152 
health assistance under title XXI of such Act (42 
U.S.C. 1397aa et seq.) which the Secretary of 
Health and Human Services determines requires 
State legislation (other than legislation appro-
priating funds) in order for the plan to meet the ad-
ditional requirement imposed by the amendments 
made by this section, such State plan shall not be 
regarded as failing to comply with the requirements 
of such title solely on the basis of its failure to meet 
this additional requirement before the first day of 
the first calendar quarter beginning after the close 
of the first regular session of the State legislature 
that begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in the 
case of a State that has a 2-year legislative session, 
each year of such session shall be deemed to be a 
separate regular session of the State legislature. 
SEC. 2008. INCREASING UNDERSTANDING OF AND IMPROV-
ING HEALTH LITERACY. 
(a) IN GENERAL.—The Secretary, in consultation 
with the Director of the National Institute on Minority 
Health and Health Disparities and the Deputy Assistant 
Secretary for Minority Health, shall award grants to eligi-
ble entities to improve health care for patient populations 
that have low health literacy. 
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(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
(1) be a hospital, health center or clinic, health 
plan, or other health entity (including a nonprofit 
minority health organization or association); and 
(2) prepare and submit to the Secretary an ap-
plication at such time, in such manner, and con-
taining such information as the Secretary may rea-
sonably require. 
(c) USE OF FUNDS.— 
(1) AGENCY FOR HEALTHCARE RESEARCH AND 
QUALITY.—A grant under subsection (a) that is 
awarded through the Director of the Agency for 
Healthcare Research and Quality shall be used— 
(A) to define and increase the under-
standing of health literacy across all areas of 
health care, including end of life care; 
(B) to investigate the correlation between 
low health literacy and health and health care; 
(C) to clarify which aspects of health lit-
eracy have an effect on health outcomes; and 
(D) for any other activity determined ap-
propriate by the Director. 
(2) HEALTH RESOURCES AND SERVICES ADMIN-
ISTRATION.—A grant under subsection (a) that is 
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awarded through the Administrator of the Health 
Resources and Services Administration shall be used 
to conduct demonstration projects for interventions 
for patients with low health literacy that may in-
clude— 
(A) the development of new disease man-
agement and end of life care programs for pa-
tients with low health literacy; 
(B) the tailoring of disease management 
programs and end of life care addressing men-
tal, physical, oral, and behavioral health condi-
tions for patients with low health literacy; 
(C) the translation of written health mate-
rials for patients with low health literacy; 
(D) the identification, implementation, and 
testing of low health literacy screening tools; 
(E) the conduct of educational campaigns 
for patients and providers about low health lit-
eracy; 
(F) the conduct of educational campaigns 
concerning health directed specifically at pa-
tients with mental disabilities, including those 
with cognitive and intellectual disabilities, de-
signed to reduce the incidence of low health lit-
eracy among these populations, which shall 
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have instructional materials in the plain lan-
guage standards promulgated under the Plain 
Writing Act of 2010 (5 U.S.C. 301 note) for 
Federal agencies; and 
(G) other activities determined appropriate 
by the Administrator. 
(d) DEFINITIONS.—In this section: 
(1) LOW HEALTH LITERACY.—The term ‘‘low 
health literacy’’ means the inability of an individual 
to obtain, process, and understand basic health in-
formation and services needed to make appropriate 
health decisions. 
(2) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services— 
(A) acting through the Director of the 
Agency for Healthcare Research and Quality, 
with respect to grants under subsection (c)(1); 
and 
(B) acting through the Administrator of 
the Health Resources and Services Administra-
tion with respect to grants under subsection 
(c)(2). 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
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such sums as may be necessary for each of fiscal years 
2025 through 2029. 
SEC. 2009. REQUIREMENTS FOR HEALTH PROGRAMS OR 
ACTIVITIES RECEIVING FEDERAL FUNDS. 
(a) COVERED ENTITY; HEALTH PROGRAM OR ACTIV-
ITY.—In this section: 
(1) COVERED ENTITY.—The term ‘‘covered en-
tity’’ means an entity described in clause (i) of sec-
tion 3401(a)(2)(C) of the Public Health Service Act, 
as added by section 2004. 
(2) HEALTH
PROGRAM
OR
ACTIVITY.—The 
term ‘‘health program or activity’’ has the meaning 
given such term in clause (ii) of such section 
3401(a)(2)(C). 
(b) REQUIREMENTS.—A covered entity, in order to 
ensure the right of individuals with limited English pro-
ficiency to receive access to high-quality health care 
through the health program or activity, shall— 
(1) ensure that appropriate clinical and support 
staff receive ongoing education and training in cul-
turally and linguistically appropriate service delivery 
at least annually; 
(2) offer and provide appropriate language as-
sistance services at no additional charge to each pa-
tient that is an individual with limited English pro-
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ficiency at all points of contact, in a timely manner 
during all hours of operation; 
(3) notify patients of their right to receive lan-
guage services in their primary language; and 
(4) utilize only qualified interpreters for an in-
dividual with limited English proficiency or qualified 
translators, except as provided in subsection (c). 
(c) EXEMPTIONS.—The requirements of subsection 
(b)(4) shall not apply as follows: 
(1) When a patient requests the use of family, 
friends, or other persons untrained in interpretation 
or translation if each of the following conditions are 
met: 
(A) The interpreter requested by the pa-
tient is over the age of 18. 
(B) The covered entity informs the patient 
in the primary language of the patient that he 
or she has the option of having the entity pro-
vide to the patient an interpreter and trans-
lation services without charge. 
(C) The covered entity informs the patient 
that the entity may not require an individual 
with a limited English proficiency to use a fam-
ily member or friend as an interpreter. 
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(D) The covered entity evaluates whether 
the person the patient wishes to use as an in-
terpreter is competent. If the covered entity has 
reason to believe that such person is not com-
petent as an interpreter, the entity provides its 
own interpreter to protect the covered entity 
from liability if the patient’s interpreter is later 
found not competent. 
(E) If the covered entity has reason to be-
lieve that there is a conflict of interest between 
the interpreter and patient, the covered entity 
may not use the patient’s interpreter. 
(F) The covered entity has the patient sign 
a waiver, witnessed by at least 1 individual not 
related to the patient, that includes the infor-
mation stated in subparagraphs (A) through 
(E) and is translated into the patient’s primary 
language. 
(2) When a medical emergency exists and the 
delay directly associated with obtaining competent 
interpreter or translation services would jeopardize 
the health of the patient, but only until a competent 
interpreter or translation service is available. 
(d) RULE
OF CONSTRUCTION.—Subsection (c)(2) 
shall not be construed to mean that emergency rooms or 
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similar entities that regularly provide health care services 
in medical emergencies are exempt from legal or regu-
latory requirements related to competent interpreter serv-
ices. 
SEC. 2010. REPORT ON FEDERAL EFFORTS TO PROVIDE 
CULTURALLY AND LINGUISTICALLY APPRO-
PRIATE HEALTH CARE SERVICES. 
(a) REPORT.—Not later than 1 year after the date 
of enactment of this Act, and annually thereafter, the Sec-
retary of Health and Human Services shall seek to enter 
into a contract with the National Academy of Medicine 
for the preparation and publication of a report that de-
scribes Federal efforts to ensure that all individuals with 
limited English proficiency have meaningful access to 
health care services and health care-related services that 
are culturally and linguistically appropriate. Such report 
shall include— 
(1) a description and evaluation of the activities 
carried out under this Act; 
(2) a description and analysis of best practices, 
model programs, guidelines, and other effective 
strategies for providing access to culturally and lin-
guistically appropriate health care services; 
(3) recommendations on the development and 
implementation of policies and practices by providers 
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of health care services and health care-related serv-
ices for individuals with limited English proficiency, 
including people with cognitive, hearing, vision, or 
print impairments; 
(4) recommend guidelines or standards for 
health literacy and plain language, informed consent, 
discharge instructions, and written communications, 
and for improvement of health care access; 
(5) a description of the effect of providing lan-
guage services on quality of health care and access 
to care; and 
(6) a description of the costs associated with or 
savings related to the provision of language services. 
(b) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
SEC. 2011. ENGLISH INSTRUCTION FOR INDIVIDUALS WITH 
LIMITED ENGLISH PROFICIENCY. 
(a) GRANTS AUTHORIZED.—The Secretary of Edu-
cation is authorized to provide grants to eligible entities 
for the provision of English as a second language (in this 
section referred to as ‘‘ESL’’) instruction to individuals 
with limited English proficiency, including health care-re-
lated English instruction, and shall determine, after con-
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sultation with appropriate stakeholders, the mechanism 
for administering and distributing such grants. 
(b) ELIGIBLE ENTITY.—In this section, the term ‘‘el-
igible entity’’ means— 
(1) a State; or 
(2) a community-based organization that pre-
dominantly employs and serves racial and ethnic mi-
nority groups (as defined in section 1707(g) of the 
Public Health Service Act (42 U.S.C. 300u–6(g)). 
(c) APPLICATION.—An eligible entity that desires to 
receive a grant under this section shall apply by submit-
ting to the Secretary of Education an application at such 
time, in such manner, and containing such information as 
the Secretary may require. 
(d) USE OF GRANT.—An eligible entity shall use 
grant funds provided under this section to— 
(1) develop and implement a plan for assuring 
the availability of ESL instruction, free of charge, to 
the community served by the eligible entity, that ef-
fectively integrates information about the nature of 
the United States health care system, how to access 
care, and any special language skills that may be re-
quired for individuals with limited English pro-
ficiency to access and regularly negotiate the health 
care system effectively; 
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(2) develop a plan for making ESL instruction 
available free to charge to individuals with limited 
English proficiency in the community served by the 
eligible entity who are seeking instruction, including, 
where appropriate, through the use of public-private 
partnerships; and 
(3) provide ESL instruction to individuals with 
limited English proficiency in the community served 
by the eligible entity. 
(e) SUPPLEMENT, NOT SUPPLANT.—An eligible enti-
ty awarded a grant under this section shall use funds 
made available under this section to supplement, and not 
supplant, other Federal, State, and local funds that would 
otherwise be expended to carry out activities under this 
section. 
(f) DUTIES OF THE SECRETARY.—The Secretary of 
Education shall— 
(1) collect and make publicly available annual 
data on how much Federal, State, and local govern-
ments spend annually on ESL instruction; 
(2) collect data from eligible entities awarded a 
grant under this section to identify the unmet needs 
of individuals with limited English proficiency for 
appropriate ESL instruction, including— 
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(A) the preferred written and spoken lan-
guage of such individuals; 
(B) the availability of enrollment in ESL 
instruction programs in the communities served 
by each eligible entity awarded a grant under 
this section, including the extent of waiting lists 
for ESL instruction, how many programs main-
tain waiting lists, and, for programs that do not 
have waiting lists, the reasons why such a list 
is unnecessary or otherwise not maintained; 
(C) the availability of programs to geo-
graphically isolated communities; 
(D) the impact of course enrollment poli-
cies, including open enrollment, on the avail-
ability of ESL instruction; 
(E) the number of individuals with limited 
English proficiency and the number of individ-
uals enrolled in ESL instruction programs in 
the communities served by each eligible entity 
awarded a grant under this section; 
(F) the effectiveness of the ESL instruc-
tion provided through grants awarded under 
this section in meeting the needs of individuals 
receiving such instruction; and 
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(G) an assessment of the need for pro-
grams that integrate job training and ESL in-
struction, to assist individuals with limited 
English proficiency in obtaining better jobs; 
(3) determine the cost and most appropriate 
methods of making ESL instruction available to all 
individuals with limited English proficiency in the 
United States who are seeking instruction; and 
(4) not later than 1 year after the date of en-
actment of this Act, issue a report to Congress 
that— 
(A) assesses the information collected in 
paragraphs (1), (2), and (3) and makes rec-
ommendations on steps that should be taken to 
realize the goal of making ESL instruction 
available to all individuals with limited English 
proficiency in the United States who are seek-
ing instruction; and 
(B) evaluates the impact of the grant pro-
gram authorized under this section on the ac-
cessibility of, and ability to effectively negotiate, 
the health care system for individuals with lim-
ited English proficiency who have received ESL 
instruction funded by a grant under this sec-
tion. 
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(g) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Secretary of Edu-
cation $250,000,000 for each of fiscal years 2025 through 
2029 to carry out this section. 
SEC. 2012. IMPLEMENTATION. 
(a) GENERAL PROVISIONS.— 
(1) IMMUNITY.—A person injured by a violation 
of this title (including an amendment made by this 
title) by a State may bring a civil action in the ap-
propriate Federal court for such injury in accord-
ance with this section. 
(2) REMEDIES.—In a civil action under this 
section for a violation of this title, such remedies 
shall be available as would be available in a civil ac-
tion for such violation against any party other than 
a State. 
(b) RULE OF CONSTRUCTION.—Nothing in this title 
may be construed to limit otherwise existing obligations 
of recipients of Federal financial assistance under title VI 
of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 
or any other Federal statute. 
SEC. 2013. LANGUAGE ACCESS SERVICES. 
(a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 
the Patient Protection and Affordable Care Act (42 
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U.S.C. 18022(b)(1)) is amended by adding at the end the 
following: 
‘‘(K) Language access services, including 
oral interpretation and written translations.’’. 
(b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 
COVERAGE.— 
(1) IN GENERAL.—Section 36B(c)(2)(C) of the 
Internal Revenue Code of 1986 is amended by redes-
ignating clauses (iii) and (iv) as clauses (iv) and (v), 
respectively, and by inserting after clause (ii) the fol-
lowing new clause: 
‘‘(iii) COVERAGE MUST INCLUDE LAN-
GUAGE ACCESS AND SERVICES.—Except as 
provided in clause (iv), an employee shall 
not be treated as eligible for minimum es-
sential coverage if such coverage consists 
of an eligible employer-sponsored plan (as 
defined in section 5000A(f)(2)) and the 
plan does not provide coverage for lan-
guage access services, including oral inter-
pretation and written translations.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 36B(c)(2)(C) of such Code is 
amended by striking ‘‘clause (iii)’’ each place it 
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appears in clauses (i) and (ii) and inserting 
‘‘clause (iv)’’. 
(B) Section 36B(c)(2)(C)(iv) of such Code, 
as redesignated by this subsection, is amended 
by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii), 
and (iii)’’. 
(c) QUALITY REPORTING.—Section 2717(a)(1) of the 
Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 
amended— 
(1) by striking ‘‘and’’ at the end of subpara-
graph (C); 
(2) by striking the period at the end of sub-
paragraph (D) and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(E) reduce health disparities through the 
provision of language access services, including 
oral interpretation and written translations.’’. 
(d) REGULATIONS REGARDING INTERNAL CLAIMS 
AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 
HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 
The Secretary of the Treasury, the Secretary of Labor, 
and the Secretary of Health and Human Services shall 
amend the regulations in section 54.9815–2719(e) of title 
26, Code of Federal Regulations (or successor regula-
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tions), section 2590.715–2719(e) of title 29, Code of Fed-
eral Regulations (or successor regulations), and section 
147.136(e) of title 45, Code of Federal Regulations (or 
successor regulations), respectively, to require group 
health plans and health insurance issuers offering group 
or individual health insurance coverage to which such sec-
tions apply— 
(1) to provide oral interpretation services with-
out any threshold requirements; 
(2) to provide in the English versions of all no-
tices a statement prominently displayed in not less 
than 15 non-English languages clearly indicating 
how to access the language services provided by the 
plan or issuer; and 
(3) with respect to the requirements for pro-
viding relevant notices in a culturally and linguis-
tically appropriate manner in the applicable non- 
English languages, to apply a threshold that 5 per-
cent of the population, or not less than 500 individ-
uals, in the county is literate only in the same non- 
English language in order for the language to be 
considered an applicable non-English language. 
(e) DATA COLLECTION AND REPORTING.—The Sec-
retary of Health and Human Services shall— 
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(1) amend the single streamlined application 
form developed pursuant to section 1413 of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18083) to collect the preferred spoken and written 
language for each household member applying for 
coverage under a qualified health plan through an 
Exchange under title I of such Act (42 U.S.C. 
18001 et seq.); 
(2) require navigators, certified application 
counselors, and other individuals assisting with en-
rollment to collect and report requests for language 
assistance; and 
(3) require the toll-free telephone hotlines es-
tablished pursuant to section 1311(d)(4)(B) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18031(d)(4)(B)) to submit an annual report 
documenting the number of language assistance re-
quests, the types of languages requested, the range 
and average wait time for a consumer to speak with 
an interpreter, the number of complaints and any 
steps the hotline, and any entity contracting with 
the Secretary to provide language services, have 
taken to actively address some of the consumer com-
plaints. 
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(f) EFFECTIVE DATE.—The amendments made by 
this section shall not apply to plans beginning prior to the 
date of the enactment of this Act. 
SEC. 2014. MEDICALLY UNDERSERVED POPULATIONS. 
Section 330(b)(3) of the Public Health Service Act 
(42 U.S.C. 254b(b)(3)) is amended to read as follows: 
‘‘(3) 
MEDICALLY
UNDERSERVED
POPU-
LATION.—The term ‘medically underserved popu-
lation’ means— 
‘‘(A) the population of an urban or rural 
area designated by the Secretary as— 
‘‘(i) an area with a shortage of per-
sonal health services; or 
‘‘(ii) a population group having a 
shortage of such services; or 
‘‘(B) a population of individuals, not con-
fined to a particular urban or rural area, who 
are designated by the Secretary as having a 
shortage of personal health services due to a 
specific demographic trait.’’. 
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TITLE III—HEALTH WORKFORCE 
DIVERSITY 
SEC. 3001. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
Title XXXIV of the Public Health Service Act, as 
added by section 2004, is amended by adding at the end 
the following: 
‘‘Subtitle B—Diversifying the 
Health Care Workplace 
‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 
DIVERSITY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Bureau of Health Workforce of the Health Resources 
and Services Administration, shall award a grant to an 
entity determined appropriate by the Secretary for the es-
tablishment of a national working group on workforce di-
versity. 
‘‘(b) REPRESENTATION.—In establishing the national 
working group under subsection (a): 
‘‘(1) The grantee shall ensure that the group 
has representatives of each of the following: 
‘‘(A) The Health Resources and Services 
Administration. 
‘‘(B) The Department of Health and 
Human Services Data Council. 
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‘‘(C) The Office of Minority Health of the 
Department of Health and Human Services. 
‘‘(D) The Substance Abuse and Mental 
Health Services Administration. 
‘‘(E) The Bureau of Labor Statistics of 
the Department of Labor. 
‘‘(F) The National Institute on Minority 
Health and Health Disparities. 
‘‘(G) The Agency for Healthcare Research 
and Quality. 
‘‘(H) The National Academy of Medicine. 
‘‘(I) The Indian Health Service. 
‘‘(J) The Centers for Medicare & Medicaid 
Services. 
‘‘(K) The Department of Education. 
‘‘(L) Institutions described in section 
371(a) of the Higher Education Act of 1965. 
‘‘(M) Consumer organizations. 
‘‘(N) Health professional associations, in-
cluding those that represent underrepresented 
minority populations. 
‘‘(O) Researchers in the area of health 
workforce. 
‘‘(P) Health workforce accreditation enti-
ties. 
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‘‘(Q) Private (including nonprofit) founda-
tions that have sponsored workforce diversity 
initiatives. 
‘‘(R) Local and State health departments. 
‘‘(S) Representatives of community mem-
bers to be included on admissions committees 
for health profession schools pursuant to sub-
section (c)(9). 
‘‘(T) National community-based organiza-
tions that serve as a national intermediary to 
their rural or urban affiliate members and have 
demonstrated capacity to train health care pro-
fessionals. 
‘‘(U) The Veterans Health Administration. 
‘‘(V) Other entities determined appropriate 
by the Secretary. 
‘‘(2) The grantee shall ensure that, in addition 
to the representatives under paragraph (1), the 
working group has not less than 5 health professions 
students representing various health profession fields 
and levels of training. 
‘‘(c) ACTIVITIES.—The working group established 
under subsection (a) shall convene at least twice each year 
to complete the following activities: 
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‘‘(1) Review public and private health workforce 
diversity initiatives. 
‘‘(2) Identify successful health workforce diver-
sity programs and practices. 
‘‘(3) Examine challenges relating to the devel-
opment and implementation of health workforce di-
versity initiatives. 
‘‘(4) Draft a national strategic work plan for 
health workforce diversity, including recommenda-
tions for public and private sector initiatives. 
‘‘(5) Develop a framework and methods for the 
evaluation of current and future health workforce di-
versity initiatives. 
‘‘(6) Develop recommended standards for work-
force diversity that could be applicable to all health 
professions programs and programs funded under 
this Act. 
‘‘(7) Develop guidelines to train health profes-
sionals to care for a diverse population. 
‘‘(8) Develop a workforce data collection or 
tracking system to identify where health profes-
sionals of racial and ethnic minority groups practice. 
‘‘(9) Develop a strategy for the inclusion of 
community members on admissions committees for 
health profession schools. 
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‘‘(10) Help with monitoring of standards for di-
versity, equity, and inclusion. 
‘‘(11) Other activities determined appropriate 
by the Secretary. 
‘‘(d) ANNUAL REPORT.—Not later than 1 year after 
the establishment of the working group under subsection 
(a), and annually thereafter, the working group shall pre-
pare and make available to the general public for com-
ment, an annual report on the activities of the working 
group. Such report shall include the recommendations of 
the working group for improving health workforce diver-
sity. 
‘‘(e) COORDINATION WITH OTHER EFFORTS.—In 
providing for the establishment of the working group 
under subsection (a), the Secretary shall take such steps 
as may be necessary to ensure that the work of the work-
ing group does not overlap with, or otherwise duplicate, 
other Federal Government efforts with respect to ensuring 
health equity in data collection in public health emer-
gencies. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
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‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 
WORKFORCE DIVERSITY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Deputy Assistant Secretary for Minority Health, and 
in collaboration with the Bureau of Health Workforce 
within the Health Resources and Services Administration 
and the National Institute on Minority Health and Health 
Disparities, shall establish a technical clearinghouse on 
health workforce diversity within the Office of Minority 
Health and coordinate current and future clearinghouses 
related to health workforce diversity. 
‘‘(b) INFORMATION AND SERVICES.—The clearing-
house established under subsection (a) shall offer the fol-
lowing information and services: 
‘‘(1) Information on the importance of health 
workforce diversity. 
‘‘(2) Statistical information relating to rep-
resentation of underrepresented minority populations 
in health and allied health professions and occupa-
tions. 
‘‘(3) Model health workforce diversity practices 
and programs, including integrated models of care. 
‘‘(4) Admissions policies that promote health 
workforce diversity and are in compliance with Fed-
eral and State laws. 
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‘‘(5) Retainment policies that promote comple-
tion of health profession degrees for underserved 
populations. 
‘‘(6) Lists of scholarship, loan repayment, and 
loan cancellation grants as well as fellowship infor-
mation for underserved populations for health pro-
fessions schools. 
‘‘(7) Foundation and other large organizational 
initiatives relating to health workforce diversity. 
‘‘(c) CONSULTATION.—In carrying out this section, 
the Secretary shall consult with non-Federal entities which 
may include health professional associations representing 
minority populations and sections of major health profes-
sional associations representing minority populations to 
ensure the adequacy and accuracy of information. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 
WORKFORCE DIVERSITY, EQUITY, AND IN-
CLUSION. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration and the Director of the Centers for Dis-
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ease Control and Prevention, shall award grants to eligible 
entities that demonstrate a commitment to health work-
force diversity. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) be an educational institution or entity that 
historically produces or trains meaningful numbers 
of underrepresented health professionals of minority 
populations, including— 
‘‘(A) part B institutions, as defined in sec-
tion 322 of the Higher Education Act of 1965; 
‘‘(B) historically Black professional or 
graduate institutions eligible for grants under 
section 326 of such Act; 
‘‘(C) Hispanic-serving health professions 
schools; 
‘‘(D) Hispanic-serving institutions, as de-
fined in section 502 of such Act; 
‘‘(E) Tribal Colleges or Universities, as de-
fined in section 316 of such Act; 
‘‘(F) Asian American and Native American 
Pacific Islander-serving institutions, as defined 
in section 371(c) of such Act; 
‘‘(G) institutions that have programs to re-
cruit and retain underrepresented health profes-
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sionals of minority populations, in which a sig-
nificant number of the enrolled participants are 
from minority populations; 
‘‘(H) 
health 
professional 
associations, 
which may include health professional associa-
tions representing underrepresented minority 
populations; and 
‘‘(I) institutions, including national and re-
gional community-based organizations with 
demonstrated commitment to a diversified 
workforce— 
‘‘(i) located in communities with pre-
dominantly underrepresented minority pop-
ulations; 
‘‘(ii) with whom partnerships have 
been formed for the purpose of increasing 
workforce diversity; and 
‘‘(iii) in which at least 20 percent of 
the enrolled participants are from under-
represented minority populations; and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under a 
grant under subsection (a) shall be used to expand existing 
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workforce diversity programs, implement new workforce 
diversity programs, or evaluate existing or new workforce 
diversity programs, including with respect to mental 
health care professions. Such programs shall enhance di-
versity by considering status as a member of a minority 
population as part of an individualized consideration of 
qualifications. Possible activities may include— 
‘‘(1) educational outreach programs relating to 
opportunities in the health professions; 
‘‘(2) scholarship, fellowship, grant, loan repay-
ment, and loan cancellation programs; 
‘‘(3) postbaccalaureate programs; 
‘‘(4) academic enrichment programs, particu-
larly targeting those who would not be competitive 
for health professions schools; 
‘‘(5) supporting workforce diversity in kinder-
garten through 12th grade and other health pipeline 
programs; 
‘‘(6) mentoring programs; 
‘‘(7) internship or rotation programs involving 
hospitals, health systems, health plans, and other 
health entities; 
‘‘(8) community partnership development for 
purposes relating to workforce diversity; or 
‘‘(9) leadership training. 
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‘‘(d) REPORTS.—Not later than 1 year after receiving 
a grant under this section, and annually for the term of 
the grant, a grantee shall submit to the Secretary a report 
that summarizes and evaluates all activities conducted 
under the grant. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 
RESEARCHERS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the National Institutes of Health, the Di-
rector of the Centers for Disease Control and Prevention, 
the Commissioner of Food and Drugs, the Director of the 
Agency for Healthcare Research and Quality, and the Ad-
ministrator of the Health Resources and Services Admin-
istration, shall award grants that expand existing opportu-
nities for scientists and researchers and promote the inclu-
sion of underrepresented minority populations in the 
health professions. 
‘‘(b) RESEARCH FUNDING.—The head of each agency 
listed in subsection (a) shall establish or expand existing 
programs to provide research funding to scientists and re-
searchers in training. Under such programs, the head of 
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each such entity shall give priority in allocating research 
funding to support health research in traditionally under-
served communities, including underrepresented minority 
populations, and research classified as community or 
participatory. 
‘‘(c) DATA COLLECTION.—The head of each agency 
listed in subsection (a) shall collect data on the number 
(expressed as an absolute number and a percentage) of 
underrepresented applicants from minority populations, 
and applicants from populations that are not minority 
populations, who receive and are denied agency funding 
at every stage of review. Such data shall be reported annu-
ally to the Secretary and the appropriate committees of 
Congress. 
‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec-
retary shall establish a student loan reimbursement pro-
gram to provide student loan reimbursement assistance to 
researchers who focus on racial and ethnic disparities in 
health. The Secretary shall promulgate regulations to de-
fine the scope and procedures for the program under this 
subsection. 
‘‘(e) STUDENT LOAN CANCELLATION.—The Sec-
retary shall establish a student loan cancellation program 
to provide student loan cancellation assistance to research-
ers who focus on racial and ethnic disparities in health. 
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Students participating in the program shall make a min-
imum 5-year commitment to work at an accredited health 
professions school. The Secretary shall promulgate addi-
tional regulations to define the scope and procedures for 
the program under this subsection. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 
PROFESSIONALS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention, the Assistant Secretary for Mental Health and 
Substance Use, the Administrator of the Health Resources 
and Services Administration, and the Administrator of the 
Centers for Medicare & Medicaid Services, shall establish 
a program to award grants to universities and other insti-
tutions to enter into agreements with eligible individuals 
under which— 
‘‘(1) the university or institution supports the 
eligible individual’s career in a nonresearch-related 
health and wellness profession; and 
‘‘(2) the eligible individual commits to per-
forming a period of obligated service in such a ca-
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reer to serve, or to work on health issues affecting, 
underserved communities, such as communities of 
racial and ethnic minority groups. 
‘‘(b) ELIGIBLE INDIVIDUALS.—To be an eligible indi-
vidual for purposes of subsection (a), an individual shall 
be a student in a health professions school, a graduate 
of such a school who is working in a health profession, 
an individual working in a health or wellness profession 
(including mental and behavioral health), or a faculty 
member of such a school. 
‘‘(c) APPLICATION.—To seek a grant under this sec-
tion, a university or other institution shall submit to the 
Secretary an application at such time, in such manner, 
and containing such information as the Secretary may re-
quire. 
‘‘(d) USE OF FUNDS.—A university or other institu-
tion receiving a grant under this section shall use the 
grant for agreements described in subsection (a). Such 
agreements may— 
‘‘(1) support an eligible individual’s health ac-
tivities or projects that involve underserved commu-
nities, including communities of racial and ethnic 
minority groups; 
‘‘(2) support an eligible individual’s health-re-
lated career advancement activities; 
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‘‘(3) pay, or reimburse for payment of, student 
loans or training or credentialing costs for eligible 
individuals who are health professionals and are fo-
cused on health issues affecting underserved commu-
nities, including communities of racial and ethnic 
minority groups; and 
‘‘(4) establish and promote leadership training 
programs for eligible individuals to decrease health 
disparities and to increase cultural competence with 
the goal of increasing diversity in leadership posi-
tions. 
‘‘(e) DEFINITION.—In this section, the term ‘career 
in a nonresearch-related health and wellness profession’ 
means employment or intended employment in the field 
of public health, health policy, health management, health 
administration, medicine, nursing, pharmacy, psychology, 
social work, psychiatry, other mental and behavioral 
health, allied health, community health, social work, or 
other fields determined appropriate by the Secretary, 
other than in a position that involves research. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
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‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI-
VERSITY ON QUALITY. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality (in this section referred 
to as the ‘Director’), in collaboration with the Deputy As-
sistant Secretary for Minority Health and the Director of 
the National Institute on Minority Health and Health Dis-
parities, shall award grants to eligible entities to expand 
research on the link between health workforce diversity 
and quality health care. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) be a clinical, public health, or health serv-
ices research entity or other entity determined ap-
propriate by the Director; and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under a 
grant awarded under subsection (a) shall be used to sup-
port research that investigates the effect of health work-
force diversity on— 
‘‘(1) language access; 
‘‘(2) cultural competence; 
‘‘(3) patient satisfaction; 
‘‘(4) timeliness of care; 
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‘‘(5) safety of care; 
‘‘(6) effectiveness of care; 
‘‘(7) efficiency of care; 
‘‘(8) patient outcomes; 
‘‘(9) community engagement; 
‘‘(10) resource allocation; 
‘‘(11) organizational structure; 
‘‘(12) compliance of care; or 
‘‘(13) other topics determined appropriate by 
the Director. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director shall give individualized consider-
ation to all relevant aspects of the applicant’s background. 
Consideration of prior research experience involving the 
health of underserved communities shall be such a relevant 
aspect. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Office of Minority Health, in collaboration 
with the National Institute on Minority Health and Health 
Disparities, the Office for Civil Rights, the Centers for 
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Disease Control and Prevention, the Centers for Medicare 
& Medicaid Services, the Health Resources and Services 
Administration, and other appropriate public and private 
entities, shall establish and coordinate a health and health 
care disparities education program to support, develop, 
and implement educational initiatives and outreach strate-
gies that inform health care professionals and the public 
about the existence of and methods to reduce racial and 
ethnic disparities in health and health care. 
‘‘(b) ACTIVITIES.—The Secretary, through the edu-
cation program established under subsection (a), shall, 
through the use of public awareness and outreach cam-
paigns targeting the general public and the medical com-
munity at large— 
‘‘(1) disseminate scientific evidence for the ex-
istence and extent of racial and ethnic disparities in 
health care, including disparities that are not other-
wise attributable to known factors such as access to 
care, patient preferences, or appropriateness of 
intervention, as described in the 2002 report of the 
National Academy of Medicine (formerly the ‘Insti-
tute of Medicine’) entitled ‘Unequal Treatment: Con-
fronting Racial and Ethnic Disparities in Health 
Care’, as well as the impact of disparities related to 
age, disability status, socioeconomic status, sex, gen-
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der identity, and sexual orientation on racial and 
ethnic minority groups; 
‘‘(2) disseminate new research findings to 
health care providers and patients to assist them in 
understanding, reducing, and eliminating health and 
health care disparities; 
‘‘(3) disseminate information about the impact 
of linguistic and cultural barriers on health care 
quality and the obligation of health providers who 
receive Federal financial assistance to ensure that 
individuals with limited English proficiency have ac-
cess to language access services; 
‘‘(4) disseminate information about the impor-
tance and legality of racial, ethnic, disability status, 
socioeconomic status, sex, gender identity, and sex-
ual orientation, and primary language data collec-
tion, analysis, and reporting; 
‘‘(5) design and implement specific educational 
initiatives to health care providers relating to health 
and health care disparities; 
‘‘(6) assess the impact of the programs estab-
lished under this section in raising awareness of 
health and health care disparities and providing in-
formation on available resources; and 
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‘‘(7) design and implement specific educational 
initiatives to educate the health care workforce relat-
ing to unconscious bias. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029.’’. 
SEC. 3002. HISPANIC-SERVING INSTITUTIONS, HISTORI-
CALLY BLACK COLLEGES AND UNIVERSITIES, 
HISTORICALLY BLACK PROFESSIONAL OR 
GRADUATE INSTITUTIONS, ASIAN AMERICAN 
AND NATIVE AMERICAN PACIFIC ISLANDER- 
SERVING INSTITUTIONS, TRIBAL COLLEGES, 
REGIONAL 
COMMUNITY-BASED 
ORGANIZA-
TIONS, AND NATIONAL MINORITY MEDICAL 
ASSOCIATIONS. 
Part B of title VII of the Public Health Service Act 
(42 U.S.C. 293 et seq.) is amended by adding at the end 
the following: 
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‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI-
CALLY BLACK COLLEGES AND UNIVERSITIES, 
HISTORICALLY BLACK PROFESSIONAL OR 
GRADUATE INSTITUTIONS, ASIAN AMERICAN 
AND NATIVE AMERICAN PACIFIC ISLANDER- 
SERVING INSTITUTIONS, AND TRIBAL COL-
LEGES. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration and in consultation with the Secretary of 
Education, shall award grants to Hispanic-serving institu-
tions, historically Black colleges and universities, histori-
cally Black professional or graduate institutions eligible 
for grants under section 326 of the Higher Education Act 
of 1965, Asian American and Native American Pacific Is-
lander-serving institutions, Tribal Colleges or Universities, 
regional community-based organizations, and national mi-
nority medical associations, for counseling, mentoring, and 
providing information on financial assistance to prepare 
underrepresented minority individuals to enroll in and 
graduate from health professional schools and to increase 
services for underrepresented minority students includ-
ing— 
‘‘(1) mentoring with underrepresented health 
professionals; 
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‘‘(2) providing financial assistance information 
for continued education and applications to health 
professional schools; and 
‘‘(3) retaining existing enrolled underrep-
resented minority students in a health professions 
school. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) ASIAN AMERICAN AND NATIVE AMERICAN 
PACIFIC
ISLANDER-SERVING
INSTITUTION.—The 
term ‘Asian American and Native American Pacific 
Islander-serving institution’ has the meaning given 
such term in section 320(b) of the Higher Education 
Act of 1965. 
‘‘(2) 
HISPANIC-SERVING
INSTITUTION.—The 
term ‘Hispanic-serving institution’ means an entity 
that— 
‘‘(A) is a school or program for which 
there is a definition under section 799B; 
‘‘(B) has an enrollment of full-time equiva-
lent students that is made up of at least 9 per-
cent Hispanic students; 
‘‘(C) has been effective in carrying out pro-
grams to recruit Hispanic individuals to enroll 
in and graduate from the school; 
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‘‘(D) has been effective in recruiting and 
retaining Hispanic faculty members; 
‘‘(E) has a significant number of graduates 
who are providing health services to medically 
underserved populations or to individuals in 
health professional shortage areas; and 
‘‘(F) is a Hispanic Center of Excellence in 
Health Professions Education designated under 
section 736(d)(2). 
‘‘(3) HISTORICALLY BLACK COLLEGE AND UNI-
VERSITY.—The term ‘historically Black college and 
university’ has the meaning given the term ‘part B 
institution’ as defined in section 322 of the Higher 
Education Act of 1965. 
‘‘(4) TRIBAL COLLEGE OR UNIVERSITY.—The 
term ‘Tribal College or University’ has the meaning 
given such term in section 316(b) of the Higher 
Education Act of 1965. 
‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In 
carrying out the National Health Service Corps Loan Re-
payment Program established under subpart III of part 
D of title III and the loan repayment program under sec-
tion 317F, the Secretary shall ensure, notwithstanding 
such subpart or section, that loan repayments of not less 
than $50,000 per year per person are awarded for repay-
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ment of loans incurred for enrollment or participation of 
underrepresented minority individuals in health profes-
sional schools and other health programs described in this 
section. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029.’’. 
SEC. 3003. LOAN REPAYMENT PROGRAM OF CENTERS FOR 
DISEASE CONTROL AND PREVENTION. 
Section 317F(c)(1) of the Public Health Service Act 
(42 U.S.C. 247b–7(c)(1)) is amended by striking 
‘‘$500,000 for fiscal year 1994, and such sums as may 
be necessary for each of the fiscal years 1995 through 
2002’’ and inserting ‘‘such sums as may be necessary for 
each of fiscal years 2025 through 2029’’. 
SEC. 3004. COOPERATIVE AGREEMENTS FOR ONLINE DE-
GREE PROGRAMS AT SCHOOLS OF PUBLIC 
HEALTH AND SCHOOLS OF ALLIED HEALTH. 
Part D of title VII of the Public Health Service Act 
(42 U.S.C. 294 et seq.) is amended by inserting after sec-
tion 755 of such Act (42 U.S.C. 294e) the following: 
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‘‘SEC. 755A. COOPERATIVE AGREEMENTS FOR ONLINE DE-
GREE PROGRAMS. 
‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 
acting through the Administrator of the Health Resources 
and Services Administration, in consultation with the Di-
rector of the Centers for Disease Control and Prevention, 
the Director of the Agency for Healthcare Research and 
Quality, and the Deputy Assistant Secretary for Minority 
Health, shall enter into cooperative agreements with 
schools of public health and schools of allied health to de-
sign and implement online degree programs. 
‘‘(b) PRIORITY.—In entering into cooperative agree-
ments under this section, the Secretary shall give priority 
to any school of public health or school of allied health 
that has an established track record of serving medically 
underserved communities. 
‘‘(c) REQUIREMENTS.—As a condition of entering 
into a cooperative agreement with the Secretary under this 
section, a school of public health or school of allied health 
shall agree to design and implement an online degree pro-
gram that meets the following restrictions: 
‘‘(1) Enrollment of individuals who have ob-
tained a secondary school diploma or its recognized 
equivalent. 
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‘‘(2) Maintaining a significant enrollment of 
underrepresented minority or disadvantaged stu-
dents. 
‘‘(3) Achieving a high completion rate of en-
rolled underrepresented minority or disadvantaged 
students. 
‘‘(d) PERIOD OF COOPERATIVE AGREEMENTS.—The 
period during which payments are made through a cooper-
ative agreement entered into under this section may not 
exceed 3 years. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029.’’. 
SEC. 3005. NATIONAL HEALTH CARE WORKFORCE COMMIS-
SION. 
(a) SENSE OF CONGRESS.—It is the sense of Con-
gress that the National Health Care Workforce Commis-
sion established by section 5101 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 294q) should, in car-
rying out its assigned duties under that section, give at-
tention to the needs of racial and ethnic minority groups, 
individuals with lower socioeconomic status, individuals 
with mental, developmental, and physical disabilities, les-
bian, gay, bisexual, transgender, queer, and questioning 
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populations, and individuals who are members of multiple 
minority or special population groups. 
(b) REAUTHORIZATION.—Section 5101(h)(2) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
294q(h)(2)) is amended by striking ‘‘such sums as may 
be necessary’’ and inserting ‘‘$3,000,000 for each of fiscal 
years 2025 through 2027’’. 
SEC. 3006. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 
Subtitle B of title XXXIV of the Public Health Serv-
ice Act, as added by section 3001, is further amended by 
inserting after section 3417 the following: 
‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 
SERVICES CORPS. 
‘‘(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention, in collaboration with the 
Administrator of the Health Resources and Services Ad-
ministration and the Deputy Assistant Secretary for Mi-
nority Health, shall award grants to eligible entities to in-
crease awareness among secondary and postsecondary stu-
dents of career opportunities in the health professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) be a clinical, public health, or health serv-
ices organization, community-based or nonprofit en-
tity, or other entity determined appropriate by the 
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Director of the Centers for Disease Control and Pre-
vention; 
‘‘(2) serve a health professional shortage area, 
as determined by the Secretary; 
‘‘(3) work with students, including those from 
racial and ethnic minority groups, that have ex-
pressed an interest in the health professions; and 
‘‘(4) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE
OF FUNDS.—Grant awards under sub-
section (a) shall be used to support internships that will 
increase awareness among students of non-research-based, 
career opportunities in the following health professions: 
‘‘(1) Medicine. 
‘‘(2) Nursing. 
‘‘(3) Public health. 
‘‘(4) Pharmacy. 
‘‘(5) Health administration and management. 
‘‘(6) Health policy. 
‘‘(7) Psychology. 
‘‘(8) Dentistry. 
‘‘(9) International health. 
‘‘(10) Social work. 
‘‘(11) Allied health. 
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‘‘(12) Psychiatry. 
‘‘(13) Hospice care. 
‘‘(14) Community health, patient navigation, 
and peer support. 
‘‘(15) Other professions determined appropriate 
by the Director of the Centers for Disease Control 
and Prevention. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Centers for Disease Con-
trol and Prevention shall give priority to those entities 
that— 
‘‘(1) serve a high proportion of individuals from 
disadvantaged backgrounds; 
‘‘(2) have experience in health disparity elimi-
nation programs; 
‘‘(3) facilitate the entry of disadvantaged indi-
viduals into institutions of higher education; and 
‘‘(4) provide counseling or other services de-
signed to assist disadvantaged individuals in success-
fully completing their education at the postsecondary 
level. 
‘‘(e) STIPENDS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
an entity receiving a grant under this section may 
use the funds made available through such grant to 
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award stipends for educational and living expenses 
to students participating in the internship supported 
by the grant. 
‘‘(2) LIMITATIONS.—A stipend awarded under 
paragraph (1) to an individual— 
‘‘(A) may not be provided for a period that 
exceeds 6 months; and 
‘‘(B) may not exceed $20 per day for an 
individual (notwithstanding any other provision 
of law regarding the amount of a stipend). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 
PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention, in collaboration with the 
Deputy Assistant Secretary for Minority Health, shall 
award scholarships to eligible individuals under subsection 
(b) who seek a career in public health. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a schol-
arship under subsection (a), an individual shall— 
‘‘(1) have interest, knowledge, or skill in public 
health research or public health practice, or other 
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health professions as determined appropriate by the 
Director of the Centers for Disease Control and Pre-
vention; 
‘‘(2) reside in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) demonstrate promise for becoming a leader 
in public health; 
‘‘(4) secure admission to a 4-year institution of 
higher education; and 
‘‘(5) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under an 
award under subsection (a) shall be used to support oppor-
tunities for students to become public health professionals. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director shall give priority to those stu-
dents that— 
‘‘(1) are from disadvantaged backgrounds; 
‘‘(2) have secured admissions to an institution 
described in section 371(a) of the Higher Education 
Act of 1965; and 
‘‘(3) have identified a health professional as a 
mentor at their institution described in subsection 
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(b)(4) and an academic advisor to assist in the com-
pletion of their baccalaureate degree. 
‘‘(e) SCHOLARSHIPS.—The Secretary may approve 
payment of scholarships under this section for such indi-
viduals for any period of education in student under-
graduate tenure, except that such a scholarship may not 
be provided to an individual for more than 4 years, and 
such a scholarship may not exceed $10,000 per academic 
year for an individual (notwithstanding any other provi-
sion of law regarding the amount of a scholarship). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 
FELLOWSHIP PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention, in collaboration with the 
Deputy Assistant Secretary for Minority Health, the As-
sistant Secretary for Mental Health and Substance Use, 
and the Director of the Indian Health Service, shall award 
research fellowships to eligible individuals under sub-
section (b) to conduct research that will examine gender 
and health disparities and to pursue a career in the health 
professions. 
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‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
ship under subsection (a), an individual shall— 
‘‘(1) have experience in health research or pub-
lic health practice; 
‘‘(2) reside in a health professional shortage 
area designated by the Secretary under section 332; 
‘‘(3) have expressed an interest in the health 
professions; 
‘‘(4) demonstrate promise for becoming a leader 
in the field of women’s sexual and reproductive 
health, including family planning; 
‘‘(5) secure admission to a health professions 
school or graduate program with an emphasis in 
gender studies; and 
‘‘(6) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—A fellowship awarded under 
subsection (a) to an eligible individual under subsection 
(b) shall be used to support an opportunity for the indi-
vidual to become a researcher and advance the research 
base on the intersection between gender and health. 
‘‘(d) PRIORITY.—In awarding fellowships under sub-
section (a), the Director of the Centers for Disease Con-
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trol and Prevention shall give priority to those applicants 
that— 
‘‘(1) are from disadvantaged backgrounds; and 
‘‘(2) have identified a mentor and academic ad-
visor who will assist in the completion of their grad-
uate or professional degree and have secured a re-
search assistant position with a researcher working 
in the area of gender and health. 
‘‘(e) FELLOWSHIPS.—The Director of the Centers for 
Disease Control and Prevention may approve fellowships 
for individuals under this section for any period of edu-
cation in the student’s graduate or health profession ten-
ure, except that such a fellowship may not be provided 
to an individual for more than 3 years, and such a fellow-
ship may not exceed $18,000 per academic year for an 
individual (notwithstanding any other provision of law re-
garding the amount of a fellowship). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
‘‘SEC. 3421. PAUL DAVID WELLSTONE INTERNATIONAL 
HEALTH FELLOWSHIP PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, in collaboration with 
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the Deputy Assistant Secretary for Minority Health, shall 
award research fellowships to eligible individuals under 
subsection (b) to advance their understanding of inter-
national health. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
ship under subsection (a), an individual shall— 
‘‘(1) have educational experience in the field of 
international health; 
‘‘(2) reside in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) demonstrate promise for becoming a leader 
in the field of international health; 
‘‘(4) be in the fourth year of a 4-year institu-
tion of higher education or a recent graduate of a 
4-year institution of higher education; and 
‘‘(5) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—A fellowship awarded under 
subsection (a) to an eligible individual under subsection 
(b) shall be used to support an opportunity for the indi-
vidual to become a health professional and to advance the 
knowledge of the individual about international issues re-
lating to health care access and quality. 
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‘‘(d) PRIORITY.—In awarding fellowships under sub-
section (a), the Director of the Agency for Healthcare Re-
search and Quality shall give priority to eligible individuals 
under subsection (b) that— 
‘‘(1) are from a disadvantaged background; and 
‘‘(2) have identified a mentor at a health pro-
fessions school or institution, an academic advisor to 
assist in the completion of their graduate or profes-
sional degree, and an advisor from an international 
health non-governmental organization, private volun-
teer organization, or other international institution 
or program that focuses on increasing health care 
access and quality for residents in developing coun-
tries. 
‘‘(e) FELLOWSHIPS.—A fellowship awarded under 
this section may not— 
‘‘(1) be provided to an eligible individual for 
more than a period of 6 months; 
‘‘(2) be awarded to a graduate of a 4-year insti-
tution of higher education that has not been enrolled 
in such institution for more than 1 year; or 
‘‘(3) exceed $4,000 per academic year (notwith-
standing any other provision of law regarding the 
amount of a fellowship). 
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‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
‘‘SEC. 3422. EDWARD R. ROYBAL HEALTH SCHOLAR PRO-
GRAM. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, the Administrator of 
the Centers for Medicare & Medicaid Services, and the Ad-
ministrator of the Health Resources and Services Admin-
istration, in collaboration with the Deputy Assistant Sec-
retary for Minority Health, shall award grants to eligible 
entities under subsection (b) to expose entering graduate 
students to the health professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) be a clinical, public health, or health serv-
ices organization, community-based, academic, or 
nonprofit entity, or other entity determined appro-
priate by the Director of the Agency for Healthcare 
Research and Quality; 
‘‘(2) serve in a health professional shortage 
area designated by the Secretary under section 332; 
‘‘(3) work with students obtaining a degree in 
the health professions; and 
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‘‘(4) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under a 
grant awarded under subsection (a) shall be used to sup-
port opportunities that expose students to non-research- 
based health professions, including— 
‘‘(1) public health policy; 
‘‘(2) health care and pharmaceutical policy; 
‘‘(3) health care administration and manage-
ment; 
‘‘(4) health economics; and 
‘‘(5) other professions determined appropriate 
by the Director of the Agency for Healthcare Re-
search and Quality, the Administrator of the Centers 
for Medicare & Medicaid Services, or the Adminis-
trator of the Health Resources and Services Admin-
istration. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Agency for Healthcare Re-
search and Quality, the Administrator of the Centers for 
Medicare & Medicaid Services, and the Administrator of 
the Health Resources and Services Administration, in col-
laboration with the Deputy Assistant Secretary for Minor-
ity Health, shall give priority to entities that— 
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‘‘(1) have experience with health disparity elimi-
nation programs; 
‘‘(2) facilitate training in the fields described in 
subsection (c); and 
‘‘(3) provide counseling or other services de-
signed to assist students in successfully completing 
their education at the postsecondary level. 
‘‘(e) STIPENDS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
an entity receiving a grant under this section may 
use the funds made available through such grant to 
award stipends for educational and living expenses 
to students participating in the opportunities sup-
ported by the grant. 
‘‘(2) LIMITATIONS.—A stipend awarded under 
paragraph (1) to an individual— 
‘‘(A) may not be provided for a period that 
exceeds 2 months; and 
‘‘(B) may not exceed $100 per day (not-
withstanding any other provision of law regard-
ing the amount of a stipend). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
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‘‘SEC. 3423. LEADERSHIP FELLOWSHIP PROGRAMS. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants to national minority medical or health professional 
associations to develop leadership fellowship programs for 
underrepresented health professionals in order to— 
‘‘(1) assist such professionals in becoming fu-
ture leaders in public health and health care delivery 
institutions; and 
‘‘(2) increase diversity in decision-making posi-
tions that can improve the health of underserved 
communities. 
‘‘(b) USE OF FUNDS.—A leadership fellowship pro-
gram supported under this section shall— 
‘‘(1) focus on training mid-career physicians 
and health care executives who have documented 
leadership experience and a commitment to public 
health services in underserved communities; and 
‘‘(2) support Federal public health policy and 
budget programs, and priorities that impact health 
equity, through activities such as didactic lectures 
and leader site visits. 
‘‘(c) PERIOD OF GRANTS.—The period during which 
payments are made under a grant awarded under sub-
section (a) may not exceed 3 years. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
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such sums as may be necessary for each of fiscal years 
2025 through 2029.’’. 
SEC. 3007. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 
PROGRAM. 
Section 402E of the Higher Education Act of 1965 
(20 U.S.C. 1070a–15) is amended by striking subsection 
(g) and inserting the following: 
‘‘(g) COLLABORATION IN HEALTH PROFESSION DI-
VERSITY TRAINING PROGRAMS.—The Secretary shall co-
ordinate with the Secretary of Health and Human Serv-
ices to ensure that there is collaboration between the goals 
of the program under this section and programs of the 
Health Resources and Services Administration that pro-
mote health workforce diversity. The Secretary of Edu-
cation shall take such measures as may be necessary to 
encourage students participating in projects assisted 
under this section to consider health profession careers. 
‘‘(h) FUNDING.—From amounts appropriated pursu-
ant to the authority of section 402A(g), the Secretary 
shall, to the extent practicable, allocate funds for projects 
authorized by this section in an amount that is not less 
than $31,000,000 for each of the fiscal years 2025 
through 2029.’’. 
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SEC. 3008. RULES FOR DETERMINATION OF FULL-TIME 
EQUIVALENT RESIDENTS FOR COST-REPORT-
ING PERIODS. 
(a) DGME DETERMINATIONS.—Section 1886(h)(4) 
of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 
amended by section 2006(a), is amended— 
(1) in subparagraph (E), by striking ‘‘Subject 
to subparagraphs (J) and (K), such rules’’ and in-
serting ‘‘Subject to subparagraphs (J), (K), and 
(M), such rules’’; 
(2) in subparagraph (J), by striking ‘‘Such 
rules’’ and inserting ‘‘Subject to subparagraph (M), 
such rules’’; 
(3) in subparagraph (K), by striking ‘‘In deter-
mining’’ and inserting ‘‘Subject to subparagraph 
(M), in determining’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(M) TREATMENT OF CERTAIN RESIDENTS 
AND INTERNS.—For purposes of cost-reporting 
periods beginning on or after October 1, 2025, 
in determining the hospital’s number of full- 
time equivalent residents for purposes of this 
paragraph, all time spent by an intern or resi-
dent in an approved medical residency training 
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program shall be counted toward the determina-
tion of full-time equivalency if the hospital— 
‘‘(i) is recognized as a subsection (d) 
hospital; 
‘‘(ii) is recognized as a subsection (d) 
Puerto Rico hospital; 
‘‘(iii) is reimbursed under a reim-
bursement system authorized under section 
1814(b)(3); or 
‘‘(iv) is a provider-based hospital out-
patient department.’’. 
(b) 
IME 
DETERMINATIONS.—Section 
1886(d)(5)(B)(xi) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(B)(xi)) is amended— 
(1) in subclause (II), by striking ‘‘In deter-
mining’’ and inserting ‘‘Subject to subclause (IV), in 
determining’’; 
(2) in subclause (III), by striking ‘‘In deter-
mining’’ and inserting ‘‘Subject to subclause (IV), in 
determining’’; and 
(3) by inserting after subclause (III) the fol-
lowing new subclause: 
‘‘(IV) For purposes of cost-reporting peri-
ods beginning on or after October 1, 2025, the 
provisions of subparagraph (M) of subsection 
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(h)(4) shall apply under this subparagraph in 
the same manner as they apply under such sub-
section.’’. 
SEC. 3009. DEVELOPING AND IMPLEMENTING STRATEGIES 
FOR LOCAL HEALTH EQUITY. 
(a) GRANTS.—The Secretary of Health and Human 
Services, acting jointly with the Secretary of Education 
and the Secretary of Labor, shall make grants to eligible 
institutions of higher educations for the purposes of— 
(1) in accordance with subsection (b), devel-
oping capacity— 
(A) to build an evidence base for successful 
strategies for increasing local health equity; and 
(B) to serve as national models of driving 
local health equity; and 
(2) in accordance with subsection (c), devel-
oping a strategic partnership with the community in 
which the institution is located. 
(b) DEVELOPING CAPACITY FOR INCREASING LOCAL 
HEALTH EQUITY.—As a condition of receipt of a grant 
under subsection (a), an institution of higher education 
shall agree to use such grant to build an evidence base 
for successful strategies for increasing local health equity, 
and to serve as a national model of driving local health 
equity, by supporting— 
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(1) resources to strengthen institutional metrics 
and capacity to execute institution-wide health work-
force goals that can serve as models for increasing 
health equity in communities across the United 
States; 
(2) collaborations among a cohort of institu-
tions in implementing systemic change, partnership 
development, and programmatic efforts supportive of 
health equity goals across disciplines and popu-
lations; and 
(3) enhanced or newly developed data systems 
and research infrastructure capable of informing 
current and future workforce efforts and building a 
foundation for a broader research agenda targeting 
urban health disparities. 
(c) STRATEGIC PARTNERSHIPS.—As a condition of 
receipt of a grant under subsection (a), an institution of 
higher education shall agree to use the grant to develop 
a strategic partnership with the community in which such 
institution is located for the purposes of— 
(1) strengthening connections between such in-
stitution and the community— 
(A) to improve evaluation of, and address, 
the health and health workforce needs of such 
community; and 
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(B) to engage such community in health 
workforce development; 
(2) developing, enhancing, or accelerating inno-
vative undergraduate and graduate programs in the 
biomedical sciences and health professions; and 
(3) strengthening pipeline programs in the bio-
medical sciences and health professions, including by 
developing partnerships between institutions of high-
er education and elementary schools and secondary 
schools to recruit the next generation of health pro-
fessionals earlier in the pipeline to a health care ca-
reer. 
(d) DEFINITION
OF
ELIGIBLE
INSTITUTION
OF 
HIGHER EDUCATION.—For purposes of this section, the 
term ‘‘eligible institution of higher education’’ includes— 
(1) a program authorized under section 317(a) 
of the Higher Education Act of 1965 (20 U.S.C. 
1059d(a)); and 
(2) a professional or graduate institution de-
scribed in section 326 of such Act (20 U.S.C. 
1063b). 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
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217 
SEC. 3010. HEALTH PROFESSIONS WORKFORCE FUND. 
(a) ESTABLISHMENT.—There is established in the 
Health Resources and Services Administration of the De-
partment of Health and Human Services a Health Profes-
sions Workforce Fund to provide for expanded and sus-
tained national investment in the health professions and 
nursing workforce development programs under titles VII 
and title VIII of the Public Health Service Act (42 U.S.C. 
292 et seq.; 42 U.S.C. 296 et seq.). 
(b) FUNDING.— 
(1) IN GENERAL.—There is authorized to be 
appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, 
to the Health Professions Workforce Fund— 
(A) $392,000,000 for fiscal year 2025; 
(B) $412,000,000 for fiscal year 2026; 
(C) $432,000,000 for fiscal year 2027; 
(D) $454,000,000 for fiscal year 2028; 
(E) $476,000,000 for fiscal year 2029; 
(F) $500,000,000 for fiscal year 2030; 
(G) $525,000,000 for fiscal year 2031; and 
(H) $552,000,000 for fiscal year 2032. 
(2) HEALTH
PROFESSIONS
EDUCATION
PRO-
GRAMS.—For the purpose of carrying out health 
professions education programs authorized under 
title VII of the Public Health Service Act (42 U.S.C. 
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218 
292 et seq.), in addition to any other amounts au-
thorized to be appropriated for such purpose, there 
is authorized to be appropriated out of any monies 
in the Health Professions Workforce Fund, the fol-
lowing: 
(A) $265,000,000 for fiscal year 2025. 
(B) $278,000,000 for fiscal year 2026. 
(C) $292,000,000 for fiscal year 2027. 
(D) $307,000,000 for fiscal year 2028. 
(E) $322,000,000 for fiscal year 2029. 
(F) $338,000,000 for fiscal year 2030. 
(G) $355,000,000 for fiscal year 2031. 
(H) $373,000,000 for fiscal year 2032. 
(3) NURSING WORKFORCE DEVELOPMENT PRO-
GRAMS.—For the purpose of carrying out nursing 
workforce development programs authorized under 
title VIII of the Public Health Service Act (42 
U.S.C. 296 et seq.), in addition to any other 
amounts authorized to be appropriated for such pur-
pose, there is authorized to be appropriated out of 
any monies in the Health Professions Workforce 
Fund, the following: 
(A) $127,000,000 for fiscal year 2025. 
(B) $134,000,000 for fiscal year 2026. 
(C) $140,000,000 for fiscal year 2027. 
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219 
(D) $147,000,000 for fiscal year 2028. 
(E) $154,000,000 for fiscal year 2029. 
(F) $162,000,000 for fiscal year 2030. 
(G) $170,000,000 for fiscal year 2031. 
(H) $179,000,000 for fiscal year 2032. 
SEC. 3011. FUTURE ADVANCEMENT OF ACADEMIC NURS-
ING. 
(a) SUPPORT FOR NURSING EDUCATION AND THE 
FUTURE NURSING WORKFORCE.—Part D of title VIII of 
the Public Health Service Act (42 U.S.C. 296p et seq.) 
is amended by adding at the end the following: 
‘‘SEC. 832. NURSING EDUCATION ENHANCEMENT AND MOD-
ERNIZATION 
GRANTS 
IN 
UNDERSERVED 
AREAS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, may award grants to schools of nursing 
for— 
‘‘(1) increasing the number of faculty and stu-
dents at such schools in order to enhance the pre-
paredness of the United States for, and the ability 
of the United States to address and quickly respond 
to, public health emergencies declared under section 
319 and pandemics; or 
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220 
‘‘(2) the enhancement and modernization of 
nursing education programs. 
‘‘(b) PRIORITY.—In selecting grant recipients under 
this section, the Secretary shall give priority to schools of 
nursing that— 
‘‘(1) are located in a medically underserved 
community; 
‘‘(2) are located in a health professional short-
age area as defined under section 332(a); or 
‘‘(3) are institutions of higher education listed 
under section 371(a) of the Higher Education Act of 
1965. 
‘‘(c) CONSIDERATION.—In awarding grants under 
this section, the Secretary, to the extent practicable, may 
ensure equitable distribution of awards among the geo-
graphic regions of the United States. 
‘‘(d) USE OF FUNDS.—A school of nursing that re-
ceives a grant under this section may use the funds award-
ed through such grant for activities that include— 
‘‘(1) enhancing enrollment and retention of stu-
dents at such school, with a priority for students 
from disadvantaged backgrounds (including racial or 
ethnic groups underrepresented in the nursing work-
force), individuals from rural and underserved areas, 
low-income individuals, and first generation college 
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221 
students (as defined in section 402A(h)(3) of the 
Higher Education Act of 1965); 
‘‘(2) creating, supporting, or modernizing edu-
cational programs and curriculum at such school; 
‘‘(3) retaining current faculty, and hiring new 
faculty, with an emphasis on faculty from racial or 
ethnic groups who are underrepresented in the nurs-
ing workforce; 
‘‘(4) modernizing infrastructure at such school, 
including audiovisual or other equipment, personal 
protective equipment, simulation and augmented re-
ality resources, telehealth technologies, and virtual 
and physical laboratories; 
‘‘(5) partnering with a health care facility, 
nurse-managed health clinic, community health cen-
ter, or other facility that provides health care in 
order to provide educational opportunities for the 
purpose of establishing or expanding clinical edu-
cation; 
‘‘(6) enhancing and expanding nursing pro-
grams that prepare nurse researchers and scientists; 
‘‘(7) establishing nurse-led intradisciplinary and 
interprofessional educational partnerships; and 
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222 
‘‘(8) other activities that the Secretary deter-
mines further the development, improvement, and 
expansion of schools of nursing. 
‘‘(e) REPORTS FROM ENTITIES.—Each school of 
nursing awarded a grant under this section shall submit 
an annual report to the Secretary on the activities con-
ducted under such grant, and other information as the 
Secretary may require. 
‘‘(f) REPORT TO CONGRESS.—Not later than 5 years 
after the date of the enactment of this section, the Sec-
retary shall submit to the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate and the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives a report that provides a summary of the ac-
tivities and outcomes associated with grants made under 
this section. Such report shall include— 
‘‘(1) a list of schools of nursing receiving grants 
under this section, including the primary geographic 
location of any school of nursing that was improved 
or expanded through such a grant; 
‘‘(2) the total number of students who are en-
rolled at or who have graduated from any school of 
nursing that was improved or expanded through a 
grant under this section, which such statistic shall— 
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223 
‘‘(A) to the extent such information is 
available, be deidentified and disaggregated by 
race, ethnicity, age, sex, geographic region, dis-
ability status, and other relevant factors; and 
‘‘(B) include an indication of the number 
of such students who are from racial or ethnic 
groups underrepresented in the nursing work-
force, such students who are from rural or un-
derserved areas, such students who are low-in-
come students, and such students who are first 
generation college students (as defined in sec-
tion 402A(h)(3) of the Higher Education Act of 
1965); 
‘‘(3) to the extent such information is available, 
the effects of the grants awarded under this section 
on retaining and hiring of faculty, including any in-
crease in diverse faculty, the number of clinical edu-
cation partnerships, the modernization of nursing 
education infrastructure, and other ways this section 
helps address and quickly respond to public health 
emergencies and pandemics; 
‘‘(4) recommendations for improving the grants 
awarded under this section; and 
‘‘(5) any other considerations as the Secretary 
determines appropriate. 
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224 
‘‘(g) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $1,000,000,000, to remain available until ex-
pended.’’. 
(b) STRENGTHENING
NURSE
EDUCATION.—The 
heading of part D of title VIII of the Public Health Serv-
ice Act (42 U.S.C. 296p et seq.) is amended by striking 
‘‘BASIC’’. 
SEC. 3012. SENSE OF CONGRESS RELATING TO GRADUATE 
MEDICAL EDUCATION. 
It is the sense of Congress that eliminating the limit 
of the number of residency positions that receive some 
level of Medicare support under section 1886(h) of the So-
cial Security Act (42 U.S.C. 1395ww(h)), also referred to 
as the Medical graduate medical education cap, is critical 
to— 
(1) ensuring an appropriate supply of physi-
cians to meet the health care needs in the United 
States; 
(2) facilitating equitable access for all who seek 
health care; 
(3) increasing the racial and ethnic diversity of 
physicians in the United States; and 
(4) mitigating disparities in health and health 
care. 
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225 
SEC. 3013. CAREER SUPPORT FOR SKILLED, INTERNATION-
ALLY EDUCATED HEALTH PROFESSIONALS. 
(a) GRANTS TO ELIGIBLE ENTITIES.— 
(1) AUTHORITY
TO
PROVIDE
GRANTS.—The 
Secretary of Health and Human Services (in this 
section referred to as the ‘‘Secretary’’), acting 
through the Bureau of Health Workforce within the 
Health Resources and Services Administration, the 
National Institute on Minority Health and Health 
Disparities, or the Office of Minority Health, may 
award grants to eligible entities under paragraph (2) 
to carry out activities described in subsection (b). 
(2) ELIGIBILITY.—To be eligible to receive a 
grant under this section, an entity shall— 
(A) be a clinical, public health, or health 
services organization, a community-based or 
nonprofit entity, an academic institution, a 
faith-based organization, a State, county, or 
local government, an area health education cen-
ter, or another entity determined appropriate by 
the Secretary; and 
(B) submit to the Secretary an application 
at such time, in such manner, and containing 
such information as the Secretary may require. 
(b) AUTHORIZED ACTIVITIES.—A grant awarded 
under this section shall be used— 
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(1) to provide services to assist unemployed and 
underemployed skilled immigrants, residing in the 
United States, who have legal, permanent work au-
thorization and who are internationally educated 
health professionals, enter into the health workforce 
of the United States with employment matching 
their health professional skills and education, and 
advance in employment to positions that better 
match their health professional education and exper-
tise; 
(2) to provide training opportunities to reduce 
barriers to entry and advancement in the health 
workforce for skilled, internationally educated immi-
grants; 
(3) to educate employers regarding the abilities 
and capacities of internationally educated health 
professionals; 
(4) to assist in the evaluation of foreign creden-
tials; 
(5) to support preceptorships for international 
medical graduates in hospital primary care training; 
and 
(6) to facilitate access to contextualized and ac-
celerated courses on English as a second language. 
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SEC. 3014. STUDY AND REPORT ON STRATEGIES FOR IN-
CREASING DIVERSITY. 
(a) STUDY.—The Comptroller General of the United 
States shall conduct a study on strategies for increasing 
the diversity of the health professional workforce. Such 
study shall include an analysis of strategies for increasing 
the number of health professionals from rural, lower in-
come, and underrepresented minority communities, includ-
ing which strategies are most effective for achieving such 
goal. 
(b) REPORT.—Not later than 2 years after the date 
of enactment of this Act, the Comptroller General shall 
submit to Congress a report on the study conducted under 
subsection (a), together with recommendations for such 
legislation and administrative action as the Comptroller 
General determines appropriate. 
SEC. 3015. CONRAD STATE 30 PROGRAM; PHYSICIAN RETEN-
TION. 
(a) CONRAD STATE 30 PROGRAM EXTENSION.— 
(1) IN GENERAL.—Section 220(c) of the Immi-
gration and Nationality Technical Corrections Act of 
1994 (Public Law 103–416; 8 U.S.C. 1182 note) is 
amended by striking ‘‘September 30, 2015’’ and in-
serting ‘‘the date that is 3 years after the date of 
the enactment of the Health Equity and Account-
ability Act of 2024’’. 
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228 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall take effect as if enacted on 
September 30, 2018. 
(b) RETAINING PHYSICIANS WHO HAVE PRACTICED 
IN MEDICALLY UNDERSERVED COMMUNITIES.—Section 
201(b)(1) of the Immigration and Nationality Act (8 
U.S.C. 1151(b)(1)) is amended by adding at the end the 
following: 
‘‘(F)(i) Alien physicians who have completed 
service requirements of a waiver requested under 
section 203(b)(2)(B)(ii), including— 
‘‘(I) alien physicians who completed such 
service before the date of the enactment of the 
Health Equity and Accountability Act of 2024; 
and 
‘‘(II) the spouse or children of an alien 
physician described in subclause (I). 
‘‘(ii) Nothing in this subparagraph may be con-
strued— 
‘‘(I) to prevent the filing of a petition with 
the Secretary of Homeland Security for classi-
fication under section 204(a) or the filing of an 
application for adjustment of status under sec-
tion 245 by an alien physician described in 
clause (i)(I) before the date on which such alien 
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229 
physician completed the service described in 
section 214(l) or worked full-time as a physi-
cian for an aggregate of 5 years at the location 
identified in the section 214(l) waiver or in an 
area or areas designated by the Secretary of 
Health and Human Services as having a short-
age of health care professionals; or 
‘‘(II) to permit the Secretary of Homeland 
Security to grant a petition or application de-
scribed in subclause (I) until the alien has sat-
isfied all of the requirements of the waiver re-
ceived under section 214(l).’’. 
(c) EMPLOYMENT PROTECTIONS FOR PHYSICIANS.— 
(1) EXCEPTIONS
TO
2-YEAR
FOREIGN
RESI-
DENCY
REQUIREMENT.—Section 214(l)(1) of the 
Immigration 
and 
Nationality 
Act 
(8 
U.S.C. 
1184(l)(1)) is amended— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘Attorney General’’ and insert-
ing ‘‘Secretary of Homeland Security’’; 
(B) in subparagraph (A), by striking ‘‘Di-
rector of the United States Information Agen-
cy’’ and inserting ‘‘Secretary of State’’; 
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230 
(C) in subparagraph (B), by inserting ‘‘, 
except as provided in paragraphs (7) and (8)’’ 
before the semicolon at the end; 
(D) in subparagraph (C), by amending 
clauses (i) and (ii) to read as follows: 
‘‘(i) the alien demonstrates a bona 
fide offer of full-time employment at a 
health facility or health care organization, 
which employment has been determined by 
the Secretary of Homeland Security to be 
in the public interest; and 
‘‘(ii) the alien— 
‘‘(I) has accepted employment 
with the health facility or health care 
organization in a geographic area or 
areas which are designated by the 
Secretary of Health and Human Serv-
ices as having a shortage of health 
care professionals; 
‘‘(II) begins employment by the 
later of the date that is— 
‘‘(aa) 120 days after receiv-
ing such waiver; 
‘‘(bb) 120 days after com-
pleting graduate medical edu-
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231 
cation or training under a pro-
gram approved pursuant to sec-
tion 212(j)(1); or 
‘‘(cc) 120 days after receiv-
ing nonimmigrant status or em-
ployment authorization, if the 
alien or the alien’s employer peti-
tions for such nonimmigrant sta-
tus or employment authorization 
not later than 120 days after the 
date on which the alien completes 
his or her graduate medical edu-
cation or training under a pro-
gram approved pursuant to sec-
tion 212(j)(1); and 
‘‘(III) agrees to continue to work 
for a total of not less than 3 years in 
the status authorized for such employ-
ment under this subsection, except as 
provided in paragraph (8); and’’; and 
(E) in subparagraph (D), in the matter 
preceding clause (i), by inserting ‘‘except as 
provided in paragraph (8),’’ before ‘‘in the 
case’’. 
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232 
(2) ALLOWABLE VISA STATUS FOR PHYSICIANS 
FULFILLING WAIVER REQUIREMENTS IN MEDICALLY 
UNDERSERVED
AREAS.—Section 214(l)(2)(A) of 
such Act (8 U.S.C. 1184(l)(2)(A)) is amended to 
read as follows: 
‘‘(A) Upon the request of an interested 
Federal agency or an interested State agency 
for recommendation of a waiver under this sec-
tion by a physician who is maintaining valid 
nonimmigrant 
status 
under 
section 
101(a)(15)(J) and received a favorable rec-
ommendation by the Secretary of State, the 
Secretary of Homeland Security may adjust the 
status of such physician to any status author-
ized for employment under this Act. The nu-
merical limitations set forth in subsection 
(g)(1)(A) shall not apply to any alien whose 
status is adjusted pursuant to this subpara-
graph.’’. 
(3) 
VIOLATION
OF
AGREEMENTS.—Section 
214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 
amended by inserting ‘‘substantial requirement of 
an’’ before ‘‘agreement entered into’’. 
(4) PHYSICIAN EMPLOYMENT IN UNDERSERVED 
AREAS.—Section 214(l) of such Act, as amended by 
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233 
this subsection, is further amended by adding at the 
end the following: 
‘‘(4)(A) If an interested State agency denies an 
application for a waiver under paragraph (1)(B) 
from a physician pursuing graduate medical edu-
cation or training pursuant to section 101(a)(15)(J) 
because the State has requested the maximum num-
ber of waivers permitted for that fiscal year, the 
physician’s nonimmigrant status shall be extended 
for up to 6 months if the physician agrees to seek 
a waiver under this subsection (except for paragraph 
(1)(D)(ii)) to work for an employer described in 
paragraph (1)(C) in a State that has not yet re-
quested the maximum number of waivers. 
‘‘(B) Such physician shall be authorized to 
work only for the employer referred to in subpara-
graph (A) during the period beginning on the date 
on which a new waiver application is filed with such 
State and ending on the earlier of— 
‘‘(i) the date on which the Secretary of 
Homeland Security denies such waiver; or 
‘‘(ii) the date on which the Secretary ap-
proves an application for adjustment of status 
under paragraph (2)(A) pursuant to the ap-
proval of such waiver.’’. 
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234 
(5) CONTRACT REQUIREMENTS.—Section 214(l) 
of such Act, as amended by this subsection, is fur-
ther amended by adding at the end the following: 
‘‘(5) An alien granted a waiver under para-
graph (1)(C) shall enter into an employment agree-
ment with the contracting health facility or health 
care organization that— 
‘‘(A) specifies— 
‘‘(i) the maximum number of on-call 
hours per week (which may be a monthly 
average) that the alien will be expected to 
be available; and 
‘‘(ii) the compensation the alien will 
receive for on-call time; 
‘‘(B) specifies— 
‘‘(i) whether the contracting facility or 
organization— 
‘‘(I) has secured medical mal-
practice liability protection for the 
alien under section 224(g) of the Pub-
lic Health Service Act (42 U.S.C. 
233(g); or 
‘‘(II) will pay the alien’s mal-
practice insurance premiums; and 
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235 
‘‘(ii) the amount of such liability pro-
tection that will be provided; 
‘‘(C) describes all of the work locations 
that the alien will work and includes a state-
ment that the contracting facility or organiza-
tion will not add additional work locations with-
out the approval of the Federal agency or State 
agency that requested the waiver; and 
‘‘(D) does not include a non-compete provi-
sion. 
‘‘(6) An alien granted a waiver under this sub-
section whose employment relationship with a health 
facility or health care organization terminates under 
paragraph (1)(C)(ii) during the 3-year service period 
required under paragraph (1) shall be considered to 
be maintaining lawful status in an authorized period 
of stay during the 120-day period referred to in 
items (aa) and (bb) of subclause (III) of paragraph 
(1)(C)(ii) or the 45-day period referred to in sub-
clause (III)(cc) of such paragraph.’’. 
(6) RECAPTURING
WAIVER
SLOTS
LOST
TO 
OTHER
STATES.—Section 214(l) of such Act, as 
amended by this subsection, is further amended by 
adding at the end the following: 
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‘‘(7) If a recipient of a waiver under this sub-
section terminates the recipient’s employment with a 
health facility or health care organization pursuant 
to paragraph (1)(C)(ii), including termination of em-
ployment because of circumstances described in 
paragraph (1)(C)(ii)(III), and accepts new employ-
ment with such a facility or organization in a dif-
ferent State, the State from which the alien is de-
parting may be granted an additional waiver by the 
Secretary of State for use in the fiscal year in which 
the alien’s employment was terminated.’’. 
(7) EXCEPTION
TO
3-YEAR
WORK
REQUIRE-
MENT.—Section 214(l) of such Act, as amended by 
this subsection, is further amended by adding at the 
end the following: 
‘‘(8) The 3-year work requirement set forth in 
subparagraphs (C) and (D) of paragraph (1) shall 
not apply if— 
‘‘(A)(i) the Secretary of Homeland Secu-
rity determines the existence of extenuating cir-
cumstances, including violations by the em-
ployer of the employment agreement with the 
alien or of labor and employment laws, which 
justify a lesser period of employment at such 
facility or organization; and 
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‘‘(ii) the alien demonstrates, not later than 
120 days after the employment termination 
date (unless the Secretary determines that ex-
tenuating circumstances would justify an exten-
sion), another bona fide offer of employment at 
a health facility or health care organization in 
a geographic area or areas designated by the 
Secretary of Health and Human Services as 
having a shortage of health care professionals, 
for the remainder of such 3-year period; 
‘‘(B)(i) the interested State agency that re-
quested the waiver attests to the existence of 
extenuating circumstances, including violations 
by the employer of the employment agreement 
with the alien or of labor and employment laws, 
which justify a lesser period of employment at 
such facility or organization; and 
‘‘(ii) the alien demonstrates, not later than 
120 days after the employment termination 
date (unless the Secretary determines that ex-
tenuating circumstances would justify an exten-
sion), another bona fide offer of employment at 
a health facility or health care organization in 
a geographic area or areas designated by the 
Secretary of Health and Human Services as 
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having a shortage of health care professionals, 
for the remainder of such 3-year period; or 
‘‘(C) the alien— 
‘‘(i) elects not to pursue a determina-
tion of extenuating circumstances pursuant 
to subparagraph (A) or (B); 
‘‘(ii) terminates the alien’s employ-
ment relationship with the health facility 
or health care organization at which the 
alien was employed; 
‘‘(iii) demonstrates, not later than 45 
days after the employment termination 
date, another bona fide offer of employ-
ment at a health facility or health care or-
ganization in a geographic area or areas, 
in the State that requested the alien’s 
waiver, which are designated by the Sec-
retary of Health and Human Services as 
having a shortage of health care profes-
sionals; and 
‘‘(iv) agrees to be employed for the re-
mainder of such 3-year period, and 1 addi-
tional year for each termination under 
clause (ii).’’. 
(d) ALLOTMENT OF CONRAD STATE 30 WAIVERS.— 
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(1) IN GENERAL.—Section 214(l) of the Immi-
gration and Nationality Act (8 U.S.C. 1184(l)), as 
amended by subsection (c), is further amended by 
adding at the end the following: 
‘‘(9)(A)(i) All States shall be allotted a total of 35 
waivers under paragraph (1)(B) for a fiscal year if 90 per-
cent of the waivers available to the States receiving at 
least 5 waivers were used in the previous fiscal year. 
‘‘(ii) When an allotment occurs under clause (i), all 
States shall be allotted an additional 5 waivers under 
paragraph (1)(B) for each subsequent fiscal year if 90 
percent of the waivers available to the States receiving at 
least 5 waivers were used in the previous fiscal year. If 
the States are allotted 45 or more waivers for a fiscal year, 
the States will only receive an additional increase of 5 
waivers the following fiscal year if 95 percent of the waiv-
ers available to the States receiving at least 1 waiver were 
used in the previous fiscal year. 
‘‘(B) Any increase in allotments under subparagraph 
(A) shall be maintained indefinitely, unless in a fiscal year 
the total number of such waivers granted is 5 percent 
lower than in the last year in which there was an increase 
in the number of waivers allotted pursuant to this para-
graph, in which case— 
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‘‘(i) the number of waivers allotted shall be de-
creased by 5 for all States beginning in the next fis-
cal year; and 
‘‘(ii) each additional 5 percent decrease in such 
waivers granted from the last year in which there 
was an increase in the allotment, shall result in an 
additional decrease of 5 waivers allotted for all 
States, provided that the number of waivers allotted 
for all States shall not drop below 30.’’. 
(2) ACADEMIC
MEDICAL
CENTERS.—Section 
214(l)(1)(D) of such Act, as amended by subsection 
(c)(1)(E), is further amended— 
(A) in clause (ii), by striking ‘‘and’’ at the 
end; 
(B) in clause (iii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(iv) in the case of a request by an inter-
ested State agency— 
‘‘(I) the head of such agency deter-
mines that the alien is to practice medicine 
in, or be on the faculty of a residency pro-
gram at, an academic medical center (as 
defined in section 411.355(e)(2) of title 42, 
Code of Federal Regulations, or a similar 
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successor regulation), without regard to 
whether such facility is located within an 
area designated by the Secretary of Health 
and Human Services as having a shortage 
of health care professionals; and 
‘‘(II) the head of such agency deter-
mines that— 
‘‘(aa) the alien physician’s work 
is in the public interest; and 
‘‘(bb) the grant of such waiver 
would not cause the number of the 
waivers granted on behalf of aliens for 
such State for a fiscal year to exceed 
3 (within the limitation in subpara-
graph (B) and subject to paragraph 
(6)), in accordance with the conditions 
of this clause.’’. 
(e) AMENDMENTS TO THE PROCEDURES, DEFINI-
TIONS, AND OTHER PROVISIONS RELATED TO PHYSICIAN 
IMMIGRATION.— 
(1) DUAL
INTENT
FOR
PHYSICIANS
SEEKING 
GRADUATE MEDICAL TRAINING.—Section 214(b) of 
the Immigration and Nationality Act (8 U.S.C. 
1184(b)) is amended by striking ‘‘and other than a 
nonimmigrant described in any provision of section 
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101(a)(15)(H)(i) except subclause (b1) of such sec-
tion)’’ and inserting ‘‘a nonimmigrant described in 
any provision of section 101(a)(15)(H)(i) (except 
subclause (b1) of such section), and an alien coming 
to the United States to receive graduate medical 
education or training as described in section 212(j) 
or to take examinations required to receive graduate 
medical education or training as described in section 
212(j))’’. 
(2) PHYSICIAN
NATIONAL
INTEREST
WAIVER 
CLARIFICATIONS.— 
(A) PRACTICE AND GEOGRAPHIC AREA.— 
Section 203(b)(2)(B)(ii)(I) of the Immigration 
and 
Nationality 
Act 
(8 
U.S.C. 
1153(b)(2)(B)(ii)(I)) is amended by striking 
items (aa) and (bb) and inserting the following: 
‘‘(aa) the alien physician agrees to 
work on a full-time basis practicing pri-
mary care, specialty medicine, or a com-
bination thereof, in an area or areas des-
ignated by the Secretary of Health and 
Human Services as having a shortage of 
health care professionals, or at a health 
care facility under the jurisdiction of the 
Secretary of Veterans Affairs; or 
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‘‘(bb) the alien physician is pursuing 
such waiver based upon service at a facility 
or facilities that serve patients who reside 
in a geographic area or areas designated 
by the Secretary of Health and Human 
Services as having a shortage of health 
care professionals (without regard to 
whether such facility or facilities are lo-
cated within such an area) and a Federal 
agency, or a local, county, regional, or 
State department of public health deter-
mines the alien physician’s work was or 
will be in the public interest.’’. 
(B) FIVE-YEAR SERVICE REQUIREMENT.— 
Section 203(b)(2)(B)(ii) of such Act, as amend-
ed by subparagraph (A), is further amended— 
(i) by moving subclauses (II), (III), 
and (IV) 4 ems to the left; and 
(ii) in subclause (II)— 
(I) by inserting ‘‘(aa)’’ after 
‘‘(II)’’; and 
(II) by adding at the end the fol-
lowing: 
‘‘(bb) The 5-year service requirement 
described in item (aa) shall begin on the 
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date on which the alien physician begins 
work in the shortage area in any legal sta-
tus and not on the date on which an immi-
grant visa petition is filed or approved. 
Such service shall be aggregated without 
regard to when such service began and 
without regard to whether such service 
began during or in conjunction with a 
course of graduate medical education. 
‘‘(cc) An alien physician shall not be 
required to submit an employment contract 
with a term exceeding the balance of the 5- 
year commitment yet to be served or an 
employment contract dated within a min-
imum time period before filing a visa peti-
tion under this subsection. 
‘‘(dd) An alien physician shall not be 
required to file additional immigrant visa 
petitions upon a change of work location 
from the location approved in the original 
national interest immigrant petition.’’. 
(3) TECHNICAL CLARIFICATION REGARDING AD-
VANCED
DEGREE
FOR
PHYSICIANS.—Section 
203(b)(2)(A) of such Act is amended by adding at 
the end the following: ‘‘An alien physician holding a 
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foreign medical degree that has been deemed suffi-
cient for acceptance by an accredited United States 
medical residency or fellowship program is a member 
of the professions holding an advanced degree or its 
equivalent.’’. 
(4) SHORT-TERM
WORK
AUTHORIZATION
FOR 
PHYSICIANS COMPLETING THEIR RESIDENCIES.— 
(A) IN GENERAL.—A physician completing 
graduate medical education or training de-
scribed in section 212(j) of the Immigration 
and Nationality Act (8 U.S.C. 1182(j)) as a 
nonimmigrant 
described 
in 
section 
101(a)(15)(H)(i) 
of 
such 
Act 
(8 
U.S.C. 
1101(a)(15)(H)(i))— 
(i) shall have such nonimmigrant sta-
tus automatically extended until October 1 
of the fiscal year for which a petition for 
a continuation of such nonimmigrant sta-
tus has been submitted in a timely manner 
and the employment start date for the ben-
eficiary of such petition is October 1 of 
that fiscal year; and 
(ii) shall be authorized to be employed 
incident to status during the period be-
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tween the filing of such petition and Octo-
ber 1 of such fiscal year. 
(B) TERMINATION.—The physician’s sta-
tus and employment authorization shall termi-
nate on the date that is 30 days after the date 
on which a petition described in clause (i)(I) is 
rejected, denied, or revoked. 
(C) AUTOMATIC
EXTENSION.—A physi-
cian’s status and employment authorization will 
automatically extend to October 1 of the next 
fiscal year if all of the visas described in section 
101(a)(15)(H)(i) of the Immigration and Na-
tionality Act (8 U.S.C. 1101(a)(15)(H)(i)) that 
were authorized to be issued for the fiscal year 
have been issued. 
(5) APPLICABILITY
OF
SECTION
212(e)
TO 
SPOUSES AND CHILDREN OF J–1 EXCHANGE VISI-
TORS.—A spouse or child of an exchange visitor de-
scribed in section 101(a)(15)(J) of the Immigration 
and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall 
not be subject to the requirements under section 
212(e) of such Act (8 U.S.C. 1182(e)). 
(f) ANNUAL CONRAD STATE 30 J–1 VISA WAIVER 
PROGRAM STATISTICAL REPORT.—The Director of U.S. 
Citizenship and Immigration Service shall submit an an-
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nual report to Congress and to the Secretary of Health 
and Human Services that identifies the number of aliens 
admitted during the most recently concluded fiscal year 
as a result of the Conrad State 30 J–1 Visa Waiver Pro-
gram established under sections 212(e) and 214(l) of the 
Immigration and Nationality Act (8 U.S.C. 1182(e) and 
1184(l)), broken down by State. 
SEC. 3016. GRANTS FOR SCHOOLS OF MEDICINE AND 
SCHOOLS OF OSTEOPATHIC MEDICINE IN UN-
DERSERVED AREAS. 
Subpart II of part C of title VII of the Public Health 
Service Act (42 U.S.C. 293m et seq.) is amended by add-
ing at the end the following: 
‘‘SEC. 749C. GRANTS FOR SCHOOLS OF MEDICINE AND 
SCHOOLS OF OSTEOPATHIC MEDICINE IN UN-
DERSERVED AREAS. 
‘‘(a) IN GENERAL.—The Secretary may award grants 
to institutions of higher education (including consortiums 
of such institutions) for the establishment, improvement, 
or expansion of a school of medicine or osteopathic medi-
cine, or a branch campus of a school of medicine or osteo-
pathic medicine. 
‘‘(b) PRIORITY.—In selecting grant recipients under 
this section, the Secretary shall give priority to any insti-
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tution of higher education (or consortium of such institu-
tions) that— 
‘‘(1) proposes to use the grant for the establish-
ment of a school of medicine or osteopathic medi-
cine, or a branch campus of a school of medicine or 
osteopathic medicine, in an area— 
‘‘(A) in which— 
‘‘(i) no other such school is based; or 
‘‘(ii) in the case in which the school of 
medicine or osteopathic medicine proposed 
to be established would be a minority-serv-
ing institution, no other minority-serving 
institution that includes a school of medi-
cine or osteopathic medicine is based; and 
‘‘(B) that is a medically underserved com-
munity or a health professional shortage area; 
or 
‘‘(2) is a minority-serving institution described 
in section 371(a) of the Higher Education Act of 
1965 or an institution or program described in sec-
tion 326(e) of such Act. 
‘‘(c) CONSIDERATIONS.—In awarding grants under 
this section, the Secretary, to the extent practicable, may 
ensure equitable distribution of awards among the geo-
graphical regions of the United States. 
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‘‘(d) USE OF FUNDS.—An institution of higher edu-
cation (or a consortium of such institutions)— 
‘‘(1) shall use grant amounts received under 
this section to— 
‘‘(A) recruit, enroll, and retain medical 
students who are pursuing a degree of doctor of 
medicine or doctor of osteopathy, including in-
dividuals who are from disadvantaged back-
grounds (including racial and ethnic groups 
underrepresented among medical students and 
health professions), individuals from rural and 
underserved areas, low-income individuals, and 
first generation college students, at a school of 
medicine or osteopathic medicine or a branch 
campus of a school of medicine or osteopathic 
medicine; and 
‘‘(B) develop, implement, and expand cur-
riculum that emphasizes care for rural and un-
derserved populations, including accessible and 
culturally and linguistically appropriate care 
and services, at such school or branch campus; 
and 
‘‘(2) may use grant amounts received under this 
section to— 
‘‘(A) plan and construct— 
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‘‘(i) a school of medicine or osteo-
pathic medicine, or a branch campus of a 
school of medicine or osteopathic medicine, 
in an area in which no other such school 
is based; or 
‘‘(ii) a school of medicine or osteo-
pathic medicine, or a branch campus of a 
school of medicine or osteopathic medicine, 
that will be a minority-serving institution, 
in an area in which no other such school 
that is a minority-serving institution is 
based; 
‘‘(B) plan, develop, and meet criteria for 
accreditation for a school of medicine or osteo-
pathic medicine or a branch campus of a school 
of medicine or osteopathic medicine; 
‘‘(C) hire faculty, including faculty from 
racial and ethnic groups who are underrep-
resented among the medical and other health 
professions, and other staff to serve at such a 
school or branch campus; 
‘‘(D) support educational programs at such 
a school or branch campus; 
‘‘(E) modernize and expand infrastructure 
at such a school or branch campus; and 
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‘‘(F) support other activities that the Sec-
retary determines further the establishment, 
improvement, or expansion of a school of medi-
cine or osteopathic medicine or a branch cam-
pus of a school of medicine or osteopathic medi-
cine. 
‘‘(e) APPLICATION.—To be eligible to receive a grant 
under subsection (a), an institution of higher education 
(or a consortium of such institutions), shall submit an ap-
plication to the Secretary at such time, in such manner, 
and containing such information as the Secretary may re-
quire, including a description of the institution’s or con-
sortium’s planned activities described in subsection (d). 
‘‘(f) REPORTING.— 
‘‘(1) REPORTS FROM ENTITIES.—Each institu-
tion of higher education, or consortium of such insti-
tutions, awarded a grant under this section shall 
submit an annual report to the Secretary on the ac-
tivities conducted under such grant, and other infor-
mation as the Secretary may require. 
‘‘(2) REPORT TO CONGRESS.—Not later than 5 
years after the date of enactment of this section and 
every 5 years thereafter, the Secretary shall submit 
to the Committee on Health, Education, Labor, and 
Pensions of the Senate and the Committee on En-
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ergy and Commerce of the House of Representatives 
a report that provides a summary of the activities 
and outcomes associated with grants made under 
this section. Such reports shall include— 
‘‘(A) a list of awardees, including their pri-
mary geographic location, and location of any 
school of medicine or osteopathic medicine, or a 
branch campus of a school of medicine or osteo-
pathic medicine that was established, improved, 
or expanded under this program; 
‘‘(B) the total number of students (includ-
ing the number of students from racial and eth-
nic groups underrepresented among medical 
students and health professions, low-income 
students, and first generation college students) 
who— 
‘‘(i) are enrolled at or who have grad-
uated from any school of medicine or os-
teopathic medicine, or a branch campus of 
a school of medicine or osteopathic medi-
cine, that was established, improved, or ex-
panded under this program, deidentified 
and disaggregated by race, ethnicity, age, 
sex, geographic region, disability status, 
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and other relevant factors, to the extent 
such information is available; and 
‘‘(ii) who subsequently participate in 
an accredited internship or medical resi-
dency program upon graduation from any 
school of medicine or osteopathic medicine, 
or a branch campus of a school of medicine 
or osteopathic medicine, that was estab-
lished, improved, or expanded under this 
program, deidentified and disaggregated by 
race, ethnicity, age, sex, geographic region, 
disability status, medical specialty pursued, 
and other relevant factors, to the extent 
such information is available; 
‘‘(C) the effects of such program on the 
health care provider workforce, including any 
impact 
on 
demographic 
representation 
disaggregated by race, ethnicity, and sex, and 
the fields or specialties pursued by students 
who have graduated from any school of medi-
cine or osteopathic medicine, or a branch cam-
pus of a school of medicine or osteopathic medi-
cine, that was established, improved, or ex-
panded under this program; 
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‘‘(D) the effects of such program on health 
care access in underserved areas, including 
medically underserved communities and health 
professional shortage areas; and 
‘‘(E) recommendations for improving the 
program described in this section, and any 
other considerations as the Secretary deter-
mines appropriate. 
‘‘(3) PUBLIC
AVAILABILITY.—The Secretary 
shall make reports submitted under paragraph (2) 
publicly available on the website of the Department 
of Health and Human Services. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) BRANCH CAMPUS.— 
‘‘(A) IN
GENERAL.—The term ‘branch 
campus’, with respect to a school of medicine or 
osteopathic medicine, means an additional loca-
tion of such school that is geographically apart 
and independent of the main campus, at which 
the school offers at least 50 percent of the pro-
gram leading to a degree of doctor of medicine 
or doctor of osteopathy that is offered at the 
main campus. 
‘‘(B) INDEPENDENCE
FROM
MAIN
CAM-
PUS.—For purposes of subparagraph (A), the 
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location of a school described in such subpara-
graph shall be considered to be independent of 
the main campus described in such subpara-
graph if the location— 
‘‘(i) is permanent in nature; 
‘‘(ii) offers courses in educational pro-
grams leading to a degree, certificate, or 
other recognized educational credential; 
‘‘(iii) has its own faculty and adminis-
trative or supervisory organization; and 
‘‘(iv) has its own budgetary and hiring 
authority. 
‘‘(2) FIRST GENERATION COLLEGE STUDENT.— 
The term ‘first generation college student’ has the 
meaning given such term in section 402A(h)(3) of 
the Higher Education Act of 1965. 
‘‘(3) 
HEALTH
PROFESSIONAL
SHORTAGE 
AREA.—The term ‘health professional shortage area’ 
has the meaning given such term in section 332(a). 
‘‘(4) INSTITUTION OF HIGHER EDUCATION.— 
The term ‘institution of higher education’ has the 
meaning given such term in section 101 of the High-
er Education Act of 1965. 
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‘‘(5) MEDICALLY UNDERSERVED COMMUNITY.— 
The term ‘medically underserved community’ has the 
meaning given such term in section 799B(6). 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated such sums as may be nec-
essary to carry out this section.’’. 
TITLE IV—IMPROVING HEALTH 
CARE ACCESS AND QUALITY 
SEC. 4000. DEFINITION. 
In this title and the amendments made by this title, 
the term ‘‘health care’’ includes all health care needed 
throughout the life cycle and the end of life. 
Subtitle A—Reducing Barriers to 
Accessing Care 
SEC. 4001. PROTECTING PROTECTED AREAS. 
Section 287 of the Immigration and Nationality Act 
(8 U.S.C. 1357) is amended— 
(1) by striking ‘‘the Service’’ each place such 
term appears and inserting ‘‘the Department of 
Homeland Security’’; 
(2) by striking ‘‘Attorney General’’ each place 
such term appears and inserting ‘‘Secretary of 
Homeland Security’’; 
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(3) in subsection (f)(1), by striking ‘‘Commis-
sioner’’ and inserting ‘‘Director of U.S. Citizenship 
and Immigration Services’’; 
(4) in subsection (h)— 
(A) by striking ‘‘of the Immigration and 
Nationality Act’’; and 
(B) by striking ‘‘of such Act’’; and 
(5) by adding at the end the following: 
‘‘(i)(1) In this subsection: 
‘‘(A) The term ‘appropriate congressional com-
mittees’ means— 
‘‘(i) the Committee on Homeland Security 
and Governmental Affairs of the Senate; 
‘‘(ii) the Committee on the Judiciary of the 
Senate; 
‘‘(iii) the Committee on Homeland Security 
of the House of Representatives; and 
‘‘(iv) the Committee on the Judiciary of 
the House of Representatives. 
‘‘(B) The term ‘enforcement action’— 
‘‘(i) means an apprehension, arrest, inspec-
tion interview, request for identification, search, 
seizure, service of charging documents or sub-
poenas, or surveillance for the purposes of im-
migration enforcement; and 
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‘‘(ii) includes an enforcement action at, or 
focused on, a protected area that is part of a 
joint case led by another law enforcement agen-
cy. 
‘‘(C) The term ‘exigent circumstances’ means a 
situation involving— 
‘‘(i) the imminent risk of death, violence, 
or physical harm to any person or property, in-
cluding a situation implicating terrorism or the 
national security of the United States; 
‘‘(ii) the immediate arrest or pursuit of a 
dangerous felon, terrorist suspect, or other indi-
vidual presenting an imminent danger; or 
‘‘(iii) the imminent risk of destruction of 
evidence that is material to an ongoing criminal 
case. 
‘‘(D) The term ‘prior approval’ means— 
‘‘(i) in the case of officers and agents of 
U.S. Immigration and Customs Enforcement, 
prior written approval to carry out an enforce-
ment action involving a specific individual or in-
dividuals authorized by— 
‘‘(I) the Assistant Director of Oper-
ations, Homeland Security Investigations; 
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‘‘(II) the Executive Associate Direc-
tor, Homeland Security Investigations; 
‘‘(III) the Assistant Director for Field 
Operations, Enforcement and Removal Op-
erations; or 
‘‘(IV) the Executive Associate Direc-
tor for Field Operations, Enforcement and 
Removal Operations; 
‘‘(ii) in the case of officers and agents of 
U.S. Customs and Border Protection, prior 
written approval to carry out an enforcement 
action involving a specific individual or individ-
uals authorized by— 
‘‘(I) a Chief Patrol Agent; 
‘‘(II) the Director of Field Operations; 
‘‘(III) the Director of Air and Marine 
Operations; or 
‘‘(IV) the Internal Affairs Special 
Agent in Charge; and 
‘‘(iii) in the case of other Federal, State, 
or local law enforcement officers, to carry out 
an enforcement action involving a specific indi-
vidual or individuals authorized by— 
‘‘(I) the head of the Federal agency 
carrying out the enforcement action; or 
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260 
‘‘(II) the head of the State or local 
law enforcement agency carrying out the 
enforcement action. 
‘‘(E) The term ‘protected area’ includes all of 
the physical space located within 1,000 feet of— 
‘‘(i) any medical treatment or mental 
health care facility, including any hospital, doc-
tor’s office, health clinic, alcohol or drug pre-
vention, counseling, or treatment facilities, sy-
ringe exchange services, vaccination, treatment, 
or testing sites, emergent or urgent care facil-
ity, sites that serve pregnant individuals, or 
community health centers; 
‘‘(ii) any public or private school, including 
any known and licensed day care facility, pre-
school, sites of early childhood programs, pri-
mary school, secondary school, postsecondary 
school (including colleges and universities), or 
other institution of learning (including voca-
tional or trade schools); 
‘‘(iii) any scholastic or education-related 
activity or event or before or after school pro-
gram, including field trips and interscholastic 
events; 
‘‘(iv) any school bus or school bus stop; 
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261 
‘‘(v) any place where children gather, such 
as a playground, a recreation center, a library, 
a foster care facility, or a group home for chil-
dren; 
‘‘(vi) any physical structure of an organiza-
tion or subdivision of government that— 
‘‘(I) assists children, pregnant women, 
victims of crime or abuse, or individuals 
with significant mental or physical disabil-
ities; 
‘‘(II) provides social services and as-
sistance, including homeless shelters, com-
munity-based organizations, facilities that 
serve disabled persons, drug or alcohol 
counseling and treatment facilities, food 
banks or food pantries, and other places 
providing emergency and disaster services 
or assistance with food and nutrition, 
housing affordability and income or other 
services funded by State or local govern-
ment, charitable giving, the Special Sup-
plemental Nutrition Program for Women, 
Infants, and Children (WIC), Supple-
mental 
Nutrition 
Assistance 
Program 
(SNAP), Temporary Assistance for Needy 
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Families (TANF), Social Security, or the 
United States Housing Act; or 
‘‘(III) provides hospice, palliative, or 
other available end-of-life care services to 
terminally ill persons; 
‘‘(vii) any church, synagogue, mosque, or 
other place of worship or religious study, in-
cluding buildings rented for the purpose of reli-
gious services, retreats, counseling, workshops, 
instruction, and education; 
‘‘(viii) any Federal, State, or local court-
house, including the office of an individual’s 
legal counsel or representative, and a probation, 
parole, or supervised release office; 
‘‘(ix) the site of a funeral, grave-side cere-
mony, rosary, wedding, or other religious cere-
mony or observance; 
‘‘(x) any public demonstration, such as a 
march, a rally, or a parade; 
‘‘(xi) any domestic violence shelter, rape 
crisis center, child advocacy center, supervised 
visitation center, family justice center, or victim 
services provider; 
‘‘(xii) any congressional district office; 
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‘‘(xiii) indoor and outdoor premises of a 
State department of motor vehicles; 
‘‘(xiv) a place where disaster or emergency 
response and relief is provided, including evacu-
ation routes, places where shelter or emergency 
supplies, food, or water are distributed, or 
places where registration for disaster-relief as-
sistance or family reunification is underway; or 
‘‘(xv) any other location specified by the 
Secretary of Homeland Security for purposes of 
this subsection. 
‘‘(2)(A) An enforcement action may not take place 
at, or be focused on, a protected area unless— 
‘‘(i) the action involves exigent circumstances; 
and 
‘‘(ii) prior approval for the enforcement action 
was obtained. 
‘‘(B) If an enforcement action is initiated pursuant 
to subparagraph (A) and the exigent circumstances per-
mitting the enforcement action cease, the enforcement ac-
tion shall be discontinued until such exigent circumstances 
reemerge. 
‘‘(C) If an enforcement action is carried out in viola-
tion of this subsection— 
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264 
‘‘(i) no information resulting from the enforce-
ment action may be entered into the record or re-
ceived into evidence in a removal proceeding result-
ing from the enforcement action; and 
‘‘(ii) the noncitizen who is the subject of such 
removal proceeding may file a motion for the imme-
diate termination of the removal proceeding. 
‘‘(3)(A) This subsection shall apply to any enforce-
ment action by officers or agents of the Department of 
Homeland Security, including— 
‘‘(i) officers or agents of U.S. Immigration and 
Customs Enforcement; 
‘‘(ii) officers or agents of U.S. Customs and 
Border Protection; and 
‘‘(iii) any individual designated to perform im-
migration enforcement functions pursuant to sub-
section (g). 
‘‘(B) While carrying out an enforcement action within 
a protected area, officers and agents referred to in sub-
paragraph (A) shall make every effort— 
‘‘(i) to limit the time spent in the protected 
area; 
‘‘(ii) to limit the enforcement action in the pro-
tected area to the person or persons for whom prior 
approval was obtained; and 
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265 
‘‘(iii) to conduct themselves discreetly. 
‘‘(C) If, while carrying out an enforcement action 
that is not initiated in or focused on a protected area, offi-
cers or agents are led into a protected area, and no exigent 
circumstance and prior approval with respect to the pro-
tected area, such officers or agents shall— 
‘‘(i) cease before taking any further enforce-
ment action; 
‘‘(ii) conduct themselves in a discreet manner; 
‘‘(iii) maintain surveillance on an individual; 
and 
‘‘(iv) immediately consult their supervisor in 
order to determine whether such enforcement action 
should be discontinued. 
‘‘(D) The limitations under this paragraph shall not 
apply to the transportation of an individual apprehended 
at or near a land or sea border to a hospital or health 
care provider for the purpose of providing medical care 
to such individual. 
‘‘(4)(A) Each official specified in subparagraph (B) 
shall ensure that the employees under his or her super-
vision receive annual training regarding compliance 
with— 
‘‘(i) the requirements under this subsection with 
respect to enforcement actions at or focused on pro-
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266 
tected areas and enforcement actions that lead offi-
cers or agents to a protected area; and 
‘‘(ii) the requirements under section 239 of this 
Act and section 384 of the Illegal Immigration Re-
form and Immigrant Responsibility Act of 1996 (8 
U.S.C. 1367). 
‘‘(B) The officials specified in this subparagraph 
are— 
‘‘(i) the Chief Counsel of each Field Office of 
U.S. Immigration and Customs Enforcement; 
‘‘(ii) each Field Office Director of U.S. Immi-
gration and Customs Enforcement; 
‘‘(iii) each Special Agent in Charge of U.S. Im-
migration and Customs Enforcement; 
‘‘(iv) each Chief Patrol Agent of U.S. Customs 
and Border Protection; 
‘‘(v) the Director of Field Operations of U.S. 
Customs and Border Protection; 
‘‘(vi) the Director of Air and Marine Operations 
of U.S. Customs and Border Protection; 
‘‘(vii) the Internal Affairs Special Agent in 
Charge of U.S. Customs and Border Protection; and 
‘‘(viii) the chief law enforcement officer of each 
State or local law enforcement agency that enters 
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267 
into a written agreement with the Department of 
Homeland Security pursuant to subsection (g). 
‘‘(5) Not later than 180 days after the date of the 
enactment of the Health Equity and Accountability Act 
of 2024, the Secretary of Homeland Security shall modify 
the Notice to Appear form (Form I–862)— 
‘‘(A) to provide the subject of an enforcement 
action with information, written in plain language, 
summarizing the restrictions against enforcement 
actions at protected areas (as described in this sub-
section) and the remedies available to the individual 
if such action violates such restrictions; 
‘‘(B) to ensure that the information provided 
pursuant to subparagraph (A) is accessible to an in-
dividual with limited English proficiency; and 
‘‘(C) to ensure that the subject of an enforce-
ment action is not permitted to verify that the offi-
cers or agents that carried out such action complied 
with the restrictions set forth in this subsection. 
‘‘(6)(A) The Director of U.S. Immigration and Cus-
toms Enforcement and the Commissioner of U.S. Customs 
and Border Protection shall each submit an annual report 
to the appropriate congressional committees that includes 
the information set forth in subparagraph (B) with respect 
to the respective agency. 
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269 
‘‘(dd) a report describing what oc-
curred during and immediately after such 
action; 
‘‘(IV) the components of the agency in-
volved in the enforcement action; 
‘‘(V) a description of the enforcement ac-
tion, including the nature of the criminal activ-
ity of its intended target; 
‘‘(VI) the number of individuals, if any, ar-
rested or taken into custody; 
‘‘(VII) the number of collateral arrests, if 
any, and the reasons for each such arrest; 
‘‘(VIII) a certification whether the location 
administrator of a protected area was contacted 
before, during, or after the enforcement action; 
and 
‘‘(IX) the percentage of all of the staff 
members and supervisors reporting to the offi-
cials listed in paragraph (4)(B) who completed 
the training required under paragraph (4)(A). 
‘‘(7) Nothing in the subsection may be construed— 
‘‘(A) to affect the authority of Federal, State, 
or local law enforcement agencies— 
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270 
‘‘(i) to enforce generally applicable Federal 
or State criminal laws unrelated to immigra-
tion; or 
‘‘(ii) to protect residents from imminent 
threats to public safety; or 
‘‘(B) to limit or override the protections pro-
vided in— 
‘‘(i) section 239; or 
‘‘(ii) section 384 of the Illegal Immigration 
Reform and Immigrant Responsibility Act of 
1996 (8 U.S.C. 1367).’’. 
SEC. 4002. REPEAL OF REQUIREMENT FOR DOCUMENTA-
TION EVIDENCING CITIZENSHIP OR NATION-
ALITY UNDER THE MEDICAID PROGRAM. 
(a) REPEAL.—Subsections (i)(22) and (x) of section 
1903 of the Social Security Act (42 U.S.C. 1396b) are 
each repealed. 
(b) CONFORMING AMENDMENTS.— 
(1) STATE
PAYMENTS
FOR
MEDICAL
ASSIST-
ANCE.—Section 1902 of the Social Security Act (42 
U.S.C. 1396a) is amended— 
(A) by amending paragraph (46) of sub-
section (a) to read as follows: 
‘‘(46) provide that information is requested and 
exchanged for purposes of income and eligibility 
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271 
verification in accordance with a State system which 
meets the requirements of section 1137 of this 
Act;’’; 
(B) in subsection (e)(13)(A)(i)— 
(i) in the matter preceding subclause 
(I), by striking ‘‘sections 1902(a)(46)(B) 
and 1137(d)’’ and inserting ‘‘section 
1137(d)’’; and 
(ii) in subclause (IV), by striking 
‘‘1902(a)(46)(B) or’’; and 
(C) by striking subsection (ee). 
(2) REPEAL.—Subsection (c) of section 6036 of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396b 
note) is repealed. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act. 
SEC. 4003. LIFT THE BAR ACT. 
(a) ELIMINATION OF ARBITRARY ELIGIBILITY RE-
STRICTIONS.— 
(1) IN GENERAL.—Sections 402, 403, 411, 412, 
421, and 422 of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 (8 
U.S.C. 1612, 1613, 1621, 1622, 1631, and 1632) 
are repealed. 
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272 
(2) CONFORMING AMENDMENTS.—Title IV of 
the Personal Responsibility and Work Opportunity 
Reconciliation Act of 1996 (8 U.S.C. 1601 et seq.) 
is amended— 
(A) 
in 
section 
401(b)(5) 
(8 
U.S.C. 
1611(b)(5)), by striking ‘‘the program defined 
in section 402(a)(3)(A) (relating to the supple-
mental security income program)’’ and inserting 
‘‘the Supplemental Security Income Program 
under title XVI of the Social Security Act (42 
U.S.C. 1381 et seq.)’’; 
(B) in section 404(a) (8 U.S.C. 1614(a)), 
by striking ‘‘, 402, or 403’’; 
(C) in section 413 (8 U.S.C. 1625)— 
(i) by striking ‘‘A State’’ and insert-
ing the following: 
‘‘(a) STATE
OR
LOCAL
PUBLIC
BENEFIT
DE-
FINED.—In this section, the term ‘State or local public 
benefit’— 
‘‘(1) except as provided in paragraphs (2) and 
(3), means— 
‘‘(A) any grant, contract, loan, professional 
license, or commercial license provided by an 
agency of a State or local government or by ap-
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273 
propriated funds of a State or local govern-
ment; and 
‘‘(B) any retirement, welfare, health, dis-
ability, public or assisted housing, postsec-
ondary education, food assistance, unemploy-
ment benefit, or any other similar benefit for 
which payments or assistance are provided to 
an individual, household, or family eligibility 
unit by an agency of a State or local govern-
ment or by appropriated funds of a State or 
local government; 
‘‘(2) does not apply— 
‘‘(A) to any contract, professional license, 
or commercial license for a nonimmigrant 
whose visa for entry is related to such employ-
ment in the United States, or to a citizen of a 
freely associated state, if section 141 of the ap-
plicable compact of free association approved in 
Public Law 99–239 or 99–658 (or a successor 
provision) is in effect; 
‘‘(B) with respect to benefits for an alien 
who as a work authorized nonimmigrant or as 
an alien lawfully admitted for permanent resi-
dence under the Immigration and Nationality 
Act qualified for such benefits and for whom 
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274 
the United States under reciprocal treaty agree-
ments is required to pay benefits, as determined 
by the Secretary of State, after consultation 
with the Attorney General; or 
‘‘(C) to the issuance of a professional li-
cense to, or the renewal of a professional license 
by, a foreign national not physically present in 
the United States; and 
‘‘(3) does not include any Federal public ben-
efit. 
‘‘(b) PROOF
OF ELIGIBILITY REQUIREMENT.—A 
State’’; and 
(ii) in subsection (b), as redesignated, 
by 
striking 
‘‘(as 
defined 
in 
section 
411(c))’’; 
(D) in section 432(d) (8 U.S.C. 1642(d)), 
by striking ‘‘(as defined in section 411(c))’’ and 
inserting ‘‘(as defined in section 413(a))’’; 
(E) in section 435 (8 U.S.C. 1645), by 
striking ‘‘(as provided under section 403)’’; and 
(F) in section 436 (8 U.S.C. 1646)— 
(i) by striking ‘‘the food stamp pro-
gram (as defined in section 402(a)(3)(B))’’ 
and inserting ‘‘the supplemental nutrition 
assistance program established under the 
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277 
(A) in the header, by striking ‘‘QUALIFIED 
ALIENS’’ and inserting ‘‘QUALIFIED NONCITI-
ZENS’’; 
(B) in paragraph (3), by striking ‘‘or’’ at 
the end; 
(C) in paragraph (4), by striking the pe-
riod at the end and inserting ‘‘; or’’; and 
(D) by inserting after paragraph (4) the 
following: 
‘‘(5) a noncitizen— 
‘‘(A) in a category that was treated as law-
fully present for purposes of section 1101 of the 
Patient Protection and Affordable Care Act of 
2010 (42 U.S.C. 18001); 
‘‘(B) who met the requirements of section 
402(a)(2)(D) of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 
(8 U.S.C. 1612(a)(2)(D)) on or before January 
1, 2021; 
‘‘(C) who is granted special immigrant ju-
venile 
status 
as 
described 
by 
section 
101(a)(27)(J) of the Immigration and Nation-
ality Act (8 U.S.C. 1101(a)(27)(J)); 
‘‘(D) who has a pending, bona fide applica-
tion for nonimmigrant status under section 
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101(a)(15)(U) of the Immigration and Nation-
ality Act (8 U.S.C. 1101(1)(15)(U)); 
‘‘(E) who was granted relief under the De-
ferred Action for Childhood Arrivals program; 
or 
‘‘(F) who is not described in subpara-
graphs (A) through (E), is not a citizen of the 
United States, resides in a State or territory of 
the United States, and is authorized by Federal 
law to be present in the United States.’’; and 
(3) by adding at the end the following: 
‘‘(d) NONCITIZEN.—In this title, the term ‘noncit-
izen’ means any individual who is not a citizen of the 
United States.’’. 
(d) CHILD NUTRITION PROGRAMS.—Section 742 of 
the Personal Responsibility and Work Opportunity Rec-
onciliation Act of 1996 (8 U.S.C. 1615) is amended— 
(1) in subsection (a)— 
(A) in the header by striking ‘‘SCHOOL 
LUNCH AND BREAKFAST PROGRAMS’’ and in-
serting ‘‘CHILD NUTRITION PROGRAMS’’; 
(B) by striking ‘‘the school lunch pro-
gram’’ and inserting ‘‘any program’’; and 
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279 
(C) by striking ‘‘the school breakfast pro-
gram under section 4 of the’’ and inserting 
‘‘any program under’’; and 
(2) in subsection (b), by amending paragraph 
(1) to read as follows: 
‘‘(1) IN GENERAL.—A State may not deny ben-
efits under programs established under the provi-
sions of law described in paragraph (2) on the basis 
of an individual’s citizenship or immigration sta-
tus.’’. 
(e) EXCLUSION OF MEDICAL ASSISTANCE EXPENDI-
TURES FOR CITIZENS OF FREELY ASSOCIATED STATES.— 
Section 1108(h) of the Social Security Act (42 U.S.C. 
1308(h)) is amended— 
(1) by striking ‘‘Expenditures’’ and inserting: 
‘‘(1) IN GENERAL.—Expenditures’’; and 
(2) by adding at the end the following: 
‘‘(2) EXCEPTION.—With respect to eligibility 
for benefits under a State plan approved under title 
XIX (other than medical assistance described in sec-
tion 401(b)(1)(A) of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 (8 
U.S.C. 1611(b)(1)(A))), paragraph (1) shall not 
apply to any individual who lawfully resides in 1 of 
the 50 States or in the District of Columbia in ac-
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280 
cordance with the Compacts of Free Association be-
tween the Government of the United States and the 
Governments of the Federated States of Micronesia, 
the Republic of the Marshall Islands, and the Re-
public of Palau and shall not apply, at the option of 
the Governor of Puerto Rico, the Virgin Islands, 
Guam, the Northern Mariana Islands, or American 
Samoa as communicated to the Secretary of Health 
and Human Services in writing, to any individual 
who lawfully resides in the respective territory in ac-
cordance with such Compacts.’’. 
(f) CHILDREN’S HEALTH INSURANCE PROGRAM.— 
Effective January 1, 2025, section 2107(e)(1) of the So-
cial Security Act (42 U.S.C. 1397gg(e)(1)) is amended— 
(1) by striking subparagraph (P); and 
(2) by redesignating subparagraphs (Q), (R), 
(S), (T), and (U) as subparagraphs (P), (Q), (R), 
(S), and (T), respectively. 
(g) CONFORMING AMENDMENTS.— 
(1) SUPPLEMENTAL
FOOD
ASSISTANCE
PRO-
GRAM.—The Food and Nutrition Act of 2008 (7 
U.S.C. 2011 et seq.) is amended— 
(A) in section 5 (7 U.S.C. 2014)— 
(i) in subsection (d)(10), by striking 
‘‘(k)’’ and inserting ‘‘(j)’’; 
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281 
(ii) by striking subsection (i); and 
(iii) by redesignating subsections (j), 
(k), (l), (m), and (n) as subsections (i), (j), 
(k), (l), and (m), respectively; 
(B) in section 6 (7 U.S.C. 2015)— 
(i) in subsection (f), by striking ‘‘an 
alien lawfully admitted for permanent’’ and 
all that follows through the end of the sub-
section and inserting ‘‘a noncitizen who is 
lawfully present in the United States.’’; 
and 
(ii) in subsection (s)(2), by striking 
‘‘(i), (k), (l), (m), and (n)’’ and inserting 
‘‘(j), (k), (l), and (m)’’; and 
(C) in section 11(e)(2)(B)(v)(II) (7 U.S.C. 
2020(e)(2)(B)(v)(II)) by striking ‘‘aliens’’ and 
inserting ‘‘noncitizens’’. 
(2) MEDICAID.—Section 1903(v) of the Social 
Security Act (42 U.S.C. 1396b(v)) is amended— 
(A) in paragraph (1), by striking ‘‘admit-
ted for’’ and all that follows and inserting 
‘‘present in the United States.’’; and 
(B) by striking paragraph (4). 
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(3) HOUSING ASSISTANCE.—Section 214(a) of 
the Housing and Community Development Act of 
1980 (42 U.S.C. 1436a(a)) is amended— 
(A) by redesignating paragraphs (6) and 
(7) as paragraphs (7) and (8), respectively; and 
(B) by inserting after paragraph (5) the 
following: 
‘‘(6) a qualified noncitizen (as defined in sec-
tion 431 of the Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996 (8 U.S.C. 
1641));’’. 
(4) ASSISTANCE NOT TREATED AS DEBT AB-
SENT
FRAUD.—Section 213A of the Immigration 
and Nationality Act (8 U.S.C. 1183a) is amended— 
(A) in subsection (a)(3)— 
(i) in subparagraph (A), by striking 
‘‘(as provided under section 403 of the 
Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996)’’; and 
(ii) in subparagraph (B), in the un-
designated matter following clause (ii), by 
striking ‘‘(as provided under section 403 of 
the Personal Responsibility and Work Op-
portunity Reconciliation Act of 1996)’’; 
and 
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(B) in subsection (b)(1)(A) is amended by 
striking ‘‘benefit,’’ and inserting ‘‘benefit by 
fraud,’’. 
(h) FEDERAL AGENCY GUIDANCE.—Not later than 
180 days after the date of the enactment of this Act, each 
Federal agency affected by any of the amendments made 
by this section shall issue guidance with respect to the im-
plementation of such amendments. 
(i) EFFECTIVE DATE.—Except as otherwise provided 
in this section, the amendments made by this section— 
(1) shall take effect on the date of the enact-
ment of this Act; and 
(2) shall apply to services furnished on or after 
the date that is 180 days after the date on which 
any guidance is issued pursuant to subsection (h). 
SEC. 4004. IMPROVE AFFORDABILITY AND REDUCE PRE-
MIUM COSTS OF HEALTH INSURANCE FOR 
CONSUMERS. 
(a) IN GENERAL.—Section 36B(b)(3)(A) of the In-
ternal Revenue Code of 1986 is amended to read as fol-
lows: 
‘‘(A) APPLICABLE PERCENTAGE.—The ap-
plicable percentage for any taxable year shall be 
the percentage such that the applicable percent-
age for any taxpayer whose household income is 
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within an income tier specified in the following 
table shall increase, on a sliding scale in a lin-
ear manner, from the initial premium percent-
age to the final premium percentage specified in 
such table for such income tier: 
‘‘In the case of household income (expressed as a 
percent of poverty line) within the following in-
come tier: 
The initial 
premium 
percentage 
is— 
The final 
premium 
percentage 
is— 
Up to 150 percent ..................................................
0.0 
0.0
150 percent up to 200 percent ...............................
0.0 
3.0
200 percent up to 250 percent ...............................
3.0 
4.0
250 percent up to 300 percent ...............................
4.0 
6.0
300 percent up to 400 percent ...............................
6.0 
8.5
400 percent and higher ..........................................
8.5 
8.5.’’. 
(b) CONFORMING AMENDMENTS.—Section 36B(c)(1) 
of the Internal Revenue Code of 1986 is amended— 
(1) by striking ‘‘but does not exceed 400 per-
cent’’ in subparagraph (A), and 
(2) by striking subparagraph (E). 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2023. 
SEC. 4005. REMOVING CITIZENSHIP AND IMMIGRATION 
BARRIERS 
TO 
ACCESS 
TO 
AFFORDABLE 
HEALTH CARE UNDER THE ACA. 
(a) IN GENERAL.— 
(1) PREMIUM TAX CREDITS.—Section 36B of 
the Internal Revenue Code of 1986 is amended— 
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(A) in subsection (c)(1), by amending sub-
paragraph (B) to read as follows: 
‘‘(B) SPECIAL RULE FOR CERTAIN INDI-
VIDUALS
INELIGIBLE
FOR
MEDICAID
DUE
TO 
STATUS.—If— 
‘‘(i) a taxpayer has a household in-
come which is not greater than 100 per-
cent of an amount equal to the poverty line 
for a family of the size involved, 
‘‘(ii) the taxpayer is a noncitizen who 
is not eligible for the Medicaid program 
under title XIX of the Social Security Act 
by reason of the individual’s immigration 
status, 
‘‘(iii) the taxpayer is ineligible for 
minimum essential coverage under section 
5000A(f)(1)(A)(ii), and 
‘‘(iv) under the Medicaid eligibility 
criteria for noncitizens in effect on Decem-
ber 26, 2020, the taxpayer would be ineli-
gible for such minimum essential coverage 
by reason of the taxpayer’s immigration 
status, 
the taxpayer shall, for purposes of the credit 
under this section, be treated as an applicable 
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taxpayer with a household income which is 
equal to 100 percent of the poverty line for a 
family of the size involved.’’. 
(B) by striking subsection (e). 
(2) COST-SHARING REDUCTIONS.—Section 1402 
of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18071) is amended— 
(A) by striking subsection (e); and 
(B) by redesignating subsections (f) and 
(g) as subsections (e) and (f), respectively. 
(3) BASIC
HEALTH
PROGRAM
ELIGIBILITY.— 
Section 1331(e)(1)(B) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 
amended by striking ‘‘lawfully present in the United 
States,’’. 
(4) RESTRICTIONS ON FEDERAL PAYMENTS.— 
Section 1412 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18082) is amended— 
(A) by striking subsection (d); and 
(B) by redesignating subsection (e) as sub-
section (d). 
(5) REQUIREMENT TO MAINTAIN MINIMUM ES-
SENTIAL COVERAGE.—Section 5000A(d) of the In-
ternal Revenue Code of 1986 is amended— 
(A) by striking paragraph (3); and 
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(B) by redesignating paragraph (4) as 
paragraph (3). 
(b) CONFORMING AMENDMENTS.— 
(1) ESTABLISHMENT
OF
PROGRAM.—Section 
1411(a) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18081(a)) is amended— 
(A) by striking paragraph (1); and 
(B) by redesignating paragraphs (2), (3), 
and (4) as paragraphs (1), (2), and (3), respec-
tively. 
(2) QUALIFIED INDIVIDUALS.—Section 1312(f) 
of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18032(f)) is amended— 
(A) in the heading, by striking ‘‘; ACCESS 
LIMITED
TO CITIZENS
AND LAWFUL RESI-
DENTS’’; and 
(B) by striking paragraph (3). 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to years, plan years, and taxable 
years, as applicable, beginning after December 31, 2024. 
SEC. 4006. HEAL FOR IMMIGRANT FAMILIES ACT. 
(a) CONSISTENCY
IN HEALTH INSURANCE COV-
ERAGE FOR INDIVIDUALS WITH FEDERALLY AUTHOR-
IZED PRESENCE, INCLUDING DEFERRED ACTION.— 
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(1) IN GENERAL.—For purposes of eligibility 
under any of the provisions described in paragraph 
(2), all individuals granted federally authorized pres-
ence in the United States shall be considered to be 
lawfully present in the United States. 
(2) PROVISIONS
DESCRIBED.—The provisions 
described in this paragraph are the following: 
(A) 
EXCHANGE
ELIGIBILITY.—Section 
1411 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18031). 
(B) 
REDUCED
COST-SHARING
ELIGI-
BILITY.—Section 1402 of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 
18071). 
(C) PREMIUM SUBSIDY ELIGIBILITY.—Sec-
tion 36B of the Internal Revenue Code of 1986 
(26 U.S.C. 36B). 
(D) MEDICAID AND CHIP ELIGIBILITY.— 
Titles XIX and XXI of the Social Security Act, 
including under section 1903(v) of such Act (42 
U.S.C. 1396b(v)). 
(3) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Paragraph (1) shall 
take effect on the date of enactment of this Act. 
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(B) TRANSITION
THROUGH
SPECIAL
EN-
ROLLMENT PERIOD.—In the case of an indi-
vidual described in paragraph (1) who, before 
the first day of the first annual open enrollment 
period under subparagraph (B) of section 
1311(c)(6) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18031(c)(6)) be-
ginning after the date of enactment of this Act, 
is granted federally authorized presence in the 
United States and who, as a result of such sub-
section, qualifies for a subsidy under a provi-
sion described in subparagraph (B) or (C) of 
paragraph (2), the Secretary of Health and 
Human Services shall establish a special enroll-
ment period under subparagraph (C) of such 
section 1311(c)(6) during which such individual 
may enroll in qualified health plans through 
Exchanges under title I of the Patient Protec-
tion and Affordable Care Act and qualify for 
such a subsidy. For such an individual who has 
been granted federally authorized presence in 
the United States as of the date of enactment 
of this Act, such special enrollment period shall 
begin not later than 90 days after such date of 
enactment. Nothing in this paragraph shall be 
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construed as affecting the authority of the Sec-
retary to establish additional special enrollment 
periods under such subparagraph (C). 
(b) STATE OPTION TO EXPAND MEDICAID
AND 
CHIP TO INDIVIDUALS WITHOUT LAWFUL PRESENCE.— 
(1) MEDICAID.— 
(A) 
IN
GENERAL.—Section 
1902(a)(10)(A)(ii) of the Social Security Act 
(42 U.S.C. 1396a(a)(10)(A)(ii)) is amended— 
(i) in subclause (XXII), by striking 
‘‘or’’ at the end; 
(ii) in subclause (XXIII), by striking 
the semicolon and inserting ‘‘; or’’; and 
(iii) by adding at the end the fol-
lowing new subclause: 
‘‘(XXIV) who would be eligible 
under the State plan (or waiver of 
such plan) under this title if they were 
citizens of the United States;’’. 
(B) CONFORMING
AMENDMENT.—Section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended, in the matter preceding 
paragraph (1)— 
(i) in the matter designated as clause 
(xvi), by striking ‘‘or’’ at the end; 
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(ii) in the matter designated as clause 
(xvii), by adding ‘‘or’’ at the end; and 
(iii) by inserting after the matter des-
ignated as clause (xvii) the following: 
‘‘(xviii) 
individuals 
described 
in 
section 
1902(a)(10)(A)(ii)(XXIV),’’. 
(2) CHIP.—Title XXI of the Social Security 
Act (42 U.S.C. 1397aa et seq.) is amended by in-
serting after section 2112 the following new section: 
‘‘SEC. 2112A. STATE OPTION TO PROVIDE COVERAGE FOR 
INDIVIDUALS WITHOUT LAWFUL PRESENCE. 
‘‘A State may elect through an amendment to its 
State child health plan under section 2102 to treat an in-
dividual as a targeted low-income child or a targeted low- 
income pregnant woman for purposes of this title if such 
individual would otherwise be included as such a child or 
such a pregnant woman (as applicable) under such plan 
if the individual were a citizen of the United States.’’. 
(3) NONAPPLICATION OF ELIGIBILITY PROHIBI-
TION.—Section 401(a) of the Personal Responsi-
bility and Work Opportunity Reconciliation Act of 
1996 (42 U.S.C. 1611(a)) is amended by adding at 
the end the following new sentence: ‘‘The preceding 
sentence shall not apply with respect to a nonciti-
zen’s eligibility under a State plan (or waiver of such 
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292 
plan) under title XIX of the Social Security Act or 
under a State child health plan (or waiver of such 
plan) under title XXI of such Act to the extent that 
such State has elected to make such individual so el-
igible pursuant to section 1902(a)(10)(A)(ii)(XXIV) 
or 2112A of such Act, respectively.’’. 
(c) PRESERVING ACCESS TO COVERAGE.— 
(1) IN GENERAL.—Nothing in this section, in-
cluding the amendments made by this section, shall 
prevent lawfully present noncitizens who are ineli-
gible for full benefits under the Medicaid program 
under title XIX of the Social Security Act from se-
curing a credit for which such lawfully present non-
citizens would be eligible under section 36B(c)(1)(B) 
of the Internal Revenue Code of 1986 and under the 
Medicaid provisions for lawfully present noncitizens, 
as in effect on the date prior to the date of enact-
ment of this Act. 
(2) DEFINITION.—For purposes of paragraph 
(1), the term ‘‘full benefits’’ means, with respect to 
an individual and State, medical assistance for all 
services covered under the State plan under title 
XIX of the Social Security Act that is not less in 
amount, duration, or scope, or is determined by the 
Secretary of Health and Human Services to be sub-
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293 
stantially equivalent to the medical assistance avail-
able 
for 
an 
individual 
described 
in 
section 
1902(a)(10)(A)(i) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)(i)). 
SEC. 4007. STUDY ON THE UNINSURED. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall— 
(1) conduct a study, in accordance with the 
standards under section 3101 of the Public Health 
Service Act (42 U.S.C. 300kk), on the demographic 
characteristics of the population of individuals who 
do not have health insurance or oral health coverage; 
and 
(2) predict, based on such study, the demo-
graphic characteristics of the population of individ-
uals who would remain without health insurance 
after the end of any annual open enrollment or any 
special enrollment period or upon enactment and im-
plementation of any legislative changes to the Pa-
tient Protection and Affordable Care Act (Public 
Law 111–148) that affect the number of persons eli-
gible for health insurance. 
(b) REPORTING REQUIREMENTS.— 
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(1) IN GENERAL.—Not later than 12 months 
after the date of the enactment of this Act, the Sec-
retary shall submit to the Congress the results of 
the study under subsection (a)(1) and the prediction 
made under subsection (a)(2). 
(2) REPORTING OF DEMOGRAPHIC CHARACTER-
ISTICS.—The Secretary shall— 
(A) report the demographic characteristics 
under paragraphs (1) and (2) of subsection (a) 
on the basis of racial and ethnic minority group 
(as defined in section 1707(g)(1) of the Public 
Health Service Act), and stratify the reporting 
on each racial and ethnic minority group by 
other demographic characteristics that can im-
pact access to health insurance, such as sexual 
orientation, gender identity, primary language, 
disability status, sex, socioeconomic status, age 
group, citizenship, and immigration status, in a 
manner consistent with title I of this Act, in-
cluding the amendments made by such title; 
and 
(B) not use such report, or any informa-
tion gathered in preparing such report— 
(i) to engage in or anticipate any de-
portation or immigration related enforce-
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ment action by any entity, including the 
Department of Homeland Security; or 
(ii) for the exploitation of, or discrimi-
nation against, communities of color or the 
LGBTQ+ population. 
SEC. 4008. MEDICAID FALLBACK COVERAGE PROGRAM FOR 
LOW-INCOME ADULTS IN NON-EXPANSION 
STATES. 
(a) IN GENERAL.—As soon as possible after the date 
of enactment of this Act the Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall— 
(1) directly or by contract, establish a program 
that offers eligible individuals the opportunity to en-
roll in health benefits coverage that meets the re-
quirements described in subsection (c) and any re-
quirements applicable to such coverage pursuant to 
subsection (d); and 
(2) ensure that such program is administered 
consistent 
with 
the 
requirements 
of 
section 
431.10(c)(2) of title 42, Code of Federal Regula-
tions. 
(b) DEFINITION OF ELIGIBLE INDIVIDUAL.—In this 
section, the term ‘‘eligible individual’’ means an individual 
who— 
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(1) 
is 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) of the Social Security Act 
(42 U.S.C. 1396a(a)(10)(A)(i)(VIII)); 
(2) resides in a State that— 
(A) does not expend amounts for medical 
assistance under title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.) for all individ-
uals described in such section; and 
(B) did not expend amounts for medical 
assistance under such title for all such individ-
uals as of the date of enactment of this Act; 
and 
(3) would not be eligible for medical assistance 
under such State’s plan for medical assistance under 
title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.), or a waiver of such plan, as such plan or 
waiver was in effect on such date. 
(c) 
HEALTH
BENEFITS
COVERAGE
REQUIRE-
MENTS.—The requirements described in this subsection 
with respect to health benefits coverage are the following: 
(1) ESSENTIAL HEALTH BENEFITS.—At a min-
imum, the coverage meets the minimum standards 
required under paragraph (5) of section 1937(b) of 
the Social Security Act (42 U.S.C. 1396u–7(b)) for 
benchmark coverage described in paragraph (1) of 
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297 
such section or benchmark equivalent coverage de-
scribed in paragraph (2) of such section. 
(2) PREMIUMS
AND
COST-SHARING.—No pre-
miums are imposed for the coverage, and deduct-
ibles, cost-sharing, or similar charges may only be 
imposed in accordance with the requirements im-
posed on State Medicaid plans under section 1916 of 
the Social Security Act (42 U.S.C. 1396o). 
(d) APPLICATION OF REQUIREMENTS AND PROVI-
SIONS OF TITLE XIX OF THE SOCIAL SECURITY ACT.— 
The Secretary shall specify that— 
(1) any requirement applicable to the furnishing 
of medical assistance under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.) by States that 
have elected to make medical assistance available to 
individuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) of such title (42 U.S.C. 
1396a(a)(10)(A)(i)(VIII)) that does not conflict with 
the requirements specified in subsection (c) applies 
to the program established under this section; and 
(2) other provisions of such title apply to such 
program. 
(e) NO STATE MANDATE.—Nothing in this section 
shall be construed as requiring a State to make expendi-
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298 
tures related to the program established under this section 
and the Secretary shall not impose any such requirement. 
(f) FUNDING.—There are appropriated to the Sec-
retary for each fiscal year beginning with fiscal year 2025 
from any funds in the Treasury not otherwise appro-
priated, such sums as are necessary to carry out this sec-
tion. 
SEC. 4009. INCREASE AND EXTENSION OF TEMPORARY EN-
HANCED FMAP FOR STATES WHICH BEGIN TO 
EXPEND AMOUNTS FOR CERTAIN MANDA-
TORY INDIVIDUALS. 
(a) IN GENERAL.—Section 1905(ii)(1) of the Social 
Security Act (42 U.S.C. 1396d(ii)(1)) is amended— 
(1) by striking ‘‘8-quarter period’’ and inserting 
‘‘40-quarter period’’; and 
(2) by striking ‘‘5 percentage points’’ and in-
serting ‘‘10 percentage points’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of section 9814 of the American Rescue Plan Act 
of 2021 (Public Law 117–2). 
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Subtitle B—Improvement of 
Coverage 
SEC. 4101. MEDICAID IN THE TERRITORIES. 
(a) ELIMINATION OF GENERAL MEDICAID FUNDING 
LIMITATIONS (‘‘CAP’’) FOR TERRITORIES.— 
(1) IN GENERAL.—Section 1108 of the Social 
Security Act (42 U.S.C. 1308) is amended— 
(A) in subsection (f), in the matter pre-
ceding paragraph (1), by striking ‘‘subsections 
(g) and (h)’’ and inserting ‘‘subsections (g), 
(h), and (j)’’; 
(B) in subsection (g)(2), in the matter pre-
ceding subparagraph (A), by inserting ‘‘sub-
section (j) and’’ after ‘‘subject to’’; 
(C) in subsection (i), by striking paragraph 
(4); and 
(D) by adding at the end the following new 
subsection: 
‘‘(j) SUNSET OF MEDICAID FUNDING LIMITATIONS 
FOR PUERTO RICO, THE VIRGIN ISLANDS, GUAM, THE 
NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA.— 
Subsections (f) and (g) shall not apply to Puerto Rico, 
the Virgin Islands, Guam, the Northern Mariana Islands, 
and American Samoa beginning with fiscal year 2025.’’. 
(2) CONFORMING AMENDMENTS.— 
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300 
(A) Section 1902(j) of the Social Security 
Act (42 U.S.C. 1396a(j)) is amended by strik-
ing ‘‘, the limitation in section 1108(f),,’’. 
(B) Section 1903(u) of the Social Security 
Act (42 U.S.C. 1396b(u)) is amended by strik-
ing paragraph (4). 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply beginning with fiscal 
year 2025. 
(b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL 
ASSISTANCE PERCENTAGE (FMAP) LIMITATION
FOR 
PUERTO RICO.—Section 1905 of the Social Security Act 
(42 U.S.C. 1396d) is amended— 
(1) in subsection (b), in the first sentence, by 
inserting ‘‘for fiscal years before fiscal year 2026’’ 
after ‘‘American Samoa’’; and 
(2) in subsection (ff)(2), by striking ‘‘2027’’ 
and inserting ‘‘2025’’. 
(c) PERMITTING MEDICAID DSH ALLOTMENTS FOR 
TERRITORIES.—Section 1923(f) of the Social Security Act 
(42 U.S.C. 1396r–4(f)) is amended— 
(1) in paragraph (6), by adding at the end the 
following new subparagraph: 
‘‘(C) TERRITORIES.— 
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‘‘(i) FISCAL
YEAR
2025.—For fiscal 
year 2025, the DSH allotment for Puerto 
Rico, the Virgin Islands, Guam, the North-
ern Mariana Islands, and American Samoa 
shall bear the same ratio to $300,000,000 
as the ratio of the number of individuals 
who are low-income or uninsured and re-
siding in such respective territory (as esti-
mated from time to time by the Secretary) 
bears to the sums of the number of such 
individuals residing in all of the territories. 
‘‘(ii) SUBSEQUENT
FISCAL
YEAR.— 
For each subsequent fiscal year, the DSH 
allotment for each such territory is subject 
to an increase in accordance with para-
graph (3).’’; and 
(2) in paragraph (9), by inserting before the pe-
riod at the end the following: ‘‘, and includes, begin-
ning with fiscal year 2025, Puerto Rico, the Virgin 
Islands, Guam, the Northern Mariana Islands, and 
American Samoa’’. 
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SEC. 4102. EXTENSION OF THE SUPPLEMENTAL SECURITY 
INCOME PROGRAM TO PUERTO RICO, THE 
UNITED STATES VIRGIN ISLANDS, GUAM, AND 
AMERICAN SAMOA. 
(a) IN GENERAL.—Section 303 of the Social Security 
Amendments of 1972 (86 Stat. 1484) is amended by strik-
ing subsection (b). 
(b) CONFORMING AMENDMENTS.— 
(1) 
DEFINITION
OF
STATE.—Section 
1101(a)(1) of the Social Security Act (42 U.S.C. 
1301(a)(1)) is amended by striking the 5th sentence 
and inserting the following: ‘‘Such term when used 
in title XVI includes Puerto Rico, the United States 
Virgin Islands, Guam, and American Samoa.’’. 
(2) ELIMINATION
OF
LIMIT
ON
TOTAL
PAY-
MENTS
TO
THE
TERRITORIES.—Section 1108 of 
such Act (42 U.S.C. 1308) is amended— 
(A) in the section heading, by striking ‘‘; 
LIMITATION ON TOTAL PAYMENTS’’; 
(B) by striking subsection (a); and 
(C) in subsection (c), by striking para-
graphs (2) and (4) and redesignating para-
graphs (3) and (5) as paragraphs (2) and (4), 
respectively. 
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303 
(3) UNITED STATES NATIONALS TREATED THE 
SAME AS CITIZENS.—Section 1614(a)(1)(B) of such 
Act (42 U.S.C. 1382c(a)(1)(B)) is amended— 
(A) in clause (i)(I), by inserting ‘‘or na-
tional,’’ after ‘‘citizen’’; 
(B) in clause (i)(II), by adding ‘‘; or’’ at 
the end; and 
(C) in clause (ii), by inserting ‘‘or na-
tional’’ after ‘‘citizen’’. 
(4) TERRITORIES
INCLUDED
IN
GEOGRAPHIC 
MEANING OF UNITED STATES.—Section 1614(e) of 
such Act (42 U.S.C. 1382c(e)) is amended by strik-
ing ‘‘and the District of Columbia’’ and inserting ‘‘, 
the District of Columbia, Puerto Rico, the United 
States 
Virgin 
Islands, 
Guam, 
and 
American 
Samoa’’. 
(c) WAIVER AUTHORITY.—The Commissioner of So-
cial Security may waive or modify any statutory require-
ment relating to the provision of benefits under the Sup-
plemental Security Income Program under title XVI of the 
Social Security Act in Puerto Rico, the United States Vir-
gin Islands, Guam, or American Samoa, to the extent that 
the Commissioner deems it necessary in order to adapt 
the program to the needs of the territory involved. 
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304 
(d) EFFECTIVE DATE.—This section and the amend-
ments made by this section shall take effect on the 1st 
day of the 1st Federal fiscal year that begins 1 year or 
more after the date of the enactment of this Act. 
SEC. 4103. EXTENSION OF MEDICARE SECONDARY PAYER. 
(a) IN GENERAL.—Section 1862(b)(1)(C) of the So-
cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend-
ed— 
(1) in the last sentence, by inserting ‘‘, and be-
fore January 1, 2025’’ after ‘‘prior to such date)’’; 
and 
(2) by adding at the end the following new sen-
tence: ‘‘Effective for items and services furnished on 
or after January 1, 2025 (with respect to periods 
beginning on or after the date that is 42 months 
prior to such date), clauses (i) and (ii) shall be ap-
plied by substituting ‘42-month’ for ‘12-month’ each 
place it appears.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act. For purposes of determining an individual’s sta-
tus under section 1862(b)(1)(C) of the Social Security Act 
(42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 
(a), an individual who is within the coordinating period 
as of the date of enactment of this Act shall have that 
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305 
period extended to the full 42 months described in the last 
sentence of such section, as added by the amendment 
made by subsection (a)(2). 
SEC. 4104. INDIAN DEFINED IN TITLE I OF THE PATIENT 
PROTECTION AND AFFORDABLE CARE ACT. 
(a) DEFINITION OF INDIAN.—Section 1304 of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18024) is amended by adding at the end the following: 
‘‘(f) INDIAN.—In this title: 
‘‘(1) IN GENERAL.—The term ‘Indian’ means— 
‘‘(A) an Indian, a California Indian, or an 
Urban Indian (as those terms are defined in 
section 4 of the Indian Health Care Improve-
ment Act (25 U.S.C. 1603)); or 
‘‘(B) an individual who is of Indian de-
scent and a member of an Indian community 
served by a local facility or program of the In-
dian Health Service. 
‘‘(2) INCLUSIONS.—The term ‘Indian’ includes 
the following individuals: 
‘‘(A) A member of a federally recognized 
Indian Tribe. 
‘‘(B) A resident of an urban center who 
meets 1 or more of the following criteria: 
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306 
‘‘(i) A member of a Tribe, band, or 
other organized group of Indians, including 
those Tribes, bands, or groups terminated 
since 1940 and those recognized as of the 
date of enactment of the Health Equity 
and Accountability Act of 2024 or later by 
the State in which they reside, or being a 
descendant, in the first or second degree, 
of any such member. 
‘‘(ii) An Eskimo or Aleut or other 
Alaska Native. 
‘‘(iii) An individual who is determined 
to be an Indian under regulations promul-
gated by the Secretary. 
‘‘(C) An individual who is considered by 
the Secretary of the Interior to be an Indian for 
any purpose. 
‘‘(D) An individual who is considered by 
the Secretary to be an Indian for purposes of 
eligibility for services provided by the Indian 
Health Service, including as a California In-
dian, Eskimo, Aleut, or other Alaska Native.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) AFFORDABLE CHOICES OF HEALTH BEN-
EFIT PLANS.—Section 1311(c)(6)(D) of the Patient 
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307 
Protection and Affordable Care Act (42 U.S.C. 
18031(c)(6)(D)) is amended by striking ‘‘(as defined 
in section 4 of the Indian Health Care Improvement 
Act)’’. 
(2) REDUCED COST-SHARING FOR INDIVIDUALS 
ENROLLING IN QUALIFIED HEALTH PLANS.—Section 
1402(d) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18071(d)) is amended— 
(A) in paragraph (1), in the matter pre-
ceding subparagraph (A), by striking ‘‘(as de-
fined in section 4(d) of the Indian Self-Deter-
mination and Education Assistance Act (25 
U.S.C. 450b(d)))’’; and 
(B) in paragraph (2), in the matter pre-
ceding subparagraph (A), by striking ‘‘(as so 
defined)’’. 
(3) EXEMPTION
FROM
PENALTY
FOR
NOT 
MAINTAINING
MINIMUM
ESSENTIAL
COVERAGE.— 
Section 5000A(e) of the Internal Revenue Code of 
1986 is amended by striking paragraph (3) and in-
serting the following: 
‘‘(3) INDIANS.—Any applicable individual who 
is an Indian (as defined in section 1304(f) of the 
Patient Protection and Affordable Care Act).’’. 
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308 
(c) EFFECTIVE DATE OF IRC AMENDMENT.—The 
amendment made by subsection (b)(3) shall apply to tax-
able years beginning after the date of the enactment of 
this Act. 
SEC. 4105. REMOVING MEDICARE BARRIER TO HEALTH 
CARE. 
(a) PART A.—Section 1818(a)(3)(B) of the Social 
Security Act (42 U.S.C. 1395i–2(a)(3)(B)) is amended by 
striking ‘‘an alien’’ and all that follows through ‘‘under 
this section’’ and inserting ‘‘an individual who is lawfully 
present in the United States’’. 
(b) PART B.—Section 1836(a)(2)(B) of the Social 
Security Act (42 U.S.C. 1395o(a)(2)(B)) is amended by 
striking ‘‘an alien’’ and all that follows through ‘‘under 
this part’’ and inserting ‘‘an individual who is lawfully 
present in the United States’’. 
SEC. 4106. LOWERING MEDICARE PREMIUMS AND PRE-
SCRIPTION DRUG COSTS. 
(a) MEDICARE COST ASSISTANCE PROGRAM.— 
(1) IN GENERAL.—Title XVIII of the Social Se-
curity Act (42 U.S.C. 1395 et seq.) is amended by 
adding at the end the following new section: 
‘‘SEC. 1899C. MEDICARE COST ASSISTANCE PROGRAM. 
‘‘(a) IN GENERAL.—Effective beginning January 1, 
2025, in the case of a Medicare Cost Assistance Program 
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309 
eligible individual (as defined in subsection (b)(1)), the 
Secretary shall provide Medicare cost assistance for the 
following costs incurred with respect to the individual: 
‘‘(1) Premiums under section 1818. 
‘‘(2) Premiums under section 1839. 
‘‘(3) Coinsurance under this title (including co-
insurance described in section 1813). 
‘‘(4) Deductibles established under this title (in-
cluding those described in section 1813 and section 
1833(b)). 
‘‘(5) The difference between the amount that is 
paid under section 1833(a) and the amount that 
would be paid under such section if any reference to 
a percent less than 100 percent therein were deemed 
a reference to ‘100 percent’. 
‘‘(b) DETERMINATION OF ELIGIBILITY.— 
‘‘(1) MEDICARE
COST
ASSISTANCE
PROGRAM 
ELIGIBLE INDIVIDUAL DEFINED.—The term ‘Medi-
care Cost Assistance Program eligible individual’ 
means an individual who— 
‘‘(A) is eligible for, and is receiving, med-
ical assistance for the payment of medicare 
cost-sharing under a State Medicaid program 
pursuant to clause (i), (iii), or (iv) of section 
1902(a)(10)(E) as of December 31, 2024; or 
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‘‘(B)(i) is entitled to hospital insurance 
benefits under part A (including an individual 
entitled to such benefits pursuant to an enroll-
ment under section 1818); and 
‘‘(ii) has income at or below 200 percent of 
the poverty line applicable to a family of the 
size involved. 
‘‘(2) JOINT DETERMINATION BY COMMISSIONER 
OF SOCIAL SECURITY FOR LIS AND MEDICARE COST 
ASSISTANCE.— 
‘‘(A) IN GENERAL.—The determination of 
whether an individual is a Medicare Cost As-
sistance Program eligible individual shall be de-
termined by the Commissioner of Social Secu-
rity (referred to in this section as the ‘Commis-
sioner’) jointly with the determination of wheth-
er an individual is a subsidy eligible individual 
described in section 1860D–14(a)(3). Such de-
termination shall be made with respect to eligi-
bility for Medicare cost assistance under this 
section and premium and cost-sharing subsidies 
under section 1860D–14 upon application of an 
individual for a determination with respect to 
eligibility for either such assistance or such sub-
sidies. There are authorized to be appropriated 
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311 
to the Social Security Administration such 
sums as may be necessary for the determination 
of eligibility under this paragraph. 
‘‘(B) 
EFFECTIVE
PERIOD.—Determina-
tions under this paragraph with respect to eligi-
bility for each of such assistance or such sub-
sidies shall be effective beginning with the 
month in which the individual applies for a de-
termination described in subparagraph (A) and 
shall remain in effect until such time as the 
Secretary determines the individual is no longer 
eligible as determined under subparagraph 
(C)(ii). 
‘‘(C) REDETERMINATIONS.—With respect 
to eligibility determinations under this para-
graph— 
‘‘(i) redeterminations shall be made at 
the same time with respect to eligibility for 
Medicare cost assistance under this section 
and cost-sharing subsidies under section 
1860D–14, but not more frequently than 
once every 12 months; 
‘‘(ii) a redetermination shall automati-
cally determine that an individual remains 
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312 
eligible for such assistance or subsidies un-
less— 
‘‘(I) the Commissioner has infor-
mation indicating that the individual’s 
circumstances have changed such that 
the individual is no longer eligible for 
such assistance or subsidies; 
‘‘(II) the Commissioner sends no-
tice to the individual regarding such 
information that requests a response 
either confirming or correcting such 
information; and 
‘‘(III) the individual either con-
firms such information or fails to pro-
vide documentation indicating that 
such circumstances have not changed 
within 60 days of receiving the notice 
described in subclause (II); 
‘‘(iii) the Commissioner shall establish 
procedures for appeals of such determina-
tions that are similar to the procedures de-
scribed in the third sentence of section 
1631(c)(1)(A); and 
‘‘(iv) judicial review of the final deci-
sion of the Commissioner made after a 
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313 
hearing shall be available to the same ex-
tent, and with the same limitations, as pro-
vided in subsections (g) and (h) of section 
205. 
‘‘(D) TREATMENT
OF
MEDICAID
BENE-
FICIARIES.—The Secretary shall provide that 
individuals who are full-benefit dual eligible in-
dividuals (as defined in section 1935(c)(6)) or 
who are recipients of supplemental security in-
come benefits under title XVI shall be treated 
as a Medicare Cost Assistance Program eligible 
individual and, in the case of such individual 
who is a part D eligible individual, a subsidy el-
igible individual described in section 1860D– 
14(a)(3). 
‘‘(E) SIMPLIFIED APPLICATION FORM.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall develop and distribute a simplified 
application form for use by individuals in 
applying for Medicare cost assistance 
under this section and premium and cost- 
sharing subsidies under section 1860D–14. 
Such form shall be easily readable based 
on culturally fluid language for all demo-
graphics beyond just the various languages 
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314 
offered. An audio version, digital version, 
and photo-voice option should also be pro-
vided for all learners. The Secretary shall 
provide for the translation of such applica-
tion form into at least the 10 languages 
(other than English) that are most often 
used by individuals applying for hospital 
insurance benefits under section 226 or 
226A and shall make the translated forms 
available to the Commissioner of Social Se-
curity. 
‘‘(ii) CONSULTATION.—In developing 
the form under clause (i), the Secretary 
shall consult with beneficiary groups. 
‘‘(3) INCOME DETERMINATIONS.—For purposes 
of applying this section— 
‘‘(A) in the case of an individual who is 
not treated as a Medicare Cost Assistance Pro-
gram eligible individual or a subsidy eligible in-
dividual under paragraph (2)(D), income shall 
be determined in the manner described under 
section 1612 for purposes of the supplemental 
security income program, except that support 
and maintenance furnished in kind shall not be 
counted as income; and 
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315 
‘‘(B) the term ‘poverty line’ has the mean-
ing given such term in section 673(2) of the 
Community Services Block Grant Act (42 
U.S.C. 9902(2)), including any revision re-
quired by such section. 
‘‘(c) BENEFICIARY PROTECTIONS.— 
‘‘(1) IN GENERAL.—In the case in which the 
payment for Medicare cost assistance for a Medicare 
Cost Assistance Program eligible individual with re-
spect to an item or service is reduced or eliminated, 
the individual shall not have any legal liability to 
make payment to a provider of services (as defined 
in section 1861(u)), a supplier (as defined in section 
1861(d)), or to an organization described in section 
1903(m)(1)(A) for the service, and any lawful sanc-
tion that may be imposed upon a provider of serv-
ices, a supplier, or such an organization for excess 
charges under this title or title XIX shall apply to 
the imposition of any charge imposed upon the indi-
vidual in such case. 
‘‘(2) CLARIFICATION.—This paragraph shall 
not be construed as preventing payment of any 
medicare cost assistance by a medicare supplemental 
policy or an employer retiree health plan on behalf 
of an individual. 
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316 
‘‘(d) ADMINISTRATION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish procedures for the administration of the pro-
gram under this section. 
‘‘(2) FUNDING.—For purposes of carrying out 
this section, the Secretary shall make payments from 
the Federal Hospital Insurance Trust Fund under 
section 1817 and the Federal Supplementary Med-
ical Insurance Trust Fund under section 1841, in 
such proportion as the Secretary determines appro-
priate, of such amounts as the Secretary determines 
necessary to provide Medicare cost assistance under 
this section. 
‘‘(e) REFERENCES TO MEDICARE COST-SHARING.— 
Effective beginning January 1, 2025, any reference to 
medicare cost-sharing described in section 1905(p) shall 
be deemed a reference to Medicare cost assistance under 
this section. 
‘‘(f) OUTREACH EFFORTS.—For provisions relating 
to outreach efforts to increase awareness of the availability 
of Medicare cost assistance, see section 1144.’’. 
(2) SPECIAL ENROLLMENT PERIOD.— 
(A) 
NO
PREMIUM
PENALTY.—Section 
1839(b) of the Social Security Act (42 U.S.C. 
1395r(b)) is amended, in the last sentence, by 
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317 
inserting the following before the period: ‘‘or, 
effective beginning January 1, 2025, for indi-
viduals who are Medicare Cost Assistance Pro-
gram eligible individuals (as defined in section 
1899C(b)(1)).’’. 
(B) SPECIAL ENROLLMENT PERIOD.—Sec-
tion 1837 of the Social Security Act (42 U.S.C. 
1395p) is amended by adding at the end the 
following new subsection: 
‘‘(p) SPECIAL ENROLLMENT PERIOD FOR MEDICARE 
COST ASSISTANCE PROGRAM ELIGIBLE INDIVIDUAL.— 
‘‘(1) IN GENERAL.—Effective beginning Janu-
ary 1, 2025, the Secretary shall establish special en-
rollment periods for Medicare Cost Assistance Pro-
gram eligible individuals (as defined in section 
1899C(b)(1)). 
‘‘(2) COVERAGE PERIOD.—In the case of an in-
dividual who enrolls during the special enrollment 
period provided under paragraph (1), the coverage 
period under this part shall— 
‘‘(A) begin on the first day of the first 
month in which the individual applies for a de-
termination under section 1899C(b)(2)(A); and 
‘‘(B) remain in effect until such time as 
the Secretary determines the individual is no 
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