H. R. 259 

One Hundred Sixteenth Congress 

of the 

United States of America 

AT THE FIRST SESSION 

Begun and held at the City of Washington on Thursday, 

the third day of January, two thousand and nineteen 

An Act 

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, and for other purposes. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Medicaid Extenders Act of 2019’’. 

SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING 

DEMONSTRATION. 

(a) GENERAL FUNDING.—Section 6071(h) of the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is amended— 

(1) in paragraph (1)— 

(A) in subparagraph (D), by striking ‘‘and’’ after the 

semicolon; 

(B) in subparagraph (E), by striking the period at 

the end and inserting ‘‘; and’’; and 

(C) by adding at the end the following: 

‘‘(F) subject to paragraph (3), $112,000,000 for fiscal 

year 2019.’’; 

(2) in paragraph (2)— 

(A) by striking ‘‘Amounts made’’ and inserting ‘‘Subject 

to paragraph (3), amounts made’’; and 

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

‘‘September 30, 2021’’; and 

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

‘‘(3) SPECIAL RULE FOR FY 2019.—Funds appropriated under 

paragraph (1)(F) shall be made available for grants to States 

only if such States have an approved MFP demonstration 

project under this section as of December 31, 2018.’’. 

(b) FUNDING FOR QUALITY ASSURANCE AND IMPROVEMENT; 

TECHNICAL ASSISTANCE; OVERSIGHT.—Section 6071(f) of the Deficit 

Reduction Act of 2005 (42 U.S.C. 1396a note) is amended by striking 

paragraph (2) and inserting the following: 

‘‘(2) FUNDING.—From the amounts appropriated under sub- section (h)(1)(F) for fiscal year 2019, $500,000 shall be available 

to the Secretary for such fiscal year to carry out this subsection.’’. 

(c) TECHNICAL AMENDMENT.—Section 6071(b) of the Deficit 

Reduction Act of 2005 (42 U.S.C. 1396a note) is amended by adding 

at the end the following: 

‘‘(10) SECRETARY.—The term ‘Secretary’ means the Secretary of Health and Human Services.’’. 
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SEC. 3. EXTENSION OF PROTECTION FOR MEDICAID RECIPIENTS OF 

HOME AND COMMUNITY-BASED SERVICES AGAINST 

SPOUSAL IMPOVERISHMENT. 

(a) IN GENERAL.—Section 2404 of Public Law 111–148 (42 

U.S.C. 1396r–5 note) is amended by striking ‘‘the 5-year period 

that begins on January 1, 2014,’’ and inserting ‘‘the period beginning 

on January 1, 2014, and ending on March 31, 2019,’’. 

(b) RULE OF CONSTRUCTION.— 

(1) PROTECTING STATE SPOUSAL INCOME AND ASSET DISREGARD FLEXIBILITY UNDER WAIVERS AND PLAN AMENDMENTS.— 

Nothing in section 2404 of Public Law 111–148 (42 U.S.C. 

1396r–5 note) or section 1924 of the Social Security Act (42 

U.S.C. 1396r–5) shall be construed as prohibiting a State from 

disregarding an individual’s spousal income and assets under 

a State waiver or plan amendment described in paragraph 

(2) for purposes of making determinations of eligibility for 

home and community-based services or home and communitybased attendant services and supports under such waiver or 

plan amendment. 

(2) STATE WAIVER OR PLAN AMENDMENT DESCRIBED.—A 

State waiver or plan amendment described in this paragraph 

is any of the following: 

(A) A waiver or plan amendment to provide medical 

assistance for home and community-based services under 

a waiver or plan amendment under subsection (c), (d), 

or (i) of section 1915 of the Social Security Act (42 U.S.C. 

1396n) or under section 1115 of such Act (42 U.S.C. 1315). 

(B) A plan amendment to provide medical assistance 

for home and community-based services for individuals by 

reason of being determined eligible under section 

1902(a)(10)(C) of such Act (42 U.S.C. 1396a(a)(10)(C)) or 

by reason of section 1902(f) of such Act (42 U.S.C. 1396a(f)) 

or otherwise on the basis of a reduction of income based 

on costs incurred for medical or other remedial care under 

which the State disregarded the income and assets of the 

individual’s spouse in determining the initial and ongoing 

financial eligibility of an individual for such services in 

place of the spousal impoverishment provisions applied 

under section 1924 of such Act (42 U.S.C. 1396r–5). 

(C) A plan amendment to provide medical assistance 

for home and community-based attendant services and supports under section 1915(k) of such Act (42 U.S.C. 

1396n(k)). 

SEC. 4. REDUCTION IN FMAP AFTER 2020 FOR STATES WITHOUT ASSET 

VERIFICATION PROGRAM. 

Section 1940 of the Social Security Act (42 U.S.C. 1396w) 

is amended by adding at the end the following new subsection: 

‘‘(k) REDUCTION IN FMAP AFTER 2020 FOR NON-COMPLIANT

STATES.— 

‘‘(1) IN GENERAL.—With respect to a calendar quarter beginning on or after January 1, 2021, the Federal medical assistance 

percentage otherwise determined under section 1905(b) for a 

non-compliant State shall be reduced— 

‘‘(A) for calendar quarters in 2021 and 2022, by 0.12 

percentage points; 
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‘‘(B) for calendar quarters in 2023, by 0.25 percentage 

points; 

‘‘(C) for calendar quarters in 2024, by 0.35 percentage 

points; and 

‘‘(D) for calendar quarters in 2025 and each year thereafter, by 0.5 percentage points. 

‘‘(2) NON-COMPLIANT STATE DEFINED.—For purposes of this 

subsection, the term ‘non-compliant State’ means a State— 

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

Columbia; 

‘‘(B) with respect to which the Secretary has not 

approved a State plan amendment submitted under subsection (a)(2); and 

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

asset verification program in accordance with this section.’’. 

SEC. 5. MEDICAID IMPROVEMENT FUND. 

Section 1941(b)(1) of the Social Security Act (42 U.S.C. 1396w– 1(b)(1)) is amended by striking ‘‘$31,000,000’’ and inserting 

‘‘$6,000,000’’. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.