,000,000	10,240,000	15,891,835,000	492,771,000	15,399,064,000	2,404,201,080.90	2,404,201,081	10,240,000
IDAHO	71.00	16,866,254	17,271,044	1,804,672,000	22,633,000	1,782,039,000	257,338,513.22	257,338,513	17,271,044
IOWA	59.59	40,408,349	41,378,149	3,701,627,000	53,705,000	3,647,922,000	548,131,133	548,131,133	41,378,149
MINNESOTA	50.00	76,637,045	78,476,334	9,033,277,000	127,149,000	8,906,128,000	1,406,230,737	1,406,230,737	78,476,334
MONTANA	66.00	11,646,847	11,926,371	1,035,493,000	18,023,000	1,017,470,000	149,228,933	149,228,933	11,926,371
NEBRASKA	55.76	29,036,347	29,733,219	1,982,015,000	40,798,000	1,941,217,000	296,825,210	296,825,210	29,733,219
NEW MEXICO	69.07	20,901,012	21,402,636	3,663,793,000	21,380,000	3,642,413,000	528,995,548	528,995,548	21,402,636
NORTH DAKOTA	52.27	9,801,133	10,036,360	783,683,000	1,474,000	782,209,000	121,835,802	121,835,802	10,036,360
OKLAHOMA	64.00	37,157,353	38,049,129	4,822,776,000	49,525,000	4,773,251,000	704,972,455	704,972,455	38,049,129
OREGON	62.44	46,446,693	47,561,414	5,261,131,000	100,645,000	5,160,486,000	766,583,852	766,583,852	47,561,414
SOUTH DAKOTA	56.19	11,332,733	11,604,719	792,356,000	2,821,000	789,535,000	120,472,428	120,472,428	11,604,719
UTAH	69.61	20,129,695	20,612,808	2,104,256,000	29,583,000	2,074,673,000	300,818,582	300,818,582	20,612,808
WISCONSIN	59.74	96,998,597	99,326,563	7,576,743,000	159,936,000	7,416,807,000	1,113,732,845	1,113,732,845	99,326,563
WYOMING	50.00	232,233	237,807	548,369,000	463,000	547,906,000	86,511,474	86,511,474	237,807
TOTAL LOW DSH STATES	0.00	502,047,621	514,096,764	66,585,209,000	1,200,402,000	65,384,807,000	9,962,060,622	9,962,060,622	514,096,763
TOTAL	0.00	10,506,576,140	10,758,733,967	455,853,953,000	16,344,826,000	439,509,127,000	67,429,283,058	67,429,283,058	11,543,793,966
FOOTNOTES:
/1 Begining FY 2013, under section 1923(f)(6)(B)(II) of the Act, Hawaii's DSH allotments are determined as for low-DSH states. This means its allotments are determined as for all States, by increasing the previous fiscal year allotment by the CPI-U for the previous fiscal year.
/2 Tennessee's DSH allotments are determined under section 1923(f)(6)(A)(v)(II) of the Act. Under this provision, Tennessee's DSH payments for FY 2013 are limited to $53,100,000
/3 FY 2013 DSH allotment for Louisiana determined under the provisions of section 1903(f)(3)(C) and (D) of the Act.

Key to Chart 3. Final IMD DSH Limit for FY 2012

Key to Chart 3—Final IMD DSH Limit For FY: 2012

The final FY 2012 IMD DSH limits for the non-low DSH States are presented in the top section of this chart and the final FY 2012 IMD DSH Limits for the low-DSH States are presented in the bottom section of the chart]

Column	Description
Column A	State.
Column B	Inpatient Hospital Services FY 95 DSH Total Computable. This column contains the States' total computable FY 1995 inpatient hospital DSH expenditures as reported on the Form CMS-64.
Column C	IMD and Mental Health Services FY 95 DSH Total Computable. This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on the Form CMS-64 as of January 1, 1997.
Column D	Total Inpatient & IMD & Mental Health FY 95 DSH Total Computable, Col. B + C. This column contains the total computation of all inpatient hospital DSH expenditures and mental health facility DSH expenditures for FY 1995 as reported on the Form CMS-64 as of January 1, 1997 (representing the sum of Column B and Column C).
Column E	Applicable Percent Col. C/D. This column contains the “applicable percentage” representing the total Computable FY 1995 mental health facility DSH expenditures divided by total computable all inpatient hospital and mental health facility DSH expenditures for FY 1995 (the amount in Column C divided by the amount in Column D) Per section 1923(h)(2)(A)(ii)(III) Of the Act, for FYs after FY 2002, the applicable Percentage can be no greater than 33 percent.
Column F	FY 2012 Federal Share DSH Allotment. This column contains the states' final FY 2012 DSH allotments.
Column G	FY 2012 FMAP.
Column H	FY 2012 DSH Allotments in Total Computable Col. F/G. This column contains States' FY 2012 total computable DSH allotment (determined as Column F/Column G).
Column I	Col E × Col H in TC. This column contains the applicable percent of FY 2012 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount in Column H)
Column J	FY 2012 TC IMD DSH Limit. Lesser of Col. C or I. This column contains the total computable amount of the FY 2012 TC IMD DSH Limit equal to the lesser of the amount in Column C or Column I.
Column K	FY 2012 IMD DSH Limit in Federal Share, Col. G × J. This column contains the FY 2012 federal share IMD DSH limit determined by converting the total computable FY 2012 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2012 FMAP in Column G.

Chart 3—Final IMD DSH Limit for FY: 2012

State	Impatient hospital service for FY 95 DSH total computable	IMD and mental health services FY 95 DSH total computable	Total inpatient & IMD and mental health FY 95 DSH total computable Col B + C	Applicable percent Col C/D	FY 2012 Allotment in FS	FY 2012 FMAP	FY 2012 Allotments In TC Col F/G	CoL E x Col H In TC	FY 2012 TC IMD Limit (Lesser Of Col 1 or Col C)	2012 FY 2012 IMD Limit in FS Col G x J
A	B	C	D	E	F	G	H	I	J	K
ALABAMA	413,006,229	4,451,770	417,457,999	1.07%	315,520,769	68.62%	459,808,757	4,903,398	4,451,770	3,054,805
ARIZONA	93,916,100	28,474,900	122,391,000	23.27%	103,890,985	67.30%	154,369,963	35,914,971	28,474,900	19,163,608
CALIFORNIA	2,189,879,543	1,555,919	2,191,435,462	0.07%	1,124,844,365	50.00%	2,249,688,730	1,597,279	1,555,919	777,960
COLORADO	173,900,441	594,776	174,495,217	0.34%	94,912,751	50.00%	189,825,502	647,030	594,776	297,388
CONNECTICUT	303,359,275	105,573,725	408,933,000	25.82%	205,216,760	50.00%	410,433,520	105,961,112	105,573,725	52,786,863
DISTRICT OF COLUMBIA	39,532,234	6,545,136	46,077,370	14.20%	62,847,632	70.00%	89,782,331	12,753,279	6,545,136	4,581,595
FLORIDA	184,468,014	149,714,986	334,183,000	33.00%	205,216,760	56.04%	366,196,931	120,844,987	120,844,987	67,721,531
GEORGIA	407,343,557	0	407,343,557	0.00%	275,760,021	66.16%	416,807,771	0	0	0
HAWAII	0	0	0	0.00%	10,000,000	50.48%	19,809,826	0	0	0
ILLINOIS	315,868,508	89,408,276	405,276,784	22.06%	220,608,017	50.00%	441,216,034	97,336,849	89,408,276	44,704,138
INDIANA	79,960,783	153,566,302	233,527,085	33.00%	219,325,413	66.96%	327,546,913	108,090,481	108,090,481	72,377,386
KANSAS	11,587,208	76,663,508	88,250,716	33.00%	42,325,957	56.91%	74,373,497	24,543,254	24,543,254	13,967,566
KENTUCKY	158,804,908	37,443,073	196,247,981	19.08%	148,782,151	71.18%	209,022,409	39,880,366	37,443,073	26,651,979
LOUISIANA	1,078,512,169	132,917,149	1,211,429,318	10.97%	731,960,000	61.09%	1,198,166,639	131,461,977	131,461,977	80,310,122
MAINE	99,957,958	60,958,342	160,916,300	33.00%	107,738,799	63.27%	170,284,177	56,193,779	56,193,779	35,553,804
MARYLAND	22,226,467	120,873,531	143,099,998	33.00%	78,238,890	50.00%	156,477,780	51,637,667	51,637,667	25,818,834
MASSACHUSETTS	469,653,946	105,635,054	575,289,000	18.36%	312,955,559	50.00%	625,911,118	114,930,330	105,635,054	52,817,527
MICHIGAN	133,258,800	304,765,552	438,024,352	33.00%	271,912,207	66.14%	411,116,128	135,668,322	135,668,322	89,731,028
MISSISSIPPI	182,608,033	0	182,608,033	0.00%	156,477,779	74.18%	210,943,353	0	0	0
MISSOURI	521,946,524	207,234,618	729,181,142	28.42%	486,107,200	63.45%	766,126,399	217,734,528	207,234,618	131,490,365
NEVADA	73,560,000	0	73,560,000	0.00%	47,456,375	56.20%	84,441,948	0	0	0
NEW HAMPSHIRE	92,675,916	94,753,948	187,429,864	33.00%	164,274,500	50.00%	328,549,000	108,421,170	94,753,948	47,376,974
NEW JERSEY	736,742,539	357,370,461	1,094,113,000	32.66%	660,541,446	50.00%	1,321,082,892	431,505,706	357,370,461	178,685,231
NEW YORK	2,418,869,368	605,000,000	3,023,869,368	20.01%	1,648,147,103	50.00%	3,296,294,206	659,505,340	605,000,000	302,500,000
NORTH CAROLINA	193,201,966	236,072,627	429,274,593	33.00%	302,694,721	65.28%	463,686,766	153,016,633	153,016,633	99,889,258
OHIO	535,731,956	93,432,758	629,164,714	14.85%	416,846,544	64.15%	649,799,757	96,497,121	93,432,758	59,937,114
PENNSYLVANIA	388,207,319	579,199,682	967,407,001	33.00%	575,889,532	55.07%	1,045,740,933	345,094,508	345,094,508	190,043,546
RHODE ISLAND	108,503,167	2,397,833	110,901,000	2.16%	66,695,447	52.12%	127,965,171	2,766,784	2,397,833	1,249,751
SOUTH CAROLINA	366,681,364	72,076,341	438,757,705	16.43%	336,042,444	70.24%	478,420,336	78,591,867	72,076,341	50,626,422
TENNESSEE	0	0	0	0.00%	123,562,982	66.36%	186,200,998	0	0	0
TEXAS	1,220,515,401	292,513,592	1,513,028,993	19.33%	981,192,634	58.22%	1,685,318,849	325,822,355	292,513,592	170,301,413
VERMONT	19,979,252	9,071,297	29,050,549	31.23%	23,086,886	57.58%	40,095,321	12,520,127	9,071,297	5,223,253
VIRGINIA	129,313,480	7,770,268	137,083,748	5.67%	89,892,713	50.00%	179,785,426	10,190,712	7,770,268	3,885,134
WASHINGTON	171,725,815	163,836,435	335,562,250	33.00%	189,825,503	50.00%	379,651,006	125,284,832	125,284,832	62,642,416
WEST VIRGINIA	66,962,606	18,887,045	85,849,651	22.00%	69,260,656	72.62%	95,374,079	20,982,433	18,887,045	13,715,772
TOTAL	13,402,460,846	4,118,758,904	17,521,219,750		10,870,051,501		19,310,314,466	3,630,299,198	3,392,027,231	1,907,882,783
LOW DSH STATES
ALASKA	2,506,827	17,611,765	20,118,592	33.00%	20,901,012	50.00%	41,802,024	13,794,668	13,794,668	6,897,334
ARKANSAS	2,422,649	819,351	3,242,000	25.27%	44,262,980	70.71%	62,597,907	15,820,376	819,351	579,363
DELAWARE	0	7,069,000	7,069,000	33.00%	9,289,338	54.17%	17,148,492	5,659,002	5,659,002	3,065,482
IDAHO	2,081,429	0	2,081,429	0.00%	16,866,254	70.23%	24,015,740	0	0	0
IOWA	12,011,250	0	12,011,250	0.00%	40,408,349	60.71%	66,559,626	0	0	0
MINNESOTA	24,240,000	5,257,214	29,497,214	17.82%	76,637,045	50.00%	153,274,090	27,317,654	5,257,214	2,628,607
MONTANA	237,048	0	237,048	0.00%	11,646,847	66.11%	17,617,376	0	0	0
NEBRASKA	6,449,102	1,811,337	8,260,439	21.93%	29,036,347	56.64%	51,264,737	11,241,257	1,811,337	1,025,941
NEW MEXICO	6,490,015	254,786	6,744,801	3.78%	20,901,012	69.36%	30,134,100	1,138,321	254,786	176,720
NORTH DAKOTA	214,523	988,478	1,203,001	33.00%	9,801,133	55.40%	17,691,576	5,838,220	988,478	547,617
OKLAHOMA	20,019,969	3,273,248	23,293,217	14.05%	37,157,353	63.88%	58,167,428	8,173,900	3,273,248	2,090,951
OREGON	11,437,908	19,975,092	31,413,000	33.00%	46,446,693	62.91%	73,830,381	24,364,026	19,975,092	12,566,330
SOUTH DAKOTA	321,120	751,299	1,072,419	33.00%	11,332,733	59.13%	19,165,792	6,324,711	751,299	444,243
UTAH	3,621,116	934,586	4,555,702	20.51%	20,129,695	70.99%	28,355,677	5,817,066	934,586	663,463
WISCONSIN	6,609,524	4,492,011	11,101,535	33.00%	96,998,597	60.53%	160,248,797	52,882,103	4,492,011	2,719,014
WYOMING	0	0	0	0.00%	232,233	50.00%	464,466	0	0	0
TOTAL LOW DSH STATES	98,662,480	63,238,167	161,900,647		492,047,621		822,338,209	178,371,303	58,011,072	33,405,065
TOTAL	13,501,123,326	4,181,997,071	17,683,120,397		11,362,099,122		20,132,652,675	3,808,670,501	3,450,038,303	1,941,287,848

Key to Chart 4. Preliminary IMD DSH Limit for FY 2013

Key to Chart 4—Preliminary IMD DSH Limit FOR FY: 2013

[The preliminary FY 2013 IMD DSH Limits for the non-low DSH States are presented in the top section of this chart and the preliminary FY 2013 IMD DSH limits for the low-DSH States are presented in the bottom section of the chart]

Column	Description
Column A	State.
Column B	Inpatient Hospital Services FY 95 DSH Total Computable.
	This column contains the States' total computable FY
	1995 inpatient hospital DSH expenditures as reported on the
	Form CMS-64.
Column C	IMD and Mental Health Services FY 95 DSH Total Computable. This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on the Form CMS-64 as of January 1, 1997.
Column D	Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total Computable, Col. B + C. This column contains the total computation of all inpatient hospital DSH expenditures and mental health facility DSH expenditures for FY 1995 as reported on the Form CMS-64 as of January 1, 1997 (representing the sum of Column B and Column C).
Column E	Applicable Percentage, Col. C/D. This column contains the “applicable percentage” representing the total Computable FY 1995 mental health facility DSH expenditures divided by total computable all inpatient hospital and mental health facility DSH expenditures for FY 1995 (the amount in Column C divided by the amount in Column D) Per section 1923(h)(2)(A)(ii)(III) Of the Act, for FYs after FY 2002, the applicable Percentage can be no greater than 33 percent.
Column F	FY 2013 Federal Share DSH Allotment. This column contains the states' preliminary FY 2012 DSH allotments.
Column G	FY 2013 FMAP.
Column H	FY 2013 DSH Allotments in Total Computable, Col. F/G. This column contains states' FY 2013 total computable DSH allotment (determined as Column F/Column G).
Column I	Applicable Percentage Applied to FY 2013 Allotments in TC, Col E x Col H. This column contains the applicable percentage of FY 2013 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount in Column H).
Column J	FY 2013 TC IMD DSH Limit. Lesser of Col. I or C. This column contains the total computable FY 2013 TC IMD DSH Limit equal to the lesser of the amount in Column I or Column C.
Column K	FY 2013 IMD DSH Limit in Federal Share, Col. G x J. This column contains the FY 2013 Federal Share IMD DSH limit determined by converting the total computable FY 2013 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2013 FMAP in Column G.

Chart 4—Preliminary IMD DSH Limit for FY: 2013

State	Inpatient hospital services FY 95 DSH total computable	IMD and mental health services FY 95 DSH total computable	Total inpatient & IMD & mental health FY 95 DSH total computable Col B + C	Applicable percentage Col C/D	FY 2013 Allotment in FS	FY 2013 FMAPs	FY 2013 Allotments in TC Col F/G	Applicable percentage applied to FY 2013 allotments in TC Col E × Col H	FY 2013 TC IMD Limit (lesser of Col I or Col C)	2013 FY 2013 IMD Limit in FS Col G × J
A	B	C	D	E	F	G	H	I	J	K
ALABAMA	$413,006,229	$4,451,770	$417,457,999	1.07	$323,093,267	68.53	$471,462,523	$5,027,674	$4,451,770	$3,050,798
ARIZONA	93,916,100	28,474,900	122,391,000	23.27	106,384,369	65.68	161,973,765	37,684,035	28,474,900	18,702,314
CALIFORNIA	2,189,879,543	1,555,919	2,191,435,462	0.07	1,151,840,630	50.00	2,303,681,260	1,635,614	1,555,919	777,960
COLORADO	173,900,441	594,776	174,495,217	0.34	97,190,657	50.00	194,381,314	662,559	594,776	297,388
CONNECTICUT	303,359,275	105,573,725	408,933,000	25.82	210,141,962	50.00	420,283,924	108,504,179	105,573,725	52,786,863
DISTRICT OF COLUMBIA	39,532,234	6,545,136	46,077,370	14.20	64,355,975	70.00	91,937,107	13,059,358	6,545,136	4,581,595
FLORIDA	184,468,014	149,714,986	334,183,000	33.00	210,141,962	58.08	361,814,673	119,398,842	119,398,842	69,346,847
GEORGIA	407,343,557	0	407,343,557	0.00	282,378,262	65.56	430,717,300	0	0	0
ILLINOIS	315,868,508	89,408,276	405,276,784	22.06	225,902,609	50.00	451,805,218	99,672,933	89,408,276	44,704,138
INDIANA	79,960,783	153,566,302	233,527,085	33.00	224,589,223	67.16	334,409,206	110,355,038	110,355,038	74,114,444
KANSAS	11,587,208	76,663,508	88,250,716	33.00	43,341,780	56.51	76,697,540	25,310,188	25,310,188	14,302,787
KENTUCKY	158,804,908	37,443,073	196,247,981	19.08	152,352,923	70.55	215,950,281	41,202,167	37,443,073	26,416,088
LOUISIANA	1,078,512,169	132,917,149	1,211,429,318	10.97	731,960,000	61.24	1,195,231,875	131,139,977	131,139,977	80,310,122
MAINE	99,957,958	60,958,342	160,916,300	33.00	110,324,530	62.57	176,321,768	58,186,183	58,186,183	36,407,095
MARYLAND	22,226,467	120,873,531	143,099,998	33.00	80,116,623	50.00	160,233,246	52,876,971	52,876,971	26,438,486
MASSACHUSETTS	469,653,946	105,635,054	575,289,000	18.36	320,466,492	50.00	640,932,984	117,688,658	105,635,054	52,817,527
MICHIGAN	133,258,800	304,765,552	438,024,352	33.00	278,438,100	66.39	419,397,650	138,401,225	138,401,225	91,884,573
MISSISSIPPI	182,608,033	0	182,608,033	0.00	160,233,246	73.43	218,212,238	0	0	0
MISSOURI	521,946,524	207,234,618	729,181,142	28.42	497,773,773	61.37	811,102,775	230,516,896	207,234,618	127,179,885
NEVADA	73,560,000	0	73,560,000	0.00	48,595,328	59.74	81,344,707	0	0	0
NEW HAMPSHIRE	92,675,916	94,753,948	187,429,864	33.00	168,217,088	50.00	336,434,176	111,023,278	94,753,948	47,376,974
NEW JERSEY	736,742,539	357,370,461	1,094,113,000	32.66	676,394,441	50.00	1,352,788,882	441,861,843	357,370,461	178,685,231
NEW YORK	2,418,869,368	605,000,000	3,023,869,368	20.01	1,687,702,633	50.00	3,375,405,266	675,333,468	605,000,000	302,500,000
NORTH CAROLINA	193,201,966	236,072,627	429,274,593	33.00	309,959,394	65.51	473,148,212	156,138,910	156,138,910	102,286,600
OHIO	535,731,956	93,432,758	629,164,714	14.85	426,850,861	63.58	671,360,272	99,698,919	93,432,758	59,404,548
PENNSYLVANIA	388,207,319	579,199,682	967,407,001	33.00	589,710,881	54.28	1,086,423,878	358,519,880	358,519,880	194,604,591
RHODE ISLAND	108,503,167	2,397,833	110,901,000	2.16	68,296,138	51.26	133,234,760	2,880,720	2,397,833	1,229,129
SOUTH CAROLINA	366,681,364	72,076,341	438,757,705	16.43	344,107,463	70.43	488,580,808	80,260,965	72,076,341	50,763,367
TENNESSEE	0	0	0	0.00	53,100,000	66.13	80,296,386	0	0	0
TEXAS	1,220,515,401	292,513,592	1,513,028,993	19.33	1,004,741,257	59.30	1,694,336,015	327,565,642	292,513,592	173,460,560
VERMONT	19,979,252	9,071,297	29,050,549	31.23	23,640,971	56.04	42,185,887	13,172,925	9,071,297	5,083,555
VIRGINIA	129,313,480	7,770,268	137,083,748	5.67	92,050,138	50.00	184,100,276	10,435,289	7,770,268	3,885,134
WASHINGTON	171,725,815	163,836,435	335,562,250	33.00	194,381,315	50.00	388,762,630	128,291,668	128,291,668	64,145,834
WEST VIRGINIA	66,962,606	18,887,045	85,849,651	22.00	70,922,912	72.04	98,449,350	21,658,997	18,887,045	13,606,227
TOTAL	13,402,460,846	4,118,758,904	17,521,219,750		11,029,697,203		19,623,398,153	3,718,165,001	3,418,809,673	1,921,150,660
LOW DSH STATES
ALASKA	2,506,827	17,611,765	20,118,592	33.00	21,402,636	50.00	42,805,272	14,125,740	14,125,740	7,062,870
ARKANSAS	2,422,649	819,351	3,242,000	25.27	45,325,292	70.17	64,593,547	16,324,734	819,351	574,939
DELAWARE	0	7,069,000	7,069,000	33.00	9,512,282	55.67	17,086,909	5,638,680	5,638,680	3,139,053
HAWAII	0	0	0	0.00	10,240,000	51.86	19,745,469	0	0	0
IDAHO	2,081,429	0	2,081,429	0.00	17,271,044	71.00	24,325,414	0	0	0
IOWA	12,011,250	0	12,011,250	0.00	41,378,149	59.59	69,438,075	0	0	0
MINNESOTA	24,240,000	5,257,214	29,497,214	17.82	78,476,334	50.00	156,952,668	27,973,278	5,257,214	2,628,607
MONTANA	237,048	0	237,048	0.00	11,926,371	66.00	18,070,259	0	0	0
NEBRASKA	6,449,102	1,811,337	8,260,439	21.93	29,733,219	55.76	53,323,563	11,692,713	1,811,337	1,010,002
NEW MEXICO	6,490,015	254,786	6,744,801	3.78	21,402,636	69.07	30,986,877	1,170,535	254,786	175,981
NORTH DAKOTA	214,523	988,478	1,203,001	33.00	10,036,360	52.27	19,200,995	6,336,328	988,478	516,677
OKLAHOMA	20,019,969	3,273,248	23,293,217	14.05	38,049,129	64.00	59,451,764	8,354,379	3,273,248	2,094,879
OREGON	11,437,908	19,975,092	31,413,000	33.00	47,561,414	62.44	76,171,387	25,136,558	19,975,092	12,472,447
SOUTH DAKOTA	321,120	751,299	1,072,419	33.00	11,604,719	56.19	20,652,641	6,815,372	751,299	422,155
UTAH	3,621,116	934,586	4,555,702	20.51	20,612,808	69.61	29,611,849	6,074,765	934,586	650,565
WISCONSIN	6,609,524	4,492,011	11,101,535	33.00	99,326,563	59.74	166,264,752	54,867,368	4,492,011	2,683,527
WYOMING	0	0	0	0.00	237,807	50.00	475,614	0	0	0
TOTAL LOW DSH STATES	98,662,480	63,238,167	161,900,647		514,096,763		869,157,055	184,510,449	58,321,822	33,431,702
TOTAL	13,501,123,326	4,181,997,071	17,683,120,397		11,543,793,966		20,492,555,208	3,902,675,450	3,477,131,494	1,954,582,362