[Congressional Record Volume 163, Number 127 (Thursday, July 27, 2017)]
[Senate]
[Page S4528]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 532. Mr. RUBIO submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 37, insert the following after line 13:
       ``(5) Adjustments to state expenditures targets to promote 
     program equity across states.--
       ``(A) In general.--Beginning with fiscal year 2020, the 
     target per capita medical assistance expenditures for a 1903A 
     enrollee category, State, and fiscal year, as determined 
     under paragraph (2), shall be adjusted (subject to 
     subparagraph (C)(i)) in accordance with this paragraph.
       ``(B) Adjustment based on level of per capita spending for 
     1903a enrollee categories.--Subject to subparagraph (C), with 
     respect to a State, fiscal year, and 1903A enrollee category, 
     if the State's per capita categorical medical assistance 
     expenditures (as defined in subparagraph (D)) for the State 
     and category in the preceding fiscal year--
       ``(i) exceed the mean per capita categorical medical 
     assistance expenditures for the category for all States for 
     such preceding year by not less than 25 percent, the State's 
     target per capita medical assistance expenditures for such 
     category for the fiscal year involved shall be reduced by a 
     percentage that shall be determined by the Secretary but 
     which shall not be less than 0.5 percent or greater than 3 
     percent; or
       ``(ii) are less than the mean per capita categorical 
     medical assistance expenditures for the category for all 
     States for such preceding year by not less than 25 percent, 
     the State's target per capita medical assistance expenditures 
     for such category for the fiscal year involved shall be 
     increased by a percentage that shall be determined by the 
     Secretary but which shall not be less than 0.5 percent or 
     greater than 3 percent.
       ``(C) Rules of application.--
       ``(i) Budget neutrality requirement.--In determining the 
     appropriate percentages by which to adjust States' target per 
     capita medical assistance expenditures for a category and 
     fiscal year under this paragraph, the Secretary shall make 
     such adjustments in a manner that does not result in a net 
     increase in Federal payments under this section for such 
     fiscal year, and if the Secretary cannot adjust such 
     expenditures in such a manner there shall be no adjustment 
     under this paragraph for such fiscal year.
       ``(ii) Assumption regarding state expenditures.--For 
     purposes of clause (i), in the case of a State that has its 
     target per capita medical assistance expenditures for a 1903A 
     enrollee category and fiscal year increased under this 
     paragraph, the Secretary shall assume that the categorical 
     medical assistance expenditures (as defined in subparagraph 
     (D)(ii)) for such State, category, and fiscal year will equal 
     such increased target medical assistance expenditures.
       ``(iii) Nonapplication to low-density states.--This 
     paragraph shall not apply to any State that has a population 
     density of less than 15 individuals per square mile, based on 
     the most recent data available from the Bureau of the Census.
       ``(iv) Disregard of adjustment.--Any adjustment under this 
     paragraph to target medical assistance expenditures for a 
     State, 1903A enrollee category, and fiscal year shall be 
     disregarded when determining the target medical assistance 
     expenditures for such State and category for a succeeding 
     year under paragraph (2).
       ``(v) Application for fiscal years 2020 and 2021.--In 
     fiscal years 2020 and 2021, the Secretary shall apply this 
     paragraph by deeming all categories of 1903A enrollees to be 
     a single category.
       ``(D) Per capita categorical medical assistance 
     expenditures.--
       ``(i) In general.--In this paragraph, the term `per capita 
     categorical medical assistance expenditures' means, with 
     respect to a State, 1903A enrollee category, and fiscal year, 
     an amount equal to--

       ``(I) the categorical medical expenditures (as defined in 
     clause (ii)) for the State, category, and year; divided by
       ``(II) the number of 1903A enrollees for the State, 
     category, and year.

       ``(ii) Categorical medical assistance expenditures.--The 
     term `categorical medical assistance expenditures' means, 
     with respect to a State, 1903A enrollee category, and fiscal 
     year, an amount equal to the total medical assistance 
     expenditures (as defined in paragraph (2)) for the State and 
     fiscal year that are attributable to 1903A enrollees in the 
     category, excluding any excluded expenditures (as defined in 
     paragraph (3)) for the State and fiscal year that are 
     attributable to 1903A enrollees in the category.
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