I 118th CONGRESS 2d Session H. R. 8327 IN THE HOUSE OF REPRESENTATIVES May 8, 2024 Mr. Sablan (for himself, Mr. Moylan , and Mrs. Radewagen ) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XI of the Social Security Act to provide for the redistribution of unused territorial cap amounts under the Medicaid program.

1. Short title This Act may be cited as the Ensuring Medicaid Continuity for the Insular Areas Act of 2024 . 2. Providing for the redistribution of unused territorial cap amounts under the Medicaid program Section 1108(g) of the Social Security Act ( 42 U.S.C. 1308(g) ) is amended by adding at the end the following new paragraph: (14) Procedure for redistribution of unused amounts (A) In general For each fiscal year (beginning with fiscal year 2022), in the case that there is at least 1 specified territory (as defined in subparagraph (D)) with unused amounts (as so defined) with respect to such fiscal year, the Secretary shall determine an appropriate procedure, with respect to each territory that is a shortfall territory (as so defined) for such fiscal year, to increase the limit otherwise determined under this subsection on the amount certified by the Secretary under title XIX for payment to such territory by the amount specified in subparagraph (B). (B) Amount specified (i) In general For purposes of subsection (A), the amount specified in this subparagraph is, with respect to a shortfall territory and a fiscal year— (I) in the case the aggregate unused amounts for such fiscal year for all specified territories are greater than the aggregate shortfall amounts for such fiscal year for all such territories, the difference between the amount that would have been certified by the Secretary under title XIX for payment to such shortfall territory for such fiscal year without application of this paragraph and the amount of payment that such territory would have received under title XIX had this section not applied; and (II) in the case the aggregate unused amounts for such fiscal year for all specified territories are less than the aggregate shortfall amounts for such fiscal year for all such territories, an amount that bears the same ratio to such aggregate unused amounts as such shortfall territory’s shortfall amount bears to such aggregate shortfall amounts. (ii) Retrospective adjustment The Secretary may adjust any increases made under this paragraph for a fiscal year as necessary on the basis of information reported by specified territories not later than November 30 of the succeeding fiscal year, as determined appropriate by the Secretary. (C) Nonapplication of increase to future fiscal years Any increase in the limit described in subparagraph (A) of a specified territory for a fiscal year shall not be taken into account in determining such limit for such territory in the succeeding fiscal year. (D) Definitions In this paragraph: (i) Shortfall amount The term shortfall amount means, with respect to a specified territory that, but for the limit on the amount certified by the Secretary under title XIX for payment to such territories for a fiscal year established under this section, would have received payment under title XIX for such fiscal year in an amount exceeding such limit, the amount of such excess. (ii) Shortfall territory The term shortfall territory means, with respect to a fiscal year, a specified territory with respect to which the amount that would be payable to such territory under title XIX for such year, without application of this section, exceeds the limit on the amount certified by the Secretary under title XIX for payment to such territory for such year established under this section (without application of this paragraph). (iii) Specified territory The term specified territory means the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. (iv) Unused amount The term unused amount means, with respect to a specified territory that was subject to a limit on the amount certified by the Secretary under title XIX for payment to such territory for a fiscal year established under this section but for which the Secretary so certified an amount for such fiscal year that was lower than such limit, the difference between such amount and such limit. .