Title: VACC Act
Policy area: Health

Summary:
Vaccine And Coverage Certainty Act or the VACC Act
This bill modifies provisions under Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) relating to the cost and coverage of vaccines for COVID-19 (i.e., coronavirus disease 2019), as well as provisions relating to Medicaid coverage of certain citizens of the Freely Associated States, the applicable Federal Medical Assistance Percentage for the Medicaid expansion population, and the health insurance premium tax credit.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4509 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  2d Session
                                S. 4509

To provide for affordable coverage of COVID-19 vaccines under Medicare, 
 Medicaid, and the Children's Health Insurance Program, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             August 6, 2020

   Mr. Wyden introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To provide for affordable coverage of COVID-19 vaccines under Medicare, 
 Medicaid, and the Children's Health Insurance Program, and for other 
                               purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Vaccine And 
Coverage Certainty Act'' or the ``VACC Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
            TITLE I--ENSURING COVERAGE OF COVID-19 VACCINES

Sec. 101. Ensuring affordability of federally funded COVID-19 vaccines 
                            under Medicare.
Sec. 102. Mandatory coverage of COVID-19 vaccines under Medicaid and 
                            CHIP.
Sec. 103. Inclusion of federally funded COVID-19 vaccines under 
                            Medicaid drug rebate program; coverage of 
                            COVID-19 vaccines under State pediatric 
                            vaccine distribution program.
Sec. 104. Temporary enhanced Federal match for medical assistance for 
                            COVID-19 vaccines.
               TITLE II--ENSURING COVERAGE UNDER MEDICAID

Sec. 201. Increased FMAP for medical assistance to newly eligible 
                            individuals.
Sec. 202. Medicaid coverage for citizens of Freely Associated States.
            TITLE III--ENSURING COVERAGE IN THE MARKETPLACE

Sec. 301. Disregard of additional unemployment compensation for 
                            purposes of premium tax credit and cost-
                            sharing subsidies.

            TITLE I--ENSURING COVERAGE OF COVID-19 VACCINES

SEC. 101. ENSURING AFFORDABILITY OF FEDERALLY FUNDED COVID-19 VACCINES 
              UNDER MEDICARE.

    (a) In General.--Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended--
            (1) in subsection (a)(1)(B), by inserting ``subject to 
        subsection (dd)(1) (with respect to payment for federally 
        funded COVID-19 vaccines),'' after ``1861(s)(10)(A),''; and
            (2) by adding at the end the following new subsection:
    ``(dd) Ensuring Affordability of Federally Funded COVID-19 
Vaccines.--
            ``(1) Initial payment.--For purposes of subsection 
        (a)(1)(B), the amount of charges that are considered reasonable 
        with respect to an applicable COVID-19 vaccine during the first 
        year that such vaccine is administered under this part 
        (referred to in this subsection as the `initial payment year') 
        shall not exceed the amount described in paragraph (3).
            ``(2) Applicable covid-19 vaccine.--
                    ``(A) In general.--In this subsection, the term 
                `applicable COVID-19 vaccine' means a vaccine--
                            ``(i) approved by the Food and Drug 
                        Administration under section 351 of the Public 
                        Health Service Act or authorized for emergency 
                        use under section 564 of the Federal Food, 
                        Drug, and Cosmetic Act for immunization against 
                        COVID-19; and
                            ``(ii) whose manufacturer was provided 
                        funding for research or development of such 
                        vaccine or for the manufacture of such vaccine 
                        under a contract with the Federal Government 
                        (including the Biodefense Advanced Research and 
                        Development Authority of the Department of 
                        Health and Human Services) or under a Federal 
                        grant program using funds made available under 
                        the Coronavirus Aid, Relief, and Economic 
                        Security Act (Public Law 116-136), or 
                        subsequently enacted legislation.
                    ``(B) Nonapplication to vaccines purchased for 
                federal distribution.--Such term shall not include any 
                doses of such vaccine that are purchased under a 
                Federal contract or grant agreement described in 
                paragraph (2)(B) for Federal distribution.
            ``(3) Amount described.--The amount described in this 
        paragraph, with respect to an applicable COVID-19 vaccine, is 
        the Federal procurement cost per dose accounting for Federal 
        costs under all Federal contracts or grant agreements described 
        in paragraph (2)(B) for the initial supply order with respect 
        to such vaccine, not including the cost of any option to buy 
        future doses of such vaccine under such contracts or 
        agreements.
            ``(4) Payment in subsequent years.--For provisions relating 
        to payment for an applicable COVID-19 vaccine in years after 
        the initial payment year, see section 1842(o)(1)(A)(iv) 
        (relating to payment amount equal to 95 percent of the average 
        wholesale price).
            ``(5) Rebate if price increases faster than inflation.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                Secretary shall establish a process under which, with 
                respect to an applicable COVID-19 vaccine of a 
                manufacturer, effective beginning with the first year 
                after the initial payment year, if the amount of 
                payment for the vaccine under this part increases 
                faster than inflation with respect to a rebate period 
                specified by the Secretary, the manufacturer of such 
                vaccine shall, not later than 30 days after receipt 
                from the Secretary of the rebate amount for such rebate 
                period, provide a rebate to the Secretary that is equal 
                to the amount specified in subparagraph (C) for such 
                vaccine and rebate period.
                    ``(B) Exceptions.--The process established under 
                this paragraph shall provide for the following 
                exceptions with respect to an applicable COVID-19 
                vaccine of a manufacturer:
                            ``(i) If the Secretary determines that 
                        there are exceptional circumstances, such as a 
                        substantial increase in development or 
                        manufacturing costs due to circumstances 
                        outside the control of the manufacturer.
                            ``(ii) The manufacturer demonstrates, to 
                        the satisfaction of the Secretary, that it has 
                        significantly improved the clinical efficacy or 
                        safety of such vaccine relative to its clinical 
                        efficacy or safety when it was first procured 
                        or contracted for by the Federal Government. 
                        For purposes of the preceding sentence, a 
                        manufacturer may demonstrate the improved 
                        clinical efficacy or safety of a particular 
                        COVID-19 vaccine according to a process 
                        established by the Advisory Committee on 
                        Immunization Practices at the Centers for 
                        Disease Control in coordination with the Food 
                        and Drug Administration. The results of any 
                        assessment under this clause with respect to an 
                        applicable COVID-19 vaccine shall be made 
                        public.
                    ``(C) Rebate amount.--The amount of a rebate under 
                this subparagraph, with respect to an applicable COVID-
                19 vaccine of a manufacturer, is the product of--
                            ``(i) the total number of doses of such 
                        vaccine administered during the rebate period; 
                        and
                            ``(ii) the amount (if any) by which--
                                    ``(I) the amount of payment for the 
                                vaccine under this part during the 
                                rebate period; exceeds
                                    ``(II) the inflation-adjusted 
                                payment amount determined under 
                                subparagraph (D) of this paragraph for 
                                such vaccine during the rebate period.
                    ``(D) Determination of inflation-adjusted payment 
                amount.--The inflation-adjusted payment amount 
                determined under this subparagraph for an applicable 
                COVID-19 vaccine for a rebate period is--
                            ``(i) the amount of payment for the vaccine 
                        under this part during the initial payment year 
                        as described in paragraph (1); increased by
                            ``(ii) the percentage by which the rebate 
                        period CPI-U (as defined in subparagraph (F)) 
                        for the rebate period exceeds the benchmark 
                        period CPI-U (as defined in subparagraph (E)).
                    ``(E) Benchmark period cpi-u.--The term `benchmark 
                period CPI-U' means the consumer price index for all 
                urban consumers (United States city average) for the 
                first calendar quarter in the initial payment year.
                    ``(F) Rebate period cpi-u.--The term `rebate period 
                CPI-U' means, with respect to a rebate period, the 
                consumer price index for all urban consumers (United 
                States city average) for the last month of the calendar 
                quarter that is two calendar quarters prior to the 
                rebate period.
                    ``(G) Provision of information.--A manufacturer of 
                an applicable COVID-19 vaccine shall provide to the 
                Secretary such information, at such time and in such 
                manner as the Secretary specifies, as is needed to 
                carry out this paragraph.
                    ``(H) Rebate deposits.--Amounts paid as rebates 
                under this paragraph shall be deposited into the 
                Federal Supplementary Medical Insurance Trust Fund 
                established under section 1841.
                    ``(I) Enforcement.--
                            ``(i) Civil money penalty.--
                                    ``(I) In general.--The Secretary 
                                shall impose a civil money penalty on a 
                                manufacturer that fails to comply with 
                                the requirements under this paragraph 
                                with respect to providing a rebate for 
                                an applicable COVID-19 vaccine for a 
                                rebate period for each such failure in 
                                an amount equal to the sum of--
                                            ``(aa) the rebate amount 
                                        specified pursuant to 
                                        subparagraph (C) for such 
                                        vaccine for such rebate period; 
                                        and
                                            ``(bb) 25 percent of such 
                                        amount.
                                    ``(II) Application.--The provisions 
                                of section 1128A (other than 
                                subsections (a) (with respect to 
                                amounts of penalties or additional 
                                assessments) and (b)) shall apply to a 
                                civil money penalty under this clause 
                                in the same manner as such provisions 
                                apply to a penalty or proceeding under 
                                section 1128A(a).
                            ``(ii) No payment for manufacturers who 
                        fail to pay penalty.--If the manufacturer of an 
                        applicable COVID-19 vaccine fails to pay a 
                        civil money penalty under clause (i) with 
                        respect to the failure to provide a rebate for 
                        an applicable COVID-19 vaccine for a rebate 
                        period by a date specified by the Secretary 
                        after the imposition of such penalty, no 
                        payment shall be available under this part for 
                        such vaccine for calendar quarters beginning on 
                        or after such date until the Secretary 
                        determines the manufacturer has paid the 
                        penalty due under such clause.
                    ``(J) Implementation.--There shall be no 
                administrative or judicial review under section 1869, 
                section 1878, or otherwise, of the determination of the 
                rebate amount for an applicable COVID-19 vaccine under 
                subparagraph (C), including the determination of--
                            ``(i) the total number of COVID-19 vaccines 
                        administered during the rebate period under 
                        subparagraph (C)(i); and
                            ``(ii) the inflation-adjusted payment 
                        amount under subparagraph (D).''.
    (b) Conforming Amendment.--Section 1842(o)(1)(A)(iv) of the Social 
Security Act (42 U.S.C. 1395u(o)(1)(A)(iv)) is amended by striking ``A 
vaccine'' and inserting ``Subject to section 1833(dd)(1) (relating to 
payment for an applicable COVID-19 vaccine during initial payment 
year), a vaccine''.

SEC. 102. MANDATORY COVERAGE OF COVID-19 VACCINES UNDER MEDICAID AND 
              CHIP.

    (a) Medicaid.--
            (1) In general.--Section 1905(a)(4) of the Social Security 
        Act (42 U.S.C. 1396d(a)(4)) is amended--
                    (A) by striking ``and (D)'' and inserting ``(D)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting ``; and (E) a COVID-19 vaccine licensed under 
                section 351 of the Public Health Service Act, or 
                approved or authorized under sections 505 or 564 of the 
                Federal Food, Drug, and Cosmetic Act, and 
                administration of the vaccine;''.
            (2) Prohibition of cost sharing.--
                    (A) In general.--Subsections (a)(2) and (b)(2) of 
                section 1916 of the Social Security Act (42 U.S.C. 
                1396o) are each amended--
                            (i) in subparagraph (F), by striking ``or'' 
                        at the end;
                            (ii) in subparagraph (G), by striking ``; 
                        and'' and inserting ``, or''; and
                            (iii) by adding at the end the following 
                        subparagraph:
                    ``(H) a COVID-19 vaccine licensed under section 351 
                of the Public Health Service Act, or approved or 
                authorized under sections 505 or 564 of the Federal 
                Food, Drug, and Cosmetic Act, and the administration of 
                such vaccine; and''.
                    (B) Application to alternative cost sharing.--
                Section 1916A(b)(3)(B) of the Social Security Act (42 
                U.S.C. 1396o-1(b)(3)(B)) is amended--
                            (i) in clause (xi), by striking ``any 
                        visit'' and inserting ``any service''; and
                            (ii) by adding at the end the following 
                        clause:
                            ``(xii) A COVID-19 vaccine licensed under 
                        section 351 of the Public Health Service Act, 
                        or approved or authorized under sections 505 or 
                        564 of the Federal Food, Drug, and Cosmetic 
                        Act, and the administration of such vaccine.''.
                    (C) Clarification.--The amendments made by this 
                subsection shall apply with respect to a State plan of 
                a territory in the same manner as the amendments apply 
                to a State plan of 1 of the 50 States or the District 
                of Columbia.
    (b) CHIP.--
            (1) In general.--Section 2103(c) of the Social Security Act 
        (42 U.S.C. 1397cc(c)) is amended by adding at the end the 
        following paragraph:
            ``(11) Coverage of covid-19 vaccines.--Regardless of the 
        type of coverage elected by a State under subsection (a), child 
        health assistance provided under such coverage for targeted 
        low-income children and, in the case of a State that State 
        elects to provide pregnancy-related assistance under such 
        coverage pursuant to section 2112, such pregnancy-related 
        assistance for targeted low-income pregnant women (as defined 
        in section 2112(d)) shall include coverage of a COVID-19 
        vaccine licensed under section 351 of the Public Health Service 
        Act, or approved or authorized under sections 505 or 564 of the 
        Federal Food, Drug, and Cosmetic Act, and the administration of 
        such vaccine.''.
            (2) Prohibition of cost sharing.--Section 2103(e)(2) of the 
        Social Security Act (42 U.S.C. 1397cc(e)(2)), as amended by 
        section 6004(b)(3) of the Families First Coronavirus Response 
        Act, is amended--
                    (A) in the paragraph header, by inserting ``a 
                covid-19 vaccine,'' before ``or pregnancy-related 
                assistance''; and
                    (B) by striking ``visits described in section 
                1916(a)(2)(G), or'' and inserting ``services described 
                in section 1916(a)(2)(G), vaccines described in section 
                1916(a)(2)(H), or''.

SEC. 103. INCLUSION OF FEDERALLY FUNDED COVID-19 VACCINES UNDER 
              MEDICAID DRUG REBATE PROGRAM; COVERAGE OF COVID-19 
              VACCINES UNDER STATE PEDIATRIC VACCINE DISTRIBUTION 
              PROGRAM.

    (a) Inclusion in Medicaid Drug Rebate Program.--
            (1) In general.--Section 1927 of the Social Security Act 
        (42 U.S.C. 1396r-8) is amended--
                    (A) in subsection (b)(1)(A), by inserting ``(or, in 
                the case of an applicable COVID-19 vaccine administered 
                after July 1, 2020, an amount specified in subsection 
                (l))'' after ``1990'';
                    (B) in subsection (k)--
                            (i) in paragraph (2)--
                                    (I) in subparagraph (B)--
                                            (aa) in the matter 
                                        preceding clause (i), by 
                                        inserting ``(except in the case 
                                        of an applicable COVID-19 
                                        vaccine)'' after ``other than a 
                                        vaccine''; and
                                            (bb) in clause (iii), by 
                                        striking ``; and'' and 
                                        inserting a semicolon;
                                    (II) in subparagraph (C), by 
                                striking the period at the end and 
                                inserting ``; and''; and
                                    (III) by adding at the end the 
                                following new subparagraph:
                    ``(D) an applicable COVID-19 vaccine.''; and
                            (ii) by adding at the end the following new 
                        paragraph:
            ``(12) Applicable covid-19 vaccine.--The term `applicable 
        COVID-19 vaccine' has the meaning given such term in section 
        1833(dd)(2).''; and
                    (C) by adding at the end the following new 
                subsection:
    ``(l) Determination of Amount of Rebate for Applicable COVID-19 
Vaccines.--
            ``(1) In general.--The amount of the rebate specified in 
        this subsection for a rebate period with respect to an 
        applicable COVID-19 vaccine shall be equal to the product of--
                    ``(A) the total number of units of the vaccine paid 
                for under the State plan in the rebate period (as 
                reported by the State); and
                    ``(B) the difference between the average 
                manufacturer price and the inflation-adjusted Federal 
                procurement price (as defined in paragraph (2)) for the 
                vaccine.
            ``(2) Inflation-adjusted federal procurement price.--For 
        purposes of this section, the term `inflation-adjusted Federal 
        procurement price' means, with respect to an applicable COVID-
        19 vaccine and a rebate period--
                    ``(A) for rebate periods occurring during the first 
                12-month period that such vaccine is provided to State 
                plans under this title, the amount specified for the 
                vaccine under section 1833(dd)(3); and
                    ``(B) for rebate periods occurring after such 12-
                month period--
                            ``(i) the amount specified for the vaccine 
                        under section 1833(dd)(3); increased by
                            ``(ii) the percentage by which the consumer 
                        price index for all urban consumers (United 
                        States city average) for the month before the 
                        month in which the rebate period begins exceeds 
                        such index for the month in which such 12-month 
                        period begins.
            ``(3) Exceptions.--No rebate shall be payable with respect 
        to an applicable COVID-19 vaccine of a manufacturer and a 
        rebate period occurring after the 12-month period described in 
        paragraph (2)(A) if the Secretary determines that an exception 
        described in section 1833(dd)(5)(B) applies with respect to the 
        vaccine for the rebate period.''.
            (2) Prohibition on prior authorization.--Section 
        1927(d)(1)(A) of the Social Security Act (42 U.S.C. 1396r-
        8(d)(1)(A)) is amended by inserting ``other than an applicable 
        COVID-19 vaccine'' after ``covered outpatient drug''.
            (3) No exclusion of applicable covid-19 vaccines.--Section 
        1927(d)(7) of the Social Security Act (42 U.S.C. 1396r-8(d)(7)) 
        is amended by adding at the end the following:
            ``(D) Applicable COVID-19 vaccines.''.
    (b) Ensuring Coverage and Affordability Under State Pediatric 
Vaccine Distribution Program.--Section 1928 of the Social Security Act 
(42 U.S.C. 1396s) is amended--
            (1) in subsection (a)(1)--
                    (A) in subparagraph (A), by striking ``; and'' and 
                inserting a semicolon;
                    (B) in subparagraph (B), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following 
                subparagraph:
                    ``(C) each vaccine-eligible child (as defined in 
                subsection (b)) is entitled to receive a COVID-19 
                vaccine from a program-registered provider without 
                charge for--
                            ``(i) the cost of such vaccine; or
                            ``(ii) the administration of such 
                        vaccine.'';
            (2) in subsection (c)(2), by adding at the end the 
        following subparagraph:
                    ``(D) The provider will provide and administer a 
                COVID-19 vaccine to a vaccine-eligible child in 
                accordance with the same requirements as the 
                requirements that apply under the preceding 
                subparagraphs to the provision and administration of a 
                qualified pediatric vaccine to such a child.'';
            (3) in subsection (d)(3), by adding at the end the 
        following new subparagraph:
                    ``(D) Limitation on price increases for applicable 
                covid-19 vaccines.--
                            ``(i) In general.--Subject to clause (ii), 
                        with respect to any contract entered into under 
                        this subsection for an applicable COVID-19 
                        vaccine after the first such contract entered 
                        into with respect to such vaccine, no price for 
                        the purchase of such vaccine for vaccine-
                        eligible children shall be agreed to by the 
                        Secretary under this subsection if the price 
                        per dose of such vaccine (including any 
                        delivery costs and any applicable excise tax 
                        established under section 4131 of the Internal 
                        Revenue Code of 1986) exceeds--
                                    ``(I) the price per dose for the 
                                vaccine in effect under the first 
                                contract entered into under this 
                                subsection for the purchase of such 
                                vaccine; increased by
                                    ``(II) the percentage increase in 
                                the consumer price index for all urban 
                                consumers (all items; United States 
                                city average) from the month before 
                                such first contract is entered into to 
                                the month before the month in which the 
                                contract involved is entered into.
                            ``(ii) Exception.--The limitation described 
                        in clause (i) shall not apply with respect to 
                        an applicable COVID-19 vaccine and a contract 
                        if the Secretary determines that an exception 
                        described in section 1833(dd)(5)(B) applies 
                        with respect to the vaccine for the contract 
                        period.''; and
            (4) in subsection (h), by adding at the end the following 
        new paragraph:
            ``(10) COVID-19 vaccine; applicable covid-19 vaccine.--
                    ``(A) COVID-19 vaccine.--The term `COVID-19 
                vaccine' means a COVID-19 vaccine licensed under 
                section 351 of the Public Health Service Act, or 
                approved or authorized under section 505 or 564 of the 
                Federal Food, Drug, and Cosmetic Act, provided that 
                such vaccine is included on the list under subsection 
                (e).
                    ``(B) Applicable covid-19 vaccine.--The term 
                `applicable COVID-19 vaccine' means a vaccine described 
                in section 1833(dd)(2), provided that such vaccine is 
                included on the list under subsection (e).''.
    (c) Effective Date.--The amendments made by this section take 
effect on the date of enactment of this Act and apply to rebate 
agreements entered into on or after such date without regard to whether 
final regulations to carry out such amendments have been promulgated as 
of such date.

SEC. 104. TEMPORARY ENHANCED FEDERAL MATCH FOR MEDICAL ASSISTANCE FOR 
              COVID-19 VACCINES.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (b), by striking ``and (ff)'' and 
        inserting ``(ff), and (gg)''; and
            (2) by adding at the end the following new subsection:
    ``(gg) Temporary Enhanced Federal Match for COVID-19 Vaccine and 
Administration.--
            ``(1) In general.--Notwithstanding subsection (b), with 
        respect to medical assistance for vaccines and the 
        administration of vaccines described in subsection (a)(4)(E) 
        that is furnished during the period described in paragraph (2), 
        the Federal medical assistance percentage for a State shall be 
        equal to 100 percent.
            ``(2) Period described.--The period described in this 
        paragraph is the period that--
                    ``(A) begins with the date of enactment of this 
                subsection; and
                    ``(B) ends with the date that is 1 year after the 
                last day of the emergency period defined in paragraph 
                (1)(B) of section 1135(g).''.
    (b) Exclusion From Territorial Caps.--Section 1108 of the Social 
Security Act (42 U.S.C. 1308) is amended--
            (1) in subsection (f), in the matter preceding paragraph 
        (1), by striking ``subsection (g) and section 1935(e)(1)(B)'' 
        and inserting ``subsections (g) and (h) and section 
        1935(e)(1)(B)''; and
            (2) by adding at the end the following:
    ``(h) Exclusion From Caps of Amounts Attributable to Certain 
Increased FMAP.--Any payment made to a territory for a fiscal year in 
which the Federal medical assistance percentage for the territory is 
determined under section 1905(gg) shall not be taken into account for 
purposes of applying payment limits under subsections (f) and (g) to 
the extent that such payment exceeds the amount of the payment that 
would have been made to the territory for the year if the Federal 
medical assistance percentage for the territory had been determined 
without regard to such section.''.

               TITLE II--ENSURING COVERAGE UNDER MEDICAID

SEC. 201. INCREASED FMAP FOR MEDICAL ASSISTANCE TO NEWLY ELIGIBLE 
              INDIVIDUALS.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (y)(1)--
                    (A) in subparagraph (A), by striking ``2014, 2015, 
                and 2016'' and inserting ``each of the first 3 
                consecutive 12-month periods in which the State 
                provides medical assistance to newly eligible 
                individuals'';
                    (B) in subparagraph (B), by striking ``2017'' and 
                inserting ``the fourth consecutive 12-month period in 
                which the State provides medical assistance to newly 
                eligible individuals'';
                    (C) in subparagraph (C), by striking ``2018'' and 
                inserting ``the fifth consecutive 12-month period in 
                which the State provides medical assistance to newly 
                eligible individuals'';
                    (D) in subparagraph (D), by striking ``2019'' and 
                inserting ``the sixth consecutive 12-month period in 
                which the State provides medical assistance to newly 
                eligible individuals''; and
                    (E) in subparagraph (E), by striking ``2020 and 
                each year thereafter'' and inserting ``the seventh 
                consecutive 12-month period in which the State provides 
                medical assistance to newly eligible individuals and 
                each such period thereafter''; and
            (2) in subsection (z)(2)(B)(i)(II), by inserting ``(as in 
        effect on the day before the enactment of the Vaccine And 
        Coverage Certainty Act)'' after ``subsection (y)(1)''.
    (b) Retroactive Application.--The amendments made by subsection 
(a)(1) shall take effect as if included in the enactment of Public Law 
111-148 and shall apply to amounts expended by any State for medical 
assistance for newly eligible individuals described in subclause (VIII) 
of section 1902(a)(10)(A)(i) of the Social Security Act under a State 
Medicaid plan (or a waiver of such plan) during the period before the 
date of enactment of this Act.

SEC. 202. MEDICAID COVERAGE FOR CITIZENS OF FREELY ASSOCIATED STATES.

    (a) In General.--Section 402(b)(2) of the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(b)(2)) 
is amended by adding at the end the following new subparagraph:
                    ``(G) Medicaid exception for citizens of freely 
                associated states.--With respect to eligibility for 
                benefits for the designated Federal program defined in 
                paragraph (3)(C) (relating to the Medicaid program), 
                section 401(a) and paragraph (1) shall not apply to any 
                individual who lawfully resides in 1 of the 50 States 
                or the District of Columbia in accordance with the 
                Compacts of Free Association between the Government of 
                the United States and the Governments of the Federated 
                States of Micronesia, the Republic of the Marshall 
                Islands, and the Republic of Palau and shall not apply, 
                at the option of the Governor of Puerto Rico, the 
                Virgin Islands, Guam, the Northern Mariana Islands, or 
                American Samoa as communicated to the Secretary of 
                Health and Human Services in writing, to any individual 
                who lawfully resides in the respective territory in 
                accordance with such Compacts.''.
    (b) Exception to 5-Year Limited Eligibility.--Section 403(d) of 
such Act (8 U.S.C. 1613(d)) is amended--
            (1) in paragraph (1), by striking ``or'' at the end;
            (2) in paragraph (2), by striking the period at the end and 
        inserting ``; or''; and
            (3) by adding at the end the following new paragraph:
            ``(3) an individual described in section 402(b)(2)(G), but 
        only with respect to the designated Federal program defined in 
        section 402(b)(3)(C).''.
    (c) 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 and 
        inserting a comma;
            (2) in paragraph (7), by striking the period at the end and 
        inserting ``, or''; and
            (3) by adding at the end the following new paragraph:
            ``(8) an individual who lawfully resides in 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 designated Federal program defined in section 402(b)(3)(C) 
        (relating to the Medicaid program).''.
    (d) Application to State Plans.--Section 1902(a)(10)(A)(i) of the 
Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)) is amended by 
inserting after subclause (IX) the following:
                                    ``(X) who are described in section 
                                402(b)(2)(G) of the Personal 
                                Responsibility and Work Opportunity 
                                Reconciliation Act of 1996 and eligible 
                                for benefits under this title by reason 
                                of application of such section;''.
    (e) Conforming Amendments.--Section 1108 of the Social Security Act 
(42 U.S.C. 1308), as amended by section 104, is amended--
            (1) in subsection (f), in the matter preceding paragraph 
        (1), by striking ``subsections (g) and (h)'' and inserting 
        ``subsections (g), (h), and (i)''; and
            (2) by adding at the end the following:
    ``(i) Exclusion of Medical Assistance Expenditures for Citizens of 
Freely Associated States.--Expenditures for medical assistance provided 
to an individual described in section 431(b)(8) of the Personal 
Responsibility and Work Opportunity Reconciliation Act of 1996 (8 
U.S.C. 1641(b)(8)) shall not be taken into account for purposes of 
applying payment limits under subsections (f) and (g).''.
    (f) Effective Date.--The amendments made by this section shall 
apply to benefits for items and services furnished on or after the date 
of the enactment of this Act.

            TITLE III--ENSURING COVERAGE IN THE MARKETPLACE

SEC. 301. DISREGARD OF ADDITIONAL UNEMPLOYMENT COMPENSATION FOR 
              PURPOSES OF PREMIUM TAX CREDIT AND COST-SHARING 
              SUBSIDIES.

    (a) In General.--Section 36B(d)(2)(B) of the Internal Revenue Code 
of 1986 is amended--
            (1) by redesignating clauses (i), (ii), and (iii) as 
        subclauses (I), (II), and (III), respectively, and by moving 
        such subclauses 2 ems to the right;
            (2) by striking ``adjusted gross income increased by'' and 
        inserting ``adjusted gross income--
                            ``(i) decreased by the amount of any 
                        Federal pandemic unemployment compensation paid 
                        to an individual under section 2104 of division 
                        A of the CARES Act during the taxable year; and
                            ``(ii) increased by--''; and
            (3) by adding at the end the following new flush sentence:
``Clause (i) shall not apply to the extent that such decrease results 
in a household income for the taxpayer which is less than 100 percent 
of the poverty line for a family of the size involved.''.
    (b) Temporary Suspension of Recapture of Excess Advance Payments.--
Section 36B(f)(2) of the Internal Revenue Code of 1986 is amended by 
adding at the end the following new subparagraph:
                    ``(C) Special rule for 2020 and 2021.--Subparagraph 
                (A) shall not apply to any taxable year beginning in 
                2020 or 2021.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2019.
                                 <all>