I 

118TH CONGRESS 

2D SESSION H. R. 8327 

To amend title XI of the Social Security Act to provide for the redistribution 

of unused territorial cap amounts under the Medicaid program. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 8, 2024 

Mr. SABLAN (for himself, Mr. MOYLAN, and Mrs. RADEWAGEN) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce 

A BILL 

To amend title XI of the Social Security Act to provide 

for the redistribution of unused territorial cap amounts 

under the Medicaid program. 

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 ‘‘Ensuring Medicaid 

5 Continuity for the Insular Areas Act of 2024’’. 


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1 SEC. 2. PROVIDING FOR THE REDISTRIBUTION OF UNUSED 

2 TERRITORIAL CAP AMOUNTS UNDER THE 

3 MEDICAID PROGRAM. 

4 Section 1108(g) of the Social Security Act (42 U.S.C. 

5 1308(g)) is amended by adding at the end the following 

6 new paragraph: 

7 ‘‘(14) PROCEDURE FOR REDISTRIBUTION OF

8 UNUSED AMOUNTS.— 

9 ‘‘(A) IN GENERAL.—For each fiscal year 

10 (beginning with fiscal year 2022), in the case 

11 that there is at least 1 specified territory (as 

12 defined in subparagraph (D)) with unused 

13 amounts (as so defined) with respect to such 

14 fiscal year, the Secretary shall determine an ap15 propriate procedure, with respect to each terri16 tory that is a shortfall territory (as so defined) 

17 for such fiscal year, to increase the limit other18 wise determined under this subsection on the 

19 amount certified by the Secretary under title 

20 XIX for payment to such territory by the 

21 amount specified in subparagraph (B). 

22 ‘‘(B) AMOUNT SPECIFIED.— 

23 ‘‘(i) IN GENERAL.—For purposes of 

24 subsection (A), the amount specified in 

25 this subparagraph is, with respect to a 

26 shortfall territory and a fiscal year— 


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1 ‘‘(I) in the case the aggregate 

2 unused amounts for such fiscal year 

3 for all specified territories are greater 

4 than the aggregate shortfall amounts 

5 for such fiscal year for all such terri6 tories, the difference between the 

7 amount that would have been certified 

8 by the Secretary under title XIX for 

9 payment to such shortfall territory for 

10 such fiscal year without application of 

11 this paragraph and the amount of 

12 payment that such territory would 

13 have received under title XIX had this 

14 section not applied; and 

15 ‘‘(II) in the case the aggregate 

16 unused amounts for such fiscal year 

17 for all specified territories are less 

18 than the aggregate shortfall amounts 

19 for such fiscal year for all such terri20 tories, an amount that bears the same 

21 ratio to such aggregate unused 

22 amounts as such shortfall territory’s 

23 shortfall amount bears to such aggre24 gate shortfall amounts. 


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1 ‘‘(ii) RETROSPECTIVE ADJUST2 MENT.—The Secretary may adjust any in3 creases made under this paragraph for a 

4 fiscal year as necessary on the basis of in5 formation reported by specified territories 

6 not later than November 30 of the suc7 ceeding fiscal year, as determined appro8 priate by the Secretary. 

9 ‘‘(C) NONAPPLICATION OF INCREASE TO

10 FUTURE FISCAL YEARS.—Any increase in the 

11 limit described in subparagraph (A) of a speci12 fied territory for a fiscal year shall not be taken 

13 into account in determining such limit for such 

14 territory in the succeeding fiscal year. 

15 ‘‘(D) DEFINITIONS.—In this paragraph: 

16 ‘‘(i) SHORTFALL AMOUNT.—The term 

17 ‘shortfall amount’ means, with respect to a 

18 specified territory that, but for the limit on 

19 the amount certified by the Secretary 

20 under title XIX for payment to such terri21 tories for a fiscal year established under 

22 this section, would have received payment 

23 under title XIX for such fiscal year in an 

24 amount exceeding such limit, the amount 

25 of such excess. 


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1 ‘‘(ii) SHORTFALL TERRITORY.—The 

2 term ‘shortfall territory’ means, with re3 spect to a fiscal year, a specified territory 

4 with respect to which the amount that 

5 would be payable to such territory under 

6 title XIX for such year, without application 

7 of this section, exceeds the limit on the 

8 amount certified by the Secretary under 

9 title XIX for payment to such territory for 

10 such year established under this section 

11 (without application of this paragraph). 

12 ‘‘(iii) SPECIFIED TERRITORY.—The 

13 term ‘specified territory’ means the Virgin 

14 Islands, Guam, the Northern Mariana Is15 lands, and American Samoa. 

16 ‘‘(iv) UNUSED AMOUNT.—The term 

17 ‘unused amount’ means, with respect to a 

18 specified territory that was subject to a 

19 limit on the amount certified by the Sec20 retary under title XIX for payment to such 

21 territory for a fiscal year established under 

22 this section but for which the Secretary so 

23 certified an amount for such fiscal year 

24 that was lower than such limit, the difVerDate Sep 11 2014 22:20 Jun 13, 2024 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8327.IH H8327

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1 ference between such amount and such 

2 limit.’’. 

Æ 


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