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(8) in section 2731 (42 U.S.C. 300gg–11), as so 
redesignated by section 1001(3)— 
(A) by striking the section heading and all 
that follows through subsection (b); 
(B) in subsection (c)— 
(i) in paragraph (1)— 
(I) in the matter preceding sub-
paragraph (A), by striking ‘‘small 
group’’ and inserting ‘‘group and indi-
vidual’’; and 
(II) in subparagraph (B)— 
(aa) in the matter preceding 
clause (i), by inserting ‘‘and indi-
viduals’’ after ‘‘employers’’; 
(bb) in clause (i), by insert-
ing ‘‘or any additional individ-
uals’’ after ‘‘additional groups’’; 
and 
(cc) in clause (ii), by strik-
ing ‘‘without regard to the claims 
experience of those employers and 
their employees (and their de-
pendents) or any health status-re-
lated factor relating to such’’ and 
inserting ‘‘and individuals with-
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out regard to the claims experi-
ence of those individuals, employ-
ers and their employees (and their 
dependents) or any health status- 
related factor relating to such in-
dividuals’’; and 
(ii) in paragraph (2), by striking 
‘‘small group’’ and inserting ‘‘group or in-
dividual’’; 
(C) in subsection (d)— 
(i) by striking ‘‘small group’’ each 
place that such appears and inserting 
‘‘group or individual’’; and 
(ii) in paragraph (1)(B)— 
(I) by striking ‘‘all employers’’ 
and inserting ‘‘all employers and indi-
viduals’’; 
(II) by striking ‘‘those employers’’ 
and inserting ‘‘those individuals, em-
ployers’’; and 
(III) by striking ‘‘such employees’’ 
and inserting ‘‘such individuals, em-
ployees’’; 
(D) by striking subsection (e); 
(E) by striking subsection (f); and
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(F) by transferring such section (as amend-
ed by this paragraph) to appear at the end of 
section 2702 (as added by section 1001(4)); 
(9) in section 2732 (42 U.S.C. 300gg–12), as so 
redesignated by section 1001(3)— 
(A) by striking the section heading and all 
that follows through subsection (a); 
(B) in subsection (b)— 
(i) in the matter preceding paragraph 
(1), by striking ‘‘group health plan in the 
small or large group market’’ and inserting 
‘‘health insurance coverage offered in the 
group or individual market’’; 
(ii) in paragraph (1), by inserting ‘‘, 
or individual, as applicable,’’ after ‘‘plan 
sponsor’’; 
(iii) in paragraph (2), by inserting ‘‘, 
or individual, as applicable,’’ after ‘‘plan 
sponsor’’; and 
(iv) by striking paragraph (3) and in-
serting the following: 
‘‘(3) VIOLATION
OF
PARTICIPATION
OR
CON-
TRIBUTION RATES.—In the case of a group health 
plan, the plan sponsor has failed to comply with a 
material plan provision relating to employer con-
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tribution or group participation rules, pursuant to 
applicable State law.’’; 
(C) in subsection (c)— 
(i) in paragraph (1)— 
(I) in the matter preceding sub-
paragraph (A), by striking ‘‘group 
health insurance coverage offered in the 
small or large group market’’ and in-
serting ‘‘group or individual health in-
surance coverage’’; 
(II) in subparagraph (A), by in-
serting ‘‘or individual, as applicable,’’ 
after ‘‘plan sponsor’’; 
(III) in subparagraph (B)— 
(aa) by inserting ‘‘or indi-
vidual, as applicable,’’ after ‘‘plan 
sponsor’’; and 
(bb) by inserting ‘‘or indi-
vidual health insurance coverage’’; 
and 
(IV) in subparagraph (C), by in-
serting ‘‘or individuals, as applicable,’’ 
after ‘‘those sponsors’’; and 
(ii) in paragraph (2)(A)—
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(I) in the matter preceding clause 
(i), by striking ‘‘small group market or 
the large group market, or both mar-
kets,’’ and inserting ‘‘individual or 
group market, or all markets,’’; and 
(II) in clause (i), by inserting ‘‘or 
individual, as applicable,’’ after ‘‘plan 
sponsor’’; and 
(D) by transferring such section (as amend-
ed by this paragraph) to appear at the end of 
section 2703 (as added by section 1001(4)); 
(10) in section 2733 (42 U.S.C. 300gg–13), as so 
redesignated by section 1001(4)— 
(A) in subsection (a)— 
(i) in the matter preceding paragraph 
(1), by striking ‘‘small employer’’ and in-
serting ‘‘small employer or an individual’’; 
(ii) in paragraph (1), by inserting ‘‘, 
or individual, as applicable,’’ after ‘‘em-
ployer’’ each place that such appears; and 
(iii) in paragraph (2), by striking 
‘‘small employer’’ and inserting ‘‘employer, 
or individual, as applicable,’’; 
(B) in subsection (b)— 
(i) in paragraph (1)—
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(I) in the matter preceding sub-
paragraph (A), by striking ‘‘small em-
ployer’’ and inserting ‘‘employer, or 
individual, as applicable,’’; 
(II) in subparagraph (A), by add-
ing ‘‘and’’ at the end; 
(III) by striking subparagraphs 
(B) and (C); and 
(IV) in subparagraph (D)— 
(aa) by inserting ‘‘, or indi-
vidual, as applicable,’’ after ‘‘em-
ployer’’; and 
(bb) by redesignating such 
subparagraph as subparagraph 
(B); 
(ii) in paragraph (2)— 
(I) by striking ‘‘small employers’’ 
each place that such term appears and 
inserting ‘‘employers, or individuals, 
as applicable,’’; and 
(II) by striking ‘‘small employer’’ 
and inserting ‘‘employer, or indi-
vidual, as applicable,’’; and 
(C) by redesignating such section (as 
amended by this paragraph) as section 2709 and
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transferring such section to appear after section 
2708 (as added by section 1001(5)); 
(11) by redesignating subpart 4 as subpart 2; 
(12) in section 2735 (42 U.S.C. 300gg–21), as so 
redesignated by section 1001(4)— 
(A) by striking subsection (a); 
(B) by striking ‘‘subparts 1 through 3’’ each 
place that such appears and inserting ‘‘subpart 
1’’; 
(C) by redesignating subsections (b) through 
(e) as subsections (a) through (d), respectively; 
and 
(D) by redesignating such section (as 
amended by this paragraph) as section 2722; 
(13) in section 2736 (42 U.S.C. 300gg–22), as so 
redesignated by section 1001(4)— 
(A) in subsection (a)— 
(i) in paragraph (1), by striking 
‘‘small or large group markets’’ and insert-
ing ‘‘individual or group market’’; and 
(ii) in paragraph (2), by inserting ‘‘or 
individual health insurance coverage’’ after 
‘‘group health plans’’;
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(B) in subsection (b)(1)(B), by inserting 
‘‘individual health insurance coverage or’’ after 
‘‘respect to’’; and 
(C) by redesignating such section (as 
amended by this paragraph) as section 2723; 
(14) in section 2737(a)(1) (42 U.S.C. 300gg–23), 
as so redesignated by section 1001(4)— 
(A) by inserting ‘‘individual or’’ before 
‘‘group health insurance’’; and 
(B) by redesignating such section(as amend-
ed by this paragraph) as section 2724; 
(15) in section 2762 (42 U.S.C. 300gg–62)— 
(A) in the section heading by inserting 
‘‘AND APPLICATION’’ before the period; and 
(B) by adding at the end the following: 
‘‘(c) APPLICATION OF PART A PROVISIONS.— 
‘‘(1) IN
GENERAL.—The provisions of part A 
shall apply to health insurance issuers providing 
health insurance coverage in the individual market in 
a State as provided for in such part. 
‘‘(2) CLARIFICATION.—To the extent that any 
provision of this part conflicts with a provision of 
part A with respect to health insurance issuers pro-
viding health insurance coverage in the individual
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market in a State, the provisions of such part A shall 
apply.’’; and 
(16) in section 2791(e) (42 U.S.C. 300gg– 
91(e))— 
(A) in paragraph (2), by striking ‘‘51’’ and 
inserting ‘‘101’’; and 
(B) in paragraph (4)— 
(i) by striking ‘‘at least 2’’ each place 
that such appears and inserting ‘‘at least 
1’’; and 
(ii) by striking ‘‘50’’ and inserting 
‘‘100’’. 
(d) APPLICATION.—Notwithstanding any other provi-
sion of the Patient Protection and Affordable Care Act, 
nothing in such Act (or an amendment made by such Act) 
shall be construed to— 
(1) prohibit (or authorize the Secretary of 
Health and Human Services to promulgate regula-
tions that prohibit) a group health plan or health in-
surance issuer from carrying out utilization manage-
ment techniques that are commonly used as of the 
date of enactment of this Act; or 
(2) restrict the application of the amendments 
made by this subtitle.
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‘‘(b) EXCEPTION.—Notwithstanding subsection (a), the 
provisions of sections 2716 and 2718 of title XXVII of the 
Public Health Service Act (as amended by the Patient Pro-
tection and Affordable Care Act) shall not apply with re-
spect to self-insured group health plans, and the provisions 
of this subchapter shall continue to apply to such plans as 
if such sections of the Public Health Service Act (as so 
amended) had not been enacted.’’. 
SEC. 1563. SENSE OF THE SENATE PROMOTING FISCAL RE-
SPONSIBILITY. 
(a) FINDINGS.—The Senate makes the following find-
ings: 
(1) Based on Congressional Budget Office (CBO) 
estimates, this Act will reduce the Federal deficit be-
tween 2010 and 2019. 
(2) CBO projects this Act will continue to reduce 
budget deficits after 2019. 
(3) Based on CBO estimates, this Act will extend 
the solvency of the Medicare HI Trust Fund. 
(4) This Act will increase the surplus in the So-
cial Security Trust Fund, which should be reserved to 
strengthen the finances of Social Security. 
(5) The initial net savings generated by the 
Community Living Assistance Services and Supports
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(B) by adding ‘‘or’’ at the end of subclause 
(VII); and 
(C) by inserting after subclause (VII) the 
following: 
‘‘(VIII) beginning January 1, 
2014, who are under 65 years of age, 
not pregnant, not entitled to, or en-
rolled for, benefits under part A of title 
XVIII, or enrolled for benefits under 
part B of title XVIII, and are not de-
scribed in a previous subclause of this 
clause, and whose income (as deter-
mined under subsection (e)(14)) does 
not exceed 133 percent of the poverty 
line (as defined in section 2110(c)(5)) 
applicable to a family of the size in-
volved, subject to subsection (k);’’. 
(2) PROVISION OF AT LEAST MINIMUM ESSEN-
TIAL COVERAGE.— 
(A) IN GENERAL.—Section 1902 of such Act 
(42 U.S.C. 1396a) is amended by inserting after 
subsection (j) the following: 
‘‘(k)(1) The medical assistance provided to an indi-
vidual described in subclause (VIII) of subsection 
(a)(10)(A)(i) shall consist of benchmark coverage described
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in section 1937(b)(1) or benchmark equivalent coverage de-
scribed in section 1937(b)(2). Such medical assistance shall 
be provided subject to the requirements of section 1937, 
without regard to whether a State otherwise has elected the 
option to provide medical assistance through coverage under 
that section, unless an individual described in subclause 
(VIII) of subsection (a)(10)(A)(i) is also an individual for 
whom, under subparagraph (B) of section 1937(a)(2), the 
State may not require enrollment in benchmark coverage 
described in subsection (b)(1) of section 1937 or benchmark 
equivalent coverage described in subsection (b)(2) of that 
section.’’. 
(B) 
CONFORMING
AMENDMENT.—Section 
1903(i) of the Social Security Act, as amended 
by section 6402(c), is amended— 
(i) in paragraph (24), by striking ‘‘or’’ 
at the end; 
(ii) in paragraph (25), by striking the 
period and inserting ‘‘; or’’; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(26) with respect to any amounts expended for 
medical assistance for individuals described in sub-
clause (VIII) of subsection (a)(10)(A)(i) other than 
medical assistance provided through benchmark cov-
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erage described in section 1937(b)(1) or benchmark 
equivalent coverage described in section 1937(b)(2).’’. 
(3) FEDERAL FUNDING FOR COST OF COVERING 
NEWLY ELIGIBLE INDIVIDUALS.—Section 1905 of the 
Social Security Act (42 U.S.C. 1396d), is amended— 
(A) in subsection (b), in the first sentence, 
by inserting ‘‘subsection (y) and’’ before ‘‘section 
1933(d)’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(y) INCREASED FMAP FOR MEDICAL ASSISTANCE 
FOR NEWLY ELIGIBLE MANDATORY INDIVIDUALS.— 
‘‘(1) AMOUNT OF INCREASE.— 
‘‘(A) 100 PERCENT FMAP.—During the pe-
riod that begins on January 1, 2014, and ends 
on December 31, 2016, notwithstanding sub-
section (b), the Federal medical assistance per-
centage determined for a State that is one of the 
50 States or the District of Columbia for each 
fiscal year occurring during that period with re-
spect to amounts expended for medical assistance 
for newly eligible individuals described in sub-
clause (VIII) of section 1902(a)(10)(A)(i) shall 
be equal to 100 percent. 
‘‘(B) 2017 AND 2018.—
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‘‘(i) IN GENERAL.—During the period 
that begins on January 1, 2017, and ends 
on December 31, 2018, notwithstanding sub-
section (b) and subject to subparagraph (D), 
the Federal medical assistance percentage 
determined for a State that is one of the 50 
States or the District of Columbia for each 
fiscal year occurring during that period 
with respect to amounts expended for med-
ical assistance for newly eligible individuals 
described in subclause (VIII) of section 
1902(a)(10)(A)(i), shall be increased by the 
applicable percentage point increase speci-
fied in clause (ii) for the quarter and the 
State. 
‘‘(ii) APPLICABLE PERCENTAGE POINT 
INCREASE.— 
‘‘(I) IN GENERAL.—For purposes 
of clause (i), the applicable percentage 
point increase for a quarter is the fol-
lowing: 
‘‘For any fiscal year 
quarter occurring in 
the calendar year: 
If the State is an ex-
pansion State, the 
applicable percent-
age point increase is: 
If the State is not an 
expansion State, the 
applicable percent-
age point increase is: 
2017 
30.3 
34.3 
2018 
31.3 
33.3
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‘‘(II) 
EXPANSION
STATE
DE-
FINED.—For purposes of the table in 
subclause (I), a State is an expansion 
State if, on the date of the enactment 
of the Patient Protection and Afford-
able Care Act, the State offers health 
benefits coverage statewide to parents 
and 
nonpregnant, 
childless 
adults 
whose income is at least 100 percent of 
the poverty line, that is not dependent 
on access to employer coverage, em-
ployer contribution, or employment 
and is not limited to premium assist-
ance, hospital-only benefits, a high de-
ductible health plan, or alternative 
benefits under a demonstration pro-
gram authorized under section 1938. A 
State that offers health benefits cov-
erage to only parents or only nonpreg-
nant childless adults described in the 
preceding sentence shall not be consid-
ered to be an expansion State. 
‘‘(C) 2019 AND SUCCEEDING YEARS.—Be-
ginning January 1, 2019, notwithstanding sub-
section (b) but subject to subparagraph (D), the
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Federal medical assistance percentage deter-
mined for a State that is one of the 50 States or 
the District of Columbia for each fiscal year 
quarter occurring during that period with re-
spect to amounts expended for medical assistance 
for newly eligible individuals described in sub-
clause (VIII) of section 1902(a)(10)(A)(i), shall 
be increased by 32.3 percentage points. 
‘‘(D) LIMITATION.—The Federal medical as-
sistance percentage determined for a State under 
subparagraph (B) or (C) shall in no case be 
more than 95 percent. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) NEWLY ELIGIBLE.—The term ‘newly 
eligible’ means, with respect to an individual de-
scribed 
in 
subclause 
(VIII) 
of 
section 
1902(a)(10)(A)(i), an individual who is not 
under 19 years of age (or such higher age as the 
State may have elected) and who, on the date of 
enactment of the Patient Protection and Afford-
able Care Act, is not eligible under the State 
plan or under a waiver of the plan for full bene-
fits or for benchmark coverage described in sub-
paragraph (A), (B), or (C) of section 1937(b)(1) 
or benchmark equivalent coverage described in
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section 1937(b)(2) that has an aggregate actu-
arial value that is at least actuarially equivalent 
to benchmark coverage described in subpara-
graph (A), (B), or (C) of section 1937(b)(1), or 
is eligible but not enrolled (or is on a waiting 
list) for such benefits or coverage through a 
waiver under the plan that has a capped or lim-
ited enrollment that is full. 
‘‘(B) FULL BENEFITS.—The term ‘full bene-
fits’ means, with respect to an individual, med-
ical assistance for all services covered under the 
State plan under this title that is not less in 
amount, duration, or scope, or is determined by 
the Secretary to be substantially equivalent, to 
the medical assistance available for an indi-
vidual described in section 1902(a)(10)(A)(i).’’. 
(4) STATE OPTIONS TO OFFER COVERAGE EAR-
LIER AND PRESUMPTIVE ELIGIBILITY; CHILDREN RE-
QUIRED TO HAVE COVERAGE FOR PARENTS TO BE EL-
IGIBLE.— 
(A) IN GENERAL.—Subsection (k) of section 
1902 of the Social Security Act (as added by 
paragraph (2)), is amended by inserting after 
paragraph (1) the following:
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‘‘(2) Beginning with the first day of any fiscal year 
quarter that begins on or after January 1, 2011, and before 
January 1, 2014, a State may elect through a State plan 
amendment to provide medical assistance to individuals 
who would be described in subclause (VIII) of subsection 
(a)(10)(A)(i) if that subclause were effective before January 
1, 2014. A State may elect to phase-in the extension of eligi-
bility for medical assistance to such individuals based on 
income, so long as the State does not extend such eligibility 
to individuals described in such subclause with higher in-
come before making individuals described in such subclause 
with lower income eligible for medical assistance. 
‘‘(3) If an individual described in subclause (VIII) of 
subsection (a)(10)(A)(i) is the parent of a child who is 
under 19 years of age (or such higher age as the State may 
have elected) who is eligible for medical assistance under 
the State plan or under a waiver of such plan (under that 
subclause or under a State plan amendment under para-
graph (2), the individual may not be enrolled under the 
State plan unless the individual’s child is enrolled under 
the State plan or under a waiver of the plan or is enrolled 
in other health insurance coverage. For purposes of the pre-
ceding sentence, the term ‘parent’ includes an individual 
treated as a caretaker relative for purposes of carrying out 
section 1931.’’.
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(B) PRESUMPTIVE
ELIGIBILITY.—Section 
1920 of the Social Security Act (42 U.S.C. 
1396r–1) is amended by adding at the end the 
following: 
‘‘(e) If the State has elected the option to provide a 
presumptive eligibility period under this section or section 
1920A, the State may elect to provide a presumptive eligi-
bility period (as defined in subsection (b)(1)) for individ-
uals who are eligible for medical assistance under clause 
(i)(VIII) of subsection (a)(10)(A) or section 1931 in the 
same manner as the State provides for such a period under 
this section or section 1920A, subject to such guidance as 
the Secretary shall establish.’’. 
(5) CONFORMING AMENDMENTS.— 
(A) Section 1902(a)(10) of such Act (42 
U.S.C. 1396a(a)(10)) is amended in the matter 
following subparagraph (G), by striking ‘‘and 
(XIV)’’ and inserting ‘‘(XIV)’’ and by inserting 
‘‘and (XV) the medical assistance made available 
to an individual described in subparagraph 
(A)(i)(VIII) shall be limited to medical assist-
ance described in subsection (k)(1)’’ before the 
semicolon.
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(B) Section 1902(l)(2)(C) of such Act (42 
U.S.C. 1396a(l)(2)(C)) is amended by striking 
‘‘100’’ and inserting ‘‘133’’. 
(C) Section 1905(a) of such Act (42 U.S.C. 
1396d(a)) is amended in the matter preceding 
paragraph (1)— 
(i) by striking ‘‘or’’ at the end of clause 
(xii); 
(ii) by inserting ‘‘or’’ at the end of 
clause (xiii); and 
(iii) by inserting after clause (xiii) the 
following: 
‘‘(xiv) 
individuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII),’’. 
(D) Section 1903(f)(4) of such Act (42 
U.S.C. 1396b(f)(4)) is amended by inserting 
‘‘1902(a)(10)(A)(i)(VIII),’’ 
after 
‘‘1902(a)(10)(A)(i)(VII),’’. 
(E) Section 1937(a)(1)(B) of such Act (42 
U.S.C. 1396u–7(a)(1)(B)) is amended by insert-
ing 
‘‘subclause 
(VIII) 
of 
section 
1902(a)(10)(A)(i) or under’’ after ‘‘eligible 
under’’.
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(b) MAINTENANCE
OF
MEDICAID
INCOME
ELIGI-
BILITY.—Section 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘and’’ at the end of para-
graph (72); 
(B) by striking the period at the end of 
paragraph (73) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (73) the 
following new paragraph: 
‘‘(74) provide for maintenance of effort under the 
State plan or under any waiver of the plan in ac-
cordance with subsection (gg).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(gg) MAINTENANCE OF EFFORT.— 
‘‘(1) GENERAL REQUIREMENT TO MAINTAIN ELI-
GIBILITY
STANDARDS
UNTIL
STATE
EXCHANGE
IS 
FULLY
OPERATIONAL.—Subject to the succeeding 
paragraphs of this subsection, during the period that 
begins on the date of enactment of the Patient Protec-
tion and Affordable Care Act and ends on the date on 
which the Secretary determines that an Exchange es-
tablished by the State under section 1311 of the Pa-
tient Protection and Affordable Care Act is fully oper-
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ational, as a condition for receiving any Federal pay-
ments under section 1903(a) for calendar quarters oc-
curring during such period, a State shall not have in 
effect eligibility standards, methodologies, or proce-
dures under the State plan under this title or under 
any waiver of such plan that is in effect during that 
period, that are more restrictive than the eligibility 
standards, methodologies, or procedures, respectively, 
under the plan or waiver that are in effect on the date 
of enactment of the Patient Protection and Affordable 
Care Act. 
‘‘(2) CONTINUATION OF ELIGIBILITY STANDARDS 
FOR CHILDREN UNTIL OCTOBER 1, 2019.—The require-
ment under paragraph (1) shall continue to apply to 
a State through September 30, 2019, with respect to 
the eligibility standards, methodologies, and proce-
dures under the State plan under this title or under 
any waiver of such plan that are applicable to deter-
mining the eligibility for medical assistance of any 
child who is under 19 years of age (or such higher age 
as the State may have elected). 
‘‘(3) NONAPPLICATION.—During the period that 
begins on January 1, 2011, and ends on December 31, 
2013, the requirement under paragraph (1) shall not 
apply to a State with respect to nonpregnant, non-
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disabled adults who are eligible for medical assistance 
under the State plan or under a waiver of the plan 
at the option of the State and whose income exceeds 
133 percent of the poverty line (as defined in section 
2110(c)(5)) applicable to a family of the size involved 
if, on or after December 31, 2010, the State certifies 
to the Secretary that, with respect to the State fiscal 
year during which the certification is made, the State 
has a budget deficit, or with respect to the succeeding 
State fiscal year, the State is projected to have a 
budget deficit. Upon submission of such a certifi-
cation to the Secretary, the requirement under para-
graph (1) shall not apply to the State with respect to 
any remaining portion of the period described in the 
preceding sentence. 
‘‘(4) DETERMINATION OF COMPLIANCE.— 
‘‘(A) STATES
SHALL
APPLY
MODIFIED 
GROSS INCOME.—A State’s determination of in-
come in accordance with subsection (e)(14) shall 
not be considered to be eligibility standards, 
methodologies, or procedures that are more re-
strictive than the standards, methodologies, or 
procedures in effect under the State plan or 
under a waiver of the plan on the date of enact-
ment of the Patient Protection and Affordable
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procedures that are more restrictive than the 
standards, methodologies, or procedures in effect 
under the State plan or under a waiver of the 
plan on the date of enactment of the Patient Pro-
tection and Affordable Care Act for purposes of 
determining compliance with the requirements of 
paragraph (1), (2), or (3).’’. 
(c) MEDICAID BENCHMARK BENEFITS MUST CONSIST 
OF AT LEAST MINIMUM ESSENTIAL COVERAGE.—Section 
1937(b) of such Act (42 U.S.C. 1396u–7(b)) is amended— 
(1) in paragraph (1), in the matter preceding 
subparagraph (A), by inserting ‘‘subject to para-
graphs (5) and (6),’’ before ‘‘each’’; 
(2) in paragraph (2)— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘subject to paragraphs (5) and 
(6)’’ after ‘‘subsection (a)(1),’’; 
(B) in subparagraph (A)— 
(i) by redesignating clauses (iv) and 
(v) as clauses (vi) and (vii), respectively; 
and 
(ii) by inserting after clause (iii), the 
following: 
‘‘(iv) Coverage of prescription drugs. 
‘‘(v) Mental health services.’’; and
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(C) in subparagraph (C)— 
(i) by striking clauses (i) and (ii); and 
(ii) by redesignating clauses (iii) and 
(iv) as clauses (i) and (ii), respectively; and 
(3) by adding at the end the following new para-
graphs: 
‘‘(5) MINIMUM STANDARDS.—Effective January 
1, 2014, any benchmark benefit package under para-
graph (1) or benchmark equivalent coverage under 
paragraph (2) must provide at least essential health 
benefits as described in section 1302(b) of the Patient 
Protection and Affordable Care Act. 
‘‘(6) MENTAL HEALTH SERVICES PARITY.— 
‘‘(A) IN
GENERAL.—In the case of any 
benchmark benefit package under paragraph (1) 
or benchmark equivalent coverage under para-
graph (2) that is offered by an entity that is not 
a medicaid managed care organization and that 
provides both medical and surgical benefits and 
mental health or substance use disorder benefits, 
the entity shall ensure that the financial require-
ments and treatment limitations applicable to 
such mental health or substance use disorder ben-
efits comply with the requirements of section 
2705(a) of the Public Health Service Act in the
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same manner as such requirements apply to a 
group health plan. 
‘‘(B) DEEMED COMPLIANCE.—Coverage pro-
vided with respect to an individual described in 
section 1905(a)(4)(B) and covered under the 
State plan under section 1902(a)(10)(A) of the 
services described in section 1905(a)(4)(B) (relat-
ing to early and periodic screening, diagnostic, 
and treatment services defined in section 
1905(r)) and provided in accordance with sec-
tion 1902(a)(43), shall be deemed to satisfy the 
requirements of subparagraph (A).’’. 
(d) ANNUAL REPORTS ON MEDICAID ENROLLMENT.— 
(1) STATE REPORTS.—Section 1902(a) of the So-
cial Security Act (42 U.S.C. 1396a(a)), as amended 
by subsection (b), is amended— 
(A) by striking ‘‘and’’ at the end of para-
graph (73); 
(B) by striking the period at the end of 
paragraph (74) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (74) the 
following new paragraph: 
‘‘(75) provide that, beginning January 2015, 
and annually thereafter, the State shall submit a re-
port to the Secretary that contains—
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‘‘(A) the total number of enrolled and newly 
enrolled individuals in the State plan or under 
a waiver of the plan for the fiscal year ending 
on September 30 of the preceding calendar year, 
disaggregated by population, including children, 
parents, nonpregnant childless adults, disabled 
individuals, elderly individuals, and such other 
categories or sub-categories of individuals eligible 
for medical assistance under the State plan or 
under a waiver of the plan as the Secretary may 
require; 
‘‘(B) a description, which may be specified 
by population, of the outreach and enrollment 
processes used by the State during such fiscal 
year; and 
‘‘(C) any other data reporting determined 
necessary by the Secretary to monitor enrollment 
and retention of individuals eligible for medical 
assistance under the State plan or under a waiv-
er of the plan.’’. 
(2) REPORTS TO CONGRESS.—Beginning April 
2015, and annually thereafter, the Secretary of 
Health and Human Services shall submit a report to 
the appropriate committees of Congress on the total 
enrollment and new enrollment in Medicaid for the
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fiscal year ending on September 30 of the preceding 
calendar year on a national and State-by-State basis, 
and shall include in each such report such rec-
ommendations 
for 
administrative 
or 
legislative 
changes to improve enrollment in the Medicaid pro-
gram as the Secretary determines appropriate. 
(e) STATE OPTION FOR COVERAGE FOR INDIVIDUALS 
WITH INCOME THAT EXCEEDS 133 PERCENT OF THE POV-
ERTY LINE.— 
(1) COVERAGE
AS
OPTIONAL
CATEGORICALLY 
NEEDY GROUP.—Section 1902 of the Social Security 
Act (42 U.S.C. 1396a) is amended— 
(A) in subsection (a)(10)(A)(ii)— 
(i) in subclause (XVIII), by striking 
‘‘or’’ at the end; 
(ii) in subclause (XIX), by adding 
‘‘or’’ at the end; and 
(iii) by adding at the end the following 
new subclause: 
‘‘(XX) 
beginning 
January 
1, 
2014, who are under 65 years of age 
and are not described in or enrolled 
under a previous subclause of this 
clause, and whose income (as deter-
mined under subsection (e)(14)) exceeds
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133 percent of the poverty line (as de-
fined in section 2110(c)(5)) applicable 
to a family of the size involved but 
does not exceed the highest income eli-
gibility level established under the 
State plan or under a waiver of the 
plan, subject to subsection (hh);’’ and 
(B) by adding at the end the following new 
subsection: 
‘‘(hh)(1) A State may elect to phase-in the extension 
of eligibility for medical assistance to individuals described 
in subclause (XX) of subsection (a)(10)(A)(ii) based on the 
categorical group (including nonpregnant childless adults) 
or income, so long as the State does not extend such eligi-
bility to individuals described in such subclause with higher 
income before making individuals described in such sub-
clause with lower income eligible for medical assistance. 
‘‘(2) If an individual described in subclause (XX) of 
subsection (a)(10)(A)(ii) is the parent of a child who is 
under 19 years of age (or such higher age as the State may 
have elected) who is eligible for medical assistance under 
the State plan or under a waiver of such plan, the indi-
vidual may not be enrolled under the State plan unless the 
individual’s child is enrolled under the State plan or under 
a waiver of the plan or is enrolled in other health insurance
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coverage. For purposes of the preceding sentence, the term 
‘parent’ includes an individual treated as a caretaker rel-
ative for purposes of carrying out section 1931.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1905(a) of such Act (42 U.S.C. 
1396d(a)), as amended by subsection (a)(5)(C), 
is amended in the matter preceding paragraph 
(1)— 
(i) by striking ‘‘or’’ at the end of clause 
(xiii); 
(ii) by inserting ‘‘or’’ at the end of 
clause (xiv); and 
(iii) by inserting after clause (xiv) the 
following: 
‘‘(xv) 
individuals 
described 
in 
section 
1902(a)(10)(A)(ii)(XX),’’. 
(B) Section 1903(f)(4) of such Act (42 
U.S.C. 1396b(f)(4)) is amended by inserting 
‘‘1902(a)(10)(A)(ii)(XX),’’ 
after 
‘‘1902(a)(10)(A)(ii)(XIX),’’. 
(C) Section 1920(e) of such Act (42 U.S.C. 
1396r–1(e)), as added by subsection (a)(4)(B), is 
amended by inserting ‘‘or clause (ii)(XX)’’ after 
‘‘clause (i)(VIII)’’.
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SEC. 2002. INCOME ELIGIBILITY FOR NONELDERLY DETER-
MINED USING MODIFIED GROSS INCOME. 
(a) IN GENERAL.—Section 1902(e) of the Social Secu-
rity Act (42 U.S.C. 1396a(e)) is amended by adding at the 
end the following: 
‘‘(14) INCOME
DETERMINED
USING
MODIFIED 
GROSS INCOME.— 
‘‘(A) IN
GENERAL.—Notwithstanding sub-
section (r) or any other provision of this title, ex-
cept as provided in subparagraph (D), for pur-
poses of determining income eligibility for med-
ical assistance under the State plan or under 
any waiver of such plan and for any other pur-
pose applicable under the plan or waiver for 
which a determination of income is required, in-
cluding with respect to the imposition of pre-
miums and cost-sharing, a State shall use the 
modified gross income of an individual and, in 
the case of an individual in a family greater 
than 1, the household income of such family. A 
State shall establish income eligibility thresholds 
for populations to be eligible for medical assist-
ance under the State plan or a waiver of the 
plan using modified gross income and household 
income that are not less than the effective income 
eligibility levels that applied under the State
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plan or waiver on the date of enactment of the 
Patient Protection and Affordable Care Act. For 
purposes of complying with the maintenance of 
effort requirements under subsection (gg) during 
the transition to modified gross income and 
household income, a State shall, working with 
the Secretary, establish an equivalent income test 
that ensures individuals eligible for medical as-
sistance under the State plan or under a waiver 
of the plan on the date of enactment of the Pa-
tient Protection and Affordable Care Act, do not 
lose coverage under the State plan or under a 
waiver of the plan. The Secretary may waive 
such provisions of this title and title XXI as are 
necessary to ensure that States establish income 
and eligibility determination systems that pro-
tect beneficiaries. 
‘‘(B) 
NO
INCOME
OR
EXPENSE
DIS-
REGARDS.—No type of expense, block, or other 
income disregard shall be applied by a State to 
determine income eligibility for medical assist-
ance under the State plan or under any waiver 
of such plan or for any other purpose applicable 
under the plan or waiver for which a determina-
tion of income is required.
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‘‘(C) NO ASSETS TEST.—A State shall not 
apply any assets or resources test for purposes of 
determining eligibility for medical assistance 
under the State plan or under a waiver of the 
plan. 
‘‘(D) EXCEPTIONS.— 
‘‘(i) INDIVIDUALS ELIGIBLE BECAUSE 
OF OTHER AID OR ASSISTANCE, ELDERLY 
INDIVIDUALS, MEDICALLY
NEEDY
INDIVID-
UALS, 
AND
INDIVIDUALS
ELIGIBLE
FOR 
MEDICARE COST-SHARING.—Subparagraphs 
(A), (B), and (C) shall not apply to the de-
termination of eligibility under the State 
plan or under a waiver for medical assist-
ance for the following: 
‘‘(I) Individuals who are eligible 
for medical assistance under the State 
plan or under a waiver of the plan on 
a basis that does not require a deter-
mination of income by the State agen-
cy administering the State plan or 
waiver, including as a result of eligi-
bility for, or receipt of, other Federal 
or State aid or assistance, individuals 
who are eligible on the basis of receiv-
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ing (or being treated as if receiving) 
supplemental security income benefits 
under title XVI, and individuals who 
are eligible as a result of being or 
being deemed to be a child in foster 
care under the responsibility of the 
State. 
‘‘(II) Individuals who have at-
tained age 65. 
‘‘(III) Individuals who qualify for 
medical assistance under the State 
plan or under any waiver of such plan 
on the basis of being blind or disabled 
(or being treated as being blind or dis-
abled) without regard to whether the 
individual is eligible for supplemental 
security income benefits under title 
XVI on the basis of being blind or dis-
abled and including an individual who 
is eligible for medical assistance on the 
basis of section 1902(e)(3). 
‘‘(IV) Individuals described in 
subsection (a)(10)(C). 
‘‘(V) Individuals described in any 
clause of subsection (a)(10)(E).
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based services furnished under a waiver or 
State plan amendment under section 1915 
or a waiver under section 1115, and serv-
ices described in section 1917(c)(1)(C)(ii). 
‘‘(v) GRANDFATHER OF CURRENT EN-
ROLLEES UNTIL DATE OF NEXT REGULAR 
REDETERMINATION.—An individual who, 
on January 1, 2014, is enrolled in the State 
plan or under a waiver of the plan and who 
would be determined ineligible for medical 
assistance solely because of the application 
of the modified gross income or household 
income standard described in subparagraph 
(A), shall remain eligible for medical assist-
ance under the State plan or waiver (and 
subject to the same premiums and cost-shar-
ing as applied to the individual on that 
date) through March 31, 2014, or the date 
on which the individual’s next regularly 
scheduled redetermination of eligibility is to 
occur, whichever is later. 
‘‘(E) TRANSITION
PLANNING
AND
OVER-
SIGHT.—Each State shall submit to the Sec-
retary for the Secretary’s approval the income 
eligibility thresholds proposed to be established
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‘‘(F) LIMITATION
ON
SECRETARIAL
AU-
THORITY.—The Secretary shall not waive com-
pliance with the requirements of this paragraph 
except to the extent necessary to permit a State 
to coordinate eligibility requirements for dual el-
igible 
individuals 
(as 
defined 
in 
section 
1915(h)(2)(B)) under the State plan or under a 
waiver of the plan and under title XVIII and in-
dividuals who require the level of care provided 
in a hospital, a nursing facility, or an inter-
mediate care facility for the mentally retarded. 
‘‘(G) DEFINITIONS OF MODIFIED GROSS IN-
COME AND HOUSEHOLD INCOME.—In this para-
graph, the terms ‘modified gross income’ and 
‘household income’ have the meanings given such 
terms in section 36B(d)(2) of the Internal Rev-
enue Code of 1986. 
‘‘(H) CONTINUED
APPLICATION
OF
MED-
ICAID RULES REGARDING POINT-IN-TIME INCOME 
AND
SOURCES
OF
INCOME.—The requirement 
under this paragraph for States to use modified 
gross income and household income to determine 
income eligibility for medical assistance under 
the State plan or under any waiver of such plan 
and for any other purpose applicable under the
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plan or waiver for which a determination of in-
come is required shall not be construed as affect-
ing or limiting the application of— 
‘‘(i) the requirement under this title 
and under the State plan or a waiver of the 
plan to determine an individual’s income as 
of the point in time at which an applica-
tion for medical assistance under the State 
plan or a waiver of the plan is processed; 
or 
‘‘(ii) any rules established under this 
title or under the State plan or a waiver of 
the plan regarding sources of countable in-
come.’’. 
(b) CONFORMING AMENDMENT.—Section 1902(a)(17) 
of such Act (42 U.S.C. 1396a(a)(17)) is amended by insert-
ing ‘‘(e)(14),’’ before ‘‘(l)(3)’’. 
(c) EFFECTIVE DATE.—The amendments made by sub-
sections (a) and (b) take effect on January 1, 2014. 
SEC. 2003. REQUIREMENT TO OFFER PREMIUM ASSISTANCE 
FOR EMPLOYER-SPONSORED INSURANCE. 
(a) IN GENERAL.—Section 1906A of such Act (42 
U.S.C. 1396e–1) is amended— 
(1) in subsection (a)—
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(A) by striking ‘‘may elect to’’ and insert-
ing ‘‘shall’’; 
(B) by striking ‘‘under age 19’’; and 
(C) by inserting ‘‘, in the case of an indi-
vidual under age 19,’’ after ‘‘(and’’; 
(2) in subsection (c), in the first sentence, by 
striking ‘‘under age 19’’; and 
(3) in subsection (d)— 
(A) in paragraph (2)— 
(i) in the first sentence, by striking 
‘‘under age 19’’; and 
(ii) by striking the third sentence and 
inserting ‘‘A State may not require, as a 
condition of an individual (or the individ-
ual’s parent) being or remaining eligible for 
medical assistance under this title, that the 
individual (or the individual’s parent) 
apply for enrollment in qualified employer- 
sponsored coverage under this section.’’; and 
(B) in paragraph (3), by striking ‘‘the par-
ent of an individual under age 19’’ and insert-
ing ‘‘an individual (or the parent of an indi-
vidual)’’; and 
(4) in subsection (e), by striking ‘‘under age 19’’ 
each place it appears.
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(b) CONFORMING AMENDMENT.—The heading for sec-
tion 1906A of such Act (42 U.S.C. 1396e–1) is amended 
by striking ‘‘OPTION FOR CHILDREN’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section take effect on January 1, 2014. 
SEC. 2004. MEDICAID COVERAGE FOR FORMER FOSTER 
CARE CHILDREN. 
(a) IN GENERAL.—Section 1902(a)(10)(A)(i) of the 
Social Security Act (42 U.S.C. 1396a), as amended by sec-
tion 2001(a)(1), is amended— 
(1) by striking ‘‘or’’ at the end of subclause 
(VII); 
(2) by adding ‘‘or’’ at the end of subclause 
(VIII); and 
(3) by inserting after subclause (VIII) the fol-
lowing: 
‘‘(IX) who were in foster care 
under the responsibility of a State for 
more than 6 months (whether or not 
consecutive) but are no longer in such 
care, who are not described in any of 
subclauses (I) through (VII) of this 
clause, and who are under 25 years of 
age;’’.
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(b) OPTION
TO
PROVIDE
PRESUMPTIVE
ELIGI-
BILITY.—Section 1920(e) of such Act (42 U.S.C. 1396r– 
1(e)), as added by section 2001(a)(4)(B) and amended by 
section 2001(e)(2)(C), is amended by inserting ‘‘, clause 
(i)(IX),’’ after ‘‘clause (i)(VIII)’’. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1903(f)(4) of such Act (42 U.S.C. 
1396b(f)(4)), as amended by section 2001(a)(5)(D), is 
amended by inserting ‘‘1902(a)(10)(A)(i)(IX),’’ after 
‘‘1902(a)(10)(A)(i)(VIII),’’. 
(2) Section 1937(a)(2)(B)(viii) of such Act (42 
U.S.C. 1396u–7(a)(2)(B)(viii)) is amended by insert-
ing ‘‘, or the individual qualifies for medical assist-
ance on the basis of section 1902(a)(10)(A)(i)(IX)’’ 
before the period. 
(d) EFFECTIVE DATE.—The amendments made by this 
section take effect on January 1, 2019. 
SEC. 2005. PAYMENTS TO TERRITORIES. 
(a) INCREASE
IN
LIMIT
ON
PAYMENTS.—Section 
1108(g) of the Social Security Act (42 U.S.C. 1308(g)) is 
amended— 
(1) in paragraph (2), in the matter preceding 
subparagraph (A), by striking ‘‘paragraph (3)’’ and 
inserting ‘‘paragraphs (3) and (5)’’;
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(2) in paragraph (4), by striking ‘‘and (3)’’ and 
inserting ‘‘(3), and (4)’’; and 
(3) by adding at the end the following para-
graph: 
‘‘(5) FISCAL YEAR 2011 AND THEREAFTER.—The 
amounts otherwise determined under this subsection 
for Puerto Rico, the Virgin Islands, Guam, the North-
ern Mariana Islands, and American Samoa for the 
second, third, and fourth quarters of fiscal year 2011, 
and for each fiscal year after fiscal year 2011 (after 
the application of subsection (f) and the preceding 
paragraphs of this subsection), shall be increased by 
30 percent.’’. 
(b) DISREGARD OF PAYMENTS FOR MANDATORY EX-
PANDED ENROLLMENT.—Section 1108(g)(4) of such Act (42 
U.S.C. 1308(g)(4)) is amended— 
(1) by striking ‘‘to fiscal years beginning’’ and 
inserting ‘‘to— 
‘‘(A) fiscal years beginning’’; 
(2) by striking the period at the end and insert-
ing ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(B) fiscal years beginning with fiscal year 
2014, payments made to Puerto Rico, the Virgin 
Islands, Guam, the Northern Mariana Islands,