S. 2071 — 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 two-year relief coverage period, in accordance with new section 1949 of the Social Security Act. New section 1949 defines key terms as follows: (1) disaster, as a major disaster declared by the President under the Stafford Act on or after January 1, 2027, a national emergency under the National Emergencies Act, or a public health emergency under the Public Health Service Act; (2) direct impact area, as the geographic area of the disaster (with areas posted on CMS and FEMA websites); (3) home state, as the state of a survivor's residence on the disaster declaration date; (4) relief coverage period, as two years from declaration; and (5) relief-eligible survivor, as a disaster survivor with family income not exceeding the higher of 133% of the federal poverty level (or 200% for pregnant individuals, children, or SSDI recipients) or the home state's standard, disregarding unemployment compensation and FEMA individual assistance received during the period (with eligibility generally limited to the relief coverage period but extended for pregnant and postpartum individuals through at least 60 days postpartum and for those with pending Medicaid or CHIP applications through at least 60 days post-period or application resolution).

This section directs the Secretary of Health and Human Services to take specified actions to improve state Medicaid responses to increased demand for medical assistance from relief-eligible survivors of disasters (i.e., individuals eligible for temporary Medicaid coverage following a disaster, as defined in section 1949(b)(5) of the Social Security Act). Specifically, the section (1) requires the Secretary to issue guidance to state Medicaid directors by January 1, 2027 (and update as necessary) on best practices for expediting in-state provider approvals and using out-of-state providers under state Medicaid plans or waivers; (2) directs the Secretary to provide technical assistance and support to states for developing or expanding infrastructure, strategies, or innovations (including Medicaid demonstration projects) to deliver such assistance, with a report to Congress due within 180 days of enactment detailing an action plan; and (3) establishes a grant program to award grants to up to 5 states for establishing or operating home and community-based services (HCBS) emergency response corps—multistakeholder groups led by state or nonprofit representatives serving older adults or people with disabilities, including area agencies on aging (i.e., local entities under the Older Americans Act responsible for coordinating services for individuals age 60 and older)—with grants for 2-year terms and $10 million authorized annually for FY2027 through FY2032.

This section provides a 100% federal medical assistance percentage (FMAP) for Medicaid expenditures 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 payments to territories from the payment limitations under section 1108(f) and (g) (i.e., disregards them when applying territorial caps on total payments for programs including Medicaid). The section applies a 100% enhanced FMAP to CHIP expenditures for child health assistance or pregnancy-related assistance provided to targeted low-income individuals in such areas and adjusts a state's CHIP allotment to account for the increased federal share (increasing the allotment projection by the state share of projected expenditures and reconciling based on actuals). It further establishes a moratorium on Medicaid and CHIP eligibility redeterminations for individuals residing in direct impact areas during the relief coverage period.

This section expands the definition of "emergency area" under Section 1135(g)(1) of the Social Security Act—which authorizes the Secretary of HHS to waive or modify certain Medicare, Medicaid, and CHIP requirements during a declared emergency—to include any geographical area determined by the Secretary to have a significant number of evacuees from an emergency area. (Thus, waiver authority applies to areas hosting evacuees from emergency areas.)

This section excludes from the computation of the Medicare Part B late enrollment period—used to determine the permanent premium penalty (10% of the statutory rate for each full 12-month period of delayed enrollment)—any month within a disaster relief coverage period (as defined in section 1949(b)(4) of the Social Security Act) for an individual who is a survivor of a disaster (as defined in section 1949(b)(6)). (Thus, such disaster survivors do not accrue Part B late enrollment penalties for time covered under disaster relief.)

This section establishes the effective date of the Act and its amendments as the date of enactment. It permits a delay in a state's compliance with new Medicaid (title XIX of the Social Security Act) plan requirements if state legislation (other than appropriations) is needed, until the first day of the first calendar quarter after the close of the first regular state legislative session ending after the one-year anniversary of enactment (with each year of a two-year session treated separately).

This section directs the Secretary of Health and Human Services, not later than 24 months after enactment, to enter into a 5-year agreement through a contract, grant, or cooperative agreement with an independent nonprofit entity experienced in program evaluations to (1) conduct a multi-year evaluation of the Act's impact on relief-eligible survivors (including individuals with disabilities and pregnant individuals) and (2) prepare specified reports. The evaluation must assess, at a minimum, (1) the availability of and access to Medicaid services for such survivors 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; and (3) state compliance actions, including inter-state coordination, coordination between state agencies and qualified providers, and activities of the HCBS emergency response corps (as described in section 3(c)). The Secretary 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.