I 
111TH CONGRESS 
1ST SESSION H. R. 3001 
To address the health disparities experienced by lesbian, gay, bisexual, and 
transgender Americans, to eliminate the barriers they face in accessing 
quality health care, and to ensure that good health and well-being is 
accessible to all. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 23, 2009 
Ms. BALDWIN (for herself, Mr. WAXMAN, Ms. LEE of California, Mr. HONDA, 
and Ms. VELA´ZQUEZ) introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Commit-
tees on Armed Services, the Judiciary, Ways and Means, Oversight and 
Government Reform, House Administration, Education and Labor, Vet-
erans’ Affairs, Transportation and Infrastructure, Select Intelligence 
(Permanent Select), and Foreign Affairs, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To address the health disparities experienced by lesbian, 
gay, bisexual, and transgender Americans, to eliminate 
the barriers they face in accessing quality health care, 
and to ensure that good health and well-being is acces-
sible to all. 
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 ‘‘Ending LGBT Health 
Disparities Act’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents of this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
Sec. 3. Definition. 
Sec. 4. Effective date. 
TITLE I—HEALTH ACCESS AND PROMOTION 
Subtitle A—Private Health Insurance 
Sec. 101. Tax Equity for Health Plan Beneficiaries Act. 
Sec. 102. Preexisting condition exclusion patient protection. 
Sec. 103. Domestic Partnership Benefits and Obligations Act. 
Subtitle B—Public Health Insurance 
Sec. 111. Optional Medicaid coverage of low-income HIV-infected individuals. 
Sec. 112. Expanded definition of spouse for purposes of the Medicare program. 
Sec. 113. Ending the Medicare Disability Waiting Period Act. 
Sec. 114. Including costs incurred by AIDS drug assistance programs in pro-
viding prescription drugs toward the annual out-of-pocket 
threshold under Medicare part D. 
Sec. 115. Nondiscrimination based on gender identity or sexual orientation 
under the Medicaid, Medicare, and CHIP programs. 
Subtitle C—Miscellaneous 
Sec. 121. Health Promotion Grants. 
Sec. 122. Mental Health Promotion Grants. 
Sec. 123. Health Insurance Coverage Grants. 
TITLE II—CULTURAL COMPETENCY AND WORKFORCE 
Sec. 201. Amendment to the Public Health Service Act. 
Sec. 202. Definitions. 
Sec. 203. Federal reimbursement for culturally competent services under the 
Medicare, Medicaid, and Children’s Health Insurance Pro-
grams. 
Sec. 204. Report on Federal efforts to provide culturally competent health care 
services to sexual and gender minorities. 
TITLE III—RESEARCH AND DATA COLLECTION 
Sec. 301. No compelled disclosure of data. 
Sec. 302. Federal collection of data on sexual and gender minorities. 
Sec. 303. Inclusion of sexual orientation and gender identity in federally funded 
health surveys. 
Sec. 304. Research on sexual and gender minority health. 
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TITLE IV—INFRASTRUCTURE AND CAPACITY BUILDING 
Sec. 401. Office of LGBT Health. 
Sec. 402. Community health centers. 
TITLE V—OLDER AMERICANS SUPPORT PROGRAM 
Sec. 501. Priority. 
TITLE VI—MISCELLANEOUS PROVISIONS 
Sec. 601. Nondiscrimination contingency for VAWA grant funds; Grant pro-
gram for LGBT victims of violence. 
Sec. 602. National Baseline Study on Domestic Violence and Sexual Assault in 
the LGBT Community. 
Sec. 603. Assistance to reduce teen pregnancy, HIV/AIDS, and other sexually 
transmitted diseases and to support healthy adolescent develop-
ment. 
Sec. 604. Mother’s and father’s insurance benefits under Social Security for 
same-sex surviving parents. 
Sec. 605. Prohibition against discrimination on the basis of sexual orientation 
or gender identity under the health benefits program for Fed-
eral employees. 
Sec. 606. Prohibition against discrimination on the basis of sex, gender iden-
tity, or sexual orientation under certain laws providing health 
care and other benefits for members of the Armed Forces and 
Veterans. 
SEC. 3. DEFINITION. 
In this Act: 
(1) Unless otherwise specified, the term ‘‘Sec-
retary’’ means the Secretary of Health and Human 
Services. 
(2) The terms ‘‘sexual or gender minority’’ and 
‘‘sexual and gender minority’’ mean a lesbian, gay, 
bisexual, or transgender individual. 
SEC. 4. EFFECTIVE DATE. 
Unless otherwise specified, this Act and the amend-
ments made this Act shall take effect on the date that 
is 30 days after the date of the enactment of this Act. 
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TITLE I—HEALTH ACCESS AND 
PROMOTION 
Subtitle A—Private Health 
Insurance 
SEC. 101. TAX EQUITY FOR HEALTH PLAN BENEFICIARIES 
ACT. 
(a) APPLICATION OF ACCIDENT AND HEALTH PLANS 
TO ELIGIBLE BENEFICIARIES.— 
(1) EXCLUSION
OF
CONTRIBUTIONS.—Section 
106 of the Internal Revenue Code of 1986 (relating 
to contributions by employer to accident and health 
plans) is amended by adding at the end the following 
new subsection: 
‘‘(f) COVERAGE PROVIDED
FOR ELIGIBLE BENE-
FICIARIES OF EMPLOYEES.— 
‘‘(1) IN GENERAL.—Subsection (a) shall apply 
with respect to an eligible beneficiary and any quali-
fying child who is a dependent of the eligible bene-
ficiary. 
‘‘(2) QUALIFYING
CHILD; DEPENDENT.—For 
purposes of this subsection— 
‘‘(A) 
QUALIFYING
CHILD.—The 
term 
‘qualifying child’ has the meaning given such 
term by section 152(c). 
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‘‘(B) DEPENDENT.—The term ‘dependent’ 
has the meaning given such term by section 
105(b).’’. 
(2) EXCLUSION OF AMOUNTS EXPENDED FOR 
MEDICAL
CARE.—The first sentence of section 
105(b) of such Code (relating to amounts expended 
for medical care) is amended by inserting before the 
period the following: ‘‘and eligible beneficiary and 
the qualifying children of the eligible beneficiary 
(within the meaning of section 106(f)) with respect 
to the taxpayer’’. 
(3) PAYROLL TAXES.— 
(A) Section 3121(a)(2) of such Code is 
amended— 
(i) by inserting ‘‘, or his eligible bene-
ficiary or any qualifying children of the eli-
gible beneficiary,’’ after ‘‘his dependents’’ 
both places it appears, 
(ii) by inserting ‘‘, and eligible bene-
ficiaries and qualifying children of eligible 
beneficiaries (within the meaning of section 
106(f)),’’ after ‘‘their dependents’’ the first 
place it appears, and 
(iii) by inserting ‘‘, eligible bene-
ficiaries, and qualifying children of eligible 
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beneficiaries’’ after ‘‘their dependents’’ the 
second place it appears. 
(B) Section 3231(e)(1) of such Code is 
amended— 
(i) by inserting ‘‘, or his eligible bene-
ficiary or any qualifying children of his eli-
gible beneficiary,’’ after ‘‘his dependents’’, 
(ii) by inserting ‘‘, and eligible bene-
ficiaries and qualifying children of eligible 
beneficiaries (within the meaning of section 
106(f)),’’ after ‘‘their dependents’’ the first 
place it appears, and 
(iii) by inserting ‘‘, eligible bene-
ficiaries, and qualifying children of eligible 
beneficiaries’’ after ‘‘their dependents’’ the 
second place it appears. 
(C) Section 3306(b)(2) of such Code is 
amended— 
(i) by inserting ‘‘, or his eligible bene-
ficiary or any qualifying children of his eli-
gible beneficiary,’’ after ‘‘his dependents’’ 
both places it appears, 
(ii) by inserting ‘‘, and eligible bene-
ficiaries and qualifying children of eligible 
beneficiaries (within the meaning of section 
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106(f)),’’ after ‘‘their dependents’’ the first 
place it appears, and 
(iii) by inserting ‘‘, eligible bene-
ficiaries, and qualifying children of eligible 
beneficiaries’’ after ‘‘their dependents’’ the 
second place it appears. 
(D) Section 3401(a) of such Code is 
amended by striking ‘‘or’’ at the end of para-
graph (21), by striking the period at the end of 
paragraph (22) and inserting ‘‘; or’’, and by in-
serting after paragraph (22) the following new 
paragraph: 
‘‘(23) for any payment made to or for the ben-
efit of an employee or his eligible beneficiary or any 
qualifying children of his eligible beneficiary (within 
the meaning of section 106(f)) if at the time of such 
payment it is reasonable to believe that the employee 
will be able to exclude such payment from income 
under section 106(f) or under section 105 by ref-
erence in section 105(b) to section 106(f);’’. 
(4) EFFECTIVE DATE.—The amendments made 
by this section shall apply to taxable years beginning 
after December 31, 2009. 
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(b) EXPANSION OF DEPENDENCY FOR PURPOSES OF 
DEDUCTION FOR HEALTH INSURANCE COSTS OF SELF- 
EMPLOYED INDIVIDUALS.— 
(1) IN GENERAL.—Subsection (l) of section 162 
of the Internal Revenue Code of 1986 (relating to 
special rules for health insurance costs of self-em-
ployed individuals) is amended by adding at the end 
the following new paragraph: 
‘‘(6) DEPENDENTS.—For purposes of this sub-
section, the term ‘dependents’ shall include the fol-
lowing with respect to the taxpayer— 
‘‘(A) any individual who satisfies the re-
quirements 
of 
sections 
152(c)(3)(A) 
and 
152(d)(2)(H) (determined without regard to 
subsections (d)(1)(B) and (d)(1)(D) thereof), 
and 
‘‘(B) one individual who does not satisfy 
the requirements of section 152(c)(3)(A), but 
who satisfies the requirements of section 
152(d)(2)(H) (determined without regard to 
subsections (d)(1)(B) and (d)(1)(C) thereof).’’. 
(2) CONFORMING AMENDMENT.—Subparagraph 
(B) of section 162(l)(2) of such Code is amended by 
inserting ‘‘or dependent (as defined in paragraph 
(1))’’ after ‘‘spouse’’. 
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(3) EFFECTIVE DATE.—The amendments made 
by this section shall apply to taxable years beginning 
after December 31, 2009. 
(c) EXTENSION
TO ELIGIBLE BENEFICIARIES
OF 
SICK AND ACCIDENT BENEFITS PROVIDED TO MEMBERS 
OF A VOLUNTARY EMPLOYEES’ BENEFICIARY ASSOCIA-
TION AND THEIR DEPENDENTS.— 
(1) IN GENERAL.—Section 501(c)(9) of the In-
ternal Revenue Code of 1986 (relating to list of ex-
empt organizations) is amended by adding at the 
end the following new sentence: ‘‘For purposes of 
providing for the payment of sick and accident bene-
fits to members of such an association and their de-
pendents, the term ‘dependents’ shall include any in-
dividual who is an eligible beneficiary, or qualified 
child of an eligible beneficiary, as determined under 
the terms of a medical benefit, health insurance, or 
other program under which members and their de-
pendents are entitled to sick and accident benefits.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by this section shall apply to taxable years beginning 
after December 31, 2009. 
(d) FLEXIBLE
SPENDING
ARRANGEMENTS
AND 
HEALTH REIMBURSEMENT ARRANGEMENTS.—The Sec-
retary of Treasury shall issue guidance of general applica-
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months’’ and inserting ‘‘3 months’’, and by 
striking 
‘‘18 
months’’ 
and 
inserting 
‘‘9 
months’’. 
(3) AMENDMENTS TO THE INTERNAL REVENUE 
CODE OF 1986.— 
(A) REDUCTION IN LOOK-BACK PERIOD.— 
Paragraph (1) of section 9801(a) of the Inter-
nal Revenue Code of 1986 (relating to limita-
tion on preexisting condition exclusion period 
and crediting for periods of previous coverage) 
is amended by striking ‘‘6-month period’’ and 
inserting ‘‘30-day period’’. 
(B) REDUCTION
IN
PERMITTED
PRE-
EXISTING
CONDITION
LIMITATION
PERIOD.— 
Paragraph (2) of section 9801(a) of such Code 
is amended by striking ‘‘12 months’’ and insert-
ing ‘‘3 months’’, and by striking ‘‘18 months’’ 
and inserting ‘‘9 months’’. 
(4) EFFECTIVE DATE.— 
(A) IN GENERAL.—Except as provided in 
paragraph (2), the amendments made by this 
subsection shall apply with respect to group 
health plans for plan years beginning after the 
end of the 12th calendar month following the 
date of the enactment of this Act. 
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(B) SPECIAL RULE FOR COLLECTIVE BAR-
GAINING AGREEMENTS.—In the case of a group 
health plan maintained pursuant to one or more 
collective bargaining agreements between em-
ployee representatives and one or more employ-
ers ratified before the date of the enactment of 
this Act, the amendments made by this sub-
section shall not apply to plan years beginning 
before the earlier of— 
(i) the date on which the last of the 
collective bargaining agreements relating to 
the plan terminates (determined without 
regard to any extension thereof agreed to 
after the date of the enactment of this 
Act), or 
(ii) 3 years after the date of the en-
actment of this Act. 
For purposes of clause (i), any plan amendment 
made pursuant to a collective bargaining agree-
ment relating to the plan which amends the 
plan solely to conform to any requirement 
added by the amendments made by this sub-
section shall not be treated as a termination of 
such collective bargaining agreement. 
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(b) AMENDMENTS RELATING TO PREEXISTING CON-
DITION EXCLUSIONS IN HEALTH INSURANCE COVERAGE 
IN THE INDIVIDUAL MARKET.— 
(1) APPLICABILITY OF GROUP HEALTH INSUR-
ANCE LIMITATIONS ON IMPOSITION OF PREEXISTING 
CONDITION EXCLUSIONS.— 
(A) IN GENERAL.—Subpart 1 of part B of 
title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg–41 et seq.) is amended by in-
serting after section 2741 the following: 
‘‘SEC. 2741A. APPLICATION OF GROUP HEALTH INSURANCE 
LIMITATIONS 
ON 
IMPOSITION 
OF 
PRE-
EXISTING CONDITION EXCLUSIONS. 
‘‘(a) IN GENERAL.—Subject to subsection (b), a 
health insurance issuer that provides individual health in-
surance coverage may not impose a preexisting condition 
exclusion (as defined in subsection (b)(1)(A) of section 
2701) with respect to such coverage except to the extent 
that such exclusion could be imposed consistent with such 
section if such coverage were group health insurance cov-
erage. 
‘‘(b) LIMITATION.—In the case of an individual 
who— 
‘‘(1) is enrolled in individual health insurance 
coverage; 
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‘‘(2) during the period of such enrollment has 
a condition for which no medical advice, diagnosis, 
care, or treatment had been recommended or re-
ceived as of the enrollment date; and 
‘‘(3) seeks to enroll under other individual 
health insurance coverage which provides benefits 
different from those provided under the coverage re-
ferred to in paragraph (1) with respect to such con-
dition, 
the issuer of the individual health insurance coverage de-
scribed in paragraph (2) may impose a preexisting condi-
tion exclusion with respect to such condition and any bene-
fits in addition to those provided under the coverage re-
ferred to in paragraph (1), but such exclusion may not 
extend for a period of more than 3 months. 
‘‘SEC. 2741B. ELIGIBILITY TO ENROLL. 
‘‘(a) IN GENERAL.—Subject to subsection (d), an in-
dividual health plan, and a health insurance issuer offer-
ing health insurance in the individual market, may not de-
cline to offer coverage to, deny enrollment of, or establish 
rules for eligibility (including continued eligibility) to en-
roll under the terms of the plan, an individual based on 
any of the following health status-related factors in rela-
tion to the individual or a dependent of the individual: 
‘‘(1) Health status. 
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‘‘(2) Medical condition (including both physical 
and mental illnesses). 
‘‘(3) Claims experience. 
‘‘(4) Receipt of health care. 
‘‘(5) Medical history. 
‘‘(6) Genetic information. 
‘‘(7) Evidence of insurability (including condi-
tions arising out of acts of domestic violence). 
‘‘(8) Disability. 
‘‘(b) NO APPLICATION
TO BENEFITS
OR EXCLU-
SIONS.—To the extent consistent with section 2701, sub-
section (a) shall not be construed— 
‘‘(1) to require an individual health plan, or a 
health insurance issuer offering health insurance on 
the individual market, to provide particular benefits 
other than those provided under the terms of such 
plan or coverage; or 
‘‘(2) to prevent such a plan or coverage from 
establishing limitations or restrictions on the 
amount, level, extent, or nature of the benefits or 
coverage for similarly situated individuals enrolled in 
the plan or coverage. 
‘‘(c) RULES FOR ELIGIBILITY.—In subsection (a), 
the term ‘rules for eligibility’, with respect to enrollment 
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under the terms of a plan, includes any rule defining any 
applicable waiting period for such enrollment. 
‘‘(d) IN PREMIUM CONTRIBUTIONS.— 
‘‘(1) IN GENERAL.—An individual health plan, 
and a health insurance issuer offering health insur-
ance on the individual market, may not require any 
individual (as a condition of enrollment or continued 
enrollment under the plan) to pay a premium or 
contribution which is greater than such premium or 
contribution for a similarly situated individual en-
rolled in the plan on the basis of any health status- 
related factor in relation to the individual or to an 
individual enrolled under the plan as a dependent of 
the individual. 
‘‘(2) CONSTRUCTION.—Nothing in subsection 
(a) shall be construed to prevent an individual 
health plan, and a health insurance issuer offering 
health insurance on the individual market from es-
tablishing premium discounts or rebates or modi-
fying otherwise applicable copayments or deductibles 
in return for adherence to programs of health pro-
motion and disease prevention.’’. 
(B) ELIMINATION
OF
COBRA
REQUIRE-
MENT.—Subsection (b) of section 2741 of the 
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Public Health Service Act (42 U.S.C. 300gg– 
41) is amended— 
(i) by adding ‘‘and’’ at the end of 
paragraph (2); 
(ii) by striking the semicolon at the 
end of paragraph (3) and inserting a pe-
riod; and 
(iii) by striking paragraphs (4) and 
(5). 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to health 
insurance coverage offered, sold, issued, renewed, in 
effect, or operated in the individual market after the 
end of the 12th calendar month following the date 
of the enactment of this Act. 
SEC. 103. DOMESTIC PARTNERSHIP BENEFITS AND OBLIGA-
TIONS ACT. 
(a) BENEFITS TO DOMESTIC PARTNERS OF FED-
ERAL EMPLOYEES.— 
(1) IN GENERAL.—An employee who has a do-
mestic partner and the domestic partner of the em-
ployee shall be entitled to benefits available to, and 
shall be subject to obligations imposed upon, a mar-
ried employee and the spouse of the employee. 
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(2) CERTIFICATION OF ELIGIBILITY.—In order 
to obtain benefits and assume obligations under this 
section, an employee shall file an affidavit of eligi-
bility for benefits and obligations with the Office of 
Personnel Management identifying the domestic 
partner of the employee and certifying that the em-
ployee and the domestic partner of the employee— 
(A) are each other’s sole domestic partner 
and intend to remain so indefinitely; 
(B) have a common residence, and intend 
to continue the arrangement; 
(C) are at least 18 years of age and men-
tally competent to consent to contract; 
(D) share responsibility for a significant 
measure of each other’s common welfare and fi-
nancial obligations; 
(E) are not married to or domestic part-
ners with anyone else; 
(F) are same sex domestic partners, and 
not related in a way that, if the 2 were of the 
opposite sex, would prohibit legal marriage in 
the State in which they reside; and 
(G) understand that willful falsification of 
information within the affidavit may lead to dis-
ciplinary action and the recovery of the cost of 
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benefits received related to such falsification 
and may constitute a criminal violation. 
(3) DISSOLUTION OF PARTNERSHIP.— 
(A) IN GENERAL.—An employee or domes-
tic partner of an employee who obtains benefits 
under this section shall file a statement of dis-
solution of the domestic partnership with the 
Office of Personnel Management not later than 
30 days after the death of the employee or the 
domestic partner or the date of dissolution of 
the domestic partnership. 
(B) DEATH OF EMPLOYEE.—In a case in 
which an employee dies, the domestic partner of 
the employee at the time of death shall receive 
under this section such benefits as would be re-
ceived by the widow or widower of an employee. 
(C) OTHER
DISSOLUTION
OF
PARTNER-
SHIP.— 
(i) IN GENERAL.—In a case in which 
a domestic partnership dissolves by a 
method other than death of the employee 
or domestic partner of the employee, any 
benefits received by the domestic partner 
as a result of this section shall terminate. 
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(ii) EXCEPTION.—In a case in which 
a domestic partnership dissolves by a 
method other than death of the employee 
or domestic partner of the employee, the 
former domestic partner of the employee 
shall be entitled to benefits available to, 
and shall be subject to obligations imposed 
upon, a former spouse. 
(4) STEPCHILDREN.—For purposes of affording 
benefits under this section, any natural or adopted 
child of a domestic partner of an employee shall be 
deemed a stepchild of the employee. 
(5) CONFIDENTIALITY.—Any information sub-
mitted to the Office of Personnel Management under 
paragraph (2) shall be used solely for the purpose of 
certifying an individual’s eligibility for benefits 
under paragraph (1). 
(6) REGULATIONS AND ORDERS.— 
(A) OFFICE
OF
PERSONNEL
MANAGE-
MENT.—Not later than 6 months after the date 
of enactment of this Act, the Office of Per-
sonnel Management shall promulgate regula-
tions to implement paragraphs (2) and (3). 
(B) OTHER EXECUTIVE BRANCH REGULA-
TIONS.—Not later than 6 months after the date 
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of enactment of this Act, the President or des-
ignees of the President shall promulgate regula-
tions to implement this section with respect to 
benefits and obligations administered by agen-
cies or other entities of the executive branch. 
(C) OTHER REGULATIONS AND ORDERS.— 
Not later than 6 months after the date of en-
actment of this Act, each agency or other entity 
or official not within the executive branch that 
administers a program providing benefits or im-
posing obligations shall promulgate regulations 
or orders to implement this section with respect 
to the program. 
(D) PROCEDURE.—Regulations and orders 
required under this paragraph shall be promul-
gated after notice to interested persons and an 
opportunity for comment. 
(7) DEFINITIONS.—In this section: 
(A) 
BENEFITS.—The 
term 
‘‘benefits’’ 
means— 
(i) health insurance and enhanced 
dental and vision benefits, as provided 
under chapters 89, 89A, and 89B of title 
5, United States Code; 
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(ii) retirement and disability benefits 
and plans, as provided under— 
(I) chapters 83 and 84 of title 5, 
United States Code; 
(II) chapter 8 of the Foreign 
Service Act of 1980 (22 U.S.C. 4041 
et seq.); and 
(III) the Central Intelligence 
Agency Retirement Act of 1964 for 
Certain Employees (50 U.S.C. chapter 
38); 
(iii) family, medical, and emergency 
leave, as provided under— 
(I) subchapters III, IV, and V of 
chapter 63 of title 5, United States 
Code; 
(II) the Family and Medical 
Leave Act of 1993 (29 U.S.C. 2601 et 
seq.), insofar as that Act applies to 
the Government Accountability Office 
and the Library of Congress; 
(III) section 202 of the Congres-
sional Accountability Act of 1995 (2 
U.S.C. 1312); and 
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(IV) section 412 of title 3, 
United States Code; 
(iv) Federal group life insurance, as 
provided under chapter 87 of title 5, 
United States Code; 
(v) long-term care insurance, as pro-
vided under chapter 90 of title 5, United 
States Code; 
(vi) compensation for work injuries, as 
provided under chapter 81 of title 5, 
United States Code; 
(vii) benefits for disability, death, or 
captivity, as provided under— 
(I) sections 5569 and 5570 of 
title 5, United States Code; 
(II) section 413 of the Foreign 
Service Act of 1980 (22 U.S.C. 3973); 
(III) part L of title I of the Om-
nibus Crime Control and Safe Streets 
Act of 1968 (42 U.S.C. 3796 et seq.), 
insofar as that part applies to any 
employee; and 
(viii) travel, transportation, and re-
lated payments and benefits, as provided 
under— 
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(I) chapter 57 of title 5, United 
States Code; 
(II) chapter 9 of the Foreign 
Service Act of 1980 (22 U.S.C. 4081 
et seq.); and 
(III) section 1599b of title 10, 
United States Code; and 
(ix) any other benefit similar to a ben-
efit described under clauses (i) through 
(viii) provided by or on behalf of the 
United States to any employee. 
(B) DOMESTIC PARTNER.—The term ‘‘do-
mestic partner’’ means an adult unmarried per-
son living with another adult unmarried person 
of the same sex in a committed, intimate rela-
tionship. 
(C) EMPLOYEE.—The term ‘‘employee’’— 
(i) means an officer or employee of 
the United States or of any department, 
agency, or other entity of the United 
States, including the President, the Vice 
President, a Member of Congress, or a 
Federal judge; and 
(ii) shall not include a member of the 
uniformed services. 
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(D) OBLIGATIONS.—The term ‘‘obliga-
tions’’ means any duties or responsibilities with 
respect to Federal employment that would be 
incurred by a married employee or by the 
spouse of an employee. 
(E) UNIFORMED
SERVICES.—The term 
‘‘uniformed services’’ has the meaning given 
under section 2101(3) of title 5, United States 
Code. 
(b) EFFECTIVE DATE.—This section and the amend-
ments made by this section shall— 
(1) with respect to the provision of benefits and 
obligations, take effect 6 months after the date of 
enactment of this Act; and 
(2) apply to any individual who is employed as 
an employee on or after the date of enactment of 
this Act. 
Subtitle B—Public Health 
Insurance 
SEC. 111. OPTIONAL MEDICAID COVERAGE OF LOW-INCOME 
HIV-INFECTED INDIVIDUALS. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a), as amended by section 
5006(b)(1) of division B of Public Law 11–5, is amend-
ed— 
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(1) in subsection (a)(10)(A)(ii)— 
(A) by striking ‘‘or’’ at the end of sub-
clause (XVIII); 
(B) by adding ‘‘or’’ at the end of subclause 
(XIX); and 
(C) by adding at the end the following: 
‘‘(XX) who are described in subsection (gg) (re-
lating to HIV-infected individuals);’’; and 
(2) by adding at the end the following: 
‘‘(gg) HIV-infected individuals described in this sub-
section are individuals not described in subsection 
(a)(10)(A)(i)— 
‘‘(1) who are infected with HIV; 
‘‘(2) whose income (as determined under the 
State plan under this title with respect to disabled 
individuals) does not exceed the maximum amount 
of income a disabled individual described in sub-
section (a)(10)(A)(i) may have to obtain medical as-
sistance under the plan; and 
‘‘(3) whose resources (as determined under the 
State plan under this title with respect to disabled 
individuals) do not exceed the maximum amount of 
resources a disabled individual described in sub-
section (a)(10)(A)(i) may have to obtain medical as-
sistance under the plan.’’. 
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(b) ENHANCED MATCH.—The first sentence of sec-
tion 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended 
by striking ‘‘section 1902(a)(10)(A)(ii)(XVIII)’’ and in-
serting 
‘‘subclause 
(XVIII) 
or 
(XX) 
of 
section 
1902(a)(10)(A)(ii)’’. 
(c) CONFORMING AMENDMENTS.—Section 1905(a) of 
such Act (42 U.S.C. 1396d(a)) is amended, in the matter 
preceding paragraph (1)— 
(1) by striking ‘‘or’’ at the end of clause (xii); 
(2) by adding ‘‘or’’ at the end of clause (xiii); 
and 
(3) by inserting after clause (xiii) the following: 
‘‘(xiv) 
individuals 
described 
in 
section 
1902(gg);’’. 
(d) EXEMPTION FROM FUNDING LIMITATION FOR 
TERRITORIES.—Section 1108(g) of the Social Security 
Act (42 U.S.C. 1308(g)) is amended by adding at the end 
the following: 
‘‘(5) DISREGARDING MEDICAL ASSISTANCE FOR 
OPTIONAL
LOW-INCOME
HIV-INFECTED
INDIVID-
UALS.—The limitations under subsection (f) and this 
subsection shall not apply to amounts expended for 
medical assistance for individuals described in sec-
tion 1902(gg) who are only eligible for such assist-
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ance 
on 
the 
basis 
of 
section 
1902(a)(10)(A)(ii)(XX).’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to calendar quarters beginning on 
or after the date of the enactment of this Act, without 
regard to whether or not final regulations to carry out 
such amendments have been promulgated by such date. 
SEC. 112. EXPANDED DEFINITION OF SPOUSE FOR PUR-
POSES OF THE MEDICARE PROGRAM. 
Section 1101(a) of the Social Security Act (42 U.S.C. 
1301a)) is amended by adding at the end the following: 
‘‘(11) Notwithstanding section 7 of title 1, 
United States Code, for purposes title XVIII of this 
Act— 
‘‘(A) the term ‘spouse’ means an individual 
in a relationship that any State recognizes as a 
marriage or similar union under the laws of a 
State providing for such marriage or similar 
union; and 
‘‘(B) the term ‘married’ means in a rela-
tionship that any State recognizes as a mar-
riage or similar union under the laws of a State 
providing for such marriage or similar union.’’. 
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SEC. 113. ENDING THE MEDICARE DISABILITY WAITING PE-
RIOD ACT. 
(a) PHASE-OUT OF WAITING PERIOD FOR MEDICARE 
DISABILITY BENEFITS.— 
(1) IN GENERAL.—Section 226(b) of the Social 
Security Act (42 U.S.C. 426(b)) is amended— 
(A) in paragraph (2)(A), by striking ‘‘, and 
has for 24 calendar months been entitled to,’’ 
and inserting ‘‘, and for the waiting period (as 
defined in subsection (k)) has been entitled 
to,’’; 
(B) in paragraph (2)(B), by striking ‘‘, 
and has been for not less than 24 months,’’ and 
inserting ‘‘, and has been for not less than the 
waiting period,’’; 
(C) in paragraph (2)(C)(ii), by striking ‘‘, 
including the requirement that he has been en-
titled to the specified benefits for 24 months,’’ 
and inserting ‘‘, including the requirement that 
the individual has been entitled to the specified 
benefits for the waiting period,’’; and 
(D) in the flush matter following para-
graph (2)(C)(ii)(II)— 
(i) in the first sentence, by striking 
‘‘for each month beginning with the later 
of (I) July 1973 or (II) the twenty-fifth 
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