S. 245Senate117th Congress (2021-2023)In Committee

SAME Act of 2021

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Updated February 7, 2026 at 10:18 PM UTC

The SAME Act of 2021 amends title XIX of the Social Security Act to give every state that chooses to expand Medicaid the same level of federal matching assistance, no matter when the expansion occurs. It changes the formula that sets the Federal Medical Assistance Percentage (FMAP) so that the same rate applies for each of the first seven consecutive 12‑month periods of coverage and continues thereafter. The changes also apply retroactively to cover Medicaid spending on newly eligible individuals that occurred before the law was enacted. This affects states that expand Medicaid and the newly eligible Medicaid beneficiaries in those states.

Key Provisions

Replaces the year‑by‑year FMAP schedule with language that provides the same matching rate for each of the first three, fourth, fifth, sixth, and seventh consecutive 12‑month periods of Medicaid expansion, and for all periods thereafter.
Makes the new FMAP provisions apply retroactively to Medicaid expenditures for newly eligible individuals incurred before the law’s enactment.

Legislative Activity

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1 earlier action

SenateIntro Referral Latest Action

Read twice and referred to the Committee on Finance.

Finance Committee

February 4, 2021

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SenateIntro Referral

Introduced in Senate

February 4, 2021

SenateIntro Referral

Read twice and referred to the Committee on Finance.

Finance Committee

February 4, 2021

Bill Text

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Introduced in SenateIssued February 4, 2021

117th CONGRESS

1st Session

S. 245

IN THE SENATE OF THE UNITED STATES

February 4, 2021

Mr. Warner (for himself, Mr. Warnock, Mr. Kaine, Mr. Carper, Ms. Stabenow, Mr. Casey, Ms. Baldwin, Mr. Peters, Mr. Coons, Mr. King, and Mr. Ossoff) introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place, and for other purposes.

Short title

This Act may be cited as the States Achieve Medicaid Expansion Act of 2021 or the SAME Act of 2021.

Increased FMAP for medical assistance to newly eligible individuals

(a)

In general

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—

(1)

in subsection (y)(1)—

(A)

in subparagraph (A), by striking 2014, 2015, and 2016 and inserting each of the first 3 consecutive 12-month periods in which the State provides medical assistance to newly eligible individuals;

(B)

in subparagraph (B), by striking 2017 and inserting the fourth consecutive 12-month period in which the State provides medical assistance to newly eligible individuals;

(C)

in subparagraph (C), by striking 2018 and inserting the fifth consecutive 12-month period in which the State provides medical assistance to newly eligible individuals;

(D)

in subparagraph (D), by striking 2019 and inserting the sixth consecutive 12-month period in which the State provides medical assistance to newly eligible individuals; and

(E)

in subparagraph (E), by striking 2020 and each year thereafter and inserting the seventh consecutive 12-month period in which the State provides medical assistance to newly eligible individuals and each such period thereafter; and

(2)

in subsection (z)(2)(B)(i)(II), by inserting (as in effect on the day before the enactment of the States Achieve Medicaid Expansion Act of 2021) after subsection (y)(1).

(b)

Retroactive application

The amendments made by subsection (a)(1) shall take effect as if included in the enactment of Public Law 111–148 and shall apply to amounts expended by any State for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i) of the Social Security Act under a State Medicaid plan (or a waiver of such plan) during the period before the date of enactment of this Act.