,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #acbe  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #b1 #bjag,mr4    
,buc%on introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce  ,a ,,bill  ,to am5d title     
,,xix ( ! ,social ,security ,act to     
provide ,/ates ) flexibility ) respect  
to provid+ premium assi/ance "u !       
,m$icaid program4  #a4 ,provid+         
flexibility ) respect to premium        
assi/ance "u ,m$icaid  7a7 ,9 g5]al     
,section #aijf ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;e7 is am5d$-- 
7#a7 9 subsection 7c77#b71 by /rik+ su* 
plan4 & ins]t+ su* gr\p heal? plan42 &  
7#b7 by ins]t+ aft] subsection 7c7 !    
foll[+ new subsection3  7d7 ,/ate option
 = noneld]ly1 nondisabl$ adults  7#a7 ,9
 g5]al ,beg9n+ on ,janu>y #a1 #bjah1 9 !
 case ( a ,/ate elect+ ! option describ$
 9 p>agraph 7#b7 ( subsection 7a71 !    
,secret>y may1 ^u ! approval ( a ,/ate  
plan am5dm5t submitt$ by ! ,/ate1 waive 
! requirem5t ( p>agraph 7#c7 ( su*      

subsection to ! ext5t su* requirem5t    
provides = paym5t ( premiums &          
d$uctibles & o!r co/-%>+ obligations )  
respect to ! items & s]vices describ$ 9 
su* p>agraph furni%$ to individuals     
describ$ 9 p>agraph 7#c7 ( ?is          
subsection4  7#b7 ,co/-effectiv5ess     
7,a7 ,9 g5]al ,! ,secret>y may approve a
 ,/ate plan am5dm5t "u ?is subsection if
 ! ,secret>y det]m9es t ! paym5t (      
premiums & d$uctibles & o!r co/-%>+     
obligations "u ! gr\p heal? plan or     
plans involv$ is co/-effective relative 
to ! am\nt ( exp5ditures "u ! ,/ate     
plan1 includ+ adm9i/rative exp5ditures1 
& exclud+ paym5ts = copaym5ts or        
co9surance1 t ! ,/ate w\ld h made to    
provide comp>able cov]age ( !           
individuals describ$ 9 p>agraph 7#c7    
involv$4  7,b7 ,det]m9ation ,= purposes 
( subp>agraph 7,a71 co/-effectiv5ess    
%all be det]m9$-- 7i7 on an annual basis
 by comp>+--  7,i7 ! am\nt ( exp5ditures
 p] employ] = cov]age "u ! gr\p heal?   
plan or plans involv$ ( ! individuals   

describ$ 9 p>agraph 7#c7 = ! prec$+ #d  
cal5d> qu>t]s2 to  7,,ii7 ! av]age p]   
capita am\nt ( exp5ditures t ! ,/ate    
made "u ! ,/ate plan to provide         
comp>able cov]age ( su* individuals =   
su* cal5d> qu>t]s2 &  7ii7 9 ! case (   
individuals describ$ 9 p>agraph 7#c7 :o 
are p>5ts ( *ildr5-- 7,i7 if ! p>5t is  
eligible = enrollm5t 9 a gr\p heal?     
plan1 bas$ on ! co/ ( pur*as+ family    
cov]age "u ! gr\p heal? plan2 &  7,,ii7 
if ! p>5t is n s eligible1 bas$ on ! co/
 ( individual cov]age = ! p>5t & ea*    
*ild4  7,c7 ,*ild def9$ ,9 ?is p>agraph1
 ! t]m *ild has ! mean+ giv5 su* t]m 9  
section #aijb7;e77#ac77;,g74  7#c7      
,noneld]ly1 nondisabl$ adults ,!        
individuals describ$ 9 ?is p>agraph are 
individuals :o are "u #fe ye>s ( age1 n 
pregnant1 n entitl$ to1 or enroll$ =1   
b5efits "u "p ,a ( title ,,xviii1 or    
enroll$ = b5efits "u "p ,b ( title      
,,xviii1 are n describ$ 9 subclauses    
7,i7 ?r\gh 7,,vii7 ( section            
#aijb7;a77#aj77;,a77i71 & o!rwise       

entitl$ to m$ical assi/ance "u ?is      
title4  4  7b7 ,premium assi/ance       
subsidy option ,section #aijf;,a ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acif;e-#a7 is am5d$ by add+ at ! end ! 
foll[+ new subsection3  7f7 ,/ate option
 = noneld]ly1 nondisabl$ adults  7#a7 ,9
 g5]al ,beg9n+ on ,janu>y #a1 #bjah1 9 !
 case ( a ,/ate elect+ to provide a     
premium assi/ance subsidy z describ$ 9  
subsection 7a71 ! ,secret>y may1 ^u !   
approval ( a ,/ate plan am5dm5t submitt$
 by ! ,/ate1 waive ! requirem5t (       
subsection 7e7 to ! ext5t su* requirem5t
 provides = paym5t ( premiums &         
d$uctibles & o!r co/-%>+ obligations )  
respect to ! items & s]vices describ$ 9 
su* subsection furni%$ to individuals   
describ$ 9 p>agraph 7#c74  7#b7         
,co/-effectiv5ess  7,a7 ,9 g5]al ,!     
,secret>y may approve a ,/ate plan      
am5dm5t "u ?is subsection if ! ,secret>y
 det]m9es t ! paym5t ( premiums &       
d$uctibles & o!r co/-%>+ obligations "u 
! qualifi$ employ]-sponsor$ cov]age     

involv$ is co/-effective relative to !  
am\nt ( exp5ditures "u ! ,/ate plan1    
includ+ adm9i/rative exp5ditures1 &     
exclud+ paym5ts = copaym5ts or          
co9surance1 t ! ,/ate w\ld h made to    
provide comp>able cov]age ( !           
individuals describ$ 9 p>agraph         
7#c77;,b7 involv$4  7,b7 ,det]m9ation ,=
 purposes ( subp>agraph 7,a71           
co/-effectiv5ess %all be det]m9$-- 7i7  
on an annual basis by comp>+--  7,i7 !  
am\nt ( exp5ditures p] employ] = cov]age
 "u ! qualifi$ employ]-sponsor$ cov]age 
involv$ ( ! individuals describ$ 9      
p>agraph 7#c77;,b7 = ! prec$+ #d cal5d> 
qu>t]s2 to  7,,ii7 ! av]age p] capita   
am\nt ( exp5ditures t ! ,/ate made "u ! 
,/ate plan to provide comp>able cov]age 
( su* individuals = su* cal5d> qu>t]s2 &
  7ii7 9 ! case ( individuals describ$ 9
 p>agraph 7#c7 :o are p>5ts (           
individuals "u #ai ye>s ( age--  7,i7 if
 ! p>5t is eligible = enrollm5t 9       
qualifi$ employ]-sponsor$ cov]age1 bas$ 
on ! co/ ( pur*as+ family cov]age "u su*

 qualifi$ employ]-sponsor$ cov]age2 &   
7,,ii7 if ! p>5t is n s eligible1 bas$  
on ! co/ ( individual cov]age = ! p>5t &
 ea* su* individual "u #ai ye>s ( age4  
7#c7 ,noneld]ly1 nondisabl$ adults ,!   
individuals describ$ 9 ?is p>agraph are 
individuals 7or ! p>5ts ( individuals7  
:o are--  7,a7 p>ticipat+ 9 a premium   
assi/ance subsidy "u ?is section =      
qualifi$ employ]-sponsor$ cov]age2 &    
7,b7 "u #fe ye>s ( age1 n pregnant1 n   
entitl$ to1 or enroll$ =1 b5efits "u "p 
,a ( title ,,xviii1 or enroll$ = b5efits
 "u "p ,b ( title ,,xviii1 & are n      
describ$ 9 subclauses 7,i7 ?r\gh 7,,vii7
 ( section #aijb7;a77#aj77;,a77i74  4