I 
118TH CONGRESS 
1ST SESSION H. R. 3004 
To amend the Internal Revenue Code of 1986 to provide for a temporary 
expansion of health insurance premium tax credits for certain low-income 
populations, and to amend title XIX of the Social Security Act to 
establish a Federal Medicaid program. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 28, 2023 
Mrs. FLETCHER introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend the Internal Revenue Code of 1986 to provide 
for a temporary expansion of health insurance premium 
tax credits for certain low-income populations, and to 
amend title XIX of the Social Security Act to establish 
a Federal Medicaid program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Affordable Care Cov-
erage Expansion and Support for States Act’’ or the ‘‘AC-
CESS Act’’. 
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SEC. 2. TEMPORARY EXPANSION OF HEALTH INSURANCE 
PREMIUM TAX CREDITS FOR CERTAIN LOW- 
INCOME POPULATIONS. 
(a) IN GENERAL.—Section 36B of the Internal Rev-
enue Code of 1986 is amended by redesignating subsection 
(h) as subsection (i) and by inserting after subsection (g) 
the following new subsection: 
‘‘(h) CERTAIN TEMPORARY RULES BEGINNING IN 
2024.—With respect to any taxable year beginning after 
December 31, 2023, and before January 1, 2027— 
‘‘(1) ELIGIBILITY
FOR
CREDIT
NOT
LIMITED 
BASED ON INCOME.—Subsection (c)(1)(A) shall be 
disregarded in determining whether a taxpayer is an 
applicable taxpayer. 
‘‘(2) CREDIT ALLOWED TO CERTAIN LOW-IN-
COME
EMPLOYEES
OFFERED
EMPLOYER-PROVIDED 
COVERAGE.—Subclause 
(II) 
of 
subsection 
(c)(2)(C)(i) shall not apply if the taxpayer’s house-
hold income does not exceed 138 percent of the pov-
erty line for a family of the size involved. Subclause 
(II) of subsection (c)(2)(C)(i) shall also not apply to 
an individual described in the last sentence of such 
subsection if the taxpayer’s household income does 
not exceed 138 percent of the poverty line for a fam-
ily of the size involved. 
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‘‘(3) CREDIT ALLOWED TO CERTAIN LOW-IN-
COME EMPLOYEES OFFERED QUALIFIED SMALL EM-
PLOYER
HEALTH
REIMBURSEMENT
ARRANGE-
MENTS.—A qualified small employer health reim-
bursement arrangement shall not be treated as con-
stituting affordable coverage for an employee (or any 
spouse or dependent of such employee) for any 
months of a taxable year if the employee’s household 
income for such taxable year does not exceed 138 
percent of the poverty line for a family of the size 
involved. 
‘‘(4) LIMITATIONS ON RECAPTURE.— 
‘‘(A) IN GENERAL.—In the case of a tax-
payer whose household income is less than 200 
percent of the poverty line for the size of the 
family involved for the taxable year, the amount 
of the increase under subsection (f)(2)(A) shall 
in no event exceed $300 (one-half of such 
amount in the case of a taxpayer whose tax is 
determined under section 1(c) for the taxable 
year). 
‘‘(B) LIMITATION ON INCREASE FOR CER-
TAIN NON-FILERS.—In the case of any taxpayer 
who would not be required to file a return of 
tax for the taxable year but for any require-
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ment to reconcile advance credit payments 
under subsection (f), if an Exchange established 
under title I of the Patient Protection and Af-
fordable Care Act has determined that— 
‘‘(i) such taxpayer is eligible for ad-
vance payments under section 1412 of 
such Act for any portion of such taxable 
year, and 
‘‘(ii) such taxpayer’s household in-
come for such taxable year is projected to 
not exceed 138 percent of the poverty line 
for a family of the size involved, 
subsection (f)(2)(A) shall not apply to such tax-
payer for such taxable year and such taxpayer 
shall not be required to file such return of tax. 
‘‘(C) INFORMATION
PROVIDED
BY
EX-
CHANGE.—The information required to be pro-
vided by an Exchange to the Secretary and to 
the taxpayer under subsection (f)(3) shall in-
clude such information as is necessary to deter-
mine whether such Exchange has made the de-
terminations described in clauses (i) and (ii) of 
subparagraph (B) with respect to such tax-
payer.’’. 
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(b) EMPLOYER SHARED RESPONSIBILITY PROVISION 
NOT APPLICABLE WITH RESPECT TO CERTAIN LOW-IN-
COME TAXPAYERS RECEIVING PREMIUM ASSISTANCE.— 
Section 4980H(c)(3) is amended to read as follows: 
‘‘(3) APPLICABLE PREMIUM TAX CREDIT AND 
COST-SHARING REDUCTION.— 
‘‘(A) IN GENERAL.—The term ‘applicable 
premium tax credit and cost-sharing reduction’ 
means— 
‘‘(i) any premium tax credit allowed 
under section 36B, 
‘‘(ii) any cost-sharing reduction under 
section 1402 of the Patient Protection and 
Affordable Care Act, and 
‘‘(iii) any advance payment of such 
credit or reduction under section 1412 of 
such Act. 
‘‘(B) EXCEPTION WITH RESPECT TO CER-
TAIN
LOW-INCOME
TAXPAYERS.—Such term 
shall not include any premium tax credit, cost- 
sharing reduction, or advance payment other-
wise described in subparagraph (A) if such 
credit, reduction, or payment is allowed or paid 
for a taxable year of an employee (beginning 
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after December 31, 2023, and before January 
1, 2027) with respect to which— 
‘‘(i) an Exchange established under 
title I of the Patient Protection and Af-
fordable Care Act has determined that 
such employee’s household income for such 
taxable year is projected to not exceed 138 
percent of the poverty line for a family of 
the size involved, or 
‘‘(ii) such employee’s household in-
come for such taxable year does not exceed 
138 percent of the poverty line for a family 
of the size involved.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2023. 
SEC. 3. CLOSING THE MEDICAID COVERAGE GAP. 
(a) FEDERAL MEDICAID PROGRAM TO CLOSE COV-
ERAGE GAP IN NONEXPANSION STATES.—Title XIX of 
the Social Security Act (42 U.S.C. 1396 et seq.) is amend-
ed by adding at the end the following new section: 
‘‘SEC. 1948. FEDERAL MEDICAID PROGRAM TO CLOSE COV-
ERAGE GAP IN NONEXPANSION STATES. 
‘‘(a) ESTABLISHMENT.—In the case of a State that 
the Secretary determines (based on the State plan under 
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this title, waiver of such plan, or other relevant informa-
tion) is not expected to expend amounts under the State 
plan (or waiver of such plan) for all individuals described 
in section 1902(a)(10)(A)(i)(VIII) during a year (begin-
ning with 2027) (in this section defined as ‘a coverage 
gap State’, with respect to such year), the Secretary shall 
(including through contract with eligible entities (as speci-
fied by the Secretary), consistent with subsection (b)) pro-
vide for the offering to such individuals residing in such 
State of a health benefits plan (in this section referred 
to as the ‘Federal Medicaid program’ or the ‘Program’), 
for each quarter during the period beginning on January 
1 of such year, and ending with the last day of the first 
quarter during which the State provides medical assist-
ance to all such individuals under the State plan (or waiv-
er of such plan). Under the Federal Medicaid program, 
the Secretary— 
‘‘(1) may use the Federally Facilitated Market-
place to facilitate eligibility determinations and en-
rollments under the Federal Medicaid Program and 
shall establish a set of eligibility rules to be applied 
under the Program in a manner consistent with sec-
tion 1902(e)(14); and 
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‘‘(2) shall establish benefits, beneficiary protec-
tions, and access to care standards by, at a min-
imum— 
‘‘(A) establishing a minimum set of bene-
fits to be provided (and providing such benefits) 
under the Federal Medicaid program, which 
shall be in compliance with the requirements of 
section 1937 and shall consist of benchmark 
coverage described in section 1937(b)(1) or 
benchmark equivalent coverage described in sec-
tion 1937(b)(2) to the same extent as medical 
assistance provided to such an individual under 
this title (without application of this section) is 
required under section 1902(k)(1) to consist of 
such benchmark coverage or benchmark equiva-
lent coverage; 
‘‘(B) applying the provisions of sections 
1902(a)(8), 1902(a)(34) (which may be applied 
in accordance with such phased-in implementa-
tion as the Secretary deems necessary, but be-
ginning as soon as practicable), and 1943 with 
respect to such an individual, benefits under the 
Federal Medicaid program, and making applica-
tion for such benefits (which may be in accord-
ance with a phased-in implementation as the 
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Secretary deems necessary, but beginning as 
soon as practicable) in the same manner as 
such provisions would apply to such an indi-
vidual, medical assistance under this title (other 
than pursuant to this section), and making ap-
plication for such medical assistance under this 
title (other than pursuant to this section); and 
providing that redeterminations and appeals of 
eligibility and coverage determinations of serv-
ices (including benefit reductions, terminations, 
and suspension) shall be conducted under the 
Federal Medicaid program in accordance with a 
Federal fair hearing process established by the 
Secretary that is subject to the same require-
ments as applied with respect to redetermina-
tions and appeals of eligibility, and with respect 
to coverage of services (including benefit reduc-
tions, terminations, and suspension), under a 
State plan under this title and that may provide 
for such fair hearings related to denials of eligi-
bility (based on modified adjusted gross income 
eligibility determinations) to be conducted 
through the Federally Facilitated Marketplace 
for Exchanges; 
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‘‘(C) applying, in accordance with sub-
section (d), the provisions of section 1927 
(other than subparagraphs (B) and (C) of sub-
section (b)(1) of such section) with respect to 
the Secretary and payment under the Federal 
Medicaid program for covered outpatient drugs 
with respect to a rebate period in the same 
manner and to the same extent as such provi-
sions apply with respect to a State and payment 
under the State plan for covered outpatient 
drugs with respect to the rebate period; and 
‘‘(D) applying the provisions of sections 
1902(a)(14), 1902(a)(23), 1902(a)(47), and 
1920 through 1920C (as applicable) to the Fed-
eral Medicaid program and such individuals en-
rolled in such program in the same manner and 
to the same extent as such provisions apply to 
a State plan and such individuals eligible for 
medical assistance under the State plan, and 
applying 
the 
provisions 
of 
section 
1902(a)(30)(A) with respect to medical assist-
ance available under the Federal Medicaid pro-
gram in the same manner and to the same ex-
tent as such provisions apply to medical assist-
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ance under a State plan under this title, except 
that— 
‘‘(i) the Secretary shall provide that 
no cost sharing shall be applied under the 
Federal Medicaid program; 
‘‘(ii) the Secretary may waive the pro-
visions of subparagraph (A) of section 
1902(a)(23) to the extent deemed appro-
priate to facilitate the implementation of 
managed care; and 
‘‘(iii) in applying the provisions of sec-
tion 
1902(a)(47) 
and 
sections 
1920 
through 1920C, the Secretary— 
‘‘(I) shall establish a single pre-
sumptive eligibility process for individ-
uals eligible under the Federal Med-
icaid program, under which the Sec-
retary may contract with entities to 
carry out such process; and 
‘‘(II) may apply such provisions 
and process in accordance with such 
phased-in implementation as the Sec-
retary deems necessary, but beginning 
as soon as practicable. 
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‘‘(b) ADMINISTRATION OF FEDERAL MEDICAID PRO-
GRAM THROUGH CONTRACTS WITH MEDICAID MANAGED 
CARE ORGANIZATION AND THIRD PARTY PLAN ADMINIS-
TRATOR REQUIREMENTS.— 
‘‘(1) IN GENERAL.—For the purpose of admin-
istering the benefits under the Program (across all 
coverage gap geographic areas (as defined in para-
graph (8))) to provide medical assistance to individ-
uals described in section 1902(a)(10)(A)(i)(VIII) en-
rolled under the Federal Medicaid program and re-
siding in such areas, the Secretary shall solicit bids 
described in paragraph (2) and enter into contracts 
with a total of at least 2 eligible entities (as speci-
fied by the Secretary, which may be a medicaid 
managed care organization (in this section defined 
as including a managed care organization described 
in section 1932(a)(1)(B)(i), a prepaid inpatient 
health plan, and a prepaid ambulatory health plans 
(as defined in section 438.2 of title 42, Code of Fed-
eral Regulations)), a third party plan administrator, 
or both). An eligible entity entering into a contract 
with the Secretary under this paragraph may admin-
ister such benefits as a Medicaid managed care or-
ganization (as so defined), in which case such con-
tract shall be in accordance with paragraph (3) with 
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respect to such geographic area, or as a third-party 
administrator, in which case such contract shall be 
in accordance with paragraph (4) with respect to 
such geographic area. The Secretary may so con-
tract with a Medicaid managed care organization or 
third party plan administrator in each coverage gap 
geographic area (and may specify which type of eli-
gible entity may bid with respect to a coverage gap 
geographic area or areas) and may contract with 
more than one such eligible entity in the same cov-
erage gap geographic area. 
‘‘(2) BIDS.— 
‘‘(A) IN GENERAL.—To be eligible to enter 
into a contract under this subsection, for a 
year, an entity shall submit (at such time, in 
such manner, and containing such information 
as specified by the Secretary) one or more bids 
to administer the Program in one or more cov-
erage gap geographic areas, which reflects the 
projected monthly cost to the entity of fur-
nishing benefits under the Program to an indi-
vidual enrolled under the Program in such a ge-
ographic area (or areas) for such year. 
‘‘(B) SELECTION.—In selecting from bids 
submitted under subparagraph (A) for purposes 
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of entering into contracts with eligible entities 
under this subsection, with respect to a cov-
erage gap geographic area, the Secretary shall 
take into account at least each of the following, 
with respect to each such bid: 
‘‘(i) Network adequacy (as proposed 
in the submitted bid). 
‘‘(ii) The amount, duration, and scope 
of benefits (such as value-added services 
offered in the submitted bid), as compared 
to the minimum set of benefits established 
by 
the 
Secretary 
under 
subsection 
(a)(2)(A). 
‘‘(iii) The amount of the bid, taking 
into account the average per member cost 
of providing medical assistance under 
State plans under this title (or waivers of 
such plans) to individuals enrolled in such 
plans (or waivers) who are at least 18 
years of age and residing in the coverage 
gap geographic area, as well as the average 
cost of providing medical assistance under 
State plans under this title (and waivers of 
such plans) to individuals described in sec-
tion 1902(a)(10)(A)(i)(VIII). 
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