II 

115TH CONGRESS 

1ST SESSION S. 2001 

To establish a State public option through Medicaid to provide Americans 

with the choice of a high-quality, low-cost health insurance plan. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 24, 2017 

Mr. SCHATZ (for himself, Mr. BOOKER, Ms. HARRIS, Mr. HEINRICH, Mr. 

SANDERS, Ms. CORTEZ MASTO, Mr. WHITEHOUSE, Mrs. GILLIBRAND, 

Ms. KLOBUCHAR, Mr. FRANKEN, Mr. MARKEY, Ms. WARREN, Mr. 

LEAHY, Mr. MERKLEY, Mr. REED, Ms. BALDWIN, Ms. HIRONO, Mr. 

MURPHY, and Mr. UDALL) introduced the following bill; which was read 

twice and referred to the Committee on Finance 

A BILL 

To establish a State public option through Medicaid to provide Americans with the choice of a high-quality, lowcost health insurance plan. 

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 ‘‘State Public Option 

5 Act’’. 

6 SEC. 2. MEDICAID BUY-IN OPTION. 

7 (a) IN GENERAL.—Section 1902 of the Social Secu8 rity Act (42 U.S.C. 1396a) is amended— 


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1 (1) in subsection (a)(10)— 

2 (A) in subparagraph (A)(ii)— 

3 (i) in subclause (XXI), by striking ‘‘; 

4 or’’ and inserting a semicolon; 

5 (ii) in subclause (XXII), by adding 

6 ‘‘or’’ at the end; and 

7 (iii) by adding at the end the fol8 lowing new subclause: 

9 ‘‘(XXIII) beginning January 1, 

10 2018, who are residents of the State 

11 and are not concurrently enrolled in 

12 another health insurance coverage 

13 plan, subject, in the case of individ14 uals described in subsection (nn) and 

15 notwithstanding section 1916 (except 

16 for subsection (k) of such section), to 

17 payment of premiums or other cost18 sharing charges;’’; and 

19 (B) in the matter following subparagraph 

20 (G), in clause (XV), by inserting ‘‘or subsection 

21 (nn)’’ after ‘‘described in subparagraph 

22 (A)(i)(VIII)’’; and 

23 (2) by adding at the end the following new sub24 section: 


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1 ‘‘(nn) PREVIOUSLY UNDESCRIBED INDIVIDUALS.— 

2 Individuals described in this subsection are individuals 

3 who are— 

4 ‘‘(1) described in subclause (XXIII) of sub5 section (a)(10)(A)(ii); and 

6 ‘‘(2) are not described in any other subclause of 

7 such subsection or any other provision in this Act 

8 which provides for eligibility for medical assist9 ance.’’. 

10 (b) PROVISION OF AT LEAST MINIMUM COVERAGE.— 

11 (1) IN GENERAL.—Section 1902(k)(1) of the 

12 Social Security Act (42 U.S.C. 1396a(k)(1)) is 

13 amended by inserting ‘‘or an individual described in 

14 subsection (nn)’’ after ‘‘an individual described in 

15 subclause (VIII) of subsection (a)(10)(A)(i)’’ each 

16 place it appears. 

17 (2) CONFORMING AMENDMENT.—Section 

18 1903(i)(26) of the Social Security Act (42 U.S.C. 

19 1396b(i)(26)) is amended by striking ‘‘individuals 

20 described in subclause (VIII) of subsection 

21 (a)(10)(A)(i)’’ and inserting ‘‘individuals described 

22 in subsection (a)(10)(A)(i)(VIII) or (nn) of section 

23 1902’’. 

24 (c) FEDERAL FINANCIAL PARTICIPATION IN BUY-IN

25 PROGRAM.— 


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1 (1) ENHANCED MATCH FOR ADMINISTRATIVE

2 EXPENSES.—Section 1903(a) of the Social Security 

3 Act (42 U.S.C. 1396b(a)) is amended— 

4 (A) by redesignating paragraph (7) as 

5 paragraph (8); and 

6 (B) by inserting after paragraph (6) the 

7 following new paragraph: 

8 ‘‘(7) an amount equal to 90 percent of the 

9 sums expended during the quarter which are attrib10 utable to reasonable administrative expenses related 

11 to the administration of a Medicaid buy-in program 

12 for individuals described in section 

13 1902(a)(10)(A)(ii)(XXIII); plus’’. 

14 (2) TREATMENT OF PREMIUM AND COST-SHAR15 ING REVENUES FROM MEDICAID BUY-IN PROGRAM.— 

16 (A) IN GENERAL.—For purposes of section 

17 1903(a)(1) of the Social Security Act (42 

18 U.S.C. 1396b(a)(1)), for any fiscal quarter dur19 ing which a State collects premiums, cost-shar20 ing, or similar charges under subsection (k) of 

21 section 1916 of such Act (42 U.S.C. 1396o) (as 

22 added by this Act), including any advance pay23 ments of premium tax credits under section 

24 1412 of the Patient Protection and Affordable 

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1 tions under section 1402 of such Act that are 

2 received by the State, the total amount ex3 pended during such quarter as medical assist4 ance for individuals who buy into Medicaid cov5 erage under subclause (XXIII) of section 

6 1902(a)(10)(A)(ii) of the Social Security Act 

7 (as added by this Act) shall be reduced by the 

8 amount of such premiums or charges. 

9 (B) TREATMENT OF EXCESS PREMIUMS.— 

10 Each State that collects premiums or similar 

11 charges under subsection (k) of section 1916 of 

12 the Social Security Act (42 U.S.C. 1396o) (as 

13 added by this Act) in a fiscal year shall pay to 

14 the Secretary of Health and Human Services, 

15 at such time and in such form and manner as 

16 the Secretary shall specify, an amount equal to 

17 50 percent of the amount, if any, by which— 

18 (i) the total amount of such premiums 

19 and charges collected by the State for such 

20 year; exceeds 

21 (ii) the total amount expended by the 

22 State during such year as medical assist23 ance for individuals who buy into Medicaid 

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1 tion 1902(a)(10)(A)(ii) of such Act (as 

2 added by this Act). 

3 (d) COST-SHARING REQUIREMENT.—Section 1916 of 

4 the Social Security Act (42 U.S.C. 1396o) is amended by 

5 adding at the end the following new subsection: 

6 ‘‘(k) PREMIUMS AND COST-SHARING FOR INDIVID7 UALS PARTICIPATING IN MEDICAID BUY-IN PROGRAM.— 

8 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

9 with respect to individuals who are eligible for med10 ical assistance under subsection 

11 (a)(10)(A)(ii)(XXIII) of section 1902 and are de12 scribed in subsection (nn) of such section, a State 

13 may— 

14 ‘‘(A) impose premiums, deductibles, cost15 sharing, or other similar charges that are actu16 arially fair; and 

17 ‘‘(B) vary the premium rate imposed on an 

18 individual based only on the factors described in 

19 section 2701(a)(1)(A) of the Public Health 

20 Service Act and subject to the same limitations 

21 on the weight which may be given to such fac22 tors under such section. 

23 ‘‘(2) LIMITATIONS.— 

24 ‘‘(A) PREMIUMS.—The total amount of 

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1 section with respect to all individuals described 

2 in paragraph (1) in a family shall not exceed an 

3 amount equal to 9.5 percent of the family’s 

4 household income (as defined in section 

5 36B(d)(2) of the Internal Revenue Code of 

6 1986) for the year involved. 

7 ‘‘(B) OTHER COST-SHARING.— 

8 ‘‘(i) IN GENERAL.—The cost-sharing 

9 limitations described in section 1302(c) of 

10 the Patient Protection and Affordable Care 

11 Act shall apply to cost-sharing (as defined 

12 in such section) for medical assistance pro13 vided under section 

14 1902(a)(10)(A)(ii)(XXIII) in the same 

15 manner as such limitations apply to cost16 sharing under qualified health plans under 

17 title I of such Act. 

18 ‘‘(ii) AVAILABILITY OF COST-SHARING

19 REDUCTIONS.—Individuals provided med20 ical assistance under section 

21 1902(a)(10)(A)(ii)(XXIII) and subject to 

22 cost-sharing under this subsection are eli23 gible for cost-sharing reductions under sec24 tion 1402 of the Patient Protection and 

25 Affordable Care Act (subject to the income 


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1 eligibility threshold in subsection (b)(2) of 

2 such section), and in applying such sec3 tion— 

4 ‘‘(I) enrollment in a State plan 

5 under section 

6 1902(a)(10)(A)(ii)(XXIII) shall be 

7 treated as coverage under a qualified 

8 health plan in the silver level of cov9 erage in the individual market offered 

10 through an Exchange established for 

11 or by the State under title I of the 

12 Patient Protection and Affordable 

13 Care Act; and 

14 ‘‘(II) the State agency admin15 istering such plan shall be treated as 

16 the issuer of such plan. 

17 ‘‘(3) PREMIUMS AND COST-SHARING FOR CER18 TAIN OTHER INDIVIDUALS.—If an individual is eligi19 ble for medical assistance under subsection 

20 (a)(10)(A)(ii)(XXIII) of section 1902 and is not de21 scribed in subsection (nn) of such section, a State— 

22 ‘‘(A) shall not impose premiums and cost23 sharing on the individual under this subsection; 

24 and 


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1 ‘‘(B) may impose premiums and cost-shar2 ing on the individual to the extent allowed by 

3 another provision of this Act (other than sec4 tion 1902(a)(10)(A)(ii)(XXIII)) which provides 

5 for eligibility for medical assistance, but only if 

6 the individual is described in such other provi7 sion. 

8 ‘‘(4) APPLICATION OF PREMIUM ASSISTANCE

9 TAX CREDITS.—An individual who is required to pay 

10 premiums under this subsection for a year for med11 ical assistance shall be eligible for a premium assist12 ance credit under section 36B of the Internal Rev13 enue Code to the same extent that such individual 

14 would be eligible for a premium assistance credit 

15 under such section if such individual had paid the 

16 same amount in premiums for coverage under a 

17 qualified health plan for such year.’’. 

18 (e) MANAGED CARE.—Section 1932(a)(1)(A)(i) of 

19 the Social Security Act (42 U.S.C. 1396u–2(a)(1)(A)(i)) 

20 is amended by inserting ‘‘, including an individual who is 

21 eligible for such assistance after buying into such coverage 

22 under section 1902(a)(10)(A)(ii)(XXIII),’’ after ‘‘the 

23 State plan under this title’’. 

24 (f) OFFERING BUY-IN PROGRAM ON STATE EX25 CHANGE; ENROLLMENT PERIODS.— 


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1 (1) IN GENERAL.—A State that has elected to 

2 allow individuals to buy into Medicaid coverage 

3 under section 1902(a)(10)(A)(ii)(XXIII) of the So4 cial Security Act (42 U.S.C. 

5 1396a(a)(10)(A)(ii)(XXIII)) shall allow individuals 

6 to enroll in such coverage through the Federal, Fed7 erally-facilitated, or State Exchange established pur8 suant to title I of the Patient Protection and Afford9 able Care Act. 

10 (2) ENROLLMENT PERIODS.—A State may limit 

11 the enrollment of individuals into Medicaid coverage 

12 under section 1902(a)(10)(A)(ii)(XXIII) of the So13 cial Security Act (42 U.S.C. 

14 1396a(a)(10)(A)(ii)(XXIII)) to the enrollment peri15 ods provided for under section 1311(c)(6) of the Pa16 tient Protection and Affordable Care Act (42 U.S.C. 

17 18031(c)(6)). 

18 (g) APPLICATION OF ADVANCED PREMIUM TAX

19 CREDITS TO MEDICAID BUY-IN PLANS.— 

20 (1) IN GENERAL.—Section 36B of the Internal 

21 Revenue Code of 1986 is amended— 

22 (A) in subsection (b)(3)(B), by adding at 

23 the end the following new sentence: 

24 ‘‘If an applicable taxpayer resides in a rating 

25 area in which no silver plan is offered on the 


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1 individual market but the taxpayer buys into 

2 Medicaid coverage under section 

3 1902(a)(10)(A)(ii)(XXIII) of the Social Secu4 rity Act, such Medicaid coverage shall be 

5 deemed to be the applicable second lowest cost 

6 silver plan with respect to such taxpayer.’’; and 

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

8 subsection: 

9 ‘‘(h) APPLICATION TO INDIVIDUALS PURCHASING

10 MEDICAID COVERAGE.—In the case of any individual who 

11 buys into Medicaid coverage under section 

12 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act, this 

13 section shall be applied with the following modifications: 

14 ‘‘(1) The amount determined under subsection 

15 (b)(2)(A) shall be increased by the amount of the 

16 monthly premiums paid for such coverage. 

17 ‘‘(2) Subsection (c)(2)(A)(i) shall be applied by 

18 treating coverage under the Medicaid program under 

19 title XIX of the Social Security Act in the same 

20 manner as a qualified health plan that was enrolled 

21 in through an Exchange. 

22 ‘‘(3) In applying subsection (c)(2)(B)— 

23 ‘‘(A) an individual shall not be considered 

24 to be eligible for minimum essential coverage 

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1 son of eligibility for medical assistance under a 

2 State Medicaid program under section 

3 1902(a)(10)(A)(ii)(XXIII); and 

4 ‘‘(B) an individual who is not covered by 

5 minimum essential coverage described in section 

6 5000A(f)(1)(B) shall not be considered to be el7 igible for such coverage.’’. 

8 (2) ADVANCED PAYMENT OF CREDIT.— 

9 (A) IN GENERAL.—The Secretary of 

10 Health and Human Services, in consultation 

11 with the Secretary of the Treasury, shall estab12 lish a program under which— 

13 (i) upon request of a State agency ad14 ministering a State Medicaid program 

15 under title XIX of the Social Security Act, 

16 advance determinations are made in a 

17 manner similar to advanced determination 

18 under section 1411 of the Patient Protec19 tion and Affordable Care Act with respect 

20 to the income eligibility of individuals en21 rolling in such program for the premium 

22 tax credit allowable under section 36B of 

23 the Internal Revenue Code of 1986 and 

24 the cost-sharing reductions under section 


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1 1402 of the Patient Protection and Afford2 able Care Act; 

3 (ii) the Secretary notifies— 

4 (I) the State agency admin5 istering the program and the Sec6 retary of the Treasury of the advance 

7 determinations; and 

8 (II) the Secretary of the Treas9 ury of the name and employer identi10 fication number of each employer with 

11 respect to whom 1 or more employee 

12 of the employer were determined to be 

13 eligible for the premium tax credit 

14 under section 36B of the Internal 

15 Revenue Code of 1986 and the cost16 sharing reductions under section 1402 

17 of the Patient Protection and Afford18 able Care Act because— 

19 (aa) the employer did not 

20 provide minimum essential cov21 erage; or 

22 (bb) the employer provided 

23 such minimum essential coverage 

24 but it was determined under sec25 tion 36B(c)(2)(C) of such Code 


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1 to either be unaffordable to the 

2 employee or not provide the re3 quired minimum actuarial value; 

4 and 

5 (iii) the Secretary of the Treasury 

6 makes advance payments of such credit or 

7 reductions to the State agency admin8 istering the program in order to reduce the 

9 premiums payable by individuals eligible 

10 for such credit. 

11 (B) DETERMINATIONS AND PAYMENTS.— 

12 Rules similar to subsections (b) and (c) of sec13 tion 1412 of the Patient Protection and Afford14 able Care Act shall apply for purposes of this 

15 subsection. 

16 (C) COORDINATION WITH CREDIT.— 

17 (i) IN GENERAL.—Section 36B of the 

18 Internal Revenue Code of 1986 is amended 

19 by inserting ‘‘and under section 2(g)(2) of 

20 the State Public Option Act’’ after ‘‘sec21 tion 1412 of the Patient Protection and 

22 Affordable Care Act’’ each place it appears 

23 in subsections (f)(1), (f)(2), and (g)(1). 

24 (ii) INFORMATION REPORTING.—Sec25 tion 36B(f)(3) of such Code is amended by 


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1 adding at the end the following flush sen2 tence: ‘‘In the case of any coverage under 

3 the medicaid program under title XIX of 

4 the Social Security Act for which a credit 

5 under this section is allowable by reason of 

6 subsection (h), the State agency admin7 istering the Medicaid program shall be 

8 treated as an Exchange for purposes of 

9 this paragraph and subparagraph (A) shall 

10 not apply.’’. 

11 (3) CONFORMING AMENDMENT RELATING TO

12 EMPLOYER RESPONSIBILITY.—Paragraph (6) of sec13 tion 4980H(c) of the Internal Revenue Code of 1986 

14 is amended by inserting ‘‘, except that for purposes 

15 of subsections (a)(2) and (b)(2), the term ‘qualified 

16 health plan’ shall include any plan described in sec17 tion 36B(h)’’ after ‘‘such Act’’. 

18 (h) CONFORMING AMENDMENTS.— 

19 (1) Section 1902(a)(10) of the Social Security 

20 Act (42 U.S.C. 1396a(a)(10)), as amended by sub21 section (a), is further amended, in the matter fol22 lowing subparagraph (G)— 

23 (A) by striking ‘‘and (XVII)’’ and inserting 

24 ‘‘, (XVII)’’; and 


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1 (B) by inserting ‘‘, and (XVIII) the med2 ical assistance made available to an individual 

3 described in subparagraph (A)(ii)(XXIII) shall 

4 be limited to medical assistance described in 

5 subsection (k)(1)’’ before the semicolon. 

6 (2) Section 1903(f)(4) of the Social Security 

7 Act (42 U.S.C. 1396b(f)(4)) is amended by inserting 

8 ‘‘1902(a)(10)(A)(ii)(XXIII),’’ after 

9 ‘‘1902(a)(10)(A)(ii)(XXII),’’. 

10 (3) Section 1905(a) of the Social Security Act 

11 (42 U.S.C. 1396d(a)) is amended in the matter pre12 ceding paragraph (1)— 

13 (A) by striking ‘‘or’’ at the end of clause 

14 (xvi); 

15 (B) by inserting ‘‘or’’ at the end of clause 

16 (xvii); and 

17 (C) by inserting after clause (xvii) the fol18 lowing new clause: 

19 ‘‘(xviii) individuals described in section 

20 1902(a)(10)(A)(ii)(XXIII),’’. 

21 (4) Section 1916A(a)(1) of the Social Security 

22 Act (42 U.S.C. 1396o–1(a)(1)) is amended by strik23 ing ‘‘or (j)’’ and inserting ‘‘(j), or (k)’’. 

24 (5) Section 1937(a)(1)(B) of the Social Secu25 rity Act (42 U.S.C. 1396u–7(a)(1)(B)) is amended 


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1 by inserting ‘‘, subclause (XXIII) of section 

2 1902(a)(10)(A)(ii),’’ after ‘‘1902(a)(10)(A)(i)’’. 

3 SEC. 3. DEVELOPMENT OF STATE-LEVEL METRICS ON MED4 ICAID BENEFICIARY ACCESS AND SATISFAC5 TION. 

6 (a) IN GENERAL.— 

7 (1) DEVELOPMENT OF METRICS.—Not later 

8 than 1 year after the date of enactment of this Act, 

9 the Director of the Agency for Healthcare Research 

10 and Quality, in consultation with the Deputy Admin11 istrator for the Center for Medicaid and CHIP Serv12 ices and State Medicaid Directors, shall develop 

13 standardized, State-level metrics of access to, and 

14 satisfaction with, providers, including primary care 

15 and specialist providers, with respect to individuals 

16 who are enrolled in State Medicaid plans under title 

17 XIX of the Social Security Act. 

18 (2) PROCESS.—The Director of the Agency for 

19 Healthcare Research and Quality shall develop the 

20 metrics described in paragraph (1) through a public 

21 process, which shall provide opportunities for stake22 holders to participate. 

23 (b) UPDATING METRICS.—The Director of the Agen24 cy for Healthcare Research and Quality, in consultation 

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1 icaid and CHIP Services and State Medicaid Directors, 

2 shall update the metrics developed under subsection (a) 

3 not less than once every 3 years. 

4 (c) STATE IMPLEMENTATION FUNDING.—The Direc5 tor of the Agency for Healthcare Research and Quality 

6 may award funds, from the amount appropriated under 

7 subsection (d), to States for the purpose of implementing 

8 the metrics developed under this section. 

9 (d) APPROPRIATION.—There is appropriated to the 

10 Director of the Agency for Healthcare Research and Qual11 ity out of any funds in the Treasury not otherwise appro12 priated, $200,000,000 for fiscal year 2019, to remain 

13 available until expended, for the purpose of carrying out 

14 this section. 

15 SEC. 4. RENEWAL OF APPLICATION OF MEDICARE PAY16 MENT RATE FLOOR TO PRIMARY CARE SERV17 ICES FURNISHED UNDER MEDICAID AND IN18 CLUSION OF ADDITIONAL PROVIDERS. 

19 (a) RENEWAL OF PAYMENT FLOOR; ADDITIONAL

20 PROVIDERS.— 

21 (1) IN GENERAL.—Section 1902(a)(13) of the 

22 Social Security Act (42 U.S.C. 1396a(a)(13)) is 

23 amended by striking subparagraph (C) and inserting 

24 the following: 


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1 ‘‘(C) payment for primary care services (as 

2 defined in subsection (jj)) at a rate that is not 

3 less than 100 percent of the payment rate that 

4 applies to such services and physician under 

5 part B of title XVIII (or, if greater, the pay6 ment rate that would be applicable under such 

7 part if the conversion factor under section 

8 1848(d) for the year involved were the conver9 sion factor under such section for 2009), and 

10 that is not less than the rate that would other11 wise apply to such services under this title if 

12 the rate were determined without regard to this 

13 subparagraph, and that are— 

14 ‘‘(i) furnished in 2013 and 2014, by a 

15 physician with a primary specialty designa16 tion of family medicine, general internal 

17 medicine, or pediatric medicine; or 

18 ‘‘(ii) furnished in the period that be19 gins on the first day of the first month 

20 that begins after the date of enactment of 

21 the State Public Option Act— 

22 ‘‘(I) by a physician with a pri23 mary specialty designation of family 

24 medicine, general internal medicine, 

25 or pediatric medicine, but only if the 


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1 physician self-attests that the physi2 cian is Board certified in family medi3 cine, general internal medicine, or pe4 diatric medicine; 

5 ‘‘(II) by a physician with a pri6 mary specialty designation of obstet7 rics and gynecology, but only if the 

8 physician self-attests that the physi9 cian is Board certified in obstetrics 

10 and gynecology; 

11 ‘‘(III) by an advanced practice 

12 clinician, as defined by the Secretary, 

13 that works under the supervision of— 

14 ‘‘(aa) a physician that satis15 fies the criteria specified in sub16 clause (I) or (II); or 

17 ‘‘(bb) a nurse practitioner or 

18 a physician assistant (as such 

19 terms are defined in section 

20 1861(aa)(5)(A)) who is working 

21 in accordance with State law, or 

22 a certified nurse-midwife (as de23 fined in section 1861(gg)) who is 

24 working in accordance with State 

25 law; 


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1 ‘‘(IV) by a rural health clinic, 

2 Federally-qualified health center, or 

3 other health clinic that receives reim4 bursement on a fee schedule applica5 ble to a physician, a nurse practi6 tioner or a physician assistant (as 

7 such terms are defined in section 

8 1861(aa)(5)(A)) who is working in ac9 cordance with State law, or a certified 

10 nurse-midwife (as defined in section 

11 1861(gg)) who is working in accord12 ance with State law, for services fur13 nished by a physician, nurse practi14 tioner, physician assistant, or certified 

15 nurse-midwife, or services furnished 

16 by an advanced practice clinician su17 pervised by a physician described in 

18 subclause (I)(aa) or (II)(aa), another 

19 advanced practice clinician, or a cer20 tified nurse-midwife; or 

21 ‘‘(V) by a nurse practitioner or a 

22 physician assistant (as such terms are 

23 defined in section 1861(aa)(5)(A)) 

24 who is working in accordance with 

25 State law, or a certified nurse-midwife 


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1 (as defined in section 1861(gg)) who 

2 is working in accordance with State 

3 law, in accordance with procedures 

4 that ensure that the portion of the 

5 payment for such services that the 

6 nurse practitioner, physician assist7 ant, or certified nurse-midwife is paid 

8 is not less than the amount that the 

9 nurse practitioner, physician assist10 ant, or certified nurse-midwife would 

11 be paid if the services were provided 

12 under part B of title XVIII;’’. 

13 (2) CONFORMING AMENDMENTS.—Section 

14 1905(dd) of the Social Security Act (42 U.S.C. 

15 1396d(dd)) is amended— 

16 (A) by striking ‘‘Notwithstanding’’ and in17 serting the following: 

18 ‘‘(1) IN GENERAL.—Notwithstanding’’; 

19 (B) by inserting ‘‘or furnished during an 

20 additional period specified in paragraph (2),’’ 

21 after ‘‘2015,’’; and 

22 (C) by adding at the end the following: 

23 ‘‘(2) ADDITIONAL PERIODS.—For purposes of 

24 paragraph (1), the following are additional periods: 


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1 ‘‘(A) The period that begins on the first 

2 day of the first month that begins after the 

3 date of enactment of the State Public Option 

4 Act.’’. 

5 (b) IMPROVED TARGETING OF PRIMARY CARE.—Sec6 tion 1902(jj) of the Social Security Act (42 U.S.C. 

7 1396a(jj)) is amended— 

8 (1) by redesignating paragraphs (1) and (2) as 

9 subparagraphs (A) and (B), respectively and realign10 ing the left margins accordingly; 

11 (2) by striking ‘‘For purposes of’’ and inserting 

12 the following: 

13 ‘‘(1) IN GENERAL.—For purposes of’’; and 

14 (3) by adding at the end the following: 

15 ‘‘(2) EXCLUSIONS.—Such term does not include 

16 any services described in subparagraph (A) or (B) of 

17 paragraph (1) if such services are provided in an 

18 emergency department of a hospital.’’. 

19 (c) ENSURING PAYMENT BY MANAGED CARE ENTI20 TIES.— 

21 (1) IN GENERAL.—Section 1903(m)(2)(A) of 

22 the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) 

23 is amended— 

24 (A) in clause (xii), by striking ‘‘and’’ after 

25 the semicolon; 


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1 (B) by realigning the left margin of clause 

2 (xiii) so as to align with the left margin of 

3 clause (xii) and by striking the period at the 

4 end of clause (xiii) and inserting ‘‘; and’’; and 

5 (C) by inserting after clause (xiii) the fol6 lowing: 

7 ‘‘(xiv) such contract provides that (I) payments 

8 to providers specified in section 1902(a)(13)(C) for 

9 primary care services defined in section 1902(jj) 

10 that are furnished during a year or period specified 

11 in section 1902(a)(13)(C) and section 1905(dd) are 

12 at least equal to the amounts set forth and required 

13 by the Secretary by regulation, (II) the entity shall, 

14 upon request, provide documentation to the State, 

15 sufficient to enable the State and the Secretary to 

16 ensure compliance with subclause (I), and (III) the 

17 Secretary shall approve payments described in sub18 clause (I) that are furnished through an agreed 

19 upon capitation, partial capitation, or other value20 based payment arrangement if the capitation, partial 

21 capitation, or other value-based payment arrange22 ment is based on a reasonable methodology and the 

23 entity provides documentation to the State sufficient 

24 to enable the State and the Secretary to ensure com25 pliance with subclause (I).’’. 


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•S 2001 IS

1 (2) CONFORMING AMENDMENT.—Section 

2 1932(f) of the Social Security Act (42 U.S.C. 

3 1396u–2(f)) is amended by inserting ‘‘and clause 

4 (xiv) of section 1903(m)(2)(A)’’ before the period. 

5 SEC. 5. MEDICAID ACCESS GRANTS. 

6 (a) IN GENERAL.—Beginning in fiscal year 2019, the 

7 Secretary of Health and Human Services (referred to in 

8 this section as the ‘‘Secretary’’) shall award grants to 

9 States that submit an application meeting the require10 ments of subsection (b) for the purpose of improving ac11 cess to services for individuals enrolled in State Medicaid 

12 plans under title XIX of the Social Security Act. 

13 (b) APPLICATION REQUIREMENTS.—To be eligible 

14 for a grant under this section, a State shall submit to the 

15 Secretary, at such time and in such manner as the Sec16 retary shall require, an application that contains the fol17 lowing: 

18 (1) A description of gaps in access to providers 

19 for individuals enrolled in the State Medicaid plan 

20 that the State has identified, and how the State pro21 poses to fix such gaps. 

22 (2) A discussion of any changes the State pro23 poses to make to the reimbursement of providers 

24 under the State Medicaid plan, including changes to 

25 the fee-for-service rates for providers of services 


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•S 2001 IS

1 under such plans or moving to population-based or 

2 episode-based payment models. 

3 (3) A justification establishing that the changes 

4 proposed by the State will increase access to pro5 viders for individuals enrolled in the State Medicaid 

6 plan, and a plan for measuring changes to such ac7 cess over the grant period. 

8 (c) USE OF FUNDS.— 

9 (1) IN GENERAL.—If the Secretary determines 

10 that a State is using grant funds awarded under this 

11 section in a manner that is inconsistent with the 

12 purpose described in subsection (a) or paragraph 

13 (2), the Secretary may withhold or reduce future 

14 grant payments or recover previous grant payments 

15 to the State under this section as the Secretary 

16 deems appropriate. 

17 (2) USE OF FUNDS TO IMPLEMENT MEDICAID

18 BUY-IN PROGRAM.—A State may use up to 10 per19 cent of the amount of a grant awarded to the State 

20 under this section for the purpose of implementing 

21 a Medicaid buy-in program under subclause (XXIII) 

22 of section 1902(a)(10)(A)(ii) of the Social Security 

23 Act (42 U.S.C. 1396a(a)(10)(A)(ii)). 

24 (3) USE OF FUNDS TO INCREASE MEDICAID

25 PROVIDER PAYMENT RATES.—Notwithstanding any 


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•S 2001 IS

1 other provision of law, a State may use grant funds 

2 awarded under this section for the purpose of fi3 nancing the portion of the non-Federal share of ex4 penditures under the State Medicaid plan under title 

5 XIX of the Social Security Act (42 U.S.C. 1396 et 

6 seq.) that is attributable to an increase in the pay7 ment rate for providers under such plan. 

8 (d) SELECTION OF STATES AND MAXIMUM GRANT

9 AMOUNT.—In awarding grants to States under this sec10 tion, the Secretary shall— 

11 (1) ensure that geographically diverse areas, in12 cluding rural and underserved areas, are included; 

13 and 

14 (2) award grants both to States that have elect15 ed to expand Medicaid eligibility under section 

16 1902(a)(10)(A)(i)(VIII) of the Social Security Act 

17 (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) and to States 

18 that have not so elected. 

19 (e) APPROPRIATION.—There is appropriated to the 

20 Secretary, out of any funds in the Treasury not otherwise 

21 appropriated, $100,000,000,000 for fiscal year 2018, to 

22 remain available until September 30, 2021, for the pur23 pose of making grants under this section. 


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•S 2001 IS

1 SEC. 6. INCREASED FMAP FOR MEDICAL ASSISTANCE TO 

2 NEWLY ELIGIBLE INDIVIDUALS. 

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

4 Security Act (42 U.S.C. 1396d(y)(1)) is amended— 

5 (1) in subparagraph (A), by striking ‘‘2014, 

6 2015, and 2016’’ and inserting ‘‘each of the first 3 

7 consecutive 12-month periods in which the State 

8 provides medical assistance to newly eligible individ9 uals’’; 

10 (2) in subparagraph (B), by striking ‘‘2017’’ 

11 and inserting ‘‘the fourth consecutive 12-month pe12 riod in which the State provides medical assistance 

13 to newly eligible individuals’’; 

14 (3) in subparagraph (C), by striking ‘‘2018’’ 

15 and inserting ‘‘the fifth consecutive 12-month period 

16 in which the State provides medical assistance to 

17 newly eligible individuals’’; 

18 (4) in subparagraph (D), by striking ‘‘2019’’ 

19 and inserting ‘‘the sixth consecutive 12-month period 

20 in which the State provides medical assistance to 

21 newly eligible individuals’’; and 

22 (5) in subparagraph (E), by striking ‘‘2020 and 

23 each year thereafter’’ and inserting ‘‘the seventh 

24 consecutive 12-month period in which the State pro25 vides medical assistance to newly eligible individuals 

26 and each such period thereafter’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall take effect as if included in the enact3 ment of Public Law 111–148. 

Æ 


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