; increased by (II) the growth factor determined under subclause (ii). (ii) Growth factor For each fiscal year or portion of a fiscal year described in subparagraph (A), the Secretary shall, not later than September 1 of the fiscal year preceding such fiscal year or portion of a fiscal year, determine a growth factor for each State that takes into account— (I) the percentage increase in health care costs in the State; (II) the total amount expended by the State for the previous fiscal year on medical assistance for institutional long-term care services; (III) the increase, if any, in the total population of the State from July of 2022 to July of the fiscal year preceding the fiscal year involved; (IV) the increase, if any, in the population of individuals aged 65 and older of the State from July of 2022 to July of the fiscal year preceding the fiscal year involved