S.Amdt. 620

SA 620. Mr. JOHNSON submitted an amendment intended to be proposed by
him to the bill H.R. 1628, to provide for reconciliation pursuant to
title II of the concurrent resolution on the budget for fiscal year
2017; which was ordered to lie on the table; as follows:

Strike section 112 and insert the following:

SEC. 112. REPEAL OF MEDICAID EXPANSION.

(a) In General.--Title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) is amended--
(1) in section 1902 (42 U.S.C. 1396a)--
(A) in subsection (a)(10)(A)--
(i) in clause (i)(VIII), by inserting ``and ending December
31, 2017,'' after ``2014,'';
(ii) in clause (ii)(XX), by inserting ``and ending December
31, 2017,'' after ``2014,''; and
(iii) in clause (ii), by adding at the end the following
new subclause:
``(XXIII) beginning January 1, 2018, who are grandfathered
expansion enrollees (as defined in subsection (nn)(1));'';
and
(B) by adding at the end the following new subsection:
``(nn) Grandfathered Expansion Enrollees.--
``(1) In general.--In this title, the term `grandfathered
expansion enrollee' means an individual--
``(A) who is under 65 years of age;
``(B) who is not pregnant;
``(C) who is not entitled to, or enrolled for, benefits
under part A of title XVIII, or enrolled for benefits under
part B of title XVIII;
``(D) who is not described in any of subclauses (I) through
(VII) of subsection (a)(10)(A)(i);
``(E) whose income (as determined under subsection (e)(14))
does not exceed 133 percent of the poverty line (as defined
in section 2110(c)(5)) applicable to a family of the size
involved; and
``(F) was enrolled under the State plan under this title
(or a waiver of such plan) as of December 31, 2017.
``(2) State option to limit eligibility.--A State may deem
an individual who is a grandfathered expansion enrollee to no
longer be a grandfathered expansion enrollee if, after
December 31, 2017, such individual has a break in eligibility
for medical assistance under the State plan under this title
for such a period of time as the State may specify (but which
shall in no case be less than 6 months).
``(3) Application of related provisions.--Any reference in
subsection (a)(10)(G), (k), or (gg) of this section or in
section 1903, 1905(a), 1920(e), or 1937(a)(1)(B) to
individuals described in subclause (VIII) of subsection
(a)(10)(A)(i) shall be deemed to include a reference to
grandfathered expansion enrollees.''; and
(2) in section 1905 (42 U.S.C. 1396d)--
(A) in subsection (y)(1)--
(i) in the matter preceding subparagraph (A)--

(I) by inserting ``and that has elected to cover newly
eligible individuals before March 1, 2017'' after ``that is
one of the 50 States or the District of Columbia''; and
(II) by striking ``shall be equal to'' and inserting ``who,
for periods after December 31, 2019, are grandfathered
expansion enrollees (as defined in section 1902(nn)(1)),
shall be equal to the higher of the percentage otherwise
determined for the State and year under subsection (b)
(without regard to this subsection) and''; and

(ii) in subparagraph (D), by striking ``and'' after the
semicolon; and
(iii) by striking subparagraph (E) and inserting the
following new subparagraphs:
``(E) 90 percent for calendar quarters in 2020;
``(F) 85 percent for calendar quarters in 2021;
``(G) 80 percent for calendar quarters in 2022; and
``(H) 75 percent for calendar quarters in 2023.''; and
(B) in subsection (z)(2)--
(i) in subparagraph (A)--

(I) by inserting ``through 2023'' after ``each year
thereafter''; and
(II) by striking ``shall be equal to'' and inserting ``and
for periods after December 31, 2019 and before January 1,
2024, who are grandfathered expansion enrollees (as defined
in section 1902(nn)(1)) shall be equal to the higher of the
percentage otherwise determined for the State and year under
subsection (b) (without regard to this subsection) and''; and

(ii) in subparagraph (B)(ii)--

(I) in subclause (III), by adding ``and'' at the end; and
(II) by striking subclauses (IV), (V), and (VI) and
inserting the following new subclause:

``(IV) 2017 and each subsequent year through 2023 is 80
percent.''.
(b) Temporary Increase to Per Capita Caps.--Section
1903A(c) of the Social Security Act, as added by this Act, is
amended by adding at the end the following new paragraph:
``(6) Increase to state expenditures targets.--
``(A) In general.--For each of fiscal years 2020 through
2026, in determining the target total medical assistance
expenditures for a State and fiscal year under paragraph (1),
the Secretary shall increase, by the amount determined for
the State and year under subparagraph (B), the sum of the
products, for each of the 1903A enrollee categories (as
defined in subsection (e)(2)) except for the category
described in subsection (e)(2)(D), of the target per capita
medical assistance expenditures (as defined in paragraph (2))
for the enrollee category, State, and fiscal year, and the
number of 1903A enrollees for such enrollee category, State,
and fiscal year, as determined under subsection (e)(4).
``(B) Adjustment.--The amount determined under this
subparagraph for a State and year shall be equal to the
annual increase amount for the year (as defined in
subparagraph (C)) multiplied by the ratio of--
``(i) the average monthly number of individuals enrolled in
the State plan under this title (including, if applicable,
individuals enrolled in a Medicaid Flexibility Program
conducted by the State under section 1903B but excluding any
individual enrolled under section 1902(a)(10)(A)(ii)(XXIII))
for the previous fiscal year; to
``(ii) the sum of the average monthly numbers of
individuals enrolled in a State plan under this title
(including, if applicable, individuals enrolled in a Medicaid
Flexibility Program conducted by a State under section 1903B
but excluding any individual enrolled under section
1902(a)(10)(A)(ii)(XXIII)) for the previous fiscal year for
all States.
``(C) Annual increase amount.--In this paragraph, the term
`annual increase amount' means, with respect to a fiscal year
during the period described in subparagraph (A), an amount
equal to the total amount of additional Federal payments
which would have been made for medical assistance provided to
individuals under subclause (XXIII) of section
1902(a)(10)(A)(ii) for such fiscal year if the requirement
described in section 1902(nn)(1)(F) (relating to enrollment
as of December 31, 2017) did not apply (as determined by the
Director of the Office of Management and Budget).
``(D) Disregard of increase.--Any adjustment under this
paragraph to target total medical assistance expenditures for
a State and fiscal year shall be disregarded when determining
the target total medical assistance expenditures for such
State for a succeeding year under paragraph (1).''.
(c) Expansion Repeal Savings Payments.--
(1) In general.--As soon as practicable after the date of
enactment of this section, the Secretary of Health and Human
Services shall make a payment to each State in the amount
determined for the State under paragraph (3).
(2) Use of funds.--
(A) In general.--A State shall use any payment received
under this section to finance the non-Federal share of
expenditures under the State plan under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) which are not
attributable to medical assistance provided to individuals
under subclause (XXIII) of section 1902(a)(10)(A)(ii) of such
Act for the year in which such payment is received.
(B) Nonapplication of restrictions.--Any provision of law
restricting the use of Federal funds for the purpose
described in subparagraph (A) shall not apply to payments
made to States under this subsection.
(3) Payment amounts.--The amount of a payment determined
under this paragraph for a State shall be equal to the
product of--
(A) the amount appropriated under paragraph (4); and
(B) the ratio of--
(i) the average monthly number of individuals enrolled in
the State plan under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) for calendar year 2016, excluding any
individuals enrolled under clause (i)(VIII) or (ii)(XX) of
section 1902(a)(10)(A) of such Act; to

[[Page S4568]]

(ii) the sum of the average monthly numbers of individuals
enrolled in State plans under such title XIX for calendar
year 2016 for all States, excluding any individuals enrolled
under clause (i)(VIII) or (ii)(XX) of section 1902(a)(10)(A)
of such Act.
(4) Appropriation.--For the purpose of carrying out this
subsection, there is appropriated to the Secretary of Health
and Human Services for fiscal year 2018 to remain available
until expended, an amount equal to the total amount of
additional Federal payments which would have been made for
medical assistance provided to individuals under subclause
(XXIII) of section 1902(a)(10)(A)(ii) of the Social Security
Act (42 U.S.C. 1396a(a)(10)(A)(ii)) for the period beginning
on January 1, 2018 and ending on September 30, 2019, if the
requirement described in section 1902(nn)(1)(F) of such Act
(relating to enrollment as of December 31, 2017) did not
apply (as determined by the Director of the Office of
Management and Budget).
(d) Sunset of Essential Health Benefits Requirement.--
Section 1937(b)(5) of the Social Security Act (42 U.S.C.
1396u-7(b)(5)) is amended by adding at the end the following:
``This paragraph shall not apply after December 31, 2019.''.
______