| Department of Health and Human Services |
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OMB No. |
0938-0101 |
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| Centers for Medicare & Medicaid Services |
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| Medicaid Program Budget Report |
| Medical Assistance Payments |
| Explanations of Changes Between Submissions, Fiscal Years and Base Year |
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| State: |
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Submission Date: |
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| Medicaid (Non-M-SCHIP) |
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Total Computable |
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Dollars |
Percent |
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(000's) |
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A |
B |
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| 1. Changes in FY |
(1) |
from Previous Submission |
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| 2. Changes in FY |
(2) |
from Previous Submission |
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| 3. Changes from Base Year to FY |
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(1) |
- Current Submission |
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| 4. Changes from FY |
(1) |
to FY |
(2) |
- Current Submission |
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| Form CMS-37.4 |
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Report Date: |
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