[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4684 Introduced in Senate (IS)]

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118th CONGRESS
  2d Session
                                S. 4684

     To ensure affordable health insurance coverage for low-income 
         individuals in States that have not expanded Medicaid.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                July 11 (legislative day, July 10), 2024

 Mr. Warnock (for himself, Ms. Baldwin, Mr. Casey, Ms. Warren, and Mr. 
    Ossoff) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
     To ensure affordable health insurance coverage for low-income 
         individuals in States that have not expanded Medicaid.

    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 ``Bridge to Medicaid Act of 2024''.

SEC. 2. ENSURING AFFORDABILITY OF COVERAGE FOR CERTAIN LOW-INCOME 
              POPULATIONS.

    (a) Reducing Cost Sharing Under Qualified Health Plans.--Section 
1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 
18071) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (2), by inserting ``(or, with 
                respect to plan years 2026, 2027, and 2028, whose 
                household income does not exceed 400 percent of the 
                poverty line for a family of the size involved)'' 
                before the period; and
                    (B) in the matter following paragraph (2), by 
                adding at the end the following new sentence: ``In the 
                case of an individual who is determined at any point to 
                have a household income for 2025 that does not exceed 
                138 percent of the poverty line for a family of the 
                size involved, such individual shall, for each month 
                during such year, be treated as having a household 
                income equal to 100 percent for purposes of applying 
                this section.''; and
            (2) in subsection (c)--
                    (A) in paragraph (1)(A), in the matter preceding 
                clause (i), by inserting ``, with respect to eligible 
                insureds (other than, with respect to plan years 2026, 
                2027, and 2028, specified enrollees (as defined in 
                paragraph (6)(C))),'' after ``first be achieved'';
                    (B) in paragraph (2), in the matter preceding 
                subparagraph (A), by inserting ``with respect to 
                eligible insureds (other than, with respect to plan 
                years 2026, 2027, and 2028, specified enrollees)'' 
                after ``under the plan'';
                    (C) in paragraph (3)--
                            (i) in subparagraph (A), by striking ``this 
                        subsection'' and inserting ``paragraph (1) or 
                        (2)''; and
                            (ii) in subparagraph (B), by striking 
                        ``this section'' and inserting ``paragraphs (1) 
                        and (2)''; and
                    (D) by adding at the end the following new 
                paragraph:
            ``(6) Special rule for specified enrollees.--
                    ``(A) In general.--The Secretary shall establish 
                procedures under which the issuer of a qualified health 
                plan to which this section applies shall reduce cost-
                sharing under the plan with respect to months occurring 
                during plan years 2026, 2027, and 2028 for enrollees 
                who are specified enrollees (as defined in subparagraph 
                (C)) in a manner sufficient to increase the plan's 
                share of the total allowed costs of benefits provided 
                under the plan to 99 percent of such costs.
                    ``(B) Methods for reducing cost sharing.--
                            ``(i) In general.--An issuer of a qualified 
                        health plan making reductions under this 
                        paragraph shall notify the Secretary of such 
                        reductions and the Secretary shall, out of 
                        funds made available under clause (ii), make 
                        periodic and timely payments to the issuer 
                        equal to 12 percent of the total allowed costs 
                        of benefits provided under each such plan to 
                        specified enrollees during plan years 2026, 
                        2027, and 2028.
                            ``(ii) Appropriation.--In addition to 
                        amounts otherwise available, there are 
                        appropriated, out of any money in the Treasury 
                        not otherwise appropriated, such sums as may be 
                        necessary to the Secretary to make payments 
                        under clause (i).
                    ``(C) Specified enrollee defined.--For purposes of 
                this section, the term `specified enrollee' means, with 
                respect to a plan year, an eligible insured who is 
                determined at any point to have a household income for 
                such plan year that does not exceed 138 percent of the 
                poverty line for a family of the size involved. Such 
                insured shall be deemed to be a specified enrollee for 
                each month in such plan year.''.
    (b) Open Enrollments Applicable to Certain Lower-Income 
Populations.--Section 1311(c) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18031(c)) is amended--
            (1) in paragraph (6)--
                    (A) in subparagraph (C), by striking at the end 
                ``and'';
                    (B) in subparagraph (D), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(E) with respect to a qualified health plan with 
                respect to which section 1402 applies, for months 
                occurring during the period beginning on January 1, 
                2025, and ending on December 31, 2028, enrollment 
                periods described in subparagraph (A) of paragraph (8) 
                for individuals described in subparagraph (B) of such 
                paragraph.''; and
            (2) by adding at the end the following new paragraph:
            ``(8) Special enrollment period for certain low-income 
        populations.--
                    ``(A) In general.--The enrollment period described 
                in this paragraph is, in the case of an individual 
                described in subparagraph (B), the continuous period 
                beginning on the first day that such individual is so 
                described.
                    ``(B) Individual described.--For purposes of 
                subparagraph (A), an individual described in this 
                subparagraph is an individual--
                            ``(i) with a household income that does not 
                        exceed 138 percent of the poverty line for a 
                        family of the size involved; and
                            ``(ii) who is not eligible for minimum 
                        essential coverage (as defined in section 
                        5000A(f) of the Internal Revenue Code of 1986), 
                        other than for coverage described in any of 
                        subparagraphs (B) through (E) of paragraph (1) 
                        of such section.''.
    (c) Additional Benefits for Certain Low-Income Individuals for Plan 
Years 2027 and 2028.--Section 1301(a) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18021(a)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (B), by striking ``and'' at the 
                end;
                    (B) in subparagraph (C)(iv), by striking the period 
                and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) provides, with respect to a plan offered in 
                the silver level of coverage to which section 1402 
                applies during plan year 2027 and 2028, for benefits 
                described in paragraph (5) in the case of an individual 
                who has a household income that does not exceed 138 
                percent of the poverty line for a family of the size 
                involved, and who is eligible to receive cost-sharing 
                reductions under section 1402.''; and
            (2) by adding at the end the following new paragraph:
            ``(5) Additional benefits for certain low-income 
        individuals for plan year 2027 and 2028.--
                    ``(A) In general.--
                            ``(i) Benefits.--For purposes of paragraph 
                        (1)(D), the benefits described in this 
                        paragraph to be provided by a qualified health 
                        plan are benefits consisting of--
                                    ``(I) non-emergency medical 
                                transportation services (as described 
                                in section 1902(a)(4) of the Social 
                                Security Act) for which Federal 
                                payments would have been available 
                                under title XIX of the Social Security 
                                Act had such services been furnished to 
                                an individual enrolled under a State 
                                plan (or waiver of such plan) under 
                                such title; and
                                    ``(II) services described in 
                                subsection (a)(4)(C) of section 1905 of 
                                such Act for which Federal payments 
                                would have been so available;
                        which are not otherwise provided under such 
                        plan as part of the essential health benefits 
                        package described in section 1302(a).
                            ``(ii) Condition on provision of 
                        benefits.--Benefits described in this paragraph 
                        shall be provided--
                                    ``(I) without any restriction on 
                                the choice of a qualified provider from 
                                whom an individual may receive such 
                                benefits; and
                                    ``(II) without any imposition of 
                                cost sharing.
                    ``(B) Payments for additional benefits.--
                            ``(i) In general.--An issuer of a qualified 
                        health plan making payments for services 
                        described in subparagraph (A) furnished to 
                        individuals described in paragraph (1)(D) 
                        during plan year 2027 or 2028 shall notify the 
                        Secretary of such payments and the Secretary 
                        shall, out of funds made available under clause 
                        (ii), make periodic and timely payments to the 
                        issuer equal to payments for such services so 
                        furnished.
                            ``(ii) Appropriation.--In addition to 
                        amounts otherwise available, there is 
                        appropriated, out of any money in the Treasury 
                        not otherwise appropriated, such sums as may be 
                        necessary to the Secretary to make payments 
                        under clause (i).''.
    (d) Education and Outreach Activities.--
            (1) In general.--Section 1321(c) of the Patient Protection 
        and Affordable Care Act (42 U.S.C. 18041(c)) is amended by 
        adding at the end the following new paragraph:
            ``(3) Outreach and educational activities.--
                    ``(A) In general.--In the case of an Exchange 
                established or operated by the Secretary within a State 
                pursuant to this subsection, the Secretary shall carry 
                out outreach and educational activities for purposes of 
                informing individuals described in section 
                1902(a)(10)(A)(i)(VIII) of the Social Security Act who 
                reside in States that have not expended amounts under a 
                State plan (or waiver of such plan) under title XIX of 
                such Act for all such individuals about qualified 
                health plans offered through the Exchange, including by 
                informing such individuals of the availability of 
                coverage under such plans and financial assistance for 
                coverage under such plans. Such outreach and 
                educational activities shall be provided in a manner 
                that is culturally and linguistically appropriate to 
                the needs of the populations being served by the 
                Exchange (including hard-to-reach populations, such as 
                racial and sexual minorities, limited English 
                proficient populations, individuals residing in areas 
                where the unemployment rates exceeds the national 
                average unemployment rate, individuals in rural areas, 
                veterans, and young adults).
                    ``(B) Limitation on use of funds.--Funds 
                appropriated under this paragraph shall not be used to 
                promote any health insurance coverage other than 
                qualified health plans.
                    ``(C) Funding.--In addition to amounts otherwise 
                available, there is appropriated, out of any money in 
                the Treasury not otherwise appropriated, to remain 
                available until expended, $105,000,000 for fiscal year 
                2025 to carry out this paragraph, of which--
                            ``(i) $15,000,000 shall be used to carry 
                        out this paragraph in fiscal year 2025; and
                            ``(ii) $30,000,000 shall be used to carry 
                        out this paragraph for each of fiscal years 
                        2026 through 2028.''.
            (2) Navigator program.--Section 1311(i) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18031(i)) is 
        amended--
                    (A) in paragraph (1)--
                            (i) by striking ``An Exchange'' and 
                        inserting the following:
                    ``(A) In general.--An Exchange''; and
                            (ii) by adding at the end the following:
                    ``(B) Grants for eligible entities with respect to 
                certain states.--The Secretary shall establish a 
                program to award grants to entities described in 
                paragraph (2) to carry out the duties described in 
                paragraph (3) in one or more States that do not provide 
                under the State plan under title XIX of the Social 
                Security Act (or a waiver of such plan) benchmark 
                coverage described in section 1937(b)(1) of such Act or 
                benchmark equivalent coverage described in section 
                1937(b)(2) of such Act to all individuals described in 
                section 1902(a)(10)(A)(i)(VIII) of such Act.''; and
                    (B) in paragraph (6)--
                            (i) by striking ``Grants under'' and 
                        inserting the following:
                    ``(A) State exchanges.--Except as provided in 
                subparagraph (B), grants under''; and
                            (ii) by adding at the end the following new 
                        subparagraph:
                    ``(B) Federal exchanges; grants to eligible 
                entities with respect to certain states.--For purposes 
                of carrying out this subsection, with respect to an 
                Exchange established and operated by the Secretary 
                within a State pursuant to section 1321(c) and with 
                respect to grants under paragraph (1)(B), the Secretary 
                shall obligate not less than $10,000,000 out of amounts 
                collected through the user fees on participating health 
                insurance issuers pursuant to section 156.50 of title 
                45, Code of Federal Regulations (or any successor 
                regulations) for fiscal year 2026, and not less than 
                $20,000,000 for each of fiscal years 2027 and 2028. 
                Such amount so obligated for a fiscal year shall remain 
                available until expended.''.
    (e) Funding.--In addition to amounts otherwise available, there is 
appropriated to the Secretary of Health and Human Services for fiscal 
year 2025, out of any money in the Treasury not otherwise appropriated, 
$65,000,000, to remain available until expended, for purposes of 
carrying out the provisions of, and the amendments made by, this 
section.

SEC. 3. TEMPORARY EXPANSION OF HEALTH INSURANCE PREMIUM TAX CREDITS FOR 
              CERTAIN LOW-INCOME POPULATIONS.

    (a) In General.--Section 36B of the Internal Revenue Code of 1986 
is amended by redesignating subsection (h) as subsection (i) and by 
inserting after subsection (g) the following new subsection:
    ``(h) Certain Temporary Rules Beginning in 2026.--With respect to 
any taxable year beginning after December 31, 2025, and before January 
1, 2029--
            ``(1) Eligibility for credit not limited based on income.--
        Subsection (c)(1)(A) shall be applied without regard to `equals 
        or exceeds 100 percent but'.
            ``(2) Credit allowed to certain low-income employees 
        offered employer-provided coverage.--In the case of an 
        individual whose household income does not exceed 138 percent 
        of the poverty line for a family of the size involved, clause 
        (i) of subsection (c)(2)(C) shall be applied (including in the 
        case of any individual described in the last sentence of such 
        clause) without regard to subclause (II) thereof.
            ``(3) Credit allowed to certain low-income employees 
        offered qualified small employer health reimbursement 
        arrangements.--A qualified small employer health reimbursement 
        arrangement shall not be treated as constituting affordable 
        coverage for an employee (or any spouse or dependent of such 
        employee) for any months of a taxable year if the employee's 
        household income for such taxable year does not exceed 138 
        percent of the poverty line for a family of the size involved.
            ``(4) Limitations on recapture.--
                    ``(A) In general.--In the case of a taxpayer whose 
                household income is less than 200 percent of the 
                poverty line for the size of the family involved for 
                the taxable year, the amount of the increase under 
                subsection (f)(2)(A) shall in no event exceed $300 
                (one-half of such amount in the case of a taxpayer 
                whose tax is determined under section 1(c) for the 
                taxable year).
                    ``(B) Limitation on increase for certain non-
                filers.--In the case of any taxpayer who would not be 
                required to file a return of tax for the taxable year 
                but for any requirement to reconcile advance credit 
                payments under subsection (f), if an Exchange 
                established under title I of the Patient Protection and 
                Affordable Care Act has determined that--
                            ``(i) such taxpayer is eligible for advance 
                        payments under section 1412 of such Act for any 
                        portion of such taxable year, and
                            ``(ii) such taxpayer's household income for 
                        such taxable year is projected not to exceed 
                        138 percent of the poverty line for a family of 
                        the size involved,
                subsection (f)(2)(A) shall not apply to such taxpayer 
                for such taxable year and such taxpayer shall not be 
                required to file such return of tax.
                    ``(C) Information provided by exchange.--The 
                information required to be provided by an Exchange to 
                the Secretary and to the taxpayer under subsection 
                (f)(3) shall include such information as is necessary 
                to determine whether such Exchange has made the 
                determinations described in clauses (i) and (ii) of 
                subparagraph (B) with respect to such taxpayer.''.
    (b) Employer Shared Responsibility Provision Not Applicable With 
Respect to Certain Low-Income Taxpayers Receiving Premium Assistance.--
Section 4980H(c)(3) of the Internal Revenue Code of 1986 is amended to 
read as follows:
            ``(3) Applicable premium tax credit and cost-sharing 
        reduction.--
                    ``(A) In general.--The term `applicable premium tax 
                credit and cost-sharing reduction' means--
                            ``(i) any premium tax credit allowed under 
                        section 36B,
                            ``(ii) any cost-sharing reduction under 
                        section 1402 of the Patient Protection and 
                        Affordable Care Act, and
                            ``(iii) any advance payment of such credit 
                        or reduction under section 1412 of such Act.
                    ``(B) Exception with respect to certain low-income 
                taxpayers.--Such term shall not include any premium tax 
                credit, cost-sharing reduction, or advance payment 
                otherwise described in subparagraph (A) if such credit, 
                reduction, or payment is allowed or paid for a taxable 
                year of an employee (beginning after December 31, 2025, 
                and before January 1, 2029) with respect to which--
                            ``(i) an Exchange established under title I 
                        of the Patient Protection and Affordable Care 
                        Act has determined that such employee's 
                        household income for such taxable year is 
                        projected to not exceed 138 percent of the 
                        poverty line for a family of the size involved, 
                        or
                            ``(ii) such employee's household income for 
                        such taxable year does not exceed 138 percent 
                        of the poverty line for a family of the size 
                        involved.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2025.

SEC. 4. FURTHER INCREASE IN FMAP FOR MEDICAL ASSISTANCE FOR NEWLY 
              ELIGIBLE MANDATORY INDIVIDUALS.

    Section 1905(y)(1) of the Social Security Act (42 U.S.C. 
1396d(y)(1)) is amended--
            (1) in subparagraph (D), by striking at the end ``and'';
            (2) in subparagraph (E), by striking ``2020 and each year 
        thereafter.'' and inserting ``2020, 2021, 2022, 2023, 2024, and 
        2025;''; and
            (3) by adding at the end the following new subparagraphs:
                    ``(F) 93 percent for calendar quarters in 2026, 
                2027, and 2028; and
                    ``(G) 90 percent for calendar quarters in 2029 and 
                each year thereafter.''.
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