I 
112TH CONGRESS 
2D SESSION 
H. R. 4160 
To amend the Social Security Act to replace the Medicaid program and 
the Children’s Health Insurance program with a block grant to the 
States, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 7, 2012 
Mr. ROKITA (for himself, Mr. HUELSKAMP, Mr. BROUN of Georgia, and Mr. 
JORDAN) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means, Education and the Workforce, the Judiciary, Natural 
Resources, House Administration, Rules, and Appropriations, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend the Social Security Act to replace the Medicaid 
program and the Children’s Health Insurance program 
with a block grant to the States, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘State Health Flexibility Act of 2012’’. 
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(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Health grants to the States for health care services to indigent individ-
uals. 
‘‘TITLE XXII—BLOCK GRANTS TO STATES FOR HEALTH CARE 
SERVICES TO INDIGENT INDIVIDUALS 
‘‘Sec. 2201. Purpose. 
‘‘Sec. 2202. Grants to States. 
‘‘Sec. 2203. Administrative and fiscal accountability. 
‘‘Sec. 2204. Nondiscrimination provisions. 
‘‘Sec. 2205. Emergency assistance. 
‘‘Sec. 2206. Definitions. 
Sec. 3. Repeal of PPACA, HCERA, and the Federal requirements of Medicaid 
and CHIP. 
Sec. 4. Severability. 
Sec. 5. Effective date. 
SEC. 2. HEALTH GRANTS TO THE STATES FOR HEALTH 
CARE SERVICES TO INDIGENT INDIVIDUALS. 
(a) HEALTH CARE BLOCK GRANT TO STATES.—The 
Social Security Act is amended by adding at the end the 
following new title: 
‘‘TITLE XXII—BLOCK GRANTS TO 
STATES FOR HEALTH CARE 
SERVICES TO INDIGENT INDI-
VIDUALS 
‘‘SEC. 2201. PURPOSE. 
‘‘The purpose of this title is to provide Federal finan-
cial assistance to the States, in the form of a single grant, 
to allow the States maximum flexibility in providing, and 
financing the provision of, health-care-related items and 
services to indigent individuals. 
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‘‘SEC. 2202. GRANTS TO STATES. 
‘‘(a) IN GENERAL.—Subject to the requirements of 
this title, each State is entitled to receive from the Sec-
retary of the Treasury a grant for each quarter of fiscal 
years 2013, 2014, 2015, 2016, 2017, 2018, 2019, 2020, 
2021, and 2022, in an amount that is equal to 25 percent 
of the total amount received by a State under title XIX 
and title XXI for fiscal year 2012. 
‘‘(b) APPROPRIATION.—Out of any money in the 
Treasury of the United States not otherwise appropriated, 
there are appropriated for fiscal years 2013, 2014, 2015, 
2016, 2017, 2018, 2019, 2020, 2021 and 2022 such sums 
as are necessary for grants under this section. 
‘‘(c) REQUIREMENTS RELATING TO INTERGOVERN-
MENTAL FINANCING.—The Secretary of the Treasury 
shall make the transfer of funds under grants under sub-
section (a) directly to each State in accordance with the 
requirements of section 6503 of title 31, United States 
Code. 
‘‘(d) EXPENDITURE OF FUNDS.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), amounts received by a State under this 
title for any fiscal year shall be expended by the 
State in such fiscal year or in the succeeding fiscal 
year. 
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‘‘(2) USE OF RAINY DAY FUND PERMITTED.— 
Of the amounts received by a State under this title, 
the State may set aside, in a separate account, such 
amounts as the State deems necessary to provide, 
without fiscal limitation, health-care-related items 
and services for indigent individuals during— 
‘‘(A) periods of unexpectedly high rates of 
unemployment; or 
‘‘(B) periods related to circumstances that 
are not described in subparagraph (A) and that 
cause unexpected increases in the need for such 
items and services for such individuals. 
‘‘(3) FUNDS REMAINING AFTER FISCAL YEAR 
2022.—If, after 2022, a State has funds in the ac-
count under paragraph (2), the State may only ex-
pend such funds if such funds are used in a manner 
that is permitted under subsection (e), as such sub-
section is in effect on September 30, 2022. 
‘‘(e) USE OF FUNDS.—A State may only use the 
amounts received under subsection (a) as follows: 
‘‘(1) GENERAL
PURPOSE.—For the purpose 
under section 2201, including the provision of 
health-care-related items and services as required 
under section 2205. Nothing in this title shall be 
construed as limiting the flexibility of a State to de-
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