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<p>COMMITTEE PRINT Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of the Patient Protection and Afford- able Care Act TITLE I—ENERGY AND 1 COMMERCE 2 Subtitle A—Patient Access to 3 Public Health Programs 4 SEC. 101. THE PREVENTION AND PUBLIC HEALTH FUND. 5 (a) IN GENERAL.—Subsection (b) of section 4002 of 6 the Patient Protection and Affordable Care Act (42 7 U.S.C. 300u–11), as amended by section 5009 of the 21st 8 Century Cures Act, is amended— 9 (1) in paragraph (2), by adding ‘‘and’’ at the 10 end; 11 (2) in paragraph (3)— 12 (A) by striking ‘‘each of fiscal years 2018 13 and 2019’’ and inserting ‘‘fiscal year 2018’’; 14 and 15 (B) by striking the semicolon at the end 16 and inserting a period; and 17 (3) by striking paragraphs (4) through (8). 18 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 2 (b) RESCISSION OF UNOBLIGATED FUNDS.—Of the 1 funds made available by such section 4002, the unobli- 2 gated balance at the end of fiscal year 2018 is rescinded. 3 SEC. 102. COMMUNITY HEALTH CENTER PROGRAM. 4 Effective as if included in the enactment of the Medi- 5 care Access and CHIP Reauthorization Act of 2015 (Pub- 6 lic Law 114–10, 129 Stat. 87), paragraph (1) of section 7 221(a) of such Act is amended by inserting ‘‘, and an ad- 8 ditional $422,000,000 for fiscal year 2017’’ after ‘‘2017’’. 9 SEC. 103. FEDERAL PAYMENTS TO STATES. 10 (a) IN GENERAL.—Notwithstanding section 504(a), 11 1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or 12 2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 13 1396a(a)(23), 1396b(a), 1397a, 1397d(a)(4), 14 1397bb(a)(7), 1397ee(a)(1)), or the terms of any Med- 15 icaid waiver in effect on the date of enactment of this Act 16 that is approved under section 1115 or 1915 of the Social 17 Security Act (42 U.S.C. 1315, 1396n), for the 1-year pe- 18 riod beginning on the date of the enactment of this Act, 19 no Federal funds provided from a program referred to in 20 this subsection that is considered direct spending for any 21 year may be made available to a State for payments to 22 a prohibited entity, whether made directly to the prohib- 23 ited entity or through a managed care organization under 24 contract with the State. 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 3 (b) DEFINITIONS.—In this section: 1 (1) PROHIBITED ENTITY.—The term ‘‘prohib- 2 ited entity’’ means an entity, including its affiliates, 3 subsidiaries, successors, and clinics— 4 (A) that, as of the date of enactment of 5 this Act— 6 (i) is an organization described in sec- 7 tion 501(c)(3) of the Internal Revenue 8 Code of 1986 and exempt from tax under 9 section 501(a) of such Code; 10 (ii) is an essential community provider 11 described in section 156.235 of title 45, 12 Code of Federal Regulations (as in effect 13 on the date of enactment of this Act), that 14 is primarily engaged in family planning 15 services, reproductive health, and related 16 medical care; and 17 (iii) provides for abortions, other than 18 an abortion— 19 (I) if the pregnancy is the result 20 of an act of rape or incest; or 21 (II) in the case where a woman 22 suffers from a physical disorder, phys- 23 ical injury, or physical illness that 24 would, as certified by a physician, 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 4 place the woman in danger of death 1 unless an abortion is performed, in- 2 cluding a life-endangering physical 3 condition caused by or arising from 4 the pregnancy itself; and 5 (B) for which the total amount of Federal 6 and State expenditures under the Medicaid pro- 7 gram under title XIX of the Social Security Act 8 in fiscal year 2014 made directly to the entity 9 and to any affiliates, subsidiaries, successors, or 10 clinics of the entity, or made to the entity and 11 to any affiliates, subsidiaries, successors, or 12 clinics of the entity as part of a nationwide 13 health care provider network, exceeded 14 $350,000,000. 15 (2) DIRECT SPENDING.—The term ‘‘direct 16 spending’’ has the meaning given that term under 17 section 250(c) of the Balanced Budget and Emer- 18 gency Deficit Control Act of 1985 (2 U.S.C. 900(c)). 19 Subtitle B—Medicaid Program 20 Enhancement 21 SEC. 111. REPEAL OF MEDICAID PROVISIONS. 22 The Social Security Act is amended— 23 (1) in section 1902 (42 U.S.C. 1396a)— 24 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 5 (A) in subsection (a)(47)(B), by inserting 1 ‘‘and provided that any such election shall cease 2 to be effective on January 1, 2020, and no such 3 election shall be made after that date’’ before 4 the semicolon at the end; and 5 (B) in subsection (l)(2)(C), by inserting 6 ‘‘and ending December 31, 2019,’’ after ‘‘Janu- 7 ary 1, 2014,’’; 8 (2) in section 1915(k)(2) (42 U.S.C. 9 1396n(k)(2)), by striking ‘‘during the period de- 10 scribed in paragraph (1)’’ and inserting ‘‘on or after 11 the date referred to in paragraph (1) and before 12 January 1, 2020’’; and 13 (3) in section 1920(e) (42 U.S.C. 1396r–1(e)), 14 by striking ‘‘under clause (i)(VIII), clause (i)(IX), or 15 clause (ii)(XX) of subsection (a)(10)(A)’’ and insert- 16 ing ‘‘under clause (i)(VIII) or clause (ii)(XX) of sec- 17 tion 1902(a)(10)(A) before January 1, 2020, section 18 1902(a)(10)(A)(i)(IX),’’. 19 SEC. 112. REPEAL OF MEDICAID EXPANSION. 20 (a) IN GENERAL.—Section 1902(a)(10)(A) of the So- 21 cial Security Act (42 U.S.C. 1396a(a)(10)(A)) is amend- 22 ed— 23 (1) in clause (i)(VIII), by inserting ‘‘at the op- 24 tion of a State,’’ after ‘‘January 1, 2014,’’; and 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 6 (2) in clause (ii)(XX), by inserting ‘‘and ending 1 December 31, 2019,’’ after ‘‘2014,’’. 2 (b) TERMINATION OF EFMAP FOR NEW ACA EX- 3 PANSION ENROLLEES.—Section 1905 of the Social Secu- 4 rity Act (42 U.S.C. 1396d) is amended— 5 (1) in subsection (y)(1), in the matter preceding 6 subparagraph (A), by striking ‘‘with respect to’’ and 7 all that follows through ‘‘shall be’’ and inserting 8 ‘‘with respect to amounts expended before January 9 1, 2020, by such State for medical assistance for 10 newly eligible individuals described in subclause 11 (VIII) of section 1902(a)(10)(A)(i) who are enrolled 12 under the State plan (or a waiver of the plan) before 13 such date and with respect to amounts expended 14 after such date by such State for medical assistance 15 for individuals described in such subclause who were 16 enrolled under such plan (or waiver of such plan) as 17 of December 31, 2019, and who do not have a break 18 in eligibility for medical assistance under such State 19 plan (or waiver) for more than one month after such 20 date, shall be’’; and 21 (2) in subsection (z)(2)— 22 (A) in subparagraph (A), by striking 23 ‘‘medical assistance for individuals’’ and all that 24 follows through ‘‘shall be’’ and inserting 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 7 ‘‘amounts expended before January 1, 2020, by 1 such State for medical assistance for individuals 2 described in section 1902(a)(10)(A)(i)(VIII) 3 who are nonpregnant childless adults with re- 4 spect to whom the State may require enrollment 5 in benchmark coverage under section 1937 and 6 who are enrolled under the State plan (or a 7 waiver of the plan) before such date and with 8 respect to amounts expended after such date by 9 such State for medical assistance for individuals 10 described in such section, who are nonpregnant 11 childless adults with respect to whom the State 12 may require enrollment in benchmark coverage 13 under section 1937, who were enrolled under 14 such plan (or waiver of such plan) as of Decem- 15 ber 31, 2019, and who do not have a break in 16 eligibility for medical assistance under such 17 State plan (or waiver) for more than one month 18 after such date, shall be’’ ; and 19 (B) in subparagraph (B)(ii)— 20 (i) in subclause (III), by adding 21 ‘‘and’’ at the end; and 22 (ii) by striking subclauses (IV), (V), 23 and (VI) and inserting the following new 24 subclause: 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 8 ‘‘(IV) 2017 and each subsequent year is 80 1 percent.’’. 2 (c) SUNSET OF ESSENTIAL HEALTH BENEFITS RE- 3 QUIREMENT.—Section 1937(b)(5) of the Social Security 4 Act (42 U.S.C. 1396u–7(b)(5)) is amended by adding at 5 the end the following: ‘‘This paragraph shall not apply 6 after December 31, 2019.’’. 7 SEC. 113. ELIMINATION OF DSH CUTS. 8 Section 1923(f) of the Social Security Act (42 U.S.C. 9 1396r–4(f)) is amended— 10 (1) in paragraph (7)— 11 (A) in subparagraph (A)— 12 (i) in clause (i)— 13 (I) in the matter preceding sub- 14 clause (I), by striking ‘‘2025’’ and in- 15 serting ‘‘2019’’; and 16 (ii) in clause (ii)— 17 (I) in subclause (I), by adding 18 ‘‘and’’ at the end; 19 (II) in subclause (II), by striking 20 the semicolon at the end and inserting 21 a period; and 22 (III) by striking subclauses (III) 23 through (VIII); and 24 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 9 (B) by adding at the end the following new 1 subparagraph: 2 ‘‘(C) EXEMPTION FROM EXEMPTION FOR 3 NON-EXPANSION STATES.— 4 ‘‘(i) IN GENERAL.—In the case of a 5 State that is a non-expansion State for a 6 fiscal year, subparagraph (A)(i) shall not 7 apply to the DSH allotment for such State 8 and fiscal year. 9 ‘‘(ii) NO CHANGE IN REDUCTION FOR 10 EXPANSION STATES.—In the case of a 11 State that is an expansion State for a fis- 12 cal year, the DSH allotment for such State 13 and fiscal year shall be determined as if 14 clause (i) did not apply. 15 ‘‘(iii) NON-EXPANSION AND EXPAN- 16 SION STATE DEFINED.— 17 ‘‘(I) The term ‘expansion State’ 18 means with respect to a fiscal year, a 19 State that, as of July 1 of the pre- 20 ceding fiscal year, provides for eligi- 21 bility under clause (i)(VIII) or 22 (ii)(XX) of section 1902(a)(10)(A) for 23 medical assistance under this title (or 24 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 10 a waiver of the State plan approved 1 under section 1115). 2 ‘‘(II) The term ‘non-expansion 3 State’ means, with respect to a fiscal 4 year, a State that is not an expansion 5 State.’’; and 6 (2) in paragraph (8), by striking ‘‘fiscal year 7 2025’’ and inserting ‘‘fiscal year 2019’’. 8 SEC. 114. REDUCING STATE MEDICAID COSTS. 9 (a) LETTING STATES DISENROLL HIGH DOLLAR 10 LOTTERY WINNERS.— 11 (1) IN GENERAL.—Section 1902 of the Social 12 Security Act (42 U.S.C. 1396a) is amended— 13 (A) in subsection (a)(17), by striking 14 ‘‘(e)(14), (e)(14)’’ and inserting ‘‘(e)(14), 15 (e)(15)’’; and 16 (B) in subsection (e)— 17 (i) in paragraph (14) (relating to 18 modified adjusted gross income), by adding 19 at the end the following new subparagraph: 20 ‘‘(J) TREATMENT OF CERTAIN LOTTERY 21 WINNINGS AND INCOME RECEIVED AS A LUMP 22 SUM.— 23 ‘‘(i) IN GENERAL.—In the case of an 24 individual who is the recipient of qualified 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 11 lottery winnings (pursuant to lotteries oc- 1 curring on or after January 1, 2020) or 2 qualified lump sum income (received on or 3 after such date) and whose eligibility for 4 medical assistance is determined based on 5 the application of modified adjusted gross 6 income under subparagraph (A), a State 7 shall, in determining such eligibility, in- 8 clude such winnings or income (as applica- 9 ble) as income received— 10 ‘‘(I) in the month in which such 11 winnings or income (as applicable) is 12 received if the amount of such 13 winnings or income is less than 14 $80,000; 15 ‘‘(II) over a period of 2 months 16 if the amount of such winnings or in- 17 come (as applicable) is greater than or 18 equal to $80,000 but less than 19 $90,000; 20 ‘‘(III) over a period of 3 months 21 if the amount of such winnings or in- 22 come (as applicable) is greater than or 23 equal to $90,000 but less than 24 $100,000; and 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 12 ‘‘(IV) over a period of 3 months 1 plus 1 additional month for each in- 2 crement of $10,000 of such winnings 3 or income (as applicable) received, not 4 to exceed a period of 120 months (for 5 winnings or income of $1,260,000 or 6 more), if the amount of such winnings 7 or income is greater than or equal to 8 $100,000. 9 ‘‘(ii) COUNTING IN EQUAL INSTALL- 10 MENTS.—For purposes of subclauses (II), 11 (III), and (IV) of clause (i), winnings or 12 income to which such subclause applies 13 shall be counted in equal monthly install- 14 ments over the period of months specified 15 under such subclause. 16 ‘‘(iii) HARDSHIP EXEMPTION.—An in- 17 dividual whose income, by application of 18 clause (i), exceeds the applicable eligibility 19 threshold established by the State, may 20 continue to be eligible for medical assist- 21 ance to the extent that the State deter- 22 mines, under procedures established by the 23 State under the State plan (or in the case 24 of a waiver of the plan under section 1115, 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 13 incorporated in such waiver), or as other- 1 wise established by such State in accord- 2 ance with such standards as may be speci- 3 fied by the Secretary, that the denial of eli- 4 gibility of the individual would cause an 5 undue medical or financial hardship as de- 6 termined on the basis of criteria estab- 7 lished by the Secretary. 8 ‘‘(iv) NOTIFICATIONS AND ASSIST- 9 ANCE REQUIRED IN CASE OF LOSS OF ELI- 10 GIBILITY.—A State shall, with respect to 11 an individual who loses eligibility for med- 12 ical assistance under the State plan (or a 13 waiver of such plan) by reason of clause 14 (i), before the date on which the individual 15 loses such eligibility, inform the individual 16 of the date on which the individual would 17 no longer be considered ineligible by reason 18 of such clause to receive medical assistance 19 under the State plan or under any waiver 20 of such plan and the date on which the in- 21 dividual would be eligible to reapply to re- 22 ceive such medical assistance. 23 ‘‘(v) QUALIFIED LOTTERY WINNINGS 24 DEFINED.—In this subparagraph, the term 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 14 ‘qualified lottery winnings’ means winnings 1 from a sweepstakes, lottery, or pool de- 2 scribed in paragraph (3) of section 4402 of 3 the Internal Revenue Code of 1986 or a 4 lottery operated by a multistate or multi- 5 jurisdictional lottery association, including 6 amounts awarded as a lump sum payment. 7 ‘‘(vi) QUALIFIED LUMP SUM INCOME 8 DEFINED.—In this subparagraph, the term 9 ‘qualified lump sum income’ means income 10 that is received as a lump sum from one 11 of the following sources: 12 ‘‘(I) Monetary winnings from 13 gambling (as defined by the Secretary 14 and including monetary winnings from 15 gambling activities described in sec- 16 tion 1955(b)(4) of title 18, United 17 States Code). 18 ‘‘(II) Income received as liquid 19 assets from the estate (as defined in 20 section 1917(b)(4)) of a deceased in- 21 dividual.’’; and 22 (ii) by striking ‘‘(14) EXCLUSION’’ 23 and inserting ‘‘(15) EXCLUSION’’. 24 (2) RULES OF CONSTRUCTION.— 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 15 (A) INTERCEPTION OF LOTTERY WINNINGS 1 ALLOWED.—Nothing in the amendment made 2 by paragraph (1)(B)(i) shall be construed as 3 preventing a State from intercepting the State 4 lottery winnings awarded to an individual in the 5 State to recover amounts paid by the State 6 under the State Medicaid plan under title XIX 7 of the Social Security Act for medical assistance 8 furnished to the individual. 9 (B) APPLICABILITY LIMITED TO ELIGI- 10 BILITY OF RECIPIENT OF LOTTERY WINNINGS 11 OR LUMP SUM INCOME.—Nothing in the amend- 12 ment made by paragraph (1)(B)(i) shall be con- 13 strued, with respect to a determination of 14 household income for purposes of a determina- 15 tion of eligibility for medical assistance under 16 the State plan under title XIX of the Social Se- 17 curity Act (42 U.S.C. 1396 et seq.) (or a waiver 18 of such plan) made by applying modified ad- 19 justed gross income under subparagraph (A) of 20 section 1902(e)(14) of such Act (42 U.S.C. 21 1396a(e)(14)), as limiting the eligibility for 22 such medical assistance of any individual that is 23 a member of the household other than the indi- 24 vidual (or the individual’s spouse) who received 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 16 qualified lottery winnings or qualified lump-sum 1 income (as defined in subparagraph (J) of such 2 section 1902(e)(14), as added by paragraph 3 (1)(B)(i) of this subsection). 4 (b) REPEAL OF RETROACTIVE ELIGIBILITY.— 5 (1) IN GENERAL.— 6 (A) STATE PLAN REQUIREMENTS.—Section 7 1902(a)(34) of the Social Security Act (42 8 U.S.C. 1396a(a)(34)) is amended by striking 9 ‘‘in or after the third month before the month 10 in which he made application’’ and inserting ‘‘in 11 or after the month in which the individual made 12 application’’. 13 (B) DEFINITION OF MEDICAL ASSIST- 14 ANCE.—Section 1905(a) of the Social Security 15 Act (42 U.S.C. 1396d(a)) is amended by strik- 16 ing ‘‘in or after the third month before the 17 month in which the recipient makes application 18 for assistance’’ and inserting ‘‘in or after the 19 month in which the recipient makes application 20 for assistance’’. 21 (2) EFFECTIVE DATE.—The amendments made 22 by paragraph (1) shall apply to medical assistance 23 with respect to individuals whose eligibility for such 24 assistance is based on an application for such assist- 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 17 ance made (or deemed to be made) on or after Octo- 1 ber 1, 2017. 2 (c) ENSURING STATES ARE NOT FORCED TO PAY 3 FOR INDIVIDUALS INELIGIBLE FOR THE PROGRAM.— 4 (1) IN GENERAL.—Section 1137(f) of the Social 5 Security Act (42 U.S.C. 1320b–7(f)) is amended— 6 (A) by striking ‘‘Subsections (a)(1) and 7 (d)’’ and inserting ‘‘(1) Subsections (a)(1) and 8 (d)’’; and 9 (B) by adding at the end the following new 10 paragraph: 11 ‘‘(2)(A) Subparagraphs (A) and (B)(ii) of subsection 12 (d)(4) shall not apply in the case of an initial determina- 13 tion made on or after the date that is 6 months after the 14 date of the enactment of this paragraph with respect to 15 the eligibility of an alien described in subparagraph (B) 16 for benefits under the program listed in subsection (b)(2). 17 ‘‘(B) An alien described in this subparagraph is an 18 individual declaring to be a citizen or national of the 19 United States with respect to whom a State, in accordance 20 with section 1902(a)(46)(B), requires— 21 ‘‘(i) pursuant to 1902(ee), the submission of a 22 social security number; or 23 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 18 ‘‘(ii) pursuant to 1903(x), the presentation of 1 satisfactory documentary evidence of citizenship or 2 nationality.’’. 3 (2) NO PAYMENTS FOR MEDICAL ASSISTANCE 4 PROVIDED BEFORE PRESENTATION OF EVIDENCE.— 5 Section 1903(i)(22) of the Social Security Act (42 6 U.S.C. 1396b(i)(22)) is amended— 7 (A) by striking ‘‘with respect to amounts 8 expended’’ and inserting ‘‘(A) with respect to 9 amounts expended’’; 10 (B) by inserting ‘‘and’’ at the end; and 11 (C) by adding at the end the following new 12 subparagraph: 13 ‘‘(B) in the case of a State that elects to pro- 14 vide a reasonable period to present satisfactory doc- 15 umentary evidence of such citizenship or nationality 16 pursuant to paragraph (2)(C) of section 1902(ee) or 17 paragraph (4) of subsection (x) of this section, for 18 amounts expended for medical assistance for such an 19 individual (other than an individual described in 20 paragraph (2) of such subsection (x)) during such 21 period;’’. 22 (3) CONFORMING AMENDMENTS.—Section 23 1137(d)(4) of the Social Security Act (42 U.S.C. 24 1320b–7(d)(4)) is amended— 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 19 (A) in subparagraph (A), in the matter 1 preceding clause (i), by inserting ‘‘subject to 2 subsection (f)(2),’’ before ‘‘the State’’; and 3 (B) in subparagraph (B)(ii), by inserting 4 ‘‘subject to subsection (f)(2),’’ before ‘‘pending 5 such verification’’. 6 (d) UPDATING ALLOWABLE HOME EQUITY LIMITS 7 IN MEDICAID.— 8 (1) IN GENERAL.—Section 1917(f)(1) of the 9 Social Security Act (42 U.S.C. 1396p(f)(1)) is 10 amended— 11 (A) in subparagraph (A), by striking ‘‘sub- 12 paragraphs (B) and (C)’’ and inserting ‘‘sub- 13 paragraph (B)’’; 14 (B) by striking subparagraph (B); 15 (C) by redesignating subparagraph (C) as 16 subparagraph (B); and 17 (D) in subparagraph (B), as so redesig- 18 nated, by striking ‘‘dollar amounts specified in 19 this paragraph’’ and inserting ‘‘dollar amount 20 specified in subparagraph (A)’’. 21 (2) EFFECTIVE DATE.— 22 (A) IN GENERAL.—The amendments made 23 by paragraph (1) shall apply with respect to eli- 24 gibility determinations made after the date that 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 20 is 180 days after the date of the enactment of 1 this section. 2 (B) EXCEPTION FOR STATE LEGISLA- 3 TION.—In the case of a State plan under title 4 XIX of the Social Security Act that the Sec- 5 retary of Health and Human Services deter- 6 mines requires State legislation in order for the 7 respective plan to meet any requirement im- 8 posed by amendments made by this subsection, 9 the respective plan shall not be regarded as fail- 10 ing to comply with the requirements of such 11 title solely on the basis of its failure to meet 12 such an additional requirement before the first 13 day of the first calendar quarter beginning after 14 the close of the first regular session of the 15 State legislature that begins after the date of 16 the enactment of this Act. For purposes of the 17 previous sentence, in the case of a State that 18 has a 2-year legislative session, each year of the 19 session shall be considered to be a separate reg- 20 ular session of the State legislature. 21 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 21 SEC. 115. SAFETY NET FUNDING FOR NON-EXPANSION 1 STATES. 2 Title XIX of the Social Security Act is amended by 3 inserting after section 1923 (42 U.S.C. 1396r–4) the fol- 4 lowing new section: 5 ‘‘ADJUSTMENT IN PAYMENT FOR SERVICES OF SAFETY 6 NET PROVIDERS IN NON-EXPANSION STATES 7 ‘‘SEC. 1923A. (a) IN GENERAL.—Subject to the limi- 8 tations of this section, for each year during the period be- 9 ginning with 2018 and ending with 2021, each State that 10 is one of the 50 States or the District of Columbia and 11 that, as of July 1 of the preceding year, did not provide 12 for eligibility under clause (i)(VIII) or (ii)(XX) of section 13 1902(a)(10)(A) for medical assistance under this title (or 14 a waiver of the State plan approved under section 1115) 15 (each such State or District referred to in this section for 16 the year as a ‘non-expansion State’) may adjust the pay- 17 ment amounts otherwise provided under the State plan 18 under this title (or a waiver of such plan) to health care 19 providers that provide health care services to individuals 20 enrolled under this title (in this section referred to as ‘eli- 21 gible providers’). 22 ‘‘(b) INCREASE IN APPLICABLE FMAP.—Notwith- 23 standing section 1905(b), the Federal medical assistance 24 percentage applicable with respect to expenditures attrib- 25 utable to a payment adjustment under subsection (a) for 26 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 22 which payment is permitted under subsection (c) shall be 1 equal to— 2 ‘‘(1) 100 percent for calendar quarters in cal- 3 endar years 2018, 2019, 2020, and 2021; and 4 ‘‘(2) 95 percent for calendar quarters in cal- 5 endar year 2022. 6 ‘‘(c) LIMITATIONS; DISQUALIFICATION OF STATES.— 7 ‘‘(1) ANNUAL ALLOTMENT LIMITATION.—Pay- 8 ment under section 1903(a) shall not be made to a 9 State with respect to any payment adjustment made 10 under this section for all calendar quarters in a year 11 in excess of the $2,000,000,000 multiplied by the 12 ratio of— 13 ‘‘(A) the population of the State with in- 14 come below 138 percent of the poverty line in 15 2015 (as determined based the table entitled 16 ‘Health Insurance Coverage Status and Type 17 by Ratio of Income to Poverty Level in the Past 18 12 Months by Age’ for the universe of the civil- 19 ian noninstitutionalized population for whom 20 poverty status is determined based on the 2015 21 American Community Survey 1-Year Estimates, 22 as published by the Bureau of the Census), to 23 ‘‘(B) the sum of the populations under 24 subparagraph (A) for all non-expansion States. 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 23 ‘‘(2) LIMITATION ON PAYMENT ADJUSTMENT 1 AMOUNT FOR INDIVIDUAL PROVIDERS.—The amount 2 of a payment adjustment under subsection (a) for an 3 eligible provider may not exceed the provider’s costs 4 incurred in furnishing health care services (as deter- 5 mined by the Secretary and net of payments under 6 this title, other than under this section, and by unin- 7 sured patients) to individuals who either are eligible 8 for medical assistance under the State plan (or 9 under a waiver of such plan) or have no health in- 10 surance or health plan coverage for such services. 11 ‘‘(d) DISQUALIFICATION IN CASE OF STATE COV- 12 ERAGE EXPANSION.—If a State is a non-expansion for a 13 year and provides eligibility for medical assistance de- 14 scribed in subsection (a) during the year, the State shall 15 no longer be treated as a non-expansion State under this 16 section for any subsequent years.’’. 17 SEC. 116. PROVIDING INCENTIVES FOR INCREASED FRE- 18 QUENCY OF ELIGIBILITY REDETERMINA- 19 TIONS. 20 (a) IN GENERAL.—Section 1902(e)(14) of the Social 21 Security Act (42 U.S.C. 1396a(e)(14)) (relating to modi- 22 fied adjusted gross income), as amended by section 23 114(a)(1), is further amended by adding at the end the 24 following: 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 24 ‘‘(K) FREQUENCY OF ELIGIBILITY REDE- 1 TERMINATIONS.—Beginning on October 1, 2 2017, and notwithstanding subparagraph (H), 3 in the case of an individual whose eligibility for 4 medical assistance under the State plan under 5 this title (or a waiver of such plan) is deter- 6 mined based on the application of modified ad- 7 justed gross income under subparagraph (A) 8 and who is so eligible on the basis of clause 9 (i)(VIII) or clause (ii)(XX) of subsection 10 (a)(10)(A), a State shall redetermine such indi- 11 vidual’s eligibility for such medical assistance 12 no less frequently than once every 6 months.’’. 13 (b) CIVIL MONETARY PENALTY.—Section 1128A(a) 14 of the Social Security Act (42 U.S.C. 1320a–7(a)) is 15 amended, in the matter following paragraph (10), by strik- 16 ing ‘‘(or, in cases under paragraph (3)’’ and inserting the 17 following: ‘‘(or, in cases under paragraph (1) in which an 18 individual was knowingly enrolled on or after October 1, 19 2017, pursuant to section 1902(a)(10)(A)(i)(VIII) for 20 medical assistance under the State plan under title XIX 21 whose income does not meet the income threshold specified 22 in such section or in which a claim was presented on or 23 after October 1, 2017, as a claim for an item or service 24 furnished to an individual described in such section but 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 25 whose enrollment under such State plan is not made on 1 the basis of such individual’s meeting the income threshold 2 specified in such section, $20,000 for each such individual 3 or claim; in cases under paragraph (3)’’. 4 (c) INCREASED ADMINISTRATIVE MATCHING PER- 5 CENTAGE.—For each calendar quarter during the period 6 beginning on October 1, 2017, and ending on December 7 31, 2019, the Federal matching percentage otherwise ap- 8 plicable under section 1903(a) of the Social Security Act 9 (42 U.S.C. 1396b(a)) with respect to State expenditures 10 during such quarter that are attributable to meeting the 11 requirement of section 1902(e)(14) (relating to determina- 12 tions of eligibility using modified adjusted gross income) 13 of such Act shall be increased by 5 percentage points with 14 respect to State expenditures attributable to activities car- 15 ried out by the State (and approved by the Secretary) to 16 increase the frequency of eligibility redeterminations re- 17 quired by subparagraph (K) of such section (relating to 18 eligibility redeterminations made on a 6-month basis) (as 19 added by subsection (a)). 20 Subtitle C—Per Capita Allotment 21 for Medical Assistance 22 SEC. 121. PER CAPITA ALLOTMENT FOR MEDICAL ASSIST- 23 ANCE. 24 Title XIX of the Social Security Act is amended— 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 26 (1) in section 1903 (42 U.S.C. 1396b)— 1 (A) in subsection (a), in the matter before 2 paragraph (1), by inserting ‘‘and section 3 1903A(a)’’ after ‘‘except as otherwise provided 4 in this section’’; and 5 (B) in subsection (d)(1), by striking ‘‘to 6 which’’ and inserting ‘‘to which, subject to sec- 7 tion 1903A(a),’’; and 8 (2) by inserting after such section 1903 the fol- 9 lowing new section: 10 ‘‘SEC. 1903A. PER CAPITA-BASED CAP ON PAYMENTS FOR 11 MEDICAL ASSISTANCE. 12 ‘‘(a) APPLICATION OF PER CAPITA CAP ON PAY- 13 MENTS FOR MEDICAL ASSISTANCE EXPENDITURES.— 14 ‘‘(1) IN GENERAL.—If a State has excess ag- 15 gregate medical assistance expenditures (as defined 16 in paragraph (2)) for a fiscal year (beginning with 17 fiscal year 2020), the amount of payment to the 18 State under section 1903(a)(1) for each quarter in 19 the following fiscal year shall be reduced by 1⁄4 of 20 the excess aggregate medical assistance payments 21 (as defined in paragraph (3)) for that previous fiscal 22 year. In this section, the term ‘State’ means only the 23 50 States and the District of Columbia. 24 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 27 ‘‘(2) EXCESS AGGREGATE MEDICAL ASSISTANCE 1 EXPENDITURES.—In this subsection, the term ‘ex- 2 cess aggregate medical assistance expenditures’ 3 means, for a State for a fiscal year, the amount (if 4 any) by which— 5 ‘‘(A) the amount of the adjusted total med- 6 ical assistance expenditures (as defined in sub- 7 section (b)(1)) for the State and fiscal year; ex- 8 ceeds 9 ‘‘(B) the amount of the target total med- 10 ical assistance expenditures (as defined in sub- 11 section (c)) for the State and fiscal year. 12 ‘‘(3) EXCESS AGGREGATE MEDICAL ASSISTANCE 13 PAYMENTS.—In this subsection, the term ‘excess ag- 14 gregate medical assistance payments’ means, for a 15 State for a fiscal year, the product of— 16 ‘‘(A) the excess aggregate medical assist- 17 ance expenditures (as defined in paragraph (2)) 18 for the State for the fiscal year; and 19 ‘‘(B) the Federal average medical assist- 20 ance matching percentage (as defined in para- 21 graph (4)) for the State for the fiscal year. 22 ‘‘(4) FEDERAL AVERAGE MEDICAL ASSISTANCE 23 MATCHING PERCENTAGE.—In this subsection, the 24 term ‘Federal average medical assistance matching 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 28 percentage’ means, for a State for a fiscal year, the 1 ratio (expressed as a percentage) of— 2 ‘‘(A) the amount of the Federal payments 3 that would be made to the State under section 4 1903(a)(1) for medical assistance expenditures 5 for calendar quarters in the fiscal year if para- 6 graph (1) did not apply; to 7 ‘‘(B) the amount of the medical assistance 8 expenditures for the State and fiscal year. 9 ‘‘(b) ADJUSTED TOTAL MEDICAL ASSISTANCE EX- 10 PENDITURES.—Subject to subsection (g), the following 11 shall apply: 12 ‘‘(1) IN GENERAL.—In this section, the term 13 ‘adjusted total medical assistance expenditures’ 14 means, for a State— 15 ‘‘(A) for fiscal year 2016, the product of— 16 ‘‘(i) the amount of the medical assist- 17 ance expenditures (as defined in paragraph 18 (2)) for the State and fiscal year, reduced 19 by the amount of any excluded expendi- 20 tures (as defined in paragraph (3)) for the 21 State and fiscal year otherwise included in 22 such medical assistance expenditures; and 23 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 29 ‘‘(ii) the 1903A FY16 population per- 1 centage (as defined in paragraph (4)) for 2 the State; or 3 ‘‘(B) for fiscal year 2019 or a subsequent 4 fiscal year, the amount of the medical assist- 5 ance expenditures (as defined in paragraph (2)) 6 for the State and fiscal year that is attributable 7 to 1903A enrollees, reduced by the amount of 8 any excluded expenditures (as defined in para- 9 graph (3)) for the State and fiscal year other- 10 wise included in such medical assistance ex- 11 penditures. 12 ‘‘(2) MEDICAL ASSISTANCE EXPENDITURES.— 13 In this section, the term ‘medical assistance expendi- 14 tures’ means, for a State and fiscal year, the med- 15 ical assistance payments as reported by medical 16 service category on the Form CMS-64 quarterly ex- 17 pense report (or successor to such a report form, 18 and including enrollment data and subsequent ad- 19 justments to any such report, in this section referred 20 to collectively as a ‘CMS-64 report’) that directly re- 21 sult from providing medical assistance under the 22 State plan (including under a waiver of the plan) for 23 which payment is (or may otherwise be) made pur- 24 suant to section 1903(a)(1). 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 30 ‘‘(3) EXCLUDED EXPENDITURES.—In this sec- 1 tion, the term ‘excluded expenditures’ means, for a 2 State and fiscal year, expenditures under the State 3 plan (or under a waiver of such plan) that are at- 4 tributable to any of the following: 5 ‘‘(A) DSH.—Payment adjustments made 6 for disproportionate share hospitals under sec- 7 tion 1923. 8 ‘‘(B) MEDICARE COST-SHARING.—Pay- 9 ments made for medicare cost-sharing (as de- 10 fined in section 1905(p)(3)). 11 ‘‘(C) SAFETY NET PROVIDER PAYMENT AD- 12 JUSTMENTS IN NON-EXPANSION STATES.—Pay- 13 ment adjustments under subsection (a) of sec- 14 tion 1923A for which payment is permitted 15 under subsection (c) of such section. 16 ‘‘(4) 1903A FY 16 POPULATION PERCENTAGE.— 17 In this subsection, the term ‘1903A FY16 popu- 18 lation percentage’ means, for a State, the Sec- 19 retary’s calculation of the percentage of the actual 20 medical assistance expenditures, as reported by the 21 State on the CMS–64 reports for calendar quarters 22 in fiscal year 2016, that are attributable to 1903A 23 enrollees (as defined in subsection (e)(1)). 24 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 31 ‘‘(c) TARGET TOTAL MEDICAL ASSISTANCE EXPEND- 1 ITURES.— 2 ‘‘(1) CALCULATION.—In this section, the term 3 ‘target total medical assistance expenditures’ means, 4 for a State for a fiscal year, the sum of the prod- 5 ucts, for each of the 1903A enrollee categories (as 6 defined in subsection (e)(2)), of— 7 ‘‘(A) the target per capita medical assist- 8 ance expenditures (as defined in paragraph (2)) 9 for the enrollee category, State, and fiscal year; 10 and 11 ‘‘(B) the number of 1903A enrollees for 12 such enrollee category, State, and fiscal year, as 13 determined under subsection (e)(4). 14 ‘‘(2) TARGET PER CAPITA MEDICAL ASSISTANCE 15 EXPENDITURES.—In this subsection, the term ‘tar- 16 get per capita medical assistance expenditures’ 17 means, for a 1903A enrollee category, State, and a 18 fiscal year, an amount equal to— 19 ‘‘(A) the provisional FY19 target per cap- 20 ita amount for such enrollee category (as cal- 21 culated under subsection (d)(5)) for the State; 22 increased by 23 ‘‘(B) the percentage increase in the med- 24 ical care component of the consumer price index 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 32 for all urban consumers (U.S. city average) 1 from September of 2019 to September of the 2 fiscal year involved. 3 ‘‘(d) CALCULATION OF FY19 PROVISIONAL TARGET 4 AMOUNT FOR EACH 1903A ENROLLEE CATEGORY.—Sub- 5 ject to subsection (g), the following shall apply: 6 ‘‘(1) CALCULATION OF BASE AMOUNTS FOR FIS- 7 CAL YEAR 2016.—For each State the Secretary shall 8 calculate (and provide notice to the State not later 9 than April 1, 2018, of) the following: 10 ‘‘(A) The amount of the adjusted total 11 medical assistance expenditures (as defined in 12 subsection (b)(1)) for the State for fiscal year 13 2016. 14 ‘‘(B) The number of 1903A enrollees for 15 the State in fiscal year 2016 (as determined 16 under subsection (e)(4)). 17 ‘‘(C) The average per capita medical as- 18 sistance expenditures for the State for fiscal 19 year 2016 equal to— 20 ‘‘(i) the amount calculated under sub- 21 paragraph (A); divided by 22 ‘‘(ii) the number calculated under sub- 23 paragraph (B). 24 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 33 ‘‘(2) FISCAL YEAR 2019 AVERAGE PER CAPITA 1 AMOUNT BASED ON INFLATING THE FISCAL YEAR 2 2016 AMOUNT TO FISCAL YEAR 2019 BY CPI-MED- 3 ICAL.—The Secretary shall calculate a fiscal year 4 2019 average per capita amount for each State 5 equal to— 6 ‘‘(A) the average per capita medical assist- 7 ance expenditures for the State for fiscal year 8 2016 (calculated under paragraph (1)(C)); in- 9 creased by 10 ‘‘(B) the percentage increase in the med- 11 ical care component of the consumer price index 12 for all urban consumers (U.S. city average) 13 from September, 2016 to September, 2019. 14 ‘‘(3) AGGREGATE AND AVERAGE EXPENDI- 15 TURES PER CAPITA FOR FISCAL YEAR 2019.—The 16 Secretary shall calculate for each State the fol- 17 lowing: 18 ‘‘(A) The amount of the adjusted total 19 medical assistance expenditures (as defined in 20 subsection (b)(1)) for the State for fiscal year 21 2019. 22 ‘‘(B) The number of 1903A enrollees for 23 the State in fiscal year 2019 (as determined 24 under subsection (e)(4)). 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 34 ‘‘(4) PER CAPITA EXPENDITURES FOR FISCAL 1 YEAR 2019 FOR EACH 1903A ENROLLEE CATEGORY.— 2 The Secretary shall calculate (and provide notice to 3 each State not later than January 1, 2020, of) the 4 following: 5 ‘‘(A)(i) For each 1903A enrollee category, 6 the amount of the adjusted total medical assist- 7 ance expenditures (as defined in subsection 8 (b)(1)) for the State for fiscal year 2019 for in- 9 dividuals in the enrollee category, calculated by 10 excluding from medical assistance expenditures 11 those expenditures attributable to expenditures 12 described in clause (iii) or non-DSH supple- 13 mental expenditures (as defined in clause (ii)). 14 ‘‘(ii) In this paragraph, the term ‘non- 15 DSH supplemental expenditure’ means a pay- 16 ment to a provider under the State plan (or 17 under a waiver of the plan) that— 18 ‘‘(I) is not made under section 1923; 19 ‘‘(II) is not made with respect to a 20 specific item or service for an individual; 21 ‘‘(III) is in addition to any payments 22 made to the provider under the plan (or 23 waiver) for any such item or service; and 24 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 35 ‘‘(IV) complies with the limits for ad- 1 ditional payments to providers under the 2 plan (or waiver) imposed pursuant to sec- 3 tion 1902(a)(30)(A), including the regula- 4 tions specifying upper payment limits 5 under the State plan in part 447 of title 6 42, Code of Federal Regulations (or any 7 successor regulations). 8 ‘‘(iii) An expenditure described in this 9 clause is an expenditure that meets the criteria 10 specified in subclauses (I), (II), and (III) of 11 clause (ii) and is authorized under section 1115 12 for the purposes of funding a delivery system 13 reform pool, uncompensated care pool, a des- 14 ignated state health program, or any other 15 similar expenditure (as defined by the Sec- 16 retary). 17 ‘‘(B) For each 1903A enrollee category, 18 the number of 1903A enrollees for the State in 19 fiscal year 2019 in the enrollee category (as de- 20 termined under subsection (e)(4)). 21 ‘‘(C) For fiscal year 2016, the State’s non- 22 DSH supplemental payment percentage is equal 23 to the ratio (expressed as a percentage) of— 24 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 36 ‘‘(i) the total amount of non-DSH 1 supplemental expenditures (as defined in 2 subparagraph (A)(ii)) for the State for fis- 3 cal year 2016; to 4 ‘‘(ii) the amount described in sub- 5 section (b)(1)(A) for the State for fiscal 6 year 2016. 7 ‘‘(D) For each 1903A enrollee category an 8 average medical assistance expenditures per 9 capita for the State for fiscal year 2019 for the 10 enrollee category equal to— 11 ‘‘(i) the amount calculated under sub- 12 paragraph (A) for the State, increased by 13 the non-DSH supplemental payment per- 14 centage for the State (as calculated under 15 subparagraph (C)); divided by 16 ‘‘(ii) the number calculated under sub- 17 paragraph (B) for the State for the en- 18 rollee category. 19 ‘‘(5) PROVISIONAL FY19 PER CAPITA TARGET 20 AMOUNT FOR EACH 1903A ENROLLEE CATEGORY.— 21 Subject to subsection (f)(2), the Secretary shall cal- 22 culate for each State a provisional FY19 per capita 23 target amount for each 1903A enrollee category 24 equal to the average medical assistance expenditures 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 37 per capita for the State for fiscal year 2019 (as cal- 1 culated under paragraph (4)(D)) for such enrollee 2 category multiplied by the ratio of— 3 ‘‘(A) the product of— 4 ‘‘(i) the fiscal year 2019 average per 5 capita amount for the State, as calculated 6 under paragraph (2); and 7 ‘‘(ii) the number of 1903A enrollees 8 for the State in fiscal year 2019, as cal- 9 culated under paragraph (3)(B); to 10 ‘‘(B) the amount of the adjusted total 11 medical assistance expenditures for the State 12 for fiscal year 2019, as calculated under para- 13 graph (3)(A). 14 ‘‘(e) 1903A ENROLLEE; 1903A ENROLLEE CAT- 15 EGORY.—Subject to subsection (g), for purposes of this 16 section, the following shall apply: 17 ‘‘(1) 1903A ENROLLEE.—The term ‘1903A en- 18 rollee’ means, with respect to a State and a month, 19 any Medicaid enrollee (as defined in paragraph (3)) 20 for the month, other than such an enrollee who for 21 such month is in any of the following categories of 22 excluded individuals: 23 ‘‘(A) CHIP.—An individual who is pro- 24 vided, under this title in the manner described 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 38 in section 2101(a)(2), child health assistance 1 under title XXI. 2 ‘‘(B) IHS.—An individual who receives 3 any medical assistance under this title for serv- 4 ices for which payment is made under the third 5 sentence of section 1905(b). 6 ‘‘(C) BREAST AND CERVICAL CANCER 7 SERVICES ELIGIBLE INDIVIDUAL.—An indi- 8 vidual who is entitled to medical assistance 9 under this title only pursuant to section 10 1902(a)(10)(A)(ii)(XVIII). 11 ‘‘(D) PARTIAL-BENEFIT ENROLLEES.—An 12 individual who— 13 ‘‘(i) is an alien who is entitled to med- 14 ical assistance under this title only pursu- 15 ant to section 1903(v)(2); 16 ‘‘(ii) is entitled to medical assistance 17 under this title only pursuant to subclause 18 (XII) or (XXI) of section 19 1902(a)(10)(A)(ii) (or pursuant to a waiv- 20 er that provides only comparable benefits); 21 ‘‘(iii) is a dual eligible individual (as 22 defined in section 1915(h)(2)(B)) and is 23 entitled to medical assistance under this 24 title (or under a waiver) only for some or 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 39 all of medicare cost-sharing (as defined in 1 section 1905(p)(3)); or 2 ‘‘(iv) is entitled to medical assistance 3 under this title and for whom the State is 4 providing a payment or subsidy to an em- 5 ployer for coverage of the individual under 6 a group health plan pursuant to section 7 1906 or section 1906A (or pursuant to a 8 waiver that provides only comparable bene- 9 fits). 10 ‘‘(2) 1903A ENROLLEE CATEGORY.—The term 11 ‘1903A enrollee category’ means each of the fol- 12 lowing: 13 ‘‘(A) ELDERLY.—A category of 1903A en- 14 rollees who are 65 years of age or older. 15 ‘‘(B) BLIND AND DISABLED.—A category 16 of 1903A enrollees (not described in the pre- 17 vious subparagraph) who are eligible for med- 18 ical assistance under this title on the basis of 19 being blind or disabled. 20 ‘‘(C) CHILDREN.—A category of 1903A 21 enrollees (not described in a previous subpara- 22 graph) who are children under 19 years of age. 23 ‘‘(D) EXPANSION ENROLLEES.—A cat- 24 egory of 1903A enrollees (not described in a 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 40 previous subparagraph) for whom the amounts 1 expended for medical assistance are subject to 2 an increase or change in the Federal medical 3 assistance percentage under subsection (y) or 4 (z)(2), respectively, of section 1905. 5 ‘‘(E) OTHER NONELDERLY, NONDISABLED, 6 NON-EXPANSION ADULTS.—A category of 7 1903A enrollees who are not described in any 8 previous subparagraph. 9 ‘‘(3) MEDICAID ENROLLEE.—The term ‘Med- 10 icaid enrollee’ means, with respect to a State for a 11 month, an individual who is eligible for medical as- 12 sistance for items or services under this title and en- 13 rolled under the State plan (or a waiver of such 14 plan) under this title for the month. 15 ‘‘(4) DETERMINATION OF NUMBER OF 1903A 16 ENROLLEES.—The number of 1903A enrollees for a 17 State and fiscal year, and, if applicable, for a 1903A 18 enrollee category, is the average monthly number of 19 Medicaid enrollees for such State and fiscal year 20 (and, if applicable, in such category) that are re- 21 ported through the CMS–64 report under (and sub- 22 ject to audit under) subsection (h). 23 ‘‘(f) SPECIAL PAYMENT RULES.— 24 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 41 ‘‘(1) APPLICATION IN CASE OF RESEARCH AND 1 DEMONSTRATION PROJECTS AND OTHER WAIVERS.— 2 In the case of a State with a waiver of the State 3 plan approved under section 1115, section 1915, or 4 another provision of this title, this section shall 5 apply to medical assistance expenditures and medical 6 assistance payments under the waiver, in the same 7 manner as if such expenditures and payments had 8 been made under a State plan under this title and 9 the limitations on expenditures under this section 10 shall supersede any other payment limitations or 11 provisions (including limitations based on a per cap- 12 ita limitation) otherwise applicable under such a 13 waiver. 14 ‘‘(2) TREATMENT OF STATES EXPANDING COV- 15 ERAGE AFTER FISCAL YEAR 2016.—In the case of a 16 State that did not provide for medical assistance for 17 the 1903A enrollee category described in subsection 18 (e)(2)(D) during fiscal year 2016 but which provides 19 for such assistance for such category in a subse- 20 quent year, the provisional FY19 per capita target 21 amount for such enrollee category under subsection 22 (d)(5) shall be equal to the provisional FY19 per 23 capita target amount for the 1903A enrollee cat- 24 egory described in subsection (e)(2)(E). 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 42 ‘‘(3) IN CASE OF STATE FAILURE TO REPORT 1 NECESSARY DATA.—If a State for any quarter in a 2 fiscal year (beginning with fiscal year 2019) fails to 3 satisfactorily submit data on expenditures and en- 4 rollees in accordance with subsection (h)(1), for such 5 fiscal year and any succeeding fiscal year for which 6 such data are not satisfactorily submitted— 7 ‘‘(A) the Secretary shall calculate and 8 apply subsections (a) through (e) with respect 9 to the State as if all 1903A enrollee categories 10 for which such expenditure and enrollee data 11 were not satisfactorily submitted were a single 12 1903A enrollee category; and 13 ‘‘(B) the growth factor otherwise applied 14 under subsection (c)(2)(B) shall be decreased 15 by 1 percentage point. 16 ‘‘(g) RECALCULATION OF CERTAIN AMOUNTS FOR 17 DATA ERRORS.—The amounts and percentage calculated 18 under paragraphs (1) and (4)(C) of subsection (d) for a 19 State for fiscal year 2016, and the amounts of the ad- 20 justed total medical assistance expenditures calculated 21 under subsection (b) and the number of Medicaid enrollees 22 and 1903A enrollees determined under subsection (e)(4) 23 for a State for fiscal year 2016, fiscal year 2019, and any 24 subsequent fiscal year, may be adjusted by the Secretary 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 43 based upon an appeal (filed by the State in such a form, 1 manner, and time, and containing such information relat- 2 ing to data errors that support such appeal, as the Sec- 3 retary specifies) that the Secretary determines to be valid, 4 except that any adjustment by the Secretary under this 5 subsection for a State may not result in an increase of 6 the target total medical assistance expenditures exceeding 7 2 percent. 8 ‘‘(h) REQUIRED REPORTING AND AUDITING OF 9 CMS–64 DATA; TRANSITIONAL INCREASE IN FEDERAL 10 MATCHING PERCENTAGE FOR CERTAIN ADMINISTRATIVE 11 EXPENSES.— 12 ‘‘(1) REPORTING.—In addition to the data re- 13 quired on form Group VIII on the CMS–64 report 14 form as of January 1, 2017, in each CMS-64 report 15 required to be submitted (for each quarter beginning 16 on or after October 1, 2018), the State shall include 17 data on medical assistance expenditures within such 18 categories of services and categories of enrollees (in- 19 cluding each 1903A enrollee category and each cat- 20 egory of excluded individuals under subsection 21 (e)(1)) and the numbers of enrollees within each of 22 such enrollee categories, as the Secretary determines 23 are necessary (including timely guidance published 24 as soon as possible after the date of the enactment 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 44 of this section) in order to implement this section 1 and to enable States to comply with the requirement 2 of this paragraph on a timely basis. 3 ‘‘(2) AUDITING.—The Secretary shall conduct 4 for each State an audit of the number of individuals 5 and expenditures reported through the CMS–64 re- 6 port for fiscal year 2016, fiscal year 2019, and each 7 subsequent fiscal year, which audit may be con- 8 ducted on a representative sample (as determined by 9 the Secretary). 10 ‘‘(3) TEMPORARY INCREASE IN FEDERAL 11 MATCHING PERCENTAGE TO SUPPORT IMPROVED 12 DATA REPORTING SYSTEMS FOR FISCAL YEARS 2018 13 AND 2019.—For amounts expended during calendar 14 quarters beginning on or after October 1, 2017, and 15 before October 1, 2019— 16 ‘‘(A) the Federal matching percentage ap- 17 plied under section 1903(a)(3)(A)(i) shall be in- 18 creased by 10 percentage points to 100 percent; 19 ‘‘(B) the Federal matching percentage ap- 20 plied under section 1903(a)(3)(B) shall be in- 21 creased by 25 percentage points to 100 percent; 22 and 23 ‘‘(C) the Federal matching percentage ap- 24 plied under section 1903(a)(7) shall be in- 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 45 creased by 10 percentage points to 60 percent 1 but only with respect to amounts expended that 2 are attributable to a State’s additional adminis- 3 trative expenditures to implement the data re- 4 quirements of paragraph (1).’’. 5 Subtitle D—Patient Relief and 6 Health Insurance Market Stability 7 SEC. 131. REPEAL OF COST-SHARING SUBSIDY. 8 (a) IN GENERAL.—Section 1402 of the Patient Pro- 9 tection and Affordable Care Act is repealed. 10 (b) EFFECTIVE DATE.—The repeal made by sub- 11 section (a) shall apply to cost-sharing reductions (and pay- 12 ments to issuers for such reductions) for plan years begin- 13 ning after December 31, 2019. 14 SEC. 132. PATIENT AND STATE STABILITY FUND. 15 The Social Security Act (42 U.S.C. 301 et seq.) is 16 amended by adding at the end the following new title: 17 ‘‘TITLE XXII—PATIENT AND 18 STATE STABILITY FUND 19 ‘‘SEC. 2201. ESTABLISHMENT OF PROGRAM. 20 ‘‘There is hereby established the ‘Patient and State 21 Stability Fund’ to be administered by the Secretary of 22 Health and Human Services, acting through the Adminis- 23 trator of the Centers for Medicare & Medicaid Services 24 (in this section referred to as the ‘Administrator’), to pro- 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 46 vide funding, in accordance with this title, to the 50 States 1 and the District of Columbia (each referred to in this sec- 2 tion as a ‘State’) during the period, subject to section 3 2204(c), beginning on January 1, 2018, and ending on 4 December 31, 2026, for the purposes described in section 5 2202. 6 ‘‘SEC. 2202. USE OF FUNDS. 7 ‘‘A State may use the funds allocated to the State 8 under this title for any of the following purposes: 9 ‘‘(1) Helping, through the provision of financial 10 assistance, high-risk individuals who do not have ac- 11 cess to health insurance coverage offered through an 12 employer enroll in health insurance coverage in the 13 individual market in the State, as such market is de- 14 fined by the State (whether through the establish- 15 ment of a new mechanism or maintenance of an ex- 16 isting mechanism for such purpose). 17 ‘‘(2) Providing incentives to appropriate entities 18 to enter into arrangements with the State to help 19 stabilize premiums for health insurance coverage in 20 the individual market, as such markets are defined 21 by the State. 22 ‘‘(3) Reducing the cost for providing health in- 23 surance coverage in the individual market and small 24 group market, as such markets are defined by the 25 VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM March 6, 2017 (4:32 p.m.) G:\P\15\HT\REC1\ECTITLE_16.XML g:\VHLC\030617\030617.310.xml (653419|4) 47 State, to individuals who have, or are projected to </p>