,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #dfga  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #ae1 #bjai,mr4
 ,kim 7= himself1 ,ms4 ,blunt ,ro*e/]1 &
 ,mr4 ,evans7 introduc$ ! foll[+ bill2  
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committee 
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d titles     
,,xviii & ,,xix ( ! ,social ,security   
,act to r$uce co/-%>+1 align income &   
res\rce eligibility te/s1 simplify      
enrollm5t1 & provide = o!r program      
improvem5ts = l[-income ,m$ic>e         
b5efici>ies4  #a4 ,%ort title ,?is ,act 
may be cit$ z ! ,help+ ,s5iors ,af=d    
,heal? ,c>e ,act4  #b4 ,r$uc+ co/-%>+1  
align+ income & res\rce eligibility     
te/s1 simplify+ enrollm5t1 & o!r program
 improvem5ts = l[-income b5efici>ies    
7a7 ,increase 9 income eligibility to   
#ace p]c5t ( ,,fpl = qualifi$ ,m$ic>e   

b5efici>ies  7#a7 ,9 g5]al ,section     
#aije7p77#b77;,a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acif;d7p77#b77;,a77
 is am5d$ by /rik+ %all be at lea/ !    
p]c5t provid$ "u subp>agraph 7,b7 7b n m
 ?an #ajj p]c5t7 ( ! (ficial pov]ty l9e 
& all t foll[s ?r\gh ! p]iod at ! end & 
ins]t+ ! foll[+3  %all be-- 7i7 be=e    
,janu>y #a1 #bjba1 at lea/ ! p]c5t      
provid$ "u subp>agraph 7,b7 7b n m ?an  
#ajj p]c5t7 ( ! (ficial pov]ty l9e 7z   
def9$ by ! ,(fice ( ,managem5t &        
,budget1 & revis$ annually 9 accordance 
) section #fgc7b7 ( ! ,omnibus ,budget  
,reconciliation ,act ( #aiha7 applicable
 to a family ( ! size involv$2 &  7ii7  
on or aft] ,janu>y #a1 #bjba1 equal to  
#ace p]c5t ( ! (ficial pov]ty l9e 7z s  
def9$ & revis$7 applicable to a family (
 ! size involv$4  4  7#b7 ,n c\nt+ 9-k9d
 support & ma9t5ance z income ,section  
#aije7p77#b77;,d7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acif;d7p77#b77;,d77
 is am5d$ by add+ at ! end ! foll[+ new 
clause3  7iii7 ,9 det]m9+ income "u ?is 

subsection1 support & ma9t5ance furni%$ 
9 k9d %all n be c\nt$ z income4  4  7b7 
,increase 9 income eligibility to #bjj  
p]c5t ( ,,fpl = specifi$ l[-,income     
,m$ic>e b5efici>ies  7#a7 ,eligibility (
 individuals ) incomes bel[ #aej p]c5t (
 ,,fpl ,section #aijb7;a77#aj77;,e7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7a77#aj77;,e77 is am5d$-- 7,a7 by
 add+ & at ! end ( clause 7ii72  7,b7 9 
clause 7iii7-- 7i7 by /rik+ & #abj p]c5t
 9 #aiie & ye>s !reaft] & ins]t+ #abj   
p]c5t 9 #aiie & ye>s !reaft] be=e #bjba1
 & #bjj p]c5t 9 #bjba & ye>s !reaft]2 & 
7ii7 by /rik+ & at ! end2 &  7,c7 by    
/rik+ clause 7iv74  7#b7 ,ref]5ces      
,section #aije7p77#a7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acif;d7p77#a77 is am5d$ by add+ at &   
bel[ subp>agraph 7,c7 ! foll[+ flu%     
s5t5ce3  ,! t]m specifi$ l[-income      
m$ic>e b5efici>y means an individual    
describ$ 9 section                      
#aijb7;a77#aj77;,e77iii74 4  7#c7       
,con=m+ am5dm5ts  7,a7 ,! fir/ s5t5ce ( 

section #aije7;b7 ( su* ,act 7#db       
,u4,s4,c4 #acif;d7b77 is am5d$ by /rik+ 
8& section #aicc7;d704  7,b7 ,section   
#aicc ( su* ,act 7#db ,u4,s4,c4         
#acifu-#c7 is repeal$4  7c7 #ajj p]c5t  
,,fmap ,section #aije ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acif;d7  
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7gg7 ,increas$ ,,fmap =    
exp&$ m$ic>e co/-,%>+ populations  7#a7 
,9 g5]al ,not)/&+ subsection 7b71 )     
respect to exp5ditures describ$ 9       
p>agraph 7#b7 ! ,f$]al m$ical assi/ance 
p]c5tage %all be equal to #ajj p]c5t4   
7#b7 ,exp5ditures describ$ ,!           
exp5ditures describ$ 9 ?is p>agraph are 
exp5ditures made on or aft] ,janu>y #a1 
#bjba1 = m$ical assi/ance = m$ic>e      
co/-%>+ provid$ to any individual "u    
clause 7i71 7ii71 or 7iii7 ( section    
#aijb7;a77#aj77;,e7 :o w\ld n h be5     
eligible = m$ic>e co/-%>+ "u any su*    
clause "u ! income or res\rce           
eligibility /&>ds 9 effect on ,octob]   
#a1 #bjah4  4  7d7 ,consolidation (     

l[-,income subsidy res\rce eligibility  
te/s  7#a7 ,9 g5]al ,section            
#ahfj;,d-#ad7;a77#c7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#aad7;a77#c77 is am5d$-- 7,a7 by 
/rik+ subp>agraph 7,d72  7,b7 by        
r$esignat+ subp>agraphs 7,e7 ?r\gh 7,g7 
z subp>agraphs 7,d7 ?r\gh 7,f71         
respectively2 &  7,c7 9 ! head+ (       
subp>agraph 7,d71 z s r$esignat$1 by    
/rik+ ,alt]native4  7#b7 ,cl>ification (
 c]ta9 rules relat+ to income & res\rce 
det]m9ations ,section                   
#ahfj;,d-#ad7;a77#c7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#aad7;a77#c771 z am5d$ by        
p>agraph 7#a71 is am5d$ by /rik+        
subp>agraph 7,f7 & ins]t+ ! foll[+ new  
subp>agraphs3  7,f7 ,res\rce exclusions 
,9 det]m9+ ! res\rces ( an individual 7&
 ! eligible sp\se ( ! individual1 if    
any7 "u section #afac = purposes (      
subp>agraph 7,d7--  7i7 no "p ( ! value 
( any life insurance policy %all be tak5
 into acc\nt2  7ii7 no "p ( ! value (   

any vehicle %all be tak5 into acc\nt2   
7iii7 !re %all be exclud$ an am\nt equal
 to #a1ejj ea* ) respect to any         
individual or eligible sp\se ( an       
individual :o atte/s t "s ( ! res\rces (
 su* individual or sp\se w be us$ to    
meet ! burial & relat$ exp5ses ( su*    
individual or sp\se2 &  7iv7 no balance 
91 or b5efits receiv$ "u1 an employee   
p5sion b5efit plan 7z def9$ 9 section #c
 ( ! ,employee ,retirem5t ,income       
,security ,act ( #aigd7 %all be tak5    
into acc\nt4  7,g7 ,family size ,9      
det]m9+ ! size ( ! family ( an          
individual = purposes ( det]m9+ ! income
 eligibility ( su* individual "u ?is    
section1 an individual's family %all    
consi/ (--  7i7 ! individual2  7ii7 !   
individual's sp\se :o lives 9 ! same    
h\sehold z ! individual 7if any72 &     
7iii7 any o!r individuals :o-- 7,i7 are 
relat$ to ! individual ^: income        
eligibility is 9 "q or su* individual's 
sp\se :o lives 9 ! same h\sehold2       
7,,ii7 are liv+ 9 ! same h\sehold z su* 

individual2 &  7,,iii7 are dep5d5t on   
su* individual or su* individual's sp\se
 :o is liv+ 9 ! same h\sehold = at lea/ 
"o-half ( _! f9ancial support4  4  7#c7 
,con=m+ am5dm5ts ,section               
#ahfj;,d-#ad7;a7 ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is 
am5d$-- 7,a7 9 p>agraph 7#a71 9 ! matt] 
prec$+ subp>agraph 7,a71 by ins]t+ 7z   
det]m9$ "u p>agraph 7#c77;,g77 aft]     
family ( ! size involv$2 &  7,b7 9      
p>agraph 7#c71 z am5d$ by p>agraphs 7#a7
 & 7#b7-- 7i7 9 subp>agraph 7,a71 9 !   
matt] prec$+ clause 7i71 by /rik+       
subp>agraph 7,f7 & ins]t+ subp>agraph   
7,e72  7ii7 9 subp>agraph 7,a77ii71 by  
ins]t+ 7z det]m9$ "u subp>agraph 7,g77  
aft] family ( ! size involv$2  7iii7 9  
subp>agraph 7,a77iii71 by /rik+ or 7,e72
  7iv7 9 subp>agraph 7,b77v71 9 ! matt] 
prec$+ subclause 7,i71 by /rik+         
subp>agraph 7,f7 & ins]t+ subp>agraph   
7,e72 &  7v7 9 subp>agraph 7,d77i71 9 ! 
matt] prec$+ subclause 7,i71 by /rik+   
subject to ! life insurance policy      

exclusion provid$ "u subp>agraph 7,g7 & 
ins]t+ subject to ! res\rce exclusions  
provid$ "u subp>agraph 7,f74  7e7       
,alignm5t ( l[-,income subsidy & m$ic>e 
sav+s program income & res\rce          
eligibility te/s  7#a7 ,application (   
,m$icaid sp\sal impov]i%m5t res\rce     
all[ance to ,,msp & ,,lis res\rce       
eligibility ,section #aije7p77#a77;,c7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acif;d7p77#a77;,c77 is am5d$ to read z
 foll[s3  7,c7 ^: res\rces 7z det]m9$ "u
 section #afac = purposes ( !           
supplem5tal security income program     
subject to ! res\rce exclusions "u      
subp>agraph 7,g7 ( section              
#ahfj;,d-#ad7;a77#c77 d n exce$--  7i7 9
 ! case ( an individual ) a sp\se1 an   
am\nt equal to ! sum ( ! fir/ am\nt     
specifi$ 9 subsection 7f77#b77;,a77i7 ( 
section #aibd 7z adju/$ "u subsection   
7g7 ( su* section7 & ! am\nt specifi$ 9 
subsection 7f77#b77;,a77ii77,,ii7 ( su* 
section 7z s adju/$72 or  7ii7 9 ! case 
( an individual :o does n h a sp\se1 an 

am\nt equal to  ( ! am\nt describ$ 9    
clause 7i74  4  7#b7 ,application to    
,q,d,w,is ,section #aije7s77#c7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7s77#c77 is am5d$ to read z      
foll[s3  7#c7 ^: res\rces 7z det]m9$ "u 
section #afac = purposes ( ! supplem5tal
 security income program subject to !   
res\rce exclusions "u subp>agraph 7,g7 (
 section #ahfj;,d-#ad7;a77#c77 d n      
exce$--  7,a7 9 ! case ( an individual )
 a sp\se1 ! am\nt 9 effect = ! ye> "u   
clause 7i7 ( subsection 7p77#a77;,c72 & 
7,b7 9 ! case ( an individual :o does n 
h a sp\se1 ! am\nt 9 effect = ! ye> "u  
clause 7ii7 ( subsection 7p77#a77;,c72 &
  4  7#c7 ,application to ,,lis ,clause 
7i7 ( section #ahfj;,d-#ad7;a77#c77;,d7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#aad7;a77#c77;,d771 z  
r$esignat$ & am5d$ by subsection        
7d77#a71 is am5d$ to read z foll[s3  7i7
 ,9 g5]al ,! res\rces requirem5t ( ?is  
subp>agraph is t an individual's        
res\rces 7z det]m9$ "u section #afac =  

purposes ( ! supplem5tal security income
 program subject to ! res\rce exclusions
 provid$ "u subp>agraph 7,g77 d n exce$ 
! am\nt 9 effect = ! ye> "u section     
#aije7p77#a77;,c77ii74  4  7f7          
,enrollm5t simplifications  7#a7        
,application ( #c-mon? retroactive      
eligibility to ,q,m,bs  7,a7 ,9 g5]al   
,section #aijb7;e77#h7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acif;a7e77#h77 is am5d$ by /rik+ aft] !
 end ( ! mon? 9 :i* ! det]m9ation fir/  
occurs & ins]t+ 9 or aft] ! ?ird mon?   
be=e ! mon? 9 :i* ! individual makes    
application = assi/ance4  7,b7 ,process 
= submitt+ claims dur+ retroactive      
eligibility p]iod ,section #aijb7;e77#h7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acif;a7e77#h77 is fur!r am5d$
 by add+ at ! end ! foll[+3 ,! ,secret>y
 %all provide = a process "u :i* claims 
= m$ical assi/ance "u ! ,/ate plan may  
be submitt$ = s]vices furni%$ to su* an 
individual dur+ su* #c-mon? p]iod be=e !
 mon? 9 :i* ! individual made           

application = assi/ance44  7,c7 ,con=m+ 
am5dm5t ,section #aije7;a7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acif;d7a77 is am5d$1 9 ! matt] prec$+  
p>agraph 7#a71 by /rik+ or1 9 ! case (  
m$ic>e co/-%>+ ) respect to a qualifi$  
m$ic>e b5efici>y describ$ 9 subsection  
7p77#a71 if provid$ aft] ! mon? 9 :i* ! 
individual becomes su* a b5efici>y4     
7#b7 ,/ate option = #ab-mon? cont9u\s   
eligibility = ,s,l,m,bs & ,q,w,d,is     
,section #aijb7;e77#ab7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acif;a7e77#ab77 is am5d$-- 7,a7 by     
r$esignat+ subp>agraphs 7,a7 & 7,b7 z   
clauses 7i7 & 7ii71 respectively2  7,b7 
by ins]t+ 7,a7 aft] 7#ab72 &  7,c7 by   
add+ at ! end ! foll[+3  7,b7 ,at !     
option ( ! ,/ate1 ! plan may provide t  
an individual :o is det]m9$ to be       
eligible = b5efits "u a ,/ate plan      
approv$ "u ?is title "u any ( ! foll[+  
eligibility categories1 or :o is        
r$et]m9$ to be eligible = su* b5efits "u
 any ( su* categories1 %all be consid]$ 

to meet ! eligibility requirem5ts met on
 ! date ( application & %all rema9      
eligible = ^? b5efits until ! end ( !   
#ab-mon? p]iod foll[+ ! date ( !        
det]m9ation or r$et]m9ation (           
eligibility1 except t a ,/ate may       
provide = su* det]m9ations m frequ5tly1 
b n m frequ5tly ?an once e #f mon?s = an
 individual3  7i7 ,a specifi$ l[-income 
m$ic>e b5efici>y describ$ 9 subsection  
7a77#aj77;,e77iii7 ( ?is section :o is  
det]m9$ eligible = m$ic>e co/ %>+       
describ$ 9 section                      
#aije7p77#c77;,a77ii74  7ii7 ,a qualifi$
 disabl$ & work+ individual describ$ 9  
section #aije7s7 :o is det]m9$ eligible 
= m$ic>e co/-%>+ describ$ 9 section     
#aije7p77#c77;,a77i74  4  7#c7 ,/ate    
option to use ,express ,lane eligibility
 = ! ,m$ic>e ,sav+s ,program ,section   
#aijb7;e77#ac77;,a7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;a7e77#ac77;,a77 is am5d$ by add+  
at ! end ! foll[+ new clause3  7iii7    
,/ate option to ext5d express lane      

eligibility to o!r populations  7,i7 ,9 
g5]al ,at ! option ( ! ,/ate1 ! ,/ate   
may apply ! provisions ( ?is p>agraph ) 
respect to det]m9+ eligibility "u ?is   
title = an eligible individual 7z def9$ 
9 subclause 7,,ii774 ,9 apply+ ?is      
p>agraph 9 ! case ( a ,/ate mak+ su* an 
option1 any ref]5ce 9 ?is p>agraph to a 
*ild ) respect to ?is title 7o!r ?an a  
ref]5ce to *ild heal? assi/ance7 %all be
 deem$ to be a ref]5ce to an eligible   
individual4  7,,ii7 ,eligible individual
 def9$ ,9 ?is clause1 ! t]m eligible    
individual means any ( ! foll[+3 7aa7 ,a
 qualifi$ m$ic>e b5efici>y describ$ 9   
section #aije7p77#a7 = purposes (       
det]m9+ eligibility = m$ic>e co/-%>+ 7z 
def9$ 9 section #aije7p77#c774  7bb7 ,a 
specifi$ l[-income m$ic>e b5efici>y     
describ$ 9 subsection 7a77#aj77;,e77iii7
 ( ?is section = purposes ( det]m9+     
eligibility = m$ic>e co/-%>+ describ$ 9 
section #aije7p77#c77;,a77ii74  7cc7 ,a 
qualifi$ disabl$ & work+ individual     
describ$ 9 section #aije7s7 = purposes (

 det]m9+ eligibility = m$ic>e co/-%>+   
describ$ 9 section #aije7p77#c77;,a77i74
  4  7g7 ,m$icaid treatm5t ( c]ta9      
,m$ic>e provid]s ,section #aijb7n7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7n77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraph3  7#d7 ,a ,/ate plan
 %all n d5y a claim f a provid] or      
suppli] ) respect to m$ic>e co/-%>+     
describ$ 9 subp>agraph 7,b71 7,c71 or   
7,d7 ( section #aije7p77#c7 = an item or
 s]vice :i* is eligible = paym5t "u     
title ,,xviii on ! basis t ! provid] or 
suppli] does n h a provid] agreem5t 9   
effect "u ?is title or does n o!rwise   
s]ve all individuals entitl$ to m$ical  
assi/ance "u ?is title4 ,! ,/ate %all   
create a me*anism ?r\gh :i* provid] or  
suppli]s t d n o!rwise h provid]        
agreem5ts ) ! ,/ate c bill ! ,/ate =    
m$ic>e co/-%>+ = qualifi$ m$ic>e        
b5efici>ies4  4  7h7 ,eligibility = o!r 
programs ,section #aije7p7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acif;d7p77 is am5d$ by add+ at ! end ! 

foll[+ new p>agraph3  7#g7 ,not)/&+ any 
o!r provision ( law1 any m$ical         
assi/ance = "s or all m$ic>e co/-%>+ "u 
?is title %all n be consid]$ income or  
res\rces 9 det]m9+ eligibility =1 or !  
am\nt ( assi/ance or b5efits provid$ "u1
 any o!r public b5efit provid$ "u ,f$]al
 law or ! law ( any ,/ate or political  
subdivision !re(4  4  7i7 ,treatm5t (   
qualifi$ ,m$ic>e b5efici>ies1 specifi$  
l[-,income ,m$ic>e b5efici>ies1 & o!r   
dual eligibles z m$ic>e b5efici>ies     
,section #ahfb ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciey7 is am5d$ by 
add+ at ! end ! foll[+ new subsection3  
7p7 ,treatm5t ( ,qualifi$ ,m$ic>e       
,b5efici>ies 7,q,m,bs71 ,specifi$       
,l[-,income ,m$ic>e ,b5efici>ies        
7,s,l,m,bs71 & ,o!r ,dual ,eligibles    
,no?+ 9 ?is title %all be con/ru$ z     
au?oriz+ a provid] ( s]vices or suppli] 
to discrim9ate 7?r\gh a private         
contractual arrangem5t or o!rwise7 aga9/
 an individual :o is o!rwise entitl$ to 
s]vices "u ?is title on ! basis t !     

individual is a qualifi$ m$ic>e         
b5efici>y 7z def9$ 9 section            
#aije7p77#a771 a specifi$ l[-income     
m$ic>e b5efici>y1 or is o!rwise eligible
 = m$ical assi/ance = m$ic>e co/-%>+ or 
o!r b5efits "u title ,,xix4  4  7j7     
,additional ,fund+ = ,/ate ,heal?       
,insurance ,assi/ance ,programs  7#a7   
,grants  7,a7 ,9 g5]al ,! ,secret>y (   
,heal? & ,human ,s]vices 79 ?is         
subsection ref]r$ to z ! ,secret>y7 %all
 use am\nts made available "u           
subp>agraph 7,b7 to make grants to      
,/ates = ,/ate heal? insurance assi/ance
 programs receiv+ assi/ance "u section  
#dcfj ( ! ,omnibus ,budget              
,reconciliation ,act ( #aiij4  7,b7     
,fund+ ,= purposes ( mak+ grants "u ?is 
subsection1 ! ,secret>y %all provide = !
 transf]1 f ! ,f$]al ,hospital          
,insurance ,tru/ ,fund "u section #ahag 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i7 & ! ,f$]al           
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund "u section #ahda ( su* ,act 7#db  

,u4,s4,c4 #aciet71 9 ! same proportion z
 ! ,secret>y det]m9es "u section        
#ahec7;f7 ( su* ,act 7#db ,u4,s4,c4     
#aciew-#bc7;f771 ( #ej1jjj1jjj to !     
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices     
,program ,managem5t ,acc\nt = ea* ( !   
fiscal ye>s #bjba ?r\gh #bjbe1 to rema9 
available until exp5d$4  7#b7 ,am\nt (  
grants ,! am\nt ( a grant to a ,/ate "u 
?is subsection f ! total am\nt made     
available "u p>agraph 7#a7 %all be equal
 to ! sum ( ! am\nt allocat$ to ! ,/ate 
"u p>agraph 7#c77;,a7 & ! am\nt allocat$
 to ! ,/ate "u subp>agraph 7#c77;,b74   
7#c7 ,allocation to ,/ates  7,a7        
,allocation bas$ on p]c5tage ( l[-income
 b5efici>ies ,! am\nt allocat$ to a     
,/ate "u ?is subp>agraph f #b_/c ( !    
total am\nt made available "u p>agraph  
7#a7 %all be bas$ on ! numb] (          
individuals :o meet ! requirem5t "u     
subsection 7a77#c77;,a77ii7 ( section   
#ahfj;,d-#ad ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciew-#aad7 b :o h n    
enroll$ to receive a subsidy "u su*     

section #ahfj;,d-#ad relative to ! total
 numb] ( individuals :o meet !          
requirem5t "u su* subsection            
7a77#c77;,a77ii7 9 ea* ,/ate1 z e/imat$ 
by ! ,secret>y4  7,b7 ,allocation bas$  
on p]c5tage ( rural b5efici>ies ,! am\nt
 allocat$ to a ,/ate "u ?is subp>agraph 
f #a_/c ( ! total am\nt made available  
"u p>agraph 7#a7 %all be bas$ on ! numb]
 ( "p ,d eligible individuals 7z def9$ 9
 section #ahfj;,d-#a7;a77#c77;,a7 ( su* 
,act 7#db ,u4,s4,c4                     
#aciew-#aja7;a77#c77;,a777 resid+ 9 a   
rural area relative to ! total numb] (  
su* individuals 9 ea* ,/ate1 z e/imat$  
by ! ,secret>y4  7#d7 ,portion ( grant  
bas$ on p]c5tage ( l[-income b5efici>ies
 to be us$ to provide outrea* to        
individuals :o may be subsidy eligible  
individuals or eligible = ! ,m$ic>e     
,sav+s ,program ,ea* grant aw>d$ "u ?is 
subsection ) respect to am\nts allocat$ 
"u p>agraph 7#c77;,a7 %all be us$ to    
provide outrea* to individuals :o may be
 subsidy eligible individuals 7z def9$ 9

 section #ahfj;,d-#ad7;a77#c77;,a7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#aad7;a77#c77;,a777 or eligible =
 ! program ( m$ical assi/ance = paym5t (
 ! co/ ( m$ic>e co/-%>+ "u ! ,m$icaid   
program pursuant to sections            
#aijb7;a77#aj77;,e7 & #aicc ( su* ,act  
7#db ,u4,s4,c4 #acif;a7a77#aj77;,e71    
#acifu-#c74  7k7 ,effective date  7#a7  
,9 g5]al ,except z provid$ 9 p>agraph   
7#b71 ! am5dm5ts & repeal made by ?is   
section take effect on ,janu>y #a1      
#bjba1 &1 ) respect to title ,,xix ( !  
,social ,security ,act1 apply to cal5d> 
qu>t]s beg9n+ on or aft] ,janu>y #a1    
#bjba4  7#b7 ,exception = ,/ate         
legislation ,9 ! case ( a ,/ate plan =  
m$ical assi/ance "u title ,,xix ( !     
,social ,security ,act :i* ! ,secret>y (
 ,heal? & ,human ,s]vices det]m9es      
requires ,/ate legislation 7o!r ?an     
legislation appropriat+ funds7 9 ord] = 
! plan to meet ! additional requirem5ts 
impos$ by ! am5dm5ts & repeal made by   
?is section1 ! ,/ate plan %all n be     

reg>d$ z fail+ to comply ) ! requirem5ts
 ( su* title solely on ! basis ( its    
failure to meet ^! additional           
requirem5ts be=e ! fir/ day ( ! fir/    
cal5d> qu>t] beg9n+ aft] ! close ( !    
fir/ regul> session ( ! ,/ate           
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 su* session %all be deem$ to be a      
sep>ate regul> session ( ! ,/ate        
legislature4