I 
117TH CONGRESS 
1ST SESSION H. R. 1353 
To amend title XIX of the Social Security Act to increase Federal support 
to State Medicaid programs during economic downturns, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 25, 2021 
Mrs. LEE of Nevada (for herself, Mr. HORSFORD, Mr. VARGAS, Mr. GRI-
JALVA, Ms. TITUS, Ms. MOORE of Wisconsin, Ms. BARRAGA´N, Ms. 
WASSERMAN SCHULTZ, Ms. UNDERWOOD, Mr. CARSON, Mr. SAN NICO-
LAS, Ms. NORTON, Mr. COHEN, Ms. TLAIB, Mrs. HAYES, Mr. THOMPSON 
of Mississippi, Mr. EVANS, Mr. HASTINGS, Ms. DEAN, Mr. JONES, Mr. 
LARSON of Connecticut, Mr. GARCI´A of Illinois, Ms. CRAIG, Ms. SCHA-
KOWSKY, Mr. SMITH of Washington, Ms. CHU, Ms. MCCOLLUM, Mr. 
PETERS, Mr. DANNY K. DAVIS of Illinois, Mrs. WATSON COLEMAN, Ms. 
SHERRILL, Ms. DELBENE, Ms. SEWELL, Ms. WILD, Mr. SCHIFF, Ms. 
KUSTER, Ms. LOIS FRANKEL of Florida, Mr. RYAN, Mr. MEEKS, Ms. 
PORTER, Mrs. BEATTY, Mrs. DINGELL, Ms. SCHRIER, Mr. BERA, Ms. 
DELAURO, Mr. KILMER, Mr. SUOZZI, Mr. NEGUSE, and Mr. RUIZ) intro-
duced 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 increase 
Federal support to State Medicaid programs during eco-
nomic downturns, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Coronavirus Medicaid 
Response Act’’. 
SEC. 2. INCREASING FEDERAL SUPPORT TO STATE MED-
ICAID 
PROGRAMS 
DURING 
ECONOMIC 
DOWNTURNS. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (b), by striking ‘‘and (ff)’’ and 
inserting ‘‘(ff), and (hh)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(hh) 
INCREASED
FMAP 
DURING
ECONOMIC 
DOWNTURNS.— 
‘‘(1) IN GENERAL.—If a fiscal quarter that be-
gins on or after January 1, 2020, is an economic 
downturn quarter (as defined in paragraph (2)) with 
respect to a State, then the Federal medical assist-
ance percentage determined for the State and quar-
ter under subsection (b) shall be equal to the per-
centage determined for the State and quarter under 
paragraph (3). 
‘‘(2) ECONOMIC DOWNTURN QUARTER.— 
‘‘(A) IN GENERAL.— 
‘‘(i) IN GENERAL.—In this subsection, 
the term ‘economic downturn quarter’ 
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means, with respect to a State, a fiscal 
quarter during which the State’s unem-
ployment rate for the quarter exceeds the 
percentage determined for the State and 
quarter under clause (ii). 
‘‘(ii) THRESHOLD PERCENTAGE.—The 
percentage determined under this clause 
for a State and fiscal quarter is the per-
centage equal to the lower of— 
‘‘(I) the State unemployment 
rate at the 20th percentile of the dis-
tribution of the State’s quarterly un-
employment rates for the 60-quarter 
period preceding the quarter involved, 
increased by 1 percentage point; and 
‘‘(II) the State’s average quar-
terly unemployment rate for the 12- 
quarter period preceding the quarter 
involved, increased by 1 percentage 
point. 
‘‘(B) UNEMPLOYMENT DATA.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), for purposes of deter-
mining unemployment rates for a State 
and a quarter under this paragraph, the 
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Secretary shall use data from the Local 
Area Unemployment Statistics from the 
Bureau of Labor Statistics. 
‘‘(ii) APPLICATION TO CERTAIN TER-
RITORIES.—In the case of the Virgin Is-
lands, Guam, the Northern Mariana Is-
lands, American Samoa, or any other juris-
diction for which suitable data from the 
Local Area Unemployment Statistics from 
the Bureau of Labor Statistics are unavail-
able, the Secretary shall use data from the 
U–3 unemployment measure of the Bureau 
of Labor Statistics to make any necessary 
determinations under subparagraph (A). 
‘‘(3) INCREASED
FMAP
DURING
ECONOMIC 
DOWNTURN QUARTER.— 
‘‘(A) IN GENERAL.—During a fiscal quar-
ter that is an economic downturn quarter with 
respect to a State, the Federal medical assist-
ance percentage for the State and quarter de-
termined under subsection (b) shall be equal 
to— 
‘‘(i) the Federal medical assistance 
percentage determined for the State and 
quarter under subsection (b) without re-
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gard to this subsection (but including any 
increase to such percentage for such quar-
ter made pursuant to section 6008(a) of 
the Families First Coronavirus Response 
Act); increased by 
‘‘(ii) the number of percentage points 
(rounded to the nearest tenth of a percent-
age point) equal to the product of— 
‘‘(I) the number of percentage 
points (rounded to the nearest tenth 
of a percentage point) by which the 
unemployment rate for the State and 
quarter exceeds the percentage deter-
mined for the State and quarter 
under paragraph (2)(A)(ii); and 
‘‘(II) 4.8. 
‘‘(B) RULES
OF
APPLICATION.—The fol-
lowing rules shall apply with respect to the Fed-
eral medical assistance percentage determined 
for a State and an economic downturn quarter 
under this subsection: 
‘‘(i) SCOPE
OF
APPLICATION.—Such 
Federal medical assistance percentage shall 
not apply for purposes of— 
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‘‘(I) disproportionate share hos-
pital payments described in section 
1923; 
‘‘(II) payments under part D of 
title IV; or 
‘‘(III) any payments under this 
title that are based on a Federal med-
ical assistance percentage determined 
for a State under subsection (aa) (but 
only to the extent that such Federal 
medical assistance percentage is high-
er 
than 
the 
economic 
recovery 
FMAP). 
‘‘(ii) LIMITATION.—In no case shall— 
‘‘(I) the Federal medical assist-
ance percentage determined for a 
State and quarter pursuant to this 
subsection exceed 95 percent; or 
‘‘(II) any increase to the Federal 
medical assistance percentage deter-
mined for a State and quarter pursu-
ant to this subsection result in the ap-
plication of a Federal medical assist-
ance percentage that exceeds 95 per-
cent. 
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‘‘(iii) APPLICATION
TO
CHIP.—Not-
withstanding the first sentence of section 
2105(b), the application of this subsection 
may result in the enhanced FMAP of a 
State for a fiscal year under such section 
exceeding 85 percent, but in no case may 
the application of this subsection before 
application of the second sentence of such 
section result in the enhanced FMAP of 
the State exceeding 95 percent. 
‘‘(4) ADVANCE PAYMENT; RETROSPECTIVE AD-
JUSTMENT.— 
‘‘(A) IN GENERAL.—Prior to the beginning 
of each fiscal quarter that begins on or after 
July 1, 2020, the Secretary shall, with respect 
to each State— 
‘‘(i) make an initial determination, 
based on the projections made for the 
State and quarter under subparagraph 
(B), as to— 
‘‘(I) whether the application of 
this subsection is expected to result in 
the application of a higher Federal 
medical assistance percentage for the 
State and quarter than the percentage 
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for purposes of determining the Federal 
medical assistance percentage and en-
hanced FMAP of the State for the quarter; 
and 
‘‘(ii) 
in 
accordance 
with 
section 
1903(d)(2) and section 2105(e), reduce or 
increase the amount payable to the State 
under section 1903(a) or section 2105 for 
a subsequent fiscal quarter to the extent of 
any overpayment or underpayment under 
either such section which the Secretary de-
termines was made as a result of an incor-
rect initial determination under subpara-
graph (A)(i) with respect to the application 
of this subsection for purposes of deter-
mining the Federal medical assistance per-
centage and enhanced FMAP of the State 
for such prior fiscal quarter. 
‘‘(5) RETROSPECTIVE APPLICATION OF OVER- 
THE-LIMIT FMAP INCREASES.— 
‘‘(A) IN GENERAL.—If a State has excess 
percentage points with respect to an economic 
downturn quarter and an applicable FMAP (as 
determined under subparagraph (B)), the State 
may elect to apply such excess percentage 
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points to increase such applicable FMAP for 
one or more quarters during the look-back pe-
riod for the State and economic downturn quar-
ter in accordance with this paragraph. 
‘‘(B) EXCESS PERCENTAGE POINTS.—For 
purposes of this paragraph, the number of ex-
cess percentage points for a State, economic 
downturn quarter, and an applicable FMAP 
shall be equal to the number of percentage 
points by which— 
‘‘(i) the applicable FMAP for the 
State and quarter (after application of 
paragraph (3) but without regard to sub-
paragraph (B)(ii) of such paragraph); ex-
ceeds 
‘‘(ii) 95 percent. 
‘‘(C) EFFECT OF APPLICATION OF EXCESS 
PERCENTAGE
POINTS.—If a State elects to 
apply excess percentage points to an applicable 
FMAP to a quarter during a look-back period 
under this paragraph, the Secretary shall deter-
mine the additional amount of payment under 
section 1903(a) to which the State would have 
been entitled for such quarter if the applicable 
FMAP (as so increased) had been in effect for 
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such quarter, and shall treat such additional 
amount as an underpayment for such quarter. 
‘‘(D) DISTRIBUTION OF EXCESS PERCENT-
AGE POINTS.—A State that has excess percent-
age points with respect to an economic down-
turn quarter and applicable FMAP may elect to 
divide such points among more than 1 quarter 
during the look-back period for such State and 
quarter provided that no excess percentage 
point (or fraction of an excess percentage point) 
is applied to the applicable FMAP of more than 
1 quarter. 
‘‘(E) LIMITATIONS.— 
‘‘(i) NO
INCREASES
OVER
100
PER-
CENT.—A State may not increase an appli-
cable FMAP for any quarter during a look- 
back period under this paragraph if such 
increase would result in the applicable 
FMAP for such quarter exceeding 100 per-
cent. 
‘‘(ii) SCOPE
OF
APPLICATION.—Any 
increase to an applicable FMAP of a State 
for a fiscal quarter under this paragraph— 
‘‘(I) shall only apply with respect 
to payments for amounts expended by 
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the State for medical assistance for 
services furnished during such quarter 
to which such applicable FMAP is ap-
plicable; and 
‘‘(II) shall not apply with respect 
to payments described in paragraph 
(3)(B)(i). 
‘‘(F) DEFINITIONS.—In this paragraph: 
‘‘(i) APPLICABLE
FMAP.—The term 
‘applicable FMAP’ means, with respect to 
a State and fiscal quarter— 
‘‘(I) the Federal medical assist-
ance percentage determined for the 
State and quarter under subsection 
(b); 
‘‘(II) the Federal medical assist-
ance percentage applicable under sub-
section (y); 
‘‘(III) the Federal medical assist-
ance percentage applicable under sub-
section (z)(2); 
‘‘(IV) the Federal medical assist-
ance percentage determined for the 
State and quarter under subsection 
(ff); or 
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‘‘(V) the enhanced FMAP deter-
mined for the State and quarter 
under section 2105(b). 
‘‘(ii) LOOK-BACK PERIOD.—The term 
‘look-back period’ means, with respect to a 
State and a fiscal quarter that is an eco-
nomic downturn quarter for the State, the 
period of 4 fiscal quarters that ends with 
the fourth quarter which precedes the most 
recent fiscal quarters that was not an eco-
nomic downturn quarter for the State. 
‘‘(6) REQUIREMENT
FOR
ALL
STATES.—This 
subsection shall not apply to a State with respect to 
a fiscal quarter, if— 
‘‘(A) eligibility standards, methodologies, 
or procedures under the State plan or a waiver 
of such plan are more restrictive during such 
quarter than the eligibility standards, meth-
odologies, or procedures, respectively, under 
such plan (or waiver) as in effect on the last 
day of the most recent fiscal quarter that was 
not an economic downturn quarter for the 
State; 
‘‘(B) the amount of any premium imposed 
by the State pursuant to section 1916 or 1916A 
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during such quarter, with respect to an indi-
vidual enrolled under such plan (or waiver), ex-
ceeds the amount of such premium as of the 
date described in subparagraph (A); or 
‘‘(C) the State fails to provide that an in-
dividual who is enrolled for benefits under such 
plan (or waiver) as of the date described in sub-
paragraph (A) or enrolls for benefits under 
such plan (or waiver) during the period begin-
ning with such date and ending with the day 
before the first day of the next quarter that is 
not an economic downturn quarter for the State 
shall be treated as eligible for such benefits for 
not less than 12 months after such date or (if 
later) the date that such individual so enrolls 
unless the individual requests a voluntary ter-
mination of eligibility or the individual ceases to 
be a resident of the State.’’. 
(b) EXCLUSION OF ECONOMIC DOWNTURN FMAP 
INCREASES FROM TERRITORIAL CAPS; SPECIAL RULE 
FOR CHIP ALLOTMENTS.— 
(1) EXCLUSION
FROM
TERRITORIAL
CAPS.— 
Section 1108 of the Social Security Act (42 U.S.C. 
1308) is amended— 
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(A) in subsection (f), in the matter pre-
ceding paragraph (1), by striking ‘‘subsection 
(g) and section 1935(e)(1)(B)’’ and inserting 
‘‘subsections 
(g) 
and 
(h) 
and 
section 
1935(e)(1)(B)’’; and 
(B) by adding at the end the following: 
‘‘(h) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB-
UTABLE TO ECONOMIC DOWNTURN FMAP.—Any pay-
ment made to a territory for a fiscal year in which the 
Federal medical assistance percentage for the territory is 
determined under section 1905(hh) shall not be taken into 
account for purposes of applying payment limits under 
subsections (f) and (g) to the extent that such payment 
exceeds the amount of the payment that would have been 
made to the territory for the year if the Federal medical 
assistance percentage for the territory had been deter-
mined without regard to such section.’’. 
(2) CHIP ALLOTMENTS.—Section 2104(m) of 
the Social Security Act (42 U.S.C. 1397dd(m)) is 
amended— 
(A) in paragraph (2)(B), in the matter 
preceding clause (i), by striking ‘‘paragraphs 
(5) and (7)’’ and inserting ‘‘paragraphs (5), 
(7), and (12)’’; and 
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(B) by adding at the end the following new 
paragraph: 
‘‘(12) SPECIAL RULE FOR ADJUSTING ALLOT-
MENTS
DURING
FISCAL
YEARS
WITH
ECONOMIC 
DOWNTURN QUARTERS.— 
‘‘(A) IN GENERAL.—If a fiscal quarter oc-
curring during fiscal year 2020 or any suc-
ceeding fiscal year is determined to be an eco-
nomic downturn quarter with respect to a State 
(as determined under section 1905(hh)) then, 
as soon as practicable after such determination, 
the Secretary shall increase the allotment for 
the State and fiscal year in accordance with 
subparagraph (B). 
‘‘(B) AMOUNT OF INCREASE.— 
‘‘(i) IN GENERAL.—The amount of an 
increase to the allotment of a State de-
scribed in subparagraph (A) for a fiscal 
year shall be equal to the amount by which 
Federal payments made to the State for 
the preceding fiscal year under this title 
would have been increased (without regard 
to whether such payments would exceed 
the amount of the State’s allotment for 
such preceding fiscal year) if the enhanced 
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FMAP determined for the State for such 
preceding fiscal year had been increased to 
the same extent that the State’s enhanced 
FMAP for the fiscal year involved is ex-
pected to be increased as a result of the 
application of section 1905(hh) relative to 
the enhanced FMAP that would apply to 
the State for the fiscal year involved with-
out the application of such section. 
‘‘(ii) INCLUSION
OF
PROJECTED
IN-
CREASES.—In increasing the allotment of a 
State for a fiscal year under this para-
graph, the Secretary may base the calcula-
tion of such increase on projections made 
by the Secretary with respect to— 
‘‘(I) the number of fiscal quar-
ters during such fiscal year that will 
be economic downturn quarters; and 
‘‘(II) the effect that the applica-
tion of section 1905(hh) is expected to 
have on the enhanced FMAP of the 
State for such fiscal year. 
‘‘(C) DISREGARD
OF
INCREASED
PAY-
MENTS
FOR
PURPOSES
OF
FUTURE
ALLOT-
MENTS.—Any Federal payment made to a State 
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under this title for a fiscal year in which the 
Federal medical assistance percentage for the 
State is determined under section 1905(hh) 
shall be disregarded when determining the allot-
ment of the State for any subsequent year, in-
cluding for purposes of applying this paragraph, 
to the extent that such payment exceeds the 
amount of the payment that would have been 
made to the State for the year if the Federal 
medical assistance percentage for the State and 
year had been determined without regard to 
such section.’’. 
(c) CONFORMING AMENDMENTS.—Section 1905(cc) 
of the Social Security Act (42 U.S.C. 1396d(cc)) is 
amended— 
(1) by striking ‘‘and section 6008 of the Fami-
lies First Coronavirus Response Act’’ and inserting 
‘‘, section 6008 of the Families First Coronavirus 
Response Act, and subsection (hh) of this section’’; 
and 
(2) by inserting ‘‘, and, in applying such treat-
ments to an increase in the Federal medical assist-
ance percentage of a State under subsection (hh) 
with respect to a fiscal quarter that is an economic 
downturn quarter for the State, the reference to 
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‘December 31, 2009’ shall be deemed to be a ref-
erence to ‘March 11, 2020’, or, if later, the last day 
of the most recent fiscal quarter that was not an 
economic downturn quarter for the State’’ before the 
period. 
Æ 
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