I 

116TH CONGRESS 

1ST SESSION H. R. 260 

To extend the Medicaid Money Follows the Person Rebalancing demonstration, to extend protection for Medicaid recipients of home and community-based services against spousal impoverishment, to extend the Temporary Assistance for Needy Families program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 4, 2019 

Mr. PALLONE (for himself, Mr. WALDEN, and Mr. NEAL) introduced the following bill; which was referred to the Committee on Ways and Means, 

and in addition to the Committees on Energy and Commerce, and the 

Budget, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To extend the Medicaid Money Follows the Person Rebalancing demonstration, to extend protection for Medicaid 

recipients of home and community-based services against 

spousal impoverishment, to extend the Temporary Assistance for Needy Families program, 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, 


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1 SECTION 1. SHORT TITLE. 

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

3 and TANF Extenders Act of 2019’’. 

4 TITLE I—MEDICAID EXTENDERS 

5 SEC. 101. EXTENSION OF MONEY FOLLOWS THE PERSON 

6 REBALANCING DEMONSTRATION. 

7 (a) GENERAL FUNDING.—Section 6071(h) of the 

8 Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is 

9 amended— 

10 (1) in paragraph (1)— 

11 (A) in subparagraph (D), by striking 

12 ‘‘and’’ after the semicolon; 

13 (B) in subparagraph (E), by striking the 

14 period at the end and inserting ‘‘; and’’; and 

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

16 ‘‘(F) subject to paragraph (3), 

17 $112,000,000 for fiscal year 2019.’’; 

18 (2) in paragraph (2)— 

19 (A) by striking ‘‘Amounts made’’ and in20 serting ‘‘Subject to paragraph (3), amounts 

21 made’’; and 

22 (B) by striking ‘‘September 30, 2016’’ and 

23 inserting ‘‘September 30, 2021’’; and 

24 (3) by adding at the end the following new 

25 paragraph: 


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1 ‘‘(3) SPECIAL RULE FOR FY 2019.—Funds ap2 propriated under paragraph (1)(F) shall be made 

3 available for grants to States only if such States 

4 have an approved MFP demonstration project under 

5 this section as of December 31, 2018.’’. 

6 (b) FUNDING FOR QUALITY ASSURANCE AND IM7 PROVEMENT; TECHNICAL ASSISTANCE; OVERSIGHT.— 

8 Section 6071(f) of the Deficit Reduction Act of 2005 (42 

9 U.S.C. 1396a note) is amended by striking paragraph (2) 

10 and inserting the following: 

11 ‘‘(2) FUNDING.—From the amounts appro12 priated under subsection (h)(1)(F) for fiscal year 

13 2019, $500,000 shall be available to the Secretary 

14 for such fiscal year to carry out this subsection.’’. 

15 (c) TECHNICAL AMENDMENT.—Section 6071(b) of 

16 the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) 

17 is amended by adding at the end the following: 

18 ‘‘(10) SECRETARY.—The term ‘Secretary’ 

19 means the Secretary of Health and Human Serv20 ices.’’. 


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1 SEC. 102. EXTENSION OF PROTECTION FOR MEDICAID RE2 CIPIENTS OF HOME AND COMMUNITY-BASED 

3 SERVICES AGAINST SPOUSAL IMPOVERISH4 MENT. 

5 (a) IN GENERAL.—Section 2404 of Public Law 111– 

6 148 (42 U.S.C. 1396r–5 note) is amended by striking ‘‘the 

7 5-year period that begins on January 1, 2014,’’ and in8 serting ‘‘the period beginning on January 1, 2014, and 

9 ending on March 31, 2019,’’. 

10 (b) RULE OF CONSTRUCTION.— 

11 (1) PROTECTING STATE SPOUSAL INCOME AND

12 ASSET DISREGARD FLEXIBILITY UNDER WAIVERS

13 AND PLAN AMENDMENTS.—Nothing in section 2404 

14 of Public Law 111–148 (42 U.S.C. 1396r–5 note) or 

15 section 1924 of the Social Security Act (42 U.S.C. 

16 1396r–5) shall be construed as prohibiting a State 

17 from disregarding an individual’s spousal income 

18 and assets under a State waiver or plan amendment 

19 described in paragraph (2) for purposes of making 

20 determinations of eligibility for home and commu21 nity-based services or home and community-based 

22 attendant services and supports under such waiver 

23 or plan amendment. 

24 (2) STATE WAIVER OR PLAN AMENDMENT DE25 SCRIBED.—A State waiver or plan amendment de26 scribed in this paragraph is any of the following: 


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1 (A) A waiver or plan amendment to pro2 vide medical assistance for home and commu3 nity-based services under a waiver or plan 

4 amendment under subsection (c), (d), or (i) of 

5 section 1915 of the Social Security Act (42 

6 U.S.C. 1396n) or under section 1115 of such 

7 Act (42 U.S.C. 1315). 

8 (B) A plan amendment to provide medical 

9 assistance for home and community-based serv10 ices for individuals by reason of being deter11 mined eligible under section 1902(a)(10)(C) of 

12 such Act (42 U.S.C. 1396a(a)(10)(C)) or by 

13 reason of section 1902(f) of such Act (42 

14 U.S.C. 1396a(f)) or otherwise on the basis of a 

15 reduction of income based on costs incurred for 

16 medical or other remedial care under which the 

17 State disregarded the income and assets of the 

18 individual’s spouse in determining the initial 

19 and ongoing financial eligibility of an individual 

20 for such services in place of the spousal impov21 erishment provisions applied under section 1924 

22 of such Act (42 U.S.C. 1396r–5). 

23 (C) A plan amendment to provide medical 

24 assistance for home and community-based atVerDate Sep 11 2014 02:10 Jan 17, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H260.IH H260

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1 tendant services and supports under section 

2 1915(k) of such Act (42 U.S.C. 1396n(k)). 

3 SEC. 103. REDUCTION IN FMAP AFTER 2020 FOR STATES 

4 WITHOUT ASSET VERIFICATION PROGRAM. 

5 Section 1940 of the Social Security Act (42 U.S.C. 

6 1396w) is amended by adding at the end the following 

7 new subsection: 

8 ‘‘(k) REDUCTION IN FMAP AFTER 2020 FOR NON9 COMPLIANT STATES.— 

10 ‘‘(1) IN GENERAL.—With respect to a calendar 

11 quarter beginning on or after January 1, 2021, the 

12 Federal medical assistance percentage otherwise de13 termined under section 1905(b) for a non-compliant 

14 State shall be reduced— 

15 ‘‘(A) for calendar quarters in 2021 and 

16 2022, by 0.12 percentage points; 

17 ‘‘(B) for calendar quarters in 2023, by 

18 0.25 percentage points; 

19 ‘‘(C) for calendar quarters in 2024, by 

20 0.35 percentage points; and 

21 ‘‘(D) for calendar quarters in 2025 and 

22 each year thereafter, by 0.5 percentage points. 

23 ‘‘(2) NON-COMPLIANT STATE DEFINED.—For 

24 purposes of this subsection, the term ‘non-compliant 

25 State’ means a State— 


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1 ‘‘(A) that is one of the 50 States or the 

2 District of Columbia; 

3 ‘‘(B) with respect to which the Secretary 

4 has not approved a State plan amendment sub5 mitted under subsection (a)(2); and 

6 ‘‘(C) that is not operating, on an ongoing 

7 basis, an asset verification program in accord8 ance with this section.’’. 

9 SEC. 104. MEDICAID IMPROVEMENT FUND. 

10 Section 1941(b)(1) of the Social Security Act (42 

11 U.S.C. 1396w–1(b)(1)) is amended by striking 

12 ‘‘$31,000,000’’ and inserting ‘‘$6,000,000’’. 

13 SEC. 105. BUDGETARY EFFECTS. 

14 (a) STATUTORY PAYGO SCORECARDS.—The budg15 etary effects of this title shall not be entered on either 

16 PAYGO scorecard maintained pursuant to section 4(d) of 

17 the Statutory Pay-As-You-Go Act of 2010 (2 U.S.C. 

18 933(d)). 

19 (b) SENATE PAYGO SCORECARDS.—The budgetary 

20 effects of this title shall not be entered on any PAYGO 

21 scorecard maintained for purposes of section 4106 of H. 

22 Con. Res. 71 (115th Congress). 

23 (c) CLASSIFICATION OF BUDGETARY EFFECTS.— 

24 Notwithstanding Rule 3 of the Budget Scorekeeping 

25 Guidelines set forth in the joint explanatory statement of 


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1 the committee of conference accompanying Conference Re2 port 105–217 and section 250(c)(8) of the Balanced 

3 Budget and Emergency Deficit Control Act of 1985, the 

4 budgetary effects of this title shall not be estimated— 

5 (1) for purposes of section 251 of the Balanced 

6 Budget and Emergency Deficit Control Act of 1985; 

7 and 

8 (2) for purposes of paragraph (4)(C) of section 

9 3 of the Statutory Pay-As-You-Go Act of 2010 as 

10 being included in an appropriation Act. 

11 (d) PAYGO ANNUAL REPORT.—For the purposes of 

12 the annual report issued pursuant to section 5 of the Stat13 utory Pay-As-You-Go Act of 2010 (2 U.S.C. 934) after 

14 adjournment of the second session of the 115th Congress, 

15 and for determining whether a sequestration order is nec16 essary under such section, the debit for the budget year 

17 on the 5-year scorecard, if any, and the 10-year scorecard, 

18 if any, shall be deducted from such scorecard in 2019 and 

19 added to such scorecard in 2020. 

20 TITLE II—TANF AND TECHNICAL 

21 CORRECTIONS 

22 SEC. 201. TANF PROGRAM EXTENSIONS. 

23 (a) FAMILY ASSISTANCE GRANTS.—Section 

24 403(a)(1) of the Social Security Act (42 U.S.C. 603(a)(1)) 


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1 is amended in each of subparagraphs (A) and (C) by strik2 ing ‘‘2017 and 2018’’ and inserting ‘‘2019 and 2020’’. 

3 (b) HEALTHY MARRIAGE PROMOTION AND RESPON4 SIBLE FATHERHOOD GRANTS.—Section 403(a)(2)(D) of 

5 such Act (42 U.S.C. 603(a)(2)(D)) is amended— 

6 (1) by striking ‘‘2017 and 2018’’ and inserting 

7 ‘‘2019 and 2020’’; and 

8 (2) by striking ‘‘for fiscal year 2017 or 2018’’. 

9 (c) CONTINGENCY FUND.—Section 403(b)(2) of such 

10 Act (42 U.S.C. 603(b)(2)) is amended by striking ‘‘fiscal 

11 year 2018’’ and inserting ‘‘each of fiscal years 2019 and 

12 2020’’. 

13 (d) TRIBAL FAMILY ASSISTANCE GRANTS.—Para14 graphs (1)(A) and (2)(A) of section 412(a) of such Act 

15 (42 U.S.C. 612(a)) are each amended by striking ‘‘2017 

16 and 2018’’ and inserting ‘‘2019 and 2020’’. 

17 (e) CHILD CARE.—Section 418(a)(3) of such Act (42 

18 U.S.C. 618(a)(3)) is amended by striking ‘‘2017 and 

19 2018’’ and inserting ‘‘2019 and 2020’’. 

20 (f) GRANTS TO THE TERRITORIES.—Section 

21 1108(b)(2) of such Act (42 U.S.C. 1308(b)(2)) is amend22 ed by striking ‘‘2017 and 2018’’ and inserting ‘‘2019 and 

23 2020’’. 


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1 SEC. 202. MEASURING AND UNDERSTANDING OUTCOMES. 

2 (a) IN GENERAL.—Section 411(a) of the Social Secu3 rity Act (42 U.S.C. 611(a)) is amended by redesignating 

4 paragraph (7) as paragraph (8) and inserting after para5 graph (6) the following: 

6 ‘‘(7) REPORT ON ENGAGEMENT, EMPLOYMENT

7 AND OUTCOMES.— 

8 ‘‘(A) REPORTING AGREEMENT.—Each 

9 State and the Secretary shall enter into an 

10 agreement specifying the manner by which the 

11 information and data described in this para12 graph shall be collected and reported to the 

13 Secretary beginning in fiscal year 2020. 

14 ‘‘(i) OUTCOMES FOR EXITING RECIPI15 ENTS.—Information and data regarding 

16 families who formerly received assistance 

17 and included a work-eligible individual 

18 (disaggregated by type of family, reason 

19 for exit, and participation in work activi20 ties during the preceding fiscal year) under 

21 the State program funded under this part 

22 or under any State program funded with 

23 qualified State expenditures (as defined in 

24 section 409(a)(7)(B)(i)), with respect to 

25 the following: 


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1 ‘‘(I) The percentage with at least 

2 1 formerly work-eligible individual em3 ployed during the 2nd quarter after 

4 exiting from the program. 

5 ‘‘(II) The percentage with at 

6 least 1 formerly work-eligible indi7 vidual employed during the 4th quar8 ter after exiting from the program. 

9 ‘‘(III) The median earnings when 

10 at least 1 formerly work-eligible indi11 vidual is employed during the 2d 

12 quarter after exiting from the pro13 gram. 

14 ‘‘(IV) The percentage with at 

15 least 1 formerly work-eligible indi16 vidual employed during any of the 

17 first 4 quarters after exiting from the 

18 program. 

19 ‘‘(V) The distribution of income 

20 and earnings, including relative to 

21 poverty and deep poverty, for each of 

22 the first 4 quarters ending after the 

23 quarter of exit from assistance. 


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1 ‘‘(VI) The percentage who, at the 

2 time of exit from the program, were 

3 subject to the following: 

4 ‘‘(aa) A penalty under sec5 tion 407(e). 

6 ‘‘(bb) A sanction or penalty 

7 described in section 404 or 408. 

8 ‘‘(cc) A penalty or sanction 

9 not described in item (aa) or 

10 (bb). 

11 ‘‘(ii) ENGAGEMENT AND EMPLOY12 MENT OF CURRENT RECIPIENTS.— 

13 ‘‘(I) WORK-ELIGIBLE INDIVID14 UALS.—In the case of current work-el15 igible individuals under the State pro16 gram funded under this part or under 

17 any State program funded with quali18 fied State expenditures (as defined in 

19 section 409(a)(7)(B)(i)), the following 

20 information relative to the current 

21 quarter being reported: 

22 ‘‘(aa) Earnings in each of 

23 the 4 quarters immediately pre24 ceding the quarter. 


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1 ‘‘(bb) Standard measures of 

2 employment, earnings, receipt of 

3 assistance, and participation in 

4 work activities (as defined in sec5 tion 407(d)) in each of the first 

6 4 quarters following the quarter. 

7 ‘‘(II) ALL RECIPIENTS.—The 

8 percentage of recipients of assistance 

9 under the State program funded 

10 under this part or under any State 

11 program funded with qualified State 

12 expenditures (as defined in section 

13 409(a)(7)(B)(i)) who have not at14 tained 24 years of age and who obtain 

15 a high school degree or its recognized 

16 equivalent while receiving the assist17 ance. 

18 ‘‘(B) STATISTICAL ADJUSTMENT MODEL

19 FOR EMPLOYMENT OUTCOMES.—The Secretary, 

20 in consultation with the Secretary of Labor and 

21 relevant experts, shall develop recommendations 

22 by March 1, 2020, on how to establish and dis23 seminate an objective statistical model that will 

24 allow the Secretary to make adjustments to the 

25 data reported pursuant to subclauses (I) 


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1 through (IV) of subparagraph (A)(i) of this 

2 paragraph, based on economic conditions and 

3 the characteristics of participants. To the ex4 tent practicable, the recommendations shall be 

5 compatible with the statistical adjustment 

6 model developed under section 

7 116(b)(3)(A)(viii) of the Workforce Innovation 

8 and Opportunity Act (29 U.S.C. 

9 3141(b)(3)(A)(viii)) and, with respect to a 

10 State, the State adjusted levels of performance 

11 established for the State under that section.’’. 

12 SEC. 203. TECHNICAL CORRECTIONS TO DATA EXCHANGE 

13 STANDARDS TO IMPROVE PROGRAM COORDI14 NATION. 

15 (a) IN GENERAL.—Section 411(d) of the Social Secu16 rity Act (42 U.S.C. 611(d)) is amended to read as follows: 

17 ‘‘(d) DATA EXCHANGE STANDARDS FOR IMPROVED

18 INTEROPERABILITY.— 

19 ‘‘(1) DESIGNATION.—The Secretary shall, in 

20 consultation with an interagency work group estab21 lished by the Office of Management and Budget and 

22 considering State government perspectives, by rule, 

23 designate data exchange standards to govern, under 

24 this part— 


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1 ‘‘(A) necessary categories of information 

2 that State agencies operating programs under 

3 State plans approved under this part are re4 quired under applicable Federal law to elec5 tronically exchange with another State agency; 

6 and 

7 ‘‘(B) Federal reporting and data exchange 

8 required under applicable Federal law. 

9 ‘‘(2) REQUIREMENTS.—The data exchange 

10 standards required by paragraph (1) shall, to the ex11 tent practicable— 

12 ‘‘(A) incorporate a widely accepted, non13 proprietary, searchable, computer-readable for14 mat, such as the eXtensible Markup Language; 

15 ‘‘(B) contain interoperable standards devel16 oped and maintained by intergovernmental 

17 partnerships, such as the National Information 

18 Exchange Model; 

19 ‘‘(C) incorporate interoperable standards 

20 developed and maintained by Federal entities 

21 with authority over contracting and financial 

22 assistance; 

23 ‘‘(D) be consistent with and implement ap24 plicable accounting principles; 


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1 ‘‘(E) be implemented in a manner that is 

2 cost-effective and improves program efficiency 

3 and effectiveness; and 

4 ‘‘(F) be capable of being continually up5 graded as necessary. 

6 ‘‘(3) RULE OF CONSTRUCTION.—Nothing in 

7 this subsection shall be construed to require a 

8 change to existing data exchange standards found to 

9 be effective and efficient.’’. 

10 (b) EFFECTIVE DATE.—Not later than the date that 

11 is 24 months after the date of the enactment of this sec12 tion, the Secretary of Health and Human Services shall 

13 issue a proposed rule that— 

14 (1) identifies federally required data exchanges, 

15 include specification and timing of exchanges to be 

16 standardized, and address the factors used in deter17 mining whether and when to standardize data ex18 changes; and 

19 (2) specifies State implementation options and 

20 describes future milestones. 

21 SEC. 204. UNEMPLOYMENT INSURANCE TECHNICAL COR22 RECTIONS. 

23 Section 306(a) of the Social Security Act (42 U.S.C. 

24 506(a)) is amended— 


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1 (1) by striking ‘‘individuals’’ and inserting 

2 ‘‘claimants of regular compensation, including claim3 ants’’; and 

4 (2) by inserting a comma after ‘‘section 

5 303(j)’’. 

Æ 


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