HR3990-119

What This Bill Does

The Disaster Relief Medicaid Act creates a standing Medicaid response for disasters. Beginning January 1, 2027, state Medicaid plans must provide medical assistance to relief-eligible survivors during a disaster relief coverage period. Disasters include Stafford Act major disasters with federal individual or public assistance, National Emergencies Act declarations, and Public Health Service Act public health emergencies. CMS and FEMA must post direct impact areas. A relief coverage period runs for two years after the disaster declaration. Eligibility turns on home-state residence at the time of declaration and family income not exceeding the higher of 133 percent of poverty, or for a child under 19 or pregnant individual, the applicable state Medicaid or CHIP income standard. HHS must issue Medicaid director guidance by January 1, 2027 on expedited provider approval and use of out-of-state providers, provide technical assistance for state infrastructure or demonstrations, and report a plan of action within 180 days. HHS must award grants for HCBS emergency response corps in states with a history of hosting disaster evacuees, using trained providers to serve relief-eligible survivors needing home and community-based services. For residents of direct impact areas during relief coverage periods, Medicaid and CHIP federal match is 100 percent, and extra territory payments do not count against statutory caps. Areas hosting significant evacuees can be treated as emergency areas for section 1135 waiver purposes. Disaster relief months are excluded from Medicare Part B late-enrollment penalty calculations for survivors. State plans needing legislation get transition protection. HHS must fund an independent five-year evaluation of access, HCBS, mental health, care coordination, provider capacity, demographics including people with disabilities and pregnant individuals, state compliance, state coordination, provider coordination, and HCBS corps activity, with interim and follow-up reports to Senate Finance, Senate Aging, House Energy and Commerce, and House Ways and Means.

Who Benefits and How

Disaster survivors benefit from Medicaid coverage during a two-year relief period after qualifying disasters, emergencies, or public health emergencies. Pregnant disaster survivors benefit from higher income thresholds where state Medicaid or CHIP pregnancy standards apply. Children in disaster areas benefit from child-specific Medicaid or CHIP income standards during relief coverage periods. People with disabilities after disasters benefit from HCBS emergency response corps and evaluation of home and community-based services. States hosting evacuees benefit from grants to establish or operate HCBS emergency response corps. Direct impact area residents benefit from 100 percent federal Medicaid and CHIP support for covered assistance. Medicare Part B enrollees affected by disasters benefit because relief months are excluded from late-enrollment penalty calculations.

Who Bears the Burden and How

State Medicaid agencies must provide relief coverage, coordinate home-state rules, process survivors, and implement provider or evacuee policies. CMS disaster Medicaid staff must post direct impact areas, issue guidance, provide technical assistance, and oversee 100 percent matching. FEMA website staff must coordinate direct impact area postings with CMS. HHS grant staff must award and oversee HCBS emergency response corps grants. Independent evaluation contractors must conduct a five-year evaluation and prepare interim and follow-up reports. Federal taxpayers bear the cost of new Medicaid coverage, 100 percent matching, CHIP matching, HCBS grants, and evaluation work.

Key Provisions

• Creates Disaster Relief Medicaid for relief-eligible survivors beginning January 1, 2027.
• Provides two-year relief coverage periods after major disasters, national emergencies, or public health emergencies.
• Requires CMS and FEMA to post direct impact areas.
• Requires HHS guidance on expedited provider approval and out-of-state provider use.
• Authorizes grants for HCBS emergency response corps in states hosting disaster evacuees.
• Provides 100 percent Medicaid and CHIP federal matching for direct-impact-area residents during relief periods.
• Treats areas hosting significant evacuees as emergency areas for waiver purposes.
• Excludes disaster relief months from Medicare Part B late-enrollment penalty calculations.
• Requires a five-year independent evaluation with interim and follow-up reports.