ACCESS Act

I 118TH CONGRESS 1ST SESSION H. R. 3004 To amend the Internal Revenue Code of 1986 to provide for a temporary expansion of health insurance premium tax credits for certain low-income populations, and to amend title XIX of the Social Security Act to establish a Federal Medicaid program. IN THE HOUSE OF REPRESENTATIVES APRIL 28, 2023 Mrs. FLETCHER introduced the following bill; which was referred to the Com- mittee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speak- er, in each case for consideration of such provisions as fall within the ju- risdiction of the committee concerned A BILL To amend the Internal Revenue Code of 1986 to provide for a temporary expansion of health insurance premium tax credits for certain low-income populations, and to amend title XIX of the Social Security Act to establish a Federal Medicaid program. 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 ‘‘Affordable Care Cov- 4 erage Expansion and Support for States Act’’ or the ‘‘AC- 5 CESS Act’’. 6 VerDate Sep 11 2014 01:45 Jun 21, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3004.IH H3004 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3004 IH SEC. 2. TEMPORARY EXPANSION OF HEALTH INSURANCE 1 PREMIUM TAX CREDITS FOR CERTAIN LOW- 2 INCOME POPULATIONS. 3 (a) IN GENERAL.—Section 36B of the Internal Rev- 4 enue Code of 1986 is amended by redesignating subsection 5 (h) as subsection (i) and by inserting after subsection (g) 6 the following new subsection: 7 ‘‘(h) CERTAIN TEMPORARY RULES BEGINNING IN 8 2024.—With respect to any taxable year beginning after 9 December 31, 2023, and before January 1, 2027— 10 ‘‘(1) ELIGIBILITY FOR CREDIT NOT LIMITED 11 BASED ON INCOME.—Subsection (c)(1)(A) shall be 12 disregarded in determining whether a taxpayer is an 13 applicable taxpayer. 14 ‘‘(2) CREDIT ALLOWED TO CERTAIN LOW-IN- 15 COME EMPLOYEES OFFERED EMPLOYER-PROVIDED 16 COVERAGE.—Subclause (II) of subsection 17 (c)(2)(C)(i) shall not apply if the taxpayer’s house- 18 hold income does not exceed 138 percent of the pov- 19 erty line for a family of the size involved. Subclause 20 (II) of subsection (c)(2)(C)(i) shall also not apply to 21 an individual described in the last sentence of such 22 subsection if the taxpayer’s household income does 23 not exceed 138 percent of the poverty line for a fam- 24 ily of the size involved. 25 VerDate Sep 11 2014 01:45 Jun 21, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3004.IH H3004 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3004 IH ‘‘(3) CREDIT ALLOWED TO CERTAIN LOW-IN- 1 COME EMPLOYEES OFFERED QUALIFIED SMALL EM- 2 PLOYER HEALTH REIMBURSEMENT ARRANGE- 3 MENTS.—A qualified small employer health reim- 4 bursement arrangement shall not be treated as con- 5 stituting affordable coverage for an employee (or any 6 spouse or dependent of such employee) for any 7 months of a taxable year if the employee’s household 8 income for such taxable year does not exceed 138 9 percent of the poverty line for a family of the size 10 involved. 11 ‘‘(4) LIMITATIONS ON RECAPTURE.— 12 ‘‘(A) IN GENERAL.—In the case of a tax- 13 payer whose household income is less than 200 14 percent of the poverty line for the size of the 15 family involved for the taxable year, the amount 16 of the increase under subsection (f)(2)(A) shall 17 in no event exceed $300 (one-half of such 18 amount in the case of a taxpayer whose tax is 19 determined under section 1(c) for the taxable 20 year). 21 ‘‘(B) LIMITATION ON INCREASE FOR CER- 22 TAIN NON-FILERS.—In the case of any taxpayer 23 who would not be required to file a return of 24 tax for the taxable year but for any require- 25 VerDate Sep 11 2014 01:45 Jun 21, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3004.IH H3004 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3004 IH ment to reconcile advance credit payments 1 under subsection (f), if an Exchange established 2 under title I of the Patient Protection and Af- 3 fordable Care Act has determined that— 4 ‘‘(i) such taxpayer is eligible for ad- 5 vance payments under section 1412 of 6 such Act for any portion of such taxable 7 year, and 8 ‘‘(ii) such taxpayer’s household in- 9 come for such taxable year is projected to 10 not exceed 138 percent of the poverty line 11 for a family of the size involved, 12 subsection (f)(2)(A) shall not apply to such tax- 13 payer for such taxable year and such taxpayer 14 shall not be required to file such return of tax. 15 ‘‘(C) INFORMATION PROVIDED BY EX- 16 CHANGE.—The information required to be pro- 17 vided by an Exchange to the Secretary and to 18 the taxpayer under subsection (f)(3) shall in- 19 clude such information as is necessary to deter- 20 mine whether such Exchange has made the de- 21 terminations described in clauses (i) and (ii) of 22 subparagraph (B) with respect to such tax- 23 payer.’’. 24 VerDate Sep 11 2014 01:45 Jun 21, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3004.IH H3004 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3004 IH (b) EMPLOYER SHARED RESPONSIBILITY PROVISION 1 NOT APPLICABLE WITH RESPECT TO CERTAIN LOW-IN- 2 COME TAXPAYERS RECEIVING PREMIUM ASSISTANCE.— 3 Section 4980H(c)(3) is amended to read as follows: 4 ‘‘(3) APPLICABLE PREMIUM TAX CREDIT AND 5 COST-SHARING REDUCTION.— 6 ‘‘(A) IN GENERAL.—The term ‘applicable 7 premium tax credit and cost-sharing reduction’ 8 means— 9 ‘‘(i) any premium tax credit allowed 10 under section 36B, 11 ‘‘(ii) any cost-sharing reduction under 12 section 1402 of the Patient Protection and 13 Affordable Care Act, and 14 ‘‘(iii) any advance payment of such 15 credit or reduction under section 1412 of 16 such Act. 17 ‘‘(B) EXCEPTION WITH RESPECT TO CER- 18 TAIN LOW-INCOME TAXPAYERS.—Such term 19 shall not include any premium tax credit, cost- 20 sharing reduction, or advance payment other- 21 wise described in subparagraph (A) if such 22 credit, reduction, or payment is allowed or paid 23 for a taxable year of an employee (beginning 24 VerDate Sep 11 2014 01:45 Jun 21, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3004.IH H3004 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 3004 IH after December 31, 2023, and before January 1 1, 2027) with respect to which— 2 ‘‘(i) an Exchange established under 3 title I of the Patient Protection and Af- 4 fordable Care Act has determined that 5 such employee’s household income for such 6 taxable year is projected to not exceed 138 7 percent of the poverty line for a family of 8 the size involved, or 9 ‘‘(ii) such employee’s household in- 10 come for such taxable year does not exceed 11 138 percent of the poverty line for a family 12 of the size involved.’’. 13 (c) EFFECTIVE DATE.—The amendments made by 14 this section shall apply to taxable years beginning after 15 December 31, 2023. 16 SEC. 3. CLOSING THE MEDICAID COVERAGE GAP. 17 (a) FEDERAL MEDICAID PROGRAM TO CLOSE COV- 18 ERAGE GAP IN NONEXPANSION STATES.—Title XIX of 19 the Social Security Act (42 U.S.C. 1396 et seq.) is amend- 20 ed by adding at the end the following new section: 21 ‘‘SEC. 1948. FEDERAL MEDICAID PROGRAM TO CLOSE COV- 22 ERAGE GAP IN NONEXPANSION STATES. 23 ‘‘(a) ESTABLISHMENT.—In the case of a State that 24 the Secretary determines (based on the State plan under 25 VerDate Sep 11 2014 01:45 Jun 21, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3004.IH H3004 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 3004 IH this title, waiver of such plan, or other relevant informa- 1 tion) is not expected to expend amounts under the State 2 plan (or waiver of such plan) for all individuals described 3 in section 1902(a)(10)(A)(i)(VIII) during a year (begin- 4 ning with 2027) (in this section defined as ‘a coverage 5 gap State’, with respect to such year), the Secretary shall 6 (including through contract with eligible entities (as speci- 7 fied by the Secretary), consistent with subsection (b)) pro- 8 vide for the offering to such individuals residing in such 9 State of a health benefits plan (in this section referred 10 to as the ‘Federal Medicaid program’ or the ‘Program’), 11 for each quarter during the period beginning on January 12 1 of such year, and ending with the last day of the first 13 quarter during which the State provides medical assist- 14 ance to all such individuals under the State plan (or waiv- 15 er of such plan). Under the Federal Medicaid program, 16 the Secretary— 17 ‘‘(1) may use the Federally Facilitated Market- 18 place to facilitate eligibility determinations and en- 19 rollments under the Federal Medicaid Program and 20 shall establish a set of eligibility rules to be applied 21 under the Program in a manner consistent with sec- 22 tion 1902(e)(14); and 23 VerDate Sep 11 2014 01:45 Jun 21, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3004.IH H3004 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 3004 IH ‘‘(2) shall establish benefits, beneficiary protec- 1 tions, and access to care standards by, at a min- 2 imum— 3 ‘‘(A) establishing a minimum set of bene- 4 fits to be provided (and providing such benefits) 5 under the Federal Medicaid program, which 6 shall be in compliance with the requirements of 7 section 1937 and shall consist of benchmark 8 coverage described in section 1937(b)(1) or 9 benchmark equivalent coverage described in sec- 10 tion 1937(b)(2) to the same extent as medical 11 assistance provided to such an individual under 12 this title (without application of this section) is 13 required under section 1902(k)(1) to consist of 14 such benchmark coverage or benchmark equiva- 15 lent coverage; 16 ‘‘(B) applying the provisions of sections 17 1902(a)(8), 1902(a)(34) (which may be applied 18 in accordance with such phased-in implementa- 19 tion as the Secretary deems necessary, but be- 20 ginning as soon as practicable), and 1943 with 21 respect to such an individual, benefits under the 22 Federal Medicaid program, and making applica- 23 tion for such benefits (which may be in accord- 24 ance with a phased-in implementation as the 25 VerDate Sep 11 2014 01:45 Jun 21, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3004.IH H3004 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 3004 IH Secretary deems necessary, but beginning as 1 soon as practicable) in the same manner as 2 such provisions would apply to such an indi- 3 vidual, medical assistance under this title (other 4 than pursuant to this section), and making ap- 5 plication for such medical assistance under this 6 title (other than pursuant to this section); and 7 providing that redeterminations and appeals of 8 eligibility and coverage determinations of serv- 9 ices (including benefit reductions, terminations, 10 and suspension) shall be conducted under the 11 Federal Medicaid program in accordance with a 12 Federal fair hearing process established by the 13 Secretary that is subject to the same require- 14 ments as applied with respect to redetermina- 15 tions and appeals of eligibility, and with respect 16 to coverage of services (including benefit reduc- 17 tions, terminations, and suspension), under a 18 State plan under this title and that may provide 19 for such fair hearings related to denials of eligi- 20 bility (based on modified adjusted gross income 21 eligibility determinations) to be conducted 22 through the Federally Facilitated Marketplace 23 for Exchanges; 24 VerDate Sep 11 2014 01:45 Jun 21, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3004.IH H3004 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 3004 IH ‘‘(C) applying, in accordance with sub- 1 section (d), the provisions of section 1927 2 (other than subparagraphs (B) and (C) of sub- 3 section (b)(1) of such section) with respect to 4 the Secretary and payment under the Federal 5 Medicaid program for covered outpatient drugs 6 with respect to a rebate period in the same 7 manner and to the same extent as such provi- 8 sions apply with respect to a State and payment 9 under the State plan for covered outpatient 10 drugs with respect to the rebate period; and 11 ‘‘(D) applying the provisions of sections 12 1902(a)(14), 1902(a)(23), 1902(a)(47), and 13 1920 through 1920C (as applicable) to the Fed- 14 eral Medicaid program and such individuals en- 15 rolled in such program in the same manner and 16 to the same extent as such provisions apply to 17 a State plan and such individuals eligible for 18 medical assistance under the State plan, and 19 applying the provisions of section 20 1902(a)(30)(A) with respect to medical assist- 21 ance available under the Federal Medicaid pro- 22 gram in the same manner and to the same ex- 23 tent as such provisions apply to medical assist- 24 VerDate Sep 11 2014 01:45 Jun 21, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3004.IH H3004 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 3004 IH ance under a State plan under this title, except 1 that— 2 ‘‘(i) the Secretary shall provide that 3 no cost sharing shall be applied under the 4 Federal Medicaid program; 5 ‘‘(ii) the Secretary may waive the pro- 6 visions of subparagraph (A) of section 7 1902(a)(23) to the extent deemed appro- 8 priate to facilitate the implementation of 9 managed care; and 10 ‘‘(iii) in applying the provisions of sec- 11 tion 1902(a)(47) and sections 1920 12 through 1920C, the Secretary— 13 ‘‘(I) shall establish a single pre- 14 sumptive eligibility process for individ- 15 uals eligible under the Federal Med- 16 icaid program, under which the Sec- 17 retary may contract with entities to 18 carry out such process; and 19 ‘‘(II) may apply such provisions 20 and process in accordance with such 21 phased-in implementation as the Sec- 22 retary deems necessary, but beginning 23 as soon as practicable. 24 VerDate Sep 11 2014 01:45 Jun 21, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3004.IH H3004 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 3004 IH ‘‘(b) ADMINISTRATION OF FEDERAL MEDICAID PRO- 1 GRAM THROUGH CONTRACTS WITH MEDICAID MANAGED 2 CARE ORGANIZATION AND THIRD PARTY PLAN ADMINIS- 3 TRATOR REQUIREMENTS.— 4 ‘‘(1) IN GENERAL.—For the purpose of admin- 5 istering the benefits under the Program (across all 6 coverage gap geographic areas (as defined in para- 7 graph (8))) to provide medical assistance to individ- 8 uals described in section 1902(a)(10)(A)(i)(VIII) en- 9 rolled under the Federal Medicaid program and re- 10 siding in such areas, the Secretary shall solicit bids 11 described in paragraph (2) and enter into contracts 12 with a total of at least 2 eligible entities (as speci- 13 fied by the Secretary, w [Text truncated for display. 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