489 
section 1903A’’ after ‘‘except as otherwise pro-
vided in this section’’. 
(B) Section 1903(d) of such Act (42 
U.S.C. 1396b(d)) is amended— 
(i) in paragraph (1), by inserting 
‘‘and under section 1903A’’ after ‘‘sub-
sections (a) and (b)’’; 
(ii) in paragraph (2)— 
(I) in subparagraph (A), by in-
serting ‘‘or section 1903A’’ after ‘‘was 
made under this section’’; and 
(II) in subparagraph (B), by in-
serting ‘‘or section 1903A’’ after 
‘‘under subsection (a)’’; 
(iii) in paragraph (4)— 
(I) by striking ‘‘under this sub-
section’’ and inserting ‘‘, with respect 
to this section or section 1903A, 
under this subsection’’; and 
(II) by striking ‘‘under this sec-
tion’’ and inserting ‘‘under the respec-
tive section’’; and 
(iv) in paragraph (5), by inserting ‘‘or 
section 1903A’’ after ‘‘overpayment under 
this section’’. 
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490 
(3) CONFORMING WAIVER AUTHORITY.—Section 
1115(a)(2)(A) of the Social Security Act (42 U.S.C. 
1315(a)(2)(A)) is amended by striking ‘‘or 1903’’ 
and inserting ‘‘1903, or 1903A’’. 
(4) REPORT
ON
ADDITIONAL
CONFORMING 
AMENDMENTS NEEDED.—Not later than 6 months 
after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall submit 
to Congress a report that includes a description of 
any additional technical and conforming amend-
ments to law that are required to properly carry out 
this Act. 
SEC. 402. INCOME LIMITATIONS FOR REFUNDABLE CRED-
ITS FOR COVERAGE UNDER A QUALIFIED 
HEALTH PLAN. 
(a) IN GENERAL.—Subparagraphs (A) and (B) of 
section 36B(c)(1) of the Internal Revenue Code of 1986 
are amended by inserting after ‘‘100 percent’’ each place 
such term appears the following: ‘‘(or, in the case of a 
taxpayer enrolled through an Exchange utilized by such 
State that makes the election described in section 1903A 
of the Social Security Act, the percentage established by 
such State under part A of title IV of such Act for pur-
poses of eligibility under title XIX of such Act as of Janu-
ary 1, 2009)’’. 
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491 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to taxable years begin-
ning after the date of the enactment of this Act. 
SEC. 403. MEDICAID ELIGIBILITY DETERMINATIONS. 
(a) STATE FLEXIBILITY TO USE CONTRACTORS TO 
MAKE ELIGIBILITY DETERMINATIONS
ON BEHALF
OF 
STATE.—Section 1902(a)(5) of the Social Security Act 
(42 U.S.C. 1396a(a)(5)) is amended by inserting before 
the semicolon at the end the following: ‘‘, but such deter-
minations of eligibility may be made, at the option of a 
State, under a contract with another State or local agency 
or a contractor so long as the contract does not provide 
incentives for the agency or contractor to delay eligibility 
determinations or to deny eligibility for individuals other-
wise eligible for medical assistance’’. 
(b) FREQUENCY
OF ELIGIBILITY REDETERMINA-
TIONS.—Section 1902(e)(14) of the Social Security Act 
(42 U.S.C. 1396a(e)(14)) is amended by adding at the 
end the following: 
‘‘(L) FREQUENCY OF ELIGIBILITY REDE-
TERMINATIONS.—Beginning 
on 
October 
1, 
2019, and notwithstanding subparagraph (H), 
in the case of an individual whose eligibility for 
medical assistance under the State plan under 
this title (or a waiver of such plan) is deter-
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mined based on the application of modified ad-
justed gross income under subparagraph (A) 
and who is so eligible on the basis of clause 
(i)(VIII), (ii)(XX), or (ii)(XXIII) of subsection 
(a)(10)(A), at the option of the State, the State 
plan may provide that the individual’s eligibility 
shall be redetermined every 6 months (or such 
shorter number of months as the State may 
elect).’’. 
SEC. 404. LOWERING SAFE HARBOR THRESHOLD WITH RE-
SPECT TO STATE TAXES ON HEALTH CARE 
PROVIDERS. 
Section 1903(w)(4)(C)(ii) of the Social Security Act 
(42 U.S.C. 1396b(w)(4)(C)(ii)) is amended— 
(1) by striking ‘‘of fiscal years beginning’’ and 
inserting ‘‘of fiscal years— 
‘‘(I) beginning’’; and 
(2) by striking ‘‘it appears.’’ and inserting the 
following: ‘‘it appears; 
‘‘(II) beginning on or after January 1, 
2021, and before January 1, 2030, ‘4 percent’ 
shall be substituted for ‘6 percent’ each place it 
appears; 
‘‘(III) beginning on or after January 1, 
2030, and before January 1, 2035, ‘3 percent’ 
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493 
shall be substituted for ‘6 percent’ each place it 
appears; 
‘‘(IV) beginning on or after January 1, 
2035, and before January 1, 2040, ‘2 percent’ 
shall be substituted for ‘6 percent’ each place it 
appears; 
‘‘(V) beginning on or after January 1, 
2040, and before January 1, 2045, ‘1 percent’ 
shall be substituted for ‘6 percent’ each place it 
appears; and 
‘‘(VI) beginning on or after January 1, 
2045, ‘0 percent’ shall be substituted for ‘6 per-
cent’ each place it appears.’’. 
SEC. 405. PROVIDING FOR STATE APPROVAL AND IMPLE-
MENTATION OF SPECIFIED WAIVERS UNDER 
THE MEDICAID PROGRAM. 
Section 1115 of the Social Security Act (42 U.S.C. 
1315) is amended— 
(1) in subsection (d)— 
(A) in paragraph (1), by striking ‘‘An ap-
plication’’ and inserting ‘‘Subject to paragraph 
(4), an application’’; and 
(B) by adding at the end the following new 
paragraph: 
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