I 
115TH CONGRESS 
1ST SESSION H. R. 1325 
To amend title XIX of the Social Security Act to provide States with flexibility 
with respect to providing premium assistance under the Medicaid program. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 2, 2017 
Mr. BUCSHON 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 
States with flexibility with respect to providing premium 
assistance 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. PROVIDING FLEXIBILITY WITH RESPECT TO 
PREMIUM ASSISTANCE UNDER MEDICAID. 
(a) IN GENERAL.—Section 1906 of the Social Secu-
rity Act (42 U.S.C. 1396e) is amended— 
(1) in subsection (c)(2), by striking ‘‘such 
plan.’’ and inserting ‘‘such group health plan.’’; and 
(2) by inserting after subsection (c) the fol-
lowing new subsection: 
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‘‘(d) STATE
OPTION
FOR
NONELDERLY, NON-
DISABLED ADULTS.— 
‘‘(1) IN GENERAL.—Beginning on January 1, 
2018, in the case of a State electing the option de-
scribed in paragraph (2) of subsection (a), the Sec-
retary may, upon the approval of a State plan 
amendment submitted by the State, waive the re-
quirement of paragraph (3) of such subsection to the 
extent such requirement provides for payment of 
premiums and deductibles and other cost-sharing ob-
ligations with respect to the items and services de-
scribed in such paragraph furnished to individuals 
described in paragraph (3) of this subsection. 
‘‘(2) COST-EFFECTIVENESS.— 
‘‘(A) IN
GENERAL.—The Secretary may 
approve a State plan amendment under this 
subsection if the Secretary determines that the 
payment of premiums and deductibles and other 
cost-sharing obligations under the group health 
plan or plans involved is cost-effective relative 
to the amount of expenditures under the State 
plan, including administrative expenditures, and 
excluding payments for copayments or coinsur-
ance, that the State would have made to pro-
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vide comparable coverage of the individuals de-
scribed in paragraph (3) involved. 
‘‘(B) DETERMINATION.—For purposes of 
subparagraph (A), cost-effectiveness shall be de-
termined— 
‘‘(i) on an annual basis by com-
paring— 
‘‘(I) the amount of expenditures 
per employer for coverage under the 
group health plan or plans involved of 
the individuals described in paragraph 
(3) for the preceding 4 calendar quar-
ters; to 
‘‘(II) the average per capita 
amount of expenditures that the State 
made under the State plan to provide 
comparable coverage of such individ-
uals for such calendar quarters; and 
‘‘(ii) in the case of individuals de-
scribed in paragraph (3) who are parents 
of children— 
‘‘(I) if the parent is eligible for 
enrollment in a group health plan, 
based on the cost of purchasing family 
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coverage under the group health plan; 
and 
‘‘(II) if the parent is not so eligi-
ble, based on the cost of individual 
coverage for the parent and each 
child. 
‘‘(C) CHILD DEFINED.—In this paragraph, 
the term ‘child’ has the meaning given such 
term in section 1902(e)(13)(G). 
‘‘(3) NONELDERLY, NONDISABLED ADULTS.— 
The individuals described in this paragraph are indi-
viduals who are under 65 years of age, not pregnant, 
not entitled to, or enrolled for, benefits under part 
A of title XVIII, or enrolled for benefits under part 
B of title XVIII, are not described in subclauses (I) 
through (VII) of section 1902(a)(10)(A)(i), and oth-
erwise entitled to medical assistance under this 
title.’’. 
(b) PREMIUM ASSISTANCE SUBSIDY OPTION.—Sec-
tion 1906A of the Social Security Act (42 U.S.C. 1396e– 
1) is amended by adding at the end the following new sub-
section: 
‘‘(f) STATE
OPTION
FOR
NONELDERLY, NON-
DISABLED ADULTS.— 
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‘‘(1) IN GENERAL.—Beginning on January 1, 
2018, in the case of a State electing to provide a 
premium assistance subsidy as described in sub-
section (a), the Secretary may, upon the approval of 
a State plan amendment submitted by the State, 
waive the requirement of subsection (e) to the extent 
such requirement provides for payment of premiums 
and deductibles and other cost-sharing obligations 
with respect to the items and services described in 
such subsection furnished to individuals described in 
paragraph (3). 
‘‘(2) COST-EFFECTIVENESS.— 
‘‘(A) IN
GENERAL.—The Secretary may 
approve a State plan amendment under this 
subsection if the Secretary determines that the 
payment of premiums and deductibles and other 
cost-sharing obligations under the qualified em-
ployer-sponsored coverage involved is cost-effec-
tive relative to the amount of expenditures 
under the State plan, including administrative 
expenditures, and excluding payments for co-
payments or coinsurance, that the State would 
have made to provide comparable coverage of 
the individuals described in paragraph (3)(B) 
involved. 
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‘‘(B) DETERMINATION.—For purposes of 
subparagraph (A), cost-effectiveness shall be de-
termined— 
‘‘(i) on an annual basis by com-
paring— 
‘‘(I) the amount of expenditures 
per employer for coverage under the 
qualified employer-sponsored coverage 
involved of the individuals described in 
paragraph (3)(B) for the preceding 4 
calendar quarters; to 
‘‘(II) the average per capita 
amount of expenditures that the State 
made under the State plan to provide 
comparable coverage of such individ-
uals for such calendar quarters; and 
‘‘(ii) in the case of individuals de-
scribed in paragraph (3) who are parents 
of individuals under 19 years of age— 
‘‘(I) if the parent is eligible for 
enrollment in qualified employer-spon-
sored coverage, based on the cost of 
purchasing family coverage under 
such 
qualified 
employer-sponsored 
coverage; and 
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‘‘(II) if the parent is not so eligi-
ble, based on the cost of individual 
coverage for the parent and each such 
individual under 19 years of age. 
‘‘(3) NONELDERLY, NONDISABLED ADULTS.— 
The individuals described in this paragraph are indi-
viduals (or the parents of individuals) who are— 
‘‘(A) participating in a premium assistance 
subsidy under this section for qualified em-
ployer-sponsored coverage; and 
‘‘(B) under 65 years of age, not pregnant, 
not entitled to, or enrolled for, benefits under 
part A of title XVIII, or enrolled for benefits 
under part B of title XVIII, and are not de-
scribed in subclauses (I) through (VII) of sec-
tion 1902(a)(10)(A)(i).’’. 
Æ 
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