Sec. 204. Continued coverage of institutional long-term care and other services under Medicaid
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Title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ) is amended by inserting the following section after section 1948: For quarters beginning on or after the date on which benefits are first available under section 106(a) of the Medicare for All Act , notwithstanding any other provision of this title— a State plan for medical assistance shall provide for making medical assistance available for institutional long-term care services in a manner consistent with this section; and no payment to a State shall be made under this title with respect to expenditures incurred by the State in providing medical assistance on or after such date for services that are not— institutional long-term care services; or other services for which benefits are not available under the Medicare for All Act and which are furnished under a State plan for medical assistance which provided for medical assistance for such services on March 1, 2025.
In this section, the term institutional long-term care services means the following: Nursing facility services for individuals 21 years of age or over described in subparagraph
(A)of section 1905(a)(4). Inpatient services for individuals 65 years of age or over provided in an institution for mental disease described in section 1905(a)(14). Intermediate care facility services described in section 1905(a)(15). Inpatient psychiatric hospital services for individuals under age 21 described in section 1905(a)(16). Nursing facility services described in section 1905(a)(31). Beginning on the date described in subsection (a), no payment may be made under section 1903 with respect to medical assistance provided under a State plan for medical assistance if the State adopts income, resource, or other standards and methodologies for purposes of determining an individual's eligibility for medical assistance under the State plan that are more restrictive than those applied as of January 1, 2025. In determining whether a State has adopted income or resource standards that are more restrictive than the standards which applied as of January 1, 2025, the Secretary shall deem the amount of any such standard that was applied as of such date to be increased by the percentage increase in the medical care component of the consumer price index for all urban consumers (U.S. city average) from September of 2022 to September of the fiscal year for which the Secretary is making such determination. For each fiscal year or portion of a fiscal year that occurs during the period that begins on the first day of the first fiscal quarter that begins on or after the date on which benefits are first available under section 106(a) of the Medicare for All Act , as a condition of receiving payments under section 1903(a), a State shall make expenditures for medical assistance for institutional long-term care services in an amount that is not less than the expenditure floor determined for the State and fiscal year (or portion of a fiscal year) under subparagraph (B). For each fiscal year or portion of a fiscal year described in subparagraph (A), the Secretary shall determine for each State an expenditure floor that shall be equal to— the amount of the State's expenditures for fiscal year 2024 on medical assistance for institutional long-term care services; increased by the growth factor determined under subclause (ii). For each fiscal year or portion of a fiscal year described in subparagraph (A), the Secretary shall, not later than September 1 of the fiscal year preceding such fiscal year or portion of a fiscal year, determine a growth factor for each State that takes into account— the percentage increase in health care costs in the State; the total amount expended by the State for the previous fiscal year on medical assistance for institutional long-term care services; the increase, if any, in the total population of the State from July of 2024 to July of the fiscal year preceding the fiscal year involved; the increase, if any, in the population of individuals aged 65 and older of the State from July of 2024 to July of the fiscal year preceding the fiscal year involved; and the decrease, if any, in the population of the State that requires medical assistance for institutional long-term care services that is attributable to the availability of coverage for the services described in section 201(a)(16) of the Medicare for All Act . Any amount determined under this subparagraph for a portion of a fiscal year shall be prorated based on the length of such portion of a fiscal year relative to a complete fiscal year. Beginning on the date described in subsection (a), any provision of this title requiring a State plan for medical assistance to make available medical assistance for services that are not institutional long-term care services or items and services described in section 901(a)(3)(A)(ii) of the Medicare for All Act shall have no effect. .
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Sec. 204
Continued coverage of institutional long-term care and other services under Medicaid
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