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103D CONGRESS

1ST SESSION H. R. 3659

To amend title XIX of the Social Security Act to improve the Federal

medical assistance percentage used under the medicaid program, and

for other purposes.

IN THE HOUSE OF REPRESENTATIVES

NOVEMBER 22, 1993

Mrs. MALONEY (for herself, Mr. RANGEL, Mr. GILMAN, Mr. MANTON, Mr.

NADLER, Mr. ENGEL, Mrs. LOWEY, Mr. OWENS, Mr. HINCHEY, Mr.

HOCHBRUECKNER, Mr. MCNULTY, Mr. FLAKE, Ms. VELA ́ZQUEZ, Mr.

SCHUMER, Mr. ACKERMAN, Ms. SLAUGHTER, Mr. QUINN, and Mr.

SERRANO) introduced the following bill; which was referred to the Committee on Energy and Commerce

A BILL

To amend title XIX of the Social Security Act to improve

the Federal medical assistance percentage used under

the medicaid program, 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 ‘‘Medicaid Fair Funding

5 Act of 1993’’.
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1 SEC. 2. CHANGE IN FEDERAL MEDICAL ASSISTANCE PER2 CENTAGE.

3 (a) IN GENERAL.—Subsection (b) of section 1905 of

4 the Social Security Act (42 U.S.C. 1396d(b)) is amended

5 to read as follows:

6 ‘‘(b)(1)(A) Except as provided in paragraph (3), the

7 term ‘Federal medical assistance percentage’ means, for

8 each of the 50 States and the District of Columbia, 100

9 percent reduced by the product of the applicable percent10 age (as defined in subparagraph (B)) and the ratio of—

11 ‘‘(i) the per capita income ratio (as defined in

12 subparagraph (C)) of the State, to—

13 ‘‘(ii) the population in poverty ratio (as defined

14 in subparagraph (D)) of the State.

15 ‘‘(B)(i) For purposes of this subsection, the term ‘ap16 plicable percentage’ means a percentage estimated by the

17 Secretary with the advice of the General Accounting Office

18 that, when applied under subparagraph (A), would result

19 in an amount of aggregate payments under section

20 1903(a) for calendar years 1994 through 1998 equal to

21 the amount of aggregate payments that would have been

22 made under such section for quarters in such years if this

23 subsection were applied as in effect on the day before the

24 date of the enactment of the Medicaid Fair Funding Act

25 of 1993.
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1 ‘‘(ii) The applicable percentage estimated by the Sec2 retary under clause (i) shall continue to apply with respect

3 to quarters beginning after calendar year 1998.

4 ‘‘(C) For purposes of this subsection, the term ‘per

5 capita income ratio’ means—

6 ‘‘(i) an amount equal to the most recent 3-year

7 average of the total personal income of the State, as

8 determined in accordance with the provisions of sec9 tion 1101(a)(8)(B), divided by

10 ‘‘(ii) an amount equal to the total personal in11 come of the continental United States (including

12 Alaska and Hawaii), as determined under section

13 1101(a)(8)(B).

14 ‘‘(D) For purposes of this subsection, the term ‘popu15 lation in poverty ratio’ means—

16 ‘‘(i) an amount equal to the 3-year-average of

17 the number of individuals in the State whose family

18 income is below the income official poverty line (as

19 defined by the Office of Management and Budget

20 and revised annually in accordance with section

21 673(2) of the Omnibus Budget Reconciliation Act of

22 1981), divided by

23 ‘‘(ii) an amount equal to the sum of the aver24 ages determined under clause (i) for the 50 States.
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1 ‘‘(2) The Federal medical assistance percentage for

2 Puerto Rico, the Virgin Islands, Guam, the Northern Mar3 iana Islands, and American Samoa shall be 50 percent.

4 ‘‘(3)(A) Except as provided in subparagraph (B), the

5 Federal medical assistance percentage shall in no case be

6 less than 40 percent or greater than 83 percent.

7 ‘‘(B) The Federal medical assistance percentage shall

8 be 100 percent with respect to amounts expended as medi9 cal assistance for services which are received through an

10 Indian Health Service facility whether operated by the In11 dian Health Service or by an Indian tribe or tribal organi12 zation (as defined in section 4 of the Indian Health Care

13 Improvement Act).

14 ‘‘(4) For purposes of any provision of law other than

15 a provision of this title, unless otherwise specifically pro16 vided, any reference to the ‘Federal medical assistance

17 percentage’ as defined in this section shall be considered

18 a reference to such term as defined under this subsection

19 as in effect on the day before the date of the enactment

20 of the Medicaid Fair Funding Act of 1993.’’.

21 (b) CONFORMING AMENDMENT.—Section 1118 of the

22 Social Security Act (42 U.S.C. 1318) is amended by strik23 ing ‘‘(as defined in section 1905)’’ and inserting ‘‘(as de24 fined in section 1905(b), as in effect on the day before
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1 the date of the enactment of the Medicaid Fair Funding

2 Act of 1993)’’.

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

4 this section shall apply to payments made to States with

5 respect to calendar quarters beginning on or after January

6 1, 1994.

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