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103D CONGRESS
1ST SESSION
H. R. 3659
To amend title XIX of the Social Security Act to improve the Federal
medical assistance percentage used under the medicaid program, and
for other purposes.
IN THE HOUSE OF REPRESENTATIVES
NOVEMBER 22, 1993
Mrs. MALONEY (for herself, Mr. RANGEL, Mr. GILMAN, Mr. MANTON, Mr.
NADLER, Mr. ENGEL, Mrs. LOWEY, Mr. OWENS, Mr. HINCHEY, Mr.
HOCHBRUECKNER, Mr. MCNULTY, Mr. FLAKE, Ms. VELA´ZQUEZ, Mr.
SCHUMER, Mr. ACKERMAN, Ms. SLAUGHTER, Mr. QUINN, and Mr.
SERRANO) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce
A BILL
To amend title XIX of the Social Security Act to improve
the Federal medical assistance percentage used under
the medicaid program, 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 ‘‘Medicaid Fair Funding
Act of 1993’’.
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SEC. 2. CHANGE IN FEDERAL MEDICAL ASSISTANCE PER-
CENTAGE.
(a) IN GENERAL.—Subsection (b) of section 1905 of
the Social Security Act (42 U.S.C. 1396d(b)) is amended
to read as follows:
‘‘(b)(1)(A) Except as provided in paragraph (3), the
term ‘Federal medical assistance percentage’ means, for
each of the 50 States and the District of Columbia, 100
percent reduced by the product of the applicable percent-
age (as defined in subparagraph (B)) and the ratio of—
‘‘(i) the per capita income ratio (as defined in
subparagraph (C)) of the State, to—
‘‘(ii) the population in poverty ratio (as defined
in subparagraph (D)) of the State.
‘‘(B)(i) For purposes of this subsection, the term ‘ap-
plicable percentage’ means a percentage estimated by the
Secretary with the advice of the General Accounting Office
that, when applied under subparagraph (A), would result
in an amount of aggregate payments under section
1903(a) for calendar years 1994 through 1998 equal to
the amount of aggregate payments that would have been
made under such section for quarters in such years if this
subsection were applied as in effect on the day before the
date of the enactment of the Medicaid Fair Funding Act
of 1993.
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‘‘(ii) The applicable percentage estimated by the Sec-
retary under clause (i) shall continue to apply with respect
to quarters beginning after calendar year 1998.
‘‘(C) For purposes of this subsection, the term ‘per
capita income ratio’ means—
‘‘(i) an amount equal to the most recent 3-year
average of the total personal income of the State, as
determined in accordance with the provisions of sec-
tion 1101(a)(8)(B), divided by
‘‘(ii) an amount equal to the total personal in-
come of the continental United States (including
Alaska and Hawaii), as determined under section
1101(a)(8)(B).
‘‘(D) For purposes of this subsection, the term ‘popu-
lation in poverty ratio’ means—
‘‘(i) an amount equal to the 3-year-average of
the number of individuals in the State whose family
income is below the income official poverty line (as
defined by the Office of Management and Budget
and revised annually in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of
1981), divided by
‘‘(ii) an amount equal to the sum of the aver-
ages determined under clause (i) for the 50 States.
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‘‘(2) The Federal medical assistance percentage for
Puerto Rico, the Virgin Islands, Guam, the Northern Mar-
iana Islands, and American Samoa shall be 50 percent.
‘‘(3)(A) Except as provided in subparagraph (B), the
Federal medical assistance percentage shall in no case be
less than 40 percent or greater than 83 percent.
‘‘(B) The Federal medical assistance percentage shall
be 100 percent with respect to amounts expended as medi-
cal assistance for services which are received through an
Indian Health Service facility whether operated by the In-
dian Health Service or by an Indian tribe or tribal organi-
zation (as defined in section 4 of the Indian Health Care
Improvement Act).
‘‘(4) For purposes of any provision of law other than
a provision of this title, unless otherwise specifically pro-
vided, any reference to the ‘Federal medical assistance
percentage’ as defined in this section shall be considered
a reference to such term as defined under this subsection
as in effect on the day before the date of the enactment
of the Medicaid Fair Funding Act of 1993.’’.
(b) CONFORMING AMENDMENT.—Section 1118 of the
Social Security Act (42 U.S.C. 1318) is amended by strik-
ing ‘‘(as defined in section 1905)’’ and inserting ‘‘(as de-
fined in section 1905(b), as in effect on the day before