II 

117TH CONGRESS 

1ST SESSION S. 2646 

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 

AUGUST 5, 2021 

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

and Ms. WARREN) 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, 2023, 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 a 

21 major disaster— 

22 ‘‘(A) that is declared on or after January 

23 1, 2023, by the President in accordance with 

24 section 401 of the Robert T. Stafford Disaster 


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1 Relief and Emergency Assistance Act (42 

2 U.S.C. 5170); and 

3 ‘‘(B) which the President has determined 

4 warrants individual and public assistance from 

5 the Federal Government under such Act. 

6 ‘‘(2) DIRECT IMPACT AREA.— 

7 ‘‘(A) IN GENERAL.—The term ‘direct im8 pact area’ means, with respect to a disaster, the 

9 geographic area in which the disaster exists. 

10 ‘‘(B) WEBSITE POSTING OF DIRECT IM11 PACT AREAS.—As soon as practicable after a 

12 disaster is declared (as described in paragraph 

13 (1)(A)), the Secretary shall post on the website 

14 of the Centers for Medicare & Medicaid Serv15 ices a list of the areas identified as the direct 

16 impact areas of the disaster. 

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

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

19 State in which the survivor was living and was a 

20 resident, as determined by the State in which the 

21 survivor is applying for medical assistance under 

22 this title, during the 7-day period preceding the date 

23 on which the disaster is declared (as described in 

24 paragraph (1)(A)). 


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

2 ‘relief coverage period’ means, with respect to a dis3 aster, the period that begins on the date the disaster 

4 is declared (as described in paragraph (1)(A)) and 

5 ends on the day that is 2 years after such date. 

6 ‘‘(5) RELIEF-ELIGIBLE SURVIVOR.— 

7 ‘‘(A) IN GENERAL.—Subject to subpara8 graph (C), the term ‘relief-eligible survivor’ 

9 means an individual who is a survivor of a dis10 aster whose family income does not exceed the 

11 higher of— 

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

13 survivor who is a pregnant woman, a child, 

14 or a recipient of benefits under title II on 

15 the basis of a disability, 200 percent) of 

16 the poverty line; or 

17 ‘‘(ii) the income eligibility standard 

18 that would otherwise apply to the survivor 

19 under the State plan of the survivor’s 

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

21 ‘‘(B) DISREGARD OF UNEMPLOYMENT IN22 COME.—For purposes of this section, and not23 withstanding section 1902(e)(14)(B), the in24 come of a survivor of a disaster shall not in25 clude any amount received during the relief covVerDate Sep 11 2014 22:13 Aug 11, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2646.IS S2646

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1 erage period of the disaster under a law of the 

2 United States or a State which is in the nature 

3 of unemployment compensation. 

4 ‘‘(C) LIMITATION TO RELIEF COVERAGE

5 PERIOD.— 

6 ‘‘(i) IN GENERAL.—Except as pro7 vided in clauses (ii) and (iii), for purposes 

8 of this section, an individual shall not be 

9 considered to be a relief-eligible survivor on 

10 the basis of the individual’s status as a 

11 survivor of a disaster after the end of the 

12 relief coverage period of the disaster. 

13 ‘‘(ii) CONTINUOUS ELIGIBILITY FOR

14 DISASTER RELIEF COVERAGE FOR PREG15 NANT AND POSTPARTUM INDIVIDUALS.—In 

16 the case of an individual who, while preg17 nant, receives medical assistance as a re18 lief-eligible survivor of a disaster under a 

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

20 accordance with this section, such indi21 vidual shall continue to be eligible for med22 ical assistance as a relief-eligible survivor 

23 through the end of the month in which the 

24 60-day period (beginning on the last day of 

25 the pregnancy) ends, without regard to 


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1 whether the pregnancy ends before or after 

2 the end of the relief coverage period of the 

3 disaster. 

4 ‘‘(iii) CONTINUOUS ELIGIBILITY FOR

5 INDIVIDUALS WITH PENDING APPLICA6 TIONS.—If an individual who receives med7 ical assistance as a relief-eligible survivor 

8 of a disaster under a State plan (or a 

9 waiver of such a plan) in accordance with 

10 this section has an application pending for 

11 medical assistance under the State plan (or 

12 waiver) under this title or for child health 

13 assistance or pregnancy-related assistance 

14 under a State plan under title XXI (or a 

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

16 relief coverage period of the disaster ends, 

17 such individual shall continue to be eligible 

18 for medical assistance as a relief-eligible 

19 survivor through the earlier of— 

20 ‘‘(I) the end of the month in 

21 which the 60-day period (beginning on 

22 the last day of such relief coverage pe23 riod) ends; and 

24 ‘‘(II) the date on which the indi25 vidual’s application for medical assistVerDate Sep 11 2014 22:13 Aug 11, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2646.IS S2646

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1 ance, child health assistance, or preg2 nancy-related assistance (as applica3 ble) is approved or denied. 

4 ‘‘(6) SURVIVOR.— 

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

6 means, with respect to a disaster, an individual 

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

8 ‘‘(B) RESIDENTS AND EVACUEES OF DI9 RECT IMPACT AREAS.—An individual described 

10 in this subparagraph is an individual who, on 

11 any day during the 7-day period preceding the 

12 date on which a disaster is declared (as de13 scribed in paragraph (1)(A)), has a primary 

14 residence in the disaster’s direct impact area. 

15 ‘‘(C) INDIVIDUALS WHO LOST EMPLOY16 MENT.—An individual described in this sub17 paragraph is an individual— 

18 ‘‘(i) whose worksite, on any day dur19 ing the 7-day period preceding the date on 

20 which a disaster is declared (as so de21 scribed), was located in the disaster’s di22 rect impact area; 

23 ‘‘(ii) who was employed by an em24 ployer that— 


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1 ‘‘(I) conducted an active trade or 

2 business in such area on any day dur3 ing such 7-day period; and 

4 ‘‘(II) was unable to operate such 

5 trade or business as a result of the 

6 disaster on any day during the disas7 ter’s relief coverage period; and 

8 ‘‘(iii) whose employment with such 

9 employer was terminated. 

10 ‘‘(D) TREATMENT OF HOMELESS PER11 SONS.—In the case of an individual who was 

12 homeless on any day during the 7-day period 

13 preceding the date on which a disaster is de14 clared (as so described), the individual’s resi15 dency for purposes of subparagraph (B) shall 

16 be determined as it would otherwise be deter17 mined by the home State of the individual for 

18 purposes of this title. 

19 ‘‘(E) EFFECT OF CONCURRENT ELIGI20 BILITY FOR MEDICAID OR CHIP.—An individ21 ual’s eligibility for medical assistance under a 

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

23 health assistance or pregnancy-related assist24 ance under a State plan under title XXI (or a 

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


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1 under this section shall not prevent the indi2 vidual from being treated as a survivor under 

3 this section, and the rights afforded to an indi4 vidual who is eligible for or enrolled under a 

5 State plan (or waiver) under either such title 

6 shall not be affected by the individual’s receipt 

7 of medical assistance as a relief-eligible survivor 

8 of a disaster in accordance with this section. 

9 ‘‘(c) ELIGIBILITY.— 

10 ‘‘(1) SIMPLIFIED APPLICATION.— 

11 ‘‘(A) IN GENERAL.—For purposes of deter12 mining eligibility for medical assistance under 

13 this section, each State may accept a simplified, 

14 streamlined application form (as developed by 

15 the Secretary in consultation with the National 

16 Association of State Medicaid Directors), which 

17 shall— 

18 ‘‘(i) require an applicant for medical 

19 assistance in accordance with this section 

20 as a survivor of a disaster to— 

21 ‘‘(I) provide the applicant’s mail22 ing address for the duration of the re23 lief coverage period of the disaster; 

24 and 


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1 ‘‘(II) agree to update the infor2 mation described in subclause (I) if it 

3 changes during such period; 

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

5 making a fraudulent application described 

6 in subsection (g); 

7 ‘‘(iii) require the applicant to assign 

8 to the State any rights of the applicant (or 

9 any other individual who is a relief-eligible 

10 survivor and on whose behalf the applicant 

11 has the legal authority to execute an as12 signment of such rights) as described and 

13 in accordance with the requirements of sec14 tion 1912; 

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

16 health insurance coverage in which the ap17 plicant was enrolled immediately prior to 

18 submitting the application for medical as19 sistance under this section; and 

20 ‘‘(v) require the applicant to self-at21 test that the applicant— 

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

23 the disaster; and 

24 ‘‘(II) if applicable, requires home 

25 and community-based services. 


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1 ‘‘(B) NO DOCUMENTATION REQUIRE2 MENT.— 

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

4 require an applicant for medical assistance 

5 as a survivor of a disaster under this sec6 tion to provide any documentation or other 

7 evidence— 

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

9 relief-eligible survivor; and 

10 ‘‘(II) if applicable, that the appli11 cant requires home and community12 based services. 

13 ‘‘(ii) USE OF AVAILABLE ELECTRONIC

14 DATA SOURCES.—In making determina15 tions with respect to the status of an appli16 cant for medical assistance as a survivor of 

17 a disaster under this section, or such an 

18 applicant’s need for home and community19 based services, a State may use data relat20 ing to the applicant that is available to the 

21 State from electronic data sources. 

22 ‘‘(2) PRESUMPTIVE ELIGIBILITY FOR RELIEF23 ELIGIBLE SURVIVORS.— 

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

25 for making medical assistance available to an 


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1 individual as a relief-eligible survivor under this 

2 section during a presumptive eligibility period. 

3 ‘‘(B) PRESUMPTIVE ELIGIBILITY PERIOD

4 DEFINED.—For purposes of this paragraph— 

5 ‘‘(i) the term ‘presumptive eligibility 

6 period’ means, with respect to an indi7 vidual, the period that— 

8 ‘‘(I) begins with the date on 

9 which a qualified provider determines, 

10 on the basis of preliminary informa11 tion, that the individual satisfies the 

12 criteria for eligibility for medical as13 sistance as a relief-eligible survivor 

14 under this section; and 

15 ‘‘(II) ends with (and includes) 

16 the earlier of— 

17 ‘‘(aa) the day on which a de18 termination is made with respect 

19 to the eligibility of the individual 

20 for medical assistance as a relief21 eligible survivor under this sec22 tion; or 

23 ‘‘(bb) in the case of an indi24 vidual who does not file an appli25 cation by the last day of the 


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1 month following the month dur2 ing which the provider makes the 

3 determination referred to in item 

4 (aa), such last day; and 

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

6 the meaning given such term in section 

7 1920. 

8 ‘‘(C) COORDINATION BETWEEN STATE

9 AGENCIES AND QUALIFIED PROVIDERS.— 

10 ‘‘(i) PROVISION OF FORMS AND IN11 FORMATION TO QUALIFIED PROVIDERS.— 

12 The State agency shall provide qualified 

13 providers with— 

14 ‘‘(I) such forms as are necessary 

15 for an individual to make application 

16 for medical assistance under the State 

17 plan as a relief-eligible survivor; and 

18 ‘‘(II) information on how to as19 sist individuals and their authorized 

20 representatives in completing and fil21 ing such forms. 

22 ‘‘(ii) PROVISION OF NOTICE OF DE23 TERMINATIONS TO STATE AGENCIES.—A 

24 qualified provider that determines under 

25 this subparagraph that an individual is eliVerDate Sep 11 2014 22:13 Aug 11, 2021 Jkt 019200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S2646.IS S2646

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1 gible for medical assistance under a State 

2 plan as a relief-eligible survivor under this 

3 section shall— 

4 ‘‘(I) notify the State agency of 

5 the determination within 5 working 

6 days after the date on which deter7 mination is made; and 

8 ‘‘(II) inform the individual at the 

9 time the determination is made that 

10 the individual is required to make ap11 plication for medical assistance under 

12 the State plan by not later than the 

13 last day of the month following the 

14 month during which the determination 

15 is made. 

16 ‘‘(D) APPLICATION REQUIREMENT.—An 

17 individual who is determined by a qualified pro18 vider to be presumptively eligible as a relief-eli19 gible survivor for medical assistance under a 

20 State plan shall make application for medical 

21 assistance under such plan by not later than 

22 the last day of the month following the month 

23 during which the determination is made, which 

24 application may be the streamlined application 

25 described in paragraph (1). 


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1 ‘‘(E) TREATMENT AS MEDICAL ASSIST2 ANCE.—Notwithstanding any other provision of 

3 this title, items and services that are— 

4 ‘‘(i) furnished to an individual during 

5 a presumptive eligibility period under this 

6 paragraph by a provider that is eligible for 

7 payments under the State plan; and 

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

9 covered by the State plan, 

10 shall be treated as medical assistance provided 

11 to a relief-eligible survivor of a disaster during 

12 the relief coverage period of the disaster under 

13 this section. 

14 ‘‘(3) CONTINUOUS ELIGIBILITY.— 

15 ‘‘(A) IN GENERAL.—Subject to subpara16 graph (B), an individual who is determined by 

17 a State to be a relief-eligible survivor of a dis18 aster shall remain eligible for medical assistance 

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

20 as such a survivor, without the need for any re21 determination of eligibility, for the duration of 

22 the relief coverage period of the disaster. 

23 ‘‘(B) EXCEPTIONS.—A State may termi24 nate the eligibility of an individual who is deter25 mined by a State to be a relief-eligible survivor 


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1 of a disaster before the end of the relief cov2 erage period of the disaster if— 

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

4 authorized representative) requests a vol5 untary termination of eligibility; 

6 ‘‘(ii) the individual ceases to be a resi7 dent of the State; 

8 ‘‘(iii) the State determines that eligi9 bility was erroneously granted because of 

10 State error or fraud, abuse, or perjury at11 tributed to the individual (or the individ12 ual’s authorized representative); or 

13 ‘‘(iv) the individual dies. 

14 ‘‘(4) ISSUANCE OF DISASTER RELIEF MEDICAID

15 ELIGIBILITY CARD.—A State shall issue a disaster 

16 relief Medicaid eligibility card to each applicant who 

17 is determined to be a relief-eligible survivor of a dis18 aster and eligible for medical assistance under this 

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

20 relief coverage period of the disaster. 

21 ‘‘(5) VERIFICATION OF STATUS AS A RELIEF22 ELIGIBLE SURVIVOR.— 

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

24 a good faith effort to verify the status of an in25 dividual who is enrolled in the State plan (or a 


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

2 of a disaster in accordance with this section. 

3 Such effort shall not delay the determination of 

4 the eligibility of the individual for medical as5 sistance under this section, and a State may en6 roll an individual in the State plan or waiver 

7 under this section pending such verification. 

8 ‘‘(B) EVIDENCE OF VERIFICATION.—A 

9 State may satisfy the verification requirement 

10 under subparagraph (A) with respect to an in11 dividual by showing that the State obtained in12 formation from the Social Security Administra13 tion, the Internal Revenue Service, or, if appli14 cable, the State Medicaid agency of the home 

15 State of the individual. 

16 ‘‘(6) DETERMINATION BY EXPRESS LANE AGEN17 CY.—Any determination or redetermination of eligi18 bility or verification of status made under this sec19 tion shall be made by an Express Lane agency (as 

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

21 ‘‘(d) SCOPE OF COVERAGE.— 

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

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

24 accordance with this section shall provide medical 

25 assistance that is equal in amount and scope to the 


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1 medical assistance that would otherwise be made 

2 available to such survivor if the survivor were en3 rolled in the State plan (or waiver of such plan) as 

4 an individual described in clause (i) of section 

5 1902(a)(10)(A), except that, in the case of such a 

6 survivor whose home State is not the State providing 

7 medical assistance to the individual, the State shall 

8 also provide medical assistance for any item or serv9 ice for which medical assistance is available to indi10 viduals described in clause (i) of section 

11 1902(a)(10)(A) under the State plan (or waiver) of 

12 the survivor’s home State. 

13 ‘‘(2) PROVIDER PAYMENT RATES FOR HOME

14 STATE SERVICES.—In the case of medical assistance 

15 provided under this section by a State to a relief-eli16 gible survivor of a disaster whose home State is not 

17 the State providing such assistance for an item or 

18 service which is not otherwise available under the 

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

20 available under the State plan (or waiver) of the sur21 vivor’s home State, the State shall pay the provider 

22 of such item or service at the same rate that the 

23 home State would pay for the item or service if it 

24 were provided under the plan or waiver of the home 

25 State (or, if no such payment rate applies under the 


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1 plan or waiver of the home State, the usual and cus2 tomary prevailing rate for the item or service for the 

3 community in which it is provided). 

4 ‘‘(3) RETROACTIVE COVERAGE.— 

5 ‘‘(A) IN GENERAL.—Notwithstanding sec6 tion 1905(a), a State shall provide medical as7 sistance for items and services furnished in the 

8 State beginning with the first day of the relief 

9 coverage period of a disaster to any relief-eligi10 ble survivor of the disaster who submits an ap11 plication for such assistance before the deadline 

12 described in subparagraph (B). 

13 ‘‘(B) APPLICATION DEADLINE.—The dead14 line for a relief-eligible survivor of a disaster to 

15 submit an application for medical assistance in 

16 accordance with this section is the date that is 

17 90 days after the end of the disaster’s relief 

18 coverage period. 

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

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

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

22 provided medical assistance in accordance with this 

23 section during the relief coverage period of the dis24 aster, the child shall be treated as having been born 

25 to a pregnant woman eligible for medical assistance 


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1 under the State plan (or waiver of such plan) and 

2 shall be eligible for medical assistance under such 

3 plan (or waiver) in accordance with section 

4 1902(e)(4). Notwithstanding subsection (f), the Fed5 eral medical assistance percentage determined for a 

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

7 apply to medical assistance provided during the year 

8 to a child under the State plan (or waiver) in ac9 cordance with the preceding sentence. 

10 ‘‘(5) OPTION TO PROVIDE EXTENDED MENTAL

11 HEALTH AND CARE COORDINATION BENEFITS.—A 

12 State may provide, without regard to any restric13 tions on amount, duration, scope, or comparability, 

14 or other restrictions under this title or the State 

15 plan or waiver of such plan (other than restrictions 

16 applicable to services provided in an institution for 

17 mental diseases), medical assistance to relief-eligible 

18 survivors of a disaster under this section for ex19 tended mental health and care coordination services, 

20 which may include the following: 

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

22 services (including specialized assessments for 

23 individuals with cognitive impairments). 

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

25 health medications at the dosages and freVerDate Sep 11 2014 22:13 Aug 11, 2021 Jkt 019200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S2646.IS S2646

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1 quencies prescribed by health professionals for 

2 depression, post-traumatic stress disorder, and 

3 other mental disorders. 

4 ‘‘(C) Treatment of alcohol and substance 

5 abuse determined to result from circumstances 

6 related to the disaster. 

7 ‘‘(D) Psychotherapy, rehabilitation and 

8 other treatments administered by psychiatrists, 

9 psychologists, or social workers for conditions 

10 exacerbated by, or resulting from, the disaster. 

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

12 disaster. 

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

14 crises related to the disaster. 

15 ‘‘(G) Inpatient mental health care in a 

16 general hospital. 

17 ‘‘(H) Family counseling for families where 

18 a member of the immediate family is a survivor 

19 of the disaster or a first responder to the dis20 aster or includes an individual who has died as 

21 a result of the disaster. 

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

23 health and long-term care services, arranging 

24 for (and when necessary, enrollment in waiver 

25 programs or other specialized programs) and 


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1 coordination related to, primary and specialty 

2 medical care, which may include personal care 

3 services, durable medical equipment and sup4 plies, assistive technology, and transportation. 

5 ‘‘(6) OPTION TO PROVIDE HOME AND COMMU6 NITY-BASED SERVICES.— 

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

8 medical assistance under this section for home 

9 and community-based services to a relief-eligible 

10 survivor of a disaster, including any survivor 

11 who is an individual described in subparagraph 

12 (B), who self-attests that the survivor imme13 diately requires such services, without regard to 

14 whether the survivor would require the level of 

15 care provided in a hospital, nursing facility, or 

16 intermediate care facility for the develop17 mentally disabled. 

18 ‘‘(B) INDIVIDUALS DESCRIBED.—Individ19 uals described in this subparagraph are relief20 eligible survivors of a disaster who— 

21 ‘‘(i) on any day during the week pre22 ceding the date on which the disaster is de23 clared (as described in subsection 

24 (b)(1)(A))— 


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1 ‘‘(I) had been receiving home and 

2 community-based services in a direct 

3 impact area under a waiver under sec4 tion 1115 or section 1915; 

5 ‘‘(II) had been receiving support 

6 services from a primary family care7 giver who, as a result of the disaster, 

8 is no longer available to provide serv9 ices; or 

10 ‘‘(III) had been receiving per11 sonal care, home health, or rehabilita12 tive services under a State plan under 

13 this title or under a waiver granted 

14 under sections 1115 or 1915; or 

15 ‘‘(ii) are disabled (as determined 

16 under the State plan). 

17 ‘‘(C) WAIVER OF RESTRICTIONS.—With re18 spect to the provision of home and community19 based services under this paragraph, the Sec20 retary— 

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

22 ‘‘(I) the number of individuals 

23 who may receive home or community24 based services under a waiver de25 scribed in subparagraph (B)(i)(I); 


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1 ‘‘(II) budget neutrality require2 ments applicable to such waiver; and 

3 ‘‘(III) populations eligible for 

4 services under such waiver; and 

5 ‘‘(ii) may waive any other restriction 

6 applicable under such a waiver that would 

7 prevent a State from providing home and 

8 community-based services in accordance 

9 with this paragraph. 

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

11 the Secretary an annual report that includes— 

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

13 were determined by the State to be relief-eligible 

14 survivors of a disaster in the preceding year; and 

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

16 disaster who were determined to be eligible for, and 

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

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

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

20 ‘‘(f) 100 PERCENT FEDERAL MATCHING PAY21 MENTS.— 

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

23 1905(b), the Federal medical assistance percentage 

24 shall be equal to 100 percent with respect to 

25 amounts expended by a State— 


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1 ‘‘(A) for medical assistance provided in ac2 cordance with this section to relief-eligible sur3 vivors of a disaster during the relief coverage 

4 period of the disaster and, in the case of indi5 viduals described in clause (ii) or (iii) of sub6 section (b)(5)(C), during the applicable periods 

7 described in such clauses; and 

8 ‘‘(B) that are directly attributable to ad9 ministrative activities related to the provision of 

10 medical assistance under this section, including 

11 costs attributable to obtaining recoveries under 

12 subsection (g). 

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

14 TERRITORIES.—The limitations on payment under 

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

16 apply to Federal payments under this title that are 

17 based on the Federal medical assistance percentage 

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

19 be disregarded in applying such subsections. 

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

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

22 State, as the result of verification activities con23 ducted by the State or otherwise, determines after a 

24 fair hearing that an individual has knowingly made 

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1 sistance as a relief-eligible survivor of a disaster 

2 under this section, the State shall, subject to para3 graph (2), seek recovery from the individual for the 

4 full amount of the cost of medical assistance pro5 vided to the individual under this section. 

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

7 a State from the requirement to seek recovery from 

8 an individual under paragraph (1) if the Secretary 

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

10 State to do so. 

11 ‘‘(3) REIMBURSEMENT TO THE FEDERAL GOV12 ERNMENT.—Amounts expended by a State for med13 ical assistance provided to an individual under this 

14 section that are subsequently recovered by the State 

15 under this subsection shall be treated as an overpay16 ment under this title to the extent that payments 

17 were made to the State for such amounts. 

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

19 All payments attributable to providing medical assistance 

20 to relief-eligible survivors of disasters in accordance with 

21 this section shall be disregarded for purposes of section 

22 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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•S 2646 IS

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) Other organizations that address 

9 the needs of older adults and people with 

10 disabilities. 

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

12 a State or nonprofit agency serving older adults 

13 or people with disabilities. 

14 (D) The corps operates under a plan to 

15 meet the acute and long-term services and sup16 port needs of relief-eligible survivors (as defined 

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

18 Act) of disasters, and is provided with the re19 sources necessary to execute such plan. 

20 (3) GRANTS.— 

21 (A) LIMITATION.—The Secretary may 

22 award a grant under this subsection to up to 5 

23 States. 

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

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


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1 (4) AUTHORIZATION.—There are authorized to 

2 be appropriated to carry out this subsection, 

3 $10,000,000 for each of fiscal years 2022 through 

4 2027, to remain available until expended. 

5 SEC. 4. TARGETED MEDICAID RELIEF FOR DIRECT IMPACT 

6 AREAS. 

7 (a) 100 PERCENT FEDERAL MATCHING PAYMENTS

8 FOR MEDICAL ASSISTANCE PROVIDED IN A DIRECT IM9 PACT AREA.— 

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

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

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

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

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

15 subsection: 

16 ‘‘(jj) 100 PERCENT FMAP FOR ALL MEDICAL AS17 SISTANCE PROVIDED IN DISASTER DIRECT IMPACT

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

19 medical assistance percentage for a State and fiscal year 

20 shall be equal to 100 percent with respect to amounts ex21 pended by the State during the year for medical assistance 

22 for an individual who, at the time the assistance is pro23 vided to the individual, is a resident of a direct impact 

24 area of a disaster during the disaster’s relief coverage pe25 riod (as such terms are defined in section 1948).’’. 


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1 (2) EXCLUSION OF ENHANCED PAYMENTS

2 FROM TERRITORIAL CAPS.—Notwithstanding any 

3 other provision of law, for purposes of section 1108 

4 of the Social Security Act (42 U.S.C. 1308), with re5 spect to any additional amount paid to a territory as 

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

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

8 (A) the limitation on payments to terri9 tories under subsections (f) and (g) of such sec10 tion 1108 shall not apply to such additional 

11 amounts; and 

12 (B) such additional amounts shall be dis13 regarded in applying such subsections. 

14 (3) APPLICATION TO CHIP.— 

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

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

17 amended by adding at the end the following 

18 new paragraph: 

19 ‘‘(13) 100 PERCENT MATCH FOR ASSISTANCE

20 PROVIDED IN DISASTER DIRECT IMPACT AREAS.— 

21 Notwithstanding subsection (b), the enhanced 

22 FMAP for a State, with respect to payments under 

23 subsection (a) for expenditures under the State plan 

24 for child health assistance for targeted low-income 

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1 uals who are targeted low-income women that is pro2 vided to such a child or individual who, at the time 

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

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

5 coverage period (as such terms are defined in section 

6 1948) shall be equal to 100 percent.’’. 

7 (B) ADJUSTMENT OF CHIP ALLOT8 MENTS.—Section 2104(m) of the Social Secu9 rity Act (42 U.S.C. 1397dd(m)) is amended— 

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

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

12 and 

13 (ii) by adding at the end the following 

14 new paragraph: 

15 ‘‘(13) ADJUSTING ALLOTMENTS TO ACCOUNT

16 FOR INCREASED FEDERAL PAYMENTS FOR ASSIST17 ANCE PROVIDED IN DISASTER DIRECT IMPACT

18 AREAS.—If a State (including the District of Colum19 bia and each commonwealth and territory) receives 

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

21 section 2105 for expenditures that are subject to the 

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

23 of such section— 

24 ‘‘(A) the amount of the allotment deter25 mined for the State under this subsection for 


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1 such fiscal year shall be increased by the prod2 uct of— 

3 ‘‘(i) the amount of such expenditures 

4 that the State is projected to make for 

5 such fiscal year; and 

6 ‘‘(ii) a percentage equal to 100 per7 cent reduced by a number of percentage 

8 points equal to the enhanced FMAP deter9 mined for the State and fiscal year under 

10 subsection (b) of section 2105; and 

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

12 year are available, the amount of such allot13 ment, as increased under subparagraph (A), 

14 shall be further increased or reduced, as appro15 priate, on the basis of the difference between— 

16 ‘‘(i) the amount of the increase deter17 mined under subparagraph (A); and 

18 ‘‘(ii) the product of— 

19 ‘‘(I) the actual amount of State 

20 expenditures that are subject to the 

21 enhanced FMAP specified under sec22 tion 2105(c)(13); and 

23 ‘‘(II) the percentage determined 

24 for the State under subparagraph 

25 (A)(ii).’’. 


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1 (b) MORATORIUM ON REDETERMINATIONS.—During 

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

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

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

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

6 of the disaster shall not be required to conduct eligibility 

7 redeterminations under the State’s plans or waivers of 

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

9 1396 et seq., 1397aa et seq.) with respect to individuals 

10 who reside in such area. 

11 SEC. 5. AUTHORITY TO WAIVE REQUIREMENTS DURING NA12 TIONAL EMERGENCIES WITH RESPECT TO 

13 EVACUEES FROM AN EMERGENCY AREA. 

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

15 U.S.C. 1320b–5(g)(1)) is amended— 

16 (1) by redesignating subparagraphs (A) and 

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

18 (2) by striking ‘‘An ‘emergency area’ ’’ and in19 serting the following: 

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

21 and 

22 (3) by adding at the end the following new sub23 paragraph: 

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

25 area in which the Secretary determines there are a 


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•S 2646 IS

1 significant number of evacuees from an area de2 scribed in subparagraph (A) shall also be considered 

3 to be an ‘emergency area’ for purposes of this sec4 tion.’’. 

5 SEC. 6. EXCLUSION OF DISASTER RELIEF COVERAGE PE6 RIOD IN COMPUTING MEDICARE PART B 

7 LATE ENROLLMENT PERIOD. 

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

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

10 period at the end the following: ‘‘or, in the case of an indi11 vidual who is a survivor of a disaster (as defined in para12 graph (6) of section 1948(b)), any month any part of 

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

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

15 SEC. 7. EFFECTIVE DATE. 

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

17 and the amendments made by this Act shall take effect 

18 on the date of enactment of this Act. 

19 (b) DELAY PERMITTED IF STATE LEGISLATION RE20 QUIRED.—In the case of a State plan approved under title 

21 XIX of the Social Security Act which the Secretary of 

22 Health and Human Services determines requires State 

23 legislation (other than legislation appropriating funds) in 

24 order for the plan to meet the additional requirement im25 posed by this section, the State plan shall not be regarded 


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•S 2646 IS

1 as failing to comply with the requirements of such title 

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

3 additional requirement before the 1st day of the 1st cal4 endar quarter beginning after the close of the 1st regular 

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

6 period beginning with the date of the enactment of this 

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

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

9 year of the session is deemed to be a separate regular ses10 sion of the State legislature. 

Æ 


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