H.R. 3990 — Disaster Relief Medicaid Act

This section requires state Medicaid plans, beginning January 1, 2027, to provide medical assistance to relief-eligible survivors of specified disasters during a 2-year relief coverage period in accordance with new section 1949 of the Social Security Act. Specified disasters include major disasters declared by the President under the Stafford Act (42 U.S.C. 5170), national emergencies under the National Emergencies Act (50 U.S.C. 1601 et seq.), or public health emergencies under section 319 of the Public Health Service Act (42 U.S.C. 247d), with the Secretary required to post direct impact areas on CMS and FEMA websites. A relief-eligible survivor is an individual in a disaster's direct impact area (using pre-disaster home state residency standards) whose family income does not exceed the higher of 133% of the federal poverty line (or 200% for pregnant individuals, children, or disability benefit recipients) or the home state's standard, disregarding unemployment compensation and FEMA individual assistance; eligibility generally ends after the relief coverage period but continues for pregnant and postpartum individuals through applicable postpartum periods and for those with pending Medicaid, CHIP, or pregnancy-related applications through a 60-day grace period or application resolution.

This section directs the Secretary of Health and Human Services (HHS), by January 1, 2027, to issue guidance (and updates as needed) to state Medicaid directors on best practices for (1) expediting approvals of Medicaid providers under title XIX of the Social Security Act (SSA) or waivers thereof after a disaster and (2) using out-of-state providers to serve relief-eligible survivors of disasters (as defined in SSA §1949(b)(5)). It further requires HHS to provide technical assistance and support to states developing or expanding Medicaid infrastructure, strategies, or innovations (including demonstration projects) to deliver medical assistance to such survivors post-disaster, along with a report to Congress within 180 days of enactment detailing an action plan. Additionally, it establishes a grant program authorizing $10 million annually for FY2027 through FY2032 to award two-year grants to up to five states with a history of hosting disaster relocatees, for establishing or operating home and community-based services (HCBS) emergency response corps under Medicaid. Such corps must be led by a state or nonprofit representative serving older adults or people with disabilities; include representatives from voluntary organizations, area agencies on aging (as defined in 42 U.S.C. 3002), Medicare, state Medicaid and disability agencies, nonprofit providers, Medicaid or CHIP enrollees, centers for independent living, and related entities; and operate under a plan with resources to address acute and long-term needs of relief-eligible survivors.

This section establishes a 100 percent federal medical assistance percentage (FMAP) for state expenditures under Medicaid (Title XIX of the Social Security Act) for medical assistance provided to individuals residing in a direct impact area of a disaster during the disaster's relief coverage period (as defined in section 1949). It excludes such additional federal payments to territories from the payment limitations under section 1108(f) and (g) and disregards them in applying those limitations. The section applies a parallel 100 percent enhanced FMAP to CHIP (Title XXI) expenditures for child health assistance provided to targeted low-income children or pregnancy-related assistance for targeted low-income women in such areas and adjusts CHIP allotments to offset the increased federal share (i.e., increasing allotments based on projected and actual state expenditures subject to the enhanced FMAP). This section further prohibits states from conducting eligibility redeterminations under Medicaid or CHIP for individuals residing in such areas during the relief coverage period.

This section expands the definition of "emergency area" under the Secretary of Health and Human Services' (HHS) authority to waive or modify certain Medicare, Medicaid, and Children's Health Insurance Program (CHIP) requirements during public health emergencies (i.e., SSA §1135). It revises subparagraph (A) to cross-reference subparagraphs (B) and (C) (from subparagraph (B) only) and adds new subparagraph (C) to include any geographical area the Secretary determines has a significant number of evacuees from an area described in subparagraph (A). (Thus, waivers may apply in areas receiving evacuees, not only the declared emergency area.)

This section excludes from the Medicare Part B late enrollment period—used to compute the permanent premium penalty (10% of the standard premium for each full 12-month period of non-enrollment)—any month any part of which is within the relief coverage period of a disaster (as defined in paragraphs (4) and (6) of section 1949(b) of the Social Security Act) for survivors of such disaster. (Thus, affected individuals avoid additional premium penalties attributable to time covered under disaster relief.)

This section makes the Act and its amendments effective on the date of enactment, subject to a compliance delay for states whose Medicaid state plans (i.e., under title XIX of the Social Security Act) require state legislation (other than appropriations) to meet the new requirements. In such cases, the state plan is not deemed noncompliant before the first day of the first calendar quarter after the first regular state legislative session ending after the one-year anniversary of enactment (with each year of a two-year legislative session treated as a separate regular session).

This section directs the Secretary of Health and Human Services (HHS), not later than 24 months after enactment, to enter into a 5-year agreement with an independent nonprofit entity experienced in program evaluations to conduct a multi-year evaluation of the Act's impact on relief-eligible survivors (including individuals with disabilities and pregnant individuals) and to prepare specified reports. The evaluation must assess at a minimum (1) the availability of and access to Medicaid services nationally and in each state, territory, and tribal organization—including scope and coverage of services, home and community-based services (HCBS), extended mental health and care coordination services, and provider capacity; (2) the demographics of individuals receiving these benefits, including those with disabilities and pregnant individuals; and (3) state compliance actions, including interstate coordination, coordination between state agencies and qualified providers, and activities of the HCBS emergency response corps (as described in section 3(c)). HHS must submit to the Senate Committee on Finance, Senate Special Committee on Aging, House Committee on Energy and Commerce, and House Committee on Ways and Means (1) an interim report on the evaluation not later than 3 years after the evaluation commences and (2) a follow-up report not later than 24 months after the interim report.