HR3321-119

2. Phase-out of enhanced Federal match for medical assistance provided to low-income individuals under Medicaid Section 1905(y) of the Social Security Act (42 U.S.C. 1396d(y)) is amended— in paragraph (1)— in subparagraph (A), by inserting and subject to paragraph (4) after Notwithstanding subsection (b); in subparagraph (D), by striking ; and and inserting a semicolon; in subparagraph (E), by striking and each year thereafter. and inserting through 2026;; and by adding at the end the following new subparagraphs: for calendar quarters in each of calendar years 2027 through 2034, the percentage that applied under this subsection for calendar quarters in the preceding calendar year minus the applicable number of percentage points determined for the State under paragraph (3) or, if higher, the Federal medical assistance percentage otherwise determined for the State and year under subsection (b) (without regard to this subsection); and for calendar quarters in 2035 and each year thereafter, the Federal medical assistance percentage otherwise determined for the State and year under subsection (b) (without regard to this subsection). by adding at the end the following new paragraphs: For purposes of paragraph (1)(F), the applicable number of percentage points for a State is the number of percentage points equal to— the percentage points difference between— 90 percent; and the Federal medical assistance percentage determined for the State under subsection (b) (without regard to this subsection) for fiscal year 2026; divided by 8. Notwithstanding any other provision of law, for calendar years after 2024— paragraph (1) shall not apply to a non-expansion State (as defined in subparagraph (B)); if a non-expansion State elects on or after the date of enactment of this paragraph to expend amounts for all or any individuals described in section 1902(a)(10)(A)(i)(VIII), the Federal medical assistance percentage otherwise determined for the State and year under subsection (b) (without regard to this subsection) shall apply to amounts expended by such State for medical assistance for such individuals; and an expansion State (as defined in such subparagraph) may, at the option of the State, elect to only expend amounts for medical assistance for newly eligible individuals described in section 1902(a)(10)(A)(i)(VIII) whose income does not exceed 100 percent of the Federal poverty line (as defined for purposes of such section) and continue to receive the Federal medical assistance percentage specified under paragraph (1) for such amounts. In this paragraph: The term expansion State means a State that is not a non-expansion State. The term non-expansion State means a State that has not expended amounts for all individuals described in section 1902(a)(10)(A)(i)(VIII) before the date of the enactment of this paragraph. Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended by striking subsection (ii). (F) for calendar quarters in each of calendar years 2027 through 2034, the percentage that applied under this subsection for calendar quarters in the preceding calendar year minus the applicable number of percentage points determined for the State under paragraph (3) or, if higher, the Federal medical assistance percentage otherwise determined for the State and year under subsection (b) (without regard to this subsection); and (G)for calendar quarters in 2035 and each year thereafter, the Federal medical assistance percentage otherwise determined for the State and year under subsection (b) (without regard to this subsection).; and (3)Applicable number of percentage pointsFor purposes of paragraph (1)(F), the applicable number of percentage points for a State is the number of percentage points equal to— (A)the percentage points difference between— (i)90 percent; and (ii)the Federal medical assistance percentage determined for the State under subsection (b) (without regard to this subsection) for fiscal year 2026; divided by (B)8. (4)Rules of application for calendar years after 2024 (A)In generalNotwithstanding any other provision of law, for calendar years after 2024— (i)paragraph (1) shall not apply to a non-expansion State (as defined in subparagraph (B)); (ii)if a non-expansion State elects on or after the date of enactment of this paragraph to expend amounts for all or any individuals described in section 1902(a)(10)(A)(i)(VIII), the Federal medical assistance percentage otherwise determined for the State and year under subsection (b) (without regard to this subsection) shall apply to amounts expended by such State for medical assistance for such individuals; and (iii)an expansion State (as defined in such subparagraph) may, at the option of the State, elect to only expend amounts for medical assistance for newly eligible individuals described in section 1902(a)(10)(A)(i)(VIII) whose income does not exceed 100 percent of the Federal poverty line (as defined for purposes of such section) and continue to receive the Federal medical assistance percentage specified under paragraph (1) for such amounts. (B)DefinitionsIn this paragraph: (i)Expansion StateThe term expansion State means a State that is not a non-expansion State. (ii)Non-expansion StateThe term non-expansion State means a State that has not expended amounts for all individuals described in section 1902(a)(10)(A)(i)(VIII) before the date of the enactment of this paragraph..