[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 439 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 439
To amend title XIX of the Social Security Act to increase Federal
support to State Medicaid programs during economic downturns, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 25, 2021
Mr. Casey (for himself, Ms. Cortez Masto, Mr. Bennet, Mr. Brown, Mr.
Wyden, Mrs. Shaheen, Mr. Merkley, Mr. Warner, Mr. Menendez, Ms. Rosen,
Ms. Smith, Mr. Peters, Mr. Booker, Mr. Van Hollen, Mr. Tester, Ms.
Stabenow, Mr. Whitehouse, Mr. Cardin, Ms. Warren, Ms. Klobuchar, Mr.
King, Ms. Hassan, and Mr. Carper) introduced the following bill; which
was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to increase Federal
support to State Medicaid programs during economic downturns, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Coronavirus Medicaid Response Act''.
SEC. 2. INCREASING FEDERAL SUPPORT TO STATE MEDICAID PROGRAMS DURING
ECONOMIC DOWNTURNS.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (b), by striking ``and (ff)'' and
inserting ``(ff), and (hh)''; and
(2) by adding at the end the following new subsection:
``(hh) Increased FMAP During Economic Downturns.--
``(1) In general.--If a fiscal quarter that begins on or
after January 1, 2020, is an economic downturn quarter (as
defined in paragraph (2)) with respect to a State, then the
Federal medical assistance percentage determined for the State
and quarter under subsection (b) shall be equal to the
percentage determined for the State and quarter under paragraph
(3).
``(2) Economic downturn quarter.--
``(A) In general.--
``(i) In general.--In this subsection, the
term `economic downturn quarter' means, with
respect to a State, a fiscal quarter during
which the State's unemployment rate for the
quarter exceeds the percentage determined for
the State and quarter under clause (ii).
``(ii) Threshold percentage.--The
percentage determined under this clause for a
State and fiscal quarter is the percentage
equal to the lower of--
``(I) the State unemployment rate
at the 20\th\ percentile of the
distribution of the State's quarterly
unemployment rates for the 60-quarter
period preceding the quarter involved,
increased by 1 percentage point; and
``(II) the State's average
quarterly unemployment rate for the 12-
quarter period preceding the quarter
involved, increased by 1 percentage
point.
``(B) Unemployment data.--
``(i) In general.--Except as provided in
clause (ii), for purposes of determining
unemployment rates for a State and a quarter
under this paragraph, the Secretary shall use
data from the Local Area Unemployment
Statistics from the Bureau of Labor Statistics.
``(ii) Application to certain
territories.--In the case of the Virgin
Islands, Guam, the Northern Mariana Islands,
American Samoa, or any other jurisdiction for
which suitable data from the Local Area
Unemployment Statistics from the Bureau of
Labor Statistics are unavailable, the Secretary
shall use data from the U-3 unemployment
measure of the Bureau of Labor Statistics to
make any necessary determinations under
subparagraph (A).
``(3) Increased fmap during economic downturn quarter.--
``(A) In general.--During a fiscal quarter that is
an economic downturn quarter with respect to a State,
the Federal medical assistance percentage for the State
and quarter determined under subsection (b) shall be
equal to--
``(i) the Federal medical assistance
percentage determined for the State and quarter
under subsection (b) without regard to this
subsection (but including any increase to such
percentage for such quarter made pursuant to
section 6008(a) of the Families First
Coronavirus Response Act); increased by
``(ii) the number of percentage points
(rounded to the nearest tenth of a percentage
point) equal to the product of--
``(I) the number of percentage
points (rounded to the nearest tenth of
a percentage point) by which the
unemployment rate for the State and
quarter exceeds the percentage
determined for the State and quarter
under paragraph (2)(A)(ii); and
``(II) 4.8.
``(B) Rules of application.--The following rules
shall apply with respect to the Federal medical
assistance percentage determined for a State and an
economic downturn quarter under this subsection:
``(i) Scope of application.--Such Federal
medical assistance percentage shall not apply
for purposes of--
``(I) disproportionate share
hospital payments described in section
1923;
``(II) payments under part D of
title IV; or
``(III) any payments under this
title that are based on a Federal
medical assistance percentage
determined for a State under subsection
(aa) (but only to the extent that such
Federal medical assistance percentage
is higher than the economic recovery
FMAP).
``(ii) Limitation.--In no case shall--
``(I) the Federal medical
assistance percentage determined for a
State and quarter pursuant to this
subsection exceed 95 percent; or
``(II) any increase to the Federal
medical assistance percentage
determined for a State and quarter
pursuant to this subsection result in
the application of a Federal medical
assistance percentage that exceeds 95
percent.
``(iii) Application to chip.--
Notwithstanding the first sentence of section
2105(b), the application of this subsection may
result in the enhanced FMAP of a State for a
fiscal year under such section exceeding 85
percent, but in no case may the application of
this subsection before application of the
second sentence of such section result in the
enhanced FMAP of the State exceeding 95
percent.
``(4) Advance payment; retrospective adjustment.--
``(A) In general.--Prior to the beginning of each
fiscal quarter that begins on or after July 1, 2020,
the Secretary shall, with respect to each State--
``(i) make an initial determination, based
on the projections made for the State and
quarter under subparagraph (B), as to--
``(I) whether the application of
this subsection is expected to result
in the application of a higher Federal
medical assistance percentage for the
State and quarter than the percentage
that would otherwise apply without
regard to this subsection; and--
``(II) if the application of this
subsection is expected to result in
such a higher Federal medical
assistance percentage for the State and
quarter, what such higher percentage is
expected to be; and
``(ii) if the Secretary determines under
clause (i) that the application of this
subsection is expected to result in the
application of a higher Federal medical
assistance percentage for the State and quarter
than the percentage that would otherwise apply
without regard to this subsection--
``(I) apply such higher Federal
medical assistance percentage of the
State for purposes of making payments
to the State for amounts expended
during such quarter as medical
assistance under the State plan; and
``(II) take into account such
higher Federal medical assistance
percentage of the State for purposes of
calculating the enhanced FMAP for the
State and quarter under section
2105(b).
``(B) Projection of state unemployment rates.--
Prior to the beginning of each fiscal quarter that
begins on or after July 1, 2020, the Secretary, acting
through the Chief Actuary of the Centers for Medicare &
Medicaid Services, shall, using the most recently
available data described in paragraph (2)(B), make
projections with respect to--
``(i) the unemployment rates for each State
for such quarter;
``(ii) the threshold percentages described
in paragraph (2)(A)(ii) for each State for such
quarter; and
``(iii) the national unemployment rate for
such quarter.
``(C) Retrospective adjustment.--As soon as
practicable after final unemployment data becomes
available for a fiscal quarter that begins on or after
July 1, 2020, the Secretary shall, with respect to each
State--
``(i) make a final determination with
respect to the application of this subsection
for purposes of determining the Federal medical
assistance percentage and enhanced FMAP of the
State for the quarter; and
``(ii) in accordance with section
1903(d)(2) and section 2105(e), reduce or
increase the amount payable to the State under
section 1903(a) or section 2105 for a
subsequent fiscal quarter to the extent of any
overpayment or underpayment under either such
section which the Secretary determines was made
as a result of an incorrect initial
determination under subparagraph (A)(i) with
respect to the application of this subsection
for purposes of determining the Federal medical
assistance percentage and enhanced FMAP of the
State for such prior fiscal quarter.
``(5) Retrospective application of over-the-limit fmap
increases.--
``(A) In general.--If a State has excess percentage
points with respect to an economic downturn quarter and
an applicable FMAP (as determined under subparagraph
(B)), the State may elect to apply such excess
percentage points to increase such applicable FMAP for
one or more quarters during the look-back period for
the State and economic downturn quarter in accordance
with this paragraph.
``(B) Excess percentage points.--For purposes of
this paragraph, the number of excess percentage points
for a State, economic downturn quarter, and an
applicable FMAP shall be equal to the number of
percentage points by which--
``(i) the applicable FMAP for the State and
quarter (after application of paragraph (3) but
without regard to subparagraph (B)(ii) of such
paragraph); exceeds
``(ii) 95 percent.
``(C) Effect of application of excess percentage
points.--If a State elects to apply excess percentage
points to an applicable FMAP to a quarter during a
look-back period under this paragraph, the Secretary
shall determine the additional amount of payment under
section 1903(a) to which the State would have been
entitled for such quarter if the applicable FMAP (as so
increased) had been in effect for such quarter, and
shall treat such additional amount as an underpayment
for such quarter.
``(D) Distribution of excess percentage points.--A
State that has excess percentage points with respect to
an economic downturn quarter and applicable FMAP may
elect to divide such points among more than 1 quarter
during the look-back period for such State and quarter
provided that no excess percentage point (or fraction
of an excess percentage point) is applied to the
applicable FMAP of more than 1 quarter.
``(E) Limitations.--
``(i) No increases over 100 percent.--A
State may not increase an applicable FMAP for
any quarter during a look-back period under
this paragraph if such increase would result in
the applicable FMAP for such quarter exceeding
100 percent.
``(ii) Scope of application.--Any increase
to an applicable FMAP of a State for a fiscal
quarter under this paragraph--
``(I) shall only apply with respect
to payments for amounts expended by the
State for medical assistance for
services furnished during such quarter
to which such applicable FMAP is
applicable; and
``(II) shall not apply with respect
to payments described in paragraph
(3)(B)(i).
``(F) Definitions.--In this paragraph:
``(i) Applicable fmap.--The term
`applicable FMAP' means, with respect to a
State and fiscal quarter--
``(I) the Federal medical
assistance percentage determined for
the State and quarter under subsection
(b);
``(II) the Federal medical
assistance percentage applicable under
subsection (y);
``(III) the Federal medical
assistance percentage applicable under
subsection (z)(2);
``(IV) the Federal medical
assistance percentage determined for
the State and quarter under subsection
(ff); or
``(V) the enhanced FMAP determined
for the State and quarter under section
2105(b).
``(ii) Look-back period.--The term `look-
back period' means, with respect to a State and
a fiscal quarter that is an economic downturn
quarter for the State, the period of 4 fiscal
quarters that ends with the fourth quarter
which precedes the most recent fiscal quarters
that was not an economic downturn quarter for
the State.
``(6) Requirement for all states.--This subsection shall
not apply to a State with respect to a fiscal quarter, if--
``(A) eligibility standards, methodologies, or
procedures under the State plan or a waiver of such
plan are more restrictive during such quarter than the
eligibility standards, methodologies, or procedures,
respectively, under such plan (or waiver) as in effect
on the last day of the most recent fiscal quarter that
was not an economic downturn quarter for the State;
``(B) the amount of any premium imposed by the
State pursuant to section 1916 or 1916A during such
quarter, with respect to an individual enrolled under
such plan (or waiver), exceeds the amount of such
premium as of the date described in subparagraph (A);
or
``(C) the State fails to provide that an individual
who is enrolled for benefits under such plan (or
waiver) as of the date described in subparagraph (A) or
enrolls for benefits under such plan (or waiver) during
the period beginning with such date and ending with the
day before the first day of the next quarter that is
not an economic downturn quarter for the State shall be
treated as eligible for such benefits for not less than
12 months after such date or (if later) the date that
such individual so enrolls unless the individual
requests a voluntary termination of eligibility or the
individual ceases to be a resident of the State.''.
(b) Exclusion of Economic Downturn FMAP Increases From Territorial
Caps; Special Rule for CHIP Allotments.--
(1) Exclusion from territorial caps.--Section 1108 of the
Social Security Act (42 U.S.C. 1308) is amended--
(A) in subsection (f), in the matter preceding
paragraph (1), by striking ``subsection (g) and section
1935(e)(1)(B)'' and inserting ``subsections (g) and (h)
and section 1935(e)(1)(B)''; and
(B) by adding at the end the following:
``(h) Exclusion From Caps of Amounts Attributable to Economic
Downturn FMAP.--Any payment made to a territory for a fiscal year in
which the Federal medical assistance percentage for the territory is
determined under section 1905(hh) shall not be taken into account for
purposes of applying payment limits under subsections (f) and (g) to
the extent that such payment exceeds the amount of the payment that
would have been made to the territory for the year if the Federal
medical assistance percentage for the territory had been determined
without regard to such section.''.
(2) CHIP allotments.--Section 2104(m) of the Social
Security Act (42 U.S.C. 1397dd(m)) is amended--
(A) in paragraph (2)(B), in the matter preceding
clause (i), by striking ``paragraphs (5) and (7)'' and
inserting ``paragraphs (5), (7), and (12)''; and
(B) by adding at the end the following new
paragraph:
``(12) Special rule for adjusting allotments during fiscal
years with economic downturn quarters.--
``(A) In general.--If a fiscal quarter occurring
during fiscal year 2020 or any succeeding fiscal year
is determined to be an economic downturn quarter with
respect to a State (as determined under section
1905(hh)) then, as soon as practicable after such
determination, the Secretary shall increase the
allotment for the State and fiscal year in accordance
with subparagraph (B).
``(B) Amount of increase.--
``(i) In general.--The amount of an
increase to the allotment of a State described
in subparagraph (A) for a fiscal year shall be
equal to the amount by which Federal payments
made to the State for the preceding fiscal year
under this title would have been increased
(without regard to whether such payments would
exceed the amount of the State's allotment for
such preceding fiscal year) if the enhanced
FMAP determined for the State for such
preceding fiscal year had been increased to the
same extent that the State's enhanced FMAP for
the fiscal year involved is expected to be
increased as a result of the application of
section 1905(hh) relative to the enhanced FMAP
that would apply to the State for the fiscal
year involved without the application of such
section.
``(ii) Inclusion of projected increases.--
In increasing the allotment of a State for a
fiscal year under this paragraph, the Secretary
may base the calculation of such increase on
projections made by the Secretary with respect
to--
``(I) the number of fiscal quarters
during such fiscal year that will be
economic downturn quarters; and
``(II) the effect that the
application of section 1905(hh) is
expected to have on the enhanced FMAP
of the State for such fiscal year.
``(C) Disregard of increased payments for purposes
of future allotments.--Any Federal payment made to a
State under this title for a fiscal year in which the
Federal medical assistance percentage for the State is
determined under section 1905(hh) shall be disregarded
when determining the allotment of the State for any
subsequent year, including for purposes of applying
this paragraph, to the extent that such payment exceeds
the amount of the payment that would have been made to
the State for the year if the Federal medical
assistance percentage for the State and year had been
determined without regard to such section.''.
(c) Conforming Amendments.--Section 1905(cc) of the Social Security
Act (42 U.S.C. 1396d(cc)) is amended--
(1) by striking ``and section 6008 of the Families First
Coronavirus Response Act'' and inserting ``, section 6008 of
the Families First Coronavirus Response Act, and subsection
(hh) of this section''; and
(2) by inserting ``, and, in applying such treatments to an
increase in the Federal medical assistance percentage of a
State under subsection (hh) with respect to a fiscal quarter
that is an economic downturn quarter for the State, the
reference to `December 31, 2009' shall be deemed to be a
reference to `March 11, 2020', or, if later, the last day of
the most recent fiscal quarter that was not an economic
downturn quarter for the State'' before the period.
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