I 

116TH CONGRESS 

1ST SESSION H. R. 3215 

To provide Medicaid assistance to individuals and families affected by a 

disaster or emergency, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 11, 2019 

Ms. SHALALA (for herself, Mr. LANGEVIN, Ms. NORTON, and Miss GONZA ́LEZCOLO ́N of Puerto Rico) introduced the following bill; which was referred 

to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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 provide Medicaid assistance to individuals and families 

affected by a disaster or emergency, 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 ‘‘Disaster Relief Med5 icaid Act’’. 

6 SEC. 2. MEDICAID RELIEF FOR DISASTER SURVIVORS. 

7 Title XIX of the Social Security Act (42 U.S.C. 1396 

8 et seq.) is amended— 


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1 (1) in section 1902(a)— 

2 (A) in paragraph (85), by striking ‘‘; and’’ 

3 and inserting a semicolon; 

4 (B) in paragraph (86), by striking the pe5 riod at the end and inserting ‘‘; and’’; and 

6 (C) by inserting after paragraph (86) the 

7 following new paragraph: 

8 ‘‘(87) beginning January 1, 2020, provide for 

9 making medical assistance available to relief-eligible 

10 survivors of disasters during relief coverage periods 

11 in accordance with section 1947.’’; and 

12 (2) by adding at the end the following new sec13 tion: 

14 ‘‘SEC. 1947. DISASTER RELIEF MEDICAID FOR SURVIVORS 

15 OF MAJOR DISASTERS. 

16 ‘‘(a) IN GENERAL.—Notwithstanding any other pro17 vision of this title, a State plan shall provide medical as18 sistance to a relief-eligible survivor of a disaster in accord19 ance with this section. 

20 ‘‘(b) DEFINITIONS.—In this section: 

21 ‘‘(1) DISASTER.—The term ‘disaster’ means a 

22 major disaster— 

23 ‘‘(A) that is declared on or after January 

24 1, 2020, by the President in accordance with 

25 section 401 of the Robert T. Stafford Disaster 


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1 Relief and Emergency Assistance Act (42 

2 U.S.C. 5170); and 

3 ‘‘(B) which the President has determined 

4 warrants individual and public assistance from 

5 the Federal Government under such Act. 

6 ‘‘(2) DIRECT IMPACT AREA.— 

7 ‘‘(A) IN GENERAL.—The term ‘direct im8 pact area’ means, with respect to a disaster, the 

9 geographic area in which the disaster exists. 

10 ‘‘(B) WEBSITE POSTING OF DIRECT IM11 PACT AREAS.—As soon as practicable after a 

12 disaster is declared (as described in paragraph 

13 (1)(A)), the Secretary shall post on the website 

14 of the Centers for Medicare & Medicaid Serv15 ices a list of the areas identified as the direct 

16 impact areas of the disaster. 

17 ‘‘(3) HOME STATE.—The term ‘home State’ 

18 means, with respect to a survivor of a disaster, the 

19 State in which the survivor was a resident during 

20 the 7-day period preceding the date on which the 

21 disaster is declared (as described in paragraph 

22 (1)(A)). 

23 ‘‘(4) RELIEF COVERAGE PERIOD.—The term 

24 ‘relief coverage period’ means, with respect to a dis25 aster, the period that begins on the date the disaster 


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1 is declared (as described in paragraph (1)(A)) and 

2 ends on the day that is 2 years after such date. 

3 ‘‘(5) RELIEF-ELIGIBLE SURVIVOR.— 

4 ‘‘(A) IN GENERAL.—The term ‘relief-eligi5 ble survivor’ means an individual who is a sur6 vivor of a disaster whose family income does not 

7 exceed the higher of— 

8 ‘‘(i) 133 percent (or, in the case of a 

9 survivor who is a pregnant woman, a child, 

10 or a recipient of benefits under title II on 

11 the basis of a disability, 200 percent) of 

12 the poverty line; or 

13 ‘‘(ii) the income eligibility standard 

14 that would otherwise apply to the survivor 

15 under the State plan or waiver of the sur16 vivor’s host State. 

17 ‘‘(B) DISREGARD OF UNEMPLOYMENT IN18 COME.—For purposes of this section, and not19 withstanding section 1902(e)(14)(B), the in20 come of a survivor of a disaster shall not in21 clude any amount received during the relief cov22 erage period of the disaster under a law of the 

23 United States or a State which is in the nature 

24 of unemployment compensation. 

25 ‘‘(6) SURVIVOR.— 


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1 ‘‘(A) IN GENERAL.—The term ‘survivor’ 

2 means, with respect to a disaster, an individual 

3 who is described in subparagraph (B) or (C). 

4 ‘‘(B) RESIDENTS AND EVACUEES OF DI5 RECT IMPACT AREAS.—An individual described 

6 in this subparagraph is an individual who, on 

7 any day during the 7-day period preceding the 

8 date on which a disaster is declared (as de9 scribed in paragraph (1)(A)), has a primary 

10 residence in the disaster’s direct impact area. 

11 ‘‘(C) INDIVIDUALS WHO LOST EMPLOY12 MENT.—An individual described in this sub13 paragraph is an individual— 

14 ‘‘(i) whose worksite, on any day dur15 ing the 7-day period preceding the date on 

16 which a disaster is declared (as so de17 scribed), was located in the disaster’s di18 rect impact area; 

19 ‘‘(ii) who was employed by an em20 ployer that— 

21 ‘‘(I) conducted an active trade or 

22 business in such area on any day dur23 ing such 7-day period; and 

24 ‘‘(II) was unable to operate such 

25 trade or business as a result of the 


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1 disaster on any day during the disas2 ter’s relief coverage period; and 

3 ‘‘(iii) whose employment with such 

4 employer was terminated. 

5 ‘‘(D) TREATMENT OF HOMELESS PER6 SONS.—For purposes of subparagraph (B), in 

7 the case of an individual who was homeless on 

8 any day during the 7-day period preceding the 

9 date on which a disaster is declared (as so de10 scribed), the individual’s ‘residence’ during such 

11 period shall be determined as it would otherwise 

12 be determined for purposes of this title. 

13 ‘‘(E) EFFECT OF CONCURRENT ELIGI14 BILITY FOR MEDICAID.—An individual’s eligi15 bility for medical assistance under a State plan 

16 (or waiver of such plan) on a basis other than 

17 under this section shall not prevent the indi18 vidual from being treated as a survivor under 

19 this section, and the rights afforded to an indi20 vidual who is eligible for or enrolled under a 

21 State plan (or waiver) shall not be affected by 

22 the individual’s receipt of medical assistance as 

23 a relief-eligible survivor of a disaster in accord24 ance with this section. 

25 ‘‘(c) ELIGIBILITY.— 


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1 ‘‘(1) SIMPLIFIED APPLICATION.— 

2 ‘‘(A) IN GENERAL.—For purposes of deter3 mining eligibility for medical assistance under 

4 this section, each State shall use a simplified, 

5 1-page application form (as developed by the 

6 Secretary in consultation with the National As7 sociation of State Medicaid Directors), which 

8 shall— 

9 ‘‘(i) require an applicant for medical 

10 assistance in accordance with this section 

11 as a survivor of a disaster to— 

12 ‘‘(I) provide the applicant’s ex13 pected address for the duration of the 

14 relief coverage period of the disaster; 

15 and 

16 ‘‘(II) agree to update the infor17 mation described in subclause (I) if it 

18 changes during such period; 

19 ‘‘(ii) provide notice of the penalties for 

20 making a fraudulent application described 

21 in subsection (h); 

22 ‘‘(iii) require the applicant to assign 

23 to the State any rights of the applicant (or 

24 any other individual who is a relief-eligible 

25 survivor and on whose behalf the applicant 


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1 has the legal authority to execute an as2 signment of such rights) in accordance 

3 with the requirements of section 1912; 

4 ‘‘(iv) require the applicant to list any 

5 health insurance coverage in which the ap6 plicant was enrolled immediately prior to 

7 submitting the application for medical as8 sistance under this section; and 

9 ‘‘(v) require the applicant to self-at10 test that the applicant— 

11 ‘‘(I) is a relief-eligible survivor of 

12 the disaster; and 

13 ‘‘(II) if applicable, requires home 

14 and community-based services. 

15 ‘‘(B) NO DOCUMENTATION REQUIRE16 MENT.—A State shall not require an applicant 

17 for medical assistance as a survivor of a dis18 aster under this section to provide any docu19 mentation or other evidence— 

20 ‘‘(i) of the applicant’s status as a re21 lief-eligible survivor; and 

22 ‘‘(ii) if applicable, that the applicant 

23 requires home and community-based serv24 ices. 


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1 ‘‘(C) PRESUMPTIVE ELIGIBILITY.—If an 

2 applicant submits a completed application to a 

3 provider or facility described in section 

4 1902(a)(55) (or any other provider or facility 

5 participating in the State plan or under a waiv6 er of such plan that is qualified to make pre7 sumptive eligibility determinations under such 

8 plan or waiver) and it appears to the provider 

9 or facility that the applicant is a relief-eligible 

10 survivor of a disaster who is eligible for medical 

11 assistance under the plan based on the informa12 tion in the application, the applicant will be 

13 deemed to be a relief-eligible survivor for med14 ical assistance under such plan in accordance 

15 with this section. 

16 ‘‘(D) CONTINUOUS ELIGIBILITY.—An ap17 plicant who is determined to be a relief-eligible 

18 survivor of a disaster shall be eligible for med19 ical assistance under this section, without the 

20 need for any redetermination of eligibility, for 

21 the duration of the relief coverage period of the 

22 disaster. 

23 ‘‘(E) TIMELY PROCESSING OF APPLICA24 TIONS.—Each State shall establish such proc25 esses as are necessary to ensure that applicaVerDate Sep 11 2014 05:06 Jun 12, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3215.IH H3215

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1 tions for medical assistance under this section 

2 are processed in a timely manner. 

3 ‘‘(2) ISSUANCE OF DISASTER RELIEF MEDICAID

4 ELIGIBILITY CARD.—A State shall issue a disaster 

5 relief Medicaid eligibility card to each applicant who 

6 is determined to be a relief-eligible survivor of a dis7 aster and eligible for medical assistance under this 

8 section, which shall be valid for the duration of the 

9 relief coverage period of the disaster. 

10 ‘‘(3) VERIFICATION OF STATUS AS A RELIEF11 ELIGIBLE SURVIVOR.— 

12 ‘‘(A) IN GENERAL.—The State shall make 

13 a good faith effort to verify the status of an in14 dividual who is enrolled in the State plan as a 

15 relief-eligible survivor of a disaster in accord16 ance with this section. Such effort shall not 

17 delay the determination of the eligibility of the 

18 individual for medical assistance under this sec19 tion. 

20 ‘‘(B) EVIDENCE OF VERIFICATION.—A 

21 State may satisfy the verification requirement 

22 under subparagraph (A) with respect to an in23 dividual by showing that the State obtained in24 formation from the Social Security Administra25 tion, the Internal Revenue Service, or, if appliVerDate Sep 11 2014 05:06 Jun 12, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3215.IH H3215

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1 cable, the State Medicaid agency of the home 

2 State of the individual. 

3 ‘‘(4) DETERMINATION BY EXPRESS LANE AGEN4 CY.—Any determination or redetermination of eligi5 bility or verification of status made under this sec6 tion shall be made by an Express Lane agency (as 

7 defined in section 1902(e)(13)(F)). 

8 ‘‘(d) TERMINATION OF ELIGIBILITY.— 

9 ‘‘(1) IN GENERAL.—Except as provided in para10 graph (4), no medical assistance shall be provided 

11 under this section to a relief-eligible survivor of a 

12 disaster after the end of the relief coverage period 

13 of the disaster. 

14 ‘‘(2) NOTICE OF TERMINATION OF ELIGIBILITY; 

15 ASSISTANCE IN APPLYING FOR REGULAR MED16 ICAID.— 

17 ‘‘(A) IN GENERAL.—No later than 2 

18 months before the end of a relief coverage pe19 riod of a disaster, a State shall provide each re20 lief-eligible survivor of the disaster who is re21 ceiving medical assistance under the State plan 

22 in accordance with this section with written no23 tice that includes— 

24 ‘‘(i) the date after which, subject to 

25 the exception described in paragraph (4), 


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1 the survivor will no longer be eligible for 

2 such assistance; 

3 ‘‘(ii) information regarding eligibility 

4 (other than under this section) for medical 

5 assistance under the State plan (or waiver 

6 of such plan); and 

7 ‘‘(iii) an application for such assist8 ance and information regarding how to 

9 submit a completed application and how to 

10 obtain assistance with completing such ap11 plication. 

12 ‘‘(B) ASSISTANCE IN APPLYING FOR MED13 ICAID.—Before the end of the relief coverage 

14 period of a disaster, the State shall— 

15 ‘‘(i) provide any relief-eligible survivor 

16 of the disaster who is receiving medical as17 sistance under the State plan assistance 

18 with applying for medical assistance under 

19 the State plan (or waiver ) for periods be20 ginning after the end of such relief cov21 erage period; and 

22 ‘‘(ii) ensure that such assistance is 

23 easily accessible to such survivors. 

24 ‘‘(3) PRESUMPTIVE ELIGIBILITY PERIOD FOR

25 PENDING APPLICATIONS.—In the case of a relief-eliVerDate Sep 11 2014 05:06 Jun 12, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H3215.IH H3215

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1 gible survivor of a disaster who, on the date that the 

2 relief coverage period of the disaster ends, has an 

3 application pending for medical assistance under the 

4 State plan (or waiver of such plan) for periods be5 ginning after such relief coverage period, such sur6 vivor shall be deemed to be eligible for medical as7 sistance under such plan or waiver for 60 days after 

8 such date. Medical assistance provided to such an 

9 individual during such 60-day period shall not be 

10 treated as medical assistance provided under this 

11 section and the Federal medical assistance percent12 age described in subsection (f) shall not apply to 

13 amounts expended on such assistance. 

14 ‘‘(4) PREGNANT WOMEN.—In the case of a re15 lief-eligible survivor of a disaster who, while preg16 nant, receives medical assistance under the State 

17 plan in accordance with this section, such survivor 

18 shall continue to be eligible for such assistance 

19 through the end of the month in which the 60-day 

20 period (beginning on the last day of her pregnancy) 

21 ends, without regard to whether the pregnancy ends 

22 before or after the end of the relief coverage period 

23 of the disaster and without requiring the survivor to 

24 reapply for such assistance. 

25 ‘‘(e) SCOPE OF COVERAGE.— 


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1 ‘‘(1) IN GENERAL.—A State providing medical 

2 assistance to a relief-eligible survivor of a disaster in 

3 accordance with this section shall provide medical 

4 assistance that is equal in amount and scope to the 

5 medical assistance that would otherwise be made 

6 available to such survivor if the survivor were en7 rolled in the State plan (or waiver of such plan) as 

8 an individual described in clause (i) of section 

9 1902(a)(10)(A), except that, in the case of such a 

10 survivor whose home State is not the State providing 

11 medical assistance to the individual, the State shall 

12 also provide medical assistance for any item or serv13 ice for which medical assistance is available to indi14 viduals described in clause (i) of section 

15 1902(a)(10)(A) under the State plan (or waiver) of 

16 the survivor’s home State. 

17 ‘‘(2) PROVIDER PAYMENT RATES FOR HOME

18 STATE SERVICES.—In the case of medical assistance 

19 provided by a State to a relief-eligible survivor of a 

20 disaster in accordance with this section for an item 

21 or service which is not available under the State 

22 plan (or waiver of such plan) but which is available 

23 under the State plan (or waiver) of the survivor’s 

24 home State, the State shall pay the provider of such 

25 item or service at the same rate that the home State 


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1 would pay for the item or service if it were provided 

2 under the plan or waiver of the home State (or, if 

3 no such payment rate applies under the plan or 

4 waiver of the home State, the usual and customary 

5 prevailing rate for the item or service for the com6 munity in which it is provided). 

7 ‘‘(3) RETROACTIVE COVERAGE.— 

8 ‘‘(A) IN GENERAL.—Notwithstanding sec9 tion 1905(a), a State shall provide medical as10 sistance for items and services furnished in the 

11 State beginning with the first day of the relief 

12 coverage period of a disaster to any relief-eligi13 ble survivor of the disaster who submits an ap14 plication for such assistance before the deadline 

15 described in subparagraph (B). 

16 ‘‘(B) APPLICATION DEADLINE.—The dead17 line for a relief-eligible survivor of a disaster to 

18 submit an application for medical assistance in 

19 accordance with this section is the date that is 

20 90 days after the end of the disaster’s relief 

21 coverage period. 

22 ‘‘(4) CHILDREN BORN TO PREGNANT WOMEN.— 

23 In the case of a child born to a relief-eligible sur24 vivor of a disaster who is provided medical assist25 ance in accordance with this section during the relief 


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1 coverage period of the disaster, the child shall be 

2 treated as having been born to a pregnant woman el3 igible for medical assistance under the State plan (or 

4 waiver of such plan) and shall be eligible for medical 

5 assistance under such plan (or waiver) in accordance 

6 with section 1902(e)(4). Notwithstanding subsection 

7 (g), the Federal medical assistance percentage deter8 mined for a State and fiscal year under section 

9 1905(b) shall apply to medical assistance provided 

10 during the year to a child under the State plan (or 

11 waiver) in accordance with the preceding sentence. 

12 ‘‘(5) OPTION TO PROVIDE EXTENDED MENTAL

13 HEALTH AND CARE COORDINATION BENEFITS.—A 

14 State may provide, without regard to any restric15 tions on amount, duration, scope, or comparability, 

16 or other restrictions under this title or the State 

17 plan or waiver of such plan (other than restrictions 

18 applicable to services provided in an institution for 

19 mental diseases), medical assistance to relief-eligible 

20 survivors of a disaster under this section for ex21 tended mental health and care coordination services, 

22 which may include the following: 

23 ‘‘(A) Screening, assessment, and diagnostic 

24 services (including specialized assessments for 

25 individuals with cognitive impairments). 


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1 ‘‘(B) Coverage for a full range of mental 

2 health medications at the dosages and fre3 quencies prescribed by health professionals for 

4 depression, post-traumatic stress disorder, and 

5 other mental disorders. 

6 ‘‘(C) Treatment of alcohol and substance 

7 abuse determined to result from circumstances 

8 related to the disaster. 

9 ‘‘(D) Psychotherapy, rehabilitation and 

10 other treatments administered by psychiatrists, 

11 psychologists, or social workers for conditions 

12 exacerbated by, or resulting from, the disaster. 

13 ‘‘(E) In-patient mental health care. 

14 ‘‘(F) Family counseling for families where 

15 a member of the immediate family is a survivor 

16 of the disaster or first responder to the disaster 

17 or includes an individual who has died as a re18 sult of the disaster. 

19 ‘‘(G) In connection with the provision of 

20 health and long-term care services, arranging 

21 for, (and when necessary, enrollment in waiver 

22 programs or other specialized programs), and 

23 coordination related to, primary and specialty 

24 medical care, which may include personal care 


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1 services, durable medical equipment and sup2 plies, assistive technology, and transportation. 

3 ‘‘(6) OPTION TO PROVIDE HOME AND COMMU4 NITY-BASED SERVICES.— 

5 ‘‘(A) IN GENERAL.—A State may provide 

6 medical assistance under this section for home 

7 and community-based services to a relief-eligible 

8 survivor of a disaster, including any survivor 

9 who is an individual described in subparagraph 

10 (B), who self-attests that the survivor imme11 diately requires such services, without regard to 

12 whether the survivor would require the level of 

13 care provided in a hospital, nursing facility, or 

14 intermediate care facility for the develop15 mentally disabled. 

16 ‘‘(B) INDIVIDUALS DESCRIBED.—Individ17 uals described in this subparagraph are relief18 eligible survivors of a disaster who— 

19 ‘‘(i) on any day during the week pre20 ceding the date on which the disaster is de21 clared (as described in subsection 

22 (b)(1)(A))— 

23 ‘‘(I) had been receiving home and 

24 community-based services in a direct 


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1 impact area under a waiver under sec2 tion 1115 or section 1915; 

3 ‘‘(II) had been receiving support 

4 services from a primary family care5 giver who, as a result of the disaster, 

6 is no longer available to provide serv7 ices; or 

8 ‘‘(III) had been receiving per9 sonal care, home health, or rehabilita10 tive services under a State plan under 

11 this title or under a waiver granted 

12 under sections 1115 or 1915; or 

13 ‘‘(ii) are disabled (as determined 

14 under the State plan). 

15 ‘‘(C) WAIVER OF RESTRICTIONS.—With re16 spect to the provision of home and community17 based services under this paragraph, the Sec18 retary— 

19 ‘‘(i) shall waive any limitations on— 

20 ‘‘(I) the number of individuals 

21 who may receive home or community22 based services under a waiver de23 scribed in subparagraph (B)(i)(I); 

24 ‘‘(II) budget neutrality require25 ments applicable to such waiver; and 


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1 ‘‘(III) populations eligible for 

2 services under such waiver; and 

3 ‘‘(ii) may waive any other restriction 

4 applicable under such a waiver that would 

5 prevent a State from providing home and 

6 community-based services in accordance 

7 with this paragraph. 

8 ‘‘(f) STATE REPORTS.—Each State shall submit to 

9 the Secretary an annual report that includes— 

10 ‘‘(1) information on how the State is satisfying 

11 the requirements of subsection (d)(2) (relating to 

12 providing notice of termination of medical assistance 

13 under this section and assistance in applying for 

14 medical assistance other than under this section); 

15 ‘‘(2) the number of survivors of a disaster who 

16 were determined by the State to be relief-eligible 

17 survivors of a disaster in the preceding year; and 

18 ‘‘(3) the number of relief-eligible survivors of a 

19 disaster who were determined to be eligible for, and 

20 enrolled in, the State plan (or waiver of such plan) 

21 or the State child health plan under title XXI (or 

22 waiver of such plan) other than under this section. 

23 ‘‘(g) 100 PERCENT FEDERAL MATCHING PAY24 MENTS.— 


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1 ‘‘(1) IN GENERAL.—Notwithstanding section 

2 1905(b), the Federal medical assistance percentage 

3 shall be equal to 100 percent with respect to 

4 amounts expended by a State— 

5 ‘‘(A) for medical assistance provided in ac6 cordance with this section to relief-eligible sur7 vivors of a disaster during the relief coverage 

8 period of the disaster; 

9 ‘‘(B) that are directly attributable to ad10 ministrative activities related to the provision of 

11 medical assistance under this section, including 

12 costs attributable to obtaining recoveries under 

13 subsection (h); 

14 ‘‘(C) that are directly attributable to pro15 viding application assistance in accordance with 

16 subsection (d)(2)(B); and 

17 ‘‘(D) for medical assistance provided to re18 lief-eligible survivors of a disaster after the end 

19 of the relief coverage period of the disaster in 

20 accordance with subsection (d)(4). 

21 ‘‘(2) DISREGARD OF LIMITS ON PAYMENTS TO

22 TERRITORIES.—The limitations on payment under 

23 subsections (f) and (g) of section 1108 shall not 

24 apply to Federal payments under this title that are 

25 based on the Federal medical assistance percentage 


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1 described in paragraph (1), and such payments shall 

2 be disregarded in applying such subsections. 

3 ‘‘(h) PENALTY FOR FRAUDULENT APPLICATIONS.— 

4 ‘‘(1) INDIVIDUAL LIABLE FOR COSTS.—If a 

5 State, as the result of verification activities con6 ducted by the State or otherwise, determines after a 

7 fair hearing that an individual has knowingly made 

8 a false attestation in an application for medical as9 sistance as a relief-eligible survivor of a disaster 

10 under this section, the State shall, subject to para11 graph (2), seek recovery from the individual for the 

12 full amount of the cost of medical assistance pro13 vided to the individual under this section. 

14 ‘‘(2) EXCEPTION.—The Secretary shall exempt 

15 a State from the requirement to seek recovery from 

16 an individual under paragraph (1) if the Secretary 

17 determines that it would not be cost-effective for the 

18 State to do so. 

19 ‘‘(3) REIMBURSEMENT TO THE FEDERAL GOV20 ERNMENT.—Amounts expended by a State for med21 ical assistance provided to an individual under this 

22 section that are subsequently recovered by the State 

23 under this subsection shall be treated as an overpay24 ment under this title to the extent that payments 

25 were made to the State for such amounts. 


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1 ‘‘(i) EXEMPTION FROM ERROR RATE PENALTIES.— 

2 All payments attributable to providing medical assistance 

3 to relief-eligible survivors of disasters in accordance with 

4 this section shall be disregarded for purposes of section 

5 1903(u).’’. 

6 SEC. 3. PROMOTING EFFECTIVE AND INNOVATIVE STATE 

7 RESPONSES TO INCREASED DEMAND FOR 

8 MEDICAL ASSISTANCE FOLLOWING A DIS9 ASTER. 

10 (a) GUIDANCE ON INCREASING ACCESS TO PRO11 VIDERS.—Not later than October 1, 2020, the Secretary 

12 of Health and Human Services (in this section referred 

13 to as the ‘‘Secretary’’) shall issue (and update as the Sec14 retary determines necessary) guidance to State Medicaid 

15 directors on best practices for— 

16 (1) expediting the approval of providers under 

17 a State Medicaid plan under title XIX of the Social 

18 Security Act (42 U.S.C. 1396 et seq.), or waiver of 

19 such plan, after a disaster to meet increased demand 

20 for medical assistance under the plan or waiver from 

21 relief-eligible survivors (as defined in section 

22 1947(b)(5) of such Act) of disasters; and 

23 (2) using out-of-State providers to provide care 

24 to relief-eligible survivors of a disaster under the 

25 plan or waiver. 


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1 (b) TECHNICAL ASSISTANCE AND SUPPORT FOR IN2 NOVATIVE STATE STRATEGIES TO RESPOND TO IN3 CREASED DEMAND FOR MEDICAL ASSISTANCE FOL4 LOWING A DISASTERS.— 

5 (1) IN GENERAL.—The Secretary shall provide 

6 technical assistance and support to States to develop 

7 or expand infrastructure, strategies, or innovations 

8 (including through State Medicaid demonstration 

9 projects) to provide medical assistance under a State 

10 Medicaid plan under title XIX of the Social Security 

11 Act (42 U.S.C. 1396 et seq.), or a waiver of such 

12 a plan, to relief-eligible survivors (as defined in sec13 tion 1947(b)(5) of such Act) of disasters. 

14 (2) REPORT.—Not later than 180 days after 

15 the date of enactment of this Act, the Secretary 

16 shall issue a report to Congress detailing a plan of 

17 action to carry out the requirements of paragraph 

18 (1). 

19 (c) HCBS EMERGENCY RESPONSE CORPS GRANT

20 PROGRAM.— 

21 (1) IN GENERAL.—The Secretary shall award 

22 grants under this subsection to States for the pur23 pose of establishing or operating HCBS emergency 

24 response corps that meet the requirements of para25 graph (2) to provide medical assistance for home 


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1 and community-based services under a State Med2 icaid plan under title XIX of the Social Security Act 

3 (42 U.S.C. 1396 et seq.) to relief-eligible survivors 

4 (as defined in section 1947(b)(5) of such Act) of dis5 asters. 

6 (2) HOME AND COMMUNITY-BASED SERVICES

7 EMERGENCY RESPONSE CORPS.—An HCBS emer8 gency response corps meets the requirements of this 

9 paragraph if it satisfies the following requirements: 

10 (A) The corps serves a State with a history 

11 of hosting individuals who are forced to relocate 

12 to the State from another State due to a dis13 aster (as determined by the Secretary). 

14 (B) The corps is composed of representa15 tives from each of the following: 

16 (i) Voluntary organizations delivering 

17 assistance. 

18 (ii) Area agencies on aging (as defined 

19 in section 102 of the Older Americans Act 

20 of 1965 (42 U.S.C. 3002)). 

21 (iii) The Medicare program under title 

22 XVIII of the Social Security Act (42 

23 U.S.C. 1395 et seq.). 

24 (iv) The State agency responsible for 

25 administering the State Medicaid program 


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1 under title XIX of the Social Security Act 

2 (42 U.S.C. 1396 et seq.). 

3 (v) State agencies serving older adults 

4 and people with disabilities. 

5 (vi) Nonprofit service providers. 

6 (vii) Other organizations that address 

7 the needs of older adults and people with 

8 disabilities. 

9 (C) The corps is led by a representative of 

10 a State or nonprofit agency serving older adults 

11 or people with disabilities. 

12 (D) The corps operates under a plan to 

13 meet the acute and long-term services and sup14 port needs of relief-eligible survivors (as defined 

15 in section 1947(b)(5) of the Social Security 

16 Act) of disasters, and is provided with the re17 sources necessary to execute such plan. 

18 (3) GRANTS.— 

19 (A) LIMITATION.—The Secretary may 

20 award a grant under this subsection to up to 5 

21 States. 

22 (B) TERM OF GRANTS.—Grants under this 

23 subsection shall be made for a term of 2 years. 

24 (4) AUTHORIZATION.—There are authorized to 

25 be appropriated to carry out this subsection, 


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1 $10,000,000 for each of fiscal years 2020 through 

2 2025, to remain available until expended. 

3 SEC. 4. TARGETED MEDICAID RELIEF FOR DIRECT IMPACT 

4 AREAS. 

5 (a) 100 PERCENT FEDERAL MATCHING PAYMENTS

6 FOR MEDICAL ASSISTANCE PROVIDED IN A DIRECT IM7 PACT AREA.— 

8 (1) IN GENERAL.—Section 1905 of the Social 

9 Security Act (42 U.S.C. 1396d) is amended— 

10 (A) in subsection (b), by striking ‘‘and 

11 (aa)’’ and inserting ‘‘(aa), and (ff)’’; and 

12 (B) by adding at the end the following new 

13 subsection: 

14 ‘‘(ff) 100 PERCENT FMAP FOR ALL MEDICAL AS15 SISTANCE PROVIDED IN DISASTER DIRECT IMPACT

16 AREAS.—Notwithstanding subsection (b), the Federal 

17 medical assistance percentage for a State and fiscal year 

18 shall be equal to 100 percent with respect to amounts ex19 pended by the State during the year for medical assistance 

20 for an individual who, at the time the assistance is pro21 vided to the individual, is a resident of a direct impact 

22 area of a disaster during the disaster’s relief coverage pe23 riod (as such terms are defined in section 1947).’’. 

24 (2) APPLICATION TO CHIP.—Section 2105(a) of 

25 the Social Security Act (42 U.S.C. 1397ee(a)) is 


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1 amended by adding at the end the following new 

2 paragraph: 

3 ‘‘(5) 100 PERCENT MATCH FOR ALL CHILD

4 HEALTH ASSISTANCE PROVIDED IN DISASTER DI5 RECT IMPACT AREAS.—Notwithstanding paragraph 

6 (1), the Secretary shall pay to each State with a 

7 plan approved under this title, from its allotment 

8 under section 2104, an amount for each quarter 

9 equal to 100 percent of expenditures in the quarter 

10 for child health assistance under the plan for tar11 geted low-income children or pregnancy-related as12 sistance for targeted low-income women that is pro13 vided to such a child or woman who, at the time the 

14 assistance is provided, is a resident of a direct im15 pact area of a disaster during the disaster’s relief 

16 coverage period (as such terms are defined in section 

17 1947).’’. 

18 (b) MORATORIUM ON REDETERMINATIONS.—During 

19 the relief coverage period (as defined in paragraph (4) of 

20 section 1947(b) of the Social Security Act, as added by 

21 section 2)) of a disaster, a State that contains a direct 

22 impact area (as defined in paragraph (2) of such section) 

23 of the disaster shall not be required to conduct eligibility 

24 redeterminations under the State’s plans or waivers of 

25 such plans under title XIX or XXI of such Act (42 U.S.C. 


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1 1396 et seq., 1397aa) with respect to individuals who re2 side in such area. 

3 SEC. 5. AUTHORITY TO WAIVE REQUIREMENTS DURING NA4 TIONAL EMERGENCIES WITH RESPECT TO 

5 EVACUEES FROM AN EMERGENCY AREA. 

6 Section 1135(g)(1) of the Social Security Act (42 

7 U.S.C. 1320b–5(g)(1)) is amended— 

8 (1) by redesignating subparagraphs (A) and 

9 (B) as clauses (i) and (ii), respectively; 

10 (2) by striking ‘‘An ‘emergency area’ ’’ and in11 serting the following: 

12 ‘‘(A) IN GENERAL.—An emergency area’’; 

13 and 

14 (3) by adding at the end the following new sub15 paragraph: 

16 ‘‘(B) ADDITIONAL AREAS.—Any geographical 

17 area in which the Secretary determines there are a 

18 significant number of evacuees from an area de19 scribed in subparagraph (A) shall also be considered 

20 to be an ‘emergency area’ for purposes of this sec21 tion.’’. 


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1 SEC. 6. EXCLUSION OF DISASTER RELIEF COVERAGE PE2 RIOD IN COMPUTING MEDICARE PART B 

3 LATE ENROLLMENT PERIOD. 

4 Section 1839(b) of such Act (42 U.S.C. 1395r(b)) is 

5 amended, in the second sentence, by inserting before the 

6 period at the end the following: ‘‘or, in the case of an indi7 vidual who is a survivor of a disaster (as defined in para8 graph (6) of section 1947(b)), any month any part of 

9 which is within the relief coverage period (as defined in 

10 paragraph (4) of such section) of such disaster’’. 

11 SEC. 7. EFFECTIVE DATE. 

12 (a) IN GENERAL.—Subject to subsection (b), this Act 

13 and the amendments made by this Act shall take effect 

14 on the date of enactment of this Act. 

15 (b) DELAY PERMITTED IF STATE LEGISLATION RE16 QUIRED.—In the case of a State plan approved under title 

17 XIX of the Social Security Act which the Secretary of 

18 Health and Human Services determines requires State 

19 legislation (other than legislation appropriating funds) in 

20 order for the plan to meet the additional requirement im21 posed by this section, the State plan shall not be regarded 

22 as failing to comply with the requirements of such title 

23 solely on the basis of the failure of the plan to meet such 

24 additional requirement before the 1st day of the 1st cal25 endar quarter beginning after the close of the 1st regular 

26 session of the State legislature that ends after the 1-year 


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1 period beginning with the date of the enactment of this 

2 section. For purposes of the preceding sentence, in the 

3 case of a State that has a 2-year legislative session, each 

4 year of the session is deemed to be a separate regular ses5 sion of the State legislature. 

Æ 


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