UPDATED CY 2020 GEOGRAPHIC ADJUSTMENT FACTORS (GAFs)*												
Carrier	State	Locality Number	Medicare Locality	2019 GAF*	2020 GAF (with 1.0 Work Floor)*	"Percent Change 
(2019-2020 with 1.0 Work Floor)*"	2020 GAF (without 1.0 Work Floor)*	"Percent Change 
(2019-2020 without 1.0 Work Floor)*"	2021 GAF	"Percent Change
(2019-2021)"		
10112	AL	00	ALABAMA	0.929	0.938	0.9%	0.930	0.1%	0.931	0.2%		
02102	AK	01	ALASKA**	1.294	1.293	-0.1%	1.293	-0.1%	1.291	-0.3%		
03102	AZ	00	ARIZONA	0.980	0.976	-0.4%	0.971	-0.9%	0.963	-1.8%		
07102	AR	13	ARKANSAS	0.924	0.916	-0.9%	0.904	-2.2%	0.884	-4.3%		
01112	CA	54	BAKERSFIELD	1.027	1.034	0.7%	1.034	0.7%	1.034	0.7%		
01112	CA	55	CHICO	1.025	1.025	0.1%	1.025	0.1%	1.026	0.1%		
01182	CA	71	EL CENTRO	1.025	1.027	0.2%	1.027	0.2%	1.027	0.2%		
01112	CA	56	FRESNO	1.025	1.025	0.1%	1.025	0.1%	1.026	0.1%		
01112	CA	57	HANFORD-CORCORAN	1.025	1.025	0.0%	1.025	0.0%	1.026	0.1%		
01182	CA	18	LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY)	1.090	1.091	0.1%	1.091	0.1%	1.092	0.2%		
01182	CA	26	LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY)	1.090	1.091	0.1%	1.091	0.1%	1.092	0.2%		
01112	CA	58	MADERA	1.025	1.025	0.1%	1.025	0.1%	1.026	0.1%		
01112	CA	59	MERCED	1.025	1.025	0.1%	1.025	0.1%	1.026	0.1%		
01112	CA	60	MODESTO	1.025	1.025	0.1%	1.025	0.1%	1.026	0.1%		
01112	CA	51	NAPA	1.119	1.110	-0.8%	1.110	-0.8%	1.100	-1.7%		
01112	CA	07	SAN FRANCISCO-OAKLAND-HAYWARD (ALAMEDA/CONTRA COSTA CNTY)	1.159	1.161	0.2%	1.161	0.2%	1.163	0.4%		
01182	CA	17	OXNARD-THOUSAND OAKS-VENTURA	1.077	1.080	0.3%	1.080	0.3%	1.082	0.5%		
01112	CA	61	REDDING	1.025	1.025	0.1%	1.025	0.1%	1.026	0.1%		
01112	CA	62	RIVERSIDE-SAN BERNARDINO-ONTARIO	1.033	1.036	0.3%	1.036	0.3%	1.039	0.5%		
01112	CA	63	SACRAMENTO--ROSEVILLE--ARDEN-ARCADE	1.036	1.034	-0.2%	1.034	-0.2%	1.036	0.0%		
01112	CA	64	SALINAS	1.040	1.058	1.8%	1.058	1.8%	1.067	2.6%		
01182	CA	72	SAN DIEGO-CARLSBAD	1.045	1.058	1.2%	1.058	1.2%	1.066	2.0%		
01112	CA	05	SAN FRANCISCO-OAKLAND-HAYWARD (SAN FRANCISCO CNTY)	1.159	1.161	0.2%	1.161	0.2%	1.163	0.4%		
01112	CA	52	SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY)	1.140	1.146	0.5%	1.146	0.5%	1.154	1.2%		
01112	CA	65	SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY)	1.104	1.143	3.6%	1.143	3.6%	1.174	6.3%		
01182	CA	73	SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE	1.029	1.031	0.2%	1.031	0.2%	1.035	0.6%		
01112	CA	06	SAN FRANCISCO-OAKLAND-HAYWARD (SAN MATEO CNTY)	1.159	1.161	0.2%	1.161	0.2%	1.163	0.4%		
01112	CA	09	SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY)	1.175	1.185	0.9%	1.185	0.9%	1.195	1.8%		
01112	CA	66	SANTA CRUZ-WATSONVILLE	1.069	1.073	0.4%	1.073	0.4%	1.086	1.6%		
01182	CA	74	SANTA MARIA-SANTA BARBARA	1.054	1.063	0.8%	1.063	0.8%	1.073	1.8%		
01112	CA	67	SANTA ROSA	1.052	1.065	1.2%	1.065	1.2%	1.075	2.2%		
01112	CA	68	STOCKTON-LODI	1.025	1.026	0.1%	1.026	0.1%	1.026	0.1%		
01112	CA	53	VALLEJO-FAIRFIELD	1.119	1.110	-0.8%	1.110	-0.8%	1.100	-1.7%		
01112	CA	69	VISALIA-PORTERVILLE	1.025	1.025	0.1%	1.025	0.1%	1.026	0.1%		
01112	CA	70	YUBA CITY	1.025	1.025	0.1%	1.025	0.1%	1.026	0.1%		
01112	CA	75	REST OF CALIFORNIA	1.025	1.025	0.1%	1.025	0.1%	1.026	0.1%		
04112	CO	01	COLORADO	1.010	1.011	0.1%	1.011	0.1%	1.011	0.2%		
13102	CT	00	CONNECTICUT	1.072	1.069	-0.2%	1.069	-0.2%	1.067	-0.5%		
12202	DC	01	DC + MD/VA SUBURBS	1.126	1.136	0.9%	1.136	0.9%	1.146	1.8%		
12102	DE	01	DELAWARE	1.017	1.013	-0.4%	1.013	-0.4%	1.009	-0.8%		
09102	FL	03	FORT LAUDERDALE	1.040	1.038	-0.1%	1.033	-0.6%	1.027	-1.2%		
09102	FL	04	MIAMI	1.080	1.080	0.0%	1.076	-0.4%	1.072	-0.7%		
09102	FL	99	REST OF FLORIDA	0.994	0.993	-0.1%	0.985	-0.9%	0.976	-1.8%		
10212	GA	01	ATLANTA	1.002	0.999	-0.4%	0.999	-0.4%	0.995	-0.7%		
10212	GA	99	REST OF GEORGIA	0.958	0.950	-0.9%	0.943	-1.5%	0.929	-3.1%		
01212	HI	01	"HAWAII, GUAM"	1.049	1.052	0.3%	1.052	0.3%	1.055	0.6%		
02202	ID	00	IDAHO	0.935	0.927	-0.8%	0.916	-2.1%	0.896	-4.1%		
06102	IL	16	CHICAGO	1.059	1.061	0.2%	1.061	0.2%	1.062	0.3%		
06102	IL	12	EAST ST. LOUIS	1.005	1.004	-0.1%	1.000	-0.5%	0.995	-1.0%		
06102	IL	15	SUBURBAN CHICAGO	1.053	1.053	0.0%	1.053	0.0%	1.053	0.0%		
06102	IL	99	REST OF ILLINOIS	0.973	0.971	-0.2%	0.964	-0.9%	0.956	-1.7%		
08102	IN	00	INDIANA	0.937	0.935	-0.3%	0.925	-1.2%	0.914	-2.5%		
05102	IA	00	IOWA	0.934	0.934	0.0%	0.926	-0.9%	0.918	-1.7%		
05202	KS	00	KANSAS	0.944	0.940	-0.4%	0.930	-1.4%	0.917	-2.8%		
15102	KY	00	KENTUCKY	0.938	0.936	-0.3%	0.928	-1.1%	0.918	-2.1%		
07202	LA	01	NEW ORLEANS	0.996	0.993	-0.3%	0.987	-0.9%	0.978	-1.8%		
07202	LA	99	REST OF LOUISIANA	0.958	0.957	-0.1%	0.947	-1.1%	0.937	-2.2%		
14112	ME	03	SOUTHERN MAINE	0.989	0.986	-0.3%	0.984	-0.5%	0.979	-1.0%		
14112	ME	99	REST OF MAINE	0.951	0.945	-0.6%	0.936	-1.6%	0.921	-3.2%		
12302	MD	01	BALTIMORE/SURR. CNTYS	1.067	1.069	0.2%	1.069	0.2%	1.071	0.4%		
12302	MD	99	REST OF MARYLAND	1.023	1.024	0.1%	1.024	0.1%	1.025	0.2%		
14212	MA	01	METROPOLITAN BOSTON	1.100	1.104	0.4%	1.104	0.4%	1.109	0.9%		
14212	MA	99	REST OF MASSACHUSETTS	1.043	1.038	-0.4%	1.038	-0.4%	1.034	-0.9%		
08202	MI	01	DETROIT	1.025	1.025	0.0%	1.022	-0.2%	1.020	-0.5%		
08202	MI	99	REST OF MICHIGAN	0.964	0.962	-0.3%	0.955	-1.0%	0.945	-2.1%		
06202	MN	00	MINNESOTA	0.978	0.978	0.0%	0.978	0.0%	0.978	0.0%		
07302	MS	00	MISSISSIPPI	0.915	0.915	0.0%	0.904	-1.2%	0.893	-2.4%		
05302	MO	02	METROPOLITAN KANSAS CITY	0.987	0.981	-0.6%	0.976	-1.1%	0.966	-2.1%		
05302	MO	01	METROPOLITAN ST. LOUIS	0.984	0.984	0.0%	0.981	-0.3%	0.979	-0.5%		
05302	MO	99	REST OF MISSOURI	0.938	0.932	-0.7%	0.921	-1.9%	0.903	-3.8%		
03202	MT	01	MONTANA***	1.027	1.013	-1.4%	1.000	-2.6%	0.973	-5.2%		
05402	NE	00	NEBRASKA	0.930	0.928	-0.2%	0.921	-1.0%	0.911	-2.1%		
01312	NV	00	NEVADA***	1.005	1.007	0.3%	1.007	0.3%	1.018	1.3%		
14312	NH	40	NEW HAMPSHIRE	1.022	1.018	-0.4%	1.018	-0.5%	1.013	-0.9%		
12402	NJ	01	NORTHERN NJ	1.099	1.106	0.6%	1.106	0.6%	1.113	1.2%		
12402	NJ	99	REST OF NEW JERSEY	1.065	1.072	0.7%	1.072	0.7%	1.080	1.4%		
04212	NM	05	NEW MEXICO	0.975	0.968	-0.8%	0.963	-1.3%	0.950	-2.6%		
13202	NY	01	MANHATTAN	1.134	1.149	1.3%	1.149	1.3%	1.164	2.7%		
13202	NY	02	NYC SUBURBS/LONG ISLAND	1.162	1.179	1.5%	1.179	1.5%	1.196	3.0%		
13202	NY	03	POUGHKPSIE/N NYC SUBURBS	1.053	1.071	1.7%	1.071	1.7%	1.089	3.4%		
13292	NY	04	QUEENS	1.164	1.183	1.6%	1.183	1.6%	1.202	3.3%		
13282	NY	99	REST OF NEW YORK	0.960	0.965	0.5%	0.962	0.2%	0.964	0.4%		
11502	NC	00	NORTH CAROLINA	0.956	0.958	0.2%	0.952	-0.4%	0.948	-0.8%		
03302	ND	01	NORTH DAKOTA***	0.980	0.978	-0.2%	0.970	-1.0%	0.960	-2.0%		
15202	OH	00	OHIO	0.963	0.964	0.1%	0.960	-0.3%	0.957	-0.7%		
04312	OK	00	OKLAHOMA	0.949	0.943	-0.6%	0.933	-1.7%	0.916	-3.5%		
02302	OR	01	PORTLAND	1.020	1.020	0.0%	1.020	0.0%	1.020	0.0%		
02302	OR	99	REST OF OREGON	0.976	0.966	-1.0%	0.962	-1.4%	0.949	-2.8%		
12502	PA	01	METROPOLITAN PHILADELPHIA	1.061	1.059	-0.2%	1.059	-0.2%	1.057	-0.4%		
12502	PA	99	REST OF PENNSYLVANIA	0.973	0.970	-0.3%	0.967	-0.6%	0.961	-1.2%		
09202	PR	20	PUERTO RICO	1.003	1.003	0.0%	1.002	0.0%	1.002	-0.1%		
14412	RI	01	RHODE ISLAND	1.036	1.034	-0.2%	1.034	-0.2%	1.031	-0.5%		
11202	SC	01	SOUTH CAROLINA	0.941	0.942	0.1%	0.935	-0.7%	0.928	-1.4%		
03402	SD	02	SOUTH DAKOTA***	0.974	0.973	-0.1%	0.960	-1.4%	0.947	-2.7%		
10312	TN	35	TENNESSEE	0.935	0.933	-0.3%	0.925	-1.0%	0.916	-2.1%		
04412	TX	31	AUSTIN	0.999	1.003	0.4%	1.003	0.4%	1.007	0.9%		
04412	TX	20	BEAUMONT	0.959	0.957	-0.2%	0.954	-0.5%	0.950	-1.0%		
04412	TX	09	BRAZORIA	1.002	1.004	0.3%	1.004	0.3%	1.007	0.5%		
04412	TX	11	DALLAS	1.002	1.003	0.1%	1.003	0.1%	1.004	0.2%		
04412	TX	28	FORT WORTH	0.986	0.986	0.0%	0.986	0.0%	0.986	-0.1%		
04412	TX	15	GALVESTON	1.008	1.008	0.0%	1.008	0.0%	1.009	0.0%		
04412	TX	18	HOUSTON	1.013	1.019	0.6%	1.019	0.6%	1.025	1.2%		
04412	TX	99	REST OF TEXAS	0.963	0.963	-0.1%	0.961	-0.3%	0.958	-0.6%		
03502	UT	09	UTAH	0.974	0.965	-1.0%	0.957	-1.8%	0.940	-3.5%		
14512	VT	50	VERMONT	0.989	0.986	-0.4%	0.981	-0.8%	0.973	-1.6%		
11302	VA	00	VIRGINIA	0.990	0.992	0.2%	0.991	0.2%	0.993	0.3%		
09202	VI	50	VIRGIN ISLANDS	1.003	1.003	0.0%	1.002	0.0%	1.002	-0.1%		
02402	WA	02	SEATTLE (KING CNTY)	1.076	1.086	0.9%	1.086	0.9%	1.096	1.8%		
02402	WA	99	REST OF WASHINGTON	1.001	0.998	-0.3%	0.998	-0.3%	0.995	-0.6%		
11402	WV	16	WEST VIRGINIA	0.949	0.947	-0.2%	0.937	-1.3%	0.925	-2.5%		
06302	WI	00	WISCONSIN	0.953	0.948	-0.5%	0.943	-1.0%	0.933	-2.0%		
03602	WY	21	WYOMING***	0.995	0.994	-0.1%	0.986	-0.9%	0.978	-1.7%		
"MAC assignments as of December 19, 2019"												
												
GAF equation: (0.50866 * work GPCI) + (0.44839 * PE GPCI) + (0.04295 * MP GPCI).												
												
"*For January 1, 2020 through May 22, 2020, the GAFs reflect 1.0 Work GPCI floor as required by Section 101 of division N of the Further Consolidated Appropriations Act of 2020.  "												
"(* Note:  For January 1, 2019 through December 31, 2019 the GPCIs reflect a 1.0 Work GPCI floor as required by the Bipartisan Budget Act of 2018)."												
"   The 1.0 Work GPCI floor expires on May 22, 2020, therefore GAFs for 2020 are also shown without a 1.0 floor, and the GAFs for 2021 do not reflect a 1.0 floor."												
												
**GAF reflects a 1.5 work GPCI floor in Alaska established by the MIPPA.												
***GAF reflects a 1.0 PE GPCI floor for frontier states established by the Affordable Care Act.												
												
 												
