H. R. 259 
One Hundred Sixteenth Congress 
of the 
United States of America 
AT THE FIRST SESSION 
Begun and held at the City of Washington on Thursday, 
the third day of January, two thousand and nineteen 
An Act 
To extend the Medicaid Money Follows the Person Rebalancing demonstration, 
to extend protection for Medicaid recipients of home and community-based services 
against spousal impoverishment, and for other purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicaid Extenders Act of 2019’’. 
SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING 
DEMONSTRATION. 
(a) GENERAL FUNDING.—Section 6071(h) of the Deficit Reduc-
tion Act of 2005 (42 U.S.C. 1396a note) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (D), by striking ‘‘and’’ after the 
semicolon; 
(B) in subparagraph (E), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(F) subject to paragraph (3), $112,000,000 for fiscal 
year 2019.’’; 
(2) in paragraph (2)— 
(A) by striking ‘‘Amounts made’’ and inserting ‘‘Subject 
to paragraph (3), amounts made’’; and 
(B) by striking ‘‘September 30, 2016’’ and inserting 
‘‘September 30, 2021’’; and 
(3) by adding at the end the following new paragraph: 
‘‘(3) SPECIAL RULE FOR FY 2019.—Funds appropriated under 
paragraph (1)(F) shall be made available for grants to States 
only if such States have an approved MFP demonstration 
project under this section as of December 31, 2018.’’. 
(b) FUNDING
FOR QUALITY ASSURANCE
AND IMPROVEMENT; 
TECHNICAL ASSISTANCE; OVERSIGHT.—Section 6071(f) of the Deficit 
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended by striking 
paragraph (2) and inserting the following: 
‘‘(2) FUNDING.—From the amounts appropriated under sub-
section (h)(1)(F) for fiscal year 2019, $500,000 shall be available 
to the Secretary for such fiscal year to carry out this sub-
section.’’. 
(c) TECHNICAL AMENDMENT.—Section 6071(b) of the Deficit 
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended by adding 
at the end the following: 
‘‘(10) SECRETARY.—The term ‘Secretary’ means the Sec-
retary of Health and Human Services.’’.
H. R. 259—2 
SEC. 3. EXTENSION OF PROTECTION FOR MEDICAID RECIPIENTS OF 
HOME 
AND 
COMMUNITY-BASED 
SERVICES 
AGAINST 
SPOUSAL IMPOVERISHMENT. 
(a) IN GENERAL.—Section 2404 of Public Law 111–148 (42 
U.S.C. 1396r–5 note) is amended by striking ‘‘the 5-year period 
that begins on January 1, 2014,’’ and inserting ‘‘the period beginning 
on January 1, 2014, and ending on March 31, 2019,’’. 
(b) RULE OF CONSTRUCTION.— 
(1) PROTECTING
STATE
SPOUSAL
INCOME
AND
ASSET
DIS-
REGARD FLEXIBILITY UNDER WAIVERS AND PLAN AMENDMENTS.— 
Nothing in section 2404 of Public Law 111–148 (42 U.S.C. 
1396r–5 note) or section 1924 of the Social Security Act (42 
U.S.C. 1396r–5) shall be construed as prohibiting a State from 
disregarding an individual’s spousal income and assets under 
a State waiver or plan amendment described in paragraph 
(2) for purposes of making determinations of eligibility for 
home and community-based services or home and community- 
based attendant services and supports under such waiver or 
plan amendment. 
(2) STATE
WAIVER
OR
PLAN
AMENDMENT
DESCRIBED.—A 
State waiver or plan amendment described in this paragraph 
is any of the following: 
(A) A waiver or plan amendment to provide medical 
assistance for home and community-based services under 
a waiver or plan amendment under subsection (c), (d), 
or (i) of section 1915 of the Social Security Act (42 U.S.C. 
1396n) or under section 1115 of such Act (42 U.S.C. 1315). 
(B) A plan amendment to provide medical assistance 
for home and community-based services for individuals by 
reason 
of 
being 
determined 
eligible 
under 
section 
1902(a)(10)(C) of such Act (42 U.S.C. 1396a(a)(10)(C)) or 
by reason of section 1902(f) of such Act (42 U.S.C. 1396a(f)) 
or otherwise on the basis of a reduction of income based 
on costs incurred for medical or other remedial care under 
which the State disregarded the income and assets of the 
individual’s spouse in determining the initial and ongoing 
financial eligibility of an individual for such services in 
place of the spousal impoverishment provisions applied 
under section 1924 of such Act (42 U.S.C. 1396r–5). 
(C) A plan amendment to provide medical assistance 
for home and community-based attendant services and sup-
ports under section 1915(k) of such Act (42 U.S.C. 
1396n(k)). 
SEC. 4. REDUCTION IN FMAP AFTER 2020 FOR STATES WITHOUT ASSET 
VERIFICATION PROGRAM. 
Section 1940 of the Social Security Act (42 U.S.C. 1396w) 
is amended by adding at the end the following new subsection: 
‘‘(k) REDUCTION IN FMAP AFTER 2020 FOR NON-COMPLIANT 
STATES.— 
‘‘(1) IN GENERAL.—With respect to a calendar quarter begin-
ning on or after January 1, 2021, the Federal medical assistance 
percentage otherwise determined under section 1905(b) for a 
non-compliant State shall be reduced— 
‘‘(A) for calendar quarters in 2021 and 2022, by 0.12 
percentage points;
H. R. 259—3 
‘‘(B) for calendar quarters in 2023, by 0.25 percentage 
points; 
‘‘(C) for calendar quarters in 2024, by 0.35 percentage 
points; and 
‘‘(D) for calendar quarters in 2025 and each year there-
after, by 0.5 percentage points. 
‘‘(2) NON-COMPLIANT STATE DEFINED.—For purposes of this 
subsection, the term ‘non-compliant State’ means a State— 
‘‘(A) that is one of the 50 States or the District of 
Columbia; 
‘‘(B) with respect to which the Secretary has not 
approved a State plan amendment submitted under sub-
section (a)(2); and 
‘‘(C) that is not operating, on an ongoing basis, an 
asset verification program in accordance with this section.’’. 
SEC. 5. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(1) of the Social Security Act (42 U.S.C. 1396w– 
1(b)(1)) is amended by striking ‘‘$31,000,000’’ and inserting 
‘‘$6,000,000’’. 
Speaker of the House of Representatives. 
Vice President of the United States and
President of the Senate.