SEC. 2. REDISTRIBUTION OF FEDERAL MEDICAID FUNDS 
TO STATES ELECTING TO MEET ACA MED-
ICAID 
EXPANSION 
REQUIREMENTS 
FROM 
STATES NOT SO ELECTING. 
(a) IN GENERAL.—Section 1903 of the Social Secu-
rity Act (42 U.S.C. 1396b) is amended by adding at the 
end the following new subsection: 
‘‘(aa) BONUS FOR STATES ELECTING TO MEET ACA 
MEDICAID EXPANSION REQUIREMENTS FROM FUNDS 
MADE AVAILABLE BY OTHER STATES NOT ELECTING TO 
MEET THOSE REQUIREMENTS.— 
‘‘(1) IN GENERAL.—In the case of a partici-
pating State for a fiscal year as determined under 
paragraph (2), in accordance with regulations of the 
Secretary, the State shall be entitled to an increase 
in payments under its State plan under this title in 
an amount determined under paragraph (3) of the 
Secretary’s estimate of the net reduction in Federal 
expenditures for nonparticipating States (including 
the amount of the additional Federal financial par-
ticipation under this title that otherwise would have 
been paid to such States if they were participating 
States) during the fiscal year as a result of such 
States not applying the ACA Medicaid expansion re-
quirements. 
‘‘(2) NOTICE REGARDING PARTICIPATION.— 
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‘‘(A) IN GENERAL.—Before the beginning 
of each fiscal year (beginning with fiscal year 
2014) each of the 50 States and the District of 
Columbia is requested to inform the Secretary, 
in a form and manner specified by the Sec-
retary and accompanied by such assurances re-
garding State plan amendments as the Sec-
retary may specify, if the State will be applying 
its State plan under this title for such fiscal 
year in accordance with the requirements speci-
fied in the amendments made by paragraphs 
(1) and (2) of section 2001(a) of the Patient 
Protection and Affordable Care Act (in this 
subsection referred to as the ‘ACA Medicaid ex-
pansion requirements’), which include require-
ments described in— 
‘‘(i) section 1902(a)(10)(A)(I)(VIII); 
and 
‘‘(ii) section 1902(k). 
The Secretary shall not accept information sub-
mitted under this subparagraph for a fiscal 
year after the beginning of the fiscal year in-
volved. 
‘‘(B) DETERMINATION OF PARTICIPATING 
AND NONPARTICIPATING STATES.—Taking into 
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account the information submitted under sub-
paragraph (A) for a fiscal year, the Secretary 
shall determine for the fiscal year which of the 
50 States and the District of Columbia will be 
applying the ACA Medicaid expansion require-
ments for the fiscal year and which will not. 
For purposes of this subsection— 
‘‘(i) each State or District determined 
to be applying such requirements for a fis-
cal year is referred to as a ‘participating 
State’ for such fiscal year; and 
‘‘(ii) each State or District determined 
not to be applying such requirements for a 
fiscal year is referred to as a ‘nonpartici-
pating State’ for such fiscal year. 
‘‘(3) AMOUNT
OF
INCREASE.—The Secretary 
shall compute the increase in payments under this 
subsection for a participating State for a fiscal year, 
to the extent of available funds, in accordance with 
a formula specified by the Secretary. Within the 
amount of available funds, such formula may take 
into account elements such as— 
‘‘(A) increasing to 100 percent the FMAP 
for newly eligible mandatory individuals; 
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‘‘(B) increasing the matching percentage 
for administrative costs attributable to applica-
tion of ACA Medicaid expansion requirements; 
and 
‘‘(C) an increase in DSH allotments. 
‘‘(4) PUBLICATION OF INFORMATION ON ESTI-
MATED IMPACT OF NONPARTICIPATION.—The Sec-
retary shall publish for each nonparticipating State 
for each fiscal year— 
‘‘(A) the amount of the additional Federal 
funds under this title for the fiscal year that 
the Secretary estimates the State has forgone 
as a result of its not being a participating State 
for such fiscal year; and 
‘‘(B) the number of additional beneficiaries 
that would have been covered under the State 
plan under this title in the fiscal year if the 
State had been a participating State for the fis-
cal year.’’. 
Æ 
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