42 U.S.C. § 1396d | Definitions

For purposes of this subchapter—

(a)

Medical assistance

section 1396a(a)(10)(A) of this titleThe term “medical assistance” means payment of part or all of the cost of the following care and services or the care and services themselves, or both (if provided in or after the third month before the month in which the recipient makes application for assistance or, in the case of medicare cost-sharing with respect to a qualified medicare beneficiary described in subsection (p)(1), if provided after the month in which the individual becomes such a beneficiary) for individuals, and, with respect to physicians’ or dentists’ services, at the option of the State, to individuals (other than individuals with respect to whom there is being paid, or who are eligible, or would be eligible if they were not in a medical institution, to have paid with respect to them a State supplementary payment and are eligible for medical assistance equal in amount, duration, and scope to the medical assistance made available to individuals described in ) not receiving aid or assistance under any plan of the State approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV, and with respect to whom supplemental security income benefits are not being paid under subchapter XVI, who are—

(i)

under the age of 21, or, at the option of the State, under the age of 20, 19, or 18 as the State may choose,

(ii)

1 See References in Text note below.

relatives specified in section 606(b)(1)  of this title with whom a child is living if such child is (or would, if needy, be) a dependent child under part A of subchapter IV,

(iii)

65 years of age or older,

(iv)

blind, with respect to States eligible to participate in the State plan program established under subchapter XVI,

(v)

18 years of age or older and permanently and totally disabled, with respect to States eligible to participate in the State plan program established under subchapter XVI,

(vi)

persons essential (as described in the second sentence of this subsection) to individuals receiving aid or assistance under State plans approved under subchapter I, X, XIV, or XVI,

(vii)

section 1382c of this title blind or disabled as defined in , with respect to States not eligible to participate in the State plan program established under subchapter XVI,

(viii)

pregnant women,

(ix)

section 1396r–6 of this title individuals provided extended benefits under ,

(x)

section 1396a(u)(1) of this title individuals described in ,

(xi)

section 1396a(z)(1) of this title individuals described in ,

(xii)

employed individuals with a medically improved disability (as defined in subsection (v)),

(xiii)

section 1396a(aa) of this title individuals described in ,

(xiv)

individuals described in section 1396a(a)(10)(A)(i)(VIII) or 1396a(a)(10)(A)(i)(IX) of this title,

(xv)

section 1396a(a)(10)(A)(ii)(XX) of this title individuals described in ,

(xvi)

section 1396a(ii) of this title individuals described in , or

(xvii)

section 1396n(i) of this title individuals who are eligible for home and community-based services under needs-based criteria established under paragraph (1)(A) of , or who are eligible for home and community-based services under paragraph (6) of such section, and who will receive home and community-based services pursuant to a State plan amendment under such subsection,

but whose income and resources are insufficient to meet all of such cost—

(1)

inpatient hospital services (other than services in an institution for mental diseases);

(2)

(A)

lll outpatient hospital services, (B) consistent with State law permitting such services, rural health clinic services (as defined in subsection ()(1)) and any other ambulatory services which are offered by a rural health clinic (as defined in subsection ()(1)) and which are otherwise included in the plan, and (C) Federally-qualified health center services (as defined in subsection ()(2)) and any other ambulatory services offered by a Federally-qualified health center and which are otherwise included in the plan;

(3)

(A)

other laboratory and X-ray services; and

(B)

section 1320b–5(g) of this titleMarch 18, 2020 in vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of beginning on or after , for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products;

(4)

(A)

2 So in original. The word “and” probably should not appear.

2March 11, 2021section 1320b–5(g)(1)(B) of this titleMarch 11, 2021section 1320b–5(g)(1)(B) of this title section 1396a(a)(10)(B) of this title nursing facility services (other than services in an institution for mental diseases) for individuals 21 years of age or older; (B) early and periodic screening, diagnostic, and treatment services (as defined in subsection (r)) for individuals who are eligible under the plan and are under the age of 21; (C) family planning services and supplies furnished (directly or under arrangements with others) to individuals of child-bearing age (including minors who can be considered to be sexually active) who are eligible under the State plan and who desire such services and supplies; and  (D) counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in subsection (bb)); and  (E) during the period beginning on , and ending on the last day of the first calendar quarter that begins one year after the last day of the emergency period described in , a COVID–19 vaccine and administration of the vaccine; and (F) during the period beginning on , and ending on the last day of the first calendar quarter that begins one year after the last day of the emergency period described in , testing and treatments for COVID–19, including specialized equipment and therapies (including preventive therapies), and, without regard to the requirements of (relating to comparability), in the case of an individual who is diagnosed with or presumed to have COVID–19, during the period such individual has (or is presumed to have) COVID–19, the treatment of a condition that may seriously complicate the treatment of COVID–19, if otherwise covered under the State plan (or waiver of such plan);

(5)

(A)

section 1395x(r)(1) of this title section 1395x(r)(2) of this title section 1395x(r)(1) of this title physicians’ services furnished by a physician (as defined in ), whether furnished in the office, the patient’s home, a hospital, or a nursing facility, or elsewhere, and (B) medical and surgical services furnished by a dentist (described in ) to the extent such services may be performed under State law either by a doctor of medicine or by a doctor of dental surgery or dental medicine and would be described in clause (A) if furnished by a physician (as defined in );

(6)

medical care, or any other type of remedial care recognized under State law, furnished by licensed practitioners within the scope of their practice as defined by State law;

(7)

home health care services;

(8)

private duty nursing services;

(9)

clinic services furnished by or under the direction of a physician, without regard to whether the clinic itself is administered by a physician, including such services furnished outside the clinic by clinic personnel to an eligible individual who does not reside in a permanent dwelling or does not have a fixed home or mailing address;

(10)

dental services;

(11)

physical therapy and related services;

(12)

prescribed drugs, dentures, and prosthetic devices; and eyeglasses prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the individual may select;

(13)

other diagnostic, screening, preventive, and rehabilitative services, including—

(A)

any clinical preventive services that are assigned a grade of A or B by the United States Preventive Services Task Force;

(B)

with respect to an adult individual, approved vaccines recommended by the Advisory Committee on Immunization Practices (an advisory committee established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) and their administration; and

(C)

any medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under State law, for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level;

(14)

inpatient hospital services and nursing facility services for individuals 65 years of age or over in an institution for mental diseases;

(15)

section 1396a(a)(31) of this title services in an intermediate care facility for the mentally retarded (other than in an institution for mental diseases) for individuals who are determined, in accordance with , to be in need of such care;

(16)

(A)

January 1, 1973 effective , inpatient psychiatric hospital services for individuals under age 21, as defined in subsection (h), and, (B) for individuals receiving services described in subparagraph (A), early and periodic screening, diagnostic, and treatment services (as defined in subsection (r)), whether or not such screening, diagnostic, and treatment services are furnished by the provider of the services described in such subparagraph;

(17)

section 1395x(gg) of this title services furnished by a nurse-midwife (as defined in ) which the nurse-midwife is legally authorized to perform under State law (or the State regulatory mechanism provided by State law), whether or not the nurse-midwife is under the supervision of, or associated with, a physician or other health care provider, and without regard to whether or not the services are performed in the area of management of the care of mothers and babies throughout the maternity cycle;

(18)

o hospice care (as defined in subsection ());

(19)

section 1396n(g)(2) of this title section 1396a(z)(2)(F) of this title case management services (as defined in ) and TB-related services described in ;

(20)

section 1396a(e)(9)(C) of this title respiratory care services (as defined in );

(21)

services furnished by a certified pediatric nurse practitioner or certified family nurse practitioner (as defined by the Secretary) which the certified pediatric nurse practitioner or certified family nurse practitioner is legally authorized to perform under State law (or the State regulatory mechanism provided by State law), whether or not the certified pediatric nurse practitioner or certified family nurse practitioner is under the supervision of, or associated with, a physician or other health care provider;

(22)

section 1396t of this title home and community care (to the extent allowed and as defined in ) for functionally disabled elderly individuals;

(23)

section 1396u of this title community supported living arrangements services (to the extent allowed and as defined in );

(24)

personal care services furnished to an individual who is not an inpatient or resident of a hospital, nursing facility, intermediate care facility for the mentally retarded, or institution for mental disease that are (A) authorized for the individual by a physician in accordance with a plan of treatment or (at the option of the State) otherwise authorized for the individual in accordance with a service plan approved by the State, (B) provided by an individual who is qualified to provide such services and who is not a member of the individual’s family, and (C) furnished in a home or other location;

(25)

primary care case management services (as defined in subsection (t));

(26)

section 1396u–4 of this title services furnished under a PACE program under to PACE program eligible individuals enrolled under the program under such section;

(27)

subject to subsection (x), primary and secondary medical strategies and treatment and services for individuals who have Sickle Cell Disease;

(28)

ll freestanding birth center services (as defined in subsection ()(3)(A)) and other ambulatory services that are offered by a freestanding birth center (as defined in subsection ()(3)(B)) and that are otherwise included in the plan;

(29)

October 1, 2020 subject to paragraphs (2) and (3) of subsection (ee), beginning on , medication-assisted treatment (as defined in paragraph (1) of such subsection);

(30)

subject to subsection (gg), routine patient costs for items and services furnished in connection with participation in a qualifying clinical trial (as defined in such subsection);

(31)

certified community behavioral health clinic services, as defined in subsection (jj); and

(32)

any other medical care, and any other type of remedial care recognized under State law, specified by the Secretary,

except as otherwise provided in paragraph (16), such term does not include—

(A)

section 1396a(a)(84)(D) of this title section 1396a(nn)(2) of this title section 1396a(nn)(3) of this title any such payments with respect to care or services for any individual who is an inmate of a public institution (except as a patient in a medical institution, or in the case of an eligible juvenile described in with respect to the screenings, diagnostic services, referrals, and targeted case management services required under such section, or, at the option of the State, for an individual who is an eligible juvenile (as defined in ), while such individual is an inmate of a public institution (as defined in ) pending disposition of charges); or

(B)

l any such payments with respect to care or services for any individual who has not attained 65 years of age and who is a patient in an institution for mental diseases (except in the case of services provided under a State plan amendment described in section 1396n() of this title).

section 1396a(a)(10)(A) of this titleFor purposes of clause (vi) of the preceding sentence, a person shall be considered essential to another individual if such person is the spouse of and is living with such individual, the needs of such person are taken into account in determining the amount of aid or assistance furnished to such individual (under a State plan approved under subchapter I, X, XIV, or XVI), and such person is determined, under such a State plan, to be essential to the well-being of such individual. The payment described in the first sentence may include expenditures for medicare cost-sharing and for premiums under part B of subchapter XVIII for individuals who are eligible for medical assistance under the plan and (A) are receiving aid or assistance under any plan of the State approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV, or with respect to whom supplemental security income benefits are being paid under subchapter XVI, or (B) with respect to whom there is being paid a State supplementary payment and are eligible for medical assistance equal in amount, duration, and scope to the medical assistance made available to individuals described in , and, except in the case of individuals 65 years of age or older and disabled individuals entitled to health insurance benefits under subchapter XVIII who are not enrolled under part B of subchapter XVIII, other insurance premiums for medical or any other type of remedial care or the cost thereof. No service (including counseling) shall be excluded from the definition of “medical assistance” solely because it is provided as a treatment service for alcoholism or drug dependency. In the case of a woman who is eligible for medical assistance on the basis of being pregnant (including through the end of the month in which the 60-day period beginning on the last day of her pregnancy ends), who is a patient in an institution for mental diseases for purposes of receiving treatment for a substance use disorder, and who was enrolled for medical assistance under the State plan immediately before becoming a patient in an institution for mental diseases or who becomes eligible to enroll for such medical assistance while such a patient, the exclusion from the definition of “medical assistance” set forth in the subdivision (B) following the last numbered paragraph of the first sentence of this subsection shall not be construed as prohibiting Federal financial participation for medical assistance for items or services that are provided to the woman outside of the institution.

(b)

Federal medical assistance percentage; State percentage; Indian health care percentage

section 1396u–3(d) of this title section 1397ee(b) of this title section 1396a(a)(10)(A)(ii)(XVIII) of this titleAugust 16, 2022section 1301(a)(8)(B) of this title 25 U.S.C. 1603March 11, 202125 U.S.C. 1603(29)25 U.S.C. 1651 section 11711(4) of this title section 11705(b) of this title section 11707 of this title section 1396r–4 of this title section 1397dd of this title section 1397ee(b) of this title section 1396a(ss) of this title section 1396a(a)(10)(A)(ii)(XXIII) of this title section 1396b(a)(7) of this titleSubject to subsections (y), (z), (aa), (ff), (hh), and (ii) and , the term “Federal medical assistance percentage” for any State shall be 100 per centum less the State percentage; and the State percentage shall be that percentage which bears the same ratio to 45 per centum as the square of the per capita income of such State bears to the square of the per capita income of the continental United States (including Alaska) and Hawaii; except that (1) the Federal medical assistance percentage shall in no case be less than 50 per centum or more than 83 per centum, (2) the Federal medical assistance percentage for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa shall be 55 percent, (3) for purposes of this subchapter and subchapter XXI, the Federal medical assistance percentage for the District of Columbia shall be 70 percent, (4) the Federal medical assistance percentage shall be equal to the enhanced FMAP described in with respect to medical assistance provided to individuals who are eligible for such assistance only on the basis of , (5) in the case of a State that provides medical assistance for services described in subsection (a)(13)(A), and prohibits cost-sharing for such services, the Federal medical assistance percentage, as determined under this subsection and subsection (y) (without regard to paragraph (1)(C) of such subsection), shall be increased by 1 percentage point with respect to medical assistance for such services and for items and services described in subsection (a)(4)(D), and (6) during the first 8 fiscal quarters beginning on or after the effective date of this clause, in the case of a State which, as of , provides medical assistance for vaccines described in subsection (a)(13)(B) and their administration and prohibits cost-sharing for such vaccines, the Federal medical assistance percentage, as determined under this subsection and subsection (y), shall be increased by 1 percentage point with respect to medical assistance for such vaccines and their administration. The Federal medical assistance percentage for any State shall be determined and promulgated in accordance with the provisions of . Notwithstanding the first sentence of this section, the Federal medical assistance percentage shall be 100 per centum with respect to amounts expended as medical assistance for services which are received through an Indian Health Service facility whether operated by the Indian Health Service or by an Indian tribe or tribal organization (as defined in section 4 of the Indian Health Care Improvement Act []); for the 8 fiscal year quarters beginning with the first fiscal year quarter beginning after , the Federal medical assistance percentage shall also be 100 per centum with respect to amounts expended as medical assistance for services which are received through an Urban Indian organization (as defined in paragraph (29) of section 4 of the Indian Health Care Improvement Act []) that has a grant or contract with the Indian Health Service under title V of such Act [ et seq.]; and, for such 8 fiscal year quarters, the Federal medical assistance percentage shall also be 100 per centum with respect to amounts expended as medical assistance for services which are received through a Native Hawaiian Health Center (as defined in ) or a qualified entity (as defined in ) that has a grant or contract with the Papa Ola Lokahi under . Notwithstanding the first sentence of this subsection, in the case of a State plan that meets the condition described in subsection (u)(1), with respect to expenditures (other than expenditures under ) described in subsection (u)(2)(A) or subsection (u)(3) for the State for a fiscal year, and that do not exceed the amount of the State’s available allotment under , the Federal medical assistance percentage is equal to the enhanced FMAP described in . Notwithstanding the first sentence of this subsection, the Federal medical assistance percentage shall be 100 per centum with respect to (and, notwithstanding any other provision of this subchapter, available for) medical assistance provided to uninsured individuals (as defined in ) who are eligible for such assistance only on the basis of and with respect to expenditures described in that a State demonstrates to the satisfaction of the Secretary are attributable to administrative costs related to providing for such medical assistance to such individuals under the State plan.

(c)

Nursing facility

section 1396r(a) of this titleFor definition of the term “nursing facility”, see .

(d)

Intermediate care facility for mentally retarded

The term “intermediate care facility for the mentally retarded” means an institution (or distinct part thereof) for the mentally retarded or persons with related conditions if—

(1)

the primary purpose of such institution (or distinct part thereof) is to provide health or rehabilitative services for mentally retarded individuals and the institution meets such standards as may be prescribed by the Secretary;

(2)

the mentally retarded individual with respect to whom a request for payment is made under a plan approved under this subchapter is receiving active treatment under such a program; and

(3)

January 1, 1975 in the case of a public institution, the State or political subdivision responsible for the operation of such institution has agreed that the non-Federal expenditures in any calendar quarter prior to , with respect to services furnished to patients in such institution (or distinct part thereof) in the State will not, because of payments made under this subchapter, be reduced below the average amount expended for such services in such institution in the four quarters immediately preceding the quarter in which the State in which such institution is located elected to make such services available under its plan approved under this subchapter.

(e)

Physicians’ services

In the case of any State the State plan of which (as approved under this subchapter)—

(1)

section 1396a(a)(12) of this title does not provide for the payment of services (other than services covered under ) provided by an optometrist; but

(2)

at a prior period did provide for the payment of services referred to in paragraph (1);

the term “physicians’ services” (as used in subsection (a)(5)) shall include services of the type which an optometrist is legally authorized to perform where the State plan specifically provides that the term “physicians’ services”, as employed in such plan, includes services of the type which an optometrist is legally authorized to perform, and shall be reimbursed whether furnished by a physician or an optometrist.

(f)

Nursing facility services

For purposes of this subchapter, the term “nursing facility services” means services which are or were required to be given an individual who needs or needed on a daily basis nursing care (provided directly by or requiring the supervision of nursing personnel) or other rehabilitation services which as a practical matter can only be provided in a nursing facility on an inpatient basis.

(g)

Chiropractors’ services

If the State plan includes provision of chiropractors’ services, such services include only—

(1)

section 1395x(r)(5) of this title services provided by a chiropractor (A) who is licensed as such by the State and (B) who meets uniform minimum standards promulgated by the Secretary under ; and

(2)

services which consist of treatment by means of manual manipulation of the spine which the chiropractor is legally authorized to perform by the State.

(h)

Inpatient psychiatric hospital services for individuals under age 21

(1)

For purposes of paragraph (16) of subsection (a), the term “inpatient psychiatric hospital services for individuals under age 21” includes only—

(A)

section 1395x(f) of this title inpatient services which are provided in an institution (or distinct part thereof) which is a psychiatric hospital as defined in or in another inpatient setting that the Secretary has specified in regulations;

(B)

inpatient services which, in the case of any individual (i) involve active treatment which meets such standards as may be prescribed in regulations by the Secretary, and (ii) a team, consisting of physicians and other personnel qualified to make determinations with respect to mental health conditions and the treatment thereof, has determined are necessary on an inpatient basis and can reasonably be expected to improve the condition, by reason of which such services are necessary, to the extent that eventually such services will no longer be necessary; and

(C)

inpatient services which, in the case of any individual, are provided prior to (i) the date such individual attains age 21, or (ii) in the case of an individual who was receiving such services in the period immediately preceding the date on which he attained age 21, (I) the date such individual no longer requires such services, or (II) if earlier, the date such individual attains age 22;

(2)

December 31, 1971 Such term does not include services provided during any calendar quarter under the State plan of any State if the total amount of the funds expended, during such quarter, by the State (and the political subdivisions thereof) from non-Federal funds for inpatient services included under paragraph (1), and for active psychiatric care and treatment provided on an outpatient basis for eligible mentally ill children, is less than the average quarterly amount of the funds expended, during the 4-quarter period ending , by the State (and the political subdivisions thereof) from non-Federal funds for such services.

(i)

Institution for mental diseases

The term “institution for mental diseases” means a hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.

(j)

State supplementary payment

The term “State supplementary payment” means any cash payment made by a State on a regular basis to an individual who is receiving supplemental security income benefits under subchapter XVI or who would but for his income be eligible to receive such benefits, as assistance based on need in supplementation of such benefits (as determined by the Commissioner of Social Security), but only to the extent that such payments are made with respect to an individual with respect to whom supplemental security income benefits are payable under subchapter XVI, or would but for his income be payable under that subchapter.

(k)

Supplemental security income benefits

section 211 of Public Law 93–66Increased supplemental security income benefits payable pursuant to shall not be considered supplemental security income benefits payable under subchapter XVI.

(l)

Rural health clinics

(1)

section 1395x(aa) of this title section 1395x(aa)(2) of this title section 1395x(aa)(2)(B) of this title The terms “rural health clinic services” and “rural health clinic” have the meanings given such terms in , except that (A) clause (ii) of shall not apply to such terms, and (B) the physician arrangement required under shall only apply with respect to rural health clinic services and, with respect to other ambulatory care services, the physician arrangement required shall be only such as may be required under the State plan for those services.

(2)

(A)

section 1395x(aa)(1) of this title 3

3 So in original. Probably should be “a”.

section 1395x(aa)(2)(B) of this title The term “Federally-qualified health center services” means services of the type described in subparagraphs (A) through (C) of when furnished to an individual as an  patient of a Federally-qualified health center and, for this purpose, any reference to a rural health clinic or a physician described in is deemed a reference to a Federally-qualified health center or a physician at the center, respectively.

(B)

The term “Federally-qualified health center” means an entity which—

(i)

section 254b of this title is receiving a grant under ,

(ii)

(I)

is receiving funding from such a grant under a contract with the recipient of such a grant, and

(II)

section 254b of this title meets the requirements to receive a grant under ,

(iii)

based on the recommendation of the Health Resources and Services Administration within the Public Health Service, is determined by the Secretary to meet the requirements for receiving such a grant, including requirements of the Secretary that an entity may not be owned, controlled, or operated by another entity, or

(iv)

January 1, 1990 was treated by the Secretary, for purposes of part B of subchapter XVIII, as a comprehensive Federally funded health center as of ;

Public Law 93–638 25 U.S.C. 5321 25 U.S.C. 1651 4

4 So in original. Probably should be clause “(iii),”. See References in Text note below.

and includes an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act () [ et seq.] or by an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act [ et seq.] for the provision of primary health services. In applying clause (ii), the Secretary may waive any requirement referred to in such clause for up to 2 years for good cause shown.

(3)

(A)

The term “freestanding birth center services” means services furnished to an individual at a freestanding birth center (as defined in subparagraph (B)) at such center.

(B)

The term “freestanding birth center” means a health facility—

(i)

that is not a hospital;

(ii)

where childbirth is planned to occur away from the pregnant woman’s residence;

(iii)

that is licensed or otherwise approved by the State to provide prenatal labor and delivery or postpartum care and other ambulatory services that are included in the plan; and

(iv)

that complies with such other requirements relating to the health and safety of individuals furnished services by the facility as the State shall establish.

(C)

A State shall provide separate payments to providers administering prenatal labor and delivery or postpartum care in a freestanding birth center (as defined in subparagraph (B)), such as nurse midwives and other providers of services such as birth attendants recognized under State law, as determined appropriate by the Secretary. For purposes of the preceding sentence, the term “birth attendant” means an individual who is recognized or registered by the State involved to provide health care at childbirth and who provides such care within the scope of practice under which the individual is legally authorized to perform such care under State law (or the State regulatory mechanism provided by State law), regardless of whether the individual is under the supervision of, or associated with, a physician or other health care provider. Nothing in this subparagraph shall be construed as changing State law requirements applicable to a birth attendant.

(m)

Qualified family member

(1)

¹¹ Subject to paragraph (2), the term “qualified family member” means an individual (other than a qualified pregnant woman or child, as defined in subsection (n)) who is a member of a family that would be receiving aid under the State plan under part A of subchapter IV pursuant to section 607  of this title if the State had not exercised the option under section 607(b)(2)(B)(i)  of this title.

(2)

September 30, 1998 No individual shall be a qualified family member for any period after .

(n)

“Qualified pregnant woman or child” defined

The term “qualified pregnant woman or child” means—

(1)

a pregnant woman who—

(A)

section 607 of this title would be eligible for aid to families with dependent children under part A of subchapter IV (or would be eligible for such aid if coverage under the State plan under part A of subchapter IV included aid to families with dependent children of unemployed parents pursuant to ) if her child had been born and was living with her in the month such aid would be paid, and such pregnancy has been medically verified;

(B)

section 607 of this title is a member of a family which would be eligible for aid under the State plan under part A of subchapter IV pursuant to if the plan required the payment of aid pursuant to such section; or

(C)

otherwise meets the income and resources requirements of a State plan under part A of subchapter IV; and

(2)

September 30, 1983 a child who has not attained the age of 19, who was born after (or such earlier date as the State may designate), and who meets the income and resources requirements of the State plan under part A of subchapter IV.

(o)

Optional hospice benefits

(1)

(A)

section 1395x(dd)(1) of this title section 1395x(dd)(2) of this title section 1395d(d)(2)(A) of this title Subject to subparagraphs (B) and (C), the term “hospice care” means the care described in furnished by a hospice program (as defined in ) to a terminally ill individual who has voluntarily elected (in accordance with paragraph (2)) to have payment made for hospice care instead of having payment made for certain benefits described in and for which payment may otherwise be made under subchapter XVIII and intermediate care facility services under the plan. For purposes of such election, hospice care may be provided to an individual while such individual is a resident of a skilled nursing facility or intermediate care facility, but the only payment made under the State plan shall be for the hospice care.

(B)

section 1395x(dd)(2) of this title For purposes of this subchapter, with respect to the definition of hospice program under , the Secretary may allow an agency or organization to make the assurance under subparagraph (A)(iii) of such section without taking into account any individual who is afflicted with acquired immune deficiency syndrome (AIDS).

(C)

A voluntary election to have payment made for hospice care for a child (as defined by the State) shall not constitute a waiver of any rights of the child to be provided with, or to have payment made under this subchapter for, services that are related to the treatment of the child’s condition for which a diagnosis of terminal illness has been made.

(2)

An individual’s voluntary election under this subsection—

(A)

section 1395d(d)(2) of this title shall be made in accordance with procedures that are established by the State and that are consistent with the procedures established under ;

(B)

section 1395d(d)(1) of this title shall be for such a period or periods (which need not be the same periods described in ) as the State may establish; and

(C)

may be revoked at any time without a showing of cause and may be modified so as to change the hospice program with respect to which a previous election was made.

(3)

In the case of an individual—

(A)

who is residing in a nursing facility or intermediate care facility for the mentally retarded and is receiving medical assistance for services in such facility under the plan,

(B)

section 1395d(d) of this title who is entitled to benefits under part A of subchapter XVIII and has elected, under , to receive hospice care under such part, and

(C)

with respect to whom the hospice program under such subchapter and the nursing facility or intermediate care facility for the mentally retarded have entered into a written agreement under which the program takes full responsibility for the professional management of the individual’s hospice care and the facility agrees to provide room and board to the individual,

section 1396a(a)(13)(B) of this title section 1396a(a)(10)(A) of this title section 1395e(a)(4) of this titleinstead of any payment otherwise made under the plan with respect to the facility’s services, the State shall provide for payment to the hospice program of an amount equal to the additional amount determined in and, if the individual is an individual described in , shall provide for payment of any coinsurance amounts imposed under .

(p)

Qualified medicare beneficiary; medicare cost-sharing

(1)

The term “qualified medicare beneficiary” means an individual—

(A)

section 1395i–2 of this title section 1395i–2a of this titleo who is entitled to hospital insurance benefits under part A of subchapter XVIII (including an individual entitled to such benefits pursuant to an enrollment under , but not including an individual entitled to such benefits only pursuant to an enrollment under ) or who is enrolled under part B for the purpose of coverage of immunosuppressive drugs under section 1395(b) of this title,

(B)

section 1382a of this title whose income (as determined under for purposes of the supplemental security income program, except as provided in paragraph (2)(D)) does not exceed an income level established by the State consistent with paragraph (2), and

(C)

section 1382b of this titleJanuary 1, 2010section 1395w–114(a)(3) of this title whose resources (as determined under for purposes of the supplemental security income program) do not exceed twice the maximum amount of resources that an individual may have and obtain benefits under that program or, effective beginning with , whose resources (as so determined) do not exceed the maximum resource level applied for the year under subparagraph (D) of (determined without regard to the life insurance policy exclusion provided under subparagraph (G) of such section) applicable to an individual or to the individual and the individual’s spouse (as the case may be).

(2)

(A)

section 9902(2) of this title The income level established under paragraph (1)(B) shall be at least the percent provided under subparagraph (B) (but not more than 100 percent) of the official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with ) applicable to a family of the size involved.

(B)

Except as provided in subparagraph (C), the percent provided under this clause, with respect to eligibility for medical assistance on or after—

(i)

January 1, 1989 , is 85 percent,

(ii)

January 1, 1990 , is 90 percent, and

(iii)

January 1, 1991 , is 100 percent.

(C)

section 1396a(f) of this titleJanuary 1, 1987 In the case of a State which has elected treatment under and which, as of , used an income standard for individuals age 65 or older which was more restrictive than the income standard established under the supplemental security income program under subchapter XVI, the percent provided under subparagraph (B), with respect to eligibility for medical assistance on or after—

(i)

January 1, 1989 , is 80 percent,

(ii)

January 1, 1990 , is 85 percent,

(iii)

January 1, 1991 , is 95 percent, and

(iv)

January 1, 1992 , is 100 percent.

(D)

(i)

section 415(i) of this title In determining under this subsection the income of an individual who is entitled to monthly insurance benefits under subchapter II for a transition month (as defined in clause (ii)) in a year, such income shall not include any amounts attributable to an increase in the level of monthly insurance benefits payable under such subchapter which have occurred pursuant to for benefits payable for months beginning with December of the previous year.

(ii)

For purposes of clause (i), the term “transition month” means each month in a year through the month following the month in which the annual revision of the official poverty line, referred to in subparagraph (A), is published.

(3)

section 1396a(n)(2) of this title The term “medicare cost-sharing” means (subject to ) the following costs incurred with respect to a qualified medicare beneficiary, without regard to whether the costs incurred were for items and services for which medical assistance is otherwise available under the plan:

(A)

(i)

premiums under section 1395i–2 or 1395i–2a of this title, and

(ii)

section 1395r of this title 5

5 So in original. The comma probably should be a period.

premiums under ,

(B)

section 1395e of this title Coinsurance under subchapter XVIII (including coinsurance described in ).

(C)

section 1395e of this titlel Deductibles established under subchapter XVIII (including those described in and section 1395(b) of this title).

(D)

l The difference between the amount that is paid under section 1395(a) of this title and the amount that would be paid under such section if any reference to “80 percent” therein were deemed a reference to “100 percent”.

section 1395mm of this titleSuch term also may include, at the option of a State, premiums for enrollment of a qualified medicare beneficiary with an eligible organization under .

(4)

Notwithstanding any other provision of this subchapter, in the case of a State (other than the 50 States and the District of Columbia)—

(A)

section 1396a(a)(10)(E) of this title the requirement stated in shall be optional, and

(B)

6 So in original. The words “of such paragraph” probably should follow “subparagraph (B)”.

7 So in original. Probably should be “or section”.

6 for purposes of paragraph (2), the State may substitute for the percent provided under subparagraph (B)  or  1396a(a)(10)(E)(iii) of this title of such paragraph  any percent.

section 1315 of this title section 1396a(a)(10)(E) of this titleIn the case of any State which is providing medical assistance to its residents under a waiver granted under , the Secretary shall require the State to meet the requirement of in the same manner as the State would be required to meet such requirement if the State had in effect a plan approved under this subchapter.

(5)

(A)

The Secretary shall develop and distribute to States a simplified application form for use by individuals (including both qualified medicare beneficiaries and specified low-income medicare beneficiaries) in applying for medical assistance for medicare cost-sharing under this subchapter in the States which elect to use such form. Such form shall be easily readable by applicants and uniform nationally. The Secretary shall provide for the translation of such application form into at least the 10 languages (other than English) that are most often used by individuals applying for hospital insurance benefits under section 426 or 426–1 of this title and shall make the translated forms available to the States and to the Commissioner of Social Security.

(B)

In developing such form, the Secretary shall consult with beneficiary groups and the States.

(6)

section 1320b–14 of this title For provisions relating to outreach efforts to increase awareness of the availability of medicare cost-sharing, see .

(q)

Qualified severely impaired individual

The term “qualified severely impaired individual” means an individual under age 65—

(1)

who for the month preceding the first month to which this subsection applies to such individual—

(A)

section 1382(b) of this title section 1382e of this title section 212 of Public Law 93–66 section 1382h(a) of this title received (i) a payment of supplemental security income benefits under on the basis of blindness or disability, (ii) a supplementary payment under or under on such basis, (iii) a payment of monthly benefits under , or (iv) a supplementary payment under section 1382e(c)(3), and

(B)

was eligible for medical assistance under the State plan approved under this subchapter; and

(2)

with respect to whom the Commissioner of Social Security determines that—

(A)

the individual continues to be blind or continues to have the disabling physical or mental impairment on the basis of which he was found to be under a disability and, except for his earnings, continues to meet all non-disability-related requirements for eligibility for benefits under subchapter XVI,

(B)

section 1382(b) of this title the income of such individual would not, except for his earnings, be equal to or in excess of the amount which would cause him to be ineligible for payments under (if he were otherwise eligible for such payments),

(C)

the lack of eligibility for benefits under this subchapter would seriously inhibit his ability to continue or obtain employment, and

(D)

the individual’s earnings are not sufficient to allow him to provide for himself a reasonable equivalent of the benefits under subchapter XVI (including any federally administered State supplementary payments), this subchapter, and publicly funded attendant care services (including personal care assistance) that would be available to him in the absence of such earnings.

section 1382h(b) of this titleIn the case of an individual who is eligible for medical assistance pursuant to in June, 1987, the individual shall be a qualified severely impaired individual for so long as such individual meets the requirements of paragraph (2).

(r)

Early and periodic screening, diagnostic, and treatment services

The term “early and periodic screening, diagnostic, and treatment services” means the following items and services:

(1)

Screening services—

(A)

which are provided—

(i)

section 1396s(c)(2)(B)(i) of this title at intervals which meet reasonable standards of medical and dental practice, as determined by the State after consultation with recognized medical and dental organizations involved in child health care and, with respect to immunizations under subparagraph (B)(iii), in accordance with the schedule referred to in for pediatric vaccines, and

(ii)

at such other intervals, indicated as medically necessary, to determine the existence of certain physical or mental illnesses or conditions; and

(B)

which shall at a minimum include—

(i)

a comprehensive health and developmental history (including assessment of both physical and mental health development),

(ii)

a comprehensive unclothed physical exam,

(iii)

section 1396s(c)(2)(B)(i) of this title appropriate immunizations (according to the schedule referred to in for pediatric vaccines) according to age and health history,

(iv)

laboratory tests (including lead blood level assessment appropriate for age and risk factors), and

(v)

health education (including anticipatory guidance).

(2)

Vision services—

(A)

which are provided—

(i)

at intervals which meet reasonable standards of medical practice, as determined by the State after consultation with recognized medical organizations involved in child health care, and

(ii)

at such other intervals, indicated as medically necessary, to determine the existence of a suspected illness or condition; and

(B)

which shall at a minimum include diagnosis and treatment for defects in vision, including eyeglasses.

(3)

Dental services—

(A)

which are provided—

(i)

at intervals which meet reasonable standards of dental practice, as determined by the State after consultation with recognized dental organizations involved in child health care, and

(ii)

at such other intervals, indicated as medically necessary, to determine the existence of a suspected illness or condition; and

(B)

which shall at a minimum include relief of pain and infections, restoration of teeth, and maintenance of dental health.

(4)

Hearing services—

(A)

which are provided—

(i)

at intervals which meet reasonable standards of medical practice, as determined by the State after consultation with recognized medical organizations involved in child health care, and

(ii)

at such other intervals, indicated as medically necessary, to determine the existence of a suspected illness or condition; and

(B)

which shall at a minimum include diagnosis and treatment for defects in hearing, including hearing aids.

(5)

Such other necessary health care, diagnostic services, treatment, and other measures described in subsection (a) to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan.

July 1, 1990Nothing in this subchapter shall be construed as limiting providers of early and periodic screening, diagnostic, and treatment services to providers who are qualified to provide all of the items and services described in the previous sentence or as preventing a provider that is qualified under the plan to furnish one or more (but not all) of such items or services from being qualified to provide such items and services as part of early and periodic screening, diagnostic, and treatment services. The Secretary shall, not later than , and every 12 months thereafter, develop and set annual participation goals for each State for participation of individuals who are covered under the State plan under this subchapter in early and periodic screening, diagnostic, and treatment services.

(s)

Qualified disabled and working individual

The term “qualified disabled and working individual” means an individual—

(1)

section 1395i–2a of this title who is entitled to enroll for hospital insurance benefits under part A of subchapter XVIII under ;

(2)

section 1382a of this title section 9902(2) of this title whose income (as determined under for purposes of the supplemental security income program) does not exceed 200 percent of the official poverty line (as defined by the Office of Management and Budget and revised annually in accordance with ) applicable to a family of the size involved;

(3)

section 1382b of this title whose resources (as determined under for purposes of the supplemental security income program) do not exceed twice the maximum amount of resources that an individual or a couple (in the case of an individual with a spouse) may have and obtain benefits for supplemental security income benefits under subchapter XVI; and

(4)

who is not otherwise eligible for medical assistance under this subchapter.

(t)

Primary care case management services; primary care case manager; primary care case management contract; and primary care

(1)

The term “primary care case management services” means case-management related services (including locating, coordinating, and monitoring of health care services) provided by a primary care case manager under a primary care case management contract.

(2)

The term “primary care case manager” means any of the following that provides services of the type described in paragraph (1) under a contract referred to in such paragraph:

(A)

A physician, a physician group practice, or an entity employing or having other arrangements with physicians to provide such services.

(B)

At State option—

(i)

a nurse practitioner (as described in subsection (a)(21));

(ii)

section 1395x(gg) of this title a certified nurse-midwife (as defined in ); or

(iii)

section 1395x(aa)(5) of this title a physician assistant (as defined in ).

(3)

The term “primary care case management contract” means a contract between a primary care case manager and a State under which the manager undertakes to locate, coordinate, and monitor covered primary care (and such other covered services as may be specified under the contract) to all individuals enrolled with the manager, and which—

(A)

provides for reasonable and adequate hours of operation, including 24-hour availability of information, referral, and treatment with respect to medical emergencies;

(B)

restricts enrollment to individuals residing sufficiently near a service delivery site of the manager to be able to reach that site within a reasonable time using available and affordable modes of transportation;

(C)

provides for arrangements with, or referrals to, sufficient numbers of physicians and other appropriate health care professionals to ensure that services under the contract can be furnished to enrollees promptly and without compromise to quality of care;

(D)

prohibits discrimination on the basis of health status or requirements for health care services in enrollment, disenrollment, or reenrollment of individuals eligible for medical assistance under this subchapter;

(E)

section 1396u–2(a)(4) of this title provides for a right for an enrollee to terminate enrollment in accordance with ; and

(F)

section 1396u–2 of this title complies with the other applicable provisions of .

(4)

For purposes of this subsection, the term “primary care” includes all health care services customarily provided in accordance with State licensure and certification laws and regulations, and all laboratory services customarily provided by or through, a general practitioner, family medicine physician, internal medicine physician, obstetrician/gynecologist, or pediatrician.

(u)

Conditions for State plans

(1)

The conditions described in this paragraph for a State plan are as follows:

(A)

section 1397ee(d)(1) of this title The State is complying with the requirement of .

(B)

The plan provides for such reporting of information about expenditures and payments attributable to the operation of this subsection as the Secretary deems necessary in order to carry out the fourth sentence of subsection (b).

(2)

(A)

For purposes of subsection (b), the expenditures described in this subparagraph are expenditures for medical assistance for optional targeted low-income children described in subparagraph (B).

(B)

section 1397jj(b)(1) of this titleMarch 31, 1997lsection 1396a(a)(10)(A)(ii)(XIX) of this title For purposes of this paragraph, the term “optional targeted low-income child” means a targeted low-income child as defined in (determined without regard to that portion of subparagraph (C) of such section concerning eligibility for medical assistance under this subchapter) who would not qualify for medical assistance under the State plan under this subchapter as in effect on (but taking into account the expansion of age of eligibility effected through the operation of section 1396a()(1)(D) of this title). Such term excludes any child eligible for medical assistance only by reason of .

(3)

October 1, 1983lMarch 31, 1997 For purposes of subsection (b), the expenditures described in this paragraph are expenditures for medical assistance for children who are born before , and who would be described in section 1396a()(1)(D) of this title if they had been born on or after such date, and who are not eligible for such assistance under the State plan under this subchapter based on such State plan as in effect as of .

(4)

section 1308 of this title section 1396b(a)(1) of this title section 1397ee(b) of this title The limitations on payment under subsections (f) and (g) of shall not apply to Federal payments made under based on an enhanced FMAP described in .

(v)

Employed individual with a medically improved disability

(1)

The term “employed individual with a medically improved disability” means an individual who—

(A)

is at least 16, but less than 65, years of age;

(B)

is employed (as defined in paragraph (2));

(C)

section 1396a(a)(10)(A)(ii)(XV) of this title ceases to be eligible for medical assistance under because the individual, by reason of medical improvement, is determined at the time of a regularly scheduled continuing disability review to no longer be eligible for benefits under section 423(d) or 1382c(a)(3) of this title; and

(D)

continues to have a severe medically determinable impairment, as determined under regulations of the Secretary.

(2)

For purposes of paragraph (1), an individual is considered to be “employed” if the individual—

(A)

section 206 of title 29 is earning at least the applicable minimum wage requirement under and working at least 40 hours per month; or

(B)

is engaged in a work effort that meets substantial and reasonable threshold criteria for hours of work, wages, or other measures, as defined by the State and approved by the Secretary.

(w)

Independent foster care adolescent

(1)

For purposes of this subchapter, the term “independent foster care adolescent” means an individual—

(A)

who is under 21 years of age;

(B)

who, on the individual’s 18th birthday, was in foster care under the responsibility of a State; and

(C)

whose assets, resources, and income do not exceed such levels (if any) as the State may establish consistent with paragraph (2).

(2)

section 1396u–1(b) of this title The levels established by a State under paragraph (1)(C) may not be less than the corresponding levels applied by the State under .

(3)

section 1396a(a)(10)(A)(ii)(XVII) of this title A State may limit the eligibility of independent foster care adolescents under to those individuals with respect to whom foster care maintenance payments or independent living services were furnished under a program funded under part E of subchapter IV before the date the individuals attained 18 years of age.

(x)

Strategies, treatment, and services

For purposes of subsection (a)(27), the strategies, treatment, and services described in that subsection include the following:

(1)

Chronic blood transfusion (with deferoxamine chelation) to prevent stroke in individuals with Sickle Cell Disease who have been identified as being at high risk for stroke.

(2)

Genetic counseling and testing for individuals with Sickle Cell Disease or the sickle cell trait to allow health care professionals to treat such individuals and to prevent symptoms of Sickle Cell Disease.

(3)

Other treatment and services to prevent individuals who have Sickle Cell Disease and who have had a stroke from having another stroke.

(y)

Increased FMAP for medical assistance for newly eligible mandatory individuals

(1)

Amount of increase

section 1396a(a)(10)(A)(i) of this titleNotwithstanding subsection (b), the Federal medical assistance percentage for a State that is one of the 50 States or the District of Columbia, with respect to amounts expended by such State for medical assistance for newly eligible individuals described in subclause (VIII) of , shall be equal to—

(A)

100 percent for calendar quarters in 2014, 2015, and 2016;

(B)

95 percent for calendar quarters in 2017;

(C)

94 percent for calendar quarters in 2018;

(D)

93 percent for calendar quarters in 2019; and

(E)

90 percent for calendar quarters in 2020 and each year thereafter.

(2)

Definitions

In this subsection:

(A)

Newly eligible

section 1396a(a)(10)(A)(i) of this titleDecember 1, 2009section 1396u–7(b)(1) of this title section 1396u–7(b)(2) of this title section 1396u–7(b)(1) of this titleThe term “newly eligible” means, with respect to an individual described in subclause (VIII) of , an individual who is not under 19 years of age (or such higher age as the State may have elected) and who, as of , is not eligible under the State plan or under a waiver of the plan for full benefits or for benchmark coverage described in subparagraph (A), (B), or (C) of or benchmark equivalent coverage described in that has an aggregate actuarial value that is at least actuarially equivalent to benchmark coverage described in subparagraph (A), (B), or (C) of , or is eligible but not enrolled (or is on a waiting list) for such benefits or coverage through a waiver under the plan that has a capped or limited enrollment that is full.

(B)

Full benefits

section 1396a(a)(10)(A)(i) of this titleThe term “full benefits” means, with respect to an individual, medical assistance for all services covered under the State plan under this subchapter that is not less in amount, duration, or scope, or is determined by the Secretary to be substantially equivalent, to the medical assistance available for an individual described in .

(z)

Equitable support for certain States

(1)

(A)

January 1, 2014December 31, 2015section 1396a(a)(10)(A)(i) of this title During the period that begins on , and ends on , notwithstanding subsection (b), the Federal medical assistance percentage otherwise determined under subsection (b) with respect to a fiscal year occurring during that period shall be increased by 2.2 percentage points for any State described in subparagraph (B) for amounts expended for medical assistance for individuals who are not newly eligible (as defined in subsection (y)(2)) individuals described in subclause (VIII) of .

(B)

For purposes of subparagraph (A), a State described in this subparagraph is a State that—

(i)

is an expansion State described in paragraph (3);

(ii)

the Secretary determines will not receive any payments under this subchapter on the basis of an increased Federal medical assistance percentage under subsection (y) for expenditures for medical assistance for newly eligible individuals (as so defined); and

(iii)

8 So in original.

has not been approved by the Secretary to divert a portion of the DSH allotment for a State to the costs of providing medical assistance or other health benefits coverage under a waiver that is in effect on July 2009.

(2)

(A)

section 1396a(a)(10)(A)(i)(VIII) of this title section 1396u–7 of this title For calendar quarters in 2014 and each year thereafter, the Federal medical assistance percentage otherwise determined under subsection (b) for an expansion State described in paragraph (3) with respect to medical assistance for individuals described in who are nonpregnant childless adults with respect to whom the State may require enrollment in benchmark coverage under shall be equal to the percent specified in subparagraph (B)(i) for such year.

(B)

(i)

The percent specified in this subparagraph for a State for a year is equal to the Federal medical assistance percentage (as defined in the first sentence of subsection (b)) for the State increased by a number of percentage points equal to the transition percentage (specified in clause (ii) for the year) of the number of percentage points by which—

(I)

such Federal medical assistance percentage for the State, is less than

(II)

the percent specified in subsection (y)(1) for the year.

(ii)

The transition percentage specified in this clause for—

(I)

2014 is 50 percent;

(II)

2015 is 60 percent;

(III)

2016 is 70 percent;

(IV)

2017 is 80 percent;

(V)

2018 is 90 percent; and

(VI)

2019 and each subsequent year is 100 percent.

(3)

March 23, 2010section 1396u–8 of this title A State is an expansion State if, on , the State offers health benefits coverage statewide to parents and nonpregnant, childless adults whose income is at least 100 percent of the poverty line, that includes inpatient hospital services, is not dependent on access to employer coverage, employer contribution, or employment and is not limited to premium assistance, hospital-only benefits, a high deductible health plan, or alternative benefits under a demonstration program authorized under . A State that offers health benefits coverage to only parents or only nonpregnant childless adults described in the preceding sentence shall not be considered to be an expansion State.

(aa)

Special adjustment to FMAP determination for certain States recovering from a major disaster

(1)

January 1, 2011 Notwithstanding subsection (b), beginning , the Federal medical assistance percentage for a fiscal year for a disaster-recovery FMAP adjustment State shall be equal to the following:

(A)

section 5001 of Public Law 111–5 section 5001 of Public Law 111–5 In the case of the first fiscal year (or part of a fiscal year) for which this subsection applies to the State, the State’s regular FMAP shall be increased by 50 percent of the number of percentage points by which the State’s regular FMAP for such fiscal year is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of (if applicable to the preceding fiscal year) and without regard to this subsection, subsections (y) and (z), and subsections (b) and (c) of .

(B)

In the case of the second or any succeeding fiscal year for which this subsection applies to the State, the State’s regular FMAP for such fiscal year shall be increased by 25 percent (or 50 percent in the case of fiscal year 2013) of the number of percentage points by which the State’s regular FMAP for such fiscal year is less than the Federal medical assistance percentage received by the State during the preceding fiscal year.

(2)

42 U.S.C. 5170 42 U.S.C. 5121 In this subsection, the term “disaster-recovery FMAP adjustment State” means a State that is one of the 50 States or the District of Columbia, for which, at any time during the preceding 7 fiscal years, the President has declared a major disaster under section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act [] and determined as a result of such disaster that every county or parish in the State warrant individual and public assistance or public assistance from the Federal Government under such Act [ et seq.] and for which—

(A)

section 5001 of Public Law 111–5 section 5001 of Public Law 111–5 in the case of the first fiscal year (or part of a fiscal year) for which this subsection applies to the State, the State’s regular FMAP for the fiscal year is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of (if applicable to the preceding fiscal year) and without regard to this subsection, subsections (y) and (z), and subsections (b) and (c) of , by at least 3 percentage points; and

(B)

in the case of the second or any succeeding fiscal year for which this subsection applies to the State, the State’s regular FMAP for the fiscal year is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year under this subsection by at least 3 percentage points.

(3)

In this subsection, the term “regular FMAP” means, for each fiscal year for which this subsection applies to a State, the Federal medical assistance percentage that would otherwise apply to the State for the fiscal year, as determined under subsection (b) and without regard to this subsection, subsections (y) and (z), and section 10202 of the Patient Protection and Affordable Care Act.

(4)

section 1396r–4 of this title 9

9 So in original. Probably should be preceded by “section”.

The Federal medical assistance percentage determined for a disaster-recovery FMAP adjustment State under paragraph (1) shall apply for purposes of this subchapter (other than with respect to disproportionate share hospital payments described in and payments under this subchapter that are based on the enhanced FMAP described in 1397ee(b)  of this title) and shall not apply with respect to payments under subchapter IV (other than under part E of subchapter IV) or payments under subchapter XXI.

(bb)

Counseling and pharmacotherapy for cessation of tobacco use by pregnant women

(1)

For purposes of this subchapter, the term “counseling and pharmacotherapy for cessation of tobacco use by pregnant women” means diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and nonprescription tobacco cessation agents approved by the Food and Drug Administration) for cessation of tobacco use by pregnant women who use tobacco products or who are being treated for tobacco use that is furnished—

(A)

by or under the supervision of a physician; or

(B)

by any other health care professional who—

(i)

is legally authorized to furnish such services under State law (or the State regulatory mechanism provided by State law) of the State in which the services are furnished; and

(ii)

is authorized to receive payment for other services under this subchapter or is designated by the Secretary for this purpose.

(2)

Subject to paragraph (3), such term is limited to—

(A)

services recommended with respect to pregnant women in “Treating Tobacco Use and Dependence: 2008 Update: A Clinical Practice Guideline”, published by the Public Health Service in May 2008, or any subsequent modification of such Guideline; and

(B)

such other services that the Secretary recognizes to be effective for cessation of tobacco use by pregnant women.

(3)

Such term shall not include coverage for drugs or biologicals that are not otherwise covered under this subchapter.

(cc)

Requirement for certain States

section 1396a(a)(2) of this title section 1396r–4 of this titleDecember 31, 2009section 1396r–4 of this titleDecember 31, 2009March 11, 2020Notwithstanding subsections (y), (z), and (aa), in the case of a State that requires political subdivisions within the State to contribute toward the non-Federal share of expenditures required under the State plan under , the State shall not be eligible for an increase in its Federal medical assistance percentage under such subsections if it requires that political subdivisions pay a greater percentage of the non-Federal share of such expenditures, or a greater percentage of the non-Federal share of payments under , than the respective percentages that would have been required by the State under the State plan under this subchapter, State law, or both, as in effect on , and without regard to any such increase. Voluntary contributions by a political subdivision to the non-Federal share of expenditures under the State plan under this subchapter or to the non-Federal share of payments under , shall not be considered to be required contributions for purposes of this subsection. The treatment of voluntary contributions, and the treatment of contributions required by a State under the State plan under this subchapter, or State law, as provided by this subsection, shall also apply to the increases in the Federal medical assistance percentage under section 5001 of the American Recovery and Reinvestment Act of 2009 and section 6008 of the Families First Coronavirus Response Act, except that in applying such treatments to the increases in the Federal medical assistance percentage under section 6008 of the Families First Coronavirus Response Act, the reference to “” shall be deemed to be a reference to “”.

(dd)

Increased FMAP for additional expenditures for primary care services

section 1396a(a)(13)(C) of this titleJanuary 1, 2013January 1, 2015section 1396u–2(f) of this titleJuly 1, 2009Notwithstanding subsection (b), with respect to the portion of the amounts expended for medical assistance for services described in furnished on or after , and before , that is attributable to the amount by which the minimum payment rate required under such section (or, by application, ) exceeds the payment rate applicable to such services under the State plan as of , the Federal medical assistance percentage for a State that is one of the 50 States or the District of Columbia shall be equal to 100 percent. The preceding sentence does not prohibit the payment of Federal financial participation based on the Federal medical assistance percentage for amounts in excess of those specified in such sentence.

(ee)

Medication-assisted treatment

(1)

Definition

For purposes of subsection (a)(29), the term “medication-assisted treatment”—

(A)

section 355 of title 21 section 262 of this title means all drugs approved under , including methadone, and all biological products licensed under to treat opioid use disorders; and

(B)

includes, with respect to the provision of such drugs and biological products, counseling services and behavioral therapy.

(2)

Exception

section 1396b(m) of this title section 1396d(t)(3) of this titleThe provisions of paragraph (29) of subsection (a) shall not apply with respect to a State if such State certifies, not less than every 5 years and to the satisfaction of the Secretary, that implementing such provisions statewide for all individuals eligible to enroll in the State plan (or waiver of the State plan) would not be feasible by reason of a shortage of qualified providers of medication-assisted treatment, or facilities providing such treatment, that will contract with the State or a managed care entity with which the State has a contract under or under .

(3)

Application of rebate requirements

section 1396r–8 of this titleThe requirements of shall apply to any drug or biological product described in paragraph (1)(A) that is—

(A)

section 1396a(a)(10)(A) of this title furnished as medical assistance in accordance with subsection (a)(29) and ; and

(B)

section 1396r–8(k) of this title a covered outpatient drug (as defined in , except that, in applying paragraph (2)(A) of such section to a drug described in paragraph (1)(A), such drug shall be deemed a prescribed drug for purposes of subsection (a)(12)).

(ff)

Increase in FMAP for territories for certain fiscal years

Notwithstanding subsection (b) or (z)(2), subject to subsections (hh) and (ii)—

(1)

October 1, 2019December 20, 2019 for the period beginning , and ending , the Federal medical assistance percentage for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa shall be equal to 100 percent;

(2)

December 21, 2019December 3, 2021January 1, 2022September 30, 2027 for the period beginning , and ending , and for the period beginning , and ending , the Federal medical assistance percentage for Puerto Rico shall be equal to 76 percent; and

(3)

section 1308(g)(8)(B) of this titleDecember 21, 2019 subject to , beginning , the Federal medical assistance percentage for the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa shall be equal to 83 percent.

(gg)

(1)

Routine patient costs

For purposes of subsection (a)(30), with respect to a State and an individual enrolled under the State plan (or a waiver of such plan) who participates in a qualifying clinical trial, routine patient costs—

(A)

include any item or service provided to the individual under the qualifying clinical trial, including—

(i)

any item or service provided to prevent, diagnose, monitor, or treat complications resulting from such participation, to the extent that the provision of such an item or service to the individual outside the course of such participation would otherwise be covered under the State plan or waiver; and

(ii)

any item or service required solely for the provision of the investigational item or service that is the subject of such trial, including the administration of such investigational item or service; and

(B)

does not include—

(i)

an item or service that is the investigational item or service that is—

(I)

the subject of the qualifying clinical trial; and

(II)

not otherwise covered outside of the clinical trial under the State plan or waiver; or

(ii)

an item or service that is—

(I)

provided to the individual solely to satisfy data collection and analysis needs for the qualifying clinical trial and is not used in the direct clinical management of the individual; and

(II)

not otherwise covered under the State plan or waiver.

(2)

Qualifying clinical trial defined

(A)

In general

For purposes of this subsection and subsection (a)(30), the term “qualifying clinical trial” means a clinical trial (in any clinical phase of development) that is conducted in relation to the prevention, detection, or treatment of any serious or life-threatening disease or condition and is described in any of the following clauses:

(i)

The study or investigation is approved, conducted, or supported (which may include funding through in-kind contributions) by one or more of the following:

(I)

The National Institutes of Health.

(II)

The Centers for Disease Control and Prevention.

(III)

The Agency for Healthcare Research and Quality.

(IV)

The Centers for Medicare & Medicaid Services.

(V)

A cooperative group or center of any of the entities described in subclauses (I) through (IV) or the Department of Defense or the Department of Veterans Affairs.

(VI)

A qualified non-governmental research entity identified in the guidelines issued by the National Institutes of Health for center support grants.

(VII)

Any of the following if the conditions described in subparagraph (B) are met:

(aa)

The Department of Veterans Affairs.

(bb)

The Department of Defense.

(cc)

The Department of Energy.

(ii)

section 355(i) of title 21 section 262(a)(3) of this title The clinical trial is conducted pursuant to an investigational new drug exemption under or an exemption for a biological product undergoing investigation under .

(iii)

The clinical trial is a drug trial that is exempt from being required to have an exemption described in clause (ii).

(B)

Conditions

For purposes of subparagraph (A)(i)(VII), the conditions described in this subparagraph, with respect to a clinical trial approved or funded by an entity described in such subparagraph (A)(i)(VII), are that the clinical trial has been reviewed and approved through a system of peer review that the Secretary determines—

(i)

to be comparable to the system of peer review of studies and investigations used by the National Institutes of Health; and

(ii)

assures unbiased review of the highest scientific standards by qualified individuals with no interest in the outcome of the review.

(3)

Coverage determination requirements

A determination with respect to coverage under subsection (a)(30) for an individual participating in a qualifying clinical trial—

(A)

shall be expedited and completed within 72 hours;

(B)

shall be made without limitation on the geographic location or network affiliation of the health care provider treating such individual or the principal investigator of the qualifying clinical trial;

(C)

shall be based on attestation regarding the appropriateness of the qualifying clinical trial by the health care provider and principal investigator described in subparagraph (B), which shall be made using a streamlined, uniform form developed for State use by the Secretary and that includes the option to reference information regarding the qualifying clinical trial that is publicly available on a website maintained by the Secretary, such as clinicaltrials.gov (or a successor website); and

(D)

shall not require submission of the protocols of the qualifying clinical trial, or any other documentation that may be proprietary or determined by the Secretary to be burdensome to provide.

(hh)

Temporary increased FMAP for medical assistance for coverage and administration of COVID–19 vaccines

(1)

In general

Notwithstanding any other provision of this subchapter, during the period described in paragraph (2), the Federal medical assistance percentage for a State, with respect to amounts expended by the State for medical assistance for a vaccine described in subsection (a)(4)(E) (and the administration of such a vaccine), shall be equal to 100 percent.

(2)

Period described

The period described in this paragraph is the period that—

(A)

March 11, 2021 begins on the first day of the first quarter beginning after ; and

(B)

section 1320b–5(g)(1)(B) of this title ends on the last day of the first quarter that begins one year after the last day of the emergency period described in .

(3)

Exclusion of expenditures from territorial caps

section 1308 of this titleAny payment made to a territory for expenditures for medical assistance under subsection (a)(4)(E) that are subject to the Federal medical assistance percentage specified under paragraph (1) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of .

(ii)

Temporary increase in FMAP for medical assistance under State medicaid plans which begin to expend amounts for certain mandatory individuals

(1)

In general

section 1396a(a)(10)(A)(i)(VIII) of this titleFor each quarter occurring during the 8-quarter period beginning with the first calendar quarter during which a qualifying State (as defined in paragraph (3)) expends amounts for all individuals described in under the State plan (or waiver of such plan), the Federal medical assistance percentage determined under subsection (b) for such State shall, after application of any increase, if applicable, under section 6008 of the Families First Coronavirus Response Act, be increased by 5 percentage points, except for any quarter (and each subsequent quarter) during such period during which the State ceases to provide medical assistance to any such individual under the State plan (or waiver of such plan).

(2)

Special application rules

Any increase described in paragraph (1) (or payment made for expenditures on medical assistance that are subject to such increase)—

(A)

section 1396r–4 of this title shall not apply with respect to disproportionate share hospital payments described in ;

(B)

section 1397ee of this title shall not be taken into account in calculating the enhanced FMAP of a State under ;

(C)

shall not be taken into account for purposes of part A, D, or E of subchapter IV; and

(D)

section 1308 of this title shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of .

(3)

Definition

For purposes of this subsection, the term “qualifying State” means a State which—

(A)

section 1396a(a)(10)(A)(i)(VIII) of this titleMarch 11, 2021 has not expended amounts for all individuals described in before ; and

(B)

January 1, 2026 begins to expend amounts for all such individuals prior to .

(jj)

Certified community behavioral health clinic services

(1)

In general

The term “certified community behavioral health services” means any of the following services when furnished to an individual as a patient of a certified community behavioral health clinic (as defined in paragraph (2)), in a manner reflecting person-centered care and which, if not available directly through a certified community behavioral health clinic, may be provided or referred through formal relationships with other providers:

(A)

Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization.

(B)

Screening, assessment, and diagnosis, including risk assessment.

(C)

Patient-centered treatment planning or similar processes, including risk assessment and crisis planning.

(D)

Outpatient mental health and substance use services.

(E)

Outpatient clinic primary care screening and monitoring of key health indicators and health risk.

(F)

Intensive case management services.

(G)

Psychiatric rehabilitation services.

(H)

Peer support and counselor services and family supports.

(I)

Intensive, community-based mental health care for members of the armed forces and veterans who are eligible for medical assistance, particularly such members and veterans located in rural areas, provided the care is consistent with minimum clinical mental health guidelines promulgated by the Veterans Health Administration, including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration.

(2)

Certified community behavioral health clinic

The term “certified community behavioral health clinic” means an organization that—

(A)

¹January 1, 2024 has been certified by a State as meeting the criteria established by the Secretary pursuant to subsection (a) of section 223 of the Protecting Access to Medicare Act  as of , and any subsequent updates to such criteria, regardless of whether the State is carrying out a demonstration program under this subchapter under subsection (d) of such section;

(B)

is engaged in furnishing all of the services described in paragraph (1); and

(C)

agrees, as a condition of the certification described in subparagraph (A), to furnish to the State or Secretary any data required as part of ongoing monitoring of the organization’s provision of services, including encounter data, clinical outcomes data, quality data, and such other data as the State or Secretary may require.

(kk)

FMAP for treatment of an emergency medical condition

10 So in original. Probably should be “subsections”.

October 1, 202611

11 So in original. Probably should be “section”.

11Notwithstanding subsection  (y) and (z), beginning on , the Federal medical assistance percentage for payments for care and services described in paragraph (2) of subsection  1396b(v) of this title furnished to an alien described in paragraph (1) of such subsection  shall not exceed the Federal medical assistance percentage determined under subsection (b) for such State.

Aug. 14, 1935, ch. 531 Pub. L. 89–97, title I, § 121(a)July 30, 196579 Stat. 351 Pub. L. 90–248, title IIJan. 2, 196881 Stat. 905 Pub. L. 92–223, § 4(a)Dec. 28, 197185 Stat. 809 Pub. L. 92–603, title IIOct. 30, 197286 Stat. 1384 Pub. L. 93–233Dec. 31, 197387 Stat. 963 Pub. L. 94–437, title IV, § 402(e)Sept. 30, 197690 Stat. 1410 Pub. L. 95–210, § 2(a)Dec. 13, 197791 Stat. 1488 Pub. L. 95–292, § 8(a)June 13, 197892 Stat. 316 Pub. L. 96–473, § 6(k)Oct. 19, 198094 Stat. 2266 Pub. L. 96–499, title IX, § 965(a)Dec. 5, 198094 Stat. 2651 Pub. L. 97–35, title XXIAug. 13, 198195 Stat. 806 Pub. L. 97–248, title ISept. 3, 198296 Stat. 376 Pub. L. 98–369, div. B, title IIIJuly 18, 198498 Stat. 1091 Pub. L. 99–272, title IXApr. 7, 1986100 Stat. 201 Pub. L. 99–509, title IXOct. 21, 1986100 Stat. 2053 Pub. L. 99–514, title XVIII, § 1895(c)(3)(A)Oct. 22, 1986100 Stat. 2935 Pub. L. 100–203, title IVDec. 22, 1987101 Stat. 1330–119 Pub. L. 100–360, title III, § 301(a)(2)July 1, 1988102 Stat. 748–750 Pub. L. 100–485, title III, § 303(b)(2)Oct. 13, 1988102 Stat. 2392 Pub. L. 100–647, title VIII, § 8434(a)Nov. 10, 1988102 Stat. 3805 Pub. L. 101–234, title II, § 201(b)Dec. 13, 1989103 Stat. 1981 Pub. L. 101–239, title VIDec. 19, 1989103 Stat. 2261–2265 Pub. L. 101–508, title IVNov. 5, 1990104 Stat. 1388–163 Pub. L. 103–66, title XIIIAug. 10, 1993107 Stat. 612 Pub. L. 103–296, title I, § 108(d)(2)Aug. 15, 1994108 Stat. 1486 Pub. L. 104–299, § 4(b)(2)Oct. 11, 1996110 Stat. 3645 Pub. L. 105–33, title IVAug. 5, 1997111 Stat. 494 Pub. L. 105–100, title I, § 162(1)Nov. 19, 1997111 Stat. 2188 Pub. L. 106–113, div. B, § 1000(a)(6)lNov. 29, 1999113 Stat. 1536 Pub. L. 106–169, title I, § 121(a)(2)Dec. 14, 1999113 Stat. 1829 Pub. L. 106–170, title II, § 201(a)(2)(B)Dec. 17, 1999113 Stat. 1892 Pub. L. 106–354, § 2(a)(4)Oct. 24, 2000114 Stat. 1382 Pub. L. 106–554, § 1(a)(6) [title VII, § 709(a), title VIII, § 802(d)(1), (2), title IX, § 911(a)(2)]Dec. 21, 2000114 Stat. 2763 Pub. L. 108–357, title VII, § 712(a)(1)Oct. 22, 2004118 Stat. 1558 Pub. L. 109–171, title VI, § 6062(c)(2)Feb. 8, 2006120 Stat. 98 Pub. L. 110–275, title IJuly 15, 2008122 Stat. 2503 Pub. L. 111–148, title IIMar. 23, 2010124 Stat. 272 Pub. L. 111–152, title IMar. 30, 2010124 Stat. 1051 Pub. L. 112–96, title III, § 3204(a)Feb. 22, 2012126 Stat. 193 Pub. L. 112–141, div. F, title I, § 100123(b)July 6, 2012126 Stat. 915 Pub. L. 114–255, div. B, title XII, § 12005(a)Dec. 13, 2016130 Stat. 1275 Pub. L. 115–271, title IOct. 24, 2018132 Stat. 3914 Pub. L. 116–59, div. B, title III, § 1302Sept. 27, 2019133 Stat. 1105 Pub. L. 116–69, div. B, title III, § 1302Nov. 21, 2019133 Stat. 1137 Pub. L. 116–94, div. N, title I, § 202(c)Dec. 20, 2019133 Stat. 3107 Pub. L. 116–127, div. FMar. 18, 2020134 Stat. 204 Pub. L. 116–136, div. A, title III, § 3717Mar. 27, 2020134 Stat. 425 Pub. L. 116–159, div. C, title VI, § 2601(a)Oct. 1, 2020134 Stat. 738 Pub. L. 116–260, div. CC, title II, § 210(a)Dec. 27, 2020134 Stat. 2989 Pub. L. 117–2, title IXMar. 11, 2021135 Stat. 208 Pub. L. 117–43, div. D, title I, § 3105(a)Sept. 30, 2021135 Stat. 380 Pub. L. 117–70, div. C, title I, § 2104(a)Dec. 3, 2021135 Stat. 1504 Pub. L. 117–86, div. B, title I, § 1104(a)Feb. 18, 2022136 Stat. 17 Pub. L. 117–103, div. P, title II, § 201(a)Mar. 15, 2022136 Stat. 802 Pub. L. 117–169, title I, § 11405(a)(3)Aug. 16, 2022136 Stat. 1901 Pub. L. 117–180, div. D, title I, § 103Sept. 30, 2022136 Stat. 2135 Pub. L. 117–229, div. C, title I, § 103Dec. 16, 2022136 Stat. 2311 Pub. L. 117–328, div. FF, title VDec. 29, 2022136 Stat. 5934 Pub. L. 118–42, div. G, title IMar. 9, 2024138 Stat. 399 Pub. L. 119–21, title VIIJuly 4, 2025139 Stat. 298(, title XIX, § 1905, as added , , ; amended , §§ 230, 233, 241(f)(6), 248(e), title III, § 302(a), , , 917, 919, 929; , , ; , §§ 212(a), 247(b), 275(a), 278(a)(21)–(23), 280, 297(a), 299, 299B, 299E(b), 299L, , , 1425, 1452–1454, 1459–1462, 1464; , §§ 13(a)(13)–(18), 18(w), (x)(7)–(10), (y)(2), , , 964, 972, 973; , , ; , (b), , ; , (b), , ; , , ; , , ; , §§ 2162(a)(2), 2172(b), , , 808; , §§ 136(c), 137(b)(17), (18), (f), , , 379, 381; , §§ 2335(f), 2340(b), 2361(b), 2371(a), 2373(b)(15)–(20), , , 1093, 1104, 1110, 1112; , §§ 9501(a), 9505(a), 9511(a), , , 208, 212; , §§ 9403(b), (d), (g)(3), 9404(b), 9408(c)(1), 9435(b)(2), , , 2054, 2056, 2061, 2070; , , ; , §§ 4073(d), 4101(c)(1), 4103(a), 4105(a), 4114, 4118(p)(8), 4211(e), (f), (h)(6), , , 1330–141, 1330–146, 1330–147, 1330–152, 1330–159, 1330–204 to 1330–206; –(d), (g)(2), title IV, § 411(h)(4)(E), (k)(4), (8), (14)(A), , , 787, 791, 794, 798; , title IV, § 401(d)(2), title VI, § 608(d)(14)(A)–(G), (J), (f)(3), , , 2396, 2415, 2416, 2424; , (b)(3), (4), , ; , , ; , §§ 6402(c)(1), 6403(a), (c), (d)(2), 6404(a), (b), 6405(a), 6408(d)(2), (4)(A), (B), , , 2268, 2269; , §§ 4402(d)(2), 4501(a), (c), (e)(1), 4601(a)(2), 4704(c), (d), (e)(1), 4705(a), 4711(a), 4712(a), 4713(b), 4717, 4719(a), 4721(a), 4722, 4755(a)(1)(A), , to 1388–166, 1388–172, 1388–174, 1388–187, 1388–191, 1388–193, 1388–194, 1388–209; , §§ 13601(a), 13603(e), 13605(a), 13606(a), 13631(f)(2), (g)(1), , , 620, 621, 644, 645; , (3), , ; , , ; , §§ 4702(a), 4711(c)(1), 4712(d)(1), 4714(a)(2), 4725(b)(1), 4732(b), 4802(a)(1), 4911(a), , , 508–510, 518, 520, 538, 570; , (2), , ; [title VI, §§ 605(a), 608(), (m), (aa)(3)], , , 1501A–396 to 1501A–398; , (c)(5), , , 1830; , (C), , ; , (c), , , 1384; , , , 2763A–578, 2763A–581, 2763A–584; , , ; , , ; , §§ 112, 118(a), , , 2507; , §§ 2001(a)(3), (5)(C), (e)(2)(A), 2005(c)(1), 2006, 2301(a), 2302(a), 2303(a)(4)(A), 2304, 2402(d)(2)(B), title IV, §§ 4106(a), (b), 4107(a), title X, § 10201(c), , , 275, 279, 284, 292–294, 296, 304, 559, 560, 918; , §§ 1201, 1202(b), , , 1053; , , ; , , ; , , ; , §§ 1006(b)(2), (3), 1012(a), title V, § 5052(a)(1), , , 3919, 3971; , , ; , , ; , , ; , §§ 6004(a)(1), (3)(D), 6008(c), , , 206, 209; , , ; , , ; , title IV, § 402(f)(1), , , 3001; , §§ 9811(a)(1), (b), 9814, 9815, , , 211, 215; , , ; , , ; , , ; , , ; , , ; , , ; , , ; , §§ 5101(b), 5121(b), 5122(a)(1), , , 5942, 5943; , §§ 201(a), 205(c)(3), (4), 209(a), , , 406, 412; , §§ 71110(a), 71112(b), 71114, , , 299, 301.)

Amendment of Subsection (a)

Pub. L. 119–21, title VII, § 71112(b)July 4, 2025139 Stat. 299Dec. 31, 2026section 1396a(a)(34)(A) of this title section 1396a(a)(34)(B) of this title, (d), , , provided that, applicable to medical assistance, child health assistance, and pregnancy-related assistance with respect to individuals whose eligibility for such assistance is based on an application made on or after the first day of the first quarter that begins after , subsection (a) of this section is amended by striking “in or after the third month before the month in which the recipient makes application for assistance” and inserting “, with respect to an individual described in , in or after the month before the month in which the recipient makes application for assistance, and with respect to an individual described in , in or after the second month before the month in which the recipient makes application for assistance”. See 2025 Amendment note below.

Editorial Notes

References in Text

Section 606 of this title Pub. L. 104–193, title I, § 103(a)(1)Aug. 22, 1996110 Stat. 2112, referred to in subsec. (a)(ii), was repealed and a new section 606 enacted by , , , and, as so enacted, no longer contains a subsec. (b)(1).

lPub. L. 94–437Sept. 30, 197690 Stat. 1400 section 1601 of Title 25The Indian Health Care Improvement Act, referred to in subsecs. (b) and ()(2)(B), is , , . Title V of the Act is classified generally to subchapter IV (§ 1651 et seq.) of chapter 18 of Title 25. For complete classification of this Act to the Code, see Short Title note set out under and Tables.

section 1396a of this titleFor the effective date of this clause, referred to in subsec. (b)(6), see Effective Date of 2022 Amendment note set out under .

Section 211 of Pub. L. 93–66 section 211 of Pub. L. 93–66July 9, 197387 Stat. 152 section 1382 of this title, referred to in subsec. (k), is , , , which is set out as a note under .

lPub. L. 93–638Jan. 4, 197588 Stat. 2206 section 5301 of Title 25The Indian Self-Determination Act, referred to in subsec. ()(2)(B), is title I of , , , which was classified principally to part A (§ 450f et seq.) of subchapter II of chapter 14 of Title 25, Indians, prior to editorial reclassification as subchapter I (§ 5321 et seq.) of chapter 46 of Title 25. For complete classification of this Act to the Code, see Short Title note set out under and Tables.

lPub. L. 101–508, title IV, § 4704(c)(3)Nov. 5, 1990104 Stat. 1388–172Clause (ii), referred to in subsec. ()(2)(B), was redesignated as cl. (iii) by , , .

Section 607 of this title Pub. L. 104–193, title I, § 103(a)(1)Aug. 22, 1996110 Stat. 2112, referred to in subsec. (m)(1), was repealed and a new section 607 enacted by , , , and, as so enacted, no longer contains a subsec. (b)(2)(B)(i).

Section 212 of Public Law 93–66 section 212 of Pub. L. 93–66July 9, 197387 Stat. 155 section 1382 of this title, referred to in subsec. (q)(1)(A), is , title II, , , which is set out as a note under .

Section 5001 of Public Law 111–5 section 5001 of Pub. L. 111–5Feb. 17, 2009123 Stat. 496 and section 5001 of the American Recovery and Reinvestment Act of 2009, referred to in subsecs. (aa)(1)(A), (2)(A), and (cc), is , div. B, title V, , , which was formerly set out as a note under this section.

Pub. L. 93–288May 22, 197488 Stat. 143 section 5121 of this titleThe Robert T. Stafford Disaster Relief and Emergency Assistance Act, referred to in subsec. (aa)(2), is , , , which is classified principally to chapter 68 (§ 5121 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under and Tables.

section 10202 of Pub. L. 111–148Section 10202 of the Patient Protection and Affordable Care Act, referred to in subsec. (aa)(3), is , which is set out as a note under this section.

section 6008 of Pub. L. 116–127Section 6008 of the Families First Coronavirus Response Act, referred to in subsecs. (cc) and (ii)(1), is , which amended this section and enacted provisions set out as a note under this section.

section 223 of Pub. L. 113–93 section 1396a of this titleSection 223 of the Protecting Access to Medicare Act, referred to in subsec. (jj)(2)(A), probably means , known as the Protecting Access to Medicare Act of 2014, which is set out as a note under .

Amendments

Pub. L. 119–21, § 71112(b)section 1396a(a)(34)(A) of this title section 1396a(a)(34)(B) of this title2025—Subsec. (a). , substituted “, with respect to an individual described in , in or after the month before the month in which the recipient makes application for assistance, and with respect to an individual described in , in or after the second month before the month in which the recipient makes application for assistance” for “in or after the third month before the month in which the recipient makes application for assistance”.

Pub. L. 119–21, § 71114Subsec. (ii)(3). , substituted “which—” for “which”, inserted subpar. (A) designation before “has not”, and added subpar. (B).

Pub. L. 119–21, § 71110(a)Subsec. (kk). , added subsec. (kk).

Pub. L. 118–42, § 205(c)(4)2024—Subsec. (a). , substituted “the last numbered paragraph” for “paragraph (30)” in concluding provisions.

Pub. L. 118–42, § 205(c)(3)Pub. L. 117–328, § 5122(a)(1), made technical amendment to directory language of . See 2022 Amendment note below.

Pub. L. 118–42, § 201(a)(1)October 1, 2020October 1, 2020September 30, 2025Subsec. (a)(29). , substituted “beginning on ,” for “for the period beginning , and ending ,”.

Pub. L. 118–42, § 209(a)(1)Subsec. (a)(31), (32). , added par. (31) and redesignated former par. (31) as (32).

Pub. L. 118–42, § 201(a)(2)Subsec. (ee)(2). , substituted “if such State certifies, not less than every 5 years and to the satisfaction of the Secretary,” for “for the period specified in such paragraph, if before the beginning of such period the State certifies to the satisfaction of the Secretary”.

Pub. L. 118–42, § 209(a)(2)Subsec. (jj). , added subsec. (jj).

Pub. L. 117–328, § 5122(a)(1)Pub. L. 118–42, § 205(c)(3)section 1396a(nn)(2) of this title section 1396a(nn)(3) of this title section 1396a(a)(84)(D) of this title2022—Subsec. (a). , as amended by , in subd. (A) following par. (32), inserted “, or, at the option of the State, for an individual who is an eligible juvenile (as defined in ), while such individual is an inmate of a public institution (as defined in ) pending disposition of charges” after “or in the case of an eligible juvenile described in with respect to the screenings, diagnostic services, referrals, and targeted case management services required under such section”.

Pub. L. 117–328, § 5121(b)section 1396a(a)(84)(D) of this title, in subd. (A) following par. (31), inserted “, or in the case of an eligible juvenile described in with respect to the screenings, diagnostic services, referrals, and targeted case management services required under such section” after “(except as a patient in a medical institution”.

Pub. L. 117–169, § 11405(a)(3)(A)Subsec. (b). –(C), substituted “(5) in the case of” for “and (5) in the case of”, “services described in subsection (a)(13)(A), and prohibits cost-sharing for such services” for “services and vaccines described in subparagraphs (A) and (B) of subsection (a)(13), and prohibits cost-sharing for such services and vaccines”, and “medical assistance for such services” for “medical assistance for such services and vaccines”.

Pub. L. 117–169, § 11405(a)(3)(D)August 16, 2022Subsec. (b)(6). , inserted “, and (6) during the first 8 fiscal quarters beginning on or after the effective date of this clause, in the case of a State which, as of , provides medical assistance for vaccines described in subsection (a)(13)(B) and their administration and prohibits cost-sharing for such vaccines, the Federal medical assistance percentage, as determined under this subsection and subsection (y), shall be increased by 1 percentage point with respect to medical assistance for such vaccines and their administration” before the first period.

Pub. L. 117–328, § 5101(b)(1)Subsec. (ff). , struck out “Temporary” before “increase in FMAP” in heading.

Pub. L. 117–328, § 5101(b)(2)section 1308(g)(7)(C) of this titleDecember 21, 2019September 30, 2027December 23, 2022Subsec. (ff)(2). , struck out “subject to ,” before “for the period beginning ,” and substituted “,” for “”.

Pub. L. 117–229, § 103(1)December 23, 2022December 16, 2022, substituted “” for “”.

Pub. L. 117–180 substituted “December 16” for “December 13”.

Pub. L. 117–103, § 201(a)(1)January 1, 2022December 13, 2022December 3, 2021, inserted “and for the period beginning , and ending ” after “and ending ,”.

Pub. L. 117–328, § 5101(b)(3)December 21, 2019December 21, 2019December 23, 2022Subsec. (ff)(3). , substituted “beginning ” for “for the period beginning , and ending ”.

Pub. L. 117–229, § 103(2)December 23, 2022December 16, 2022, substituted “” for “”.

Pub. L. 117–180 substituted “December 16” for “December 13”.

Pub. L. 117–103, § 201(a)(2)December 13, 2022March 11, 2022, substituted “” for “”.

Pub. L. 117–86March 11, 2022February 18, 2022 substituted “” for “”.

Pub. L. 117–2, § 9811(a)(1)2021—Subsec. (a)(4). , added cls. (E) and (F).

Pub. L. 117–2, § 9815March 11, 2021section 11711(4) of this title section 11705(b) of this title section 11707 of this titleSubsec. (b). , inserted “; for the 8 fiscal year quarters beginning with the first fiscal year quarter beginning after , the Federal medical assistance percentage shall also be 100 per centum with respect to amounts expended as medical assistance for services which are received through an Urban Indian organization (as defined in paragraph (29) of section 4 of the Indian Health Care Improvement Act) that has a grant or contract with the Indian Health Service under title V of such Act; and, for such 8 fiscal year quarters, the Federal medical assistance percentage shall also be 100 per centum with respect to amounts expended as medical assistance for services which are received through a Native Hawaiian Health Center (as defined in ) or a qualified entity (as defined in ) that has a grant or contract with the Papa Ola Lokahi under ” after “(as defined in section 4 of the Indian Health Care Improvement Act)”.

Pub. L. 117–2, § 9814(1), substituted “(hh), and (ii)” for “and (hh)”.

Pub. L. 117–2, § 9811(b)(1), substituted “(ff), and (hh)” for “and (ff)”.

Pub. L. 117–43December 3, 2021September 30, 2021Subsec. (ff). substituted “” for “” in two places.

Pub. L. 117–2, § 9814(2), substituted “subject to subsections (hh) and (ii)” for “subject to subsection (hh)” in introductory provisions.

Pub. L. 117–2, § 9811(b)(2), inserted “, subject to subsection (hh)” after “or (z)(2)” in introductory provisions.

Pub. L. 117–70February 18, 2022December 3, 2021Subsec. (ff)(3). substituted “” for “”.

Pub. L. 117–2, § 9811(b)(3)Subsec. (hh). , added subsec. (hh).

Pub. L. 117–2, § 9814(3)Subsec. (ii). , added subsec. (ii).

Pub. L. 116–127, § 6004(a)(1)(A)2020—Subsec. (a)(3)(A). , (B), designated existing provisions as subpar. (A) and inserted “and” at end.

Pub. L. 116–136Subsec. (a)(3)(B). struck out “that are approved, cleared, or authorized under section 360(k), 360c, 360e or 360bbb–3 of title 21” after “that causes COVID–19”.

Pub. L. 116–127, § 6004(a)(1)(C), added subpar. (B).

Pub. L. 116–159, § 2601(a)(1)Subsec. (a)(29). , substituted “subject to paragraphs (2) and (3)” for “subject to paragraph (2)” and realigned margins.

Pub. L. 116–260, § 210(a)(1)Subsec. (a)(30), (31). , added par. (30) and redesignated former par. (30) as (31).

Pub. L. 116–127, § 6004(a)(3)(D)section 1396a(ss) of this title section 1396a(a)(10)(A)(ii)(XXIII) of this title section 1396b(a)(7) of this titleSubsec. (b). , inserted at end “Notwithstanding the first sentence of this subsection, the Federal medical assistance percentage shall be 100 per centum with respect to (and, notwithstanding any other provision of this subchapter, available for) medical assistance provided to uninsured individuals (as defined in ) who are eligible for such assistance only on the basis of and with respect to expenditures described in that a State demonstrates to the satisfaction of the Secretary are attributable to administrative costs related to providing for such medical assistance to such individuals under the State plan.”

Pub. L. 116–260, § 402(f)(1)osection 1395i–2a of this titleSubsec. (p)(1)(A). , inserted “or who is enrolled under part B for the purpose of coverage of immunosuppressive drugs under section 1395(b) of this title” after “under )”.

Pub. L. 116–127, § 6008(c)December 31, 2009March 11, 2020Subsec. (cc). , inserted before period at end “and section 6008 of the Families First Coronavirus Response Act, except that in applying such treatments to the increases in the Federal medical assistance percentage under section 6008 of the Families First Coronavirus Response Act, the reference to ‘’ shall be deemed to be a reference to ‘’ ”.

Pub. L. 116–159, § 2601(a)(2)Subsec. (ee)(3). , added par. (3).

Pub. L. 116–260, § 210(a)(2)Subsec. (gg). , added subsec. (gg).

Pub. L. 116–59, § 1302(1)2019—Subsec. (b). , substituted “(aa), and (ff)” for “and (aa)”.

Pub. L. 116–94October 1, 2019December 20, 2019Subsec. (ff). amended subsec. (ff) generally. Prior to amendment, text read as follows: “Notwithstanding subsection (b) or (z)(2), the Federal medical assistance percentage for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa shall be equal to 100 percent for the period beginning , and ending .”

Pub. L. 116–69December 20, 2019November 21, 2019 substituted “” for “”.

Pub. L. 116–59, § 1302(2), added subsec. (ff).

Pub. L. 115–271, § 5052(a)(1)l2018—Subsec. (a). , in subd. (B) following par. (30), inserted “(except in the case of services provided under a State plan amendment described in section 1396n() of this title)” before period at end.

Pub. L. 115–271, § 1012(a), inserted at end “In the case of a woman who is eligible for medical assistance on the basis of being pregnant (including through the end of the month in which the 60-day period beginning on the last day of her pregnancy ends), who is a patient in an institution for mental diseases for purposes of receiving treatment for a substance use disorder, and who was enrolled for medical assistance under the State plan immediately before becoming a patient in an institution for mental diseases or who becomes eligible to enroll for such medical assistance while such a patient, the exclusion from the definition of ‘medical assistance’ set forth in the subdivision (B) following paragraph (30) of the first sentence of this subsection shall not be construed as prohibiting Federal financial participation for medical assistance for items or services that are provided to the woman outside of the institution.”

Pub. L. 115–271, § 1006(b)(2)Subsec. (a)(29), (30). , added par. (29) and redesignated former par. (29) as (30).

Pub. L. 115–271, § 1006(b)(3)Subsec. (ee). , added subsec. (ee).

Pub. L. 114–255January 1, 1973January 1, 19732016—Subsec. (a)(16). substituted “(A) effective ” for “effective ” and inserted before semicolon at end “, and, (B) for individuals receiving services described in subparagraph (A), early and periodic screening, diagnostic, and treatment services (as defined in subsection (r)), whether or not such screening, diagnostic, and treatment services are furnished by the provider of the services described in such subparagraph”.

Pub. L. 112–96, § 3204(a)(1)(A)section 5001 of Public Law 111–5 section 5001 of Public Law 111–5 section 5001 of Public Law 111–5 section 5001 of Public Law 111–52012—Subsec. (aa)(1)(A). , substituted “the State’s regular FMAP shall be increased by 50 percent of the number of percentage points by which the State’s regular FMAP for such fiscal year is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of (if applicable to the preceding fiscal year) and without regard to this subsection, subsections (y) and (z), and subsections (b) and (c) of .” for “the Federal medical assistance percentage determined for the fiscal year without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act, increased by 50 percent of the number of percentage points by which the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act, is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of (if applicable to the preceding fiscal year) and without regard to this subsection, subsection (y), and subsections (b) and (c) of .”

Pub. L. 112–141Subsec. (aa)(1)(B). substituted “25 percent (or 50 percent in the case of fiscal year 2013)” for “25 percent”.

Pub. L. 112–96, § 3204(a)(1)(B), substituted “State’s regular FMAP for such fiscal year shall be increased by 25 percent of the number of percentage points by which the State’s regular FMAP for such fiscal year is less than the Federal medical assistance percentage received by the State during the preceding fiscal year.” for “Federal medical assistance percentage determined for the preceding fiscal year under this subsection for the State, increased by 25 percent of the number of percentage points by which the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act, is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year under this subsection.”

Pub. L. 112–96, § 3204(a)(2)(A)Subsec. (aa)(2)(A). , substituted “State’s regular FMAP for the fiscal year” for “Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act,” and “subsections (y) and (z)” for “subsection (y)”.

Pub. L. 112–96, § 3204(a)(2)(B)Subsec. (aa)(2)(B). , substituted “State’s regular FMAP for the fiscal year” for “Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act,”.

Pub. L. 112–96, § 3204(a)(3)Subsec. (aa)(3), (4). , (4), added par. (3) and redesignated former par. (3) as (4).

Pub. L. 111–148, § 23042010—Subsec. (a). , inserted “or the care and services themselves, or both” before “(if provided in or after” in introductory provisions.

Pub. L. 111–148, § 10201(c)(1)Subsec. (a)(xiv). , inserted “or 1396a(a)(10)(A)(i)(IX)” after “section 1396a(a)(10)(A)(i)(VIII)”.

Pub. L. 111–148, § 2001(a)(5)(C), added cl. (xiv).

Pub. L. 111–148, § 2001(e)(2)(A)Subsec. (a)(xv). , added cl. (xv).

Pub. L. 111–148, § 2303(a)(4)(A)Subsec. (a)(xvi). , added cl. (xvi).

Pub. L. 111–148, § 2402(d)(2)(B)Subsec. (a)(xvii). , added cl. (xvii).

Pub. L. 111–148, § 4107(a)(1)Subsec. (a)(4). , added cl. (D).

Pub. L. 111–148, § 4106(a)Subsec. (a)(13). , amended par. (13) generally. Prior to amendment, par. (13) read as follows: “other diagnostic, screening, preventive, and rehabilitative services, including any medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under State law, for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level;”.

Pub. L. 111–148, § 2301(a)(1)Subsec. (a)(28), (29). , added par. (28) and redesignated former par. (28) as (29).

Pub. L. 111–148, § 10201(c)(2)Subsec. (b). , inserted “, (z),” before “and (aa)” in first sentence.

Pub. L. 111–148, § 4106(b), substituted “, (4)” for “and (4)” and inserted before period at end of first sentence “, and (5) in the case of a State that provides medical assistance for services and vaccines described in subparagraphs (A) and (B) of subsection (a)(13), and prohibits cost-sharing for such services and vaccines, the Federal medical assistance percentage, as determined under this subsection and subsection (y) (without regard to paragraph (1)(C) of such subsection), shall be increased by 1 percentage point with respect to medical assistance for such services and vaccines and for items and services described in subsection (a)(4)(D)”.

Pub. L. 111–148, § 2006(1), substituted “subsections (y) and (aa)” for “subsection (y)” in first sentence.

Pub. L. 111–148, § 2005(c)(1), substituted “shall be 55 percent” for “shall be 50 per centum” in first sentence.

Pub. L. 111–148, § 2001(a)(3)(A)section 1396u–3(d) of this title, inserted “subsection (y) and” before “” in first sentence.

lPub. L. 111–148, § 2301(a)(2)Subsec. ()(3). , added par. (3).

oPub. L. 111–148, § 2302(a)(1)Subsec. ()(1)(A). , substituted “subparagraphs (B) and (C)” for “subparagraph (B)”.

oPub. L. 111–148, § 2302(a)(2)Subsec. ()(1)(C). , added subpar. (C).

Pub. L. 111–148, § 2001(a)(3)(B)Subsec. (y). , added subsec. (y).

Pub. L. 111–152, § 1201(1)(B)Subsec. (y)(1). , added par. (1) and struck out former par. (1). Prior to amendment, par. (1) related to the amount of increase for the Federal medical assistance percentage.

Pub. L. 111–152, § 1201(1)(A)Subsec. (y)(1)(B)(ii)(II). , redesignated subcl. (II) as par. (5) of subsec. (z).

Pub. L. 111–148, § 10201(c)(3)(A), inserted “includes inpatient hospital services,” after “100 percent of the poverty line, that”.

Pub. L. 111–148, § 10201(c)(3)(B)December 1, 2009March 23, 2010Subsec. (y)(2)(A). , substituted “as of ” for “on ”.

Pub. L. 111–148, § 10201(c)(4)Subsec. (z). , added subsec. (z).

Pub. L. 111–152, § 1201(2)(A)December 31, 2015September 30, 2019Subsec. (z)(1)(A). , substituted “” for “”.

Pub. L. 111–152, § 1201(2)(A)Subsec. (z)(1)(B)(i). , substituted “paragraph (3)” for “subsection (y)(1)(B)(ii)(II)”.

Pub. L. 111–152, § 1201(2)(B)Subsec. (z)(2). , added par. (2) and struck out former par. (2), which read as follows:

January 1, 2014December 31, 2016“(A) During the period that begins on , and ends on , notwithstanding subsection (b), the Federal medical assistance percentage otherwise determined under subsection (b) with respect to all or any portion of a fiscal year occurring during that period shall be increased by .5 percentage point for a State described in subparagraph (B) for amounts expended for medical assistance under the State plan under this subchapter or under a waiver of that plan during that period.

“(B) For purposes of subparagraph (A), a State described in this subparagraph is a State that—

“(i) is described in clauses (i) and (ii) of paragraph (1)(B); and

“(ii) is the State with the highest percentage of its population insured during 2008, based on the Current Population Survey.”

Pub. L. 111–152, § 1201(2)(C)Subsec. (z)(3). , redesignated par. (5) as (3), struck out heading, and substituted “A State is” for “For purposes of the table in subclause (I), a State is”.

Pub. L. 111–152, § 1201(2)(B)January 1, 2017section 1396a(a)(10)(A)(i) of this title, struck out par. (3), which read as follows: “Notwithstanding subsection (b) and paragraphs (1) and (2) of this subsection, the Federal medical assistance percentage otherwise determined under subsection (b) with respect to all or any portion of a fiscal year that begins on or after , for the State of Nebraska, with respect to amounts expended for newly eligible individuals described in subclause (VIII) of , shall be determined as provided for under subsection (y)(1)(A) (notwithstanding the period provided for in such paragraph).”

Pub. L. 111–152, § 1201(2)(B)Subsec. (z)(4). , struck out par. (4) which read as follows: “The increase in the Federal medical assistance percentage for a State under paragraphs (1), (2), or (3) shall apply only for purposes of this subchapter and shall not apply with respect to—

section 1396r–4 of this title“(A) disproportionate share hospital payments described in ;

“(B) payments under subchapter IV;

“(C) payments under subchapter XXI; and

section 1397ee(b) of this title“(D) payments under this subchapter that are based on the enhanced FMAP described in .”

Pub. L. 111–152, § 1201(2)(C)Subsec. (z)(5). , redesignated par. (5) as (3).

Pub. L. 111–152, § 1201(1)(A), redesignated subsec. (y)(1)(B)(ii)(II) as subsec. (z)(5) and realigned margins.

Pub. L. 111–148, § 2006(2)Subsec. (aa). , added subsec. (aa).

Pub. L. 111–148, § 10201(c)(5)Subsec. (aa)(1), (2). , substituted “without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act” for “without regard to this subsection and subsection (y)” wherever appearing.

Pub. L. 111–148, § 4107(a)(2)Subsec. (bb). , added subsec. (bb).

Pub. L. 111–148, § 10201(c)(6)Subsec. (cc). , added subsec. (cc).

Pub. L. 111–152, § 1202(b)Subsec. (dd). , added subsec. (dd).

Pub. L. 110–275, § 112January 1, 2010section 1395w–114(a)(3) of this title2008—Subsec. (p)(1)(C). , inserted “or, effective beginning with , whose resources (as so determined) do not exceed the maximum resource level applied for the year under subparagraph (D) of (determined without regard to the life insurance policy exclusion provided under subparagraph (G) of such section) applicable to an individual or to the individual and the individual’s spouse (as the case may be)” before period at end.

Pub. L. 110–275, § 118(a)Subsec. (p)(5)(A). , inserted at end “The Secretary shall provide for the translation of such application form into at least the 10 languages (other than English) that are most often used by individuals applying for hospital insurance benefits under section 426 or 426–1 of this title and shall make the translated forms available to the States and to the Commissioner of Social Security.”

Pub. L. 109–171 section 1396a(a)(10)(A)(ii)(XIX) of this title2006—Subsec. (u)(2)(B). inserted at end “Such term excludes any child eligible for medical assistance only by reason of .”

Pub. L. 108–357, § 712(a)(1)(A)2004—Subsec. (a)(27), (28). , added par. (27) and redesignated former par. (27) as (28).

Pub. L. 108–357, § 712(a)(1)(B)Subsec. (x). , added subsec. (x).

Pub. L. 106–354, § 2(a)(4)2000—Subsec. (a)(xiii). , added cl. (xiii).

Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(d)(1)]section 1397dd of this title section 1397dd of this title section 1397dd(d)(2) of this title section 1397ee of this titleSubsec. (b). , in last sentence, substituted “the State’s available allotment under ” for “the State’s allotment under (not taking into account reductions under ) for the fiscal year reduced by the amount of any payments made under to the State from such allotment for such fiscal year”.

Pub. L. 106–354, § 2(c)section 1397ee(b) of this title section 1396a(a)(10)(A)(ii)(XVIII) of this title, in first sentence, struck out “and” before “(3)” and inserted before period at end “, and (4) the Federal medical assistance percentage shall be equal to the enhanced FMAP described in with respect to medical assistance provided to individuals who are eligible for such assistance only on the basis of ”.

Pub. L. 106–554, § 1(a)(6) [title VII, § 709(a)]Subsec. (p)(5). , added par. (5).

Pub. L. 106–554, § 1(a)(6) [title IX, § 911(a)(2)]Subsec. (p)(6). , added par. (6).

Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(d)(2)]section 1397dd(d) of this titleSubsec. (u)(1)(B). , struck out “and ” before period at end.

Pub. L. 106–113, § 1000(a)(6) [title VI, § 608(aa)(3)]Subsec. (a)(15). , substituted “1396a(a)(31) of this title” for “1396a(a)(31)(A) of this title”.

Pub. L. 106–113, § 1000(a)(6) [title VI, § 605(a)]section 1396r–4 of this titleSubsec. (b). , inserted “(other than expenditures under )” after “with respect to expenditures” in last sentence.

Pub. L. 106–113, § 1000(a)(6)lSubsec. (b)(1). [title VI, § 608()], substituted “83 per centum,” for “83 per centum,,”.

lPub. L. 106–113, § 1000(a)(6) [title VI, § 608(m)]Subsec. ()(2)(B). , substituted “an entity” for “a entity” in introductory provisions.

Pub. L. 106–169, § 121(c)(5)(A)Subsec. (v). , redesignated subsec. (v), related to independent foster care adolescent, as (w).

Pub. L. 106–169, § 121(a)(2), added subsec. (v), related to independent foster care adolescent.

Pub. L. 106–170, § 201(a)(2)(B), added subsec. (v).

Pub. L. 106–169, § 121(c)(5)Subsec. (w). , redesignated subsec. (v) as (w) and substituted “1396a(a)(10)(A)(ii)(XVII)” for “1396a(a)(10)(A)(ii)(XV)”.

Pub. L. 105–33, § 4702(a)(1)1997—Subsec. (a)(25). , added par. (25). Former par. (25) redesignated (26).

Pub. L. 105–33, § 4802(a)(1)Subsec. (a)(26). , added par. (26). Former par. (26) redesignated (27).

Pub. L. 105–33, § 4702(a)(1)(B), redesignated par. (25) as (26) and substituted comma for period at end.

Pub. L. 105–33, § 4802(a)(1)(B)Subsec. (a)(27). , redesignated par. (26) as (27).

Pub. L. 105–100, § 162(1)section 1397dd of this title section 1397dd(d)(2) of this title section 1397ee of this titleSubsec. (b). , inserted “for the State for a fiscal year, and that do not exceed the amount of the State’s allotment under (not taking into account reductions under ) for the fiscal year reduced by the amount of any payments made under to the State from such allotment for such fiscal year,” after “subsection (u)(3)”.

Pub. L. 105–33, § 4911(a)(1)section 1397ee(b) of this title, inserted at end “Notwithstanding the first sentence of this subsection, in the case of a State plan that meets the condition described in subsection (u)(1), with respect to expenditures described in subsection (u)(2)(A) or subsection (u)(3) the Federal medical assistance percentage is equal to the enhanced FMAP described in .”

Pub. L. 105–33, § 4732(b)section 1396u–3(d) of this title, substituted “Subject to , the term” for “The term”.

Pub. L. 105–33, § 4725(b)(1), in first sentence, substituted “, (2)” for “and (2)” and inserted before period “, and (3) for purposes of this subchapter and subchapter XXI, the Federal medical assistance percentage for the District of Columbia shall be 70 percent”.

lPub. L. 105–33, § 4712(d)(1)Subsec. ()(2)(B)(iii). , inserted “including requirements of the Secretary that an entity may not be owned, controlled, or operated by another entity,” after “such a grant,”.

oPub. L. 105–33, § 4711(c)(1)section 1396a(a)(13)(B) of this title section 1396a(a)(13)(D) of this titleSubsec. ()(3). , substituted “amount determined in ” for “amount described in ” in concluding provisions.

Pub. L. 105–33, § 4714(a)(2)section 1396a(n)(2) of this titleSubsec. (p)(3). , inserted “(subject to )” after “means” in introductory provisions.

Pub. L. 105–33, § 4702(a)(2)Subsec. (t). , added subsec. (t).

Pub. L. 105–33, § 4911(a)(2)Subsec. (u). , added subsec. (u).

Pub. L. 105–100, § 162(2)(A)Subsec. (u)(1)(B). , substituted “the fourth sentence of subsection (b)” for “paragraph (2)”.

Pub. L. 105–100, § 162(2)(B)Subsec. (u)(2)(A). , substituted “subparagraph (B)” for “subparagraph (C), but not in excess, for a State for a fiscal year, of the amount described in subparagraph (B) for the State and fiscal year”.

Pub. L. 105–100, § 162(2)(C)Subsec. (u)(2)(B), (C). , added subpar. (B) and struck out former subpars. (B) and (C) which read as follows:

section 1397dd of this title section 1397dd(d)(2) of this title section 1397ee of this title“(B) The amount described in this subparagraph, for a State for a fiscal year, is the amount of the State’s allotment under (not taking into account reductions under ) for the fiscal year reduced by the amount of any payments made under to the State from such allotment for such fiscal year.

section 1397jj(b)(1) of this titleApril 15, 1997l“(C) For purposes of this paragraph, the term ‘optional targeted low-income child’ means a targeted low-income child as defined in who would not qualify for medical assistance under the State plan under this subchapter based on such plan as in effect on (but taking into account the expansion of age of eligibility effected through the operation of section 1396a()(2)(D) of this title).”

Pub. L. 105–100, § 162(2)(D)March 31, 1997April 15, 1997Subsec. (u)(3). , substituted “described in this paragraph” for “described in this subparagraph” and “” for “”.

Pub. L. 105–100, § 162(2)(E)Subsec. (u)(4). , added par. (4).

lPub. L. 104–299 section 254b of this title1996—Subsec. ()(2)(B)(i), (ii)(II). substituted “” for “section 254b, 254c, 256, or 256a of this title”.

Pub. L. 103–2961994—Subsecs. (j), (q)(2). substituted “Commissioner of Social Security” for “Secretary”.

Pub. L. 103–66, § 13603(e)(1)1993—Subsec. (a)(xi). –(3), added cl. (xi).

Pub. L. 103–66, § 13601(a)(1)Subsec. (a)(7). , struck out “including personal care services (A) prescribed by a physician for an individual in accordance with a plan of treatment, (B) provided by an individual who is qualified to provide such services and who is not a member of the individual’s family, (C) supervised by a registered nurse, and (D) furnished in a home or other location; but not including such services furnished to an inpatient or resident of a nursing facility” after “services”.

Pub. L. 103–66, § 13605(a)Subsec. (a)(17). , inserted before semicolon at end “, and without regard to whether or not the services are performed in the area of management of the care of mothers and babies throughout the maternity cycle”.

Pub. L. 103–66, § 13603(e)(4)section 1396a(z)(2)(F) of this titleSubsec. (a)(19). , amended par. (19) generally, inserting reference to TB-related services described in .

Pub. L. 103–66, § 13601(a)(2)Subsec. (a)(21). , struck out “and” at end.

Pub. L. 103–66, § 13601(a)(4)Subsec. (a)(22). , redesignated par. (23) as (22). Former par. (22) redesignated (25).

Pub. L. 103–66, § 13601(a)(4)Subsec. (a)(23). , redesignated par. (24) as (23). Former par. (23) redesignated (22).

Pub. L. 103–66, § 13601(a)(5)Subsec. (a)(24). , added par. (24). Former par. (24) redesignated (23).

Pub. L. 103–66, § 13601(a)(3), which directed amendment of par. (24) by substituting semicolon for comma at end, was executed by substituting semicolon for period at end to reflect the probable intent of Congress.

Pub. L. 103–66, § 13601(a)(4)Subsec. (a)(25). , redesignated par. (22) as (25), transferred such par. to appear after par. (23), and substituted period for semicolon at end.

lPub. L. 103–66, § 13631(f)(2)(B)Subsec. ()(2)(B). , in concluding provisions, inserted “or by an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act for the provision of primary health services” before “. In applying clause”.

lPub. L. 103–66, § 13631(f)(2)(A)Subsec. ()(2)(B)(i). , substituted “256, or 256a” for “or 256”.

Pub. L. 103–66, § 13606(a)(1), struck out “or” at end.

lPub. L. 103–66, § 13631(f)(2)(A)Subsec. ()(2)(B)(ii). , substituted “256, or 256a” for “or 256” in subcl. (II).

Pub. L. 103–66, § 13606(a)(2), (3), realigned margin and substituted a comma for semicolon at end.

lPub. L. 103–66, § 13606(a)(4)Subsec. ()(2)(B)(iv). , (5), added cl. (iv).

Pub. L. 103–66, § 13631(g)(1)(A)section 1396s(c)(2)(B)(i) of this titleSubsec. (r)(1)(A)(i). , inserted “and, with respect to immunizations under subparagraph (B)(iii), in accordance with the schedule referred to in for pediatric vaccines” after “child health care”.

Pub. L. 103–66, § 13631(g)(1)(B)section 1396s(c)(2)(B)(i) of this titleSubsec. (r)(1)(B)(iii). , inserted “(according to the schedule referred to in for pediatric vaccines)” after “appropriate immunizations”.

Pub. L. 101–508, § 47221990—Subsec. (a). , inserted at end “No service (including counseling) shall be excluded from the definition of ‘medical assistance’ solely because it is provided as a treatment service for alcoholism or drug dependency.”

Pub. L. 101–508, § 4402(d)(2)section 1396a(a)(10)(A) of this title, inserted at end “The payment described in the first sentence may include expenditures for medicare cost-sharing and for premiums under part B of subchapter XVIII for individuals who are eligible for medical assistance under the plan and (A) are receiving aid or assistance under any plan of the State approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV, or with respect to whom supplemental security income benefits are being paid under subchapter XVI, or (B) with respect to whom there is being paid a State supplementary payment and are eligible for medical assistance equal in amount, duration, and scope to the medical assistance made available to individuals described in , and, except in the case of individuals 65 years of age or older and disabled individuals entitled to health insurance benefits under subchapter XVIII who are not enrolled under part B of subchapter XVIII, other insurance premiums for medical or any other type of remedial care or the cost thereof.”

Pub. L. 101–508, § 4713(b)Subsec. (a)(x). , added cl. (x).

Pub. L. 101–508, § 4704(e)(1)Pub. L. 101–239, § 6402(c)(1)Subsec. (a)(2)(C). , repealed . See 1989 Amendment note below.

Pub. L. 101–508, § 4721(a)Subsec. (a)(7). , substituted “services including personal care services” for “services” and added subpars. (A) to (D).

Pub. L. 101–508, § 4719(a)Subsec. (a)(13). , inserted before semicolon at end “, including any medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under State law, for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level”.

Pub. L. 101–508, § 4711(a)(1)Subsec. (a)(22). , which directed amendment of par. (22) by striking “and” at end, could not be executed because the word did not appear.

Pub. L. 101–508, § 4712(a)(1)Subsec. (a)(23). , inserted “and” after semicolon at end.

Pub. L. 101–508, § 4711(a)(2), (3), which directed amendment of subsec. (a) by redesignating par. (23) as (24) and adding a new par. (23), was executed by adding the new par. (23), there being no former par. (23).

Pub. L. 101–508, § 4712(a)(2)Subsec. (a)(24). , (3), which directed amendment of subsec. (a) by redesignating par. (24) as (25) and adding a new par. (24), was executed by adding the new par. (24), there being no former par. (24).

Pub. L. 101–508, § 4755(a)(1)(A)section 1395x(f) of this titleSubsec. (h)(1)(A). , inserted “or in another inpatient setting that the Secretary has specified in regulations” after “”.

lPub. L. 101–508, § 4704(c)(1)Subsec. ()(2)(A). , substituted “patient” for “outpatient”.

lPub. L. 101–508, § 4704(d)(2)Public Law 93–638 Pub. L. 101–508, § 4704(c)(3)Subsec. ()(2)(B). , which directed amendment of subpar. (B) by inserting “and includes an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act ().” after and below cl. (ii), was executed by inserting the new language after cl. (iii) to reflect the probable intent of Congress and the intervening redesignation of former cl. (ii) as (iii) by . See below.

Pub. L. 101–508, § 4704(c)(2), substituted “entity” for “facility” in introductory provisions.

lPub. L. 101–508, § 4704(c)(3)Subsec. ()(2)(B)(ii), (iii). , (d)(1), added cl. (ii), redesignated former cl. (ii) as (iii), and substituted comma for period at end of cl. (iii).

Pub. L. 101–508, § 4601(a)(2)Subsec. (n)(2). , substituted “age of 19” for “age of 7 (or any age designated by the State that exceeds 7 but does not exceed 8)”.

oPub. L. 101–508, § 4717 section 1395d(d)(2)(A) of this titleSubsec. ()(1)(A). , inserted “and for which payment may otherwise be made under subchapter XVIII” after “”.

oPub. L. 101–508, § 4705(a)(1)Subsec. ()(3). , struck out “a State which elects not to provide medical assistance for hospice care, but provides medical assistance for skilled nursing or intermediate care facility services with respect to” after “In the case of” in introductory provisions.

Pub. L. 101–508, § 4705(a)(3)section 1396a(a)(13)(D) of this title section 1396a(a)(13) of this title section 1396a(a)(13)(D) of this title, (4), in concluding provisions, substituted “the additional amount described in ” for “the amounts allocated under the plan for room and board in the facility, in accordance with the rates established under ,” and struck out at end “For purposes of this paragraph and , the term ‘room and board’ includes performance of personal care services, including assistance in activities of daily living, in socializing activities, administration of medication, maintaining the cleanliness of a resident’s room, and supervising and assisting in the use of durable medical equipment and prescribed therapies.”

oPub. L. 101–508, § 4705(a)(2)Subsec. ()(3)(A), (C). , substituted “nursing facility or intermediate care facility for the mentally retarded” for “skilled nursing or intermediate care facility”.

Pub. L. 101–508, § 4501(e)(1)(A)Subsec. (p)(1)(B). , which directed amendment of subpar. (B) by inserting “, except as provided in paragraph (2)(D)” after “supplementary social security income program”, was executed by inserting the new language after “supplemental security income program” to reflect the probable intent of Congress.

Pub. L. 101–508, § 4501(a)(1)January 1, 1992Subsec. (p)(2)(B). , inserted “and” at end of cl. (ii), substituted “100 percent.” for “95 percent, and” in cl. (iii), and struck out cl. (iv) which read as follows: “, is 100 percent.”

Pub. L. 101–508, § 4501(a)(2)January 1, 1993Subsec. (p)(2)(C). , substituted “95 percent, and” for “90 percent,” in cl. (iii) and “100 percent.” for “95 percent, and” in cl. (iv) and struck out cl. (v) which read as follows: “, is 100 percent.”

Pub. L. 101–508, § 4501(e)(1)(B)Subsec. (p)(2)(D). , added subpar. (D).

Pub. L. 101–508, § 4501(c)(2)section 1315 of this title section 1396a(a)(10)(E) of this titleSubsec. (p)(4). , inserted at end “In the case of any State which is providing medical assistance to its residents under a waiver granted under , the Secretary shall require the State to meet the requirement of in the same manner as the State would be required to meet such requirement if the State had in effect a plan approved under this subchapter.”

Pub. L. 101–508, § 4501(c)(1)Subsec. (p)(4)(B). , inserted “or 1396a(a)(10)(E)(iii) of this title” after “subparagraph (B)”.

Pub. L. 101–239, § 6404(a)(2)ll1989—Subsec. (a)(2)(B). , substituted “subsection ()(1)” for “subsection ()” in two places.

Pub. L. 101–239, § 6404(a)(3)Subsec. (a)(2)(C). , added cl. (C) relating to Federally-qualified health center services.

Pub. L. 101–239, § 6402(c)(1)Pub. L. 101–508, § 4704(e)(1), which directed addition of cl. (C) relating to ambulatory services, was repealed by .

Pub. L. 101–239, § 6403(d)(2)July 1, 1969Subsec. (a)(4)(B). , amended cl. (B) generally. Prior to amendment, cl. (B) read as follows: “effective , such early and periodic screening and diagnosis of individuals who are eligible under the plan and are under the age of 21 to ascertain their physical or mental defects, and such health care, treatment, and other measures to correct or ameliorate defects and chronic conditions discovered thereby, as may be provided in regulations of the Secretary; and”.

Pub. L. 101–239, § 6405(a)Subsec. (a)(21), (22). , added par. (21) and redesignated former par. (21) as (22).

lPub. L. 101–239, § 6404(b)Subsec. (). , designated existing provisions as par. (1), redesignated former cls. (1) and (2) as (A) and (B), respectively, and added par. (2).

Pub. L. 101–239, § 6408(d)(4)(B)section 1395i–2a of this title section 1395i–2 of this titleSubsec. (p)(1)(A). , inserted “, but not including an individual entitled to such benefits only pursuant to an enrollment under ” after “”.

Pub. L. 101–239, § 6408(d)(4)(A)(i)section 1395i–2 of this titleSubsec. (p)(3)(A). , amended subpar. (A) generally. Prior to amendment, subpar. (A) read as follows: “Premiums under subchapter XVIII of this chapter (including under part B and, if applicable, under ).”

Pub. L. 101–239, § 6408(d)(4)(A)(ii)Subsec. (p)(3)(A)(i). , substituted “section 1395i–2 or 1395i–2a” for “section 1395i–2”.

Pub. L. 101–234, § 201(b)(1)section 1395e of this titlelsection 1395e of this titlelsection 1395m(c)(1) of this titleSubsec. (p)(3)(C). , substituted “Deductibles” for “Subject to paragraph (4), deductibles” and “ and section 1395(b) of this title)” for “, section 1395(b) of this title, and ”.

Pub. L. 101–234, § 201(b)(2)section 1395m(c)(1) of this title section 1396a(a)(10)(A)(i) of this titleSubsec. (p)(4), (5). , redesignated par. (5) as (4) and struck out former par. (4) which read as follows: “In a State which provides medical assistance for prescribed drugs under subsection (a)(12) of this section, instead of providing to qualified medicare beneficiaries, under paragraph (3)(C), medicare cost-sharing with respect to the annual deductible for covered outpatient drugs under , the State may provide to such beneficiaries, before charges for covered outpatient drugs for a year reach such deductible amount, benefits for prescribed drugs in the same amount, duration, and scope as the benefits made available under the State plan for individuals described in .”

Pub. L. 101–239, § 6403(c)July 1, 1990Subsec. (r). , inserted at end “The Secretary shall, not later than , and every 12 months thereafter, develop and set annual participation goals for each State for participation of individuals who are covered under the State plan under this subchapter in early and periodic screening, diagnostic, and treatment services.”

Pub. L. 101–239, § 6403(a), added subsec. (r).

Pub. L. 101–239, § 6408(d)(2)Subsec. (s). , added subsec. (s).

Pub. L. 100–647, § 8434(b)(3)1988—Subsec. (a). , substituted “in the case of medicare cost-sharing with respect to a qualified medicare beneficiary” for “in the case of a qualified medicare beneficiary” in introductory provisions.

Pub. L. 100–485, § 303(b)(2)Subsec. (a)(ix). , added cl. (ix).

Pub. L. 100–360, § 411(k)(4)Subsec. (a)(5)(B). , substituted “described in clause (A) if” for “described in subparagraph (A) if”.

Pub. L. 100–360, § 411(h)(4)(E)Pub. L. 100–203, § 4073(d)(1)Subsec. (a)(17). , amended , see 1987 Amendment note below.

Pub. L. 100–360, § 411(k)(14)(A)Subsec. (i). , added subsec. (i).

Pub. L. 100–485, § 401(d)(2)Subsec. (m). , added subsec. (m).

oPub. L. 100–360, § 411(k)(8)(A)Pub. L. 100–203, § 4114Subsec. ()(1). , made clarifying amendment to directory language of , see 1987 Amendment note below.

oPub. L. 100–360, § 411(k)(8)(B)Subsec. ()(1)(B). , struck out “only” after “For purposes of this subchapter” and substituted “immune deficiency syndrome (AIDS)” for “immunodeficiency syndrome”.

oPub. L. 100–485, § 608(f)(3)Subsec. ()(3). , realigned the margin of par. (3).

Pub. L. 100–647, § 8434(a)section 1396a(a)(10)(E) of this titleSubsec. (p)(1). , redesignated subpars. (C) and (D) as (B) and (C), respectively, and struck out former subpar. (B) which read: “who, but for , is not eligible for medical assistance under the plan,”.

Pub. L. 100–360, § 301(a)(2)Subsec. (p)(1)(B). , struck out “and the election of the State” after “1396a(a)(10)(E) of this title”.

Pub. L. 100–360, § 301(c)(1)Pub. L. 100–485, § 608(d)(14)(E)(i)Subsec. (p)(1)(C). , as amended by , substituted “paragraph (2)” for “paragraph (2)(A)”.

Pub. L. 100–360, § 301(c)(2)Pub. L. 100–485, § 608(d)(14)(E)(ii)Subsec. (p)(1)(D). , as amended by , substituted “twice” for “(except as provided in paragraph (2)(B))”.

Pub. L. 100–647, § 8434(b)(4)Subsec. (p)(2)(A). , substituted “paragraph (1)(B)” for “paragraph (1)(C)”.

Pub. L. 100–360, § 301(b)(1)Pub. L. 100–485, § 608(d)(14)(A), as amended by , substituted “shall be at least the percent provided under subparagraph (B) (but not more than 100 percent)” for “may not exceed a percentage (not more than 100 percent)”.

Pub. L. 100–360, § 301(c)(3)(A)Pub. L. 100–485, § 608(d)(14)(E)(iii), which directed amendment of subpar. (A) by striking “(2)(A)” and inserting “(2)”, was repealed by .

Pub. L. 100–360, § 301(b)(2)Pub. L. 100–485, § 608(d)(14)(B), which directed amendment of subpar. (A) by inserting “(i)” after “(2)(A)”, was repealed by .

Pub. L. 100–360, § 301(b)(2)Pub. L. 100–485, § 608(d)(14)(B)section 1396a(a)(10)(A) of this title section 1396a(a)(10)(A) of this titleSubsec. (p)(2)(B). , formerly § 301(b)(3), as renumbered and amended by –(D)(ii), added subpar. (B) and struck out former subpar. (B) which read as follows: “In the case of a State that provides medical assistance to individuals not described in and at the State’s option, the State may use under paragraph (1)(D) such resource level (which is higher than the level described in that paragraph) as may be applicable with respect to individuals described in paragraph (1)(A) who are not described in .”

Pub. L. 100–360, § 301(c)(3)(B)Pub. L. 100–485, § 608(d)(14)(E)(iii), which directed amendment of par. (2) by striking subpar. (B), was repealed by .

Pub. L. 100–360, § 301(b)(2)Pub. L. 100–485, § 608(d)(14)(B)Subsec. (p)(2)(C). , formerly § 301(b)(3), as renumbered and amended by , (C), (D)(i), (iii), added subpar. (C).

Pub. L. 100–360, § 301(d)(1)Pub. L. 100–485, § 608(d)(14)(G)(ii)Subsec. (p)(3). , as added by , inserted “without regard to whether the costs incurred were for items and services for which medical assistance is otherwise available under the plan” after “qualified medicare beneficiary” in introductory provisions.

Pub. L. 100–360, § 301(d)(2)Pub. L. 100–485, § 608(d)(14)(G)(i)section 1395i–2 of this title section 1395i–2 of this titleSubsec. (p)(3)(A). , formerly § 301(d)(1), as renumbered by , substituted “under subchapter XVIII of this chapter (including under part B and, if applicable, under )” for “under part B and (if applicable) under ”.

Pub. L. 100–360, § 301(d)(3)Pub. L. 100–485, § 608(d)(14)(G)(i)section 1395e of this titleSubsec. (p)(3)(B). , formerly § 301(d)(2), as renumbered by , amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: “Deductibles and coinsurance described in .”

Pub. L. 100–360, § 301(d)(3)Pub. L. 100–485, § 608(d)(14)(F)lSubsec. (p)(3)(C). , formerly § 301(d)(2), as renumbered and amended by , (G)(i), amended subpar. (C) generally. Prior to amendment, subpar. (C) read as follows: “The annual deductible described in section 1395(b) of this title.”

Pub. L. 100–360, § 301(d)(4)Pub. L. 100–485, § 618(d)(14)(G)(i)Subsec. (p)(4). , formerly § 301(d)(3), as renumbered by , added par. (4).

Pub. L. 100–360, § 301(g)(2)Pub. L. 100–485, § 608(d)(14)(J)Subsec. (p)(5). , as amended by , added par. (5).

Pub. L. 100–203, § 4211(f)1987—Subsec. (a)(4)(A). , struck out “skilled” before “nursing”.

Pub. L. 100–203, § 4211(h)(6)(A)Subsec. (a)(5). , struck out “skilled” before “nursing” in cl. (A).

Pub. L. 100–203, § 4103(a), designated existing provisions as cl. (A) and added cl. (B).

Pub. L. 100–203, § 4105(a)Subsec. (a)(9). , inserted provision including services furnished to an eligible individual who does not reside in a permanent dwelling or have a fixed home or mailing address.

Pub. L. 100–203, § 4211(h)(6)(B)Subsec. (a)(14). , substituted “and nursing facility services” for “, skilled nursing facility services, and intermediate care facility services”.

Pub. L. 100–203, § 4211(h)(6)(C)Subsec. (a)(15). , substituted “services in an intermediate care facility for the mentally retarded (other than” for “intermediate care facility services (other than such services”.

Pub. L. 100–203, § 4073(d)(1)Pub. L. 100–360, § 411(h)(4)(E)section 1395x(gg) of this titleSubsec. (a)(17). , as amended by , substituted “(as defined in )” for “(as defined in subsection (m) of this section)”.

Pub. L. 100–203, § 4211(e)(1)Subsec. (c). , amended subsec. (c) generally. Prior to amendment, subsec. (c) defined “intermediate care facility”.

Pub. L. 100–203, § 4211(e)(2)Subsec. (d). , substituted “intermediate care facility for the mentally retarded” for “intermediate care facility” and “means an” for “may include services in a public”, and in par. (3) inserted “in the case of a public institution” after “(3)”.

Pub. L. 100–203, § 4211(e)(3)Subsec. (f). , struck out “skilled” before “nursing” in four places and before “rehabilitation”.

Pub. L. 100–203, § 4211(e)(4)section 1395x(j) of this titleSubsec. (i). , struck out subsec. (i) which provided that for purposes of this subchapter “skilled nursing facility” also includes any institution which is located in a State on an Indian reservation and is certified by the Secretary as being a qualified skilled nursing facility by meeting the requirements of .

Pub. L. 100–203, § 4073(d)(2)section 1395x(gg) of this titleSubsec. (m). , struck out subsec. (m) which defined “nurse-midwife”. See .

Pub. L. 100–203, § 4101(c)(1)Subsec. (n)(2). , substituted “has not attained the age of 7 (or any age designated by the State that exceeds 7 but does not exceed 8)” for “is under 5 years of age”.

oPub. L. 100–203, § 4114 Pub. L. 100–360, § 411(k)(8)(A)Subsec. ()(1). , as amended by , designated existing provisions as subpar. (A), substituted “Subject to subparagraph (B), the” for “The”, and added subpar. (B).

Pub. L. 100–203, § 4118(p)(8)Subsec. (p)(2)(A). , struck out “nonfarm” before “official”.

Pub. L. 99–509, § 9403(g)(3)1986—Subsec. (a). , inserted “or, in the case of a qualified medicare beneficiary described in subsection (p)(1), if provided after the month in which the individual becomes such a beneficiary” after “makes application for assistance”.

Pub. L. 99–272, § 9505(a)(1)Subsec. (a)(18). , added par. (18). Former par. (18) redesignated (19).

Pub. L. 99–514, § 1895(c)(3)(A)Subsec. (a)(19). , added par. (19). Former par. (19) redesignated (20).

Pub. L. 99–272, § 9505(a)(1)(B), redesignated former par. (18) as (19).

Pub. L. 99–509, § 9408(c)(1)Subsec. (a)(20). , added par. (20). Former par. (20) redesignated (21).

Pub. L. 99–514, § 1895(c)(3)(A)(ii), redesignated former par. (19) as (20).

Pub. L. 99–509, § 9408(c)(1)(B)Subsec. (a)(21). , redesignated former par. (20) as (21).

Pub. L. 99–272, § 9501(a)Subsec. (n)(1)(C). , added subpar. (C).

Pub. L. 99–272, § 9511(a)September 30, 1983Subsec. (n)(2). , inserted “(or such earlier date as the State may designate)” after “”.

oPub. L. 99–272, § 9505(a)(2)oSubsec. (). , added subsec. ().

oPub. L. 99–509, § 9435(b)(2)Subsec. ()(3). , added par. (3).

Pub. L. 99–509, § 9403(b)Subsec. (p). , (d), added subsec. (p).

Pub. L. 99–509, § 9404(b)Subsec. (q). , added subsec. (q).

Pub. L. 98–369, § 2335(f)1984—Subsec. (a). , substituted “mental diseases” for “tuberculosis or mental diseases” in subd. (B) following par. (18).

Pub. L. 98–369, § 2373(b)(17), substituted “clause (vi)” for “clauses (vi)” and “well-being” for “well being” in last sentence.

Pub. L. 98–369, § 2335(f)Subsec. (a)(1). , substituted “mental diseases” for “tuberculosis or mental diseases”.

Pub. L. 98–369, § 2335(f)Subsec. (a)(4). , substituted “mental diseases” for “tuberculosis or mental diseases”.

Pub. L. 98–369, § 2373(b)(15), inserted a semicolon before “(B)”.

Pub. L. 98–369, § 2371(a)Subsec. (a)(9). , amended par. (9) generally, inserting “furnished by or under the direction of a physician, without regard to whether the clinic itself is administered by a physician”.

Pub. L. 98–369, § 2335(f)Subsec. (a)(14), (15). , substituted “mental diseases” for “tuberculosis or mental diseases”.

Pub. L. 98–369, § 2373(b)(16)Subsec. (a)(17). , substituted “the nurse-midwife” for “he” in two places.

Pub. L. 98–369, § 2373(b)(18)section 1301(a)(8)(B) of this title section 1301(a)(8) of this titleSubsec. (b). , substituted “” for “subparagraph (B) of ”.

Pub. L. 98–369, § 2373(b)(19)Subsec. (d)(1). , substituted “the institution meets” for “which meet”.

Pub. L. 98–369, § 2340(b)Subsec. (h)(1)(A). , amended subpar. (A) generally. Prior to amendment, subpar. (A) read as follows: “inpatient services which are provided in an institution which is accredited as a psychiatric hospital by the Joint Commission on Accreditation of Hospitals;”.

Pub. L. 98–369, § 2373(b)(20)Subsec. (m). , substituted “the nurse” for “he” in two places.

Pub. L. 98–369, § 2361(b)Subsec. (n). , added subsec. (n).

Pub. L. 97–248, § 137(b)(17)1982—Subsec. (a)(i). , struck out “or any reasonable category of such individuals,” after “as the State may choose,”.

Pub. L. 97–248, § 137(b)(18)Subsec. (a)(viii). , added cl. (viii).

Pub. L. 97–248, § 136(c)Subsec. (b)(2). , substituted “the Northern Mariana Islands, and American Samoa” for “and the Northern Mariana Islands”.

Pub. L. 97–248, § 137(f)Subsec. (h)(1)(C). , redesignated cls. (i) and (ii) as subcls. (I) and (II), respectively, and redesignated cls. (A) and (B) as cls. (i) and (ii), respectively.

Pub. L. 97–35, § 2172(b)section 606(a)(2) of this title1981—Subsec. (a). , in cl. (i), inserted “or, at the option of the State, under the age of 20, 19, or 18 as the State may choose, or any reasonable category of such individuals,” and in cl. (ii), struck out reference to .

Pub. L. 97–35, § 2162(a)(2)Subsec. (b). , inserted reference to Northern Mariana Islands.

Pub. L. 96–499, § 965(a)(1)(B)1980—Subsec. (a)(17), (18). , (C), added par. (17) and redesignated former par. (17) as (18).

Pub. L. 96–473Subsec. (c). substituted “clause (1)” for “clauses (1)”.

Pub. L. 96–499, § 965(a)(2)Subsec. (m). , added subsec. (m).

Pub. L. 95–292 section 1395x(j)(14) of this title1978—Subsec. (c). added cl. (4) to first sentence relating to a requirement that intermediate care facilities meet with respect to protection of patients’ personal funds, and inserted reference to that cl. (4) in provisions covering intermediate care facilities on Indian reservations.

Pub. L. 95–210, § 2(a)1977—Subsec. (a)(2). , designated existing provisions as cl. (A) and added cl. (B).

lPub. L. 95–210, § 2(b)lSubsec. (). , added subsec. ().

Pub. L. 94–4371976—Subsec. (b). inserted provision requiring that the Federal medical assistance percentage be 100 per centum for services received through an Indian Health Service facility.

Pub. L. 93–233, § 13(a)(13)section 1396a(a)(10)(A) of this title1973—Subsec. (a). , substituted in introductory text “individuals (other than individuals with respect to whom there is being paid, or who are eligible or would be eligible if they were not in a medical institution, to have paid with respect to them a State supplementary payment and are eligible for medical assistance equal in amount, duration, and scope to the medical assistance made available to individuals described in ) not receiving aid or assistance under any plan of the State approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV, and with respect to whom supplemental security income benefits are not being paid under subchapter XVI” for “individuals not receiving aid or assistance under the State’s plan approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV”.

Pub. L. 93–233, § 13(a)(14)Subsec. (a)(iv). , inserted “with respect to States eligible to participate in the State plan program established under subchapter XVI,” after “blind,”.

Pub. L. 93–233, § 13(a)(15)Subsec. (a)(v). , substituted “with respect to States eligible to participate in the State plan program established under subchapter XVI,” for “or”.

Pub. L. 93–233, § 13(a)(16)Subsec. (a)(vi). , inserted “or” at end of text.

Pub. L. 93–233, § 13(a)(17)Subsec. (a)(vii). , added cl. (vii).

Pub. L. 93–233, § 18(x)(7)Subsec. (a)(16). , substituted “under age 21, as defined in subsection (h); and” for “under 21, as defined in subsection (e);”.

Pub. L. 93–233, § 18(y)(2)July 30, 1965January 1, 1966June 30, 1966section 1301(a)(8) of this titleSubsec. (b). , struck out “; except that the Secretary shall promulgate such percentage as soon as possible after , which promulgation shall be conclusive for each of the six quarters in the period beginning , and ending with the close of ” after “”.

Pub. L. 93–233, § 18(x)(8)Subsec. (c). , substituted “skilled nursing facility” for “skilled nursing home” wherever appearing.

Pub. L. 93–233, § 18(w)Subsec. (h)(1)(B). , substituted “(i) involve active treatment” for “, involves active treatment (i)”; struck out “pursuant to subchapter XVIII of this chapter” after “may be prescribed”; and substituted “(ii)” for “(ii) which”, respectively.

Pub. L. 93–233, § 18(x)(10)Subsec. (h)(2). , substituted “paragraph (1)” for “paragraph (e)(1)”.

Pub. L. 93–233, § 18(x)(9)Pub. L. 92–603, § 299L(b)Subsec. (i). , redesignated subsec. (h) as added by , and relating to skilled nursing facility, as subsec. (i).

Pub. L. 93–233, § 13(a)(18)Subsecs. (j), (k). , added subsecs. (j) and (k).

Pub. L. 92–603Subsec. (a)(4). , §§ 278(a)(21), 299E(b), substituted “skilled nursing facility” for “skilled nursing home” and added cl. (C).

Pub. L. 92–603 section 1395x(r)(1) of this titleSubsec. (a)(5). , §§ 278(a)(22), 280, substituted “skilled nursing facility” for “skilled nursing home” and inserted “furnished by a physician (as defined in )” after “physicians’ services”.

Pub. L. 92–603Subsec. (a)(14). , §§ 278(a)(23), 297(a), substituted “skilled nursing facility” for “skilled nursing home” and inserted reference to intermediate care facility services.

Pub. L. 92–603, § 299B(a)Subsec. (a)(15) to (17). , added par. (16) and redesignated existing pars. (15) and (16) as (17) and (15), respectively.

Pub. L. 92–603, § 299L(a)Subsec. (c). , inserted provision defining “intermediate care facility” with respect to any institution located in a State on an Indian reservation.

Pub. L. 92–603, § 299January 1, 1975Subsec. (d)(3). , inserted provisions relating to reduction of non-Federal expenditures in any calendar quarter prior to .

Pub. L. 92–603, § 212(a)Subsec. (e). , added subsec. (e).

Pub. L. 92–603, § 247(b)Subsec. (f). , added subsec. (f).

Pub. L. 92–603, § 275(a)Subsec. (g). , added subsec. (g).

Pub. L. 92–603, § 299L(b)Subsec. (h). , added subsec. (h) relating to skilled nursing facility.

Pub. L. 92–603, § 299B(b), added subsec. (h) relating to inpatient psychiatric hospital services for individuals under age 21.

Pub. L. 92–223, § 4(a)(2)Subsecs. (c), (d). , added subsecs. (c) and (d).

Pub. L. 90–248, § 2301968—Subsec. (a). , inserted “, and with respect to physicians’ or dentists’ services, at the option of the State, to individuals not receiving aid or assistance under the State’s plan approved under subchapter I, X, XIV, XVI, or part A of subchapter IV” after “for individuals” in text preceding cl. (i).

Pub. L. 90–248, § 233(b), inserted provision deeming, for purposes of cl. (vi) of the preceding sentence, a person as essential to another individual if such person is the spouse of and is living with such individual, the needs of such person are taken into account in determining the amount of aid or assistance furnished to such individual (under a State plan approved under subchapter I, X, XIV, or XV of this chapter, and such person is determined, under such a State plan, to be essential to the well being of such individual.

Pub. L. 90–248, § 241(f)(6)Subsec. (a)(ii). , inserted “part A of” before “subchapter IV”.

Pub. L. 90–248, § 233(a)Subsec. (a)(vi). , added cl. (vi).

Pub. L. 90–248, § 302(a)Subsec. (a)(4). , designated existing provisions as cl. (A) and added cl. (B).

Pub. L. 90–248, § 248(e)Subsec. (b). , substituted in cl. (2) of first sentence “50” for “55”.

Statutory Notes and Related Subsidiaries

Effective Date of 2025 Amendment

section 71112(b) of Pub. L. 119–21Dec. 31, 2026section 71112(d) of Pub. L. 119–21 section 1396a of this titleAmendment by applicable to medical assistance, child health assistance, and pregnancy-related assistance with respect to individuals whose eligibility for such assistance is based on an application made on or after the first day of the first quarter that begins after , see , set out as a note under .

Effective Date of 2024 Amendment

Pub. L. 118–42, div. G, title I, § 209(b)Mar. 9, 2024138 Stat. 413

Mar. 9, 2024“The amendments made by this section [amending this section] shall apply with respect to medical assistance furnished on or after the date of enactment of this Act [].”

, , , provided that:

Effective Date of 2022 Amendment

section 5121(b) of Pub. L. 117–328Dec. 29, 2022section 5121(d) of Pub. L. 117–328 section 1396a of this titleAmendment by applicable beginning on the first day of the first calendar quarter that begins on or after the date that is 24 months after , see , set out as a note under .

section 5122(a)(1) of Pub. L. 117–328Dec. 29, 2022section 5122(c) of Pub. L. 117–328 section 1396a of this titleAmendment by effective on the first day of the first calendar quarter that begins after the date that is 24 months after , and applicable to items and services furnished for periods beginning on or after such date, see , set out as a note under .

Pub. L. 117–169Aug. 16, 2022section 11405(c) of Pub. L. 117–169 section 1396a of this titleAmendment by effective on the 1st day of the 1st fiscal quarter that begins on or after the date that is 1 year after , and applicable to expenditures made under a State plan or waiver of such plan under title XIX of the Social Security Act or under a State child health plan or waiver of such plan under title XXI of such Act on or after such effective date, see , set out as a note under .

Effective Date of 2020 Amendment

section 210(a) of Pub. L. 116–260Jan. 1, 2022section 210(e) of Pub. L. 116–260 section 1308 of this titleAmendment by applicable with respect to items and services furnished on or after , see , set out as a note under .

Pub. L. 116–159, div. C, title VI, § 2601(c)Oct. 1, 2020134 Stat. 738

section 1396r–8 of this title Public Law 115–271 132 Stat. 3914“The amendments made by this section [amending this section and ] shall take effect as if included in the enactment of section 1006(b) of the SUPPORT for Patients and Communities Act (; ).”

, , , provided that:

Effective Date of 2018 Amendment

Pub. L. 115–271Oct. 1, 2020Oct. 1, 2025section 1006(b)(4) of Pub. L. 115–271 section 1396a of this titleAmendment by section 1006(b)(2), (3) of applicable with respect to medical assistance provided on or after , and before , with exception if State legislation required, see , set out as a note under .

Pub. L. 115–271, title I, § 1012(b)Oct. 24, 2018132 Stat. 3920

“(1)

In general .—

Oct. 24, 2018Except as provided in paragraph (2), the amendment made by subsection (a) [amending this section] shall take effect on the date of enactment of this Act [].

“(2)

Rule for changes requiring state legislation .—

42 U.S.C. 1396In the case of a State plan under title XIX of the Social Security Act [ et seq.] which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendment made by subsection (a), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.”

, , , provided that:

Effective Date of 2016 Amendment

Pub. L. 114–255, div. B, title XII, § 12005(b)Dec. 13, 2016130 Stat. 1275

January 1, 2019“The amendments made by subsection (a) [amending this section] shall apply with respect to items and services furnished in calendar quarters beginning on or after .”

, , , provided that:

Effective Date of 2012 Amendment

Pub. L. 112–141, div. F, title I, § 100123(c)July 6, 2012126 Stat. 915

section 3204 of Public Law 112–96“The amendments made by this section [amending this section and provisions set out as a note under this section] shall be effective as if included in the enactment of .”

, , , provided that:

Pub. L. 112–96, title III, § 3204(b)Feb. 22, 2012126 Stat. 194 Pub. L. 112–141, div. F, title I, § 100123(a)July 6, 2012126 Stat. 915

October 1, 2012“The amendments made by subsection (a) [amending this section] shall take effect on .”

, , , as amended by , , , provided that:

Effective Date of 2010 Amendment

Pub. L. 111–148, title II, § 2005(c)(2)Mar. 23, 2010124 Stat. 284 Pub. L. 111–152, title I, § 1204(b)(2)(B)Mar. 30, 2010124 Stat. 1056

July 1, 2011“The amendment made by paragraph (1) [amending this section] takes effect on .”

, , , as amended by , , , provided that:

section 2301(a) of Pub. L. 111–148Mar. 23, 2010section 2301(c) of Pub. L. 111–148 section 1396a of this titleAmendment by effective , and applicable to services furnished on or after such date, with certain exceptions, see , set out as an Effective and Termination Dates of 2010 Amendment note under .

section 2303(a)(4)(A) of Pub. L. 111–148Mar. 23, 2010section 2303(d) of Pub. L. 111–148 section 1396a of this titleAmendment by effective , and applicable to items and services furnished on or after such date, see , set out as an Effective and Termination Dates of 2010 Amendment note under .

section 2402(d)(2)(B) of Pub. L. 111–148Mar. 23, 2010section 2402(g) of Pub. L. 111–148 section 1396a of this titleAmendment by effective on the first day of the first fiscal year quarter that begins after , see , set out as an Effective and Termination Dates of 2010 Amendment note under .

Pub. L. 111–148, title IV, § 4106(c)Mar. 23, 2010124 Stat. 560

January 1, 2013“The amendments made under this section [amending this section] shall take effect on .”

, , , provided that:

Pub. L. 111–148, title IV, § 4107(d)Mar. 23, 2010124 Stat. 561

ooOctober 1, 2010“The amendments made by this section [amending this section and sections 1396, 1396–1, and 1396r–8 of this title] shall take effect on .”

, , , provided that:

Effective Date of 2008 Amendment

Pub. L. 110–275, title I, § 118(b)July 15, 2008122 Stat. 2508

January 1, 2010“The amendment made by subsection (a) [amending this section] shall take effect on .”

, , , provided that:

Effective Date of 2006 Amendment

Pub. L. 109–171Jan. 1, 2007section 6062(d) of Pub. L. 109–171 section 1396a of this titleAmendment by applicable to medical assistance for items and services furnished on or after , see , set out as a note under .

Effective Date of 2004 Amendment

Pub. L. 108–357Oct. 22, 2004section 712(d) of Pub. L. 108–357 section 1396b of this titleAmendment by effective , and applicable to medical assistance and services provided under this subchapter on or after that date, see , set out as a note under .

Effective Date of 2000 Amendments

Pub. L. 106–554, § 1(a)(6) [title VII, § 709(b)]Dec. 21, 2000114 Stat. 2763

Dec. 21, 2000“The amendment made by subsection (a) [amending this section] shall take effect 1 year after the date of the enactment of this Act [], regardless of whether regulations have been promulgated to carry out such amendment by such date. The Secretary of Health and Human Services shall develop the uniform application form under such amendment by not later than 9 months after the date of the enactment of this Act.”

, , , 2763A–578, provided that:

Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(f)]Dec. 21, 2000114 Stat. 2763

Pub. L. 105–33 111 Stat. 552“The amendments made by this section [amending this section and sections 1397dd, 1397ee, and 1397jj of this title] shall be effective as if included in the enactment of section 4901 of the BBA [] ().”

, , , 2763A–582, provided that:

Pub. L. 106–554Dec. 21, 2000Pub. L. 106–554 section 1320b–14 of this titleAmendment by section 1(a)(6) [title IX, § 911(a)(2)] of effective one year after , see section 1(a)(6) [title IX, § 911(c)] of , set out as an Effective Date note under .

Pub. L. 106–354Oct. 1, 2000section 2(d) of Pub. L. 106–354 section 1396a of this titleAmendment by applicable to medical assistance for items and services furnished on or after , without regard to whether final regulations to carry out such amendments have been promulgated by such date, see , set out as a note under .

Effective Date of 1999 Amendments

Pub. L. 106–170Oct. 1, 2000section 201(d) of Pub. L. 106–170 section 1396a of this titleAmendment by applicable to medical assistance for items and services furnished on or after , see , set out as a note under .

section 121(a)(2) of Pub. L. 106–169Oct. 1, 1999section 121(b) of Pub. L. 106–169 section 1396a of this titleAmendment by applicable to medical assistance for items and services furnished on or after , see , set out as a note under .

Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, § 605(b)]Nov. 29, 1999113 Stat. 1536

October 1, 1999“The amendment made by subsection (a) [amending this section] takes effect on , and applies to expenditures made on or after such date.”

, , , 1501A–396, provided that:

Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, § 608(aa)]Nov. 29, 1999113 Stat. 1536 Pub. L. 105–33, , , 1501A–398, provided that the amendment made by section 1000(a)(6) [title VI, § 608(aa)(3)] is effective as if included in the enactment of BBA [the Balanced Budget Act of 1997, ].

lPub. L. 106–113Nov. 29, 1999Pub. L. 106–113 section 1396a of this titleAmendment by section 1000(a)(6) [title VI, § 608(), (m)] of effective , see section 1000(a)(6) [title VI, § 608(bb)] of , set out as a note under .

Effective Date of 1997 Amendment

Pub. L. 105–100, title I, § 162Nov. 19, 1997111 Stat. 2188 Pub. L. 105–33, , , provided that the amendment made by that section is effective as if included in the enactment of subtitle J (§§ 4901–4923) of title IV of the Balanced Budget Act of 1997, .

section 4702(a) of Pub. L. 105–33Oct. 1, 1997section 4710(b)(1) of Pub. L. 105–33 section 1396b of this titleAmendment by applicable to primary care case management services furnished on or after , subject to provisions relating to extension of effective date for State law amendments, and to nonapplication to waivers, see , set out as a note under .

section 4711(c)(1) of Pub. L. 105–33Aug. 5, 1997Oct. 1, 1997section 4711(d) of Pub. L. 105–33 section 1396a of this titleAmendment by effective , and applicable to payment for items and services furnished on or after , see , set out as a note under .

Pub. L. 105–33, title IV, § 4712(d)(2)Aug. 5, 1997111 Stat. 509

Aug. 5, 1997“The amendment made by paragraph (1) [amending this section] shall apply to services furnished on or after the date of the enactment of this Act [].”

, , , provided that:

section 4714(a)(2) of Pub. L. 105–33Aug. 5, 1997section 1396a(n) of this titleAug. 5, 1997section 4714(c) of Pub. L. 105–33 section 1396a of this titleAmendment by applicable to payment for (and with respect to provider agreements with respect to) items and services furnished on or after , and to payment by a State for items and services furnished before such date if such payment is subject of lawsuit that is based on subsection (p) of this section and and that is pending as of, or is initiated after , see , set out as a note under .

Pub. L. 105–33, title IV, § 4725(b)(2)Aug. 5, 1997111 Stat. 518

“The amendments made by paragraph (1) [amending this section] shall apply to—

“(A)

October 1, 1997 items and services furnished on or after ;

“(B)

payments made on a capitation or other risk-basis for coverage occurring on or after such date; and

“(C)

42 U.S.C. 1396r–4(f) payments attributable to DSH allotments for such States determined under section 1923(f) of such Act () for fiscal years beginning with fiscal year 1998.”

, , , provided that:

section 4911(a) of Pub. L. 105–33Oct. 1, 1997section 4911(c) of Pub. L. 105–33 section 1396a of this titleAmendment by applicable to medical assistance for items and services furnished on or after , see , set out as a note under .

Effective Date of 1996 Amendment

Pub. L. 104–299Oct. 1, 1996section 5 of Pub. L. 104–299 section 233 of this titleAmendment by effective , see , as amended, set out as a note under .

Effective Date of 1994 Amendment

Pub. L. 103–296Mar. 31, 1995section 110(a) of Pub. L. 103–296 section 401 of this titleAmendment by effective , see , set out as a note under .

Effective Date of 1993 Amendment

section 13601(a) of Pub. L. 103–66 Pub. L. 101–508 section 13601(c) of Pub. L. 103–66 section 1396a of this titleAmendment by effective as if included in enactment of section 4721(a) of the Omnibus Budget Reconciliation Act of 1990, , see , set out as a note under .

section 13603(e) of Pub. L. 103–66Jan. 1, 1994section 13603 of Pub. L. 103–66 section 13603(f) of Pub. L. 103–66 section 1396a of this titleAmendment by applicable to medical assistance furnished on or after , without regard to whether or not final regulations to carry out the amendments by have been promulgated by such date, see , set out as a note under .

Pub. L. 103–66, title XIII, § 13605(b)Aug. 10, 1993107 Stat. 621

October 1, 1993“The amendment made by subsection (a) [amending this section] shall apply to services furnished on or after .”

, , , provided that:

Pub. L. 103–66, title XIII, § 13606(b)Aug. 10, 1993107 Stat. 621

July 1, 1993“The amendments made by subsection (a) [amending this section] shall apply to calendar quarters beginning on or after .”

, , , provided that:

section 13631(f)(2) of Pub. L. 103–66Oct. 1, 1993section 13631(f) of Pub. L. 103–66 section 13631(f)(3) of Pub. L. 103–66 section 1396a of this titleAmendment by applicable, except as otherwise provided, to calendar quarters beginning on or after , without regard to whether or not final regulations to carry out the amendments by have been promulgated by such date, see , set out as a note under .

Pub. L. 103–66, title XIII, § 13631(g)(2)Aug. 10, 1993107 Stat. 645

42 U.S.C. 1396d(r)(1)(A)(i)“The amendments made by subparagraphs (A) and (B) of paragraph (1) [amending this section] shall first apply 90 days after the date the schedule referred to in subparagraphs [sic] (A)(i) and subparagraph (B)(iii) of section 1905(r)(1) of the Social Security Act [, (B)(iii)] (as amended by such respective subparagraphs) is first established.”

, , , provided that:

Effective Date of 1990 Amendment

section 4402(d)(2) of Pub. L. 101–508Jan. 1, 1991section 4402 of Pub. L. 101–508 section 4402(e) of Pub. L. 101–508 section 1396a of this titleAmendment by applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after , without regard to whether or not final regulations to carry out the amendments by have been promulgated by such date, see , set out as a note under .

Pub. L. 101–508Jan. 1, 1991section 4501 of Pub. L. 101–508 section 4501(e)(1) of Pub. L. 101–508 section 4501(f) of Pub. L. 101–508 section 1396a of this titleAmendment by section 4501(a), (c), (e)(1) of applicable to calendar quarters beginning on or after , without regard to whether or not regulations to implement the amendments by are promulgated by such date, except that amendment by is applicable to determinations of income for months beginning with January 1991, see , set out as a note under .

section 4601(a)(2) of Pub. L. 101–508July 1, 1991section 4601 of Pub. L. 101–508 section 4601(b) of Pub. L. 101–508 section 1396a of this titleAmendment by applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after , without regard to whether or not final regulations to carry out the amendments by have been promulgated by such date, see , set out as a note under .

Pub. L. 101–508 Pub. L. 101–239 section 4704(f) of Pub. L. 101–508 section 1396a of this titleAmendment by section 4704(c), (d), (e)(1) of effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989, , see , set out as a note under .

Pub. L. 101–508, title IV, § 4705(b)Nov. 5, 1990104 Stat. 1388–173

Pub. L. 101–239 section 1396a of this title“The amendments made by subsection (a) [amending this section] shall be effective as if included in the amendments made by section 6408(c)(1) of the Omnibus Budget Reconciliation Act of 1989 [, amending ].”

, , , provided that:

section 4711(a) of Pub. L. 101–508July 1, 1991section 4711 of Pub. L. 101–508 section 4711(e) of Pub. L. 101–508 section 1396a of this titleAmendment by applicable to home and community care furnished on or after , without regard to whether or not final regulations to carry out the amendments by have been promulgated by such date, see , set out as a note under .

section 4712(a) of Pub. L. 101–508July 1, 1991section 1396u(h) of this title section 4712 of Pub. L. 101–508 section 4712(c) of Pub. L. 101–508 section 1396u of this titleAmendment by applicable to community supported living arrangements services furnished on or after the later of , or 30 days after the publication of regulations setting forth interim requirements under without regard to whether or not final regulations to carry out the amendments by have been promulgated by such date, see , set out as an Effective Date note under .

section 4713(b) of Pub. L. 101–508Jan. 1, 1991section 4713(c) of Pub. L. 101–508 section 1396a of this titleAmendment by applicable to medical assistance furnished on or after , see , set out as a note under .

Pub. L. 101–508, title IV, § 4719(b)Nov. 5, 1990104 Stat. 1388–193

Nov. 5, 1990“The amendment made by subsection (a) [amending this section] shall take effect on the date of the enactment of this Act [].”

, , , provided that:

Pub. L. 101–508, title IV, § 4721(b)Nov. 5, 1990104 Stat. 1388–194

October 1, 1994“The amendment made by this section [amending this section] shall become effective with respect to personal care services provided on or after .”

, , , provided that:

Pub. L. 101–508, title IV, § 4755(a)(1)(B)Nov. 5, 1990104 Stat. 1388–209

Pub. L. 98–369“The amendment made by subparagraph (A) [amending this section] shall be effective as if included in the enactment of the Deficit Reduction Act of 1984 [].”

, , , provided that:

Effective Date of 1989 Amendment

Pub. L. 101–239Apr. 1, 1990section 6403 of Pub. L. 101–239 section 6403(e) of Pub. L. 101–239 section 1396a of this titleAmendment by section 6403(a), (c), (d)(2) of effective , without regard to whether or not final regulations to carry out the amendments by have been promulgated by such date, see , set out as a note under .

Pub. L. 101–239Apr. 1, 1990section 6404 of Pub. L. 101–239 section 6404(d) of Pub. L. 101–239 section 1396a of this titleAmendment by section 6404(a), (b) of applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after , without regard to whether or not final regulations to carry out the amendments by have been promulgated by such date, see , set out as a note under .

section 6405(a) of Pub. L. 101–239July 1, 1990section 6405(c) of Pub. L. 101–239 section 1396a of this titleAmendment by effective with respect to services furnished by a certified pediatric nurse practitioner or certified family nurse practitioner on or after , see , set out as a note under .

Pub. L. 101–239July 1, 1990section 6408(d) of Pub. L. 101–239 section 6408(d)(5) of Pub. L. 101–239 section 1396a of this titleAmendment by section 6408(d)(2), (4)(A), (B) of applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after , without regard to whether or not final regulations to carry out the amendments by have been promulgated by such date, see , set out as a note under .

Pub. L. 101–234Jan. 1, 1990section 201(c) of Pub. L. 101–234 section 1320a–7a of this titleAmendment by effective , see , set out as a note under .

Effective Date of 1988 Amendment

Pub. L. 100–647 Pub. L. 100–360 section 8434(c) of Pub. L. 100–647 section 1396a of this titleAmendment by effective as if included in the enactment of section 301 of the Medicare Catastrophic Coverage Act of 1988, , see , set out as a note under .

section 303(b)(2) of Pub. L. 100–485Apr. 1, 1990Oct. 1, 1990section 303(f)(1) of Pub. L. 100–485 section 1396a of this titleAmendment by applicable to payments under this subchapter for calendar quarters beginning on or after (or, in the case of the Commonwealth of Kentucky, ) (without regard to whether regulations to implement such amendment are promulgated by such date), with respect to families that cease to be eligible for aid under part A of subchapter IV of this chapter on or after that date, see , set out as a note under .

section 401(d)(2) of Pub. L. 100–485Oct. 1, 1990section 1308(a) of this title section 401(g) of Pub. L. 100–485 section 1396a of this titleAmendment by effective , except as provided in subsec. (m)(2) of this section and not effective for Puerto Rico, Guam, American Samoa, and the Virgin Islands, until the date of repeal of limitations contained in on payments to such jurisdictions for purposes of making maintenance payments under this part and part E of this subchapter, see , as amended, set out as a note under .

Pub. L. 100–485 Pub. L. 100–360 section 608(g)(1) of Pub. L. 100–485 section 704 of this titleAmendment by section 608(d)(14)(A)–(G), (J) of effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, , see , set out as a note under .

section 608(f)(3) of Pub. L. 100–485Oct. 13, 1988section 608(g)(2) of Pub. L. 100–485 section 704 of this titleAmendment by effective , see , set out as a note under .

Pub. L. 100–360Jan. 1, 1989Jan. 1, 1989section 301(h) of Pub. L. 100–360 section 1396a of this titleAmendment by section 301(a)(2)–(d) of applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after , without regard to whether or not final regulations to carry out such amendment have been promulgated by that date, with respect to medical assistance for monthly premiums under subchapter XVIII of this chapter for months beginning with January 1989, and items and services furnished on and after , see , set out as a note under .

section 411 of Pub. L. 100–360 Pub. L. 100–360 Pub. L. 100–203 Pub. L. 100–203 section 411(a) of Pub. L. 100–360 section 106 of Title 1Except as specifically provided in , amendment by section 411(h)(4)(E), (k)(4), (8) of , as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, , effective as if included in the enactment of that provision in , see , set out as a Reference to OBRA; Effective Date note under , General Provisions.

Pub. L. 100–360, title IV, § 411(k)(14)(B)July 1, 1988102 Stat. 799

July 1, 1988“The amendment made by subparagraph (A) [amending this section] shall take effect on the date of the enactment of this Act [].”

, , , provided that:

Effective Date of 1987 Amendment

section 4073(d) of Pub. L. 100–203July 1, 1988section 4073(e) of Pub. L. 100–203 section 1395k of this titleAmendment by effective with respect to services performed on or after , see , set out as a note under .

Pub. L. 100–203, title IV, § 4101(c)(3)Dec. 22, 1987101 Stat. 1330–141

“(A)

section 1396a of this titleOctober 1, 1988 The amendments made by this subsection [amending this section and ] shall apply to medical assistance furnished on or after .

“(B)

42 U.S.C. 1396d(n)(2) For purposes of section 1905(n)(2) of the Social Security Act [] (as amended by subsection (a) [probably means “subsection (c)”]) for medical assistance furnished during fiscal year 1989, any reference to ‘age of 7’ is deemed to be a reference to ‘age of 6’.”

, , , provided that:

Pub. L. 100–203, title IV, § 4103(b)Dec. 22, 1987101 Stat. 1330–146

“(1)

42 U.S.C. 1396January 1, 1988 The amendment made by subsection (a) [amending this section] applies (except as provided under paragraph (2)) to payments under title XIX of the Social Security Act [ et seq.] for calendar quarters beginning on or after , without regard to whether or not final regulations to carry out such amendment have been promulgated by such date.

“(2)

Dec. 22, 1987 In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendment made by subsection (a), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act [].”

, , , provided that:

Pub. L. 100–203, title IV, § 4105(b)Dec. 22, 1987101 Stat. 1330–147

January 1, 1988“The amendment made by subsection (a) [amending this section] shall apply to services furnished on or after , without regard to whether regulations to implement such amendment are promulgated by such date.”

, , , provided that:

Pub. L. 100–203Oct. 1, 1990section 1396r of this title Pub. L. 100–203 section 1396r of this titleAmendments by section 4211(e), (f), (h)(6) of applicable to nursing facility services furnished on or after , without regard to whether regulations implementing such amendments are promulgated by such date, except as otherwise specifically provided in , with transitional rule, see section 4214(a), (b)(2) of , as amended, set out as an Effective Date note under .

Effective Date of 1986 Amendment

Pub. L. 99–514 Pub. L. 99–272 section 1895(e) of Pub. L. 99–514 section 162 of Title 26Amendment by effective, except as otherwise provided, as if included in enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985, , see , set out as a note under , Internal Revenue Code.

Pub. L. 99–509July 1, 1987section 9403(h) of Pub. L. 99–509 section 1396a of this titleAmendment by section 9403(b), (d), (g)(3) of applicable to payments under this subchapter for calendar quarters beginning on or after , without regard to whether or not final regulations to carry out such amendments have been promulgated by such date, see , set out as a note under .

section 9404(b) of Pub. L. 99–509July 1, 1987section 9404(c) of Pub. L. 99–509 section 1396a of this titleAmendment by applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after , without regard to whether regulations to implement such amendments are promulgated by such date, see , set out as a note under .

section 9408(c)(1) of Pub. L. 99–509Oct. 21, 1986section 9408(d) of Pub. L. 99–509 section 1396a of this titleAmendment by applicable to services furnished on or after , see , set out as a note under .

Pub. L. 99–272, title IX, § 9501(d)(1)Apr. 7, 1986100 Stat. 202

“(A)

42 U.S.C. 1396July 1, 1986 The amendments made by subsection (a) [amending this section] apply (except as provided under subparagraph (B)) to payments under title XIX of the Social Security Act [ et seq.] for calendar quarters beginning on or after the [sic] , without regard to whether or not final regulations to carry out the amendments have been promulgated by that date.

“(B)

Apr. 7, 1986 In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by subsection (a), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act [].”

, , , provided that:

section 9505(a) of Pub. L. 99–272Apr. 7, 1986section 9505(e) of Pub. L. 99–272 section 1396a of this titleAmendment by applicable to medical assistance provided for hospice care furnished on or after , see , set out as a note under .

Pub. L. 99–272, title IX, § 9511(b)Apr. 7, 1986100 Stat. 212 Pub. L. 99–509, title IX, § 9435(d)(2)Oct. 21, 1986100 Stat. 2070

April 1, 1986“The amendment made by this section [amending this section] shall apply to services furnished on or after , without regard to whether or not regulations to carry out the amendment have been promulgated by that date.”

, , , as amended by , , , provided that:

Effective Date of 1984 Amendment

section 2335(f) of Pub. L. 98–369July 18, 1984section 2335(g) of Pub. L. 98–369 section 1395f of this titleAmendment by effective , see , set out as a note under .

section 2340(b) of Pub. L. 98–369July 18, 1984section 2340(c) of Pub. L. 98–369 section 1395x of this titleAmendment by effective , see , set out as a note under .

section 2361(b) of Pub. L. 98–369Oct. 1, 1984section 2361(d) of Pub. L. 98–369 section 1396a of this titleAmendment by applicable to calendar quarters beginning on or after , without regard to whether or not final regulations to carry out the amendment have been promulgated by such date, except as otherwise provided, see , set out as a note under .

Pub. L. 98–369, div. B, title III, § 2371(b)July 18, 198498 Stat. 1110

July 18, 1984“The amendment made by subsection (a) [amending this section] shall apply to services furnished on or after the date of the enactment of this Act [].”

, , , provided that:

Effective Date of 1982 Amendment

section 136(c) of Pub. L. 97–248Oct. 1, 1982section 136(e) of Pub. L. 97–248 section 1301 of this titleAmendment by effective , see , set out as a note under .

Pub. L. 97–248 Pub. L. 97–35 section 137(d)(2) of Pub. L. 97–248 section 1396a of this titleAmendment by section 137(b)(17), (18) of effective as if originally included as part of this section as this section was amended by the Omnibus Budget Reconciliation Act of 1981, , see , set out as a note under .

July 1, 1978“The amendments made by subsections (a) and (b) [amending this section] shall become effective on .”

, , , provided that:

Effective Date of 1977 Amendment

Pub. L. 95–210Dec. 13, 1977section 2(f) of Pub. L. 95–210 section 1395cc of this titleAmendment by applicable to medical assistance provided, under a State plan approved under subchapter XIX of this chapter, on and after the first day of the first calendar quarter that begins more than six months after , with exception for plans requiring State legislation, see , set out as a note under .

Effective Date of 1973 Amendment

Pub. L. 93–233 section 1396b of this titleDec. 31, 1973section 13(d) of Pub. L. 93–233 section 1396a of this titleAmendment by section 13(a)(13)–(18) of effective with respect to payments under for calendar quarters commencing after , see , set out as a note under .

Effective Date of 1972 Amendment

Pub. L. 92–603, title II, § 212(b)Oct. 30, 197286 Stat. 1384

42 U.S.C. 1396d(e)Oct. 30, 1972“The provisions of subsection (e) of section 1905 of the Social Security Act [] (as added by subsection (a) of this section) shall be applicable in the case of services performed on or after the date of enactment of this Act [].”

, , , provided that:

section 247(b) of Pub. L. 92–603Dec. 31, 1972section 247(c) of Pub. L. 92–603 section 1395f of this titleAmendment by effective with respect to services furnished after , see , set out as a note under .

Pub. L. 92–603, title II, § 275(b)Oct. 30, 197286 Stat. 1452

June 30, 1973“The amendment made by this section [amending this section] shall be effective with respect to services furnished after .”

, , , provided that:

Pub. L. 92–603, title II, § 297(b)Oct. 30, 197286 Stat. 1460

December 31, 1972“The amendment made by this section [amending this section] shall apply with respect to services furnished after .”

, , , provided that:

Effective Date of 1971 Amendment

Pub. L. 92–223Jan. 1, 1972section 4(d) of Pub. L. 92–223 section 1396a of this titleAmendment by effective , see , set out as a note under .

Effective Date of 1968 Amendment

Pub. L. 90–248, title II, § 248(e)Jan. 2, 196881 Stat. 919, , , provided that the amendment made by that section is effective with respect to quarters after 1967.

Construction of 2004 Amendment

Pub. L. 108–357, title VII, § 712(a)(2)Oct. 22, 2004118 Stat. 1558

42 U.S.C. 1396d 42 U.S.C. 1396Oct. 22, 200442 U.S.C. 1396d(r)“Nothing in subsections (a)(27) or (x) of section 1905 of the Social Security Act (), as added by paragraph (1), shall be construed as implying that a State medicaid program under title XIX of such Act [ et seq.] could not have treated, prior to the date of enactment of this Act [], any of the primary and secondary medical strategies and treatment and services described in such subsections as medical assistance under such program, including as early and periodic screening, diagnostic, and treatment services under section 1905(r) of such Act [].”

, , , provided that:

Construction of 1999 Amendment

Pub. L. 106–170 Pub. L. 106–169 Pub. L. 106–170 section 121(c)(1) of Pub. L. 106–169 section 1396a of this titleAmendment by to be executed as if had been enacted after the enactment of , see , set out as a note under .

Review of State Implementation of Early and Periodic Screening, Diagnostic, and Treatment Services

Pub. L. 117–159, div. A, title I, § 11004June 25, 2022136 Stat. 1319

“(a)

Review.—

“(1)

In general .—

June 25, 2022Not later than 24 months after the date of enactment of Act [probably means “this Act”, ], and every 5 years thereafter, the Secretary shall—

“(A)

42 U.S.C. 1396a(a)(43) review State implementation of the requirements for providing early and periodic screening, diagnostic, and treatment services under Medicaid in accordance with sections 1902(a)(43), 1905(a)(4)(B), and 1905(r) of the Social Security Act (, 1396d(a)(4)(B), 1396d(r)), including with respect to the provision of such services by managed care organizations, prepaid inpatient health plans, prepaid ambulatory health plans, and primary care case managers;

“(B)

identify gaps and deficiencies with respect to State compliance with such requirements;

“(C)

provide technical assistance to States to address such gaps and deficiencies; and

“(D)

issue guidance to States on the Medicaid coverage requirements for such services that includes best practices for ensuring children have access to comprehensive health care services, including children without a mental health or substance use disorder diagnosis.

“(2)

Reports to congress .—

Not later than 6 months after each date on which the Secretary completes the activities described in paragraph (1), the Secretary shall submit to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives a report on the most recent activities completed for purposes of such paragraph that includes the findings made, and descriptions of actions taken by the Secretary or by States as a result of such activities, and any additional actions the Secretary plans to carry out or that States are required to carry out as a result of such activities.

“(3)

Funding .—

Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary to carry out this subsection, to remain available until expended, $5,000,000, for each of fiscal years 2023 and 2024, and $1,000,000 for each fiscal year thereafter.

“(b)

GAO Study and Report.—

“(1)

Study .—

42 U.S.C. 1396d(a)(4)(B)42 U.S.C. 1396d(r)42 U.S.C. 1396a(a)(43)The Comptroller General of the United States (in this subsection referred to as the ‘Comptroller General’) shall conduct a study evaluating State implementation under Medicaid of the early and periodic screening, diagnostic, and treatment services benefit required for children by section 1905(a)(4)(B) of the Social Security Act () and as defined in section 1905(r) of such Act () and provided in accordance with the requirements of section 1902(a)(43) of such Act (), specifically with respect to State oversight of managed care organizations, prepaid inpatient health plans, prepaid ambulatory health plans, and primary care case managers, and shall provide recommendations as appropriate to improve State compliance with the requirements for providing such benefit, State oversight of managed care organizations, prepaid inpatient health plans, prepaid ambulatory health plans, and primary care case managers, and oversight of State programs under Medicaid by the Administrator of the Centers for Medicare & Medicaid Services.

“(2)

Report .—

Not later than 3 years after the date of enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1) that includes the recommendations required by such paragraph, as well as recommendations for such legislation and administrative action as the Comptroller General determines appropriate.

“(c)

Definitions .—

In this section:

“(1)

Medicaid .—

42 U.S.C. 1396The term ‘Medicaid’ means the program established under title XIX of the Social Security Act ( et seq.).

“(2)

Secretary .—

Except as otherwise provided, the term ‘Secretary’ means the Secretary of Health and Human Services.

“(3)

State .—

42 U.S.C. 1301(a)(1)42 U.S.C. 1396The term ‘State’ has the meaning given that term in section 1101(a)(1) of the Social Security Act () for purposes of titles XIX and XXI of such Act [ et seq., 1397aa et seq.].”

, , , provided that:

Additional Support for Medicaid Home and Community-Based Services During the COVID–19 Emergency

Pub. L. 117–2, title IX, § 9817Mar. 11, 2021135 Stat. 216

“(a)

Increased FMAP.—

“(1)

In general .—

42 U.S.C. 1396d(b)42 U.S.C. 1396d 42 U.S.C. 1396n(k)Public Law 116–127 42 U.S.C. 1308Notwithstanding section 1905(b) of the Social Security Act () or section 1905(ff), in the case of a State that meets the HCBS program requirements under subsection (b), the Federal medical assistance percentage determined for the State under section 1905(b) of such Act (or, if applicable, under section 1905(ff)) and, if applicable, increased under subsection (y), (z), (aa), or (ii) of section 1905 of such Act (), section 1915(k) of such Act (), or section 6008(a) of the Families First Coronavirus Response Act () [set out as a note below], shall be increased by 10 percentage points with respect to expenditures of the State under the State Medicaid program for home and community-based services (as defined in paragraph (2)(B)) that are provided during the HCBS program improvement period (as defined in paragraph (2)(A)). In no case may the application of the previous sentence result in the Federal medical assistance percentage determined for a State being more than 95 percent with respect to such expenditures. Any payment made to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa for expenditures on medical assistance that are subject to the Federal medical assistance percentage increase specified under the first sentence of this paragraph shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108 of the Social Security Act ().

“(2)

Definitions .—

In this section:

“(A)

HCBS program improvement period .—

The term ‘HCBS program improvement period’ means, with respect to a State, the period—

“(i)

April 1, 2021 beginning on ; and

“(ii)

March 31, 2022 ending on .

“(B)

Home and community-based services .—

The term ‘home and community-based services’ means any of the following:

“(i)

42 U.S.C. 1396d(a) Home health care services authorized under paragraph (7) of section 1905(a) of the Social Security Act ().

“(ii)

Personal care services authorized under paragraph (24) of such section.

“(iii)

PACE services authorized under paragraph (26) of such section.

“(iv)

42 U.S.C. 1396n 42 U.S.C. 1315 42 U.S.C. 1396u–7 Home and community-based services authorized under subsections (b), (c), (i), (j), and (k) of section 1915 of such Act (), such services authorized under a waiver under section 1115 of such Act (), and such services through coverage authorized under section 1937 of such Act ().

“(v)

42 U.S.C. 1396d(a)(19)42 U.S.C. 1396n(g) Case management services authorized under section 1905(a)(19) of the Social Security Act () and section 1915(g) of such Act ().

“(vi)

42 U.S.C. 1396d(a)(13) Rehabilitative services, including those related to behavioral health, described in section 1905(a)(13) of such Act ().

“(vii)

Such other services specified by the Secretary of Health and Human Services.

“(C)

Eligible individual .—

The term ‘eligible individual’ means an individual who is eligible for and enrolled for medical assistance under a State Medicaid program and includes an individual who becomes eligible for medical assistance under a State Medicaid program when removed from a waiting list.

“(D)

Medicaid program .—

42 U.S.C. 1396 42 U.S.C. 1315The term ‘Medicaid program’ means, with respect to a State, the State program under title XIX of the Social Security Act ( et seq.) (including any waiver or demonstration under such title or under section 1115 of such Act () relating to such title).

“(E)

State .—

42 U.S.C. 1396The term ‘State’ has the meaning given such term for purposes of title XIX of the Social Security Act ( et seq.).

“(b)

State Requirements for FMAP Increase .—

As conditions for receipt of the increase under subsection (a) to the Federal medical assistance percentage determined for a State, the State shall meet each of the following requirements (referred to in subsection (a) as the HCBS program requirements):

“(1)

Supplement, not supplant .—

April 1, 2021The State shall use the Federal funds attributable to the increase under subsection (a) to supplement, and not supplant, the level of State funds expended for home and community-based services for eligible individuals through programs in effect as of .

“(2)

Required implementation of certain activities .—

The State shall implement, or supplement the implementation of, one or more activities to enhance, expand, or strengthen home and community-based services under the State Medicaid program.”

, , , provided that:

Temporary Increase of Medicaid FMAP

Pub. L. 116–127, div. F, § 6008(a)Mar. 18, 2020134 Stat. 208 Pub. L. 116–136, div. A, title III, § 3720Mar. 27, 2020134 Stat. 427 Pub. L. 116–260, div. X, § 11Dec. 27, 2020134 Stat. 2417 Pub. L. 117–328, div. FF, title V, § 5131(a)Dec. 29, 2022136 Stat. 5949

“(a)

In General.—

“(1)

Temporary fmap increase .—

42 U.S.C. 1320b–5(g)December 31, 202342 U.S.C. 1396d(b)Subject to subsections (b) and (f), for each calendar quarter occurring during the period beginning on the first day of the emergency period defined in paragraph (1)(B) of section 1135(g) of the Social Security Act () and ending on , the Federal medical assistance percentage determined for each State, including the District of Columbia, American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, Puerto Rico, and the United States Virgin Islands, under section 1905(b) of the Social Security Act () shall be increased by the applicable number of percentage points for the quarter (as determined in paragraph (2)).

“(2)

Applicable number of percentage points .—

For purposes of paragraph (1), the applicable number of percentage points for a calendar quarter is the following:

“(A)

March 31, 2023 For each calendar quarter that occurs during the portion of the period described in paragraph (1) that ends on , 6.2 percentage points.

“(B)

April 1, 2023June 30, 2023 For the calendar quarter that begins on , and ends on , 5 percentage points.

“(C)

July 1, 2023September 30, 2023 For the calendar quarter that begins on , and ends on , 2.5 percentage points.

“(D)

October 1, 2023December 31, 2023 For the calendar quarter that begins on , and ends on , 1.5 percentage points.

“(b)

Requirement for All States .—

A State described in subsection (a)(1) may not receive the increase described in such subsection in the Federal medical assistance percentage for such State, with respect to a quarter, if—

“(1)

42 U.S.C. 1396 42 U.S.C. 1315January 1, 2020 eligibility standards, methodologies, or procedures under the State plan of such State under title XIX of the Social Security Act ( et seq.) (including any waiver under such title or section 1115 of such Act ()) are more restrictive during such quarter than the eligibility standards, methodologies, or procedures, respectively, under such plan (or waiver) as in effect on ;

“(2)

42 U.S.C. 1396ooJanuary 1, 2020 the amount of any premium imposed by the State pursuant to section 1916 or 1916A of such Act (, 1396–1) during such quarter exceeds the amount of such premium as of ;

“(3)

March 18, 2020March 18, 2020March 31, 2023March 31, 2023 the State fails to provide that an individual who is enrolled for benefits under such plan (or waiver) as of , or enrolls for benefits under such plan (or waiver) during the period beginning on , and ending , shall be treated as eligible for such benefits through , unless the individual requests a voluntary termination of eligibility or the individual ceases to be a resident of the State; or

“(4)

the State does not provide coverage under such plan (or waiver), without the imposition of cost sharing, during such quarter for any testing services and treatments for COVID–19, including vaccines, specialized equipment, and therapies.

“(d)

Delay in Application of Premium Requirement .—

During the 30 day period beginning on the date of enactment of this Act, a State shall not be ineligible for the increase to the Federal medical assistance percentage of the State described in subsection (a) on the basis that the State imposes a premium that violates the requirement of subsection (b)(2) if such premium was in effect on the date of enactment of this Act.

“(e)

Application to Title IV-E Payments .—

42 U.S.C. 670 42 U.S.C. 1396If the District of Columbia receives the increase described in subsection (a) in the Federal medical assistance percentage for the District of Columbia with respect to a quarter, the Federal medical assistance percentage for the District of Columbia, as so increased, shall apply to payments made to the District of Columbia under part E of title IV of the Social Security Act ( et seq.) for that quarter, and the payments under such part shall be deemed to be made on the basis of the Federal medical assistance percentage applied with respect to such District for purposes of title XIX of such Act ( et seq.) and as increased under subsection (a).

“(f)

Eligibility Redeterminations During Transition Period.—

“(1)

In general .—

April 1, 2023December 31, 2023April 1, 2023 For each calendar quarter occurring during the portion of the period described in subsection (a)(1) that begins on , and ends on (such portion to be referred to in this subsection as the ‘transition period’), if a State described in such subsection satisfies the conditions of subsection (b) and paragraph (2) of this subsection, the State shall receive the increase to the Federal medical assistance percentage of the State applicable under subsection (a). Nothing in this subsection shall be construed as prohibiting a State, following the expiration of the condition described in paragraph (3) of subsection (b), from initiating renewals, post-enrollment verifications, and redeterminations over a 12-month period for all individuals who are enrolled in such plan (or waiver) as of .

“(2)

Conditions for fmap increase during transition period .—

The conditions of this paragraph with respect to a State and the transition period are the following:

“(A)

Compliance with federal requirements .—

42 U.S.C. 1396a(e)(14)(A)The State conducts eligibility redeterminations under title XIX of the Social Security Act in accordance with all Federal requirements applicable to such redeterminations, including renewal strategies authorized under section 1902(e)(14)(A) of the Social Security Act () or other alternative processes and procedures approved by the Secretary of Health and Human Services.

“(B)

Maintenance of up-to-date contact information .—

The State, using the National Change of Address Database Maintained by the United States Postal Service, State health and human services agencies, or other reliable sources of contact information, attempts to ensure that it has up-to-date contact information (including a mailing address, phone number, and email address) for each individual for whom the State conducts an eligibility redetermination.

“(C)

Requirement to attempt to contact beneficiaries prior to disenrollment .—

The State does not disenroll from the State plan or waiver any individual who is determined ineligible for medical assistance under the State plan or waiver pursuant to such a redetermination on the basis of returned mail unless the State first undertakes a good faith effort to contact the individual using more than one modality.

“(g)

Applicable Quarters .—

A State that ceases to meet the requirements of subsection (b) or (f) (as applicable) shall not qualify for the increase described in subsection (a) in the Federal medical assistance percentage for such State for the calendar quarter in which the State ceases to meet such requirements.”

, (b), (d)–(g), , , as amended by , , ; , , ; , , , provided that:

Pub. L. 111–5, div. B, title V, § 5001Feb. 17, 2009123 Stat. 496 Pub. L. 111–226, title II, § 201Aug. 10, 2010124 Stat. 2393June 30, 2011, , , as amended by , , , provided for a temporary increase of the Federal medical assistance percentage rate that States are reimbursed for most Medicaid expenditures through .

Incentives for States To Offer Home and Community-Based Services as a Long-Term Care Alternative to Nursing Homes

Pub. L. 111–148, title X, § 10202Mar. 23, 2010124 Stat. 923

“(a)

State Balancing Incentive Payments Program .—

42 U.S.C. 1396d(b)Notwithstanding section 1905(b) of the Social Security Act (), in the case of a balancing incentive payment State, as defined in subsection (b), that meets the conditions described in subsection (c), during the balancing incentive period, the Federal medical assistance percentage determined for the State under section 1905(b) of such Act and, if applicable, increased under subsection (z) or (aa) shall be increased by the applicable percentage points determined under subsection (d) with respect to eligible medical assistance expenditures described in subsection (e).

“(b)

Balancing Incentive Payment State .—

A balancing incentive payment State is a State—

“(1)

in which less than 50 percent of the total expenditures for medical assistance under the State Medicaid program for a fiscal year for long-term services and supports (as defined by the Secretary under subsection (f))(1)) [sic] are for non-institutionally-based long-term services and supports described in subsection (f)(1)(B);

“(2)

that submits an application and meets the conditions described in subsection (c); and

“(3)

that is selected by the Secretary to participate in the State balancing incentive payment program established under this section.

“(c)

Conditions .—

The conditions described in this subsection are the following:

“(1)

Application .—

The State submits an application to the Secretary that includes, in addition to such other information as the Secretary shall require—

“(A)

a proposed budget that details the State’s plan to expand and diversify medical assistance for non-institutionally-based long-term services and supports described in subsection (f)(1)(B) under the State Medicaid program during the balancing incentive period and achieve the target spending percentage applicable to the State under paragraph (2), including through structural changes to how the State furnishes such assistance, such as through the establishment of a ‘no wrong door—single entry point system’, optional presumptive eligibility, case management services, and the use of core standardized assessment instruments, and that includes a description of the new or expanded offerings of such services that the State will provide and the projected costs of such services; and

“(B)

42 U.S.C. 1396n(i)42 U.S.C. 1382(b)(1) in the case of a State that proposes to expand the provision of home and community-based services under its State Medicaid program through a State plan amendment under section 1915(i) of the Social Security Act [], at the option of the State, an election to increase the income eligibility for such services from 150 percent of the poverty line to such higher percentage as the State may establish for such purpose, not to exceed 300 percent of the supplemental security income benefit rate established by section 1611(b)(1) of the Social Security Act ().

“(2)

Target spending percentages.—

“(A)

October 1, 2015 In the case of a balancing incentive payment State in which less than 25 percent of the total expenditures for long-term services and supports under the State Medicaid program for fiscal year 2009 are for home and community-based services, the target spending percentage for the State to achieve by not later than , is that 25 percent of the total expenditures for long-term services and supports under the State Medicaid program are for home and community-based services.

“(B)

October 1, 2015 In the case of any other balancing incentive payment State, the target spending percentage for the State to achieve by not later than , is that 50 percent of the total expenditures for long-term services and supports under the State Medicaid program are for home and community-based services.

“(3)

Maintenance of eligibility requirements .—

December 31, 2010The State does not apply eligibility standards, methodologies, or procedures for determining eligibility for medical assistance for non-institutionally-based long-term services and supports described in subsection (f)(1)(B) under the State Medicaid program that are more restrictive than the eligibility standards, methodologies, or procedures in effect for such purposes on .

“(4)

Use of additional funds .—

The State agrees to use the additional Federal funds paid to the State as a result of this section only for purposes of providing new or expanded offerings of non-institutionally-based long-term services and supports described in subsection (f)(1)(B) under the State Medicaid program.

“(5)

Structural changes .—

The State agrees to make, not later than the end of the 6-month period that begins on the date the State submits an application under this section, the following changes:

“(A)

No wrong door—single entry point system ‘’.—

Development of a statewide system to enable consumers to access all long-term services and supports through an agency, organization, coordinated network, or portal, in accordance with such standards as the State shall establish and that shall provide information regarding the availability of such services, how to apply for such services, referral services for services and supports otherwise available in the community, and determinations of financial and functional eligibility for such services and supports, or assistance with assessment processes for financial and functional eligibility.

“(B)

Conflict-free case management services .—

Conflict-free case management services to develop a service plan, arrange for services and supports, support the beneficiary (and, if appropriate, the beneficiary’s caregivers) in directing the provision of services and supports for the beneficiary, and conduct ongoing monitoring to assure that services and supports are delivered to meet the beneficiary’s needs and achieve intended outcomes.

“(C)

Core standardized assessment instruments .—

Development of core standardized assessment instruments for determining eligibility for non-institutionally-based long-term services and supports described in subsection (f)(1)(B), which shall be used in a uniform manner throughout the State, to determine a beneficiary’s needs for training, support services, medical care, transportation, and other services, and develop an individual service plan to address such needs.

“(6)

Data collection .—

The State agrees to collect from providers of services and through such other means as the State determines appropriate the following data:

“(A)

Services data .—

Services data from providers of non-institutionally-based long-term services and supports described in subsection (f)(1)(B) on a per-beneficiary basis and in accordance with such standardized coding procedures as the State shall establish in consultation with the Secretary.

“(B)

Quality data .—

Quality data on a selected set of core quality measures agreed upon by the Secretary and the State that are linked to population-specific outcomes measures and accessible to providers.

“(C)

Outcomes measures .—

Outcomes measures data on a selected set of core population-specific outcomes measures agreed upon by the Secretary and the State that are accessible to providers and include—

“(i)

measures of beneficiary and family caregiver experience with providers;

“(ii)

measures of beneficiary and family caregiver satisfaction with services; and

“(iii)

measures for achieving desired outcomes appropriate to a specific beneficiary, including employment, participation in community life, health stability, and prevention of loss in function.

“(d)

Applicable Percentage Points Increase in FMAP.—

The applicable percentage points increase is—

“(1)

in the case of a balancing incentive payment State subject to the target spending percentage described in subsection (c)(2)(A), 5 percentage points; and

“(2)

in the case of any other balancing incentive payment State, 2 percentage points.

“(e)

Eligible Medical Assistance Expenditures.—

“(1)

In general .—

Subject to paragraph (2), medical assistance described in this subsection is medical assistance for non-institutionally-based long-term services and supports described in subsection (f)(1)(B) that is provided by a balancing incentive payment State under its State Medicaid program during the balancing incentive payment period.

“(2)

Limitation on payments .—

In no case may the aggregate amount of payments made by the Secretary to balancing incentive payment States under this section during the balancing incentive period exceed $3,000,000,000.

“(f)

Definitions .—

In this section:

“(1)

Long-term services and supports defined .—

The term ‘long-term services and supports’ has the meaning given that term by Secretary and may include any of the following (as defined for purposes of State Medicaid programs):

“(A)

Institutionally-based long-term services and supports.—

Services provided in an institution, including the following:

“(i)

Nursing facility services.

“(ii)

42 U.S.C. 1396d(a)(15) Services in an intermediate care facility for the mentally retarded described in subsection (a)(15) of section 1905 of such Act [].

“(B)

Non-institutionally-based long-term services and supports.—

Services not provided in an institution, including the following:

“(i)

42 U.S.C. 1396n(c)42 U.S.C. 1315 Home and community-based services provided under subsection (c), (d), or (i) of section 1915 of such Act [, (d), (i)] or under a waiver under section 1115 of such Act [].

“(ii)

Home health care services.

“(iii)

Personal care services.

“(iv)

42 U.S.C. 1396d(a)(26) Services described in subsection (a)(26) of section 1905 of such Act [] (relating to PACE program services).

“(v)

42 U.S.C. 1396n(j) Self-directed personal assistance services described in section 1915(j) of such Act [].

“(2)

Balancing incentive period .—

October 1, 2011September 30, 2015The term ‘balancing incentive period’ means the period that begins on , and ends on .

“(3)

Poverty line .—

42 U.S.C. 1397jj(c)(5)The term ‘poverty line’ has the meaning given that term in section 2110(c)(5) of the Social Security Act ().

“(4)

State medicaid program .—

42 U.S.C. 1396The term ‘State Medicaid program’ means the State program for medical assistance provided under a State plan under title XIX of the Social Security Act [ et seq.] and under any waiver approved with respect to such State plan.”

, , , provided that:

State Authority Under Medicaid

Pub. L. 111–3, title I, § 115Feb. 4, 2009123 Stat. 35

42 U.S.C. 1396d“Notwithstanding any other provision of law, including the fourth sentence of subsection (b) of section 1905 of the Social Security Act () or subsection (u) of such section, at State option, the Secretary shall provide the State with the Federal medical assistance percentage determined for the State for Medicaid with respect to expenditures described in section 1905(u)(2)(A) of such Act or otherwise made to provide medical assistance under Medicaid to a child who could be covered by the State under CHIP.”

, , , provided that:

section 1(c) of Pub. L. 111–3 section 1396 of this title[For definitions of “CHIP”, “Medicaid”, and “Secretary”, see , set out as a Definitions note under .]

Adjustment in Computation of FMAP To Disregard an Extraordinary Employer Pension Contribution

Pub. L. 111–3, title VI, § 614Feb. 4, 2009123 Stat. 101

“(a)

In General .—

42 U.S.C. 1396Only for purposes of computing the FMAP (as defined in subsection (e)) for a State for a fiscal year (beginning with fiscal year 2006) and applying the FMAP under title XIX of the Social Security Act [ et seq.], any significantly disproportionate employer pension or insurance fund contribution described in subsection (b) shall be disregarded in computing the per capita income of such State, but shall not be disregarded in computing the per capita income for the continental United States (and Alaska) and Hawaii.

“(b)

Significantly Disproportionate Employer Pension and Insurance Fund Contribution.—

“(1)

In general .—

For purposes of this section, a significantly disproportionate employer pension and insurance fund contribution described in this subsection with respect to a State is any identifiable employer contribution towards pension or other employee insurance funds that is estimated to accrue to residents of such State for a calendar year (beginning with calendar year 2003) if the increase in the amount so estimated exceeds 25 percent of the total increase in personal income in that State for the year involved.

“(2)

Data to be used .—

Feb. 4, 2009For estimating and adjustment a FMAP already calculated as of the date of the enactment of this Act [] for a State with a significantly disproportionate employer pension and insurance fund contribution, the Secretary shall use the personal income data set originally used in calculating such FMAP.

“(3)

Special adjustment for negative growth .—

If in any calendar year the total personal income growth in a State is negative, an employer pension and insurance fund contribution for the purposes of calculating the State’s FMAP for a calendar year shall not exceed 125 percent of the amount of such contribution for the previous calendar year for the State.

“(c)

Hold Harmless .—

No State shall have its FMAP for a fiscal year reduced as a result of the application of this section.

“(d)

Report .—

May 15, 2009Not later than , the Secretary shall submit to the Congress a report on the problems presented by the current treatment of pension and insurance fund contributions in the use of Bureau of Economic Affairs calculations for the FMAP and for Medicaid and on possible alternative methodologies to mitigate such problems.

“(e)

Defined FMAP .—

42 U.S.C. 1396(d)For purposes of this section, the term ‘FMAP’ means the Federal medical assistance percentage, as defined in section 1905(b) of the Social Security Act ( [1396d[b]]).”

, , , provided that:

section 1(c) of Pub. L. 111–3 section 1396 of this title[For definitions of “Medicaid” and “Secretary”, see , set out as a Definitions note under .]

Temporary State Fiscal Relief

Pub. L. 108–27, title IV, § 401(a)May 28, 2003117 Stat. 764 Pub. L. 108–74, § 2(a)Aug. 15, 2003117 Stat. 896Oct. 1, 2004Pub. L. 108–27, title IV, § 401(a)(9)May 28, 2003117 Stat. 766, , , as amended by , , , which authorized $10,000,000,000 for an increase of the Medicaid Federal medical assistance percentage (FMAP) for the last 2 calendar quarters of fiscal year 2003 and the first 3 quarters of fiscal year 2004 and set forth State eligibility requirements, and was repealed effective , by , , .

Alaska FMAPs

Pub. L. 106–554, § 1(a)(6) [title VII, § 706]Dec. 21, 2000114 Stat. 2763

42 U.S.C. 1396d(b)42 U.S.C. 1396“Notwithstanding the first sentence of section 1905(b) of the Social Security Act (), only with respect to each of fiscal years 2001 through 2005, for purposes of titles XIX and XXI of the Social Security Act [ et seq., 1397aa et seq.], the State percentage used to determine the Federal medical assistance percentage for Alaska shall be that percentage which bears the same ratio to 45 percent as the square of the adjusted per capita income of Alaska (determined by dividing the State’s 3-year average per capita income by 1.05) bears to the square of the per capita income of the 50 States.”

, , , 2763A–577, provided that:

Pub. L. 105–33, title IV, § 4725(a)Aug. 5, 1997111 Stat. 518

42 U.S.C. 1396d(b)“Notwithstanding the first sentence of section 1905(b) of the Social Security Act (), the Federal medical assistance percentage determined under such sentence for Alaska shall be 59.8 percent but only with respect to—

“(1)

42 U.S.C. 1396 42 U.S.C. 1397aa items and services furnished under a State plan under title XIX [ et seq.] or under a State child health plan under title XXI of such Act [ et seq.] during fiscal years 1998, 1999, and 2000;

“(2)

payments made on a capitation or other risk-basis under such titles for coverage occurring during such period; and

“(3)

42 U.S.C. 1396r–4(f) payments under title XIX of such Act attributable to DSH allotments for such State determined under section 1923(f) of such Act () for such fiscal years.”

, , , provided that:

EPSDT Benefit Study and Report

Pub. L. 105–33, title IV, § 4744Aug. 5, 1997111 Stat. 524

“(a)

Study.—

“(1)

In general .—

42 U.S.C. 1396 42 U.S.C. 1396d(r)The Secretary of Health and Human Services, in consultation with Governors, directors of State medicaid programs, the American Academy of Actuaries, and representatives of appropriate provider and beneficiary organizations, shall conduct a study of the provision of early and periodic screening, diagnostic, and treatment services under the medicaid program under title XIX of the Social Security Act [ et seq.] in accordance with the requirements of section 1905(r) of such Act ().

“(2)

Required contents .—

The study conducted under paragraph (1) shall include examination of the actuarial value of the provision of such services under the medicaid program and an examination of the portions of such actuarial value that are attributable to paragraph (5) of section 1905(r) of such Act and to the second sentence of such section.

“(b)

Report .—

Aug. 5, 1997Not later than 12 months after the date of the enactment of this Act [], the Secretary of Health and Human Services shall submit a report to Congress on the results of the study conducted under subsection (a).”

, , , provided that:

July 16, 1996References to Provisions of Part A of Subchapter IV Considered References to Such Provisions as in Effect

July 16, 1996section 1396u–1(a) of this titleFor provisions that certain references to provisions of part A (§ 601 et seq.) of subchapter IV of this chapter be considered references to such provisions of part A as in effect , see .

Limitation on Disallowances or Deferral of Federal Financial Participation for Certain Inpatient Psychiatric Hospital Services for Individuals Under Age 21

Pub. L. 101–508, title IV, § 4706Nov. 5, 1990104 Stat. 1388–173

“(a)

In General .—

(1)

42 U.S.C. 1396d(h)42 U.S.C. 301 If the Secretary of Health and Human Services makes a determination that a psychiatric facility has failed to comply with certification of need requirements for inpatient psychiatric hospital services for individuals under age 21 pursuant to section 1905(h) of the Social Security Act [], and such determination has not been subject to a final judicial decision, any disallowance or deferral of Federal financial participation under such Act [ et seq.] based on such determination shall only apply to the period of time beginning with the first day of noncompliance and ending with the date by which the psychiatric facility develops documentation (using plan of care or utilization review procedures) of the need for inpatient care with respect to such individuals.

“(2)

42 U.S.C. 1396 Any disallowance of Federal financial participation under title XIX of the Social Security Act [ et seq.] relating to the failure of a psychiatric facility to comply with certification of need requirements—

“(A)

shall not exceed 25 percent of the amount of Federal financial participation for the period described in paragraph (1); and

“(B)

shall not apply to any fiscal year before the fiscal year that is 3 years before the fiscal year in which the determination of noncompliance described in paragraph (1) is made.

“(b)

Effective Date .—

Nov. 5, 1990Subsection (a) shall apply to disallowance actions and deferrals of Federal financial participation with respect to services provided before the date of enactment of this Act [].”

, , , provided that:

Intermediate Care Facility; Access and Visitation Rights

Pub. L. 100–360, title IV, § 411llJuly 1, 1988102 Stat. 803 Pub. L. 100–485, title VI, § 608(d)(27)(E)Oct. 13, 1988102 Stat. 2423

July 1, 198842 U.S.C. 1396r(c)42 U.S.C. 1396r 42 U.S.C. 1396d(c)“Effective as of the date of the enactment of this Act [] and until the effective date of section 1919(c) of such Act [, see Effective Date note set out under ], section 1905(c) of the Social Security Act [] is deemed to include the requirement described in section 1919(c)(3)(A) of such Act (as inserted by section 4211(a)(3) of OBRA).”

()(3)(C)(i), formerly § 411()(3)(C), , , as redesignated by , , , provided that:

Regulations for Intermediate Care Facilities for Mentally Retarded

Pub. L. 99–272, title IX, § 9514Apr. 7, 1986100 Stat. 213

42 U.S.C. 1396Apr. 7, 1986“The Secretary of Health and Human Services shall promulgate proposed regulations revising standards for intermediate care facilities for the mentally retarded under title XIX of the Social Security Act [ et seq.] within 60 days after the date of the enactment of this Act [].”

, , , provided that:

Life Safety Code Recognition

Pub. L. 99–272, title IX, § 9515Apr. 7, 1986100 Stat. 213

42 U.S.C. 1396d(c)“For purposes of section 1905(c) of the Social Security Act [], an intermediate care facility for the mentally retarded (as defined in section 1905(d) of such Act) which meets the requirements of the relevant sections of the 1985 edition of the Life Safety Code of the National Fire Protection Association shall be deemed to meet the fire safety requirements for intermediate care facilities for the mentally retarded until such time as the Secretary specifies a later edition of the Life Safety Code for purposes of such section, or the Secretary determines that more stringent standards are necessary to protect the safety of residents of such facilities.”

, , , provided that:

Study of Federal Medical Assistance Percentage Formula and of Adjustments of Target Amounts for Federal Medicaid Expenditures; Report to Congress

Pub. L. 97–35, title XXI, § 2165Aug. 13, 198195 Stat. 806Oct. 1, 1982, , , directed the Comptroller General, in consultation with the Advisory Committee for Intergovernmental Relations, to study the Federal medical assistance percentage formula as applicable to distribution of Federal funds to States, with a view to revising the medicaid matching formula so as to take into account factors which might result in a more equitable distribution of Federal funds to States under this chapter, and to report to Congress on such study not later than .

Costs Charged to Personal Funds of Patients in Intermediate Care Facilities; Costs Included in Charges for Services; Regulations

Pub. L. 95–292, § 8(c)June 13, 197892 Stat. 316 Pub. L. 95–292July 1, 1978section 1302 of this title, (d)(2), , , required the Secretary of Health, Education, and Welfare to issue regulations, within 90 days after enactment of but not later than , defining those costs that may be charged to the personal funds of patients in intermediate care facilities who are individuals receiving medical assistance under a State plan approved under title XIX of the Social Security Act, and those costs that are to be included in the reasonable cost or reasonable charge for intermediate care facility services. See .