I 

114TH CONGRESS 

2D SESSION H. R. 5375 

To amend titles XIX and XXI of the Social Security Act to eliminate the 

CHIP maintenance of effort requirement and to eliminate DSH cuts 

for States not implementing the ACA Medicaid expansion. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 27, 2016 

Mr. MULLIN introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to eliminate the CHIP maintenance of effort requirement 

and to eliminate DSH cuts for States not implementing 

the ACA Medicaid expansion. 

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 ‘‘Preserving Access to 

5 Medicaid for Americans Act of 2016’’. 


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1 SEC. 2. ELIMINATION OF MOE REQUIREMENT FOR CHIP 

2 ELIGIBILITY. 

3 Section 2105(d)(3) of the Social Security Act (42 

4 U.S.C. 1397ee(d)(3)) is amended by striking ‘‘September 

5 30, 2019’’ and inserting ‘‘the date of the enactment of 

6 the Preserving Access to Medicaid for Americans Act of 

7 2016’’. 

8 SEC. 3. ELIMINATION OF DSH CUTS FOR STATES NOT IM9 PLEMENTING ACA EXPANSION. 

10 (a) IN GENERAL.—Section 1923(f)(7) of the Social 

11 Security Act (42 U.S.C. 1396r–4(f)(7)) is amended— 

12 (1) in subparagraph (A)— 

13 (A) in clause (i)— 

14 (i) in the matter preceding subclause 

15 (I), by striking ‘‘each of fiscal years 2018 

16 through 2025’’ and inserting ‘‘fiscal year 

17 2018 and each subsequent fiscal year’’; 

18 and 

19 (ii) in subclause (I)— 

20 (I) by striking ‘‘the amount spec21 ified under the DSH health reform 

22 methodology under subparagraph 

23 (B)’’ and inserting ‘‘the amount of 

24 the aggregate reduction target’’; and 

25 (II) by striking ‘‘DSH allotments 

26 to States’’ and inserting ‘‘the DSH alVerDate Sep 11 2014 23:08 Jun 02, 2016 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5375.IH H5375

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1 lotment to each expansion State’’ each 

2 place it appears; 

3 (B) in clause (ii)— 

4 (i) in the matter preceding subclause 

5 (I), by striking ‘‘The aggregate reduc6 tions’’ and inserting ‘‘In applying subpara7 graph (B), the aggregate reduction tar8 gets’’; 

9 (ii) in subclause (VII), by striking 

10 ‘‘and’’ at the end; 

11 (iii) in subclause (VIII), by striking 

12 the period at the end and inserting ‘‘; 

13 and’’; and 

14 (iv) by adding at the end the following 

15 new subclause: 

16 ‘‘(IX) $8,000,000,000 for fiscal 

17 year 2026 and, subject to subpara18 graph (C), each subsequent fiscal 

19 year.’’; 

20 (C) by amending clause (iv) to read as fol21 lows: 

22 ‘‘(iv) DEFINITIONS.—For purposes of 

23 this paragraph: 

24 ‘‘(I) The term ‘expansion State’ 

25 means, for a fiscal year, a State that, 


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1 as of the date that is 180 days before 

2 the start of such fiscal year, provides 

3 for eligibility under clause (i)(VIII) or 

4 (ii)(XX) of section 1902(a)(10)(A) for 

5 medical assistance under this title (or 

6 a waiver of the State plan approved 

7 under section 1115). 

8 ‘‘(II) The term ‘non-expansion 

9 State’ means, for a fiscal year, a 

10 State that is not an expansion State 

11 for such fiscal year.’’; and 

12 (D) in clause (v), by striking ‘‘DISTRIBU13 TION OF AGGREGATE REDUCTIONS.—The Sec14 retary shall distribute the aggregate reduc15 tions’’ and inserting ‘‘DISTRIBUTION OF AG16 GREGATE REDUCTION TARGETS.—The Sec17 retary shall distribute the aggregate reduction 

18 targets under clause (ii) among all the States 

19 (including non-expansion States)’’; 

20 (2) in subparagraph (B), by adding at the end 

21 the following new clause: 

22 ‘‘(iv) The methodology imposes reduc23 tion targets as if the reductions under sub24 paragraph (A) were applied to all States, 

25 including non-expansion States.’’; and 


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1 (3) by adding at the end the following new sub2 paragraph: 

3 ‘‘(C) EXTENSION OF REDUCTION FOR EX4 PANSION STATES TO PAY FOR ELIMINATION OF

5 REDUCTION FOR NON-EXPANSION STATES.— 

6 The aggregate amount of reductions under sub7 paragraph (A) for fiscal years after fiscal year 

8 2025 shall not exceed the sum of the aggregate 

9 reduction targets distributed under clause (v) to 

10 non-expansion States for fiscal years 2018 

11 through 2025.’’. 

12 (b) CONFORMING AMENDMENT.—Section 1923(f)(8) 

13 of the Social Security Act (42 U.S.C. 1396r–4(f)(8)) is 

14 amended by striking ‘‘fiscal year 2025’’ and inserting ‘‘the 

15 last fiscal year for which a reduction is made under para16 graph (7)(A)’’. 

Æ 


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