232 
(2) AMENDMENTS TO SOCIAL SECURITY ACT.— 
(A) 
IN
GENERAL.—Section 
1902(a)(10)(A)(i)(IX) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)(A)(i)(IX)), as 
amended by section 1002(a) of the SUPPORT 
for Patients and Communities Act (Public Law 
115–271), is amended— 
(i) in item (bb), by striking the semi-
colon at the end and inserting ‘‘; and’’; and 
(ii) by striking item (dd). 
(B) EFFECTIVE DATE.—The amendments 
made by this paragraph shall take effect on 
January 1, 2023. 
(b) OUTREACH EFFORTS
FOR ENROLLMENT
OF 
FORMER FOSTER CHILDREN.—Section 1902(a) of the So-
cial Security Act (42 U.S.C. 1396a(a)) is amended— 
(1) in paragraph (85), by striking ‘‘; and’’ and 
inserting a semicolon; 
(2) in paragraph (86), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (86) the fol-
lowing new paragraph: 
‘‘(87) not later than January 1, 2020, establish 
an outreach and enrollment program, in coordination 
with the State agency responsible for administering 
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the State plan under part E of title IV and any 
other appropriate or interested agencies, designed to 
increase the enrollment of individuals who are eligi-
ble for medical assistance under the State plan 
under paragraph (10)(A)(i)(IX) in accordance with 
best practices established by the Secretary.’’. 
SEC. 507. REMOVING CITIZENSHIP AND IMMIGRATION BAR-
RIERS TO ACCESS TO AFFORDABLE HEALTH 
CARE UNDER ACA. 
(a) IN GENERAL.— 
(1) PREMIUM TAX CREDITS.—Section 36B of 
the Internal Revenue Code of 1986 is amended— 
(A) in subsection (c)(1)(B)— 
(i) by amending the heading to read 
as follows: ‘‘SPECIAL RULE FOR CERTAIN 
INDIVIDUALS
INELIGIBLE
FOR
MEDICAID 
DUE TO STATUS’’, and 
(ii) in clause (ii), by striking ‘‘lawfully 
present in the United States, but’’ and in-
serting ‘‘who’’, and 
(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 by striking sub-
section (e). 
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(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 by 
striking subsection (d). 
(5) REQUIREMENT TO MAINTAIN MINIMUM ES-
SENTIAL COVERAGE.—Section 5000A(d) of the In-
ternal Revenue Code of 1986 is amended by striking 
paragraph (3) and by redesignating paragraph (4) 
as paragraph (3). 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1411(a) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18081(a)) is 
amended by striking paragraph (1) and redesig-
nating paragraphs (2), (3), and (4) as paragraphs 
(1), (2), and (3), respectively. 
(2) Section 1312(f) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18032(f)) is 
amended— 
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(A) in the heading, by striking ‘‘; ACCESS 
LIMITED
TO CITIZENS
AND LAWFUL RESI-
DENTS’’; and 
(B) by striking paragraph (3). 
SEC. 508. 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 ‘‘subsection 
(g)’’ and inserting ‘‘subsections (g) and (h)’’; 
(B) in subsection (g)(2), in the matter pre-
ceding subparagraph (A), by inserting ‘‘and 
subsection (h)’’ after ‘‘paragraphs (3) and (5)’’; 
and 
(C) by adding at the end the following new 
subsection: 
‘‘(h) SUNSET OF MEDICAID FUNDING LIMITATIONS 
FOR PUERTO RICO, THE VIRGIN ISLANDS
OF
THE 
UNITED STATES, GUAM, THE NORTHERN MARIANA IS-
LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 
shall not apply to Puerto Rico, the Virgin Islands of the 
United States, Guam, the Northern Mariana Islands, and 
American Samoa beginning with fiscal year 2020.’’. 
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(2) CONFORMING AMENDMENTS.— 
(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). 
(C) Section 1323(c)(1) of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 
18043(c)(1)) is amended by striking ‘‘2019’’ 
and inserting ‘‘2018’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this section shall apply beginning with fiscal year 
2021. 
(b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL 
ASSISTANCE PERCENTAGE (FMAP) LIMITATION
FOR 
TERRITORIES.—Section 1905(b) of the Social Security 
Act (42 U.S.C. 1396d(b)) is amended, in clause (2), by 
inserting ‘‘for fiscal years before fiscal year 2020’’ after 
‘‘American Samoa’’. 
(c) APPLICATION OF MEDICAID WAIVER AUTHORITY 
TO ALL OF THE TERRITORIES.— 
(1) IN GENERAL.—Section 1902(j) of the Social 
Security Act (42 U.S.C. 1396a(j)) is amended— 
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(A) by striking ‘‘American Samoa and the 
Northern Mariana Islands’’ and inserting 
‘‘Puerto Rico, the Virgin Islands of the United 
States, Guam, the Northern Mariana Islands, 
and American Samoa’’; 
(B) by striking ‘‘American Samoa or the 
Northern Mariana Islands’’ and inserting 
‘‘Puerto Rico, the Virgin Islands of the United 
States, Guam, the Northern Mariana Islands, 
or American Samoa’’; 
(C) by inserting ‘‘(1)’’ after ‘‘(j)’’; 
(D) by inserting ‘‘except as otherwise pro-
vided in this subsection,’’ after ‘‘Notwith-
standing any other requirement of this title’’; 
and 
(E) by adding at the end the following: 
‘‘(2) The Secretary may not waive under this 
subsection 
the 
requirement 
of 
subsection 
(a)(10)(A)(i)(IX) (relating to coverage of adults for-
merly under foster care) with respect to any terri-
tory.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this section shall apply beginning October 1, 
2021. 
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(d) PERMITTING MEDICAID DSH ALLOTMENTS FOR 
TERRITORIES.—Section 1923(f) of the Social Security Act 
(42 U.S.C. 1396r–4) is amended— 
(1) in paragraph (6), by adding at the end the 
following new subparagraph: 
‘‘(C) TERRITORIES.— 
‘‘(i) FISCAL
YEAR
2020.—For fiscal 
year 2020, the DSH allotment for Puerto 
Rico, the Virgin Islands of the United 
States, Guam, the Northern Mariana Is-
lands, and American Samoa shall bear the 
same ratio to $300,000,000 as the ratio of 
the number of individuals who are low-in-
come or uninsured and residing in such re-
spective territory (as estimated from time 
to time by the Secretary) bears to the 
sums of the number of such individuals re-
siding 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 (2).’’; and 
(2) in paragraph (9), by inserting before the pe-
riod at the end the following: ‘‘, and includes, begin-
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ning with fiscal year 2021, Puerto Rico, the Virgin 
Islands of the United States, Guam, the Northern 
Mariana Islands, and American Samoa’’. 
SEC. 509. REMOVING MEDICARE BARRIER TO HEALTH 
CARE. 
(a) PART A.—Section 1818(a)(3) of the Social Secu-
rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 
‘‘an alien’’ and all that follows through ‘‘under this sec-
tion’’ and inserting ‘‘an individual who is lawfully present 
in the United States’’. 
(b) PART B.—Section 1836(2) of the Social Security 
Act (42 U.S.C. 1395o(2)) 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. 510. REMOVING BARRIERS TO HEALTH CARE AND NU-
TRITION ASSISTANCE FOR CHILDREN, PREG-
NANT PERSONS, AND LAWFULLY PRESENT IN-
DIVIDUALS. 
(a) MEDICAID.—Section 1903(v) of the Social Secu-
rity Act (42 U.S.C. 1396b(v)) is amended by striking 
paragraph (4) and inserting the following new paragraph: 
‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 
403, and 421 of the Personal Responsibility and Work Op-
portunity Reconciliation Act of 1996 and paragraph (1), 
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payment shall be made to a State under this section for 
medical assistance furnished to an alien under this title 
(including an alien described in such paragraph) who 
meets any of the following conditions: 
‘‘(i) The alien is otherwise eligible for such as-
sistance under the State plan approved under this 
title (other than the requirement of the receipt of 
aid or assistance under title IV, supplemental secu-
rity income benefits under title XVI, or a State sup-
plementary payment) within either or both of the 
following eligibility categories: 
‘‘(I) Children under 21 years of age, in-
cluding any optional targeted low-income child 
(as 
such 
term 
is 
defined 
in 
section 
1905(u)(2)(B)). 
‘‘(II) Pregnant persons during pregnancy 
and during the 12-month period beginning on 
the last day of the pregnancy. 
‘‘(ii) The alien is lawfully present in the United 
States. 
‘‘(B) No debt shall accrue under an affidavit of sup-
port against any sponsor of an alien who meets the condi-
tions specified in subparagraph (A) on the basis of the 
provision of medical assistance to such alien under this 
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paragraph and the cost of such assistance shall not be con-
sidered as an unreimbursed cost.’’. 
(b) 
SCHIP.—Subparagraph 
(N) 
of 
section 
2107(e)(1) of the Social Security Act (42 U.S.C. 
1397gg(e)(1)) is amended to read as follows: 
‘‘(N) Paragraph (4) of section 1903(v) (re-
lating to coverage of categories of children, 
pregnant persons, and other lawfully present in-
dividuals).’’. 
(c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not-
withstanding sections 401(a), 402(a), and 403(a) of the 
Personal Responsibility and Work Opportunity Reconcili-
ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 
and section 6(f) of the Food and Nutrition Act of 2008 
(7 U.S.C. 2015(f)), persons who are lawfully present in 
the United States shall be not be ineligible for benefits 
under the supplemental nutrition assistance program on 
the basis of their immigration status or date of entry into 
the United States. 
(d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 
Section 421(d)(3) of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 
1631(d)(3)) is amended by striking ‘‘to the extent that 
a qualified alien is eligible under section 402(a)(2)(J)’’ 
and inserting, ‘‘to the extent that a child is a member of 
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a household under the supplemental nutrition assistance 
program’’. 
(e) 
ENSURING
PROPER
SCREENING.—Section 
11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 
U.S.C. 2020(e)(2)(B)) is amended— 
(1) by redesignating clauses (vi) and (vii) as 
clauses (vii) and (viii); and 
(2) by inserting after clause (v) the following: 
‘‘(vi) shall provide a method for imple-
menting section 421 of the Personal Re-
sponsibility and Work Opportunity Rec-
onciliation Act of 1996 (8 U.S.C. 1631) 
that does not require any unnecessary in-
formation from persons who may be ex-
empt from that provision;’’. 
SEC. 511. 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— 
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(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 
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) PAYMENT TO STATES.—Section 1903 of the 
Social Security Act (42 U.S.C. 1396b) is amended— 
(A) in subsection (i), by redesignating 
paragraphs (23) through (26) as paragraphs 
(22) through (25), respectively; and 
(B) by redesignating subsections (y) and 
(z) as subsections (x) and (y), respectively. 
(3) REPEAL.—Subsection (c) of section 6036 of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396b 
note) is repealed. 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of the Deficit Reduction Act of 2005. 
TITLE VI—COMMUNITY BASED 
GRANTS 
SEC. 601. GRANTS FOR RACIAL AND ETHNIC APPROACHES 
TO COMMUNITY HEALTH. 
(a) PURPOSE.—It is the purpose of this section to 
award grants to assist communities in mobilizing and or-
ganizing resources in support of effective 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 Secretary 
of Health and Human Services, acting through the Ad-
ministrator of the Health Resources and Services Admin-
istration (referred to in this section as the ‘‘Secretary’’), 
shall award grants to eligible entities to assist in design-
ing, implementing, and evaluating culturally and linguis-
tically appropriate, science-based, and community-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— 
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(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) Indian tribes or tribal orga-
nizations (as such terms are defined 
in section 4 of the Indian Self-Deter-
mination and Education Assistance 
Act (25 U.S.C. 5304)), the Indian 
Health Service, or any other organiza-
tion that serves Alaska Natives; and 
(V) interested public or private 
health care providers or organizations 
as determined appropriate by the Sec-
retary; and 
(ii) at least 1 member from a commu-
nity-based organization that represents the 
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246 
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, musculoskeletal 
diseases and obesity, prostate cancer screening 
and management, cardiovascular disease, diabe-
tes, child and adult immunization levels, oral 
disease, 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. 
(d) SUSTAINABILITY.—The Secretary shall give pri-
ority to an eligible entity under this section if the entity 
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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.—Any funds provided to an eli-
gible entity through a grant under this section shall— 
(1) supplement, not supplant, any other Federal 
funds made available to the entity for the purposes 
of this section; and 
(2) not be used to duplicate the activities of any 
other health disparity grant program under this Act, 
including an amendment made by 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 eligible entities receiving grants under this sec-
tion to share best practices, evaluation results, and reports 
with communities not affiliated with such entities, by 
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using the Internet, conferences, and other pertinent infor-
mation regarding the projects funded by this section, in-
cluding through using outreach efforts of the Office of Mi-
nority Health and the Centers for Disease Control and 
Prevention. 
(h) ADMINISTRATIVE
BURDENS.—The Secretary 
shall make every effort to minimize duplicative or unneces-
sary administrative burdens on eligible entities receiving 
grants under this section. 
(i) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section. 
SEC. 602. GRANTS TO PROMOTE HEALTH FOR UNDER-
SERVED COMMUNITIES. 
Part Q of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER-
SERVED COMMUNITIES. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col-
laboration with the Administrator of the Health Resources 
and Services Administration and other Federal officials 
determined appropriate by the Secretary, is authorized to 
award grants to eligible entities— 
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‘‘(1) to promote health for underserved commu-
nities, with preference given to projects that benefit 
racial and ethnic minority women, racial and ethnic 
minority children, adolescents, and lesbian, gay, bi-
sexual, transgender, queer, or questioning commu-
nities; and 
‘‘(2) to strengthen health outreach initiatives in 
medically underserved communities, including lin-
guistically isolated populations. 
‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 
subsection (a) may be used to support the activities of 
community health workers, including such activities— 
‘‘(1) to educate and provide outreach regarding 
enrollment in health insurance including the State 
Children’s Health Insurance Program under title 
XXI of the Social Security Act, Medicare under title 
XVIII of such Act, and Medicaid under title XIX of 
such Act; 
‘‘(2) to educate and provide outreach in a com-
munity setting regarding health problems prevalent 
among underserved communities, and especially 
among racial and ethnic minority women, racial and 
ethnic minority children, adolescents, and lesbian, 
gay, bisexual, transgender, queer, or questioning 
communities; 
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‘‘(3) to educate and provide experiential learn-
ing opportunities and target risk factors and healthy 
behaviors that impede or contribute to achieving 
positive health outcomes, including— 
‘‘(A) healthy nutrition; 
‘‘(B) physical activity; 
‘‘(C) overweight or obesity; 
‘‘(D) tobacco use, including the use of e- 
cigarettes and vaping; 
‘‘(E) alcohol and substance use; 
‘‘(F) injury and violence; 
‘‘(G) sexual health; 
‘‘(H) mental health; 
‘‘(I) musculoskeletal health and arthritis; 
‘‘(J) prenatal and postnatal care; 
‘‘(K) dental and oral health; 
‘‘(L) understanding informed consent; 
‘‘(M) stigma; and 
‘‘(N) environmental hazards; 
‘‘(4) to promote community wellness and aware-
ness; and 
‘‘(5) to educate and refer target populations to 
appropriate health care agencies and community- 
based programs and organizations in order to in-
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crease access to quality health care services, includ-
ing preventive health services. 
‘‘(c) APPLICATION.— 
‘‘(1) IN
GENERAL.—Each eligible entity that 
desires to receive a grant under subsection (a) shall 
submit an application to the Secretary, at such time, 
in such manner, and accompanied by such additional 
information as the Secretary may require. 
‘‘(2) CONTENTS.—Each application submitted 
pursuant to paragraph (1) shall— 
‘‘(A) describe the activities for which as-
sistance under this section is sought; 
‘‘(B) contain an assurance that, with re-
spect to each community health worker pro-
gram receiving funds under the grant awarded, 
such program provides in-language training and 
supervision to community health workers to en-
able such workers to provide authorized pro-
gram activities in (at least) the most commonly 
used languages within a particular geographic 
region; 
‘‘(C) contain an assurance that the appli-
cant will evaluate the effectiveness of commu-
nity health worker programs receiving funds 
under the grant; 
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‘‘(D) contain an assurance that each com-
munity health worker program receiving funds 
under the grant will provide culturally com-
petent services in the linguistic context most 
appropriate for the individuals served by the 
program; 
‘‘(E) contain a plan to document and dis-
seminate project descriptions and results to 
other States and organizations as identified by 
the Secretary; and 
‘‘(F) describe plans to enhance the capac-
ity of individuals to utilize health services and 
health-related social services under Federal, 
State, and local programs by— 
‘‘(i) assisting individuals in estab-
lishing eligibility under the programs and 
in receiving the services or other benefits 
of the programs; and 
‘‘(ii) providing other services, as the 
Secretary determines to be appropriate, 
which may include transportation and 
translation services. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to those appli-
cants— 
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‘‘(1) who propose to target geographic areas 
that— 
‘‘(A)(i) have a high percentage of residents 
who are uninsured or underinsured (if the tar-
geted geographic area is located in a State that 
has elected to make medical assistance available 
under section 1902(a)(10)(A)(i)(VIII) of the 
Social Security Act to individuals described in 
such section); 
‘‘(ii) have a high percentage of under-
insured residents in a particular geographic 
area (if the targeted geographic area is located 
in a State that has not so elected); or 
‘‘(iii) have a high number of households ex-
periencing extreme poverty; and 
‘‘(B) have a high percentage of families for 
whom English is not their primary language or 
including smaller limited English-proficient 
communities within the region that are not oth-
erwise reached by linguistically appropriate 
health services; 
‘‘(2) with experience in providing health or 
health-related social services to individuals who are 
underserved with respect to such services; and 
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254 
‘‘(3) with documented community activity and 
experience with community health workers. 
‘‘(e) COLLABORATION WITH ACADEMIC INSTITU-
TIONS.—The Secretary shall encourage community health 
worker programs receiving funds under this section to col-
laborate with academic institutions, including minority- 
serving institutions. Nothing in this section shall be con-
strued to require such collaboration. 
‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE-
NESS.—The Secretary shall establish guidelines for ensur-
ing the quality of the training and supervision of commu-
nity health workers under the programs funded under this 
section and for ensuring the cost effectiveness of such pro-
grams. 
‘‘(g) MONITORING.—The Secretary shall monitor 
community health worker programs identified in approved 
applications and shall determine whether such programs 
are in compliance with the guidelines established under 
subsection (f). 
‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to community health worker 
programs identified in approved applications with respect 
to planning, developing, and operating programs under the 
grant. 
‘‘(i) REPORT TO CONGRESS.— 
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255 
‘‘(1) IN
GENERAL.—Not later than 4 years 
after the date on which the Secretary first awards 
grants under subsection (a), the Secretary shall sub-
mit to Congress a report regarding the grant 
project. 
‘‘(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
‘‘(A) A description of the programs for 
which grant funds were used. 
‘‘(B) The number of individuals served. 
‘‘(C) An evaluation of— 
‘‘(i) the effectiveness of these pro-
grams; 
‘‘(ii) the cost of these programs; and 
‘‘(iii) the impact of these programs on 
the health outcomes of the community resi-
dents. 
‘‘(D) Recommendations for sustaining the 
community health worker programs developed 
or assisted under this section. 
‘‘(E) Recommendations regarding training 
to enhance career opportunities for community 
health workers. 
‘‘(j) DEFINITIONS.—In this section: 
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‘‘(1) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health, including dental, oral, mental, 
and environmental health, or nutrition needs; 
‘‘(F) by taking into consideration the 
needs of the communities served, including the 
prevalence rates of risk factors that impede 
achieving positive healthy outcomes among 
women and children, especially among racial 
and ethnic minority women and children; and 
‘‘(G) by providing referral and followup 
services. 
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257 
‘‘(2) COMMUNITY SETTING.—The term ‘commu-
nity setting’ means a home or a community organi-
zation that serves a population. 
‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means— 
‘‘(A) a unit of State, territorial, local, or 
Tribal government (including a federally recog-
nized Tribe or Alaska Native village); or 
‘‘(B) a community-based organization. 
‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 
The term ‘medically underserved community’ means 
a community— 
‘‘(A) that has a substantial number of in-
dividuals who are members of a medically un-
derserved population, as defined by section 
330(b)(3); 
‘‘(B) a significant portion of which is a 
health professional shortage area as designated 
under section 332; and 
‘‘(C) that includes populations that are lin-
guistically isolated, such as geographic areas 
with a shortage of health professionals able to 
provide linguistically appropriate services. 
‘‘(5) SUPPORT.—The term ‘support’ means the 
provision of training, supervision, and materials 
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needed to effectively deliver the services described in 
subsection (b), reimbursement for services, and 
other benefits. 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$15,000,000 for each of fiscal years 2021 through 2025.’’. 
SEC. 603. ADDRESSING COVID–19 HEALTH INEQUITIES AND 
IMPROVING HEALTH EQUITY. 
(a) IN GENERAL.—Not later than 60 days after the 
date of enactment of this Act, the Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’), acting through the Director of the Centers for 
Disease Control and Prevention, shall award grants to eli-
gible entities to establish or expand programs to improve 
health equity regarding COVID–19 and reduce or elimi-
nate inequities, including racial and ethnic inequities, in 
the incidence, prevalence, and health outcomes of COVID– 
19. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
(1) be a nongovernmental entity or consortium 
of entities that works to improve health and health 
equity in populations or communities disproportion-
ately affected by adverse health outcomes, includ-
ing— 
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259 
(A) racial and ethnic minority commu-
nities; 
(B) Indian Tribes, Tribal organizations, 
and urban Indian organizations; 
(C) people with disabilities; 
(D) English language learners; 
(E) older adults; 
(F) low-income communities; 
(G) justice-involved communities; 
(H) immigrant communities; and 
(I) communities on the basis of their sex-
ual orientation or gender identity; 
(2) have demonstrated experience in success-
fully working in and partnering with such commu-
nities, and have an established record of accomplish-
ment in improving health outcomes or preventing, 
reducing or eliminating health inequities, including 
racial and ethnic inequities, in those communities; 
(3) communicate with State, local, and Tribal 
health departments to coordinate grant activities, as 
appropriate; and 
(4) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
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(c) USE OF FUNDS.—An entity shall use amounts re-
ceived under grant under this section to establish, improve 
upon, or expand programs to improve health equity re-
garding COVID–19 and reduce or eliminate inequities, in-
cluding racial and ethnic inequities, in the incidence, prev-
alence, and health outcomes of COVID–19. Such uses may 
include— 
(1) acquiring and distributing medical supplies, 
such as personal protective equipment, to commu-
nities that are at an increased risk of COVID–19; 
(2) helping people enroll in a health insurance 
plan that meets minimum essential coverage; 
(3) increasing the availability of COVID–19 
testing and any future COVID–19 treatments or 
vaccines in communities that are at an increased 
risk of COVID–19; 
(4) aiding communities and individuals in fol-
lowing guidelines and best practices in regards to 
COVID–19, including physical distancing guidelines; 
(5) helping communities and COVID–19 sur-
vivors recover and cope with the long-term health 
impacts of COVID–19; 
(6) addressing social determinants of health, 
such as transportation, nutrition, housing, discrimi-
nation, health care access, including mental health 
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261 
care and substance use disorder prevention, treat-
ment, and recovery, health literacy, employment sta-
tus, and working conditions, education, income, and 
stress, that impact COVID–19 incidence, prevalence, 
and health outcomes, and facilitating or providing 
access to needed services; 
(7) the provision of anti-racism and implicit 
and explicit bias training for health care providers 
and other relevant professionals; 
(8) creating and disseminating culturally in-
formed, linguistically appropriate, accessible, and 
medically accurate outreach and education regarding 
COVID–19; 
(9) acquiring, retaining, and training a diverse 
workforce; and 
(10) improving the accessibility to health care, 
including accessibility to health care providers, men-
tal health care, and COVID–19 testing for people 
with disabilities. 
(d) ADMINISTRATION.— 
(1) PRIORITY.—In awarding grants under this 
section, the Secretary shall give priority to eligible 
entities that are a community-based organization or 
have an established history of successfully working 
in and partnering with the community or with popu-
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262 
lations which the entity intends to provide services 
under the grant. The Secretary shall also utilize 
available demographic data to give priority to eligible 
entities working with populations or communities 
disproportionately affected by COVID–19. 
(2) GEOGRAPHICAL DIVERSITY.—The Secretary 
shall seek to ensure geographical diversity among 
grant recipients. 
(3) REDUCTION
OF
BURDENS.—In admin-
istering the grant program under this section, the 
Secretary shall make every effort to minimize unnec-
essary administrative burdens on eligible entities re-
ceiving such grants. 
(4) TECHNICAL
ASSISTANCE.—The Secretary 
shall provide technical assistance to eligible entities 
on best practices for applying grants under this sec-
tion. 
(e) DURATION.—A grant awarded under this section 
shall be for a period of 3 years. 
(f) REPORTING.— 
(1) BY GRANTEE.—Not later than 180 days 
after the end of a grant period under this section, 
the grantee shall submit to the Secretary a report on 
the activities conducted under the grant, including— 
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(A) a description of the impact of grant 
activities, including on— 
(i) outreach and education related to 
COVID–19; and 
(ii) improving public health activities 
related to COVID–19, including physical 
distancing; 
(B) the number of individuals reached by 
the activities under the grant and, to the extent 
known, the disaggregated demographic data of 
such individuals, such as by race, ethnicity, sex 
(including sexual orientation and gender iden-
tity), income, disability status, or primary lan-
guage; and 
(C) any other information the Secretary 
determines is necessary. 
(2) BY
SECRETARY.—Not later than 1 year 
after the end of the grant program under this sec-
tion, the Secretary shall submit to Congress a report 
on the grant program, including a summary of the 
information gathered under paragraph (1). 
(g) SUPPLEMENT, NOT SUPPLANT.—Grants awarded 
under this Act shall be used to supplement and not sup-
plant any other Federal funds made available to carry out 
the activities described in this Act. 
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264 
(h) FUNDING.—Out of funds in the Treasury not oth-
erwise appropriated, there are appropriated to carry out 
this section, $500,000,000 for each of fiscal years 2020 
through 2022. 
SEC. 604. IMPROVING SOCIAL DETERMINANTS OF HEALTH. 
(a) FINDINGS.—Congress finds the following: 
(1) Healthy People 2020 defines social deter-
minants of health as conditions in the environments 
in which people live, learn, work, play, worship, and 
age that affect a wide range of health, functioning, 
and quality-of-life outcomes and risks. 
(2) One of the overarching goals of Healthy 
People 2020 is to ‘‘create social and physical envi-
ronments that promote good health for all’’. 
(3) Healthy People 2020 developed a ‘‘place- 
based’’ organizing framework, reflecting five key 
areas of social determinants of health namely— 
(A) economic stability; 
(B) education; 
(C) social and community context; 
(D) health and health care; and 
(E) neighborhood and built environment. 
(4) It is estimated that medical care accounts 
for only 10 to 20 percent of the modifiable contribu-
tors to healthy outcomes for a population. 
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(5) The Centers for Medicare & Medicaid Serv-
ices has indicated the importance of the social deter-
minants in its work stating that, ‘‘As we seek to fos-
ter innovation, rethink rural health, find solutions to 
the opioid epidemic, and continue to put patients 
first, we need to take into account social deter-
minants of health and recognize their importance.’’. 
(6) The Department of Health and Human 
Services’ Public Health 3.0 initiative recognizes the 
role of public health in working across sectors on so-
cial determinants of health, as well as the role of 
public health as chief health strategist in commu-
nities. 
(7) Through its Health Impact in 5 Years ini-
tiative, the Centers for Disease Control and Preven-
tion has highlighted nonclinical, community-wide ap-
proaches that show positive health impacts, results 
within five years, and cost effectiveness or cost sav-
ings over the lifetime of the population or earlier. 
(8) Health departments and the Centers for 
Disease Control and Prevention are not funded for 
such cross-cutting work. 
(9) Providing grants to public health depart-
ments and other eligible entities to coordinate cross- 
sector collaboration will allow a community-wide, evi-
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dence-based approach to address underlying social 
determinants of health. 
(b) SOCIAL
DETERMINANTS
OF
HEALTH
PRO-
GRAM.— 
(1) PROGRAM.—To the extent and in the 
amounts made available in advance in appropriations 
Acts, the Director of the Centers for Disease Control 
and Prevention (in this section referred to as the 
‘‘Director’’) shall carry out a program, to be known 
as the Social Determinants of Health Program (in 
this section referred to as the ‘‘Program’’), to 
achieve the following goals: 
(A) Improve health outcomes and reduce 
health inequities by coordinating social deter-
minants of health activities across the Centers 
for Disease Control and Prevention. 
(B) Improve the capacity of public health 
agencies and community organizations to ad-
dress social determinants of health in commu-
nities. 
(2) ACTIVITIES.—To achieve the goals listed in 
paragraph (1), the Director shall carry out activities 
including the following: 
(A) Coordinating across the Centers for 
Disease Control and Prevention to ensure that 
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454 
cense under section 351 of the Public Health Service 
Act, the Secretary may by order require the holder 
of the approved application or license to conduct, by 
a date specified by the Secretary, postmarket studies 
to investigate the disparity. 
‘‘(2) LABELING.—If the Secretary determines 
that the postmarket studies confirm that there is a 
disparity described in paragraph (1), the labeling of 
the drug or biological product shall include appro-
priate information about the disparity. 
‘‘(3) STUDY DESIGN.—The Secretary may, in 
an order under paragraph (1), specify all aspects of 
the design of the postmarket studies required under 
such paragraph for a drug or biological product, in-
cluding the number of studies and study partici-
pants, and the other demographic characteristics of 
the study participants. 
‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 
Secretary may, by order and as necessary, modify 
any aspect of the design of a postmarket study re-
quired in an order under paragraph (1) after issuing 
such order. 
‘‘(5) STUDY
RESULTS.—The results from a 
study required under paragraph (1) shall be sub-
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