Coronavirus Medicaid Response Act

II 117TH CONGRESS 1ST SESSION S. 439 To amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during economic downturns, and for other purposes. IN THE SENATE OF THE UNITED STATES FEBRUARY 25, 2021 Mr. CASEY (for himself, Ms. CORTEZ MASTO, Mr. BENNET, Mr. BROWN, Mr. WYDEN, Mrs. SHAHEEN, Mr. MERKLEY, Mr. WARNER, Mr. MENENDEZ, Ms. ROSEN, Ms. SMITH, Mr. PETERS, Mr. BOOKER, Mr. VAN HOLLEN, Mr. TESTER, Ms. STABENOW, Mr. WHITEHOUSE, Mr. CARDIN, Ms. WAR- REN, Ms. KLOBUCHAR, Mr. KING, Ms. HASSAN, and Mr. CARPER) intro- duced the following bill; which was read twice and referred to the Com- mittee on Finance A BILL To amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during eco- nomic downturns, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Coronavirus Medicaid 4 Response Act’’. 5 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 2 •S 439 IS SEC. 2. INCREASING FEDERAL SUPPORT TO STATE MED- 1 ICAID PROGRAMS DURING ECONOMIC 2 DOWNTURNS. 3 (a) IN GENERAL.—Section 1905 of the Social Secu- 4 rity Act (42 U.S.C. 1396d) is amended— 5 (1) in subsection (b), by striking ‘‘and (ff)’’ and 6 inserting ‘‘(ff), and (hh)’’; and 7 (2) by adding at the end the following new sub- 8 section: 9 ‘‘(hh) INCREASED FMAP DURING ECONOMIC 10 DOWNTURNS.— 11 ‘‘(1) IN GENERAL.—If a fiscal quarter that be- 12 gins on or after January 1, 2020, is an economic 13 downturn quarter (as defined in paragraph (2)) with 14 respect to a State, then the Federal medical assist- 15 ance percentage determined for the State and quar- 16 ter under subsection (b) shall be equal to the per- 17 centage determined for the State and quarter under 18 paragraph (3). 19 ‘‘(2) ECONOMIC DOWNTURN QUARTER.— 20 ‘‘(A) IN GENERAL.— 21 ‘‘(i) IN GENERAL.—In this subsection, 22 the term ‘economic downturn quarter’ 23 means, with respect to a State, a fiscal 24 quarter during which the State’s unem- 25 ployment rate for the quarter exceeds the 26 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 3 •S 439 IS percentage determined for the State and 1 quarter under clause (ii). 2 ‘‘(ii) THRESHOLD PERCENTAGE.—The 3 percentage determined under this clause 4 for a State and fiscal quarter is the per- 5 centage equal to the lower of— 6 ‘‘(I) the State unemployment 7 rate at the 20th percentile of the dis- 8 tribution of the State’s quarterly un- 9 employment rates for the 60-quarter 10 period preceding the quarter involved, 11 increased by 1 percentage point; and 12 ‘‘(II) the State’s average quar- 13 terly unemployment rate for the 12- 14 quarter period preceding the quarter 15 involved, increased by 1 percentage 16 point. 17 ‘‘(B) UNEMPLOYMENT DATA.— 18 ‘‘(i) IN GENERAL.—Except as pro- 19 vided in clause (ii), for purposes of deter- 20 mining unemployment rates for a State 21 and a quarter under this paragraph, the 22 Secretary shall use data from the Local 23 Area Unemployment Statistics from the 24 Bureau of Labor Statistics. 25 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 4 •S 439 IS ‘‘(ii) APPLICATION TO CERTAIN TER- 1 RITORIES.—In the case of the Virgin Is- 2 lands, Guam, the Northern Mariana Is- 3 lands, American Samoa, or any other juris- 4 diction for which suitable data from the 5 Local Area Unemployment Statistics from 6 the Bureau of Labor Statistics are unavail- 7 able, the Secretary shall use data from the 8 U–3 unemployment measure of the Bureau 9 of Labor Statistics to make any necessary 10 determinations under subparagraph (A). 11 ‘‘(3) INCREASED FMAP DURING ECONOMIC 12 DOWNTURN QUARTER.— 13 ‘‘(A) IN GENERAL.—During a fiscal quar- 14 ter that is an economic downturn quarter with 15 respect to a State, the Federal medical assist- 16 ance percentage for the State and quarter de- 17 termined under subsection (b) shall be equal 18 to— 19 ‘‘(i) the Federal medical assistance 20 percentage determined for the State and 21 quarter under subsection (b) without re- 22 gard to this subsection (but including any 23 increase to such percentage for such quar- 24 ter made pursuant to section 6008(a) of 25 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 5 •S 439 IS the Families First Coronavirus Response 1 Act); increased by 2 ‘‘(ii) the number of percentage points 3 (rounded to the nearest tenth of a percent- 4 age point) equal to the product of— 5 ‘‘(I) the number of percentage 6 points (rounded to the nearest tenth 7 of a percentage point) by which the 8 unemployment rate for the State and 9 quarter exceeds the percentage deter- 10 mined for the State and quarter 11 under paragraph (2)(A)(ii); and 12 ‘‘(II) 4.8. 13 ‘‘(B) RULES OF APPLICATION.—The fol- 14 lowing rules shall apply with respect to the Fed- 15 eral medical assistance percentage determined 16 for a State and an economic downturn quarter 17 under this subsection: 18 ‘‘(i) SCOPE OF APPLICATION.—Such 19 Federal medical assistance percentage shall 20 not apply for purposes of— 21 ‘‘(I) disproportionate share hos- 22 pital payments described in section 23 1923; 24 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 6 •S 439 IS ‘‘(II) payments under part D of 1 title IV; or 2 ‘‘(III) any payments under this 3 title that are based on a Federal med- 4 ical assistance percentage determined 5 for a State under subsection (aa) (but 6 only to the extent that such Federal 7 medical assistance percentage is high- 8 er than the economic recovery 9 FMAP). 10 ‘‘(ii) LIMITATION.—In no case shall— 11 ‘‘(I) the Federal medical assist- 12 ance percentage determined for a 13 State and quarter pursuant to this 14 subsection exceed 95 percent; or 15 ‘‘(II) any increase to the Federal 16 medical assistance percentage deter- 17 mined for a State and quarter pursu- 18 ant to this subsection result in the ap- 19 plication of a Federal medical assist- 20 ance percentage that exceeds 95 per- 21 cent. 22 ‘‘(iii) APPLICATION TO CHIP.—Not- 23 withstanding the first sentence of section 24 2105(b), the application of this subsection 25 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 7 •S 439 IS may result in the enhanced FMAP of a 1 State for a fiscal year under such section 2 exceeding 85 percent, but in no case may 3 the application of this subsection before 4 application of the second sentence of such 5 section result in the enhanced FMAP of 6 the State exceeding 95 percent. 7 ‘‘(4) ADVANCE PAYMENT; RETROSPECTIVE AD- 8 JUSTMENT.— 9 ‘‘(A) IN GENERAL.—Prior to the beginning 10 of each fiscal quarter that begins on or after 11 July 1, 2020, the Secretary shall, with respect 12 to each State— 13 ‘‘(i) make an initial determination, 14 based on the projections made for the 15 State and quarter under subparagraph 16 (B), as to— 17 ‘‘(I) whether the application of 18 this subsection is expected to result in 19 the application of a higher Federal 20 medical assistance percentage for the 21 State and quarter than the percentage 22 that would otherwise apply without re- 23 gard to this subsection; and— 24 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 8 •S 439 IS ‘‘(II) if the application of this 1 subsection is expected to result in 2 such a higher Federal medical assist- 3 ance percentage for the State and 4 quarter, what such higher percentage 5 is expected to be; and 6 ‘‘(ii) if the Secretary determines under 7 clause (i) that the application of this sub- 8 section is expected to result in the applica- 9 tion of a higher Federal medical assistance 10 percentage for the State and quarter than 11 the percentage that would otherwise apply 12 without regard to this subsection— 13 ‘‘(I) apply such higher Federal 14 medical assistance percentage of the 15 State for purposes of making pay- 16 ments to the State for amounts ex- 17 pended during such quarter as med- 18 ical assistance under the State plan; 19 and 20 ‘‘(II) take into account such 21 higher Federal medical assistance per- 22 centage of the State for purposes of 23 calculating the enhanced FMAP for 24 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 9 •S 439 IS the State and quarter under section 1 2105(b). 2 ‘‘(B) PROJECTION OF STATE UNEMPLOY- 3 MENT RATES.—Prior to the beginning of each 4 fiscal quarter that begins on or after July 1, 5 2020, the Secretary, acting through the Chief 6 Actuary of the Centers for Medicare & Medicaid 7 Services, shall, using the most recently available 8 data described in paragraph (2)(B), make pro- 9 jections with respect to— 10 ‘‘(i) the unemployment rates for each 11 State for such quarter; 12 ‘‘(ii) the threshold percentages de- 13 scribed in paragraph (2)(A)(ii) for each 14 State for such quarter; and 15 ‘‘(iii) the national unemployment rate 16 for such quarter. 17 ‘‘(C) RETROSPECTIVE ADJUSTMENT.—As 18 soon as practicable after final unemployment 19 data becomes available for a fiscal quarter that 20 begins on or after July 1, 2020, the Secretary 21 shall, with respect to each State— 22 ‘‘(i) make a final determination with 23 respect to the application of this subsection 24 for purposes of determining the Federal 25 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 10 •S 439 IS medical assistance percentage and en- 1 hanced FMAP of the State for the quarter; 2 and 3 ‘‘(ii) in accordance with section 4 1903(d)(2) and section 2105(e), reduce or 5 increase the amount payable to the State 6 under section 1903(a) or section 2105 for 7 a subsequent fiscal quarter to the extent of 8 any overpayment or underpayment under 9 either such section which the Secretary de- 10 termines was made as a result of an incor- 11 rect initial determination under subpara- 12 graph (A)(i) with respect to the application 13 of this subsection for purposes of deter- 14 mining the Federal medical assistance per- 15 centage and enhanced FMAP of the State 16 for such prior fiscal quarter. 17 ‘‘(5) RETROSPECTIVE APPLICATION OF OVER- 18 THE-LIMIT FMAP INCREASES.— 19 ‘‘(A) IN GENERAL.—If a State has excess 20 percentage points with respect to an economic 21 downturn quarter and an applicable FMAP (as 22 determined under subparagraph (B)), the State 23 may elect to apply such excess percentage 24 points to increase such applicable FMAP for 25 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 11 •S 439 IS one or more quarters during the look-back pe- 1 riod for the State and economic downturn quar- 2 ter in accordance with this paragraph. 3 ‘‘(B) EXCESS PERCENTAGE POINTS.—For 4 purposes of this paragraph, the number of ex- 5 cess percentage points for a State, economic 6 downturn quarter, and an applicable FMAP 7 shall be equal to the number of percentage 8 points by which— 9 ‘‘(i) the applicable FMAP for the 10 State and quarter (after application of 11 paragraph (3) but without regard to sub- 12 paragraph (B)(ii) of such paragraph); ex- 13 ceeds 14 ‘‘(ii) 95 percent. 15 ‘‘(C) EFFECT OF APPLICATION OF EXCESS 16 PERCENTAGE POINTS.—If a State elects to 17 apply excess percentage points to an applicable 18 FMAP to a quarter during a look-back period 19 under this paragraph, the Secretary shall deter- 20 mine the additional amount of payment under 21 section 1903(a) to which the State would have 22 been entitled for such quarter if the applicable 23 FMAP (as so increased) had been in effect for 24 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 12 •S 439 IS such quarter, and shall treat such additional 1 amount as an underpayment for such quarter. 2 ‘‘(D) DISTRIBUTION OF EXCESS PERCENT- 3 AGE POINTS.—A State that has excess percent- 4 age points with respect to an economic down- 5 turn quarter and applicable FMAP may elect to 6 divide such points among more than 1 quarter 7 during the look-back period for such State and 8 quarter provided that no excess percentage 9 point (or fraction of an excess percentage point) 10 is applied to the applicable FMAP of more than 11 1 quarter. 12 ‘‘(E) LIMITATIONS.— 13 ‘‘(i) NO INCREASES OVER 100 PER- 14 CENT.—A State may not increase an appli- 15 cable FMAP for any quarter during a look- 16 back period under this paragraph if such 17 increase would result in the applicable 18 FMAP for such quarter exceeding 100 per- 19 cent. 20 ‘‘(ii) SCOPE OF APPLICATION.—Any 21 increase to an applicable FMAP of a State 22 for a fiscal quarter under this paragraph— 23 ‘‘(I) shall only apply with respect 24 to payments for amounts expended by 25 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 13 •S 439 IS the State for medical assistance for 1 services furnished during such quarter 2 to which such applicable FMAP is ap- 3 plicable; and 4 ‘‘(II) shall not apply with respect 5 to payments described in paragraph 6 (3)(B)(i). 7 ‘‘(F) DEFINITIONS.—In this paragraph: 8 ‘‘(i) APPLICABLE FMAP.—The term 9 ‘applicable FMAP’ means, with respect to 10 a State and fiscal quarter— 11 ‘‘(I) the Federal medical assist- 12 ance percentage determined for the 13 State and quarter under subsection 14 (b); 15 ‘‘(II) the Federal medical assist- 16 ance percentage applicable under sub- 17 section (y); 18 ‘‘(III) the Federal medical assist- 19 ance percentage applicable under sub- 20 section (z)(2); 21 ‘‘(IV) the Federal medical assist- 22 ance percentage determined for the 23 State and quarter under subsection 24 (ff); or 25 VerDate Sep 11 2014 03:31 Mar 18, 2021 Jkt 019200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S439.IS S439 kjohnson on DSK79L0C42PROD with BILLS 14 •S 439 IS ‘‘(V) the enhanced FMAP deter- 1 mined for th [Text truncated for display. 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