I 

111TH CONGRESS 

1ST SESSION H. R. 2680 

To amend the Social Security Act to provide for payment parity for Puerto 

Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and 

American Samoa under the Medicaid Program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 3, 2009 

Ms. BORDALLO (for herself, Mr. SERRANO, Mr. FALEOMAVAEGA, Mrs. 

CHRISTENSEN, Mr. PIERLUISI, and Mr. SABLAN) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Social Security Act to provide for payment 

parity for Puerto Rico, the Virgin Islands, Guam, the 

Northern Mariana Islands, and American Samoa under 

the Medicaid Program, 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 ‘‘Territorial Health Par5 ity Act of 2009’’. 


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1 SEC. 2. MEDICAID PAYMENT PARITY FOR THE TERRI2 TORIES. 

3 (a) ELIMINATION OF FUNDING LIMITATIONS FOR

4 PUERTO RICO, THE VIRGIN ISLANDS, GUAM, THE NORTH5 ERN MARIANA ISLANDS, AND AMERICAN SAMOA.— 

6 (1) IN GENERAL.—Section 1108 of the Social 

7 Security Act (42 U.S.C. 1308) is amended— 

8 (A) in subsection (f), in the matter before 

9 paragraph (1), by striking ‘‘subsection (g)’’ and 

10 inserting ‘‘subsections (g) and (h)’’; 

11 (B) in subsection (g)(2), in the matter be12 fore subparagraph (A), by inserting ‘‘and sub13 section (h)’’ after ‘‘paragraph (3)’’; and 

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

15 subsection: 

16 ‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER17 TO RICO, THE VIRGIN ISLANDS, GUAM, THE NORTHERN

18 MARIANA ISLANDS, AND AMERICAN SAMOA.—Subsections 

19 (f) and (g) shall not apply to Puerto Rico, the Virgin Is20 lands, Guam, the Northern Mariana Islands, and Amer21 ican Samoa for any fiscal year after fiscal year 2009.’’. 

22 (2) CONFORMING AMENDMENT.—Section 

23 1903(u) of such Act (42 U.S.C. 1396c(u)) is amend24 ed by striking paragraph (4). 


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1 (3) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply beginning with fiscal 

3 year 2010. 

4 (b) PARITY IN FMAP.— 

5 (1) IN GENERAL.—Section 1905(b)(2) of such 

6 Act (42 U.S.C. 1396d(b)(2)) is amended by insert7 ing after ‘‘50 per centum’’ the following: ‘‘(except 

8 that, beginning with fiscal year 2012, the Federal 

9 medical assistance percentage for Puerto Rico, the 

10 Virgin Islands, Guam, the Northern Mariana Is11 lands, and American Samoa shall be the Federal 

12 medical assistance percentage determined by the 

13 Secretary in consultation (for the Virgin Islands, 

14 Guam, the Northern Mariana Islands, and American 

15 Samoa) with the Secretary of the Interior)’’. 

16 (2) 2-FISCAL-YEAR TRANSITION.—Notwith17 standing any other provision of law, during fiscal 

18 years 2010 and 2011, the Federal medical assist19 ance percentage established under section 1905(b) of 

20 the Social Security Act (42 U.S.C. 1396d(b)) for 

21 Puerto Rico, the Virgin Islands, Guam, the North22 ern Mariana Islands, and American Samoa shall be 

23 the highest such Federal medical assistance percent24 age applicable to any of the 50 States or the District 

25 of Columbia for the fiscal year involved, taking into 


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1 account the application of subsections (a) and (b)(1) 

2 of 5001 of division B of the American Recovery and 

3 Reinvestment Act of 2009 (Public Law 111–5) to 

4 such States and District for calendar quarters dur5 ing such fiscal years for which such subsections 

6 apply respectively. 

7 (3) PER CAPITA INCOME DATA.— 

8 (A) REPORT TO CONGRESS.—Not later 

9 than October 1, 2010, the Secretary of Health 

10 and Human Services shall submit to Congress 

11 a report that describes the per capita income 

12 data used to promulgate the Federal medical 

13 assistance percentage in the territories and how 

14 such data differ from the per capita income 

15 data used to promulgate Federal medical assist16 ance percentages for the 50 States and the Dis17 trict of Columbia. The report should include 

18 recommendations on how the Federal medical 

19 assistance percentages can be calculated for the 

20 territories to ensure parity with the 50 States 

21 and the District of Columbia. 

22 (B) APPLICATION.—Section 1101(a)(8)(B) 

23 of the Social Security Act (42 U.S.C. 

24 1308(a)(8)(B)) is amended— 


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1 (i) by striking ‘‘(other than Puerto 

2 Rico, the Virgin Islands, and Guam)’’ and 

3 inserting ‘‘(including Puerto Rico, the Vir4 gin Islands, Guam, the Northern Mariana 

5 Islands, and American Samoa)’’; and 

6 (ii) by inserting ‘‘(or, if such satisfac7 tory data are not available in the case of 

8 the Virgin Islands, Guam, the Northern 

9 Mariana Islands, or American Samoa, sat10 isfactory data available from the Depart11 ment of the Interior for the same period, 

12 or if such satisfactory data are not avail13 able in the case of Puerto Rico, satisfac14 tory data available from the Government of 

15 the Commonwealth of Puerto Rico for the 

16 same period)’’ after ‘‘Department of Com17 merce’’. 

18 (4) RELATION TO AMERICAN RECOVERY AND

19 REINVESTMENT ACT OF 2009.—For any period and 

20 territory in which the provisions of this subsection 

21 apply to a territory, the provisions of section 

22 5001(b)(2) of division B of the American Recovery 

23 and Reinvestment Act of 2009 (Public Law 111–5) 

24 shall not apply (except as otherwise specifically pro25 vided in paragraph (2)). 


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1 SEC. 3. CLARIFICATION OF MEDICAID COVERAGE FOR CITI2 ZENS OF FREELY ASSOCIATED STATES. 

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

4 Responsibility and Work Opportunity Reconciliation Act 

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

6 the end the following: 

7 ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS

8 OF FREELY ASSOCIATED STATES.—With respect 

9 to eligibility for benefits for the program de10 fined in paragraph (3)(C) (relating to the Med11 icaid program), paragraph (1) shall not apply 

12 to any individual who lawfully resides in the 

13 United States (including territories and posses14 sions of the United States) in accordance with 

15 the Compacts of Free Association between the 

16 Government of the United States and the Gov17 ernments of the Federated States of Micro18 nesia, the Republic of the Marshall Islands, and 

19 the Republic of Palau.’’. 

20 (b) CONFORMING DEFINITION OF QUALIFIED

21 ALIEN.—Section 431(b) of such Act (8 U.S.C. 1641(b)) 

22 is amended— 

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

24 end; 

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

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


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1 (3) by adding at the end the following: 

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

3 United States (including territories and possessions 

4 of the United States) in accordance with a Compact 

5 of Free Association referred to in section 

6 402(b)(2)(G), but only with respect to the program 

7 defined in section 402(b)(3)(C) (relating to the Med8 icaid program).’’. 

9 (c) SETTING FMAP AT 100 PERCENT.—The third 

10 sentence of section 1905(b) of the Social Security Act (42 

11 U.S.C. 1396d(b)) is amended by inserting before the pe12 riod at the end the following: ‘‘and as medical assistance 

13 for individuals described in section 402(b)(2)(G) of the 

14 Personal Responsibility and Work Opportunity Reconcili15 ation Act of 1996’’. 

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

17 this Act take effect on October 1, 2009, Act and apply 

18 to benefits and assistance provided on or after that date. 

Æ 


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