228 
transmission of infectious agents in healthcare 
settings; and 
(B) relevant scientific research on novel 
pathogens. 
SEC. 40003. SURVEILLANCE, TRACKING, AND INVESTIGA-
TION OF WORK-RELATED CASES OF COVID–19 
AMONG HEALTH CARE WORKERS. 
The Director of the Centers for Disease Control and 
Prevention, in conjunction with the Director of the Na-
tional Institute for Occupational Safety and Health, 
shall— 
(1) collect and analyze case reports and other 
data on COVID–19, to identify and evaluate the ex-
tent, nature, and source of COVID–19 among em-
ployees in the occupations and sectors described in 
subparagraphs (A) through (C) of section 2(a)(1); 
(2) investigate, as appropriate, individual cases 
of COVID–19 among such employees to evaluate the 
source of exposure and adequacy of infection and ex-
posure control programs and measures; 
(3) provide regular periodic reports on COVID– 
19 disease among such employees to the public; and 
(4) based on such reports and investigations 
make recommendations on needed actions or guid-
ance to protect such employees from COVID–19. 
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229 
DIVISION 
E—COVID–19 
WORK-
FORCE 
EMERGENCY 
RE-
SPONSE ACT OF 2020 
SEC. 50001. SHORT TITLE. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Workforce Emergency Response Act of 2020’’. 
SEC. 50002. DEFINITIONS. 
In this Act: 
(1) CORONAVIRUS.—The term ‘‘coronavirus’’ 
means coronavirus as defined in section 506 of the 
Coronavirus Preparedness and Response Supple-
mental Appropriations Act, 2020 (Public Law 116– 
123). 
(2) COVID–19 NATIONAL
EMERGENCY.—The 
term ‘‘COVID–19 national emergency’’ means the 
national emergency declared by the President under 
the National Emergencies Act (50 U.S.C. 1601 et 
seq.) on March 13, 2020, with respect to the 
coronavirus. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Labor. 
(4) WIOA TERMS.—Except as otherwise pro-
vided, the terms in this Act have the meanings given 
the terms in section 3 of the Workforce Innovation 
and Opportunity Act (29 U.S.C. 3102). 
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230 
SEC. 50003. WORKFORCE RESPONSE ACTIVITIES. 
(a) IN GENERAL.—The purpose of this section is to 
provide the increased flexibility needed for State and local 
areas to provide continuity of services during the COVID– 
19 national emergency. 
(b) ADMINISTRATIVE COSTS.—Notwithstanding sec-
tion 128(b)(4) of the Workforce Innovation and Oppor-
tunity Act (29 U.S.C. 3163(b)(4)), of the funds allocated 
to a local area, including a single State local area, under 
subtitle B of title I of such Act (29 U.S.C. 3151 et seq.) 
that remain unobligated for program year 2019, an 
amount up to 20 percent may be used for the administra-
tive costs of carrying out local workforce investment activi-
ties under chapter 2 or chapter 3 of subtitle B of title 
I of such Act (29 U.S.C. 3151 et seq.), as long as any 
amount used under this subsection that exceeds the 
amount authorized for administrative costs under section 
128(b)(4)(A) of such Act (29 U.S.C. 3163(b)(4)) is used 
to respond to the COVID–19 national emergency. 
(c) RAPID RESPONSE ACTIVITIES.— 
(1) STATEWIDE RAPID RESPONSE.—Of the re-
served by a Governor under section 128(a) of the 
Workforce Innovation and Opportunity Act (29 
U.S.C. 3163(a)) for statewide activities that remain 
unobligated for program year 2019, such funds may 
be used for the statewide rapid response activities 
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231 
described in section 134(a)(2)(A) of such Act (29 
U.S.C. 3174(a)(2)(A)) for responding to the 
COVID–19 national emergency. 
(2) LOCAL BOARDS.—Of the funds reserved by 
a Governor under section 133(a)(2) of such Act (29 
U.S.C. 3173(a)(2)) that remain unobligated for pro-
gram year 2019, such funds may be distributed by 
the Governor not later than 30 days after the date 
of enactment of this Act to local boards most im-
pacted by the coronavirus, at the determination of 
the Governor, for rapid response activities related to 
responding to the COVID–19 national emergency. 
DIVISION F—FAMILY SUPPORT 
PROVISIONS 
SEC. 60001. CONTINUED SAFE OPERATION OF CHILD WEL-
FARE PROGRAMS AND SUPPORT FOR OLDER 
FOSTER YOUTH. 
(a) FUNDING INCREASES.— 
(1) GENERAL
PROGRAM.—The dollar amount 
specified in section 477(h)(1) of the Social Security 
Act for fiscal year 2020 is deemed to be 
$185,900,000. 
(2) EDUCATION
AND
TRAINING
VOUCHERS.— 
The dollar amount specified in section 477(h)(2) of 
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232 
such Act for fiscal year 2020 is deemed to be 
$78,000,000. 
(b) PROGRAMMATIC FLEXIBILITY.—With respect to 
the period that begins on March 1, 2020, and ends with 
the close of calendar year 2020: 
(1) ELIMINATION OF AGE LIMITATIONS ON ELI-
GIBILITY FOR ASSISTANCE.—Eligibility for services 
or assistance under a State program operated pursu-
ant to section 477 of the Social Security Act shall 
be provided without regard to the age of the recipi-
ent. 
(2) SUSPENSION OF WORK AND EDUCATION RE-
QUIREMENTS UNDER THE EDUCATION AND TRAIN-
ING VOUCHER PROGRAM.—Section 477(i)(3) of the 
Social Security Act shall be applied and adminis-
tered without regard to any work or education re-
quirement. 
(3) AUTHORITY TO WAIVE LIMITATION ON PER-
CENTAGE OF FUNDS USED FOR HOUSING ASSIST-
ANCE.—The Secretary of Health and Human Serv-
ices (in this subsection referred to as the ‘‘Sec-
retary’’) may apply and administer section 477 of 
the Social Security Act without regard to subsection 
(b)(3)(B) of such section. 
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233 
(4) AUTHORITY TO WAIVE RULES CONFLICTING 
WITH
NEEDED
ASSISTANCE
AND
SERVICES.—The 
Secretary may waive any requirement imposed by or 
under part B or E of title IV of the Social Security 
Act (including any limitation on the ability of con-
tractors pursuant to such part B or E to apply for 
no-cost contract extensions) that the Secretary 
deems to be in conflict with using funds made avail-
able pursuant to this section or other statutes for 
the provision of financial, education, work, housing, 
and other assistance and services needed in response 
to the public health emergency declared by the Sec-
retary pursuant to section 319 of the Public Health 
Service Act on January 31, 2020, entitled ‘‘Deter-
mination that a Public Health Emergency Exists 
Nationwide as the Result of the 2019 Novel 
Coronavirus’’. 
(5) AUTHORITY
OF
STATES
TO
DETERMINE 
HOW
DAILY
ACTIVITIES
MAY
BE
CONDUCTED
RE-
MOTELY.—The Secretary may allow a State to de-
termine how daily activities under the State plan de-
veloped under part B of title IV of the Social Secu-
rity Act and the State program funded under section 
477 of such Act may be conducted through elec-
tronic means to comply with public health guidelines 
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234 
relating to social distancing, including conducting 
any required court proceedings pertaining to chil-
dren in care. In making any such determination, the 
State shall work to ensure that the safety and health 
of each child in care remains paramount. 
(6) COUNTING OF REMOTE CASEWORKER VISITS 
AS IN-PERSON VISITS.—In the case of a foster child 
who has attained 18 years of age and with respect 
to whom foster care maintenance payments are 
being made under a State plan approved under part 
E of title IV of the Social Security Act, caseworker 
contact with the child that includes visual and audi-
tory contact and which is conducted solely by elec-
tronic means is deemed an in-person visit to the 
child by the caseworker for purposes of section 
424(f)(1)(A) of such Act if the child is visited by the 
caseworker in person not less than once every 6 
months while in such care. 
(7) ELIMINATION OF EDUCATION AND EMPLOY-
MENT
REQUIREMENTS
FOR
CERTAIN
FOSTER 
YOUTH.—The Secretary may waive the applicability 
of 
subclauses 
(I) 
through 
(IV) 
of 
section 
475(8)(B)(iv) of the Social Security Act. 
(c) STATE DEFINED.—In subsection (a), the term 
‘‘State’’ has the meaning given the term in section 
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1101(a) of the Social Security Act for purposes of title 
IV of the Social Security Act, and includes an Indian tribe, 
tribal organization, or tribal consortium with an applica-
tion and plan approved under this section 477(j) of such 
Act for fiscal year 2020. 
SEC. 60002. ALLOWING HOME VISITING PROGRAMS TO CON-
TINUE SERVING FAMILIES SAFELY. 
(a) IN GENERAL.—For purposes of section 511 of the 
Social Security Act, during the period that begins on Feb-
ruary 1, 2020, and ends with the close of calendar year 
2020— 
(1) a virtual home visit shall be considered a 
home visit; 
(2) funding for, and staffing levels of, a pro-
gram conducted pursuant to such section shall not 
be reduced on account of reduced enrollment in the 
program; and 
(3) funds provided for such a program may be 
used— 
(A) to train home visitors in conducting a 
virtual home visit and in emergency prepared-
ness and response planning for families served; 
(B) for the acquisition by families enrolled 
in the program of such technological means as 
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236 
are needed to conduct and support a virtual 
home visit; and 
(C) to provide emergency supplies (such as 
diapers, formula, non-perishable food, water, 
hand soap and hand sanitizer) to families 
served. 
(b) VIRTUAL HOME VISIT DEFINED.—In subsection 
(a), the term ‘‘virtual home visit’’ means a visit that is 
conducted solely by electronic means. 
(c) AUTHORITY TO DELAY DEADLINES.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services may extend the deadline by which 
a requirement of section 511 of the Social Security 
Act must be met, by such period of time as the Sec-
retary deems appropriate. 
(2) GUIDANCE.—The Secretary shall provide to 
eligible entities funded under section 511 of the So-
cial Security Act information on the parameters 
used in extending a deadline under paragraph (1) of 
this subsection. 
SEC. 60003. EMERGENCY FLEXIBILITY FOR CHILD SUPPORT 
PROGRAMS. 
(a) IN GENERAL.—With respect to the period that 
begins on March 1, 2020, and ends with the close of cal-
endar year 2021: 
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237 
(1) The Secretary of Health and Human Serv-
ices (in this subsection referred to as the ‘‘Sec-
retary’’) may increase any percentage in effect for 
purposes of section 455(a)(1) of the Social Security 
Act to not more than 100 percent. 
(2) On application of an Indian tribe therefor, 
the Secretary may waive any matching funds re-
quirement imposed on the tribe under section 455(f) 
of such Act. 
(3) Paragraphs (2) and (8) of section 409(a) of 
such Act shall have no force or effect. 
(4) The Secretary may exempt a State from 
any requirement of section 466 of such Act. 
(5) The Secretary may not impose a penalty or 
take any other adverse action against a State pursu-
ant to section 452(g)(1) of such Act for failure to 
achieve a paternity establishment percentage of less 
than 90 percent. 
(6) The Secretary may not find that the pater-
nity establishment percentage for a State is not 
based on reliable data for purposes of section 
452(g)(1) of such Act, and the Secretary may not 
determine that the data which a State submitted 
pursuant to section 452(a)(4)(C)(i) of such Act and 
which is used in determining a performance level is 
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238 
not complete or reliable for purposes of section 
458(b)(5)(B) of such Act, on the basis of the failure 
of the State to submit OCSE Form 396 or 34 in a 
timely manner. 
(7) The Secretary may not impose a penalty or 
take any other adverse action against a State for 
failure to comply with section 454A(g)(1)(A)(i) of 
such Act. 
(8) The Secretary may not disapprove a State 
plan submitted pursuant to part D of title IV of 
such Act for failure of the plan to meet the require-
ment of section 454(1) of such Act, and may not im-
pose a penalty or take any other adverse action 
against a State with such a plan that meets that re-
quirement for failure to comply with that require-
ment. 
(9) To the extent that a preceding provision of 
this section applies with respect to a provision of law 
applicable to a program operated by an Indian tribe 
or tribal organization (as defined in subsections (e) 
and (l) of section 4 of the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450b)), 
that preceding provision shall apply with respect to 
the Indian tribe or tribal organization. 
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239 
(b) STATE DEFINED.—In subsection (a), the term 
‘‘State’’ has the meaning given the term in section 
1101(a) of the Social Security Act for purposes of title 
IV of such Act. 
SEC. 60004. EMERGENCY FLEXIBILITY FOR STATE TANF 
PROGRAMS. 
(a) STATE PROGRAMS.—Sections 407 and 408(a)(7) 
of the Social Security Act shall have no force or effect 
during the applicable period, and paragraphs (3), (9), 
(14), and (15) of section 409(a) of such Act shall not 
apply with respect to conduct engaged in during the pe-
riod. 
(b) TRIBAL PROGRAMS.—The minimum work partici-
pation requirements and time limits established under sec-
tion 412(c) of the Social Security Act shall have no force 
or effect during the applicable period, and the penalties 
established under such section shall not apply with respect 
to conduct engaged in during the period. 
(c) PENALTY FOR NONCOMPLIANCE.— 
(1) IN GENERAL.—If the Secretary of Health 
and Human Services finds that a State or an Indian 
tribe has imposed a work requirement as a condition 
of receiving assistance, or a time limit on the provi-
sion of assistance, under a program funded under 
part A of title IV of the Social Security Act or any 
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240 
program funded with qualified State expenditures 
(as defined in section 409(a)(7)(B)(i) of such Act) 
during the applicable period, or has imposed a pen-
alty for failure to comply with a work requirement 
during the period, the Secretary shall reduce the 
grant payable to the State under section 403(a)(1) 
of such Act or the grant payable to the tribe under 
section 412(a)(1) of such Act, as the case may be, 
for fiscal year 2021 by an amount equal to 5 percent 
of the State or tribal family assistance grant, as the 
case may be. 
(2) APPLICABILITY OF CERTAIN PROVISIONS.— 
For purposes of subsections (c) and (d) of section 
409 of the Social Security Act, paragraph (1) of this 
subsection shall be considered to be included in sec-
tion 409(a) of such Act. 
(d) DEFINITIONS.—In this section: 
(1) APPLICABLE PERIOD.—The term ‘‘applica-
ble period’’ means the period that begins on March 
1, 2020, and ends with the close of calendar year 
2020. 
(2) WORK REQUIREMENT.—The term ‘‘work re-
quirement’’ means a requirement to engage in a 
work activity (as defined in section 407(d) of the So-
cial Security Act). 
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241 
(3) OTHER TERMS.—Each other term has the 
meaning given the term in section 419 of the Social 
Security Act. 
DIVISION G—HEALTH POLICIES 
TITLE I—MEDICAID 
SEC. 70101. INCREASING FEDERAL SUPPORT TO STATE 
MEDICAID PROGRAMS DURING ECONOMIC 
DOWNTURNS. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (b), by striking ‘‘and (ff)’’ and 
inserting ‘‘(ff), and (gg)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(gg) 
INCREASED
FMAP 
DURING
ECONOMIC 
DOWNTURNS.— 
‘‘(1) IN GENERAL.—Notwithstanding subsection 
(b), (y), or (z)(2), if a fiscal quarter that begins on 
or after January 1, 2020, is an economic downturn 
quarter (as defined in paragraph (2)) with respect to 
a State, then the Federal medical assistance percent-
age applicable to amounts expended by the State for 
medical assistance for services furnished during such 
quarter shall be increased in accordance with para-
graphs (3) and (4). 
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242 
‘‘(2) ECONOMIC DOWNTURN QUARTER.— 
‘‘(A) IN GENERAL.— 
‘‘(i) IN GENERAL.—In this subsection, 
the term ‘economic downturn quarter’ 
means, with respect to a State, a fiscal 
quarter during which the State’s unem-
ployment rate for the quarter exceeds the 
percentage determined for the State and 
quarter under clause (ii). 
‘‘(ii) THRESHOLD PERCENTAGE.—The 
percentage determined under this clause 
for a State and fiscal quarter is the per-
centage equal to the lower of— 
‘‘(I) the State unemployment 
rate at the 20th percentile of the dis-
tribution of the State’s quarterly un-
employment rates for the 60-quarter 
period preceding the quarter involved, 
increased by 1 percentage point; and 
‘‘(II) the State’s average quar-
terly unemployment rate for the 12- 
quarter period preceding the quarter 
involved, increased by 1 percentage 
point. 
‘‘(B) UNEMPLOYMENT DATA.— 
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243 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), for purposes of deter-
mining unemployment rates for a State 
and a quarter under this paragraph, the 
Secretary shall use data from the Local 
Area Unemployment Statistics from the 
Bureau of Labor Statistics. 
‘‘(ii) APPLICATION TO CERTAIN TER-
RITORIES.—In the case of the Virgin Is-
lands, Guam, the Northern Mariana Is-
lands, or American Samoa, the Secretary 
shall use data from the U–6 unemployment 
measure of the Bureau of Labor Statistics 
to make any necessary determinations 
under subparagraph (A). 
‘‘(3) FMAP 
INCREASE
DURING
ECONOMIC 
DOWNTURN QUARTER.— 
‘‘(A) IN GENERAL.—During a fiscal quar-
ter that is an economic downturn quarter with 
respect to a State, the Federal medical assist-
ance percentage otherwise determined for the 
State and quarter under subsection (b) and, if 
applicable, the Federal medical assistance per-
centage applicable under subsection (y), (z)(2), 
or (ff) with respect to medical assistance fur-
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244 
nished by the State during such quarter to indi-
viduals described in either such subsection shall 
be increased by the number of percentage 
points (rounded to the nearest tenth of a per-
centage point) equal to the product of— 
‘‘(i) the number of percentage points 
(rounded to the nearest tenth of a percent-
age point) by which the unemployment 
rate for the State and quarter exceeds the 
percentage determined for the State and 
quarter under paragraph (2)(A)(ii); and 
‘‘(ii) 4.8. 
‘‘(B) APPLICATION OF COVID–19 FMAP IN-
CREASE.—Any increase applicable to the Fed-
eral medical assistance percentage of a State 
for a fiscal quarter under subparagraph (A) 
shall be in addition to any increase to such per-
centage for such quarter made pursuant to sec-
tion 6008(a) of the Families First Coronavirus 
Response Act. 
‘‘(C) LIMITATION.—In no case shall an in-
crease to the Federal medical assistance per-
centage of a State under this paragraph result 
in a Federal medical assistance percentage that 
exceeds 95 percent. 
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‘‘(D) SCOPE
OF
APPLICATION.—Any in-
crease to the Federal medical assistance per-
centage of a State for a fiscal quarter under 
this paragraph shall only apply with respect to 
payments for amounts expended by the State 
for medical assistance for services furnished 
during such quarter and shall not apply with 
respect to— 
‘‘(i) disproportionate share hospital 
payments described in section 1923; 
‘‘(ii) payments under title IV or XXI; 
‘‘(iii) any payments under this title 
that are based on the enhanced FMAP de-
scribed in section 2105(b); or 
‘‘(iv) any payments under this title 
that are based on a Federal medical assist-
ance percentage determined for a State 
under subsection (aa) (but only to the ex-
tent that such Federal medical assistance 
percentage is higher than the economic re-
covery FMAP). 
‘‘(4) ADVANCE PAYMENT; RETROSPECTIVE AD-
JUSTMENT.— 
‘‘(A) IN GENERAL.—Prior to the beginning 
of each fiscal quarter that begins on or after 
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July 1, 2020, the Secretary shall, with respect 
to each State— 
‘‘(i) determine the increase (if any) 
that is expected to apply to the Federal 
medical assistance percentage of such 
State for such quarter under this sub-
section based on the projections made for 
the State and quarter under subparagraph 
(B); and 
‘‘(ii) shall apply such increase to the 
Federal medical assistance percentage of 
the State for purposes of making payments 
to the State for amounts expended during 
such quarter as medical assistance under 
the State plan. 
‘‘(B) PROJECTION OF STATE UNEMPLOY-
MENT RATES.—Prior to the beginning of each 
fiscal quarter that begins on or after July 1, 
2020, the Secretary, acting through the Chief 
Actuary of the Centers for Medicare & Medicaid 
Services, shall, using the most recently available 
data described in paragraph (2)(B), make pro-
jections with respect to— 
‘‘(i) the unemployment rates for each 
State for such quarter; 
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247 
‘‘(ii) the threshold percentages de-
scribed in paragraph (2)(A)(ii) for each 
State for such quarter; and 
‘‘(iii) the national unemployment rate 
for such quarter. 
‘‘(C) RETROSPECTIVE
ADJUSTMENT.—As 
soon as practicable after final unemployment 
data becomes available for a fiscal quarter that 
begins on or after July 1, 2020, the Secretary 
shall, with respect to each State— 
‘‘(i) make a final determination of the 
increase (if any) applicable to the Federal 
medical assistance percentage of the State 
for the quarter under this subsection; and 
‘‘(ii) in accordance with subsection 
(d)(2) of section 1903, reduce or increase 
the amount payable to the State under 
subsection (a) of such section for a subse-
quent fiscal quarter to the extent of any 
overpayment or underpayment which the 
Secretary determines was made as a result 
of a miscalculation of the increase applica-
ble to the Federal medical assistance per-
centage of the State for such prior fiscal 
quarter under this subsection. 
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‘‘(5) RETROSPECTIVE APPLICATION OF OVER- 
THE-LIMIT FMAP INCREASES.— 
‘‘(A) IN GENERAL.—If a State has excess 
percentage points with respect to an economic 
downturn quarter and an applicable FMAP (as 
determined under subparagraph (B)), the State 
may elect to apply such excess percentage 
points to increase such applicable FMAP for 
one or more quarters during the look-back pe-
riod for the State and economic downturn quar-
ter in accordance with this paragraph. 
‘‘(B) EXCESS PERCENTAGE POINTS.—For 
purposes of this paragraph, the number of ex-
cess percentage points for a State, economic 
downturn quarter, and an applicable FMAP 
shall be equal to the number of percentage 
points by which— 
‘‘(i) the applicable FMAP for the 
State and quarter (after application of 
paragraph (3) but without regard to sub-
paragraph (C) of such paragraph); exceeds 
‘‘(ii) 95 percent. 
‘‘(C) EFFECT OF APPLICATION OF EXCESS 
PERCENTAGE
POINTS.—If a State elects to 
apply excess percentage points to an applicable 
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FMAP to a quarter during a look-back period 
under this paragraph, the Secretary shall deter-
mine the additional amount of payment under 
section 1903(a) to which the State would have 
been entitled for such quarter if the applicable 
FMAP (as so increased) had been in effect for 
such quarter, and shall treat such additional 
amount as an underpayment for such quarter. 
‘‘(D) DISTRIBUTION OF EXCESS PERCENT-
AGE POINTS.—A State that has excess percent-
age points with respect to an economic down-
turn quarter and applicable FMAP may elect to 
divide such points among more than 1 quarter 
during the look-back period for such State and 
quarter provided that no excess percentage 
point (or fraction of an excess percentage point) 
is applied to the applicable FMAP of more than 
1 quarter. 
‘‘(E) LIMITATIONS.— 
‘‘(i) NO
INCREASES
OVER
100
PER-
CENT.—A State may not increase an appli-
cable FMAP for any quarter during a look- 
back period under this paragraph if such 
increase would result in the applicable 
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FMAP for such quarter exceeding 100 per-
cent. 
‘‘(ii) SCOPE
OF
APPLICATION.—Any 
increase to an applicable FMAP of a State 
for a fiscal quarter under this paragraph— 
‘‘(I) shall only apply with respect 
to payments for amounts expended by 
the State for medical assistance for 
services furnished during such quarter 
to which such applicable FMAP is ap-
plicable; and 
‘‘(II) shall not apply with respect 
to payments described in paragraph 
(3)(D). 
‘‘(F) DEFINITIONS.—In this paragraph: 
‘‘(i) APPLICABLE
FMAP.—The term 
‘applicable FMAP’ means, with respect to 
a State and fiscal quarter— 
‘‘(I) the Federal medical assist-
ance percentage determined for the 
State and quarter under subsection 
(b); 
‘‘(II) the Federal medical assist-
ance percentage applicable under sub-
section (y); 
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251 
‘‘(III) the Federal medical assist-
ance percentage applicable under sub-
section (z)(2); or 
‘‘(IV) the Federal medical assist-
ance percentage determined for the 
State and quarter under subsection 
(ff). 
‘‘(ii) LOOK-BACK PERIOD.—The term 
‘look-back period’ means, with respect to a 
State and a fiscal quarter that is an eco-
nomic downturn quarter for the State, the 
period of 4 fiscal quarters that ends with 
the fourth quarter which precedes the most 
recent fiscal quarters that was not an eco-
nomic downturn quarter for the State. 
‘‘(6) REQUIREMENT FOR ALL STATES.—A State 
may not receive an increase in the Federal medical 
assistance percentage for such State under this sub-
section, with respect to a fiscal quarter, if— 
‘‘(A) eligibility standards, methodologies, 
or procedures under the State plan or a waiver 
of such plan are more restrictive during such 
quarter than the eligibility standards, meth-
odologies, or procedures, respectively, under 
such plan (or waiver) as in effect on the last 
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day of the most recent fiscal quarter that was 
not an economic downturn quarter for the 
State; 
‘‘(B) the amount of any premium imposed 
by the State pursuant to section 1916 or 1916A 
during such quarter, with respect to an indi-
vidual enrolled under such plan (or waiver), ex-
ceeds the amount of such premium as of the 
date described in subparagraph (A); or 
‘‘(C) the State fails to provide that an in-
dividual who is enrolled for benefits under such 
plan (or waiver) as of the date described in sub-
paragraph (A) or enrolls for benefits under 
such plan (or waiver) during the period begin-
ning with such date and ending with the day 
before the first day of the next quarter that is 
not an economic downturn quarter for the State 
shall be treated as eligible for such benefits for 
not less than 12 months (or, if such period is 
less than 12 months, throughout such period) 
unless the individual requests a voluntary ter-
mination of eligibility or the individual ceases to 
be a resident of the State.’’. 
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