II 

111TH CONGRESS 

1ST SESSION S. 1377 

To provide for an automatic increase in the Federal matching rate for the 

Medicaid program during periods of national economic downturn to help 

States cope with increases in Medicaid costs. 

IN THE SENATE OF THE UNITED STATES 

JUNE 25, 2009 

Mr. ROCKEFELLER introduced the following bill; which was read twice and 

referred to the Committee on Finance 

A BILL 

To provide for an automatic increase in the Federal matching 

rate for the Medicaid program during periods of national 

economic downturn to help States cope with increases 

in Medicaid costs. 

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

3 SECTION 1. AUTOMATIC INCREASE IN THE FEDERAL MED4 ICAL ASSISTANCE PERCENTAGE DURING PE5 RIODS OF NATIONAL ECONOMIC DOWNTURN. 

6 (a) NATIONAL ECONOMIC DOWNTURN ASSISTANCE

7 FMAP.— 


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

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

3 (A) in subsection (b), in the first sen4 tence— 

5 (i) by striking ‘‘and (4)’’ and inserting 

6 ‘‘(4)’’; and 

7 (ii) by inserting ‘‘and (5) with respect 

8 to each fiscal year quarter other than the 

9 first quarter of a national economic down10 turn assistance period described in sub11 section (y)(1), the Federal medical assist12 ance percentage for any State described in 

13 subsection (y)(2) shall be equal to the na14 tional economic downturn assistance 

15 FMAP determined for the State for the 

16 quarter under subsection (y)(3)’’ before 

17 the period; and 

18 (B) by adding at the end the following: 

19 ‘‘(y) NATIONAL ECONOMIC DOWNTURN ASSISTANCE

20 FMAP.—For purposes of clause (5) of the first sentence 

21 of subsection (b): 

22 ‘‘(1) NATIONAL ECONOMIC DOWNTURN ASSIST23 ANCE PERIOD.—A national economic downturn as24 sistance period described in this paragraph— 


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1 ‘‘(A) begins with the first fiscal year quar2 ter for which the Secretary determines that for 

3 at least 23 States, the rolling average unem4 ployment rate for that quarter has increased by 

5 at least 10 percent over the corresponding quar6 ter for the most recent preceding 12-month pe7 riod for which data are available (in this sub8 section referred to as the ‘trigger quarter’); and 

9 ‘‘(B) ends with the first succeeding fiscal 

10 year quarter for which the Secretary determines 

11 that less than 23 States have a rolling average 

12 unemployment rate for that quarter with an in13 crease of at least 10 percent over the cor14 responding quarter for the most recent pre15 ceding 12-month period for which data are 

16 available. 

17 ‘‘(2) ELIGIBLE STATE.—A State described in 

18 this paragraph is a State for which the Secretary de19 termines that the rolling average unemployment rate 

20 for the State for any quarter occurring during a na21 tional economic downturn assistance period de22 scribed in paragraph (1) has increased over the cor23 responding quarter for the most recent preceding 

24 12-month period for which data are available. 


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1 ‘‘(3) DETERMINATION OF NATIONAL ECONOMIC

2 DOWNTURN ASSISTANCE FMAP.— 

3 ‘‘(A) IN GENERAL.—The national economic 

4 downturn assistance FMAP for a fiscal year 

5 quarter determined with respect to a State 

6 under this paragraph is equal to the Federal 

7 medical assistance percentage for the State for 

8 that quarter increased by the number of per9 centage points determined by— 

10 ‘‘(i) dividing— 

11 ‘‘(I) the Medicaid additional un12 employed increased cost amount de13 termined under subparagraph (B) for 

14 the quarter; by 

15 ‘‘(II) the State’s total Medicaid 

16 quarterly spending amount deter17 mined under subparagraph (C) for the 

18 quarter; and 

19 ‘‘(ii) multiplying the quotient deter20 mined under clause (i) by 100. 

21 ‘‘(B) MEDICAID ADDITIONAL UNEMPLOYED

22 INCREASED COST AMOUNT.—For purposes of 

23 subparagraph (A)(i)(I), the Medicaid additional 

24 unemployed increased cost amount determined 


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1 under this subparagraph with respect to a State 

2 and a quarter is the product of the following: 

3 ‘‘(i) STATE INCREASE IN ROLLING AV4 ERAGE NUMBER OF UNEMPLOYED INDIVID5 UALS FROM THE BASE QUARTER OF UNEM6 PLOYMENT.— 

7 ‘‘(I) IN GENERAL.—The amount 

8 determined by subtracting the rolling 

9 average number of unemployed indi10 viduals in the State for the base un11 employment quarter for the State de12 termined under subclause (II) from 

13 the rolling average number of unem14 ployed individuals in the State for the 

15 quarter. 

16 ‘‘(II) BASE UNEMPLOYMENT

17 QUARTER DEFINED.— 

18 ‘‘(aa) IN GENERAL.—For 

19 purposes of subclause (I), except 

20 as provided in item (bb), the base 

21 quarter for a State is the quarter 

22 with the lowest rolling average 

23 number of unemployed individ24 uals in the State in the 12-month 

25 period preceding the trigger 


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1 quarter for a national economic 

2 downturn assistance period de3 scribed in paragraph (1). 

4 ‘‘(bb) EXCEPTION.—If the 

5 rolling average number of unem6 ployed individuals in a State for 

7 a quarter occurring during a na8 tional economic downturn assist9 ance period described in para10 graph (1) is less than the rolling 

11 average number of unemployed 

12 individuals in the State for the 

13 base quarter determined under 

14 item (aa), that quarter shall be 

15 treated as the base quarter for 

16 the State for such national eco17 nomic downturn assistance pe18 riod. 

19 ‘‘(ii) NATIONAL AVERAGE AMOUNT OF

20 ADDITIONAL FEDERAL MEDICAID SPEND21 ING PER ADDITIONAL UNEMPLOYED INDI22 VIDUAL.—In the case of— 

23 ‘‘(I) a calendar quarter occurring 

24 in fiscal year 2012, $350; and 


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1 ‘‘(II) a calendar quarter occur2 ring in any succeeding fiscal year, the 

3 amount applicable under this clause 

4 for calendar quarters occurring during 

5 the preceding fiscal year, increased by 

6 the annual percentage increase in the 

7 medical care component of the con8 sumer price index for all urban con9 sumers (U.S. city average), as round10 ed up in an appropriate manner. 

11 ‘‘(iii) STATE NONDISABLED, NON12 ELDERLY ADULTS AND CHILDREN MED13 ICAID SPENDING INDEX.— 

14 ‘‘(I) IN GENERAL.—With respect 

15 to a State, the quotient (not to exceed 

16 1.00) of— 

17 ‘‘(aa) the State expenditure 

18 per person in poverty amount de19 termined under subclause (II); 

20 divided by— 

21 ‘‘(bb) the National expendi22 ture per person in poverty 

23 amount determined under sub24 clause (III). 


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1 ‘‘(II) STATE EXPENDITURE PER

2 PERSON IN POVERTY AMOUNT.—For 

3 purposes of subclause (I)(aa), the 

4 State expenditure per person in pov5 erty amount is the quotient of— 

6 ‘‘(aa) the total amount of 

7 annual expenditures by the State 

8 for providing medical assistance 

9 under the State plan to non10 disabled, nonelderly adults and 

11 children; divided by 

12 ‘‘(bb) the total number of 

13 nonelderly adults and children in 

14 poverty who reside in the State, 

15 as determined under paragraph 

16 (4)(A). 

17 ‘‘(III) NATIONAL EXPENDITURE

18 PER PERSON IN POVERTY AMOUNT.— 

19 For purposes of subclause (I)(bb), the 

20 National expenditure per person in 

21 poverty amount is the quotient of— 

22 ‘‘(aa) the sum of the total 

23 amounts determined under sub24 clause (II)(aa) for all States; di25 vided by 


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1 ‘‘(bb) the sum of the total 

2 amounts determined under sub3 clause (II)(bb) for all States. 

4 ‘‘(C) STATE’S TOTAL MEDICAID QUAR5 TERLY SPENDING AMOUNT.—For purposes of 

6 subparagraph (A)(i)(II), the State’s total Med7 icaid quarterly spending amount determined 

8 under this subparagraph with respect to a State 

9 and a quarter is the amount equal to— 

10 ‘‘(i) the total amount of expenditures 

11 by the State for providing medical assist12 ance under the State plan to all individuals 

13 enrolled in the plan for the most recent fis14 cal year for which data is available; divided 

15 by 

16 ‘‘(ii) 4. 

17 ‘‘(4) DATA.—In making the determinations re18 quired under this subsection, the Secretary shall use, 

19 in addition to the most recent available data from 

20 the Bureau of Labor Statistics Local Area Unem21 ployment Statistics for each State referred to in 

22 paragraph (5), the most recently available— 

23 ‘‘(A) data from the Bureau of the Census 

24 with respect to the number of nonelderly adults 

25 and children who reside in a State described in 


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1 paragraph (2) with family income below the 

2 poverty line (as defined in section 2110(c)(5)) 

3 applicable to a family of the size involved (or, 

4 if the Secretary determines it appropriate, a 

5 multiyear average of such data); 

6 ‘‘(B) data reported to the Secretary by a 

7 State described in paragraph (2) with respect to 

8 expenditures for medical assistance under the 

9 State plan under this title for nondisabled, non10 elderly adults and children; and 

11 ‘‘(C) econometric studies of the responsive12 ness of Medicaid enrollments and spending to 

13 changes in rolling average unemployment rates 

14 and other factors, including State spending on 

15 certain Medicaid populations. 

16 ‘‘(5) DEFINITION OF ‘ROLLING AVERAGE NUM17 BER OF UNEMPLOYED INDIVIDUALS’, ‘ROLLING AV18 ERAGE UNEMPLOYMENT RATE’.—In this subsection, 

19 the term— 

20 ‘‘(A) ‘rolling average number of unem21 ployed individuals’ means, with respect to a cal22 endar quarter and a State, the average of the 

23 12 most recent months of seasonally adjusted 

24 unemployment data for each State; 


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1 ‘‘(B) ‘rolling average unemployment rate’ 

2 means, with respect to a calendar quarter and 

3 a State, the average of the 12 most recent 

4 monthly unemployment rates for the State; and 

5 ‘‘(C) ‘monthly unemployment rate’ means, 

6 with respect to a State, the quotient of— 

7 ‘‘(i) the monthly seasonally adjusted 

8 number of unemployed individuals for the 

9 State; divided by 

10 ‘‘(ii) the monthly seasonally adjusted 

11 number of the labor force for the State, 

12 using the most recent data available from the Bu13 reau of Labor Statistics Local Area Unemployment 

14 Statistics for each State. 

15 ‘‘(6) INCREASE IN CAP ON PAYMENTS TO TER16 RITORIES.—With respect to any fiscal year quarter 

17 for which the national economic downturn assistance 

18 Federal medical assistance percentage applies to 

19 Puerto Rico, the Virgin Islands, Guam, the North20 ern Mariana Islands, or American Samoa, the 

21 amounts otherwise determined for such common22 wealth or territory under subsections (f) and (g) of 

23 section 1108 shall be increased by such percentage 

24 of such amounts as the Secretary determines is 

25 equal to twice the average increase in the national 


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1 economic downturn assistance FMAP determined for 

2 all States described in paragraph (2) for the quar3 ter. 

4 ‘‘(7) SCOPE OF APPLICATION.—The national 

5 economic downturn assistance FMAP shall only 

6 apply for purposes of payments under section 1903 

7 for a quarter and shall not apply with respect to— 

8 ‘‘(A) disproportionate share hospital pay9 ments described in section 1923; 

10 ‘‘(B) payments under title IV or XXI; or 

11 ‘‘(C) any payments under this title that 

12 are based on the enhanced FMAP described in 

13 section 2105(b). 

14 ‘‘(8) ADDITIONAL REQUIREMENT FOR CERTAIN

15 STATES.—In the case of a State described in para16 graph (2) that requires political subdivisions within 

17 the State to contribute toward the non-Federal share 

18 of expenditures required under section 1902(a)(2), 

19 the State shall not require that such political sub20 divisions pay for any fiscal year quarters occurring 

21 during a national economic downturn assistance pe22 riod a greater percentage of the non-Federal share 

23 of such expenditures, or a greater percentage of the 

24 non-Federal share of payments under section 1923, 

25 than the respective percentage that would have been 


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1 required by the State under State law in effect on 

2 the first day of the fiscal year quarter occurring im3 mediately prior to the trigger quarter for the pe4 riod.’’. 

5 (2) EFFECTIVE DATE; NO RETROACTIVE APPLI6 CATION.—The amendments made by paragraph (1) 

7 take effect on January 1, 2012. In no event may a 

8 State receive a payment on the basis of the national 

9 economic downturn assistance Federal medical as10 sistance percentage determined for the State under 

11 section 1905(y)(3) of the Social Security Act for 

12 amounts expended by the State prior to January 1, 

13 2012. 

14 (b) GAO STUDY AND REPORT.— 

15 (1) STUDY.—The Comptroller General of the 

16 United States shall analyze the previous periods of 

17 national economic downturn, including the most re18 cent such period in effect as of the date of enact19 ment of this Act, and the past and projected effects 

20 of temporary increases in the Federal medical assist21 ance percentage under the Medicaid program with 

22 respect to such periods. 

23 (2) REPORT.—Not later than April 1, 2011, the 

24 Comptroller General of the United States shall sub25 mit a report to Congress on the results of the analVerDate Nov 24 2008 04:35 Jun 26, 2009 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S1377.IS S1377

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1 ysis conducted under paragraph (1). Such report 

2 shall include such recommendations as the Comp3 troller General determines appropriate for modifying 

4 the national economic downturn assistance FMAP 

5 established under section 1905(y) of the Social Secu6 rity Act (as added by subsection (a)) to improve the 

7 effectiveness of the application of such percentage in 

8 addressing the needs of States during periods of na9 tional economic downturn, including recommenda10 tions for— 

11 (A) improvements to the factors that begin 

12 and end the application of such percentage; 

13 (B) how the determination of such percent14 age could be adjusted to address State and re15 gional economic variations during such periods; 

16 and 

17 (C) how the determination of such percent18 age could be adjusted to be more responsive to 

19 actual Medicaid costs incurred by States during 

20 such periods, as well as to the effects of any 

21 other specific economic indicators that the 

22 Comptroller General determines appropriate. 

Æ 


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