Sec. 760. Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities
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Section 1902(e) of the Social Security Act ( 42 U.S.C. 1396a(e) ) is amended by adding at the end the following: The State plan shall provide for the automatic enrollment or reinstatement of enrollment of an eligible individual— if such individual is scheduled to be released from a public institution due to the completion of sentence, not less than 30 days prior to the scheduled date of the release; and if such individual is to be released from a public institution on parole or on probation, as soon as possible after the date on which the determination to release such individual was made, and before the date such individual is released.
If a State makes a determination that an individual is not eligible to be enrolled under the State plan— on or before the date by which the individual would be enrolled under clause (i), such clause shall not apply to such individual; or after such date, the State may terminate the enrollment of such individual. Subject to subparagraph (A)(ii), an eligible individual who is enrolled, or whose enrollment is reinstated, under subparagraph
(A)shall be eligible for medical assistance that is provided after the date that the eligible individual is released from the public institution. No provision of this paragraph may be construed to permit payment for care or services for which payment is excluded under the subdivision
(A)that follows paragraph
(29)of section 1905(a). Any period of continuous eligibility under this title shall be suspended on the date an individual enrolled under this title becomes an inmate of a public institution (except as a patient of a medical institution). Notwithstanding any changes to State law related to continuous eligibility during the time that an individual is an inmate of a public institution (except as a patient of a medical institution), subject to clause (iii), with respect to an eligible individual who was subject to a suspension under clause (i), on the date that such individual is released from a public institution the suspension of continuous eligibility under such clause shall be lifted for a period that is equal to the time remaining in the period of continuous eligibility for such individual on the date that such period was suspended under such clause. If a State makes a determination that an individual is not eligible to be enrolled under the State plan— on or before the date that the suspension of continuous eligibility is lifted under clause (ii), such clause shall not apply to such individual; or after such date, the State may terminate the enrollment of such individual. For purposes of this paragraph, the term automatic enrollment or reinstatement of enrollment means that the State determines eligibility for medical assistance under the State plan without a program application from, or on behalf of, the eligible individual, but an individual can only be automatically enrolled in the State Medicaid plan if the individual affirmatively consents to being enrolled through affirmation in writing, by telephone, orally, through electronic signature, or through any other means specified by the Secretary. For purposes of this paragraph, the term eligible individual means an individual who is an inmate of a public institution (except as a patient in a medical institution)— who was enrolled under the State plan for medical assistance immediately before becoming an inmate of such an institution; or is diagnosed with human immunodeficiency virus. . Subject to paragraph (6), for each State for which the Secretary of Health and Human Services has approved an application under paragraph (3), the Federal matching payments (including payments based on the Federal medical assistance percentage) made to such State under section 1903 of the Social Security Act (42 U.S.C. 1396b) shall be increased by 5.0 percentage points for payments to the State for the activities permitted under paragraph
(2)or a period of one year. A State may only use increased matching payments authorized under paragraph (1)— to strengthen the State’s enrollment and administrative resources for the purpose of improving processes for enrolling (or reinstating the enrollment of) eligible individuals (as such term is defined in subparagraph
(E)of paragraph
(15)of section 1902(e) of the Social Security Act (as amended by subsection (a))); and for medical assistance (as such term is defined in section 1905(a) of the Social Security Act) provided to such eligible individuals. The Secretary may only make payments to a State in the increased amount if— the State has amended the State plan under section 1902(e) of the Social Security Act to incorporate the requirements of paragraph
(15)of such section (as added by subsection (a)); the State has submitted an application to the Secretary that includes a plan for implementing the requirements of section 1902(e)(15) of the Social Security Act under the State’s amended State plan before the end of the 90-day period beginning on the date that the State receives increased matching payments under paragraph (1); the State’s application meets the satisfaction of the Secretary; and the State enters an agreement with the Secretary that states that— the State will only use the increased matching funds for the uses permitted under paragraph (2); and at the end of the period under paragraph (1), the State will submit to the Secretary, and make publicly available, a report that contains the information required under paragraph (4). The information that is required in the report under paragraph (3)(D)(ii) includes— the results of an evaluation of the impact of the implementation of the requirements of section 1902(e)(15) of the Social Security Act on improving the State’s processes for enrolling of individuals who are released from public institutions into the Medicaid program; the number of individuals who were automatically enrolled (or whose enrollment is reinstated) under such section 1902(e)(15) during the period under paragraph (1); and any other information that is required by the Secretary. Subject to paragraph (6), the amounts otherwise determined for Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa under subsections
(f)and
(g)of section 1108 of the Social Security Act ( 42 U.S.C. 1308 ) shall each be increased by the necessary amount to allow for the increase in the Federal matching payments under paragraph (1), but only for the period under such paragraph for such State. In the case of such an increase for a territory, subsection (a)(1) of such section 1108 shall be applied without regard to any increase in payment made to the territory under part E of title IV of such Act that is attributable to the increase in Federal medical assistance percentage effected under paragraph
(1)for the territory. With respect to a State, at the end of the period under paragraph (1), no increased matching payments may be made to such State under this subsection. Subject to clause (ii), a State is not eligible for an increase in its Federal matching payments under paragraph (1), or an increase in a cap amount under paragraph (5), if eligibility standards, methodologies, or procedures under its State plan under title XIX of the Social Security Act (including any waiver under such title or under section 1115 of such Act ( 42 U.S.C. 1315 )) are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan (or waiver) as in effect on the date of enactment of this Act. A State that has restricted eligibility standards, methodologies, or procedures under its State plan under title XIX of the Social Security Act (including any waiver under such title or under section 1115 of such Act ( 42 U.S.C. 1315 )) after the date of enactment of this Act, is no longer ineligible under subparagraph
(A)beginning with the first calendar quarter in which the State has reinstated eligibility standards, methodologies, or procedures that are no more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan (or waiver) as in effect on such date. The Secretary may not waive the application of this subsection under section 1115 of the Social Security Act or otherwise. In no case shall an increase in Federal matching payments under this subsection result in Federal matching payments that exceed 100 percent. Except as provided in paragraph (2), the amendments made by subsection
(a)shall take effect 180 days after the date of the enactment of this Act and shall apply to services furnished on or after such date. In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
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Sec. 760
Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities
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