Sec. 115. Safety net funding for non-expansion States
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Title XIX of the Social Security Act is amended by inserting after section 1923 ( 42 U.S.C. 1396r–4 ) the following new section: Subject to the limitations of this section, for each year during the period beginning with fiscal year 2018 and ending with fiscal year 2022, each State that is one of the 50 States or the District of Columbia and that, as of July 1 of the preceding fiscal year, did not provide for eligibility under clause (i)(VIII) or (ii)(XX) of section 1902(a)(10)(A) for medical assistance under this title (or a waiver of the State plan approved under section 1115) (each such State or District referred to in this section for the fiscal year as a non-expansion State ) may adjust the payment amounts otherwise provided under the State plan under this title (or a waiver of such plan) to health care providers that provide health care services to individuals enrolled under this title (in this section referred to as eligible providers ) so long as the payment adjustment to such an eligible provider does not exceed the provider’s costs in furnishing health care services (as determined by the Secretary and net of payments under this title, other than under this section, and by uninsured patients) to individuals who either are eligible for medical assistance under the State plan (or under a waiver of such plan) or have no health insurance or health plan coverage for such services.
Notwithstanding section 1905(b), the Federal medical assistance percentage applicable with respect to expenditures attributable to a payment adjustment under subsection
(a)for which payment is permitted under subsection
(c)shall be equal to— 100 percent for calendar quarters in fiscal years 2018, 2019, 2020, and 2021; and 95 percent for calendar quarters in fiscal year 2022. Payment under section 1903(a) shall not be made to a State with respect to any payment adjustment made under this section for all calendar quarters in a fiscal year in excess of the $2,000,000,000 multiplied by the ratio of— the population of the State with income below 138 percent of the poverty line in 2015 (as determined based the table entitled Health Insurance Coverage Status and Type by Ratio of Income to Poverty Level in the Past 12 Months by Age for the universe of the civilian noninstitutionalized population for whom poverty status is determined based on the 2015 American Community Survey 1–Year Estimates, as published by the Bureau of the Census), to the sum of the populations under paragraph
(1)for all non-expansion States. If a State is a non-expansion for a fiscal year and provides eligibility for medical assistance described in subsection
(a)during the fiscal year, the State shall no longer be treated as a non-expansion State under this section for any subsequent fiscal years. .
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- 42 USC 1396r–4
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Sec. 115
Safety net funding for non-expansion States
Cite42 USC 1396r–4
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