,i  #aahth ,,congress  #b;d ,session    
,h4 ,r4 #igjh  ,,in ,,the ,,house ,,of  
,,representatives  ,september #ai1 #bjbd
 ,ms4 ,sewell introduced the following  
bill2 which was referred to the         
,committee on ,energy and ,commerce1 and
 in addition to the ,committee on ,ways 
and ,means1 for a period to be          
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to ensure affordable health 
insurance coverage for low-income       
individuals in ,states that have not    
expanded ,medicaid4  #a4 ,short title   
,this ,act may be cited as the ,bridge  
to ,medicaid ,act of #bjbd4  #b4        
,ensuring affordability of coverage for 
certain low-income populations  7a7     
,reducing cost sharing under qualified  
health plans ,section #adjb of the      
,patient ,protection and ,affordable    
,care ,act 7#db ,u4,s4,c4 #ahjga7 is    
amended--  7#a7 in subsection 7b7-- 7,a7

 in paragraph 7#b71 by inserting 7or1   
with respect to plan years #bjbf1 #bjbg1
 and #bjbh1 whose household income does 
not exceed #djj percent of the poverty  
line for a family of the size involved7 
before the period2 and  7,b7 in the     
matter following paragraph 7#b71 by     
adding at the end the following new     
sentence3 ,in the case of an individual 
who is determined at any point to have a
 household income for #bjbe that does   
not exceed #ach percent of the poverty  
line for a family of the size involved1 
such individual shall1 for each month   
during such year1 be treated as having a
 household income equal to #ajj percent 
for purposes of applying this section42 
and  7#b7 in subsection 7c7--  7,a7 in  
paragraph 7#a77;,a71 in the matter      
preceding clause 7i71 by inserting 1    
with respect to eligible insureds 7other
 than1 with respect to plan years #bjbf1
 #bjbg1 and #bjbh1 specified enrollees  
7as defined in paragraph 7#f77;,c7771   
after first be achieved2  7,b7 in       

paragraph 7#b71 in the matter preceding 
subparagraph 7,a71 by inserting with    
respect to eligible insureds 7other     
than1 with respect to plan years #bjbf1 
#bjbg1 and #bjbh1 specified enrollees7  
after under the plan2  7,c7 in paragraph
 7#c7-- 7i7 in subparagraph 7,a71 by    
striking this subsection and inserting  
paragraph 7#a7 or 7#b72 and  7ii7 in    
subparagraph 7,b71 by striking this     
section and inserting paragraphs 7#a7   
and 7#b72 and  7,d7 by adding at the end
 the following new paragraph3  7#f7     
,special rule for specified enrollees   
7,a7 ,in general ,the ,secretary shall  
establish procedures under which the    
issuer of a qualified health plan to    
which this section applies shall reduce 
cost-sharing under the plan with respect
 to months occurring during plan years  
#bjbf1 #bjbg1 and #bjbh for enrollees   
who are specified enrollees 7as defined 
in subparagraph 7,c77 in a manner       
sufficient to increase the plan's share 
of the total allowed costs of benefits  

provided under the plan to #ii percent  
of such costs4  7,b7 ,methods for       
reducing cost sharing  7i7 ,in general  
,an issuer of a qualified health plan   
making reductions under this paragraph  
shall notify the ,secretary of such     
reductions and the ,secretary shall1 out
 of funds made available under clause   
7ii71 make periodic and timely payments 
to the issuer equal to #ab percent of   
the total allowed costs of benefits     
provided under each such plan to        
specified enrollees during plan years   
#bjbf1 #bjbg1 and #bjbh4  7ii7          
,appropriation ,in addition to amounts  
otherwise available1 there are          
appropriated1 out of any money in the   
,treasury not otherwise appropriated1   
such sums as may be necessary to the    
,secretary to make payments under clause
 7i74  7,c7 ,specified enrollee defined 
,for purposes of this section1 the term 
specified enrollee means1 with respect  
to a plan year1 an eligible insured who 
is determined at any point to have a    

household income for such plan year that
 does not exceed #ach percent of the    
poverty line for a family of the size   
involved4 ,such insured shall be deemed 
to be a specified enrollee for each     
month in such plan year4  4  7b7 ,open  
enrollments applicable to certain       
lower-income populations ,section       
#acaa7;c7 of the ,patient ,protection   
and ,affordable ,care ,act 7#db         
,u4,s4,c4 #ahjca7;c77 is amended-- 7#a7 
in paragraph 7#f7--  7,a7 in            
subparagraph 7,c71 by striking at the   
end and2  7,b7 in subparagraph 7,d71 by 
striking the period at the end and      
inserting 2 and2 and  7,c7 by adding at 
the end the following new subparagraph3 
7,e7 with respect to a qualified health 
plan with respect to which section #adjb
 applies1 for months occurring during   
the period beginning on ,january #a1    
#bjbf1 and ending on ,december #ca1     
#bjbh1 enrollment periods described in  
subparagraph 7,a7 of paragraph 7#h7 for 
individuals described in subparagraph   

7,b7 of such paragraph4  2 and  7#b7 by 
adding at the end the following new     
paragraph3  7#h7 ,special enrollment    
period for certain low-income           
populations  7,a7 ,in general ,the      
enrollment period described in this     
paragraph is1 in the case of an         
individual described in subparagraph    
7,b71 the continuous period beginning on
 the first day that such individual is  
so described4  7,b7 ,individual         
described ,for purposes of subparagraph 
7,a71 an individual described in this   
subparagraph is an individual-- 7i7 with
 a household income that does not exceed
 #ach percent of the poverty line for a 
family of the size involved2 and  7ii7  
who is not eligible for minimum         
essential coverage 7as defined in       
section #ejjj;,a7f7 of the ,internal    
,revenue ,code of #aihf71 other than for
 coverage described in any of           
subparagraphs 7,b7 through 7,e7 of      
paragraph 7#a7 of such section4  4  7c7 
,additional benefits for certain        

low-,income individuals for plan years  
#bjbf and #bjbg ,section #acja7;a7 of   
the ,patient ,protection and ,affordable
 ,care ,act 7#db ,u4,s4,c4 #ahjba7;a77  
is amended--  7#a7 in paragraph 7#a7--  
7,a7 in subparagraph 7,b71 by striking  
and at the end2  7,b7 in subparagraph   
7,c77iv71 by striking the period and    
inserting 2 and2 and  7,c7 by adding at 
the end the following new subparagraph3 
7,d7 provides1 with respect to a plan   
offered in the silver level of coverage 
to which section #adjb applies during   
plan year #bjbf and #bjbg1 for benefits 
described in paragraph 7#e7 in the case 
of an individual who has a household    
income that does not exceed #ach percent
 of the poverty line for a family of the
 size involved1 and who is eligible to  
receive cost-sharing reductions under   
section #adjb4  2 and  7#b7 by adding at
 the end the following new paragraph3   
7#e7 ,additional benefits for certain   
low-income individuals for plan year    
#bjbf and #bjbg  7,a7 ,in general  7i7  

,benefits ,for purposes of paragraph    
7#a77;,d71 the benefits described in    
this paragraph to be provided by a      
qualified health plan are benefits      
consisting of-- 7,i7 non-emergency      
medical transportation services 7as     
described in section #aijb7;a77#d7 of   
the ,social ,security ,act7 for which   
,federal payments would have been       
available under title ,,xix of the      
,social ,security ,act had such services
 been furnished to an individual        
enrolled under a ,state plan 7or waiver 
of such plan7 under such title2 and     
7,,ii7 services described in subsection 
7a77#d77;,c7 of section #aije of such   
,act for which ,federal payments would  
have been so available2  which are not  
otherwise provided under such plan as   
part of the essential health benefits   
package described in section #acjb7;a74 
7ii7 ,condition on provision of benefits
 ,benefits described in this paragraph  
shall be provided--  7,i7 without any   
restriction on the choice of a qualified

 provider from whom an individual may   
receive such benefits2 and  7,,ii7      
without any imposition of cost sharing4 
7,b7 ,payments for additional benefits  
7i7 ,in general ,an issuer of a         
qualified health plan making payments   
for services described in subparagraph  
7,a7 furnished to individuals described 
in paragraph 7#a77;,d7 during plan year 
#bjbf or #bjbg shall notify the         
,secretary of such payments and the     
,secretary shall1 out of funds made     
available under clause 7ii71 make       
periodic and timely payments to the     
issuer equal to payments for such       
services so furnished4  7ii7            
,appropriation ,in addition to amounts  
otherwise available1 there is           
appropriated1 out of any money in the   
,treasury not otherwise appropriated1   
such sums as may be necessary to the    
,secretary to make payments under clause
 7i74  4  7d7 ,education and outreach   
activities  7#a7 ,in general ,section   
#acba7;c7 of the ,patient ,protection   

and ,affordable ,care ,act 7#db         
,u4,s4,c4 #ahjda7;c77 is amended by     
adding at the end the following new     
paragraph3  7#c7 ,outreach and          
educational activities  7,a7 ,in general
 ,in the case of an ,exchange           
established or operated by the          
,secretary within a ,state pursuant to  
this subsection1 the ,secretary shall   
carry out outreach and educational      
activities for purposes of informing    
individuals described in section        
#aijb7;a77#aj77;,a77i77,,viii7 of the   
,social ,security ,act who reside in    
,states that have not expended amounts  
under a ,state plan 7or waiver of such  
plan7 under title ,,xix of such ,act for
 all such individuals about qualified   
health plans offered through the        
,exchange1 including by informing such  
individuals of the availability of      
coverage under such plans and financial 
assistance for coverage under such      
plans4 ,such outreach and educational   
activities shall be provided in a manner

 that is culturally and linguistically  
appropriate to the needs of the         
populations being served by the         
,exchange 7including hard-to-reach      
populations1 such as racial and sexual  
minorities1 limited ,english proficient 
populations1 individuals residing in    
areas where the unemployment rates      
exceeds the national average            
unemployment rate1 individuals in rural 
areas1 veterans1 and young adults74     
7,b7 ,limitation on use of funds ,funds 
appropriated under this paragraph shall 
not be used to promote any health       
insurance coverage other than qualified 
health plans4  7,c7 ,funding ,in        
addition to amounts otherwise available1
 there is appropriated1 out of any money
 in the ,treasury not otherwise         
appropriated1 to remain available until 
expended1 #aje1jjj1jjj for fiscal year  
#bjbf to carry out this paragraph1 of   
which--  7i7 #ae1jjj1jjj shall be used  
to carry out this paragraph in fiscal   
year #bjbf2 and  7ii7 #cj1jjj1jjj shall 

be used to carry out this paragraph for 
each of fiscal years #bjbg through      
#bjbh4  4  7#b7 ,navigator program      
,section #acaa7;i7 of the ,patient      
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #ahjca7;i77 is amended-- 
7,a7 in paragraph 7#a7--  7i7 by        
striking ,an ,exchange and inserting the
 following3  7,a7 ,in general ,an       
,exchange  2 and  7ii7 by adding at the 
end the following3  7,b7 ,grants for    
eligible entities with respect to       
certain ,states ,the ,secretary shall   
establish a program to award grants to  
entities described in paragraph 7#b7 to 
carry out the duties described in       
paragraph 7#c7 in one or more ,states   
that do not provide under the ,state    
plan under title ,,xix of the ,social   
,security ,act 7or a waiver of such     
plan7 benchmark coverage described in   
section #aicg7;b77#a7 of such ,act or   
benchmark equivalent coverage described 
in section #aicg7;b77#b7 of such ,act to
 all individuals described in section   

#aijb7;a77#aj77;,a77i77,,viii7 of such  
,act4  2 and  7,b7 in paragraph 7#f7--  
7i7 by striking ,grants under and       
inserting the following3  7,a7 ,state   
,exchanges ,grants under  2 and  7ii7 by
 adding at the end the following new    
subparagraph3  7,b7 ,federal ,exchanges2
 grants to eligible entities with       
respect to certain ,states ,for purposes
 of carrying out this subsection1 with  
respect to an ,exchange established and 
operated by the ,secretary within a     
,state pursuant to section #acba7;c7 and
 with respect to grants under paragraph 
7#a77;,b71 the ,secretary shall obligate
 not less than #aj1jjj1jjj out of       
amounts collected through the user fees 
on participating health insurance       
issuers pursuant to section #aef4ej of  
title #de1 ,code of ,federal            
,regulations 7or any successor          
regulations7 for fiscal year #bjbf1 and 
not less than #bj1jjj1jjj for each of   
fiscal years #bjbg and #bjbh4 ,such     
amount so obligated for a fiscal year   

shall remain available until expended4  
4  7e7 ,funding ,in addition to amounts 
otherwise available1 there is           
appropriated to the ,secretary of       
,health and ,human ,services for fiscal 
year #bjbf1 out of any money in the     
,treasury not otherwise appropriated1   
#fe1jjj1jjj1 to remain available until  
expended1 for purposes of carrying out  
the provisions of1 and the amendments   
made by1 this section4  #c4 ,temporary  
expansion of health insurance premium   
tax credits for certain low-income      
populations  7a7 ,in general ,section   
#cf;,b of the ,internal ,revenue ,code  
of #aihf is amended by redesignating    
subsection 7h7 as subsection 7i7 and by 
inserting after subsection 7g7 the      
following new subsection3  7h7 ,certain 
temporary rules beginning in #bjbf ,with
 respect to any taxable year beginning  
after ,december #ca1 #bjbe1 and before  
,january #a1 #bjbi--  7#a7 ,eligibility 
for credit not limited based on income  
,subsection 7c77#a77;,a7 shall be       

applied without regard to equals or     
exceeds #ajj percent but4  7#b7 ,credit 
allowed to certain low-income employees 
offered employer-provided coverage ,in  
the case of an individual whose         
household income does not exceed #ach   
percent of the poverty line for a family
 of the size involved1 clause 7i7 of    
subsection 7c77#b77;,c7 shall be applied
 7including in the case of any          
individual described in the last        
sentence of such clause7 without regard 
to subclause 7,,ii7 thereof4  7#c7      
,credit allowed to certain low-income   
employees offered qualified small       
employer health reimbursement           
arrangements ,a qualified small employer
 health reimbursement arrangement shall 
not be treated as constituting          
affordable coverage for an employee 7or 
any spouse or dependent of such         
employee7 for any months of a taxable   
year if the employee's household income 
for such taxable year does not exceed   
#ach percent of the poverty line for a  

family of the size involved4  7#d7      
,limitations on recapture  7,a7 ,in     
general ,in the case of a taxpayer whose
 household income is less than #bjj     
percent of the poverty line for the size
 of the family involved for the taxable 
year1 the amount of the increase under  
subsection 7f77#b77;,a7 shall in no     
event exceed #cjj 7one-half of such     
amount in the case of a taxpayer whose  
tax is determined under section #a7;c7  
for the taxable year74  7,b7 ,limitation
 on increase for certain non-filers ,in 
the case of any taxpayer who would not  
be required to file a return of tax for 
the taxable year but for any requirement
 to reconcile advance credit payments   
under subsection 7f71 if an ,exchange   
established under title ,i of the       
,patient ,protection and ,affordable    
,care ,act has determined that-- 7i7    
such taxpayer is eligible for advance   
payments under section #adab of such    
,act for any portion of such taxable    
year1 and  7ii7 such taxpayer's         

household income for such taxable year  
is projected not to exceed #ach percent 
of the poverty line for a family of the 
size involved1  subsection 7f77#b77;,a7 
shall not apply to such taxpayer for    
such taxable year and such taxpayer     
shall not be required to file such      
return of tax4  7,c7 ,information       
provided by ,exchange ,the information  
required to be provided by an ,exchange 
to the ,secretary and to the taxpayer   
under subsection 7f77#c7 shall include  
such information as is necessary to     
determine whether such ,exchange has    
made the determinations described in    
clauses 7i7 and 7ii7 of subparagraph    
7,b7 with respect to such taxpayer4  4  
7b7 ,employer shared responsibility     
provision not applicable with respect to
 certain low-,income taxpayers receiving
 premium assistance ,section            
#dihj;,h7c77#c7 of the ,internal        
,revenue ,code of #aihf is amended to   
read as follows3  7#c7 ,applicable      
premium tax credit and cost-sharing     

reduction  7,a7 ,in general ,the term   
applicable premium tax credit and       
cost-sharing reduction means--  7i7 any 
premium tax credit allowed under section
 #cf;,b1  7ii7 any cost-sharing         
reduction under section #adjb of the    
,patient ,protection and ,affordable    
,care ,act1 and  7iii7 any advance      
payment of such credit or reduction     
under section #adab of such ,act4  7,b7 
,exception with respect to certain      
low-income taxpayers ,such term shall   
not include any premium tax credit1     
cost-sharing reduction1 or advance      
payment otherwise described in          
subparagraph 7,a7 if such credit1       
reduction1 or payment is allowed or paid
 for a taxable year of an employee      
7beginning after ,december #ca1 #bjbe1  
and before ,january #a1 #bjbi7 with     
respect to which--  7i7 an ,exchange    
established under title ,i of the       
,patient ,protection and ,affordable    
,care ,act has determined that such     
employee's household income for such    

taxable year is projected to not exceed 
#ach percent of the poverty line for a  
family of the size involved1 or  7ii7   
such employee's household income for    
such taxable year does not exceed #ach  
percent of the poverty line for a family
 of the size involved4  4  7c7          
,effective date ,the amendments made by 
this section shall apply to taxable     
years beginning after ,december #ca1    
#bjbe4  #d4 ,further increase in ,,fmap 
for ,medical ,assistance for ,newly     
,eligible ,mandatory ,individuals       
,section #aije7y77#a7 of the ,social    
,security ,act 7#db ,u4,s4,c4           
#acif;d7y77#a77 is amended--  7#a7 in   
subparagraph 7,d71 by striking at the   
end and2  7#b7 in subparagraph 7,e71 by 
striking #bjbj and each year thereafter4
 and inserting #bjbj1 #bjba1 #bjbb1     
#bjbc1 #bjbd1 and #bjbe22 and  7#c7 by  
adding at the end the following new     
subparagraphs3  7,f7 #ic percent for    
calendar quarters in #bjbf1 #bjbg1 and  
#bjbh2 and  7,g7 #ij percent for        

calendar quarters in #bjbi and each year
 thereafter4  4