II
111th CONGRESS
1st Session
S. 1377
IN THE SENATE OF THE UNITED STATES
June 25, 2009
Mr. Rockefeller introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To provide for an automatic increase in the Federal matching rate for the Medicaid program during periods of national economic downturn to help States cope with increases in Medicaid costs.
Automatic increase in the Federal medical assistance percentage during periods of national economic downturn
National Economic Downturn Assistance FMAP
In general
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—
in subsection (b), in the first sentence—
by
striking and (4)
and inserting (4)
; and
by
inserting and (5) with respect to each fiscal year quarter other than
the first quarter of a national economic downturn assistance period described
in subsection (y)(1), the Federal medical assistance percentage for any State
described in subsection (y)(2) shall be equal to the national economic downturn
assistance FMAP determined for the State for the quarter under subsection
(y)(3)
before the period; and
by adding at the end the following:
National Economic Downturn Assistance FMAP
For purposes of clause (5) of the first sentence of subsection (b):
National economic downturn assistance period
A national economic downturn assistance period described in this paragraph—
begins with the
first fiscal year quarter for which the Secretary determines that for at least
23 States, the rolling average unemployment rate for that quarter has increased
by at least 10 percent over the corresponding quarter for the most recent
preceding 12-month period for which data are available (in this subsection
referred to as the trigger quarter
); and
ends with the first succeeding fiscal year quarter for which the Secretary determines that less than 23 States have a rolling average unemployment rate for that quarter with an increase of at least 10 percent over the corresponding quarter for the most recent preceding 12-month period for which data are available.
Eligible state
A State described in this paragraph is a State for which the Secretary determines that the rolling average unemployment rate for the State for any quarter occurring during a national economic downturn assistance period described in paragraph (1) has increased over the corresponding quarter for the most recent preceding 12-month period for which data are available.
Determination of national economic downturn assistance fmap
In general
The national economic downturn assistance FMAP for a fiscal year quarter determined with respect to a State under this paragraph is equal to the Federal medical assistance percentage for the State for that quarter increased by the number of percentage points determined by—
dividing—
the Medicaid additional unemployed increased cost amount determined under subparagraph (B) for the quarter; by
the State's total Medicaid quarterly spending amount determined under subparagraph (C) for the quarter; and
multiplying the quotient determined under clause (i) by 100.
Medicaid additional unemployed increased cost amount
For purposes of subparagraph (A)(i)(I), the Medicaid additional unemployed increased cost amount determined under this subparagraph with respect to a State and a quarter is the product of the following:
State increase in rolling average number of unemployed individuals from the base quarter of unemployment
In general
The amount determined by subtracting the rolling average number of unemployed individuals in the State for the base unemployment quarter for the State determined under subclause (II) from the rolling average number of unemployed individuals in the State for the quarter.
Base unemployment quarter defined
In general
For purposes of subclause (I), except as provided in item (bb), the base quarter for a State is the quarter with the lowest rolling average number of unemployed individuals in the State in the 12-month period preceding the trigger quarter for a national economic downturn assistance period described in paragraph (1).
Exception
If the rolling average number of unemployed individuals in a State for a quarter occurring during a national economic downturn assistance period described in paragraph (1) is less than the rolling average number of unemployed individuals in the State for the base quarter determined under item (aa), that quarter shall be treated as the base quarter for the State for such national economic downturn assistance period.
National average amount of additional federal medicaid spending per additional unemployed individual
In the case of—
a calendar quarter occurring in fiscal year 2012, $350; and
a calendar quarter occurring in any succeeding fiscal year, the amount applicable under this clause for calendar quarters occurring during the preceding fiscal year, increased by the annual percentage increase in the medical care component of the consumer price index for all urban consumers (U.S. city average), as rounded up in an appropriate manner.
State nondisabled, nonelderly adults and children medicaid spending index
In general
With respect to a State, the quotient (not to exceed 1.00) of—
the State expenditure per person in poverty amount determined under subclause (II); divided by—
the National expenditure per person in poverty amount determined under subclause (III).
State expenditure per person in poverty amount
For purposes of subclause (I)(aa), the State expenditure per person in poverty amount is the quotient of—
the total amount of annual expenditures by the State for providing medical assistance under the State plan to nondisabled, nonelderly adults and children; divided by
the total number of nonelderly adults and children in poverty who reside in the State, as determined under paragraph (4)(A).
National expenditure per person in poverty amount
For purposes of subclause (I)(bb), the National expenditure per person in poverty amount is the quotient of—
the sum of the total amounts determined under subclause (II)(aa) for all States; divided by
the sum of the total amounts determined under subclause (II)(bb) for all States.
State's total Medicaid quarterly spending amount
For purposes of subparagraph (A)(i)(II), the State's total Medicaid quarterly spending amount determined under this subparagraph with respect to a State and a quarter is the amount equal to—
the total amount of expenditures by the State for providing medical assistance under the State plan to all individuals enrolled in the plan for the most recent fiscal year for which data is available; divided by
4.
Data
In making the determinations required under this subsection, the Secretary shall use, in addition to the most recent available data from the Bureau of Labor Statistics Local Area Unemployment Statistics for each State referred to in paragraph (5), the most recently available—
data from the Bureau of the Census with respect to the number of nonelderly adults and children who reside in a State described in paragraph (2) with family income below the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved (or, if the Secretary determines it appropriate, a multiyear average of such data);
data reported to the Secretary by a State described in paragraph (2) with respect to expenditures for medical assistance under the State plan under this title for nondisabled, nonelderly adults and children; and
econometric studies of the responsiveness of Medicaid enrollments and spending to changes in rolling average unemployment rates and other factors, including State spending on certain Medicaid populations.
Definition of rolling average number of unemployed individuals, rolling average unemployment rate
In this subsection, the term—
rolling average number of unemployed individuals means, with respect to a calendar quarter and a State, the average of the 12 most recent months of seasonally adjusted unemployment data for each State;
rolling average unemployment rate means, with respect to a calendar quarter and a State, the average of the 12 most recent monthly unemployment rates for the State; and
monthly unemployment rate means, with respect to a State, the quotient of—
the monthly seasonally adjusted number of unemployed individuals for the State; divided by
the monthly seasonally adjusted number of the labor force for the State,
Increase in cap on payments to territories
With respect to any fiscal year quarter for which the national economic downturn assistance Federal medical assistance percentage applies to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, the amounts otherwise determined for such commonwealth or territory under subsections (f) and (g) of section 1108 shall be increased by such percentage of such amounts as the Secretary determines is equal to twice the average increase in the national economic downturn assistance FMAP determined for all States described in paragraph (2) for the quarter.
Scope of application
The national economic downturn assistance FMAP shall only apply for purposes of payments under section 1903 for a quarter and shall not apply with respect to—
disproportionate share hospital payments described in section 1923;
payments under title IV or XXI; or
any payments under this title that are based on the enhanced FMAP described in section 2105(b).
Additional requirement for certain states
In the case of a State described in paragraph (2) that requires political subdivisions within the State to contribute toward the non-Federal share of expenditures required under section 1902(a)(2), the State shall not require that such political subdivisions pay for any fiscal year quarters occurring during a national economic downturn assistance period a greater percentage of the non-Federal share of such expenditures, or a greater percentage of the non-Federal share of payments under section 1923, than the respective percentage that would have been required by the State under State law in effect on the first day of the fiscal year quarter occurring immediately prior to the trigger quarter for the period.
.
Effective date; no retroactive application
The amendments made by paragraph (1) take effect on January 1, 2012. In no event may a State receive a payment on the basis of the national economic downturn assistance Federal medical assistance percentage determined for the State under section 1905(y)(3) of the Social Security Act for amounts expended by the State prior to January 1, 2012.
GAO study and report
Study
The Comptroller General of the United States shall analyze the previous periods of national economic downturn, including the most recent such period in effect as of the date of enactment of this Act, and the past and projected effects of temporary increases in the Federal medical assistance percentage under the Medicaid program with respect to such periods.
Report
Not later than April 1, 2011, the Comptroller General of the United States shall submit a report to Congress on the results of the analysis conducted under paragraph (1). Such report shall include such recommendations as the Comptroller General determines appropriate for modifying the national economic downturn assistance FMAP established under section 1905(y) of the Social Security Act (as added by subsection (a)) to improve the effectiveness of the application of such percentage in addressing the needs of States during periods of national economic downturn, including recommendations for—
improvements to the factors that begin and end the application of such percentage;
how the determination of such percentage could be adjusted to address State and regional economic variations during such periods; and
how the determination of such percentage could be adjusted to be more responsive to actual Medicaid costs incurred by States during such periods, as well as to the effects of any other specific economic indicators that the Comptroller General determines appropriate.