II 

117TH CONGRESS 

1ST SESSION S. 2639 

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 

AUGUST 5, 2021 

Mr. SCHATZ (for himself, Mr. LUJA ́N, Mrs. SHAHEEN, Ms. WARREN, Ms. 

KLOBUCHAR, Mr. MERKLEY, Mr. HEINRICH, Mr. REED, Ms. SMITH, Ms. 

ROSEN, Ms. HIRONO, Mr. BLUMENTHAL, Mr. BOOKER, Mr. MARKEY, 

Mrs. GILLIBRAND, Mr. LEAHY, Mr. DURBIN, Mr. MURPHY, and Mr. 

WHITEHOUSE) 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 (XXII), by striking ‘‘; 

4 or’’ and inserting a semicolon; 

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

6 ‘‘or’’ at the end; and 

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

9 ‘‘(XXIV) beginning January 1, 

10 2022, 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 (tt) 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), by inserting ‘‘or subparagraph 

21 (A)(ii)(XXIV)’’ after ‘‘described in subpara22 graph (A)(i)(VIII)’’; and 

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


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1 ‘‘(tt) PREVIOUSLY UNDESCRIBED INDIVIDUALS.—In2 dividuals described in this subsection are individuals who 

3 are— 

4 ‘‘(1) described in subclause (XXIV) 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 subclause (XXIV) of subsection (a)(10)(A)(ii)’’ after 

15 ‘‘an individual described in subclause (VIII) of sub16 section (a)(10)(A)(i)’’ each 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 subsections (a)(10)(A)(i)(VIII) or 

23 (a)(10)(A)(ii)(XXIV) of section 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 such quarter which are at10 tributable to reasonable administrative expenses re11 lated to the administration of a Medicaid buy-in pro12 gram for individuals described in section 

13 1902(a)(10)(A)(ii)(XXIV); 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 (XXIV) 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)(XXIV) of section 1902 and are de12 scribed in subsection (tt) 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 8.5 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)(XXIV) 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)(XXIV) 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)(XXIV) 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)(XXIV) of section 1902 and is not de21 scribed in subsection (tt) 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)(XXIV)) 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)(XXIV),’’ 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)(XXIV) of the So4 cial Security Act (as added by this Act) shall allow 

5 individuals to enroll in such coverage through the 

6 Federal, federally facilitated, or State Exchange es7 tablished pursuant to title I of the Patient Protec8 tion and Affordable Care Act. 

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

10 the enrollment of individuals into Medicaid coverage 

11 under section 1902(a)(10)(A)(ii)(XXIV) of the So12 cial Security Act (as added by this Act) to the en13 rollment periods provided for under section 

14 1311(c)(6) of the Patient Protection and Affordable 

15 Care Act. 

16 (g) APPLICATION OF ADVANCED PREMIUM TAX

17 CREDITS TO MEDICAID BUY-IN PLANS.— 

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

19 Revenue Code of 1986 is amended— 

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

21 the end the following new sentence: 

22 ‘‘If an applicable taxpayer resides in a rating 

23 area in which no silver plan is offered on the 

24 individual market but the taxpayer buys into 

25 Medicaid coverage under section 


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1 1902(a)(10)(A)(ii)(XXIV) of the Social Secu2 rity Act, such Medicaid coverage shall be 

3 deemed to be the applicable second lowest cost 

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

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

6 subsection: 

7 ‘‘(h) APPLICATION TO INDIVIDUALS PURCHASING

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

9 buys into Medicaid coverage under section 

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

11 section shall be applied with the following modifications: 

12 ‘‘(1) The amount determined under subsection 

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

14 monthly premiums paid for such coverage. 

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

16 treating coverage under the Medicaid program under 

17 title XIX of the Social Security Act in the same 

18 manner as a qualified health plan that was enrolled 

19 in through an Exchange. 

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

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

22 to be eligible for minimum essential coverage 

23 described in section 5000A(f)(1)(A)(ii) by rea24 son of eligibility for medical assistance under a 


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1 State Medicaid program under section 

2 1902(a)(10)(A)(ii)(XXIV); and 

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

4 minimum essential coverage described in section 

5 5000A(f)(1)(B) shall not be considered to be el6 igible for such coverage.’’. 

7 (2) ADVANCED PAYMENT OF CREDIT.— 

8 (A) IN GENERAL.—The Secretary of 

9 Health and Human Services, in consultation 

10 with the Secretary of the Treasury, shall estab11 lish a program under which— 

12 (i) upon request of a State agency ad13 ministering a State Medicaid program 

14 under title XIX of the Social Security Act, 

15 advance determinations are made in a 

16 manner similar to advanced determinations 

17 under section 1412 of the Patient Protec18 tion and Affordable Care Act with respect 

19 to the income eligibility of individuals en20 rolling in such program for the premium 

21 tax credit allowable under section 36B of 

22 the Internal Revenue Code of 1986 and 

23 the cost-sharing reductions under section 

24 1402 of the Patient Protection and Afford25 able Care Act; 


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1 (ii) the Secretary notifies— 

2 (I) the State agency admin3 istering the program and the Sec4 retary of the Treasury of the advance 

5 determinations; and 

6 (II) the Secretary of the Treas7 ury of the name and employer identi8 fication number of each employer with 

9 respect to whom 1 or more employees 

10 of the employer were determined to be 

11 eligible for the premium tax credit 

12 under section 36B of the Internal 

13 Revenue Code of 1986 and the cost14 sharing reductions under section 1402 

15 of the Patient Protection and Afford16 able Care Act because— 

17 (aa) the employer did not 

18 provide minimum essential cov19 erage; or 

20 (bb) the employer provided 

21 such minimum essential coverage 

22 but it was determined under sec23 tion 36B(c)(2)(C) of such Code 

24 to either be unaffordable to the 

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1 quired minimum actuarial value; 

2 and 

3 (iii) the Secretary of the Treasury 

4 makes advance payments of such credit or 

5 reductions to the State agency admin6 istering the program in order to reduce the 

7 premiums payable by individuals eligible 

8 for such credit. 

9 (B) DETERMINATIONS AND PAYMENTS.— 

10 Rules similar to subsections (b) and (c) of sec11 tion 1412 of the Patient Protection and Afford12 able Care Act shall apply for purposes of this 

13 subsection. 

14 (C) COORDINATION WITH CREDIT.— 

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

16 Internal Revenue Code of 1986 is amended 

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

18 the State Public Option Act’’ after ‘‘sec19 tion 1412 of the Patient Protection and 

20 Affordable Care Act’’ each place it appears 

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

22 (ii) INFORMATION REPORTING.—Sec23 tion 36B(f)(3) of such Code is amended by 

24 adding at the end the following flush sen25 tence: ‘‘In the case of any coverage under 


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1 the Medicaid program under title XIX of 

2 the Social Security Act for which a credit 

3 under this section is allowable by reason of 

4 subsection (h), the State agency admin5 istering the Medicaid program shall be 

6 treated as an Exchange for purposes of 

7 this paragraph and subparagraph (A) shall 

8 not apply.’’. 

9 (3) CONFORMING AMENDMENT RELATING TO

10 EMPLOYER RESPONSIBILITY.—Paragraph (6) of sec11 tion 4980H(c) of the Internal Revenue Code of 1986 

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

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

14 health plan’ shall include any plan described in sec15 tion 36B(h)’’ after ‘‘such Act’’. 

16 (h) CONFORMING AMENDMENTS.— 

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

18 Act (42 U.S.C. 1396a(a)(10)), as amended by sub19 section (a), is further amended, in the matter fol20 lowing subparagraph (G)— 

21 (A) by striking ‘‘and (XVIII)’’ and insert22 ing ‘‘, (XVIII)’’; and 

23 (B) by inserting ‘‘, and (XIX) the medical 

24 assistance made available to an individual de25 scribed in subparagraph (A)(ii)(XXIV) shall be 


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1 limited to medical assistance described in sub2 section (k)(1)’’ before the semicolon. 

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

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

5 ‘‘1902(a)(10)(A)(ii)(XXIV),’’ after 

6 ‘‘1902(a)(10)(A)(ii)(XXII),’’. 

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

8 (42 U.S.C. 1396d(a)) is amended, in the matter pre9 ceding paragraph (1)— 

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

11 (xvi); 

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

13 (xvii); and 

14 (C) by inserting after clause (xvii) the fol15 lowing new clause: 

16 ‘‘(xviii) individuals described in section 

17 1902(a)(10)(A)(ii)(XXIV),’’. 

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

19 Act (42 U.S.C. 1396o–1(a)(1)) is amended by strik20 ing ‘‘or (j)’’ and inserting ‘‘(j), or (k)’’. 

21 (5) Section 1937(a)(1)(B) of the Social Secu22 rity Act (42 U.S.C. 1396u–7(a)(1)(B)) is amended 

23 by inserting ‘‘, subclause (XXIV) of section 

24 1902(a)(10)(A)(ii),’’ after ‘‘1902(a)(10)(A)(i)’’. 


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1 SEC. 3. DEVELOPMENT OF STATE-LEVEL METRICS ON MED2 ICAID BENEFICIARY ACCESS AND SATISFAC3 TION. 

4 (a) IN GENERAL.— 

5 (1) DEVELOPMENT OF METRICS.—Not later 

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

7 the Director of the Agency for Healthcare Research 

8 and Quality, in consultation with State Medicaid Di9 rectors, shall develop standardized, State-level 

10 metrics of access to, and satisfaction with, providers, 

11 including primary care and specialist providers, with 

12 respect to individuals who are enrolled in State Med13 icaid plans under title XIX of the Social Security 

14 Act. 

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

16 Healthcare Research and Quality shall develop the 

17 metrics described in paragraph (1) through a public 

18 process, which shall provide opportunities for stake19 holders to participate. 

20 (b) UPDATING METRICS.—The Director of the Agen21 cy for Healthcare Research and Quality, in consultation 

22 with the Deputy Administrator for the Center for Med23 icaid and CHIP Services and State Medicaid Directors, 

24 shall update the metrics developed under subsection (a) 

25 not less than once every 3 years. 


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1 (c) STATE IMPLEMENTATION FUNDING.—The Direc2 tor of the Agency for Healthcare Research and Quality 

3 may award funds, from the amount appropriated under 

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

5 the metrics developed under this section. 

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

7 Director of the Agency for Healthcare Research and Qual8 ity, out of any funds in the Treasury not otherwise appro9 priated, $200,000,000 for fiscal year 2022, to remain 

10 available until expended, for the purpose of carrying out 

11 this section. 

12 SEC. 4. RENEWAL OF APPLICATION OF MEDICARE PAY13 MENT RATE FLOOR TO PRIMARY CARE SERV14 ICES FURNISHED UNDER MEDICAID AND IN15 CLUSION OF ADDITIONAL PROVIDERS. 

16 (a) RENEWAL OF PAYMENT FLOOR; ADDITIONAL

17 PROVIDERS.— 

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

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

20 amended by striking subparagraph (C) and inserting 

21 the following: 

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

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

24 less than 100 percent of the payment rate that 

25 applies to such services and physician under 


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1 part B of title XVIII (or, if greater, the pay2 ment rate that would be applicable under such 

3 part if the conversion factor under section 

4 1848(d) for the year involved were the conver5 sion factor under such section for 2009), and 

6 that is not less than the rate that would other7 wise apply to such services under this title if 

8 the rate were determined without regard to this 

9 subparagraph, and that are— 

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

11 physician with a primary specialty designa12 tion of family medicine, general internal 

13 medicine, or pediatric medicine; or 

14 ‘‘(ii) furnished in the period that be15 gins on the first day of the first month 

16 that begins after the date of enactment of 

17 the State Public Option Act— 

18 ‘‘(I) by a physician with a pri19 mary specialty designation of family 

20 medicine, general internal medicine, 

21 or pediatric medicine, but only if the 

22 physician self-attests that the physi23 cian is Board certified in family medi24 cine, general internal medicine, or pe25 diatric medicine; 


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1 ‘‘(II) by a physician with a pri2 mary specialty designation of obstet3 rics and gynecology, but only if the 

4 physician self-attests that the physi5 cian is Board certified in obstetrics 

6 and gynecology; 

7 ‘‘(III) by an advanced practice 

8 clinician, as defined by the Secretary, 

9 that works under the supervision of— 

10 ‘‘(aa) a physician that satis11 fies the criteria specified in sub12 clause (I) or (II); or 

13 ‘‘(bb) a nurse practitioner or 

14 a physician assistant (as such 

15 terms are defined in section 

16 1861(aa)(5)(A)) who is working 

17 in accordance with State law, or 

18 a certified nurse-midwife (as de19 fined in section 1861(gg)) who is 

20 working in accordance with State 

21 law; 

22 ‘‘(IV) by a rural health clinic, 

23 federally qualified health center, or 

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1 ble to a physician, a nurse practi2 tioner or a physician assistant (as 

3 such terms are defined in section 

4 1861(aa)(5)(A)) who is working in ac5 cordance with State law, or a certified 

6 nurse-midwife (as defined in section 

7 1861(gg)) who is working in accord8 ance with State law, for services fur9 nished by a physician, nurse practi10 tioner, physician assistant, or certified 

11 nurse-midwife, or services furnished 

12 by an advanced practice clinician su13 pervised by a physician described in 

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

15 advanced practice clinician, or a cer16 tified nurse-midwife; or 

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

18 physician assistant (as such terms are 

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

20 who is working in accordance with 

21 State law, or a certified nurse-midwife 

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

23 is working in accordance with State 

24 law, in accordance with procedures 

25 that ensure that the portion of the 


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1 payment for such services that the 

2 nurse practitioner, physician assist3 ant, or certified nurse-midwife is paid 

4 is not less than the amount that the 

5 nurse practitioner, physician assist6 ant, or certified nurse-midwife would 

7 be paid if the services were provided 

8 under part B of title XVIII;’’. 

9 (2) CONFORMING AMENDMENTS.—Section 

10 1905(dd) of the Social Security Act (42 U.S.C. 

11 1396d(dd)) is amended— 

12 (A) by striking ‘‘Notwithstanding’’ and in13 serting the following: 

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

15 (B) by inserting ‘‘or furnished during the 

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

17 after ‘‘2015,’’; and 

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

19 ‘‘(2) ADDITIONAL PERIOD.—For purposes of 

20 paragraph (1), the additional period specified in this 

21 paragraph is the period that begins on the first day 

22 of the first month that begins after the date of en23 actment of the State Public Option Act.’’. 


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1 (b) IMPROVED TARGETING OF PRIMARY CARE.—Sec2 tion 1902(jj) of the Social Security Act (42 U.S.C. 

3 1396a(jj)) is amended— 

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

5 subparagraphs (A) and (B), respectively and realign6 ing the left margins accordingly; 

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

8 the following: 

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

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

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

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

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

14 emergency department of a hospital.’’. 

15 (c) ENSURING PAYMENT BY MANAGED CARE ENTI16 TIES.— 

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

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

19 is amended— 

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

21 the semicolon; 

22 (B) in clause (xiii)— 

23 (i) by realigning the left margin so as 

24 to align with the left margin of clause (xii); 

25 and 


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1 (ii) by striking the period at the end 

2 of clause (xiii) and inserting ‘‘; and’’; and 

3 (C) by inserting after clause (xiii) the fol4 lowing: 

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

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

7 primary care services defined in section 1902(jj) 

8 that are furnished during a year or period specified 

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

10 at least equal to the amounts set forth and required 

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

12 upon request, provide documentation to the State, 

13 sufficient to enable the State and the Secretary to 

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

15 Secretary shall approve payments described in sub16 clause (I) that are furnished through an agreed 

17 upon capitation, partial capitation, or other value18 based payment arrangement if the capitation, partial 

19 capitation, or other value-based payment arrange20 ment is based on a reasonable methodology and the 

21 entity provides documentation to the State sufficient 

22 to enable the State and the Secretary to ensure com23 pliance with subclause (I).’’. 

24 (2) CONFORMING AMENDMENT.—Section 

25 1932(f) of the Social Security Act (42 U.S.C. 


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1 1396u–2(f)) is amended by inserting ‘‘and clause 

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

3 SEC. 5. INCREASED FMAP FOR MEDICAL ASSISTANCE TO 

4 NEWLY ELIGIBLE INDIVIDUALS. 

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

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

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

8 2015, and 2016’’ and inserting ‘‘each of the first 3 

9 consecutive 12-month periods in which the State 

10 provides medical assistance to newly eligible individ11 uals’’; 

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

13 and inserting ‘‘the fourth consecutive 12-month pe14 riod in which the State provides medical assistance 

15 to newly eligible individuals’’; 

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

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

18 in which the State provides medical assistance to 

19 newly eligible individuals’’; 

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

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

22 in which the State provides medical assistance to 

23 newly eligible individuals’’; and 

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

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


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1 consecutive 12-month period in which the State pro2 vides medical assistance to newly eligible individuals 

3 and each such period thereafter’’. 

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

5 subsection (a) shall take effect as if included in the enact6 ment of Public Law 111–148. 

7 SEC. 6. MEDICAID COVERAGE OF COMPREHENSIVE REPRO8 DUCTIVE HEALTH CARE SERVICES. 

9 (a) INCLUSION OF COMPREHENSIVE REPRODUCTIVE

10 HEALTH CARE SERVICES AS MEDICAL ASSISTANCE.— 

11 Section 1905(a) of the Social Security Act (42 U.S.C. 

12 1396d(a)), as amended by section 2(h), is further amend13 ed— 

14 (1) in paragraph (30), by striking ‘‘and’’ at the 

15 end; 

16 (2) by redesignating paragraph (31) as para17 graph (32); and 

18 (3) by inserting after paragraph (30) the fol19 lowing new paragraph: 

20 ‘‘(31) comprehensive reproductive health care 

21 services, including abortion services and abortion-re22 lated services; and’’. 

23 (b) REQUIRING COVERAGE OF COMPREHENSIVE RE24 PRODUCTIVE HEALTH CARE SERVICES AS CONDITION OF

25 STATE PLAN APPROVAL.—Section 1902(a)(10)(A) of the 


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1 Social Security Act (42 U.S.C. 1396a(a)(10)(A)), as 

2 amended by subsections (a) and (h) of section 2, is further 

3 amended, in the matter preceding clause (i), by striking 

4 ‘‘and (30)’’ and inserting ‘‘(30), and (31)’’. 

5 (c) CONFORMING AMENDMENT.—Section 

6 1932(e)(1)(B) of the Social Security Act (42 U.S.C. 

7 1396u–2(e)(1)(B)) is amended by striking ‘‘Clause (i)’’ 

8 and inserting ‘‘With respect to the period beginning before 

9 January 1, 2023, clause (i)’’. 

10 (d) EFFECTIVE DATE.—The amendments made by 

11 this section shall apply with respect to medical assistance 

12 furnished on or after January 1, 2023. 

Æ 


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