I 
118TH CONGRESS 
2D SESSION 
H. R. 8327 
To amend title XI of the Social Security Act to provide for the redistribution 
of unused territorial cap amounts under the Medicaid program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 8, 2024 
Mr. SABLAN (for himself, Mr. MOYLAN, and Mrs. RADEWAGEN) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce 
A BILL 
To amend title XI of the Social Security Act to provide 
for the redistribution of unused territorial cap amounts 
under the Medicaid program. 
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 ‘‘Ensuring Medicaid 
Continuity for the Insular Areas Act of 2024’’. 
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SEC. 2. PROVIDING FOR THE REDISTRIBUTION OF UNUSED 
TERRITORIAL CAP AMOUNTS UNDER THE 
MEDICAID PROGRAM. 
Section 1108(g) of the Social Security Act (42 U.S.C. 
1308(g)) is amended by adding at the end the following 
new paragraph: 
‘‘(14) PROCEDURE
FOR
REDISTRIBUTION
OF 
UNUSED AMOUNTS.— 
‘‘(A) IN GENERAL.—For each fiscal year 
(beginning with fiscal year 2022), in the case 
that there is at least 1 specified territory (as 
defined in subparagraph (D)) with unused 
amounts (as so defined) with respect to such 
fiscal year, the Secretary shall determine an ap-
propriate procedure, with respect to each terri-
tory that is a shortfall territory (as so defined) 
for such fiscal year, to increase the limit other-
wise determined under this subsection on the 
amount certified by the Secretary under title 
XIX for payment to such territory by the 
amount specified in subparagraph (B). 
‘‘(B) AMOUNT SPECIFIED.— 
‘‘(i) IN
GENERAL.—For purposes of 
subsection (A), the amount specified in 
this subparagraph is, with respect to a 
shortfall territory and a fiscal year— 
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‘‘(I) in the case the aggregate 
unused amounts for such fiscal year 
for all specified territories are greater 
than the aggregate shortfall amounts 
for such fiscal year for all such terri-
tories, the difference between the 
amount that would have been certified 
by the Secretary under title XIX for 
payment to such shortfall territory for 
such fiscal year without application of 
this paragraph and the amount of 
payment that such territory would 
have received under title XIX had this 
section not applied; and 
‘‘(II) in the case the aggregate 
unused amounts for such fiscal year 
for all specified territories are less 
than the aggregate shortfall amounts 
for such fiscal year for all such terri-
tories, an amount that bears the same 
ratio 
to 
such 
aggregate 
unused 
amounts as such shortfall territory’s 
shortfall amount bears to such aggre-
gate shortfall amounts. 
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‘‘(ii) 
RETROSPECTIVE
ADJUST-
MENT.—The Secretary may adjust any in-
creases made under this paragraph for a 
fiscal year as necessary on the basis of in-
formation reported by specified territories 
not later than November 30 of the suc-
ceeding fiscal year, as determined appro-
priate by the Secretary. 
‘‘(C) NONAPPLICATION
OF
INCREASE
TO 
FUTURE FISCAL YEARS.—Any increase in the 
limit described in subparagraph (A) of a speci-
fied territory for a fiscal year shall not be taken 
into account in determining such limit for such 
territory in the succeeding fiscal year. 
‘‘(D) DEFINITIONS.—In this paragraph: 
‘‘(i) SHORTFALL AMOUNT.—The term 
‘shortfall amount’ means, with respect to a 
specified territory that, but for the limit on 
the amount certified by the Secretary 
under title XIX for payment to such terri-
tories for a fiscal year established under 
this section, would have received payment 
under title XIX for such fiscal year in an 
amount exceeding such limit, the amount 
of such excess. 
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