I 
117TH CONGRESS 
1ST SESSION H. R. 4554 
To amend title XIX of the Social Security Act to provide grants for support 
for States to identify and act on racial disparities, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 20, 2021 
Mr. BUTTERFIELD (for himself and Mr. JOYCE of Pennsylvania) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce 
A BILL 
To amend title XIX of the Social Security Act to provide 
grants for support for States to identify and act on 
racial disparities, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Care That’s Fair Act’’. 
SEC. 2. GRANTS TO SUPPORT FOR STATES TO IDENTIFY 
AND ACT ON RACIAL DISPARITIES UNDER 
MEDICAID. 
Section 1946 of the Social Security Act (42 U.S.C. 
is amended by adding the following new subsection: 
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‘‘(d) SUPPORT FOR STATES TO IDENTIFY AND ACT 
ON RACIAL DISPARITIES.— 
‘‘(1) IN GENERAL.—The Administrator is au-
thorized to award grants to States in accordance 
with this section to analyze Medicaid claims and 
clinical data to study— 
‘‘(A) variation in Medicaid health outcomes 
and health care service utilization that are cor-
related to race and ethnicity for clinically simi-
lar patients; or 
‘‘(B) the contributing clinical and social 
factors to poor infant and maternal health out-
comes in Medicaid. 
‘‘(2) STATE APPLICATION.—A State seeking ap-
proval of a grant shall submit an application to the 
Administrator, after April 1, 2021, and prior to Sep-
tember 1, 2024, in such format as the Administrator 
requires. 
‘‘(3) LIMITATIONS.—No State shall receive— 
‘‘(A) more than one grant in any fiscal 
year; or 
‘‘(B) a grant that exceeds $500,000. 
‘‘(4) ACTION REPORT.—Each State receiving a 
grant under this subsection must submit to the Ad-
ministrator an action report no later than 2 fiscal 
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years after being awarded the grant, which the Ad-
ministrator must make public on the Centers for 
Medicare & Medicaid Services website and provide 
analysis comparing the results of the action reports 
across each grantee, taking into account variation in 
the demographics and clinical needs in each State. 
‘‘(5) DEFINITIONS.—For purposes of this sec-
tion: 
‘‘(A) ADMINISTRATOR.—The term ‘Admin-
istrator’ means the Administrator for the Cen-
ter for Medicare and Medicaid Services. 
‘‘(B) STATE.—The term ‘State’ means any 
of the 50 States or the District of Columbia. 
‘‘(C) CLINICALLY
SIMILAR.—The term 
‘clinically similar’ means, with respect to a 
State Medicaid program, Medicaid enrollees 
that have the same health status, burden of ill-
ness, comorbid conditions, and need for serv-
ices. 
‘‘(D) 
HEALTH
OUTCOMES.—The 
term 
‘health outcomes’ means, with respect to a 
State Medicaid program, a change in health 
status for a Medicaid enrollee as a result of 
care interventions. 
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‘‘(E) HEALTH
CARE
SERVICE
UTILIZA-
TION.—The term ‘health care service utiliza-
tion’ means, with respect to a State Medicaid 
program, the rate of use of a particular health 
care service, procedure, test, process, or care 
intervention. 
‘‘(F) SOCIAL FACTORS.—The term ‘social 
factors’ may include, but is not limited to— 
‘‘(i) housing; 
‘‘(ii) transportation; 
‘‘(iii) food insecurity; 
‘‘(iv) environmental conditions; 
‘‘(v) economic insecurity; 
‘‘(vi) health literacy; 
‘‘(vii) family and community insta-
bility; and 
‘‘(viii) interpersonal violence. 
‘‘(G) ACTION REPORT.—The term ‘action 
report’ means, with respect to a State Medicaid 
program— 
‘‘(i) a summary at the aggregate level 
of the results from the State analysis per-
formed under paragraph (1); 
‘‘(ii) a summary of the characteristics 
of the study, including population included, 
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time period covered, methodologies used, 
and any limitations encountered; 
‘‘(iii) the actions the State plans to 
take or would like to take under the State 
Medicaid program in the next 5 years to 
address paragraph (1)(A) or (1)(B); and 
‘‘(iv) what regulatory barriers exist in 
enacting the steps under clause (ii). 
‘‘(6) APPROPRIATIONS.—In general, there are 
appropriated, from any funds in the Treasury not 
otherwise appropriated, for grants to carry out this 
section— 
‘‘(A) $5,000,000 for fiscal year 2021; 
‘‘(B) $10,000,000 for fiscal year 2022; and 
‘‘(C) $10,000,000 for fiscal year 2023.’’. 
Æ 
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