provided under the State child health plan 
under this title (or a waiver of such plan); and 
‘‘(B) that is funded exclusively through 
non-Federal funds, including funds received by 
the State in the form of premiums for the pur-
chase of such coverage.’’. 
(2) COVERAGE RULE.— 
(A) IN GENERAL.—Section 5000A(f)(1) of 
the Internal Revenue Code of 1986 is amended 
in subparagraph (A)(iii), by inserting ‘‘or under 
a qualified CHIP look-alike program (as de-
fined in section 2107(g) of the Social Security 
Act)’’ before the comma at the end. 
(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall apply with re-
spect to taxable years beginning after December 
31, 2017. 
SEC. 302. EXTENSION OF CERTAIN PROGRAMS AND DEM-
ONSTRATION PROJECTS. 
(a) 
CHILDHOOD
OBESITY
DEMONSTRATION 
PROJECT.—Section 1139A(e)(8) of the Social Security 
Act (42 U.S.C. 1320b–9a(e)(8)) is amended— 
(1) by striking ‘‘and $10,000,000’’ and insert-
ing ‘‘, $10,000,000’’; and
(2) by inserting after ‘‘2017’’ the following: ‘‘, 
and $25,000,000 for the period of fiscal years 2018 
through 2022’’. 
(b) PEDIATRIC QUALITY MEASURES PROGRAM.— 
Section 1139A(i) of the Social Security Act (42 U.S.C. 
1320b–9a(i)) is amended— 
(1) by striking ‘‘Out of any’’ and inserting the 
following: 
‘‘(1) IN GENERAL.—Out of any’’; 
(2) by striking ‘‘there is appropriated for each’’ 
and inserting ‘‘there is appropriated— 
‘‘(A) for each’’; 
(3) by striking ‘‘, and there is appropriated for 
the period’’ and inserting ‘‘; 
‘‘(B) for the period’’; 
(4) by striking ‘‘. Funds appropriated under 
this subsection shall remain available until ex-
pended.’’ and inserting ‘‘; and’’; and 
(5) by adding at the end the following: 
‘‘(C) for the period of fiscal years 2018 
through 2022, $75,000,000 for the purpose of 
carrying out this section (other than sub-
sections (e), (f), and (g)).
‘‘(2) 
AVAILABILITY.—Funds 
appropriated 
under this subsection shall remain available until ex-
pended.’’. 
SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT 
PROGRAM. 
(a) IN GENERAL.—Section 2113 of the Social Secu-
rity Act (42 U.S.C. 1397mm) is amended— 
(1) in subsection (a)(1), by striking ‘‘2017’’ and 
inserting ‘‘2022’’; and 
(2) in subsection (g)— 
(A) by striking ‘‘and $40,000,000’’ and in-
serting ‘‘, $40,000,000’’; and 
(B) by inserting after ‘‘2017’’ the fol-
lowing: ‘‘, and $100,000,000 for the period of 
fiscal years 2018 through 2022’’. 
(b) MAKING ORGANIZATIONS THAT USE PARENT 
MENTORS
ELIGIBLE
TO
RECEIVE
GRANTS.—Section 
2113(f) of the Social Security Act (42 U.S.C. 1397mm(f)) 
is amended— 
(1) in paragraph (1)(E), by striking ‘‘or com-
munity-based doula programs’’ and inserting ‘‘, com-
munity-based doula programs, or parent mentors’’; 
and 
(2) by adding at the end the following new 
paragraph:
‘‘(5) PARENT
MENTOR.—The term ‘parent 
mentor’ means an individual who— 
‘‘(A) is a parent or guardian of at least 
one child who is an eligible child under this title 
or title XIX; and 
‘‘(B) is trained to assist families with chil-
dren who have no health insurance coverage 
with respect to improving the social deter-
minants of the health of such children, includ-
ing by providing— 
‘‘(i) education about health insurance 
coverage, including, with respect to obtain-
ing such coverage, eligibility criteria and 
application and renewal processes; 
‘‘(ii) assistance with completing and 
submitting applications for health insur-
ance coverage; 
‘‘(iii) a liaison between families and 
representatives of State plans under title 
XIX or State child health plans under this 
title; 
‘‘(iv) guidance on identifying medical 
and dental homes and community phar-
macies for children; and
‘‘(v) assistance and referrals to suc-
cessfully address social determinants of 
children’s health, including poverty, food 
insufficiency, and housing.’’. 
(c) EXCLUSION FROM MODIFIED ADJUSTED GROSS 
INCOME.—Section 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended— 
(1) in the first paragraph (14), relating to in-
come determined using modified adjusted gross in-
come, by adding at the end the following new sub-
paragraph: 
‘‘(J) EXCLUSION
OF
PARENT
MENTOR 
COMPENSATION
FROM
INCOME
DETERMINA-
TION.—Any nominal amount received by an in-
dividual as compensation, including a stipend, 
for participation as a parent mentor (as defined 
in paragraph (5) of section 2113(f)) in an activ-
ity or program funded through a grant under 
such section shall be disregarded for purposes 
of determining the income eligibility of such in-
dividual for medical assistance under the State 
plan or any waiver of such plan.’’; and 
(2) by striking ‘‘(14) EXCLUSION’’ and insert-
ing ‘‘(15) EXCLUSION’’.
SEC. 304. EXTENSION AND REDUCTION OF ADDITIONAL 
FEDERAL FINANCIAL PARTICIPATION FOR 
CHIP. 
Section 2105(b) of the Social Security Act (42 U.S.C. 
1397ee(b)) is amended in the second sentence by inserting 
‘‘and during the period that begins on October 1, 2019, 
and ends on September 30, 2020, the enhanced FMAP 
determined for a State for a fiscal year (or for any portion 
of a fiscal year occurring during such period) shall be in-
creased by 11.5 percentage points’’ after ‘‘23 percentage 
points,’’. 
SEC. 305. MODIFYING REDUCTIONS IN MEDICAID DSH AL-
LOTMENTS. 
Section 1923(f)(7)(A) of the Social Security Act (42 
U.S.C. 1396r–4(f)(7)(A)) is amended— 
(1) in clause (i), in the matter preceding sub-
clause (I), by striking ‘‘2018’’ and inserting ‘‘2020’’; 
and 
(2) in clause (ii), by striking subclauses (I) 
through (VIII) and inserting the following: 
‘‘(I) $4,000,000,000 for fiscal 
year 2020; and 
‘‘(II) $8,000,000,000 for each of 
fiscal years 2021 through 2025.’’.
of the increase otherwise provided under subpara-
graph (A) for Puerto Rico shall be further increased 
by $120,000,000 if the Financial Oversight and 
Management Board for Puerto Rico established 
under section 101 of the Puerto Rico Oversight, 
Management, and Economic Stability Act (48 
U.S.C. 2121) certifies by a majority vote that Puer-
to Rico has taken reasonable and appropriate steps 
during such period to— 
‘‘(I) reduce fraud, waste, and abuse under 
the program under title XIX; 
‘‘(II) implement strategies to reduce un-
necessary, inefficient, or excessive spending 
under title XIX; 
‘‘(III) improve the use and availability of 
Medicaid data for program operation and over-
sight; and 
‘‘(IV) improve the quality of care and pa-
tient experience for individuals enrolled under 
the program under title XIX. 
‘‘(ii) As a condition of any additional increase 
pursuant to clause (i), not later than October 1, 
2018, Puerto Rico shall submit to the Financial 
Oversight and Management Board for Puerto Rico 
a report regarding steps taken to achieve each of the
goals described in subclauses (I) through (IV) of 
clause (i). 
‘‘(E) Payments under section 1903(a)(8) for a 
quarter of a fiscal year shall not be taken into ac-
count in applying subsection (f) (as increased in ac-
cordance with this paragraph and paragraphs (1), 
(2), (3), and (4)) to Puerto Rico or the Virgin Is-
lands for such fiscal year. 
‘‘(F)(i) For the period beginning October 1, 
2017, and ending December 31, 2019, the amount 
of the increase otherwise provided under subpara-
graph (A) for the Virgin Islands shall be further in-
creased by an amount equal to the per capita equiv-
alent of the total amount of the increase provided 
for Puerto Rico under subparagraphs (C) and (D) 
for such period. 
‘‘(ii) For purposes of clause (i), the term ‘per 
capita equivalent’ means the ratio of— 
‘‘(I) the population of the Virgin Islands, 
as determined by the most recent census esti-
mate released by the Bureau of the Census be-
fore September 4, 2017; to 
‘‘(II) the population of Puerto Rico, as so 
determined.’’.
(b) FEDERAL MATCH
FOR MEDICAL PERSONNEL 
AND FRAUD REDUCTION.—Section 1903(a) of the Social 
Security Act (42 U.S.C. 1396b(a)) is amended— 
(1) in paragraph (2)(A), by inserting ‘‘subject 
to paragraph (8),’’ before ‘‘an amount’’; 
(2) in paragraph (6)— 
(A) in subparagraph (B), by inserting 
‘‘subject to paragraph (8),’’ before ‘‘75 per cen-
tum’’; and 
(B) by striking at the end ‘‘plus’’; 
(3) in paragraph (7), by striking at the end the 
period and inserting ‘‘; plus’’ ; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(8) for quarters during the period beginning 
January 1, 2018, and ending December 31, 2019, 
paragraphs (2)(A) and (6) shall apply with respect 
to Puerto Rico and the Virgin Islands as if— 
‘‘(A) the reference to ‘75 per centum’ in 
paragraph (2)(A) were a reference to ‘90 per 
centum’; and 
‘‘(B) the reference to ‘75 per centum’ in 
paragraph (6)(B) were a reference to ‘90 per 
centum’.’’.
TITLE II—OFFSETS 
SEC. 401. MEDICAID THIRD PARTY LIABILITY PROVISIONS. 
(a) MEDICAID THIRD PARTY LIABILITY.— 
(1) DELAY
OF
BIPARTISAN
BUDGET
ACT
OF 
2013 THIRD PARTY LIABILITY PROVISIONS.— 
(A) IN GENERAL.—Section 202(c) of the 
Bipartisan Budget Act of 2013 (Public Law 
113–67; 127 Stat. 1177; 42 U.S.C. 1396a 
note), as amended by section 211 of the Pro-
tecting Access to Medicare Act of 2014 (Public 
Law 113–93; 128 Stat. 1047; 42 U.S.C. 1396a 
note) and section 220 of the Medicare Access 
and CHIP Reauthorization Act of 2015 (Public 
Law 114–10), is amended by striking ‘‘2017’’ 
and inserting ‘‘2019’’. 
(B) EFFECTIVE DATE; TREATMENT.—The 
amendment made by subparagraph (A) shall 
take effect on September 30, 2017, and shall 
apply with respect to any open claims, including 
claims generated or filed, after such date. 
(2) CLARIFICATION OF DEFINITIONS APPLICA-
BLE TO THIRD PARTY LIABILITY.— 
(A) IN GENERAL.—Section 1902 of the So-
cial Security Act (42 U.S.C. 1396a) is amended
by adding at the end the following new sub-
section: 
‘‘(nn) RESPONSIBLE THIRD PARTY AND HEALTH IN-
SURER DEFINITIONS.—For purposes of subsection (a)(25) 
and section 1903(d)(2)(B): 
‘‘(1) RESPONSIBLE THIRD PARTY.—The term 
‘responsible third party’ means a health insurer, a 
pharmacy benefit manager to the extent the phar-
macy benefit manager provides information under 
this title for the purpose of coordinating benefits, an 
accountable care organization under section 1899, or 
any other party that is, by statute, contract, or 
agreement, legally responsible for payment of a 
claim for a health care item or service. Such term 
does not include a party if payment by such party 
has been made or can reasonably be expected to be 
made under a workmen’s compensation law or plan 
of the United States or a State, or under an auto-
mobile or liability insurance policy or plan (including 
a self-insured plan), or under no fault insurance. 
‘‘(2) HEALTH INSURER.—The term ‘health in-
surer’ means a group health plan, as defined in sec-
tion 607(1) of the Employee Retirement Income Se-
curity Act of 1974, a self-insured plan, a fully-in-
sured plan, a service benefit plan, a medicaid man-
aged care plan under section 1903(m) or 1932, and 
any other health plan determined appropriate by the 
Secretary.’’. 
(B) CONFORMING AMENDMENTS.—Section 
1902(a)(25) of the Social Security Act (42 
U.S.C. 1396a(a)(25)) is amended— 
(i) in subparagraph (A), in the matter 
preceding clause (i), by striking ‘‘third par-
ties’’ and all that follows through ‘‘item or 
service)’’ and inserting ‘‘responsible third 
parties’’; 
(ii) in subparagraph (G), by striking 
‘‘health insurer’’ and all that follows 
through ‘‘item or service)’’ and inserting 
‘‘responsible third party’’; 
(iii) in subparagraph (I), in the mat-
ter preceding clause (i), by striking ‘‘health 
insurers’’ and all that follows through 
‘‘item or service’’ and inserting ‘‘respon-
sible third parties’’; and 
(iv) by inserting ‘‘responsible’’ before 
‘‘third’’ each place it appears in subpara-
graphs (A)(i), (A)(ii), (C), (D), and (H). 
(3) REMOVAL OF SPECIAL TREATMENT OF CER-
TAIN TYPES OF CARE AND PAYMENTS UNDER MED-
ICAID
THIRD
PARTY
LIABILITY
RULES.—Section 
1902(a)(25) of the Social Security Act (42 U.S.C. 
1396a(a)(25)), as amended by section 202(c) of the 
Bipartisan Budget Act of 2013 (after application of 
paragraph (1)), is amended— 
(A) in subparagraph (E)— 
(i) in the matter preceding clause (i), 
by striking ‘‘prenatal or preventive’’ and 
all that follows through ‘‘State plan’’ and 
inserting ‘‘items and services provided 
under the program required under the 
State plan pursuant to paragraph (62)’’; 
and 
(ii) in clause (i)— 
(I) by striking ‘‘such service’’ 
and inserting ‘‘such items and serv-
ices’’; and 
(II) by striking each place it ap-
pears ‘‘such services’’ and inserting 
‘‘such items and services’’ each such 
place; and 
(B) by striking subparagraph (F). 
(4) CLARIFICATION OF ROLE OF HEALTH IN-
SURERS WITH RESPECT TO THIRD PARTY LIABIL-
ITY.—
(A) IN GENERAL.—Section 1902(a)(25) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(25)), as amended by paragraph (3), is 
further amended by inserting after subpara-
graph (E) the following new subparagraph: 
‘‘(F) that— 
‘‘(i) in the case of a State that pro-
vides medical assistance under this title 
through a contract with a health insurer, 
such contract shall specify any responsi-
bility of such health insurer (or other enti-
ty) with respect to recovery of payment 
from responsible third parties pursuant to 
the delegation or transfer by the State to 
such insurer (or other entity) of a right de-
scribed in subparagraph (I)(ii); and 
‘‘(ii) in the case of a State that under 
a contract described in clause (i) delegates 
or transfers to a health insurer (or other 
entity) a right described in such clause, the 
State shall provide assurances to the Sec-
retary that the State laws referred to in 
subparagraph (I), with respect to each re-
sponsibility of such health insurer (or other 
entity) specified under such clause, confer
to such health insurer (or other entity) the 
authority of the State with respect to the 
requirements 
specified 
in 
clauses 
(i) 
through (iv) of such subparagraph (I);’’. 
(B) 
TREATMENT
OF
COLLECTED 
AMOUNTS.—Section 1903(d)(2)(B) of the Social 
Security Act (42 U.S.C. 1396b(d)(2)(B)) is 
amended by adding at the end the following: 
‘‘For purposes of this subparagraph, reimburse-
ments made by a responsible third party to 
health insurers (as defined in section 1902(nn)) 
pursuant to section 1902(a)(25)(F)(ii) shall be 
treated in the same manner as reimbursements 
made to a State under the previous sentence.’’. 
(5) INCREASING STATE FLEXIBILITY WITH RE-
SPECT
TO
THIRD
PARTY
LIABILITY.—Section 
1902(a)(25)(I) of the Social Security Act (42 U.S.C. 
1396a(a)(25)(I)) is amended— 
(A) in clause (i), by striking ‘‘medical as-
sistance under the State plan’’ and inserting 
‘‘medical assistance under a State plan (or 
under a waiver of the plan)’’; 
(B) by striking clause (ii) and inserting the 
following new clause: 
‘‘(ii) accept—
‘‘(I) any State’s right of recovery 
and the assignment to any State of 
any right of an individual or other en-
tity to payment from the party for an 
item or service for which payment has 
been 
made 
under 
the 
respective 
State’s plan (or under a waiver of the 
plan); and 
‘‘(II) as a valid authorization of 
the responsible third party for the fur-
nishing of an item or service to an in-
dividual eligible to receive medical as-
sistance under this title, an authoriza-
tion made on behalf of such individual 
under the State plan (or under a 
waiver of such plan) for the fur-
nishing of such item or service to such 
individual;’’; 
(C) in clause (iii)— 
(i) by striking ‘‘respond to’’ and in-
serting ‘‘not later than 60 days after re-
ceiving’’; and 
(ii) by striking ‘‘; and’’ at the end and 
inserting ‘‘, respond to such inquiry; and’’; 
and
(D) in clause (iv), by inserting ‘‘a failure 
to obtain a prior authorization,’’ after ‘‘claim 
form,’’. 
(6) STATE
INCENTIVE
TO
PURSUE
THIRD 
PARTY LIABILITY FOR NEWLY ELIGIBLES.—Section 
1903(d)(2)(B) of the Social Security Act (42 U.S.C. 
1396b(d)(2)(B)), as amended by paragraph (4)(B), 
is further amended by adding at the end the fol-
lowing: ‘‘In the case of expenditures for medical as-
sistance provided during 2017 and subsequent years 
for individuals described in subclause (VIII) of sec-
tion 1902(a)(10)(A)(i), in determining the amount, 
if any, of overpayment under this subparagraph with 
respect to such medical assistance, the Secretary 
shall apply the Federal medical assistance percent-
age for the State under section 1905(b), notwith-
standing the application of section 1905(y).’’. 
(b) COMPLIANCE WITH THIRD PARTY INSURANCE 
REPORTING.—Section 1905 of the Social Security Act (42 
U.S.C. 1396d) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(ee) Notwithstanding subsection (b), for any year 
beginning after 2019, if a State fails to comply with the 
requirements of section 1902(a)(25) with respect to each 
calendar quarter in such year, the Secretary may reduce
the Federal medical assistance percentage by 0.1 percent-
age point for calendar quarters in each subsequent year 
in which the State fails to so comply.’’. 
(c) APPLICATION TO CHIP.— 
(1) IN
GENERAL.—Section 2107(e)(1) of the 
Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended— 
(A) by redesignating subparagraphs (B) 
through (R) as subparagraphs (C) through (S), 
respectively; and 
(B) by inserting after subparagraph (A) 
the following new subparagraph: 
‘‘(B) Section 1902(a)(25) (relating to third 
party liability).’’. 
(2) 
MANDATORY
REPORTING.—Section 
1902(a)(25)(I)(i) of the Social Security Act (42 
U.S.C. 1396a(a)(25)(I)(i)), as amended by sub-
section (a)(5), is further amended— 
(A) by striking ‘‘(and, at State option, 
child’’ and inserting ‘‘and child’’; and 
(B) by striking ‘‘title XXI)’’ and inserting 
‘‘title XXI’’. 
(d) TRAINING ON THIRD PARTY LIABILITY.—Section 
1936 of the Social Security Act (42 U.S.C. 1396u–6) is 
amended—
(1) in subsection (b)(4), by striking ‘‘and qual-
ity of care’’ and inserting ‘‘, quality of care, and the 
liability of responsible third parties (as defined in 
section 1902(nn))’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(f) THIRD PARTY LIABILITY TRAINING.—With re-
spect to education or training activities carried out pursu-
ant to subsection (b)(4) with respect to the liability of re-
sponsible third parties (as defined in section 1902(nn) for 
payment for items and services furnished under State 
plans (or under waivers of such plans)) under this title, 
the Secretary shall— 
‘‘(1) publish (and update on an annual basis) 
on the public Internet website of the Centers for 
Medicare & Medicaid Services a dedicated Internet 
page containing best practices to be used in assess-
ing such liability; 
‘‘(2) monitor efforts to assess such liability and 
analyze the challenges posed by that assessment; 
‘‘(3) distribute to State agencies administering 
the State plan under this title information related to 
such efforts and challenges; and 
‘‘(4) provide guidance to such State agencies 
with respect to State oversight of efforts under a
medicaid managed care plan under section 1903(m) 
or 1932 to assess such liability.’’. 
(e) DEVELOPMENT
OF MODEL UNIFORM FIELDS 
FOR STATES TO REPORT THIRD PARTY INFORMATION.— 
Not later than January 1, 2019, the Secretary of Health 
and Human Services shall, in consultation with the States, 
develop and make available to the States a model uniform 
reporting set of reporting fields and accompanying guid-
ance documentation that States shall use for purposes 
of— 
(1) reporting information to the Secretary with-
in the Transformed Medicaid Statistical Information 
System (T–MSIS) (or a successor system); and 
(2) collecting information that identifies respon-
sible third parties (as defined in subsection (nn) of 
section 1902 of the Social Security Act (42 U.S.C. 
1396a), as added by subsection (a)(2)(A)) and other 
relevant information for ascertaining the legal re-
sponsibility of such third parties to pay for care and 
services available under the State plan (or under a 
waiver of the plan) under title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.) or under the 
State child health plan under title XXI of such Act 
(42 U.S.C. 1397 et seq.). 
(f) EFFECTIVE DATE.—
(1) IN GENERAL.—Except as provided in para-
graph (2), this section and the amendments made by 
this section (other than as specified in the preceding 
provisions of this section) shall take effect on Octo-
ber 1, 2019, and shall apply to medical assistance or 
child health assistance provided on or after such 
date. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.), or a State child health 
plan for child health assistance under title XXI of 
such Act (42 U.S.C. 1397aa et seq.), that the Sec-
retary of Health and Human Services determines re-
quires State legislation (other than legislation appro-
priating funds) in order for the plan to meet the ad-
ditional requirement imposed by the amendments 
made under this section, such plan shall not be re-
garded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet 
this additional requirement 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 the 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 such session shall be deemed to be a 
separate regular session of the State legislature. 
SEC. 402. TREATMENT OF LOTTERY WINNINGS AND OTHER 
LUMP-SUM INCOME FOR PURPOSES OF IN-
COME ELIGIBILITY UNDER MEDICAID. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)(17), by striking ‘‘(e)(14), 
(e)(14)’’ and inserting ‘‘(e)(14), (e)(15)’’; and 
(2) in subsection (e)(14), as amended by section 
303(c), by adding at the end the following new sub-
paragraph: 
‘‘(K) TREATMENT OF CERTAIN LOTTERY 
WINNINGS AND INCOME RECEIVED AS A LUMP 
SUM.— 
‘‘(i) IN GENERAL.—In the case of an 
individual who is the recipient of qualified 
lottery winnings (pursuant to lotteries oc-
curring on or after January 1, 2018) or 
qualified lump sum income (received on or 
after such date) and whose eligibility for 
medical assistance is determined based on 
the application of modified adjusted gross 
income under subparagraph (A), a State
shall, in determining such eligibility, in-
clude such winnings or income (as applica-
ble) as income received— 
‘‘(I) in the month in which such 
winnings or income (as applicable) is 
received if the amount of such 
winnings or income is less than 
$80,000; 
‘‘(II) over a period of 2 months 
if the amount of such winnings or in-
come (as applicable) is greater than or 
equal to $80,000 but less than 
$90,000; 
‘‘(III) over a period of 3 months 
if the amount of such winnings or in-
come (as applicable) is greater than or 
equal to $90,000 but less than 
$100,000; and 
‘‘(IV) over a period of 3 months 
plus 1 additional month for each in-
crement of $10,000 of such winnings 
or income (as applicable) received, not 
to exceed a period of 120 months (for 
winnings or income of $1,260,000 or 
more), if the amount of such winnings
or income is greater than or equal to 
$100,000. 
‘‘(ii) COUNTING IN EQUAL INSTALL-
MENTS.—For purposes of subclauses (II), 
(III), and (IV) of clause (i), winnings or 
income to which such subclause applies 
shall be counted in equal monthly install-
ments over the period of months specified 
under such subclause. 
‘‘(iii) HARDSHIP EXEMPTION.—An in-
dividual whose income, by application of 
clause (i), exceeds the applicable eligibility 
threshold established by the State, shall 
continue to be eligible for medical assist-
ance to the extent that the State deter-
mines, under procedures established by the 
State (in accordance with standards speci-
fied by the Secretary), that the denial of 
eligibility of the individual would cause an 
undue medical or financial hardship as de-
termined on the basis of criteria estab-
lished by the Secretary. 
‘‘(iv) NOTIFICATIONS
AND
ASSIST-
ANCE REQUIRED IN CASE OF LOSS OF ELI-
GIBILITY.—A State shall, with respect to
an individual who loses eligibility for med-
ical assistance under the State plan (or a 
waiver of such plan) by reason of clause 
(i)— 
‘‘(I) before the date on which the 
individual loses such eligibility, inform 
the individual— 
‘‘(aa) of the individual’s op-
portunity to enroll in a qualified 
health plan offered through an 
Exchange established under title 
I of the Patient Protection and 
Affordable Care Act during the 
special enrollment period speci-
fied in section 9801(f)(3) of the 
Internal Revenue Code of 1986 
(relating to loss of Medicaid or 
CHIP coverage); and 
‘‘(bb) of the date on which 
the individual would no longer be 
considered ineligible by reason of 
clause (i) to receive medical as-
sistance under the State plan or 
under any waiver of such plan 
and be eligible to reapply to re-
ceive such medical assistance; 
and 
‘‘(II) provide technical assistance 
to the individual seeking to enroll in 
such a qualified health plan. 
‘‘(v) QUALIFIED LOTTERY WINNINGS 
DEFINED.—In this subparagraph, the term 
‘qualified lottery winnings’ means winnings 
from a sweepstakes, lottery, or pool de-
scribed in paragraph (3) of section 4402 of 
the Internal Revenue Code of 1986 or a 
lottery operated by a multistate or multi-
jurisdictional lottery association, including 
amounts awarded as a lump sum payment. 
‘‘(vi) QUALIFIED LUMP SUM INCOME 
DEFINED.—In this subparagraph, the term 
‘qualified lump sum income’ means income 
that is received as a lump sum from one 
of the following sources: 
‘‘(I) Monetary winnings from 
gambling (as defined by the Secretary 
and including gambling activities de-
scribed in section 1955(b)(4) of title 
18, United States Code).
‘‘(II) Damages received, whether 
by suit or agreement and whether as 
lump sums or as periodic payments 
(other than monthly payments), on 
account of causes of action other than 
causes of action arising from personal 
physical injuries or physical sickness. 
‘‘(III) Income received as liquid 
assets from the estate (as defined in 
section 1917(b)(4)) of a deceased in-
dividual.’’. 
(b) RULES OF CONSTRUCTION.— 
(1) INTERCEPTION OF LOTTERY WINNINGS AL-
LOWED.—Nothing in the amendment made by sub-
section (a)(2) shall be construed as preventing a 
State from intercepting the State lottery winnings 
awarded to an individual in the State to recover 
amounts paid by the State under the State Medicaid 
plan under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) for medical assistance fur-
nished to the individual. 
(2) APPLICABILITY LIMITED TO ELIGIBILITY OF 
RECIPIENT OF LOTTERY WINNINGS OR LUMP SUM 
INCOME.—Nothing in the amendment made by sub-
section (a)(2) shall be construed, with respect to a
determination of household income for purposes of a 
determination of eligibility for medical assistance 
under the State plan under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.) (or a waiver 
of such plan) made by applying modified adjusted 
gross income under subparagraph (A) of section 
1902(e)(14) of such Act (42 U.S.C. 1396a(e)(14)), 
as limiting the eligibility for such medical assistance 
of any individual that is a member of the household 
other than the individual who received qualified lot-
tery winnings or qualified lump-sum income (as de-
fined 
in 
subparagraph 
(K) 
of 
such 
section 
1902(e)(14), as added by subsection (a)(2) of this 
section). 
SEC. 403. ADJUSTMENTS TO MEDICARE PART B AND PART 
D PREMIUM SUBSIDIES FOR HIGHER INCOME 
INDIVIDUALS. 
(a) IN GENERAL.—Section 1839(i)(3)(C)(i)(II) of the 
Social Security Act (42 U.S.C. 1395r(i)(3)(C)(i)(II)) is 
amended, in the table, by striking the last row and insert-
ing the following new rows: 
‘‘More than $160,000 but less than $500,000 ..............
80 percent
At least $500,000 ...........................................................
100 percent.’’. 
(b) JOINT RETURNS.—Section 1839(i)(3)(C)(ii) of 
the Social Security Act (42 U.S.C. 1395r(i)(3)(C)(ii)) is 
amended by inserting before the period the following: ‘‘ex-
cept, with respect to the dollar amounts applied in the last 
row of the table under subclause (II) of such clause (and 
the second dollar amount specified in the second to last 
row of such table), clause (i) shall be applied by sub-
stituting dollar amounts which are 175 percent of such 
dollar amounts for the calendar year’’. 
(c) INFLATION ADJUSTMENT.—Section 1839(i) of 
the Social Security Act (42 U.S.C. 1395r(i)) is amended— 
(1) in paragraph (5)— 
(A) in subparagraph (A), by striking ‘‘In 
the case’’ and inserting ‘‘Subject to subpara-
graph (C), in the case’’; 
(B) in subparagraph (B), by striking ‘‘sub-
paragraph (A)’’ and inserting ‘‘subparagraph 
(A) or (C)’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) TREATMENT OF ADJUSTMENTS FOR 
CERTAIN HIGHER INCOME INDIVIDUALS.— 
‘‘(i) IN GENERAL.—Subparagraph (A) 
shall not apply with respect to each dollar 
amount in paragraph (3) of $500,000. 
‘‘(ii) ADJUSTMENT BEGINNING 2027.— 
In the case of any calendar year beginning 
after 2026, each dollar amount in para-
graph (3) of $500,000 shall be increased 
by an amount equal to— 
‘‘(I) such dollar amount, multi-
plied by 
‘‘(II) the percentage (if any) by 
which the average of the Consumer 
Price Index for all urban consumers 
(United States city average) for the 
12-month period ending with August 
of the preceding calendar year exceeds 
such average for the 12-month period 
ending with August 2025.’’; and 
(2) in paragraph (6)(B), by inserting ‘‘(other 
than $500,000)’’ after ‘‘the dollar amounts’’. 
Passed the House of Representatives November 3, 
2017. 
Attest: 
Clerk.
115TH CONGRESS 
1ST SESSION 
H. R. 3922 
AN ACT 
To extend funding for certain public health 
programs, and for other purposes.