I 
116TH CONGRESS 
1ST SESSION 
H. R. 259 
To extend the Medicaid Money Follows the Person Rebalancing demonstra-
tion, to extend protection for Medicaid recipients of home and commu-
nity-based services against spousal impoverishment, and for other pur-
poses. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 4, 2019 
Mr. PALLONE (for himself and Mr. WALDEN) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on the Budget, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To extend the Medicaid Money Follows the Person Rebal-
ancing demonstration, to extend protection for Medicaid 
recipients of home and community-based services against 
spousal impoverishment, 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 Extenders 
Act of 2019’’. 
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SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON RE-
BALANCING DEMONSTRATION. 
(a) GENERAL FUNDING.—Section 6071(h) of the 
Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is 
amended— 
(1) in paragraph (1)— 
(A) in subparagraph (D), by striking 
‘‘and’’ after the semicolon; 
(B) in subparagraph (E), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(F) 
subject 
to 
paragraph 
(3), 
$112,000,000 for fiscal year 2019.’’; 
(2) in paragraph (2)— 
(A) by striking ‘‘Amounts made’’ and in-
serting ‘‘Subject to paragraph (3), amounts 
made’’; and 
(B) by striking ‘‘September 30, 2016’’ and 
inserting ‘‘September 30, 2021’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(3) SPECIAL RULE FOR FY 2019.—Funds ap-
propriated under paragraph (1)(F) shall be made 
available for grants to States only if such States 
have an approved MFP demonstration project under 
this section as of December 31, 2018.’’. 
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(b) FUNDING FOR QUALITY ASSURANCE AND IM-
PROVEMENT; TECHNICAL
ASSISTANCE; OVERSIGHT.— 
Section 6071(f) of the Deficit Reduction Act of 2005 (42 
U.S.C. 1396a note) is amended by striking paragraph (2) 
and inserting the following: 
‘‘(2) FUNDING.—From the amounts appro-
priated under subsection (h)(1)(F) for fiscal year 
2019, $500,000 shall be available to the Secretary 
for such fiscal year to carry out this subsection.’’. 
(c) TECHNICAL AMENDMENT.—Section 6071(b) of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) 
is amended by adding at the end the following: 
‘‘(10) 
SECRETARY.—The 
term 
‘Secretary’ 
means the Secretary of Health and Human Serv-
ices.’’. 
SEC. 3. EXTENSION OF PROTECTION FOR MEDICAID RE-
CIPIENTS OF HOME AND COMMUNITY-BASED 
SERVICES AGAINST SPOUSAL IMPOVERISH-
MENT. 
(a) IN GENERAL.—Section 2404 of Public Law 111– 
148 (42 U.S.C. 1396r–5 note) is amended by striking ‘‘the 
5-year period that begins on January 1, 2014,’’ and in-
serting ‘‘the period beginning on January 1, 2014, and 
ending on March 31, 2019,’’. 
(b) RULE OF CONSTRUCTION.— 
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(1) PROTECTING STATE SPOUSAL INCOME AND 
ASSET
DISREGARD
FLEXIBILITY
UNDER
WAIVERS 
AND PLAN AMENDMENTS.—Nothing in section 2404 
of Public Law 111–148 (42 U.S.C. 1396r–5 note) or 
section 1924 of the Social Security Act (42 U.S.C. 
1396r–5) shall be construed as prohibiting a State 
from disregarding an individual’s spousal income 
and assets under a State waiver or plan amendment 
described in paragraph (2) for purposes of making 
determinations of eligibility for home and commu-
nity-based services or home and community-based 
attendant services and supports under such waiver 
or plan amendment. 
(2) STATE WAIVER OR PLAN AMENDMENT DE-
SCRIBED.—A State waiver or plan amendment de-
scribed in this paragraph is any of the following: 
(A) A waiver or plan amendment to pro-
vide medical assistance for home and commu-
nity-based services under a waiver or plan 
amendment under subsection (c), (d), or (i) of 
section 1915 of the Social Security Act (42 
U.S.C. 1396n) or under section 1115 of such 
Act (42 U.S.C. 1315). 
(B) A plan amendment to provide medical 
assistance for home and community-based serv-
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ices for individuals by reason of being deter-
mined eligible under section 1902(a)(10)(C) of 
such Act (42 U.S.C. 1396a(a)(10)(C)) or by 
reason of section 1902(f) of such Act (42 
U.S.C. 1396a(f)) or otherwise on the basis of a 
reduction of income based on costs incurred for 
medical or other remedial care under which the 
State disregarded the income and assets of the 
individual’s spouse in determining the initial 
and ongoing financial eligibility of an individual 
for such services in place of the spousal impov-
erishment provisions applied under section 1924 
of such Act (42 U.S.C. 1396r–5). 
(C) A plan amendment to provide medical 
assistance for home and community-based at-
tendant services and supports under section 
1915(k) of such Act (42 U.S.C. 1396n(k)). 
SEC. 4. REDUCTION IN FMAP AFTER 2020 FOR STATES 
WITHOUT ASSET VERIFICATION PROGRAM. 
Section 1940 of the Social Security Act (42 U.S.C. 
1396w) is amended by adding at the end the following 
new subsection: 
‘‘(k) REDUCTION IN FMAP AFTER 2020 FOR NON- 
COMPLIANT STATES.— 
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‘‘(1) IN GENERAL.—With respect to a calendar 
quarter beginning on or after January 1, 2021, the 
Federal medical assistance percentage otherwise de-
termined under section 1905(b) for a non-compliant 
State shall be reduced— 
‘‘(A) for calendar quarters in 2021 and 
2022, by 0.12 percentage points; 
‘‘(B) for calendar quarters in 2023, by 
0.25 percentage points; 
‘‘(C) for calendar quarters in 2024, by 
0.35 percentage points; and 
‘‘(D) for calendar quarters in 2025 and 
each year thereafter, by 0.5 percentage points. 
‘‘(2) NON-COMPLIANT
STATE
DEFINED.—For 
purposes of this subsection, the term ‘non-compliant 
State’ means a State— 
‘‘(A) that is one of the 50 States or the 
District of Columbia; 
‘‘(B) with respect to which the Secretary 
has not approved a State plan amendment sub-
mitted under subsection (a)(2); and 
‘‘(C) that is not operating, on an ongoing 
basis, an asset verification program in accord-
ance with this section.’’. 
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SEC. 5. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(1) of the Social Security Act (42 
U.S.C. 
1396w–1(b)(1)) 
is 
amended 
by 
striking 
‘‘$31,000,000’’ and inserting ‘‘$6,000,000’’. 
SEC. 6. BUDGETARY EFFECTS. 
(a) STATUTORY PAYGO SCORECARDS.—The budg-
etary effects of this Act shall not be entered on either 
PAYGO scorecard maintained pursuant to section 4(d) of 
the Statutory Pay-As-You-Go Act of 2010 (2 U.S.C. 
933(d)). 
(b) SENATE PAYGO SCORECARDS.—The budgetary 
effects of this Act shall not be entered on any PAYGO 
scorecard maintained for purposes of section 4106 of H. 
Con. Res. 71 (115th Congress). 
(c) CLASSIFICATION
OF BUDGETARY EFFECTS.— 
Notwithstanding Rule 3 of the Budget Scorekeeping 
Guidelines set forth in the joint explanatory statement of 
the committee of conference accompanying Conference Re-
port 105–217 and section 250(c)(8) of the Balanced 
Budget and Emergency Deficit Control Act of 1985, the 
budgetary effects of this Act shall not be estimated— 
(1) for purposes of section 251 of the Balanced 
Budget and Emergency Deficit Control Act of 1985; 
and 
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(2) for purposes of paragraph (4)(C) of section 
3 of the Statutory Pay-As-You-Go Act of 2010 as 
being included in an appropriation Act. 
(d) PAYGO ANNUAL REPORT.—For the purposes of 
the annual report issued pursuant to section 5 of the Stat-
utory Pay-As-You-Go Act of 2010 (2 U.S.C. 934) after 
adjournment of the second session of the 115th Congress, 
and for determining whether a sequestration order is nec-
essary under such section, the debit for the budget year 
on the 5-year scorecard, if any, and the 10-year scorecard, 
if any, shall be deducted from such scorecard in 2019 and 
added to such scorecard in 2020. 
Æ 
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