I 
109TH CONGRESS 
1ST SESSION H. R. 4447 
To amend title XIX of the Social Security Act to provide for fair treatment 
of services furnished to Indians under the Medicaid Program, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 6, 2005 
Mr. PALLONE (for himself and Mr. WAXMAN) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to provide 
for fair treatment of services furnished to Indians under 
the Medicaid Program, and for other purposes. 
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 ‘‘Medicaid Indian 
Health Act of 2005’’.
SEC. 2. APPLICATION OF 100 PERCENT FMAP FOR SERV-
ICES FURNISHED TO AN INDIAN BY AN 
URBAN INDIAN HEALTH PROGRAM. 
(a) IN GENERAL.—The third sentence of section 
1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 
is amended by inserting before the period at the end the 
following: ‘‘, or through an urban Indian health program 
receiving funds under title V of the Indian Health Care 
Improvement Act’’. 
(b) CONFORMING AMENDMENT.—Section 1911(c) of 
such Act (42 U.S.C. 1396j(c)), is amended by inserting 
‘‘, or through an urban Indian health program receiving 
funds under title V of the Indian Health Care Improve-
ment Act’’ after ‘‘facilities’’. 
SEC. 3. PROHIBITION ON IMPOSITION OF PREMIUMS, 
DEDUCTIBLES, COPAYMENTS, AND OTHER 
COST-SHARING ON INDIANS. 
Section 1916 of the Social Security Act (42 U.S.C. 
1396o) is amended— 
(1) in subsection (a)(3), by inserting ‘‘(other 
than such individuals who are Indians (as defined in 
section 4 of the Indian Health Care Improvement 
Act)’’ after ‘‘other such individuals’’; 
(2) in subsection (b), in the matter preceding 
paragraph (1), by inserting ‘‘or who are Indians (as
defined in section 4 of the Indian Health Care Im-
provement Act)’’ after ‘‘section 1902(a)(10)’’; and 
(3) in subsection (c)(1), by inserting ‘‘(other 
than such an individual who is an Indian (as defined 
in section 4 of the Indian Health Care Improvement 
Act))’’ after ‘‘section 1902(l)(1)’’. 
SEC. 4. PROHIBITION ON RECOVERY AGAINST ESTATES OF 
INDIANS. 
Section 1917(b)(1) of the Social Security Act (42 
U.S.C. 1396p(b)(1)) is amended, in the matter preceding 
subparagraph (A), by inserting ‘‘ who is not an Indian 
(as defined in section 4 of the Indian Health Care Im-
provement Act)’’ after ‘‘an individual’’ the second place 
it appears. 
SEC. 5. REQUIREMENT FOR CONSULTATION WITH INDIAN 
TRIBES PRIOR TO APPROVAL OF SECTION 
1115 WAIVERS. 
Section 1115 of the Social Security Act (42 U.S.C. 
1315) is amended by adding at the end the following: 
‘‘(g) In the case of an application for a waiver of com-
pliance with the requirements of section 1902 (or a re-
newal or extension of such a waiver) that is likely to affect 
members of an Indian tribe (as defined in section 4 of 
the Indian Health Care Improvement Act) or a tribal 
health program (whether operated by an Indian tribe or
a tribal organization (as so defined) serving such mem-
bers, the Secretary shall, prior to granting such a waiver 
under subsection (a) or renewing or extending such a 
waiver under subsection (e), consult with each such Indian 
tribe.’’. 
SEC. 6. REQUIREMENT FOR FAIR PAYMENT BY MEDICAID 
MANAGED 
CARE 
ENTITIES 
TO 
INDIAN 
HEALTH PROGRAM PROVIDERS. 
Section 1903(m)(2)(A)(ii) of the Social Security Act 
(42 U.S.C. 1396b(m)(2)(A)(ii)) is amended to read as fol-
lows: 
‘‘(ii) such contract provides, in the 
case of entity that has entered into a con-
tract for the provision of services with a 
facility or program of the Indian Health 
Service, whether operated by the Service or 
an Indian tribe or tribal organization (as 
defined in section 4 of the Indian Health 
Care Improvement Act) or an urban In-
dian health program receiving funds under 
title V of the Indian Health Care Improve-
ment Act , that is not a Federally-qualified 
health center or a rural health clinic, that 
the entity shall provide payment that is not 
less than the highest level and amount of
payment that the entity would make for 
the services if the services were furnished 
by a provider that is not a facility or pro-
gram of the Indian Health Service;’’. 
SEC. 7. TREATMENT OF MEDICAL EXPENSES PAID BY OR 
ON BEHALF OF AN INDIAN BY AN INDIAN 
HEALTH PROGRAM AS COSTS INCURRED FOR 
MEDICAL CARE FOR PURPOSES OF DETER-
MINING MEDICALLY NEEDY ELIGIBILITY. 
Section 1902(a)(17)(D) of the Social Security Act 
(42 U.S.C. 1396a(a)(17)(D)) is amended by inserting ‘‘or 
by the Indian Health Service or an Indian tribe or tribal 
organization (as defined in section 4 of the Indian Health 
Care Improvement Act)’’ after ‘‘political subdivision there-
of’’. 
SEC. 8. STATE OPTION TO EXEMPT INDIANS FROM REDUC-
TIONS IN ELIGIBILITY OR BENEFITS. 
Section 1902 of the Social Security Act (42 U.S.C. 
1396a)) is amended by inserting after subsection (j) the 
following: 
‘‘(k) The Secretary shall not disapprove a State plan 
amendment, or deny a State request for a waiver under 
section 1115 (or a renewal or extension of such a waiver), 
on the grounds that the amendment or waiver would ex-
empt Indians (as defined in section 4 of the Indian Health
Care Improvement Act) eligible for medical assistance 
from— 
‘‘(1) any restriction on eligibility for medical as-
sistance under this title that would otherwise apply 
under the amendment or waiver; 
‘‘(2) any imposition of premiums, deductibles, 
copayments, or other cost-sharing that would other-
wise apply under the amendment or waiver; or 
‘‘(3) any reduction in covered services or sup-
plies that would otherwise apply under the amend-
ment or waiver.’’. 
SEC. 9. EFFECTIVE DATE. 
(a) IN GENERAL.—Except as provided in subsection 
(b), this Act and the amendments made by this Act apply 
to items or services furnished on or after January 1, 2006. 
(b) EXTENSION OF EFFECTIVE DATE FOR STATE 
LAW AMENDMENT.—In the case of a State plan under 
title XIX of the Social Security Act which the Secretary 
of Health and Human Services determines requires State 
legislation in order for the plan to meet the additional re-
quirements imposed by the amendments made by a provi-
sion of this Act, the State plan shall not be regarded as 
failing to comply with the requirements of this Act solely 
on the basis of its failure to meet these additional require-
ments before the first day of the first calendar quarter
beginning after the close of the first regular session of the 
State legislature that begins after the date of enactment 
of this Act. For purposes of the previous sentence, in the 
case of a State that has a 2-year legislative session, each 
year of the session shall be considered to be a separate 
regular session of the State legislature. 
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