II 
116TH CONGRESS 
1ST SESSION 
H. R. 259 
IN THE SENATE OF THE UNITED STATES 
JANUARY 9, 2019 
Received 
AN ACT 
To extend the Medicaid Money Follows the Person Rebal-
ancing demonstration, to extend protection for Medicaid 
recipients of home and community-based services against 
spousal impoverishment, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicaid Extenders 
Act of 2019’’. 
SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON RE-
BALANCING DEMONSTRATION. 
(a) GENERAL FUNDING.—Section 6071(h) of the 
Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is 
amended— 
(1) in paragraph (1)— 
(A) in subparagraph (D), by striking 
‘‘and’’ after the semicolon; 
(B) in subparagraph (E), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(F) 
subject 
to 
paragraph 
(3), 
$112,000,000 for fiscal year 2019.’’; 
(2) in paragraph (2)— 
(A) by striking ‘‘Amounts made’’ and in-
serting ‘‘Subject to paragraph (3), amounts 
made’’; and 
(B) by striking ‘‘September 30, 2016’’ and 
inserting ‘‘September 30, 2021’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(3) SPECIAL RULE FOR FY 2019.—Funds ap-
propriated under paragraph (1)(F) shall be made 
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available for grants to States only if such States 
have an approved MFP demonstration project under 
this section as of December 31, 2018.’’. 
(b) FUNDING FOR QUALITY ASSURANCE AND IM-
PROVEMENT; TECHNICAL
ASSISTANCE; OVERSIGHT.— 
Section 6071(f) of the Deficit Reduction Act of 2005 (42 
U.S.C. 1396a note) is amended by striking paragraph (2) 
and inserting the following: 
‘‘(2) FUNDING.—From the amounts appro-
priated under subsection (h)(1)(F) for fiscal year 
2019, $500,000 shall be available to the Secretary 
for such fiscal year to carry out this subsection.’’. 
(c) TECHNICAL AMENDMENT.—Section 6071(b) of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) 
is amended by adding at the end the following: 
‘‘(10) 
SECRETARY.—The 
term 
‘Secretary’ 
means the Secretary of Health and Human Serv-
ices.’’. 
SEC. 3. EXTENSION OF PROTECTION FOR MEDICAID RE-
CIPIENTS OF HOME AND COMMUNITY-BASED 
SERVICES AGAINST SPOUSAL IMPOVERISH-
MENT. 
(a) IN GENERAL.—Section 2404 of Public Law 111– 
148 (42 U.S.C. 1396r–5 note) is amended by striking ‘‘the 
5-year period that begins on January 1, 2014,’’ and in-
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serting ‘‘the period beginning on January 1, 2014, and 
ending on March 31, 2019,’’. 
(b) RULE OF CONSTRUCTION.— 
(1) PROTECTING STATE SPOUSAL INCOME AND 
ASSET
DISREGARD
FLEXIBILITY
UNDER
WAIVERS 
AND PLAN AMENDMENTS.—Nothing in section 2404 
of Public Law 111–148 (42 U.S.C. 1396r–5 note) or 
section 1924 of the Social Security Act (42 U.S.C. 
1396r–5) shall be construed as prohibiting a State 
from disregarding an individual’s spousal income 
and assets under a State waiver or plan amendment 
described in paragraph (2) for purposes of making 
determinations of eligibility for home and commu-
nity-based services or home and community-based 
attendant services and supports under such waiver 
or plan amendment. 
(2) STATE WAIVER OR PLAN AMENDMENT DE-
SCRIBED.—A State waiver or plan amendment de-
scribed in this paragraph is any of the following: 
(A) A waiver or plan amendment to pro-
vide medical assistance for home and commu-
nity-based services under a waiver or plan 
amendment under subsection (c), (d), or (i) of 
section 1915 of the Social Security Act (42 
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SEC. 4. REDUCTION IN FMAP AFTER 2020 FOR STATES 
WITHOUT ASSET VERIFICATION PROGRAM. 
Section 1940 of the Social Security Act (42 U.S.C. 
1396w) is amended by adding at the end the following 
new subsection: 
‘‘(k) REDUCTION IN FMAP AFTER 2020 FOR NON- 
COMPLIANT STATES.— 
‘‘(1) IN GENERAL.—With respect to a calendar 
quarter beginning on or after January 1, 2021, the 
Federal medical assistance percentage otherwise de-
termined under section 1905(b) for a non-compliant 
State shall be reduced— 
‘‘(A) for calendar quarters in 2021 and 
2022, by 0.12 percentage points; 
‘‘(B) for calendar quarters in 2023, by 
0.25 percentage points; 
‘‘(C) for calendar quarters in 2024, by 
0.35 percentage points; and 
‘‘(D) for calendar quarters in 2025 and 
each year thereafter, by 0.5 percentage points. 
‘‘(2) NON-COMPLIANT
STATE
DEFINED.—For 
purposes of this subsection, the term ‘non-compliant 
State’ means a State— 
‘‘(A) that is one of the 50 States or the 
District of Columbia; 
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‘‘(B) with respect to which the Secretary 
has not approved a State plan amendment sub-
mitted under subsection (a)(2); and 
‘‘(C) that is not operating, on an ongoing 
basis, an asset verification program in accord-
ance with this section.’’. 
SEC. 5. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(1) of the Social Security Act (42 
U.S.C. 
1396w–1(b)(1)) 
is 
amended 
by 
striking 
‘‘$31,000,000’’ and inserting ‘‘$6,000,000’’. 
Passed the House of Representatives January 8, 
2019. 
Attest: 
KAREN L. HAAS, 
Clerk. 
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