HEALTHY KIDS Act

To extend funding for the Children’s Health Insurance Program, and for other purposes. 1. Short title This Act may be cited as the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017 HEALTHY KIDS Act 2. Table of contents The table of contents for this Act is as follows: Sec. 1. Short title. Sec. 2. Table of contents. Title I—CHIP Extension and Other Medicaid and CHIP Provisions Sec. 101. Five-year funding extension of the Children’s Health Insurance Program. Sec. 102. Extension of certain programs and demonstration projects. Sec. 103. Extension of outreach and enrollment program. Sec. 104. Extension and reduction of additional Federal financial participation for CHIP. Sec. 105. Modifying reduction in Medicaid DSH allotments. Sec. 106. Puerto Rico and the Virgin Islands Medicaid payments. Title II—Offsets Sec. 201. Medicaid third party liability provisions. Sec. 202. Treatment of lottery winnings and other lump-sum income for purposes of income eligibility under Medicaid. Sec. 203. Adjustments to Medicare part B and part D premium subsidies for higher income individuals. I CHIP Extension and Other Medicaid and CHIP Provisions 101. Five-year funding extension of the Children’s Health Insurance Program (a) Appropriation; total allotment Section 2104(a) of the Social Security Act ( 42 U.S.C. 1397dd(a) (1) in paragraph (19), by striking and (2) in paragraph (20), by striking the period at the end and inserting a semicolon; and (3) by adding at the end the following new paragraphs: (21) for fiscal year 2018, $21,500,000,000; (22) for fiscal year 2019, $22,600,000,000; (23) for fiscal year 2020, $23,700,000,000; (24) for fiscal year 2021, $24,800,000,000; and (25) for fiscal year 2022, for purposes of making 2 semi-annual allotments— (A) $2,850,000,000 for the period beginning on October 1, 2021, and ending on March 31, 2022; and (B) $2,850,000,000 for the period beginning on April 1, 2022, and ending on September 30, 2022. . (b) Allotments (1) In general Section 2104(m) of the Social Security Act ( 42 U.S.C. 1397dd(m) (A) in paragraph (2)— (i) in the heading, by striking through 2016 through 2022 (ii) in subparagraph (B)— (I) in the matter preceding clause (i), by striking (19) (24) (II) in clause (ii), in the matter preceding subclause (I), by inserting (other than fiscal year 2022) even-numbered fiscal year (III) in clause (ii)(I), by inserting (or, in the case of fiscal year 2018, under paragraph (4)) clause (i) (B) in paragraph (5)— (i) by striking or (4) (4), or (10) (ii) by striking or 2017 , 2017, or 2022 (C) in paragraph (7)— (i) in subparagraph (A), by striking 2017 2022 (ii) in subparagraph (B), in the matter preceding clause (i), by inserting (or, in the case of fiscal year 2018, by not later than the date that is 60 days after the date of the enactment of the HEALTHY KIDS Act of 2017) before the August 31 preceding the beginning of the fiscal year (iii) in the matter following subparagraph (B), by striking or fiscal year 2016 fiscal year 2016, fiscal year 2018, fiscal year 2020, or fiscal year 2022 (D) in paragraph (9)— (i) in the heading, by striking fiscal years 2015 2017 certain fiscal years (ii) by striking or (4) , (4), or (10) (iii) by striking or fiscal year 2017 , 2017, or 2022 (E) by adding at the end the following new paragraph: (10) For fiscal year 2022 (A) First half Subject to paragraphs (5) and (7), from the amount made available under subparagraph (A) of paragraph (25) of subsection (a) for the semi-annual period described in such subparagraph, increased by the amount of the appropriation for such period under section 101(b)(3) of the HEALTHY KIDS Act, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the first half ratio (described in subparagraph (D)) of the amount described in subparagraph (C). (B) Second half Subject to paragraphs (5) and (7), from the amount made available under subparagraph (B) of paragraph (25) of subsection (a) for the semi-annual period described in such subparagraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made available under such subparagraph, multiplied by the ratio of— (i) the amount of the allotment to such State under subparagraph (A); to (ii) the total of the amount of all of the allotments made available under such subparagraph. (C) Full year amount based on growth factor updated amount The amount described in this subparagraph for a State is equal to the sum of— (i) the amount of the State allotment for fiscal year 2021 determined under paragraph (2)(B)(i); and (ii) the amount of any payments made to the State under subsection (n) for fiscal year 2021, multiplied by the allotment increase factor under paragraph (6) for fiscal year 2022. (D) First half ratio The first half ratio described in this subparagraph is the ratio of— (i) the sum of— (I) the amount made available under subsection (a)(25)(A); and (II) the amount of the appropriation for such period under section 101(b)(3) of the HEALTHY KIDS Act; to (ii) the sum of— (I) the amount described in clause (i); and (II) the amount made available under subsection (a)(25)(B). . (2) Technical amendment Section 2104(m)(2)(A) of such Act ( 42 U.S.C. 1397dd(m)(2)(A) the allotment increase factor under paragraph (5) the allotment increase factor under paragraph (6) (3) One-time appropriation for fiscal year 2022 There is appropriated to the Secretary of Health and Human Services, out of any money in the Treasury not otherwise appropriated, $20,200,000,000 to accompany the allotment made for the period beginning on October 1, 2021, and ending on March 31, 2022, under paragraph (25)(A) of section 2104(a) of the Social Security Act ( 42 U.S.C. 1397dd(a) (c) Extension of the Child Enrollment Contingency Fund Section 2104(n) of the Social Security Act ( 42 U.S.C. 1397dd(n) (1) in paragraph (2)— (A) in subparagraph (A)(ii)— (i) by striking 2010, 2011, 2012, 2013, 2014, and 2016 2010 through 2014, 2016, and 2018 through 2021 (ii) by striking fiscal year 2015 and fiscal year 2017 fiscal years 2015, 2017, and 2022 (B) in subparagraph (B)— (i) by striking 2010, 2011, 2012, 2013, 2014, and 2016 2010 through 2014, 2016, and 2018 through 2021 (ii) by striking fiscal year 2015 and fiscal year 2017 fiscal years 2015, 2017, and 2022 (2) in paragraph (3)(A), in the matter preceding clause (i), by striking or a semi-annual allotment period for fiscal year 2015 or 2017 or in any of fiscal years 2018 through 2021 (or a semi-annual allotment period for fiscal year 2015, 2017, or 2022) (d) Extension of qualifying states option Section 2105(g)(4) of the Social Security Act ( 42 U.S.C. 1397ee(g)(4) (1) in the heading, by striking through 2017 through 2022 (2) in subparagraph (A), by striking 2017 2022 (e) Extension of express lane eligibility option Section 1902(e)(13)(I) of the Social Security Act ( 42 U.S.C. 1396a(e)(13)(I) 2017 2022 (f) Assurance of affordability standard for children and families (1) In general Section 2105(d)(3) of the Social Security Act ( 42 U.S.C. 1397ee(d)(3) (A) in the paragraph heading, by striking until October 1 2019 through September 30 2022 (B) in subparagraph (A), in the matter preceding clause (i)— (i) by striking 2019 2022 (ii) by striking The preceding sentence shall not be construed as preventing a State during such period During the period that begins on October 1, 2019, and ends on September 30, 2022, the preceding sentence shall only apply with respect to children in families whose income does not exceed 300 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved. The preceding sentences shall not be construed as preventing a State during any such periods (2) Conforming amendments Section 1902(gg)(2) of the Social Security Act ( 42 U.S.C. 1396a(gg)(2) (A) in the paragraph heading, by striking until October 1 2019 through September 30 2022 (B) by striking September 30, 2019, September 30, 2022 (but during the period that begins on October 1, 2019, and ends on September 30, 2022, only with respect to children in families whose income does not exceed 300 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved) (g) CHIP look-Alike plans (1) Blending risk pools Section 2107 of the Social Security Act ( 42 U.S.C. 1397gg (g) Use of blended risk pools (1) In general Nothing in this title (or any other provision of Federal law) shall be construed as preventing a State from considering children enrolled in a qualified CHIP look-alike program and children enrolled in a State child health plan under this title (or a waiver of such plan) as members of a single risk pool. (2) Qualified CHIP look-alike program In this subsection, the term qualified CHIP look-alike program (A) under which children who are under the age of 19 and are not eligible to receive medical assistance under title XIX or child health assistance under this title may purchase coverage through the State that provides benefits that are at least identical to the benefits provided under the State child health plan under this title (or a waiver of such plan); and (B) that is funded exclusively through non-Federal funds, including funds received by the State in the form of premiums for the purchase of such coverage. . (2) Coverage rule (A) In general Section 5000A(f)(1) or under a qualified CHIP look-alike program (as defined in section 2107(g) of the Social Security Act) (B) Effective date The amendment made by subparagraph (A) shall apply with respect to taxable years beginning after December 31, 2017. 102. Extension of certain programs and demonstration projects (a) Childhood obesity demonstration project Section 1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b–9a(e)(8)) is amended— (1) by striking and $10,000,000 , $10,000,000 (2) by inserting after 2017 , and $25,000,000 for the period of fiscal years 2018 through 2022 (b) Pediatric quality measures program Section 1139A(i) of the Social Security Act (42 U.S.C. 1320b–9a(i)) is amended— (1) by striking Out of any (1) In general Out of any ; (2) by striking there is appropriated for each (A) for each ; (3) by striking , and there is appropriated for the period (B) for the period ; (4) by striking . Funds appropriated under this subsection shall remain available until expended. ; and (5) by adding at the end the following: (C) for the period of fiscal years 2018 through 2022, $75,000,000 for the purpose of carrying out this section (other than subsections (e), (f), and (g)). (2) Availability Funds appropriated under this subsection shall remain available until expended. . 103. Extension of outreach and enrollment program (a) In general Section 2113 of the Social Security Act ( 42 U.S.C. 1397mm (1) in subsection (a)(1), by striking 2017 2022 (2) in subsection (g)— (A) by striking and $40,000,000 , $40,000,000 (B) by inserting after 2017 , and $100,000,000 for the period of fiscal years 2018 through 2022 (b) Making parent mentors eligible to receive grants Section 2113(f) of the Social Security Act ( 42 U.S.C. 1397mm(f) (1) in paragraph (1), by adding at the end the following new subparagraph: (H) Parent mentors. ; and (2) by adding at the end the following new paragraph: (5) Parent mentor The term parent mentor (A) is a parent or guardian of at least one child who is an eligible child under this title or title XIX; and (B) is trained to assist families with children who have no health insurance coverage with respect to improving the social determinants of the health of such children, including by providing— (i) education about health insurance coverage, including, with respect to obtaining such coverage, eligibility criteria and application and renewal processes; (ii) assistance with completing and submitting applications for health insurance coverage; (iii) a liaison between families and representatives of State plans under title XIX or State child health plans under this title; (iv) guidance on identifying medical and dental homes and community pharmacies for children; and (v) assistance and referrals to successfully address social determinants of children’s health, including poverty, food insufficiency, and housing. . 104. Extension and reduction of additional Federal financial participation for CHIP Section 2105(b) of the Social Security Act ( 42 U.S.C. 1397ee(b) and during the period that begins on October 1, 2019, and ends on September 30, 2020, the enhanced FMAP determined for a State for a fiscal year (or for any portion of a fiscal year occurring during such period) shall be increased by 11.5 percentage points 23 percentage points, 105. Modifying reduction in Medicaid DSH allotments Section 1923(f)(7)(A)(ii) of the Social Security Act ( 42 U.S.C. 1396r–4(f)(7)(A)(ii) (1) by striking subclause (I) and redesignating subclauses (II) through (VIII) as subclauses (I) through (VII), respectively; (2) in subclause (VI), as redesignated by paragraph (1), by striking at the end and (3) in subclause (VII), as redesignated by paragraph (1), by striking at the end the period and inserting a semicolon; and (4) by adding at the end the following new subclauses: (VIII) $8,000,000,000 for fiscal year 2026; and (IX) $8,000,000,000 for fiscal year 2027. . 106. Puerto Rico and the Virgin Islands Medicaid payments (a) Increased cap Section 1108(g) of the Social Security Act ( 42 U.S.C. 1308(g) (1) in paragraph (2)— (A) in subparagraph (A), by inserting (or, with respect to fiscal years 2018 and 2019, increased by such percentage increase plus one percentage point) beginning of the fiscal year (B) in subparagraph (B), by inserting (or, with respect to fiscal years 2018 and 2019, increased by such percentage increase plus one percentage point) percentage increase referred to in subparagraph (A) (2) in paragraph (5)— (A) in subparagraph (A), by striking subparagraph (B) subparagraphs (B), (C), (D), (E), and (F) (B) by adding at the end the following new subparagraphs: (C) The amount of the increase otherwise provided under subparagraph (A) for Puerto Rico shall be further increased by $880,000,000. (D) (i) For the period beginning October 1, 2017, and ending December 31, 2019, the amount of the increase otherwise provided under subparagraph (A) for Puerto Rico shall be further increased by $120,000,000 if the Financial Oversight and Management Board for Puerto Rico established under section 101 of the Puerto Rico Oversight, Management, and Economic Stability Act ( 48 U.S.C. 2121 (I) reduce fraud, waste, and abuse under the program under title XIX; (II) implement strategies to reduce unnecessary, inefficient, or excessive spending under title XIX; (III) improve the use and availability of Medicaid data for program operation and oversight; and (IV) improve the quality of care and patient experience for individuals enrolled under the program under title XIX. (ii) As a condition of any additional increase pursuant to clause (i), not later than October 1, 2018, Puerto Rico shall submit to the Financial Oversight and Management Board for Puerto Rico a report regarding steps taken to achieve each of the goals described in subclauses (I) through (IV) of clause (i). (E) Payments under section 1903(a)(8) for a quarter of a fiscal year shall not be taken into account in applying subsection (f) (as increased in accordance with this paragraph and paragraphs (1), (2), (3), and (4)) to Puerto Rico or the Virgin Islands for such fiscal year. (F) (i) For the period beginning October 1, 2017, and ending December 31, 2019, the amount of the increase otherwise provided under subparagraph (A) for the Virgin Islands shall be further increased by an amount equal to the per capita equivalent of the total amount of the increase provided for Puerto Rico under subparagraphs (C) and (D) for such period. (ii) For purposes of clause (i), the term per capita equivalent (I) the population of the Virgin Islands, as determined by the most recent census estimate released by the Bureau of the Census before September 4, 2017; to (II) the population of Puerto Rico, as so determined. . (b) Federal match for medical personnel and fraud reduction Section 1903(a) of the Social Security Act ( 42 U.S.C. 1396b(a) (1) in paragraph (2)(A), by inserting subject to paragraph (8), an amount (2) in paragraph (6)— (A) in subparagraph (B), by inserting subject to paragraph (8), 75 per centum (B) by striking at the end plus (3) in paragraph (7), by striking at the end the period and inserting ; plus (4) by adding at the end the following new paragraph: (8) for quarters during the period beginning January 1, 2018, and ending December 31, 2019, paragraphs (2)(A) and (6) shall apply with respect to Puerto Rico and the Virgin Islands as if— (A) the reference to 75 per centum 90 per centum (B) the reference to 75 per centum 90 per centum . II Offsets 201. Medicaid third party liability provisions (a) Medicaid third party liability (1) Delay of Bipartisan Budget Act of 2013 third party liability provisions (A) In general Section 202(c) of the Bipartisan Budget Act of 2013 ( Public Law 113–67 42 U.S.C. 1396a Public Law 113–93 42 U.S.C. 1396a Public Law 114–10 2017 2019 (B) Effective date; treatment The amendment made by subparagraph (A) shall take effect on September 30, 2017, and shall apply with respect to claims generated or filed after such date. (2) Clarification of definitions applicable to third party liability (A) In general Section 1902 of the Social Security Act ( 42 U.S.C. 1396a (nn) Responsible Third Party and Health Insurer Definitions For purposes of subsection (a)(25) and section 1903(d)(2)(B): (1) Responsible third party The term responsible third party (2) Health insurer The term health insurer . (B) Conforming amendments Section 1902(a)(25) of the Social Security Act ( 42 U.S.C. 1396a(a)(25) (i) in subparagraph (A), in the matter preceding clause (i), by striking third parties item or service) responsible third parties (ii) in subparagraph (G), by striking health insurer item or service) responsible third party (iii) in subparagraph (I), in the matter preceding clause (i), by striking health insurers item or service responsible third parties (iv) by inserting responsible third (3) Removal of special treatment of certain types of care and payments under Medicaid third party liability rules Section 1902(a)(25) of the Social Security Act ( 42 U.S.C. 1396a(a)(25) (4) Clarification of role of health insurers with respect to third party liability (A) In general Section 1902(a)(25) of the Social Security Act ( 42 U.S.C. 1396a(a)(25) (E) that, in the case of a State that provides medical assistance under this title through a contract with a health insurer, such contract shall specify whether the State is— (i) delegating to such insurer all or some of its right of recovery from a responsible third party for an item or service for which payment has been made under the State plan (or under a waiver of the plan); and (ii) transferring to such insurer all or some of the assignment to the State of any right of an individual or other entity to payment from a responsible third party for an item or service for which payment has been made under the State plan (or under a waiver of the plan); (F) that, in the case of a State that elects an option described in clause (i) or (ii) of subparagraph (E) with respect to a health insurer, the State shall provide assurances to the Secretary that the State laws referred to in subparagraph (I) confer to the health insurer the authority of the State with respect to the requirements specified in clauses (i) through (iv) of such subparagraph; . (B) Treatment of collected amounts Section 1903(d)(2)(B) of the Social Security Act ( 42 U.S.C. 1396b(d)(2)(B) For purposes of this subparagraph, reimbursements made by a responsible third party to health insurers pursuant to section 1902(a)(25)(E) shall be treated in the same manner as reimbursements made to a State under the previous sentence. (5) Increasing State flexibility with respect to third party liability Section 1902(a)(25)(I) of the Social Security Act ( 42 U.S.C. 1396a(a)(25)(I) (A) in clause (i), by striking medical assistance under the State plan medical assistance under a State plan (or under a waiver of the plan) (B) by striking clause (ii) and inserting the following new clause: (ii) accept— (I) any State’s right of recovery and the assignment to any State of any right of an individual or other entity to payment from the party for an item or service for which payment has been made under the respective State’s plan (or under a waiver of the plan); and (II) as a valid authorization of the responsible third party for the furnishing of an item or service to an individual eligible to receive medical assistance under this title, an authorization made on behalf of such individual under the State plan (or under a waiver of such plan) for the furnishing of such item or service to such individual; ; (C) in clause (iii)— (i) by striking respond to not later than 60 days after receiving (ii) by striking ; and , respond to such inquiry; and (D) in clause (iv), by inserting a failure to obtain a prior authorization, claim form, (6) State incentive to pursue third party liability for newly eligibles Section 1903(d)(2)(B) of the Social Security Act ( 42 U.S.C. 1396b(d)(2)(B) In the case of expenditures for medical assistance provided during 2017 and subsequent years for individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), in determining the amount, if any, of overpayment under this subparagraph with respect to such medical assistance, the Secretary shall apply the Federal medical assistance percentage for the State under section 1905(b), notwithstanding the application of section 1905(y). (b) Compliance with third party insurance reporting Section 1903 of the Social Security Act ( 42 U.S.C. 1396b (n) (1) For any year beginning after 2020 (or a sooner year as provided in paragraph (2)), if a State fails to comply with the requirements of section 1902(a)(25) with respect to each calendar quarter in such year, the Secretary may reduce the Federal medical assistance percentage by 0.1 percentage point for calendar quarters in each subsequent year in which the State fails to so comply (and cumulatively for a failure to so comply for a period of consecutive years). (2) The Secretary may apply paragraph (1)— (A) for any year beginning after 2018, if a State fails to comply with the requirements of section 1902(a)(25) with respect to payment for items and services furnished to individuals described in subclause (VIII) of section 1902(a)(10)(A)(i) or non-expansion individuals; and (B) for any year beginning after 2019, if a State fails to comply with the requirements of section 1902(a)(25) with respect to payment for items and services furnished to individuals described in subdivision (i), (iii), or (iv) of section 1905(a). (3) For purposes of this subsection, the term non-expansion individual (A) eligible for medical assistance for items or services under this title and enrolled under the State plan (or a waiver of such plan) under this title for the month; (B) not under 19 years of age; (C) not 65 years of age or older; and (D) not eligible for medical assistance under this title on the basis of being blind or disabled. . (c) Application to CHIP (1) In general Section 2107(e)(1) of the Social Security Act ( 42 U.S.C. 1397gg(e)(1) (A) by redesignating subparagraphs (B) through (R) as subparagraphs (C) through (S), respectively; and (B) by inserting after subparagraph (A) the following new subparagraph: (B) Section 1902(a)(25) (relating to third party liability). . (2) Mandatory reporting Section 1902(a)(25)(I)(i) of the Social Security Act ( 42 U.S.C. 1396a(a)(25)(I)(i) (A) by striking (and, at State option, child and child (B) by striking title XXI) title XXI (d) Training on third party liability Section 1936 of the Social Security Act ( 42 U.S.C. 1396u–6 (1) in subsection (b)(4), by striking and quality of care , quality of care, and the liability of responsible third parties (as defined in section 1902(nn)) (2) by adding at the end the following new subsection: (f) Third party liability training With respect to education or training activities carried out pursuant to subsection (b)(4) with respect to the liability of responsible third parties (as defined in section 1902(nn) for payment for items and services furnished under State plans (or under waivers of such plans)) under this title, the Secretary shall— (1) publish (and update on an annual basis) on the public Internet website of the Centers for Medicare & Medicaid Services a dedicated Internet page containing best practices to be used in assessing such liability; (2) monitor efforts to assess such liability and analyze the challenges posed by that assessment; (3) distribute to State agencies administering the State plan under this title information related to such efforts and challenges; and (4) provide guidance to such State agencies with respect to State oversight of efforts under a medicaid managed care plan under section 1903(m) or 1932 to assess such liability. . (e) Development of model uniform fields for States To report third party information Not later than January 1, 2019, the Secretary of Health and Human Services shall, in consultation with the States, develop and make available to the States a model uniform reporting field that States may use for purposes of reporting to the Secretary through the Transformed Medicaid Statistical Information System (T–MSIS) (or a successor system), or within CMS Form 64 (or any successor form), information identifying responsible third parties (as defined in subsection (nn) of section 1902 of the Social Security Act ( 42 U.S.C. 1396a 42 U.S.C. 1396 (f) Effective date (1) In general Except as provided in paragraph (2), this section and the amendments made by this section (other than as specified in the preceding provisions of this section) shall take effect on October 1, 2019, and shall apply to medical assistance or child health assistance provided on or after such date. (2) Exception if State legislation required In the case of a State plan for medical assistance under title XIX of the Social Security Act ( 42 U.S.C. 1396 42 U.S.C. 1397aa 202. Treatment of lottery winnings and other lump-sum income for purposes of income eligibility under Medicaid (a) In general Section 1902 of the Social Security Act ( 42 U.S.C. 1396a (1) in subsection (a)(17), by striking (e)(14), (e)(14) (e)(14), (e)(15) (2) in subsection (e)— (A) in paragraph (14) (relating to modified adjusted gross income), by adding at the end the following new subparagraph (J) Treatment of certain lottery winnings and income received as a lump sum (i) In general In the case of an individual who is the recipient of qualified lottery winnings (pursuant to lotteries occurring on or after January 1, 2018) or qualified lump sum income (received on or after such date) and whose eligibility for medical assistance is determined based on the application of modified adjusted gross income under subparagraph (A), a State shall, in determining such eligibility, include such winnings or income (as applicable) as income received— (I) in the month in which such winnings or income (as applicable) is received if the amount of such winnings or income is less than $80,000; (II) over a period of 2 months if the amount of such winnings or income (as applicable) is greater than or equal to $80,000 but less than $90,000; (III) over a period of 3 months if the amount of such winnings or income (as applicable) is greater than or equal to $90,000 but less than $100,000; and (IV) over a period of 3 months plus 1 additional month for each increment of $10,000 of such winnings or income (as applicable) received, not to exceed a period of 120 months (for winnings or income of $1,260,000 or more), if the amount of such winnings or income is greater than or equal to $100,000. (ii) Counting in equal installments For purposes of subclauses (II), (III), and (IV) of clause (i), winnings or income to which such subclause applies shall be counted in equal monthly installments over the period of months specified under such subclause. (iii) Hardship exemption An individual whose income, by application of clause (i), exceeds the applicable eligibility threshold established by the State, shall continue to be eligible for medical assistance to the extent that the State determines, under procedures established by the State (in accordance with standards specified by the Secretary), that the denial of eligibility of the individual would cause an undue medical or financial hardship as determined on the basis of criteria established by the Secretary. (iv) Notifications and assistance required in case of loss of eligibility A State shall, with respect to an individual who loses eligibility for medical assistance under the State plan (or a waiver of such plan) by reason of clause (i)— (I) before the date on which the individual loses such eligibility, inform the individual— (aa) of the individual’s opportunity to enroll in a qualified health plan offered through an Exchange established under title I of the Patient Protection and Affordable Care Act during the special enrollment period specified in section 9801(f)(3) (bb) of the date on which the individual would no longer be considered ineligible by reason of clause (i) to receive medical assistance under the State plan or under any waiver of such plan and be eligible to reapply to receive such medical assistance; and (II) provide technical assistance to the individual seeking to enroll in such a qualified health plan. (v) Qualified lottery winnings defined In this subparagraph, the term qualified lottery winnings section 4402 (vi) Qualified lump sum income defined In this subparagraph, the term qualified lump sum income (I) Monetary winnings from gambling (as defined by the Secretary and including gambling activities described in section 1955(b)(4) of title 18, United States Code). (II) Damages received, whether by suit or agreement and whether as lump sums or as periodic payments (other than monthly payments), on account of causes of action other than causes of action arising from personal physical injuries or physical sickness. (III) Income received as liquid assets from the estate (as defined in section 1917(b)(4)) of a deceased individual. ; and (B) by striking (14) Exclusion (15) Exclusion (b) Rules of construction (1) Interception of lottery winnings allowed Nothing in the amendment made by subsection (a)(2)(A) shall be construed as preventing a State from intercepting the State lottery winnings awarded to an individual in the State to recover amounts paid by the State under the State Medicaid plan under title XIX of the Social Security Act for medical assistance furnished to the individual. (2) Applicability limited to eligibility of recipient of lottery winnings or lump sum income Nothing in the amendment made by subsection (a)(2)(A) shall be construed, with respect to a determination of household income for purposes of a determination of eligibility for medical assistance under the State plan under title XIX of the Social Security Act ( 42 U.S.C. 1396 42 U.S.C. 1396a(e)(14) 203. Adjustments to Medicare part B and part D premium subsidies for higher income individuals (a) In general Section 1839(i)(3)(C)(i)(II) of the Social Security Act ( 42 U.S.C. 1395r(i)(3)(C)(i)(II) More than $160,000 but less than $500,000 80 percent At least $500,000 100 percent. . (b) Joint returns Section 1839(i)(3)(C)(ii) of the Social Security Act ( 42 U.S.C. 1395r(i)(3)(C)(ii) except, with respect to the dollar amounts applied in the last row of the table under subclause (II) of such clause (and the second dollar amount specified in the second to last row of such table), clause (i) shall be applied by substituting dollar amounts which are 175 percent of such dollar amounts for the calendar year (c) Inflation adjustment Section 1839(i) of the Social Security Act ( 42 U.S.C. 1395r(i) (1) in paragraph (5)— (A) in subparagraph (A), by striking In the case Subject to subparagraph (C), in the case (B) in subparagraph (B), by striking subparagraph (A) subparagraph (A) or (C) (C) by adding at the end the following new subparagraph: (C) Treatment of adjustments for certain higher income individuals (i) In general Subparagraph (A) shall not apply with respect to each dollar amount in paragraph (3) of $500,000. (ii) Adjustment beginning 2027 In the case of any calendar year beginning after 2026, each dollar amount in paragraph (3) of $500,000 shall be increased by an amount equal to— (I) such dollar amount, multiplied by (II) the percentage (if any) by which the average of the Consumer Price Index for all urban consumers (United States city average) for the 12-month period ending with August of the preceding calendar year exceeds such average for the 12-month period ending with August 2025. ; and (2) in paragraph (6)(B), by inserting (other than $500,000) the dollar amounts October 23, 2017 The Committee on Ways and Means

Summary: Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017 or the HEALTHY KIDS Act TITLE I--CHIP EXTENSION AND OTHER MEDICAID AND CHIP PROVISIONS (Sec. 101) This bill extends funding through FY2022 for the Children's Health Insurance Program (CHIP) and the Childhood Obesity Demonstration Project. In addition, the bill reauthorizes through FY2022: the qualifying-states option (which allows states that provided coverage to now CHIP-eligible children prior to CHIP's enactment to continue to provide such coverage), and the express-lane eligibility option (which allows states to use eligibility findings from other public benefit programs to determine children's eligibility for Medicaid and CHIP). Beginning in FY2020, the bill allows state child-health plans to adopt more restrictive eligibility standards with respect to children in families whose income exceeds 300% of the poverty line. (Sec. 102) The bill extends funding through FY2022 for the Childhood Obesity Demonstration Project and the Pediatric Quality Measures Program. (Sec. 103) The bill: (1) extends funding through FY2022 for specified outreach and enrollment grants, and (2) makes eligible for such grants "parent-mentors" who are trained to assist families with children who have no health-insurance coverage. (Sec. 104) Current law provides states with an enhanced Federal Matching Assistance Percentage (FMAP) for child-health assistance through FY2019. The bill maintains the enhanced FMAP in FY2020, but halves the percentage-point increase. (Sec. 105) The bill eliminates Medicaid payment reductions for disproportionate-share hospitals (which receive additional payment under Medicaid for treating a large share of low-income patients) in FY2018, but extends such reductions by two years (through FY2027). (Sec. 106) The bill also increases Medicaid funding for Puerto Rico and the U.S. Virgin Islands through FY2019. Such funding shall be further increased through 2019 for both territories if Puerto Rico takes specified actions to improve its Medicaid program. TITLE II--OFFSETS (Sec. 201) The bill alters provisions related to third-party liability under Medicaid and CHIP. (Sec. 202) The bill specifies how a state must treat qualified lottery winnings and lump-sum income for purposes of determining Medicaid eligibility. (Sec. 203) The bill eliminates Medicare premium subsidies for beneficiaries with annual incomes exceeding $500,000.