II

106TH CONGRESS

1ST SESSION S. 203

To amend title XIX of the Social Security Act to provide for an equitable

determination of the Federal medical assistance percentage.

IN THE SENATE OF THE UNITED STATES

JANUARY 19, 1999

Mr. MOYNIHAN introduced the following bill; which was read twice and

referred to the Committee on Finance

A BILL

To amend title XIX of the Social Security Act to provide

for an equitable determination of the Federal medical

assistance percentage.

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 ‘‘Equitable Federal

5 Medical Assistance Percentage Act of 1999’’.

6 SEC. 2. EQUITABLE DETERMINATION OF FEDERAL MEDI7 CAL ASSISTANCE PERCENTAGE.

8 (a) IN GENERAL.—Section 1905 of the Social Secu9 rity Act (42 U.S.C. 1396d) is amended by adding at the

10 end the following:
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1 ‘‘(v) DETERMINATION OF EQUITABLE FEDERAL

2 MEDICAL ASSISTANCE PERCENTAGE.—

3 ‘‘(1) IN GENERAL.—Except as provided in para4 graph (4), the equitable Federal medical assistance

5 percentage determined under this subsection is, for

6 any State for a fiscal year, 100 percent reduced by

7 the product of 0.45 and the ratio of—

8 ‘‘(A) the State’s share of cost-adjusted

9 total taxable resources determined under para10 graph (2); to

11 ‘‘(B) the State’s share of program need de12 termined under paragraph (3).

13 ‘‘(2) DETERMINATION OF STATE’S SHARE OF

14 COST-ADJUSTED TOTAL TAXABLE RESOURCES.—

15 ‘‘(A) IN GENERAL.—For purposes of para16 graph (1)(A), with respect to a State, the

17 State’s share of cost-adjusted total taxable re18 sources is the ratio of—

19 ‘‘(i)(I) an amount equal to the most

20 recent 3-year average of the total taxable

21 resources (TTR) of the State, as deter22 mined by the Secretary of the Treasury;

23 divided by

24 ‘‘(II) the most recent 3-year average

25 of the State’s geographic health care cost
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1 index (as determined under subparagraph

2 (B)); to

3 ‘‘(ii) an amount equal to the sum of

4 the amounts determined under clause (i)

5 for all States.

6 ‘‘(B) STATE’S GEOGRAPHIC HEALTH CARE

7 COST INDEX.—

8 ‘‘(i) IN GENERAL.—For purposes of

9 subparagraph (A)(i)(II), the geographic

10 health care cost index for a State for a fis11 cal year is the sum of—

12 ‘‘(I) 0.10;

13 ‘‘(II) 0.75 multiplied by the ratio

14 of—

15 ‘‘(aa) the most recent 3-year

16 average annual wages for hos17 pital employees in the State or

18 the District of Columbia (as de19 termined under clause (ii)); to

20 ‘‘(bb) the most recent 3-year

21 average annual wages for hos22 pital employees in the 50 States

23 and the District of Columbia (as

24 determined under that clause);

25 and
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1 ‘‘(III) 0.15 multiplied by the

2 State’s fair market rent index (as de3 termined under clause (iii)).

4 ‘‘(ii) DETERMINATION OF AVERAGE

5 ANNUAL WAGES OF HOSPITAL EMPLOY6 EES.—The Secretary shall provide for the

7 determination of the most recent 3-year

8 average annual wages for hospital employ9 ees in a State or the District of Columbia

10 and, collectively, in the 50 States and the

11 District of Columbia, based on the area

12 wage data applicable to hospitals under

13 section 1886(d)(3)(E) (or, if such data no

14 longer exists, comparable data of hospital

15 wages) for discharges occurring during the

16 fiscal years involved.

17 ‘‘(iii) DETERMINATION OF FAIR MAR18 KET RENT INDEX.—For purposes of clause

19 (i)(III), a State’s fair market rent index is

20 the ratio of—

21 ‘‘(I) the average annual fair mar22 ket rent for 2-bedroom housing units

23 in the State or the District of Colum24 bia, to be determined by the Secretary

25 of Housing and Urban Development
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1 for the most recent 3 fiscal years for

2 which data are available; to

3 ‘‘(II) the average annual fair

4 market rent for such housing units for

5 all States for such 3 fiscal years, as so

6 determined.

7 ‘‘(3) DETERMINATION OF STATE’S SHARE OF

8 PROGRAM NEED.—

9 ‘‘(A) IN GENERAL.—For purposes of para10 graph (1)(B), with respect to a State, the

11 State’s share of program need is the ratio of—

12 ‘‘(i) the State’s program need deter13 mined under subparagraph (B); to

14 ‘‘(ii) the sum of the amounts deter15 mined under clause (i) for all States.

16 ‘‘(B) DETERMINATION OF STATE PROGRAM

17 NEED.—

18 ‘‘(i) IN GENERAL.—For purposes of

19 subparagraph (A)(i), a State’s program

20 need is equal to the average (determined

21 for the most recent 5 fiscal years for which

22 data are available) of the sum of the prod23 ucts determined under clause (iv) for each

24 such fiscal year (based on the number of

25 State residents whose income is below the
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1 State’s cost-of-living adjusted poverty in2 come level (as determined under clauses

3 (ii) and (iii)).

4 ‘‘(ii) DETERMINATION OF NUMBER OF

5 STATE RESIDENTS WITH INCOMES BELOW

6 THE STATE’S COST-OF-LIVING ADJUSTED

7 POVERTY LEVEL.—

8 ‘‘(I) IN GENERAL.—For purposes

9 of clause (iv), with respect to each

10 State and the District of Columbia,

11 the number of residents whose income

12 for a fiscal year is below the State’s

13 cost-of-living adjusted poverty income

14 level applicable to a family of the size

15 involved (as determined under clause

16 (iii)) shall be determined.

17 ‘‘(II) CENSUS DATA.—The deter18 mination of the number of residents

19 under subclause (I) shall be based on

20 data made generally available by the

21 Bureau of the Census from the Cur22 rent Population Survey.

23 ‘‘(iii) DETERMINATION OF STATE’S

24 COST-OF-LIVING ADJUSTED POVERTY IN25 COME LEVEL.—
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1 ‘‘(I) IN GENERAL.—For purposes

2 of clause (ii)(I), a State’s cost-of-liv3 ing adjusted poverty income level is

4 the product of—

5 ‘‘(aa) the United States pov6 erty income threshold for the fis7 cal year involved (as defined by

8 the Office of Management and

9 Budget for general statistical

10 purposes); and

11 ‘‘(bb) the State’s cost-of-liv12 ing index (as determined under

13 subclause (II)).

14 ‘‘(II) DETERMINATION OF

15 STATE’S COST-OF-LIVING INDEX.—

16 Subject to subclause (III), a State’s

17 cost-of-living index is the sum of—

18 ‘‘(aa) 0.56; and

19 ‘‘(bb) the product of 0.44

20 and the State’s fair market rent

21 index determined under para22 graph (2)(B)(iii).

23 ‘‘(III) ALTERNATE METHODOL24 OGY.—The Commissioner of Labor

25 Statistics may use an alternate meth-
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1 odology to the formula set forth under

2 subclause (II) to determine a State’s

3 cost-of-living index for purposes of

4 subclause (I)(bb) if the Commissioner

5 determines that the alternate meth6 odology results in a more accurate de7 termination of that index.

8 ‘‘(iv) WEIGHTING OF AGE CAT9 EGORIES OF RESIDENTS IN POVERTY TO

10 ACCOUNT FOR HIGHER COST POPU11 LATIONS.—For purposes of clause (i), the

12 products determined under this clause for

13 a fiscal year are the following:

14 ‘‘(I) WEIGHTING OF ELDERLY

15 RESIDENTS IN POVERTY.—The num16 ber of residents determined under

17 clause (ii) of the State or the District

18 of Columbia for the fiscal year who

19 have attained age 65 multiplied by

20 3.65.

21 ‘‘(II) WEIGHTING OF ADULT

22 RESIDENTS IN POVERTY.—The num23 ber of residents determined under

24 clause (ii) of the State or the District

25 of Columbia for the fiscal year who
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1 have attained age 21 but have not at2 tained age 65 multiplied by 1.0.

3 ‘‘(III) WEIGHTING OF CHILDREN

4 IN POVERTY.—The number of resi5 dents determined under clause (ii) of

6 the State or the District of Columbia

7 for the fiscal year who have not at8 tained age 21 multiplied by 0.5.

9 ‘‘(4) SPECIAL RULES.—For purposes of this

10 subsection and subsection (b), the equitable Federal

11 medical assistance percentage is—

12 ‘‘(A) in the case of the District of Colum13 bia, the percentage determined under this sub14 section for the District of Columbia (without re15 gard to this paragraph) multiplied by 1.4.; and

16 ‘‘(B) in the case of Alaska, 59.8 percent.’’.

17 (b) CONFORMING AMENDMENTS.—Section 1905(b)

18 of the Social Security Act (42 U.S.C. 1396d(b)) is

19 amended—

20 (1) in the matter preceding paragraph (1), by

21 striking ‘‘100 per centum’’ and all that follows

22 through ‘‘Hawaii’’ and inserting ‘‘the equitable Fed23 eral medical assistance percentage determined under

24 subsection (v)’’;
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1 (2) in paragraph (1), by striking ‘‘50 per cen2 tum or more than 83 per centum,,’’ and inserting

3 ‘‘50 percent or more than 83 percent, and’’; and

4 (3) in paragraph (2), by striking ‘‘50 per cen5 tum’’ and all that follows through the period at the

6 end of paragraph (3) and inserting ‘‘50 percent.’’.

7 (c) EFFECTIVE DATE.—The amendments made by

8 this Act take effect on October 1, 1999.

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