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Q: SECTION 1. SHORT TITLE.

This Act may be cited as the ''Equitable Federal Medical Assistance
Percentage Act of 1999''.

SEC. 2. EQUITABLE DETERMINATION OF FEDERAL MEDICAL ASSISTANCE
PERCENTAGE.

(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended by adding at the end the following:
''(v) Determination of Equitable Federal Medical Assistance
Percentage.--
''(1) In general.--Except as provided in paragraph (4), the
equitable Federal medical assistance percentage determined
under this subsection is, for any State for a fiscal year, 100
percent reduced by the product of 0.45 and the ratio of--
''(A) the State's share of cost-adjusted total
taxable resources determined under paragraph (2); to
''(B) the State's share of program need determined
under paragraph (3).
''(2) Determination of state's share of cost-adjusted total
taxable resources.--
''(A) In general.--For purposes of paragraph
(1)(A), with respect to a State, the State's share of
cost-adjusted total taxable resources is the ratio of--
''(i)(I) an amount equal to the most recent
3-year average of the total taxable resources
(TTR) of the State, as determined by the
Secretary of the Treasury; divided by
''(II) the most recent 3-year average of
the State's geographic health care cost index
(as determined under subparagraph (B)); to
''(ii) an amount equal to the sum of the
amounts determined under clause (i) for all
States.
''(B) State's geographic health care cost index.--
''(i) In general.--For purposes of
subparagraph (A)(i)(II), the geographic health
care cost index for a State for a fiscal year
is the sum of--
''(I) 0.10;
''(II) 0.75 multiplied by the ratio
of--
''(aa) the most recent 3-
year average annual wages for
hospital employees in the State
or the District of Columbia (as
determined under clause (ii));
to
''(bb) the most recent 3-
year average annual wages for
hospital employees in the 50
States and the District of
Columbia (as determined under
that clause); and
''(III) 0.15 multiplied by the
State's fair market rent index (as
determined under clause (iii)).
''(ii) Determination of average annual
wages of hospital employees.--The Secretary
shall provide for the determination of the most
recent 3-year average annual wages for hospital
employees in a State or the District of
Columbia and, collectively, in the 50 States
and the District of Columbia, based on the area
wage data applicable to hospitals under section
1886(d)(3)(E) (or, if such data no longer
exists, comparable data of hospital wages) for
discharges occurring during the fiscal years
involved.
''(iii) Determination of fair market rent
index.--For purposes of clause (i)(III), a
State's fair market rent index is the ratio
of--
''(I) the average annual fair
market rent for 2-bedroom housing units
in the State or the District of
Columbia, to be determined by the
Secretary of Housing and Urban
Development for the most recent 3
fiscal years for which data are
available; to
''(II) the average annual fair
market rent for such housing units for
all States for such 3 fiscal years, as
so determined.
''(3) Determination of state's share of program need.--
''(A) In general.--For purposes of paragraph
(1)(B), with respect to a State, the State's share of
program need is the ratio of--
''(i) the State's program need determined
under subparagraph (B); to
''(ii) the sum of the amounts determined
under clause (i) for all States.
''(B) Determination of state program need.--
''(i) In general.--For purposes of
subparagraph (A)(i), a State's program need is
equal to the average (determined for the most
recent 5 fiscal years for which data are
available) of the sum of the products
determined under clause (iv) for each such
fiscal year (based on the number of State
residents whose income is below the State's
cost-of-living adjusted poverty income level (as determined under
clauses (ii) and (iii)).
''(ii) Determination of number of state
residents with incomes below the State's cost-
of-living adjusted poverty level.--
''(I) In general.--For purposes of
clause (iv), with respect to each State
and the District of Columbia, the
number of residents whose income for a
fiscal year is below the State's cost-
of-living adjusted poverty income level
applicable to a family of the size
involved (as determined under clause
(iii)) shall be determined.
''(II) Census data.--The
determination of the number of
residents under subclause (I) shall be
based on data made generally available
by the Bureau of the Census from the
Current Population Survey.
''(iii) Determination of state's cost-of-
living adjusted poverty income level.--
''(I) In general.--For purposes of
clause (ii)(I), a State's cost-of-
living adjusted poverty income level is
the product of--
''(aa) the United States
poverty income threshold for
the fiscal year involved (as
defined by the Office of
Management and Budget for
general statistical purposes);
and
''(bb) the State's cost-of-
living index (as determined
under subclause (II)).
''(II) Determination of state's
cost-of-living index.--Subject to
subclause (III), a State's cost-of-
living index is the sum of--
''(aa) 0.56; and
''(bb) the product of 0.44
and the State's fair market
rent index determined under
paragraph (2)(B)(iii).
''(III) Alternate methodology.--The
Commissioner of Labor Statistics may
use an alternate methodology to the
formula set forth under subclause (II)
to determine a State's cost-of-living
index for purposes of subclause (I)(bb)
if the Commissioner determines that the
alternate methodology results in a more
accurate determination of that index.
''(iv) Weighting of age categories of
residents in poverty to account for higher cost
populations.--For purposes of clause (i), the
products determined under this clause for a
fiscal year are the following:
''(I) Weighting of elderly
residents in poverty.--The number of
residents determined under clause (ii)
of the State or the District of
Columbia for the fiscal year who have
attained age 65 multiplied by 3.65.
''(II) Weighting of adult residents
in poverty.--The number of residents
determined under clause (ii) of the
State or the District of Columbia for
the fiscal year who have attained age
21 but have not attained age 65
multiplied by 1.0.
''(III) Weighting of children in
poverty.--The number of residents
determined under clause (ii) of the
State or the District of Columbia for
the fiscal year who have not attained
age 21 multiplied by 0.5.
''(4) Special rules.--For purposes of this subsection and
subsection (b), the equitable Federal medical assistance
percentage is--
''(A) in the case of the District of Columbia, the
percentage determined under this subsection for the
District of Columbia (without regard to this paragraph)
multiplied by 1.4.; and
''(B) in the case of Alaska, 59.8 percent.''.
(b) Conforming Amendments.--Section 1905(b) of the Social Security
Act (42 U.S.C. 1396d(b)) is amended--
(1) in the matter preceding paragraph (1), by striking
''100 per centum'' and all that follows through ''Hawaii'' and
inserting ''the equitable Federal medical assistance percentage
determined under subsection (v)'';
(2) in paragraph (1), by striking ''50 per centum or more
than 83 per centum,,'' and inserting ''50 percent or more than
83 percent, and''; and
(3) in paragraph (2), by striking ''50 per centum'' and all
that follows through the period at the end of paragraph (3) and
inserting ''50 percent.''.
(c) Effective Date.--The amendments made by this Act take effect on
October 1, 1999.
A:
Equitable Federal Medical Assistance Percentage Act of 1999 - Amends title XIX (Medicaid) of the Social Security Act to provide for the stated purpose of determining an equitable Federal medical assistance percentage for use under Medicaid.