,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #bgae  ,,in ,,the ,,house ,,of  
,,representatives  ,may #ad1 #bjai,mr4  
,green of ,tennessee 7for himself1 ,mr4 
,wright1 ,mr4 ,armstrong1 ,mr4 ,norman1 
,mr4 ,marshall1 and ,mr4 ,kevin ,hern of
 ,oklahoma7 introduced the following    
bill2 which was referred to the         
,committee on ,energy and ,commerce  ,a 
,,bill  ,to amend title ,,xi of the     
,social ,security ,act to provide for   
,state approval and implementation of   
specified waivers under the ,medicaid   
program4  #a4 ,short title ,this ,act   
may be cited as the ,medicaid           
,improvement and ,state ,flexibility    
,act of #bjai4  #b4 ,providing for      
,state approval and implementation of   
specified waivers under the ,medicaid   
program ,section #aaae of the ,social   
,security ,act 7#db ,u4,s4,c4 #acae7 is 
amended--  7#a7 in subsection 7d7-- 7,a7
 in paragraph 7#a71 by striking ,an     
application and inserting ,subject to   
paragraph 7#d71 an application2 and     

7,b7 by adding at the end the following 
new paragraph3  7#d7 7,a7 ,an           
experimental1 pilot1 or demonstration   
project undertaken under subsection 7a7 
may be approved or renewed by a ,state  
if such project is described in         
subparagraph 7,b74  7,b7 ,an            
experimental1 pilot1 or demonstration   
project is described in this            
subparagraph if such project provides   
for a waiver of requirements with       
respect to a ,state plan 7or a waiver of
 such plan7 under title ,,xix such      
that--  7i7 individuals enrolled under  
such plan 7or such waiver7 may elect to 
participate in such project with respect
 to a year2  7ii7 such individuals who  
elect to so participate-- 7,i7 are      
furnished with an electronic benefits   
transfer card in an amount determined   
appropriate by the ,state for purposes  
of purchasing primary care services and 
medications during such year2  7,,ii7   
are furnished a cash payment by the     
,state equal to the amount of funds     

remaining on the individual's electronic
 benefits transfer card at the end of   
such year2 and  7,,iii7 are enrolled in 
a catastrophic insurance program        
determined appropriate by the ,state for
 purposes of covering services not      
described in subclause 7,i7 and covering
 services that are described in such    
subclause if such individual exceeds the
 amount of funds provided to such       
individual on such card for such year2  
and  7iii7 ,federal expenditures under  
such title for the period during which  
such project is in effect are equal to  
or lesser than what such expenditures   
would have been during such period if   
such project were not in effect4  7,c7  
7i7 ,in no case may a project described 
in subparagraph 7,b7 result in an       
expenditure to pay for any abortion or  
to assist in the purchase1 in whole or  
in part1 of health benefit coverage that
 includes coverage of abortion4  7ii7   
,clause 7i7 shall not apply to an       
abortion only if necessary to save the  

life of the mother or if the pregnancy  
is the result of an act of rape or      
incest4  7,d7 ,for purposes of a        
,state's approval or renewal of an      
experimental1 pilot1 or demonstration   
project under subparagraph 7,a71 each   
reference to the ,secretary in          
subsection 7a7 shall be deemed to be a  
reference to the ,state4  2 and  7#b7 in
 subsection 7e71 by inserting 7other    
than such a project that is described in
 paragraph 7#d77;,b77 before the period 
at the end4