II 

118TH CONGRESS 

1ST SESSION S. 3120 

To provide Medicaid assistance to individuals and families affected by a 

disaster or emergency, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 24, 2023 

Mr. CASEY (for himself, Mr. BLUMENTHAL, Mr. WELCH, Mr. VAN HOLLEN, 

Mrs. GILLIBRAND, Ms. WARREN, Mr. BROWN, Mr. SANDERS, Mr. 

FETTERMAN, Mr. SCHATZ, and Ms. DUCKWORTH) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To provide Medicaid assistance to individuals and families 

affected by a disaster or emergency, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Disaster Relief Med5 icaid Act’’. 

6 SEC. 2. MEDICAID RELIEF FOR DISASTER SURVIVORS. 

7 Title XIX of the Social Security Act (42 U.S.C. 1396 

8 et seq.) is amended— 

9 (1) in section 1902(a)— 


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1 (A) in paragraph (86), by striking ‘‘; and’’ 

2 and inserting a semicolon; 

3 (B) in paragraph (87), by striking the pe4 riod at the end and inserting ‘‘; and’’; and 

5 (C) by inserting after paragraph (87) the 

6 following new paragraph: 

7 ‘‘(88) beginning January 1, 2025, provide for 

8 making medical assistance available to relief-eligible 

9 survivors of disasters during relief coverage periods 

10 in accordance with section 1948.’’; and 

11 (2) by adding at the end the following new sec12 tion: 

13 ‘‘SEC. 1948. DISASTER RELIEF MEDICAID FOR SURVIVORS 

14 OF MAJOR DISASTERS. 

15 ‘‘(a) IN GENERAL.—Notwithstanding any other pro16 vision of this title, a State plan shall provide medical as17 sistance to a relief-eligible survivor of a disaster in accord18 ance with this section. 

19 ‘‘(b) DEFINITIONS.—In this section: 

20 ‘‘(1) DISASTER.—The term ‘disaster’ means 

21 any of the following: 

22 ‘‘(A) A major disaster that is declared on 

23 or after January 1, 2025, by the President in 

24 accordance with section 401 of the Robert T. 

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1 ance Act (42 U.S.C. 5170) and which the 

2 President has determined warrants individual 

3 or public assistance from the Federal Govern4 ment under such Act. 

5 ‘‘(B) A national emergency declared by the 

6 President under the National Emergencies Act 

7 (50 U.S.C. 1601 et seq.). 

8 ‘‘(C) A public health emergency declared 

9 by the Secretary pursuant to section 319 of the 

10 Public Health Service Act (42 U.S.C. 247d). 

11 ‘‘(2) DIRECT IMPACT AREA.— 

12 ‘‘(A) IN GENERAL.—The term ‘direct im13 pact area’ means, with respect to a disaster, the 

14 geographic area in which the disaster exists. 

15 ‘‘(B) WEBSITE POSTING OF DIRECT IM16 PACT AREAS.—As soon as practicable after a 

17 disaster is declared (as described in subpara18 graph (A), (B), or (C) of paragraph (1), as ap19 plicable), the Secretary shall post on the 

20 websites of the Centers for Medicare & Med21 icaid Services and the Federal Emergency Man22 agement Agency a list of the areas identified as 

23 the direct impact areas of the disaster. 

24 ‘‘(3) HOME STATE.—The term ‘home State’ 

25 means, with respect to a survivor of a disaster, the 


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1 State in which the survivor was a resident (as deter2 mined in accordance with section 435.403 of title 

3 42, Code of Federal Regulations (or any successor 

4 regulation)) on the date on which the disaster is de5 clared (as described in subparagraph (A), (B), or 

6 (C) of paragraph (1), as applicable). 

7 ‘‘(4) RELIEF COVERAGE PERIOD.—The term 

8 ‘relief coverage period’ means, with respect to a dis9 aster, the period that begins on the date the disaster 

10 is declared (as described in subparagraph (A), (B), 

11 or (C) of paragraph (1), as applicable) and ends on 

12 the day that is 2 years after such date. 

13 ‘‘(5) RELIEF-ELIGIBLE SURVIVOR.— 

14 ‘‘(A) IN GENERAL.—Subject to subpara15 graph (C), the term ‘relief-eligible survivor’ 

16 means an individual who is a survivor of a dis17 aster whose family income does not exceed the 

18 higher of— 

19 ‘‘(i) 133 percent (or, in the case of a 

20 survivor who is a pregnant individual, a 

21 child, or a recipient of benefits under title 

22 II on the basis of a disability, 200 percent) 

23 of the poverty line; or 

24 ‘‘(ii) the income eligibility standard 

25 that would otherwise apply to the survivor 


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1 under the State plan of the survivor’s 

2 home State (or a waiver of such plan). 

3 ‘‘(B) DISREGARD OF UNEMPLOYMENT IN4 COME AND FEMA INDIVIDUAL ASSISTANCE

5 GRANTS.—For purposes of this section, and 

6 notwithstanding section 1902(e)(14)(B), the in7 come of a survivor of a disaster shall not in8 clude— 

9 ‘‘(i) any amount received by the sur10 vivor during the relief coverage period of 

11 the disaster under a law of the United 

12 States or a State which is in the nature of 

13 unemployment compensation; or 

14 ‘‘(ii) any amount received during the 

15 relief coverage period of the disaster by the 

16 survivor (or the survivor’s household) as 

17 assistance under a program administered 

18 by the Federal Emergency Management 

19 Agency. 

20 ‘‘(C) LIMITATION TO RELIEF COVERAGE

21 PERIOD.— 

22 ‘‘(i) IN GENERAL.—Except as pro23 vided in clauses (ii) and (iii), for purposes 

24 of this section, an individual shall not be 

25 considered to be a relief-eligible survivor on 


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1 the basis of the individual’s status as a 

2 survivor of a disaster after the end of the 

3 relief coverage period of the disaster. 

4 ‘‘(ii) CONTINUOUS ELIGIBILITY FOR

5 DISASTER RELIEF COVERAGE FOR PREG6 NANT AND POSTPARTUM INDIVIDUALS.—In 

7 the case of an individual who, while preg8 nant, receives medical assistance as a re9 lief-eligible survivor of a disaster under a 

10 State plan (or a waiver of such a plan) in 

11 accordance with this section, such indi12 vidual shall continue to be eligible for med13 ical assistance as a relief-eligible survivor 

14 through the end of the month in which the 

15 60-day period (beginning on the last day of 

16 the pregnancy) (or, if longer, the period of 

17 postpartum continuous eligibility that oth18 erwise applies to individuals who, while 

19 pregnant, are eligible for medical assist20 ance under the State plan or waiver) ends, 

21 without regard to whether the pregnancy 

22 ends before or after the end of the relief 

23 coverage period of the disaster. 

24 ‘‘(iii) CONTINUOUS ELIGIBILITY FOR

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1 TIONS.—If an individual who receives med2 ical assistance as a relief-eligible survivor 

3 of a disaster under a State plan (or a 

4 waiver of such a plan) in accordance with 

5 this section has an application pending for 

6 medical assistance under the State plan (or 

7 waiver) under this title or for child health 

8 assistance or pregnancy-related assistance 

9 under a State plan under title XXI (or a 

10 waiver of such a plan) on the date that the 

11 relief coverage period of the disaster ends, 

12 such individual shall continue to be eligible 

13 for medical assistance as a relief-eligible 

14 survivor through the earlier of— 

15 ‘‘(I) the end of the month in 

16 which the 60-day period (beginning on 

17 the last day of such relief coverage pe18 riod) ends; and 

19 ‘‘(II) the date on which the indi20 vidual’s application for medical assist21 ance, child health assistance, or preg22 nancy-related assistance (as applica23 ble) is approved or denied. 

24 ‘‘(6) SURVIVOR.— 


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1 ‘‘(A) IN GENERAL.—The term ‘survivor’ 

2 means, with respect to a disaster, an individual 

3 who is described in subparagraph (B) or (C). 

4 ‘‘(B) RESIDENTS AND EVACUEES OF DI5 RECT IMPACT AREAS.—An individual described 

6 in this subparagraph is an individual who, on 

7 the date on which a disaster is declared (as de8 scribed in subparagraph (A), (B), or (C) of 

9 paragraph (1), as applicable), has a primary 

10 residence in the disaster’s direct impact area. 

11 ‘‘(C) INDIVIDUALS WHO LOST EMPLOY12 MENT.—An individual described in this sub13 paragraph is an individual— 

14 ‘‘(i) whose worksite was located in the 

15 disaster’s direct impact area; 

16 ‘‘(ii) who was employed by an em17 ployer that— 

18 ‘‘(I) conducted an active trade or 

19 business in such area on the date on 

20 which the disaster was declared (as so 

21 described); and 

22 ‘‘(II) was unable to operate such 

23 trade or business as a result of the 

24 disaster on any day during the disas25 ter’s relief coverage period; and 


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1 ‘‘(iii) whose employment with such 

2 employer was terminated. 

3 ‘‘(D) TREATMENT OF HOMELESS PER4 SONS.—In the case of an individual who is 

5 homeless (as such term is defined in section 

6 103(a) of the McKinney-Vento Homeless As7 sistance Act (42 U.S.C. 11302(a))) on the date 

8 on which a disaster is declared (as so de9 scribed), the individual’s residency for purposes 

10 of subparagraph (B) shall be determined in ac11 cordance with section 435.403 of title 42, Code 

12 of Federal Regulations (or any successor regu13 lation). 

14 ‘‘(E) EFFECT OF CONCURRENT ELIGI15 BILITY FOR MEDICAID OR CHIP.—An individ16 ual’s eligibility for medical assistance under a 

17 State plan (or waiver of such plan) (or for child 

18 health assistance or pregnancy-related assist19 ance under a State plan under title XXI (or a 

20 waiver of such a plan)) on a basis other than 

21 under this section shall not prevent the indi22 vidual from being treated as a survivor under 

23 this section, and the rights afforded to an indi24 vidual who is eligible for or enrolled under a 

25 State plan (or waiver) under either such title 


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1 shall not be affected by the individual’s receipt 

2 of medical assistance as a relief-eligible survivor 

3 of a disaster in accordance with this section. 

4 ‘‘(c) ELIGIBILITY.— 

5 ‘‘(1) SIMPLIFIED APPLICATION.— 

6 ‘‘(A) IN GENERAL.—For purposes of deter7 mining eligibility for medical assistance under 

8 this section, each State may accept a simplified, 

9 streamlined application form (as developed by 

10 the Secretary in consultation with the National 

11 Association of State Medicaid Directors), which 

12 shall— 

13 ‘‘(i) require an applicant for medical 

14 assistance in accordance with this section 

15 as a survivor of a disaster to— 

16 ‘‘(I) provide the applicant’s mail17 ing address for the duration of the re18 lief coverage period of the disaster; 

19 and 

20 ‘‘(II) agree to update the infor21 mation described in subclause (I) if it 

22 changes during such period; 

23 ‘‘(ii) provide notice of the penalties for 

24 making a fraudulent application described 

25 in subsection (g); 


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1 ‘‘(iii) require the applicant to assign 

2 to the State any rights of the applicant (or 

3 any other individual who is a relief-eligible 

4 survivor and on whose behalf the applicant 

5 has the legal authority to execute an as6 signment of such rights) as described and 

7 in accordance with the requirements of sec8 tion 1912; 

9 ‘‘(iv) require the applicant to list any 

10 health insurance coverage in which the ap11 plicant was enrolled immediately prior to 

12 submitting the application for medical as13 sistance under this section; and 

14 ‘‘(v) require the applicant to self-at15 test that the applicant— 

16 ‘‘(I) is a relief-eligible survivor of 

17 the disaster; and 

18 ‘‘(II) if applicable, requires home 

19 and community-based services. 

20 ‘‘(B) NO DOCUMENTATION REQUIRE21 MENT.— 

22 ‘‘(i) IN GENERAL.—A State shall not 

23 require an applicant for medical assistance 

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1 tion to provide any documentation or other 

2 evidence— 

3 ‘‘(I) of the applicant’s status as a 

4 relief-eligible survivor; and 

5 ‘‘(II) if applicable, that the appli6 cant requires home and community7 based services. 

8 ‘‘(ii) USE OF AVAILABLE ELECTRONIC

9 DATA SOURCES.—In making determina10 tions with respect to the status of an appli11 cant for medical assistance as a survivor of 

12 a disaster under this section, or such an 

13 applicant’s need for home and community14 based services, a State may use data relat15 ing to the applicant that is available to the 

16 State from electronic data sources. 

17 ‘‘(2) PRESUMPTIVE ELIGIBILITY FOR RELIEF18 ELIGIBLE SURVIVORS.— 

19 ‘‘(A) IN GENERAL.—A State shall provide 

20 for making medical assistance available to an 

21 individual as a relief-eligible survivor under this 

22 section during a presumptive eligibility period. 

23 ‘‘(B) PRESUMPTIVE ELIGIBILITY PERIOD

24 DEFINED.—For purposes of this paragraph— 


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1 ‘‘(i) the term ‘presumptive eligibility 

2 period’ means, with respect to an indi3 vidual, the period that— 

4 ‘‘(I) begins with the date on 

5 which a qualified provider determines, 

6 on the basis of preliminary informa7 tion, that the individual satisfies the 

8 criteria for eligibility for medical as9 sistance as a relief-eligible survivor 

10 under this section; and 

11 ‘‘(II) ends with (and includes) 

12 the earlier of— 

13 ‘‘(aa) the day on which a de14 termination is made with respect 

15 to the eligibility of the individual 

16 for medical assistance as a relief17 eligible survivor under this sec18 tion; or 

19 ‘‘(bb) in the case of an indi20 vidual who does not file an appli21 cation by the last day of the 

22 month following the month dur23 ing which the provider makes the 

24 determination referred to in item 

25 (aa), such last day; and 


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1 ‘‘(ii) the term ‘qualified provider’ has 

2 the meaning given such term in section 

3 1920. 

4 ‘‘(C) COORDINATION BETWEEN STATE

5 AGENCIES AND QUALIFIED PROVIDERS.— 

6 ‘‘(i) PROVISION OF FORMS AND IN7 FORMATION TO QUALIFIED PROVIDERS.— 

8 The State agency shall provide qualified 

9 providers with— 

10 ‘‘(I) such forms as are necessary 

11 for an individual to make application 

12 for medical assistance under the State 

13 plan as a relief-eligible survivor; and 

14 ‘‘(II) information on how to as15 sist individuals and their authorized 

16 representatives in completing and fil17 ing such forms. 

18 ‘‘(ii) PROVISION OF NOTICE OF DE19 TERMINATIONS TO STATE AGENCIES.—A 

20 qualified provider that determines under 

21 this subparagraph that an individual is eli22 gible for medical assistance under a State 

23 plan as a relief-eligible survivor under this 

24 section shall— 


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1 ‘‘(I) notify the State agency of 

2 the determination within 5 working 

3 days after the date on which deter4 mination is made; and 

5 ‘‘(II) inform the individual at the 

6 time the determination is made that 

7 the individual is required to make ap8 plication for medical assistance under 

9 the State plan by not later than the 

10 last day of the month following the 

11 month during which the determination 

12 is made. 

13 ‘‘(D) APPLICATION REQUIREMENT.—An 

14 individual who is determined by a qualified pro15 vider to be presumptively eligible as a relief-eli16 gible survivor for medical assistance under a 

17 State plan shall make application for medical 

18 assistance under such plan by not later than 

19 the last day of the month following the month 

20 during which the determination is made, which 

21 application may be the streamlined application 

22 described in paragraph (1). 

23 ‘‘(E) TREATMENT AS MEDICAL ASSIST24 ANCE.—Notwithstanding any other provision of 

25 this title, items and services that are— 


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1 ‘‘(i) furnished to an individual during 

2 a presumptive eligibility period under this 

3 paragraph by a provider that is eligible for 

4 payments under the State plan; and 

5 ‘‘(ii) included in the care and services 

6 covered by the State plan; 

7 shall be treated as medical assistance provided 

8 to a relief-eligible survivor of a disaster during 

9 the relief coverage period of the disaster under 

10 this section. 

11 ‘‘(3) CONTINUOUS ELIGIBILITY.— 

12 ‘‘(A) IN GENERAL.—Subject to subpara13 graph (B), an individual who is determined by 

14 a State to be a relief-eligible survivor of a dis15 aster shall remain eligible for medical assistance 

16 under the State plan (or a waiver of such plan) 

17 as such a survivor, without the need for any re18 determination of eligibility, for the duration of 

19 the relief coverage period of the disaster. 

20 ‘‘(B) EXCEPTIONS.—A State may termi21 nate the eligibility of an individual who is deter22 mined by a State to be a relief-eligible survivor 

23 of a disaster before the end of the relief cov24 erage period of the disaster if— 


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1 ‘‘(i) the individual (or the individual’s 

2 authorized representative) requests a vol3 untary termination of eligibility; 

4 ‘‘(ii) the individual ceases to be a resi5 dent of the State; 

6 ‘‘(iii) the State determines that eligi7 bility was erroneously granted because of 

8 State error or fraud, abuse, or perjury at9 tributed to the individual (or the individ10 ual’s authorized representative); or 

11 ‘‘(iv) the individual dies. 

12 ‘‘(4) ISSUANCE OF DISASTER RELIEF MEDICAID

13 ELIGIBILITY CARD.—A State shall issue a disaster 

14 relief Medicaid eligibility card to each applicant who 

15 is determined to be a relief-eligible survivor of a dis16 aster and eligible for medical assistance under this 

17 section, which shall be valid for the duration of the 

18 relief coverage period of the disaster. 

19 ‘‘(5) VERIFICATION OF STATUS AS A RELIEF20 ELIGIBLE SURVIVOR.— 

21 ‘‘(A) IN GENERAL.—The State shall make 

22 a good faith effort to verify the status of an in23 dividual who is enrolled in the State plan (or a 

24 waiver of such plan) as a relief-eligible survivor 

25 of a disaster in accordance with this section. 


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1 Such effort shall not delay the determination of 

2 the eligibility of the individual for medical as3 sistance under this section, and a State may en4 roll an individual in the State plan or waiver 

5 under this section pending such verification. 

6 ‘‘(B) EVIDENCE OF VERIFICATION.—A 

7 State may satisfy the verification requirement 

8 under subparagraph (A) with respect to an in9 dividual by showing that the State obtained in10 formation from the Social Security Administra11 tion, the Internal Revenue Service, or, if appli12 cable, the State Medicaid agency of the home 

13 State of the individual. 

14 ‘‘(6) DETERMINATION BY EXPRESS LANE AGEN15 CY.—Any determination or redetermination of eligi16 bility or verification of status made under this sec17 tion shall be made by an Express Lane agency (as 

18 defined in section 1902(e)(13)(F)). 

19 ‘‘(d) SCOPE OF COVERAGE.— 

20 ‘‘(1) IN GENERAL.—A State providing medical 

21 assistance to a relief-eligible survivor of a disaster in 

22 accordance with this section shall provide medical 

23 assistance that is at least equal in amount and scope 

24 to the medical assistance that would otherwise be 

25 made available to such survivor if the survivor were 


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1 enrolled in the State plan (or waiver of such plan) 

2 as an individual described in clause (i) of section 

3 1902(a)(10)(A), except that, in the case of such a 

4 survivor whose home State is not the State providing 

5 medical assistance to the individual, the State shall 

6 also provide medical assistance for any item or serv7 ice for which medical assistance is available to indi8 viduals described in clause (i) of section 

9 1902(a)(10)(A) under the State plan (or waiver) of 

10 the survivor’s home State. 

11 ‘‘(2) PROVIDER PAYMENT RATES FOR HOME

12 STATE SERVICES.—In the case of medical assistance 

13 provided under this section by a State to a relief-eli14 gible survivor of a disaster whose home State is not 

15 the State providing such assistance for an item or 

16 service which is not otherwise available under the 

17 State plan (or waiver of such plan) but which is 

18 available under the State plan (or waiver) of the sur19 vivor’s home State, the State shall pay the provider 

20 of such item or service at least at the same rate that 

21 the home State would pay for the item or service if 

22 it were provided under the plan or waiver of the 

23 home State (or, if no such payment rate applies 

24 under the plan or waiver of the home State, the 


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1 usual and customary prevailing rate for the item or 

2 service for the community in which it is provided). 

3 ‘‘(3) RETROACTIVE COVERAGE.— 

4 ‘‘(A) IN GENERAL.—Notwithstanding sec5 tion 1905(a), a State shall provide medical as6 sistance for items and services furnished in the 

7 State beginning with the first day of the relief 

8 coverage period of a disaster to any relief-eligi9 ble survivor of the disaster who submits an ap10 plication for such assistance before the deadline 

11 described in subparagraph (B). 

12 ‘‘(B) APPLICATION DEADLINE.—The dead13 line for a relief-eligible survivor of a disaster to 

14 submit an application for medical assistance in 

15 accordance with this section is the date that is 

16 90 days after the end of the disaster’s relief 

17 coverage period. 

18 ‘‘(4) CHILDREN BORN TO RELIEF-ELIGIBLE

19 SURVIVORS OF A DISASTER.—In the case of a child 

20 born to a relief-eligible survivor of a disaster who is 

21 provided medical assistance in accordance with this 

22 section during the relief coverage period of the dis23 aster, the child shall be treated as having been born 

24 to a pregnant individual eligible for medical assist25 ance under the State plan (or waiver of such plan) 


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1 and shall be eligible for medical assistance under 

2 such plan (or waiver) in accordance with section 

3 1902(e)(4). Notwithstanding subsection (f), the Fed4 eral medical assistance percentage determined for a 

5 State and fiscal year under section 1905(b) shall 

6 apply to medical assistance provided during the year 

7 to a child under the State plan (or waiver) in ac8 cordance with the preceding sentence. 

9 ‘‘(5) OPTION TO PROVIDE EXTENDED MENTAL

10 HEALTH AND CARE COORDINATION BENEFITS.—A 

11 State may provide, without regard to any restric12 tions on amount, duration, scope, or comparability, 

13 or other restrictions under this title or the State 

14 plan or waiver of such plan (other than restrictions 

15 applicable to services provided in an institution for 

16 mental diseases), medical assistance to relief-eligible 

17 survivors of a disaster under this section for ex18 tended mental health and care coordination services, 

19 which may include the following: 

20 ‘‘(A) Screening, assessment, and diagnostic 

21 services (including specialized assessments for 

22 individuals with cognitive impairments). 

23 ‘‘(B) Coverage for a full range of mental 

24 health medications at the dosages and fre25 quencies prescribed by health professionals for 


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1 depression, post-traumatic stress disorder, and 

2 other mental disorders. 

3 ‘‘(C) Treatment of alcohol and substance 

4 abuse determined to result from circumstances 

5 related to the disaster. 

6 ‘‘(D) Psychotherapy, rehabilitation and 

7 other treatments administered by psychiatrists, 

8 psychologists, social workers, or other qualified 

9 mental or behavioral health professionals for 

10 conditions exacerbated by, or resulting from, 

11 the disaster. 

12 ‘‘(E) Peer support services related to the 

13 disaster. 

14 ‘‘(F) Mobile crisis services to assist with 

15 crises related to the disaster. 

16 ‘‘(G) Inpatient and outpatient mental 

17 health care. 

18 ‘‘(H) Family counseling for families where 

19 a member of the immediate family is a survivor 

20 of the disaster or a first responder to the dis21 aster or includes an individual who has died as 

22 a result of the disaster. 

23 ‘‘(I) In connection with the provision of 

24 health and long-term care services, arranging 

25 for, (and when necessary, enrollment in waiver 


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1 programs or other specialized programs), and 

2 coordination related to, primary and specialty 

3 medical care, which may include personal care 

4 services, durable medical equipment and sup5 plies, assistive technology, and transportation. 

6 ‘‘(6) OPTION TO PROVIDE HOME AND COMMU7 NITY-BASED SERVICES.— 

8 ‘‘(A) IN GENERAL.—A State may provide 

9 medical assistance under this section for home 

10 and community-based services to a relief-eligible 

11 survivor of a disaster, including any survivor 

12 who is an individual described in subparagraph 

13 (B), who self-attests that the survivor imme14 diately requires such services, without regard to 

15 whether the survivor would require the level of 

16 care provided in a hospital, nursing facility, or 

17 intermediate care facility for the develop18 mentally disabled. 

19 ‘‘(B) INDIVIDUALS DESCRIBED.—Individ20 uals described in this subparagraph are relief21 eligible survivors of a disaster who— 

22 ‘‘(i) on any day during the week pre23 ceding the date on which the disaster is de24 clared (as described in subparagraph (A), 


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1 (B), or (C) of subsection (b)(1), as applica2 ble)— 

3 ‘‘(I) had been receiving home and 

4 community-based services in a direct 

5 impact area under a waiver under sec6 tion 1115 or section 1915; 

7 ‘‘(II) had been receiving support 

8 services from a family caregiver who, 

9 as a result of the disaster, is no 

10 longer available to provide services; or 

11 ‘‘(III) had been receiving per12 sonal care, home health, or rehabilita13 tive services under a State plan under 

14 this title or under a waiver granted 

15 under sections 1115 or 1915; or 

16 ‘‘(ii) are disabled (as determined in 

17 accordance with the State plan of the home 

18 State of the individual). 

19 ‘‘(C) WAIVER OF RESTRICTIONS.—With re20 spect to the provision of home and community21 based services under this paragraph, the Sec22 retary— 

23 ‘‘(i) shall waive any limitations on— 

24 ‘‘(I) the number of individuals 

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1 based services under a waiver de2 scribed in subparagraph (B)(i)(I); 

3 ‘‘(II) budget neutrality require4 ments applicable to such waiver; and 

5 ‘‘(III) populations eligible for 

6 services under such waiver; and 

7 ‘‘(ii) may waive any other restriction 

8 applicable under such a waiver that would 

9 prevent a State from providing home and 

10 community-based services in accordance 

11 with this paragraph. 

12 ‘‘(e) STATE REPORTS.—Each State shall submit to 

13 the Secretary an annual report that includes— 

14 ‘‘(1) the number of survivors of a disaster who 

15 were determined by the State to be relief-eligible 

16 survivors of a disaster in the preceding year; and 

17 ‘‘(2) the number of relief-eligible survivors of a 

18 disaster who were determined to be eligible for, and 

19 enrolled in, the State plan (or waiver of such plan) 

20 or the State child health plan under title XXI (or 

21 waiver of such plan) other than under this section. 

22 ‘‘(f) 100 PERCENT FEDERAL MATCHING PAY23 MENTS.— 

24 ‘‘(1) IN GENERAL.—Notwithstanding section 

25 1905(b), the Federal medical assistance percentage 


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1 shall be equal to 100 percent with respect to 

2 amounts expended by a State— 

3 ‘‘(A) for medical assistance provided in ac4 cordance with this section to relief-eligible sur5 vivors of a disaster during the relief coverage 

6 period of the disaster and, in the case of indi7 viduals described in clause (ii) or (iii) of sub8 section (b)(5)(C), during the applicable periods 

9 described in such clauses; and 

10 ‘‘(B) that are directly attributable to ad11 ministrative activities related to the provision of 

12 medical assistance under this section, including 

13 costs attributable to obtaining recoveries under 

14 subsection (g). 

15 ‘‘(2) DISREGARD OF LIMITS ON PAYMENTS TO

16 TERRITORIES.—The limitations on payment under 

17 subsections (f) and (g) of section 1108 shall not 

18 apply to Federal payments under this title that are 

19 based on the Federal medical assistance percentage 

20 described in paragraph (1), and such payments shall 

21 be disregarded in applying such subsections. 

22 ‘‘(g) PENALTY FOR FRAUDULENT APPLICATIONS.— 

23 ‘‘(1) INDIVIDUAL LIABLE FOR COSTS.—If a 

24 State, as the result of verification activities con25 ducted by the State or otherwise, determines after a 


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1 fair hearing that an individual has knowingly made 

2 a false attestation in an application for medical as3 sistance as a relief-eligible survivor of a disaster 

4 under this section, the State shall, subject to para5 graph (2), seek recovery from the individual for the 

6 full amount of the cost of medical assistance pro7 vided to the individual under this section. 

8 ‘‘(2) EXCEPTION.—The Secretary shall exempt 

9 a State from the requirement to seek recovery from 

10 an individual under paragraph (1) if the Secretary 

11 determines that it would not be cost-effective for the 

12 State to do so. 

13 ‘‘(3) REIMBURSEMENT TO THE FEDERAL GOV14 ERNMENT.—Amounts expended by a State for med15 ical assistance provided to an individual under this 

16 section that are subsequently recovered by the State 

17 under this subsection shall be treated as an overpay18 ment under this title to the extent that payments 

19 were made to the State for such amounts. 

20 ‘‘(h) EXEMPTION FROM ERROR RATE PENALTIES.— 

21 All payments attributable to providing medical assistance 

22 to relief-eligible survivors of disasters in accordance with 

23 this section shall be disregarded for purposes of section 

24 1903(u).’’. 


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1 SEC. 3. PROMOTING EFFECTIVE AND INNOVATIVE STATE 

2 RESPONSES TO INCREASED DEMAND FOR 

3 MEDICAL ASSISTANCE FOLLOWING A DIS4 ASTER. 

5 (a) GUIDANCE ON INCREASING ACCESS TO PRO6 VIDERS.—Not later than January 1, 2023, the Secretary 

7 of Health and Human Services (in this section referred 

8 to as the ‘‘Secretary’’) shall issue (and update as the Sec9 retary determines necessary) guidance to State Medicaid 

10 directors on best practices for— 

11 (1) expediting the approval of providers under 

12 a State Medicaid plan under title XIX of the Social 

13 Security Act (42 U.S.C. 1396 et seq.), or waiver of 

14 such plan, after a disaster to meet increased demand 

15 for medical assistance under the plan or waiver from 

16 relief-eligible survivors (as defined in section 

17 1948(b)(5) of such Act) of disasters; and 

18 (2) using out-of-State providers to provide care 

19 to relief-eligible survivors of a disaster under the 

20 plan or waiver. 

21 (b) TECHNICAL ASSISTANCE AND SUPPORT FOR IN22 NOVATIVE STATE STRATEGIES TO RESPOND TO IN23 CREASED DEMAND FOR MEDICAL ASSISTANCE FOL24 LOWING A DISASTERS.— 

25 (1) IN GENERAL.—The Secretary shall provide 

26 technical assistance and support to States to develop 


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1 or expand infrastructure, strategies, or innovations 

2 (including through State Medicaid demonstration 

3 projects) to provide medical assistance under a State 

4 Medicaid plan under title XIX of the Social Security 

5 Act (42 U.S.C. 1396 et seq.), or a waiver of such 

6 a plan, to relief-eligible survivors (as defined in sec7 tion 1948(b)(5) of such Act) of disasters. 

8 (2) REPORT.—Not later than 180 days after 

9 the date of enactment of this Act, the Secretary 

10 shall issue a report to Congress detailing a plan of 

11 action to carry out the requirements of paragraph 

12 (1). 

13 (c) HCBS EMERGENCY RESPONSE CORPS GRANT

14 PROGRAM.— 

15 (1) IN GENERAL.—The Secretary shall award 

16 grants under this subsection to States for the pur17 pose of establishing or operating HCBS emergency 

18 response corps that meet the requirements of para19 graph (2) to provide medical assistance for home 

20 and community-based services under a State Med21 icaid plan under title XIX of the Social Security Act 

22 (42 U.S.C. 1396 et seq.) to relief-eligible survivors 

23 (as defined in section 1948(b)(5) of such Act) of dis24 asters. 


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1 (2) HOME AND COMMUNITY-BASED SERVICES

2 EMERGENCY RESPONSE CORPS.—An HCBS emer3 gency response corps meets the requirements of this 

4 paragraph if it satisfies the following requirements: 

5 (A) The corps serves a State with a history 

6 of hosting individuals who are forced to relocate 

7 to the State from another State due to a dis8 aster (as determined by the Secretary). 

9 (B) The corps is composed of representa10 tives from each of the following: 

11 (i) Voluntary organizations delivering 

12 assistance. 

13 (ii) Area agencies on aging (as defined 

14 in section 102 of the Older Americans Act 

15 of 1965 (42 U.S.C. 3002)). 

16 (iii) The Medicare program under title 

17 XVIII of the Social Security Act (42 

18 U.S.C. 1395 et seq.). 

19 (iv) The State agency responsible for 

20 administering the State Medicaid program 

21 under title XIX of the Social Security Act 

22 (42 U.S.C. 1396 et seq.). 

23 (v) State agencies serving older adults 

24 and people with disabilities. 

25 (vi) Nonprofit service providers. 


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1 (vii) Individuals who are enrolled in 

2 the State Medicaid program under title 

3 XIX of the Social Security Act (42 U.S.C. 

4 1396 et seq.) or the Children’s Health In5 surance Program under title XXI of the 

6 Social Security Act (42 U.S.C. 1397aa et 

7 seq.). 

8 (viii) Centers for independent living, 

9 as described in part C of title VII of the 

10 Rehabilitation Act of 1973 (29 U.S.C. 

11 796f et seq.). 

12 (ix) Other organizations that address 

13 the needs of older adults and people with 

14 disabilities. 

15 (C) The corps is led by a representative of 

16 a State or nonprofit agency serving older adults 

17 or people with disabilities. 

18 (D) The corps operates under a plan to 

19 meet the acute and long-term services and sup20 port needs of relief-eligible survivors (as defined 

21 in section 1948(b)(5) of the Social Security 

22 Act) of disasters, and is provided with the re23 sources necessary to execute such plan. 

24 (3) GRANTS.— 


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1 (A) LIMITATION.—The Secretary may 

2 award a grant under this subsection to up to 5 

3 States. 

4 (B) TERM OF GRANTS.—Grants under this 

5 subsection shall be made for a term of 2 years. 

6 (4) AUTHORIZATION.—There are authorized to 

7 be appropriated to carry out this subsection, 

8 $10,000,000 for each of fiscal years 2022 through 

9 2027, to remain available until expended. 

10 SEC. 4. TARGETED MEDICAID RELIEF FOR DIRECT IMPACT 

11 AREAS. 

12 (a) 100 PERCENT FEDERAL MATCHING PAYMENTS

13 FOR MEDICAL ASSISTANCE PROVIDED IN A DIRECT IM14 PACT AREA.— 

15 (1) IN GENERAL.—Section 1905 of the Social 

16 Security Act (42 U.S.C. 1396d) is amended— 

17 (A) in subsection (b), by striking ‘‘and 

18 (ii)’’ and inserting ‘‘(ii), and (jj)’’; and 

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

20 subsection: 

21 ‘‘(jj) 100 PERCENT FMAP FOR ALL MEDICAL AS22 SISTANCE PROVIDED IN DISASTER DIRECT IMPACT

23 AREAS.—Notwithstanding subsection (b), the Federal 

24 medical assistance percentage for a State and fiscal year 

25 shall be equal to 100 percent with respect to amounts exVerDate Sep 11 2014 00:32 Oct 26, 2023 Jkt 049200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S3120.IS S3120

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1 pended by the State during the fiscal year for medical as2 sistance for an individual who, during the fiscal quarter 

3 in which the assistance is provided to the individual, is 

4 a resident of a direct impact area of a disaster during the 

5 disaster’s relief coverage period (as such terms are defined 

6 in section 1948).’’. 

7 (2) EXCLUSION OF ENHANCED PAYMENTS

8 FROM TERRITORIAL CAPS.—Notwithstanding any 

9 other provision of law, for purposes of section 1108 

10 of the Social Security Act (42 U.S.C. 1308), with re11 spect to any additional amount paid to a territory as 

12 a result of the application of section 1905(jj) of the 

13 Social Security Act (42 U.S.C. 1396d(jj))— 

14 (A) the limitation on payments to terri15 tories under subsections (f) and (g) of such sec16 tion 1108 shall not apply to such additional 

17 amounts; and 

18 (B) such additional amounts shall be dis19 regarded in applying such subsections. 

20 (3) APPLICATION TO CHIP.— 

21 (A) IN GENERAL.—Section 2105(c) of the 

22 Social Security Act (42 U.S.C. 1397ee(a)) is 

23 amended by adding at the end the following 

24 new paragraph: 


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1 ‘‘(13) 100 PERCENT MATCH FOR ASSISTANCE

2 PROVIDED IN DISASTER DIRECT IMPACT AREAS.— 

3 Notwithstanding subsection (b), the enhanced 

4 FMAP for a State, with respect to payments under 

5 subsection (a) for expenditures under the State plan 

6 for child health assistance for targeted low-income 

7 children or pregnancy-related assistance for individ8 uals who are targeted low-income women that is pro9 vided to such a child or individual who, at the time 

10 the assistance is provided, is a resident of a direct 

11 impact area of a disaster during the disaster’s relief 

12 coverage period (as such terms are defined in section 

13 1948) shall be equal to 100 percent.’’. 

14 (B) ADJUSTMENT OF CHIP ALLOT15 MENTS.—Section 2104(m) of the Social Secu16 rity Act (42 U.S.C. 1397dd(m)) is amended— 

17 (i) in paragraph (2)(B), by striking 

18 ‘‘and (12)’’ and inserting ‘‘(12), and (13)’’; 

19 and 

20 (ii) by adding at the end the following 

21 new paragraph: 

22 ‘‘(13) ADJUSTING ALLOTMENTS TO ACCOUNT

23 FOR INCREASED FEDERAL PAYMENTS FOR ASSIST24 ANCE PROVIDED IN DISASTER DIRECT IMPACT

25 AREAS.—If a State (including the District of ColumVerDate Sep 11 2014 00:32 Oct 26, 2023 Jkt 049200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\S3120.IS S3120

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1 bia and each commonwealth and territory) receives 

2 a payment for a fiscal year under subsection (a) of 

3 section 2105 for expenditures that are subject to the 

4 enhanced FMAP specified under subsection (c)(13) 

5 of such section— 

6 ‘‘(A) the amount of the allotment deter7 mined for the State under this subsection for 

8 such fiscal year shall be increased by the prod9 uct of— 

10 ‘‘(i) the amount of such expenditures 

11 that the State is projected to make for 

12 such fiscal year; and 

13 ‘‘(ii) a percentage equal to 100 per14 cent reduced by a number of percentage 

15 points equal to the enhanced FMAP deter16 mined for the State and fiscal year under 

17 subsection (b) of section 2105; and 

18 ‘‘(B) once actual expenditures for the fiscal 

19 year are available, the amount of such allot20 ment, as increased under subparagraph (A), 

21 shall be further increased or reduced, as appro22 priate, on the basis of the difference between— 

23 ‘‘(i) the amount of the increase deter24 mined under subparagraph (A); and 

25 ‘‘(ii) the product of— 


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1 ‘‘(I) the actual amount of State 

2 expenditures that are subject to the 

3 enhanced FMAP specified under sec4 tion 2105(c)(13); and 

5 ‘‘(II) the percentage determined 

6 for the State under subparagraph 

7 (A)(ii).’’. 

8 (b) MORATORIUM ON REDETERMINATIONS.—During 

9 the relief coverage period (as defined in paragraph (4) of 

10 section 1948(b) of the Social Security Act, as added by 

11 section 2)) of a disaster, a State that contains a direct 

12 impact area (as defined in paragraph (2) of such section) 

13 of the disaster shall not be required to conduct eligibility 

14 redeterminations under the State’s plans or waivers of 

15 such plans under title XIX or XXI of such Act (42 U.S.C. 

16 1396 et seq., 1397aa) with respect to individuals who re17 side in such area. 

18 SEC. 5. AUTHORITY TO WAIVE REQUIREMENTS DURING NA19 TIONAL EMERGENCIES WITH RESPECT TO 

20 EVACUEES FROM AN EMERGENCY AREA. 

21 Section 1135(g)(1) of the Social Security Act (42 

22 U.S.C. 1320b–5(g)(1)) is amended— 

23 (1) by redesignating subparagraphs (A) and 

24 (B) as clauses (i) and (ii), respectively; 


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1 (2) by striking ‘‘An ‘emergency area’ ’’ and in2 serting the following: 

3 ‘‘(A) IN GENERAL.—An emergency area’’; 

4 and 

5 (3) by adding at the end the following new sub6 paragraph: 

7 ‘‘(B) ADDITIONAL AREAS.—Any geographical 

8 area in which the Secretary determines there are a 

9 significant number of evacuees from an area de10 scribed in subparagraph (A) shall also be considered 

11 to be an ‘emergency area’ for purposes of this sec12 tion.’’. 

13 SEC. 6. EXCLUSION OF DISASTER RELIEF COVERAGE PE14 RIOD IN COMPUTING MEDICARE PART B 

15 LATE ENROLLMENT PERIOD. 

16 Section 1839(b) of such Act (42 U.S.C. 1395r(b)) is 

17 amended, in the second sentence, by inserting before the 

18 period at the end the following: ‘‘or, in the case of an indi19 vidual who is a survivor of a disaster (as defined in para20 graph (6) of section 1948(b)), any month any part of 

21 which is within the relief coverage period (as defined in 

22 paragraph (4) of such section) of such disaster’’. 


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1 SEC. 7. EFFECTIVE DATE. 

2 (a) IN GENERAL.—Subject to subsection (b), this Act 

3 and the amendments made by this Act shall take effect 

4 on the date of enactment of this Act. 

5 (b) DELAY PERMITTED IF STATE LEGISLATION RE6 QUIRED.—In the case of a State plan approved under title 

7 XIX of the Social Security Act which the Secretary of 

8 Health and Human Services determines requires State 

9 legislation (other than legislation appropriating funds) in 

10 order for the plan to meet the additional requirement im11 posed by this section, the State plan shall not be regarded 

12 as failing to comply with the requirements of such title 

13 solely on the basis of the failure of the plan to meet such 

14 additional requirement before the 1st day of the 1st cal15 endar quarter beginning after the close of the 1st regular 

16 session of the State legislature that ends after the 1-year 

17 period beginning with the date of the enactment of this 

18 section. For purposes of the preceding sentence, in the 

19 case of a State that has a 2-year legislative session, each 

20 year of the session is deemed to be a separate regular ses21 sion of the State legislature. 

22 SEC. 8. IMPACT EVALUATION AND REPORTING. 

23 (a) IN GENERAL.—Not later than 24 months after 

24 the date of enactment of this Act, the Secretary of Health 

25 and Human Services shall enter into a 5 year agreement 

26 through a contract, grant, or cooperative agreement with 


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1 an independent nonprofit entity experienced in conducting 

2 evaluations of program and systems change efforts to— 

3 (1) conduct a multi-year evaluation on the im4 pact of this Act, with respect to relief-eligible sur5 vivors (including people with disabilities and preg6 nant individuals); and 

7 (2) prepare the reports described in subsection 

8 (c). 

9 (b) EVALUATION.—In carrying out subsection (a)(1), 

10 the entity awarded a contract, grant, or cooperative agree11 ment under this section shall evaluate at a minimum— 

12 (1) the availability of and access to Medicaid 

13 services for relief-eligible survivors under the Med14 icaid program nationally and in each State, territory 

15 and tribal organization, including scope and cov16 erage of services, provision of home and community17 based services and extended mental health and care 

18 coordination services; and provider capacity; 

19 (2) the demographics of individuals receiving 

20 these benefits, including individuals with disabilities 

21 and pregnant individuals; and 

22 (3) actions taken by States to comply with this 

23 Act, including coordination of efforts between 

24 States, coordination between State agencies and 


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1 qualified providers, and activities of HCBS emer2 gency response corps (as described in section 3(c)). 

3 (c) REPORTS.—The Secretary of Health and Human 

4 Services shall submit to the Committee on Finance of the 

5 Senate, the Special Committee on Aging of the Senate, 

6 the Committee on Energy and Commerce of the House 

7 of Representatives, and the Committee on Ways and 

8 Means of the House of Representatives the following re9 ports on the evaluation conducted under subsection (a)(1): 

10 (1) An interim report on the evaluation, to be 

11 submitted not later than 3 years after the evaluation 

12 commences. 

13 (2) A follow-up report on such evaluation, to be 

14 submitted not later than 24 months after the date 

15 on which the interim report is issued. 

Æ 


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