204 
to eligibility for benefits for the program de-
fined in paragraph (3)(C) (relating to the Med-
icaid program), paragraph (1) shall not apply 
to any individual who lawfully resides in the 
United States (including territories and posses-
sions of the United States) in accordance with 
the Compacts of Free Association between the 
Government of the United States and the Gov-
ernments of the Federated States of Micro-
nesia, the Republic of the Marshall Islands, and 
the Republic of Palau.’’. 
(b) 
CONFORMING
DEFINITION
OF
QUALIFIED 
ALIEN.—Section 431(b) of such Act (8 U.S.C. 1641(b)) 
is amended— 
(1) in paragraph (6), by striking ‘‘or’’ at the 
end; 
(2) in paragraph (7), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following: 
‘‘(8) an individual who lawfully resides in the 
United States (including territories and possessions 
of the United States) in accordance with a Compact 
of 
Free 
Association 
referred 
to 
in 
section 
402(b)(2)(G), but only with respect to the program 
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defined in section 402(b)(3)(C) (relating to the Med-
icaid program).’’. 
(c) SETTING FMAP AT 100 PERCENT.—The third 
sentence of section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)) is amended by inserting before the pe-
riod at the end the following: ‘‘; with respect to medical 
assistance 
for 
individuals 
described 
in 
section 
402(b)(2)(G) of the Personal Responsibility and Work Op-
portunity Reconciliation Act of 1996’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this Act take effect on October 1, 2011, and apply to bene-
fits and assistance provided on or after that date. 
SEC. 416. 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, 2012’’ 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, 2012 (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-
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206 
plied by substituting ‘42-month’ for ‘12-month’ each 
place it appears in the first sentence.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this subsection shall take effect on the date of enactment 
of this Act. For purposes of determining an individual’s 
status under section 1862(b)(1)(C) of the Social Security 
Act (42 U.S.C. 1395y(b)(1)(C)), as amended by para-
graph (1), an individual who is within the coordinating 
period as of the date of enactment of this Act shall have 
that period extended to the full 42 months described in 
the last sentence of such section, as added by the amend-
ment made by paragraph (1)(B). 
SEC. 417. BORDER HEALTH GRANTS. 
(a) ELIGIBLE ENTITY DEFINED.—In this section, 
the term ‘‘eligible entity’’ means a State, public institution 
of higher education, local government, tribal government, 
nonprofit health organization, community health center, or 
community clinic receiving assistance under section 330 
of the Public Health Service Act (42 U.S.C. 254b), that 
is located in the border area. 
(b) AUTHORIZATION.—From funds appropriated 
under subsection (f), the Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’), 
acting through the United States members of the United 
States-Mexico Border Health Commission, shall award 
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grants to eligible entities to address priorities and rec-
ommendations to improve the health of border area resi-
dents that are established by— 
(1) the United States members of the United 
States-Mexico Border Health Commission; 
(2) the State border health offices; and 
(3) the Secretary. 
(c) APPLICATION.—An eligible entity that desires a 
grant under subsection (b) shall submit an application to 
the Secretary at such time, in such manner, and con-
taining such information as the Secretary may require. 
(d) USE OF FUNDS.—An eligible entity that receives 
a grant under subsection (b) shall use the grant funds 
for— 
(1) programs relating to— 
(A) maternal and child health; 
(B) primary care and preventative health; 
(C) public health and public health infra-
structure; 
(D) health education and promotion; 
(E) oral health; 
(F) mental and behavioral health; 
(G) substance abuse; 
(H) health conditions that have a high 
prevalence in the border area; 
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(I) medical and health services research; 
(J) workforce training and development; 
(K) 
community 
health 
workers 
or 
promotoras; 
(L) health care infrastructure problems in 
the border area (including planning and con-
struction grants); 
(M) health disparities in the border area; 
(N) environmental health; and 
(O) outreach and enrollment services with 
respect to Federal programs (including pro-
grams authorized under titles XIX and XXI of 
the Social Security Act (42 U.S.C. 1396 and 
1397aa)); and 
(2) other programs determined appropriate by 
the Secretary. 
(e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro-
vided to an eligible entity awarded a grant under sub-
section (b) shall be used to supplement and not supplant 
other funds available to the eligible entity to carry out the 
activities described in subsection (d). 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$200,000,000 for fiscal year 2012, and such sums as may 
be necessary for each succeeding fiscal year. 
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SEC. 418. REMOVING MEDICARE BARRIER TO HEALTH 
CARE. 
Section 1818(a)(3) of the Social Security Act (42 
U.S.C. 1395i–2(a)(3)) is amended by amending subpara-
graph (B) to read as follows: ‘‘(B) an individual who is 
lawfully present in the United States’’. 
SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 
PROVIDED BY URBAN INDIAN HEALTH CEN-
TERS. 
(a) IN GENERAL.—Section 1905(b) of the Social Se-
curity Act (42 U.S.C. 1396(b)), as amended by section 
415(c), is amended by inserting ‘‘or are received through 
a program operated by an urban Indian organization 
through a grant or contract under title V of such Act’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to medical assistance provided on 
or after the date of enactment of this Act. 
SEC. 420. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 
PROVIDED TO A NATIVE HAWAIIAN THROUGH 
A FEDERALLY QUALIFIED HEALTH CENTER 
OR A NATIVE HAWAIIAN HEALTH CARE SYS-
TEM UNDER THE MEDICAID PROGRAM. 
(a) IN GENERAL.—The third sentence of section 
1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 
as amended by section 419, is amended by inserting ‘‘; 
and, with respect to medical assistance provided to a Na-
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tive Hawaiian (as defined in section 12(2) of the Native 
Hawaiian Health Care Improvement Act) through a feder-
ally qualified health center or a Native Hawaiian health 
care system (as defined in section 12(6) of such Act), 
whether directly, by referral, or under contract or other 
arrangement between such federally qualified health cen-
ter or Native Hawaiian health care system and another 
health care provider’’ before the period. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to medical assistance provided on 
or after the date of enactment of this Act. 
CHAPTER 2—EXPANSION OF ACCESS 
SEC. 421. GRANTS FOR RACIAL AND ETHNIC APPROACHES 
TO COMMUNITY HEALTH. 
(a) PURPOSE.—It is the purpose of this section to 
provide for the awarding of grants to assist communities 
in mobilizing and organizing resources in support of effec-
tive and sustainable programs that will reduce or eliminate 
disparities in health and health care experienced by racial 
and ethnic minority individuals. 
(b) AUTHORITY TO AWARD GRANTS.—The Sec-
retary, acting through the Centers for Disease Control and 
Prevention, shall award grants to eligible entities to assist 
in designing, implementing, and evaluating culturally and 
linguistically appropriate, science-based, and community- 
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driven sustainable strategies to eliminate racial and ethnic 
health and health care disparities. 
(c) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall— 
(1) represent a coalition— 
(A) whose principal purpose is to develop 
and implement interventions to reduce or elimi-
nate a health or health care disparity in a tar-
geted racial or ethnic minority group in the 
community served by the coalition; and 
(B) that includes— 
(i) members selected from among— 
(I) public health departments; 
(II) community-based organiza-
tions; 
(III) university and research or-
ganizations; 
(IV) American Indian tribal or-
ganizations, national American Indian 
organizations, Indian Health Service, 
or organizations serving Alaska Na-
tives; and 
(V) interested public or private 
health care providers or organizations 
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as deemed appropriate by the Sec-
retary; and 
(ii) at least 1 member from a commu-
nity-based organization that represents the 
targeted racial or ethnic minority group; 
and 
(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require, which shall 
include— 
(A) a description of the targeted racial or 
ethnic populations in the community to be 
served under the grant; 
(B) a description of at least 1 health dis-
parity that exists in the racial or ethnic tar-
geted populations, including health issues such 
as infant mortality, breast and cervical cancer 
screening and management, cardiovascular dis-
ease, diabetes, child and adult immunization 
levels, or other health priority areas as des-
ignated by the Secretary; and 
(C) a demonstration of a proven record of 
accomplishment of the coalition members in 
serving and working with the targeted commu-
nity. 
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(d) SUSTAINABILITY.—The Secretary shall give pri-
ority to an eligible entity under this section if the entity 
agrees that, with respect to the costs to be incurred by 
the entity in carrying out the activities for which the grant 
was awarded, the entity (and each of the participating 
partners in the coalition represented by the entity) will 
maintain its expenditures of non-Federal funds for such 
activities at a level that is not less than the level of such 
expenditures during the fiscal year immediately preceding 
the first fiscal year for which the grant is awarded. 
(e) NONDUPLICATION.—Funds provided through this 
grant program should supplement, not supplant, existing 
Federal funding, and the funds should not be used to du-
plicate the activities of the other health disparity grant 
programs in this Act. 
(f) TECHNICAL ASSISTANCE.—The Secretary may, 
either directly or by grant or contract, provide any entity 
that receives a grant under this section with technical and 
other nonfinancial assistance necessary to meet the re-
quirements of this section. 
(g) DISSEMINATION.—The Secretary shall encourage 
and enable grantees to share best practices, evaluation re-
sults, and reports with communities not affiliated with 
grantees using the Internet, conferences, and other perti-
nent information regarding the projects funded by this 
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(3) LIMITATION ON EXPENDITURES.—The Sec-
retary shall limit incentive payments under this sec-
tion in order to ensure that the aggregate expendi-
tures under title XVIII of the Social Security Act 
(including incentive payments under this subsection) 
do not exceed the amount that the Secretary esti-
mates would have been expended if the pilot projects 
under this section had not been implemented. 
(d) WAIVER AUTHORITY.—The Secretary may waive 
such provisions of titles XI and XVIII of the Social Secu-
rity Act as the Secretary determines to be appropriate for 
the conduct of the pilot projects under this section. 
(e) REPORT TO CONGRESS.—Not later than 5 years 
after the date that the first pilot project under this section 
is implemented, the Secretary shall submit to Congress a 
report on the pilot projects. Such report shall contain a 
detailed description of issues related to the expansion of 
the projects under subsection (f) and recommendations for 
such legislation and administrative actions as the Sec-
retary considers appropriate. 
(f) EXPANSION.—If the Secretary determines that 
any of the pilot projects under this section enhance health 
outcomes for Medicare beneficiaries and reduce expendi-
tures under title XVIII of the Social Security Act, the Sec-
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