[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 439 Introduced in Senate (IS)]

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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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