I 

116TH CONGRESS 

1ST SESSION H. R. 259 

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. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 4, 2019 

Mr. PALLONE (for himself and Mr. WALDEN) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on 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, 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 Extenders 

5 Act of 2019’’. 


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1 SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON RE2 BALANCING DEMONSTRATION. 

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

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

5 amended— 

6 (1) in paragraph (1)— 

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

8 ‘‘and’’ after the semicolon; 

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

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

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

12 ‘‘(F) subject to paragraph (3), 

13 $112,000,000 for fiscal year 2019.’’; 

14 (2) in paragraph (2)— 

15 (A) by striking ‘‘Amounts made’’ and in16 serting ‘‘Subject to paragraph (3), amounts 

17 made’’; and 

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

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

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

21 paragraph: 

22 ‘‘(3) SPECIAL RULE FOR FY 2019.—Funds ap23 propriated under paragraph (1)(F) shall be made 

24 available for grants to States only if such States 

25 have an approved MFP demonstration project under 

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


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1 (b) FUNDING FOR QUALITY ASSURANCE AND IM2 PROVEMENT; TECHNICAL ASSISTANCE; OVERSIGHT.— 

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

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

5 and inserting the following: 

6 ‘‘(2) FUNDING.—From the amounts appro7 priated under subsection (h)(1)(F) for fiscal year 

8 2019, $500,000 shall be available to the Secretary 

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

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

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

12 is amended by adding at the end the following: 

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

14 means the Secretary of Health and Human Serv15 ices.’’. 

16 SEC. 3. EXTENSION OF PROTECTION FOR MEDICAID RE17 CIPIENTS OF HOME AND COMMUNITY-BASED 

18 SERVICES AGAINST SPOUSAL IMPOVERISH19 MENT. 

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

21 148 (42 U.S.C. 1396r–5 note) is amended by striking ‘‘the 

22 5-year period that begins on January 1, 2014,’’ and in23 serting ‘‘the period beginning on January 1, 2014, and 

24 ending on March 31, 2019,’’. 

25 (b) RULE OF CONSTRUCTION.— 


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1 (1) PROTECTING STATE SPOUSAL INCOME AND

2 ASSET DISREGARD FLEXIBILITY UNDER WAIVERS

3 AND PLAN AMENDMENTS.—Nothing in section 2404 

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

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

6 1396r–5) shall be construed as prohibiting a State 

7 from disregarding an individual’s spousal income 

8 and assets under a State waiver or plan amendment 

9 described in paragraph (2) for purposes of making 

10 determinations of eligibility for home and commu11 nity-based services or home and community-based 

12 attendant services and supports under such waiver 

13 or plan amendment. 

14 (2) STATE WAIVER OR PLAN AMENDMENT DE15 SCRIBED.—A State waiver or plan amendment de16 scribed in this paragraph is any of the following: 

17 (A) A waiver or plan amendment to pro18 vide medical assistance for home and commu19 nity-based services under a waiver or plan 

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

21 section 1915 of the Social Security Act (42 

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

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

24 (B) A plan amendment to provide medical 

25 assistance for home and community-based servVerDate Sep 11 2014 03:31 Jan 05, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H259.IH H259

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1 ices for individuals by reason of being deter2 mined eligible under section 1902(a)(10)(C) of 

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

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

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

6 reduction of income based on costs incurred for 

7 medical or other remedial care under which the 

8 State disregarded the income and assets of the 

9 individual’s spouse in determining the initial 

10 and ongoing financial eligibility of an individual 

11 for such services in place of the spousal impov12 erishment provisions applied under section 1924 

13 of such Act (42 U.S.C. 1396r–5). 

14 (C) A plan amendment to provide medical 

15 assistance for home and community-based at16 tendant services and supports under section 

17 1915(k) of such Act (42 U.S.C. 1396n(k)). 

18 SEC. 4. REDUCTION IN FMAP AFTER 2020 FOR STATES 

19 WITHOUT ASSET VERIFICATION PROGRAM. 

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

21 1396w) is amended by adding at the end the following 

22 new subsection: 

23 ‘‘(k) REDUCTION IN FMAP AFTER 2020 FOR NON24 COMPLIANT STATES.— 


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

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

3 Federal medical assistance percentage otherwise de4 termined under section 1905(b) for a non-compliant 

5 State shall be reduced— 

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

7 2022, by 0.12 percentage points; 

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

9 0.25 percentage points; 

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

11 0.35 percentage points; and 

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

13 each year thereafter, by 0.5 percentage points. 

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

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

16 State’ means a State— 

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

18 District of Columbia; 

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

20 has not approved a State plan amendment sub21 mitted under subsection (a)(2); and 

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

23 basis, an asset verification program in accord24 ance with this section.’’. 


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1 SEC. 5. MEDICAID IMPROVEMENT FUND. 

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

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

4 ‘‘$31,000,000’’ and inserting ‘‘$6,000,000’’. 

5 SEC. 6. BUDGETARY EFFECTS. 

6 (a) STATUTORY PAYGO SCORECARDS.—The budg7 etary effects of this Act shall not be entered on either 

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

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

10 933(d)). 

11 (b) SENATE PAYGO SCORECARDS.—The budgetary 

12 effects of this Act shall not be entered on any PAYGO 

13 scorecard maintained for purposes of section 4106 of H. 

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

15 (c) CLASSIFICATION OF BUDGETARY EFFECTS.— 

16 Notwithstanding Rule 3 of the Budget Scorekeeping 

17 Guidelines set forth in the joint explanatory statement of 

18 the committee of conference accompanying Conference Re19 port 105–217 and section 250(c)(8) of the Balanced 

20 Budget and Emergency Deficit Control Act of 1985, the 

21 budgetary effects of this Act shall not be estimated— 

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

23 Budget and Emergency Deficit Control Act of 1985; 

24 and 


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

2 3 of the Statutory Pay-As-You-Go Act of 2010 as 

3 being included in an appropriation Act. 

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

5 the annual report issued pursuant to section 5 of the Stat6 utory Pay-As-You-Go Act of 2010 (2 U.S.C. 934) after 

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

8 and for determining whether a sequestration order is nec9 essary under such section, the debit for the budget year 

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

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

12 added to such scorecard in 2020. 

Æ 


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