II 

116TH CONGRESS 

1ST SESSION S. 2218 

To amend title IV of the Personal Responsibility and Work Opportunity 

Reconciliation Act of 1996 to restore Medicaid coverage for citizens 

of the Freely Associated States lawfully residing in the United States 

under the Compacts of Free Association between the Government of 

the United States and the Governments of the Federated States of 

Micronesia, the Republic of the Marshall Islands, and the Republic of 

Palau. 

IN THE SENATE OF THE UNITED STATES 

JULY 23, 2019 

Ms. HIRONO (for herself and Mr. SCHATZ) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

A BILL 

To amend title IV of the Personal Responsibility and Work 

Opportunity Reconciliation Act of 1996 to restore Medicaid coverage for citizens of the Freely Associated States 

lawfully residing in the United States under the Compacts of Free Association between the Government of 

the United States and the Governments of the Federated 

States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Covering our FAS Al3 lies Act’’. 

4 SEC. 2. MEDICAID COVERAGE FOR CITIZENS OF FREELY AS5 SOCIATED STATES. 

6 (a) IN GENERAL.—Section 402(b)(2) of the Personal 

7 Responsibility and Work Opportunity Reconciliation Act 

8 of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 

9 the end the following new subparagraph: 

10 ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS

11 OF FREELY ASSOCIATED STATES.—With respect 

12 to eligibility for benefits for the designated Fed13 eral program defined in paragraph (3)(C) (re14 lating to the Medicaid program), section 401(a) 

15 and paragraph (1) shall not apply to any indi16 vidual who lawfully resides in 1 of the 50 States 

17 or the District of Columbia in accordance with 

18 the Compacts of Free Association between the 

19 Government of the United States and the Gov20 ernments of the Federated States of Micro21 nesia, the Republic of the Marshall Islands, and 

22 the Republic of Palau and shall not apply, at 

23 the option of the Governor of Puerto Rico, the 

24 Virgin Islands, Guam, the Northern Mariana 

25 Islands, or American Samoa as communicated 

26 to the Secretary of Health and Human Services 


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1 in writing, to any individual who lawfully re2 sides in the respective territory in accordance 

3 with such Compacts.’’. 

4 (b) EXCEPTION TO 5-YEAR LIMITED ELIGIBILITY.— 

5 Section 403(d) of such Act (8 U.S.C. 1613(d)) is amend6 ed— 

7 (1) in paragraph (1), by striking ‘‘or’’ at the 

8 end; 

9 (2) in paragraph (2), by striking the period at 

10 the end and inserting ‘‘; or’’; and 

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

12 paragraph: 

13 ‘‘(3) an individual described in section 

14 402(b)(2)(G), but only with respect to the des15 ignated Federal program defined in section 

16 402(b)(3)(C).’’. 

17 (c) DEFINITION OF QUALIFIED ALIEN.—Section 

18 431(b) of such Act (8 U.S.C. 1641(b)) is amended— 

19 (1) in paragraph (6), by striking ‘‘; or’’ at the 

20 end and inserting a comma; 

21 (2) in paragraph (7), by striking the period at 

22 the end and inserting ‘‘, or’’; and 

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

24 paragraph: 


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1 ‘‘(8) an individual who lawfully resides in the 

2 United States in accordance with a Compact of Free 

3 Association referred to in section 402(b)(2)(G), but 

4 only with respect to the designated Federal program 

5 defined in section 402(b)(3)(C) (relating to the Med6 icaid program).’’. 

7 (d) CONFORMING AMENDMENTS.—Section 1108 of 

8 the Social Security Act (42 U.S.C. 1308) is amended— 

9 (1) in subsection (f), in the matter preceding 

10 paragraph (1), by striking ‘‘subsection (g)’’ and in11 serting ‘‘subsections (g) and (h)’’; and 

12 (2) by adding at the end the following: 

13 ‘‘(h) Expenditures for medical assistance provided to 

14 an individual described in section 431(b)(8) of the Per15 sonal Responsibility and Work Opportunity Reconciliation 

16 Act of 1996 shall not be taken into account for purposes 

17 of applying payment limits under subsections (f) and 

18 (g).’’. 

19 (e) EFFECTIVE DATE.—The amendments made by 

20 this section shall apply to benefits for items and services 

21 furnished on or after the date of the enactment of this 

22 Act. 

Æ 


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