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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4063 Introduced in Senate (IS)]

<DOC>

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. Lujan, 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, low-cost health insurance 
                                 plan.

    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 ``State Public Option Act''.

SEC. 2. MEDICAID BUY-IN OPTION.

    (a) In General.--Section 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended--
            (1) in subsection (a)(10)--
                    (A) in subparagraph (A)(ii)--
                            (i) in subclause (XXII), by striking ``; 
                        or'' and inserting a semicolon;
                            (ii) in subclause (XXIII), by adding ``or'' 
                        at the end; and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(XXIV) beginning January 1, 2025, 
                                who are residents of the State and are 
                                not concurrently enrolled in another 
                                health insurance coverage plan, 
                                subject, in the case of individuals 
                                described in subsection (uu) and 
                                notwithstanding section 1916 (except 
                                for subsection (k) of such section), to 
                                payment of premiums or other cost-
                                sharing charges;''; and
                    (B) in the matter following subparagraph (G), by 
                inserting ``or subparagraph (A)(ii)(XXIV)'' after 
                ``described in subparagraph (A)(i)(VIII)''; and
            (2) by adding at the end the following new subsection:
    ``(uu) Previously Undescribed Individuals.--Individuals described 
in this subsection are individuals who are--
            ``(1) described in subclause (XXIV) of subsection 
        (a)(10)(A)(ii); and
            ``(2) are not described in any other subclause of such 
        subsection or any other provision in this Act which provides 
        for eligibility for medical assistance.''.
    (b) Provision of at Least Minimum Coverage.--
            (1) In general.--Section 1902(k)(1) of the Social Security 
        Act (42 U.S.C. 1396a(k)(1)) is amended by inserting ``or an 
        individual described in subclause (XXIV) of subsection 
        (a)(10)(A)(ii)'' after ``an individual described in subclause 
        (VIII) of subsection (a)(10)(A)(i)'' each place it appears.
            (2) Conforming amendment.--Section 1903(i)(26) of the 
        Social Security Act (42 U.S.C. 1396b(i)(26)) is amended by 
        striking ``individuals described in subclause (VIII) of 
        subsection (a)(10)(A)(i)'' and inserting ``individuals 
        described in subsections (a)(10)(A)(i)(VIII) or 
        (a)(10)(A)(ii)(XXIV) of section 1902''.
    (c) Federal Financial Participation in Buy-In Program.--
            (1) Enhanced match for administrative expenses.--Section 
        1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) is 
        amended--
                    (A) by redesignating paragraph (7) as paragraph 
                (8); and
                    (B) by inserting after paragraph (6) the following 
                new paragraph:
            ``(7) an amount equal to 90 percent of the sums expended 
        during such quarter which are attributable to reasonable 
        administrative expenses related to the administration of a 
        Medicaid buy-in program for individuals described in section 
        1902(a)(10)(A)(ii)(XXIV) (as found necessary by the Secretary 
        for the proper and efficient administration of such a program); 
        plus''.
            (2) Treatment of premium and cost-sharing revenues from 
        medicaid buy-in program.--
                    (A) In general.--For purposes of section 1903(a)(1) 
                of the Social Security Act (42 U.S.C. 1396b(a)(1)), for 
                any fiscal quarter during which a State collects 
                premiums, cost-sharing, or similar charges under 
                subsection (k) of section 1916 of such Act (42 U.S.C. 
                1396o) (as added by this Act), including any advance 
                payments of premium tax credits under section 1412 of 
                the Patient Protection and Affordable Care Act or 
                payments for cost-sharing reductions under section 1402 
                of such Act that are received by the State, the total 
                amount expended during such quarter as medical 
                assistance for individuals who buy into Medicaid 
                coverage under subclause (XXIV) of section 
                1902(a)(10)(A)(ii) of the Social Security Act (as added 
                by this Act) shall be reduced by the amount of such 
                premiums or charges.
                    (B) Treatment of excess premiums.--Each State that 
                collects premiums or similar charges under subsection 
                (k) of section 1916 of the Social Security Act (42 
                U.S.C. 1396o) (as added by this Act) in a fiscal year 
                shall pay to the Secretary of Health and Human 
                Services, at such time and in such form and manner as 
                the Secretary shall specify, an amount equal to 50 
                percent of the amount, if any, by which--
                            (i) the total amount of such premiums and 
                        charges collected by the State for such year; 
                        exceeds
                            (ii) the total amount expended by the State 
                        during such year as medical assistance for 
                        individuals who buy into Medicaid coverage 
                        under subclause (XXIV) of section 
                        1902(a)(10)(A)(ii) of such Act (as added by 
                        this Act).
    (d) Cost-Sharing Requirement.--Section 1916 of the Social Security 
Act (42 U.S.C. 1396o) is amended by adding at the end the following new 
subsection:
    ``(k) Premiums and Cost-Sharing for Individuals Participating in 
Medicaid Buy-In Program.--
            ``(1) In general.--Subject to paragraph (2), with respect 
        to individuals who are eligible for medical assistance under 
        subsection (a)(10)(A)(ii)(XXIV) of section 1902 and are 
        described in subsection (uu) of such section, a State may--
                    ``(A) impose premiums, deductibles, cost-sharing, 
                or other similar charges that are determined on an 
                actuarially sound basis; and
                    ``(B) vary the premium rate imposed on an 
                individual based only on the factors described in 
                section 2701(a)(1)(A) of the Public Health Service Act 
                and subject to the same limitations on the weight which 
                may be given to such factors under such section.
            ``(2) Limitations.--
                    ``(A) Premiums.--The total amount of premiums 
                imposed for a year under this subsection with respect 
                to all individuals described in paragraph (1) in a 
                family shall not exceed an amount equal to 8.5 percent 
                of the family's household income (as defined in section 
                36B(d)(2) of the Internal Revenue Code of 1986) for the 
                year involved.
                    ``(B) Other cost-sharing.--
                            ``(i) In general.--The cost-sharing 
                        limitations described in section 1302(c) of the 
                        Patient Protection and Affordable Care Act 
                        shall apply to cost-sharing (as defined in such 
                        section) for medical assistance provided under 
                        section 1902(a)(10)(A)(ii)(XXIV) in the same 
                        manner as such limitations apply to cost-
                        sharing under qualified health plans under 
                        title I of such Act.
                            ``(ii) Availability of cost-sharing 
                        reductions.--Individuals provided medical 
                        assistance under section 
                        1902(a)(10)(A)(ii)(XXIV) and subject to cost-
                        sharing under this subsection are eligible for 
                        cost-sharing reductions under section 1402 of 
                        the Patient Protection and Affordable Care Act 
                        (subject to the income eligibility threshold in 
                        subsection (b)(2) of such section), and in 
                        applying such section--
                                    ``(I) enrollment in a State plan 
                                under section 1902(a)(10)(A)(ii)(XXIV) 
                                shall be treated as coverage under a 
                                qualified health plan in the silver 
                                level of coverage in the individual 
                                market offered through an Exchange 
                                established for or by the State under 
                                title I of the Patient Protection and 
                                Affordable Care Act; and
                                    ``(II) the State agency 
                                administering such plan shall be 
                                treated as the issuer of such plan.
            ``(3) Premiums and cost-sharing for certain other 
        individuals.--If an individual is eligible for medical 
        assistance under subsection (a)(10)(A)(ii)(XXIV) of section 
        1902 and is not described in subsection (uu) of such section, a 
        State--
                    ``(A) shall not impose premiums and cost-sharing on 
                the individual under this subsection; and
                    ``(B) may impose premiums and cost-sharing on the 
                individual to the extent allowed by another provision 
                of this Act (other than section 
                1902(a)(10)(A)(ii)(XXIV)) which provides for 
                eligibility for medical assistance, but only if the 
                individual is described in such other provision.
            ``(4) Application of premium assistance tax credits.--An 
        individual who is required to pay premiums under this 
        subsection for a year for medical assistance shall be eligible 
        for a premium assistance credit under section 36B of the 
        Internal Revenue Code to the same extent that such individual 
        would be eligible for a premium assistance credit under such 
        section if such individual had paid the same amount in premiums 
        for coverage under a qualified health plan for such year.''.
    (e) Managed Care.--Section 1932(a)(1)(A)(i) of the Social Security 
Act (42 U.S.C. 1396u-2(a)(1)(A)(i)) is amended by inserting ``, 
including an individual who is eligible for such assistance after 
buying into such coverage under section 1902(a)(10)(A)(ii)(XXIV),'' 
after ``the State plan under this title''.
    (f) Offering Buy-In Program on State Exchange; Enrollment 
Periods.--
            (1) In general.--A State that has elected to allow 
        individuals to buy into Medicaid coverage under section 
        1902(a)(10)(A)(ii)(XXIV) of the Social Security Act (as added 
        by this Act) shall allow individuals to enroll in such coverage 
        through an Exchange established by or for the State under title 
        I of the Patient Protection and Affordable Care Act.
            (2) Enrollment periods.--A State may limit the enrollment 
        of individuals into Medicaid coverage under section 
        1902(a)(10)(A)(ii)(XXIV) of the Social Security Act (as added 
        by this Act) to the enrollment periods provided for under 
        section 1311(c)(6) of the Patient Protection and Affordable 
        Care Act.
    (g) Application of Advanced Premium Tax Credits to Medicaid Buy-In 
Plans.--
            (1) In general.--Section 36B of the Internal Revenue Code 
        of 1986 is amended--
                    (A) in subsection (b)(3)(B), by adding at the end 
                the following new sentence:
                ``If an applicable taxpayer resides in a rating area in 
                which no silver plan is offered on the individual 
                market but the taxpayer buys into Medicaid coverage 
                under section 1902(a)(10)(A)(ii)(XXIV) of the Social 
                Security Act, such Medicaid coverage shall be deemed to 
                be the applicable second lowest cost silver plan with 
                respect to such taxpayer.''; and
                    (B) by redesignating subsection (h) as subsection 
                (i); and
                    (C) by inserting after subsection (g) the following 
                new subsection:
    ``(h) Application to Individuals Purchasing Medicaid Coverage.--In 
the case of any individual who buys into Medicaid coverage under 
section 1902(a)(10)(A)(ii)(XXIV) of the Social Security Act, this 
section shall be applied with the following modifications:
            ``(1) The amount determined under subsection (b)(2)(A) 
        shall be increased by the amount of the monthly premiums paid 
        for such coverage.
            ``(2) Subsection (c)(2)(A)(i) shall be applied by treating 
        coverage under the Medicaid program under title XIX of the 
        Social Security Act in the same manner as a qualified health 
        plan that was enrolled in through an Exchange.
            ``(3) In applying subsection (c)(2)(B)--
                    ``(A) an individual shall not be considered to be 
                eligible for minimum essential coverage described in 
                section 5000A(f)(1)(A)(ii) by reason of eligibility for 
                medical assistance under a State Medicaid program under 
                section 1902(a)(10)(A)(ii)(XXIV); and
                    ``(B) an individual who is not covered by minimum 
                essential coverage described in section 5000A(f)(1)(B) 
                shall not be considered to be eligible for such 
                coverage.''.
            (2) Advanced payment of credit.--
                    (A) In general.--The Secretary of Health and Human 
                Services, in consultation with the Secretary of the 
                Treasury, shall establish a program under which--
                            (i) upon request of a State agency 
                        administering a State Medicaid program under 
                        title XIX of the Social Security Act, advance 
                        determinations are made in a manner similar to 
                        advanced determinations under section 1412 of 
                        the Patient Protection and Affordable Care Act 
                        with respect to the income eligibility of 
                        individuals enrolling in such program for the 
                        premium tax credit allowable under section 36B 
                        of the Internal Revenue Code of 1986 and the 
                        cost-sharing reductions under section 1402 of 
                        the Patient Protection and Affordable Care Act;
                            (ii) the Secretary notifies--
                                    (I) the State agency administering 
                                the program and the Secretary of the 
                                Treasury of the advance determinations; 
                                and
                                    (II) the Secretary of the Treasury 
                                of the name and employer identification 
                                number of each employer with respect to 
                                whom 1 or more employees of the 
                                employer were determined to be eligible 
                                for the premium tax credit under 
                                section 36B of the Internal Revenue 
                                Code of 1986 and the cost-sharing 
                                reductions under section 1402 of the 
                                Patient Protection and Affordable Care 
                                Act because--
                                            (aa) the employer did not 
                                        provide minimum essential 
                                        coverage; or
                                            (bb) the employer provided 
                                        such minimum essential coverage 
                                        but it was determined under 
                                        section 36B(c)(2)(C) of such 
                                        Code to either be unaffordable 
                                        to the employee or not provide 
                                        the required minimum actuarial 
                                        value; and
                            (iii) the Secretary of the Treasury makes 
                        advance payments of such credit or reductions 
                        to the State agency administering the program 
                        in order to reduce the premiums payable by 
                        individuals eligible for such credit.
                    (B) Determinations and payments.--Rules similar to 
                subsections (b) and (c) of section 1412 of the Patient 
                Protection and Affordable Care Act shall apply for 
                purposes of this subsection.
                    (C) Coordination with credit.--
                            (i) In general.--Section 36B of the 
                        Internal Revenue Code of 1986 is amended by 
                        inserting ``and under section 2(g)(2) of the 
                        State Public Option Act'' after ``section 1412 
                        of the Patient Protection and Affordable Care 
                        Act'' each place it appears in subsections 
                        (f)(1), (f)(2), and (g)(1).
                            (ii) Information reporting.--Section 
                        36B(f)(3) of such Code is amended by adding at 
                        the end the following flush sentence: ``In the 
                        case of any coverage under the Medicaid program 
                        under title XIX of the Social Security Act for 
                        which a credit under this section is allowable 
                        by reason of subsection (h), the State agency 
                        administering the Medicaid program shall be 
                        treated as an Exchange for purposes of this 
                        paragraph and subparagraph (A) shall not 
                        apply.''.
            (3) Conforming amendment relating to employer 
        responsibility.--Paragraph (6) of section 4980H(c) of the 
        Internal Revenue Code of 1986 is amended by inserting ``, 
        except that for purposes of subsections (a)(2) and (b)(2), the 
        term `qualified health plan' shall include any plan described 
        in section 36B(h)'' after ``such Act''.
    (h) Conforming Amendments.--
            (1) Section 1902(a)(10) of the Social Security Act (42 
        U.S.C. 1396a(a)(10)), as amended by subsection (a), is further 
        amended, in the matter following subparagraph (G)--
                    (A) by striking ``and (XVIII)'' and inserting ``, 
                (XVIII)''; and
                    (B) by inserting ``, and (XIX) the medical 
                assistance made available to an individual described in 
                subparagraph (A)(ii)(XXIV) shall be limited to medical 
                assistance described in subsection (k)(1)'' before the 
                semicolon.
            (2) Section 1903(f)(4) of the Social Security Act (42 
        U.S.C. 1396b(f)(4)) is amended by inserting 
        ``1902(a)(10)(A)(ii)(XXIV),'' after 
        ``1902(a)(10)(A)(ii)(XXII),''.
            (3) Section 1905(a) of the Social Security Act (42 U.S.C. 
        1396d(a)) is amended, in the matter preceding paragraph (1)--
                    (A) by striking ``or'' at the end of clause (xvi);
                    (B) by inserting ``or'' at the end of clause 
                (xvii); and
                    (C) by inserting after clause (xvii) the following 
                new clause:
            ``(xviii) individuals described in section 
        1902(a)(10)(A)(ii)(XXIV),''.
            (4) Section 1916A(a)(1) of the Social Security Act (42 
        U.S.C. 1396o-1(a)(1)) is amended by striking ``or (j)'' and 
        inserting ``(j), or (k)''.
            (5) Section 1937(a)(1)(B) of the Social Security Act (42 
        U.S.C. 1396u-7(a)(1)(B)) is amended by inserting ``, subclause 
        (XXIV) of section 1902(a)(10)(A)(ii),'' after 
        ``1902(a)(10)(A)(i)''.

SEC. 3. REVIEWING AND UPDATING MEDICAID QUALITY MEASURES.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall review quality 
measures that are in use under the Medicaid program and, not later than 
January 1, 2029, shall update such measures to the extent necessary to 
ensure that such quality measures are appropriate for the population of 
individuals who are eligible to buy into Medicaid coverage under 
subclause (XXIV) of section 1902(a)(10)(A)(ii) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)(A)(ii)), as added by section 2.
    (b) Reporting.--The Secretary shall review, and, not later than 
January 1, 2031, update any corresponding State reporting requirements 
to include the quality measures under subsection (a).
    (c) State Implementation Funding.--The Secretary may award funds, 
from the amount appropriated under subsection (d), to States for the 
purpose of updating and implementing the metrics developed under this 
section.
    (d) Appropriation.--There is appropriated to the Secretary, out of 
any funds in the Treasury not otherwise appropriated, $50,000,000 for 
fiscal year 2025, to remain available until expended, for the purpose 
of carrying out this section.

SEC. 4. RENEWAL OF APPLICATION OF MEDICARE PAYMENT RATE FLOOR TO 
              PRIMARY CARE SERVICES FURNISHED UNDER MEDICAID AND 
              INCLUSION OF ADDITIONAL PROVIDERS.

    (a) Renewal of Payment Floor; Additional Providers.--
            (1) In general.--Section 1902(a)(13) of the Social Security 
        Act (42 U.S.C. 1396a(a)(13)) is amended by striking 
        subparagraph (C) and inserting the following:
                    ``(C) payment for primary care services (as defined 
                in subsection (jj)) at a rate that is not less than 100 
                percent of the payment rate that applies to such 
                services and physician under part B of title XVIII (or, 
                if greater, the payment rate that would be applicable 
                under such part if the conversion factor under section 
                1848(d) for the year involved were the conversion 
                factor under such section for 2009), and that is not 
                less than the rate that would otherwise apply to such 
                services under this title if the rate were determined 
                without regard to this subparagraph, and that are--
                            ``(i) furnished in 2013 and 2014, by a 
                        physician with a primary specialty designation 
                        of family medicine, general internal medicine, 
                        or pediatric medicine; or
                            ``(ii) furnished in the period that begins 
                        on the first day of the first month that begins 
                        after the date of enactment of the State Public 
                        Option Act--
                                    ``(I) by a physician with a primary 
                                specialty designation of family 
                                medicine, general internal medicine, or 
                                pediatric medicine, but only if the 
                                physician self-attests that the 
                                physician is Board certified in family 
                                medicine, general internal medicine, or 
                                pediatric medicine;
                                    ``(II) by a physician with a 
                                primary specialty designation of 
                                obstetrics and gynecology, but only if 
                                the physician self-attests that the 
                                physician is Board certified in 
                                obstetrics and gynecology;
                                    ``(III) by an advanced practice 
                                clinician, as defined by the Secretary, 
                                that works under the supervision of--
                                            ``(aa) a physician that 
                                        satisfies the criteria 
                                        specified in subclause (I) or 
                                        (II); or
                                            ``(bb) a nurse practitioner 
                                        or a physician assistant (as 
                                        such terms are defined in 
                                        section 1861(aa)(5)(A)) who is 
                                        working in accordance with 
                                        State law, or a certified 
                                        nurse-midwife (as defined in 
                                        section 1861(gg)) who is 
                                        working in accordance with 
                                        State law;
                                    ``(IV) by a rural health clinic, 
                                federally qualified health center, or 
                                other health clinic that receives 
                                reimbursement on a fee schedule 
                                applicable to a physician, a nurse 
                                practitioner or a physician assistant 
                                (as such terms are defined in section 
                                1861(aa)(5)(A)) who is working in 
                                accordance with State law, or a 
                                certified nurse-midwife (as defined in 
                                section 1861(gg)) who is working in 
                                accordance with State law, for services 
                                furnished by a physician, nurse 
                                practitioner, physician assistant, or 
                                certified nurse-midwife, or services 
                                furnished by an advanced practice 
                                clinician supervised by a physician 
                                described in subclause (I)(aa) or 
                                (II)(aa), another advanced practice 
                                clinician, or a certified nurse-
                                midwife; or
                                    ``(V) by a nurse practitioner or a 
                                physician assistant (as such terms are 
                                defined in section 1861(aa)(5)(A)) who 
                                is working in accordance with State 
                                law, or a certified nurse-midwife (as 
                                defined in section 1861(gg)) who is 
                                working in accordance with State law, 
                                in accordance with procedures that 
                                ensure that the portion of the payment 
                                for such services that the nurse 
                                practitioner, physician assistant, or 
                                certified nurse-midwife is paid is not 
                                less than the amount that the nurse 
                                practitioner, physician assistant, or 
                                certified nurse-midwife would be paid 
                                if the services were provided under 
                                part B of title XVIII;''.
            (2) Conforming amendments.--Section 1905(dd) of the Social 
        Security Act (42 U.S.C. 1396d(dd)) is amended--
                    (A) by striking ``Notwithstanding'' and inserting 
                the following:
            ``(1) In general.--Notwithstanding'';
                    (B) by inserting ``or furnished during the 
                additional period specified in paragraph (2),'' after 
                ``2015,''; and
                    (C) by adding at the end the following:
            ``(2) Additional period.--For purposes of paragraph (1), 
        the additional period specified in this paragraph is the period 
        that begins on the date that is 1 year after the date of 
        enactment of the State Public Option Act.''.
    (b) Improved Targeting of Primary Care.--Section 1902(jj) of the 
Social Security Act (42 U.S.C. 1396a(jj)) is amended--
            (1) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively and realigning the left 
        margins accordingly;
            (2) by striking ``For purposes of'' and inserting the 
        following:
            ``(1) In general.--For purposes of''; and
            (3) by adding at the end the following:
            ``(2) Exclusions.--Such term does not include any services 
        described in subparagraph (A) or (B) of paragraph (1) if such 
        services are provided in an emergency department of a 
        hospital.''.
    (c) Ensuring Payment by Managed Care Entities.--
            (1) In general.--Section 1903(m)(2)(A) of the Social 
        Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
                    (A) in clause (xii), by striking ``and'' after the 
                semicolon;
                    (B) in clause (xiii)--
                            (i) by realigning the left margin so as to 
                        align with the left margin of clause (xii); and
                            (ii) by striking the period at the end of 
                        clause (xiii) and inserting ``; and''; and
                    (C) by inserting after clause (xiii) the following:
            ``(xiv) such contract provides that (I) payments to 
        providers specified in section 1902(a)(13)(C) for primary care 
        services defined in section 1902(jj) that are furnished during 
        a year or period specified in section 1902(a)(13)(C) and 
        section 1905(dd) are at least equal to the amounts set forth 
        and required by the Secretary by regulation, (II) the entity 
        shall, upon request, provide documentation to the State, 
        sufficient to enable the State and the Secretary to ensure 
        compliance with subclause (I), and (III) the Secretary shall 
        approve payments described in subclause (I) that are furnished 
        through an agreed upon capitation, partial capitation, or other 
        value-based payment arrangement if the capitation, partial 
        capitation, or other value-based payment arrangement is based 
        on a reasonable methodology and the entity provides 
        documentation to the State sufficient to enable the State and 
        the Secretary to ensure compliance with subclause (I).''.
            (2) Conforming amendment.--Section 1932(f) of the Social 
        Security Act (42 U.S.C. 1396u-2(f)) is amended by inserting 
        ``and clause (xiv) of section 1903(m)(2)(A)'' before the 
        period.

SEC. 5. INCREASED FMAP FOR MEDICAL ASSISTANCE TO NEWLY ELIGIBLE 
              INDIVIDUALS.

    (a) In General.--Section 1905(y)(1) of the Social Security Act (42 
U.S.C. 1396d(y)(1)) is amended--
            (1) in subparagraph (A), by striking ``2014, 2015, and 
        2016'' and inserting ``each of the first 3 consecutive 12-month 
        periods in which the State provides medical assistance to newly 
        eligible individuals'';
            (2) in subparagraph (B), by striking ``2017'' and inserting 
        ``the fourth consecutive 12-month period in which the State 
        provides medical assistance to newly eligible individuals'';
            (3) in subparagraph (C), by striking ``2018'' and inserting 
        ``the fifth consecutive 12-month period in which the State 
        provides medical assistance to newly eligible individuals'';
            (4) in subparagraph (D), by striking ``2019'' and inserting 
        ``the sixth consecutive 12-month period in which the State 
        provides medical assistance to newly eligible individuals''; 
        and
            (5) in subparagraph (E), by striking ``2020 and each year 
        thereafter'' and inserting ``the seventh consecutive 12-month 
        period in which the State provides medical assistance to newly 
        eligible individuals and each such period thereafter''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect as if included in the enactment of Public Law 111-148.

SEC. 6. MEDICAID COVERAGE OF COMPREHENSIVE SEXUAL AND REPRODUCTIVE 
              HEALTH CARE SERVICES.

    (a) Inclusion of Comprehensive Sexual and Reproductive Health Care 
Services as Medical Assistance.--Section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)), as amended by section 2(h) and section 209(a) 
of title I of division G of the Consolidated Appropriations Act, 2024, 
is further amended--
            (1) in paragraph (31), by striking ``and'' at the end;
            (2) by redesignating paragraph (32) as paragraph (33); and
            (3) by inserting after paragraph (31) the following new 
        paragraph:
            ``(32) comprehensive sexual and reproductive health care 
        services, including abortion services and abortion-related 
        services; and''.
    (b) Requiring Coverage of Comprehensive Sexual and Reproductive 
Health Care Services as Condition of State Plan Approval.--Section 
1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)), 
as amended by subsections (a) and (h) of section 2, is further amended, 
in the matter preceding clause (i), by striking ``and (30)'' and 
inserting ``(30), and (32)''.
    (c) Conforming Amendments.--
            (1) Section 1932(e)(1)(B) of the Social Security Act (42 
        U.S.C. 1396u-2(e)(1)(B)) is amended by striking ``Clause (i)'' 
        and inserting ``With respect to the period beginning before 
        January 1, 2023, clause (i)''.
            (2) Section 1937(b) of the Social Security Act (42 U.S.C. 
        1396u-7(b)) is amended by adding at the end the following new 
        paragraph:
            ``(9) Coverage of comprehensive sexual and reproductive 
        health services.--Notwithstanding the previous provisions of 
        this section, a State may not provide for medical assistance 
        through enrollment of an individual with benchmark coverage or 
        benchmark-equivalent coverage under this section unless such 
        coverage includes medical assistance for comprehensive sexual 
        and reproductive health care services, including abortion 
        services and abortion-related services.''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to medical assistance furnished on or after January 
1, 2025.
                                 <all>
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