119-hr3990

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3990 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3990

To provide Medicaid assistance to individuals and families affected by 
 a disaster or emergency, and for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 June 12, 2025

Mr. Panetta (for himself and Ms. Tokuda) introduced the following bill; 
 which was referred to the Committee on Energy and Commerce, and in 
 addition to the Committee on Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
 of such provisions as fall within the jurisdiction of the committee 
 concerned

_______________________________________________________________________

 A BILL

To provide Medicaid assistance to individuals and families affected by 
 a disaster or emergency, and for other purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Disaster Relief Medicaid Act''.

SEC. 2. MEDICAID RELIEF FOR DISASTER SURVIVORS.

 Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended--

    (1) in 

section 1902

    (a) --
        (A) in paragraph

    (86) , by striking ``; and'' and 
 inserting a semicolon;
        (B) in paragraph

    (87) , by striking the period at 
 the end and inserting ``; and''; and
            (C) by inserting after paragraph

    (87) the following 
 new paragraph:
 ``

    (88) beginning January 1, 2027, provide for making 
 medical assistance available to relief-eligible survivors of 
 disasters during relief coverage periods in accordance with 
 

section 1949.''; and

    (2) by adding at the end the following new section:

``

SEC. 1949. DISASTER RELIEF MEDICAID FOR SURVIVORS OF MAJOR DISASTERS.

 ``

    (a) In General.--Notwithstanding any other provision of this 
title, a State plan shall provide medical assistance to a relief-
eligible survivor of a disaster in accordance with this section.
 ``

    (b) 

=== Definitions. ===
-In this section:
 ``

    (1) Disaster.--The term `disaster' means any of the 
 following:
 ``
        (A) A major disaster that is declared on or after 
 January 1, 2027, by the President in accordance with 
 

section 401 of the Robert T. Stafford Disaster Relief 
 and Emergency Assistance Act (42 U.S.C. 5170) and which 
 the President has determined warrants individual or 
 public assistance from the Federal Government under 
 such Act.
 ``
        (B) A national emergency declared by the 
 President under the National Emergencies Act (50 U.S.C. 
 1601 et seq.).
 ``
            (C) A public health emergency declared by the 
 Secretary pursuant to 

section 319 of the Public Health 
 Service Act (42 U.S.C. 247d).
 ``

    (2) Direct impact area.--
 ``
        (A) In general.--The term `direct impact area' 
 means, with respect to a disaster, the geographic area 
 in which the disaster exists.
 ``
        (B) Website posting of direct impact areas.--As 
 soon as practicable after a disaster is declared (as 
 described in subparagraph
        (A) ,
        (B) , or
            (C) of paragraph

    (1) , as applicable), the Secretary shall post on the 
 websites of the Centers for Medicare & Medicaid 
 Services and the Federal Emergency Management Agency a 
 list of the areas identified as the direct impact areas 
 of the disaster.
 ``

    (3) Home state.--The term `home State' means, with 
 respect to a survivor of a disaster, the State in which the 
 survivor was a resident (as determined in accordance with 
 

section 435.403 of title 42, Code of Federal Regulations (or 
 any successor regulation)) on the date on which the disaster is 
 declared (as described in subparagraph
        (A) ,
        (B) , or
            (C) of 
 paragraph

    (1) , as applicable).
 ``

    (4) Relief coverage period.--The term `relief coverage 
 period' means, with respect to a disaster, the period that 
 begins on the date the disaster is declared (as described in 
 subparagraph
        (A) ,
        (B) , or
            (C) of paragraph

    (1) , as applicable) 
 and ends on the day that is 2 years after such date.
 ``

    (5) Relief-eligible survivor.--
 ``
        (A) In general.--Subject to subparagraph
            (C) , the 
 term `relief-eligible survivor' means an individual who 
 is a survivor of a disaster whose family income does 
 not exceed the higher of--
 ``
            (i) 133 percent (or, in the case of a 
 survivor who is a pregnant individual, a child, 
 or a recipient of benefits under title II on 
 the basis of a disability, 200 percent) of the 
 poverty line; or
 ``
            (ii) the income eligibility standard that 
 would otherwise apply to the survivor under the 
 State plan of the survivor's home State (or a 
 waiver of such plan).
 ``
        (B) Disregard of unemployment income and fema 
 individual assistance grants.--For purposes of this 
 section, and notwithstanding 

section 1902

    (e)

    (14)
        (B) , 
 the income of a survivor of a disaster shall not 
 include--
 ``
            (i) any amount received by the survivor 
 during the relief coverage period of the 
 disaster under a law of the United States or a 
 State which is in the nature of unemployment 
 compensation; or
 ``
            (ii) any amount received during the 
 relief coverage period of the disaster by the 
 survivor (or the survivor's household) as 
 assistance under a program administered by the 
 Federal Emergency Management Agency.
 ``
            (C) Limitation to relief coverage period.--
 ``
            (i) In general.--Except as provided in 
 clauses
            (ii) and
            (iii) , for purposes of this 
 section, an individual shall not be considered 
 to be a relief-eligible survivor on the basis 
 of the individual's status as a survivor of a 
 disaster after the end of the relief coverage 
 period of the disaster.
 ``
            (ii) Continuous eligibility for disaster 
 relief coverage for pregnant and postpartum 
 individuals.--In the case of an individual who, 
 while pregnant, receives medical assistance as 
 a relief-eligible survivor of a disaster under 
 a State plan (or a waiver of such a plan) in 
 accordance with this section, such individual 
 shall continue to be eligible for medical 
 assistance as a relief-eligible survivor 
 through the end of the month in which the 60-
 day period (beginning on the last day of the 
 pregnancy) (or, if longer, the period of 
 postpartum continuous eligibility that 
 otherwise applies to individuals who, while 
 pregnant, are eligible for medical assistance 
 under the State plan or waiver) ends, without 
 regard to whether the pregnancy ends before or 
 after the end of the relief coverage period of 
 the disaster.
 ``
            (iii) Continuous eligibility for 
 individuals with pending applications.--If an 
 individual who receives medical assistance as a 
 relief-eligible survivor of a disaster under a 
 State plan (or a waiver of such a plan) in 
 accordance with this section has an application 
 pending for medical assistance under the State 
 plan (or waiver) under this title or for child 
 health assistance or pregnancy-related 
 assistance under a State plan under title XXI 
 (or a waiver of such a plan) on the date that 
 the relief coverage period of the disaster 
 ends, such individual shall continue to be 
 eligible for medical assistance as a relief-
 eligible survivor through the earlier of--
 ``
            (I) the end of the month in which 
 the 60-day period (beginning on the 
 last day of such relief coverage 
 period) ends; and
 ``
            (II) the date on which the 
 individual's application for medical 
 assistance, child health assistance, or 
 pregnancy-related assistance (as 
 applicable) is approved or denied.
 ``

    (6) Survivor.--
 ``
        (A) In general.--The term `survivor' means, with 
 respect to a disaster, an individual who is described 
 in subparagraph
        (B) or
            (C) .
 ``
        (B) Residents and evacuees of direct impact 
 areas.--An individual described in this subparagraph is 
 an individual who, on the date on which a disaster is 
 declared (as described in subparagraph
        (A) ,
        (B) , or
            (C) of paragraph

    (1) , as applicable), has a primary 
 residence in the disaster's direct impact area.
 ``
            (C) Individuals who lost employment.--An 
 individual described in this subparagraph is an 
 individual--
 ``
            (i) whose worksite was located in the 
 disaster's direct impact area;
 ``
            (ii) who was employed by an employer 
 that--
 ``
            (I) conducted an active trade or 
 business in such area on the date on 
 which the disaster was declared (as so 
 described); and
 ``
            (II) was unable to operate such 
 trade or business as a result of the 
 disaster on any day during the 
 disaster's relief coverage period; and
 ``
            (iii) whose employment with such employer 
 was terminated.
 ``
            (D) Treatment of homeless persons.--In the case 
 of an individual who is homeless (as such term is 
 defined in 

section 103

    (a) of the McKinney-Vento 
 Homeless Assistance Act (42 U.S.C. 11302

    (a) )) on the 
 date on which a disaster is declared (as so described), 
 the individual's residency for purposes of subparagraph
        (B) shall be determined in accordance with 

section 435.403 of title 42, Code of Federal Regulations (or 
 any successor regulation).
 ``
        (E) Effect of concurrent eligibility for medicaid 
 or chip.--An individual's eligibility for medical 
 assistance under a State plan (or waiver of such plan) 
 (or for child health assistance or pregnancy-related 
 assistance under a State plan under title XXI (or a 
 waiver of such a plan)) on a basis other than under 
 this section shall not prevent the individual from 
 being treated as a survivor under this section, and the 
 rights afforded to an individual who is eligible for or 
 enrolled under a State plan (or waiver) under either 
 such title shall not be affected by the individual's 
 receipt of medical assistance as a relief-eligible 
 survivor of a disaster in accordance with this section.
 ``
            (c) Eligibility.--
 ``

    (1) Simplified application.--
 ``
        (A) In general.--For purposes of determining 
 eligibility for medical assistance under this section, 
 each State may accept a simplified, streamlined 
 application form (as developed by the Secretary in 
 consultation with the National Association of State 
 Medicaid Directors), which shall--
 ``
            (i) require an applicant for medical 
 assistance in accordance with this section as a 
 survivor of a disaster to--
 ``
            (I) provide the applicant's 
 mailing address for the duration of the 
 relief coverage period of the disaster; 
 and
 ``
            (II) agree to update the 
 information described in subclause
            (I) if it changes during such period;
 ``
            (ii) provide notice of the penalties for 
 making a fraudulent application described in 
 subsection

    (g) ;
 ``
            (iii) require the applicant to assign to 
 the State any rights of the applicant (or any 
 other individual who is a relief-eligible 
 survivor and on whose behalf the applicant has 
 the legal authority to execute an assignment of 
 such rights) as described and in accordance 
 with the requirements of 

section 1912;
 ``
            (iv) require the applicant to list any 
 health insurance coverage in which the 
 applicant was enrolled immediately prior to 
 submitting the application for medical 
 assistance under this section; and
 ``
            (v) require the applicant to self-attest 
 that the applicant--
 ``
            (I) is a relief-eligible survivor 
 of the disaster; and
 ``
            (II) if applicable, requires home 
 and community-based services.
 ``
        (B) No documentation requirement.--
 ``
            (i) In general.--A State shall not 
 require an applicant for medical assistance as 
 a survivor of a disaster under this section to 
 provide any documentation or other evidence--
 ``
            (I) of the applicant's status as 
 a relief-eligible survivor; and
 ``
            (II) if applicable, that the 
 applicant requires home and community-
 based services.
 ``
            (ii) Use of available electronic data 
 sources.--In making determinations with respect 
 to the status of an applicant for medical 
 assistance as a survivor of a disaster under 
 this section, or such an applicant's need for 
 home and community-based services, a State may 
 use data relating to the applicant that is 
 available to the State from electronic data 
 sources.
 ``

    (2) Presumptive eligibility for relief-eligible 
 survivors.--
 ``
        (A) In general.--A State shall provide for making 
 medical assistance available to an individual as a 
 relief-eligible survivor under this section during a 
 presumptive eligibility period.
 ``
        (B) Presumptive eligibility period defined.--For 
 purposes of this paragraph--
 ``
            (i) the term `presumptive eligibility 
 period' means, with respect to an individual, 
 the period that--
 ``
            (I) begins with the date on which 
 a qualified provider determines, on the 
 basis of preliminary information, that 
 the individual satisfies the criteria 
 for eligibility for medical assistance 
 as a relief-eligible survivor under 
 this section; and
 ``
            (II) ends with (and includes) the 
 earlier of--
 ``

    (aa) the day on which a 
 determination is made with 
 respect to the eligibility of 
 the individual for medical 
 assistance as a relief-eligible 
 survivor under this section; or
 ``

    (bb) in the case of an 
 individual who does not file an 
 application by the last day of 
 the month following the month 
 during which the provider makes 
 the determination referred to 
 in item

    (aa) , such last day; 
 and
 ``
            (ii) the term `qualified provider' has 
 the meaning given such term in 

section 1920.
 ``
            (C) Coordination between state agencies and 
 qualified providers.--
 ``
            (i) Provision of forms and information to 
 qualified providers.--The State agency shall 
 provide qualified providers with--
 ``
            (I) such forms as are necessary 
 for an individual to make application 
 for medical assistance under the State 
 plan as a relief-eligible survivor; and
 ``
            (II) information on how to assist 
 individuals and their authorized 
 representatives in completing and 
 filing such forms.
 ``
            (ii) Provision of notice of 
 determinations to state agencies.--A qualified 
 provider that determines under this 
 subparagraph that an individual is eligible for 
 medical assistance under a State plan as a 
 relief-eligible survivor under this section 
 shall--
 ``
            (I) notify the State agency of 
 the determination within 5 working days 
 after the date on which determination 
 is made; and
 ``
            (II) inform the individual at the 
 time the determination is made that the 
 individual is required to make 
 application for medical assistance 
 under the State plan by not later than 
 the last day of the month following the 
 month during which the determination is 
 made.
 ``
            (D) Application requirement.--An individual who 
 is determined by a qualified provider to be 
 presumptively eligible as a relief-eligible survivor 
 for medical assistance under a State plan shall make 
 application for medical assistance under such plan by 
 not later than the last day of the month following the 
 month during which the determination is made, which 
 application may be the streamlined application 
 described in paragraph

    (1) .
 ``
        (E) Treatment as medical assistance.--
 Notwithstanding any other provision of this title, 
 items and services that are--
 ``
            (i) furnished to an individual during a 
 presumptive eligibility period under this 
 paragraph by a provider that is eligible for 
 payments under the State plan; and
 ``
            (ii) included in the care and services 
 covered by the State plan;
 shall be treated as medical assistance provided to a 
 relief-eligible survivor of a disaster during the 
 relief coverage period of the disaster under this 
 section.
 ``

    (3) Continuous eligibility.--
 ``
        (A) In general.--Subject to subparagraph
        (B) , an 
 individual who is determined by a State to be a relief-
 eligible survivor of a disaster shall remain eligible 
 for medical assistance under the State plan (or a 
 waiver of such plan) as such a survivor, without the 
 need for any redetermination of eligibility, for the 
 duration of the relief coverage period of the disaster.
 ``
        (B) Exceptions.--A State may terminate the 
 eligibility of an individual who is determined by a 
 State to be a relief-eligible survivor of a disaster 
 before the end of the relief coverage period of the 
 disaster if--
 ``
            (i) the individual (or the individual's 
 authorized representative) requests a voluntary 
 termination of eligibility;
 ``
            (ii) the individual ceases to be a 
 resident of the State;
 ``
            (iii) the State determines that 
 eligibility was erroneously granted because of 
 State error or fraud, abuse, or perjury 
 attributed to the individual (or the 
 individual's authorized representative); or
 ``
            (iv) the individual dies.
 ``

    (4) Issuance of disaster relief medicaid eligibility 
 card.--A State shall issue a disaster relief Medicaid 
 eligibility card to each applicant who is determined to be a 
 relief-eligible survivor of a disaster and eligible for medical 
 assistance under this section, which shall be valid for the 
 duration of the relief coverage period of the disaster.
 ``

    (5) Verification of status as a relief-eligible 
 survivor.--
 ``
        (A) In general.--The State shall make a good 
 faith effort to verify the status of an individual who 
 is enrolled in the State plan (or a waiver of such 
 plan) as a relief-eligible survivor of a disaster in 
 accordance with this section. Such effort shall not 
 delay the determination of the eligibility of the 
 individual for medical assistance under this section, 
 and a State may enroll an individual in the State plan 
 or waiver under this section pending such verification.
 ``
        (B) Evidence of verification.--A State may 
 satisfy the verification requirement under subparagraph
        (A) with respect to an individual by showing that the 
 State obtained information from the Social Security 
 Administration, the Internal Revenue Service, or, if 
 applicable, the State Medicaid agency of the home State 
 of the individual.
 ``

    (6) Determination by express lane agency.--Any 
 determination or redetermination of eligibility or verification 
 of status made under this section shall be made by an Express 
 Lane agency (as defined in 

section 1902

    (e)

    (13)
        (F) ).
 ``
            (d) Scope of Coverage.--
 ``

    (1) In general.--A State providing medical assistance to 
 a relief-eligible survivor of a disaster in accordance with 
 this section shall provide medical assistance that is at least 
 equal in amount and scope to the medical assistance that would 
 otherwise be made available to such survivor if the survivor 
 were enrolled in the State plan (or waiver of such plan) as an 
 individual described in clause
            (i) of 

section 1902

    (a)

    (10)
        (A) , 
 except that, in the case of such a survivor whose home State is 
 not the State providing medical assistance to the individual, 
 the State shall also provide medical assistance for any item or 
 service for which medical assistance is available to 
 individuals described in clause
            (i) of 

section 1902

    (a)

    (10)
        (A) under the State plan (or waiver) of the survivor's home State.
 ``

    (2) Provider payment rates for home state services.--In 
 the case of medical assistance provided under this section by a 
 State to a relief-eligible survivor of a disaster whose home 
 State is not the State providing such assistance for an item or 
 service which is not otherwise available under the State plan 
 (or waiver of such plan) but which is available under the State 
 plan (or waiver) of the survivor's home State, the State shall 
 pay the provider of such item or service at least at the same 
 rate that the home State would pay for the item or service if 
 it were provided under the plan or waiver of the home State 
 (or, if no such payment rate applies under the plan or waiver 
 of the home State, the usual and customary prevailing rate for 
 the item or service for the community in which it is provided).
 ``

    (3) Retroactive coverage.--
 ``
        (A) In general.--Notwithstanding 

section 1905

    (a) , 
 a State shall provide medical assistance for items and 
 services furnished in the State beginning with the 
 first day of the relief coverage period of a disaster 
 to any relief-eligible survivor of the disaster who 
 submits an application for such assistance before the 
 deadline described in subparagraph
        (B) .
 ``
        (B) Application deadline.--The deadline for a 
 relief-eligible survivor of a disaster to submit an 
 application for medical assistance in accordance with 
 this section is the date that is 90 days after the end 
 of the disaster's relief coverage period.
 ``

    (4) Children born to relief-eligible survivors of a 
 disaster.--In the case of a child born to a relief-eligible 
 survivor of a disaster who is provided medical assistance in 
 accordance with this section during the relief coverage period 
 of the disaster, the child shall be treated as having been born 
 to a pregnant individual eligible for medical assistance under 
 the State plan (or waiver of such plan) and shall be eligible 
 for medical assistance under such plan (or waiver) in 
 accordance with 

section 1902

    (e)

    (4) . Notwithstanding subsection

    (f) , the Federal medical assistance percentage determined for a 
 State and fiscal year under 

section 1905

    (b) shall apply to 
 medical assistance provided during the year to a child under 
 the State plan (or waiver) in accordance with the preceding 
 sentence.
 ``

    (5) Option to provide extended mental health and care 
 coordination benefits.--A State may provide, without regard to 
 any restrictions on amount, duration, scope, or comparability, 
 or other restrictions under this title or the State plan or 
 waiver of such plan (other than restrictions applicable to 
 services provided in an institution for mental diseases), 
 medical assistance to relief-eligible survivors of a disaster 
 under this section for extended mental health and care 
 coordination services, which may include the following:
 ``
        (A) Screening, assessment, and diagnostic 
 services (including specialized assessments for 
 individuals with cognitive impairments).
 ``
        (B) Coverage for a full range of mental health 
 medications at the dosages and frequencies prescribed 
 by health professionals for depression, post-traumatic 
 stress disorder, and other mental disorders.
 ``
            (C) Treatment of alcohol and substance abuse 
 determined to result from circumstances related to the 
 disaster.
 ``
            (D) Psychotherapy, rehabilitation and other 
 treatments administered by psychiatrists, 
 psychologists, social workers, or other qualified 
 mental or behavioral health professionals for 
 conditions exacerbated by, or resulting from, the 
 disaster.
 ``
        (E) Peer support services related to the 
 disaster.
 ``
        (F) Mobile crisis services to assist with crises 
 related to the disaster.
 ``
        (G) Inpatient and outpatient mental health care.
 ``
        (H) Family counseling for families where a member 
 of the immediate family is a survivor of the disaster 
 or a first responder to the disaster or includes an 
 individual who has died as a result of the disaster.
 ``
            (I) In connection with the provision of health 
 and long-term care services, arranging for, (and when 
 necessary, enrollment in waiver programs or other 
 specialized programs), and coordination related to, 
 primary and specialty medical care, which may include 
 personal care services, durable medical equipment and 
 supplies, assistive technology, and transportation.
 ``

    (6) Option to provide home and community-based 
 services.--
 ``
        (A) In general.--A State may provide medical 
 assistance under this section for home and community-
 based services to a relief-eligible survivor of a 
 disaster, including any survivor who is an individual 
 described in subparagraph
        (B) , who self-attests that 
 the survivor immediately requires such services, 
 without regard to whether the survivor would require 
 the level of care provided in a hospital, nursing 
 facility, or intermediate care facility for the 
 developmentally disabled.
 ``
        (B) Individuals described.--Individuals described 
 in this subparagraph are relief-eligible survivors of a 
 disaster who--
 ``
            (i) on any day during the week preceding 
 the date on which the disaster is declared (as 
 described in subparagraph
        (A) ,
        (B) , or
            (C) of 
 subsection

    (b)

    (1) , as applicable)--
 ``
            (I) had been receiving home and 
 community-based services in a direct 
 impact area under a waiver under 
 

section 1115 or 

section 1915;
 ``
            (II) had been receiving support 
 services from a family caregiver who, 
 as a result of the disaster, is no 
 longer available to provide services; 
 or
 ``
            (III) had been receiving personal 
 care, home health, or rehabilitative 
 services under a State plan under this 
 title or under a waiver granted under 
 sections 1115 or 1915; or
 ``
            (ii) are disabled (as determined in 
 accordance with the State plan of the home 
 State of the individual).
 ``
            (C) Waiver of restrictions.--With respect to the 
 provision of home and community-based services under 
 this paragraph, the Secretary--
 ``
            (i) shall waive any limitations on--
 ``
            (I) the number of individuals who 
 may receive home or community-based 
 services under a waiver described in 
 subparagraph
        (B)
            (i) 
            (I) ;
 ``
            (II) budget neutrality 
 requirements applicable to such waiver; 
 and
 ``
            (III) populations eligible for 
 services under such waiver; and
 ``
            (ii) may waive any other restriction 
 applicable under such a waiver that would 
 prevent a State from providing home and 
 community-based services in accordance with 
 this paragraph.
 ``

    (e) State Reports.--Each State shall submit to the Secretary an 
annual report that includes--
 ``

    (1) the number of survivors of a disaster who were 
 determined by the State to be relief-eligible survivors of a 
 disaster in the preceding year; and
 ``

    (2) the number of relief-eligible survivors of a disaster 
 who were determined to be eligible for, and enrolled in, the 
 State plan (or waiver of such plan) or the State child health 
 plan under title XXI (or waiver of such plan) other than under 
 this section.
 ``

    (f) 100 Percent Federal Matching Payments.--
 ``

    (1) In general.--Notwithstanding 

section 1905

    (b) , the 
 Federal medical assistance percentage shall be equal to 100 
 percent with respect to amounts expended by a State--
 ``
        (A) for medical assistance provided in accordance 
 with this section to relief-eligible survivors of a 
 disaster during the relief coverage period of the 
 disaster and, in the case of individuals described in 
 clause
            (ii) or
            (iii) of subsection

    (b)

    (5)
            (C) , during 
 the applicable periods described in such clauses; and
 ``
        (B) that are directly attributable to 
 administrative activities related to the provision of 
 medical assistance under this section, including costs 
 attributable to obtaining recoveries under subsection

    (g) .
 ``

    (2) Disregard of limits on payments to territories.--The 
 limitations on payment under subsections

    (f) and

    (g) of 

section 1108 shall not apply to Federal payments under this title that 
 are based on the Federal medical assistance percentage 
 described in paragraph

    (1) , and such payments shall be 
 disregarded in applying such subsections.
 ``

    (g) Penalty for Fraudulent Applications.--
 ``

    (1) Individual liable for costs.--If a State, as the 
 result of verification activities conducted by the State or 
 otherwise, determines after a fair hearing that an individual 
 has knowingly made a false attestation in an application for 
 medical assistance as a relief-eligible survivor of a disaster 
 under this section, the State shall, subject to paragraph

    (2) , 
 seek recovery from the individual for the full amount of the 
 cost of medical assistance provided to the individual under 
 this section.
 ``

    (2) Exception.--The Secretary shall exempt a State from 
 the requirement to seek recovery from an individual under 
 paragraph

    (1) if the Secretary determines that it would not be 
 cost-effective for the State to do so.
 ``

    (3) Reimbursement to the federal government.--Amounts 
 expended by a State for medical assistance provided to an 
 individual under this section that are subsequently recovered 
 by the State under this subsection shall be treated as an 
 overpayment under this title to the extent that payments were 
 made to the State for such amounts.
 ``

    (h) Exemption From Error Rate Penalties.--All payments 
attributable to providing medical assistance to relief-eligible 
survivors of disasters in accordance with this section shall be 
disregarded for purposes of 

section 1903

    (u) .''.

SEC. 3. PROMOTING EFFECTIVE AND INNOVATIVE STATE RESPONSES TO INCREASED 
 DEMAND FOR MEDICAL ASSISTANCE FOLLOWING A DISASTER.

    (a) Guidance on Increasing Access to Providers.--Not later than 
January 1, 2027, the Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall issue (and update as 
the Secretary determines necessary) guidance to State Medicaid 
directors on best practices for--

    (1) expediting the approval of providers under a State 
 Medicaid plan under title XIX of the Social Security Act (42 
 U.S.C. 1396 et seq.), or waiver of such plan, after a disaster 
 to meet increased demand for medical assistance under the plan 
 or waiver from relief-eligible survivors (as defined in 

section 1949

    (b)

    (5) of such Act) of disasters; and

    (2) using out-of-State providers to provide care to relief-
 eligible survivors of a disaster under the plan or waiver.

    (b) Technical Assistance and Support for Innovative State 
Strategies To Respond to Increased Demand for Medical Assistance 
Following a Disaster.--

    (1) In general.--The Secretary shall provide technical 
 assistance and support to States to develop or expand 
 infrastructure, strategies, or innovations (including through 
 State Medicaid demonstration projects) to provide medical 
 assistance under a State Medicaid plan under title XIX of the 
 Social Security Act (42 U.S.C. 1396 et seq.), or a waiver of 
 such a plan, to relief-eligible survivors (as defined in 
 

section 1949

    (b)

    (5) of such Act) of disasters.

    (2) Report.--Not later than 180 days after the date of 
 enactment of this Act, the Secretary shall issue a report to 
 Congress detailing a plan of action to carry out the 
 requirements of paragraph

    (1) .
            (c) HCBS Emergency Response Corps Grant Program.--

    (1) In general.--The Secretary shall award grants under 
 this subsection to States for the purpose of establishing or 
 operating HCBS emergency response corps that meet the 
 requirements of paragraph

    (2) to provide medical assistance for 
 home and community-based services under a State Medicaid plan 
 under title XIX of the Social Security Act (42 U.S.C. 1396 et 
 seq.) to relief-eligible survivors (as defined in 

section 1949

    (b)

    (5) of such Act) of disasters.

    (2) Home and community-based services emergency response 
 corps.--An HCBS emergency response corps meets the requirements 
 of this paragraph if it satisfies the following requirements:
        (A) The corps serves a State with a history of 
 hosting individuals who are forced to relocate to the 
 State from another State due to a disaster (as 
 determined by the Secretary).
        (B) The corps is composed of representatives from 
 each of the following:
            (i) Voluntary organizations delivering 
 assistance.
            (ii) Area agencies on aging (as defined in 
 

section 102 of the Older Americans Act of 1965 
 (42 U.S.C. 3002)).
            (iii) The Medicare program under title 
 XVIII of the Social Security Act (42 U.S.C. 
 1395 et seq.).
            (iv) The State agency responsible for 
 administering the State Medicaid program under 
 title XIX of the Social Security Act (42 U.S.C. 
 1396 et seq.).
            (v) State agencies serving older adults and 
 people with disabilities.
            (vi) Nonprofit service providers.
            (vii) Individuals who are enrolled in the 
 State Medicaid program under title XIX of the 
 Social Security Act (42 U.S.C. 1396 et seq.) or 
 the Children's Health Insurance Program under 
 title XXI of the Social Security Act (42 U.S.C. 
 1397aa et seq.).
            (viii) Centers for independent living, as 
 described in part C of title VII of the 
 Rehabilitation Act of 1973 (29 U.S.C. 796f et 
 seq.).
            (ix) Other organizations that address the 
 needs of older adults and people with 
 disabilities.
            (C) The corps is led by a representative of a State 
 or nonprofit agency serving older adults or people with 
 disabilities.
            (D) The corps operates under a plan to meet the 
 acute and long-term services and support needs of 
 relief-eligible survivors (as defined in 

section 1949

    (b)

    (5) of the Social Security Act) of disasters, 
 and is provided with the resources necessary to execute 
 such plan.

    (3) Grants.--
        (A) Limitation.--The Secretary may award a grant 
 under this subsection to up to 5 States.
        (B) Term of grants.--Grants under this subsection 
 shall be made for a term of 2 years.

    (4) Authorization.--There are authorized to be appropriated 
 to carry out this subsection, $10,000,000 for each of fiscal 
 years 2027 through 2032, to remain available until expended.

SEC. 4. TARGETED MEDICAID RELIEF FOR DIRECT IMPACT AREAS.

    (a) 100 Percent Federal Matching Payments for Medical Assistance 
Provided in a Direct Impact Area.--

    (1) In general.--

Section 1905 of the Social Security Act 
 (42 U.S.C. 1396d) is amended--
        (A) in subsection

    (b) , by striking ``and
            (ii) '' and 
 inserting ``
            (ii) , and

    (kk) ''; and
        (B) by adding at the end the following new 
 subsection:
 ``

    (kk) 100 Percent FMAP for All Medical Assistance Provided in 
Disaster Direct Impact Areas.--Notwithstanding subsection

    (b) , the 
Federal medical assistance percentage for a State and fiscal year shall 
be equal to 100 percent with respect to amounts expended by the State 
during the fiscal year for medical assistance for an individual who, 
during the fiscal quarter in which the assistance is provided to the 
individual, is a resident of a direct impact area of a disaster during 
the disaster's relief coverage period (as such terms are defined in 

section 1949).''.

    (2) Exclusion of enhanced payments from territorial caps.--
 Notwithstanding any other provision of law, for purposes of 
 

section 1108 of the Social Security Act (42 U.S.C. 1308), with 
 respect to any additional amount paid to a territory as a 
 result of the application of subsection

    (kk) of 

section 1905 of 
 the Social Security Act (42 U.S.C. 1396d), as added by 
 paragraph

    (1) --
        (A) the limitation on payments to territories under 
 subsections

    (f) and

    (g) of such 

section 1108 shall not 
 apply to such additional amounts; and
        (B) such additional amounts shall be disregarded in 
 applying such subsections.

    (3) Application to chip.--
        (A) In general.--

Section 2105
            (c) of the Social 
 Security Act (42 U.S.C. 1397ee

    (a) ) is amended by adding 
 at the end the following new paragraph:
 ``

    (13) 100 percent match for assistance provided in 
 disaster direct impact areas.--Notwithstanding subsection

    (b) , 
 the enhanced FMAP for a State, with respect to payments under 
 subsection

    (a) for expenditures under the State plan for child 
 health assistance for targeted low-income children or 
 pregnancy-related assistance for individuals who are targeted 
 low-income women that is provided to such a child or individual 
 who, at the time the assistance is provided, is a resident of a 
 direct impact area of a disaster during the disaster's relief 
 coverage period (as such terms are defined in 

section 1949) 
 shall be equal to 100 percent.''.
        (B) Adjustment of chip allotments.--

Section 2104
            (m) of the Social Security Act (42 U.S.C. 1397dd
            (m) ) is 
 amended--
            (i) in paragraph

    (2)
        (B) , by striking ``and

    (12) '' and inserting ``

    (12) , and

    (13) ''; and
            (ii) by adding at the end the following new 
 paragraph:
 ``

    (13) Adjusting allotments to account for increased 
 federal payments for assistance provided in disaster direct 
 impact areas.--If a State (including the District of Columbia 
 and each commonwealth and territory) receives a payment for a 
 fiscal year under subsection

    (a) of 

section 2105 for 
 expenditures that are subject to the enhanced FMAP specified 
 under subsection
            (c) (13) of such section--
 ``
        (A) the amount of the allotment determined for 
 the State under this subsection for such fiscal year 
 shall be increased by the product of--
 ``
            (i) the amount of such expenditures that 
 the State is projected to make for such fiscal 
 year; and
 ``
            (ii) a percentage equal to 100 percent 
 reduced by a number of percentage points equal 
 to the enhanced FMAP determined for the State 
 and fiscal year under subsection

    (b) of 

section 2105; and
 ``
        (B) once actual expenditures for the fiscal year 
 are available, the amount of such allotment, as 
 increased under subparagraph
        (A) , shall be further 
 increased or reduced, as appropriate, on the basis of 
 the difference between--
 ``
            (i) the amount of the increase determined 
 under subparagraph
        (A) ; and
 ``
            (ii) the product of--
 ``
            (I) the actual amount of State 
 expenditures that are subject to the 
 enhanced FMAP specified under 

section 2105
            (c) (13) ; and
 ``
            (II) the percentage determined 
 for the State under subparagraph
        (A)
            (ii) .''.

    (b) Moratorium on Redeterminations.--During the relief coverage 
period (as defined in paragraph

    (4) of 

section 1949

    (b) of the Social 
Security Act, as added by 

section 2) of a disaster, a State that 
contains a direct impact area (as defined in paragraph

    (2) of such 
section) of the disaster shall not be required to conduct eligibility 
redeterminations under the State's plans or waivers of such plans under 
title XIX or XXI of such Act (42 U.S.C. 1396 et seq., 1397aa) with 
respect to individuals who reside in such area.

SEC. 5. AUTHORITY TO WAIVE REQUIREMENTS DURING NATIONAL EMERGENCIES 
 WITH RESPECT TO EVACUEES FROM AN EMERGENCY AREA.

 

Section 1135

    (g)

    (1) of the Social Security Act (42 U.S.C. 1320b-
5

    (g)

    (1) ) is amended--

    (1) in subparagraph
        (A) , by striking ``subparagraph
        (B) '' 
 and inserting ``subparagraphs
        (B) and
            (C) ''; and

    (2) by adding at the end the following new subparagraph:
 ``
            (C) Additional areas.--Any geographical area in which the 
 Secretary determines there are a significant number of evacuees 
 from an area described in subparagraph
        (A) shall also be 
 considered to be an `emergency area' for purposes of this 
 section.''.

SEC. 6. EXCLUSION OF DISASTER RELIEF COVERAGE PERIOD IN COMPUTING 
 MEDICARE PART B LATE ENROLLMENT PERIOD.

 

Section 1839

    (b) of such Act (42 U.S.C. 1395r

    (b) ) is amended, in the 
second sentence, by inserting before the period at the end the 
following: ``or, in the case of an individual who is a survivor of a 
disaster (as defined in paragraph

    (6) of 

section 1949

    (b) ), any month 
any part of which is within the relief coverage period (as defined in 
paragraph

    (4) of such section) of such disaster''.

SEC. 7. EFFECTIVE DATE.

    (a) In General.--Subject to subsection

    (b) , this Act and the 
amendments made by this Act shall take effect on the date of enactment 
of this Act.

    (b) Delay Permitted if State Legislation Required.--In the case of 
a State plan approved 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 this section, 
the State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of the failure of the 
plan to meet such additional requirement before the 1st day of the 1st 
calendar quarter beginning after the close of the 1st regular session 
of the State legislature that ends after the 1-year period beginning 
with the date of the enactment of this section. For purposes of the 
preceding sentence, in the case of a State that has a 2-year 
legislative session, each year of the session is deemed to be a 
separate regular session of the State legislature.

SEC. 8. IMPACT EVALUATION AND REPORTING.

    (a) In General.--Not later than 24 months after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
enter into a 5-year agreement through a contract, grant, or cooperative 
agreement with an independent nonprofit entity experienced in 
conducting evaluations of program and systems change efforts to--

    (1) conduct a multi-year evaluation on the impact of this 
 Act, with respect to relief-eligible survivors (including 
 people with disabilities and pregnant individuals); and

    (2) prepare the reports described in subsection
            (c) .

    (b) Evaluation.--In carrying out subsection

    (a)

    (1) , the entity 
awarded a contract, grant, or cooperative agreement under this section 
shall evaluate at a minimum--

    (1) the availability of and access to Medicaid services for 
 relief-eligible survivors under the Medicaid program nationally 
 and in each State, territory and tribal organization, including 
 scope and coverage of services, provision of home and 
 community-based services and extended mental health and care 
 coordination services; and provider capacity;

    (2) the demographics of individuals receiving these 
 benefits, including individuals with disabilities and pregnant 
 individuals; and

    (3) actions taken by States to comply with this Act, 
 including coordination of efforts between states, coordination 
 between state agencies and qualified providers, and activities 
 of HCBS emergency response corps (as described in 

section 3
            (c) ).
            (c) Reports.--The Secretary of Health and Human Services shall 
submit to the Committee on Finance of the Senate, the Special Committee 
on Aging of the Senate, the Committee on Energy and Commerce of the 
House of Representatives, and the Committee on Ways and Means of the 
House of Representatives the following reports on the evaluation 
conducted under subsection

    (a)

    (1) :

    (1) An interim report on the evaluation, to be submitted 
 not later than 3 years after the evaluation commences.

    (2) A follow-up report on such evaluation, to be submitted 
 not later than 24 months after the date on which the interim 
 report is issued.
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