I 
116TH CONGRESS 
1ST SESSION H. R. 4666 
To amend title XVIII of the Social Security Act to provide certain low- 
income territorial residents with automatic eligibility for premium and 
cost-sharing subsidies under the Medicare program, and for other pur-
poses. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 11, 2019 
Ms. SHALALA (for herself and Mr. SOTO) introduced the following bill; which 
was referred to the Committee on Energy and Commerce, and in addition 
to the Committee on Ways and Means, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
certain low-income territorial residents with automatic 
eligibility for premium and cost-sharing subsidies under 
the Medicare program, 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. AUTOMATIC ELIGIBILITY OF CERTAIN LOW-IN-
COME TERRITORIAL RESIDENTS FOR PRE-
MIUM AND COST-SHARING SUBSIDIES UNDER 
THE MEDICARE PROGRAM; SUNSET OF EN-
HANCED ALLOTMENT PROGRAM. 
(a) AUTOMATIC ELIGIBILITY OF CERTAIN LOW-IN-
COME TERRITORIAL RESIDENTS
FOR PREMIUM
AND 
COST-SHARING SUBSIDIES UNDER THE MEDICARE PRO-
GRAM.— 
(1) IN GENERAL.—Section 1860D–14(a)(3) of 
the Social Security Act (42 U.S.C. 1395w– 
114(a)(3)) is amended— 
(A) in subparagraph (B)(v)— 
(i) in subclause (I), by striking ‘‘and’’ 
at the end; 
(ii) in subclause (II), by striking the 
period and inserting ‘‘; and’’; and 
(iii) by inserting after subclause (II) 
the following new subclause: 
‘‘(III) with respect to plan years 
beginning on or after January 1, 
2021, shall provide that any part D 
eligible individual who is enrolled for 
medical assistance under the State 
Medicaid plan of a territory (as de-
fined in section 1935(f)) under title 
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XIX (or a waiver of such a plan) shall 
be treated as a subsidy eligible indi-
vidual described in paragraph (1).’’; 
and 
(B) in subparagraph (F), by adding at the 
end the following new sentence: ‘‘The previous 
sentence shall not apply with respect to eligi-
bility determinations for premium and cost- 
sharing subsidies under this section made on or 
after January 1, 2021.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1860D–31(j)(2)(D) of the Social Security Act (42 
U.S.C. 1395w–141(j)(2)(D)) is amended by adding 
at the end the following new sentence: ‘‘The previous 
sentence shall not apply with respect to amounts 
made available to a State under this paragraph on 
or after January 1, 2021.’’. 
(b) SUNSET
OF
ENHANCED
ALLOTMENT
PRO-
GRAM.— 
(1) IN GENERAL.—Section 1935(e) of the So-
cial Security Act (42 U.S.C. 1396u–5(e)) is amend-
ed— 
(A) in paragraph (1)(A), by inserting after 
‘‘such State’’ the following: ‘‘before January 1, 
2021’’; and 
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