II 

116TH CONGRESS 

2D SESSION S. 4509 

To provide for affordable coverage of COVID–19 vaccines under Medicare, 

Medicaid, and the Children’s Health Insurance Program, and for other 

purposes. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 6, 2020 

Mr. WYDEN introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To provide for affordable coverage of COVID–19 vaccines 

under Medicare, Medicaid, and the Children’s Health 

Insurance Program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Vaccine And Coverage Certainty Act’’ or the ‘‘VACC 

6 Act’’. 

7 (b) TABLE OF CONTENTS.—The table of contents for 

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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TITLE I—ENSURING COVERAGE OF COVID–19 VACCINES 

Sec. 101. Ensuring affordability of federally funded COVID–19 vaccines under 

Medicare. 

Sec. 102. Mandatory coverage of COVID–19 vaccines under Medicaid and 

CHIP. 

Sec. 103. Inclusion of federally funded COVID–19 vaccines under Medicaid 

drug rebate program; coverage of COVID–19 vaccines under 

State pediatric vaccine distribution program. 

Sec. 104. Temporary enhanced Federal match for medical assistance for 

COVID–19 vaccines. 

TITLE II—ENSURING COVERAGE UNDER MEDICAID 

Sec. 201. Increased FMAP for medical assistance to newly eligible individuals. 

Sec. 202. Medicaid coverage for citizens of Freely Associated States. 

TITLE III—ENSURING COVERAGE IN THE MARKETPLACE 

Sec. 301. Disregard of additional unemployment compensation for purposes of 

premium tax credit and cost-sharing subsidies. 

1 TITLE I—ENSURING COVERAGE 

2 OF COVID–19 VACCINES 

3 SEC. 101. ENSURING AFFORDABILITY OF FEDERALLY 

4 FUNDED COVID–19 VACCINES UNDER MEDI5 CARE. 

6 (a) IN GENERAL.—Section 1833 of the Social Secu7 rity Act (42 U.S.C. 1395l) is amended— 

8 (1) in subsection (a)(1)(B), by inserting ‘‘sub9 ject to subsection (dd)(1) (with respect to payment 

10 for federally funded COVID–19 vaccines),’’ after 

11 ‘‘1861(s)(10)(A),’’; and 

12 (2) by adding at the end the following new sub13 section: 

14 ‘‘(dd) ENSURING AFFORDABILITY OF FEDERALLY

15 FUNDED COVID–19 VACCINES.— 


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1 ‘‘(1) INITIAL PAYMENT.—For purposes of sub2 section (a)(1)(B), the amount of charges that are 

3 considered reasonable with respect to an applicable 

4 COVID–19 vaccine during the first year that such 

5 vaccine is administered under this part (referred to 

6 in this subsection as the ‘initial payment year’) shall 

7 not exceed the amount described in paragraph (3). 

8 ‘‘(2) APPLICABLE COVID–19 VACCINE.— 

9 ‘‘(A) IN GENERAL.—In this subsection, the 

10 term ‘applicable COVID–19 vaccine’ means a 

11 vaccine— 

12 ‘‘(i) approved by the Food and Drug 

13 Administration under section 351 of the 

14 Public Health Service Act or authorized 

15 for emergency use under section 564 of the 

16 Federal Food, Drug, and Cosmetic Act for 

17 immunization against COVID–19; and 

18 ‘‘(ii) whose manufacturer was pro19 vided funding for research or development 

20 of such vaccine or for the manufacture of 

21 such vaccine under a contract with the 

22 Federal Government (including the Bio23 defense Advanced Research and Develop24 ment Authority of the Department of 

25 Health and Human Services) or under a 


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1 Federal grant program using funds made 

2 available under the Coronavirus Aid, Re3 lief, and Economic Security Act (Public 

4 Law 116–136), or subsequently enacted 

5 legislation. 

6 ‘‘(B) NONAPPLICATION TO VACCINES PUR7 CHASED FOR FEDERAL DISTRIBUTION.—Such 

8 term shall not include any doses of such vaccine 

9 that are purchased under a Federal contract or 

10 grant agreement described in paragraph (2)(B) 

11 for Federal distribution. 

12 ‘‘(3) AMOUNT DESCRIBED.—The amount de13 scribed in this paragraph, with respect to an applica14 ble COVID–19 vaccine, is the Federal procurement 

15 cost per dose accounting for Federal costs under all 

16 Federal contracts or grant agreements described in 

17 paragraph (2)(B) for the initial supply order with 

18 respect to such vaccine, not including the cost of any 

19 option to buy future doses of such vaccine under 

20 such contracts or agreements. 

21 ‘‘(4) PAYMENT IN SUBSEQUENT YEARS.—For 

22 provisions relating to payment for an applicable 

23 COVID–19 vaccine in years after the initial payment 

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1 ment amount equal to 95 percent of the average 

2 wholesale price). 

3 ‘‘(5) REBATE IF PRICE INCREASES FASTER

4 THAN INFLATION.— 

5 ‘‘(A) IN GENERAL.—Subject to subpara6 graph (B), the Secretary shall establish a proc7 ess under which, with respect to an applicable 

8 COVID–19 vaccine of a manufacturer, effective 

9 beginning with the first year after the initial 

10 payment year, if the amount of payment for the 

11 vaccine under this part increases faster than in12 flation with respect to a rebate period specified 

13 by the Secretary, the manufacturer of such vac14 cine shall, not later than 30 days after receipt 

15 from the Secretary of the rebate amount for 

16 such rebate period, provide a rebate to the Sec17 retary that is equal to the amount specified in 

18 subparagraph (C) for such vaccine and rebate 

19 period. 

20 ‘‘(B) EXCEPTIONS.—The process estab21 lished under this paragraph shall provide for 

22 the following exceptions with respect to an ap23 plicable COVID–19 vaccine of a manufacturer: 

24 ‘‘(i) If the Secretary determines that 

25 there are exceptional circumstances, such 


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1 as a substantial increase in development or 

2 manufacturing costs due to circumstances 

3 outside the control of the manufacturer. 

4 ‘‘(ii) The manufacturer demonstrates, 

5 to the satisfaction of the Secretary, that it 

6 has significantly improved the clinical effi7 cacy or safety of such vaccine relative to 

8 its clinical efficacy or safety when it was 

9 first procured or contracted for by the 

10 Federal Government. For purposes of the 

11 preceding sentence, a manufacturer may 

12 demonstrate the improved clinical efficacy 

13 or safety of a particular COVID–19 vac14 cine according to a process established by 

15 the Advisory Committee on Immunization 

16 Practices at the Centers for Disease Con17 trol in coordination with the Food and 

18 Drug Administration. The results of any 

19 assessment under this clause with respect 

20 to an applicable COVID–19 vaccine shall 

21 be made public. 

22 ‘‘(C) REBATE AMOUNT.—The amount of a 

23 rebate under this subparagraph, with respect to 

24 an applicable COVID–19 vaccine of a manufac25 turer, is the product of— 


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1 ‘‘(i) the total number of doses of such 

2 vaccine administered during the rebate pe3 riod; and 

4 ‘‘(ii) the amount (if any) by which— 

5 ‘‘(I) the amount of payment for 

6 the vaccine under this part during the 

7 rebate period; exceeds 

8 ‘‘(II) the inflation-adjusted pay9 ment amount determined under sub10 paragraph (D) of this paragraph for 

11 such vaccine during the rebate period. 

12 ‘‘(D) DETERMINATION OF INFLATION-AD13 JUSTED PAYMENT AMOUNT.—The inflation-ad14 justed payment amount determined under this 

15 subparagraph for an applicable COVID–19 vac16 cine for a rebate period is— 

17 ‘‘(i) the amount of payment for the 

18 vaccine under this part during the initial 

19 payment year as described in paragraph 

20 (1); increased by 

21 ‘‘(ii) the percentage by which the re22 bate period CPI–U (as defined in subpara23 graph (F)) for the rebate period exceeds 

24 the benchmark period CPI–U (as defined 

25 in subparagraph (E)). 


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1 ‘‘(E) BENCHMARK PERIOD CPI–U.—The 

2 term ‘benchmark period CPI–U’ means the con3 sumer price index for all urban consumers 

4 (United States city average) for the first cal5 endar quarter in the initial payment year. 

6 ‘‘(F) REBATE PERIOD CPI–U.—The term 

7 ‘rebate period CPI–U’ means, with respect to a 

8 rebate period, the consumer price index for all 

9 urban consumers (United States city average) 

10 for the last month of the calendar quarter that 

11 is two calendar quarters prior to the rebate pe12 riod. 

13 ‘‘(G) PROVISION OF INFORMATION.—A 

14 manufacturer of an applicable COVID–19 vac15 cine shall provide to the Secretary such infor16 mation, at such time and in such manner as the 

17 Secretary specifies, as is needed to carry out 

18 this paragraph. 

19 ‘‘(H) REBATE DEPOSITS.—Amounts paid 

20 as rebates under this paragraph shall be depos21 ited into the Federal Supplementary Medical 

22 Insurance Trust Fund established under section 

23 1841. 

24 ‘‘(I) ENFORCEMENT.— 

25 ‘‘(i) CIVIL MONEY PENALTY.— 


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1 ‘‘(I) IN GENERAL.—The Sec2 retary shall impose a civil money pen3 alty on a manufacturer that fails to 

4 comply with the requirements under 

5 this paragraph with respect to pro6 viding a rebate for an applicable 

7 COVID–19 vaccine for a rebate period 

8 for each such failure in an amount 

9 equal to the sum of— 

10 ‘‘(aa) the rebate amount 

11 specified pursuant to subpara12 graph (C) for such vaccine for 

13 such rebate period; and 

14 ‘‘(bb) 25 percent of such 

15 amount. 

16 ‘‘(II) APPLICATION.—The provi17 sions of section 1128A (other than 

18 subsections (a) (with respect to 

19 amounts of penalties or additional as20 sessments) and (b)) shall apply to a 

21 civil money penalty under this clause 

22 in the same manner as such provi23 sions apply to a penalty or proceeding 

24 under section 1128A(a). 


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1 ‘‘(ii) NO PAYMENT FOR MANUFACTUR2 ERS WHO FAIL TO PAY PENALTY.—If the 

3 manufacturer of an applicable COVID–19 

4 vaccine fails to pay a civil money penalty 

5 under clause (i) with respect to the failure 

6 to provide a rebate for an applicable 

7 COVID–19 vaccine for a rebate period by 

8 a date specified by the Secretary after the 

9 imposition of such penalty, no payment 

10 shall be available under this part for such 

11 vaccine for calendar quarters beginning on 

12 or after such date until the Secretary de13 termines the manufacturer has paid the 

14 penalty due under such clause. 

15 ‘‘(J) IMPLEMENTATION.—There shall be 

16 no administrative or judicial review under sec17 tion 1869, section 1878, or otherwise, of the de18 termination of the rebate amount for an appli19 cable COVID–19 vaccine under subparagraph 

20 (C), including the determination of— 

21 ‘‘(i) the total number of COVID–19 

22 vaccines administered during the rebate 

23 period under subparagraph (C)(i); and 

24 ‘‘(ii) the inflation-adjusted payment 

25 amount under subparagraph (D).’’. 


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1 (b) CONFORMING AMENDMENT.—Section 

2 1842(o)(1)(A)(iv) of the Social Security Act (42 U.S.C. 

3 1395u(o)(1)(A)(iv)) is amended by striking ‘‘A vaccine’’ 

4 and inserting ‘‘Subject to section 1833(dd)(1) (relating to 

5 payment for an applicable COVID–19 vaccine during ini6 tial payment year), a vaccine’’. 

7 SEC. 102. MANDATORY COVERAGE OF COVID–19 VACCINES 

8 UNDER MEDICAID AND CHIP. 

9 (a) MEDICAID.— 

10 (1) IN GENERAL.—Section 1905(a)(4) of the 

11 Social Security Act (42 U.S.C. 1396d(a)(4)) is 

12 amended— 

13 (A) by striking ‘‘and (D)’’ and inserting 

14 ‘‘(D)’’; and 

15 (B) by striking the semicolon at the end 

16 and inserting ‘‘; and (E) a COVID–19 vaccine 

17 licensed under section 351 of the Public Health 

18 Service Act, or approved or authorized under 

19 sections 505 or 564 of the Federal Food, Drug, 

20 and Cosmetic Act, and administration of the 

21 vaccine;’’. 

22 (2) PROHIBITION OF COST SHARING.— 

23 (A) IN GENERAL.—Subsections (a)(2) and 

24 (b)(2) of section 1916 of the Social Security 

25 Act (42 U.S.C. 1396o) are each amended— 


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1 (i) in subparagraph (F), by striking 

2 ‘‘or’’ at the end; 

3 (ii) in subparagraph (G), by striking 

4 ‘‘; and’’ and inserting ‘‘, or’’; and 

5 (iii) by adding at the end the fol6 lowing subparagraph: 

7 ‘‘(H) a COVID–19 vaccine licensed under 

8 section 351 of the Public Health Service Act, or 

9 approved or authorized under sections 505 or 

10 564 of the Federal Food, Drug, and Cosmetic 

11 Act, and the administration of such vaccine; 

12 and’’. 

13 (B) APPLICATION TO ALTERNATIVE COST

14 SHARING.—Section 1916A(b)(3)(B) of the So15 cial Security Act (42 U.S.C. 1396o–1(b)(3)(B)) 

16 is amended— 

17 (i) in clause (xi), by striking ‘‘any 

18 visit’’ and inserting ‘‘any service’’; and 

19 (ii) by adding at the end the following 

20 clause: 

21 ‘‘(xii) A COVID–19 vaccine licensed 

22 under section 351 of the Public Health 

23 Service Act, or approved or authorized 

24 under sections 505 or 564 of the Federal 


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1 Food, Drug, and Cosmetic Act, and the 

2 administration of such vaccine.’’. 

3 (C) CLARIFICATION.—The amendments 

4 made by this subsection shall apply with respect 

5 to a State plan of a territory in the same man6 ner as the amendments apply to a State plan 

7 of 1 of the 50 States or the District of Colum8 bia. 

9 (b) CHIP.— 

10 (1) IN GENERAL.—Section 2103(c) of the So11 cial Security Act (42 U.S.C. 1397cc(c)) is amended 

12 by adding at the end the following paragraph: 

13 ‘‘(11) COVERAGE OF COVID–19 VACCINES.—Re14 gardless of the type of coverage elected by a State 

15 under subsection (a), child health assistance pro16 vided under such coverage for targeted low-income 

17 children and, in the case of a State that State elects 

18 to provide pregnancy-related assistance under such 

19 coverage pursuant to section 2112, such pregnancy20 related assistance for targeted low-income pregnant 

21 women (as defined in section 2112(d)) shall include 

22 coverage of a COVID–19 vaccine licensed under sec23 tion 351 of the Public Health Service Act, or ap24 proved or authorized under sections 505 or 564 of 


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1 the Federal Food, Drug, and Cosmetic Act, and the 

2 administration of such vaccine.’’. 

3 (2) PROHIBITION OF COST SHARING.—Section 

4 2103(e)(2) of the Social Security Act (42 U.S.C. 

5 1397cc(e)(2)), as amended by section 6004(b)(3) of 

6 the Families First Coronavirus Response Act, is 

7 amended— 

8 (A) in the paragraph header, by inserting 

9 ‘‘A COVID–19 VACCINE,’’ before ‘‘OR PREG10 NANCY-RELATED ASSISTANCE’’; and 

11 (B) by striking ‘‘visits described in section 

12 1916(a)(2)(G), or’’ and inserting ‘‘services de13 scribed in section 1916(a)(2)(G), vaccines de14 scribed in section 1916(a)(2)(H), or’’. 

15 SEC. 103. INCLUSION OF FEDERALLY FUNDED COVID–19 

16 VACCINES UNDER MEDICAID DRUG REBATE 

17 PROGRAM; COVERAGE OF COVID–19 VAC18 CINES UNDER STATE PEDIATRIC VACCINE 

19 DISTRIBUTION PROGRAM. 

20 (a) INCLUSION IN MEDICAID DRUG REBATE PRO21 GRAM.— 

22 (1) IN GENERAL.—Section 1927 of the Social 

23 Security Act (42 U.S.C. 1396r–8) is amended— 

24 (A) in subsection (b)(1)(A), by inserting 

25 ‘‘(or, in the case of an applicable COVID–19 


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1 vaccine administered after July 1, 2020, an 

2 amount specified in subsection (l))’’ after 

3 ‘‘1990’’; 

4 (B) in subsection (k)— 

5 (i) in paragraph (2)— 

6 (I) in subparagraph (B)— 

7 (aa) in the matter preceding 

8 clause (i), by inserting ‘‘(except 

9 in the case of an applicable 

10 COVID–19 vaccine)’’ after 

11 ‘‘other than a vaccine’’; and 

12 (bb) in clause (iii), by strik13 ing ‘‘; and’’ and inserting a semi14 colon; 

15 (II) in subparagraph (C), by 

16 striking the period at the end and in17 serting ‘‘; and’’; and 

18 (III) by adding at the end the 

19 following new subparagraph: 

20 ‘‘(D) an applicable COVID–19 vaccine.’’; 

21 and 

22 (ii) by adding at the end the following 

23 new paragraph: 


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1 ‘‘(12) APPLICABLE COVID–19 VACCINE.—The 

2 term ‘applicable COVID–19 vaccine’ has the mean3 ing given such term in section 1833(dd)(2).’’; and 

4 (C) by adding at the end the following new 

5 subsection: 

6 ‘‘(l) DETERMINATION OF AMOUNT OF REBATE FOR

7 APPLICABLE COVID–19 VACCINES.— 

8 ‘‘(1) IN GENERAL.—The amount of the rebate 

9 specified in this subsection for a rebate period with 

10 respect to an applicable COVID–19 vaccine shall be 

11 equal to the product of— 

12 ‘‘(A) the total number of units of the vac13 cine paid for under the State plan in the rebate 

14 period (as reported by the State); and 

15 ‘‘(B) the difference between the average 

16 manufacturer price and the inflation-adjusted 

17 Federal procurement price (as defined in para18 graph (2)) for the vaccine. 

19 ‘‘(2) INFLATION-ADJUSTED FEDERAL PROCURE20 MENT PRICE.—For purposes of this section, the 

21 term ‘inflation-adjusted Federal procurement price’ 

22 means, with respect to an applicable COVID–19 vac23 cine and a rebate period— 

24 ‘‘(A) for rebate periods occurring during 

25 the first 12-month period that such vaccine is 


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1 provided to State plans under this title, the 

2 amount specified for the vaccine under section 

3 1833(dd)(3); and 

4 ‘‘(B) for rebate periods occurring after 

5 such 12-month period— 

6 ‘‘(i) the amount specified for the vac7 cine under section 1833(dd)(3); increased 

8 by 

9 ‘‘(ii) the percentage by which the con10 sumer price index for all urban consumers 

11 (United States city average) for the month 

12 before the month in which the rebate pe13 riod begins exceeds such index for the 

14 month in which such 12-month period be15 gins. 

16 ‘‘(3) EXCEPTIONS.—No rebate shall be payable 

17 with respect to an applicable COVID–19 vaccine of 

18 a manufacturer and a rebate period occurring after 

19 the 12-month period described in paragraph (2)(A) 

20 if the Secretary determines that an exception de21 scribed in section 1833(dd)(5)(B) applies with re22 spect to the vaccine for the rebate period.’’. 

23 (2) PROHIBITION ON PRIOR AUTHORIZATION.— 

24 Section 1927(d)(1)(A) of the Social Security Act (42 

25 U.S.C. 1396r–8(d)(1)(A)) is amended by inserting 


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1 ‘‘other than an applicable COVID–19 vaccine’’ after 

2 ‘‘covered outpatient drug’’. 

3 (3) NO EXCLUSION OF APPLICABLE COVID–19

4 VACCINES.—Section 1927(d)(7) of the Social Secu5 rity Act (42 U.S.C. 1396r–8(d)(7)) is amended by 

6 adding at the end the following: 

7 ‘‘(D) Applicable COVID–19 vaccines.’’. 

8 (b) ENSURING COVERAGE AND AFFORDABILITY

9 UNDER STATE PEDIATRIC VACCINE DISTRIBUTION PRO10 GRAM.—Section 1928 of the Social Security Act (42 

11 U.S.C. 1396s) is amended— 

12 (1) in subsection (a)(1)— 

13 (A) in subparagraph (A), by striking ‘‘; 

14 and’’ and inserting a semicolon; 

15 (B) in subparagraph (B), by striking the 

16 period and inserting ‘‘; and’’; and 

17 (C) by adding at the end the following sub18 paragraph: 

19 ‘‘(C) each vaccine-eligible child (as defined 

20 in subsection (b)) is entitled to receive a 

21 COVID–19 vaccine from a program-registered 

22 provider without charge for— 

23 ‘‘(i) the cost of such vaccine; or 

24 ‘‘(ii) the administration of such vac25 cine.’’; 


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1 (2) in subsection (c)(2), by adding at the end 

2 the following subparagraph: 

3 ‘‘(D) The provider will provide and admin4 ister a COVID–19 vaccine to a vaccine-eligible 

5 child in accordance with the same requirements 

6 as the requirements that apply under the pre7 ceding subparagraphs to the provision and ad8 ministration of a qualified pediatric vaccine to 

9 such a child.’’; 

10 (3) in subsection (d)(3), by adding at the end 

11 the following new subparagraph: 

12 ‘‘(D) LIMITATION ON PRICE INCREASES

13 FOR APPLICABLE COVID–19 VACCINES.— 

14 ‘‘(i) IN GENERAL.—Subject to clause 

15 (ii), with respect to any contract entered 

16 into under this subsection for an applicable 

17 COVID–19 vaccine after the first such 

18 contract entered into with respect to such 

19 vaccine, no price for the purchase of such 

20 vaccine for vaccine-eligible children shall be 

21 agreed to by the Secretary under this sub22 section if the price per dose of such vaccine 

23 (including any delivery costs and any appli24 cable excise tax established under section 


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1 4131 of the Internal Revenue Code of 

2 1986) exceeds— 

3 ‘‘(I) the price per dose for the 

4 vaccine in effect under the first con5 tract entered into under this sub6 section for the purchase of such vac7 cine; increased by 

8 ‘‘(II) the percentage increase in 

9 the consumer price index for all urban 

10 consumers (all items; United States 

11 city average) from the month before 

12 such first contract is entered into to 

13 the month before the month in which 

14 the contract involved is entered into. 

15 ‘‘(ii) EXCEPTION.—The limitation de16 scribed in clause (i) shall not apply with 

17 respect to an applicable COVID–19 vaccine 

18 and a contract if the Secretary determines 

19 that an exception described in section 

20 1833(dd)(5)(B) applies with respect to the 

21 vaccine for the contract period.’’; and 

22 (4) in subsection (h), by adding at the end the 

23 following new paragraph: 

24 ‘‘(10) COVID–19 VACCINE; APPLICABLE

25 COVID–19 VACCINE.— 


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1 ‘‘(A) COVID–19 VACCINE.—The term 

2 ‘COVID–19 vaccine’ means a COVID–19 vac3 cine licensed under section 351 of the Public 

4 Health Service Act, or approved or authorized 

5 under section 505 or 564 of the Federal Food, 

6 Drug, and Cosmetic Act, provided that such 

7 vaccine is included on the list under subsection 

8 (e). 

9 ‘‘(B) APPLICABLE COVID–19 VACCINE.— 

10 The term ‘applicable COVID–19 vaccine’ means 

11 a vaccine described in section 1833(dd)(2), pro12 vided that such vaccine is included on the list 

13 under subsection (e).’’. 

14 (c) EFFECTIVE DATE.—The amendments made by 

15 this section take effect on the date of enactment of this 

16 Act and apply to rebate agreements entered into on or 

17 after such date without regard to whether final regulations 

18 to carry out such amendments have been promulgated as 

19 of such date. 

20 SEC. 104. TEMPORARY ENHANCED FEDERAL MATCH FOR 

21 MEDICAL ASSISTANCE FOR COVID–19 VAC22 CINES. 

23 (a) IN GENERAL.—Section 1905 of the Social Secu24 rity Act (42 U.S.C. 1396d) is amended— 


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1 (1) in subsection (b), by striking ‘‘and (ff)’’ and 

2 inserting ‘‘(ff), and (gg)’’; and 

3 (2) by adding at the end the following new sub4 section: 

5 ‘‘(gg) TEMPORARY ENHANCED FEDERAL MATCH

6 FOR COVID–19 VACCINE AND ADMINISTRATION.— 

7 ‘‘(1) IN GENERAL.—Notwithstanding subsection 

8 (b), with respect to medical assistance for vaccines 

9 and the administration of vaccines described in sub10 section (a)(4)(E) that is furnished during the period 

11 described in paragraph (2), the Federal medical as12 sistance percentage for a State shall be equal to 100 

13 percent. 

14 ‘‘(2) PERIOD DESCRIBED.—The period de15 scribed in this paragraph is the period that— 

16 ‘‘(A) begins with the date of enactment of 

17 this subsection; and 

18 ‘‘(B) ends with the date that is 1 year 

19 after the last day of the emergency period de20 fined in paragraph (1)(B) of section 1135(g).’’. 

21 (b) EXCLUSION FROM TERRITORIAL CAPS.—Section 

22 1108 of the Social Security Act (42 U.S.C. 1308) is 

23 amended— 

24 (1) in subsection (f), in the matter preceding 

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1 tion 1935(e)(1)(B)’’ and inserting ‘‘subsections (g) 

2 and (h) and section 1935(e)(1)(B)’’; and 

3 (2) by adding at the end the following: 

4 ‘‘(h) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB5 UTABLE TO CERTAIN INCREASED FMAP.—Any payment 

6 made to a territory for a fiscal year in which the Federal 

7 medical assistance percentage for the territory is deter8 mined under section 1905(gg) shall not be taken into ac9 count for purposes of applying payment limits under sub10 sections (f) and (g) to the extent that such payment ex11 ceeds the amount of the payment that would have been 

12 made to the territory for the year if the Federal medical 

13 assistance percentage for the territory had been deter14 mined without regard to such section.’’. 

15 TITLE II—ENSURING COVERAGE 

16 UNDER MEDICAID 

17 SEC. 201. INCREASED FMAP FOR MEDICAL ASSISTANCE TO 

18 NEWLY ELIGIBLE INDIVIDUALS. 

19 (a) IN GENERAL.—Section 1905 of the Social Secu20 rity Act (42 U.S.C. 1396d) is amended— 

21 (1) in subsection (y)(1)— 

22 (A) in subparagraph (A), by striking 

23 ‘‘2014, 2015, and 2016’’ and inserting ‘‘each of 

24 the first 3 consecutive 12-month periods in 


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1 which the State provides medical assistance to 

2 newly eligible individuals’’; 

3 (B) in subparagraph (B), by striking 

4 ‘‘2017’’ and inserting ‘‘the fourth consecutive 

5 12-month period in which the State provides 

6 medical assistance to newly eligible individuals’’; 

7 (C) in subparagraph (C), by striking 

8 ‘‘2018’’ and inserting ‘‘the fifth consecutive 12- 

9 month period in which the State provides med10 ical assistance to newly eligible individuals’’; 

11 (D) in subparagraph (D), by striking 

12 ‘‘2019’’ and inserting ‘‘the sixth consecutive 12- 

13 month period in which the State provides med14 ical assistance to newly eligible individuals’’; 

15 and 

16 (E) in subparagraph (E), by striking 

17 ‘‘2020 and each year thereafter’’ and inserting 

18 ‘‘the seventh consecutive 12-month period in 

19 which the State provides medical assistance to 

20 newly eligible individuals and each such period 

21 thereafter’’; and 

22 (2) in subsection (z)(2)(B)(i)(II), by inserting 

23 ‘‘(as in effect on the day before the enactment of the 

24 Vaccine And Coverage Certainty Act)’’ after ‘‘sub25 section (y)(1)’’. 


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•S 4509 IS

1 (b) RETROACTIVE APPLICATION.—The amendments 

2 made by subsection (a)(1) shall take effect as if included 

3 in the enactment of Public Law 111–148 and shall apply 

4 to amounts expended by any State for medical assistance 

5 for newly eligible individuals described in subclause (VIII) 

6 of section 1902(a)(10)(A)(i) of the Social Security Act 

7 under a State Medicaid plan (or a waiver of such plan) 

8 during the period before the date of enactment of this Act. 

9 SEC. 202. MEDICAID COVERAGE FOR CITIZENS OF FREELY 

10 ASSOCIATED STATES. 

11 (a) IN GENERAL.—Section 402(b)(2) of the Personal 

12 Responsibility and Work Opportunity Reconciliation Act 

13 of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 

14 the end the following new subparagraph: 

15 ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS

16 OF FREELY ASSOCIATED STATES.—With respect 

17 to eligibility for benefits for the designated Fed18 eral program defined in paragraph (3)(C) (re19 lating to the Medicaid program), section 401(a) 

20 and paragraph (1) shall not apply to any indi21 vidual who lawfully resides in 1 of the 50 States 

22 or the District of Columbia in accordance with 

23 the Compacts of Free Association between the 

24 Government of the United States and the Gov25 ernments of the Federated States of MicroVerDate Sep 11 2014 18:19 Aug 27, 2020 Jkt 099200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S4509.IS S4509

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•S 4509 IS

1 nesia, the Republic of the Marshall Islands, and 

2 the Republic of Palau and shall not apply, at 

3 the option of the Governor of Puerto Rico, the 

4 Virgin Islands, Guam, the Northern Mariana 

5 Islands, or American Samoa as communicated 

6 to the Secretary of Health and Human Services 

7 in writing, to any individual who lawfully re8 sides in the respective territory in accordance 

9 with such Compacts.’’. 

10 (b) EXCEPTION TO 5-YEAR LIMITED ELIGIBILITY.— 

11 Section 403(d) of such Act (8 U.S.C. 1613(d)) is amend12 ed— 

13 (1) in paragraph (1), by striking ‘‘or’’ at the 

14 end; 

15 (2) in paragraph (2), by striking the period at 

16 the end and inserting ‘‘; or’’; and 

17 (3) by adding at the end the following new 

18 paragraph: 

19 ‘‘(3) an individual described in section 

20 402(b)(2)(G), but only with respect to the des21 ignated Federal program defined in section 

22 402(b)(3)(C).’’. 

23 (c) DEFINITION OF QUALIFIED ALIEN.—Section 

24 431(b) of such Act (8 U.S.C. 1641(b)) is amended— 


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•S 4509 IS

1 (1) in paragraph (6), by striking ‘‘; or’’ at the 

2 end and inserting a comma; 

3 (2) in paragraph (7), by striking the period at 

4 the end and inserting ‘‘, or’’; and 

5 (3) by adding at the end the following new 

6 paragraph: 

7 ‘‘(8) an individual who lawfully resides in the 

8 United States in accordance with a Compact of Free 

9 Association referred to in section 402(b)(2)(G), but 

10 only with respect to the designated Federal program 

11 defined in section 402(b)(3)(C) (relating to the Med12 icaid program).’’. 

13 (d) APPLICATION TO STATE PLANS.—Section 

14 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 

15 1396a(a)(10)(A)(i)) is amended by inserting after sub16 clause (IX) the following: 

17 ‘‘(X) who are described in section 

18 402(b)(2)(G) of the Personal Respon19 sibility and Work Opportunity Rec20 onciliation Act of 1996 and eligible 

21 for benefits under this title by reason 

22 of application of such section;’’. 

23 (e) CONFORMING AMENDMENTS.—Section 1108 of 

24 the Social Security Act (42 U.S.C. 1308), as amended by 

25 section 104, is amended— 


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•S 4509 IS

1 (1) in subsection (f), in the matter preceding 

2 paragraph (1), by striking ‘‘subsections (g) and (h)’’ 

3 and inserting ‘‘subsections (g), (h), and (i)’’; and 

4 (2) by adding at the end the following: 

5 ‘‘(i) EXCLUSION OF MEDICAL ASSISTANCE EXPENDI6 TURES FOR CITIZENS OF FREELY ASSOCIATED STATES.— 

7 Expenditures for medical assistance provided to an indi8 vidual described in section 431(b)(8) of the Personal Re9 sponsibility and Work Opportunity Reconciliation Act of 

10 1996 (8 U.S.C. 1641(b)(8)) shall not be taken into ac11 count for purposes of applying payment limits under sub12 sections (f) and (g).’’. 

13 (f) EFFECTIVE DATE.—The amendments made by 

14 this section shall apply to benefits for items and services 

15 furnished on or after the date of the enactment of this 

16 Act. 

17 TITLE III—ENSURING COV18 ERAGE IN THE MARKET19 PLACE 

20 SEC. 301. DISREGARD OF ADDITIONAL UNEMPLOYMENT 

21 COMPENSATION FOR PURPOSES OF PRE22 MIUM TAX CREDIT AND COST-SHARING SUB23 SIDIES. 

24 (a) IN GENERAL.—Section 36B(d)(2)(B) of the In25 ternal Revenue Code of 1986 is amended— 


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•S 4509 IS

1 (1) by redesignating clauses (i), (ii), and (iii) as 

2 subclauses (I), (II), and (III), respectively, and by 

3 moving such subclauses 2 ems to the right; 

4 (2) by striking ‘‘adjusted gross income in5 creased by’’ and inserting ‘‘adjusted gross income— 

6 ‘‘(i) decreased by the amount of any 

7 Federal pandemic unemployment com8 pensation paid to an individual under sec9 tion 2104 of division A of the CARES Act 

10 during the taxable year; and 

11 ‘‘(ii) increased by—’’; and 

12 (3) by adding at the end the following new 

13 flush sentence: 

14 ‘‘Clause (i) shall not apply to the extent that such decrease 

15 results in a household income for the taxpayer which is 

16 less than 100 percent of the poverty line for a family of 

17 the size involved.’’. 

18 (b) TEMPORARY SUSPENSION OF RECAPTURE OF EX19 CESS ADVANCE PAYMENTS.—Section 36B(f)(2) of the In20 ternal Revenue Code of 1986 is amended by adding at the 

21 end the following new subparagraph: 

22 ‘‘(C) SPECIAL RULE FOR 2020 AND 2021.— 

23 Subparagraph (A) shall not apply to any tax24 able year beginning in 2020 or 2021.’’. 


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•S 4509 IS

1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to taxable years beginning after 

3 December 31, 2019. 

Æ 


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