119-hr3995

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3995 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3995

 To establish a State public option through Medicaid to provide 
Americans with the choice of a high-quality, low-cost health insurance 
 plan.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 June 12, 2025

 Ms. Schrier 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 establish a State public option through Medicaid to provide 
Americans with the choice of a high-quality, low-cost health insurance 
 plan.

 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 ``State Public Option Act''.

SEC. 2. MEDICAID BUY-IN OPTION.

    (a) In General.--

Section 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended--

    (1) in subsection

    (a)

    (10) --
        (A) in subparagraph
        (A)
            (ii) --
            (i) in subclause
            (XXII) , by striking ``; 
 or'' and inserting a semicolon;
            (ii) in subclause
            (XXIII) , by adding ``or'' 
 at the end; and
            (iii) by adding at the end the following 
 new subclause:
 ``
            (XXIV) beginning January 1, 2026, 
 who are residents of the State and are 
 not concurrently enrolled in another 
 health insurance coverage plan, 
 subject, in the case of individuals 
 described in subsection

    (uu) and 
 notwithstanding 

section 1916 (except 
 for subsection

    (k) of such section), to 
 payment of premiums or other cost-
 sharing charges;''; and
        (B) in the matter following subparagraph
        (G) , by 
 inserting ``or subparagraph
        (A)
            (ii) 
            (XXIV) '' after 
 ``described in subparagraph
        (A)
            (i) 
            (VIII) ''; and

    (2) by adding at the end the following new subsection:
 ``

    (uu) Previously Undescribed Individuals.--Individuals described 
in this subsection are individuals who are--
 ``

    (1) described in subclause
            (XXIV) of subsection

    (a)

    (10)
        (A)
            (ii) ; and
 ``

    (2) are not described in any other subclause of such 
 subsection or any other provision in this Act which provides 
 for eligibility for medical assistance.''.

    (b) Provision of at Least Minimum Coverage.--

    (1) In general.--

Section 1902

    (k)

    (1) of the Social Security 
 Act (42 U.S.C. 1396a

    (k)

    (1) ) is amended by inserting ``or an 
 individual described in subclause
            (XXIV) of subsection

    (a)

    (10)
        (A)
            (ii) '' after ``an individual described in subclause
            (VIII) of subsection

    (a)

    (10)
        (A)
            (i) '' each place it appears.

    (2) Conforming amendment.--

Section 1903
            (i) (26) of the 
 Social Security Act (42 U.S.C. 1396b
            (i) (26) ) is amended by 
 striking ``individuals described in subclause
            (VIII) of 
 subsection

    (a)

    (10)
        (A)
            (i) '' and inserting ``individuals 
 described in subsections

    (a)

    (10)
        (A)
            (i) 
            (VIII) or

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) of 

section 1902''.
            (c) Federal Financial Participation in Buy-In Program.--

    (1) Enhanced match for administrative expenses.--

Section 1903

    (a) of the Social Security Act (42 U.S.C. 1396b

    (a) ) is 
 amended--
        (A) by redesignating paragraph

    (7) as paragraph

    (8) ; and
        (B) by inserting after paragraph

    (6) the following 
 new paragraph:
 ``

    (7) an amount equal to 90 percent of the sums expended 
 during such quarter which are attributable to reasonable 
 administrative expenses related to the administration of a 
 Medicaid buy-in program for individuals described in 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) (as found necessary by the Secretary 
 for the proper and efficient administration of such a program); 
 plus''.

    (2) Treatment of premium and cost-sharing revenues from 
 medicaid buy-in program.--
        (A) In general.--For purposes of 

section 1903

    (a)

    (1) of the Social Security Act (42 U.S.C. 1396b

    (a)

    (1) ), for 
 any fiscal quarter during which a State collects 
 premiums, cost-sharing, or similar charges under 
 subsection

    (k) of 

section 1916 of such Act (42 U.S.C. 
 1396o) (as added by this Act), including any advance 
 payments of premium tax credits under 

section 1412 of 
 the Patient Protection and Affordable Care Act or 
 payments for cost-sharing reductions under 

section 1402 
 of such Act that are received by the State, the total 
 amount expended during such quarter as medical 
 assistance for individuals who buy into Medicaid 
 coverage under subclause
            (XXIV) of 

section 1902

    (a)

    (10)
        (A)
            (ii) of the Social Security Act (as added 
 by this Act) shall be reduced by the amount of such 
 premiums or charges.
        (B) Treatment of excess premiums.--Each State that 
 collects premiums or similar charges under subsection

    (k) of 

section 1916 of the Social Security Act (42 
 U.S.C. 1396o) (as added by this Act) in a fiscal year 
 shall pay to the Secretary of Health and Human 
 Services, at such time and in such form and manner as 
 the Secretary shall specify, an amount equal to 50 
 percent of the amount, if any, by which--
            (i) the total amount of such premiums and 
 charges collected by the State for such year; 
 exceeds
            (ii) the total amount expended by the State 
 during such year as medical assistance for 
 individuals who buy into Medicaid coverage 
 under subclause
            (XXIV) of 

section 1902

    (a)

    (10)
        (A)
            (ii) of such Act (as added by 
 this Act).
            (d) Cost-Sharing Requirement.--

Section 1916 of the Social Security 
Act (42 U.S.C. 1396o) is amended by adding at the end the following new 
subsection:
 ``

    (k) Premiums and Cost-Sharing for Individuals Participating in 
Medicaid Buy-In Program.--
 ``

    (1) In general.--Subject to paragraph

    (2) , with respect 
 to individuals who are eligible for medical assistance under 
 subsection

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) of 

section 1902 and are 
 described in subsection

    (uu) of such section, a State may--
 ``
        (A) impose premiums, deductibles, cost-sharing, 
 or other similar charges that are determined on an 
 actuarially sound basis; and
 ``
        (B) vary the premium rate imposed on an 
 individual based only on the factors described in 
 

section 2701

    (a)

    (1)
        (A) of the Public Health Service Act 
 and subject to the same limitations on the weight which 
 may be given to such factors under such section.
 ``

    (2) Limitations.--
 ``
        (A) Premiums.--The total amount of premiums 
 imposed for a year under this subsection with respect 
 to all individuals described in paragraph

    (1) in a 
 family shall not exceed an amount equal to 8.5 percent 
 of the family's household income (as defined in 

section 36B
            (d) (2) of the Internal Revenue Code of 1986) for the 
 year involved.
 ``
        (B) Other cost-sharing.--
 ``
            (i) In general.--The cost-sharing 
 limitations described in 

section 1302
            (c) of the 
 Patient Protection and Affordable Care Act 
 shall apply to cost-sharing (as defined in such 
 section) for medical assistance provided under 
 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) in the same 
 manner as such limitations apply to cost-
 sharing under qualified health plans under 
 title I of such Act.
 ``
            (ii) Availability of cost-sharing 
 reductions.--Individuals provided medical 
 assistance under 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) and subject to cost-
 sharing under this subsection are eligible for 
 cost-sharing reductions under 

section 1402 of 
 the Patient Protection and Affordable Care Act 
 (subject to the income eligibility threshold in 
 subsection

    (b)

    (2) of such section), and in 
 applying such section--
 ``
            (I) enrollment in a State plan 
 under 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) shall be treated as coverage under a 
 qualified health plan in the silver 
 level of coverage in the individual 
 market offered through an Exchange 
 established for or by the State under 
 title I of the Patient Protection and 
 Affordable Care Act; and
 ``
            (II) the State agency 
 administering such plan shall be 
 treated as the issuer of such plan.
 ``

    (3) Premiums and cost-sharing for certain other 
 individuals.--If an individual is eligible for medical 
 assistance under subsection

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) of 

section 1902 and is not described in subsection

    (uu) of such section, a 
 State--
 ``
        (A) shall not impose premiums and cost-sharing on 
 the individual under this subsection; and
 ``
        (B) may impose premiums and cost-sharing on the 
 individual to the extent allowed by another provision 
 of this Act (other than 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) ) which provides for 
 eligibility for medical assistance, but only if the 
 individual is described in such other provision.
 ``

    (4) Application of premium assistance tax credits.--An 
 individual who is required to pay premiums under this 
 subsection for a year for medical assistance shall be eligible 
 for a premium assistance credit under 

section 36B of the 
 Internal Revenue Code to the same extent that such individual 
 would be eligible for a premium assistance credit under such 
 section if such individual had paid the same amount in premiums 
 for coverage under a qualified health plan for such year.''.

    (e) Managed Care.--

Section 1932

    (a)

    (1)
        (A)
            (i) of the Social Security 
Act (42 U.S.C. 1396u-2

    (a)

    (1)
        (A)
            (i) ) is amended by inserting ``, 
including an individual who is eligible for such assistance after 
buying into such coverage under 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) ,'' 
after ``the State plan under this title''.

    (f) Offering Buy-In Program on State Exchange; Enrollment 
Periods.--

    (1) In general.--A State that has elected to allow 
 individuals to buy into Medicaid coverage under 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) of the Social Security Act (as added 
 by this Act) shall allow individuals to enroll in such coverage 
 through an Exchange established by or for the State under title 
 I of the Patient Protection and Affordable Care Act.

    (2) Enrollment periods.--A State may limit the enrollment 
 of individuals into Medicaid coverage under 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) of the Social Security Act (as added 
 by this Act) to the enrollment periods provided for under 
 

section 1311
            (c) (6) of the Patient Protection and Affordable 
 Care Act.

    (g) Application of Advanced Premium Tax Credits to Medicaid Buy-In 
Plans.--

    (1) In general.--

Section 36B of the Internal Revenue Code 
 of 1986 is amended--
        (A) in subsection

    (b)

    (3)
        (B) , by adding at the end 
 the following new sentence:
 ``If an applicable taxpayer resides in a rating area in 
 which no silver plan is offered on the individual 
 market but the taxpayer buys into Medicaid coverage 
 under 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) of the Social 
 Security Act, such Medicaid coverage shall be deemed to 
 be the applicable second lowest cost silver plan with 
 respect to such taxpayer.'';
        (B) by redesignating subsection

    (h) as subsection
            (i) ; and
            (C) by inserting after subsection

    (g) the following 
 new subsection:
 ``

    (h) Application to Individuals Purchasing Medicaid Coverage.--In 
the case of any individual who buys into Medicaid coverage under 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) of the Social Security Act, this 
section shall be applied with the following modifications:
 ``

    (1) The amount determined under subsection

    (b)

    (2)
        (A) shall be increased by the amount of the monthly premiums paid 
 for such coverage.
 ``

    (2) Subsection
            (c) (2)
        (A)
            (i) shall be applied by treating 
 coverage under the Medicaid program under title XIX of the 
 Social Security Act in the same manner as a qualified health 
 plan that was enrolled in through an Exchange.
 ``

    (3) In applying subsection
            (c) (2)
        (B) --
 ``
        (A) an individual shall not be considered to be 
 eligible for minimum essential coverage described in 
 

section 5000A

    (f)

    (1)
        (A)
            (ii) by reason of eligibility for 
 medical assistance under a State Medicaid program under 
 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) ; and
 ``
        (B) an individual who is not covered by minimum 
 essential coverage described in 

section 5000A

    (f)

    (1)
        (B) shall not be considered to be eligible for such 
 coverage.''.

    (2) Advanced payment of credit.--
        (A) In general.--The Secretary of Health and Human 
 Services, in consultation with the Secretary of the 
 Treasury, shall establish a program under which--
            (i) upon request of a State agency 
 administering a State Medicaid program under 
 title XIX of the Social Security Act, advance 
 determinations are made in a manner similar to 
 advanced determinations under 

section 1412 of 
 the Patient Protection and Affordable Care Act 
 with respect to the income eligibility of 
 individuals enrolling in such program for the 
 premium tax credit allowable under 

section 36B 
 of the Internal Revenue Code of 1986 and the 
 cost-sharing reductions under 

section 1402 of 
 the Patient Protection and Affordable Care Act;
            (ii) the Secretary notifies--
            (I) the State agency administering 
 the program and the Secretary of the 
 Treasury of the advance determinations; 
 and
            (II) the Secretary of the Treasury 
 of the name and employer identification 
 number of each employer with respect to 
 whom 1 or more employees of the 
 employer were determined to be eligible 
 for the premium tax credit under 
 

section 36B of the Internal Revenue 
 Code of 1986 and the cost-sharing 
 reductions under 

section 1402 of the 
 Patient Protection and Affordable Care 
 Act because--

    (aa) the employer did not 
 provide minimum essential 
 coverage; or

    (bb) the employer provided 
 such minimum essential coverage 
 but it was determined under 
 

section 36B
            (c) (2)
            (C) of such 
 Code to either be unaffordable 
 to the employee or not provide 
 the required minimum actuarial 
 value; and
            (iii) the Secretary of the Treasury makes 
 advance payments of such credit or reductions 
 to the State agency administering the program 
 in order to reduce the premiums payable by 
 individuals eligible for such credit.
        (B) Determinations and payments.--Rules similar to 
 subsections

    (b) and
            (c) of 

section 1412 of the Patient 
 Protection and Affordable Care Act shall apply for 
 purposes of this subsection.
            (C) Coordination with credit.--
            (i) In general.--

Section 36B of the 
 Internal Revenue Code of 1986 is amended by 
 inserting ``and under 

section 2

    (g)

    (2) of the 
 State Public Option Act'' after ``

section 1412 
 of the Patient Protection and Affordable Care 
 Act'' each place it appears in subsections

    (f)

    (1) ,

    (f)

    (2) , and

    (g)

    (1) .
            (ii) Information reporting.--

Section 36B

    (f)

    (3) of such Code is amended by adding at 
 the end the following flush sentence: ``In the 
 case of any coverage under the Medicaid program 
 under title XIX of the Social Security Act for 
 which a credit under this section is allowable 
 by reason of subsection

    (h) , the State agency 
 administering the Medicaid program shall be 
 treated as an Exchange for purposes of this 
 paragraph and subparagraph
        (A) shall not 
 apply.''.

    (3) Conforming amendment relating to employer 
 responsibility.--Paragraph

    (6) of 

section 4980H
            (c) of the 
 Internal Revenue Code of 1986 is amended by inserting ``, 
 except that for purposes of subsections

    (a)

    (2) and

    (b)

    (2) , the 
 term `qualified health plan' shall include any plan described 
 in 

section 36B

    (h) '' after ``such Act''.

    (h) Conforming Amendments.--

    (1) Section 1902

    (a)

    (10) of the Social Security Act (42 
 U.S.C. 1396a

    (a)

    (10) ), as amended by subsection

    (a) , is further 
 amended, in the matter following subparagraph
        (G) --
        (A) by striking ``and
            (XVIII) '' and inserting ``,
            (XVIII) ''; and
        (B) by inserting ``, and
            (XIX) the medical 
 assistance made available to an individual described in 
 subparagraph
        (A)
            (ii) 
            (XXIV) shall be limited to medical 
 assistance described in subsection

    (k)

    (1) '' before the 
 semicolon.

    (2) Section 1903

    (f)

    (4) of the Social Security Act (42 
 U.S.C. 1396b

    (f)

    (4) ) is amended by inserting 
 ``1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) ,'' after 
 ``1902

    (a)

    (10)
        (A)
            (ii) 
            (XXII) ,''.

    (3) Section 1905

    (a) of the Social Security Act (42 U.S.C. 
 1396d

    (a) ) is amended, in the matter preceding paragraph

    (1) --
        (A) by striking ``or'' at the end of clause
            (xvi) ;
        (B) by inserting ``or'' at the end of clause
            (xvii) ; and
            (C) by inserting after clause
            (xvii) the following 
 new clause:
 ``
            (xviii) individuals described in 

section 1902

    (a)

    (10)
        (A)
            (ii) 
            (XXIV) ,''.

    (4) Section 1916A

    (a)

    (1) of the Social Security Act (42 
 U.S.C. 1396o-1

    (a)

    (1) ) is amended by striking ``or

    (j) '' and 
 inserting ``

    (j) , or

    (k) ''.

    (5) Section 1937

    (a)

    (1)
        (B) of the Social Security Act (42 
 U.S.C. 1396u-7

    (a)

    (1)
        (B) ) is amended by inserting ``, subclause
            (XXIV) of 

section 1902

    (a)

    (10)
        (A)
            (ii) ,'' after 
 ``1902

    (a)

    (10)
        (A)
            (i) ''.

SEC. 3. REVIEWING AND UPDATING MEDICAID QUALITY MEASURES.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall review quality 
measures that are in use under the Medicaid program and, not later than 
January 1, 2030, shall update such measures to the extent necessary to 
ensure that such quality measures are appropriate for the population of 
individuals who are eligible to buy into Medicaid coverage under 
subclause
            (XXIV) of 

section 1902

    (a)

    (10)
        (A)
            (ii) of the Social Security 
Act (42 U.S.C. 1396a

    (a)

    (10)
        (A)
            (ii) ), as added by 

section 2.

    (b) Reporting.--The Secretary shall review, and, not later than 
January 1, 2032, update any corresponding State reporting requirements 
to include the quality measures under subsection

    (a) .
            (c) State Implementation Funding.--The Secretary may award funds, 
from the amount appropriated under subsection
            (d) , to States for the 
purpose of updating and implementing the metrics developed under this 
section.
            (d) Appropriation.--There is appropriated to the Secretary, out of 
any funds in the Treasury not otherwise appropriated, $50,000,000 for 
fiscal year 2026, to remain available until expended, for the purpose 
of carrying out this section.

SEC. 4. RENEWAL OF APPLICATION OF MEDICARE PAYMENT RATE FLOOR TO 
 PRIMARY CARE SERVICES FURNISHED UNDER MEDICAID AND 
 INCLUSION OF ADDITIONAL PROVIDERS.

    (a) Renewal of Payment Floor; Additional Providers.--

    (1) In general.--

Section 1902

    (a)

    (13) of the Social Security 
 Act (42 U.S.C. 1396a

    (a)

    (13) ) is amended by striking 
 subparagraph
            (C) and inserting the following:
 ``
            (C) payment for primary care services (as defined 
 in subsection

    (jj) ) at a rate that is not less than 100 
 percent of the payment rate that applies to such 
 services and physician under part B of title XVIII (or, 
 if greater, the payment rate that would be applicable 
 under such part if the conversion factor under 

section 1848
            (d) for the year involved were the conversion 
 factor under such section for 2009), and that is not 
 less than the rate that would otherwise apply to such 
 services under this title if the rate were determined 
 without regard to this subparagraph, and that are--
 ``
            (i) furnished in 2013 and 2014, by a 
 physician with a primary specialty designation 
 of family medicine, general internal medicine, 
 or pediatric medicine; or
 ``
            (ii) furnished in the period that begins 
 on the first day of the first month that begins 
 after the date of enactment of the State Public 
 Option Act--
 ``
            (I) by a physician with a primary 
 specialty designation of family 
 medicine, general internal medicine, or 
 pediatric medicine, but only if the 
 physician self-attests that the 
 physician is Board certified in family 
 medicine, general internal medicine, or 
 pediatric medicine;
 ``
            (II) by a physician with a 
 primary specialty designation of 
 obstetrics and gynecology, but only if 
 the physician self-attests that the 
 physician is Board certified in 
 obstetrics and gynecology;
 ``
            (III) by an advanced practice 
 clinician, as defined by the Secretary, 
 that works under the supervision of--
 ``

    (aa) a physician that 
 satisfies the criteria 
 specified in subclause
            (I) or
            (II) ; or
 ``

    (bb) a nurse practitioner 
 or a physician assistant (as 
 such terms are defined in 
 

section 1861

    (aa)

    (5)
        (A) ) who is 
 working in accordance with 
 State law, or a certified 
 nurse-midwife (as defined in 
 

section 1861

    (gg) ) who is 
 working in accordance with 
 State law;
 ``
            (IV) by a rural health clinic, 
 federally qualified health center, or 
 other health clinic that receives 
 reimbursement on a fee schedule 
 applicable to a physician, a nurse 
 practitioner or a physician assistant 
 (as such terms are defined in 

section 1861

    (aa)

    (5)
        (A) ) who is working in 
 accordance with State law, or a 
 certified nurse-midwife (as defined in 
 

section 1861

    (gg) ) who is working in 
 accordance with State law, for services 
 furnished by a physician, nurse 
 practitioner, physician assistant, or 
 certified nurse-midwife, or services 
 furnished by an advanced practice 
 clinician supervised by a physician 
 described in subclause
            (I) (aa) or
            (II) (aa) , another advanced practice 
 clinician, or a certified nurse-
 midwife; or
 ``
            (V) by a nurse practitioner or a 
 physician assistant (as such terms are 
 defined in 

section 1861

    (aa)

    (5)
        (A) ) who 
 is working in accordance with State 
 law, or a certified nurse-midwife (as 
 defined in 

section 1861

    (gg) ) who is 
 working in accordance with State law, 
 in accordance with procedures that 
 ensure that the portion of the payment 
 for such services that the nurse 
 practitioner, physician assistant, or 
 certified nurse-midwife is paid is not 
 less than the amount that the nurse 
 practitioner, physician assistant, or 
 certified nurse-midwife would be paid 
 if the services were provided under 
 part B of title XVIII;''.

    (2) Conforming amendments.--

Section 1905
            (dd) of the Social 
 Security Act (42 U.S.C. 1396d
            (dd) ) is amended--
        (A) by striking ``Notwithstanding'' and inserting 
 the following:
 ``

    (1) In general.--Notwithstanding'';
        (B) by inserting ``or furnished during the 
 additional period specified in paragraph

    (2) ,'' after 
 ``2015,''; and
            (C) by adding at the end the following:
 ``

    (2) Additional period.--For purposes of paragraph

    (1) , 
 the additional period specified in this paragraph is the period 
 that begins on the date that is 1 year after the date of 
 enactment of the State Public Option Act.''.

    (b) Improved Targeting of Primary Care.--

Section 1902

    (jj) of the 
Social Security Act (42 U.S.C. 1396a

    (jj) ) is amended--

    (1) by redesignating paragraphs

    (1) and

    (2) as 
 subparagraphs
        (A) and
        (B) , respectively and realigning the left 
 margins accordingly;

    (2) by striking ``For purposes of'' and inserting the 
 following:
 ``

    (1) In general.--For purposes of''; and

    (3) by adding at the end the following:
 ``

    (2) Exclusions.--Such term does not include any services 
 described in subparagraph
        (A) or
        (B) of paragraph

    (1) if such 
 services are provided in an emergency department of a 
 hospital.''.
            (c) Ensuring Payment by Managed Care Entities.--

    (1) In general.--

Section 1903
            (m) (2)
        (A) of the Social 
 Security Act (42 U.S.C. 1396b
            (m) (2)
        (A) ) is amended--
        (A) in clause
            (xii) , by striking ``and'' after the 
 semicolon;
        (B) in clause
            (xiii) --
            (i) by realigning the left margin so as to 
 align with the left margin of clause
            (xii) ; and
            (ii) by striking the period at the end of 
 clause
            (xiii) and inserting ``; and''; and
            (C) by inserting after clause
            (xiii) the following:
 ``
            (xiv) such contract provides that
            (I) payments to 
 providers specified in 

section 1902

    (a)

    (13)
            (C) for primary care 
 services defined in 

section 1902

    (jj) that are furnished during 
 a year or period specified in 

section 1902

    (a)

    (13)
            (C) and 
 

section 1905
            (dd) are at least equal to the amounts set forth 
 and required by the Secretary by regulation,
            (II) the entity 
 shall, upon request, provide documentation to the State, 
 sufficient to enable the State and the Secretary to ensure 
 compliance with subclause
            (I) , and
            (III) the Secretary shall 
 approve payments described in subclause
            (I) that are furnished 
 through an agreed upon capitation, partial capitation, or other 
 value-based payment arrangement if the capitation, partial 
 capitation, or other value-based payment arrangement is based 
 on a reasonable methodology and the entity provides 
 documentation to the State sufficient to enable the State and 
 the Secretary to ensure compliance with subclause
            (I) .''.

    (2) Conforming amendment.--

Section 1932

    (f) of the Social 
 Security Act (42 U.S.C. 1396u-2

    (f) ) is amended by inserting 
 ``and clause
            (xiv) of 

section 1903
            (m) (2)
        (A) '' before the 
 period.

SEC. 5. INCREASED FMAP FOR MEDICAL ASSISTANCE TO NEWLY ELIGIBLE 
 INDIVIDUALS.

    (a) In General.--

Section 1905

    (y)

    (1) of the Social Security Act (42 
U.S.C. 1396d

    (y)

    (1) ) is amended--

    (1) in subparagraph
        (A) , by striking ``2014, 2015, and 
 2016'' and inserting ``each of the first 3 consecutive 12-month 
 periods in which the State provides medical assistance to newly 
 eligible individuals'';

    (2) in subparagraph
        (B) , by striking ``2017'' and inserting 
 ``the fourth consecutive 12-month period in which the State 
 provides medical assistance to newly eligible individuals'';

    (3) in subparagraph
            (C) , by striking ``2018'' and inserting 
 ``the fifth consecutive 12-month period in which the State 
 provides medical assistance to newly eligible individuals'';

    (4) in subparagraph
            (D) , by striking ``2019'' and inserting 
 ``the sixth consecutive 12-month period in which the State 
 provides medical assistance to newly eligible individuals''; 
 and

    (5) in subparagraph
        (E) , by striking ``2020 and each year 
 thereafter'' and inserting ``the seventh consecutive 12-month 
 period in which the State provides medical assistance to newly 
 eligible individuals and each such period thereafter''.

    (b) Effective Date.--The amendments made by subsection

    (a) shall 
take effect as if included in the enactment of Public Law 111-148.

SEC. 6. MEDICAID COVERAGE OF COMPREHENSIVE SEXUAL AND REPRODUCTIVE 
 HEALTH CARE SERVICES.

    (a) Inclusion of Comprehensive Sexual and Reproductive Health Care 
Services as Medical Assistance.--

Section 1905

    (a) of the Social Security 
Act (42 U.S.C. 1396d

    (a) ), as amended by 

section 2

    (h) and 

section 209

    (a) of title I of division G of the Consolidated Appropriations Act, 2024, 
is further amended--

    (1) in paragraph

    (31) , by striking ``and'' at the end;

    (2) by redesignating paragraph

    (32) as paragraph

    (33) ; and

    (3) by inserting after paragraph

    (31) the following new 
 paragraph:
 ``

    (32) comprehensive sexual and reproductive health care 
 services, including abortion services and abortion-related 
 services; and''.

    (b) Requiring Coverage of Comprehensive Sexual and Reproductive 
Health Care Services as Condition of State Plan Approval.--

Section 1902

    (a)

    (10)
        (A) of the Social Security Act (42 U.S.C. 1396a

    (a)

    (10)
        (A) ), 
as amended by subsections

    (a) and

    (h) of 

section 2, is further amended, 
in the matter preceding clause
            (i) , by striking ``and

    (30) '' and 
inserting ``

    (30) , and

    (32) ''.
            (c) Conforming Amendments.--

    (1) Section 1932

    (e)

    (1)
        (B) of the Social Security Act (42 
 U.S.C. 1396u-2

    (e)

    (1)
        (B) ) is amended by striking ``Clause
            (i) '' 
 and inserting ``With respect to the period beginning before 
 January 1, 2023, clause
            (i) ''.

    (2) Section 1937

    (b) of the Social Security Act (42 U.S.C. 
 1396u-7

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

    (9) Coverage of comprehensive sexual and reproductive 
 health services.--Notwithstanding the previous provisions of 
 this section, a State may not provide for medical assistance 
 through enrollment of an individual with benchmark coverage or 
 benchmark-equivalent coverage under this section unless such 
 coverage includes medical assistance for comprehensive sexual 
 and reproductive health care services, including abortion 
 services and abortion-related services.''.
            (d) Effective Date.--The amendments made by this section shall 
apply with respect to medical assistance furnished on or after January 
1, 2026.
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