I 
115TH CONGRESS 
1ST SESSION 
H. R. 682 
To amend titles XIX and XXI of the Social Security Act to eliminate the 
CHIP maintenance of effort requirement and to eliminate DSH cuts 
for States not implementing the ACA Medicaid expansion. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 24, 2017 
Mr. MULLIN (for himself, Mr. RUSSELL, and Mr. GROTHMAN) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend titles XIX and XXI of the Social Security Act 
to eliminate the CHIP maintenance of effort requirement 
and to eliminate DSH cuts for States not implementing 
the ACA Medicaid expansion. 
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 ‘‘Preserving Access to 
Medicaid for Americans Act of 2017’’. 
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SEC. 2. ELIMINATION OF MOE REQUIREMENT FOR CHIP 
ELIGIBILITY. 
Section 2105(d)(3) of the Social Security Act (42 
U.S.C. 1397ee(d)(3)) is amended by striking ‘‘September 
30, 2019’’ and inserting ‘‘the date of the enactment of 
the Preserving Access to Medicaid for Americans Act of 
2017’’. 
SEC. 3. ELIMINATION OF DSH CUTS FOR STATES NOT IM-
PLEMENTING ACA EXPANSION. 
(a) IN GENERAL.—Section 1923(f)(7) of the Social 
Security Act (42 U.S.C. 1396r–4(f)(7)) is amended— 
(1) in subparagraph (A)— 
(A) in clause (i)— 
(i) in the matter preceding subclause 
(I), by striking ‘‘each of fiscal years 2018 
through 2025’’ and inserting ‘‘each of fis-
cal years 2019 through 2028’’; and 
(ii) in subclause (I)— 
(I) by striking ‘‘the amount spec-
ified under the DSH health reform 
methodology 
under 
subparagraph 
(B)’’ and inserting ‘‘the amount of 
the aggregate reduction target’’; and 
(II) by striking ‘‘DSH allotments 
to States’’ and inserting ‘‘the DSH al-
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lotment to each expansion State’’ each 
place it appears; 
(B) in clause (ii)— 
(i) in the matter preceding subclause 
(I), by striking ‘‘The aggregate reduc-
tions’’ and inserting ‘‘In applying subpara-
graph (B), the aggregate reduction tar-
gets’’; 
(ii) by striking subclause (I); 
(iii) by redesignating subclauses (II) 
through (VIII) as subclauses (I) through 
(VII), respectively; 
(iv) in subclause (VI) (as so redesig-
nated), by striking ‘‘and’’ at the end; 
(v) in subclause (VII) (as so redesig-
nated), by striking the period at the end 
and inserting ‘‘; and’’; and 
(vi) by adding at the end the following 
new subclause: 
‘‘(VIII) $8,000,000,000 for fiscal 
years 2027 and 2028.’’; 
(C) by amending clause (iv) to read as fol-
lows: 
‘‘(iv) DEFINITIONS.—For purposes of 
this paragraph: 
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‘‘(I) The term ‘expansion State’ 
means, for a fiscal year, a State that, 
as of the date that is 180 days before 
the start of such fiscal year, provides 
for eligibility under clause (i)(VIII) or 
(ii)(XX) of section 1902(a)(10)(A) for 
medical assistance under this title (or 
a waiver of the State plan approved 
under section 1115). 
‘‘(II) The term ‘non-expansion 
State’ means, for a fiscal year, a 
State that is not an expansion State 
for such fiscal year. 
‘‘(III) The term ‘State’ means 
the 50 States and the District of Co-
lumbia.’’; and 
(D) in clause (v), by striking ‘‘DISTRIBU-
TION OF AGGREGATE REDUCTIONS.—The Sec-
retary shall distribute the aggregate reductions 
under clause (ii) among States’’ and inserting 
‘‘DISTRIBUTION
OF
AGGREGATE
REDUCTION 
TARGETS.—The Secretary shall distribute the 
aggregate reduction targets under clause (ii) 
among all the States (including non-expansion 
States)’’; and 
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(2) in subparagraph (B), by adding at the end 
the following new clause: 
‘‘(iv) The methodology imposes reduc-
tion targets as if the reductions under sub-
paragraph (A) were applied to all States, 
including non-expansion States.’’. 
(b) CONFORMING AMENDMENT.—Section 1923(f)(8) 
of the Social Security Act (42 U.S.C. 1396r–4(f)(8)) is 
amended by striking ‘‘fiscal year 2025’’ and inserting ‘‘fis-
cal year 2028’’. 
Æ 
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