State for such quarter under this sub-
section based on the projections made for 
the State and quarter under subparagraph 
(B); and 
‘‘(ii) shall apply such increase to the 
Federal medical assistance percentage of 
the State for purposes of making payments 
to the State for amounts expended during 
such quarter as medical assistance under 
the State plan. 
‘‘(B) PROJECTION OF STATE UNEMPLOY-
MENT RATES.—Prior to the beginning of each 
fiscal quarter that begins on or after July 1, 
2020, the Secretary, acting through the Chief 
Actuary of the Centers for Medicare & Medicaid 
Services, shall, using the most recently available 
data described in paragraph (2)(B), make pro-
jections with respect to— 
‘‘(i) the unemployment rates for each 
State for such quarter; 
‘‘(ii) the threshold percentages de-
scribed in paragraph (2)(A)(ii) for each 
State for such quarter; and 
‘‘(iii) the national unemployment rate 
for such quarter. 
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‘‘(C) RETROSPECTIVE
ADJUSTMENT.—As 
soon as practicable after final unemployment 
data becomes available for a fiscal quarter that 
begins on or after July 1, 2020, the Secretary 
shall, with respect to each State— 
‘‘(i) make a final determination of the 
increase (if any) applicable to the Federal 
medical assistance percentage of the State 
for the quarter under this subsection; and 
‘‘(ii) in accordance with subsection 
(d)(2) of section 1903, reduce or increase 
the amount payable to the State under 
subsection (a) of such section for a subse-
quent fiscal quarter to the extent of any 
overpayment or underpayment which the 
Secretary determines was made as a result 
of a miscalculation of the increase applica-
ble to the Federal medical assistance per-
centage of the State for such prior fiscal 
quarter under this subsection. 
‘‘(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 
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determined under subparagraph (B)), the State 
may elect to apply such excess percentage 
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 (C) of such paragraph); exceeds 
‘‘(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 
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FMAP (as so increased) had been in effect for 
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— 
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‘‘(I) shall only apply with respect 
to payments for amounts expended by 
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)(D). 
‘‘(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); or 
‘‘(IV) the Federal medical assist-
ance percentage determined for the 
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State and quarter under subsection 
(ff). 
‘‘(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.—A State 
may not receive an increase in the Federal medical 
assistance percentage for such State under this sub-
section, 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 (or, if such period is 
less than 12 months, throughout such period) 
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.—Section 1108 of 
the Social Security Act (42 U.S.C. 1308) is amended— 
(1) in subsection (f), in the matter preceding 
paragraph (1), by striking ‘‘subsection (g) and sec-
tion 1935(e)(1)(B)’’ and inserting ‘‘subsections (g) 
and (h) and section 1935(e)(1)(B)’’; and 
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(2) by adding at the end the following: 
‘‘(h) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB-
UTABLE TO ECONOMIC DOWNTURN FMAP.—The portion 
of any payment made to a territory for a fiscal year that 
is attributable to an increase in the Federal medical assist-
ance percentage for a fiscal quarter during such year 
under section 1905(gg) shall not be taken into account 
for purposes of applying payment limits under subsections 
(f) and (g).’’. 
Æ 
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