I 
116TH CONGRESS 
1ST SESSION H. R. 4195 
To amend titles XVIII and XIX of the Social Security Act to make premium 
and cost-sharing subsidies available to low-income Medicare part D bene-
ficiaries who reside in Puerto Rico or another territory of the United 
States. 
IN THE HOUSE OF REPRESENTATIVES 
AUGUST 20, 2019 
Miss GONZA´LEZ-COLO´N of Puerto Rico (for herself and Mr. SOTO) introduced 
the following bill; which was referred to the Committee on Energy 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 jurisdiction of the com-
mittee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to make premium and cost-sharing subsidies available 
to low-income Medicare part D beneficiaries who reside 
in Puerto Rico or another territory of the United States. 
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 ‘‘Territories Medicare 
Prescription Drug Assistance Equality Act of 2019’’. 
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SEC. 2. EQUAL TREATMENT OF RESIDENTS OF TERRI-
TORIES IN PREMIUM AND COST-SHARING 
SUBSIDIES UNDER MEDICARE PRESCRIPTION 
DRUG PROGRAM. 
(a) 
MEDICARE
ASSISTANCE.—Section 
1860D– 
14(a)(3) of the Social Security Act (42 U.S.C. 1395w– 
114(a)(3)) is amended— 
(1) in subparagraph (A), in the matter pre-
ceding clause (i), by striking ‘‘subject to subpara-
graph (F),’’; 
(2) in subparagraph (B)(v), in the matter pre-
ceding subclause (I), by striking ‘‘Subject to sub-
paragraph (F), the Secretary’’ and inserting ‘‘The 
Secretary’’; 
(3) in subparagraph (C), by adding at the end 
the following new sentence: ‘‘In the case of an indi-
vidual who is not a resident of the 50 States or the 
District of Columbia, the poverty line (as such term 
is defined in clause (ii)) that shall apply to such in-
dividual shall be the poverty line for the 48 contig-
uous States and the District of Columbia.’’; and 
(4) by striking subparagraph (F). 
(b) MEDICAID ASSISTANCE.—Section 1935 of the So-
cial Security Act (42 U.S.C. 1396u–5) is amended— 
(1) in subsection (c)(1)(A)— 
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(A) by inserting ‘‘(and each other State for 
each month beginning with January 2020)’’ 
after ‘‘January 2006’’; and 
(B) in clause (i), by inserting ‘‘or (2)(B) 
(as the case may be)’’ after ‘‘paragraph 
(2)(A)’’; 
(2) in subsection (c)(2)— 
(A) in subparagraph (A)— 
(i) by amending the heading to read 
as follows: ‘‘COMPUTATION FOR 50 STATES 
AND THE DISTRICT OF COLUMBIA’’; and 
(ii) by striking ‘‘a State described in 
paragraph (1)’’ and inserting ‘‘one of the 
50 States or the District of Columbia’’; 
(B) in subparagraph (B)— 
(i) by striking ‘‘subparagraph (A)’’ 
and inserting ‘‘subparagraph (A) or (B) 
(as the case may be)’’; and 
(ii) by redesignating such subpara-
graph as subparagraph (C); and 
(C) by inserting after subparagraph (A) 
the following new subparagraph: 
‘‘(B) COMPUTATION FOR TERRITORIES.— 
The amount computed under this paragraph for 
a State not described in subparagraph (A) and 
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for a month in a year (beginning with 2020) is 
equal to— 
‘‘(i) 1⁄12 of the product of— 
‘‘(I) 
the 
amount 
determined 
under subsection (e) for the State for 
2019; and 
‘‘(II) 100 percent minus the 
highest possible Federal medical as-
sistance percentage that may be ap-
plied to any of the 50 States for fiscal 
year 2018 under section 1905(b)(1); 
and 
‘‘(ii) increased for each year (begin-
ning with 2019 up to and including the 
year involved) by the applicable growth 
factor specified in paragraph (4) for that 
year.’’; and 
(3) in subsection (e)— 
(A) in paragraph (1)— 
(i) in subparagraph (A), by striking 
‘‘of such State; and’’ and inserting ‘‘of 
such State for years before 2020;’’; 
(ii) in subparagraph (B)— 
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(I) by inserting ‘‘for periods be-
fore January 1, 2020’’ after ‘‘(B)’’; 
and 
(II) by striking the period at the 
end and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(C) for the first 3 quarters of fiscal year 
2020 and for each subsequent fiscal year, the 
amount otherwise applied under section 1108(f) 
for the State shall be increased by the amount 
specified in paragraph (4)(A) for such period or 
fiscal year.’’; 
(B) in paragraph (2), by striking ‘‘The 
Secretary’’ and inserting ‘‘For periods before 
January 2020, the Secretary’’; 
(C) in paragraph (3)— 
(i) in the heading, by inserting ‘‘BE-
FORE SECOND QUARTER OF FISCAL YEAR 
2020’’ after ‘‘INCREASED AMOUNT’’; 
(ii) in subparagraph (A)— 
(I) in the matter before clause 
(i), by inserting ‘‘or other fiscal pe-
riod’’ after ‘‘for a year’’; and 
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‘‘(4) INCREASED
AMOUNT
BEGINNING
WITH 
SECOND QUARTER OF FISCAL YEAR 2020.— 
‘‘(A) IN GENERAL.—The amount specified 
in this paragraph for a State for the last 3 
quarters of fiscal year 2020 or for a subsequent 
fiscal year is equal to the product of— 
‘‘(i) the aggregate amount specified in 
subparagraph (B) for such period or fiscal 
year; and 
‘‘(ii) the ratio (as estimated by the 
Secretary) of— 
‘‘(I) the number of individuals 
who are entitled to benefits under 
part A or enrolled under part B and 
who reside in the State (as deter-
mined by the Secretary based on the 
most recent available data before the 
beginning of the period or year); to 
‘‘(II) the sum of such numbers 
for all States that are subject to this 
subsection. 
‘‘(B) AGGREGATE
AMOUNT.—The aggre-
gate amount specified in this subparagraph 
for— 
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‘‘(i) the last 3 quarters of fiscal year 
2020, is equal to 3 times the amount spec-
ified in paragraph (3)(B)(iv); 
‘‘(ii) fiscal year 2021, is equal to 4 
times the amount specified in paragraph 
(3)(B)(iv) increased by the same annual 
percentage increase as is applied to in-
creases in the amounts applied for the fis-
cal year and State under section 1108(f); 
or 
‘‘(iii) a subsequent fiscal year, is equal 
to the aggregate amount specified in this 
subparagraph for the previous fiscal year 
increased by the same annual percentage 
increase as is applied for the fiscal year 
and State under section 1108(f).’’. 
(c) CONFORMING AMENDMENT.—Section 1108(f) of 
the Social Security Act (42 U.S.C. 1308(f)) is amended 
by striking ‘‘1935(e)(1)(B)’’ and inserting ‘‘1935(e)(1)’’. 
(d) EFFECTIVE DATES.—The amendments made by 
subsection (a) shall take effect on January 1, 2020, and 
the amendments made by subsections (b) and (c) shall 
take effect on the date of the enactment of this Act. 
Æ 
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