SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Equitable Federal Medical Assistance 
Percentage Act of 1999''.

SEC. 2. EQUITABLE DETERMINATION OF FEDERAL MEDICAL ASSISTANCE 
              PERCENTAGE.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended by adding at the end the following:
    ``(v) Determination of Equitable Federal Medical Assistance 
Percentage.--
            ``(1) In general.--Except as provided in paragraph (4), the 
        equitable Federal medical assistance percentage determined 
        under this subsection is, for any State for a fiscal year, 100 
        percent reduced by the product of 0.45 and the ratio of--
                    ``(A) the State's share of cost-adjusted total 
                taxable resources determined under paragraph (2); to
                    ``(B) the State's share of program need determined 
                under paragraph (3).
            ``(2) Determination of state's share of cost-adjusted total 
        taxable resources.--
                    ``(A) In general.--For purposes of paragraph 
                (1)(A), with respect to a State, the State's share of 
                cost-adjusted total taxable resources is the ratio of--
                            ``(i)(I) an amount equal to the most recent 
                        3-year average of the total taxable resources 
                        (TTR) of the State, as determined by the 
                        Secretary of the Treasury; divided by
                            ``(II) the most recent 3-year average of 
                        the State's geographic health care cost index 
                        (as determined under subparagraph (B)); to
                            ``(ii) an amount equal to the sum of the 
                        amounts determined under clause (i) for all 
                        States.
                    ``(B) State's geographic health care cost index.--
                            ``(i) In general.--For purposes of 
                        subparagraph (A)(i)(II), the geographic health 
                        care cost index for a State for a fiscal year 
                        is the sum of--
                                    ``(I) 0.10;
                                    ``(II) 0.75 multiplied by the ratio 
                                of--
                                            ``(aa) the most recent 3-
                                        year average annual wages for 
                                        hospital employees in the State 
                                        or the District of Columbia (as 
                                        determined under clause (ii)); 
                                        to
                                            ``(bb) the most recent 3-
                                        year average annual wages for 
                                        hospital employees in the 50 
                                        States and the District of 
                                        Columbia (as determined under 
                                        that clause); and
                                    ``(III) 0.15 multiplied by the 
                                State's fair market rent index (as 
                                determined under clause (iii)).
                            ``(ii) Determination of average annual 
                        wages of hospital employees.--The Secretary 
                        shall provide for the determination of the most 
                        recent 3-year average annual wages for hospital 
                        employees in a State or the District of 
                        Columbia and, collectively, in the 50 States 
                        and the District of Columbia, based on the area 
                        wage data applicable to hospitals under section 
                        1886(d)(3)(E) (or, if such data no longer 
                        exists, comparable data of hospital wages) for 
                        discharges occurring during the fiscal years 
                        involved.
                            ``(iii) Determination of fair market rent 
                        index.--For purposes of clause (i)(III), a 
                        State's fair market rent index is the ratio 
                        of--
                                    ``(I) the average annual fair 
                                market rent for 2-bedroom housing units 
                                in the State or the District of 
                                Columbia, to be determined by the 
                                Secretary of Housing and Urban 
                                Development for the most recent 3 
                                fiscal years for which data are 
                                available; to
                                    ``(II) the average annual fair 
                                market rent for such housing units for 
                                all States for such 3 fiscal years, as 
                                so determined.
            ``(3) Determination of state's share of program need.--
                    ``(A) In general.--For purposes of paragraph 
                (1)(B), with respect to a State, the State's share of 
                program need is the ratio of--
                            ``(i) the State's program need determined 
                        under subparagraph (B); to
                            ``(ii) the sum of the amounts determined 
                        under clause (i) for all States.
                    ``(B) Determination of state program need.--
                            ``(i) In general.--For purposes of 
                        subparagraph (A)(i), a State's program need is 
                        equal to the average (determined for the most 
                        recent 5 fiscal years for which data are 
                        available) of the sum of the products 
                        determined under clause (iv) for each such 
                        fiscal year (based on the number of State 
                        residents whose income is below the State's 
cost-of-living adjusted poverty income level (as determined under 
clauses (ii) and (iii)).
                            ``(ii) Determination of number of state 
                        residents with incomes below the State's cost-
                        of-living adjusted poverty level.--
                                    ``(I) In general.--For purposes of 
                                clause (iv), with respect to each State 
                                and the District of Columbia, the 
                                number of residents whose income for a 
                                fiscal year is below the State's cost-
                                of-living adjusted poverty income level 
                                applicable to a family of the size 
                                involved (as determined under clause 
                                (iii)) shall be determined.
                                    ``(II) Census data.--The 
                                determination of the number of 
                                residents under subclause (I) shall be 
                                based on data made generally available 
                                by the Bureau of the Census from the 
                                Current Population Survey.
                            ``(iii) Determination of state's cost-of-
                        living adjusted poverty income level.--
                                    ``(I) In general.--For purposes of 
                                clause (ii)(I), a State's cost-of-
                                living adjusted poverty income level is 
                                the product of--
                                            ``(aa) the United States 
                                        poverty income threshold for 
                                        the fiscal year involved (as 
                                        defined by the Office of 
                                        Management and Budget for 
                                        general statistical purposes); 
                                        and
                                            ``(bb) the State's cost-of-
                                        living index (as determined 
                                        under subclause (II)).
                                    ``(II) Determination of state's 
                                cost-of-living index.--Subject to 
                                subclause (III), a State's cost-of-
                                living index is the sum of--
                                            ``(aa) 0.56; and
                                            ``(bb) the product of 0.44 
                                        and the State's fair market 
                                        rent index determined under 
                                        paragraph (2)(B)(iii).
                                    ``(III) Alternate methodology.--The 
                                Commissioner of Labor Statistics may 
                                use an alternate methodology to the 
                                formula set forth under subclause (II) 
                                to determine a State's cost-of-living 
                                index for purposes of subclause (I)(bb) 
                                if the Commissioner determines that the 
                                alternate methodology results in a more 
                                accurate determination of that index.
                            ``(iv) Weighting of age categories of 
                        residents in poverty to account for higher cost 
                        populations.--For purposes of clause (i), the 
                        products determined under this clause for a 
                        fiscal year are the following:
                                    ``(I) Weighting of elderly 
                                residents in poverty.--The number of 
                                residents determined under clause (ii) 
                                of the State or the District of 
                                Columbia for the fiscal year who have 
                                attained age 65 multiplied by 3.65.
                                    ``(II) Weighting of adult residents 
                                in poverty.--The number of residents 
                                determined under clause (ii) of the 
                                State or the District of Columbia for 
                                the fiscal year who have attained age 
                                21 but have not attained age 65 
                                multiplied by 1.0.
                                    ``(III) Weighting of children in 
                                poverty.--The number of residents 
                                determined under clause (ii) of the 
                                State or the District of Columbia for 
                                the fiscal year who have not attained 
                                age 21 multiplied by 0.5.
            ``(4) Special rules.--For purposes of this subsection and 
        subsection (b), the equitable Federal medical assistance 
        percentage is--
                    ``(A) in the case of the District of Columbia, the 
                percentage determined under this subsection for the 
                District of Columbia (without regard to this paragraph) 
                multiplied by 1.4.; and
                    ``(B) in the case of Alaska, 59.8 percent.''.
    (b) Conforming Amendments.--Section 1905(b) of the Social Security 
Act (42 U.S.C. 1396d(b)) is amended--
            (1) in the matter preceding paragraph (1), by striking 
        ``100 per centum'' and all that follows through ``Hawaii'' and 
        inserting ``the equitable Federal medical assistance percentage 
        determined under subsection (v)'';
            (2) in paragraph (1), by striking ``50 per centum or more 
        than 83 per centum,,'' and inserting ``50 percent or more than 
        83 percent, and''; and
            (3) in paragraph (2), by striking ``50 per centum'' and all 
        that follows through the period at the end of paragraph (3) and 
        inserting ``50 percent.''.
    (c) Effective Date.--The amendments made by this Act take effect on 
October 1, 1999.
Equitable Federal Medical Assistance Percentage Act of 1999 - Amends title XIX (Medicaid) of the Social Security Act to provide for the stated purpose of determining an equitable Federal medical assistance percentage for use under Medicaid.
Equitable Federal Medical Assistance Percentage Act of 1999