I 
117TH CONGRESS 
1ST SESSION H. R. 4595 
To require the Secretary of Health and Human Services to establish a 
program to provide health care coverage to low-income adults in States 
that have not expanded Medicaid. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 21, 2021 
Ms. BOURDEAUX (for herself, Ms. CASTOR of Florida, Mrs. MCBATH, Ms. 
ROSS, Ms. MANNING, Ms. WILLIAMS of Georgia, Mr. VEASEY, Ms. 
MOORE of Wisconsin, Mr. CARSON, Mr. THOMPSON of Mississippi, Mr. 
DANNY K. DAVIS of Illinois, Mr. CLYBURN, Mrs. MURPHY of Florida, 
Mr. COOPER, Mr. BISHOP of Georgia, Mr. JOHNSON of Georgia, Mr. 
KIND, Mr. BUTTERFIELD, Ms. LOIS FRANKEL of Florida, Ms. SEWELL, 
Mr. COHEN, Mr. CRIST, Mr. PRICE of North Carolina, Mr. SOTO, Ms. 
WASSERMAN SCHULTZ, Mrs. DEMINGS, Mr. DEUTCH, Ms. JACKSON LEE, 
Mr. LAWSON of Florida, Mr. DAVID SCOTT of Georgia, Ms. ADAMS, Mr. 
GREEN of Texas, Mr. CASTRO of Texas, and Mr. ALLRED) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To require the Secretary of Health and Human Services 
to establish a program to provide health care coverage 
to low-income adults in States that have not expanded 
Medicaid. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicaid Saves Lives 
Act’’. 
SEC. 2. MEDICAID FALLBACK COVERAGE PROGRAM FOR 
LOW-INCOME ADULTS IN NON-EXPANSION 
STATES. 
(a) IN GENERAL.—As soon as possible after the date 
of enactment of this Act the Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall— 
(1) directly or by contract, establish a program 
that offers eligible individuals the opportunity to en-
roll in health benefits coverage that meets the re-
quirements described in subsection (c) and any re-
quirements applicable to such coverage pursuant to 
subsection (d); and 
(2) ensure that such program is administered 
consistent 
with 
the 
requirements 
of 
section 
431.10(c)(2) of title 42, Code of Federal Regula-
tions. 
(b) DEFINITION OF ELIGIBLE INDIVIDUAL.—In this 
section, the term ‘‘eligible individual’’ means an individual 
who— 
(1) 
is 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) of the Social Security Act 
(42 U.S.C. 1396a(a)(10)(A)(i)(VIII)); 
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(2) resides in a State that— 
(A) does not expend amounts for medical 
assistance under title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.) for all individ-
uals described in such section; and 
(B) did not expend amounts for medical 
assistance under such title for all such individ-
uals as of the date of enactment of this Act; 
and 
(3) would not be eligible for medical assistance 
under such State’s plan for medical assistance under 
title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.), or a waiver of such plan, as such plan or 
waiver was in effect on such date. 
(c) 
HEALTH
BENEFITS
COVERAGE
REQUIRE-
MENTS.—The requirements described in this subsection 
with respect to health benefits coverage are the following: 
(1) ESSENTIAL HEALTH BENEFITS.—At a min-
imum, the coverage meets the minimum standards 
required under paragraph (5) of section 1937(b) of 
the Social Security Act (42 U.S.C. 1396u–7(b)) for 
benchmark coverage described in paragraph (1) of 
such section or benchmark equivalent coverage de-
scribed in paragraph (2) of such section. 
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(2) PREMIUMS
AND
COST-SHARING.—No pre-
miums are imposed for the coverage, and deduct-
ibles, cost sharing, or similar charges may only be 
imposed in accordance with the requirements im-
posed on State Medicaid plans under section 1916 of 
the Social Security Act (42 U.S.C. 1396o). 
(d) APPLICATION OF REQUIREMENTS AND PROVI-
SIONS OF TITLE XIX OF THE SOCIAL SECURITY ACT.— 
The Secretary shall specify that— 
(1) any requirement applicable to the furnishing 
of medical assistance under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.) by States that 
have elected to make medical assistance available to 
individuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) of such title (42 U.S.C. 
1396a(a)(10)(A)(i)(VIII)) that does not conflict with 
the requirements specified in subsection (c) applies 
to the program established under this section; and 
(2) other provisions of such title apply to such 
program. 
(e) NO STATE MANDATE.—Nothing in this section 
shall be construed as requiring a State to make expendi-
tures related to the program established under this section 
and the Secretary shall not impose any such requirement. 
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(f) FUNDING.—There are appropriated to the Sec-
retary for each fiscal year beginning with fiscal year 2021 
from any funds in the Treasury not otherwise appro-
priated, such sums as are necessary to carry out this sec-
tion. 
SEC. 3. INCREASE AND EXTENSION OF TEMPORARY EN-
HANCED FMAP FOR STATES WHICH BEGIN TO 
EXPEND AMOUNTS FOR CERTAIN MANDA-
TORY INDIVIDUALS. 
(a) IN GENERAL.—Section 1905(ii)(1) of the Social 
Security Act (42 U.S.C. 1396d(ii)(1)) is amended— 
(1) by striking ‘‘8-quarter period’’ and inserting 
‘‘40-quarter period’’; and 
(2) by striking ‘‘5 percentage points’’ and in-
serting ‘‘10 percentage points’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of section 9814 of the American Rescue Plan Act 
of 2021 (Public Law 117–2). 
Æ 
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