Medicaid Extenders Act of 2019

Mr. President, I wish submit to the Senate the budget scorekeeping report for June 2019. The report compares current-law levels of spending and revenues with the amounts the Senate agreed to in the Bipartisan Budget Act of 2018 BBAl8. This information is necessary for the Senate Budget Committee to determine whether budgetary points of order lie against pending legislation. The Republican staff of the Budget Committee and the Congressional Budget Office, CBO, prepared this report pursuant to section 308(b) of the Congressional Budget Act, CBA.

This is my fifth scorekeeping report this year. My last filing can be found in the Congressional Record for May 22, 2019. The information included in this report is current through June 24, 2019.

Since my last filing, Congress has cleared three pieces of legislation with significant budgetary effects. The first, the Additional Supplemental Appropriations for Disaster Relief Act, 2019, P.L. 116-20, provided $19.1 billion in emergency discretionary appropriations to address recent natural disasters. The second, the Blue Water Navy Vietnam Veterans Act of 2019, H.R. 299, increased compensation for certain veterans and modified veteran home loan programs. The final bill, the Taxpayer First Act, H.R. 3151, modified several rules that govern the organization of and operations at the Internal Revenue Service.

Budget Committee Republican staff prepared Tables A-C.

Table A gives the amount by which each Senate authorizing committee exceeds or is below its allocation for budget authority and outlays under the Fiscal Year 2019 enforceable levels filing required by BBA18. This information is used for enforcing committee allocations pursuant to section 302 of the CBA. For this reporting period, 9 of the 16 authorizing committees are not in compliance with their allocations. Over the current 10-year enforceable window, authorizing committees have increased outlays by a combined $3.6 billion. Of the bills clearing Congress this reporting period, H.R. 299 added to the Veterans' Affairs Committee's existing violations, including an increase in spending of $394 million over the 10-year window, while H.R. 3151 reduced spending scoreable to the Finance Committee by $201 million over the same time period.

Table B provides the amount by which the Senate Committee on Appropriations is below or exceeds the statutory spending limits. This information is used to determine points of order related to the spending caps found in sections 312 and 314 of the CBA. Appropriations for Fiscal Year 2019, displayed in this table, show that the Appropriations Committee is compliant with spending limits for the current fiscal year. Those limits for regular discretionary spending are $647 billion for accounts in the defense category and $597 billion for accounts in the nondefense category of spending.

The Fiscal Year 2018 budget resolution contained points of order limiting the use of changes in mandatory programs in appropriations bills, CHIMP. Table C, which tracks the CHIMP limit of $15 billion for Fiscal Year 2019, shows the Appropriations Committee has enacted $15 billion worth of full-year CHIMPs for this Fiscal Year.

In addition to the tables provided by Budget Committee Republican staff, I am submitting CBO tables, which I will use to enforce budget totals approved by Congress.

For Fiscal Year 2019, CBO estimates that current-law levels are $2.9 billion above and $3.3 billion below enforceable levels for budget authority and outlays, respectively. Revenues are $426 million below the level assumed in the budget resolution. These figures remain unchanged since the May Scorekeeping Report, as the appropriation provided in P.L. 116-20 was accompanied by a concurrent and equivalent increase in aggregate spending levels pursuant to section 314 of the CBA. This adjustment can be found in the Congressional Record for May 23, 2019. Further, Social Security revenues are at the levels assumed for Fiscal

Year 2019, while Social Security outlays are $4 million above assumed levels for the budget year.

CBO's report also provides information needed to enforce the Senate pay-as-you-go, PAYGO, rule. The PAYGO scorecard shows deficit increases in Fiscal Year 2019 of $1,957 million, $427 million revenue loss, $1,530 million outlay increase; over the Fiscal Year 2018-2023 period of $3,412 million, $907 million revenue loss, $2,505 million outlay increase; and over the Fiscal Year 2018-2028 period of $800 million, $798 million revenue loss, $2 million outlay increase. During this reporting period, H.R. 3151 had the effect of reducing deficits by $37 million over both the Fiscal Year 2018-2023 and Fiscal Year 2018-2028 periods, while H.R. 299 increased deficits by $76 million and $394 million over the same periods, respectively.

This submission also includes a table tracking the Senate's budget enforcement activity on the floor since the enforcement filing on May 7, 2018. Since my last report, no new budgetary points of order were raised. On May 23, 2019, however, a Senator made a preemptive motion to waive all applicable points of order against the supplemental appropriations bill that would become P.L. 116-20.

All years in the accompanying tables are fiscal years.

I ask unanimous consent that the accompanying tables be printed in the Record.

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 259) to extend the Medicaid Money Follows the Person Rebalancing demonstration, to extend protection for Medicaid recipients of home and community-based services against spousal impoverishment, and for other purposes, as amended.

Mr. Speaker, I ask unanimous consent that all Members have 5 legislative days to revise and extend their remarks and include extraneous material on H.R. 259.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise today to express my support for H.R. 259, the Medicaid Extenders Act of 2019. This bill would extend for 3 months the successful Money Follows the Person demonstration and the spousal impoverishment protections for home- and community-based services recipients. These two provisions have helped tens of thousands of people remain in the community with their families and friends while receiving the healthcare and other services that they need.

The MFP demonstration helps people transition from institutional settings to community-based settings so they can live in their homes and maintain their independence, and all of this is possible because the demonstration provides them access to the services in their homes that they would otherwise receive in an institution.

This is a widely used and successful program. Currently, 43 States and the District of Columbia participate. And it has helped over 75,000 people transition from institutions to the community.

I thank my colleagues, Representative Dingell and Representative Guthrie, for their bipartisan efforts to protect this important program. I urge my colleagues to support extending this program as the Energy and Commerce Committee works on a longer-term extension.

Mr. Speaker, I also support extending the protections against spousal impoverishment for beneficiaries receiving home- and community-based services. These protections ensure that people can receive the community-based services they need and that their spouse has enough income and assets to meet their living expenses. This protection expired at the end of last year, and it is vital that we act quickly to reauthorize it.

Without this protection, individuals may lose access to important services or face unnecessary institutionalization. This is a terrible choice for families to make and one that we can prevent by passing this bill. Similar to MFP, this extension will give the committee time to work on a long-term solution.

Mr. Speaker, both of these extensions were passed as part of the continuing resolution in the Senate in December. Unfortunately, since then, a fight has ensued over appropriations funding. While it is my hope that the President will drop his demand for an ineffective and unnecessary wall, I do not want these programs to be collateral damage over that debate.

Both of these programs have bipartisan support and must be extended without delay. I urge my colleagues to support H.R. 259, the Medicaid Extenders Act of 2019.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield as much time as she may consume to the gentlewoman from Michigan (Mrs. Dingell).

Mr. Speaker, I would also ask that we support this bill on a bipartisan basis without delay.

Mr. Speaker, I yield back the balance of my time.

Ms. JACKSON LEE. Mr. Speaker, I rise in support of H.R. 259, the ``Medicaid Extenders Act of 2019'' that extends the ``Medicaid Money Follows the Person'' rebalancing demonstration project.

The ``Medicaid Money Follows the Person'' demonstration project supports reintegration of persons with special needs into their communities.

Since its creation in 1965, Medicaid has been the largest source of medical and health-related services for Americans with a low income and limited resources.

Over 75,151 people with chronic conditions and disabilities have transitioned from institutions back into the community through ``Money Follows the Person'' programs as of December 2016.

My home state of Texas was among the first 30 states chosen to participate in the ``Money Follows the Person'' demonstration in 2007.

The ``Money Follows the Person'' demonstration project has helped more than 10,000 individuals transition from institutional to community-based services in the state of Texas.

In the 18th Congressional District of Texas there are 162 nursing homes and out of 162 nursing homes only 67 nursing homes accept Medicaid.

43 percent of seniors in Houston, Texas earn less than $30,000 per year.

Texas has the second largest number of individuals with disabilities of all the states and the percentage of individuals with disabilities in the state of Texas is 11.7 percent.

In the fiscal year of 2016, Health and Human Services has budgeted over $16 million in federal funding to help individuals transition out of nursing facilities, State Supported Living Centers, Intermediate Care Facilities for Individuals with Intellectual Disabilities and other institutions.

The ``Money Follows the Person'' demonstration project has helped states and the federal government save money. From 2008 to 2013, it generated $978 million in reduced Medicare and Medicaid costs after the first year of transitioning participants to home- and community-based care.

For these reasons, I ask my colleagues to join me in supporting H.R. 259.

Mr. President, I wish to submit to the Senate the budget scorekeeping report for February 2019. The report compares current-law levels of spending and revenues with the amounts the Senate agreed to in the Bipartisan Budget Act of 2018, BBA18. This information is necessary for the Senate Budget Committee to determine whether budgetary points of order lie against pending legislation. The Republican staff of the Budget Committee and the Congressional Budget Office, CBO, prepared this report pursuant to section 308(b) of the Congressional Budget Act, CBA.

This is my second scorekeeping report this year. My last filing can be found in the Congressional Record for January 10, 2019. The information included in this report is current through February 25, 2019.

Since my last filing, two bills with significant budgetary effects cleared Congress, the Medicaid Extenders Act of 2019, P.L. 116-3, and the Consolidated Appropriations Act, 2019, P.L. 116-6.

Budget Committee Republican staff prepared Tables 1-3.

Table 1 gives the amount by which each Senate authorizing committee exceeds or is below its allocation for budget authority and outlays under the most recently adopted budget resolution and the fiscal year 2019 enforceable levels filing. This information is used for enforcing committee allocations pursuant to section 302 of the CBA. Over the current 10-year enforceable window, authorizing committees have increased outlays by a combined $3.4 billion. For this reporting period, as in my last report, 8 of the 16 authorizing committees are not in compliance with their allocations. Two of these committees, Finance and Judiciary, further exacerbated their violations during this work period with the passage of Medicaid Extenders and the authorizing division, Division H, of the final 2019 appropriations bill, respectively. For the Finance Committee, P.L. 116-3 was estimated to increase budget authority over each enforceable period for its allocation, with the largest violation, $120 million, occurring in 2019. For the Judiciary Committee, Division H of P.L. 116-6, which included various immigration extenders, was estimated to increase budget authority and outlays by $30 million over the next 10 years.

Table 2 provides the amount by which the Senate Committee on Appropriations is below or exceeds the statutory spending limits. This information is used to determine points of order related to the spending caps found in sections 312 and 314 of the CBA. Appropriations for fiscal year 2019, displayed in this table, show that the Appropriations Committee is compliant with spending limits for fiscal year 2019. Those limits for regular discretionary spending are $647 billion for accounts in the defense category and $597 billion for accounts in the nondefense category of spending.

The fiscal year 2018 budget resolution contained points of order limiting the use of changes in mandatory programs in appropriations bills, CHIMPs. Table 3, which tracks the CHIMP limit of $15 billion for fiscal year 2019, shows the Appropriations Committee has enacted $15 billion worth of full-year CHIMPs for fiscal year 2019. The fiscal year 2019 CHIMPs were contained in the Labor, Health and Human Services, Education and Related Agencies division of P.L. 115-245 and the Commerce, Justice, Science, and Related Agencies division of P.L. 116- 6. This information is used for determining the point of order under section 4102, overall limit, of H. Con. Res. 71, 115th Congress.

In addition to the tables provided by Budget Committee Republican staff, I am submitting CBO tables, which I will use to enforce budget totals approved by Congress.

For fiscal year 2019, CBO estimates that current-law levels are $2.8 billion above and $3.3 billion below enforceable levels for budget authority and outlays, respectively. Revenues are $426 million below the level assumed in the budget resolution. Further, Social Security revenues are at the levels assumed for fiscal year 2019, while Social Security outlays are $4 million above assumed levels for the budget year.

CBO's report also provides information needed to enforce the Senate pay-as-you-go, PAYGO, rule. The PAYGO scorecard shows deficit increases in fiscal year 2019 of $1,930 million--$427 million revenue loss, $1,503 million outlay increase--over the fiscal year 2018-2023 period of $3,337 million--$894 million revenue loss, $2,443 million outlay increase--and over the fiscal year 2018-2028 period of $425 million-- $634 million revenue loss, $209 million outlay decrease. During this work period, one bill, the Consolidated Appropriations Act, 2019, included a statutory exemption for the budgetary effects of its Division H from the Senate's PAYGO scorecard. The Senate's PAYGO rule is enforced by section 4106 of H. Con. Res. 71, 115th Congress.

This submission also includes a table tracking the Senate's budget enforcement activity on the floor since the enforcement filing on May 7, 2018. Since my last report, no new budgetary points of order were raised.

All years in the accompanying tables are fiscal years.

I ask unanimous consent that the accompanying tables be printed in the Record.

Mr. President, I rise to submit to the Senate the budget scorekeeping report for April 2019. The report compares current-law levels of spending and revenues with the amounts the Senate agreed to in the Bipartisan Budget Act of 2018, BBA18. This information is necessary for the Senate Budget Committee to determine whether budgetary points of order lie against pending legislation. The Republican staff of the Budget Committee and the Congressional Budget Office, CBO, prepared this report pursuant to section 308(b) of the Congressional Budget Act, CBA.

This is my third scorekeeping report this year. My last filing can be found in the Congressional Record for February 27, 2019. The information included in this report is current through April 8, 2019.

Since my last filing, three bills with significant budgetary effects cleared Congress, the Pesticide Registration Improvement Extension Act of 2018, P.L. 116-8; the John D. Dingell, Jr. Conservation, Management, and Recreation Act, P.L. 116-9; and the Medicaid Services Investment and Accountability Act of 2019, H.R. 1839.

Budget Committee Republican staff prepared Tables 1-3.

Table 1 gives the amount by which each Senate authorizing committee exceeds or is below its allocation for budget authority and outlays under the fiscal year 2019 enforceable levels filing required by BBA18. This information is used for enforcing committee allocations pursuant to section 302 of the CBA. Over the current 10-year enforceable window, authorizing committees have increased outlays by a combined $3.4 billion. For this reporting period, as in my last report, 8 of the 16 authorizing committees are not in compliance with their allocations. One of these committees, Finance, further exacerbated its violations this work period with the passage of the Medicaid Services Investment and Accountability Act. CBO estimates that this measure will increase mandatory spending for all enforceable periods, including an increase in outlays of $27 million over the Fiscal Year 2019-2028 period. The Agriculture Committee reduced the size of its violations with the passage of the Pesticide Registration Improvement Extension Act, which CBO scores as reducing outlays by $5 million in Fiscal Year 2019 and by $23 million over the Fiscal Year 2019-2023 period. The Energy and Natural Resources Committee, which was not in breach of its allocation for the last reporting cycle, continued to reduce spending with the passage of the John D. Dingell, Jr. Conservation, Management, and Recreation Act. CBO estimates that this measure will reduce spending by $10 million over both the 5- and 10-year enforceable windows. This savings is credited to its allocation, as shown in the table.

Tables 2 provides the amount by which the Senate Committee on Appropriations is below or exceeds the statutory spending limits. This information is used to determine points of order related to the spending caps found in sections 312 and 314 of the CBA. Appropriations for Fiscal Year 2019, displayed in this table, show that the Appropriations Committee is compliant with spending limits for Fiscal Year 2019. Those limits for regular discretionary spending are $647 billion for accounts in the defense category and $597 billion for accounts in the nondefense category of spending.

The Fiscal Year 2018 budget resolution contained points of order limiting the use of changes in mandatory programs in appropriations bills, CHIMPs. Table 3, which tracks the CHIMP limit of $15 billion for Fiscal Year 2019, shows the Appropriations Committee has enacted $15 billion worth of full-year CHIMPs for Fiscal Year 2019.

In addition to the tables provided by Budget Committee Republican staff, I am submitting CBO tables, which I will use to enforce budget totals approved by Congress.

For Fiscal Year 2019, CBO estimates that current-law levels are $2.9 billion above and $3.3 billion below enforceable levels for budget authority and outlays, respectively. Revenues are $426 million below the level assumed in the budget resolution. Further, Social Security revenues are at the levels assumed for Fiscal Year 2019, while Social Security outlays are $4 million above assumed levels for the budget year.

CBO's report also provides information needed to enforce the Senate pay-as-you-go, PAYGO, rule. The PAYGO scorecard shows deficit increases in Fiscal Year 2019 of $1,957 million--$427 million revenue loss, $1,530 million outlay increase; over the Fiscal Year 2018-2023 period of $3,373 million--$894 million revenue loss, $2,479 million outlay increase; and over the Fiscal Year 2018-2028 period of $442 million, $634 million revenue loss, $192 million outlay decrease.

This submission also includes a table tracking the Senate's budget enforcement activity on the floor since the enforcement filing on May 7, 2018. Since my last report, no new budgetary points of order were raised.

All years in the accompanying tables are fiscal years.

I ask unanimous consent that the accompanying tables be printed in the Record.

Mr. President, I wish to submit to the Senate the budget scorekeeping report for May 2019. The report compares current-law levels of spending and revenues with the amounts the Senate agreed to in the Bipartisan Budget Act of 2018, BBA18. This information is necessary for the Senate Budget Committee to determine whether budgetary points of order lie against pending legislation.

The Republican staff of the Budget Committee and the Congressional Budget Office, CBO, prepared this report pursuant to section 308(b) of the Congressional Budget Act, CBA.

This is my fourth scorekeeping report this year. My last filing can be found in the Congressional Record for April 10, 2019. The information included in this report is current through May 20, 2019.

Since my last filing, Congress has cleared only one measure, S. 1436, a bill to make technical corrections to the computation of average pay under Public Law 110-279, with significant budgetary effects. This bill made changes to the calculation of retirement benefits for certain employees who staff the dining services for the U.S. Senate. Those services were privatized in 2008.

Budget Committee Republican staff prepared tables A-C.

Table A gives the amount by which each Senate authorizing committee exceeds or is below its allocation for budget authority and outlays under the fiscal year 2019 enforceable levels filing required by BBA18. This information is used for enforcing committee allocations pursuant to section 302 of the CBA. Over the current 10-year enforceable window, authorizing committees have increased outlays by a combined $3.4 billion. For this reporting period, 9 of the 16 authorizing committees are not in compliance with their allocations. As a result of passage of S. 1436, the Senate Committee on Rules and Administration is now in violation of its allocation for both budget authority and outlays over the fiscal year 2019-2028 period.

Table B provides the amount by which the Senate Committee on Appropriations is below or exceeds the statutory spending limits. This information is used to determine points of order related to the spending caps found in sections 312 and 314 of the CBA. Appropriations for fiscal year 2019, displayed in this table, show that the Appropriations Committee is compliant with spending limits for the current fiscal year. Those limits for regular discretionary spending are $647 billion for accounts in the defense category and $597 billion for accounts in the nondefense category of spending.

The fiscal year 2018 budget resolution contained points of order limiting the use of changes in mandatory programs in appropriations bills, CHIMPs. Table C, which tracks the CHIMP limit of $15 billion for fiscal year 2019, shows the Appropriations Committee has enacted $15 billion worth of full-year CHIMPs for this fiscal year.

In addition to the tables provided by Budget Committee Republican staff, I am submitting CBO tables, which I will use to enforce budget totals approved by Congress.

For fiscal year 2019, CBO estimates that current-law levels are $2.9 billion above and $3.3 billion below enforceable levels for budget authority and outlays, respectively. Revenues are $426 million below the level assumed in the budget resolution. Further, Social Security revenues are at the levels assumed for fiscal year 2019, while Social Security outlays are $4 million above assumed levels for the budget year.

CBO's report also provides information needed to enforce the Senate pay-as-you-go, PAYGO, rule. The PAYGO scorecard shows deficit increases in fiscal year 2019 of $1,957 million, $427 million revenue loss, $1,530 million outlay increase; over the fiscal year 2018-2023 period of $3,373 million, $894 million revenue loss, $2,479 million outlay increase; and over the fiscal year 2018-2028 period of $443 million, $634 million revenue loss, $191 million outlay decrease.

This submission also includes a table tracking the Senate's budget enforcement activity on the floor since the enforcement filing on May 7, 2018. Since my last report, no new budgetary points of order were raised.

All years in the accompanying tables are fiscal years.

I ask unanimous consent that the accompanying tables be printed in the Record.