has failed to comply with a provision of law referred to 
in subsection (a), the Attorney General may bring a civil 
action in an appropriate district court of the United States 
for such relief as may be appropriate, including injunctive 
relief. 
‘‘SEC. 2205. EMERGENCY ASSISTANCE. 
‘‘(a) IN GENERAL.—A State that receives a grant 
under this title for a fiscal year shall provide payment for 
health-care-related items and services provided to a cit-
izen, legal resident, or an alien who is not lawfully admit-
ted for permanent residence or otherwise permanently re-
siding in the United States under color of law, consistent 
with the requirements of section 1867, if— 
‘‘(1) such health-care-related items and services 
are— 
‘‘(A) necessary for the treatment of an 
emergency medical condition; and 
‘‘(B) health-care-related items and services 
that such State would provide payment for 
under this title, if provided to an indigent indi-
vidual; 
‘‘(2) the individual meets all necessary eligi-
bility requirements for health-care-related items and 
services under the State program funded under this 
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title, except for any requirement related to immigra-
tion status; and 
‘‘(3) such items and services are not related to 
an organ transplant procedure. 
‘‘(b) EMERGENCY MEDICAL CONDITION.—For pur-
poses of this section, the term ‘emergency medical condi-
tion’ means a medical condition (including emergency 
labor and delivery) manifesting itself by acute symptoms 
of sufficient severity (including severe pain) such that the 
absence of immediate medical attention could reasonably 
be expected to result in— 
‘‘(1) placing the patient’s health in serious jeop-
ardy; 
‘‘(2) serious impairment to bodily functions; or 
‘‘(3) serious dysfunction of any bodily organ or 
part. 
‘‘SEC. 2206. DEFINITIONS. 
‘‘For purposes of this title: 
‘‘(1) HEALTH-CARE-RELATED ITEMS AND SERV-
ICES.—The term ‘health-care-related items and serv-
ices’ shall be defined by a State with respect to use 
of such term for purposes of the application of this 
title to the State. 
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‘‘(2) HIGH-RISK POPULATION.—The term ‘high- 
risk population’ means individuals who are described 
in one of the following subparagraphs: 
‘‘(A) Individuals who, by reason of the ex-
istence or history of a medical condition, are 
able to acquire health coverage only at rates 
which are at least 150 percent of the standard 
risk rates for such coverage. 
‘‘(B) Individuals who are provided health 
coverage by a qualified high risk pool. 
‘‘(3) INDIGENT INDIVIDUAL.—The term ‘indi-
gent individual’ shall be defined by a State with re-
spect to use of such term for purposes of the appli-
cation of this title to the State. 
‘‘(4) QUALIFIED HIGH RISK POOL.—The term 
‘qualified high risk pool’ has the meaning given such 
term in section 2745(g)(1)(A) of the Public Health 
Service Act. 
‘‘(5) 
RISK-ADJUSTMENT
MECHANISM
DE-
FINED.—For purposes of this section, the term 
‘risk-adjustment mechanism’ means any risk-spread-
ing mechanism to subsidize the purchase of private 
health insurance for the high-risk population, includ-
ing a qualified high risk pool.’’. 
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(b) REPORT ON REDUCTION OF FEDERAL ADMINIS-
TRATIVE EXPENDITURES.—Beginning not later than Oc-
tober 31, 2014, and annually thereafter until October 31, 
2023, the Secretary of Health and Human Services, in 
consultation with the Secretary of the Treasury, shall sub-
mit a report to the Committee on Energy and Commerce 
in the House of Representatives and the Finance Com-
mittee in the Senate containing a description of the total 
reduction in Federal expenditures required to administer 
and provide oversight for the programs to provide health- 
care-related items and services to indigent individuals 
under this Act, compared to the expenditures required to 
administer and provide oversight for the programs under 
titles XIX and XXI of the Social Security Act, as in effect 
on September 30, 2012. 
(c) STATE DEFINED.—Section 1101(a)(1) of the So-
cial Security Act (42 U.S.C. 1301(a)(1)) is amended— 
(1) in the first sentence, by striking ‘‘and XXI’’ 
and inserting ‘‘XXI, and XXII’’; and 
(2) in the fourth sentence, by striking ‘‘and 
XXI’’ and inserting ‘‘, XXI, and XXII’’. 
SEC. 603. REPEAL OF FEDERAL REQUIREMENTS OF MED-
ICAID AND CHIP. 
Titles XIX and XXI of the Social Security Act are 
repealed. 
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SEC. 604. SEVERABILITY. 
If any provision of this title, or the application of 
such provision to any person or circumstance, is found to 
be unconstitutional, the remainder of this title, or the ap-
plication of that provision to other persons or cir-
cumstances, shall not be affected. 
SEC. 605. EFFECTIVE DATE. 
This title and the amendments made by this title 
shall take effect with respect to items and services fur-
nished on or after October 1, 2013. 
Æ 
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