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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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Care Act for purposes of determining compliance 
with the requirements of paragraph (1), (2), or 
(3). 
‘‘(B) STATES MAY EXPAND ELIGIBILITY OR 
MOVE WAIVERED POPULATIONS INTO COVERAGE 
UNDER THE STATE PLAN.—With respect to any 
period applicable under paragraph (1), (2), or 
(3), a State that applies eligibility standards, 
methodologies, or procedures under the State 
plan under this title or under any waiver of the 
plan that are less restrictive than the eligibility 
standards, methodologies, or procedures, applied 
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, or that makes 
individuals who, on such date of enactment, are 
eligible for medical assistance under a waiver of 
the State plan, after such date of enactment eli-
gible for medical assistance through a State plan 
amendment with an income eligibility level that 
is not less than the income eligibility level that 
applied under the waiver, or as a result of the 
application of subclause (VIII) of section 
1902(a)(10)(A)(i), shall not be considered to have 
in effect eligibility standards, methodologies, or 
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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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‘‘(ii) EXPRESS
LANE
AGENCY
FIND-
INGS.—In the case of a State that elects the 
Express Lane option under paragraph (13), 
notwithstanding subparagraphs (A), (B), 
and (C), the State may rely on a finding 
made by an Express Lane agency in ac-
cordance with that paragraph relating to 
the income of an individual for purposes of 
determining the individual’s eligibility for 
medical assistance under the State plan or 
under a waiver of the plan. 
‘‘(iii) MEDICARE PRESCRIPTION DRUG 
SUBSIDIES
DETERMINATIONS.—Subpara-
graphs (A), (B), and (C) shall not apply to 
any determinations of eligibility for pre-
mium and cost-sharing subsidies under and 
in accordance with section 1860D–14 made 
by the State pursuant to section 1935(a)(2). 
‘‘(iv) 
LONG-TERM
CARE.—Subpara-
graphs (A), (B), and (C) shall not apply to 
any determinations of eligibility of individ-
uals for purposes of medical assistance for 
nursing facility services, a level of care in 
any institution equivalent to that of nurs-
ing facility services, home or community- 
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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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