SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Fairness in Medicaid Funding Act of 
1993''.

SEC. 2. CHANGE IN FEDERAL MEDICAL ASSISTANCE PERCENTAGE.

    (a) In General.--Subsection (b) of section 1905 of the Social 
Security Act (42 U.S.C. 1396d(b)) is amended to read as follows:
    ``(b)(1)(A) Except as provided in paragraph (3), the term `Federal 
medical assistance percentage' means, for each of the 50 States and the 
District of Columbia, 100 percent reduced by the product of the 
applicable percentage (as defined in subparagraph (B)) and the ratio 
of--
            ``(i)(I) for each of the 50 States, the total taxable 
        resources ratio (as defined in subparagraph (C)) of the State, 
        or
            ``(II) for the District of Columbia, the per capita income 
        ratio (as defined in subparagraph (D)), to--
            ``(ii) the population in poverty ratio (as defined in 
        subparagraph (E)) of the State or District.
    ``(B)(i) For purposes of this subsection, the term `applicable 
percentage' means a percentage estimated by the Secretary with the 
advice of the General Accounting Office that, when applied under 
subparagraph (A), would result in an amount of aggregate payments under 
section 1903(a) for calendar years 1994 through 1998 equal to the 
amount of aggregate payments that would have been made under such 
section for quarters in such years if this subsection were applied as 
in effect on the day before the date of the enactment of the Medicaid 
Fairness in Funding Act of 1993.
    ``(ii) The applicable percentage estimated by the Secretary under 
clause (i) shall continue to apply with respect to quarters beginning 
after calendar year 1998.
    ``(C) For purposes of this subsection, the term `total taxable 
resources ratio' means--
            ``(i) an amount equal to the most recent 3-year average of 
        the total taxable resources of the State, as determined by the 
        Secretary of the Treasury, divided by
            ``(ii) an amount equal to the sum of the 3-year averages 
        determined under clause (i) for each of the 50 States.
    ``(D) For purposes of this subsection, the term `per capita income 
ratio' means--
            ``(i) an amount equal to the most recent 3-year average of 
        the total personal income of the District of Columbia, as 
        determined in accordance with the provisions of section 
        1101(a)(8)(B), divided by
            ``(ii) an amount equal to the total personal income of the 
        continental United States (including Alaska) and Hawaii, as 
        determined under section 1101(a)(8)(B).
    ``(E) For purposes of this subsection, the term `population in 
poverty ratio' means--
            ``(i) an amount equal to the 3-year-average of the number 
        of individuals in the State (or the District of Columbia) whose 
        family income is below the income official poverty line (as 
        defined by the Office of Management and Budget and revised 
        annually in accordance with section 673(2) of the Omnibus 
        Budget Reconciliation Act of 1981), divided by
            ``(ii) an amount equal to the sum of the averages 
        determined under clause (i) for the 50 States.
    ``(2) The Federal medical assistance percentage for Puerto Rico, 
the Virgin Islands, Guam, the Northern Mariana Islands, and American 
Samoa shall be 50 percent.
    ``(3)(A) Except as provided in subparagraph (B), the Federal 
medical assistance percentage shall in no case be less than 40 percent 
or greater than 83 percent.
    ``(B) The Federal medical assistance percentage shall be 100 
percent with respect to amounts expended as medical assistance for 
services which are received through an Indian Health Service facility 
whether operated by the Indian Health Service or by an Indian tribe or 
tribal organization (as defined in section 4 of the Indian Health Care 
Improvement Act).
    ``(4) For purposes of any provision of law other than a provision 
of this title, unless otherwise specifically provided, any reference to 
the `Federal medical assistance percentage' as defined in this section 
shall be considered a reference to such term as defined under this 
subsection as in effect on the day before the date of the enactment of 
the Medicaid Fairness in Funding Act of 1993.''.
    (b) Conforming Amendment.--Section 1118 of the Social Security Act 
(42 U.S.C. 1318) is amended by striking ``(as defined in section 
1905)'' and inserting ``(as defined in section 1905(b), as in effect on 
the day before the date of the enactment of the Medicaid Fairness in 
Funding Act of 1993)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to payments made to States with respect to calendar quarters 
beginning on or after January 1, 1994.

SEC. 3. ADMINISTRATION EXPENDITURES.

    (a) In General.--Section 1903(a) of the Social Security Act (42 
U.S.C. 1396b(a)) is amended--
            (1) in paragraph (2)--
                    (A) in subparagraph (A), by striking ``75 per 
                centum'' and inserting ``the Federal medical assistance 
                percentage'';
                    (B) by striking subparagraph (B) and inserting the 
                following new subparagraph:
            ``(B) with respect to amounts expended for nursing aide 
        training and competency evaluation programs, and competency 
        evaluation programs described in section 1919(e)(1) (including 
        the costs for nurses aides to complete such competency 
        evaluation programs) regardless of whether the programs are 
        provided in or outside nursing facilities or the skill of the 
        personnel involved in such programs, an amount equal to the 
        Federal medical assistance percentage of so much of the sums 
        expended during such quarter (as found necessary by the 
        Secretary for the proper and efficient administration of the 
        State plan) as are attributable to such programs; plus'';
                    (C) in subparagraph (C), by striking ``75 percent'' 
                and inserting ``the Federal medical assistance 
                percentage''; and
                    (D) by striking subparagraph (D) and inserting the 
                following new subparagraph:
            ``(D) an amount equal to the Federal medical assistance 
        percentage of so much of the sums expended (as found necessary 
        by the Secretary for the proper and efficient administration of 
        the State plan) as are attributable to State activities under 
        section 1919(g); plus'';
            (2) in paragraph (3)--
                    (A) in subparagraph (A)--
                            (i) by striking ``(A)(i)'' and inserting 
                        ``(A)'';
                            (ii) by striking ``90 per centum'' and 
                        inserting ``the Federal medical assistance 
                        percentage'';
                            (iii) by striking ``under this title, and'' 
                        and inserting ``under this title; plus''; and
                            (iv) by striking clause (ii);
                    (B) in subparagraph (B), by striking ``75 per 
                centum'' and inserting ``the Federal medical assistance 
                percentage'';
                    (C) in subparagraph (C), by striking ``75 per 
                centum'' and inserting ``the Federal medical assistance 
                percentage''; and
                    (D) in subparagraph (D), by striking ``75 percent'' 
                and inserting ``the Federal medical assistance 
                percentage'';
            (3) in paragraph (4), by striking ``100 percent'' and 
        inserting ``the Federal medical assistance percentage'';
            (4) in paragraph (5), by striking ``90 per centum'' and 
        inserting ``the Federal medical assistance percentage'';
            (5) by striking paragraph (6) and inserting the following 
        new paragraph:
            ``(6) subject to subsection (b)(3), an amount equal to the 
        Federal medical assistance percentage of the sums expended with 
        respect to costs incurred during such quarter (as found 
        necessary by the Secretary for the elimination of fraud in the 
        provision and administration of medical assistance provided 
        under the State plan) which are attributable to the 
        establishment and operation of (including the training of 
        personnel employed by) a State medicaid fraud control unit 
        (described in subsection (q)); plus''; and
            (6) in paragraph (7), by striking ``subject to section 
        1919(g)(3)(B), an amount equal to 50 per centum'' and inserting 
        ``subject to section 1919(g)(3)(C), an amount equal to the 
        Federal medical assistance percentage''.
    (b) Effective Date.--The amendments made by this section shall 
apply to payments made to States with respect to calendar quarters 
beginning on or after January 1, 1994.
Fairness in Medicaid Funding Act of 1993 - Amends title XIX (Medicaid) of the Social Security Act to change the Federal medical assistance percentage used under the Medicaid program.  Bases payments to the States for administration costs on the Federal medical assistance percentage.
Fairness in Medicaid Funding Act of 1993