‘‘(bb) the sum of the num-
ber of such individuals for all 
States described in clause (vi) for 
the third preceding year. 
‘‘(vi) STATES DESCRIBED.—For pur-
poses of clause (v), a State is described in 
this clause, with respect to 2019, 2020, 
and 2021, if the State satisfies either of 
the following criterion: 
‘‘(I) The ratio described in sub-
clause (II) of clause (v) that would be 
determined for such State by sub-
stituting ‘2015’ for each reference in 
such subclause to ‘the third preceding 
year’ and by substituting ‘all such 
States’ for the reference in item (bb) 
of such subclause to ‘all States de-
scribed in clause (vi)’ is greater than 
the ratio described in such subclause 
that would be determined for such 
State by substituting ‘2013’ for each 
reference in such subclause to ‘the 
third preceding year’ and by sub-
stituting ‘all such States’ for the ref-
VerDate Sep 11 2014 
03:23 Dec 21, 2017
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H4695.IH
H4695
SSpencer on DSKBBXCHB2PROD with BILLS
erence in item (bb) of such subclause 
to ‘all States described in clause (vi)’. 
‘‘(II) The State has fewer than 
three health insurance issuers offering 
qualified health plans through the Ex-
change for 2017. 
‘‘(B) FOR 2022 THROUGH 2028.—For pur-
poses of paragraph (1), the amount determined 
under this paragraph for a year (beginning with 
2022) during the period described in section 
2201 for a State is an amount determined in 
accordance with an allocation methodology spec-
ified by the Administrator which— 
‘‘(i) takes into consideration the ad-
justed incurred claims of such State, the 
number of residents of such State who for 
the previous year were not enrolled in a 
health plan or otherwise did not have 
health 
insurance 
coverage 
(including 
through a Federal or State health pro-
gram) and whose income is below 100 per-
cent of the poverty line applicable to a 
family of the size involved, and the number 
of health insurance issuers participating in 
VerDate Sep 11 2014 
03:23 Dec 21, 2017
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H4695.IH
H4695
SSpencer on DSKBBXCHB2PROD with BILLS
the insurance market in such State for 
such year; 
‘‘(ii) is established after consultation 
with health care consumers, health insur-
ance issuers, State insurance commis-
sioners, and other stakeholders and after 
taking into consideration additional cost 
and risk factors that may inhibit health 
care consumer and health insurance issuer 
participation; and 
‘‘(iii) reflects the goals of improving 
the health insurance risk pool, promoting a 
more competitive health insurance market, 
and increasing choice for health care con-
sumers. 
‘‘(c) ANNUAL DISTRIBUTION OF PREVIOUS YEAR’S 
REMAINING FUNDS.— In carrying out subsection (b), the 
Administrator shall, with respect to a year (beginning with 
2022 and ending with 2028), not later than March 31 of 
such year— 
‘‘(1) determine the amount of funds, if any, 
from the amounts appropriated under subsection (a) 
for the previous year but not allocated for such pre-
vious year; and 
VerDate Sep 11 2014 
03:23 Dec 21, 2017
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H4695.IH
H4695
SSpencer on DSKBBXCHB2PROD with BILLS
‘‘(2) if the Administrator determines that any 
funds were not so allocated for such previous year, 
allocate such remaining funds, in accordance with 
the allocation methodology specified pursuant to 
subsection (b)(2)(B), with, respect to a year before 
2028, any remaining funds being made available for 
allocations to States for the subsequent year. 
‘‘(d) AVAILABILITY.—Amounts appropriated under 
subsection (a) for a year and allocated to States in accord-
ance with this section shall remain available for expendi-
ture through December 31, 2028. 
‘‘(e) CONDITIONS FOR AND LIMITATIONS ON RE-
CEIPT OF FUNDS.—The Secretary may not make an allo-
cation under this title for a State, with respect to a pur-
pose described in section 2202 in the case of an allocation 
that would be made to a State pursuant to section 
2203(a), if the State does not agree that the State will 
make available non-Federal contributions towards such 
purpose in an amount equal to— 
‘‘(1) for 2020, 5 percent of the amount allo-
cated under this subsection to such State for such 
year and purpose; and 
‘‘(2) for 2021 and each subsequent year 
through 2028, 10 percent of the amount allocated 
VerDate Sep 11 2014 
03:23 Dec 21, 2017
Jkt 079200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H4695.IH
H4695
SSpencer on DSKBBXCHB2PROD with BILLS
under this subsection to such State for such year 
and purpose.’’. 
SEC. 4. MODIFICATIONS TO WAIVER FOR STATE INNOVA-
TION. 
Section 1332 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18052) is amended— 
(1) in subsection (a)(3), in the first sentence, 
by striking ‘‘individuals and small employers’’ and 
all that follows through ‘‘the State had not received 
such waiver’’ and inserting ‘‘the Secretary deter-
mines that there would be a reduction in the Federal 
deficit during the waiver period, the Secretary shall 
provide for a means by which the amount of such re-
duction’’; and 
(2) in subsection (d)— 
(A) in paragraph (1), by striking ‘‘180 
days’’ and inserting ‘‘subject to paragraph (3), 
90 days’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(3) EXPEDITED
DETERMINATION.—With re-
spect to any application under subsection (a)(1) sub-
mitted on or after the date of enactment of this 
paragraph (or any such application submitted prior 
to such date of enactment and under review by the 
VerDate Sep 11 2014 
03:23 Dec 21, 2017
Jkt 079200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H4695.IH
H4695
SSpencer on DSKBBXCHB2PROD with BILLS