•	Attachment A - MA Budget Neutrality Calculation for SFYs 2009-2011 (12 21 07) Tbl 1.xls 
o	Summary 
•	Attachment A - MA Budget Neutrality Calculation for SFYs 2009-2011 (12 21 07) Tbl 2.xls 
o	Cap 
•	Attachment A - MA Budget Neutrality Calculation for SFYs 2009-2011 (12 21 07) Tbl 3.xls 
o	Actuals 
	Attachment A: Table 1	
	MA Federal Budget Neutrality Summary	
		Total	
	State Fiscal Year	Date of Service Budget Neutrality Ceiling	CMS 64 Waiver Date of Service Expenditures	Variance	
	Original Waiver Period				
	SFY98	2,661,927,714$ 			
	SFY99	2,981,161,080$ 			
	SFY00 	3,238,525,802$ 			
	SFY01 	3,471,642,436$ 			
	WY1-4	12,353,257,032$ 	10,995,120,002$ 	1,358,137,030$ 	
	SFY02 	3,885,915,835$ 	3,866,751,936$ 	19,163,899$ 	
	Total -- Original Waiver Period	16,239,172,867$ 	14,861,871,938$ 	1,377,300,928$ 	
	Waiver Extension Period				
	SFY03	4,042,720,609$ 	4,004,850,437$ 	37,870,172$ 	
	SFY04	4,424,739,093$ 	4,507,275,250$ 	(82,536,157)$ 	
	SFY05	4,819,290,865$ 	5,267,892,379$ 	(448,601,515)$ 	
	Total -- Waiver Extension	13,286,750,567$ 	13,780,018,067$ 	(493,267,500)$ 	
	Total -- Original Waiver Period Plus First Extension	29,525,923,434$ 	28,641,890,005$ 	884,033,429$ 	
	Second Waiver Extension Period				
	SFY06 Estimated	5,257,166,705$ 	5,308,236,796$ 	(51,070,091)$ 	
	SFY07 Projected	5,588,926,487$ 	5,635,528,438$ 	(46,601,952)$ 	
	SFY08 Projected	6,051,270,987$ 	5,958,096,033$ 	93,174,954$ 	
	Total -- Waiver Extension	16,897,364,179$ 	16,901,861,268$ 	(4,497,089)$ 	
	Total -- Original Waiver Period Plus First and Second Extensions	46,423,287,612$ 	45,543,751,273$ 	879,536,339$ 	
	Third Waiver Extension Period				
	SFY09 Projected	7,315,700,504$ 	6,963,031,362$ 	352,669,142$ 	
	SFY10 Projected	7,878,069,311$ 	7,904,753,535$ 	(26,684,224)$ 	
	SFY11 Projected	8,426,081,274$ 	8,798,801,786$ 	(372,720,512)$ 	
		23,619,851,089$ 	23,666,586,683$ 	(46,735,594)$ 	
	Total -- Original Waiver Period Plus First, Second, and Third Extensions	70,043,138,702$ 	69,210,337,956$ 	832,800,745$ 	
	Remaining "Room"			832,800,745$ 	
Attachment A: Table 2	
MA Federal Budget Neutrality - Cap	Waiver Demonstration	
	Total	Total	Total	Total	Total		Total	Total	Total		Total	Total	Total		Total	Total	Total	
	WY1-SFY98	WY02-SFY99	WY03-SFY00	WY04-SFY01	WY05-SFY02		WY06-SFY03	WY07-SFY04	WY08-SFY05		WY09-SFY06	WY10-SFY07	WY11-SFY08		WY12-SFY09	WY13-SFY10	WY14-SFY11	
MEMBER MONTHS																		
Base Populations Member Months (1)																		
Families	5,551,733 	6,096,916 	6,142,251 	6,129,740 	6,801,318 		6,472,052 	6,526,521 	6,575,759 		6,626,899 	6,888,529 	7,016,961 		7,101,483 	7,207,029 	7,314,145 	
Disabled	1,860,393 	1,884,607 	1,888,228 	1,968,956 	2,041,862 		2,054,994 	2,093,164 	2,116,620 		2,200,050 	2,278,047 	2,269,720 		2,264,979 	2,258,473 	2,251,986 	
MCB	46,340 	45,378 	42,798 	39,932 	39,167 		37,831 	38,318 	30,078 		2,755 	2,726 	2,733 		2,722 	2,720 	2,717 	
Total Base	7,458,466 	8,026,901 	8,073,277 	8,138,628 	8,882,347 		8,564,876 	8,658,003 	8,722,457 		8,829,705 	9,169,302 	9,289,415 		9,369,183 	9,468,222 	9,568,848 	
1902(r)(2) Expansion Member Months (2)																		
Kids	20,787 	352,036 	685,613 	651,448 	559,602 		588,217 	543,521 	554,949 		890,240 	886,644 	969,824 		1,051,063 	1,066,829 	1,082,831 	
Disabled	25,671 	82,178 	142,949 	151,788 	145,237 		156,806 	159,055 	159,688 		211,403 	162,547 	162,430 		162,186 	162,006 	161,826 	
Breast and Cervical Cancer Treatment Program	- 	- 	- 	- 	- 		- 	531 	2,619 		4,031 	4,554 	4,642 		4,712 	4,793 	4,875 	
Total 1902(r)(2)	46,458 	434,214 	828,562 	803,236 	704,839 		745,023 	703,107 	717,257 		1,105,673 	1,053,745 	1,136,896 		1,217,961 	1,233,628 	1,249,533 	
TOTAL WAIVER MEMBER MONTHS	7,504,925 	8,461,115 	8,901,839 	8,941,864 	9,587,186 		9,309,899 	9,361,110 	9,439,713 		9,935,378 	10,223,047 	10,426,311 		10,587,145 	10,701,850 	10,818,381 	
PER MEMBER PER MONTH COSTS (PMPM)																		
Base Population PMPM																		
Families	$199.06	$214.41	$230.94	$248.74	$267.92		$288.58	$310.83	$334.79		359.23$ 	385.46$ 	413.60$ 		512.37$ 	548.14$ 	581.44$ 	
Disabled/MCB	$491.04	$519.67	$549.97	$582.03	$615.96		$677.56	$745.32	$819.85		824.79$ 	834.71$ 	901.39$ 		1,003.53$ 	1,082.52$ 	1,162.71$ 	
MCB	$438.39	$463.95	$491.00	$519.62	$549.91													
1902(r)(2) Population PMPM																		
Kids	$177.02	$186.49	$196.93	$208.16	$220.02		$236.98	$255.26	$274.94		295.01$ 	316.54$ 	339.65$ 		429.18$ 	459.61$ 	487.23$ 	
Disabled	$471.87	$497.12	$524.96	$554.88	$586.51		$645.16	$709.67	$780.64		718.13$ 	660.60$ 	724.31$ 		800.61$ 	864.17$ 	927.74$ 	
Breast and Cervical Cancer Treatment Program							$1,891.62	$2,080.78	$2,288.86		2,449.08$ 	2,620.52$ 	2,803.95$ 		3,041.13$ 	3,275.18$ 	3,522.23$ 	
TOTAL EXPENDITURES ( Member Months x PMPM) 																		
Base Population Expenditures																		
Families	1,105,130,955$ 	1,307,228,114$ 	1,418,485,022$ 	1,524,738,320$ 	1,822,226,510$ 		1,867,700,720$ 	2,028,631,063$ 	2,201,522,975$ 		2,380,605,489$ 	2,655,236,928$ 	2,902,188,388$ 		3,638,600,292$ 	3,950,480,956$ 	4,252,751,290$ 	
Disabled/MCB	913,535,491$ 	979,377,812$ 	1,038,467,150$ 	1,145,995,826$ 	1,257,715,096$ 		1,418,016,564$ 	1,588,630,350$ 	1,759,968,056$ 		1,816,859,235$ 	1,903,774,672$ 	2,048,356,117$ 		2,275,702,007$ 	2,447,794,027$ 	2,621,569,857$ 	
MCB	20,314,891$ 	21,052,914$ 	21,013,382$ 	20,749,217$ 	21,538,469$ 													
1902(r)(2) Population Expenditures																		
Kids	3,679,616$ 	65,650,212$ 	135,017,988$ 	135,602,511$ 	123,123,754$ 		139,397,830$ 	138,736,596$ 	152,575,294$ 		262,625,891$ 	280,659,321$ 	329,399,488$ 		451,095,652$ 	490,325,634$ 	527,583,455$ 	
Disabled	12,113,658$ 	40,852,029$ 	75,042,260$ 	84,224,062$ 	85,182,360$ 		101,164,781$ 	112,876,839$ 	124,659,269$ 		151,814,909$ 	107,378,803$ 	117,650,097$ 		129,848,494$ 	140,000,372$ 	150,132,476$ 	
Breast and Cervical Cancer Treatment Program								1,105,846$ 	5,994,069$ 		9,872,030$ 	11,934,485$ 	13,016,338$ 		14,329,541$ 	15,697,258$ 	17,171,045$ 	
Total Base + 1902 (r)(2) Expenditures	2,054,774,610$ 	2,414,161,080$ 	2,688,025,802$ 	2,911,309,936$ 	3,309,786,190$ 		3,526,279,894$ 	3,869,980,693$ 	4,244,719,665$ 		4,621,777,555$ 	4,958,984,210$ 	5,410,610,429$ 		6,509,575,985$ 	7,044,298,245$ 	7,569,208,122$ 	
CommonHealth hypothetical											60,817,950$ 	55,371,077$ 	66,089,358$ 		67,818,621$ 	77,254,483$ 	85,075,899$ 	
Additional hypothetical															163,734,698$ 	181,945,382$ 	197,226,054$ 	
Total Base + 1902 (r)(2) + hypotheticals	2,054,774,610$ 	2,414,161,080$ 	2,688,025,802$ 	2,911,309,936$ 	3,309,786,190$ 		3,526,279,894$ 	3,869,980,693$ 	4,244,719,665$ 		4,682,595,505$ 	5,014,355,287$ 	5,476,699,787$ 		6,741,129,304$ 	7,303,498,111$ 	7,851,510,074$ 	
DSH	607,153,104$ 	567,000,000$ 	550,500,000$ 	560,332,500$ 	576,129,645$ 		516,440,715$ 	554,758,400$ 	574,571,200$ 		574,571,200$ 	574,571,200$ 	574,571,200$ 		574,571,200$ 	574,571,200$ 	574,571,200$ 	
TOTAL EXPENDITURES WITH DSH	2,661,927,714$ 	2,981,161,080$ 	3,238,525,802$ 	3,471,642,436$ 	3,885,915,835$ 		4,042,720,609$ 	4,424,739,093$ 	4,819,290,865$ 		5,257,166,705$ 	5,588,926,487$ 	6,051,270,987$ 		7,315,700,504$ 	7,878,069,311$ 	8,426,081,274$ 	
Attachment A, Table 3	
MA Waiver Expenditures	
Reported on CMS-64.9W	
As of Period Ended 6/30/07	
Projections including over/under	
OLD MEGS		Actual	ACTUAL	ACTUAL	ACTUAL	ACTUAL	Estimated	Projected	Projected	Projected	Projected	Projected	
CATEGORY OF		Total	Total	Total	Total	Total	Total	Total	Total	Total	Total	Total	
SERVICE		WY1-4	WY05-SFY02	WY06-SFY03	WY7 - SFY 2004	WY8-SFY2005	WY9-SFY2006	WY10-SFY2007	WY11-SFY2008	WY12-SFY2009	WY13-SFY2010	WY14-SFY2011	
Standard		6,859,017,878$ 	2,306,471,743$ 	2,343,131,145$ 	2,519,794,246$ 	2,518,395,358$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
CommonHealth		215,574,151$ 	105,227,726$ 	130,395,976$ 	130,989,193$ 	121,439,404$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
Basic		497,143,818$ 	167,968,609$ 	148,619,460$ 	37,855,539$ 	38,912,995$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
Limited		66,565,370$ 	39,495,660$ 	42,159,955$ 	51,352,667$ 	36,880,409$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
Boston Pub Hlth Comm		782,895,431$ 	388,656,152$ 	514,416,154$ 	719,729,953$ 	955,297,535$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
Cambridge Pub Hlth Comm		352,549,062$ 	287,460,694$ 	314,311,886$ 	395,462,242$ 	490,134,530$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
Det - MSP		43,728,403$ 	23,636,152$ 	42,100,676$ 	28,549,180$ 	13,394,689$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
MHSPY		746,914$ 	358,953$ 	268,202$ 	666,171$ 	1,667,400$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
IRP		18,824,545$ 	19,555,118$ 	28,794,356$ 	34,219,382$ 	38,951,048$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
Essential		-$ 	-$ 	-$ 	29,317,822$ 	139,324,430$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
Breast & Cervical Cancer		-$ 	-$ 	-$ 	404,740$ 	1,768,562$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
Subtotal of old MEGs		8,837,045,571$ 	3,338,830,808$ 	3,564,197,810$ 	3,948,341,135$ 	4,356,166,360$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
NEW MEGS		Actual	ACTUAL	ACTUAL	ACTUAL	ACTUAL	Estimated	Projected	Projected	Projected	Projected	Projected	
CATEGORY OF		Total	Total	Total	Total	Total	Total	Total	Total	Total	Total	Total	
SERVICE		WY1-4	WY05-SFY02	WY06-SFY03	WY7 - SFY 2004	WY8-SFY2005	WY9-SFY2006	WY10-SFY2007	WY11-SFY2008	WY12-SFY2009	WY13-SFY2010	WY14-SFY2011	
1902 (r) (2) Children		-$ 	(994)$ 	408$ 	13,661$ 	1,504,998$ 	52,158,809$ 	61,722,651$ 	78,354,567$ 	84,244,316$ 	129,131,975$ 	150,266,254$ 	
1902 (r) (2) Disabled		-$ 	(2,518)$ 	15,036$ 	155,368$ 	6,138,415$ 	62,232,041$ 	42,593,314$ 	42,679,426$ 	52,478,312$ 	57,908,816$ 	63,550,443$ 	
Base Disabled		-$ 	674,940$ 	388,868$ 	1,671,804$ 	191,797,275$ 	1,585,549,918$ 	1,689,456,523$ 	1,756,838,553$ 	2,013,922,785$ 	2,223,391,597$ 	2,420,712,649$ 	
Base Families		-$ 	3,254$ 	18,950$ 	472,232$ 	87,739,840$ 	1,852,585,981$ 	1,990,004,501$ 	2,171,518,018$ 	2,411,792,842$ 	2,889,761,102$ 	3,188,726,877$ 	
Base MCB		-$ 	(1,039)$ 	(76)$ 	12,445$ 	243,669$ 	1,767,879$ 	1,237,243$ 	1,216,956$ 	1,667,991$ 	1,927,737$ 	2,216,854$ 	
E - Family Assistance		-$ 	-$ 	-$ 	7$ 	51,455$ 	-$ 	-$ 	-$ 	-$ 	-$ 	-$ 	
E - HIV/FA		-$ 	15,818$ 	1,332$ 	(7,824)$ 	871,623$ 	14,451,910$ 	16,646,847$ 	19,386,012$ 	19,706,435$ 	21,514,001$ 	23,328,304$ 	
Basic		-$ 	28,832$ 	36,918$ 	13,229$ 	5,383,345$ 	85,023,958$ 	106,305,488$ 	117,274,383$ 	121,436,348$ 	130,429,704$ 	139,102,120$ 	
BCCTP		-$ 	-$ 	-$ 	1,997$ 	358,262$ 	4,224,104$ 	4,385,547$ 	4,820,298$ 	5,283,775$ 	5,823,244$ 	6,367,564$ 	
CommonHealth		-$ 	(27,963)$ 	2,313$ 	241,839$ 	11,137,873$ 	60,817,950$ 	55,371,077$ 	66,089,358$ 	67,818,621$ 	77,254,483$ 	85,075,899$ 	
Essential		-$ 	-$ 	-$ 	47,764$ 	17,484,341$ 	198,457,298$ 	263,249,488$ 	290,143,433$ 	299,884,110$ 	322,579,208$ 	344,500,951$ 	
IRP		-$ 	-$ 	-$ 	-$ 	-$ 	30,402,691$ 	34,011,679$ 	37,412,847$ 	41,154,132$ 	44,858,004$ 	48,446,644$ 	
MSP		-$ 	-$ 	-$ 	-$ 	-$ 	12,260,405$ 	21,383,726$ 	22,880,587$ 	24,482,228$ 	25,951,162$ 	27,248,720$ 	
MHSPY		-$ 	-$ 	(101,813)$ 	-$ 	328,303$ 	3,732,653$ 	4,589,154$ 	4,910,395$ 	5,254,123$ 	5,569,370$ 	5,847,839$ 	
Subtotal of new MEGs		-$ 	690,330$ 	361,936$ 	2,622,522$ 	323,039,399$ 	3,963,665,596$ 	4,290,957,238$ 	4,613,524,833$ 	5,149,126,018$ 	5,936,100,403$ 	6,505,391,118$ 	
Subtotal of old and new MEGs		8,837,045,571$ 	3,339,521,138$ 	3,564,559,746$ 	3,950,963,657$ 	4,679,205,759$ 	3,963,665,596$ 	4,290,957,238$ 	4,613,524,833$ 	5,149,126,018$ 	5,936,100,403$ 	6,505,391,118$ 	
DSH		2,158,074,431$ 	527,230,798$ 	440,290,691$ 	556,311,593$ 	588,686,620$ 	-$ 	-$ 	-$ 				
SNCP		-$ 	-$ 	-$ 	-$ 	-$ 	1,344,571,200$ 	1,344,571,200$ 	1,344,571,200$ 	1,813,905,344$ 	1,968,653,132$ 	2,293,410,669$ 	
Total		10,995,120,002$ 	3,866,751,936$ 	4,004,850,437$ 	4,507,275,250$ 	5,267,892,379$ 	5,308,236,796$ 	5,635,528,438$ 	5,958,096,033$ 	6,963,031,362$ 	7,904,753,535$ 	8,798,801,786$