I 

115TH CONGRESS 

1ST SESSION H. R. 1325 

To amend title XIX of the Social Security Act to provide States with flexibility 

with respect to providing premium assistance under the Medicaid program. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 2, 2017 

Mr. BUCSHON 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 provide 

States with flexibility with respect to providing premium 

assistance under the Medicaid program. 

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

3 SECTION 1. PROVIDING FLEXIBILITY WITH RESPECT TO 

4 PREMIUM ASSISTANCE UNDER MEDICAID. 

5 (a) IN GENERAL.—Section 1906 of the Social Secu6 rity Act (42 U.S.C. 1396e) is amended— 

7 (1) in subsection (c)(2), by striking ‘‘such 

8 plan.’’ and inserting ‘‘such group health plan.’’; and 

9 (2) by inserting after subsection (c) the fol10 lowing new subsection: 


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1 ‘‘(d) STATE OPTION FOR NONELDERLY, NON2 DISABLED ADULTS.— 

3 ‘‘(1) IN GENERAL.—Beginning on January 1, 

4 2018, in the case of a State electing the option de5 scribed in paragraph (2) of subsection (a), the Sec6 retary may, upon the approval of a State plan 

7 amendment submitted by the State, waive the re8 quirement of paragraph (3) of such subsection to the 

9 extent such requirement provides for payment of 

10 premiums and deductibles and other cost-sharing ob11 ligations with respect to the items and services de12 scribed in such paragraph furnished to individuals 

13 described in paragraph (3) of this subsection. 

14 ‘‘(2) COST-EFFECTIVENESS.— 

15 ‘‘(A) IN GENERAL.—The Secretary may 

16 approve a State plan amendment under this 

17 subsection if the Secretary determines that the 

18 payment of premiums and deductibles and other 

19 cost-sharing obligations under the group health 

20 plan or plans involved is cost-effective relative 

21 to the amount of expenditures under the State 

22 plan, including administrative expenditures, and 

23 excluding payments for copayments or coinsur24 ance, that the State would have made to proVerDate Sep 11 2014 02:52 Mar 08, 2017 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1325.IH H1325

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1 vide comparable coverage of the individuals de2 scribed in paragraph (3) involved. 

3 ‘‘(B) DETERMINATION.—For purposes of 

4 subparagraph (A), cost-effectiveness shall be de5 termined— 

6 ‘‘(i) on an annual basis by com7 paring— 

8 ‘‘(I) the amount of expenditures 

9 per employer for coverage under the 

10 group health plan or plans involved of 

11 the individuals described in paragraph 

12 (3) for the preceding 4 calendar quar13 ters; to 

14 ‘‘(II) the average per capita 

15 amount of expenditures that the State 

16 made under the State plan to provide 

17 comparable coverage of such individ18 uals for such calendar quarters; and 

19 ‘‘(ii) in the case of individuals de20 scribed in paragraph (3) who are parents 

21 of children— 

22 ‘‘(I) if the parent is eligible for 

23 enrollment in a group health plan, 

24 based on the cost of purchasing family 


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1 coverage under the group health plan; 

2 and 

3 ‘‘(II) if the parent is not so eligi4 ble, based on the cost of individual 

5 coverage for the parent and each 

6 child. 

7 ‘‘(C) CHILD DEFINED.—In this paragraph, 

8 the term ‘child’ has the meaning given such 

9 term in section 1902(e)(13)(G). 

10 ‘‘(3) NONELDERLY, NONDISABLED ADULTS.— 

11 The individuals described in this paragraph are indi12 viduals who are under 65 years of age, not pregnant, 

13 not entitled to, or enrolled for, benefits under part 

14 A of title XVIII, or enrolled for benefits under part 

15 B of title XVIII, are not described in subclauses (I) 

16 through (VII) of section 1902(a)(10)(A)(i), and oth17 erwise entitled to medical assistance under this 

18 title.’’. 

19 (b) PREMIUM ASSISTANCE SUBSIDY OPTION.—Sec20 tion 1906A of the Social Security Act (42 U.S.C. 1396e– 

21 1) is amended by adding at the end the following new sub22 section: 

23 ‘‘(f) STATE OPTION FOR NONELDERLY, NON24 DISABLED ADULTS.— 


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1 ‘‘(1) IN GENERAL.—Beginning on January 1, 

2 2018, in the case of a State electing to provide a 

3 premium assistance subsidy as described in sub4 section (a), the Secretary may, upon the approval of 

5 a State plan amendment submitted by the State, 

6 waive the requirement of subsection (e) to the extent 

7 such requirement provides for payment of premiums 

8 and deductibles and other cost-sharing obligations 

9 with respect to the items and services described in 

10 such subsection furnished to individuals described in 

11 paragraph (3). 

12 ‘‘(2) COST-EFFECTIVENESS.— 

13 ‘‘(A) IN GENERAL.—The Secretary may 

14 approve a State plan amendment under this 

15 subsection if the Secretary determines that the 

16 payment of premiums and deductibles and other 

17 cost-sharing obligations under the qualified em18 ployer-sponsored coverage involved is cost-effec19 tive relative to the amount of expenditures 

20 under the State plan, including administrative 

21 expenditures, and excluding payments for co22 payments or coinsurance, that the State would 

23 have made to provide comparable coverage of 

24 the individuals described in paragraph (3)(B) 

25 involved. 


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1 ‘‘(B) DETERMINATION.—For purposes of 

2 subparagraph (A), cost-effectiveness shall be de3 termined— 

4 ‘‘(i) on an annual basis by com5 paring— 

6 ‘‘(I) the amount of expenditures 

7 per employer for coverage under the 

8 qualified employer-sponsored coverage 

9 involved of the individuals described in 

10 paragraph (3)(B) for the preceding 4 

11 calendar quarters; to 

12 ‘‘(II) the average per capita 

13 amount of expenditures that the State 

14 made under the State plan to provide 

15 comparable coverage of such individ16 uals for such calendar quarters; and 

17 ‘‘(ii) in the case of individuals de18 scribed in paragraph (3) who are parents 

19 of individuals under 19 years of age— 

20 ‘‘(I) if the parent is eligible for 

21 enrollment in qualified employer-spon22 sored coverage, based on the cost of 

23 purchasing family coverage under 

24 such qualified employer-sponsored 

25 coverage; and 


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1 ‘‘(II) if the parent is not so eligi2 ble, based on the cost of individual 

3 coverage for the parent and each such 

4 individual under 19 years of age. 

5 ‘‘(3) NONELDERLY, NONDISABLED ADULTS.— 

6 The individuals described in this paragraph are indi7 viduals (or the parents of individuals) who are— 

8 ‘‘(A) participating in a premium assistance 

9 subsidy under this section for qualified em10 ployer-sponsored coverage; and 

11 ‘‘(B) under 65 years of age, not pregnant, 

12 not entitled to, or enrolled for, benefits under 

13 part A of title XVIII, or enrolled for benefits 

14 under part B of title XVIII, and are not de15 scribed in subclauses (I) through (VII) of sec16 tion 1902(a)(10)(A)(i).’’. 

Æ 


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