[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6539 Introduced in House (IH)]

<DOC>






116th CONGRESS
  2d Session
                                H. R. 6539

   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 HOUSE OF REPRESENTATIVES

                             April 17, 2020

Mrs. Lee of Nevada introduced the following bill; which was referred to 
                  the Committee on Energy and Commerce

_______________________________________________________________________

                                 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 (gg)''; and
            (2) by adding at the end the following new subsection:
    ``(gg) Increased FMAP During Economic Downturns.--
            ``(1) In general.--Notwithstanding subsection (b), (y), or 
        (z)(2), 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 applicable to amounts expended by the 
        State for medical assistance for services furnished during such 
        quarter shall be increased in accordance with paragraphs (3) 
        and (4).
            ``(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, or 
                        American Samoa, the Secretary shall use data 
                        from the U-6 unemployment measure of the Bureau 
                        of Labor Statistics to make any necessary 
                        determinations under subparagraph (A).
            ``(3) FMAP increase 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 otherwise 
                determined for the State and quarter under subsection 
                (b) and, if applicable, the Federal medical assistance 
                percentage applicable under subsection (y), (z)(2), or 
                (ff) with respect to medical assistance furnished by 
                the State during such quarter to individuals described 
                in either such subsection shall be increased by 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) Application of covid-19 fmap increase.--Any 
                increase applicable to the Federal medical assistance 
                percentage of a State for a fiscal quarter under 
                subparagraph (A) shall be in addition to any increase 
                to such percentage for such quarter made pursuant to 
                section 6008(a) of the Families First Coronavirus 
                Response Act.
                    ``(C) Limitation.--In no case shall an increase to 
                the Federal medical assistance percentage of a State 
                under this paragraph result in a Federal medical 
                assistance percentage that exceeds 95 percent.
                    ``(D) Scope of application.--Any increase to the 
                Federal medical assistance percentage of a State for a 
                fiscal quarter under this paragraph shall only apply 
                with respect to payments for amounts expended by the 
                State for medical assistance for services furnished 
                during such quarter and shall not apply with respect 
                to--
                            ``(i) disproportionate share hospital 
                        payments described in section 1923;
                            ``(ii) payments under title IV or XXI;
                            ``(iii) any payments under this title that 
                        are based on the enhanced FMAP described in 
                        section 2105(b); or
                            ``(iv) 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).
            ``(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) determine the increase (if any) that 
                        is expected to apply to the Federal medical 
                        assistance percentage of such State for such 
                        quarter under this subsection based on the 
                        projections made for the State and quarter 
                        under subparagraph (B); and
                            ``(ii) shall apply such increase to the 
                        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.
                    ``(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 of the 
                        increase (if any) applicable to the Federal 
                        medical assistance percentage of the State for 
                        the quarter under this subsection; and
                            ``(ii) in accordance with subsection (d)(2) 
                        of section 1903, reduce or increase the amount 
                        payable to the State under subsection (a) of 
                        such section for a subsequent fiscal quarter to 
                        the extent of any overpayment or underpayment 
                        which the Secretary determines was made as a 
                        result of a miscalculation of the increase 
                        applicable to the Federal medical assistance 
                        percentage of the State for such prior fiscal 
                        quarter under this subsection.
            ``(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 (C) 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)(D).
                    ``(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); or
                                    ``(IV) the Federal medical 
                                assistance percentage determined for 
                                the State and quarter under subsection 
                                (ff).
                            ``(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.--A State may not receive 
        an increase in the Federal medical assistance percentage for 
        such State under this subsection, 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 (or, if such period is less than 12 months, 
                throughout such period) 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.--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 ``subsection (g) and section 1935(e)(1)(B)'' 
        and inserting ``subsections (g) and (h) and section 
        1935(e)(1)(B)''; and
            (2) by adding at the end the following:
    ``(h) Exclusion From Caps of Amounts Attributable to Economic 
Downturn FMAP.--The portion of any payment made to a territory for a 
fiscal year that is attributable to an increase in the Federal medical 
assistance percentage for a fiscal quarter during such year under 
section 1905(gg) shall not be taken into account for purposes of 
applying payment limits under subsections (f) and (g).''.
                                 <all>