[Congressional Record Volume 165, Number 3 (Tuesday, January 8, 2019)]
[House]
[Pages H234-H237]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     MEDICAID EXTENDERS ACT OF 2019

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 259) to extend the Medicaid Money Follows the Person 
Rebalancing demonstration, to extend protection for Medicaid recipients 
of home and community-based services against spousal impoverishment, 
and for other purposes, as amended.

[[Page H235]]

  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 259

       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 ``Medicaid Extenders Act of 
     2019''.

     SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING 
                   DEMONSTRATION.

       (a) General Funding.--Section 6071(h) of the Deficit 
     Reduction Act of 2005 (42 U.S.C. 1396a note) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (D), by striking ``and'' after the 
     semicolon;
       (B) in subparagraph (E), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding at the end the following:
       ``(F) subject to paragraph (3), $112,000,000 for fiscal 
     year 2019.'';
       (2) in paragraph (2)--
       (A) by striking ``Amounts made'' and inserting ``Subject to 
     paragraph (3), amounts made''; and
       (B) by striking ``September 30, 2016'' and inserting 
     ``September 30, 2021''; and
       (3) by adding at the end the following new paragraph:
       ``(3) Special rule for fy 2019.--Funds appropriated under 
     paragraph (1)(F) shall be made available for grants to States 
     only if such States have an approved MFP demonstration 
     project under this section as of December 31, 2018.''.
       (b) Funding for Quality Assurance and Improvement; 
     Technical Assistance; Oversight.--Section 6071(f) of the 
     Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is 
     amended by striking paragraph (2) and inserting the 
     following:
       ``(2) Funding.--From the amounts appropriated under 
     subsection (h)(1)(F) for fiscal year 2019, $500,000 shall be 
     available to the Secretary for such fiscal year to carry out 
     this subsection.''.
       (c) Technical Amendment.--Section 6071(b) of the Deficit 
     Reduction Act of 2005 (42 U.S.C. 1396a note) is amended by 
     adding at the end the following:
       ``(10) Secretary.--The term `Secretary' means the Secretary 
     of Health and Human Services.''.

     SEC. 3. EXTENSION OF PROTECTION FOR MEDICAID RECIPIENTS OF 
                   HOME AND COMMUNITY-BASED SERVICES AGAINST 
                   SPOUSAL IMPOVERISHMENT.

       (a) In General.--Section 2404 of Public Law 111-148 (42 
     U.S.C. 1396r-5 note) is amended by striking ``the 5-year 
     period that begins on January 1, 2014,'' and inserting ``the 
     period beginning on January 1, 2014, and ending on March 31, 
     2019,''.
       (b) Rule of Construction.--
       (1) Protecting state spousal income and asset disregard 
     flexibility under waivers and plan amendments.--Nothing in 
     section 2404 of Public Law 111-148 (42 U.S.C. 1396r-5 note) 
     or section 1924 of the Social Security Act (42 U.S.C. 1396r-
     5) shall be construed as prohibiting a State from 
     disregarding an individual's spousal income and assets under 
     a State waiver or plan amendment described in paragraph (2) 
     for purposes of making determinations of eligibility for home 
     and community-based services or home and community-based 
     attendant services and supports under such waiver or plan 
     amendment.
       (2) State waiver or plan amendment described.--A State 
     waiver or plan amendment described in this paragraph is any 
     of the following:
       (A) A waiver or plan amendment to provide medical 
     assistance for home and community-based services under a 
     waiver or plan amendment under subsection (c), (d), or (i) of 
     section 1915 of the Social Security Act (42 U.S.C. 1396n) or 
     under section 1115 of such Act (42 U.S.C. 1315).
       (B) A plan amendment to provide medical assistance for home 
     and community-based services for individuals by reason of 
     being determined eligible under section 1902(a)(10)(C) of 
     such Act (42 U.S.C. 1396a(a)(10)(C)) or by reason of section 
     1902(f) of such Act (42 U.S.C. 1396a(f)) or otherwise on the 
     basis of a reduction of income based on costs incurred for 
     medical or other remedial care under which the State 
     disregarded the income and assets of the individual's spouse 
     in determining the initial and ongoing financial eligibility 
     of an individual for such services in place of the spousal 
     impoverishment provisions applied under section 1924 of such 
     Act (42 U.S.C. 1396r-5).
       (C) A plan amendment to provide medical assistance for home 
     and community-based attendant services and supports under 
     section 1915(k) of such Act (42 U.S.C. 1396n(k)).

     SEC. 4. REDUCTION IN FMAP AFTER 2020 FOR STATES WITHOUT ASSET 
                   VERIFICATION PROGRAM.

       Section 1940 of the Social Security Act (42 U.S.C. 1396w) 
     is amended by adding at the end the following new subsection:
       ``(k) Reduction in FMAP After 2020 for Non-Compliant 
     States.--
       ``(1) In general.--With respect to a calendar quarter 
     beginning on or after January 1, 2021, the Federal medical 
     assistance percentage otherwise determined under section 
     1905(b) for a non-compliant State shall be reduced--
       ``(A) for calendar quarters in 2021 and 2022, by 0.12 
     percentage points;
       ``(B) for calendar quarters in 2023, by 0.25 percentage 
     points;
       ``(C) for calendar quarters in 2024, by 0.35 percentage 
     points; and
       ``(D) for calendar quarters in 2025 and each year 
     thereafter, by 0.5 percentage points.
       ``(2) Non-compliant state defined.--For purposes of this 
     subsection, the term `non-compliant State' means a State--
       ``(A) that is one of the 50 States or the District of 
     Columbia;
       ``(B) with respect to which the Secretary has not approved 
     a State plan amendment submitted under subsection (a)(2); and
       ``(C) that is not operating, on an ongoing basis, an asset 
     verification program in accordance with this section.''.

     SEC. 5. MEDICAID IMPROVEMENT FUND.

       Section 1941(b)(1) of the Social Security Act (42 U.S.C. 
     1396w-1(b)(1)) is amended by striking ``$31,000,000'' and 
     inserting ``$6,000,000''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Texas (Mr. Burgess) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks and include 
extraneous material on H.R. 259.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today to express my support for H.R. 259, the 
Medicaid Extenders Act of 2019. This bill would extend for 3 months the 
successful Money Follows the Person demonstration and the spousal 
impoverishment protections for home- and community-based services 
recipients. These two provisions have helped tens of thousands of 
people remain in the community with their families and friends while 
receiving the healthcare and other services that they need.
  The MFP demonstration helps people transition from institutional 
settings to community-based settings so they can live in their homes 
and maintain their independence, and all of this is possible because 
the demonstration provides them access to the services in their homes 
that they would otherwise receive in an institution.
  This is a widely used and successful program. Currently, 43 States 
and the District of Columbia participate. And it has helped over 75,000 
people transition from institutions to the community.
  I thank my colleagues, Representative Dingell and Representative 
Guthrie, for their bipartisan efforts to protect this important 
program. I urge my colleagues to support extending this program as the 
Energy and Commerce Committee works on a longer-term extension.
  Mr. Speaker, I also support extending the protections against spousal 
impoverishment for beneficiaries receiving home- and community-based 
services. These protections ensure that people can receive the 
community-based services they need and that their spouse has enough 
income and assets to meet their living expenses. This protection 
expired at the end of last year, and it is vital that we act quickly to 
reauthorize it.
  Without this protection, individuals may lose access to important 
services or face unnecessary institutionalization. This is a terrible 
choice for families to make and one that we can prevent by passing this 
bill. Similar to MFP, this extension will give the committee time to 
work on a long-term solution.
  Mr. Speaker, both of these extensions were passed as part of the 
continuing resolution in the Senate in December. Unfortunately, since 
then, a fight has ensued over appropriations funding. While it is my 
hope that the President will drop his demand for an ineffective and 
unnecessary wall, I do not want these programs to be collateral damage 
over that debate.
  Both of these programs have bipartisan support and must be extended 
without delay. I urge my colleagues to support H.R. 259, the Medicaid 
Extenders Act of 2019.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of the Medicaid Extenders Act of 2019, 
a bipartisan Medicaid package that moves forward House priorities with 
responsible offsets.

[[Page H236]]

  The Energy and Commerce Committee worked to draft this critical 
legislation before us today. This language passed in the House of 
Representatives in the last Congress as part of the IMPROVE Act, but in 
the other body they failed to send the bill to the President's desk. I 
urge my colleagues in both the House and the Senate to support this 
important bill.
  The package extends funding for the Money Follows the Person 
demonstration, an effort led by Representatives Brett Guthrie and 
Debbie Dingell. This Medicaid demonstration, which was established in 
2005, has enabled eligible individuals in States across the Nation to 
receive long-term care services in their homes or other community 
settings, rather than in institutions or nursing homes. Not only does 
this increase the comfort and the quality of life for many Medicaid 
beneficiaries, but it has reduced hospital readmissions and saved money 
within the Medicaid program.
  The funding for this program has already expired, and a funding 
extension is already long overdue. While we would like to have extended 
the funding for longer, it was essential to get an extension across the 
floor, even if it is just for a small period of time.
  A 3-month extension for the protection for Medicaid recipients of 
home- and community-based services against spousal impoverishment is 
also included. This effort was championed by Representatives Fred Upton 
and Debbie Dingell. Our seniors are among our most vulnerable citizens, 
and it is programs like this one that help protect them from financial 
ruin.
  This program specifically protects married individuals requiring 
Medicaid-covered long-term services and supports to ensure that they do 
not have to deplete their financial resources or bankrupt themselves in 
order to become or remain Medicaid eligible to receive such services.
  In an effort to be fiscally responsible, this legislation includes 
several offsets that make this package on net a saver.
  One of those offsets will require States to come into compliance with 
the Supplemental Appropriations Act of 2008 regarding Medicaid asset 
verification programs. This 2008 law required States to implement asset 
verification programs in order to determine or redetermine eligibility, 
and the Affordable Care Act required such programs to be filed 
electronically.
  Currently, only 33 States have operational programs. This provision 
will bring the remaining States up to speed by levying a penalty on 
States that do not have a program in place by 2020. This package 
contains must-pass provisions that the Energy and Commerce Committee 
has long fought to pass. The provisions included in this legislation 
will improve access for Medicaid beneficiaries, which is laudable and 
an important goal. Not only are these provisions imperative, but they 
are responsibly offset.

  I particularly thank the Energy and Commerce Committee staffer, Caleb 
Graff, who has spent countless hours negotiating and getting this 
package to the floor. I support this legislation and urge Members of 
the House and Senate to do so as well.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield as much time as she may consume to 
the gentlewoman from Michigan (Mrs. Dingell).
  Mrs. DINGELL. Mr. Speaker, I thank the chairman for the recognition 
and yielding me this time.
  Mr. Speaker, I rise in support of H.R. 259, the Medicaid Extenders 
Act. Our long-term care system is broken. Like millions of Americans, 
I, too, am a primary caretaker for my husband, and I meet people every 
single day. I often say taking John to the doctor is like attending a 
town hall meeting. While we continue to work towards a much needed 
overhaul of our long-term care financing, we also need to build on and 
protect existing programs.
  The Medicaid Extenders Act includes a 3-month extension of the highly 
successful Money Follows the Person program. This program provides 
grants to States to help individuals voluntarily transition from an 
institutional setting to a community care setting. Money Follows the 
Person is a win for both the beneficiaries and the taxpayers because 
the program has demonstrated significant savings over the years while 
bringing a real-time benefit to people's lives.
  The Medicaid Extenders Act also extends spousal impoverishment 
protections for seniors in Medicaid. These important protections ensure 
that individuals are not forced to spend down all of their resources, 
and too many go bankrupt, just to get the care that they need.
  However, this bill is just a partial victory. I do hope the House 
will pass it. Both programs are extended for only 3 months. While this 
is enough to keep these important programs alive for the moment, we 
must pass long-term extensions of both programs as quickly as possible.
  I will soon be introducing bipartisan legislation to do just that, 
and I look forward to working with all of my colleagues this year on 
long-term extensions of these critical programs. I urge my colleagues 
to join me in supporting H.R. 259.
  Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Kentucky (Mr. Guthrie), the primary sponsor of this bill.
  Mr. GUTHRIE. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, I rise today in support of the Medicaid Extenders Act of 
2019. The Medicaid Extenders Act of 2019 includes legislation that I 
worked on, the EMPOWER Care Act, which will extend the vital Money 
Follows the Person program.
  The Money Follows the Person program allows certain Medicaid 
beneficiaries, such as the elderly or individuals with disabilities, to 
transition from healthcare facilities to receiving care in their own 
homes or communities, if they choose to do so. This program empowers 
patients to choose the care that makes the most sense for them while 
saving taxpayers money.
  Kentucky Transitions, which operates the Money Follows the Person in 
my home State, has helped hundreds of Kentuckians transition to 
receiving care in their homes or their communities.
  I thank Congresswoman Debbie Dingell for working so hard on this 
legislation and working together on this bipartisan piece of 
legislation. I thank the chairman's kind words as he was talking about 
this legislation. I encourage my colleagues to vote for this bill.
  Mr. BURGESS. Mr. Speaker, we have no further speakers. We did pass 
this bill in this House in December. I urge all Members to support the 
bill as it goes forward today.
  Mr. Speaker, I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I would also ask that we support this bill 
on a bipartisan basis without delay.
  Mr. Speaker, I yield back the balance of my time.
   Ms. JACKSON LEE. Mr. Speaker, I rise in support of H.R. 259, the 
``Medicaid Extenders Act of 2019'' that extends the ``Medicaid Money 
Follows the Person'' rebalancing demonstration project.
  The ``Medicaid Money Follows the Person'' demonstration project 
supports reintegration of persons with special needs into their 
communities.
  Since its creation in 1965, Medicaid has been the largest source of 
medical and health-related services for Americans with a low income and 
limited resources.
  Over 75,151 people with chronic conditions and disabilities have 
transitioned from institutions back into the community through ``Money 
Follows the Person'' programs as of December 2016.
  My home state of Texas was among the first 30 states chosen to 
participate in the ``Money Follows the Person'' demonstration in 2007.
  The ``Money Follows the Person'' demonstration project has helped 
more than 10,000 individuals transition from institutional to 
community-based services in the state of Texas.
  In the 18th Congressional District of Texas there are 162 nursing 
homes and out of 162 nursing homes only 67 nursing homes accept 
Medicaid.
  43 percent of seniors in Houston, Texas earn less than $30,000 per 
year.
  Texas has the second largest number of individuals with disabilities 
of all the states and the percentage of individuals with disabilities 
in the state of Texas is 11.7 percent.
  In the fiscal year of 2016, Health and Human Services has budgeted 
over $16 million in federal funding to help individuals transition out 
of nursing facilities, State Supported Living Centers, Intermediate 
Care Facilities for Individuals with Intellectual Disabilities and 
other institutions.

[[Page H237]]

  The ``Money Follows the Person'' demonstration project has helped 
states and the federal government save money. From 2008 to 2013, it 
generated $978 million in reduced Medicare and Medicaid costs after the 
first year of transitioning participants to home- and community-based 
care.
  For these reasons, I ask my colleagues to join me in supporting H.R. 
259.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 259, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________