I 
115TH CONGRESS 
1ST SESSION H. R. 4129 
To establish a State public option through Medicaid to provide Americans 
with the choice of a high-quality, low-cost health insurance plan. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 25, 2017 
Mr. BEN RAY LUJA´N of New Mexico (for himself, Mr. BLUMENAUER, Mr. 
CARSON of Indiana, Ms. CLARKE of New York, Mr. COHEN, Mr. 
DELANEY, Mr. MICHAEL F. DOYLE of Pennsylvania, Mr. ENGEL, Ms. 
ESHOO, Ms. FUDGE, Mr. GALLEGO, Ms. JAYAPAL, Mr. JEFFRIES, Mr. 
KIHUEN, Mr. LANGEVIN, Mrs. NAPOLITANO, Mr. O’ROURKE, Ms. ROSEN, 
Ms. TITUS, Mr. TONKO, Mr. WALZ, Ms. MICHELLE LUJAN GRISHAM of 
New Mexico, Mr. TAKANO, Mr. KRISHNAMOORTHI, and Mr. CICILLINE) 
introduced the following bill; which was referred to the Committee on En-
ergy 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 provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To establish a State public option through Medicaid to pro-
vide Americans with the choice of a high-quality, low- 
cost health insurance plan. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘State Public Option 
Act’’. 
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SEC. 2. MEDICAID BUY-IN OPTION. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)(10)— 
(A) in subparagraph (A)(ii)— 
(i) in subclause (XXI), by striking ‘‘; 
or’’ and inserting a semicolon; 
(ii) in subclause (XXII), by adding 
‘‘or’’ at the end; and 
(iii) by adding at the end the fol-
lowing new subclause: 
‘‘(XXIII) beginning January 1, 
2018, who are residents of the State 
and are not concurrently enrolled in 
another health insurance coverage 
plan, subject, in the case of individ-
uals described in subsection (nn) and 
notwithstanding section 1916 (except 
for subsection (k) of such section), to 
payment of premiums or other cost- 
sharing charges;’’; and 
(B) in the matter following subparagraph 
(G), in clause (XV), by inserting ‘‘or subsection 
(nn)’’ 
after 
‘‘described 
in 
subparagraph 
(A)(i)(VIII)’’; and 
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(2) by adding at the end the following new sub-
section: 
‘‘(nn) PREVIOUSLY UNDESCRIBED INDIVIDUALS.— 
Individuals described in this subsection are individuals 
who are— 
‘‘(1) described in subclause (XXIII) of sub-
section (a)(10)(A)(ii); and 
‘‘(2) are not described in any other subclause of 
such subsection or any other provision in this Act 
which provides for eligibility for medical assist-
ance.’’. 
(b) PROVISION OF AT LEAST MINIMUM COVERAGE.— 
(1) IN GENERAL.—Section 1902(k)(1) of the 
Social Security Act (42 U.S.C. 1396a(k)(1)) is 
amended by inserting ‘‘or an individual described in 
subsection (nn)’’ after ‘‘an individual described in 
subclause (VIII) of subsection (a)(10)(A)(i)’’ each 
place it appears. 
(2) 
CONFORMING
AMENDMENT.—Section 
1903(i)(26) of the Social Security Act (42 U.S.C. 
1396b(i)(26)) is amended by striking ‘‘individuals 
described 
in 
subclause 
(VIII) 
of 
subsection 
(a)(10)(A)(i)’’ and inserting ‘‘individuals described 
in subsection (a)(10)(A)(i)(VIII) or (nn) of section 
1902’’. 
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(c) FEDERAL FINANCIAL PARTICIPATION IN BUY-IN 
PROGRAM.— 
(1) ENHANCED
MATCH
FOR
ADMINISTRATIVE 
EXPENSES.—Section 1903(a) of the Social Security 
Act (42 U.S.C. 1396b(a)) is amended— 
(A) by redesignating paragraph (7) as 
paragraph (8); and 
(B) by inserting after paragraph (6) the 
following new paragraph: 
‘‘(7) an amount equal to 90 percent of the 
sums expended during the quarter which are attrib-
utable to reasonable administrative expenses related 
to the administration of a Medicaid buy-in program 
for 
individuals 
described 
in 
section 
1902(a)(10)(A)(ii)(XXIII); plus’’. 
(2) TREATMENT OF PREMIUM AND COST-SHAR-
ING REVENUES FROM MEDICAID BUY-IN PROGRAM.— 
(A) IN GENERAL.—For purposes of section 
1903(a)(1) of the Social Security Act (42 
U.S.C. 1396b(a)(1)), for any fiscal quarter dur-
ing which a State collects premiums, cost-shar-
ing, or similar charges under subsection (k) of 
section 1916 of such Act (42 U.S.C. 1396o) (as 
added by this Act), including any advance pay-
ments of premium tax credits under section 
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1412 of the Patient Protection and Affordable 
Care Act or payments for cost-sharing reduc-
tions under section 1402 of such Act that are 
received by the State, the total amount ex-
pended during such quarter as medical assist-
ance for individuals who buy into Medicaid cov-
erage under subclause (XXIII) of section 
1902(a)(10)(A)(ii) of the Social Security Act 
(as added by this Act) shall be reduced by the 
amount of such premiums or charges. 
(B) TREATMENT OF EXCESS PREMIUMS.— 
Each State that collects premiums or similar 
charges under subsection (k) of section 1916 of 
the Social Security Act (42 U.S.C. 1396o) (as 
added by this Act) in a fiscal year shall pay to 
the Secretary of Health and Human Services, 
at such time and in such form and manner as 
the Secretary shall specify, an amount equal to 
50 percent of the amount, if any, by which— 
(i) the total amount of such premiums 
and charges collected by the State for such 
year; exceeds 
(ii) the total amount expended by the 
State during such year as medical assist-
ance for individuals who buy into Medicaid 
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coverage under subclause (XXIII) of sec-
tion 1902(a)(10)(A)(ii) of such Act (as 
added by this Act). 
(d) COST-SHARING REQUIREMENT.—Section 1916 of 
the Social Security Act (42 U.S.C. 1396o) is amended by 
adding at the end the following new subsection: 
‘‘(k) PREMIUMS AND COST-SHARING FOR INDIVID-
UALS PARTICIPATING IN MEDICAID BUY-IN PROGRAM.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
with respect to individuals who are eligible for med-
ical 
assistance 
under 
subsection 
(a)(10)(A)(ii)(XXIII) of section 1902 and are de-
scribed in subsection (nn) of such section, a State 
may— 
‘‘(A) impose premiums, deductibles, cost- 
sharing, or other similar charges that are actu-
arially fair; and 
‘‘(B) vary the premium rate imposed on an 
individual based only on the factors described in 
section 2701(a)(1)(A) of the Public Health 
Service Act and subject to the same limitations 
on the weight which may be given to such fac-
tors under such section. 
‘‘(2) LIMITATIONS.— 
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‘‘(A) PREMIUMS.—The total amount of 
premiums imposed for a year under this sub-
section with respect to all individuals described 
in paragraph (1) in a family shall not exceed an 
amount equal to 9.5 percent of the family’s 
household 
income 
(as 
defined 
in 
section 
36B(d)(2) of the Internal Revenue Code of 
1986) for the year involved. 
‘‘(B) OTHER COST-SHARING.— 
‘‘(i) IN GENERAL.—The cost-sharing 
limitations described in section 1302(c) of 
the Patient Protection and Affordable Care 
Act shall apply to cost-sharing (as defined 
in such section) for medical assistance pro-
vided 
under 
section 
1902(a)(10)(A)(ii)(XXIII) in the same 
manner as such limitations apply to cost- 
sharing under qualified health plans under 
title I of such Act. 
‘‘(ii) AVAILABILITY OF COST-SHARING 
REDUCTIONS.—Individuals provided med-
ical 
assistance 
under 
section 
1902(a)(10)(A)(ii)(XXIII) and subject to 
cost-sharing under this subsection are eli-
gible for cost-sharing reductions under sec-
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tion 1402 of the Patient Protection and 
Affordable Care Act (subject to the income 
eligibility threshold in subsection (b)(2) of 
such section), and in applying such sec-
tion— 
‘‘(I) enrollment in a State plan 
under 
section 
1902(a)(10)(A)(ii)(XXIII) 
shall 
be 
treated as coverage under a qualified 
health plan in the silver level of cov-
erage in the individual market offered 
through an Exchange established for 
or by the State under title I of the 
Patient Protection and Affordable 
Care Act; and 
‘‘(II) the State agency admin-
istering such plan shall be treated as 
the issuer of such plan. 
‘‘(3) PREMIUMS AND COST-SHARING FOR CER-
TAIN OTHER INDIVIDUALS.—If an individual is eligi-
ble 
for 
medical 
assistance 
under 
subsection 
(a)(10)(A)(ii)(XXIII) of section 1902 and is not de-
scribed in subsection (nn) of such section, a State— 
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‘‘(A) shall not impose premiums and cost- 
sharing on the individual under this subsection; 
and 
‘‘(B) may impose premiums and cost-shar-
ing on the individual to the extent allowed by 
another provision of this Act (other than sec-
tion 1902(a)(10)(A)(ii)(XXIII)) which provides 
for eligibility for medical assistance, but only if 
the individual is described in such other provi-
sion. 
‘‘(4) APPLICATION
OF
PREMIUM
ASSISTANCE 
TAX CREDITS.—An individual who is required to pay 
premiums under this subsection for a year for med-
ical assistance shall be eligible for a premium assist-
ance credit under section 36B of the Internal Rev-
enue Code to the same extent that such individual 
would be eligible for a premium assistance credit 
under such section if such individual had paid the 
same amount in premiums for coverage under a 
qualified health plan for such year.’’. 
(e) MANAGED CARE.—Section 1932(a)(1)(A)(i) of 
the Social Security Act (42 U.S.C. 1396u–2(a)(1)(A)(i)) 
is amended by inserting ‘‘, including an individual who is 
eligible for such assistance after buying into such coverage 
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under section 1902(a)(10)(A)(ii)(XXIII),’’ after ‘‘the 
State plan under this title’’. 
(f) OFFERING BUY-IN PROGRAM
ON STATE EX-
CHANGE; ENROLLMENT PERIODS.— 
(1) IN GENERAL.—A State that has elected to 
allow individuals to buy into Medicaid coverage 
under section 1902(a)(10)(A)(ii)(XXIII) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)(ii)(XXIII)) shall allow individuals 
to enroll in such coverage through the Federal, Fed-
erally-facilitated, or State Exchange established pur-
suant to title I of the Patient Protection and Afford-
able Care Act. 
(2) ENROLLMENT PERIODS.—A State may limit 
the enrollment of individuals into Medicaid coverage 
under section 1902(a)(10)(A)(ii)(XXIII) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)(ii)(XXIII)) to the enrollment peri-
ods provided for under section 1311(c)(6) of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18031(c)(6)). 
(g) APPLICATION
OF ADVANCED PREMIUM TAX 
CREDITS TO MEDICAID BUY-IN PLANS.— 
(1) IN GENERAL.—Section 36B of the Internal 
Revenue Code of 1986 is amended— 
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(A) in subsection (b)(3)(B), by adding at 
the end the following new sentence: 
‘‘If an applicable taxpayer resides in a rating 
area in which no silver plan is offered on the 
individual market but the taxpayer buys into 
Medicaid 
coverage 
under 
section 
1902(a)(10)(A)(ii)(XXIII) of the Social Secu-
rity Act, such Medicaid coverage shall be 
deemed to be the applicable second lowest cost 
silver plan with respect to such taxpayer.’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(h) APPLICATION
TO INDIVIDUALS PURCHASING 
MEDICAID COVERAGE.—In the case of any individual who 
buys 
into 
Medicaid 
coverage 
under 
section 
1902(a)(10)(A)(ii)(XXIII) of the Social Security Act, this 
section shall be applied with the following modifications: 
‘‘(1) The amount determined under subsection 
(b)(2)(A) shall be increased by the amount of the 
monthly premiums paid for such coverage. 
‘‘(2) Subsection (c)(2)(A)(i) shall be applied by 
treating coverage under the Medicaid program under 
title XIX of the Social Security Act in the same 
manner as a qualified health plan that was enrolled 
in through an Exchange. 
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‘‘(3) In applying subsection (c)(2)(B)— 
‘‘(A) an individual shall not be considered 
to be eligible for minimum essential coverage 
described in section 5000A(f)(1)(A)(ii) by rea-
son of eligibility for medical assistance under a 
State 
Medicaid 
program 
under 
section 
1902(a)(10)(A)(ii)(XXIII); and 
‘‘(B) an individual who is not covered by 
minimum essential coverage described in section 
5000A(f)(1)(B) shall not be considered to be el-
igible for such coverage.’’. 
(2) ADVANCED PAYMENT OF CREDIT.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services, in consultation 
with the Secretary of the Treasury, shall estab-
lish a program under which— 
(i) upon request of a State agency ad-
ministering a State Medicaid program 
under title XIX of the Social Security Act, 
advance determinations are made in a 
manner similar to advanced determination 
under section 1411 of the Patient Protec-
tion and Affordable Care Act with respect 
to the income eligibility of individuals en-
rolling in such program for the premium 
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tax credit allowable under section 36B of 
the Internal Revenue Code of 1986 and 
the cost-sharing reductions under section 
1402 of the Patient Protection and Afford-
able Care Act; 
(ii) the Secretary notifies— 
(I) the State agency admin-
istering the program and the Sec-
retary of the Treasury of the advance 
determinations; and 
(II) the Secretary of the Treas-
ury of the name and employer identi-
fication number of each employer with 
respect to whom 1 or more employee 
of the employer were determined to be 
eligible for the premium tax credit 
under section 36B of the Internal 
Revenue Code of 1986 and the cost- 
sharing reductions under section 1402 
of the Patient Protection and Afford-
able Care Act because— 
(aa) the employer did not 
provide minimum essential cov-
erage; or 
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Affordable Care Act’’ each place it appears 
in subsections (f)(1), (f)(2), and (g)(1). 
(ii) INFORMATION
REPORTING.—Sec-
tion 36B(f)(3) of such Code is amended by 
adding at the end the following flush sen-
tence: ‘‘In the case of any coverage under 
the medicaid program under title XIX of 
the Social Security Act for which a credit 
under this section is allowable by reason of 
subsection (h), the State agency admin-
istering the Medicaid program shall be 
treated as an Exchange for purposes of 
this paragraph and subparagraph (A) shall 
not apply.’’. 
(3) CONFORMING
AMENDMENT
RELATING
TO 
EMPLOYER RESPONSIBILITY.—Paragraph (6) of sec-
tion 4980H(c) of the Internal Revenue Code of 1986 
is amended by inserting ‘‘, except that for purposes 
of subsections (a)(2) and (b)(2), the term ‘qualified 
health plan’ shall include any plan described in sec-
tion 36B(h)’’ after ‘‘such Act’’. 
(h) CONFORMING AMENDMENTS.— 
(1) Section 1902(a)(10) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)), as amended by sub-
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section (a), is further amended, in the matter fol-
lowing subparagraph (G)— 
(A) by striking ‘‘and (XVII)’’ and inserting 
‘‘, (XVII)’’; and 
(B) by inserting ‘‘, and (XVIII) the med-
ical assistance made available to an individual 
described in subparagraph (A)(ii)(XXIII) shall 
be limited to medical assistance described in 
subsection (k)(1)’’ before the semicolon. 
(2) Section 1903(f)(4) of the Social Security 
Act (42 U.S.C. 1396b(f)(4)) is amended by inserting 
‘‘1902(a)(10)(A)(ii)(XXIII),’’ 
after 
‘‘1902(a)(10)(A)(ii)(XXII),’’. 
(3) Section 1905(a) of the Social Security Act 
(42 U.S.C. 1396d(a)) is amended in the matter pre-
ceding paragraph (1)— 
(A) by striking ‘‘or’’ at the end of clause 
(xvi); 
(B) by inserting ‘‘or’’ at the end of clause 
(xvii); and 
(C) by inserting after clause (xvii) the fol-
lowing new clause: 
‘‘(xviii) 
individuals 
described 
in 
section 
1902(a)(10)(A)(ii)(XXIII),’’. 
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(4) Section 1916A(a)(1) of the Social Security 
Act (42 U.S.C. 1396o–1(a)(1)) is amended by strik-
ing ‘‘or (j)’’ and inserting ‘‘(j), or (k)’’. 
(5) Section 1937(a)(1)(B) of the Social Secu-
rity Act (42 U.S.C. 1396u–7(a)(1)(B)) is amended 
by inserting ‘‘, subclause (XXIII) of section 
1902(a)(10)(A)(ii),’’ after ‘‘1902(a)(10)(A)(i)’’. 
SEC. 3. DEVELOPMENT OF STATE-LEVEL METRICS ON MED-
ICAID BENEFICIARY ACCESS AND SATISFAC-
TION. 
(a) IN GENERAL.— 
(1) DEVELOPMENT
OF
METRICS.—Not later 
than 1 year after the date of enactment of this Act, 
the Director of the Agency for Healthcare Research 
and Quality, in consultation with the Deputy Admin-
istrator for the Center for Medicaid and CHIP Serv-
ices and State Medicaid Directors, shall develop 
standardized, State-level metrics of access to, and 
satisfaction with, providers, including primary care 
and specialist providers, with respect to individuals 
who are enrolled in State Medicaid plans under title 
XIX of the Social Security Act. 
(2) PROCESS.—The Director of the Agency for 
Healthcare Research and Quality shall develop the 
metrics described in paragraph (1) through a public 
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process, which shall provide opportunities for stake-
holders to participate. 
(b) UPDATING METRICS.—The Director of the Agen-
cy for Healthcare Research and Quality, in consultation 
with the Deputy Administrator for the Center for Med-
icaid and CHIP Services and State Medicaid Directors, 
shall update the metrics developed under subsection (a) 
not less than once every 3 years. 
(c) STATE IMPLEMENTATION FUNDING.—The Direc-
tor of the Agency for Healthcare Research and Quality 
may award funds, from the amount appropriated under 
subsection (d), to States for the purpose of implementing 
the metrics developed under this section. 
(d) APPROPRIATION.—There is appropriated to the 
Director of the Agency for Healthcare Research and Qual-
ity out of any funds in the Treasury not otherwise appro-
priated, $200,000,000 for fiscal year 2019, to remain 
available until expended, for the purpose of carrying out 
this section. 
SEC. 4. RENEWAL OF APPLICATION OF MEDICARE PAY-
MENT RATE FLOOR TO PRIMARY CARE SERV-
ICES FURNISHED UNDER MEDICAID AND IN-
CLUSION OF ADDITIONAL PROVIDERS. 
(a) RENEWAL
OF PAYMENT FLOOR; ADDITIONAL 
PROVIDERS.— 
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(1) IN GENERAL.—Section 1902(a)(13) of the 
Social Security Act (42 U.S.C. 1396a(a)(13)) is 
amended by striking subparagraph (C) and inserting 
the following: 
‘‘(C) payment for primary care services (as 
defined in subsection (jj)) at a rate that is not 
less than 100 percent of the payment rate that 
applies to such services and physician under 
part B of title XVIII (or, if greater, the pay-
ment rate that would be applicable under such 
part if the conversion factor under section 
1848(d) for the year involved were the conver-
sion factor under such section for 2009), and 
that is not less than the rate that would other-
wise apply to such services under this title if 
the rate were determined without regard to this 
subparagraph, and that are— 
‘‘(i) furnished in 2013 and 2014, by a 
physician with a primary specialty designa-
tion of family medicine, general internal 
medicine, or pediatric medicine; or 
‘‘(ii) furnished in the period that be-
gins on the first day of the first month 
that begins after the date of enactment of 
the State Public Option Act— 
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‘‘(I) by a physician with a pri-
mary specialty designation of family 
medicine, general internal medicine, 
or pediatric medicine, but only if the 
physician self-attests that the physi-
cian is Board certified in family medi-
cine, general internal medicine, or pe-
diatric medicine; 
‘‘(II) by a physician with a pri-
mary specialty designation of obstet-
rics and gynecology, but only if the 
physician self-attests that the physi-
cian is Board certified in obstetrics 
and gynecology; 
‘‘(III) by an advanced practice 
clinician, as defined by the Secretary, 
that works under the supervision of— 
‘‘(aa) a physician that satis-
fies the criteria specified in sub-
clause (I) or (II); or 
‘‘(bb) a nurse practitioner or 
a physician assistant (as such 
terms are defined in section 
1861(aa)(5)(A)) who is working 
in accordance with State law, or 
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‘‘(V) by a nurse practitioner or a 
physician assistant (as such terms are 
defined in section 1861(aa)(5)(A)) 
who is working in accordance with 
State law, or a certified nurse-midwife 
(as defined in section 1861(gg)) who 
is working in accordance with State 
law, in accordance with procedures 
that ensure that the portion of the 
payment for such services that the 
nurse practitioner, physician assist-
ant, or certified nurse-midwife is paid 
is not less than the amount that the 
nurse practitioner, physician assist-
ant, or certified nurse-midwife would 
be paid if the services were provided 
under part B of title XVIII;’’. 
(2) 
CONFORMING
AMENDMENTS.—Section 
1905(dd) of the Social Security Act (42 U.S.C. 
1396d(dd)) is amended— 
(A) by striking ‘‘Notwithstanding’’ and in-
serting the following: 
‘‘(1) IN GENERAL.—Notwithstanding’’; 
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(B) by inserting ‘‘or furnished during an 
additional period specified in paragraph (2),’’ 
after ‘‘2015,’’; and 
(C) by adding at the end the following: 
‘‘(2) ADDITIONAL PERIODS.—For purposes of 
paragraph (1), the following are additional periods: 
‘‘(A) The period that begins on the first 
day of the first month that begins after the 
date of enactment of the State Public Option 
Act.’’. 
(b) IMPROVED TARGETING OF PRIMARY CARE.—Sec-
tion 1902(jj) of the Social Security Act (42 U.S.C. 
1396a(jj)) is amended— 
(1) by redesignating paragraphs (1) and (2) as 
subparagraphs (A) and (B), respectively and realign-
ing the left margins accordingly; 
(2) by striking ‘‘For purposes of’’ and inserting 
the following: 
‘‘(1) IN GENERAL.—For purposes of’’; and 
(3) by adding at the end the following: 
‘‘(2) EXCLUSIONS.—Such term does not include 
any services described in subparagraph (A) or (B) of 
paragraph (1) if such services are provided in an 
emergency department of a hospital.’’. 
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(c) ENSURING PAYMENT BY MANAGED CARE ENTI-
TIES.— 
(1) IN
GENERAL.—Section 1903(m)(2)(A) of 
the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) 
is amended— 
(A) in clause (xii), by striking ‘‘and’’ after 
the semicolon; 
(B) by realigning the left margin of clause 
(xiii) so as to align with the left margin of 
clause (xii) and by striking the period at the 
end of clause (xiii) and inserting ‘‘; and’’; and 
(C) by inserting after clause (xiii) the fol-
lowing: 
‘‘(xiv) such contract provides that (I) payments 
to providers specified in section 1902(a)(13)(C) for 
primary care services defined in section 1902(jj) 
that are furnished during a year or period specified 
in section 1902(a)(13)(C) and section 1905(dd) are 
at least equal to the amounts set forth and required 
by the Secretary by regulation, (II) the entity shall, 
upon request, provide documentation to the State, 
sufficient to enable the State and the Secretary to 
ensure compliance with subclause (I), and (III) the 
Secretary shall approve payments described in sub-
clause (I) that are furnished through an agreed 
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upon capitation, partial capitation, or other value- 
based payment arrangement if the capitation, partial 
capitation, or other value-based payment arrange-
ment is based on a reasonable methodology and the 
entity provides documentation to the State sufficient 
to enable the State and the Secretary to ensure com-
pliance with subclause (I).’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1932(f) of the Social Security Act (42 U.S.C. 
1396u–2(f)) is amended by inserting ‘‘and clause 
(xiv) of section 1903(m)(2)(A)’’ before the period. 
SEC. 5. MEDICAID ACCESS GRANTS. 
(a) IN GENERAL.—Beginning in fiscal year 2019, the 
Secretary of Health and Human Services (referred to in 
this section as the ‘‘Secretary’’) shall award grants to 
States that submit an application meeting the require-
ments of subsection (b) for the purpose of improving ac-
cess to services for individuals enrolled in State Medicaid 
plans under title XIX of the Social Security Act. 
(b) APPLICATION REQUIREMENTS.—To be eligible 
for a grant under this section, a State shall submit to the 
Secretary, at such time and in such manner as the Sec-
retary shall require, an application that contains the fol-
lowing: 
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(1) A description of gaps in access to providers 
for individuals enrolled in the State Medicaid plan 
that the State has identified, and how the State pro-
poses to fix such gaps. 
(2) A discussion of any changes the State pro-
poses to make to the reimbursement of providers 
under the State Medicaid plan, including changes to 
the fee-for-service rates for providers of services 
under such plans or moving to population-based or 
episode-based payment models. 
(3) A justification establishing that the changes 
proposed by the State will increase access to pro-
viders for individuals enrolled in the State Medicaid 
plan, and a plan for measuring changes to such ac-
cess over the grant period. 
(c) USE OF FUNDS.— 
(1) IN GENERAL.—If the Secretary determines 
that a State is using grant funds awarded under this 
section in a manner that is inconsistent with the 
purpose described in subsection (a) or paragraph 
(2), the Secretary may withhold or reduce future 
grant payments or recover previous grant payments 
to the State under this section as the Secretary 
deems appropriate. 
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(2) USE OF FUNDS TO IMPLEMENT MEDICAID 
BUY-IN PROGRAM.—A State may use up to 10 per-
cent of the amount of a grant awarded to the State 
under this section for the purpose of implementing 
a Medicaid buy-in program under subclause (XXIII) 
of section 1902(a)(10)(A)(ii) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)(A)(ii)). 
(3) USE
OF
FUNDS
TO
INCREASE
MEDICAID 
PROVIDER PAYMENT RATES.—Notwithstanding any 
other provision of law, a State may use grant funds 
awarded under this section for the purpose of fi-
nancing the portion of the non-Federal share of ex-
penditures under the State Medicaid plan under title 
XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.) that is attributable to an increase in the pay-
ment rate for providers under such plan. 
(d) SELECTION OF STATES AND MAXIMUM GRANT 
AMOUNT.—In awarding grants to States under this sec-
tion, the Secretary shall— 
(1) ensure that geographically diverse areas, in-
cluding rural and underserved areas, are included; 
and 
(2) award grants both to States that have elect-
ed to expand Medicaid eligibility under section 
1902(a)(10)(A)(i)(VIII) of the Social Security Act 
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(42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) and to States 
that have not so elected. 
(e) APPROPRIATION.—There is appropriated to the 
Secretary, out of any funds in the Treasury not otherwise 
appropriated, $100,000,000,000 for fiscal year 2018, to 
remain available until September 30, 2021, for the pur-
pose of making grants under this section. 
SEC. 6. INCREASED FMAP FOR MEDICAL ASSISTANCE TO 
NEWLY ELIGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Section 1905(y)(1) of the Social 
Security Act (42 U.S.C. 1396d(y)(1)) is amended— 
(1) in subparagraph (A), by striking ‘‘2014, 
2015, and 2016’’ and inserting ‘‘each of the first 3 
consecutive 12-month periods in which the State 
provides medical assistance to newly eligible individ-
uals’’; 
(2) in subparagraph (B), by striking ‘‘2017’’ 
and inserting ‘‘the fourth consecutive 12-month pe-
riod in which the State provides medical assistance 
to newly eligible individuals’’; 
(3) in subparagraph (C), by striking ‘‘2018’’ 
and inserting ‘‘the fifth consecutive 12-month period 
in which the State provides medical assistance to 
newly eligible individuals’’; 
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(4) in subparagraph (D), by striking ‘‘2019’’ 
and inserting ‘‘the sixth consecutive 12-month period 
in which the State provides medical assistance to 
newly eligible individuals’’; and 
(5) in subparagraph (E), by striking ‘‘2020 and 
each year thereafter’’ and inserting ‘‘the seventh 
consecutive 12-month period in which the State pro-
vides medical assistance to newly eligible individuals 
and each such period thereafter’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect as if included in the enact-
ment of Public Law 111–148. 
Æ 
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