505 
Treasury not otherwise appropriated, $2,500,000,000, to 
remain available until expended (except that no funds 
shall be disbursed after September 30, 2031), to carry out 
this section. 
(b) IN GENERAL.—The Secretary shall use funds ap-
propriated by subsection (a) to provide financial assistance 
to eligible entities to— 
(1) carry out eligible planning projects; or 
(2) carry out eligible installation projects. 
(c) APPLICATIONS.— 
(1) IN GENERAL.—To be eligible to receive as-
sistance under this section, an eligible entity shall 
submit to the Secretary an application at such time, 
in such manner, and containing such information as 
the Secretary may require. 
(2) INCLUSION
FOR
INSTALLATION
ASSIST-
ANCE.—For an eligible entity to receive assistance 
for an eligible installation project, the Secretary 
shall require the eligible entity to include in an ap-
plication under paragraph (1)— 
(A) information that demonstrates that the 
eligible entity has obtained, or has the capacity 
to obtain, necessary permits, subscribers, access 
to an installation site, and any other items or 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00505
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
506 
agreements necessary to complete the installa-
tion of the applicable covered facility; 
(B) information that demonstrates that the 
covered facility installed using such assistance 
will comply with local building and safety codes 
and standards; 
(C) a description of the mechanism 
through which financial benefits will be distrib-
uted to beneficiaries or subscribers; and 
(D) an estimate of the anticipated finan-
cial benefit for beneficiaries or subscribers. 
(3) 
CONSIDERATION
OF
PLANNING 
PROJECTS.—The Secretary may consider the com-
pletion of an eligible planning project pursuant to 
subsection (b)(1) by the eligible entity to be suffi-
cient to demonstrate the ability of the eligible entity 
to meet the requirements of paragraph (2)(A). 
(d) SELECTION.— 
(1) IN GENERAL.—In selecting eligible projects 
to receive assistance under this section, the Sec-
retary shall— 
(A) prioritize— 
(i) eligible installation projects that 
will result in the most financial benefit for 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00506
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
507 
beneficiaries, as determined by the Sec-
retary; 
(ii) eligible installation projects that 
will result in development of covered facili-
ties in underserved areas; and 
(iii) eligible projects that include ap-
prenticeship, job training, or community 
participation as part of their application; 
and 
(B) ensure that such assistance is provided 
in a manner that results in eligible projects 
being carried out on a geographically diverse 
basis within and among States. 
(2) DETERMINATION
OF
FINANCIAL
BEN-
EFIT.—In determining the amount of financial ben-
efit for low-income households of an eligible installa-
tion project, the Secretary shall ensure that all cal-
culations for estimated household energy savings are 
based solely on electricity offsets from the applicable 
covered facility and use formulas established by the 
State or local government with jurisdiction over the 
applicable covered facility for verifiable household 
energy savings estimates that accrue to low-income 
households. 
(e) ASSISTANCE.— 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00507
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
508 
(1) FORM.—The Secretary may provide assist-
ance under this section in the form of a grant, re-
bate, or low-interest loan. 
(2) MULTIPLE
PROJECTS
FOR
SAME
FACIL-
ITY.— 
(A) IN GENERAL.—An eligible entity may 
apply for assistance under this section for an el-
igible planning project and an eligible installa-
tion project for the same covered facility. 
(B) SEPARATE SELECTIONS.—Selection by 
the Secretary for assistance under this section 
of an eligible planning project does not require 
the Secretary to select for assistance under this 
section an eligible installation project for the 
same covered facility. 
(f) USE OF ASSISTANCE.— 
(1) ELIGIBLE PLANNING PROJECTS.—An eligi-
ble entity receiving assistance for an eligible plan-
ning project under this section may use such assist-
ance to pay the costs of pre-installation activities as-
sociated with an applicable covered facility, includ-
ing— 
(A) feasibility studies; 
(B) permitting; 
(C) site assessment; 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00508
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
509 
(D) identification of beneficiaries or sub-
scribers; or 
(E) such other costs determined by the 
Secretary to be appropriate. 
(2) ELIGIBLE
INSTALLATION
PROJECTS.—An 
eligible entity receiving assistance for an eligible in-
stallation project under this section may use such 
assistance to pay the costs of— 
(A) installation and operation of a covered 
facility, including costs associated with mate-
rials, permitting, labor, or site preparation; 
(B) storage technology sited at a covered 
facility; 
(C) interconnection service expenses; 
(D) offsetting the cost of a subscription for 
a covered facility described in subsection 
(h)(4)(A) for subscribers that are members of a 
low-income household; or 
(E) such other costs determined by the 
Secretary to be appropriate. 
(g) USE OF FUNDS.—Of the funds appropriated by 
this section, the Secretary shall use not less than 85 per-
cent to provide assistance for eligible installation projects. 
(h) DEFINITIONS.—In this section: 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00509
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
510 
(1) BENEFICIARY.—The term ‘‘beneficiary’’ 
means a low-income household that receives a finan-
cial benefit from the installation and operation of a 
covered facility. 
(2) COMMUNITY
SOLAR
FACILITY.—The term 
‘‘community solar facility’’ means a solar generating 
facility that— 
(A) has multiple subscribers that receive fi-
nancial benefits that are directly attributable to 
the facility; and 
(B) has a nameplate rating of 5 megawatts 
AC or less. 
(3) COMMUNITY
SOLAR
SUBSCRIPTION.—The 
term ‘‘community solar subscription’’ means a share 
in the capacity, or a proportional interest in the elec-
tricity generation, of a community solar facility. 
(4) COVERED
FACILITY.—The term ‘‘covered 
facility’’ means— 
(A) a community solar facility at least 50 
percent of the capacity of which is reserved for 
low-income households; 
(B) a solar generating facility located at a 
residence of a low-income household; or 
(C) a solar generating facility located at a 
multi-family affordable housing complex. 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00510
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
511 
(5) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means— 
(A) a nonprofit organization that provides 
services to low-income households or multi-fam-
ily affordable housing complexes; 
(B) a developer, owner, or operator of a 
covered facility; 
(C) a State, or political subdivision thereof; 
(D) an Indian Tribe, tribally owned electric 
utility, or tribal energy development organiza-
tion; 
(E) a Native Hawaiian community-based 
organization; 
(F) any other national or regional entity 
that has experience developing or installing 
solar generating facilities for low-income house-
holds that maximize financial benefits to those 
households; and 
(G) an electric cooperative or a munici-
pality that is an electric utility (as such terms 
are defined in section 3 of the Federal Power 
Act). 
(6) ELIGIBLE
INSTALLATION
PROJECT.—The 
term ‘‘eligible installation project’’ means a project 
to install and operate a covered facility. 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00511
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
512 
(7) ELIGIBLE PLANNING PROJECT.—The term 
‘‘eligible planning project’’ means a project to carry 
out pre-installation activities for the development of 
a covered facility. 
(8) ELIGIBLE
PROJECT.—The term ‘‘eligible 
project’’ means— 
(A) an eligible planning project; or 
(B) an eligible installation project. 
(9) FEASIBILITY STUDY.—The term ‘‘feasibility 
study’’ means a study or assessment that determines 
the feasibility of a specific solar generating facility, 
including a customer interest assessment and a 
siting assessment, as determined by the Secretary. 
(10) INDIAN TRIBE.—The term ‘‘Indian Tribe’’ 
means any Indian Tribe, band, nation, Tribal Orga-
nization, or other organized group or community, in-
cluding any Alaska Native village, Regional Corpora-
tion, or Village Corporation, that is recognized as el-
igible for the special programs and services provided 
by the United States to Indians because of their sta-
tus as Indians. 
(11) INTERCONNECTION
SERVICE.—The term 
‘‘interconnection service’’ has the meaning given 
such term in section 111(d)(15) of the Public Utility 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00512
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
513 
Regulatory Policies Act of 1978 (16 U.S.C. 
2621(d)(15)). 
(12) LOW-INCOME
HOUSEHOLD.—The term 
‘‘low-income household’’ means a household with an 
income that— 
(A) is at or below 80 percent of the area 
median income, or 200 percent of the Federal 
poverty level, whichever is higher, except that 
the Secretary may establish a higher level if the 
Secretary determines that such a higher level is 
necessary to carry out the purposes of this sec-
tion; or 
(B) if the State in which the household is 
located elects, is the basis for eligibility for as-
sistance under the Low-Income Home Energy 
Assistance Act of 1981 (42 U.S.C. 8621 et 
seq.), provided that such basis is at least 200 
percent of the Federal poverty level. 
(13) MULTI-FAMILY
AFFORDABLE
HOUSING 
COMPLEX.—The term ‘‘multi-family affordable hous-
ing complex’’ means any federally subsidized afford-
able housing complex in which at least 50 percent of 
the units are reserved for low-income households. 
(14) NATIVE HAWAIIAN COMMUNITY-BASED OR-
GANIZATION.—The term ‘‘Native Hawaiian commu-
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00513
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
514 
nity-based organization’’ means any organization 
that is composed primarily of Native Hawaiians 
from a specific community and that assists in the 
social, cultural, and educational development of Na-
tive Hawaiians in that community. 
(15) 
SECRETARY.—The 
term 
‘‘Secretary’’ 
means the Secretary of Energy. 
(16) SOLAR GENERATING FACILITY.—The term 
‘‘solar generating facility’’ means— 
(A) a generator that creates electricity 
from photons; and 
(B) the accompanying hardware enabling 
that electricity to flow— 
(i) onto the electric grid; 
(ii) into a facility or structure; or 
(iii) into an energy storage device. 
(17) STATE.—The term ‘‘State’’ means each of 
the 50 States, the District of Columbia, Guam, the 
Commonwealth of Puerto Rico, the Northern Mar-
iana Islands, the Virgin Islands, and American 
Samoa. 
(18) SUBSCRIBER.—The term ‘‘subscriber’’ 
means a person who— 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00514
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
515 
(A) owns a community solar subscription, 
or an equivalent unit or share of the capacity 
or generation of a community solar facility; or 
(B) is a member of a low-income household 
that financially benefits from a community solar 
facility, even if the person does not own a com-
munity solar subscription for the facility. 
(19) UNDERSERVED AREA.—The term ‘‘under-
served area’’ means— 
(A) a geographical area with low or no 
photovoltaic solar deployment, as determined by 
the Secretary; 
(B) a geographical area that has low or no 
access to electricity, as determined by the Sec-
retary; 
(C) a geographical area with a high energy 
burden, as determined by the Secretary; or 
(D) trust land, as defined in section 3765 
of title 38, United States Code. 
SEC. 30484. OVERSIGHT. 
In addition to amounts otherwise available, there is 
appropriated to the Department of Energy for fiscal year 
2022, out of any money in the Treasury not otherwise ap-
propriated, $50,000,000, to remain available until Sep-
tember 30, 2031 (except that no funds shall be disbursed 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00515
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
516 
after September 30, 2031), for oversight by the Depart-
ment of Energy Office of Inspector General of the Depart-
ment of Energy activities for which funding is appro-
priated in this subtitle. 
Subtitle F—Affordable Health Care 
Coverage 
SEC. 30601. ENSURING AFFORDABILITY OF COVERAGE FOR 
CERTAIN LOW-INCOME POPULATIONS. 
(a) REDUCING COST SHARING UNDER QUALIFIED 
HEALTH PLANS.—Section 1402 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18071) is amended— 
(1) in subsection (b)— 
(A) in paragraph (2), by inserting ‘‘(or, 
with respect to plan years 2023 and 2024, 
whose household income does not exceed 400 
percent of the poverty line for a family of the 
size involved)’’ before the period; and 
(B) in the matter following paragraph (2), 
by adding at the end the following new sen-
tence: ‘‘In the case of an individual with a 
household income that does not exceed 138 per-
cent of the poverty line for a family of the size 
involved for any month occurring during the pe-
riod beginning on January 1, 2022, and ending 
on December 31, 2022, such individual shall, 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00516
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
517 
for such month and for each succeeding month 
during such period, be treated as having house-
hold income equal to 100 percent for purposes 
of applying this section.’’; and 
(2) in subsection (c)— 
(A) in paragraph (1)(A), in the matter 
preceding clause (i), by inserting ‘‘, with respect 
to eligible insureds (other than, with respect to 
plan years 2023 and 2024, specified enrollees 
(as defined in paragraph (6)(C))),’’ after ‘‘first 
be achieved’’; 
(B) in paragraph (2), in the matter pre-
ceding subparagraph (A), by inserting ‘‘with re-
spect to eligible insureds (other than, with re-
spect to plan years 2023 and 2024, specified 
enrollees)’’ after ‘‘under the plan’’; 
(C) in paragraph (3)— 
(i) in subparagraph (A), by striking 
‘‘this subsection’’ and inserting ‘‘paragraph 
(1) or (2)’’; and 
(ii) in subparagraph (B), by striking 
‘‘this section’’ and inserting ‘‘paragraphs 
(1) and (2)’’; and 
(D) by adding at the end the following new 
paragraph: 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00517
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
518 
‘‘(6) SPECIAL RULE FOR SPECIFIED ENROLL-
EES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish procedures under which the issuer of 
a qualified health plan to which this section ap-
plies shall reduce cost-sharing under the plan 
with respect to months occurring during plan 
years 2023 and 2024 for enrollees who are 
specified enrollees (as defined in subparagraph 
(C)) in a manner sufficient to increase the 
plan’s share of the total allowed costs of bene-
fits provided under the plan to 99 percent of 
such costs. 
‘‘(B) METHODS
FOR
REDUCING
COST 
SHARING.— 
‘‘(i) IN
GENERAL.—An issuer of a 
qualified health plan making reductions 
under this paragraph shall notify the Sec-
retary of such reductions and the Sec-
retary shall, out of funds made available 
under clause (ii), make periodic and timely 
payments to the issuer equal to 12 percent 
of the total allowed costs of benefits pro-
vided under each such plan to specified en-
rollees during plan years 2023 and 2024. 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00518
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
519 
‘‘(ii) APPROPRIATION.—In addition to 
amounts otherwise available, there are ap-
propriated, out of any money in the Treas-
ury not otherwise appropriated, such sums 
as may be necessary to the Secretary to 
make payments under clause (i). 
‘‘(C) SPECIFIED
ENROLLEE
DEFINED.— 
For purposes of this section, the term ‘specified 
enrollee’ means, with respect to a month occur-
ring during a plan year, an eligible insured with 
a household income that does not exceed 138 
percent of the poverty line for a family of the 
size involved during such month. Such insured 
shall be deemed to be a specified enrollee for 
each succeeding month in such plan year.’’. 
(b) OPEN ENROLLMENTS APPLICABLE TO CERTAIN 
LOWER-INCOME POPULATIONS.—Section 1311(c) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18031(c)) is amended— 
(1) in paragraph (6)— 
(A) in subparagraph (C), by striking at the 
end ‘‘and’’; 
(B) in subparagraph (D), by striking the 
period at the end and inserting ‘‘; and’’; and 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00519
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
520 
(C) by adding at the end the following new 
subparagraph: 
‘‘(E) with respect to a qualified health plan 
with respect to which section 1402 applies, for 
months occurring during the period beginning 
on January 1, 2022, and ending on December 
31, 2024, enrollment periods described in sub-
paragraph (A) of paragraph (8) for individuals 
described in subparagraph (B) of such para-
graph.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(8) SPECIAL ENROLLMENT PERIOD FOR CER-
TAIN LOW-INCOME POPULATIONS.— 
‘‘(A) IN GENERAL.—The enrollment period 
described in this paragraph is, in the case of an 
individual described in subparagraph (B), the 
continuous period beginning on the first day 
that such individual is so described. 
‘‘(B) INDIVIDUAL
DESCRIBED.—For pur-
poses of subparagraph (A), an individual de-
scribed in this subparagraph is an individual— 
‘‘(i) with a household income that 
does not exceed 138 percent of the poverty 
line for a family of the size involved; and 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00520
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
521 
‘‘(ii) who is not eligible for minimum 
essential coverage (as defined in section 
5000A(f) of the Internal Revenue Code of 
1986), other than for coverage described in 
any of subparagraphs (B) through (E) of 
paragraph (1) of such section.’’. 
(c) ADDITIONAL BENEFITS FOR CERTAIN LOW-IN-
COME INDIVIDUALS
FOR PLAN YEAR 2024.—Section 
1301(a) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18021(a)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (C)(iv), by striking 
the period and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(D) provides, with respect to a plan of-
fered in the silver level of coverage to which sec-
tion 1402 applies during plan year 2024, for 
benefits described in paragraph (5) in the case 
of an individual who, for a month during such 
plan year, has a household income that does not 
exceed 138 percent of the poverty line for a 
family of the size involved, and who is eligible 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00521
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
522 
to receive cost-sharing reductions under section 
1402.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(5) ADDITIONAL
BENEFITS
FOR
CERTAIN 
LOW-INCOME INDIVIDUALS FOR PLAN YEAR 2024.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1)(D), the benefits described in this 
paragraph to be provided by a qualified health 
plan are benefits consisting of non-emergency 
medical transportation services (as described in 
section 1902(a)(4)) and services described in 
subsection (a)(4)(C) of section 1905 of the So-
cial Security Act, without any restriction on the 
choice of a qualified provider from whom such 
an individual so enrolled in such plan may re-
ceive such services described in such subsection, 
and without any imposition of cost sharing, 
which are not otherwise provided under such 
plan as part of the essential health benefits 
package described in section 1302(a). 
‘‘(B) PAYMENTS FOR ADDITIONAL BENE-
FITS.— 
‘‘(i) IN
GENERAL.—An issuer of a 
qualified health plan making payments for 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00522
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
523 
services described in subparagraph (A) fur-
nished to individuals described in para-
graph (1)(D) during plan year 2024 shall 
notify the Secretary of such payments and 
the Secretary shall, out of funds made 
available under clause (ii), make periodic 
and timely payments to the issuer equal to 
payments for such services so furnished. 
‘‘(ii) APPROPRIATION.—In addition to 
amounts otherwise available, there is ap-
propriated, out of any money in the Treas-
ury not otherwise appropriated, such sums 
as may be necessary to the Secretary to 
make payments under clause (i).’’. 
(d) EDUCATION AND OUTREACH ACTIVITIES.—— 
(1) IN GENERAL.—Section 1321(c) of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18041(c)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(3) OUTREACH
AND
EDUCATIONAL
ACTIVI-
TIES.— 
‘‘(A) IN GENERAL.—In the case of an Ex-
change established or operated by the Secretary 
within a State pursuant to this subsection, the 
Secretary shall carry out outreach and edu-
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00523
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
524 
cational activities for purposes of informing in-
dividuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) of the Social Security 
Act who reside in States that have not ex-
pended amounts under a State plan (or waiver 
of such plan) under title XIX of such Act for 
all such individuals about qualified health plans 
offered through the Exchange, including by in-
forming such individuals of the availability of 
coverage under such plans and financial assist-
ance for coverage under such plans. Such out-
reach and educational activities shall be pro-
vided in a manner that is culturally and linguis-
tically appropriate to the needs of the popu-
lations being served by the Exchange (including 
hard-to-reach populations, such as racial and 
sexual minorities, limited English proficient 
populations, individuals residing in areas where 
the unemployment rates exceeds the national 
average unemployment rate, individuals in rural 
areas, veterans, and young adults). 
‘‘(B) LIMITATION ON USE OF FUNDS.—No 
funds appropriated under this paragraph shall 
be used for expenditures for promoting non- 
ACA compliant health insurance coverage. 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00524
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
525 
‘‘(C) NON-ACA COMPLIANT HEALTH INSUR-
ANCE
COVERAGE.—For purposes of subpara-
graph (B): 
‘‘(i) The term ‘non-ACA compliant 
health insurance coverage’ means health 
insurance coverage, or a group health plan, 
that is not a qualified health plan. 
‘‘(ii) Such term includes the following: 
‘‘(I) An association health plan. 
‘‘(II) Short-term limited duration 
insurance. 
‘‘(D) FUNDING.—In addition to amounts 
otherwise available, there is appropriated, out of 
any money in the Treasury not otherwise ap-
propriated, to remain available until expended, 
$15,000,000 
for 
fiscal 
year 
2022, 
and 
$30,000,000 for each of fiscal years 2023 and 
2024, to carry out this paragraph.’’. 
(2) NAVIGATOR PROGRAM.—Section 1311(i)(6) 
of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18031(i)(6)) is amended— 
(A) 
by 
striking 
‘‘FUNDING.—Grants 
under’’ and inserting ‘‘FUNDING.— 
‘‘(A) STATE EXCHANGES.—Grants under’’; 
and 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00525
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
526 
(B) by adding at the end the following new 
subparagraph: 
‘‘(B) FEDERAL
EXCHANGES.—For pur-
poses of carrying out this subsection, with re-
spect to an Exchange established and operated 
by the Secretary within a State pursuant to sec-
tion 1321(c), the Secretary shall obligate 
$10,000,000 out of amounts collected through 
the user fees on participating health insurance 
issuers pursuant to section 156.50 of title 45, 
Code of Federal Regulations (or any successor 
regulations) 
for 
fiscal 
year 
2022, 
and 
$20,000,000 for each of fiscal years 2023 and 
2024. Such amount so obligated for a fiscal 
year shall remain available until expended.’’. 
SEC. 30602. TEMPORARY EXPANSION OF HEALTH INSUR-
ANCE PREMIUM TAX CREDITS FOR CERTAIN 
LOW-INCOME POPULATIONS. 
(a) IN GENERAL.—Section 36B is amended by redes-
ignating subsection (h) as subsection (i) and by inserting 
after subsection (g) the following new subsection: 
‘‘(h) CERTAIN
TEMPORARY
RULES
FOR
2022 
THROUGH 2024.—With respect to any taxable year begin-
ning after December 31, 2021, and before January 1, 
2025— 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00526
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
527 
‘‘(1) ELIGIBILITY
FOR
CREDIT
NOT
LIMITED 
BASED ON INCOME.—Section 36B(c)(1)(A) shall be 
disregarded in determining whether a taxpayer is an 
applicable taxpayer. 
‘‘(2) CREDIT ALLOWED TO CERTAIN LOW-IN-
COME
EMPLOYEES
OFFERED
EMPLOYER-PROVIDED 
COVERAGE.—Subclause 
(II) 
of 
subsection 
(c)(2)(C)(i) shall not apply if the taxpayer’s house-
hold income does not exceed 138 percent of the pov-
erty line for a family of the size involved. The last 
sentence of such subsection shall also apply for pur-
poses of this paragraph. Subclause (II) of subsection 
(c)(2)(C)(i) shall also not apply to an individual de-
scribed in the last sentence of such subsection if the 
taxpayer’s household income does not exceed 138 
percent of the poverty line for a family of the size 
involved. 
‘‘(3) CREDIT ALLOWED TO CERTAIN LOW-IN-
COME EMPLOYEES OFFERED QUALIFIED SMALL EM-
PLOYER
HEALTH
REIMBURSEMENT
ARRANGE-
MENTS.—A qualified small employer health reim-
bursement arrangement shall not be treated as con-
stituting affordable coverage for an employee (or any 
spouse or dependent of such employee) for any 
months of a taxable year if the employee’s household 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00527
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
528 
income for such taxable year does not exceed 138 
percent of the poverty line for a family of the size 
involved. 
‘‘(4) LIMITATIONS ON RECAPTURE.— 
‘‘(A) IN GENERAL.—In the case of a tax-
payer whose household income is less than 200 
percent of the poverty line for the size of the 
family involved for the taxable year, the amount 
of the increase under subsection (f)(2)(A) shall 
in no event exceed $300 (one-half of such 
amount in the case of a taxpayer whose tax is 
determined under section 1(c) for the taxable 
year). 
‘‘(B) LIMITATION ON INCREASE FOR CER-
TAIN NON-FILERS.—In the case of any taxpayer 
who would not be required to file a return of 
tax for the taxable year but for any require-
ment to reconcile advance credit payments 
under subsection (f), if an Exchange established 
under title I of the Patient Protection and Af-
fordable Care Act has determined that— 
‘‘(i) such taxpayer is eligible for ad-
vance payments under section 1412 of 
such Act for any portion of such taxable 
year, and 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00528
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
529 
‘‘(ii) such taxpayer’s household in-
come for such taxable year is projected to 
not exceed 138 percent of the poverty line 
for a family of the size involved, 
subsection (f)(2)(A) shall not apply to such tax-
payer for such taxable year and such taxpayer 
shall not be required to file such return of tax. 
‘‘(C) INFORMATION
PROVIDED
BY
EX-
CHANGE.—The information required to be pro-
vided by an Exchange to the Secretary and to 
the taxpayer under subsection (f)(3) shall in-
clude such information as is necessary to deter-
mine whether such Exchange has made the de-
terminations described in clauses (i) and (ii) of 
subparagraph (B) with respect to such tax-
payer.’’. 
(b) EMPLOYER SHARED RESPONSIBILITY PROVISION 
NOT APPLICABLE WITH RESPECT TO CERTAIN LOW-IN-
COME TAXPAYERS RECEIVING PREMIUM ASSISTANCE.— 
Section 4980H(c)(3) is amended to read as follows: 
‘‘(3) APPLICABLE PREMIUM TAX CREDIT AND 
COST-SHARING REDUCTION.— 
‘‘(A) IN GENERAL.—The term ‘applicable 
premium tax credit and cost-sharing reduction’ 
means— 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00529
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
530 
‘‘(i) any premium tax credit allowed 
under section 36B, 
‘‘(ii) any cost-sharing reduction under 
section 1402 of the Patient Protection and 
Affordable Care Act, and 
‘‘(iii) any advance payment of such 
credit or reduction under section 1412 of 
such Act. 
‘‘(B) EXCEPTION WITH RESPECT TO CER-
TAIN
LOW-INCOME
TAXPAYERS.—Such term 
shall not include any premium tax credit, cost- 
sharing reduction, or advance payment other-
wise described in subparagraph (A) if such 
credit, reduction, or payment is allowed or paid 
for a taxable year of an employee (beginning 
after December 31, 2021, and before January 
1, 2025) with respect to which— 
‘‘(i) an Exchange established under 
title I of the Patient Protection and Af-
fordable Care Act has determined that 
such employee’s household income for such 
taxable year is projected to not exceed 138 
percent of the poverty line for a family of 
the size involved, or 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00530
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
531 
‘‘(ii) such employee’s household in-
come for such taxable year does not exceed 
138 percent of the poverty line for a family 
of the size involved.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2021. 
SEC. 30603. ESTABLISHING A HEALTH INSURANCE AFFORD-
ABILITY FUND. 
(a) IN GENERAL.—Subtitle D of title I of the Patient 
Protection and Affordable Care Act is amended by insert-
ing after part 5 (42 U.S.C. 18061 et seq.) the following 
new part: 
‘‘PART 6—IMPROVE HEALTH INSURANCE 
AFFORDABILITY FUND 
‘‘SEC. 1351. ESTABLISHMENT OF PROGRAM. 
‘‘There is hereby established the ‘Improve Health In-
surance Affordability Fund’ to be administered by the Sec-
retary of Health and Human Services, acting through the 
Administrator of the Centers for Medicare & Medicaid 
Services (in this section referred to as the ‘Adminis-
trator’), to provide funding, in accordance with this part, 
to the 50 States and the District of Columbia (each re-
ferred to in this section as a ‘State’) beginning on January 
1, 2023, for the purposes described in section 1352. 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00531
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
532 
‘‘SEC. 1352. USE OF FUNDS. 
‘‘(a) IN GENERAL.—A State shall use the funds allo-
cated to the State under this part for one of the following 
purposes: 
‘‘(1) To provide reinsurance payments to health 
insurance issuers with respect to individuals enrolled 
under individual health insurance coverage (other 
than through a plan described in subsection (b)) of-
fered by such issuers. 
‘‘(2) To provide assistance (other than through 
payments described in paragraph (1)) to reduce out- 
of-pocket costs, such as copayments, coinsurance, 
premiums, and deductibles, of individuals enrolled 
under qualified health plans offered on the indi-
vidual market through an Exchange and of individ-
uals enrolled under standard health plans offered 
through a basic health program established under 
section 1331. 
‘‘(b) EXCLUSION
OF CERTAIN GRANDFATHERED 
PLANS, 
TRANSITIONAL
PLANS, 
STUDENT
HEALTH 
PLANS, AND EXCEPTED BENEFITS.—For purposes of 
subsection (a), a plan described in this subsection is the 
following: 
‘‘(1) A grandfathered health plan (as defined in 
section 1251). 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00532
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
533 
‘‘(2) A plan (commonly referred to as a ‘transi-
tional plan’) continued under the letter issued by the 
Centers for Medicare & Medicaid Services on No-
vember 14, 2013, to the State Insurance Commis-
sioners outlining a transitional policy for coverage in 
the individual and small group markets to which sec-
tion 1251 does not apply, and under the extension 
of the transitional policy for such coverage set forth 
in the Insurance Standards Bulletin Series guidance 
issued by the Centers for Medicare & Medicaid Serv-
ices on March 5, 2014, February 29, 2016, Feb-
ruary 13, 2017, April 9, 2018, March 25, 2019, 
January 31, 2020, and January 19, 2021, or under 
any subsequent extensions thereof. 
‘‘(3) Student health insurance coverage (as de-
fined in section 147.145 of title 45, Code of Federal 
Regulations, or any successor regulation). 
‘‘(4) Excepted benefits (as defined in section 
2791(c) of the Public Health Service Act). 
‘‘SEC. 1353. STATE ELIGIBILITY AND APPROVAL; DEFAULT 
SAFEGUARD. 
‘‘(a) ENCOURAGING STATE OPTIONS FOR ALLOCA-
TIONS.— 
‘‘(1) IN GENERAL.—Subject to subsection (b), 
to be eligible for an allocation of funds under this 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00533
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
534 
part for a year (beginning with 2023), a State shall 
submit to the Administrator an application at such 
time (but, in the case of allocations for 2023, not 
later than 120 days after the date of the enactment 
of this part and, in the case of allocations for a sub-
sequent year, not later than January 1 of the pre-
vious year) and in such form and manner as speci-
fied by the Administrator containing— 
‘‘(A) a description of how the funds will be 
used; and 
‘‘(B) such other information as the Admin-
istrator may require. 
‘‘(2) AUTOMATIC APPROVAL.—An application so 
submitted is approved (as outlined in the terms of 
the plan) unless the Administrator notifies the State 
submitting the application, not later than 90 days 
after the date of the submission of such application, 
that the application has been denied for not being in 
compliance with any requirement of this part and of 
the reason for such denial. 
‘‘(3) 5-YEAR
APPLICATION
APPROVAL.—If an 
application of a State is approved for a purpose de-
scribed in section 1352 for a year, such application 
shall be treated as approved for such purpose for 
each of the subsequent 4 years. 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00534
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
535 
‘‘(4) OVERSIGHT AUTHORITY AND AUTHORITY 
TO REVOKE APPROVAL.— 
‘‘(A) OVERSIGHT.—The Secretary may 
conduct periodic reviews of the use of funds 
provided to a State under this section, with re-
spect to a purpose described in section 1352, to 
ensure the State uses such funds for such pur-
pose and otherwise complies with the require-
ments of this section. 
‘‘(B) REVOCATION
OF
APPROVAL.—The 
approval of an application of a State, with re-
spect to a purpose described in section 1352, 
may be revoked if the State fails to use funds 
provided to the State under this section for 
such purpose or otherwise fails to comply with 
the requirements of this section. 
‘‘(b) DEFAULT FEDERAL SAFEGUARD FOR 2023 AND 
2024 FOR CERTAIN STATES.— 
‘‘(1) IN GENERAL.—For 2023 and 2024, in the 
case of a State described in paragraph (5), with re-
spect to such year, the State shall not be eligible to 
submit an application under subsection (a), and the 
Administrator, in consultation with the applicable 
State authority, shall from the amount calculated 
under paragraph (3) for such year, carry out the 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00535
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
536 
purpose described in paragraph (2) in such State for 
such year. 
‘‘(2) SPECIFIED USE.—The amount described 
in paragraph (3), with respect to a State described 
in paragraph (5) for 2023 or 2024, shall be used to 
carry 
out 
the 
purpose 
described 
in 
section 
1352(a)(1) in such State for such year, as applica-
ble, by providing reinsurance payments to health in-
surance issuers with respect to attachment range 
claims (as defined in section 1354(b)(2), using the 
dollar amounts specified in subparagraph (B) of 
such section for such year) in an amount equal to, 
subject to paragraph (4), the percentage (specified 
for such year by the Secretary under such subpara-
graph) of the amount of such claims. 
‘‘(3) AMOUNT
DESCRIBED.—The amount de-
scribed in this paragraph, with respect to 2023 or 
2024, is the amount equal to the total sum of 
amounts that the Secretary would otherwise esti-
mate under section 1354(b)(2)(A)(i) for such year 
for each State described in paragraph (5) for such 
year, as applicable, if each such State were not so 
described for such year. 
‘‘(4) ADJUSTMENT.—For purposes of this sub-
section, the Secretary may apply a percentage under 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00536
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
537 
paragraph (3) with respect to a year that is less 
than the percentage otherwise specified in section 
1354(b)(2)(B) for such year, if the cost of paying 
the total eligible attachment range claims for States 
described in paragraph (5) for such year at such 
percentage otherwise specified would exceed the 
amount calculated under paragraph (3) for such 
year. 
‘‘(5) STATE DESCRIBED.—A State described in 
this paragraph, with respect to years 2023 and 
2024, is a State that, as of January 1 of 2022 or 
2023, respectively, was not expending amounts 
under the State plan (or waiver of such plan) for all 
individuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) during such year. 
‘‘SEC. 1354. ALLOCATIONS. 
‘‘(a) APPROPRIATION.—In addition to amounts oth-
erwise available, there is appropriated, out of any money 
in 
the 
Treasury 
not 
otherwise 
appropriated, 
$10,000,000,000 for 2023 and each subsequent year to 
provide allocations for States under subsection (b) and 
payments under section 1353(b) . 
‘‘(b) ALLOCATIONS.— 
‘‘(1) PAYMENT.— 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00537
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
538 
‘‘(A) IN GENERAL.—From amounts appro-
priated under subsection (a) for a year, the 
Secretary shall, with respect to a State not de-
scribed in section 1353(b) for such year and 
not later than the date specified under subpara-
graph (B) for such year, allocate for such State 
the amount determined for such State and year 
under paragraph (2). 
‘‘(B) SPECIFIED DATE.—For purposes of 
subparagraph (A), the date specified in this 
subparagraph is— 
‘‘(i) for 2023, the date that is 90 days 
after the date of the enactment of this 
part; and 
‘‘(ii) for 2024 or a subsequent year, 
January 1 of the previous year. 
‘‘(C) 
NOTIFICATIONS
OF
ALLOCATION 
AMOUNTS.—For 2024 and each subsequent 
year, the Secretary shall notify each State of 
the amount determined for such State under 
paragraph (2) for such year by not later than 
January 1 of the previous year. 
‘‘(2) 
ALLOCATION
AMOUNT
DETERMINA-
TIONS.— 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00538
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
539 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), the amount determined under this 
paragraph for a year for a State described in 
paragraph (1)(A) for such year is the amount 
equal to— 
‘‘(i) the amount that the Secretary es-
timates would be expended under this part 
for such year on attachment range claims 
of individuals residing in such State if such 
State used such funds only for the purpose 
described in paragraph (1) of section 
1352(a) at the dollar amounts and per-
centage specified under subparagraph (B) 
for such year; minus 
‘‘(ii) the amount, if any, by which the 
Secretary determines— 
‘‘(I) the estimated amount of 
premium tax credits under section 
36B of the Internal Revenue Code of 
1986 that would be attributable to in-
dividuals residing in such State for 
such year without application of this 
part; exceeds 
‘‘(II) the estimated amount of 
premium tax credits under section 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00539
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
541 
claims at the dollar amounts and percentage so 
specified for such year. 
‘‘(3) AVAILABILITY.—Funds allocated to a 
State under this subsection for a year shall remain 
available through the end of the subsequent year.’’. 
(b) BASIC HEALTH PROGRAM FUNDING ADJUST-
MENTS.—Section 1331 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18051) is amended— 
(1) in subsection (a), by adding at the end the 
following new paragraph: 
‘‘(3) PROVISION OF INFORMATION ON QUALI-
FIED HEALTH PLAN PREMIUMS.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1, 2023, the program 
described in paragraph (1) shall provide that a 
State may not establish a basic health program 
unless such State furnishes to the Secretary, 
with respect to each qualified health plan of-
fered in such State during a year that receives 
any reinsurance payment from funds made 
available under part 6 for such year, the ad-
justed premium amount (as defined in subpara-
graph (B)) for each such plan and year. 
‘‘(B) ADJUSTED
PREMIUM
AMOUNT
DE-
FINED.—For purposes of subparagraph (A), the 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00541
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
542 
term ‘adjusted premium amount’ means, with 
respect to a qualified health plan and a year, 
the monthly premium for such plan and year 
that would have applied had such plan not re-
ceived any payments described in subparagraph 
(A) for such year.’’; and 
(2) in subsection (d)(3)(A)(ii), by adding at the 
end the following new sentence: ‘‘In making such de-
termination, the Secretary shall calculate the value 
of such premium tax credits that would have been 
provided to such individuals enrolled through a basic 
health program established by a State during a year 
using the adjusted premium amounts (as defined in 
subsection (a)(3)(B)) for qualified health plans of-
fered in such State during such year.’’. 
Subtitle G—Medicaid 
PART 1—FEDERAL MEDICAID PROGRAM TO 
CLOSE THE COVERAGE GAP 
SEC. 30701. CLOSING THE MEDICAID COVERAGE GAP. 
(a) FEDERAL MEDICAID PROGRAM TO CLOSE COV-
ERAGE GAP IN NONEXPANSION STATES.—Title XIX of 
the Social Security Act (42 U.S.C. 1396 et seq.) is amend-
ed by adding at the end the following new section: 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00542
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
543 
‘‘SEC. 1948. FEDERAL MEDICAID PROGRAM TO CLOSE COV-
ERAGE GAP IN NONEXPANSION STATES. 
‘‘(a) ESTABLISHMENT.—Not later than January 1, 
2025, the Secretary shall establish a program (in this sec-
tion referred to as the ‘Federal Medicaid program’ or the 
‘Program’ under which, in the case of a State that the 
Secretary determines (based on the State plan under this 
title, waiver of such plan, or other relevant information) 
is not expected to expend amounts under the State plan 
(or waiver of such plan) for all individuals who would be 
entitled to medical assistance pursuant to section 
1902(a)(10)(A)(i)(VIII) during a year (beginning with 
2025), (in this section defined as ‘a coverage gap State’, 
with respect to such year), the Secretary shall (including 
through contract with eligible entities (as specified by the 
Secretary), consistent with subsection (b)) provide for the 
offering to such individuals residing in such State of 
health benefits. The Federal Medicaid program shall be 
offered in a coverage gap State for each quarter during 
the period beginning on January 1 of such year, and end-
ing with the last day of the first quarter during which 
the State provides medical assistance to all such individ-
uals under the State plan (or waiver of such plan). Under 
the Federal Medicaid program, the Secretary— 
‘‘(1) may use the Federally Facilitated Market-
place to facilitate eligibility determinations and en-
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00543
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
544 
rollments under the Federal Medicaid Program and 
shall establish a set of eligibility rules to be applied 
under the Program in a manner consistent with sec-
tion 1902(e)(14); 
‘‘(2) shall establish benefits, beneficiary protec-
tions, and access to care standards by, at a min-
imum— 
‘‘(A) establishing a minimum set of health 
benefits to be provided (and providing such ben-
efits) under the Federal Medicaid program, 
which shall be in compliance with the require-
ments of section 1937 and shall consist of 
benchmark 
coverage 
described 
in 
section 
1937(b)(1) or benchmark equivalent coverage 
described in section 1937(b)(2) to the same ex-
tent as medical assistance provided to such an 
individual under this title (without application 
of this section) is required under section 
1902(k)(1) to consist of such benchmark cov-
erage or benchmark equivalent coverage; 
‘‘(B) applying the provisions of sections 
1902(a)(8), 1902(a)(34), and 1943 with respect 
to such an individual, health benefits under the 
Federal Medicaid program, and making applica-
tion for such benefits in the same manner as 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00544
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
545 
such provisions would apply to such an indi-
vidual, medical assistance under this title (other 
than pursuant to this section), and making ap-
plication for such medical assistance under this 
title (other than pursuant to this section); and 
providing that redeterminations and appeals of 
eligibility and coverage determinations of items 
and services (including benefit reductions, ter-
minations, and suspension) shall be conducted 
under the Federal Medicaid program in accord-
ance with a Federal fair hearing process estab-
lished by the Secretary that is subject to the 
same requirements as applied under section 
1902(a)(3) with respect to redeterminations 
and appeals of eligibility, and with respect to 
coverage of items and services (including benefit 
reductions, 
terminations, 
and 
suspension), 
under a State plan under this title and that 
may provide for such fair hearings related to 
denials of eligibility (based on modified adjusted 
gross income eligibility determinations) to be 
conducted through the Federally Facilitated 
Marketplace for Exchanges; 
‘‘(C) applying, in accordance with sub-
section (d), the provisions of section 1927 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00545
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
546 
(other than subparagraphs (B) and (C) of sub-
section (b)(1) of such section) with respect to 
the Secretary and payment under the Federal 
Medicaid program for covered outpatient drugs 
with respect to a rebate period in the same 
manner and to the same extent as such provi-
sions apply with respect to a State and payment 
under the State plan for covered outpatient 
drugs with respect to the rebate period; 
‘‘(D) applying the provisions of sections 
1902(a)(14), 1902(a)(23), 1902(a)(47), and 
1920 through 1920C (as applicable) to the Fed-
eral Medicaid program and such individuals en-
rolled in and entitled to health benefits under 
such program in the same manner and to the 
same extent as such provisions apply to such in-
dividuals eligible for medical assistance under 
the State plan, and applying the provisions of 
section 1902(a)(30)(A) with respect to medical 
assistance available under the Federal Medicaid 
program in the same manner and to the same 
extent as such provisions apply to medical as-
sistance under a State plan under this title, ex-
cept that— 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00546
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
547 
‘‘(i) the Secretary shall provide that 
no cost sharing shall be applied under the 
Federal Medicaid program; 
‘‘(ii) the Secretary may waive the pro-
visions of subparagraph (A) of section 
1902(a)(23) to the extent deemed appro-
priate to facilitate the implementation of 
managed care; 
‘‘(iii) in applying the provisions of sec-
tion 
1902(a)(47) 
and 
sections 
1920 
through 1920C, the Secretary— 
‘‘(I) shall establish a single pre-
sumptive eligibility process for individ-
uals eligible under the Federal Med-
icaid program, under which the Sec-
retary may contract with entities to 
carry out such process; and 
‘‘(II) may apply such provisions 
and process in accordance with such 
phased-in implementation as the Sec-
retary deems necessary, but beginning 
as soon as practicable); and 
‘‘(E) prohibiting payment from being avail-
able under the Federal Medicaid program for 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00547
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS
571 
such services are provided in a Medicaid eligible 
individual’s home. 
(C) Personal care services authorized 
under paragraph (24) of such section. 
(D) PACE services authorized under para-
graph (26) of such section. 
(E) Home and community-based services 
authorized under subsections (b), (c), (i), (j), 
and (k) of section 1915 of such Act (42 U.S.C. 
1396n), authorized under a waiver under sec-
tion 1115 of such Act (42 U.S.C. 1315), or 
provided through coverage authorized under 
section 1937 of such Act (42 U.S.C. 1396u–7). 
(F) Case management services authorized 
under section 1905(a)(19) of the Social Secu-
rity Act (42 U.S.C. 1396d(a)(19)) and section 
1915(g) of such Act (42 U.S.C. 1396n(g)). 
(G) Rehabilitative services, including those 
related to behavioral health, described in section 
1905(a)(13) 
of 
such 
Act 
(42 
U.S.C. 
1396d(a)(13)). 
(H) Self-directed personal assistance serv-
ices authorized under section 1915(j) of the So-
cial Security Act (42 U.S.C. 1396n(j)). 
VerDate Sep 11 2014 
01:59 Sep 28, 2021
Jkt 019200
PO 00000
Frm 00571
Fmt 6652
Sfmt 6201
E:\BILLS\H5376.RH
H5376
kjohnson on DSK79L0C42PROD with BILLS