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Title II — Encouraging Medicaid Expansion and Strengthening the Medicaid Program

H.R. 1425 · 116th Congress · Jun 30, 2020 · Lineage

II Encouraging Medicaid Expansion and Strengthening the Medicaid Program

Sec. 201 Incentivizing Medicaid expansion

(a)
In general— Section 1905(y)(1) of the Social Security Act (42 U.S.C. 1396d(y)(1)) is amended—
(1)
in subparagraph (A), by striking “2014, 2015, and 2016” and inserting “each of the first 3 consecutive 12-month periods in which the State provides medical assistance to newly eligible individuals”;
(2)
in subparagraph (B), by striking “2017” and inserting “the fourth consecutive 12-month period in which the State provides medical assistance to newly eligible individuals”;
(3)
in subparagraph (C), by striking “2018 ” and inserting “the fifth consecutive 12-month period in which the State provides medical assistance to newly eligible individuals”;
(4)
in subparagraph (D), by striking “2019” and inserting “the sixth consecutive 12-month period in which the State provides medical assistance to newly eligible individuals”; and
(5)
in subparagraph (E), by striking “2020 and each year thereafter” and inserting “the seventh consecutive 12-month period in which the State provides medical assistance to newly eligible individuals and each such period thereafter”.
(b)
Effective date— Beginning on January 1, 2022, the amendments made by subsection (a) shall take effect as if included in the enactment of the Patient Protection and Affordable Care Act (Public Law 111–148).

Sec. 202 Providing 12-months of continuous eligibility for Medicaid and CHIP

(a)
Requirement of 12-Month continuous enrollment under Medicaid— Section 1902(e)(12) of the Social Security Act (42 U.S.C. 1396a(e)(12)) is amended to read as follows:

“(12) 12-month continuous enrollment—Notwithstanding any other provision of this title, a State plan approved under this title (or under any waiver of such plan approved pursuant to section 1115 or section 1915), shall provide that an individual who is determined to be eligible for benefits under such plan (or waiver) shall remain eligible and enrolled for such benefits through the end of the month in which the 12-month period (beginning on the date of determination of eligibility) ends.”

(b)
Requirement of 12-Month continuous enrollment under CHIP—
(1)
In general— Section 2102(b) of the Social Security Act (42 U.S.C. 1397bb(b)) is amended by adding at the end the following new paragraph:

“(6) Requirement for 12-month continuous enrollment—Notwithstanding any other provision of this title, a State child health plan that provides child health assistance under this title through a means other than described in section 2101(a)(2), shall provide that an individual who is determined to be eligible for benefits under such plan shall remain eligible and enrolled for such benefits through the end of the month in which the 12-month period (beginning on the date of determination of eligibility) ends.”

(2)
Conforming amendment— Section 2105(a)(4)(A) of the Social Security Act (42 U.S.C. 1397ee(a)(4)(A)) is amended—
(A)
by striking “has elected the option of” and inserting “is in compliance with the requirement for”; and
(B)
by striking “applying such policy under its State child health plan under this title” and inserting “in compliance with section 2102(b)”.
(c)
Effective date—
(1)
In general— Except as provided in paragraph (2) or (3), the amendments made by subsections (a) and (b) shall apply to determinations (and redeterminations) of eligibility made on or after the date that is 12 months after the last day of the emergency period described in section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)).
(2)
Extension of effective date for State law amendment— In the case of a State plan under title XIX or State child health plan under title XXI of the Social Security Act (42 U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the respective plan to meet the additional requirement imposed by the amendment made by subsection (a) or (b), respectively, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such applicable additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.
(3)
Option to implement 12-month continuous eligibility prior to effective date— A State may elect through a State plan amendment under title XIX or XXI of the Social Security Act (42 U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) to apply the amendment made by subsection (a) or (b), respectively, on any date prior to the date specified in paragraph (1), but not sooner than the date of the enactment of this Act.

Sec. 203 Mandatory 12-months of postpartum Medicaid eligibility

(a)
Extending continuous Medicaid and CHIP coverage for pregnant and postpartum women—
(1)
Medicaid— Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended—
(A)
in section 1902(l)(1)(A), by striking “60-day period” and inserting “365-day period”;
(B)
in section 1902(e)(6), by striking “60-day period” and inserting “365-day period”;
(C)
in section 1903(v)(4)(A)(i), by striking “60-day period” and inserting “365-day period”; and
(D)
in section 1905(a), in the 4th sentence in the matter following paragraph (30), by striking “60-day period” and inserting “365-day period”.
(2)
CHIP— Section 2112 of the Social Security Act (42 U.S.C. 1397ll) is amended by striking “60-day period” each place it appears and inserting “365-day period”.
(b)
Requiring full benefits for pregnant and postpartum women—
(1)
Medicaid—
(A)
In general— Paragraph (5) of section 1902(e) of the Social Security Act (24 U.S.C. 1396a(e)) is amended to read as follows:

“(5) Any woman who is eligible for medical assistance under the State plan or a waiver of such plan and who is, or who while so eligible becomes, pregnant, shall continue to be eligible under the plan or waiver for medical assistance through the end of the month in which the 365-day period (beginning on the last day of her pregnancy) ends, regardless of the basis for the woman's eligibility for medical assistance, including if the woman's eligibility for medical assistance is on the basis of being pregnant.”

(B)
Conforming amendment— Section 1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in the matter following subparagraph (G) by striking “(VII) the medical assistance” and all that follows through “complicate pregnancy,”.
(2)
CHIP— Section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended—
(A)
by redesignating subparagraphs (H) through (S) as subparagraphs (I) through (T), respectively; and
(B)
by inserting after subparagraph (G), the following:

“(H) Section 1902(e)(5) (requiring 365-day continuous coverage for pregnant and postpartum women).”

(c)
Maintenance of effort—
(1)
Medicaid— Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—
(A)
in paragraph (74), by striking “subsection (gg); and” and inserting “subsections (gg) and (qq);”; and
(B)
by adding at the end the following new subsection:

“(qq) Maintenance of effort related to low-Income pregnant women—For calendar quarters beginning on or after the effective date described in section 203(d) of the Patient Protection and Affordable Care Enhancement Act, and before January 1, 2023, no Federal payment shall be made to a State under section 1903(a) for amounts expended under a State plan under this title or a waiver of such plan if the State—

“(1) has in effect under such plan eligibility standards, methodologies, or procedures for individuals described in subsection (l)(1) who are eligible for medical assistance under the State plan or waiver under subsection (a)(10)(A)(ii)(IX) that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, for such individuals under such plan or waiver that are in effect on the date of the enactment of this subsection; or

“(2) provides medical assistance to individuals described in subsection (l)(1) who are eligible for medical assistance under such plan or waiver under subsection (a)(10)(A)(ii)(IX) at a level that is less than the level at which the State provides such assistance to such individuals under such plan or waiver on the date of the enactment of this subsection.”

(2)
CHIP— Section 2112 of the Social Security Act (42 U.S.C. 1397ll), as amended by subsection (b), is further amended by adding at the end the following subsection:

“(g) Maintenance of effort—For calendar quarters beginning on or after the effective date described in section 203(d) of the Patient Protection and Affordable Care Enhancement Act, and before January 1, 2023, no payment may be made under section 2105(a) with respect to a State child health plan if the State—

“(1) has in effect under such plan eligibility standards, methodologies, or procedures for targeted low-income pregnant women that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan that are in effect on the date of the enactment of this subsection; or

“(2) provides pregnancy-related assistance to targeted low-income pregnant women under such plan at a level that is less than the level at which the State provides such assistance to such women under such plan on the date of the enactment of this subsection.”

(d)
Effective date—
(1)
In general— Except as provided under paragraph (2), the amendments made by subsections (a) and (b) shall take effect on (and the effective date described in this subsection shall be) the first day of the calendar quarter during which the last day of the emergency period described in section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)) occurs.
(2)
Extension of effective date for State law amendment— In the case of a State plan under title XIX or State child health plan under title XXI of the Social Security Act (42 U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the respective plan to meet the additional requirement imposed by the amendments made by subsection (a) or (b), respectively, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such applicable additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.

Sec. 204 Reducing the administrative FMAP for nonexpansion States

Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended—
(1)
in subsection (a)(7), by inserting “subsection (bb) and” before “section 1919(g)(3)(B)”; and
(2)
by adding at the end the following new subsection:

“(bb) Reduction of Federal payments for certain administrative costs of nonexpansion States

“(1) In general—In the case of a State that does not provide under the State plan of such State (or waiver of such plan) for making medical assistance available in accordance with section 1902(k)(1) to all individuals described in section 1902(a)(10)(i)(VIII) for a calendar quarter beginning on or after October 1, 2022, the Secretary may reduce the percentage specified in subsection (a)(7) for amounts described in such subsection expended during such quarter by such State by the number of percentage points specified in paragraph (2) for such quarter.

“(2) Amount of reduction—For purposes of paragraph (1), the number of percentage points specified in this paragraph for a calendar quarter is the following:

“(A) For the calendar quarter beginning on October 1, 2022, 0.5.

“(B) For a calendar quarter beginning on or after January 1, 2023, and ending before July 1, 2027, the number of percentage points specified under this paragraph for the previous quarter, plus 0.5.

“(C) For a calendar quarter beginning on or after July 1, 2027, 10.

“(3) Definition—For purposes of this subsection, the term “State” means a State that is one of the 50 States or the District of Columbia.”

Sec. 205 Enhanced reporting requirements for nonexpansion states

Section 1903 of the Social Security Act (42 U.S.C. 1396b), as amended by section 204, is further amended—
(1)
in subsection (a)(7), by striking “subsection (bb)” and inserting “subsections (bb) and (cc)”; and
(2)
by adding at the end the following new subsection:

“(cc) Reduction of Federal payments for certain administrative costs of nonexpansion States that do not satisfy reporting requirements

“(1) In general

“(A) Reduction—In the case of a nonexpansion State, with respect to a fiscal year (beginning with fiscal year 2023) that does not satisfy the reporting requirement under paragraph (2) for such fiscal year, the percentage specified in subsection (a)(7) for amounts described in such subsection expended by such State during a calendar quarter described in paragraph (4) with respect to such fiscal year, subject to subparagraph (B), shall be reduced by the number of percentage points specified in paragraph (4) for the respective calendar quarter.

“(B) Exception—In the case of a nonexpansion State that is subject to a reduction under subparagraph (A) for the calendar quarter described in paragraph (4)(A) with respect to a fiscal year, if the State satisfies the criteria described in subparagraphs (A), (B), and (C) of paragraph (2) (without regard to the dates specified in such subparagraph (A) and (C)) before the beginning of a subsequent calendar quarter described in paragraph (4) with respect to such fiscal year, then such State shall not be subject to a reduction under subparagraph (A) for such subsequent calendar quarter.

“(2) Reporting requirement—For purposes of paragraph (1), a nonexpansion State satisfies the reporting requirement under this paragraph for a fiscal year, if the nonexpansion State—

“(A) by not later than January 1 of such year, posts on the public website of the State agency administering the State plan, the information described in paragraph (3) with respect to such State for the previous year;

“(B) provides for at least a 30-day period for notice and comment on such information; and

“(C) by not later than March 1 of such year, submits to the Secretary a complete report including such information, comments submitted pursuant to subparagraph (B), and a response by the State to each such comment.

“(3) Information described—The information described in this paragraph, with respect to a State and year, is the following:

“(A) The the estimated number of individuals who were uninsured for at least 6 months, shown by age-groups of 0 to 18 years of age and of 19 years of age to 64 years of age, as well as a detailed description of the basis for the estimates.

“(B) The estimated number of the individuals estimated under subparagraph (A) in the State who would be eligible for medical assistance under the State plan if the State were to make medical assistance under the State plan available in accordance with section 1902(k)(1) to all individuals described in section 1902(a)(10)(i)(VIII), and a detailed description of the basis for the estimates.

“(C) A comprehensive listing of State income eligibility criteria for all mandatory and optional Medicaid eligibility groups for which the State plan provides medical assistance (other than with respect to individuals described in clause (i)(II), (ii)(VI), or (ii)(XXII) of section 1902(a)(10)(A)).

“(D) The total amount of hospital uncompensated-care costs and a breakdown of the source of such costs, as well as a breakdown for rural and non-rural hospitals.

“(4) Percentage described—For purposes of paragraph (1), a calendar quarter described in this paragraph, with respect to a fiscal year, and the percentage points described in this paragraph for such quarter, with respect to a State, are—

“(A) for the calendar quarter beginning on the April 1 occurring during such fiscal year, 0.5 percentage points;

“(B) for the calendar quarter beginning on the July 1 occurring during such fiscal year, 1.0 percentage point; and

“(C) for the calendar quarter beginning on the October 1 occurring during the subsequent fiscal year, 1.5 percentage points.

“(5) Payment in case of reporting State—The expenses incurred by a non-expansion State, with respect to any calendar quarter with respect to a fiscal year (beginning with 2021), for carrying out subparagraphs (A) through (C) of paragraph (2) shall, for purposes of section 1903(a)(7), be considered to be expenses necessary for the proper and efficient administration of the State plan under this title.

“(6) Nonexpanion State defined—For purposes of this subsection, the term “nonexpansion State” means, with respect to a fiscal year, a State that as of the first quarter of such fiscal year does not provide under the State plan of such State (or waiver of such plan) for making medical assistance available in accordance with section 1902(k)(1) to all individuals described in section 1902(a)(10)(i)(VIII).”

Sec. 206 Primary care pay increase

(a)
Renewal of payment floor; additional providers—
(1)
In general— Section 1902(a)(13) of the Social Security Act (42 U.S.C. 1396a(a)(13)) is amended by striking subparagraph (C) and inserting the following:

“(C) payment for primary care services (as defined in subsection (jj)) at a rate that is not less than 100 percent of the payment rate that applies to such services and physician under part B of title XVIII (or, if greater, the payment rate that would be applicable under such part if the conversion factor under section 1848(d) for the year involved were the conversion factor under such section for 2009), and that is not less than the rate that would otherwise apply to such services under this title if the rate were determined without regard to this subparagraph, and that are—

“(i) furnished during 2013 and 2014, by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine; or

“(ii) furnished during the period that begins on the first day of the first month that begins one year after the date of enactment of the Patient Protection and Affordable Care Enhancement Act and ends September 30, 2024—

“(I) by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine, but only if the physician self-attests that the physician is Board certified in family medicine, general internal medicine, or pediatric medicine;

“(II) by a physician with a primary specialty designation of obstetrics and gynecology, but only if the physician self-attests that the physician is Board certified in obstetrics and gynecology;

“(III) by an advanced practice clinician, as defined by the Secretary, that works under the supervision of—

“(aa) a physician that satisfies the criteria specified in subclause (I) or (II); or

“(bb) a nurse practitioner or a physician assistant (as such terms are defined in section 1861(aa)(5)(A)) who is working in accordance with State law, or a certified nurse-midwife (as defined in section 1861(gg)) who is working in accordance with State law;

“(IV) by a rural health clinic, Federally-qualified health center, or other health clinic that receives reimbursement on a fee schedule applicable to a physician, a nurse practitioner or a physician assistant (as such terms are defined in section 1861(aa)(5)(A)) who is working in accordance with State law, or a certified nurse-midwife (as defined in section 1861(gg)) who is working in accordance with State law, for services furnished by a physician, nurse practitioner, physician assistant, or certified nurse-midwife, or services furnished by an advanced practice clinician supervised by a physician described in subclause (I)(aa) or (II)(aa), another advanced practice clinician, or a certified nurse-midwife; or

“(V) by a nurse practitioner or a physician assistant (as such terms are defined in section 1861(aa)(5)(A)) who is working in accordance with State law, or a certified nurse-midwife (as defined in section 1861(gg)) who is working in accordance with State law, in accordance with procedures that ensure that the portion of the payment for such services that the nurse practitioner, physician assistant, or certified nurse-midwife is paid is not less than the amount that the nurse practitioner, physician assistant, or certified nurse-midwife would be paid if the services were provided under part B of title XVIII;”

(2)
Conforming amendments— Section 1905(dd) of the Social Security Act (42 U.S.C. 1396d(dd)) is amended—
(A)
by striking “Notwithstanding” and inserting the following:

“(1) In general—Notwithstanding”

(B)
by inserting “or furnished during the additional period specified in paragraph (2),” after “2015,”; and
(C)
by adding at the end the following:

“(2) Additional period—For purposes of paragraph (1), the additional period specified in this paragraph is the period that begins on the first day of the first month that begins one year after the date of enactment of the Patient Protection and Affordable Care Enhancement Act.”

(b)
Improved targeting of primary care— Section 1902(jj) of the Social Security Act (42 U.S.C. 1396a(jj)) is amended—
(1)
by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively and realigning the left margins accordingly;
(2)
by striking “For purposes of” and inserting the following:

“(1) In general—For purposes of”

(3)
by adding at the end the following:

“(2) Exclusions—Such term does not include any services described in subparagraph (A) or (B) of paragraph (1) if such services are provided in an emergency department of a hospital.”

(c)
Ensuring payment by managed care entities—
(1)
In general— Section 1903(m)(2)(A) of the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended—
(A)
in clause (xii), by striking “and” after the semicolon;
(B)
by realigning the left margin of clause (xiii) so as to align with the left margin of clause (xii) and by striking the period at the end of clause (xiii) and inserting “; and”; and
(C)
by inserting after clause (xiii) the following:

“(xiv) such contract provides that (I) payments to providers specified in section 1902(a)(13)(C) for primary care services defined in section 1902(jj) that are furnished during a year or period specified in section 1902(a)(13)(C) and section 1905(dd) are at least equal to the amounts set forth and required by the Secretary by regulation, (II) the entity shall, upon request, provide documentation to the State, sufficient to enable the State and the Secretary to ensure compliance with subclause (I), and (III) the Secretary shall approve payments described in subclause (I) that are furnished through an agreed upon capitation, partial capitation, or other value-based payment arrangement if the capitation, partial capitation, or other value-based payment arrangement is based on a reasonable methodology and the entity provides documentation to the State sufficient to enable the State and the Secretary to ensure compliance with subclause (I).”

(2)
Conforming amendment— Section 1932(f) of the Social Security Act (42 U.S.C. 1396u–2(f)) is amended by inserting “and clause (xiv) of section 1903(m)(2)(A)” before the period.

Sec. 207 Permanent funding for CHIP

(a)
In general— Section 2104(a) of the Social Security Act (42 U.S.C. 1397dd(a)) is amended—
(1)
in paragraph (26), by inserting at the end “and”;
(2)
by amending paragraph (27) to read as follows:

“(27) for each fiscal year beginning with fiscal year 2024, such sums as are necessary to fund allotments to States under subsections (c) and (m).”

(3)
by striking paragraph (28).
(b)
In general— Section 2104(a)(28) of the Social Security Act (42 U.S.C. 1397dd(a)(28)) is amended to read as follows:

“(28) for fiscal year 2027 and each subsequent year, such sums as are necessary to fund allotments to States under subsections (c) and (m).”

(c)
Allotments—
(1)
In general— Section 2104(m) of the Social Security Act (42 U.S.C. 1397dd(m)) is amended—
(A)
in paragraph (2)(B)(i), by striking “,, 2023, and 2027” and inserting “and 2023”;
(B)
in paragraph (7)—
(i)
in subparagraph (A), by striking “and ending with fiscal year 2027,”; and
(ii)
in the flush left matter at the end, by striking “or fiscal year 2026” and inserting “fiscal year 2026, or a subsequent even-numbered fiscal year”;
(C)
in paragraph (9)—
(i)
by striking “(10), or (11)” and inserting “or (10)”; and
(ii)
by striking “2023, or 2027,” and inserting “or 2023”; and
(D)
by striking paragraph (11).
(2)
Conforming amendment— Section 50101(b)(2) of the Bipartisan Budget Act of 2018 (Public Law 115–123) is repealed.

Sec. 208 Permanent extension of CHIP enrollment and quality measures

(a)
Pediatric quality measures program— Section 1139A(i)(1) of the Social Security Act (42 U.S.C. 1320b–9a(i)(1)) is amended—
(1)
in subparagraph (C), by striking at the end “and”;
(2)
in subparagraph (D), by striking the period at the end and insert a semicolon; and
(3)
by adding at the end the following new subparagraphs:

“(E) for fiscal year 2028, $15,000,000 for the purpose of carrying out this section (other than subsections (e), (f), and (g)); and

“(F) for a subsequent fiscal year, the amount appropriated under this paragraph for the previous fiscal year, increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) over such previous fiscal year, for the purpose of carrying out this section (other than subsections (e), (f), and (g)).”

(b)
Express lane eligibility option— Section 1902(e)(13) of the Social Security Act (42 U.S.C. 1396a(e)(13)) is amended by striking subparagraph (I).
(c)
Assurance of affordability standard for children and families—
(1)
In general— Section 2105(d)(3) of the Social Security Act (42 U.S.C. 1397ee(d)(3)) is amended—
(A)
in the paragraph heading, by striking “through September 30, 2027”; and
(B)
in subparagraph (A), in the matter preceding clause (i)—
(i)
by striking “During the period that begins on the date of enactment of the Patient Protection and Affordable Care Act and ends on September 30, 2027” and inserting “Beginning on the date of the enactment of the Patient Protection and Affordable Care Act”;
(ii)
by striking “During the period that begins on October 1, 2019, and ends on September 30, 2027” and inserting “Beginning on October 1, 2019”; and
(iii)
by striking “The preceding sentences shall not be construed as preventing a State during any such periods from” and inserting “The preceding sentences shall not be construed as preventing a State from”.
(2)
Conforming amendments— Section 1902(gg)(2) of the Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended—
(A)
in the paragraph heading, by striking “through September 30, 2027”; and
(B)
by striking “through September 30” and all that follows through “ends on September 30, 2027” and inserting “(but beginning on October 1, 2019,”.
(d)
Qualifying states option— Section 2105(g)(4) of the Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended—
(1)
in the paragraph heading, by striking “for fiscal years 2009 through 2027” and inserting “after fiscal year 2008”; and
(2)
in subparagraph (A), by striking “for any of fiscal years 2009 through 2027” and inserting “for any fiscal year after fiscal year 2008”.
(e)
Outreach and enrollment program— Section 2113 of the Social Security Act (42 U.S.C. 1397mm) is amended—
(1)
in subsection (a)—
(A)
in paragraph (1), by striking “during the period of fiscal years 2009 through 2027” and inserting “, beginning with fiscal year 2009,”;
(B)
in paragraph (2)—
(i)
by striking “10 percent of such amounts” and inserting “10 percent of such amounts for the period or the fiscal year for which such amounts are appropriated”; and
(ii)
by striking “during such period” and inserting “, during such period or such fiscal year,”; and
(C)
in paragraph (3), by striking “For the period of fiscal years 2024 through 2027, an amount equal to 10 percent of such amounts” and inserting “Beginning with fiscal year 2024, an amount equal to 10 percent of such amounts for the period or the fiscal year for which such amounts are appropriated”; and
(2)
in subsection (g)—
(A)
by striking “2017,,” and inserting “2017,”;
(B)
by striking “and $48,000,000” and inserting “$48,000,000”; and
(C)
by inserting after “through 2027” the following: “, $12,000,000 for fiscal year 2028, and, for each fiscal year after fiscal year 2028, the amount appropriated under this subsection for the previous fiscal year, increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) over such previous fiscal year”.
(f)
Child enrollment contingency fund— Section 2104(n) of the Social Security Act (42 U.S.C. 1397dd(n)) is amended—
(1)
in paragraph (2)—
(A)
in subparagraph (A)(ii)—
(i)
by striking “and 2024 through 2026” and inserting “beginning with fiscal year 2024”; and
(ii)
by striking “2023, and 2027” and inserting “, and 2023”; and
(B)
in subparagraph (B)—
(i)
by striking “2024 through 2026” and inserting “beginning with fiscal year 2024”; and
(ii)
by striking “2023, and 2027” and inserting “, and 2023”; and
(2)
in paragraph (3)(A)—
(A)
by striking “fiscal years 2024 through 2026” and inserting “beginning with fiscal year 2024”; and
(B)
by striking “2023, or 2027” and inserting “, or 2023”.

Sec. 209 State option to increase children’s eligibility for Medicaid and CHIP

Section 2110(b)(1)(B)(ii) of the Social Security Act (42 U.S.C. 1397jj(b)(1)(B)(ii)) is amended—
(1)
in subclause (II), by striking “or” at the end;
(2)
in subclause (III), by striking “and” at the end and inserting “or”; and
(3)
by inserting after subclause (III) the following new subclause:

“(IV) at the option of the State, whose family income exceeds the maximum income level otherwise established for children under the State child health plan as of the date of the enactment of this subclause; and”

Sec. 210 Medicaid coverage for citizens of Freely Associated States

(a)
In general— Section 402(b)(2) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at the end the following new subparagraph:

“(G) Medicaid exception for citizens of Freely Associated States—With respect to eligibility for benefits for the designated Federal program defined in paragraph (3)(C) (relating to the Medicaid program), section 401(a) and paragraph (1) shall not apply to any individual who lawfully resides in 1 of the 50 States or the District of Columbia in accordance with the Compacts of Free Association between the Government of the United States and the Governments of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau and shall not apply, at the option of the Governor of Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa as communicated to the Secretary of Health and Human Services in writing, to any individual who lawfully resides in the respective territory in accordance with such Compacts.”

(b)
Exception to 5–Year limited eligibility— Section 403(d) of such Act (8 U.S.C. 1613(d)) is amended—
(1)
in paragraph (1), by striking “or” at the end;
(2)
in paragraph (2), by striking the period at the end and inserting “; or”; and
(3)
by adding at the end the following new paragraph:

“(3) an individual described in section 402(b)(2)(G), but only with respect to the designated Federal program defined in section 402(b)(3)(C).”

(c)
Definition of qualified alien— Section 431(b) of such Act (8 U.S.C. 1641(b)) is amended—
(1)
in paragraph (6), by striking “; or” at the end and inserting a comma;
(2)
in paragraph (7), by striking the period at the end and inserting “, or”; and
(3)
by adding at the end the following new paragraph:

“(8) an individual who lawfully resides in the United States in accordance with a Compact of Free Association referred to in section 402(b)(2)(G), but only with respect to the designated Federal program defined in section 402(b)(3)(C) (relating to the Medicaid program).”

(d)
Application to State plans— Section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)) is amended by inserting after subclause (IX) the following:

“(X) who are described in section 402(b)(2)(G) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and eligible for benefits under this title by reason of application of such section;”

(e)
Conforming amendments— Section 1108 of the Social Security Act (42 U.S.C. 1308) is amended—
(1)
in subsection (f), in the matter preceding paragraph (1), by striking “subsections (g) and (h) and section 1935(e)(1)(B)” and inserting “subsections (g), (h), and (i) and section 1935(e)(1)(B)”; and
(2)
by adding at the end the following:

“(i) Exclusion of medical assistance expenditures for citizens of Freely Associated States—Expenditures for medical assistance provided to an individual described in section 431(b)(8) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1641(b)(8)) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g).”

(f)
Effective date— The amendments made by this section shall apply to benefits for items and services furnished on or after the date of the enactment of this Act.

Sec. 211 Extension of full Federal medical assistance percentage to Indian health care providers

(a)
In general— Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—
(1)
in subsection (a), by amending paragraph (9) to read as follows:

“(9) clinic services furnished by or under the direction of a physician, without regard to whether the clinic itself is administered by a physician, including—

“(A) such services furnished outside the clinic by clinic personnel to an eligible individual who does not reside in a permanent dwelling or does not have a fixed home or mailing address; and

“(B) such services provided outside the clinic on the basis of a referral from a clinic administered by an Indian Health Program (as defined in paragraph (12) of section 4 of the Indian Health Care Improvement Act, or an Urban Indian Organization as defined in paragraph (29) of section 4 of such Act that has a grant or contract with the Indian Health Service under title V of such Act;”

(2)
in subsection (b), by inserting after “(as defined in section 4 of the Indian Health Care Improvement Act)” the following: “; the Federal medical assistance percentage shall also be 100 per centum with respect to amounts expended as medical assistance for services which are received through an Urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act) that has a grant or contract with the Indian Health Service under title V of such Act”.
(b)
Extension of full Federal medical assistance percentage to services furnished by Native Hawaiian Health Care systems—
(1)
In general— Beginning on the date of enactment of this Act—
(A)
for purposes of section 1905(a)(9) of the Social Security Act (42 U.S.C. 1396d(a)(9)), services described in subsection (b) that are furnished in any location shall be deemed to be clinic services; and
(B)
notwithstanding section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), the Federal medical assistance percentage with respect to amounts expended as medical assistance for such services shall be 100 percent.
(2)
Services described— The services described in this subsection are services for which payment is available under the State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) of Hawaii (or any waiver of such plan) that—
(A)
are furnished on or after the date of enactment of this Act;
(B)
are furnished to an individual who—
(i)
is a Native Hawaiian; and
(ii)
is eligible for medical assistance under such plan; and
(C)
are furnished by an Indian health care provider (as such term is defined in section 1932(h)(4)(A) of the Social Security Act (42 U.S.C. 1396u–2(h)(4)(A)) or a Native Hawaiian health care system (without regard to whether such services are furnished through an Indian Health Service facility).