,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #fjh  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,janu>y #bb1 #bjbe,mr4
 ,doggett 7= himself1 ,mr4 ,bi%op1 ,mr4 
,cas>1 ,ms4 ,ca/or ( ,florida1 ,mr4     
,ca/ro ( ,texas1 ,mr4 ,coh51 ,mr4       
,clyburn1 ,mr4 ,cuell>1 ,ms4 ,escob>1   
,mr4 ,figures1 ,mrs4 ,flet*]1 ,ms4 ,lois
 ,frankel ( ,florida1 ,ms4 ,g>cia (     
,texas1 ,mr4 ,gre5 ( ,texas1 ,mr4       
,johnson ( ,georgia1 ,ms4 ,johnson (    
,texas1 ,mrs4 ,mc,bath1 ,mrs4           
,*]filus-,mc,cormick1 ,mr4 ,david ,scott
 ( ,georgia1 ,ms4 ,sewell1 ,mr4 ,soto1  
,mr4 ,?ompson ( ,mississippi1 ,mr4      
,turn] ( ,texas1 ,mr4 ,veasey1 ,ms4     
,wass]man ,s*ultz1 ,ms4 ,williams (     
,georgia1 ,ms4 ,wilson ( ,florida1 ,ms4 
,adams1 ,mr4 ,cleav]1 ,mr4 ,connolly1   
,ms4 ,norton1 & ,mr4 ,rask97 introduc$ !
 foll[+ bill2 :i* 0 ref]r$ to !         
,committee on ,en]gy & ,comm]ce  ,a     
,,bill  ,to am5d title ,,xix ( ! ,social
 ,security ,act to provide = a          
demon/ration project "u ! ,m$icaid      

program = political subdivisions (      
,/ates to provide m$ical assi/ance = !  
expansion population "u su* program1 & =
 o!r purposes4  #a4 ,%ort title ,?is    
,act may be cit$ z ! ,cov] ,out/&+      
,vuln]able ,expansion-eligible ,resid5ts
 ,n[ ,act or ! ,,cov] ,n[ ,act4  #b4    
,demon/ration project = political       
subdivisions ( ,/ates to provide m$ical 
assi/ance = ,m$icaid expansion          
population  7a7 ,9 g5]al ,section #aijb 
( ! ,social ,security ,act is am5d$--   
7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 
7#hf71 by /rik+ at ! end &2  7,b7 9     
p>agraph 7#hg71 by /rik+ ! p]iod at !   
end & ins]t+ 2 &2 &  7,c7 by ins]t+ aft]
 p>agraph 7#hg7 ! foll[+ new p>agraph3  
7#hh7 provide1 at ! option ( ! qualify+ 
political subdivisions ( a ,/ate1 = a   
demon/ration project describ$ 9         
subsection 7uu74  2 &  7#b7 by add+ at !
 end ! foll[+ new subsection3  7uu7     
,demon/ration project = political       
subdivisions ( ,/ates ,to provide m$ical
 assi/ance = expansion population  7#a7 

,9 g5]al ,not)/&+ section subsection    
7a77#e71 ! ,secret>y %all conduct a     
demon/ration project "u :i* ! ,secret>y 
%all1 subject to p>agraph 7#i71 select  
qualify+ political subdivisions describ$
 9 p>agraph 7#b7 to provide1 9          
accordance ) ! requirem5ts ( ?is        
subsection1 m$ical assi/ance =          
individuals describ$ 9 subclause        
7,,viii7 ( subsection 7a77#aj77;,a77i7  
:o reside 9 su* political subdivisions 9
 accordance ) ! timel9e specifi$ "u     
p>agraph 7#h74  7#b7 ,waiv] au?ority ,! 
,secret>y may waive ! requirem5ts (     
p>agraphs 7#a7 & 7#e7 ( subsection 7a7  
relat+ to /atewid5ess & relat+ to s+le  
/ate ag5cy1 respectively4  7#c7         
,qualify+ political subdivision ,a      
qualify+ political subdivision describ$ 
9 ?is p>agraph is-- 7,a7 a political    
subdivision--  7i7 locat$ 9 a ,/ate t   
has n elect$ to provide m$ical assi/ance
 = individuals describ$ 9 subclause     
7,,viii7 ( subsection 7a77#aj77;,a77i7 z
 ( ! date ( ! enactm5t ( ?is subsection2

 &  7ii7 submits an application to !    
,secret>y--  7,i7 at su* "t1 9 su*      
mann]1 & conta9+ su* in=mation z !      
,secret>y may require2 &  7,,ii7 :i* has
 und]gone a process = public notice &   
comm5t at ! political subdivision level1
 includ+ public he>+s1 suffici5t to     
ensure a mean+ful level ( public input2 
or  7,b7 any numb] ( political          
subdivisions describ$ 9 subp>agraph 7,a7
 :i* =m a p>tn]%ip = purposes (         
implem5t+ ! demon/ration project "u ?is 
subsection4  7#d7 ,l5g? ( demon/ration  
project  7,a7 ,9 g5]al ,subject to      
subp>agraph 7,b71 a qualify+ political  
subdivision select$ to p>ticipate 9 !   
demon/ration project "u ?is subsection  
or p>tn]%ip describ$ 9 p>agraph         
7#c77;,b7 7ref]r$ to 9 ?is subsection z 
a p>ticipat+ political subdivision7 %all
 provide m$ical assi/ance = individuals 
describ$ 9 subclause 7,,viii7 (         
subsection 7a77#aj77;,a77i7 = sev5 ye>s 
or ?r\gh ! day be=e ! date on :i* !     
,/ate 9 :i* su* political subdivision is

 locat$ provides = m$ical assi/ance "u !
 ,/ate plan 7or a waiv] ( su* plan7 =   
su* individuals1 :i*ev] is %ort]4  7,b7 
,ext5sion ,a p>ticipat+ political       
subdivision t p>ticipates 9 !           
demon/ration project "u ?is subsection =
 five ye>s may ext5d its p>ticipation 9 
! demon/ration project by submitt+ an   
application to ! ,secret>y at su* "t1 9 
su* mann]1 & conta9+ su* in=mation z !  
,secret>y may require4 ,"u su* ext5sion1
 su* political subdivision %all provide 
m$ical assi/ance = individuals describ$ 
9 subclause 7,,viii7 ( subsection       
7a77#aj77;,a77i7 = up to an additional  
five ye>s or ?r\gh ! day be=e ! date on 
:i* ! ,/ate 9 :i* su* political         
subdivision is locat$ provides = m$ical 
assi/ance "u ! ,/ate plan 7or a waiv] ( 
su* plan7 = su* individuals1 :i*ev] is  
%ort]4  7,c7 ,automatic enrollm5t 9 case
 ( ,/ates t elect to provide m$ical     
assi/ance = expansion population ,9 !   
case ( a p>ticipat+ political           
subdivision ^: p>ticipation 9 !         

demon/ration project "u ?is subsection  
ends because ! ,/ate 9 :i* su* political
 subdivision is locat$ elects to provide
 = m$ical assi/ance "u ! ,/ate plan 7or 
a waiv] ( su* plan7 = individuals       
describ$ 9 subclause 7,,viii7 (         
subsection 7a77#aj77;,a77i71 su* ,/ate  
%all automatically enroll "u su* ,/ate  
plan 7or waiv]7 any eligible & enroll$  
individual s describ$ receiv+ m$ical    
assi/ance f su* political subdivision & 
cov]age = su* individual "u su* ,/ate   
plan 7or waiv]7 beg9n+ ) ! fir/ day on  
:i* ! ,/ate provides m$ical assi/ance "u
 su* ,/ate plan 7or waiv]7 = individuals
 describ$ 9 subclause 7,,viii7 (        
subsection 7a77#aj77;,a77i74  7#e7      
,paym5ts  7,a7 ,9 g5]al ,! ,secret>y    
%all pay a p>ticipat+ political         
subdivision ! ,f$]al mat*+ p]c5tage     
specifi$ 9 subp>agraph 7,b7 = am\nts    
exp5d$ by su* political subdivision to  
provide m$ical assi/ance = individuals  
describ$ 9 subclause 7,,viii7 (         
subsection 7a77#aj77;,a77i74  7,b7      

,calculation ( ,f$]al & non-,f$]al %>e  
,except z provid$ "u clause 7ii7 &      
subp>agraph 7,c71 ! calculation & paym5t
 ( ! ,f$]al & non-,f$]al %>e (          
exp5ditures = m$ical assi/ance "u a     
demon/ration describ$ 9 p>agraph 7#a7   
%all be calculat$ 9 accordance ) section
 #aijc z if ! qualify+ political        
subdivision 0 a ,/ate4  7,c7 ,f$]al     
mat*+ p]c5tage ,! ,f$]al mat*+ p]c5tage 
specifi$ 9 ?is subp>agraph1 ) respect to
 a p>ticipat+ political subdivision & ! 
demon/ration project "u ?is subsection1 
is-- 7i7 #ajj p]c5t = cal5d> qu>t]s 9 ! 
fir/ ?ree ye>s t su* political          
subdivision p>ticipates 9 su*           
demon/ration project1 if applicable2    
7ii7 ) respect to a p>ticipat+ political
 subdivision :i*-- 7,i7 includes a rural
 political subdivision 7z def9$ by !    
,(fice ( ,managem5t & ,budget71 #ajj    
p]c5t = cal5d> qu>t]s 9 ! f\r? ye> t su*
 political subdivision p>ticipates 9 su*
 demon/ration project1 if applicable2 & 
7,,ii7 does n include a rural political 

subdivision 7z def9$ by ! ,(fice (      
,managem5t & ,budget71 #ie p]c5t =      
cal5d> qu>t]s 9 ! f\r? ye> t su*        
political subdivision p>ticipates 9 su* 
demon/ration project1 if applicable2    
7iii7 ) respect to a p>ticipat+         
political subdivision :i*--  7,i7       
includes a rural political subdivision  
7z def9$ by ! ,(fice ( ,managem5t &     
,budget71 #ie p]c5t = cal5d> qu>t]s 9 ! 
fif? ye> t su* political subdivision    
p>ticipates 9 su* demon/ration project1 
if applicable2 &  7,,ii7 does n include 
a rural political subdivision 7z def9$  
by ! ,(fice ( ,managem5t & ,budget71 #id
 p]c5t = cal5d> qu>t]s 9 ! fif? ye> t   
su* political subdivision p>ticipates 9 
su* demon/ration project1 if applicable2
  7iv7 ) respect to a p>ticipat+        
political subdivision :i*-- 7,i7        
includes a rural political subdivision  
7z def9$ by ! ,(fice ( ,managem5t &     
,budget71 #id p]c5t = cal5d> qu>t]s 9 ! 
six? ye> t su* political subdivision    
p>ticipates 9 su* demon/ration project1 

if applicable2 &  7,,ii7 does n include 
a rural political subdivision 7z def9$  
by ! ,(fice ( ,managem5t & ,budget71 #ic
 p]c5t = cal5d> qu>t]s 9 ! six? ye> t   
su* political subdivision p>ticipates 9 
su* demon/ration project1 if applicable2
  7v7 ) respect to a p>ticipat+         
political subdivision :i*--  7,i7       
includes a rural political subdivision  
7z def9$ by ! ,(fice ( ,managem5t &     
,budget71 #ic p]c5t = cal5d> qu>t]s 9 ! 
sev5? ye> t su* political subdivision   
p>ticipates 9 su* demon/ration project1 
if applicable2 &  7,,ii7 does n include 
a rural political subdivision 7z def9$  
by ! ,(fice ( ,managem5t & ,budget71 #ij
 p]c5t = cal5d> qu>t]s 9 ! sev5? ye> t  
su* political subdivision p>ticipates 9 
su* demon/ration project1 if applicable2
 &  7vi7 #ij p]c5t = cal5d> qu>t]s 9 !  
eigh? ye> & any subsequ5t ye>s !reaft] t
 su* political subdivision p>ticipates 9
 su* demon/ration project1 if           
applicable4  7#f7 ,comp>ability (       
b5efits to ess5tial heal? b5efits ,!    

m$ical assi/ance made available by a    
p>ticipat+ political subdivision to     
individuals describ$ 9 subclause        
7,,viii7 ( subsection 7a77#aj77;,a77i7  
%all consi/ ( cov]age describ$ 9        
subsection 7k77#a74  7#g7 ,r$uction 9   
,f$]al fund+ = m$ical assi/ance = /ates 
t take c]ta9 actions  7,a7 ,9 g5]al ,9 !
 case ( a ,/ate t does any ( ! prohibit$
 items describ$ 9 subp>agraph 7,b71 !   
,secret>y %all )hold f ! am\nt o!rwise  
payable "u section #aijc an am\nt equal 
to #be p]c5t ( ! am\nt ( adm9i/rative   
co/s "u ! ,/ate plan "u title ,,xix dur+
 a cal5d>4  7,b7 ,prohibit$ items ,=    
purposes ( subp>agraph 7,a71 a ,/ate may
 n--  7i7 %ift ! co/s ( provid+ m$ical  
assi/ance to individuals enroll$ "u a   
,/ate plan "u title ,,xix to a political
 subdivision t e/abli%es a demon/ration 
project "u ?is subsection by dis5roll+  
su* individuals f ! ,/ate plan to !     
demon/ration project ( ! political      
subdivision2  7ii7 )hold or r$uce any   
k9d ( fund+ or ,/ate support to         

political subdivision on acc\nt ( !     
political subdivision's e/abli%m5t ( a  
demon/ration project2  7iii7 increase   
taxes on taxpay]s ( a political         
subdivision on acc\nt ( ! political     
subdivision's e/abli%m5t ( a            
demon/ration project2  7iv7 require a   
political subdivision to increase or l[]
 a tax rate requir$ by ! political      
subdivision on acc\nt ( ! political     
subdivision's e/abli%m5t ( a            
demon/ration project2  7v7 prohibit a   
political subdivision f p>ticipat+ 9 a  
demon/ration project pursuant to ?is    
subsection2  7vi7 prohibit a political  
subdivision f p>ticipat+ 9 a ,f$]al     
demon/ration project1 e/abli%+ or exp&+ 
a heal? cov]age program1 contract+ or   
o!rwise ent]+ into an agreem5t ) !      
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices1 or 
receiv+ ,f$]al fund+ directly f a ,f$]al
 ag5cy2  7vii7 prohibit a heal? c>e     
provid]1 hospital1 f$]ally qualifi$     
heal? c5t]1 or rural heal? cl9ic f--    
7,i7 accept+ pati5ts ) heal? cov]age    

provid$ by a political subdivision2     
7,,ii7 accept+ paym5ts f a political    
subdivision2  7,,iii7 mak+ paym5ts1     
includ+ taxes1 to a political           
subdivision2 or  7,,iv7 p>ticipat+ 9 !  
,/ate ,m$icaid program on acc\nt (      
p>ticipation 9 a demon/ration project   
pursuant to ?is subsection2  7viii7     
refuse to all[ a political subdivision  
to rely on ,/ate ,m$icaid sy/ems & ,/ate
 ,m$icaid ag5cy /aff to implem5t a      
demon/ration project1 includ+--  7,i7 ! 
,/ate's ,m$icaid eligibility *eck &     
enrollm5t sy/em2  7,,ii7 provid] paym5t 
sy/em2  7,,iii7 claims process+ sy/em2  
7,,iv7 fair he>+ sy/em2 &  7,v7 ,f$]al  
report+ requirem5t sy/em2 or  7ix7 take 
any o!r punitive action aga9/ a         
political subdivision t e/abli% a       
demon/ration project4  7#h7 ,timel9e    
specifi$ ,= purposes ( p>agraph 7#a71 ! 
timel9e specifi$ 9 ?is p>agraph %all    
require-- 7,a7 n lat] ?an #ahj days aft]
 ! date ( ! enactm5t ( ?is subsection1 !
 ,secret>y to promulgate any regulations

 necess>y to c>ry out ?is subsection1   
includ+--  7i7 ! application requirem5ts
 = a political subdivision to apply = a 
demon/ration project1 crit]ia on :i*    
applications w be review$1 & h[ long    
political subdivisions h to beg9 !      
demon/ration once an application is     
approv$2 &  7ii7 ! application ( all    
requirem5ts "u section #aijc to a       
p>ticipat+ political subdivision z if x 
0 a ,/ate2  7,b7 n lat] ?an #ahj days   
aft] receiv+ an application f a qualify+
 political subdivision describ$ 9       
p>agraph 7#c71 ! ,secret>y to transmit a
 notice to su* qualify+ political       
subdivision ( ! application's approval  
or rejection1 & 9 case ( a rejection an 
explanation = ! rejection2 &  7,c7 n    
lat] ?an #g ye>s aft] ! approval ( an   
application1 ! ,secret>y to transmit a  
notice to su* qualify+ political        
subdivision ( ! application's approval  
or rejection = an ext5sion "u ?is       
subsection4  7#i7 ,limitation on numb] (
 demon/ration projects ,! ,secret>y may 

n approve m ?an #ajj demon/ration       
projects "u ?is subsection1 :i* may     
consi/ ( demon/ration projects implem5t$
 by a s+le p>ticipat+ political         
subdivision or implem5t$ z p>tn]%ips =m$
 by multiple p>ticipat+ political       
subdivisions 7z describ$ 9 p>agraph     
7#c77;,b774  7#aj7 ,application )\t     
reg>d to budget neutrality ,! ,secret>y 
%all n require1 z a condition = c>ry+   
out ! demon/ration project "u ?is       
subsection1 t ! demon/ration project    
ensure t su* model is budget neutral    
initially ) respect to exp5ditures "u ! 
applicable title4  7#aa7 ,report ,n lat]
 ?an #d ye>s aft] ! fir/ date ( !       
demon/ration project1 ! ,secret>y %all  
submit a report to ,congress on-- 7,a7 !
 effect ( ! demon/ration project on--   
7i7 ! numb] ( b5efici>ies enroll$ 9     
demon/ration projects "u ?is subsection2
 &  7ii7 ! am\nt ( uncomp5sat$ c>e co/s 
= ,/ate ,m$icaid plans2 &  7,b7 :e!r any
 ,/ates ) a demon/ration project "u ?is 
subsection h exp&$ ,m$icaid cov]age "u !

 ,pati5t ,protection & ,af=dable ,c>e   
,act4  4  7b7 ,paym5t to ,/ates ,section
 #aijc7;a7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #acif;b7a77 is am5d$--   
7#a7 9 p>agraph 7#f71 by /rik+ at ! end 
plus2  7#b7 9 p>agraph 7#g71 by /rik+ ! 
p]iod at ! end & ins]t+ 2 plus2 &  7#c7 
by add+ at ! end ! foll[+ new p>agraph3 
7#h7 an am\nt equal to an increase ( #e 
p]c5tage po9ts to ,f$]al mat*+ p]c5tage 
= adm9i/rative co/s = e #ajj1jjj        
individuals describ$ 9 p>agraph 7#a7 (  
section #aaae7;g7 :o are enroll$ 9 a    
demon/ration project ( a p>ticipat+     
political subdivision 7z ref]r$ to 9    
p>agraph 7#d77;,a7 ( su* section7 dur+ a
 cal5d> qu>t]4  4