I 

117TH CONGRESS 

1ST SESSION H. R. 1353 

To amend title XIX of the Social Security Act to increase Federal support 

to State Medicaid programs during economic downturns, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 25, 2021 

Mrs. LEE of Nevada (for herself, Mr. HORSFORD, Mr. VARGAS, Mr. GRIJALVA, Ms. TITUS, Ms. MOORE of Wisconsin, Ms. BARRAGA ́N, Ms. 

WASSERMAN SCHULTZ, Ms. UNDERWOOD, Mr. CARSON, Mr. SAN NICOLAS, Ms. NORTON, Mr. COHEN, Ms. TLAIB, Mrs. HAYES, Mr. THOMPSON

of Mississippi, Mr. EVANS, Mr. HASTINGS, Ms. DEAN, Mr. JONES, Mr. 

LARSON of Connecticut, Mr. GARCI ́A of Illinois, Ms. CRAIG, Ms. SCHAKOWSKY, Mr. SMITH of Washington, Ms. CHU, Ms. MCCOLLUM, Mr. 

PETERS, Mr. DANNY K. DAVIS of Illinois, Mrs. WATSON COLEMAN, Ms. 

SHERRILL, Ms. DELBENE, Ms. SEWELL, Ms. WILD, Mr. SCHIFF, Ms. 

KUSTER, Ms. LOIS FRANKEL of Florida, Mr. RYAN, Mr. MEEKS, Ms. 

PORTER, Mrs. BEATTY, Mrs. DINGELL, Ms. SCHRIER, Mr. BERA, Ms. 

DELAURO, Mr. KILMER, Mr. SUOZZI, Mr. NEGUSE, and Mr. RUIZ) 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 increase 

Federal support to State Medicaid programs during economic downturns, 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, 


pamtmann on DSKBC07HB2PROD with BILLS
2 

•HR 1353 IH

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Coronavirus Medicaid 

3 Response Act’’. 

4 SEC. 2. INCREASING FEDERAL SUPPORT TO STATE MED5 ICAID PROGRAMS DURING ECONOMIC 

6 DOWNTURNS. 

7 (a) IN GENERAL.—Section 1905 of the Social Secu8 rity Act (42 U.S.C. 1396d) is amended— 

9 (1) in subsection (b), by striking ‘‘and (ff)’’ and 

10 inserting ‘‘(ff), and (hh)’’; and 

11 (2) by adding at the end the following new sub12 section: 

13 ‘‘(hh) INCREASED FMAP DURING ECONOMIC

14 DOWNTURNS.— 

15 ‘‘(1) IN GENERAL.—If a fiscal quarter that be16 gins on or after January 1, 2020, is an economic 

17 downturn quarter (as defined in paragraph (2)) with 

18 respect to a State, then the Federal medical assist19 ance percentage determined for the State and quar20 ter under subsection (b) shall be equal to the per21 centage determined for the State and quarter under 

22 paragraph (3). 

23 ‘‘(2) ECONOMIC DOWNTURN QUARTER.— 

24 ‘‘(A) IN GENERAL.— 

25 ‘‘(i) IN GENERAL.—In this subsection, 

26 the term ‘economic downturn quarter’ 


pamtmann on DSKBC07HB2PROD with BILLS
3 

•HR 1353 IH

1 means, with respect to a State, a fiscal 

2 quarter during which the State’s unem3 ployment rate for the quarter exceeds the 

4 percentage determined for the State and 

5 quarter under clause (ii). 

6 ‘‘(ii) THRESHOLD PERCENTAGE.—The 

7 percentage determined under this clause 

8 for a State and fiscal quarter is the per9 centage equal to the lower of— 

10 ‘‘(I) the State unemployment 

11 rate at the 20th percentile of the dis12 tribution of the State’s quarterly un13 employment rates for the 60-quarter 

14 period preceding the quarter involved, 

15 increased by 1 percentage point; and 

16 ‘‘(II) the State’s average quar17 terly unemployment rate for the 12- 

18 quarter period preceding the quarter 

19 involved, increased by 1 percentage 

20 point. 

21 ‘‘(B) UNEMPLOYMENT DATA.— 

22 ‘‘(i) IN GENERAL.—Except as pro23 vided in clause (ii), for purposes of deter24 mining unemployment rates for a State 

25 and a quarter under this paragraph, the 


pamtmann on DSKBC07HB2PROD with BILLS
4 

•HR 1353 IH

1 Secretary shall use data from the Local 

2 Area Unemployment Statistics from the 

3 Bureau of Labor Statistics. 

4 ‘‘(ii) APPLICATION TO CERTAIN TER5 RITORIES.—In the case of the Virgin Is6 lands, Guam, the Northern Mariana Is7 lands, American Samoa, or any other juris8 diction for which suitable data from the 

9 Local Area Unemployment Statistics from 

10 the Bureau of Labor Statistics are unavail11 able, the Secretary shall use data from the 

12 U–3 unemployment measure of the Bureau 

13 of Labor Statistics to make any necessary 

14 determinations under subparagraph (A). 

15 ‘‘(3) INCREASED FMAP DURING ECONOMIC

16 DOWNTURN QUARTER.— 

17 ‘‘(A) IN GENERAL.—During a fiscal quar18 ter that is an economic downturn quarter with 

19 respect to a State, the Federal medical assist20 ance percentage for the State and quarter de21 termined under subsection (b) shall be equal 

22 to— 

23 ‘‘(i) the Federal medical assistance 

24 percentage determined for the State and 

25 quarter under subsection (b) without reVerDate Sep 11 2014 20:52 Mar 23, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1353.IH H1353

pamtmann on DSKBC07HB2PROD with BILLS
5 

•HR 1353 IH

1 gard to this subsection (but including any 

2 increase to such percentage for such quar3 ter made pursuant to section 6008(a) of 

4 the Families First Coronavirus Response 

5 Act); increased by 

6 ‘‘(ii) the number of percentage points 

7 (rounded to the nearest tenth of a percent8 age point) equal to the product of— 

9 ‘‘(I) the number of percentage 

10 points (rounded to the nearest tenth 

11 of a percentage point) by which the 

12 unemployment rate for the State and 

13 quarter exceeds the percentage deter14 mined for the State and quarter 

15 under paragraph (2)(A)(ii); and 

16 ‘‘(II) 4.8. 

17 ‘‘(B) RULES OF APPLICATION.—The fol18 lowing rules shall apply with respect to the Fed19 eral medical assistance percentage determined 

20 for a State and an economic downturn quarter 

21 under this subsection: 

22 ‘‘(i) SCOPE OF APPLICATION.—Such 

23 Federal medical assistance percentage shall 

24 not apply for purposes of— 


pamtmann on DSKBC07HB2PROD with BILLS
6 

•HR 1353 IH

1 ‘‘(I) disproportionate share hos2 pital payments described in section 

3 1923; 

4 ‘‘(II) payments under part D of 

5 title IV; or 

6 ‘‘(III) any payments under this 

7 title that are based on a Federal med8 ical assistance percentage determined 

9 for a State under subsection (aa) (but 

10 only to the extent that such Federal 

11 medical assistance percentage is high12 er than the economic recovery 

13 FMAP). 

14 ‘‘(ii) LIMITATION.—In no case shall— 

15 ‘‘(I) the Federal medical assist16 ance percentage determined for a 

17 State and quarter pursuant to this 

18 subsection exceed 95 percent; or 

19 ‘‘(II) any increase to the Federal 

20 medical assistance percentage deter21 mined for a State and quarter pursu22 ant to this subsection result in the ap23 plication of a Federal medical assist24 ance percentage that exceeds 95 per25 cent. 


pamtmann on DSKBC07HB2PROD with BILLS
7 

•HR 1353 IH

1 ‘‘(iii) APPLICATION TO CHIP.—Not2 withstanding the first sentence of section 

3 2105(b), the application of this subsection 

4 may result in the enhanced FMAP of a 

5 State for a fiscal year under such section 

6 exceeding 85 percent, but in no case may 

7 the application of this subsection before 

8 application of the second sentence of such 

9 section result in the enhanced FMAP of 

10 the State exceeding 95 percent. 

11 ‘‘(4) ADVANCE PAYMENT; RETROSPECTIVE AD12 JUSTMENT.— 

13 ‘‘(A) IN GENERAL.—Prior to the beginning 

14 of each fiscal quarter that begins on or after 

15 July 1, 2020, the Secretary shall, with respect 

16 to each State— 

17 ‘‘(i) make an initial determination, 

18 based on the projections made for the 

19 State and quarter under subparagraph 

20 (B), as to— 

21 ‘‘(I) whether the application of 

22 this subsection is expected to result in 

23 the application of a higher Federal 

24 medical assistance percentage for the 

25 State and quarter than the percentage 


pamtmann on DSKBC07HB2PROD with BILLS
8 

•HR 1353 IH

1 that would otherwise apply without re2 gard to this subsection; and— 

3 ‘‘(II) if the application of this 

4 subsection is expected to result in 

5 such a higher Federal medical assist6 ance percentage for the State and 

7 quarter, what such higher percentage 

8 is expected to be; and 

9 ‘‘(ii) if the Secretary determines under 

10 clause (i) that the application of this sub11 section is expected to result in the applica12 tion of a higher Federal medical assistance 

13 percentage for the State and quarter than 

14 the percentage that would otherwise apply 

15 without regard to this subsection— 

16 ‘‘(I) apply such higher Federal 

17 medical assistance percentage of the 

18 State for purposes of making pay19 ments to the State for amounts ex20 pended during such quarter as med21 ical assistance under the State plan; 

22 and 

23 ‘‘(II) take into account such 

24 higher Federal medical assistance per25 centage of the State for purposes of 


pamtmann on DSKBC07HB2PROD with BILLS
9 

•HR 1353 IH

1 calculating the enhanced FMAP for 

2 the State and quarter under section 

3 2105(b). 

4 ‘‘(B) PROJECTION OF STATE UNEMPLOY5 MENT RATES.—Prior to the beginning of each 

6 fiscal quarter that begins on or after July 1, 

7 2020, the Secretary, acting through the Chief 

8 Actuary of the Centers for Medicare & Medicaid 

9 Services, shall, using the most recently available 

10 data described in paragraph (2)(B), make pro11 jections with respect to— 

12 ‘‘(i) the unemployment rates for each 

13 State for such quarter; 

14 ‘‘(ii) the threshold percentages de15 scribed in paragraph (2)(A)(ii) for each 

16 State for such quarter; and 

17 ‘‘(iii) the national unemployment rate 

18 for such quarter. 

19 ‘‘(C) RETROSPECTIVE ADJUSTMENT.—As 

20 soon as practicable after final unemployment 

21 data becomes available for a fiscal quarter that 

22 begins on or after July 1, 2020, the Secretary 

23 shall, with respect to each State— 

24 ‘‘(i) make a final determination with 

25 respect to the application of this subsection 


pamtmann on DSKBC07HB2PROD with BILLS
10 

•HR 1353 IH

1 for purposes of determining the Federal 

2 medical assistance percentage and en3 hanced FMAP of the State for the quarter; 

4 and 

5 ‘‘(ii) in accordance with section 

6 1903(d)(2) and section 2105(e), reduce or 

7 increase the amount payable to the State 

8 under section 1903(a) or section 2105 for 

9 a subsequent fiscal quarter to the extent of 

10 any overpayment or underpayment under 

11 either such section which the Secretary de12 termines was made as a result of an incor13 rect initial determination under subpara14 graph (A)(i) with respect to the application 

15 of this subsection for purposes of deter16 mining the Federal medical assistance per17 centage and enhanced FMAP of the State 

18 for such prior fiscal quarter. 

19 ‘‘(5) RETROSPECTIVE APPLICATION OF OVER20 THE-LIMIT FMAP INCREASES.— 

21 ‘‘(A) IN GENERAL.—If a State has excess 

22 percentage points with respect to an economic 

23 downturn quarter and an applicable FMAP (as 

24 determined under subparagraph (B)), the State 

25 may elect to apply such excess percentage 


pamtmann on DSKBC07HB2PROD with BILLS
11 

•HR 1353 IH

1 points to increase such applicable FMAP for 

2 one or more quarters during the look-back pe3 riod for the State and economic downturn quar4 ter in accordance with this paragraph. 

5 ‘‘(B) EXCESS PERCENTAGE POINTS.—For 

6 purposes of this paragraph, the number of ex7 cess percentage points for a State, economic 

8 downturn quarter, and an applicable FMAP 

9 shall be equal to the number of percentage 

10 points by which— 

11 ‘‘(i) the applicable FMAP for the 

12 State and quarter (after application of 

13 paragraph (3) but without regard to sub14 paragraph (B)(ii) of such paragraph); ex15 ceeds 

16 ‘‘(ii) 95 percent. 

17 ‘‘(C) EFFECT OF APPLICATION OF EXCESS

18 PERCENTAGE POINTS.—If a State elects to 

19 apply excess percentage points to an applicable 

20 FMAP to a quarter during a look-back period 

21 under this paragraph, the Secretary shall deter22 mine the additional amount of payment under 

23 section 1903(a) to which the State would have 

24 been entitled for such quarter if the applicable 

25 FMAP (as so increased) had been in effect for 


pamtmann on DSKBC07HB2PROD with BILLS
12 

•HR 1353 IH

1 such quarter, and shall treat such additional 

2 amount as an underpayment for such quarter. 

3 ‘‘(D) DISTRIBUTION OF EXCESS PERCENT4 AGE POINTS.—A State that has excess percent5 age points with respect to an economic down6 turn quarter and applicable FMAP may elect to 

7 divide such points among more than 1 quarter 

8 during the look-back period for such State and 

9 quarter provided that no excess percentage 

10 point (or fraction of an excess percentage point) 

11 is applied to the applicable FMAP of more than 

12 1 quarter. 

13 ‘‘(E) LIMITATIONS.— 

14 ‘‘(i) NO INCREASES OVER 100 PER15 CENT.—A State may not increase an appli16 cable FMAP for any quarter during a look17 back period under this paragraph if such 

18 increase would result in the applicable 

19 FMAP for such quarter exceeding 100 per20 cent. 

21 ‘‘(ii) SCOPE OF APPLICATION.—Any 

22 increase to an applicable FMAP of a State 

23 for a fiscal quarter under this paragraph— 

24 ‘‘(I) shall only apply with respect 

25 to payments for amounts expended by 


pamtmann on DSKBC07HB2PROD with BILLS
13 

•HR 1353 IH

1 the State for medical assistance for 

2 services furnished during such quarter 

3 to which such applicable FMAP is ap4 plicable; and 

5 ‘‘(II) shall not apply with respect 

6 to payments described in paragraph 

7 (3)(B)(i). 

8 ‘‘(F) DEFINITIONS.—In this paragraph: 

9 ‘‘(i) APPLICABLE FMAP.—The term 

10 ‘applicable FMAP’ means, with respect to 

11 a State and fiscal quarter— 

12 ‘‘(I) the Federal medical assist13 ance percentage determined for the 

14 State and quarter under subsection 

15 (b); 

16 ‘‘(II) the Federal medical assist17 ance percentage applicable under sub18 section (y); 

19 ‘‘(III) the Federal medical assist20 ance percentage applicable under sub21 section (z)(2); 

22 ‘‘(IV) the Federal medical assist23 ance percentage determined for the 

24 State and quarter under subsection 

25 (ff); or 


pamtmann on DSKBC07HB2PROD with BILLS
14 

•HR 1353 IH

1 ‘‘(V) the enhanced FMAP deter2 mined for the State and quarter 

3 under section 2105(b). 

4 ‘‘(ii) LOOK-BACK PERIOD.—The term 

5 ‘look-back period’ means, with respect to a 

6 State and a fiscal quarter that is an eco7 nomic downturn quarter for the State, the 

8 period of 4 fiscal quarters that ends with 

9 the fourth quarter which precedes the most 

10 recent fiscal quarters that was not an eco11 nomic downturn quarter for the State. 

12 ‘‘(6) REQUIREMENT FOR ALL STATES.—This 

13 subsection shall not apply to a State with respect to 

14 a fiscal quarter, if— 

15 ‘‘(A) eligibility standards, methodologies, 

16 or procedures under the State plan or a waiver 

17 of such plan are more restrictive during such 

18 quarter than the eligibility standards, meth19 odologies, or procedures, respectively, under 

20 such plan (or waiver) as in effect on the last 

21 day of the most recent fiscal quarter that was 

22 not an economic downturn quarter for the 

23 State; 

24 ‘‘(B) the amount of any premium imposed 

25 by the State pursuant to section 1916 or 1916A 


pamtmann on DSKBC07HB2PROD with BILLS
15 

•HR 1353 IH

1 during such quarter, with respect to an indi2 vidual enrolled under such plan (or waiver), ex3 ceeds the amount of such premium as of the 

4 date described in subparagraph (A); or 

5 ‘‘(C) the State fails to provide that an in6 dividual who is enrolled for benefits under such 

7 plan (or waiver) as of the date described in sub8 paragraph (A) or enrolls for benefits under 

9 such plan (or waiver) during the period begin10 ning with such date and ending with the day 

11 before the first day of the next quarter that is 

12 not an economic downturn quarter for the State 

13 shall be treated as eligible for such benefits for 

14 not less than 12 months after such date or (if 

15 later) the date that such individual so enrolls 

16 unless the individual requests a voluntary ter17 mination of eligibility or the individual ceases to 

18 be a resident of the State.’’. 

19 (b) EXCLUSION OF ECONOMIC DOWNTURN FMAP 

20 INCREASES FROM TERRITORIAL CAPS; SPECIAL RULE

21 FOR CHIP ALLOTMENTS.— 

22 (1) EXCLUSION FROM TERRITORIAL CAPS.— 

23 Section 1108 of the Social Security Act (42 U.S.C. 

24 1308) is amended— 


pamtmann on DSKBC07HB2PROD with BILLS
16 

•HR 1353 IH

1 (A) in subsection (f), in the matter pre2 ceding paragraph (1), by striking ‘‘subsection 

3 (g) and section 1935(e)(1)(B)’’ and inserting 

4 ‘‘subsections (g) and (h) and section 

5 1935(e)(1)(B)’’; and 

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

7 ‘‘(h) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB8 UTABLE TO ECONOMIC DOWNTURN FMAP.—Any pay9 ment made to a territory for a fiscal year in which the 

10 Federal medical assistance percentage for the territory is 

11 determined under section 1905(hh) shall not be taken into 

12 account for purposes of applying payment limits under 

13 subsections (f) and (g) to the extent that such payment 

14 exceeds the amount of the payment that would have been 

15 made to the territory for the year if the Federal medical 

16 assistance percentage for the territory had been deter17 mined without regard to such section.’’. 

18 (2) CHIP ALLOTMENTS.—Section 2104(m) of 

19 the Social Security Act (42 U.S.C. 1397dd(m)) is 

20 amended— 

21 (A) in paragraph (2)(B), in the matter 

22 preceding clause (i), by striking ‘‘paragraphs 

23 (5) and (7)’’ and inserting ‘‘paragraphs (5), 

24 (7), and (12)’’; and 


pamtmann on DSKBC07HB2PROD with BILLS
17 

•HR 1353 IH

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

2 paragraph: 

3 ‘‘(12) SPECIAL RULE FOR ADJUSTING ALLOT4 MENTS DURING FISCAL YEARS WITH ECONOMIC

5 DOWNTURN QUARTERS.— 

6 ‘‘(A) IN GENERAL.—If a fiscal quarter oc7 curring during fiscal year 2020 or any suc8 ceeding fiscal year is determined to be an eco9 nomic downturn quarter with respect to a State 

10 (as determined under section 1905(hh)) then, 

11 as soon as practicable after such determination, 

12 the Secretary shall increase the allotment for 

13 the State and fiscal year in accordance with 

14 subparagraph (B). 

15 ‘‘(B) AMOUNT OF INCREASE.— 

16 ‘‘(i) IN GENERAL.—The amount of an 

17 increase to the allotment of a State de18 scribed in subparagraph (A) for a fiscal 

19 year shall be equal to the amount by which 

20 Federal payments made to the State for 

21 the preceding fiscal year under this title 

22 would have been increased (without regard 

23 to whether such payments would exceed 

24 the amount of the State’s allotment for 

25 such preceding fiscal year) if the enhanced 


pamtmann on DSKBC07HB2PROD with BILLS
18 

•HR 1353 IH

1 FMAP determined for the State for such 

2 preceding fiscal year had been increased to 

3 the same extent that the State’s enhanced 

4 FMAP for the fiscal year involved is ex5 pected to be increased as a result of the 

6 application of section 1905(hh) relative to 

7 the enhanced FMAP that would apply to 

8 the State for the fiscal year involved with9 out the application of such section. 

10 ‘‘(ii) INCLUSION OF PROJECTED IN11 CREASES.—In increasing the allotment of a 

12 State for a fiscal year under this para13 graph, the Secretary may base the calcula14 tion of such increase on projections made 

15 by the Secretary with respect to— 

16 ‘‘(I) the number of fiscal quar17 ters during such fiscal year that will 

18 be economic downturn quarters; and 

19 ‘‘(II) the effect that the applica20 tion of section 1905(hh) is expected to 

21 have on the enhanced FMAP of the 

22 State for such fiscal year. 

23 ‘‘(C) DISREGARD OF INCREASED PAY24 MENTS FOR PURPOSES OF FUTURE ALLOT25 MENTS.—Any Federal payment made to a State 


pamtmann on DSKBC07HB2PROD with BILLS
19 

•HR 1353 IH

1 under this title for a fiscal year in which the 

2 Federal medical assistance percentage for the 

3 State is determined under section 1905(hh) 

4 shall be disregarded when determining the allot5 ment of the State for any subsequent year, in6 cluding for purposes of applying this paragraph, 

7 to the extent that such payment exceeds the 

8 amount of the payment that would have been 

9 made to the State for the year if the Federal 

10 medical assistance percentage for the State and 

11 year had been determined without regard to 

12 such section.’’. 

13 (c) CONFORMING AMENDMENTS.—Section 1905(cc) 

14 of the Social Security Act (42 U.S.C. 1396d(cc)) is 

15 amended— 

16 (1) by striking ‘‘and section 6008 of the Fami17 lies First Coronavirus Response Act’’ and inserting 

18 ‘‘, section 6008 of the Families First Coronavirus 

19 Response Act, and subsection (hh) of this section’’; 

20 and 

21 (2) by inserting ‘‘, and, in applying such treat22 ments to an increase in the Federal medical assist23 ance percentage of a State under subsection (hh) 

24 with respect to a fiscal quarter that is an economic 

25 downturn quarter for the State, the reference to 


pamtmann on DSKBC07HB2PROD with BILLS
20 

•HR 1353 IH

1 ‘December 31, 2009’ shall be deemed to be a ref2 erence to ‘March 11, 2020’, or, if later, the last day 

3 of the most recent fiscal quarter that was not an 

4 economic downturn quarter for the State’’ before the 

5 period. 

Æ 


pamtmann on DSKBC07HB2PROD with BILLS