SEC. 2. ELIMINATION OF MOE REQUIREMENT FOR CHIP 
ELIGIBILITY. 
Section 2105(d)(3) of the Social Security Act (42 
U.S.C. 1397ee(d)(3)) is amended by striking ‘‘September 
30, 2019’’ and inserting ‘‘the date of the enactment of 
the Preserving Access to Medicaid for Americans Act of 
2016’’. 
SEC. 3. ELIMINATION OF DSH CUTS FOR STATES NOT IM-
PLEMENTING ACA EXPANSION. 
(a) IN GENERAL.—Section 1923(f)(7) of the Social 
Security Act (42 U.S.C. 1396r–4(f)(7)) is amended— 
(1) in subparagraph (A)— 
(A) in clause (i)— 
(i) in the matter preceding subclause 
(I), by striking ‘‘each of fiscal years 2018 
through 2025’’ and inserting ‘‘fiscal year 
2018 and each subsequent fiscal year’’; 
and 
(ii) in subclause (I)— 
(I) by striking ‘‘the amount spec-
ified under the DSH health reform 
methodology 
under 
subparagraph 
(B)’’ and inserting ‘‘the amount of 
the aggregate reduction target’’; and 
(II) by striking ‘‘DSH allotments 
to States’’ and inserting ‘‘the DSH al-
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lotment to each expansion State’’ each 
place it appears; 
(B) in clause (ii)— 
(i) in the matter preceding subclause 
(I), by striking ‘‘The aggregate reduc-
tions’’ and inserting ‘‘In applying subpara-
graph (B), the aggregate reduction tar-
gets’’; 
(ii) in subclause (VII), by striking 
‘‘and’’ at the end; 
(iii) in subclause (VIII), by striking 
the period at the end and inserting ‘‘; 
and’’; and 
(iv) by adding at the end the following 
new subclause: 
‘‘(IX) $8,000,000,000 for fiscal 
year 2026 and, subject to subpara-
graph (C), each subsequent fiscal 
year.’’; 
(C) by amending clause (iv) to read as fol-
lows: 
‘‘(iv) DEFINITIONS.—For purposes of 
this paragraph: 
‘‘(I) The term ‘expansion State’ 
means, for a fiscal year, a State that, 
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as of the date that is 180 days before 
the start of such fiscal year, provides 
for eligibility under clause (i)(VIII) or 
(ii)(XX) of section 1902(a)(10)(A) for 
medical assistance under this title (or 
a waiver of the State plan approved 
under section 1115). 
‘‘(II) The term ‘non-expansion 
State’ means, for a fiscal year, a 
State that is not an expansion State 
for such fiscal year.’’; and 
(D) in clause (v), by striking ‘‘DISTRIBU-
TION OF AGGREGATE REDUCTIONS.—The Sec-
retary shall distribute the aggregate reduc-
tions’’ and inserting ‘‘DISTRIBUTION
OF
AG-
GREGATE
REDUCTION
TARGETS.—The Sec-
retary shall distribute the aggregate reduction 
targets under clause (ii) among all the States 
(including non-expansion States)’’; 
(2) in subparagraph (B), by adding at the end 
the following new clause: 
‘‘(iv) The methodology imposes reduc-
tion targets as if the reductions under sub-
paragraph (A) were applied to all States, 
including non-expansion States.’’; and 
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(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) EXTENSION OF REDUCTION FOR EX-
PANSION STATES TO PAY FOR ELIMINATION OF 
REDUCTION
FOR
NON-EXPANSION
STATES.— 
The aggregate amount of reductions under sub-
paragraph (A) for fiscal years after fiscal year 
2025 shall not exceed the sum of the aggregate 
reduction targets distributed under clause (v) to 
non-expansion States for fiscal years 2018 
through 2025.’’. 
(b) CONFORMING AMENDMENT.—Section 1923(f)(8) 
of the Social Security Act (42 U.S.C. 1396r–4(f)(8)) is 
amended by striking ‘‘fiscal year 2025’’ and inserting ‘‘the 
last fiscal year for which a reduction is made under para-
graph (7)(A)’’. 
Æ 
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