I 

109TH CONGRESS 

1ST SESSION H. R. 160 

To amend title XIX of the Social Security Act to permit States to expand 

Medicaid eligibility to uninsured, poor adults. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 4, 2005 

Ms. MILLENDER-MCDONALD introduced the following bill; which was referred 

to the Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to permit 

States to expand Medicaid eligibility to uninsured, poor 

adults. 

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 ‘‘Keep America Healthy 

5 Act of 2005’’. 

6 SEC. 2. OPTIONAL MEDICAID COVERAGE OF UNINSURED, 

7 POOR ADULTS. 

8 (a) AVAILABILITY OF MEDICAID COVERAGE FOR UN9 INSURED, POOR ADULTS.— 
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1 (1) ADDITION OF OPTIONAL COVERAGE

2 GROUP.—Section 1902(a)(10)(A)(ii) of the Social 

3 Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is 

4 amended— 

5 (A) by striking ‘‘or’’ at the end of sub6 clause (XVII); 

7 (B) by striking the semicolon at the end of 

8 subclause (XVIII) and inserting ‘‘, or’’; and 

9 (C) by adding at the end the following new 

10 subclause: 

11 ‘‘(XIX) described in subsection 

12 (cc);’’. 

13 (2) ELIGIBILITY STANDARDS FOR NEW ELIGI14 BILITY GROUP.—Section 1902 of such Act is further 

15 amended by adding at the end the following new 

16 subsection: 

17 ‘‘(cc) COVERAGE OF UNINSURED, POOR ADULTS.— 

18 For purposes of subsection (a)(10)(A)(ii)(XIX), individ19 uals described in this subsection are individuals who meet 

20 the following requirements: 

21 ‘‘(1) AGE.—The individual is at least 21 years 

22 of age but is under 65 years of age. 

23 ‘‘(2) INCOME.—The income of the individual’s 

24 family does not exceed a percentage (not to exceed 

25 200 percent) specified by the State of the poverty 
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1 line (as defined in section 2110(c)(5)) applicable to 

2 a family of the size involved and, at the option of 

3 a State, the individual’s resources do not exceed 

4 such resource level as the State may establish, so 

5 long as such resource level is not more restrictive 

6 than the resources an individual may have and ob7 tain benefits under the supplemental security income 

8 program under title XVI.’’. 

9 (b) PROVISION OF ENHANCED FEDERAL MEDICAL

10 ASSISTANCE AS INCENTIVE FOR STATES TO INCREASE

11 COVERAGE.— 

12 (1) APPLICATION OF ENHANCED FEDERAL

13 MEDICAL ASSISTANCE PERCENTAGE.—Section 

14 1905(b)(4) of such Act (42 U.S.C. 1396d(b)(4)) is 

15 amended by inserting ‘‘or section 

16 1902(a)(10)(A)(ii)(XIX)’’ after ‘‘section 

17 1902(a)(10)(A)(ii)(XVIII)’’. 

18 (2) INCREASE IN MEDICAID PAYMENT LIMIT

19 FOR TERRITORIES TO ACCOMMODATE EXPANDED

20 COVERAGE FOR RESIDENTS OF PUERTO RICO, THE

21 VIRGIN ISLANDS, GUAM, AMERICAN SAMOA, AND THE

22 NORTHERN MARIANA ISLANDS.—Section 1108 of 

23 such Act (42 U.S.C. 1308) is amended— 
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1 (A) in subsection (f), by striking ‘‘sub2 section (g)’’ and inserting ‘‘subsections (g) and 

3 (h)’’; and 

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

5 subsection: 

6 ‘‘(h) INCREASE IN MEDICAID PAYMENT LIMIT TO

7 ACCOMMODATE EXPANDED COVERAGE UNDER THE KEEP

8 AMERICA HEALTHY ACT.— 

9 ‘‘(1) FISCAL YEAR 2006 AND THEREAFTER.— 

10 With respect to fiscal year 2006 and each succeeding 

11 fiscal year, if Puerto Rico, the Virgin Islands, Guam, 

12 the Northern Mariana Islands, or American Samoa 

13 provides for coverage of individuals under section 

14 1902(a)(10)(A)(ii)(XIX) in a fiscal year, the 

15 amounts otherwise determined for the respective ter16 ritory under subsections (f) and (g) for such fiscal 

17 year shall be increased by a percentage (estimated 

18 by the Secretary) equal to 120 percent of the State 

19 average Keep America Healthy percentage, esti20 mated by the Secretary under paragraph (2) for the 

21 fiscal year involved. 

22 ‘‘(2) ANNUAL ESTIMATION OF STATE AVERAGE

23 KEEP AMERICA HEALTHY PERCENTAGE.—For each 

24 such fiscal year the Secretary shall estimate a State 

25 average Keep America Healthy percentage equal to 
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1 (A) the total Federal payments under title XIX for 

2 the fiscal year for the 50 States and the District of 

3 Columbia that are attributable to individuals made 

4 eligible for benefits under section 

5 1902(a)(10)(A)(ii)(XIX), divided by (B) the total 

6 Federal payments under such title the fiscal year for 

7 such States and District.’’. 

8 (c) CONFORMING AND TECHNICAL AMENDMENTS.— 

9 (1) Section 1903(f)(4) of such Act (42 U.S.C. 

10 1396b(f)(4)) is amended by inserting 

11 ‘‘1902(a)(10)(A)(ii)(XIX),’’ after 

12 ‘‘1902(a)(10)(A)(ii)(XVIII),’’. 

13 (2) Section 1905(a) of such Act (42 U.S.C. 

14 1396d(a)) is amended, in the matter before paragraph 

15 (1)— 

16 (A) by striking ‘‘or’’ at the end of clause (xii); 

17 (B) by adding ‘‘or’’ at the end of clause (xiii); 

18 and 

19 (C) by inserting after clause (xiii) the following 

20 new clause: 

21 ‘‘(xiv) individuals described in section 

22 1902(cc),’’. 

23 (3) Section 1905(u)(4) of such Act (42 U.S.C. 

24 1396d(u)(4)) is amended by inserting before the period 
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1 at the end the following: ‘‘for individuals not covered 

2 under section 1902(a)(10)(A)(ii)(XIX)’’. 

3 (d) EFFECTIVE DATE.—The amendments made by 

4 this section shall take effect on October 1, 2005. 

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