Amendment of section by section 5121(b) of Pub. L. 117–328 applicable beginning on the first day of the first calendar quarter that begins on or after the date that is 24 months after
Pub. L. 117–328, div. FF, title V, § 5122(a)(1), (c),
Section 606 of this title, referred to in subsec. (a)(ii), was repealed and a new section 606 enacted by Pub. L. 104–193, title I, § 103(a)(1),
The Indian Health Care Improvement Act, referred to in subsecs. (b) and (l)(2)(B), is Pub. L. 94–437,
For the effective date of this clause, referred to in subsec. (b)(6), see Effective Date of 2022 Amendment note set out under section 1396a of this title.
Section 211 of Pub. L. 93–66, referred to in subsec. (k), is section 211 of Pub. L. 93–66,
The Indian Self-Determination Act, referred to in subsec. (l)(2)(B), is title I of Pub. L. 93–638,
Clause (ii), referred to in subsec. (l)(2)(B), was redesignated as cl. (iii) by Pub. L. 101–508, title IV, § 4704(c)(3),
Section 607 of this title, referred to in subsec. (m)(1), was repealed and a new section 607 enacted by Pub. L. 104–193, title I, § 103(a)(1),
Section 212 of Public Law 93–66, referred to in subsec. (q)(1)(A), is section 212 of Pub. L. 93–66, title II,
Section 5001 of Public Law 111–5 and section 5001 of the American Recovery and Reinvestment Act of 2009, referred to in subsecs. (aa)(1)(A), (2)(A), and (cc), is section 5001 of Pub. L. 111–5, div. B, title V,
The Robert T. Stafford Disaster Relief and Emergency Assistance Act, referred to in subsec. (aa)(2), is Pub. L. 93–288,
Section 10202 of the Patient Protection and Affordable Care Act, referred to in subsec. (aa)(3), is section 10202 of Pub. L. 111–148, which is set out as a note under this section.
Section 6008 of the Families First Coronavirus Response Act, referred to in subsecs. (cc) and (ii)(1), is section 6008 of Pub. L. 116–127, which amended this section and enacted provisions set out as a note under this section.
Section 223 of the Protecting Access to Medicare Act, referred to in subsec. (jj)(2)(A), probably means section 223 of Pub. L. 113–93, known as the Protecting Access to Medicare Act of 2014, which is set out as a note under section 1396a of this title.
2024—Subsec. (a). Pub. L. 118–42, § 205(c)(4), substituted “the last numbered paragraph” for “paragraph (30)” in concluding provisions.
Subsec. (a). Pub. L. 118–42, § 205(c)(3), made technical amendment to directory language of Pub. L. 117–328, § 5122(a)(1). See 2022 Amendment note below.
Subsec. (a)(29). Pub. L. 118–42, § 201(a)(1), substituted “beginning on
Subsec. (a)(31), (32). Pub. L. 118–42, § 209(a)(1), added par. (31) and redesignated former par. (31) as (32).
Subsec. (ee)(2). Pub. L. 118–42, § 201(a)(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”.
Subsec. (jj). Pub. L. 118–42, § 209(a)(2), added subsec. (jj).
2022—Subsec. (a). Pub. L. 117–328, § 5122(a)(1), as amended by Pub. L. 118–42, § 205(c)(3), 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 section 1396a(nn)(2) of this title), while such individual is an inmate of a public institution (as defined in section 1396a(nn)(3) of this title) pending disposition of charges” after “or in the case of an eligible juvenile described in section 1396a(a)(84)(D) of this title with respect to the screenings, diagnostic services, referrals, and targeted case management services required under such section”.
Pub. L. 117–328, § 5121(b), in subd. (A) following par. (31), inserted “, or in the case of an eligible juvenile described in section 1396a(a)(84)(D) of this title 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”.
Subsec. (b). Pub. L. 117–169, § 11405(a)(3)(A)–(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”.
Subsec. (b)(6). Pub. L. 117–169, § 11405(a)(3)(D), 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
Subsec. (ff). Pub. L. 117–328, § 5101(b)(1), struck out “Temporary” before “increase in FMAP” in heading.
Subsec. (ff)(2). Pub. L. 117–328, § 5101(b)(2), struck out “subject to section 1308(g)(7)(C) of this title,” before “for the period beginning
Pub. L. 117–229, § 103(1), substituted “
Pub. L. 117–180 substituted “December 16” for “December 13”.
Pub. L. 117–103, § 201(a)(1), inserted “and for the period beginning
Subsec. (ff)(3). Pub. L. 117–328, § 5101(b)(3), substituted “beginning
Pub. L. 117–229, § 103(2), substituted “
Pub. L. 117–180 substituted “December 16” for “December 13”.
Pub. L. 117–103, § 201(a)(2), substituted “
Pub. L. 117–86 substituted “
2021—Subsec. (a)(4). Pub. L. 117–2, § 9811(a)(1), added cls. (E) and (F).
Subsec. (b). Pub. L. 117–2, § 9815, inserted “; for the 8 fiscal year quarters beginning with the first fiscal year quarter beginning after
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)”.
Subsec. (ff). Pub. L. 117–43 substituted “
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.
Subsec. (ff)(3). Pub. L. 117–70 substituted “
Subsec. (hh). Pub. L. 117–2, § 9811(b)(3), added subsec. (hh).
Subsec. (ii). Pub. L. 117–2, § 9814(3), added subsec. (ii).
2020—Subsec. (a)(3)(A). Pub. L. 116–127, § 6004(a)(1)(A), (B), designated existing provisions as subpar. (A) and inserted “and” at end.
Subsec. (a)(3)(B). Pub. L. 116–136 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).
Subsec. (a)(29). Pub. L. 116–159, § 2601(a)(1), substituted “subject to paragraphs (2) and (3)” for “subject to paragraph (2)” and realigned margins.
Subsec. (a)(30), (31). Pub. L. 116–260, § 210(a)(1), added par. (30) and redesignated former par. (30) as (31).
Subsec. (b). Pub. L. 116–127, § 6004(a)(3)(D), 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 section 1396a(ss) of this title) who are eligible for such assistance only on the basis of section 1396a(a)(10)(A)(ii)(XXIII) of this title and with respect to expenditures described in section 1396b(a)(7) of this title 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.”
Subsec. (p)(1)(A). Pub. L. 116–260, § 402(f)(1), inserted “or who is enrolled under part B for the purpose of coverage of immunosuppressive drugs under section 1395o(b) of this title” after “under section 1395i–2a of this title)”.
Subsec. (cc). Pub. L. 116–127, § 6008(c), 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 ‘
Subsec. (ee)(3). Pub. L. 116–159, § 2601(a)(2), added par. (3).
Subsec. (gg). Pub. L. 116–260, § 210(a)(2), added subsec. (gg).
2019—Subsec. (b). Pub. L. 116–59, § 1302(1), substituted “(aa), and (ff)” for “and (aa)”.
Subsec. (ff). Pub. L. 116–94 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
Pub. L. 116–69 substituted “
Pub. L. 116–59, § 1302(2), added subsec. (ff).
2018—Subsec. (a). Pub. L. 115–271, § 5052(a)(1), in subd. (B) following par. (30), inserted “(except in the case of services provided under a State plan amendment described in section 1396n(l) 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.”
Subsec. (a)(29), (30). Pub. L. 115–271, § 1006(b)(2), added par. (29) and redesignated former par. (29) as (30).
Subsec. (ee). Pub. L. 115–271, § 1006(b)(3), added subsec. (ee).
2016—Subsec. (a)(16). Pub. L. 114–255 substituted “(A) effective
2012—Subsec. (aa)(1)(A). Pub. L. 112–96, § 3204(a)(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 section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, subsections (y) and (z), and subsections (b) and (c) of section 5001 of Public Law 111–5.” 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 section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, subsection (y), and subsections (b) and (c) of section 5001 of Public Law 111–5.”
Subsec. (aa)(1)(B). Pub. L. 112–141 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.”
Subsec. (aa)(2)(A). Pub. L. 112–96, § 3204(a)(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)”.
Subsec. (aa)(2)(B). Pub. L. 112–96, § 3204(a)(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,”.
Subsec. (aa)(3), (4). Pub. L. 112–96, § 3204(a)(3), (4), added par. (3) and redesignated former par. (3) as (4).
2010—Subsec. (a). Pub. L. 111–148, § 2304, inserted “or the care and services themselves, or both” before “(if provided in or after” in introductory provisions.
Subsec. (a)(xiv). Pub. L. 111–148, § 10201(c)(1), 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).
Subsec. (a)(xv). Pub. L. 111–148, § 2001(e)(2)(A), added cl. (xv).
Subsec. (a)(xvi). Pub. L. 111–148, § 2303(a)(4)(A), added cl. (xvi).
Subsec. (a)(xvii). Pub. L. 111–148, § 2402(d)(2)(B), added cl. (xvii).
Subsec. (a)(4). Pub. L. 111–148, § 4107(a)(1), added cl. (D).
Subsec. (a)(13). Pub. L. 111–148, § 4106(a), 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;”.
Subsec. (a)(28), (29). Pub. L. 111–148, § 2301(a)(1), added par. (28) and redesignated former par. (28) as (29).
Subsec. (b). Pub. L. 111–148, § 10201(c)(2), 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), inserted “subsection (y) and” before “section 1396u–3(d) of this title” in first sentence.
Subsec. (l)(3). Pub. L. 111–148, § 2301(a)(2), added par. (3).
Subsec. (o)(1)(A). Pub. L. 111–148, § 2302(a)(1), substituted “subparagraphs (B) and (C)” for “subparagraph (B)”.
Subsec. (o)(1)(C). Pub. L. 111–148, § 2302(a)(2), added subpar. (C).
Subsec. (y). Pub. L. 111–148, § 2001(a)(3)(B), added subsec. (y).
Subsec. (y)(1). Pub. L. 111–152, § 1201(1)(B), 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.
Subsec. (y)(1)(B)(ii)(II). Pub. L. 111–152, § 1201(1)(A), 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”.
Subsec. (y)(2)(A). Pub. L. 111–148, § 10201(c)(3)(B), substituted “as of
Subsec. (z). Pub. L. 111–148, § 10201(c)(4), added subsec. (z).
Subsec. (z)(1)(A). Pub. L. 111–152, § 1201(2)(A), substituted “
Subsec. (z)(1)(B)(i). Pub. L. 111–152, § 1201(2)(A), substituted “paragraph (3)” for “subsection (y)(1)(B)(ii)(II)”.
Subsec. (z)(2). Pub. L. 111–152, § 1201(2)(B), added par. (2) and struck out former par. (2), which read as follows:
“(A) During the period that begins on
“(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.”
Subsec. (z)(3). Pub. L. 111–152, § 1201(2)(C), 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), 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
Subsec. (z)(4). Pub. L. 111–152, § 1201(2)(B), 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—
“(A) disproportionate share hospital payments described in section 1396r–4 of this title;
“(B) payments under subchapter IV;
“(C) payments under subchapter XXI; and
“(D) payments under this subchapter that are based on the enhanced FMAP described in section 1397ee(b) of this title.”
Subsec. (z)(5). Pub. L. 111–152, § 1201(2)(C), 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.
Subsec. (aa). Pub. L. 111–148, § 2006(2), added subsec. (aa).
Subsec. (aa)(1), (2). Pub. L. 111–148, § 10201(c)(5), 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.
Subsec. (bb). Pub. L. 111–148, § 4107(a)(2), added subsec. (bb).
Subsec. (cc). Pub. L. 111–148, § 10201(c)(6), added subsec. (cc).
Subsec. (dd). Pub. L. 111–152, § 1202(b), added subsec. (dd).
2008—Subsec. (p)(1)(C). Pub. L. 110–275, § 112, inserted “or, effective beginning with
Subsec. (p)(5)(A). Pub. L. 110–275, § 118(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.”
2006—Subsec. (u)(2)(B). Pub. L. 109–171 inserted at end “Such term excludes any child eligible for medical assistance only by reason of section 1396a(a)(10)(A)(ii)(XIX) of this title.”
2004—Subsec. (a)(27), (28). Pub. L. 108–357, § 712(a)(1)(A), added par. (27) and redesignated former par. (27) as (28).
Subsec. (x). Pub. L. 108–357, § 712(a)(1)(B), added subsec. (x).
2000—Subsec. (a)(xiii). Pub. L. 106–354, § 2(a)(4), added cl. (xiii).
Subsec. (b). Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(d)(1)], in last sentence, substituted “the State’s available allotment under section 1397dd of this title” for “the State’s allotment under section 1397dd of this title (not taking into account reductions under section 1397dd(d)(2) of this title) for the fiscal year reduced by the amount of any payments made under section 1397ee of this title to the State from such allotment for such fiscal year”.
Pub. L. 106–354, § 2(c), 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 section 1397ee(b) of this title with respect to medical assistance provided to individuals who are eligible for such assistance only on the basis of section 1396a(a)(10)(A)(ii)(XVIII) of this title”.
Subsec. (p)(5). Pub. L. 106–554, § 1(a)(6) [title VII, § 709(a)], added par. (5).
Subsec. (p)(6). Pub. L. 106–554, § 1(a)(6) [title IX, § 911(a)(2)], added par. (6).
Subsec. (u)(1)(B). Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(d)(2)], struck out “and section 1397dd(d) of this title” before period at end.
1999—Subsec. (a)(xii). Pub. L. 106–170, § 201(a)(2)(C), added cl. (xii).
Subsec. (a)(15). Pub. L. 106–113, § 1000(a)(6) [title VI, § 608(aa)(3)], substituted “1396a(a)(31) of this title” for “1396a(a)(31)(A) of this title”.
Subsec. (b). Pub. L. 106–113, § 1000(a)(6) [title VI, § 605(a)], inserted “(other than expenditures under section 1396r–4 of this title)” after “with respect to expenditures” in last sentence.
Subsec. (b)(1). Pub. L. 106–113, § 1000(a)(6) [title VI, § 608(l)], substituted “83 per centum,” for “83 per centum,,”.
Subsec. (l)(2)(B). Pub. L. 106–113, § 1000(a)(6) [title VI, § 608(m)], substituted “an entity” for “a entity” in introductory provisions.
Subsec. (v). Pub. L. 106–169, § 121(c)(5)(A), 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).
Subsec. (w). Pub. L. 106–169, § 121(c)(5), redesignated subsec. (v) as (w) and substituted “1396a(a)(10)(A)(ii)(XVII)” for “1396a(a)(10)(A)(ii)(XV)”.
1997—Subsec. (a)(25). Pub. L. 105–33, § 4702(a)(1), added par. (25). Former par. (25) redesignated (26).
Subsec. (a)(26). Pub. L. 105–33, § 4802(a)(1), 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.
Subsec. (a)(27). Pub. L. 105–33, § 4802(a)(1)(B), redesignated par. (26) as (27).
Subsec. (b). Pub. L. 105–100, § 162(1), inserted “for the State for a fiscal year, and that do not exceed the amount of the State’s allotment under section 1397dd of this title (not taking into account reductions under section 1397dd(d)(2) of this title) for the fiscal year reduced by the amount of any payments made under section 1397ee of this title to the State from such allotment for such fiscal year,” after “subsection (u)(3)”.
Pub. L. 105–33, § 4911(a)(1), 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 section 1397ee(b) of this title.”
Pub. L. 105–33, § 4732(b), substituted “Subject to section 1396u–3(d) of this title, 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”.
Subsec. (l)(2)(B)(iii). Pub. L. 105–33, § 4712(d)(1), inserted “including requirements of the Secretary that an entity may not be owned, controlled, or operated by another entity,” after “such a grant,”.
Subsec. (o)(3). Pub. L. 105–33, § 4711(c)(1), substituted “amount determined in section 1396a(a)(13)(B) of this title” for “amount described in section 1396a(a)(13)(D) of this title” in concluding provisions.
Subsec. (p)(3). Pub. L. 105–33, § 4714(a)(2), inserted “(subject to section 1396a(n)(2) of this title)” after “means” in introductory provisions.
Subsec. (t). Pub. L. 105–33, § 4702(a)(2), added subsec. (t).
Subsec. (u). Pub. L. 105–33, § 4911(a)(2), added subsec. (u).
Subsec. (u)(1)(B). Pub. L. 105–100, § 162(2)(A), substituted “the fourth sentence of subsection (b)” for “paragraph (2)”.
Subsec. (u)(2)(A). Pub. L. 105–100, § 162(2)(B), 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”.
Subsec. (u)(2)(B), (C). Pub. L. 105–100, § 162(2)(C), added subpar. (B) and struck out former subpars. (B) and (C) which read as follows:
“(B) The amount described in this subparagraph, for a State for a fiscal year, is the amount of the State’s allotment under section 1397dd of this title (not taking into account reductions under section 1397dd(d)(2) of this title) for the fiscal year reduced by the amount of any payments made under section 1397ee of this title to the State from such allotment for such fiscal year.
“(C) For purposes of this paragraph, the term ‘optional targeted low-income child’ means a targeted low-income child as defined in section 1397jj(b)(1) of this title who would not qualify for medical assistance under the State plan under this subchapter based on such plan as in effect on
Subsec. (u)(3). Pub. L. 105–100, § 162(2)(D), substituted “described in this paragraph” for “described in this subparagraph” and “
Subsec. (u)(4). Pub. L. 105–100, § 162(2)(E), added par. (4).
1996—Subsec. (l)(2)(B)(i), (ii)(II). Pub. L. 104–299 substituted “section 254b of this title” for “section 254b, 254c, 256, or 256a of this title”.
1994—Subsecs. (j), (q)(2). Pub. L. 103–296 substituted “Commissioner of Social Security” for “Secretary”.
1993—Subsec. (a)(xi). Pub. L. 103–66, § 13603(e)(1)–(3), added cl. (xi).
Subsec. (a)(7). Pub. L. 103–66, § 13601(a)(1), 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”.
Subsec. (a)(17). Pub. L. 103–66, § 13605(a), 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”.
Subsec. (a)(19). Pub. L. 103–66, § 13603(e)(4), amended par. (19) generally, inserting reference to TB-related services described in section 1396a(z)(2)(F) of this title.
Subsec. (a)(21). Pub. L. 103–66, § 13601(a)(2), struck out “and” at end.
Subsec. (a)(22). Pub. L. 103–66, § 13601(a)(4), redesignated par. (23) as (22). Former par. (22) redesignated (25).
Subsec. (a)(23). Pub. L. 103–66, § 13601(a)(4), redesignated par. (24) as (23). Former par. (23) redesignated (22).
Subsec. (a)(24). Pub. L. 103–66, § 13601(a)(5), 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.
Subsec. (a)(25). Pub. L. 103–66, § 13601(a)(4), redesignated par. (22) as (25), transferred such par. to appear after par. (23), and substituted period for semicolon at end.
Subsec. (l)(2)(B). Pub. L. 103–66, § 13631(f)(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”.
Subsec. (l)(2)(B)(i). Pub. L. 103–66, § 13631(f)(2)(A), substituted “256, or 256a” for “or 256”.
Pub. L. 103–66, § 13606(a)(1), struck out “or” at end.
Subsec. (l)(2)(B)(ii). Pub. L. 103–66, § 13631(f)(2)(A), 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.
Subsec. (l)(2)(B)(iv). Pub. L. 103–66, § 13606(a)(4), (5), added cl. (iv).
Subsec. (r)(1)(A)(i). Pub. L. 103–66, § 13631(g)(1)(A), inserted “and, with respect to immunizations under subparagraph (B)(iii), in accordance with the schedule referred to in section 1396s(c)(2)(B)(i) of this title for pediatric vaccines” after “child health care”.
Subsec. (r)(1)(B)(iii). Pub. L. 103–66, § 13631(g)(1)(B), inserted “(according to the schedule referred to in section 1396s(c)(2)(B)(i) of this title for pediatric vaccines)” after “appropriate immunizations”.
1990—Subsec. (a). Pub. L. 101–508, § 4722, 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), 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 section 1396a(a)(10)(A) of this title, 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.”
Subsec. (a)(x). Pub. L. 101–508, § 4713(b), added cl. (x).
Subsec. (a)(2)(C). Pub. L. 101–508, § 4704(e)(1), repealed Pub. L. 101–239, § 6402(c)(1). See 1989 Amendment note below.
Subsec. (a)(7). Pub. L. 101–508, § 4721(a), substituted “services including personal care services” for “services” and added subpars. (A) to (D).
Subsec. (a)(13). Pub. L. 101–508, § 4719(a), 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”.
Subsec. (a)(22). Pub. L. 101–508, § 4711(a)(1), which directed amendment of par. (22) by striking “and” at end, could not be executed because the word did not appear.
Subsec. (a)(23). Pub. L. 101–508, § 4712(a)(1), 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).
Subsec. (a)(24). Pub. L. 101–508, § 4712(a)(2), (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).
Subsec. (h)(1)(A). Pub. L. 101–508, § 4755(a)(1)(A), inserted “or in another inpatient setting that the Secretary has specified in regulations” after “section 1395x(f) of this title”.
Subsec. (l)(2)(A). Pub. L. 101–508, § 4704(c)(1), substituted “patient” for “outpatient”.
Subsec. (l)(2)(B). Pub. L. 101–508, § 4704(d)(2), 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 (Public Law 93–638).” 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 Pub. L. 101–508, § 4704(c)(3). See below.
Pub. L. 101–508, § 4704(c)(2), substituted “entity” for “facility” in introductory provisions.
Subsec. (l)(2)(B)(ii), (iii). Pub. L. 101–508, § 4704(c)(3), (d)(1), added cl. (ii), redesignated former cl. (ii) as (iii), and substituted comma for period at end of cl. (iii).
Subsec. (n)(2). Pub. L. 101–508, § 4601(a)(2), substituted “age of 19” for “age of 7 (or any age designated by the State that exceeds 7 but does not exceed 8)”.
Subsec. (o)(1)(A). Pub. L. 101–508, § 4717, inserted “and for which payment may otherwise be made under subchapter XVIII” after “section 1395d(d)(2)(A) of this title”.
Subsec. (o)(3). Pub. L. 101–508, § 4705(a)(1), 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), (4), in concluding provisions, substituted “the additional amount described in section 1396a(a)(13)(D) of this title” for “the amounts allocated under the plan for room and board in the facility, in accordance with the rates established under section 1396a(a)(13) of this title,” and struck out at end “For purposes of this paragraph and section 1396a(a)(13)(D) of this title, 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.”
Subsec. (o)(3)(A), (C). Pub. L. 101–508, § 4705(a)(2), substituted “nursing facility or intermediate care facility for the mentally retarded” for “skilled nursing or intermediate care facility”.
Subsec. (p)(1)(B). Pub. L. 101–508, § 4501(e)(1)(A), 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.
Subsec. (p)(2)(B). Pub. L. 101–508, § 4501(a)(1), 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: “
Subsec. (p)(2)(C). Pub. L. 101–508, § 4501(a)(2), 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: “
Subsec. (p)(2)(D). Pub. L. 101–508, § 4501(e)(1)(B), added subpar. (D).
Subsec. (p)(4). Pub. L. 101–508, § 4501(c)(2), inserted at end “In the case of any State which is providing medical assistance to its residents under a waiver granted under section 1315 of this title, the Secretary shall require the State to meet the requirement of section 1396a(a)(10)(E) of this title 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.”
Subsec. (p)(4)(B). Pub. L. 101–508, § 4501(c)(1), inserted “or 1396a(a)(10)(E)(iii) of this title” after “subparagraph (B)”.
1989—Subsec. (a)(2)(B). Pub. L. 101–239, § 6404(a)(2), substituted “subsection (l)(1)” for “subsection (l)” in two places.
Subsec. (a)(2)(C). Pub. L. 101–239, § 6404(a)(3), added cl. (C) relating to Federally-qualified health center services.
Pub. L. 101–239, § 6402(c)(1), which directed addition of cl. (C) relating to ambulatory services, was repealed by Pub. L. 101–508, § 4704(e)(1).
Subsec. (a)(4)(B). Pub. L. 101–239, § 6403(d)(2), amended cl. (B) generally. Prior to amendment, cl. (B) read as follows: “effective
Subsec. (a)(21), (22). Pub. L. 101–239, § 6405(a), added par. (21) and redesignated former par. (21) as (22).
Subsec. (l). Pub. L. 101–239, § 6404(b), designated existing provisions as par. (1), redesignated former cls. (1) and (2) as (A) and (B), respectively, and added par. (2).
Subsec. (p)(1)(A). Pub. L. 101–239, § 6408(d)(4)(B), inserted “, but not including an individual entitled to such benefits only pursuant to an enrollment under section 1395i–2a of this title” after “section 1395i–2 of this title”.
Subsec. (p)(3)(A). Pub. L. 101–239, § 6408(d)(4)(A)(i), 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 section 1395i–2 of this title).”
Subsec. (p)(3)(A)(i). Pub. L. 101–239, § 6408(d)(4)(A)(ii), substituted “section 1395i–2 or 1395i–2a” for “section 1395i–2”.
Subsec. (p)(3)(C). Pub. L. 101–234, § 201(b)(1), substituted “Deductibles” for “Subject to paragraph (4), deductibles” and “section 1395e of this title and section 1395l(b) of this title)” for “section 1395e of this title, section 1395l(b) of this title, and section 1395m(c)(1) of this title”.
Subsec. (p)(4), (5). Pub. L. 101–234, § 201(b)(2), 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 section 1395m(c)(1) of this title, 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 section 1396a(a)(10)(A)(i) of this title.”
Subsec. (r). Pub. L. 101–239, § 6403(c), inserted at end “The Secretary shall, not later than
Pub. L. 101–239, § 6403(a), added subsec. (r).
Subsec. (s). Pub. L. 101–239, § 6408(d)(2), added subsec. (s).
1988—Subsec. (a). Pub. L. 100–647, § 8434(b)(3), 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.
Subsec. (a)(ix). Pub. L. 100–485, § 303(b)(2), added cl. (ix).
Subsec. (a)(5)(B). Pub. L. 100–360, § 411(k)(4), substituted “described in clause (A) if” for “described in subparagraph (A) if”.
Subsec. (a)(17). Pub. L. 100–360, § 411(h)(4)(E), amended Pub. L. 100–203, § 4073(d)(1), see 1987 Amendment note below.
Subsec. (i). Pub. L. 100–360, § 411(k)(14)(A), added subsec. (i).
Subsec. (m). Pub. L. 100–485, § 401(d)(2), added subsec. (m).
Subsec. (o)(1). Pub. L. 100–360, § 411(k)(8)(A), made clarifying amendment to directory language of Pub. L. 100–203, § 4114, see 1987 Amendment note below.
Subsec. (o)(1)(B). Pub. L. 100–360, § 411(k)(8)(B), struck out “only” after “For purposes of this subchapter” and substituted “immune deficiency syndrome (AIDS)” for “immunodeficiency syndrome”.
Subsec. (o)(3). Pub. L. 100–485, § 608(f)(3), realigned the margin of par. (3).
Subsec. (p)(1). Pub. L. 100–647, § 8434(a), redesignated subpars. (C) and (D) as (B) and (C), respectively, and struck out former subpar. (B) which read: “who, but for section 1396a(a)(10)(E) of this title, is not eligible for medical assistance under the plan,”.
Subsec. (p)(1)(B). Pub. L. 100–360, § 301(a)(2), struck out “and the election of the State” after “1396a(a)(10)(E) of this title”.
Subsec. (p)(1)(C). Pub. L. 100–360, § 301(c)(1), as amended by Pub. L. 100–485, § 608(d)(14)(E)(i), substituted “paragraph (2)” for “paragraph (2)(A)”.
Subsec. (p)(1)(D). Pub. L. 100–360, § 301(c)(2), as amended by Pub. L. 100–485, § 608(d)(14)(E)(ii), substituted “twice” for “(except as provided in paragraph (2)(B))”.
Subsec. (p)(2)(A). Pub. L. 100–647, § 8434(b)(4), substituted “paragraph (1)(B)” for “paragraph (1)(C)”.
Pub. L. 100–360, § 301(b)(1), as amended by Pub. L. 100–485, § 608(d)(14)(A), 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), which directed amendment of subpar. (A) by striking “(2)(A)” and inserting “(2)”, was repealed by Pub. L. 100–485, § 608(d)(14)(E)(iii).
Pub. L. 100–360, § 301(b)(2), which directed amendment of subpar. (A) by inserting “(i)” after “(2)(A)”, was repealed by Pub. L. 100–485, § 608(d)(14)(B).
Subsec. (p)(2)(B). Pub. L. 100–360, § 301(b)(2), formerly § 301(b)(3), as renumbered and amended by Pub. L. 100–485, § 608(d)(14)(B)–(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 section 1396a(a)(10)(A) of this title 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 section 1396a(a)(10)(A) of this title.”
Pub. L. 100–360, § 301(c)(3)(B), which directed amendment of par. (2) by striking subpar. (B), was repealed by Pub. L. 100–485, § 608(d)(14)(E)(iii).
Subsec. (p)(2)(C). Pub. L. 100–360, § 301(b)(2), formerly § 301(b)(3), as renumbered and amended by Pub. L. 100–485, § 608(d)(14)(B), (C), (D)(i), (iii), added subpar. (C).
Subsec. (p)(3). Pub. L. 100–360, § 301(d)(1), as added by Pub. L. 100–485, § 608(d)(14)(G)(ii), 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.
Subsec. (p)(3)(A). Pub. L. 100–360, § 301(d)(2), formerly § 301(d)(1), as renumbered by Pub. L. 100–485, § 608(d)(14)(G)(i), substituted “under subchapter XVIII of this chapter (including under part B and, if applicable, under section 1395i–2 of this title)” for “under part B and (if applicable) under section 1395i–2 of this title”.
Subsec. (p)(3)(B). Pub. L. 100–360, § 301(d)(3), formerly § 301(d)(2), as renumbered by Pub. L. 100–485, § 608(d)(14)(G)(i), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: “Deductibles and coinsurance described in section 1395e of this title.”
Subsec. (p)(3)(C). Pub. L. 100–360, § 301(d)(3), formerly § 301(d)(2), as renumbered and amended by Pub. L. 100–485, § 608(d)(14)(F), (G)(i), amended subpar. (C) generally. Prior to amendment, subpar. (C) read as follows: “The annual deductible described in section 1395l(b) of this title.”
Subsec. (p)(4). Pub. L. 100–360, § 301(d)(4), formerly § 301(d)(3), as renumbered by Pub. L. 100–485, § 618(d)(14)(G)(i), added par. (4).
Subsec. (p)(5). Pub. L. 100–360, § 301(g)(2), as amended by Pub. L. 100–485, § 608(d)(14)(J), added par. (5).
1987—Subsec. (a)(4)(A). Pub. L. 100–203, § 4211(f), struck out “skilled” before “nursing”.
Subsec. (a)(5). Pub. L. 100–203, § 4211(h)(6)(A), struck out “skilled” before “nursing” in cl. (A).
Pub. L. 100–203, § 4103(a), designated existing provisions as cl. (A) and added cl. (B).
Subsec. (a)(9). Pub. L. 100–203, § 4105(a), 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.
Subsec. (a)(14). Pub. L. 100–203, § 4211(h)(6)(B), substituted “and nursing facility services” for “, skilled nursing facility services, and intermediate care facility services”.
Subsec. (a)(15). Pub. L. 100–203, § 4211(h)(6)(C), substituted “services in an intermediate care facility for the mentally retarded (other than” for “intermediate care facility services (other than such services”.
Subsec. (a)(17). Pub. L. 100–203, § 4073(d)(1), as amended by Pub. L. 100–360, § 411(h)(4)(E), substituted “(as defined in section 1395x(gg) of this title)” for “(as defined in subsection (m) of this section)”.
Subsec. (c). Pub. L. 100–203, § 4211(e)(1), amended subsec. (c) generally. Prior to amendment, subsec. (c) defined “intermediate care facility”.
Subsec. (d). Pub. L. 100–203, § 4211(e)(2), 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)”.
Subsec. (f). Pub. L. 100–203, § 4211(e)(3), struck out “skilled” before “nursing” in four places and before “rehabilitation”.
Subsec. (i). Pub. L. 100–203, § 4211(e)(4), 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 section 1395x(j) of this title.
Subsec. (m). Pub. L. 100–203, § 4073(d)(2), struck out subsec. (m) which defined “nurse-midwife”. See section 1395x(gg) of this title.
Subsec. (n)(2). Pub. L. 100–203, § 4101(c)(1), 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”.
Subsec. (o)(1). Pub. L. 100–203, § 4114, as amended by Pub. L. 100–360, § 411(k)(8)(A), designated existing provisions as subpar. (A), substituted “Subject to subparagraph (B), the” for “The”, and added subpar. (B).
Subsec. (p)(2)(A). Pub. L. 100–203, § 4118(p)(8), struck out “nonfarm” before “official”.
1986—Subsec. (a). Pub. L. 99–509, § 9403(g)(3), 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”.
Subsec. (a)(18). Pub. L. 99–272, § 9505(a)(1), added par. (18). Former par. (18) redesignated (19).
Subsec. (a)(19). Pub. L. 99–514, § 1895(c)(3)(A), added par. (19). Former par. (19) redesignated (20).
Pub. L. 99–272, § 9505(a)(1)(B), redesignated former par. (18) as (19).
Subsec. (a)(20). Pub. L. 99–509, § 9408(c)(1), added par. (20). Former par. (20) redesignated (21).
Pub. L. 99–514, § 1895(c)(3)(A)(ii), redesignated former par. (19) as (20).
Subsec. (a)(21). Pub. L. 99–509, § 9408(c)(1)(B), redesignated former par. (20) as (21).
Subsec. (n)(1)(C). Pub. L. 99–272, § 9501(a), added subpar. (C).
Subsec. (n)(2). Pub. L. 99–272, § 9511(a), inserted “(or such earlier date as the State may designate)” after “
Subsec. (o). Pub. L. 99–272, § 9505(a)(2), added subsec. (o).
Subsec. (o)(3). Pub. L. 99–509, § 9435(b)(2), added par. (3).
Subsec. (p). Pub. L. 99–509, § 9403(b), (d), added subsec. (p).
Subsec. (q). Pub. L. 99–509, § 9404(b), added subsec. (q).
1984—Subsec. (a). Pub. L. 98–369, § 2335(f), 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.
Subsec. (a)(1). Pub. L. 98–369, § 2335(f), substituted “mental diseases” for “tuberculosis or mental diseases”.
Subsec. (a)(4). Pub. L. 98–369, § 2335(f), substituted “mental diseases” for “tuberculosis or mental diseases”.
Pub. L. 98–369, § 2373(b)(15), inserted a semicolon before “(B)”.
Subsec. (a)(9). Pub. L. 98–369, § 2371(a), 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”.
Subsec. (a)(14), (15). Pub. L. 98–369, § 2335(f), substituted “mental diseases” for “tuberculosis or mental diseases”.
Subsec. (a)(17). Pub. L. 98–369, § 2373(b)(16), substituted “the nurse-midwife” for “he” in two places.
Subsec. (b). Pub. L. 98–369, § 2373(b)(18), substituted “section 1301(a)(8)(B) of this title” for “subparagraph (B) of section 1301(a)(8) of this title”.
Subsec. (d)(1). Pub. L. 98–369, § 2373(b)(19), substituted “the institution meets” for “which meet”.
Subsec. (h)(1)(A). Pub. L. 98–369, § 2340(b), 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;”.
Subsec. (m). Pub. L. 98–369, § 2373(b)(20), substituted “the nurse” for “he” in two places.
Subsec. (n). Pub. L. 98–369, § 2361(b), added subsec. (n).
1982—Subsec. (a)(i). Pub. L. 97–248, § 137(b)(17), struck out “or any reasonable category of such individuals,” after “as the State may choose,”.
Subsec. (a)(viii). Pub. L. 97–248, § 137(b)(18), added cl. (viii).
Subsec. (b)(2). Pub. L. 97–248, § 136(c), substituted “the Northern Mariana Islands, and American Samoa” for “and the Northern Mariana Islands”.
Subsec. (h)(1)(C). Pub. L. 97–248, § 137(f), redesignated cls. (i) and (ii) as subcls. (I) and (II), respectively, and redesignated cls. (A) and (B) as cls. (i) and (ii), respectively.
1981—Subsec. (a). Pub. L. 97–35, § 2172(b), 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 section 606(a)(2) of this title.
Subsec. (b). Pub. L. 97–35, § 2162(a)(2), inserted reference to Northern Mariana Islands.
1980—Subsec. (a)(17), (18). Pub. L. 96–499, § 965(a)(1)(B), (C), added par. (17) and redesignated former par. (17) as (18).
Subsec. (c). Pub. L. 96–473 substituted “clause (1)” for “clauses (1)”.
Subsec. (m). Pub. L. 96–499, § 965(a)(2), added subsec. (m).
1978—Subsec. (c). Pub. L. 95–292 added cl. (4) to first sentence relating to a requirement that intermediate care facilities meet section 1395x(j)(14) of this title with respect to protection of patients’ personal funds, and inserted reference to that cl. (4) in provisions covering intermediate care facilities on Indian reservations.
1977—Subsec. (a)(2). Pub. L. 95–210, § 2(a), designated existing provisions as cl. (A) and added cl. (B).
Subsec. (l). Pub. L. 95–210, § 2(b), added subsec. (l).
1976—Subsec. (b). Pub. L. 94–437 inserted provision requiring that the Federal medical assistance percentage be 100 per centum for services received through an Indian Health Service facility.
1973—Subsec. (a). Pub. L. 93–233, § 13(a)(13), 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 section 1396a(a)(10)(A) of this title) 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”.
Subsec. (a)(iv). Pub. L. 93–233, § 13(a)(14), inserted “with respect to States eligible to participate in the State plan program established under subchapter XVI,” after “blind,”.
Subsec. (a)(v). Pub. L. 93–233, § 13(a)(15), substituted “with respect to States eligible to participate in the State plan program established under subchapter XVI,” for “or”.
Subsec. (a)(vi). Pub. L. 93–233, § 13(a)(16), inserted “or” at end of text.
Subsec. (a)(vii). Pub. L. 93–233, § 13(a)(17), added cl. (vii).
Subsec. (a)(16). Pub. L. 93–233, § 18(x)(7), substituted “under age 21, as defined in subsection (h); and” for “under 21, as defined in subsection (e);”.
Subsec. (b). Pub. L. 93–233, § 18(y)(2), struck out “; except that the Secretary shall promulgate such percentage as soon as possible after
Subsec. (c). Pub. L. 93–233, § 18(x)(8), substituted “skilled nursing facility” for “skilled nursing home” wherever appearing.
Subsec. (h)(1)(B). Pub. L. 93–233, § 18(w), 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.
Subsec. (h)(2). Pub. L. 93–233, § 18(x)(10), substituted “paragraph (1)” for “paragraph (e)(1)”.
Subsec. (i). Pub. L. 93–233, § 18(x)(9), redesignated subsec. (h) as added by Pub. L. 92–603, § 299L(b), and relating to skilled nursing facility, as subsec. (i).
Subsecs. (j), (k). Pub. L. 93–233, § 13(a)(18), added subsecs. (j) and (k).
1972—Subsec. (a). Pub. L. 92–603, § 299B(c), in text following redesignated subsec. (a)(17) substituted “as otherwise provided in paragraph (16),” for “that”.
Subsec. (a)(4). Pub. L. 92–603, §§ 278(a)(21), 299E(b), substituted “skilled nursing facility” for “skilled nursing home” and added cl. (C).
Subsec. (a)(5). Pub. L. 92–603, §§ 278(a)(22), 280, substituted “skilled nursing facility” for “skilled nursing home” and inserted “furnished by a physician (as defined in section 1395x(r)(1) of this title)” after “physicians’ services”.
Subsec. (a)(14). Pub. L. 92–603, §§ 278(a)(23), 297(a), substituted “skilled nursing facility” for “skilled nursing home” and inserted reference to intermediate care facility services.
Subsec. (a)(15) to (17). Pub. L. 92–603, § 299B(a), added par. (16) and redesignated existing pars. (15) and (16) as (17) and (15), respectively.
Subsec. (c). Pub. L. 92–603, § 299L(a), inserted provision defining “intermediate care facility” with respect to any institution located in a State on an Indian reservation.
Subsec. (d)(3). Pub. L. 92–603, § 299, inserted provisions relating to reduction of non-Federal expenditures in any calendar quarter prior to
Subsec. (e). Pub. L. 92–603, § 212(a), added subsec. (e).
Subsec. (f). Pub. L. 92–603, § 247(b), added subsec. (f).
Subsec. (g). Pub. L. 92–603, § 275(a), added subsec. (g).
Subsec. (h). Pub. L. 92–603, § 299L(b), 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.
1971—Subsec. (a)(16). Pub. L. 92–223, § 4(a)(1)(C), added cl. (16).
Subsecs. (c), (d). Pub. L. 92–223, § 4(a)(2), added subsecs. (c) and (d).
1968—Subsec. (a). Pub. L. 90–248, § 230, 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.
Subsec. (a)(ii). Pub. L. 90–248, § 241(f)(6), inserted “part A of” before “subchapter IV”.
Subsec. (a)(vi). Pub. L. 90–248, § 233(a), added cl. (vi).
Subsec. (a)(4). Pub. L. 90–248, § 302(a), designated existing provisions as cl. (A) and added cl. (B).
Subsec. (b). Pub. L. 90–248, § 248(e), substituted in cl. (2) of first sentence “50” for “55”.
Pub. L. 118–42, div. G, title I, § 209(b),
Amendment by section 5121(b) of Pub. L. 117–328 applicable beginning on the first day of the first calendar quarter that begins on or after the date that is 24 months after
Amendment by section 5122(a)(1) of Pub. L. 117–328 effective on the first day of the first calendar quarter that begins after the date that is 24 months after
Amendment by Pub. L. 117–169 effective on the 1st day of the 1st fiscal quarter that begins on or after the date that is 1 year after
Amendment by section 210(a) of Pub. L. 116–260 applicable with respect to items and services furnished on or after
Pub. L. 116–159, div. C, title VI, § 2601(c),
Amendment by section 1006(b)(2), (3) of Pub. L. 115–271 applicable with respect to medical assistance provided on or after
Pub. L. 115–271, title I, § 1012(b), “(1) Except 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) In the case of a State plan under title XIX of the Social Security Act [42 U.S.C. 1396 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.”
Pub. L. 114–255, div. B, title XII, § 12005(b),
Pub. L. 112–141, div. F, title I, § 100123(c),
Pub. L. 112–96, title III, § 3204(b),
Pub. L. 111–148, title II, § 2005(c)(2),
Amendment by section 2301(a) of Pub. L. 111–148 effective
Amendment by section 2303(a)(4)(A) of Pub. L. 111–148 effective
Amendment by section 2402(d)(2)(B) of Pub. L. 111–148 effective on the first day of the first fiscal year quarter that begins after
Pub. L. 111–148, title IV, § 4106(c),
Pub. L. 111–148, title IV, § 4107(d),
Pub. L. 110–275, title I, § 118(b),
Amendment by Pub. L. 109–171 applicable to medical assistance for items and services furnished on or after
Amendment by Pub. L. 108–357 effective
Pub. L. 106–554, § 1(a)(6) [title VII, § 709(b)],
Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(f)],
Amendment by section 1(a)(6) [title IX, § 911(a)(2)] of Pub. L. 106–554 effective one year after
Amendment by Pub. L. 106–354 applicable to medical assistance for items and services furnished on or after
Amendment by Pub. L. 106–170 applicable to medical assistance for items and services furnished on or after
Amendment by section 121(a)(2) of Pub. L. 106–169 applicable to medical assistance for items and services furnished on or after
Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, § 605(b)],
Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, § 608(aa)],
Amendment by section 1000(a)(6) [title VI, § 608(l), (m)] of Pub. L. 106–113 effective
Pub. L. 105–100, title I, § 162,
Amendment by section 4702(a) of Pub. L. 105–33 applicable to primary care case management services furnished on or after
Amendment by section 4711(c)(1) of Pub. L. 105–33 effective
Pub. L. 105–33, title IV, § 4712(d)(2),
Amendment by section 4714(a)(2) of Pub. L. 105–33 applicable to payment for (and with respect to provider agreements with respect to) items and services furnished on or after
Pub. L. 105–33, title IV, § 4725(b)(2), “(A) 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) payments attributable to DSH allotments for such States determined under section 1923(f) of such Act (42 U.S.C. 1396r–4(f)) for fiscal years beginning with fiscal year 1998.”
Amendment by section 4911(a) of Pub. L. 105–33 applicable to medical assistance for items and services furnished on or after
Amendment by Pub. L. 104–299 effective
Amendment by Pub. L. 103–296 effective
Amendment by section 13601(a) of Pub. L. 103–66 effective as if included in enactment of section 4721(a) of the Omnibus Budget Reconciliation Act of 1990, Pub. L. 101–508, see section 13601(c) of Pub. L. 103–66, set out as a note under section 1396a of this title.
Amendment by section 13603(e) of Pub. L. 103–66 applicable to medical assistance furnished on or after
Pub. L. 103–66, title XIII, § 13605(b),
Pub. L. 103–66, title XIII, § 13606(b),
Amendment by section 13631(f)(2) of Pub. L. 103–66 applicable, except as otherwise provided, to calendar quarters beginning on or after
Pub. L. 103–66, title XIII, § 13631(g)(2),
Amendment by section 4402(d)(2) of Pub. L. 101–508 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 4501(a), (c), (e)(1) of Pub. L. 101–508 applicable to calendar quarters beginning on or after
Amendment by section 4601(a)(2) of Pub. L. 101–508 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 4704(c), (d), (e)(1) of Pub. L. 101–508 effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989, Pub. L. 101–239, see section 4704(f) of Pub. L. 101–508, set out as a note under section 1396a of this title.
Pub. L. 101–508, title IV, § 4705(b),
Amendment by section 4711(a) of Pub. L. 101–508 applicable to home and community care furnished on or after
Amendment by section 4712(a) of Pub. L. 101–508 applicable to community supported living arrangements services furnished on or after the later of
Amendment by section 4713(b) of Pub. L. 101–508 applicable to medical assistance furnished on or after
Pub. L. 101–508, title IV, § 4719(b),
Pub. L. 101–508, title IV, § 4721(b),
Pub. L. 101–508, title IV, § 4755(a)(1)(B),
Amendment by section 6403(a), (c), (d)(2) of Pub. L. 101–239 effective
Amendment by section 6404(a), (b) of Pub. L. 101–239 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 6405(a) of Pub. L. 101–239 effective with respect to services furnished by a certified pediatric nurse practitioner or certified family nurse practitioner on or after
Amendment by section 6408(d)(2), (4)(A), (B) of Pub. L. 101–239 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Amendment by Pub. L. 101–234 effective
Amendment by Pub. L. 100–647 effective as if included in the enactment of section 301 of the Medicare Catastrophic Coverage Act of 1988, Pub. L. 100–360, see section 8434(c) of Pub. L. 100–647, set out as a note under section 1396a of this title.
Amendment by section 303(b)(2) of Pub. L. 100–485 applicable to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 401(d)(2) of Pub. L. 100–485 effective
Amendment by section 608(d)(14)(A)–(G), (J) of Pub. L. 100–485 effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, Pub. L. 100–360, see section 608(g)(1) of Pub. L. 100–485, set out as a note under section 704 of this title.
Amendment by section 608(f)(3) of Pub. L. 100–485 effective
Amendment by section 301(a)(2)–(d) of Pub. L. 100–360 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Except as specifically provided in section 411 of Pub. L. 100–360, amendment by section 411(h)(4)(E), (k)(4), (8) of Pub. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Pub. L. 100–203, effective as if included in the enactment of that provision in Pub. L. 100–203, see section 411(a) of Pub. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions.
Pub. L. 100–360, title IV, § 411(k)(14)(B),
Amendment by section 4073(d) of Pub. L. 100–203 effective with respect to services performed on or after
Pub. L. 100–203, title IV, § 4101(c)(3), “(A) The amendments made by this subsection [amending this section and section 1396a of this title] shall apply to medical assistance furnished on or after “(B) For purposes of section 1905(n)(2) of the Social Security Act [42 U.S.C. 1396d(n)(2)] (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’.”
Pub. L. 100–203, title IV, § 4103(b), “(1) 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 [42 U.S.C. 1396 et seq.] for calendar quarters beginning on or after “(2) 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 [
Pub. L. 100–203, title IV, § 4105(b),
Amendments by section 4211(e), (f), (h)(6) of Pub. L. 100–203 applicable to nursing facility services furnished on or after
Amendment by Pub. L. 99–514 effective, except as otherwise provided, as if included in enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985, Pub. L. 99–272, see section 1895(e) of Pub. L. 99–514, set out as a note under section 162 of Title 26, Internal Revenue Code.
Amendment by section 9403(b), (d), (g)(3) of Pub. L. 99–509 applicable to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 9404(b) of Pub. L. 99–509 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 9408(c)(1) of Pub. L. 99–509 applicable to services furnished on or after
Pub. L. 99–272, title IX, § 9501(d)(1), “(A) 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 [42 U.S.C. 1396 et seq.] for calendar quarters beginning on or after the [sic] “(B) 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 [
Amendment by section 9505(a) of Pub. L. 99–272 applicable to medical assistance provided for hospice care furnished on or after
Pub. L. 99–272, title IX, § 9511(b),
Amendment by section 2335(f) of Pub. L. 98–369 effective
Amendment by section 2340(b) of Pub. L. 98–369 effective
Amendment by section 2361(b) of Pub. L. 98–369 applicable to calendar quarters beginning on or after
Pub. L. 98–369, div. B, title III, § 2371(b),
Amendment by section 136(c) of Pub. L. 97–248 effective
Amendment by section 137(b)(17), (18) of Pub. L. 97–248 effective as if originally included as part of this section as this section was amended by the Omnibus Budget Reconciliation Act of 1981, Pub. L. 97–35, see section 137(d)(2) of Pub. L. 97–248, set out as a note under section 1396a of this title.
Amendment by section 2172(b) of Pub. L. 97–35 effective
For effective date of amendment by Pub. L. 96–499, see section 965(c) of Pub. L. 96–499, set out as a note under section 1396a of this title.
Pub. L. 95–292, § 8(d)(1),
Amendment by Pub. L. 95–210 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
Amendment by section 13(a)(13)–(18) of Pub. L. 93–233 effective with respect to payments under section 1396b of this title for calendar quarters commencing after
Pub. L. 92–603, title II, § 212(b),
Amendment by section 247(b) of Pub. L. 92–603 effective with respect to services furnished after
Pub. L. 92–603, title II, § 275(b),
Pub. L. 92–603, title II, § 297(b),
Amendment by Pub. L. 92–223 effective
Pub. L. 90–248, title II, § 248(e),
Pub. L. 108–357, title VII, § 712(a)(2),
Amendment by Pub. L. 106–170 to be executed as if Pub. L. 106–169 had been enacted after the enactment of Pub. L. 106–170, see section 121(c)(1) of Pub. L. 106–169, set out as a note under section 1396a of this title.
Pub. L. 117–159, div. A, title I, § 11004, “(a) “(1) Not later than 24 months after the date of enactment of Act [probably means “this Act”, “(A) 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 (42 U.S.C. 1396a(a)(43), 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) 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) 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) “(1) 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 (42 U.S.C. 1396d(a)(4)(B)) and as defined in section 1905(r) of such Act (42 U.S.C. 1396d(r)) and provided in accordance with the requirements of section 1902(a)(43) of such Act (42 U.S.C. 1396a(a)(43)), 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) 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) In this section:“(1) The term ‘Medicaid’ means the program established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).“(2) Except as otherwise provided, the term ‘Secretary’ means the Secretary of Health and Human Services.“(3) The term ‘State’ has the meaning given that term in section 1101(a)(1) of the Social Security Act (42 U.S.C. 1301(a)(1)) for purposes of titles XIX and XXI of such Act [42 U.S.C. 1396 et seq., 1397aa et seq.].”
Pub. L. 117–2, title IX, § 9817, “(a) “(1) Notwithstanding section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 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 (42 U.S.C. 1396d), section 1915(k) of such Act (42 U.S.C. 1396n(k)), or section 6008(a) of the Families First Coronavirus Response Act (Public Law 116–127) [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 (42 U.S.C. 1308).“(2) In this section:“(A) The term ‘HCBS program improvement period’ means, with respect to a State, the period—“(i) beginning on “(ii) ending on “(B) The term ‘home and community-based services’ means any of the following:“(i) Home health care services authorized under paragraph (7) of section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)).“(ii) Personal care services authorized under paragraph (24) of such section.“(iii) PACE services authorized under paragraph (26) of such section.“(iv) Home and community-based services authorized under subsections (b), (c), (i), (j), and (k) of section 1915 of such Act (42 U.S.C. 1396n), such services authorized under a waiver under section 1115 of such Act (42 U.S.C. 1315), and such services through coverage authorized under section 1937 of such Act (42 U.S.C. 1396u–7).“(v) Case management services authorized under section 1905(a)(19) of the Social Security Act (42 U.S.C. 1396d(a)(19)) and section 1915(g) of such Act (42 U.S.C. 1396n(g)).“(vi) Rehabilitative services, including those related to behavioral health, described in section 1905(a)(13) of such Act (42 U.S.C. 1396d(a)(13)).“(vii) Such other services specified by the Secretary of Health and Human Services.“(C) 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) The term ‘Medicaid program’ means, with respect to a State, the State program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (including any waiver or demonstration under such title or under section 1115 of such Act (42 U.S.C. 1315) relating to such title).“(E) The term ‘State’ has the meaning given such term for purposes of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).“(b) 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) The 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) 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.”
Pub. L. 116–127, div. F, § 6008(a), (b), (d)–(g), “(a) “(1) 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 (42 U.S.C. 1320b–5(g)) and ending on “(2) For purposes of paragraph (1), the applicable number of percentage points for a calendar quarter is the following:“(A) For each calendar quarter that occurs during the portion of the period described in paragraph (1) that ends on “(B) For the calendar quarter that begins on “(C) For the calendar quarter that begins on “(D) For the calendar quarter that begins on “(b) 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) eligibility standards, methodologies, or procedures under the State plan of such State under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (including any waiver under such title or section 1115 of such Act (42 U.S.C. 1315)) are more restrictive during such quarter than the eligibility standards, methodologies, or procedures, respectively, under such plan (or waiver) as in effect on “(2) the amount of any premium imposed by the State pursuant to section 1916 or 1916A of such Act (42 U.S.C. 1396o, 1396o–1) during such quarter exceeds the amount of such premium as of “(3) the State fails to provide that an individual who is enrolled for benefits under such plan (or waiver) as of “(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) 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) If 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 (42 U.S.C. 670 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 (42 U.S.C. 1396 et seq.) and as increased under subsection (a).“(f) “(1) For each calendar quarter occurring during the portion of the period described in subsection (a)(1) that begins on “(2) The conditions of this paragraph with respect to a State and the transition period are the following:“(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 (42 U.S.C. 1396a(e)(14)(A)) or other alternative processes and procedures approved by the Secretary of Health and Human Services.“(B) 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) 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) 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.”
Pub. L. 111–5, div. B, title V, § 5001,
Pub. L. 111–148, title X, § 10202, “(a) Notwithstanding section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 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) 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) The conditions described in this subsection are the following:“(1) 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) 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 [42 U.S.C. 1396n(i)], 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 (42 U.S.C. 1382(b)(1)).“(2) “(A) 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 “(B) In the case of any other balancing incentive payment State, the target spending percentage for the State to achieve by not later than “(3) The 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) 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) 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) ‘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 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) 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) 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 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 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 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) 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) “(1) 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) 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) In this section:“(1) 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) Services in an intermediate care facility for the mentally retarded described in subsection (a)(15) of section 1905 of such Act [42 U.S.C. 1396d(a)(15)].“(B) Non-institutionally-based long-term services and supports.—Services not provided in an institution, including the following:“(i) Home and community-based services provided under subsection (c), (d), or (i) of section 1915 of such Act [42 U.S.C. 1396n(c), (d), (i)] or under a waiver under section 1115 of such Act [42 U.S.C. 1315].“(ii) Home health care services.“(iii) Personal care services.“(iv) Services described in subsection (a)(26) of section 1905 of such Act [42 U.S.C. 1396d(a)(26)] (relating to PACE program services).“(v) Self-directed personal assistance services described in section 1915(j) of such Act [42 U.S.C. 1396n(j)].“(2) The term ‘balancing incentive period’ means the period that begins on “(3) The term ‘poverty line’ has the meaning given that term in section 2110(c)(5) of the Social Security Act (42 U.S.C. 1397jj(c)(5)).“(4) The term ‘State Medicaid program’ means the State program for medical assistance provided under a State plan under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] and under any waiver approved with respect to such State plan.”
Pub. L. 111–3, title I, § 115,
[For definitions of “CHIP”, “Medicaid”, and “Secretary”, see section 1(c) of Pub. L. 111–3, set out as a Definitions note under section 1396 of this title.]
Pub. L. 111–3, title VI, § 614, “(a) Only 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 [42 U.S.C. 1396 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) “(1) 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) For estimating and adjustment a FMAP already calculated as of the date of the enactment of this Act [“(3) 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) No State shall have its FMAP for a fiscal year reduced as a result of the application of this section.“(d) Not later than “(e) FMAP 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 (42 U.S.C. 1396(d) [1396d[b]]).”
[For definitions of “Medicaid” and “Secretary”, see section 1(c) of Pub. L. 111–3, set out as a Definitions note under section 1396 of this title.]
Pub. L. 108–27, title IV, § 401(a),
Pub. L. 106–554, § 1(a)(6) [title VII, § 706],
Pub. L. 105–33, title IV, § 4725(a), “(1) items and services furnished under a State plan under title XIX [42 U.S.C. 1396 et seq.] or under a State child health plan under title XXI of such Act [42 U.S.C. 1397aa 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) payments under title XIX of such Act attributable to DSH allotments for such State determined under section 1923(f) of such Act (42 U.S.C. 1396r–4(f)) for such fiscal years.”
Pub. L. 105–33, title IV, § 4744, “(a) “(1) 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 [42 U.S.C. 1396 et seq.] in accordance with the requirements of section 1905(r) of such Act (42 U.S.C. 1396d(r)).“(2) 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) Not later than 12 months after the date of the enactment of this Act [
For 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
Pub. L. 101–508, title IV, § 4706, “(a) (1) 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 [42 U.S.C. 1396d(h)], and such determination has not been subject to a final judicial decision, any disallowance or deferral of Federal financial participation under such Act [42 U.S.C. 301 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) Any disallowance of Federal financial participation under title XIX of the Social Security Act [42 U.S.C. 1396 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) Subsection (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 [
Pub. L. 100–360, title IV, § 411(l)(3)(C)(i), formerly § 411(l)(3)(C),
Pub. L. 99–272, title IX, § 9514,
Pub. L. 99–272, title IX, § 9515,
Pub. L. 97–35, title XXI, § 2165,
Pub. L. 95–292, § 8(c), (d)(2),