I 
115TH CONGRESS 
1ST SESSION 
H. R. 352 
To amend the Social Security Act to replace the Medicaid program and 
the Children’s Health Insurance program with a block grant to the 
States, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 6, 2017 
Mr. ROKITA (for himself, Mr. MESSER, Mr. FRANKS of Arizona, Mr. 
FARENTHOLD, Mr. WESTERMAN, Mr. DESJARLAIS, Mr. MOOLENAAR, 
Mr. PALAZZO, Mrs. BLACK, Mr. SCHWEIKERT, Mr. JODY B. HICE of 
Georgia, Mr. LOUDERMILK, Mr. PITTENGER, Mr. BISHOP of Utah, Mr. 
DUNCAN of South Carolina, Mr. COLE, Mr. OLSON, Mr. ROHRABACHER, 
Mr. CRAMER, Mr. MEADOWS, Mr. BRAT, Mr. STEWART, Mr. PEARCE, 
Mr. TROTT, Mr. BANKS of Indiana, Mr. BARR, and Mr. ALLEN) intro-
duced the following bill; which was referred to the Committee on Energy 
and Commerce, and in addition to the Committees on Rules, Ways and 
Means, Education and the Workforce, the Judiciary, Natural Resources, 
House Administration, and Appropriations, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Social Security Act to replace the Medicaid 
program and the Children’s Health Insurance program 
with a block grant to the States, 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; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘State Health Flexibility Act of 2017’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Health grants to the States for health care services to indigent individ-
uals. 
‘‘TITLE XXII—BLOCK GRANTS TO STATES FOR HEALTH CARE 
SERVICES TO INDIGENT INDIVIDUALS 
‘‘Sec. 2201. Purpose. 
‘‘Sec. 2202. Grants to States. 
‘‘Sec. 2203. Administrative and fiscal accountability. 
‘‘Sec. 2204. Nondiscrimination provisions. 
‘‘Sec. 2205. Definitions. 
Sec. 3. Repeal of PPACA, HCERA, and the Federal requirements of Medicaid 
and CHIP. 
Sec. 4. Severability. 
Sec. 5. Effective date. 
SEC. 2. HEALTH GRANTS TO THE STATES FOR HEALTH 
CARE SERVICES TO INDIGENT INDIVIDUALS. 
(a) HEALTH CARE BLOCK GRANT TO STATES.—The 
Social Security Act is amended by adding at the end the 
following new title: 
‘‘TITLE XXII—BLOCK GRANTS TO 
STATES FOR HEALTH CARE 
SERVICES TO INDIGENT INDI-
VIDUALS 
‘‘SEC. 2201. PURPOSE. 
‘‘The purpose of this title is to provide Federal finan-
cial assistance to the States, in the form of a single grant, 
to allow the States maximum flexibility in providing, and 
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financing the provision of, health-care-related items and 
services to indigent individuals. 
‘‘SEC. 2202. GRANTS TO STATES. 
‘‘(a) IN GENERAL.—Subject to the requirements of 
this title, each State is entitled to receive from the Sec-
retary of the Treasury a grant for each quarter of each 
of fiscal years 2018 through 2026, in an amount that is 
equal to 25 percent of the total amount received by a State 
under title XIX and title XXI for fiscal year 2013. 
‘‘(b) APPROPRIATION.—Out of any money in the 
Treasury of the United States not otherwise appropriated, 
there are appropriated for each of fiscal years 2018 
through 2026 such sums as are necessary for grants under 
this section. 
‘‘(c) REQUIREMENTS RELATING TO INTERGOVERN-
MENTAL FINANCING.—The Secretary of the Treasury 
shall make the transfer of funds under grants under sub-
section (a) directly to each State in accordance with the 
requirements of section 6503 of title 31, United States 
Code. 
‘‘(d) EXPENDITURE OF FUNDS.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), amounts received by a State under this 
title for any fiscal year shall be expended by the 
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State in such fiscal year or in the succeeding fiscal 
year. 
‘‘(2) USE OF RAINY DAY FUND PERMITTED.— 
Of the amounts received by a State under this title, 
the State may set aside, in a separate account, such 
amounts as the State deems necessary to provide, 
without fiscal limitation, health-care-related items 
and services for indigent individuals during— 
‘‘(A) periods of unexpectedly high rates of 
unemployment; or 
‘‘(B) periods related to circumstances that 
are not described in subparagraph (A) and that 
cause unexpected increases in the need for such 
items and services for such individuals. 
‘‘(3) FUNDS REMAINING AFTER FISCAL YEAR 
2027.—If, after fiscal year 2027, a State has funds 
in the account under paragraph (2), the State may 
only expend such funds if such funds are used in a 
manner that is permitted under subsection (e), as 
such subsection is in effect on September 30, 2028. 
‘‘(e) USE OF FUNDS.—A State may only use the 
amounts received under subsection (a) as follows: 
‘‘(1) GENERAL PURPOSE.—Nothing in this title 
shall be construed as limiting the flexibility of a 
State to determine which providers of such items 
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and services qualify to receive payment from a grant 
made to the State under this title. 
‘‘(2) FUNDING FOR RISK ADJUSTMENT MECHA-
NISMS.—To fund qualified high risk pools, reinsur-
ance pools, or other risk-adjustment mechanisms 
used for the purpose of subsidizing the purchase of 
private health insurance for the high-risk population. 
‘‘(3) AUTHORITY TO USE PORTION OF FEDERAL 
ASSISTANCE
FOR
OTHER
WELFARE-RELATED
PRO-
GRAMS.— 
‘‘(A) IN GENERAL.—Subject to the limit 
under subparagraph (B), to carry out a State 
program pursuant to any or all of the following 
provisions of law: 
‘‘(i) Part A of title IV of this Act. 
‘‘(ii) Section 1616 of this Act. 
‘‘(iii) The Food and Nutrition Act of 
2008. 
‘‘(B) LIMITATION.—A State may not use 
more than 30 percent of the amount received 
under subsection (a) for a fiscal year to carry 
out a State program, or programs, under sub-
paragraph (A). 
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