II 

116TH CONGRESS 

1ST SESSION H. R. 259 

IN THE SENATE OF THE UNITED STATES 

JANUARY 9, 2019 

Received 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


pamtmann on DSKBFK8HB2PROD with BILLS
2 

HR 259 RDS

1 SECTION 1. SHORT TITLE. 

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

3 Act of 2019’’. 

4 SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON RE5 BALANCING DEMONSTRATION. 

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

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

8 amended— 

9 (1) in paragraph (1)— 

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

11 ‘‘and’’ after the semicolon; 

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

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

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

15 ‘‘(F) subject to paragraph (3), 

16 $112,000,000 for fiscal year 2019.’’; 

17 (2) in paragraph (2)— 

18 (A) by striking ‘‘Amounts made’’ and in19 serting ‘‘Subject to paragraph (3), amounts 

20 made’’; and 

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

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

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

24 paragraph: 

25 ‘‘(3) SPECIAL RULE FOR FY 2019.—Funds ap26 propriated under paragraph (1)(F) shall be made 


pamtmann on DSKBFK8HB2PROD with BILLS
3 

HR 259 RDS

1 available for grants to States only if such States 

2 have an approved MFP demonstration project under 

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

4 (b) FUNDING FOR QUALITY ASSURANCE AND IM5 PROVEMENT; TECHNICAL ASSISTANCE; OVERSIGHT.— 

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

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

8 and inserting the following: 

9 ‘‘(2) FUNDING.—From the amounts appro10 priated under subsection (h)(1)(F) for fiscal year 

11 2019, $500,000 shall be available to the Secretary 

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

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

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

15 is amended by adding at the end the following: 

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

17 means the Secretary of Health and Human Serv18 ices.’’. 

19 SEC. 3. EXTENSION OF PROTECTION FOR MEDICAID RE20 CIPIENTS OF HOME AND COMMUNITY-BASED 

21 SERVICES AGAINST SPOUSAL IMPOVERISH22 MENT. 

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

24 148 (42 U.S.C. 1396r–5 note) is amended by striking ‘‘the 

25 5-year period that begins on January 1, 2014,’’ and inVerDate Sep 11 2014 22:43 Jan 17, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H259.RDS H259

pamtmann on DSKBFK8HB2PROD with BILLS
4 

HR 259 RDS

1 serting ‘‘the period beginning on January 1, 2014, and 

2 ending on March 31, 2019,’’. 

3 (b) RULE OF CONSTRUCTION.— 

4 (1) PROTECTING STATE SPOUSAL INCOME AND

5 ASSET DISREGARD FLEXIBILITY UNDER WAIVERS

6 AND PLAN AMENDMENTS.—Nothing in section 2404 

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

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

9 1396r–5) shall be construed as prohibiting a State 

10 from disregarding an individual’s spousal income 

11 and assets under a State waiver or plan amendment 

12 described in paragraph (2) for purposes of making 

13 determinations of eligibility for home and commu14 nity-based services or home and community-based 

15 attendant services and supports under such waiver 

16 or plan amendment. 

17 (2) STATE WAIVER OR PLAN AMENDMENT DE18 SCRIBED.—A State waiver or plan amendment de19 scribed in this paragraph is any of the following: 

20 (A) A waiver or plan amendment to pro21 vide medical assistance for home and commu22 nity-based services under a waiver or plan 

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

24 section 1915 of the Social Security Act (42 


pamtmann on DSKBFK8HB2PROD with BILLS
5 

HR 259 RDS

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

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

3 (B) A plan amendment to provide medical 

4 assistance for home and community-based serv5 ices for individuals by reason of being deter6 mined eligible under section 1902(a)(10)(C) of 

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

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

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

10 reduction of income based on costs incurred for 

11 medical or other remedial care under which the 

12 State disregarded the income and assets of the 

13 individual’s spouse in determining the initial 

14 and ongoing financial eligibility of an individual 

15 for such services in place of the spousal impov16 erishment provisions applied under section 1924 

17 of such Act (42 U.S.C. 1396r–5). 

18 (C) A plan amendment to provide medical 

19 assistance for home and community-based at20 tendant services and supports under section 

21 1915(k) of such Act (42 U.S.C. 1396n(k)). 


pamtmann on DSKBFK8HB2PROD with BILLS
6 

HR 259 RDS

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

2 WITHOUT ASSET VERIFICATION PROGRAM. 

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

4 1396w) is amended by adding at the end the following 

5 new subsection: 

6 ‘‘(k) REDUCTION IN FMAP AFTER 2020 FOR NON7 COMPLIANT STATES.— 

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

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

10 Federal medical assistance percentage otherwise de11 termined under section 1905(b) for a non-compliant 

12 State shall be reduced— 

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

14 2022, by 0.12 percentage points; 

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

16 0.25 percentage points; 

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

18 0.35 percentage points; and 

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

20 each year thereafter, by 0.5 percentage points. 

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

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

23 State’ means a State— 

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

25 District of Columbia; 


pamtmann on DSKBFK8HB2PROD with BILLS
7 

HR 259 RDS

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

2 has not approved a State plan amendment sub3 mitted under subsection (a)(2); and 

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

5 basis, an asset verification program in accord6 ance with this section.’’. 

7 SEC. 5. MEDICAID IMPROVEMENT FUND. 

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

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

10 ‘‘$31,000,000’’ and inserting ‘‘$6,000,000’’. 

Passed the House of Representatives January 8, 

2019. 

Attest: KAREN L. HAAS, 

Clerk. 


pamtmann on DSKBFK8HB2PROD with BILLS