I 
111TH CONGRESS 
1ST SESSION H. R. 1441 
To amend title XIX of the Social Security Act to allow States to permit 
certain Medicaid eligible individuals who have extremely high annual 
lifelong orphan drug costs to continue on Medicaid notwithstanding in-
creased income. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 11, 2009 
Mr. MARCHANT (for himself, Mrs. EMERSON, Mr. SESSIONS, Ms. GRANGER, 
Mr. BRALEY of Iowa, and Mr. ORTIZ) 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 allow 
States to permit certain Medicaid eligible individuals who 
have extremely high annual lifelong orphan drug costs 
to continue on Medicaid notwithstanding increased in-
come. 
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 ‘‘Ryan Dant Health 
Care Opportunity Act of 2009’’. 
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SEC. 2. STATE OPTION TO DISREGARD CERTAIN INCOME IN 
PROVIDING 
CONTINUED 
MEDICAID 
COV-
ERAGE FOR CERTAIN INDIVIDUALS WITH EX-
TREMELY HIGH PRESCRIPTION COSTS. 
Section 1902(e) of the Social Security Act (42 U.S.C. 
1396b(e)), as amended by section 203(a) of the Children’s 
Health Insurance Program Reauthorization Act of 2009 
(Public Law 111–3), is amended by adding at the end the 
following new paragraph: 
‘‘(14)(A) At the option of the State, in the case 
of an individual with extremely high prescription 
drug costs described in subparagraph (B) who has 
been determined (without the application of this 
paragraph) to be eligible for medical assistance 
under this title, the State may, in redetermining the 
individual’s eligibility for medical assistance under 
this title, disregard any family income of the indi-
vidual to the extent such income is less than an 
amount that is specified by the State and does not 
exceed the amount specified in subparagraph (C), or, 
if greater, income equal to the cost of the orphan 
drugs described in subparagraph (B)(iii). 
‘‘(B) An individual with extremely high pre-
scription drug costs described in this subparagraph 
for a 12-month period is an individual— 
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‘‘(i) who is covered under health insurance 
or a health benefits plan that has a maximum 
lifetime limit of not less than $1,000,000 which 
includes all prescription drug coverage; 
‘‘(ii) who has exhausted all available pre-
scription drug coverage under the plan as of the 
beginning of such period; 
‘‘(iii) who incurs (or is reasonably expected 
to incur) on an annual basis during the period 
costs for orphan drugs in excess of the amount 
specified in subparagraph (C) for the period; 
and 
‘‘(iv) whose annual family income (deter-
mined without regard to this paragraph) as of 
the beginning of the period does not exceed 75 
percent of the amount incurred for such drugs 
(as described in clause (iii)). 
‘‘(C) The amount specified in this subpara-
graph for a 12-month period beginning in— 
‘‘(i) 2009 or 2010, is $200,000; or 
‘‘(ii) a subsequent year, is the amount 
specified in clause (i) (or this subparagraph) for 
the previous year increased by the annual rate 
of increase in the medical care component of 
the consumer price index (U.S. city average) for 
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