I 
111TH CONGRESS 
1ST SESSION H. R. 2680 
To amend the Social Security Act to provide for payment parity for Puerto 
Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and 
American Samoa under the Medicaid Program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 3, 2009 
Ms. BORDALLO (for herself, Mr. SERRANO, Mr. FALEOMAVAEGA, Mrs. 
CHRISTENSEN, Mr. PIERLUISI, and Mr. SABLAN) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To amend the Social Security Act to provide for payment 
parity for Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands, and American Samoa 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 ‘‘Territorial Health Par-
ity Act of 2009’’. 
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SEC. 2. MEDICAID PAYMENT PARITY FOR THE TERRI-
TORIES. 
(a) ELIMINATION OF FUNDING LIMITATIONS FOR 
PUERTO RICO, THE VIRGIN ISLANDS, GUAM, THE NORTH-
ERN MARIANA ISLANDS, AND AMERICAN SAMOA.— 
(1) IN GENERAL.—Section 1108 of the Social 
Security Act (42 U.S.C. 1308) is amended— 
(A) in subsection (f), in the matter before 
paragraph (1), by striking ‘‘subsection (g)’’ and 
inserting ‘‘subsections (g) and (h)’’; 
(B) in subsection (g)(2), in the matter be-
fore subparagraph (A), by inserting ‘‘and sub-
section (h)’’ after ‘‘paragraph (3)’’; and 
(C) by adding at the end the following new 
subsection: 
‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER-
TO RICO, THE VIRGIN ISLANDS, GUAM, THE NORTHERN 
MARIANA ISLANDS, AND AMERICAN SAMOA.—Subsections 
(f) and (g) shall not apply to Puerto Rico, the Virgin Is-
lands, Guam, the Northern Mariana Islands, and Amer-
ican Samoa for any fiscal year after fiscal year 2009.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1903(u) of such Act (42 U.S.C. 1396c(u)) is amend-
ed by striking paragraph (4). 
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(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply beginning with fiscal 
year 2010. 
(b) PARITY IN FMAP.— 
(1) IN GENERAL.—Section 1905(b)(2) of such 
Act (42 U.S.C. 1396d(b)(2)) is amended by insert-
ing after ‘‘50 per centum’’ the following: ‘‘(except 
that, beginning with fiscal year 2012, the Federal 
medical assistance percentage for Puerto Rico, the 
Virgin Islands, Guam, the Northern Mariana Is-
lands, and American Samoa shall be the Federal 
medical assistance percentage determined by the 
Secretary in consultation (for the Virgin Islands, 
Guam, the Northern Mariana Islands, and American 
Samoa) with the Secretary of the Interior)’’. 
(2) 
2-FISCAL-YEAR
TRANSITION.—Notwith-
standing any other provision of law, during fiscal 
years 2010 and 2011, the Federal medical assist-
ance percentage established under section 1905(b) of 
the Social Security Act (42 U.S.C. 1396d(b)) for 
Puerto Rico, the Virgin Islands, Guam, the North-
ern Mariana Islands, and American Samoa shall be 
the highest such Federal medical assistance percent-
age applicable to any of the 50 States or the District 
of Columbia for the fiscal year involved, taking into 
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account the application of subsections (a) and (b)(1) 
of 5001 of division B of the American Recovery and 
Reinvestment Act of 2009 (Public Law 111–5) to 
such States and District for calendar quarters dur-
ing such fiscal years for which such subsections 
apply respectively. 
(3) PER CAPITA INCOME DATA.— 
(A) REPORT
TO
CONGRESS.—Not later 
than October 1, 2010, the Secretary of Health 
and Human Services shall submit to Congress 
a report that describes the per capita income 
data used to promulgate the Federal medical 
assistance percentage in the territories and how 
such data differ from the per capita income 
data used to promulgate Federal medical assist-
ance percentages for the 50 States and the Dis-
trict of Columbia. The report should include 
recommendations on how the Federal medical 
assistance percentages can be calculated for the 
territories to ensure parity with the 50 States 
and the District of Columbia. 
(B) APPLICATION.—Section 1101(a)(8)(B) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1308(a)(8)(B)) is amended— 
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SEC. 3. CLARIFICATION OF MEDICAID COVERAGE FOR CITI-
ZENS OF FREELY ASSOCIATED STATES. 
(a) IN GENERAL.—Section 402(b)(2) of the Personal 
Responsibility and Work Opportunity Reconciliation Act 
of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 
the end the following: 
‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 
OF FREELY ASSOCIATED STATES.—With respect 
to eligibility for benefits for the program de-
fined in paragraph (3)(C) (relating to the Med-
icaid program), paragraph (1) shall not apply 
to any individual who lawfully resides in the 
United States (including territories and posses-
sions of the United States) in accordance with 
the Compacts of Free Association between the 
Government of the United States and the Gov-
ernments of the Federated States of Micro-
nesia, the Republic of the Marshall Islands, and 
the Republic of Palau.’’. 
(b) 
CONFORMING
DEFINITION
OF
QUALIFIED 
ALIEN.—Section 431(b) of such Act (8 U.S.C. 1641(b)) 
is amended— 
(1) in paragraph (6), by striking ‘‘or’’ at the 
end; 
(2) in paragraph (7), by striking the period at 
the end and inserting ‘‘; or’’; and 
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(3) by adding at the end the following: 
‘‘(8) an individual who lawfully resides in the 
United States (including territories and possessions 
of the United States) in accordance with a Compact 
of 
Free 
Association 
referred 
to 
in 
section 
402(b)(2)(G), but only with respect to the program 
defined in section 402(b)(3)(C) (relating to the Med-
icaid program).’’. 
(c) SETTING FMAP AT 100 PERCENT.—The third 
sentence of section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)) is amended by inserting before the pe-
riod at the end the following: ‘‘and as medical assistance 
for individuals described in section 402(b)(2)(G) of the 
Personal Responsibility and Work Opportunity Reconcili-
ation Act of 1996’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this Act take effect on October 1, 2009, Act and apply 
to benefits and assistance provided on or after that date. 
Æ 
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