1059 
U.S.C. 1396n) or under section 1115 of such 
Act (42 U.S.C. 1315). 
(B) A plan amendment to provide medical 
assistance for home and community-based serv-
ices for individuals by reason of being deter-
mined eligible under section 1902(a)(10)(C) of 
such Act (42 U.S.C. 1396a(a)(10)(C)) or by 
reason of section 1902(f) of such Act (42 
U.S.C. 1396a(f)) or otherwise on the basis of a 
reduction of income based on costs incurred for 
medical or other remedial care under which the 
State disregarded the income and assets of the 
individual’s spouse in determining the initial 
and ongoing financial eligibility of an individual 
for such services in place of the spousal impov-
erishment provisions applied under section 1924 
of such Act (42 U.S.C. 1396r–5). 
(C) A plan amendment to provide medical 
assistance for home and community-based at-
tendant services and supports under section 
1915(k) of such Act (42 U.S.C. 1396n(k)).
1060 
REDUCTION IN FMAP AFTER 2020 FOR STATES WITHOUT 
ASSET VERIFICATION PROGRAM 
SEC. 303. 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;
1061 
‘‘(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.’’. 
MEDICAID IMPROVEMENT FUND 
SEC. 304. 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’’. 
BUDGETARY EFFECTS 
SEC. 305. (a) STATUTORY PAYGO SCORECARDS.— 
The budgetary effects of this division shall not be entered 
on either PAYGO scorecard maintained pursuant to sec-
tion 4(d) of the Statutory Pay-As-You-Go Act of 2010 (2 
U.S.C. 933(d)). 
(b) SENATE PAYGO SCORECARDS.—The budgetary 
effects of this division shall not be entered on any PAYGO 
scorecard maintained for purposes of section 4106 of H. 
Con. Res. 71 (115th Congress). 
(c) CLASSIFICATION
OF BUDGETARY EFFECTS.— 
Notwithstanding Rule 3 of the Budget Scorekeeping 
Guidelines set forth in the joint explanatory statement of 
the committee of conference accompanying Conference Re-
port 105–217 and section 250(c)(8) of the Balanced
1062 
Budget and Emergency Deficit Control Act of 1985, the 
budgetary effects of this division shall not be estimated— 
(1) for purposes of section 251 of such Act; and 
(2) for purposes of paragraph (4)(C) of section 
3 of the Statutory Pay-As-You-Go Act of 2010 as 
being included in an appropriation Act. 
TITLE IV 
BUDGETARY EFFECTS 
SEC. 401. Effective on the date of enactment of this 
Act, the balances on the PAYGO scorecards established 
pursuant to paragraphs (4) and (5) of section 4(d) of the 
Statutory Pay-As-You-Go Act of 2010 (2 U.S.C. 933(d)) 
shall be zero. 
Passed the House of Representatives January 3, 
2019. 
Attest: 
Clerk.
116TH CONGRESS 
1ST SESSION 
H. R. 21 
AN ACT 
Making appropriations for the fiscal year ending 
September 30, 2019, and for other purposes.