Territories Medicare Prescription Drug Assistance Equality Act of 2021
Bill: H.R.1825 | Sponsor: Resident Commissioner González-Colón, Jenniffer (R-PR)
Policy area: Health

Summary:
Territories Medicare Prescription Drug Assistance Equality Act of 2021
This bill makes certain income-based subsidies under the Medicare prescription drug benefit available to individuals who reside in Puerto Rico or another U.S. territory and are otherwise eligible.
Current law makes such individuals ineligible for premium and cost-sharing subsidies, but establishes a process for U.S. territories to apply for financial assistance with respect to the provision of Medicare prescription drugs. The bill retains a process for U.S. territories to apply for such assistance, but alters the formula by which the amount of assistance is calculated. Specifically, the bill phases in modifications to the formula that more closely align how assistance is calculated for U.S. territories with how it is calculated for the 50 states and the District of Columbia.

To amend titles XVIII and XIX of the Social Security Act to make 
  premium and cost-sharing subsidies available to low-income Medicare 
part D beneficiaries who reside in Puerto Rico or another territory of 
                           the United States.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Territories Medicare Prescription 
Drug Assistance Equality Act of 2021''.

SEC. 2. EQUAL TREATMENT OF RESIDENTS OF TERRITORIES IN PREMIUM AND 
              COST-SHARING SUBSIDIES UNDER MEDICARE PRESCRIPTION DRUG 
              PROGRAM.

    (a) Medicare Assistance.--Section 1860D-14(a)(3) of the Social 
Security Act (42 U.S.C. 1395w-114(a)(3)) is amended--
            (1) in subparagraph (A), in the matter preceding clause 
        (i), by striking ``subject to subparagraph (F),'';
            (2) in subparagraph (B)(v), in the matter preceding 
        subclause (I), by striking ``Subject to subparagraph (F), the 
        Secretary'' and inserting ``The Secretary'';
            (3) in subparagraph (C), by adding at the end the following 
        new sentence: ``In the case of an individual who is not a 
        resident of the 50 States or the District of Columbia, the 
        poverty line (as such term is defined in clause (ii)) that 
        shall apply to such individual shall be the poverty line for 
        the 48 contiguous States and the District of Columbia.''; and
            (4) by striking subparagraph (F).
    (b) Medicaid Assistance.--Section 1935 of the Social Security Act 
(42 U.S.C. 1396u-5) is amended--
            (1) in subsection (c)(1)(A)--
                    (A) by inserting ``(and each other State for each 
                month beginning with January 2020)'' after ``January 
                2006''; and
                    (B) in clause (i), by inserting ``or (2)(B) (as the 
                case may be)'' after ``paragraph (2)(A)'';
            (2) in subsection (c)(2)--
                    (A) in subparagraph (A)--
                            (i) by amending the heading to read as 
                        follows: ``Computation for 50 states and the 
                        district of columbia''; and
                            (ii) by striking ``a State described in 
                        paragraph (1)'' and inserting ``one of the 50 
                        States or the District of Columbia'';
                    (B) in subparagraph (B)--
                            (i) by striking ``subparagraph (A)'' and 
                        inserting ``subparagraph (A) or (B) (as the 
                        case may be)''; and
                            (ii) by redesignating such subparagraph as 
                        subparagraph (C); and
                    (C) by inserting after subparagraph (A) the 
                following new subparagraph:
                    ``(B) Computation for territories.--The amount 
                computed under this paragraph for a State not described 
                in subparagraph (A) and for a month in a year 
                (beginning with 2022) is equal to--
                            ``(i) \1/12\ of the product of--
                                    ``(I) the amount determined under 
                                subsection (e) for the State for 2021; 
                                and
                                    ``(II) 100 percent minus the 
                                highest possible Federal medical 
                                assistance percentage that may be 
                                applied to any of the 50 States for 
                                fiscal year 2020 under section 
                                1905(b)(1); and
                            ``(ii) increased for each year (beginning 
                        with 2021 up to and including the year 
                        involved) by the applicable growth factor 
                        specified in paragraph (4) for that year.''; 
                        and
            (3) in subsection (e)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (A), by striking ``of 
                        such State; and'' and inserting ``of such State 
                        for years before 2020;'';
                            (ii) in subparagraph (B)--
                                    (I) by inserting ``for periods 
                                before January 1, 2022'' after ``(B)''; 
                                and
                                    (II) by striking the period at the 
                                end and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(C) for the first 3 quarters of fiscal year 2022 
                and for each subsequent fiscal year, the amount 
                otherwise applied under section 1108(f) for the State 
                shall be increased by the amount specified in paragraph 
                (4)(A) for such period or fiscal year.'';
                    (B) in paragraph (2), by striking ``The Secretary'' 
                and inserting ``For periods before January 2022, the 
                Secretary'';
                    (C) in paragraph (3)--
                            (i) in the heading, by inserting ``before 
                        second quarter of fiscal year 2022'' after 
                        ``Increased amount'';
                            (ii) in subparagraph (A)--
                                    (I) in the matter before clause 
                                (i), by inserting ``or other fiscal 
                                period'' after ``for a year''; and
                                    (II) in clause (i), by inserting 
                                ``for such year or period'' after 
                                ``subparagraph (B)''; and
                            (iii) in subparagraph (B)--
                                    (I) in clause (ii), by striking 
                                ``or'' at the end;
                                    (II) in clause (iii), by striking 
                                ``a subsequent year'' and inserting ``a 
                                subsequent fiscal year (before the 
                                second quarter of fiscal year 2022)'';
                                    (III) in clause (iii), by striking 
                                the period at the end and inserting ``; 
                                and''; and
                                    (IV) by adding at the end the 
                                following:
                            ``(iv) for the first quarter of fiscal year 
                        2022, is equal to 25 percent of the aggregate 
                        amount specified in this subparagraph for the 
                        previous fiscal year increased by the annual 
                        percentage increase specified in section 1860D-
                        2(b)(6) for the year involved.'';
                    (D) by striking paragraph (4); and
                    (E) by inserting after paragraph (3) the following 
                new paragraph:
            ``(4) Increased amount beginning with second quarter of 
        fiscal year 2022.--
                    ``(A) In general.--The amount specified in this 
                paragraph for a State for the last 3 quarters of fiscal 
                year 2022 or for a subsequent fiscal year is equal to 
                the product of--
                            ``(i) the aggregate amount specified in 
                        subparagraph (B) for such period or fiscal 
                        year; and
                            ``(ii) the ratio (as estimated by the 
                        Secretary) of--
                                    ``(I) the number of individuals who 
                                are entitled to benefits under part A 
                                or enrolled under part B and who reside 
                                in the State (as determined by the 
                                Secretary based on the most recent 
                                available data before the beginning of 
                                the period or year); to
                                    ``(II) the sum of such numbers for 
                                all States that are subject to this 
                                subsection.
                    ``(B) Aggregate amount.--The aggregate amount 
                specified in this subparagraph for--
                            ``(i) the last 3 quarters of fiscal year 
                        2022, is equal to 3 times the amount specified 
                        in paragraph (3)(B)(iv);
                            ``(ii) fiscal year 2023, is equal to 4 
                        times the amount specified in paragraph 
                        (3)(B)(iv) increased by the same annual 
                        percentage increase as is applied to increases 
                        in the amounts applied for the fiscal year and 
                        State under section 1108(f); or
                            ``(iii) a subsequent fiscal year, is equal 
                        to the aggregate amount specified in this 
                        subparagraph for the previous fiscal year 
                        increased by the same annual percentage 
                        increase as is applied for the fiscal year and 
                        State under section 1108(f).''.
    (c) Conforming Amendment.--Section 1108(f) of the Social Security 
Act (42 U.S.C. 1308(f)) is amended by striking ``1935(e)(1)(B)'' and 
inserting ``1935(e)(1)''.
    (d) Effective Dates.--The amendments made by subsection (a) shall 
take effect on January 1, 2022, and the amendments made by subsections 
(b) and (c) shall take effect on the date of the enactment of this Act.
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