I 
110TH CONGRESS 
2D SESSION 
H. R. 5268 
To provide for a temporary increase of the Federal medical assistance 
percentage under the Medicaid Program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 7, 2008 
Mr. PALLONE (for himself, Mr. KING of New York, Mr. DINGELL, and Mr. 
REYNOLDS) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce 
A BILL 
To provide for a temporary increase of the Federal medical 
assistance percentage under the Medicaid Program, 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. TEMPORARY INCREASE OF MEDICAID FMAP. 
(a) PERMITTING MAINTENANCE OF FISCAL YEAR 
2007 FMAP FOR LAST 2 CALENDAR QUARTERS OF FIS-
CAL YEAR 2008.—Subject to subsection (e), if the FMAP 
determined without regard to this section for a State for 
fiscal year 2008 is less than the FMAP as so determined 
for fiscal year 2007, the FMAP for the State for fiscal 
VerDate Aug 31 2005 
21:15 Feb 08, 2008
Jkt 069200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5268.IH
H5268
pwalker on PROD1PC71 with BILLS
year 2007 shall be substituted for the State’s FMAP for 
the third and fourth calendar quarters of fiscal year 2008, 
before the application of this section. 
(b) PERMITTING MAINTENANCE OF FISCAL YEAR 
2008 FMAP FOR FIRST 3 QUARTERS OF FISCAL YEAR 
2009.—Subject to subsection (e), if the FMAP determined 
without regard to this section for a State for fiscal year 
2009 is less than the FMAP as so determined for fiscal 
year 2008, the FMAP for the State for fiscal year 2008 
shall be substituted for the State’s FMAP for the first, 
second, and third calendar quarters of fiscal year 2009, 
before the application of this section. 
(c) GENERAL 2.95 PERCENTAGE POINTS INCREASE 
FOR LAST 2 CALENDAR QUARTERS OF FISCAL YEAR 2008 
AND FIRST 3 CALENDAR QUARTERS OF FISCAL YEAR 
2009.—Subject to subsections (e), (f), and (g), for each 
State for the third and fourth calendar quarters of fiscal 
year 2008 and for the first, second, and third calendar 
quarters of fiscal year 2009, the FMAP (taking into ac-
count the application of subsections (a) and (b)) shall be 
increased by 2.95 percentage points. 
(d) INCREASE IN CAP ON MEDICAID PAYMENTS TO 
TERRITORIES.—Subject to subsections (f) and (g), with 
respect to the third and fourth calendar quarters of fiscal 
year 2008 and the first, second, and third calendar quar-
VerDate Aug 31 2005 
21:15 Feb 08, 2008
Jkt 069200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5268.IH
H5268
pwalker on PROD1PC71 with BILLS
ters of fiscal year 2009, the amounts otherwise determined 
for Puerto Rico, the Virgin Islands, Guam, the Northern 
Mariana Islands, and American Samoa under subsections 
(f) and (g) of section 1108 of the Social Security Act (42 
U.S.C. 1308) shall each be increased by an amount equal 
to 5.90 percent of such amounts. 
(e) SCOPE OF APPLICATION.—The increases in the 
FMAP for a State under this section shall apply only for 
purposes of title XIX of the Social Security Act and shall 
not apply with respect to— 
(1) disproportionate share hospital payments 
described in section 1923 of such Act (42 U.S.C. 
1396r–4); 
(2) payments under title IV or XXI of such Act 
(42 U.S.C. 601 et seq. and 1397aa et seq.); or 
(3) any payments under XIX of such Act that 
are based on the enhanced FMAP described in sec-
tion 2105(b) of such Act (42 U.S.C. 1397ee(b)). 
(f) STATE ELIGIBILITY.— 
(1) IN GENERAL.—Subject to paragraph (2), a 
State is eligible for an increase in its FMAP under 
subsection (c) or an increase in a cap amount under 
subsection (d) only if the eligibility under its State 
plan under title XIX of the Social Security Act (in-
cluding any waiver under such title or under section 
VerDate Aug 31 2005 
21:15 Feb 08, 2008
Jkt 069200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5268.IH
H5268
pwalker on PROD1PC71 with BILLS
1115 of such Act (42 U.S.C. 1315)) is no more re-
strictive than the eligibility under such plan (or 
waiver) as in effect on January 1, 2008. 
(2) STATE
REINSTATEMENT
OF
ELIGIBILITY 
PERMITTED.—A State that has restricted eligibility 
under its State plan under title XIX of the Social 
Security Act (including any waiver under such title 
or under section 1115 of such Act (42 U.S.C. 
1315)) after January 1, 2008, is eligible for an in-
crease in its FMAP under subsection (c) or an in-
crease in a cap amount under subsection (d) in the 
first calendar quarter (and subsequent calendar 
quarters) in which the State has reinstated eligibility 
that is no more restrictive than the eligibility under 
such plan (or waiver) as in effect on January 1, 
2008. 
(3) RULE
OF
CONSTRUCTION.—Nothing in 
paragraph (1) or (2) shall be construed as affecting 
a State’s flexibility with respect to benefits offered 
under the State medicaid program under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.) 
(including any waiver under such title or under sec-
tion 1115 of such Act (42 U.S.C. 1315)). 
(g) REQUIREMENT FOR CERTAIN STATES.—In the 
case of a State that requires political subdivisions within 
VerDate Aug 31 2005 
21:15 Feb 08, 2008
Jkt 069200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5268.IH
H5268
pwalker on PROD1PC71 with BILLS
(2) DATA TO BE USED.—For estimating and 
adjusting a FMAP already calculated as of the date 
of the enactment of this Act for a State with a sig-
nificantly disproportionate employer pension and in-
surance fund contribution, the Secretary of Health 
and Human Services shall use the personal income 
data set originally used in calculating such FMAP. 
(3) SPECIAL
ADJUSTMENT
FOR
NEGATIVE 
GROWTH.—If in any calendar year the total personal 
income growth in a State is negative, an employer 
pension and insurance fund contribution for the pur-
poses of calculating the State’s FMAP for a cal-
endar year shall not exceed 125 percent of the 
amount of such contribution for the previous cal-
endar year for the State. 
(c) HOLD HARMLESS.—No State shall have its 
FMAP for a fiscal year reduced as a result of the applica-
tion of this section. 
(d) REPORT.—Not later than May 15, 2008, the Sec-
retary of Health and Human Services shall submit to Con-
gress a report on the problems presented by the current 
treatment of pension and insurance fund contributions in 
the use of Bureau of Economic Affairs calculations for the 
FMAP and for Medicaid and on possible alternative meth-
odologies to mitigate such problems. 
VerDate Aug 31 2005 
21:15 Feb 08, 2008
Jkt 069200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5268.IH
H5268
pwalker on PROD1PC71 with BILLS
(e) FMAP DEFINED.—For purposes of this section, 
the term ‘‘FMAP’’ means the Federal medical assistance 
percentage, as defined in section 1905(b) of the Social Se-
curity Act (42 U.S.C. 1396(d)). 
Æ 
VerDate Aug 31 2005 
21:15 Feb 08, 2008
Jkt 069200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6301
E:\BILLS\H5268.IH
H5268
pwalker on PROD1PC71 with BILLS