,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #dajh  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #cj1 #bjbj,mr4   
,casey 7= himself1 ,ms4 ,cortez ,ma/o1  
,mr4 ,br[n1 ,mr4 ,b5net1 ,mr4 ,wyd51    
,ms4 ,ros51 ,ms4 ,smi?1 ,mr4 ,m]kley1   
,mr4 ,te/]1 ,ms4 ,/ab5[1 ,mrs4 ,%ahe51  
,mr4 ,book]1 ,ms4 ,klobu*>1 ,mr4 ,van   
,holl51 ,mr4 ,:iteh\se1 ,mr4 ,pet]s1 &  
,mr4 ,m55dez7 introduc$ ! foll[+ bill2  
:i* 0 read twice & ref]r$ to !          
,committee on ,f9ance  ,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   
,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 det]m9$ = ea* ,/ate 
= su* qu>t] "u subsection 7b7 %all be   
equal to ! p]c5tage det]m9$ = ! ,/ate & 
qu>t] "u p>agraph 7#c74  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
 ,am]ican ,samoa1 or any o!r            
jurisdiction = :i* suitable data f !    
,local ,area ,unemploym5t ,/ati/ics f ! 
,bureau ( ,labor ,/ati/ics are          
unavailable1 ! ,secret>y %all use data f
 ! ,u-#c unemploym5t measure ( ! ,bureau
 ( ,labor ,/ati/ics to make any necess>y
 det]m9ations "u subp>agraph 7,a74  7#c7
 ,increas$ ,,fmap 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 = ! ,/ate & qu>t]    
det]m9$ "u subsection 7b7 %all be equal 

to-- 7i7 ! ,f$]al m$ical assi/ance      
p]c5tage det]m9$ = ! ,/ate & qu>t] "u   
subsection 7b7 )\t reg>d to ?is         
subsection 7b includ+ any increase to   
su* p]c5tage = su* qu>t] made pursuant  
to section #fjjh7;a7 ( ! ,families ,fir/
 ,coronavirus ,response ,act72 increas$ 
by  7ii7 ! numb] ( p]c5tage po9ts 7r\nd$
 to ! ne>e/ t5? ( a p]c5tage po9t7 equal
 to ! product (-- 7,i7 ! 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 &  7,,ii7 #d4h4  7,b7    
,rules ( application ,! foll[+ rules    
%all apply ) respect to ! ,f$]al m$ical 
assi/ance p]c5tage det]m9$ = a ,/ate &  
an economic d[nturn qu>t] "u ?is        
subsection3 7i7 ,scope ( application    
,su* ,f$]al m$ical assi/ance p]c5tage   
%all n apply = purposes (-- 7,i7        
disproportionate %>e hospital paym5ts   
describ$ 9 section #aibc2  7,,ii7       
paym5ts "u "p ,d ( title ,,iv2 or       

7,,iii7 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  7ii7        
,limitation ,9 no case %all-- 7,i7 !    
,f$]al m$ical assi/ance p]c5tage det]m9$
 = a ,/ate & qu>t] pursuant to ?is      
subsection exce$ #ie p]c5t2 or  7,,ii7  
any increase to ! ,f$]al m$ical         
assi/ance p]c5tage det]m9$ = a ,/ate &  
qu>t] pursuant to ?is subsection result 
9 ! application ( a ,f$]al m$ical       
assi/ance p]c5tage t exce$s #ie p]c5t4  
7iii7 ,application to ,,*ip ,not)/&+ !  
fir/ s5t5ce ( section #baje7;b71 !      
application ( ?is subsection may result 
9 ! enhanc$ ,,fmap ( a ,/ate = a fiscal 
ye> "u su* section exce$+ #he p]c5t1 b 9
 no case may ! application ( ?is        
subsection be=e application ( ! second  
s5t5ce ( su* section result 9 ! enhanc$ 
,,fmap ( ! ,/ate exce$+ #ie p]c5t4  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 make an initial      
det]m9ation1 bas$ on ! projections made 
= ! ,/ate & qu>t] "u subp>agraph 7,b71 z
 to-- 7,i7 :e!r ! application ( ?is     
subsection is expect$ to result 9 !     
application ( a high] ,f$]al m$ical     
assi/ance p]c5tage = ! ,/ate & qu>t] ?an
 ! p]c5tage t w\ld o!rwise apply )\t    
reg>d to ?is subsection2 &--  7,,ii7 if 
! application ( ?is subsection is       
expect$ to result 9 su* a high] ,f$]al  
m$ical assi/ance p]c5tage = ! ,/ate &   
qu>t]1 :at su* high] p]c5tage is expect$
 to be2 &  7ii7 if ! ,secret>y det]m9es 
"u clause 7i7 t ! application ( ?is     
subsection is expect$ to result 9 !     
application ( a high] ,f$]al m$ical     
assi/ance p]c5tage = ! ,/ate & qu>t] ?an
 ! p]c5tage t w\ld o!rwise apply )\t    
reg>d to ?is subsection-- 7,i7 apply su*
 high] ,f$]al m$ical assi/ance p]c5tage 
( ! ,/ate = purposes ( mak+ paym5ts to !

 ,/ate = am\nts exp5d$ dur+ su* qu>t] z 
m$ical assi/ance "u ! ,/ate plan2 &     
7,,ii7 take into acc\nt su* high] ,f$]al
 m$ical assi/ance p]c5tage ( ! ,/ate =  
purposes ( calculat+ ! enhanc$ ,,fmap = 
! ,/ate & qu>t] "u section #baje7;b74   
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 ) respect  

to ! application ( ?is subsection =     
purposes ( det]m9+ ! ,f$]al m$ical      
assi/ance p]c5tage & enhanc$ ,,fmap ( ! 
,/ate = ! qu>t]2 &  7ii7 9 accordance ) 
section #aijc7;d77#b7 & section         
#baje7;e71 r$uce or increase ! am\nt    
payable to ! ,/ate "u section #aijc7;a7 
or section #baje = a subsequ5t fiscal   
qu>t] to ! ext5t ( any ov]paym5t or     
und]paym5t "u ei!r su* section :i* !    
,secret>y det]m9es 0 made z a result (  
an incorrect initial det]m9ation "u     
subp>agraph 7,a77i7 ) respect to !      
application ( ?is subsection = purposes 
( det]m9+ ! ,f$]al m$ical assi/ance     
p]c5tage & enhanc$ ,,fmap ( ! ,/ate =   
su* prior fiscal qu>t]4  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,b77ii7 ( 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;,b77i74  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       
7,,iv7 ! ,f$]al m$ical assi/ance        
p]c5tage det]m9$ = ! ,/ate & qu>t] "u   
subsection 7ff72 or  7,v7 ! enhanc$     
,,fmap det]m9$ = ! ,/ate & qu>t] "u     
section #baje7;b74  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$es ! mo/ rec5t fiscal   
qu>t]s t 0 n an economic d[nturn qu>t] =
 ! ,/ate4  7#f7 ,requirem5t = all ,/ates
 ,?is subsection %all n apply to a ,/ate
 ) respect to a fiscal qu>t]1 if-- 7,a7 
eligibility /&>ds1 me?odologies1 or     
proc$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 aft] su*
 date or 7if lat]7 ! date t su*         
individual s enrolls 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 caps2 special rule = ,,*ip   
allotm5ts  7#a7 ,exclusion 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 ,any paym5t  
made to a t]ritory = a fiscal ye> 9 :i* 
! ,f$]al m$ical assi/ance p]c5tage = !  
t]ritory is det]m9$ "u section          
#aije7;gg7 %all n be tak5 into acc\nt = 
purposes ( apply+ paym5t limits "u      
subsections 7f7 & 7g7 to ! ext5t t su*  
paym5t exce$s ! am\nt ( ! paym5t t w\ld 
h be5 made to ! t]ritory = ! ye> if !   
,f$]al m$ical assi/ance p]c5tage = !    
t]ritory _h be5 det]m9$ )\t reg>d to su*
 section4  4  7#b7 ,,*ip allotm5ts      
,section #bajd7m7 ( ! ,social ,security 

,act 7#db ,u4,s4,c4 #acig;dd7m77 is     
am5d$-- 7,a7 9 p>agraph 7#b77;,b71 9 !  
matt] prec$+ clause 7i71 by /rik+       
p>agraphs 7#e7 & 7#g7 & ins]t+ p>agraphs
 7#e71 7#g71 & 7#ab72 &  7,b7 by add+ at
 ! end ! foll[+ new p>agraph3  7#ab7    
,special rule = adju/+ allotm5ts dur+   
fiscal ye>s ) economic d[nturn qu>t]s   
7,a7 ,9 g5]al ,if a fiscal qu>t] occurr+
 dur+ fiscal ye> #bjbj or any succe$+   
fiscal ye> is det]m9$ to be an economic 
d[nturn qu>t] ) respect to a ,/ate 7z   
det]m9$ "u section #aije7;gg77 !n1 z    
soon z practicable aft] su* det]m9ation1
 ! ,secret>y %all increase ! allotm5t = 
! ,/ate & fiscal ye> 9 accordance )     
subp>agraph 7,b74  7,b7 ,am\nt (        
increase  7i7 ,9 g5]al ,! am\nt ( an    
increase to ! allotm5t ( a ,/ate        
describ$ 9 subp>agraph 7,a7 = a fiscal  
ye> %all be equal to ! am\nt by :i*     
,f$]al paym5ts made to ! ,/ate = !      
prec$+ fiscal ye> "u ?is title w\ld h   
be5 increas$ 7)\t reg>d to :e!r su*     
paym5ts w\ld exce$ ! am\nt ( ! ,/ate's  

allotm5t = su* prec$+ fiscal ye>7 if !  
enhanc$ ,,fmap det]m9$ = ! ,/ate = su*  
prec$+ fiscal ye> _h be5 increas$ to !  
same ext5t t ! ,/ate's enhanc$ ,,fmap = 
! fiscal ye> involv$ is expect$ to be   
increas$ z a result ( ! application (   
section #aije7;gg7 relative to ! enhanc$
 ,,fmap t w\ld apply to ! ,/ate = !     
fiscal ye> involv$ )\t ! application (  
su* section4  7ii7 ,inclusion ( project$
 increases ,9 increas+ ! allotm5t ( a   
,/ate = a fiscal ye> "u ?is p>agraph1 ! 
,secret>y may base ! calculation ( su*  
increase on projections made by !       
,secret>y ) respect to-- 7,i7 ! numb] ( 
fiscal qu>t]s dur+ su* fiscal ye> t w be
 economic d[nturn qu>t]s2 &  7,,ii7 !   
effect t ! application ( section        
#aije7;gg7 is expect$ to h on ! enhanc$ 
,,fmap ( ! ,/ate = su* fiscal ye>4  7,c7
 ,disreg>d ( increas$ paym5ts = purposes
 ( future allotm5ts ,any ,f$]al paym5t  
made to a ,/ate "u ?is title = a fiscal 
ye> 9 :i* ! ,f$]al m$ical assi/ance     
p]c5tage = ! ,/ate is det]m9$ "u section

 #aije7;gg7 %all be disreg>d$ :5 det]m9+
 ! allotm5t ( ! ,/ate = any subsequ5t   
ye>1 includ+ = purposes ( apply+ ?is    
p>agraph1 to ! ext5t t su* paym5t exce$s
 ! am\nt ( ! paym5t t w\ld h be5 made to
 ! ,/ate = ! ye> if ! ,f$]al m$ical     
assi/ance p]c5tage = ! ,/ate & ye> _h   
be5 det]m9$ )\t reg>d to su* section4  4