II 

118TH CONGRESS 

2D SESSION S. 4684 

To ensure affordable health insurance coverage for low-income individuals 

in States that have not expanded Medicaid. 

IN THE SENATE OF THE UNITED STATES 

JULY 11 (legislative day, JULY 10), 2024 

Mr. WARNOCK (for himself, Ms. BALDWIN, Mr. CASEY, Ms. WARREN, and Mr. 

OSSOFF) introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To ensure affordable health insurance coverage for low-income individuals in States that have not expanded Medicaid. 

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 ‘‘Bridge to Medicaid 

5 Act of 2024’’. 


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1 SEC. 2. ENSURING AFFORDABILITY OF COVERAGE FOR 

2 CERTAIN LOW-INCOME POPULATIONS. 

3 (a) REDUCING COST SHARING UNDER QUALIFIED

4 HEALTH PLANS.—Section 1402 of the Patient Protection 

5 and Affordable Care Act (42 U.S.C. 18071) is amended— 

6 (1) in subsection (b)— 

7 (A) in paragraph (2), by inserting ‘‘(or, 

8 with respect to plan years 2026, 2027, and 

9 2028, whose household income does not exceed 

10 400 percent of the poverty line for a family of 

11 the size involved)’’ before the period; and 

12 (B) in the matter following paragraph (2), 

13 by adding at the end the following new sen14 tence: ‘‘In the case of an individual who is de15 termined at any point to have a household in16 come for 2025 that does not exceed 138 percent 

17 of the poverty line for a family of the size in18 volved, such individual shall, for each month 

19 during such year, be treated as having a house20 hold income equal to 100 percent for purposes 

21 of applying this section.’’; and 

22 (2) in subsection (c)— 

23 (A) in paragraph (1)(A), in the matter 

24 preceding clause (i), by inserting ‘‘, with respect 

25 to eligible insureds (other than, with respect to 

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1 rollees (as defined in paragraph (6)(C))),’’ after 

2 ‘‘first be achieved’’; 

3 (B) in paragraph (2), in the matter pre4 ceding subparagraph (A), by inserting ‘‘with re5 spect to eligible insureds (other than, with re6 spect to plan years 2026, 2027, and 2028, spec7 ified enrollees)’’ after ‘‘under the plan’’; 

8 (C) in paragraph (3)— 

9 (i) in subparagraph (A), by striking 

10 ‘‘this subsection’’ and inserting ‘‘paragraph 

11 (1) or (2)’’; and 

12 (ii) in subparagraph (B), by striking 

13 ‘‘this section’’ and inserting ‘‘paragraphs 

14 (1) and (2)’’; and 

15 (D) by adding at the end the following new 

16 paragraph: 

17 ‘‘(6) SPECIAL RULE FOR SPECIFIED ENROLL18 EES.— 

19 ‘‘(A) IN GENERAL.—The Secretary shall 

20 establish procedures under which the issuer of 

21 a qualified health plan to which this section ap22 plies shall reduce cost-sharing under the plan 

23 with respect to months occurring during plan 

24 years 2026, 2027, and 2028 for enrollees who 

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1 graph (C)) in a manner sufficient to increase 

2 the plan’s share of the total allowed costs of 

3 benefits provided under the plan to 99 percent 

4 of such costs. 

5 ‘‘(B) METHODS FOR REDUCING COST

6 SHARING.— 

7 ‘‘(i) IN GENERAL.—An issuer of a 

8 qualified health plan making reductions 

9 under this paragraph shall notify the Sec10 retary of such reductions and the Sec11 retary shall, out of funds made available 

12 under clause (ii), make periodic and timely 

13 payments to the issuer equal to 12 percent 

14 of the total allowed costs of benefits pro15 vided under each such plan to specified en16 rollees during plan years 2026, 2027, and 

17 2028. 

18 ‘‘(ii) APPROPRIATION.—In addition to 

19 amounts otherwise available, there are ap20 propriated, out of any money in the Treas21 ury not otherwise appropriated, such sums 

22 as may be necessary to the Secretary to 

23 make payments under clause (i). 

24 ‘‘(C) SPECIFIED ENROLLEE DEFINED.— 

25 For purposes of this section, the term ‘specified 


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1 enrollee’ means, with respect to a plan year, an 

2 eligible insured who is determined at any point 

3 to have a household income for such plan year 

4 that does not exceed 138 percent of the poverty 

5 line for a family of the size involved. Such in6 sured shall be deemed to be a specified enrollee 

7 for each month in such plan year.’’. 

8 (b) OPEN ENROLLMENTS APPLICABLE TO CERTAIN

9 LOWER-INCOME POPULATIONS.—Section 1311(c) of the 

10 Patient Protection and Affordable Care Act (42 U.S.C. 

11 18031(c)) is amended— 

12 (1) in paragraph (6)— 

13 (A) in subparagraph (C), by striking at the 

14 end ‘‘and’’; 

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

16 period at the end and inserting ‘‘; and’’; and 

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

18 subparagraph: 

19 ‘‘(E) with respect to a qualified health plan 

20 with respect to which section 1402 applies, for 

21 months occurring during the period beginning 

22 on January 1, 2025, and ending on December 

23 31, 2028, enrollment periods described in sub24 paragraph (A) of paragraph (8) for individuals 


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1 described in subparagraph (B) of such para2 graph.’’; and 

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

4 paragraph: 

5 ‘‘(8) SPECIAL ENROLLMENT PERIOD FOR CER6 TAIN LOW-INCOME POPULATIONS.— 

7 ‘‘(A) IN GENERAL.—The enrollment period 

8 described in this paragraph is, in the case of an 

9 individual described in subparagraph (B), the 

10 continuous period beginning on the first day 

11 that such individual is so described. 

12 ‘‘(B) INDIVIDUAL DESCRIBED.—For pur13 poses of subparagraph (A), an individual de14 scribed in this subparagraph is an individual— 

15 ‘‘(i) with a household income that 

16 does not exceed 138 percent of the poverty 

17 line for a family of the size involved; and 

18 ‘‘(ii) who is not eligible for minimum 

19 essential coverage (as defined in section 

20 5000A(f) of the Internal Revenue Code of 

21 1986), other than for coverage described in 

22 any of subparagraphs (B) through (E) of 

23 paragraph (1) of such section.’’. 

24 (c) ADDITIONAL BENEFITS FOR CERTAIN LOW-IN25 COME INDIVIDUALS FOR PLAN YEARS 2027 AND 2028.— 


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1 Section 1301(a) of the Patient Protection and Affordable 

2 Care Act (42 U.S.C. 18021(a)) is amended— 

3 (1) in paragraph (1)— 

4 (A) in subparagraph (B), by striking 

5 ‘‘and’’ at the end; 

6 (B) in subparagraph (C)(iv), by striking 

7 the period and inserting ‘‘; and’’; and 

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

9 subparagraph: 

10 ‘‘(D) provides, with respect to a plan of11 fered in the silver level of coverage to which sec12 tion 1402 applies during plan year 2027 and 

13 2028, for benefits described in paragraph (5) in 

14 the case of an individual who has a household 

15 income that does not exceed 138 percent of the 

16 poverty line for a family of the size involved, 

17 and who is eligible to receive cost-sharing re18 ductions under section 1402.’’; and 

19 (2) by adding at the end the following new 

20 paragraph: 

21 ‘‘(5) ADDITIONAL BENEFITS FOR CERTAIN

22 LOW-INCOME INDIVIDUALS FOR PLAN YEAR 2027 AND

23 2028.— 

24 ‘‘(A) IN GENERAL.— 


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1 ‘‘(i) BENEFITS.—For purposes of 

2 paragraph (1)(D), the benefits described in 

3 this paragraph to be provided by a quali4 fied health plan are benefits consisting 

5 of— 

6 ‘‘(I) non-emergency medical 

7 transportation services (as described 

8 in section 1902(a)(4) of the Social Se9 curity Act) for which Federal pay10 ments would have been available 

11 under title XIX of the Social Security 

12 Act had such services been furnished 

13 to an individual enrolled under a 

14 State plan (or waiver of such plan) 

15 under such title; and 

16 ‘‘(II) services described in sub17 section (a)(4)(C) of section 1905 of 

18 such Act for which Federal payments 

19 would have been so available; 

20 which are not otherwise provided under 

21 such plan as part of the essential health 

22 benefits package described in section 

23 1302(a). 


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1 ‘‘(ii) CONDITION ON PROVISION OF

2 BENEFITS.—Benefits described in this 

3 paragraph shall be provided— 

4 ‘‘(I) without any restriction on 

5 the choice of a qualified provider from 

6 whom an individual may receive such 

7 benefits; and 

8 ‘‘(II) without any imposition of 

9 cost sharing. 

10 ‘‘(B) PAYMENTS FOR ADDITIONAL BENE11 FITS.— 

12 ‘‘(i) IN GENERAL.—An issuer of a 

13 qualified health plan making payments for 

14 services described in subparagraph (A) fur15 nished to individuals described in para16 graph (1)(D) during plan year 2027 or 

17 2028 shall notify the Secretary of such 

18 payments and the Secretary shall, out of 

19 funds made available under clause (ii), 

20 make periodic and timely payments to the 

21 issuer equal to payments for such services 

22 so furnished. 

23 ‘‘(ii) APPROPRIATION.—In addition to 

24 amounts otherwise available, there is ap25 propriated, out of any money in the TreasVerDate Sep 11 2014 01:28 Aug 16, 2024 Jkt 049200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4684.IS S4684

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1 ury not otherwise appropriated, such sums 

2 as may be necessary to the Secretary to 

3 make payments under clause (i).’’. 

4 (d) EDUCATION AND OUTREACH ACTIVITIES.— 

5 (1) IN GENERAL.—Section 1321(c) of the Pa6 tient Protection and Affordable Care Act (42 U.S.C. 

7 18041(c)) is amended by adding at the end the fol8 lowing new paragraph: 

9 ‘‘(3) OUTREACH AND EDUCATIONAL ACTIVI10 TIES.— 

11 ‘‘(A) IN GENERAL.—In the case of an Ex12 change established or operated by the Secretary 

13 within a State pursuant to this subsection, the 

14 Secretary shall carry out outreach and edu15 cational activities for purposes of informing in16 dividuals described in section 

17 1902(a)(10)(A)(i)(VIII) of the Social Security 

18 Act who reside in States that have not ex19 pended amounts under a State plan (or waiver 

20 of such plan) under title XIX of such Act for 

21 all such individuals about qualified health plans 

22 offered through the Exchange, including by in23 forming such individuals of the availability of 

24 coverage under such plans and financial assist25 ance for coverage under such plans. Such outVerDate Sep 11 2014 01:28 Aug 16, 2024 Jkt 049200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4684.IS S4684

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1 reach and educational activities shall be pro2 vided in a manner that is culturally and linguis3 tically appropriate to the needs of the popu4 lations being served by the Exchange (including 

5 hard-to-reach populations, such as racial and 

6 sexual minorities, limited English proficient 

7 populations, individuals residing in areas where 

8 the unemployment rates exceeds the national 

9 average unemployment rate, individuals in rural 

10 areas, veterans, and young adults). 

11 ‘‘(B) LIMITATION ON USE OF FUNDS.— 

12 Funds appropriated under this paragraph shall 

13 not be used to promote any health insurance 

14 coverage other than qualified health plans. 

15 ‘‘(C) FUNDING.—In addition to amounts 

16 otherwise available, there is appropriated, out of 

17 any money in the Treasury not otherwise ap18 propriated, to remain available until expended, 

19 $105,000,000 for fiscal year 2025 to carry out 

20 this paragraph, of which— 

21 ‘‘(i) $15,000,000 shall be used to 

22 carry out this paragraph in fiscal year 

23 2025; and 


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1 ‘‘(ii) $30,000,000 shall be used to 

2 carry out this paragraph for each of fiscal 

3 years 2026 through 2028.’’. 

4 (2) NAVIGATOR PROGRAM.—Section 1311(i) of 

5 the Patient Protection and Affordable Care Act (42 

6 U.S.C. 18031(i)) is amended— 

7 (A) in paragraph (1)— 

8 (i) by striking ‘‘An Exchange’’ and in9 serting the following: 

10 ‘‘(A) IN GENERAL.—An Exchange’’; and 

11 (ii) by adding at the end the fol12 lowing: 

13 ‘‘(B) GRANTS FOR ELIGIBLE ENTITIES

14 WITH RESPECT TO CERTAIN STATES.—The Sec15 retary shall establish a program to award 

16 grants to entities described in paragraph (2) to 

17 carry out the duties described in paragraph (3) 

18 in one or more States that do not provide under 

19 the State plan under title XIX of the Social Se20 curity Act (or a waiver of such plan) bench21 mark coverage described in section 1937(b)(1) 

22 of such Act or benchmark equivalent coverage 

23 described in section 1937(b)(2) of such Act to 

24 all individuals described in section 

25 1902(a)(10)(A)(i)(VIII) of such Act.’’; and 


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1 (B) in paragraph (6)— 

2 (i) by striking ‘‘Grants under’’ and in3 serting the following: 

4 ‘‘(A) STATE EXCHANGES.—Except as pro5 vided in subparagraph (B), grants under’’; and 

6 (ii) by adding at the end the following 

7 new subparagraph: 

8 ‘‘(B) FEDERAL EXCHANGES; GRANTS TO

9 ELIGIBLE ENTITIES WITH RESPECT TO CERTAIN

10 STATES.—For purposes of carrying out this 

11 subsection, with respect to an Exchange estab12 lished and operated by the Secretary within a 

13 State pursuant to section 1321(c) and with re14 spect to grants under paragraph (1)(B), the 

15 Secretary shall obligate not less than 

16 $10,000,000 out of amounts collected through 

17 the user fees on participating health insurance 

18 issuers pursuant to section 156.50 of title 45, 

19 Code of Federal Regulations (or any successor 

20 regulations) for fiscal year 2026, and not less 

21 than $20,000,000 for each of fiscal years 2027 

22 and 2028. Such amount so obligated for a fiscal 

23 year shall remain available until expended.’’. 

24 (e) FUNDING.—In addition to amounts otherwise 

25 available, there is appropriated to the Secretary of Health 


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1 and Human Services for fiscal year 2025, out of any 

2 money in the Treasury not otherwise appropriated, 

3 $65,000,000, to remain available until expended, for pur4 poses of carrying out the provisions of, and the amend5 ments made by, this section. 

6 SEC. 3. TEMPORARY EXPANSION OF HEALTH INSURANCE 

7 PREMIUM TAX CREDITS FOR CERTAIN LOW8 INCOME POPULATIONS. 

9 (a) IN GENERAL.—Section 36B of the Internal Rev10 enue Code of 1986 is amended by redesignating subsection 

11 (h) as subsection (i) and by inserting after subsection (g) 

12 the following new subsection: 

13 ‘‘(h) CERTAIN TEMPORARY RULES BEGINNING IN

14 2026.—With respect to any taxable year beginning after 

15 December 31, 2025, and before January 1, 2029— 

16 ‘‘(1) ELIGIBILITY FOR CREDIT NOT LIMITED

17 BASED ON INCOME.—Subsection (c)(1)(A) shall be 

18 applied without regard to ‘equals or exceeds 100 

19 percent but’. 

20 ‘‘(2) CREDIT ALLOWED TO CERTAIN LOW-IN21 COME EMPLOYEES OFFERED EMPLOYER-PROVIDED

22 COVERAGE.—In the case of an individual whose 

23 household income does not exceed 138 percent of the 

24 poverty line for a family of the size involved, clause 

25 (i) of subsection (c)(2)(C) shall be applied (including 


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1 in the case of any individual described in the last 

2 sentence of such clause) without regard to subclause 

3 (II) thereof. 

4 ‘‘(3) CREDIT ALLOWED TO CERTAIN LOW-IN5 COME EMPLOYEES OFFERED QUALIFIED SMALL EM6 PLOYER HEALTH REIMBURSEMENT ARRANGE7 MENTS.—A qualified small employer health reim8 bursement arrangement shall not be treated as con9 stituting affordable coverage for an employee (or any 

10 spouse or dependent of such employee) for any 

11 months of a taxable year if the employee’s household 

12 income for such taxable year does not exceed 138 

13 percent of the poverty line for a family of the size 

14 involved. 

15 ‘‘(4) LIMITATIONS ON RECAPTURE.— 

16 ‘‘(A) IN GENERAL.—In the case of a tax17 payer whose household income is less than 200 

18 percent of the poverty line for the size of the 

19 family involved for the taxable year, the amount 

20 of the increase under subsection (f)(2)(A) shall 

21 in no event exceed $300 (one-half of such 

22 amount in the case of a taxpayer whose tax is 

23 determined under section 1(c) for the taxable 

24 year). 


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1 ‘‘(B) LIMITATION ON INCREASE FOR CER2 TAIN NON-FILERS.—In the case of any taxpayer 

3 who would not be required to file a return of 

4 tax for the taxable year but for any require5 ment to reconcile advance credit payments 

6 under subsection (f), if an Exchange established 

7 under title I of the Patient Protection and Af8 fordable Care Act has determined that— 

9 ‘‘(i) such taxpayer is eligible for ad10 vance payments under section 1412 of 

11 such Act for any portion of such taxable 

12 year, and 

13 ‘‘(ii) such taxpayer’s household in14 come for such taxable year is projected not 

15 to exceed 138 percent of the poverty line 

16 for a family of the size involved, 

17 subsection (f)(2)(A) shall not apply to such tax18 payer for such taxable year and such taxpayer 

19 shall not be required to file such return of tax. 

20 ‘‘(C) INFORMATION PROVIDED BY EX21 CHANGE.—The information required to be pro22 vided by an Exchange to the Secretary and to 

23 the taxpayer under subsection (f)(3) shall in24 clude such information as is necessary to deter25 mine whether such Exchange has made the deVerDate Sep 11 2014 01:28 Aug 16, 2024 Jkt 049200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S4684.IS S4684

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1 terminations described in clauses (i) and (ii) of 

2 subparagraph (B) with respect to such tax3 payer.’’. 

4 (b) EMPLOYER SHARED RESPONSIBILITY PROVISION

5 NOT APPLICABLE WITH RESPECT TO CERTAIN LOW-IN6 COME TAXPAYERS RECEIVING PREMIUM ASSISTANCE.— 

7 Section 4980H(c)(3) of the Internal Revenue Code of 

8 1986 is amended to read as follows: 

9 ‘‘(3) APPLICABLE PREMIUM TAX CREDIT AND

10 COST-SHARING REDUCTION.— 

11 ‘‘(A) IN GENERAL.—The term ‘applicable 

12 premium tax credit and cost-sharing reduction’ 

13 means— 

14 ‘‘(i) any premium tax credit allowed 

15 under section 36B, 

16 ‘‘(ii) any cost-sharing reduction under 

17 section 1402 of the Patient Protection and 

18 Affordable Care Act, and 

19 ‘‘(iii) any advance payment of such 

20 credit or reduction under section 1412 of 

21 such Act. 

22 ‘‘(B) EXCEPTION WITH RESPECT TO CER23 TAIN LOW-INCOME TAXPAYERS.—Such term 

24 shall not include any premium tax credit, cost25 sharing reduction, or advance payment otherVerDate Sep 11 2014 01:28 Aug 16, 2024 Jkt 049200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S4684.IS S4684

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1 wise described in subparagraph (A) if such 

2 credit, reduction, or payment is allowed or paid 

3 for a taxable year of an employee (beginning 

4 after December 31, 2025, and before January 

5 1, 2029) with respect to which— 

6 ‘‘(i) an Exchange established under 

7 title I of the Patient Protection and Af8 fordable Care Act has determined that 

9 such employee’s household income for such 

10 taxable year is projected to not exceed 138 

11 percent of the poverty line for a family of 

12 the size involved, or 

13 ‘‘(ii) such employee’s household in14 come for such taxable year does not exceed 

15 138 percent of the poverty line for a family 

16 of the size involved.’’. 

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

18 this section shall apply to taxable years beginning after 

19 December 31, 2025. 

20 SEC. 4. FURTHER INCREASE IN FMAP FOR MEDICAL AS21 SISTANCE FOR NEWLY ELIGIBLE MANDA22 TORY INDIVIDUALS. 

23 Section 1905(y)(1) of the Social Security Act (42 

24 U.S.C. 1396d(y)(1)) is amended— 


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1 (1) in subparagraph (D), by striking at the end 

2 ‘‘and’’; 

3 (2) in subparagraph (E), by striking ‘‘2020 and 

4 each year thereafter.’’ and inserting ‘‘2020, 2021, 

5 2022, 2023, 2024, and 2025;’’; and 

6 (3) by adding at the end the following new sub7 paragraphs: 

8 ‘‘(F) 93 percent for calendar quarters in 

9 2026, 2027, and 2028; and 

10 ‘‘(G) 90 percent for calendar quarters in 

11 2029 and each year thereafter.’’. 

Æ 


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