II 

116TH CONGRESS 

1ST SESSION S. 1754 

To provide Medicaid assistance to individuals and families affected by a 

disaster or emergency, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 10, 2019 

Mr. CASEY (for himself, Mr. BROWN, Mr. BLUMENTHAL, Ms. HARRIS, and 

Mrs. GILLIBRAND) introduced the following bill; which was read twice 

and referred to the Committee on Finance 

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— 

9 (1) in section 1902(a)— 


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

2 and inserting a semicolon; 

3 (B) in paragraph (86), by striking the pe4 riod at the end and inserting ‘‘; and’’; and 

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

6 following new paragraph: 

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

8 making medical assistance available to relief-eligible 

9 survivors of disasters during relief coverage periods 

10 in accordance with section 1947.’’; and 

11 (2) by adding at the end the following new sec12 tion: 

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

14 OF MAJOR DISASTERS. 

15 ‘‘(a) IN GENERAL.—Notwithstanding any other pro16 vision of this title, a State plan shall provide medical as17 sistance to a relief-eligible survivor of a disaster in accord18 ance with this section. 

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

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

21 major disaster— 

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

23 1, 2020, by the President in accordance with 

24 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 20:35 Jun 11, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1754.IS S1754

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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 20:35 Jun 11, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1754.IS S1754

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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 20:35 Jun 11, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1754.IS S1754

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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) Peer support services related to the 

14 disaster. 

15 ‘‘(F) Mobile crisis services to assist with 

16 crises related to the disaster. 

17 ‘‘(G) In-patient mental health care in a 

18 general hospital. 

19 ‘‘(H) Family counseling for families where 

20 a member of the immediate family is a survivor 

21 of the disaster or first responder to the disaster 

22 or includes an individual who has died as a re23 sult of the disaster. 

24 ‘‘(I) In connection with the provision of 

25 health and long-term care services, arranging 


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1 for, (and when necessary, enrollment in waiver 

2 programs or other specialized programs), and 

3 coordination related to, primary and specialty 

4 medical care, which may include personal care 

5 services, durable medical equipment and sup6 plies, assistive technology, and transportation. 

7 ‘‘(6) OPTION TO PROVIDE HOME AND COMMU8 NITY-BASED SERVICES.— 

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

10 medical assistance under this section for home 

11 and community-based services to a relief-eligible 

12 survivor of a disaster, including any survivor 

13 who is an individual described in subparagraph 

14 (B), who self-attests that the survivor imme15 diately requires such services, without regard to 

16 whether the survivor would require the level of 

17 care provided in a hospital, nursing facility, or 

18 intermediate care facility for the develop19 mentally disabled. 

20 ‘‘(B) INDIVIDUALS DESCRIBED.—Individ21 uals described in this subparagraph are relief22 eligible survivors of a disaster who— 

23 ‘‘(i) on any day during the week pre24 ceding the date on which the disaster is deVerDate Sep 11 2014 20:35 Jun 11, 2019 Jkt 089200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S1754.IS S1754

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1 clared (as described in subsection 

2 (b)(1)(A))— 

3 ‘‘(I) had been receiving home and 

4 community-based services in a direct 

5 impact area under a waiver under sec6 tion 1115 or section 1915; 

7 ‘‘(II) had been receiving support 

8 services from a primary family care9 giver who, as a result of the disaster, 

10 is no longer available to provide serv11 ices; or 

12 ‘‘(III) had been receiving per13 sonal care, home health, or rehabilita14 tive services under a State plan under 

15 this title or under a waiver granted 

16 under sections 1115 or 1915; or 

17 ‘‘(ii) are disabled (as determined 

18 under the State plan). 

19 ‘‘(C) WAIVER OF RESTRICTIONS.—With re20 spect to the provision of home and community21 based services under this paragraph, the Sec22 retary— 

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

24 ‘‘(I) the number of individuals 

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1 based services under a waiver de2 scribed in subparagraph (B)(i)(I); 

3 ‘‘(II) budget neutrality require4 ments applicable to such waiver; and 

5 ‘‘(III) populations eligible for 

6 services under such waiver; and 

7 ‘‘(ii) may waive any other restriction 

8 applicable under such a waiver that would 

9 prevent a State from providing home and 

10 community-based services in accordance 

11 with this paragraph. 

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

13 the Secretary an annual report that includes— 

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

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

16 providing notice of termination of medical assistance 

17 under this section and assistance in applying for 

18 medical assistance other than under this section); 

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

20 were determined by the State to be relief-eligible 

21 survivors of a disaster in the preceding year; and 

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

23 disaster who were determined to be eligible for, and 

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


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

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

3 ‘‘(g) 100 PERCENT FEDERAL MATCHING PAY4 MENTS.— 

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

6 1905(b), the Federal medical assistance percentage 

7 shall be equal to 100 percent with respect to 

8 amounts expended by a State— 

9 ‘‘(A) for medical assistance provided in ac10 cordance with this section to relief-eligible sur11 vivors of a disaster during the relief coverage 

12 period of the disaster; 

13 ‘‘(B) that are directly attributable to ad14 ministrative activities related to the provision of 

15 medical assistance under this section, including 

16 costs attributable to obtaining recoveries under 

17 subsection (h); 

18 ‘‘(C) that are directly attributable to pro19 viding application assistance in accordance with 

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

21 ‘‘(D) for medical assistance provided to re22 lief-eligible survivors of a disaster after the end 

23 of the relief coverage period of the disaster in 

24 accordance with subsection (d)(4). 


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

2 TERRITORIES.—The limitations on payment under 

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

4 apply to Federal payments under this title that are 

5 based on the Federal medical assistance percentage 

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

7 be disregarded in applying such subsections. 

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

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

10 State, as the result of verification activities con11 ducted by the State or otherwise, determines after a 

12 fair hearing that an individual has knowingly made 

13 a false attestation in an application for medical as14 sistance as a relief-eligible survivor of a disaster 

15 under this section, the State shall, subject to para16 graph (2), seek recovery from the individual for the 

17 full amount of the cost of medical assistance pro18 vided to the individual under this section. 

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

20 a State from the requirement to seek recovery from 

21 an individual under paragraph (1) if the Secretary 

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

23 State to do so. 

24 ‘‘(3) REIMBURSEMENT TO THE FEDERAL GOV25 ERNMENT.—Amounts expended by a State for medVerDate Sep 11 2014 20:35 Jun 11, 2019 Jkt 089200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S1754.IS S1754

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1 ical assistance provided to an individual under this 

2 section that are subsequently recovered by the State 

3 under this subsection shall be treated as an overpay4 ment under this title to the extent that payments 

5 were made to the State for such amounts. 

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

7 All payments attributable to providing medical assistance 

8 to relief-eligible survivors of disasters in accordance with 

9 this section shall be disregarded for purposes of section 

10 1903(u).’’. 

11 SEC. 3. PROMOTING EFFECTIVE AND INNOVATIVE STATE 

12 RESPONSES TO INCREASED DEMAND FOR 

13 MEDICAL ASSISTANCE FOLLOWING A DIS14 ASTER. 

15 (a) GUIDANCE ON INCREASING ACCESS TO PRO16 VIDERS.—Not later than October 1, 2020, the Secretary 

17 of Health and Human Services (in this section referred 

18 to as the ‘‘Secretary’’) shall issue (and update as the Sec19 retary determines necessary) guidance to State Medicaid 

20 directors on best practices for— 

21 (1) expediting the approval of providers under 

22 a State Medicaid plan under title XIX of the Social 

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

24 such plan, after a disaster to meet increased demand 

25 for medical assistance under the plan or waiver from 


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1 relief-eligible survivors (as defined in section 

2 1947(b)(5) of such Act) of disasters; and 

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

4 to relief-eligible survivors of a disaster under the 

5 plan or waiver. 

6 (b) TECHNICAL ASSISTANCE AND SUPPORT FOR IN7 NOVATIVE STATE STRATEGIES TO RESPOND TO IN8 CREASED DEMAND FOR MEDICAL ASSISTANCE FOL9 LOWING A DISASTERS.— 

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

11 technical assistance and support to States to develop 

12 or expand infrastructure, strategies, or innovations 

13 (including through State Medicaid demonstration 

14 projects) to provide medical assistance under a State 

15 Medicaid plan under title XIX of the Social Security 

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

17 a plan, to relief-eligible survivors (as defined in sec18 tion 1947(b)(5) of such Act) of disasters. 

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

20 the date of enactment of this Act, the Secretary 

21 shall issue a report to Congress detailing a plan of 

22 action to carry out the requirements of paragraph 

23 (1). 

24 (c) HCBS EMERGENCY RESPONSE CORPS GRANT

25 PROGRAM.— 


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

2 grants under this subsection to States for the pur3 pose of establishing or operating HCBS emergency 

4 response corps that meet the requirements of para5 graph (2) to provide medical assistance for home 

6 and community-based services under a State Med7 icaid plan under title XIX of the Social Security Act 

8 (42 U.S.C. 1396 et seq.) to relief-eligible survivors 

9 (as defined in section 1947(b)(5) of such Act) of dis10 asters. 

11 (2) HOME AND COMMUNITY-BASED SERVICES

12 EMERGENCY RESPONSE CORPS.—An HCBS emer13 gency response corps meets the requirements of this 

14 paragraph if it satisfies the following requirements: 

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

16 of hosting individuals who are forced to relocate 

17 to the State from another State due to a dis18 aster (as determined by the Secretary). 

19 (B) The corps is composed of representa20 tives from each of the following: 

21 (i) Voluntary organizations delivering 

22 assistance. 

23 (ii) Area agencies on aging (as defined 

24 in section 102 of the Older Americans Act 

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


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•S 1754 IS

1 (iii) The Medicare program under title 

2 XVIII of the Social Security Act (42 

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

4 (iv) The State agency responsible for 

5 administering the State Medicaid program 

6 under title XIX of the Social Security Act 

7 (42 U.S.C. 1396 et seq.). 

8 (v) State agencies serving older adults 

9 and people with disabilities. 

10 (vi) Nonprofit service providers. 

11 (vii) Other organizations that address 

12 the needs of older adults and people with 

13 disabilities. 

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

15 a State or nonprofit agency serving older adults 

16 or people with disabilities. 

17 (D) The corps operates under a plan to 

18 meet the acute and long-term services and sup19 port needs of relief-eligible survivors (as defined 

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

21 Act) of disasters, and is provided with the re22 sources necessary to execute such plan. 

23 (3) GRANTS.— 


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1 (A) LIMITATION.—The Secretary may 

2 award a grant under this subsection to up to 5 

3 States. 

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

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

6 (4) AUTHORIZATION.—There are authorized to 

7 be appropriated to carry out this subsection, 

8 $10,000,000 for each of fiscal years 2020 through 

9 2025, to remain available until expended. 

10 SEC. 4. TARGETED MEDICAID RELIEF FOR DIRECT IMPACT 

11 AREAS. 

12 (a) 100 PERCENT FEDERAL MATCHING PAYMENTS

13 FOR MEDICAL ASSISTANCE PROVIDED IN A DIRECT IM14 PACT AREA.— 

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

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

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

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

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

20 subsection: 

21 ‘‘(ff) 100 PERCENT FMAP FOR ALL MEDICAL AS22 SISTANCE PROVIDED IN DISASTER DIRECT IMPACT

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

24 medical assistance percentage for a State and fiscal year 

25 shall be equal to 100 percent with respect to amounts exVerDate Sep 11 2014 20:35 Jun 11, 2019 Jkt 089200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S1754.IS S1754

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•S 1754 IS

1 pended by the State during the year for medical assistance 

2 for an individual who, at the time the assistance is pro3 vided to the individual, is a resident of a direct impact 

4 area of a disaster during the disaster’s relief coverage pe5 riod (as such terms are defined in section 1947).’’. 

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

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

8 amended by adding at the end the following new 

9 paragraph: 

10 ‘‘(5) 100 PERCENT MATCH FOR ALL CHILD

11 HEALTH ASSISTANCE PROVIDED IN DISASTER DI12 RECT IMPACT AREAS.—Notwithstanding paragraph 

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

14 plan approved under this title, from its allotment 

15 under section 2104, an amount for each quarter 

16 equal to 100 percent of expenditures in the quarter 

17 for child health assistance under the plan for tar18 geted low-income children or pregnancy-related as19 sistance for targeted low-income women that is pro20 vided to such a child or woman who, at the time the 

21 assistance is provided, is a resident of a direct im22 pact area of a disaster during the disaster’s relief 

23 coverage period (as such terms are defined in section 

24 1947).’’. 


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1 (b) MORATORIUM ON REDETERMINATIONS.—During 

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

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

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

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

6 of the disaster shall not be required to conduct eligibility 

7 redeterminations under the State’s plans or waivers of 

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

9 1396 et seq., 1397aa) with respect to individuals who re10 side in such area. 

11 SEC. 5. AUTHORITY TO WAIVE REQUIREMENTS DURING NA12 TIONAL EMERGENCIES WITH RESPECT TO 

13 EVACUEES FROM AN EMERGENCY AREA. 

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

15 U.S.C. 1320b–5(g)(1)) is amended— 

16 (1) by redesignating subparagraphs (A) and 

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

18 (2) by striking ‘‘An ‘emergency area’ ’’ and in19 serting the following: 

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

21 and 

22 (3) by adding at the end the following new sub23 paragraph: 

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

25 area in which the Secretary determines there are a 


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1 significant number of evacuees from an area de2 scribed in subparagraph (A) shall also be considered 

3 to be an ‘emergency area’ for purposes of this sec4 tion.’’. 

5 SEC. 6. EXCLUSION OF DISASTER RELIEF COVERAGE PE6 RIOD IN COMPUTING MEDICARE PART B 

7 LATE ENROLLMENT PERIOD. 

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

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

10 period at the end the following: ‘‘or, in the case of an indi11 vidual who is a survivor of a disaster (as defined in para12 graph (6) of section 1947(b)), any month any part of 

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

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

15 SEC. 7. EFFECTIVE DATE. 

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

17 and the amendments made by this Act shall take effect 

18 on the date of enactment of this Act. 

19 (b) DELAY PERMITTED IF STATE LEGISLATION RE20 QUIRED.—In the case of a State plan approved under title 

21 XIX of the Social Security Act which the Secretary of 

22 Health and Human Services determines requires State 

23 legislation (other than legislation appropriating funds) in 

24 order for the plan to meet the additional requirement im25 posed by this section, the State plan shall not be regarded 


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1 as failing to comply with the requirements of such title 

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

3 additional requirement before the 1st day of the 1st cal4 endar quarter beginning after the close of the 1st regular 

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

6 period beginning with the date of the enactment of this 

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

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

9 year of the session is deemed to be a separate regular ses10 sion of the State legislature. 

Æ 


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