I 119th CONGRESS 1st Session H. R. 3321 IN THE HOUSE OF REPRESENTATIVES May 9, 2025 Mr. Roy (for himself, Mr. Fitzgerald , Mr. Gill of Texas , Mr. Ogles , Mrs. Spartz , Mr. Donalds , Mr. Cloud , Mr. Harris of Maryland , Ms. Boebert , Mr. Self , Mr. Higgins of Louisiana , Mr. Brecheen , Mr. Perry , Mr. Gosar , Mr. Tiffany , and Mr. Biggs of Arizona ) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XIX of the Social Security Act to phase out the enhanced Federal match applicable to medical assistance provided to low-income adults.

1. Short title This Act may be cited as the Ending Medicaid Discrimination Against the Most Vulnerable Act . 2. Phase-out of enhanced Federal match for medical assistance provided to low-income individuals under Medicaid (a) In general Section 1905(y) of the Social Security Act ( 42 U.S.C. 1396d(y) ) is amended— (1) in paragraph (1)— (A) in subparagraph (A), by inserting and subject to paragraph (4) after Notwithstanding subsection (b) ; (B) in subparagraph (D), by striking ; and and inserting a semicolon; (C) in subparagraph (E), by striking and each year thereafter. and inserting through 2026; ; and (D) by adding at the end the following new subparagraphs: (F) for calendar quarters in each of calendar years 2027 through 2034, the percentage that applied under this subsection for calendar quarters in the preceding calendar year minus the applicable number of percentage points determined for the State under paragraph (3) or, if higher, the Federal medical assistance percentage otherwise determined for the State and year under subsection (b) (without regard to this subsection); and (G) for calendar quarters in 2035 and each year thereafter, the Federal medical assistance percentage otherwise determined for the State and year under subsection (b) (without regard to this subsection). ; and (2) by adding at the end the following new paragraphs: (3) Applicable number of percentage points For purposes of paragraph (1)(F), the applicable number of percentage points for a State is the number of percentage points equal to— (A) the percentage points difference between— (i) 90 percent; and (ii) the Federal medical assistance percentage determined for the State under subsection (b) (without regard to this subsection) for fiscal year 2026; divided by (B) 8. (4) Rules of application for calendar years after 2024 (A) In general Notwithstanding any other provision of law, for calendar years after 2024— (i) paragraph (1) shall not apply to a non-expansion State (as defined in subparagraph (B)); (ii) if a non-expansion State elects on or after the date of enactment of this paragraph to expend amounts for all or any individuals described in section 1902(a)(10)(A)(i)(VIII), the Federal medical assistance percentage otherwise determined for the State and year under subsection (b) (without regard to this subsection) shall apply to amounts expended by such State for medical assistance for such individuals; and (iii) an expansion State (as defined in such subparagraph) may, at the option of the State, elect to only expend amounts for medical assistance for newly eligible individuals described in section 1902(a)(10)(A)(i)(VIII) whose income does not exceed 100 percent of the Federal poverty line (as defined for purposes of such section) and continue to receive the Federal medical assistance percentage specified under paragraph (1) for such amounts. (B) Definitions In this paragraph: (i) Expansion State The term expansion State means a State that is not a non-expansion State. (ii) Non-expansion State The term non-expansion State means a State that has not expended amounts for all individuals described in section 1902(a)(10)(A)(i)(VIII) before the date of the enactment of this paragraph. . (b) Eliminating temporary FMAP increase for States that begin To provide medical assistance for low-Income adults Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ) is amended by striking subsection (ii).