I 

114TH CONGRESS 

1ST SESSION H. R. 778 

To amend title XIX of the Social Security Act to redistribute Federal funds 

that would otherwise be made available to States that do not provide 

for the Medicaid expansion in accordance with the Affordable Care Act 

to those States electing to provide those Medicaid benefits, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 5, 2015 

Mr. CONNOLLY 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 redistribute 

Federal funds that would otherwise be made available 

to States that do not provide for the Medicaid expansion 

in accordance with the Affordable Care Act to those 

States electing to provide those Medicaid benefits, 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 ‘‘Medicaid Expansion 

5 Incentive Act of 2015’’. 


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1 SEC. 2. REDISTRIBUTION OF FEDERAL MEDICAID FUNDS 

2 TO STATES ELECTING TO MEET ACA MED3 ICAID EXPANSION REQUIREMENTS FROM 

4 STATES NOT SO ELECTING. 

5 (a) IN GENERAL.—Section 1903 of the Social Secu6 rity Act (42 U.S.C. 1396b) is amended by adding at the 

7 end the following new subsection: 

8 ‘‘(aa) BONUS FOR STATES ELECTING TO MEET ACA 

9 MEDICAID EXPANSION REQUIREMENTS FROM FUNDS

10 MADE AVAILABLE BY OTHER STATES NOT ELECTING TO

11 MEET THOSE REQUIREMENTS.— 

12 ‘‘(1) IN GENERAL.—In the case of a partici13 pating State for a fiscal year as determined under 

14 paragraph (2), in accordance with regulations of the 

15 Secretary, the State shall be entitled to an increase 

16 in payments under its State plan under this title in 

17 an amount determined under paragraph (3) of the 

18 Secretary’s estimate of the net reduction in Federal 

19 expenditures for nonparticipating States (including 

20 the amount of the additional Federal financial par21 ticipation under this title that otherwise would have 

22 been paid to such States if they were participating 

23 States) during the fiscal year as a result of such 

24 States not applying the ACA Medicaid expansion re25 quirements. 

26 ‘‘(2) NOTICE REGARDING PARTICIPATION.— 


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1 ‘‘(A) IN GENERAL.—Before the beginning 

2 of each fiscal year (beginning with fiscal year 

3 2016) each of the 50 States and the District of 

4 Columbia is requested to inform the Secretary, 

5 in a form and manner specified by the Sec6 retary and accompanied by such assurances re7 garding State plan amendments as the Sec8 retary may specify, if the State will be applying 

9 its State plan under this title for such fiscal 

10 year in accordance with the requirements speci11 fied in the amendments made by paragraphs 

12 (1) and (2) of section 2001(a) of the Patient 

13 Protection and Affordable Care Act (in this 

14 subsection referred to as the ‘ACA Medicaid ex15 pansion requirements’), which include require16 ments described in— 

17 ‘‘(i) section 1902(a)(10)(A)(I)(VIII); 

18 and 

19 ‘‘(ii) section 1902(k). 

20 The Secretary shall not accept information sub21 mitted under this subparagraph for a fiscal 

22 year after the beginning of the fiscal year in23 volved. 

24 ‘‘(B) DETERMINATION OF PARTICIPATING

25 AND NONPARTICIPATING STATES.—Taking into 


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1 account the information submitted under sub2 paragraph (A) for a fiscal year, the Secretary 

3 shall determine for the fiscal year which of the 

4 50 States and the District of Columbia will be 

5 applying the ACA Medicaid expansion require6 ments for the fiscal year and which will not. 

7 For purposes of this subsection— 

8 ‘‘(i) each State or District determined 

9 to be applying such requirements for a fis10 cal year is referred to as a ‘participating 

11 State’ for such fiscal year; and 

12 ‘‘(ii) each State or District determined 

13 not to be applying such requirements for a 

14 fiscal year is referred to as a ‘nonpartici15 pating State’ for such fiscal year. 

16 ‘‘(3) AMOUNT OF INCREASE.—The Secretary 

17 shall compute the increase in payments under this 

18 subsection for a participating State for a fiscal year, 

19 to the extent of available funds, in accordance with 

20 a formula specified by the Secretary. Within the 

21 amount of available funds, such formula may take 

22 into account elements such as— 

23 ‘‘(A) increasing to 100 percent the FMAP 

24 for newly eligible mandatory individuals; 


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1 ‘‘(B) increasing the matching percentage 

2 for administrative costs attributable to applica3 tion of ACA Medicaid expansion requirements; 

4 and 

5 ‘‘(C) an increase in DSH allotments. 

6 ‘‘(4) PUBLICATION OF INFORMATION ON ESTI7 MATED IMPACT OF NONPARTICIPATION.—The Sec8 retary shall publish for each nonparticipating State 

9 for each fiscal year— 

10 ‘‘(A) the amount of the additional Federal 

11 funds under this title for the fiscal year that 

12 the Secretary estimates the State has forgone 

13 as a result of its not being a participating State 

14 for such fiscal year; and 

15 ‘‘(B) the number of additional beneficiaries 

16 that would have been covered under the State 

17 plan under this title in the fiscal year if the 

18 State had been a participating State for the fis19 cal year.’’. 

Æ 


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