,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #feci  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,april #ag1 #bjbj,mrs4
 ,lee ( ,nevada introduc$ ! foll[+ bill2
 :i* 0 ref]r$ to ! ,committee on ,en]gy 
& ,comm]ce  ,a ,,bill  ,to am5d title   
,,xix ( ! ,social ,security ,act to     
increase ,f$]al support to ,/ate        
,m$icaid programs dur+ economic         
d[nturns1 & = o!r purposes4  #a4 ,%ort  
title ,?is ,act may be cit$ z !         
,coronavirus ,m$icaid ,response ,act4   
#b4 ,increas+ ,f$]al support to ,/ate   
,m$icaid programs dur+ economic d[nturns
  7a7 ,9 g5]al ,section #aije ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7 is am5d$-- 7#a7 9 subsection   
7b71 by /rik+ & 7ff7 & ins]t+ 7ff71 &   
7gg72 &  7#b7 by add+ at ! end ! foll[+ 
new subsection3  7gg7 ,increas$ ,,fmap  
dur+ economic d[nturns  7#a7 ,9 g5]al   
,not)/&+ subsection 7b71 7y71 or        
7z77#b71 if a fiscal qu>t] t beg9s on or
 aft] ,janu>y #a1 #bjbj1 is an economic 
d[nturn qu>t] 7z def9$ 9 p>agraph 7#b77 

) respect to a ,/ate1 !n ! ,f$]al m$ical
 assi/ance p]c5tage applicable to am\nts
 exp5d$ by ! ,/ate = m$ical assi/ance = 
s]vices furni%$ dur+ su* qu>t] %all be  
increas$ 9 accordance ) p>agraphs 7#c7 &
 7#d74  7#b7 ,economic d[nturn qu>t]    
7,a7 ,9 g5]al  7i7 ,9 g5]al ,9 ?is      
subsection1 ! t]m economic d[nturn qu>t]
 means1 ) respect to a ,/ate1 a fiscal  
qu>t] dur+ :i* ! ,/ate's unemploym5t    
rate = ! qu>t] exce$s ! p]c5tage det]m9$
 = ! ,/ate & qu>t] "u clause 7ii74  7ii7
 ,?re%old p]c5tage ,! p]c5tage det]m9$  
"u ?is clause = a ,/ate & fiscal qu>t]  
is ! p]c5tage equal to ! l[] (-- 7,i7 ! 
,/ate unemploym5t rate at ! #bj?        
p]c5tile ( ! di/ribution ( ! ,/ate's    
qu>t]ly unemploym5t rates = ! #fj-qu>t] 
p]iod prec$+ ! qu>t] involv$1 increas$  
by #a p]c5tage po9t2 &  7,,ii7 ! ,/ate's
 av]age qu>t]ly unemploym5t rate = !    
#ab-qu>t] p]iod prec$+ ! qu>t] involv$1 
increas$ by #a p]c5tage po9t4  7,b7     
,unemploym5t data  7i7 ,9 g5]al ,except 
z provid$ 9 clause 7ii71 = purposes (   

det]m9+ unemploym5t rates = a ,/ate & a 
qu>t] "u ?is p>agraph1 ! ,secret>y %all 
use data f ! ,local ,area ,unemploym5t  
,/ati/ics f ! ,bureau ( ,labor          
,/ati/ics4  7ii7 ,application to c]ta9  
t]ritories ,9 ! case ( ! ,virg9 ,isl&s1 
,guam1 ! ,nor!rn ,m>iana ,isl&s1 or     
,am]ican ,samoa1 ! ,secret>y %all use   
data f ! ,u-#f unemploym5t measure ( !  
,bureau ( ,labor ,/ati/ics to make any  
necess>y det]m9ations "u subp>agraph    
7,a74  7#c7 ,,fmap increase dur+        
economic d[nturn qu>t]  7,a7 ,9 g5]al   
,dur+ a fiscal qu>t] t is an economic   
d[nturn qu>t] ) respect to a ,/ate1 !   
,f$]al m$ical assi/ance p]c5tage o!rwise
 det]m9$ = ! ,/ate & qu>t] "u subsection
 7b7 &1 if applicable1 ! ,f$]al m$ical  
assi/ance p]c5tage applicable "u        
subsection 7y71 7z77#b71 or 7ff7 )      
respect to m$ical assi/ance furni%$ by !
 ,/ate dur+ su* qu>t] to individuals    
describ$ 9 ei!r su* subsection %all be  
increas$ by ! numb] ( p]c5tage po9ts    
7r\nd$ to ! ne>e/ t5? ( a p]c5tage po9t7

 equal to ! product (-- 7i7 ! numb] (   
p]c5tage po9ts 7r\nd$ to ! ne>e/ t5? ( a
 p]c5tage po9t7 by :i* ! unemploym5t    
rate = ! ,/ate & qu>t] exce$s ! p]c5tage
 det]m9$ = ! ,/ate & qu>t] "u p>agraph  
7#b77;,a77ii72 &  7ii7 #d4h4  7,b7      
,application ( ,,covid-#ai ,,fmap       
increase ,any increase applicable to !  
,f$]al m$ical assi/ance p]c5tage ( a    
,/ate = a fiscal qu>t] "u subp>agraph   
7,a7 %all be 9 addition to any increase 
to su* p]c5tage = su* qu>t] made        
pursuant to section #fjjh7;a7 ( !       
,families ,fir/ ,coronavirus ,response  
,act4  7,c7 ,limitation ,9 no case %all 
an increase to ! ,f$]al m$ical assi/ance
 p]c5tage ( a ,/ate "u ?is p>agraph     
result 9 a ,f$]al m$ical assi/ance      
p]c5tage t exce$s #ie p]c5t4  7,d7      
,scope ( application ,any increase to ! 
,f$]al m$ical assi/ance p]c5tage ( a    
,/ate = a fiscal qu>t] "u ?is p>agraph  
%all only apply ) respect to paym5ts =  
am\nts exp5d$ by ! ,/ate = m$ical       
assi/ance = s]vices furni%$ dur+ su*    

qu>t] & %all n apply ) respect to-- 7i7 
disproportionate %>e hospital paym5ts   
describ$ 9 section #aibc2  7ii7 paym5ts 
"u title ,,iv or ,,xxi2  7iii7 any      
paym5ts "u ?is title t are bas$ on !    
enhanc$ ,,fmap describ$ 9 section       
#baje7;b72 or  7iv7 any paym5ts "u ?is  
title t are bas$ on a ,f$]al m$ical     
assi/ance p]c5tage det]m9$ = a ,/ate "u 
subsection 7aa7 7b only to ! ext5t t su*
 ,f$]al m$ical assi/ance p]c5tage is    
high] ?an ! economic recov]y ,,fmap74   
7#d7 ,advance paym5t2 retrospective     
adju/m5t  7,a7 ,9 g5]al ,prior to !     
beg9n+ ( ea* fiscal qu>t] t beg9s on or 
aft] ,july #a1 #bjbj1 ! ,secret>y %all1 
) respect to ea* ,/ate-- 7i7 det]m9e !  
increase 7if any7 t is expect$ to apply 
to ! ,f$]al m$ical assi/ance p]c5tage ( 
su* ,/ate = su* qu>t] "u ?is subsection 
bas$ on ! projections made = ! ,/ate &  
qu>t] "u subp>agraph 7,b72 &  7ii7 %all 
apply su* increase to ! ,f$]al m$ical   
assi/ance p]c5tage ( ! ,/ate = purposes 
( mak+ paym5ts to ! ,/ate = am\nts      

exp5d$ dur+ su* qu>t] z m$ical assi/ance
 "u ! ,/ate plan4  7,b7 ,projection (   
,/ate unemploym5t rates ,prior to !     
beg9n+ ( ea* fiscal qu>t] t beg9s on or 
aft] ,july #a1 #bjbj1 ! ,secret>y1 act+ 
?r\gh ! ,*ief ,actu>y ( ! ,c5t]s =      
,m$ic>e  ,m$icaid ,s]vices1 %all1 us+ ! 
mo/ rec5tly available data describ$ 9   
p>agraph 7#b77;,b71 make projections )  
respect to-- 7i7 ! unemploym5t rates =  
ea* ,/ate = su* qu>t]2  7ii7 ! ?re%old  
p]c5tages describ$ 9 p>agraph           
7#b77;,a77ii7 = ea* ,/ate = su* qu>t]2 &
  7iii7 ! national unemploym5t rate =   
su* qu>t]4  7,c7 ,retrospective adju/m5t
 ,z soon z practicable aft] f9al        
unemploym5t data becomes available = a  
fiscal qu>t] t beg9s on or aft] ,july   
#a1 #bjbj1 ! ,secret>y %all1 ) respect  
to ea* ,/ate-- 7i7 make a f9al          
det]m9ation ( ! increase 7if any7       
applicable to ! ,f$]al m$ical assi/ance 
p]c5tage ( ! ,/ate = ! qu>t] "u ?is     
subsection2 &  7ii7 9 accordance )      
subsection 7d77#b7 ( section #aijc1     

r$uce or increase ! am\nt payable to !  
,/ate "u subsection 7a7 ( su* section = 
a subsequ5t fiscal qu>t] to ! ext5t (   
any ov]paym5t or und]paym5t :i* !       
,secret>y det]m9es 0 made z a result ( a
 miscalculation ( ! increase applicable 
to ! ,f$]al m$ical assi/ance p]c5tage ( 
! ,/ate = su* prior fiscal qu>t] "u ?is 
subsection4  7#e7 ,retrospective        
application ( ov]-!-limit ,,fmap        
increases  7,a7 ,9 g5]al ,if a ,/ate has
 excess p]c5tage po9ts ) respect to an  
economic d[nturn qu>t] & an applicable  
,,fmap 7z det]m9$ "u subp>agraph 7,b771 
! ,/ate may elect to apply su* excess   
p]c5tage po9ts to increase su*          
applicable ,,fmap = "o or m qu>t]s dur+ 
! look-back p]iod = ! ,/ate & economic  
d[nturn qu>t] 9 accordance ) ?is        
p>agraph4  7,b7 ,excess p]c5tage po9ts  
,= purposes ( ?is p>agraph1 ! numb] (   
excess p]c5tage po9ts = a ,/ate1        
economic d[nturn qu>t]1 & an applicable 
,,fmap %all be equal to ! numb] (       
p]c5tage po9ts by :i*-- 7i7 ! applicable

 ,,fmap = ! ,/ate & qu>t] 7aft]         
application ( p>agraph 7#c7 b )\t reg>d 
to subp>agraph 7,c7 ( su* p>agraph72    
exce$s  7ii7 #ie p]c5t4  7,c7 ,effect ( 
application ( excess p]c5tage po9ts ,if 
a ,/ate elects to apply excess p]c5tage 
po9ts to an applicable ,,fmap to a qu>t]
 dur+ a look-back p]iod "u ?is p>agraph1
 ! ,secret>y %all det]m9e ! additional  
am\nt ( paym5t "u section #aijc7;a7 to  
:i* ! ,/ate w\ld h be5 entitl$ = su*    
qu>t] if ! applicable ,,fmap 7z s       
increas$7 _h be5 9 effect = su* qu>t]1 &
 %all treat su* additional am\nt z an   
und]paym5t = su* qu>t]4  7,d7           
,di/ribution ( excess p]c5tage po9ts ,a 
,/ate t has excess p]c5tage po9ts )     
respect to an economic d[nturn qu>t] &  
applicable ,,fmap may elect to divide   
su* po9ts among m ?an #a qu>t] dur+ !   
look-back p]iod = su* ,/ate & qu>t]     
provid$ t no excess p]c5tage po9t 7or   
fraction ( an excess p]c5tage po9t7 is  
appli$ to ! applicable ,,fmap ( m ?an #a
 qu>t]4  7,e7 ,limitations  7i7 ,no     

increases ov] #ajj p]c5t ,a ,/ate may n 
increase an applicable ,,fmap = any     
qu>t] dur+ a look-back p]iod "u ?is     
p>agraph if su* increase w\ld result 9 !
 applicable ,,fmap = su* qu>t] exce$+   
#ajj p]c5t4  7ii7 ,scope ( application  
,any increase to an applicable ,,fmap ( 
a ,/ate = a fiscal qu>t] "u ?is         
p>agraph-- 7,i7 %all only apply )       
respect to paym5ts = am\nts exp5d$ by ! 
,/ate = m$ical assi/ance = s]vices      
furni%$ dur+ su* qu>t] to :i* su*       
applicable ,,fmap is applicable2 &      
7,,ii7 %all n apply ) respect to paym5ts
 describ$ 9 p>agraph 7#c77;,d74  7,f7   
,def9itions ,9 ?is p>agraph3 7i7        
,applicable ,,fmap ,! t]m applicable    
,,fmap means1 ) respect to a ,/ate &    
fiscal qu>t]-- 7,i7 ! ,f$]al m$ical     
assi/ance p]c5tage det]m9$ = ! ,/ate &  
qu>t] "u subsection 7b72  7,,ii7 !      
,f$]al m$ical assi/ance p]c5tage        
applicable "u subsection 7y72  7,,iii7 !
 ,f$]al m$ical assi/ance p]c5tage       
applicable "u subsection 7z77#b72 or    

7,,iv7 ! ,f$]al m$ical assi/ance        
p]c5tage det]m9$ = ! ,/ate & qu>t] "u   
subsection 7ff74  7ii7 ,look-back p]iod 
,! t]m look-back p]iod means1 ) respect 
to a ,/ate & a fiscal qu>t] t is an     
economic d[nturn qu>t] = ! ,/ate1 !     
p]iod ( #d fiscal qu>t]s t ends ) ! f\r?
 qu>t] :i* prec$es ! mo/ rec5t fiscal   
qu>t]s t 0 n an economic d[nturn qu>t] =
 ! ,/ate4  7#f7 ,requirem5t = all ,/ates
 ,a ,/ate may n receive an increase 9 ! 
,f$]al m$ical assi/ance p]c5tage = su*  
,/ate "u ?is subsection1 ) respect to a 
fiscal qu>t]1 if-- 7,a7 eligibility     
/&>ds1 me?odologies1 or proc$ures "u !  
,/ate plan or a waiv] ( su* plan are m  
re/rictive dur+ su* qu>t] ?an !         
eligibility /&>ds1 me?odologies1 or     
proc$ures1 respectively1 "u su* plan 7or
 waiv]7 z 9 effect on ! la/ day ( ! mo/ 
rec5t fiscal qu>t] t 0 n an economic    
d[nturn qu>t] = ! ,/ate2  7,b7 ! am\nt (
 any premium impos$ by ! ,/ate pursuant 
to section #aiaf or #aiaf;,a dur+ su*   
qu>t]1 ) respect to an individual       

enroll$ "u su* plan 7or waiv]71 exce$s !
 am\nt ( su* premium z ( ! date describ$
 9 subp>agraph 7,a72 or  7,c7 ! ,/ate   
fails to provide t an individual :o is  
enroll$ = b5efits "u su* plan 7or waiv]7
 z ( ! date describ$ 9 subp>agraph 7,a7 
or enrolls = b5efits "u su* plan 7or    
waiv]7 dur+ ! p]iod beg9n+ ) su* date & 
end+ ) ! day be=e ! fir/ day ( ! next   
qu>t] t is n an economic d[nturn qu>t] =
 ! ,/ate %all be treat$ z eligible = su*
 b5efits = n less ?an #ab mon?s 7or1 if 
su* p]iod is less ?an #ab mon?s1 ?r\gh\t
 su* p]iod7 unless ! individual reque/s 
a volunt>y t]m9ation ( eligibility or ! 
individual ceases to be a resid5t ( !   
,/ate4  4  7b7 ,exclusion ( economic    
d[nturn ,,fmap increases f t]ritorial   
caps ,section #aajh ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #acjh7 is 
am5d$-- 7#a7 9 subsection 7f71 9 ! matt]
 prec$+ p>agraph 7#a71 by /rik+         
subsection 7g7 & section                
#aice7;e77#a77;,b7 & ins]t+ subsections 
7g7 & 7h7 & section #aice7;e77#a77;,b72 

&  7#b7 by add+ at ! end ! foll[+3  7h7 
,exclusion f caps ( am\nts attributable 
to economic d[nturn ,,fmap ,! portion ( 
any paym5t made to a t]ritory = a fiscal
 ye> t is attributable to an increase 9 
! ,f$]al m$ical assi/ance p]c5tage = a  
fiscal qu>t] dur+ su* ye> "u section    
#aije7;gg7 %all n be tak5 into acc\nt = 
purposes ( apply+ paym5t limits "u      
subsections 7f7 & 7g74  4