S.Amdt. 425

SA 425. Mr. ROCKEFELLER (for himself and Mr. Carper) submitted an
amendment intended to be proposed to amendment SA 98 proposed by Mr.
Inouye (for himself and Mr. Baucus) to the bill H.R. 1, making
supplemental appropriations for job preservation and creation,
infrastructure investment, energy efficiency and science, assistance to
the unemployed, and State and local fiscal stabilization, for fiscal
year ending September 30, 2009, and for other purposes; which was
ordered to lie on the table; as follows:

On page 735, after line 7, add the following:

SEC. 5006. SENSE OF THE SENATE REGARDING MAINTAINING ACCESS
TO MEDICAID DURING AN ECONOMIC DOWNTURN.

(a) Findings.--The Senate makes the following findings:
(1) Medicaid is a vital safety-net for nearly 60,000,000
low-income Americans. In times of economic downturn, Medicaid
becomes even more important for working families.
(2) The current national unemployment rate is 7.2 percent,
and many States are above the national average. Experts
believe that unemployment could rise to 9 percent or even
higher before the economy turns around.
(3) If the unemployment rate averages between 8 and 9
percent during the next 2\1/2\ years as is currently
projected, States will face an estimated funding gap of
approximately $94,000,000,000 in Medicaid and the Children's
Health Insurance Program (CHIP) during that period, according
to the most recent Urban Institute and Kaiser Family
Foundation study.
(4) States are struggling to cope with increasing Medicaid
enrollment and decreasing State revenues. The Congressional
Budget Office has projected Medicaid enrollment growth of
nearly 9 percent in fiscal year 2009 alone.
(5) According to the Government Accountability Office,
State and local fiscal pressures have led to an estimated
$312,000,000,000 operating deficit in State and local
governments over the next 2 years, which will
disproportionately impact Medicaid.
(6) States need greater financial support from the Federal
Government, not less financial support and more restrictions
that make providing quality care to those most in need more
difficult.
(7) This Act includes $90,000,000,000 in Medicaid relief to
States, $87,000,000,000 in relief through an increase in the
Federal medical assistance percentage (FMAP) and
$3,000,000,000 in reimbursement to States for expenditures
for providing medical assistance to disabled individuals that
should have been paid for by the Medicare program.
(8) The Medicaid relief in the Act will fill a significant
portion of the expected gaps in Medicaid funding over the
next 27 months and allow States to protect eligibility,
benefits and provider payments.
(9) Adding additional restrictions on a State's ability to
receive Medicaid relief moves in the wrong direction.
(10) Any maintenance of effort for eligibility should be
straightforward, as it was in the Jobs and Growth Tax Relief
Reconciliation Act of 2003 (Public Law 108-27), so that
States and the Federal Government can avoid conflicts over
questions related to applicable aspects of eligibility
policies and so that States may still undertake activities
intended to streamline eligibility procedures which in turn
could result in cost efficiencies.
(11) Requiring States to ensure certain provider payment
and benefit levels, in addition to the income eligibility
requirements already in the Act, means that some States will
simply decline the Federal help and cut their Medicaid
programs even more drastically than they already have.
(12) According to the Congressional Budget Office, adding
provider payment and benefit maintenance of effort provisions
will either reduce the overall FMAP amount to States by more
than $12,000,000,000 or increase the amount that States have
to spend on Medicaid.
(13) It is inefficient to spend vital coverage dollars on
provider payment and benefit restorations that States are
likely to do on their own, without such additional
requirements.
(14) Medicaid provider payment issues require a longer-term
solution that addresses the historical problems with Medicaid
provider payments, which is why Congress created the Medicaid
and CHIP Payment and Access Commission (MACPAC) in the
Children's Health Insurance Program Reauthorization Act of
2009.
(15) Any additional maintenance of effort requirements will
penalize States in desperate need of relief to keep their
Medicaid programs operating and will reduce the number of
families covered during this economic downturn.
(16) Providers, including physicians, community health
centers, and hospitals, are already receiving significant
relief in other areas of this Act.
(b) Sense of the Senate.--It is the sense of the Senate
that--
(1) Medicaid relief is an essential part of economic
recovery;
(2) States are required, as a condition for receiving FMAP
relief, to report to the Secretary of Health and Human
Services on the use of the FMAP relief funds, which will
alert the Secretary to any ongoing problems with access to
benefits;
(3) Congress created the Medicaid and CHIP Payment and
Access Commission (MACPAC) to take a longer-term look at
Medicaid benefits and access; and
(4) additional Medicaid maintenance of effort provisions,
as requirements for receiving FMAP relief, are unnecessary
and should not be added to the Act.
______