II 

118TH CONGRESS 

2D SESSION S. 4063 

To establish a State public option through Medicaid to provide Americans 

with the choice of a high-quality, low-cost health insurance plan. 

IN THE SENATE OF THE UNITED STATES 

MARCH 22, 2024 

Mr. SCHATZ (for himself, Mr. LUJA ́N, Mr. BLUMENTHAL, Mr. BOOKER, Mr. 

MERKLEY, Ms. KLOBUCHAR, Mr. HEINRICH, Mr. REED, Mr. WELCH, 

Ms. SMITH, Ms. HIRONO, Mrs. SHAHEEN, Mr. MURPHY, Mr. MARKEY, 

Ms. ROSEN, Mr. WHITEHOUSE, and Ms. WARREN) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To establish a State public option through Medicaid to provide Americans with the choice of a high-quality, lowcost health insurance plan. 

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. 

4 This Act may be cited as the ‘‘State Public Option 

5 Act’’. 

6 SEC. 2. MEDICAID BUY-IN OPTION. 

7 (a) IN GENERAL.—Section 1902 of the Social Secu8 rity Act (42 U.S.C. 1396a) is amended— 


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1 (1) in subsection (a)(10)— 

2 (A) in subparagraph (A)(ii)— 

3 (i) in subclause (XXII), by striking ‘‘; 

4 or’’ and inserting a semicolon; 

5 (ii) in subclause (XXIII), by adding 

6 ‘‘or’’ at the end; and 

7 (iii) by adding at the end the fol8 lowing new subclause: 

9 ‘‘(XXIV) beginning January 1, 

10 2025, who are residents of the State 

11 and are not concurrently enrolled in 

12 another health insurance coverage 

13 plan, subject, in the case of individ14 uals described in subsection (uu) and 

15 notwithstanding section 1916 (except 

16 for subsection (k) of such section), to 

17 payment of premiums or other cost18 sharing charges;’’; and 

19 (B) in the matter following subparagraph 

20 (G), by inserting ‘‘or subparagraph 

21 (A)(ii)(XXIV)’’ after ‘‘described in subpara22 graph (A)(i)(VIII)’’; and 

23 (2) by adding at the end the following new sub24 section: 


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1 ‘‘(uu) PREVIOUSLY UNDESCRIBED INDIVIDUALS.— 

2 Individuals described in this subsection are individuals 

3 who are— 

4 ‘‘(1) described in subclause (XXIV) of sub5 section (a)(10)(A)(ii); and 

6 ‘‘(2) are not described in any other subclause of 

7 such subsection or any other provision in this Act 

8 which provides for eligibility for medical assist9 ance.’’. 

10 (b) PROVISION OF AT LEAST MINIMUM COVERAGE.— 

11 (1) IN GENERAL.—Section 1902(k)(1) of the 

12 Social Security Act (42 U.S.C. 1396a(k)(1)) is 

13 amended by inserting ‘‘or an individual described in 

14 subclause (XXIV) of subsection (a)(10)(A)(ii)’’ after 

15 ‘‘an individual described in subclause (VIII) of sub16 section (a)(10)(A)(i)’’ each place it appears. 

17 (2) CONFORMING AMENDMENT.—Section 

18 1903(i)(26) of the Social Security Act (42 U.S.C. 

19 1396b(i)(26)) is amended by striking ‘‘individuals 

20 described in subclause (VIII) of subsection 

21 (a)(10)(A)(i)’’ and inserting ‘‘individuals described 

22 in subsections (a)(10)(A)(i)(VIII) or 

23 (a)(10)(A)(ii)(XXIV) of section 1902’’. 

24 (c) FEDERAL FINANCIAL PARTICIPATION IN BUY-IN

25 PROGRAM.— 


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1 (1) ENHANCED MATCH FOR ADMINISTRATIVE

2 EXPENSES.—Section 1903(a) of the Social Security 

3 Act (42 U.S.C. 1396b(a)) is amended— 

4 (A) by redesignating paragraph (7) as 

5 paragraph (8); and 

6 (B) by inserting after paragraph (6) the 

7 following new paragraph: 

8 ‘‘(7) an amount equal to 90 percent of the 

9 sums expended during such quarter which are at10 tributable to reasonable administrative expenses re11 lated to the administration of a Medicaid buy-in pro12 gram for individuals described in section 

13 1902(a)(10)(A)(ii)(XXIV) (as found necessary by 

14 the Secretary for the proper and efficient adminis15 tration of such a program); plus’’. 

16 (2) TREATMENT OF PREMIUM AND COST-SHAR17 ING REVENUES FROM MEDICAID BUY-IN PROGRAM.— 

18 (A) IN GENERAL.—For purposes of section 

19 1903(a)(1) of the Social Security Act (42 

20 U.S.C. 1396b(a)(1)), for any fiscal quarter dur21 ing which a State collects premiums, cost-shar22 ing, or similar charges under subsection (k) of 

23 section 1916 of such Act (42 U.S.C. 1396o) (as 

24 added by this Act), including any advance pay25 ments of premium tax credits under section 


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1 1412 of the Patient Protection and Affordable 

2 Care Act or payments for cost-sharing reduc3 tions under section 1402 of such Act that are 

4 received by the State, the total amount ex5 pended during such quarter as medical assist6 ance for individuals who buy into Medicaid cov7 erage under subclause (XXIV) of section 

8 1902(a)(10)(A)(ii) of the Social Security Act 

9 (as added by this Act) shall be reduced by the 

10 amount of such premiums or charges. 

11 (B) TREATMENT OF EXCESS PREMIUMS.— 

12 Each State that collects premiums or similar 

13 charges under subsection (k) of section 1916 of 

14 the Social Security Act (42 U.S.C. 1396o) (as 

15 added by this Act) in a fiscal year shall pay to 

16 the Secretary of Health and Human Services, 

17 at such time and in such form and manner as 

18 the Secretary shall specify, an amount equal to 

19 50 percent of the amount, if any, by which— 

20 (i) the total amount of such premiums 

21 and charges collected by the State for such 

22 year; exceeds 

23 (ii) the total amount expended by the 

24 State during such year as medical assist25 ance for individuals who buy into Medicaid 


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1 coverage under subclause (XXIV) of sec2 tion 1902(a)(10)(A)(ii) of such Act (as 

3 added by this Act). 

4 (d) COST-SHARING REQUIREMENT.—Section 1916 of 

5 the Social Security Act (42 U.S.C. 1396o) is amended by 

6 adding at the end the following new subsection: 

7 ‘‘(k) PREMIUMS AND COST-SHARING FOR INDIVID8 UALS PARTICIPATING IN MEDICAID BUY-IN PROGRAM.— 

9 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

10 with respect to individuals who are eligible for med11 ical assistance under subsection 

12 (a)(10)(A)(ii)(XXIV) of section 1902 and are de13 scribed in subsection (uu) of such section, a State 

14 may— 

15 ‘‘(A) impose premiums, deductibles, cost16 sharing, or other similar charges that are deter17 mined on an actuarially sound basis; and 

18 ‘‘(B) vary the premium rate imposed on an 

19 individual based only on the factors described in 

20 section 2701(a)(1)(A) of the Public Health 

21 Service Act and subject to the same limitations 

22 on the weight which may be given to such fac23 tors under such section. 

24 ‘‘(2) LIMITATIONS.— 


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1 ‘‘(A) PREMIUMS.—The total amount of 

2 premiums imposed for a year under this sub3 section with respect to all individuals described 

4 in paragraph (1) in a family shall not exceed an 

5 amount equal to 8.5 percent of the family’s 

6 household income (as defined in section 

7 36B(d)(2) of the Internal Revenue Code of 

8 1986) for the year involved. 

9 ‘‘(B) OTHER COST-SHARING.— 

10 ‘‘(i) IN GENERAL.—The cost-sharing 

11 limitations described in section 1302(c) of 

12 the Patient Protection and Affordable Care 

13 Act shall apply to cost-sharing (as defined 

14 in such section) for medical assistance pro15 vided under section 

16 1902(a)(10)(A)(ii)(XXIV) in the same 

17 manner as such limitations apply to cost18 sharing under qualified health plans under 

19 title I of such Act. 

20 ‘‘(ii) AVAILABILITY OF COST-SHARING

21 REDUCTIONS.—Individuals provided med22 ical assistance under section 

23 1902(a)(10)(A)(ii)(XXIV) and subject to 

24 cost-sharing under this subsection are eli25 gible for cost-sharing reductions under secVerDate Sep 11 2014 20:21 Apr 09, 2024 Jkt 049200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4063.IS S4063

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1 tion 1402 of the Patient Protection and 

2 Affordable Care Act (subject to the income 

3 eligibility threshold in subsection (b)(2) of 

4 such section), and in applying such sec5 tion— 

6 ‘‘(I) enrollment in a State plan 

7 under section 

8 1902(a)(10)(A)(ii)(XXIV) shall be 

9 treated as coverage under a qualified 

10 health plan in the silver level of cov11 erage in the individual market offered 

12 through an Exchange established for 

13 or by the State under title I of the 

14 Patient Protection and Affordable 

15 Care Act; and 

16 ‘‘(II) the State agency admin17 istering such plan shall be treated as 

18 the issuer of such plan. 

19 ‘‘(3) PREMIUMS AND COST-SHARING FOR CER20 TAIN OTHER INDIVIDUALS.—If an individual is eligi21 ble for medical assistance under subsection 

22 (a)(10)(A)(ii)(XXIV) of section 1902 and is not de23 scribed in subsection (uu) of such section, a State— 


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1 ‘‘(A) shall not impose premiums and cost2 sharing on the individual under this subsection; 

3 and 

4 ‘‘(B) may impose premiums and cost-shar5 ing on the individual to the extent allowed by 

6 another provision of this Act (other than sec7 tion 1902(a)(10)(A)(ii)(XXIV)) which provides 

8 for eligibility for medical assistance, but only if 

9 the individual is described in such other provi10 sion. 

11 ‘‘(4) APPLICATION OF PREMIUM ASSISTANCE

12 TAX CREDITS.—An individual who is required to pay 

13 premiums under this subsection for a year for med14 ical assistance shall be eligible for a premium assist15 ance credit under section 36B of the Internal Rev16 enue Code to the same extent that such individual 

17 would be eligible for a premium assistance credit 

18 under such section if such individual had paid the 

19 same amount in premiums for coverage under a 

20 qualified health plan for such year.’’. 

21 (e) MANAGED CARE.—Section 1932(a)(1)(A)(i) of 

22 the Social Security Act (42 U.S.C. 1396u–2(a)(1)(A)(i)) 

23 is amended by inserting ‘‘, including an individual who is 

24 eligible for such assistance after buying into such coverage 


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1 under section 1902(a)(10)(A)(ii)(XXIV),’’ after ‘‘the 

2 State plan under this title’’. 

3 (f) OFFERING BUY-IN PROGRAM ON STATE EX4 CHANGE; ENROLLMENT PERIODS.— 

5 (1) IN GENERAL.—A State that has elected to 

6 allow individuals to buy into Medicaid coverage 

7 under section 1902(a)(10)(A)(ii)(XXIV) of the So8 cial Security Act (as added by this Act) shall allow 

9 individuals to enroll in such coverage through an Ex10 change established by or for the State under title I 

11 of the Patient Protection and Affordable Care Act. 

12 (2) ENROLLMENT PERIODS.—A State may limit 

13 the enrollment of individuals into Medicaid coverage 

14 under section 1902(a)(10)(A)(ii)(XXIV) of the So15 cial Security Act (as added by this Act) to the en16 rollment periods provided for under section 

17 1311(c)(6) of the Patient Protection and Affordable 

18 Care Act. 

19 (g) APPLICATION OF ADVANCED PREMIUM TAX

20 CREDITS TO MEDICAID BUY-IN PLANS.— 

21 (1) IN GENERAL.—Section 36B of the Internal 

22 Revenue Code of 1986 is amended— 

23 (A) in subsection (b)(3)(B), by adding at 

24 the end the following new sentence: 


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1 ‘‘If an applicable taxpayer resides in a rating 

2 area in which no silver plan is offered on the 

3 individual market but the taxpayer buys into 

4 Medicaid coverage under section 

5 1902(a)(10)(A)(ii)(XXIV) of the Social Secu6 rity Act, such Medicaid coverage shall be 

7 deemed to be the applicable second lowest cost 

8 silver plan with respect to such taxpayer.’’; and 

9 (B) by redesignating subsection (h) as sub10 section (i); and 

11 (C) by inserting after subsection (g) the 

12 following new subsection: 

13 ‘‘(h) APPLICATION TO INDIVIDUALS PURCHASING

14 MEDICAID COVERAGE.—In the case of any individual who 

15 buys into Medicaid coverage under section 

16 1902(a)(10)(A)(ii)(XXIV) of the Social Security Act, this 

17 section shall be applied with the following modifications: 

18 ‘‘(1) The amount determined under subsection 

19 (b)(2)(A) shall be increased by the amount of the 

20 monthly premiums paid for such coverage. 

21 ‘‘(2) Subsection (c)(2)(A)(i) shall be applied by 

22 treating coverage under the Medicaid program under 

23 title XIX of the Social Security Act in the same 

24 manner as a qualified health plan that was enrolled 

25 in through an Exchange. 


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1 ‘‘(3) In applying subsection (c)(2)(B)— 

2 ‘‘(A) an individual shall not be considered 

3 to be eligible for minimum essential coverage 

4 described in section 5000A(f)(1)(A)(ii) by rea5 son of eligibility for medical assistance under a 

6 State Medicaid program under section 

7 1902(a)(10)(A)(ii)(XXIV); and 

8 ‘‘(B) an individual who is not covered by 

9 minimum essential coverage described in section 

10 5000A(f)(1)(B) shall not be considered to be el11 igible for such coverage.’’. 

12 (2) ADVANCED PAYMENT OF CREDIT.— 

13 (A) IN GENERAL.—The Secretary of 

14 Health and Human Services, in consultation 

15 with the Secretary of the Treasury, shall estab16 lish a program under which— 

17 (i) upon request of a State agency ad18 ministering a State Medicaid program 

19 under title XIX of the Social Security Act, 

20 advance determinations are made in a 

21 manner similar to advanced determinations 

22 under section 1412 of the Patient Protec23 tion and Affordable Care Act with respect 

24 to the income eligibility of individuals en25 rolling in such program for the premium 


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1 tax credit allowable under section 36B of 

2 the Internal Revenue Code of 1986 and 

3 the cost-sharing reductions under section 

4 1402 of the Patient Protection and Afford5 able Care Act; 

6 (ii) the Secretary notifies— 

7 (I) the State agency admin8 istering the program and the Sec9 retary of the Treasury of the advance 

10 determinations; and 

11 (II) the Secretary of the Treas12 ury of the name and employer identi13 fication number of each employer with 

14 respect to whom 1 or more employees 

15 of the employer were determined to be 

16 eligible for the premium tax credit 

17 under section 36B of the Internal 

18 Revenue Code of 1986 and the cost19 sharing reductions under section 1402 

20 of the Patient Protection and Afford21 able Care Act because— 

22 (aa) the employer did not 

23 provide minimum essential cov24 erage; or 


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1 (bb) the employer provided 

2 such minimum essential coverage 

3 but it was determined under sec4 tion 36B(c)(2)(C) of such Code 

5 to either be unaffordable to the 

6 employee or not provide the re7 quired minimum actuarial value; 

8 and 

9 (iii) the Secretary of the Treasury 

10 makes advance payments of such credit or 

11 reductions to the State agency admin12 istering the program in order to reduce the 

13 premiums payable by individuals eligible 

14 for such credit. 

15 (B) DETERMINATIONS AND PAYMENTS.— 

16 Rules similar to subsections (b) and (c) of sec17 tion 1412 of the Patient Protection and Afford18 able Care Act shall apply for purposes of this 

19 subsection. 

20 (C) COORDINATION WITH CREDIT.— 

21 (i) IN GENERAL.—Section 36B of the 

22 Internal Revenue Code of 1986 is amended 

23 by inserting ‘‘and under section 2(g)(2) of 

24 the State Public Option Act’’ after ‘‘sec25 tion 1412 of the Patient Protection and 


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1 Affordable Care Act’’ each place it appears 

2 in subsections (f)(1), (f)(2), and (g)(1). 

3 (ii) INFORMATION REPORTING.—Sec4 tion 36B(f)(3) of such Code is amended by 

5 adding at the end the following flush sen6 tence: ‘‘In the case of any coverage under 

7 the Medicaid program under title XIX of 

8 the Social Security Act for which a credit 

9 under this section is allowable by reason of 

10 subsection (h), the State agency admin11 istering the Medicaid program shall be 

12 treated as an Exchange for purposes of 

13 this paragraph and subparagraph (A) shall 

14 not apply.’’. 

15 (3) CONFORMING AMENDMENT RELATING TO

16 EMPLOYER RESPONSIBILITY.—Paragraph (6) of sec17 tion 4980H(c) of the Internal Revenue Code of 1986 

18 is amended by inserting ‘‘, except that for purposes 

19 of subsections (a)(2) and (b)(2), the term ‘qualified 

20 health plan’ shall include any plan described in sec21 tion 36B(h)’’ after ‘‘such Act’’. 

22 (h) CONFORMING AMENDMENTS.— 

23 (1) Section 1902(a)(10) of the Social Security 

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1 section (a), is further amended, in the matter fol2 lowing subparagraph (G)— 

3 (A) by striking ‘‘and (XVIII)’’ and insert4 ing ‘‘, (XVIII)’’; and 

5 (B) by inserting ‘‘, and (XIX) the medical 

6 assistance made available to an individual de7 scribed in subparagraph (A)(ii)(XXIV) shall be 

8 limited to medical assistance described in sub9 section (k)(1)’’ before the semicolon. 

10 (2) Section 1903(f)(4) of the Social Security 

11 Act (42 U.S.C. 1396b(f)(4)) is amended by inserting 

12 ‘‘1902(a)(10)(A)(ii)(XXIV),’’ after 

13 ‘‘1902(a)(10)(A)(ii)(XXII),’’. 

14 (3) Section 1905(a) of the Social Security Act 

15 (42 U.S.C. 1396d(a)) is amended, in the matter pre16 ceding paragraph (1)— 

17 (A) by striking ‘‘or’’ at the end of clause 

18 (xvi); 

19 (B) by inserting ‘‘or’’ at the end of clause 

20 (xvii); and 

21 (C) by inserting after clause (xvii) the fol22 lowing new clause: 

23 ‘‘(xviii) individuals described in section 

24 1902(a)(10)(A)(ii)(XXIV),’’. 


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1 (4) Section 1916A(a)(1) of the Social Security 

2 Act (42 U.S.C. 1396o–1(a)(1)) is amended by strik3 ing ‘‘or (j)’’ and inserting ‘‘(j), or (k)’’. 

4 (5) Section 1937(a)(1)(B) of the Social Secu5 rity Act (42 U.S.C. 1396u–7(a)(1)(B)) is amended 

6 by inserting ‘‘, subclause (XXIV) of section 

7 1902(a)(10)(A)(ii),’’ after ‘‘1902(a)(10)(A)(i)’’. 

8 SEC. 3. REVIEWING AND UPDATING MEDICAID QUALITY 

9 MEASURES. 

10 (a) IN GENERAL.—The Secretary of Health and 

11 Human Services (referred to in this section as the ‘‘Sec12 retary’’) shall review quality measures that are in use 

13 under the Medicaid program and, not later than January 

14 1, 2029, shall update such measures to the extent nec15 essary to ensure that such quality measures are appro16 priate for the population of individuals who are eligible 

17 to buy into Medicaid coverage under subclause (XXIV) of 

18 section 1902(a)(10)(A)(ii) of the Social Security Act (42 

19 U.S.C. 1396a(a)(10)(A)(ii)), as added by section 2. 

20 (b) REPORTING.—The Secretary shall review, and, 

21 not later than January 1, 2031, update any corresponding 

22 State reporting requirements to include the quality meas23 ures under subsection (a). 

24 (c) STATE IMPLEMENTATION FUNDING.—The Sec25 retary may award funds, from the amount appropriated 


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1 under subsection (d), to States for the purpose of updating 

2 and implementing the metrics developed under this sec3 tion. 

4 (d) APPROPRIATION.—There is appropriated to the 

5 Secretary, out of any funds in the Treasury not otherwise 

6 appropriated, $50,000,000 for fiscal year 2025, to remain 

7 available until expended, for the purpose of carrying out 

8 this section. 

9 SEC. 4. RENEWAL OF APPLICATION OF MEDICARE PAY10 MENT RATE FLOOR TO PRIMARY CARE SERV11 ICES FURNISHED UNDER MEDICAID AND IN12 CLUSION OF ADDITIONAL PROVIDERS. 

13 (a) RENEWAL OF PAYMENT FLOOR; ADDITIONAL

14 PROVIDERS.— 

15 (1) IN GENERAL.—Section 1902(a)(13) of the 

16 Social Security Act (42 U.S.C. 1396a(a)(13)) is 

17 amended by striking subparagraph (C) and inserting 

18 the following: 

19 ‘‘(C) payment for primary care services (as 

20 defined in subsection (jj)) at a rate that is not 

21 less than 100 percent of the payment rate that 

22 applies to such services and physician under 

23 part B of title XVIII (or, if greater, the pay24 ment rate that would be applicable under such 

25 part if the conversion factor under section 


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1 1848(d) for the year involved were the conver2 sion factor under such section for 2009), and 

3 that is not less than the rate that would other4 wise apply to such services under this title if 

5 the rate were determined without regard to this 

6 subparagraph, and that are— 

7 ‘‘(i) furnished in 2013 and 2014, by a 

8 physician with a primary specialty designa9 tion of family medicine, general internal 

10 medicine, or pediatric medicine; or 

11 ‘‘(ii) furnished in the period that be12 gins on the first day of the first month 

13 that begins after the date of enactment of 

14 the State Public Option Act— 

15 ‘‘(I) by a physician with a pri16 mary specialty designation of family 

17 medicine, general internal medicine, 

18 or pediatric medicine, but only if the 

19 physician self-attests that the physi20 cian is Board certified in family medi21 cine, general internal medicine, or pe22 diatric medicine; 

23 ‘‘(II) by a physician with a pri24 mary specialty designation of obstet25 rics and gynecology, but only if the 


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1 physician self-attests that the physi2 cian is Board certified in obstetrics 

3 and gynecology; 

4 ‘‘(III) by an advanced practice 

5 clinician, as defined by the Secretary, 

6 that works under the supervision of— 

7 ‘‘(aa) a physician that satis8 fies the criteria specified in sub9 clause (I) or (II); or 

10 ‘‘(bb) a nurse practitioner or 

11 a physician assistant (as such 

12 terms are defined in section 

13 1861(aa)(5)(A)) who is working 

14 in accordance with State law, or 

15 a certified nurse-midwife (as de16 fined in section 1861(gg)) who is 

17 working in accordance with State 

18 law; 

19 ‘‘(IV) by a rural health clinic, 

20 federally qualified health center, or 

21 other health clinic that receives reim22 bursement on a fee schedule applica23 ble to a physician, a nurse practi24 tioner or a physician assistant (as 

25 such terms are defined in section 


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1 1861(aa)(5)(A)) who is working in ac2 cordance with State law, or a certified 

3 nurse-midwife (as defined in section 

4 1861(gg)) who is working in accord5 ance with State law, for services fur6 nished by a physician, nurse practi7 tioner, physician assistant, or certified 

8 nurse-midwife, or services furnished 

9 by an advanced practice clinician su10 pervised by a physician described in 

11 subclause (I)(aa) or (II)(aa), another 

12 advanced practice clinician, or a cer13 tified nurse-midwife; or 

14 ‘‘(V) by a nurse practitioner or a 

15 physician assistant (as such terms are 

16 defined in section 1861(aa)(5)(A)) 

17 who is working in accordance with 

18 State law, or a certified nurse-midwife 

19 (as defined in section 1861(gg)) who 

20 is working in accordance with State 

21 law, in accordance with procedures 

22 that ensure that the portion of the 

23 payment for such services that the 

24 nurse practitioner, physician assist25 ant, or certified nurse-midwife is paid 


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1 is not less than the amount that the 

2 nurse practitioner, physician assist3 ant, or certified nurse-midwife would 

4 be paid if the services were provided 

5 under part B of title XVIII;’’. 

6 (2) CONFORMING AMENDMENTS.—Section 

7 1905(dd) of the Social Security Act (42 U.S.C. 

8 1396d(dd)) is amended— 

9 (A) by striking ‘‘Notwithstanding’’ and in10 serting the following: 

11 ‘‘(1) IN GENERAL.—Notwithstanding’’; 

12 (B) by inserting ‘‘or furnished during the 

13 additional period specified in paragraph (2),’’ 

14 after ‘‘2015,’’; and 

15 (C) by adding at the end the following: 

16 ‘‘(2) ADDITIONAL PERIOD.—For purposes of 

17 paragraph (1), the additional period specified in this 

18 paragraph is the period that begins on the date that 

19 is 1 year after the date of enactment of the State 

20 Public Option Act.’’. 

21 (b) IMPROVED TARGETING OF PRIMARY CARE.—Sec22 tion 1902(jj) of the Social Security Act (42 U.S.C. 

23 1396a(jj)) is amended— 


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1 (1) by redesignating paragraphs (1) and (2) as 

2 subparagraphs (A) and (B), respectively and realign3 ing the left margins accordingly; 

4 (2) by striking ‘‘For purposes of’’ and inserting 

5 the following: 

6 ‘‘(1) IN GENERAL.—For purposes of’’; and 

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

8 ‘‘(2) EXCLUSIONS.—Such term does not include 

9 any services described in subparagraph (A) or (B) of 

10 paragraph (1) if such services are provided in an 

11 emergency department of a hospital.’’. 

12 (c) ENSURING PAYMENT BY MANAGED CARE ENTI13 TIES.— 

14 (1) IN GENERAL.—Section 1903(m)(2)(A) of 

15 the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) 

16 is amended— 

17 (A) in clause (xii), by striking ‘‘and’’ after 

18 the semicolon; 

19 (B) in clause (xiii)— 

20 (i) by realigning the left margin so as 

21 to align with the left margin of clause (xii); 

22 and 

23 (ii) by striking the period at the end 

24 of clause (xiii) and inserting ‘‘; and’’; and 


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1 (C) by inserting after clause (xiii) the fol2 lowing: 

3 ‘‘(xiv) such contract provides that (I) payments 

4 to providers specified in section 1902(a)(13)(C) for 

5 primary care services defined in section 1902(jj) 

6 that are furnished during a year or period specified 

7 in section 1902(a)(13)(C) and section 1905(dd) are 

8 at least equal to the amounts set forth and required 

9 by the Secretary by regulation, (II) the entity shall, 

10 upon request, provide documentation to the State, 

11 sufficient to enable the State and the Secretary to 

12 ensure compliance with subclause (I), and (III) the 

13 Secretary shall approve payments described in sub14 clause (I) that are furnished through an agreed 

15 upon capitation, partial capitation, or other value16 based payment arrangement if the capitation, partial 

17 capitation, or other value-based payment arrange18 ment is based on a reasonable methodology and the 

19 entity provides documentation to the State sufficient 

20 to enable the State and the Secretary to ensure com21 pliance with subclause (I).’’. 

22 (2) CONFORMING AMENDMENT.—Section 

23 1932(f) of the Social Security Act (42 U.S.C. 

24 1396u–2(f)) is amended by inserting ‘‘and clause 

25 (xiv) of section 1903(m)(2)(A)’’ before the period. 


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25 

•S 4063 IS

1 SEC. 5. INCREASED FMAP FOR MEDICAL ASSISTANCE TO 

2 NEWLY ELIGIBLE INDIVIDUALS. 

3 (a) IN GENERAL.—Section 1905(y)(1) of the Social 

4 Security Act (42 U.S.C. 1396d(y)(1)) is amended— 

5 (1) in subparagraph (A), by striking ‘‘2014, 

6 2015, and 2016’’ and inserting ‘‘each of the first 3 

7 consecutive 12-month periods in which the State 

8 provides medical assistance to newly eligible individ9 uals’’; 

10 (2) in subparagraph (B), by striking ‘‘2017’’ 

11 and inserting ‘‘the fourth consecutive 12-month pe12 riod in which the State provides medical assistance 

13 to newly eligible individuals’’; 

14 (3) in subparagraph (C), by striking ‘‘2018’’ 

15 and inserting ‘‘the fifth consecutive 12-month period 

16 in which the State provides medical assistance to 

17 newly eligible individuals’’; 

18 (4) in subparagraph (D), by striking ‘‘2019’’ 

19 and inserting ‘‘the sixth consecutive 12-month period 

20 in which the State provides medical assistance to 

21 newly eligible individuals’’; and 

22 (5) in subparagraph (E), by striking ‘‘2020 and 

23 each year thereafter’’ and inserting ‘‘the seventh 

24 consecutive 12-month period in which the State pro25 vides medical assistance to newly eligible individuals 

26 and each such period thereafter’’. 


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•S 4063 IS

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

2 subsection (a) shall take effect as if included in the enact3 ment of Public Law 111–148. 

4 SEC. 6. MEDICAID COVERAGE OF COMPREHENSIVE SEXUAL 

5 AND REPRODUCTIVE HEALTH CARE SERV6 ICES. 

7 (a) INCLUSION OF COMPREHENSIVE SEXUAL AND

8 REPRODUCTIVE HEALTH CARE SERVICES AS MEDICAL

9 ASSISTANCE.—Section 1905(a) of the Social Security Act 

10 (42 U.S.C. 1396d(a)), as amended by section 2(h) and 

11 section 209(a) of title I of division G of the Consolidated 

12 Appropriations Act, 2024, is further amended— 

13 (1) in paragraph (31), by striking ‘‘and’’ at the 

14 end; 

15 (2) by redesignating paragraph (32) as para16 graph (33); and 

17 (3) by inserting after paragraph (31) the fol18 lowing new paragraph: 

19 ‘‘(32) comprehensive sexual and reproductive 

20 health care services, including abortion services and 

21 abortion-related services; and’’. 

22 (b) REQUIRING COVERAGE OF COMPREHENSIVE SEX23 UAL AND REPRODUCTIVE HEALTH CARE SERVICES AS

24 CONDITION OF STATE PLAN APPROVAL.—Section 

25 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 


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27 

•S 4063 IS

1 1396a(a)(10)(A)), as amended by subsections (a) and (h) 

2 of section 2, is further amended, in the matter preceding 

3 clause (i), by striking ‘‘and (30)’’ and inserting ‘‘(30), and 

4 (32)’’. 

5 (c) CONFORMING AMENDMENTS.— 

6 (1) Section 1932(e)(1)(B) of the Social Security 

7 Act (42 U.S.C. 1396u–2(e)(1)(B)) is amended by 

8 striking ‘‘Clause (i)’’ and inserting ‘‘With respect to 

9 the period beginning before January 1, 2023, clause 

10 (i)’’. 

11 (2) Section 1937(b) of the Social Security Act 

12 (42 U.S.C. 1396u–7(b)) is amended by adding at 

13 the end the following new paragraph: 

14 ‘‘(9) COVERAGE OF COMPREHENSIVE SEXUAL

15 AND REPRODUCTIVE HEALTH SERVICES.—Notwith16 standing the previous provisions of this section, a 

17 State may not provide for medical assistance 

18 through enrollment of an individual with benchmark 

19 coverage or benchmark-equivalent coverage under 

20 this section unless such coverage includes medical 

21 assistance for comprehensive sexual and reproductive 

22 health care services, including abortion services and 

23 abortion-related services.’’. 


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•S 4063 IS

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

2 this section shall apply with respect to medical assistance 

3 furnished on or after January 1, 2025. 

Æ 


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