§1397dd — Title 42 The Public Health and Welfare | U.S. Code

Summary

Appropriates money from the Treasury to give yearly and sometimes semi‑annual allotments to States for children’s health coverage and spells out how much is available for many fiscal years. The law lists specific dollar amounts for many years (for example, $4,295,000,000 for fiscal year 1998; $10,562,000,000 for fiscal year 2009; $12,520,000,000 for fiscal year 2010; $17,406,000,000 for fiscal year 2013; $19,147,000,000 for fiscal year 2014; two $2,850,000,000 semi‑annual amounts in fiscal year 2015; $25,900,000,000 for fiscal year 2022; and two $7,650,000,000 semi‑annual amounts for fiscal year 2029; for fiscal years 2024–2028 it provides “such sums as are necessary”). The Secretary must divide the money among States with approved child health plans using a formula that multiplies a State’s number of children (a mix of low‑income uninsured children and low‑income children) by a State cost factor, then gives each State the same share of the total. One small slice (0.25 percent) is set aside for territories and split by fixed percentages (Puerto Rico 91.6%, Guam 3.5%, Virgin Islands 2.6%, American Samoa 1.2%, Northern Mariana Islands 1.1%). Definitions used include: number of children (a weighted count of low‑income and uninsured children), State cost factor (built from wage data to reflect cost differences), and proportion (a State’s share of the total allotable amount). Unspent allotments can be redistributed to States that face funding shortfalls under procedures the Secretary sets, with rules for priority, proportional reductions if available funds are too small, and limits on how long funds remain available. Generally, allotments for fiscal years 1998–2008 stay available through the end of the second succeeding fiscal year; allotments for 2009 and later stay available through the end of the succeeding fiscal year; redistributed amounts follow a shorter availability rule. The law also creates the Child Enrollment Contingency Fund in the Treasury. For fiscal year 2009 the Fund gets an amount equal to 20 percent of the FY2009 sum listed under subsection (a)(12), and for certain later years and semi‑annual periods the Fund is supplied as needed but total yearly payments from the Fund may not exceed 20 percent of the amount made available under subsection (a) for that year or period. The Fund pays States when enrollment and spending grow above planned targets, using the extra enrolled children times projected per‑child costs multiplied by the State’s enhanced federal match; payments are cut proportionally if Fund resources are insufficient.

Title 42, §1397dd

The Public Health and Welfare — Source: USLM XML via OLRC

(a)For the purpose of providing allotments to States under this section, subject to subsection (d), there is appropriated, out of any money in the Treasury not otherwise appropriated—

(1)for fiscal year 1998, $4,295,000,000;

(2)for fiscal year 1999, $4,275,000,000;

(3)for fiscal year 2000, $4,275,000,000;

(4)for fiscal year 2001, $4,275,000,000;

(5)for fiscal year 2002, $3,150,000,000;

(6)for fiscal year 2003, $3,150,000,000;

(7)for fiscal year 2004, $3,150,000,000;

(8)for fiscal year 2005, $4,050,000,000;

(9)for fiscal year 2006, $4,050,000,000;

(10)for fiscal year 2007, $5,000,000,000;

(11)for fiscal year 2008, $5,000,000,000.11 So in original. The period probably should be a semicolon.

(12)for fiscal year 2009, $10,562,000,000;

(13)for fiscal year 2010, $12,520,000,000;

(14)for fiscal year 2011, $13,459,000,000;

(15)for fiscal year 2012, $14,982,000,000;

(16)for fiscal year 2013, $17,406,000,000;

(17)for fiscal year 2014, $19,147,000,000;

(18)for fiscal year 2015, for purposes of making 2 semi-annual allotments—

(A)$2,850,000,000 for the period beginning on October 1, 2014, and ending on March 31, 2015, and

(B)$2,850,000,000 for the period beginning on April 1, 2015, and ending on September 30, 2015;

(19)for fiscal year 2016, $19,300,000,000;

(20)for fiscal year 2017, for purposes of making 2 semi-annual allotments—

(A)$2,850,000,000 for the period beginning on October 1, 2016, and ending on March 31, 2017; and

(B)$2,850,000,000 for the period beginning on April 1, 2017, and ending on September 30, 2017;

(21)for fiscal year 2018, $21,500,000,000;

(22)for fiscal year 2019, $22,600,000,000;

(23)for fiscal year 2020, $23,700,000,000;

(24)for fiscal year 2021, $24,800,000,000;

(25)for fiscal year 2022, $25,900,000,000;

(26)for fiscal year 2023, for purposes of making two semi-annual allotments—

(A)$2,850,000,000 for the period beginning on October 1, 2022, and ending on March 31, 2023; and

(B)$2,850,000,000 for the period beginning on April 1, 2023, and ending on September 30, 2023;

(27)for each of fiscal years 2024 through 2028, such sums as are necessary to fund allotments to States under subsections (c) and (m); and

(28)for fiscal year 2029, for purposes of making two semi-annual allotments—

(A)$7,650,000,000 for the period beginning on October 1, 2028, and ending on March 31, 2029; and

(B)$7,650,000,000 for the period beginning on April 1, 2029, and ending on September 30, 2029.

(b)(1)Subject to paragraph (4) and subsections (d) and (m), of the amount available for allotment under subsection (a) for a fiscal year, reduced by the amount of allotments made under subsection (c) (determined without regard to paragraph (4) thereof) for the fiscal year, the Secretary shall allot to each State (other than a State described in such subsection) with a State child health plan approved under this subchapter the same proportion as the ratio of—

(A)the product of (i) the number of children described in paragraph (2) for the State for the fiscal year and (ii) the State cost factor for that State (established under paragraph (3)); to

(B)the sum of the products computed under subparagraph (A).

(2)(A)The number of children described in this paragraph for a State for—

(i)each of fiscal years 1998 and 1999 is equal to the number of low-income children in the State with no health insurance coverage for the fiscal year;

(ii)fiscal year 2000 is equal to—

(I)75 percent of the number of low-income children in the State for the fiscal year with no health insurance coverage, plus

(II)25 percent of the number of low-income children in the State for the fiscal year; and

(iii)each succeeding fiscal year is equal to—

(I)50 percent of the number of low-income children in the State for the fiscal year with no health insurance coverage, plus

(II)50 percent of the number of low-income children in the State for the fiscal year.

(B)For purposes of subparagraph (A), a determination of the number of low-income children (and of such children who have no health insurance coverage) for a State for a fiscal year shall be made on the basis of the arithmetic average of the number of such children, as reported and defined in the 3 most recent March supplements to the Current Population Survey of the Bureau of the Census before the beginning of the calendar year in which such fiscal year begins.

(3)(A)For purposes of paragraph (1)(A)(ii), the “State cost factor” for a State for a fiscal year equal to the sum of—

(i)0.15, and

(ii)0.85 multiplied by the ratio of—

(I)the annual average wages per employee for the State for such year (as determined under subparagraph (B)), to

(II)the annual average wages per employee for the 50 States and the District of Columbia.

(B)For purposes of subparagraph (A), the “annual average wages per employee” for a State, or for all the States, for a fiscal year is equal to the average of the annual wages per employee for the State or for the 50 States and the District of Columbia for employees in the health services industry (SIC code 8000), as reported by the Bureau of Labor Statistics of the Department of Labor for each of the most recent 3 years before the beginning of the calendar year in which such fiscal year begins.

(4)(A)The proportion of the allotment under this subsection for a subsection (b) State (as defined in subparagraph (D)) for fiscal year 2000 and each fiscal year thereafter shall be subject to the following floors and ceilings:

(i)A floor equal to $2,000,000 divided by the total of the amount available under this subsection for all such allotments for the fiscal year.

(ii)A floor of 90 percent of the proportion for the State for the preceding fiscal year.

(iii)A floor of 70 percent of the proportion for the State for fiscal year 1999.

(iv)A ceiling of 145 percent of the proportion for the State for fiscal year 1999.

(B)(i)To the extent that the application of subparagraph (A) would result in the sum of the proportions of the allotments for all subsection (b) States exceeding 1.0, the Secretary shall establish a maximum percentage increase in such proportions for all subsection (b) States for the fiscal year in a manner so that such sum equals 1.0.

(ii)To the extent that the application of subparagraph (A) would result in the sum of the proportions of the allotments for all subsection (b) States being less than 1.0, the proportions of such allotments (as computed before the application of floors under clauses (i), (ii), and (iii) of subparagraph (A)) for all subsection (b) States shall be increased in a pro rata manner (but not to exceed the ceiling established under subparagraph (A)(iv)) so that (after the application of such floors and ceiling) such sum equals 1.0.

(C)This paragraph shall not be construed as applying to (or taking into account) amounts of allotments redistributed under subsection (f).

(D)In this paragraph:

(i)The term “proportion” means, with respect to the allotment of a subsection (b) State for a fiscal year, the amount of the allotment of such State under this subsection for the fiscal year divided by the total of the amount available under this subsection for all such allotments for the fiscal year.

(ii)The term “subsection (b) State” means one of the 50 States or the District of Columbia.

(c)(1)Of the amount available for allotment under subsection (a) for a fiscal year, subject to subsections (d) and (m)(5), the Secretary shall allot 0.25 percent among each of the commonwealths and territories described in paragraph (3) in the same proportion as the percentage specified in paragraph (2) for such commonwealth or territory bears to the sum of such percentages for all such commonwealths or territories so described.

(2)The percentage specified in this paragraph for—

(A)Puerto Rico is 91.6 percent,

(B)Guam is 3.5 percent,

(C)the Virgin Islands is 2.6 percent,

(D)American Samoa is 1.2 percent, and

(E)the Northern Mariana Islands is 1.1 percent.

(3)A commonwealth or territory described in this paragraph is any of the following if it has a State child health plan approved under this subchapter:

(A)Puerto Rico.

(B)Guam.

(C)The Virgin Islands.

(D)American Samoa.

(E)The Northern Mariana Islands.

(4)(A)In addition to the allotment under paragraph (1), the Secretary shall allot each commonwealth and territory described in paragraph (3) the applicable percentage specified in paragraph (2) of the amount appropriated under subparagraph (B).

(B)For purposes of providing allotments pursuant to subparagraph (A), there is appropriated, out of any money in the Treasury not otherwise appropriated $32,000,000 for fiscal year 1999, $34,200,000 for each of fiscal years 2000 and 2001, $25,200,000 for each of fiscal years 2002 through 2004, $32,400,000 for each of fiscal years 2005 and 2006, and $40,000,000 for each of fiscal years 2007 through 2009.

(d)(1)For the purpose of providing additional allotments to shortfall States described in paragraph (2), there is appropriated, out of any money in the Treasury not otherwise appropriated, $283,000,000 for fiscal year 2006.

(2)For purposes of paragraph (1), a shortfall State described in this paragraph is a State with a State child health plan approved under this subchapter for which the Secretary estimates, on the basis of the most recent data available to the Secretary as of December 16, 2005, that the projected expenditures under such plan for such State for fiscal year 2006 will exceed the sum of—

(A)the amount of the State’s allotments for each of fiscal years 2004 and 2005 that will not be expended by the end of fiscal year 2005;

(B)the amount, if any, that is to be redistributed to the State during fiscal year 2006 in accordance with subsection (f); and

(C)the amount of the State’s allotment for fiscal year 2006.

(3)In addition to the allotments provided under subsections (b) and (c), subject to paragraph (4), of the amount available for the additional allotments under paragraph (1) for fiscal year 2006, the Secretary shall allot—

(A)to each shortfall State described in paragraph (2) such amount as the Secretary determines will eliminate the estimated shortfall described in such paragraph for the State; and

(B)to each commonwealth or territory described in subsection (c)(3), the same proportion as the proportion of the commonwealth’s or territory’s allotment under subsection (c) (determined without regard to subsection (f)) to 1.05 percent of the amount appropriated under paragraph (1).

(4)Additional allotments provided under this subsection are only available for amounts expended under a State plan approved under this subchapter for child health assistance for targeted low-income children.

(5)Notwithstanding subsections (e) and (f), amounts allotted to a State pursuant to this subsection for fiscal year 2006 shall only remain available for expenditure by the State through September 30, 2006. Any amounts of such allotments that remain unexpended as of such date shall not be subject to redistribution under subsection (f) and shall revert to the Treasury on October 1, 2006.

(e)(1)Except as provided in paragraph (2), amounts allotted to a State pursuant to this section—

(A)for each of fiscal years 1998 through 2008, shall remain available for expenditure by the State through the end of the second succeeding fiscal year; and

(B)for fiscal year 2009 and each fiscal year thereafter, shall remain available for expenditure by the State through the end of the succeeding fiscal year.

(2)Amounts redistributed to a State under subsection (f) shall be available for expenditure by the State through the end of the fiscal year in which they are redistributed.

(f)(1)The Secretary shall determine an appropriate procedure for redistribution of allotments from States that were provided allotments under this section for a fiscal year but that do not expend all of the amount of such allotments during the period in which such allotments are available for expenditure under subsection (e), to States that the Secretary determines with respect to the fiscal year for which unused allotments are available for redistribution under this subsection, are shortfall States described in paragraph (2) for such fiscal year, but not to exceed the amount of the shortfall described in paragraph (2)(A) for each such State (as may be adjusted under paragraph (2)(C)).

(2)(A)For purposes of paragraph (1), with respect to a fiscal year, a shortfall State described in this subparagraph is a State with a State child health plan approved under this subchapter for which the Secretary estimates on the basis of the most recent data available to the Secretary, that the projected expenditures under such plan for the State for the fiscal year will exceed the sum of—

(i)the amount of the State’s allotments for any preceding fiscal years that remains available for expenditure and that will not be expended by the end of the immediately preceding fiscal year;

(ii)the amount (if any) of the child enrollment contingency fund 22 So in original. Probably should be “Child Enrollment Contingency Fund”. payment under subsection (n); and

(iii)the amount of the State’s allotment for the fiscal year.

(B)(i)Subject to clause (ii), if the amounts available for redistribution under paragraph (1) for a fiscal year are less than the total amounts of the estimated shortfalls determined for the year under subparagraph (A), the amount to be redistributed under such paragraph for each shortfall State shall be reduced proportionally.

(ii)(I)For each month beginning during the period beginning on October 1, 2017, and ending March 31, 2018, subject to the succeeding subclauses of this clause, the Secretary shall redistribute any amounts available for redistribution under paragraph (1) for fiscal year 2018, to each State that is an emergency shortfall State (as defined in subclause (II)) for the month such amount as the Secretary determines will eliminate the estimated shortfall described in subclause (II) for such State for the month (as may be adjusted under subparagraph (C)) before the Secretary may redistribute such amounts to any shortfall State that is not an emergency shortfall State. In the case of any amounts redistributed under this subclause to a State that is not an emergency shortfall State, such amounts shall be determined in accordance with clause (i).

(II)For purposes of this clause, the term “emergency shortfall State” means, with respect to a month beginning during the period beginning October 1, 2017, and ending March 31, 2018, a shortfall State for which the Secretary estimates, in accordance with subparagraph (A) (unless otherwise specified in this subclause) and on a monthly basis using the most recent data available to the Secretary as of such month, that the projected expenditures under the State child health plan and under section 1397ee(g) of this title (calculated as if the reference under section 1397ee(g)(4)(A) of this title, as in effect on the day before January 22, 2018, to “2017” were a reference to “2018” and insofar as the allotments are available to the State under this subsection or subsection (e) or (m)) for such month will exceed the sum of the amounts described in clauses (i) through (iii) of subparagraph (A) for such month, including after application of any amount redistributed under paragraph (1) for a previous month for fiscal year 2018 in accordance with this clause, to such State. A shortfall State may be an emergency shortfall State under the previous sentence without regard to whether any amounts were redistributed to such State under paragraph (1) for a previous month in fiscal year 2018.

(III)The Secretary shall redistribute the amounts available for redistribution under paragraph (1) to emergency shortfall States described in subclause (II) in the order in which such States realize monthly funding shortfalls under this subchapter for fiscal year 2018. The Secretary shall only make redistributions under this clause to the extent that such amounts are available for such redistributions.

(IV)If the amounts available for redistribution under paragraph (1) for a month during the period described in subclause (I) are less than the total amounts of the estimated shortfalls determined for the month for emergency shortfall States described in subclause (II), the amount computed under subclause (I) for each emergency shortfall State shall be reduced proportionally.

(V)The Secretary shall withhold any funds redistributed under paragraph (1) for fiscal year 2018 before January 1, 2018, but which have not been obligated for amounts expended by a State as of that date, and shall redistribute such funds in accordance with the preceding subclauses of this clause.

(VI)During the period described in subclause (I), section 1397ee(g)(4) of this title, as in effect on the day before January 22, 2018, shall apply to a qualifying State (as defined in section 1397ee(g)(2) of this title) as if under section 1397ee(g)(4) of this title, as so in effect—

(aa)the reference to “2017” were a reference to “2018”; and

(bb)the reference to “under subsections (e) and (m) of such section” were a reference to “under subsections (e), (f), and (m) of such section”.

(C)The Secretary may adjust the estimates and determinations made under paragraph (1) and this paragraph with respect to a fiscal year as necessary on the basis of the amounts reported by States not later than November 30 of the succeeding fiscal year, as approved by the Secretary.

(D)Nothing in this paragraph may be construed as preventing a commonwealth or territory described in subsection (c)(3) from being treated as a shortfall State or an emergency shortfall State.

(g)(1)(A)In the case of a State that expends all of its allotment under subsection (b) or (c) for fiscal year 1998 by the end of fiscal year 2000, or for fiscal year 1999 by the end of fiscal year 2001, or for fiscal year 2000 by the end of fiscal year 2002, or for fiscal year 2001 by the end of fiscal year 2003, the Secretary shall redistribute to the State under subsection (f) (from the fiscal year 1998, 1999, 2000, or 2001 allotments of other States, respectively, as determined by the application of paragraphs (2) and (3) with respect to the respective fiscal year) the following amount:

(i)In the case of one of the 50 States or the District of Columbia, with respect to—

(I)the fiscal year 1998 allotment, the amount by which the State’s expenditures under this subchapter in fiscal years 1998, 1999, and 2000 exceed the State’s allotment for fiscal year 1998 under subsection (b);

(II)the fiscal year 1999 allotment, the amount by which the State’s expenditures under this subchapter in fiscal years 1999, 2000, and 2001 exceed the State’s allotment for fiscal year 1999 under subsection (b);

(III)the fiscal year 2000 allotment, the amount specified in subparagraph (C)(i) (less the total of the amounts under clause (ii) for such fiscal year), multiplied by the ratio of the amount specified in subparagraph (C)(ii) for the State to the amount specified in subparagraph (C)(iii); or

(IV)the fiscal year 2001 allotment, the amount specified in subparagraph (D)(i) (less the total of the amounts under clause (ii) for such fiscal year), multiplied by the ratio of the amount specified in subparagraph (D)(ii) for the State to the amount specified in subparagraph (D)(iii).

(ii)In the case of a commonwealth or territory described in subsection (c)(3), an amount that bears the same ratio to 1.05 percent of the total amount described in paragraph (2)(B)(i)(I) as the ratio of the commonwealth’s or territory’s fiscal year 1998, 1999, 2000, or 2001 allotment under subsection (c) (as the case may be) bears to the total of all such allotments for such fiscal year under such subsection.

(B)An amount redistributed to a State under this paragraph—

(i)shall not be included in the determination of the State’s allotment for any fiscal year under this section;

(ii)notwithstanding subsection (e), with respect to fiscal year 1998, 1999, or 2000, shall remain available for expenditure by the State through the end of fiscal year 2004;

(iii)notwithstanding subsection (e), with respect to fiscal year 2001, shall remain available for expenditure by the State through the end of fiscal year 2005; and

(iv)shall be counted as being expended with respect to a fiscal year allotment in accordance with applicable regulations of the Secretary.

(C)For purposes of subparagraph (A)(i)(III)—

(i)the amount specified in this clause is the amount specified in paragraph (2)(B)(i)(I) for fiscal year 2000, less the total amount remaining available pursuant to paragraph (2)(A)(iii);

(ii)the amount specified in this clause for a State is the amount by which the State’s expenditures under this subchapter in fiscal years 2000, 2001, and 2002 exceed the State’s allotment for fiscal year 2000 under subsection (b); and

(iii)the amount specified in this clause is the sum, for all States entitled to a redistribution under subparagraph (A) from the allotments for fiscal year 2000, of the amounts specified in clause (ii).

(D)For purposes of subparagraph (A)(i)(IV)—

(i)the amount specified in this clause is the amount specified in paragraph (2)(B)(i)(I) for fiscal year 2001, less the total amount remaining available pursuant to paragraph (2)(A)(iv);

(ii)the amount specified in this clause for a State is the amount by which the State’s expenditures under this subchapter in fiscal years 2001, 2002, and 2003 exceed the State’s allotment for fiscal year 2001 under subsection (b); and

(iii)the amount specified in this clause is the sum, for all States entitled to a redistribution under subparagraph (A) from the allotments for fiscal year 2001, of the amounts specified in clause (ii).

(2)(A)Notwithstanding subsection (e):

(i)Of the amounts allotted to a State pursuant to this section for fiscal year 1998 that were not expended by the State by the end of fiscal year 2000, the amount specified in subparagraph (B) for fiscal year 1998 for such State shall remain available for expenditure by the State through the end of fiscal year 2004.

(ii)Of the amounts allotted to a State pursuant to this subsection for fiscal year 1999 that were not expended by the State by the end of fiscal year 2001, the amount specified in subparagraph (B) for fiscal year 1999 for such State shall remain available for expenditure by the State through the end of fiscal year 2004.

(iii)Of the amounts allotted to a State pursuant to this section for fiscal year 2000 that were not expended by the State by the end of fiscal year 2002, 50 percent of that amount shall remain available for expenditure by the State through the end of fiscal year 2004.

(iv)Of the amounts allotted to a State pursuant to this section for fiscal year 2001 that were not expended by the State by the end of fiscal year 2003, 50 percent of that amount shall remain available for expenditure by the State through the end of fiscal year 2005.

(B)The amount specified in this subparagraph for a State for a fiscal year is equal to—

(i)the amount by which (I) the total amount available for redistribution under subsection (f) from the allotments for that fiscal year, exceeds (II) the total amounts redistributed under paragraph (1) for that fiscal year; multiplied by

(ii)the ratio of the amount of such State’s unexpended allotment for that fiscal year to the total amount described in clause (i)(I) for that fiscal year.

(C)Notwithstanding section 1397ee(c)(2)(A) of this title, with respect to any State described in subparagraph (A)(i), the State may use up to 10 percent of the amount specified in subparagraph (B) for fiscal year 1998 for expenditures for outreach activities approved by the Secretary.

(3)For purposes of calculating the amounts described in paragraphs (1) and (2) relating to the allotment for fiscal year 1998, fiscal year 1999, fiscal year 2000, or fiscal year 2001, the Secretary shall use the amounts reported by the States not later than December 15, 2000, November 30, 2001, November 30, 2002, or November 30, 2003, respectively, on HCFA Form 64 or HCFA Form 21 or CMS Form 64 or CMS Form 21, as the case may be,,33 So in original. as approved by the Secretary.

(h)(1)(A)Notwithstanding subsection (f) and subject to subparagraphs (C) and (D), with respect to months beginning during fiscal year 2007, the Secretary shall provide for a redistribution under such subsection from the allotments for fiscal year 2004 under subsection (b) that are not expended by the end of fiscal year 2006, to a shortfall State described in subparagraph (B), such amount as the Secretary determines will eliminate the estimated shortfall described in such subparagraph for such State for the month.

(B)For purposes of this paragraph, a shortfall State described in this subparagraph is a State with a State child health plan approved under this subchapter for which the Secretary estimates, on a monthly basis using the most recent data available to the Secretary as of such month, that the projected expenditures under such plan for such State for fiscal year 2007 will exceed the sum of—

(i)the amount of the State’s allotments for each of fiscal years 2005 and 2006 that was not expended by the end of fiscal year 2006; and

(ii)the amount of the State’s allotment for fiscal year 2007.

(C)The Secretary shall redistribute the amounts available for redistribution under subparagraph (A) to shortfall States described in subparagraph (B) in the order in which such States realize monthly funding shortfalls under this subchapter for fiscal year 2007. The Secretary shall only make redistributions under this paragraph to the extent that there are unexpended fiscal year 2004 allotments under subsection (b) available for such redistributions.

(D)If the amounts available for redistribution under subparagraph (A) for a month are less than the total amounts of the estimated shortfalls determined for the month under that subparagraph, the amount computed under such subparagraph for each shortfall State shall be reduced proportionally.

(2)(A)Subject to subparagraphs (C) and (D) and paragraph (5)(B), with respect to months beginning during fiscal year 2007 after March 31, 2007, the Secretary shall provide for a redistribution under subsection (f) from amounts made available for redistribution under paragraph (3) to each shortfall State described in subparagraph (B), such amount as the Secretary determines will eliminate the estimated shortfall described in such subparagraph for such State for the month.

(B)For purposes of this paragraph, a shortfall State described in this subparagraph is a State with a State child health plan approved under this subchapter for which the Secretary estimates, on a monthly basis using the most recent data available to the Secretary as of March 31, 2007, that the projected expenditures under such plan for such State for fiscal year 2007 will exceed the sum of—

(i)the amount of the State’s allotments for each of fiscal years 2005 and 2006 that was not expended by the end of fiscal year 2006;

(ii)the amount, if any, that is to be redistributed to the State in accordance with paragraph (1); and

(iii)the amount of the State’s allotment for fiscal year 2007.

(C)The Secretary shall redistribute the amounts available for redistribution under subparagraph (A) to shortfall States described in subparagraph (B) in the order in which such States realize monthly funding shortfalls under this subchapter for fiscal year 2007. The Secretary shall only make redistributions under this paragraph to the extent that such amounts are available for such redistributions.

(D)If the amounts available for redistribution under paragraph (3) for a month are less than the total amounts of the estimated shortfalls determined for the month under subparagraph (A), the amount computed under such subparagraph for each shortfall State shall be reduced proportionally.

(3)(A)The Secretary, on the basis of the most recent data available to the Secretary as of March 31, 2007—

(i)shall identify those States that received an allotment for fiscal year 2005 under subsection (b) which have not expended all of such allotment by March 31, 2007; and

(ii)for each such State shall estimate—

(I)the portion of such allotment that was not so expended by such date; and

(II)whether the State is described in subparagraph (B).

(B)A State described in this subparagraph is a State for which the Secretary determines, on the basis of the most recent data available to the Secretary as of March 31, 2007, that the total of all available allotments under this subchapter to the State as of such date,44 So in original. The comma probably should not appear. is at least equal to 200 percent of the total projected expenditures under this subchapter for the State for fiscal year 2007.

(C)(i)In the case of a State identified under subparagraph (A)(i) that is also described in subparagraph (B), notwithstanding subsection (e), the applicable amount described in clause (ii) shall not be available for expenditure by the State on or after April 1, 2007, and shall be redistributed in accordance with paragraph (2).

(ii)For purposes of clause (i), the applicable amount described in this clause is the lesser of—

(I)50 percent of the amount described in subparagraph (A)(ii)(I); or

(II)$20,000,000.

(4)(A)From the amounts provided in advance in appropriations Acts, the Secretary shall allot to each remaining shortfall State described in subparagraph (B) such amount as the Secretary determines will eliminate the estimated shortfall described in such subparagraph for the State for fiscal year 2007.

(B)For purposes of subparagraph (A), a remaining shortfall State is a State with a State child health plan approved under this subchapter for which the Secretary estimates, on the basis of the most recent data available to the Secretary as of May 25, 2007, that the projected Federal expenditures under such plan for the State for fiscal year 2007 will exceed the sum of—

(i)the amount of the State’s allotments for each of fiscal years 2005 and 2006 that will not be expended by the end of fiscal year 2006;

(ii)the amount of the State’s allotment for fiscal year 2007; and

(iii)the amounts, if any, that are to be redistributed to the State during fiscal year 2007 in accordance with paragraphs (1) and (2).

(5)(A)The Secretary may adjust the estimates and determinations made under paragraphs (1), (2), (3), and (4) as necessary on the basis of the amounts reported by States not later than November 30, 2007, on CMS Form 64 or CMS Form 21, as the case may be and as approved by the Secretary, but in no case may the applicable amount described in paragraph (3)(C)(ii) exceed the amount determined by the Secretary on the basis of the most recent data available to the Secretary as of March 31, 2007.

(B)Notwithstanding subsections (e) and (f), to the extent the Secretary determines it necessary to adjust the estimates and determinations made for purposes of paragraphs (1), (2), and (3), the Secretary may use only the allotments for fiscal year 2005 under subsection (b) that remain unexpended through the end of fiscal year 2007 for providing any additional amounts to States described in paragraph (2)(B) (without regard to whether such unexpended allotments are from States described in paragraph (3)(B)).

(C)Nothing in this subsection shall be construed as—

(i)authorizing the Secretary to use the allotments for fiscal year 2006 or 2007 under subsection (b) of States described in paragraph (3)(B) to provide additional amounts to States described in paragraph (2)(B) for purposes of eliminating the funding shortfall for such States for fiscal year 2007; or

(ii)limiting the authority of the Secretary to redistribute the allotments for fiscal year 2005 under subsection (b) that remain unexpended through the end of fiscal year 2007 and are available for redistribution under subsection (f) after the application of subparagraph (B).

(6)Notwithstanding subsections (e) and (f), amounts redistributed or allotted to a State pursuant to this subsection for fiscal year 2007 shall only remain available for expenditure by the State through September 30, 2007, and any amounts of such redistributions or allotments that remain unexpended as of such date,4 shall not be subject to redistribution under subsection (f). Nothing in the preceding sentence shall be construed as limiting the ability of the Secretary to adjust the determinations made under paragraphs (1), (2), (3), and (4) in accordance with paragraph (5).

(7)For purposes of this subsection, the term “State” means a State that receives an allotment for fiscal year 2007 under subsection (b).

(i)(1)Notwithstanding subsection (f) and subject to paragraphs (3) and (4), with respect to months beginning during fiscal year 2008, the Secretary shall provide for a redistribution under such subsection from the allotments for fiscal year 2005 under subsection (b) that are not expended by the end of fiscal year 2007, to a fiscal year 2008 shortfall State described in paragraph (2), such amount as the Secretary determines will eliminate the estimated shortfall described in such paragraph for such State for the month.

(2)A fiscal year 2008 shortfall State described in this paragraph is a State with a State child health plan approved under this subchapter for which the Secretary estimates, on a monthly basis using the most recent data available to the Secretary as of such month, that the projected expenditures under such plan for such State for fiscal year 2008 will exceed the sum of—

(A)the amount of the State’s allotments for each of fiscal years 2006 and 2007 that was not expended by the end of fiscal year 2007; and

(B)the amount of the State’s allotment for fiscal year 2008.

(3)The Secretary shall redistribute the amounts available for redistribution under paragraph (1) to fiscal year 2008 shortfall States described in paragraph (2) in the order in which such States realize monthly funding shortfalls under this subchapter for fiscal year 2008. The Secretary shall only make redistributions under this subsection to the extent that there are unexpended fiscal year 2005 allotments under subsection (b) available for such redistributions.

(4)If the amounts available for redistribution under paragraph (1) are less than the total amounts of the estimated shortfalls determined for the month under that paragraph, the amount computed under such paragraph for each fiscal year 2008 shortfall State for the month shall be reduced proportionally.

(5)The Secretary may adjust the estimates and determinations made to carry out this subsection as necessary on the basis of the amounts reported by States not later than November 30, 2007, on CMS Form 64 or CMS Form 21, as the case may be, and as approved by the Secretary.

(6)Notwithstanding subsections (e) and (f), amounts redistributed to a State pursuant to this subsection for fiscal year 2008 shall only remain available for expenditure by the State through September 30, 2008, and any amounts of such redistributions that remain unexpended as of such date, shall not be subject to redistribution under subsection (f).

(j)(1)For the purpose of providing additional allotments described in subparagraphs (A) and (B) of paragraph (3), there is appropriated, out of any money in the Treasury not otherwise appropriated, such sums as may be necessary, not to exceed $1,600,000,000 for fiscal year 2008.

(2)For purposes of paragraph (3), a shortfall State described in this paragraph is a State with a State child health plan approved under this subchapter for which the Secretary estimates, on the basis of the most recent data available to the Secretary as of November 30, 2007, that the Federal share amount of the projected expenditures under such plan for such State for fiscal year 2008 will exceed the sum of—

(A)the amount of the State’s allotments for each of fiscal years 2006 and 2007 that will not be expended by the end of fiscal year 2007;

(B)the amount, if any, that is to be redistributed to the State during fiscal year 2008 in accordance with subsection (i); and

(C)the amount of the State’s allotment for fiscal year 2008.

(A)to each shortfall State described in paragraph (2) not described in subparagraph (B), such amount as the Secretary determines will eliminate the estimated shortfall described in such paragraph for the State; and

(B)to each commonwealth or territory described in subsection (c)(3), an amount equal to the percentage specified in subsection (c)(2) for the commonwealth or territory multiplied by 1.05 percent of the sum of the amounts determined for each shortfall State under subparagraph (A).

(4)If the amounts available for additional allotments under paragraph (1) are less than the total of the amounts determined under subparagraphs (A) and (B) of paragraph (3), the amounts computed under such subparagraphs shall be reduced proportionally.

(5)The Secretary may adjust the estimates and determinations made to carry out this subsection as necessary on the basis of the amounts reported by States not later than November 30, 2008, on CMS Form 64 or CMS Form 21, as the case may be, and as approved by the Secretary.

(6)Notwithstanding subsections (e) and (f), amounts allotted to a State pursuant to this subsection for fiscal year 2008, subject to paragraph (5), shall only remain available for expenditure by the State through September 30, 2008. Any amounts of such allotments that remain unexpended as of such date shall not be subject to redistribution under subsection (f).

(k)(1)Notwithstanding subsection (f) and subject to paragraphs (3) and (4), with respect to months beginning during fiscal year 2009, the Secretary shall provide for a redistribution under such subsection from the allotments for fiscal year 2006 under subsection (b) that are not expended by the end of fiscal year 2008, to a fiscal year 2009 shortfall State described in paragraph (2), such amount as the Secretary determines will eliminate the estimated shortfall described in such paragraph for such State for the month.

(2)A fiscal year 2009 shortfall State described in this paragraph is a State with a State child health plan approved under this subchapter for which the Secretary estimates, on a monthly basis using the most recent data available to the Secretary as of such month, that the Federal share amount of the projected expenditures under such plan for such State for the first 2 quarters of fiscal year 2009 will exceed the sum of—

(A)the amount of the State’s allotments for each of fiscal years 2007 and 2008 that was not expended by the end of fiscal year 2008; and

(B)the amount of the State’s allotment for fiscal year 2009.

(3)The Secretary shall redistribute the amounts available for redistribution under paragraph (1) to fiscal year 2009 shortfall States described in paragraph (2) in the order in which such States realize monthly funding shortfalls under this subchapter for fiscal year 2009. The Secretary shall only make redistributions under this subsection to the extent that there are unexpended fiscal year 2006 allotments under subsection (b) available for such redistributions.

(4)If the amounts available for redistribution under paragraph (1) are less than the total amounts of the estimated shortfalls determined for the month under that paragraph, the amount computed under such paragraph for each fiscal year 2009 shortfall State for the month shall be reduced proportionally.

(5)The Secretary may adjust the estimates and determinations made to carry out this subsection as necessary on the basis of the amounts reported by States not later than May 31, 2009, on CMS Form 64 or CMS Form 21, as the case may be, and as approved by the Secretary.

(6)Notwithstanding subsections (e) and (f), amounts redistributed to a State pursuant to this subsection for fiscal year 2009 shall only remain available for expenditure by the State through September 30, 2009, and any amounts of such redistributions that remain unexpended as of such date, shall not be subject to redistribution under subsection (f).

(l)(1)For the purpose of providing additional allotments described in subparagraphs (A) and (B) of paragraph (3), there is appropriated, out of any money in the Treasury not otherwise appropriated, such sums as may be necessary, not to exceed $275,000,000 for the first 2 quarters of fiscal year 2009.

(2)For purposes of paragraph (3), a shortfall State described in this paragraph is a State with a State child health plan approved under this subchapter for which the Secretary estimates, on the basis of the most recent data available to the Secretary, that the Federal share amount of the projected expenditures under such plan for such State for the first 2 quarters of fiscal year 2009 will exceed the sum of—

(A)the amount of the State’s allotments for each of fiscal years 2007 and 2008 that will not be expended by the end of fiscal year 2008;

(B)the amount, if any, that is to be redistributed to the State during fiscal year 2009 in accordance with subsection (k); and

(C)the amount of the State’s allotment for fiscal year 2009.

(A)to each shortfall State described in paragraph (2) not described in subparagraph (B) such amount as the Secretary determines will eliminate the estimated shortfall described in such paragraph for the State; and

(6)Notwithstanding subsections (e) and (f), amounts allotted to a State pursuant to this subsection for fiscal year 2009, subject to paragraph (5), shall only remain available for expenditure by the State through March 31, 2009. Any amounts of such allotments that remain unexpended as of such date shall not be subject to redistribution under subsection (f).

(m)(1)(A)Subject to the succeeding provisions of this paragraph and paragraph (5), the Secretary shall allot for fiscal year 2009 from the amount made available under subsection (a)(12), to each of the 50 States and the District of Columbia 110 percent of the highest of the following amounts for such State or District:

(i)The total Federal payments to the State under this subchapter for fiscal year 2008, multiplied by the allotment increase factor determined under paragraph (6) for fiscal year 2009.

(ii)The amount allotted to the State for fiscal year 2008 under subsection (b), multiplied by the allotment increase factor determined under paragraph (6) for fiscal year 2009.

(iii)The projected total Federal payments to the State under this subchapter for fiscal year 2009, as determined on the basis of the February 2009 projections certified by the State to the Secretary by not later than March 31, 2009.

(B)Subject to the succeeding provisions of this paragraph and paragraph (5), the Secretary shall allot for fiscal year 2009 from the amount made available under subsection (a)(12) to each of the commonwealths and territories described in subsection (c)(3) an amount equal to the highest amount of Federal payments to the commonwealth or territory under this subchapter for any fiscal year occurring during the period of fiscal years 1999 through 2008, multiplied by the allotment increase factor determined under paragraph (6) for fiscal year 2009, except that subparagraph (B) thereof shall be applied by substituting “the United States” for “the State”.

(C)In the case of a qualifying State described in paragraph (2) of section 1397ee(g) of this title, the Secretary shall permit the State to submit a revised projection described in subparagraph (A)(iii) in order to take into account changes in such projections attributable to the application of paragraph (4) of such section.

(2)(A)Subject to paragraphs (4) and (6),55 See References in Text note below. from the amount made available under paragraphs (13) through (15) of subsection (a) for each of fiscal years 2010 through 2012, respectively, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for each such fiscal year as follows:

(i)For fiscal year 2010, the allotment of the State is equal to the sum of—

(I)the amount of the State allotment under paragraph (1) for fiscal year 2009; and

(II)the amount of any payments made to the State under subsection (k), (l), or (n) for fiscal year 2009,

(ii)For fiscal year 2011, the allotment of the State is equal to the Federal payments to the State that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal year 2010 (including payments made to the State under subsection (n) for fiscal year 2010 as well as amounts redistributed to the State in fiscal year 2010), multiplied by the allotment increase factor under paragraph (6) for fiscal year 2011.

(iii)For fiscal year 2012, the allotment of the State is equal to the sum of—

(I)the amount of the State allotment under clause (ii) for fiscal year 2011; and

(II)the amount of any payments made to the State under subsection (n) for fiscal year 2011,

(B)Subject to paragraphs (5), (7), and (12), from the amount made available under paragraphs (16) through (27) of subsection (a) for fiscal year 2013 and each succeeding fiscal year, respectively, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for each such fiscal year as follows:

(i)For fiscal year 2013 and each succeeding odd-numbered fiscal year (other than fiscal years 2015, 2017, 2023, and 2029), the allotment of the State is equal to the Federal payments to the State that are attributable to (and countable toward) the total amount of allotments available under this section to the State in the preceding fiscal year (including payments made to the State under subsection (n) for such preceding fiscal year as well as amounts redistributed to the State in such preceding fiscal year), multiplied by the allotment increase factor under paragraph (6) for such odd-numbered fiscal year.

(ii)Except as provided in clauses (iii) and (iv), for fiscal year 2014 and each succeeding even-numbered fiscal year, the allotment of the State is equal to the sum of—

(I)the amount of the State allotment under clause (i) (or, in the case of fiscal year 2018 or 2024, under paragraph (4) or (10), respectively) for the preceding fiscal year; and

(II)the amount of any payments made to the State under subsection (n) for such preceding fiscal year,

(iii)For fiscal year 2016, the allotment of the State is equal to the Federal payments to the State that are attributable to (and countable toward) the total amount of allotments available under this section to the State in the preceding fiscal year (including payments made to the State under subsection (n) for such preceding fiscal year as well as amounts redistributed to the State in such preceding fiscal year), but determined as if the last two sentences of section 1397ee(b) of this title were in effect in such preceding fiscal year and then multiplying the result by the allotment increase factor under paragraph (6) for fiscal year 2016.

(iv)For fiscal year 2018, with respect to the allotment of the State for fiscal year 2017, any amounts of such allotment that remain available for expenditure by the State in fiscal year 2018 shall be reduced by one-third.

(3)(A)Subject to paragraphs (5) and (7), from the amount made available under subparagraph (A) of paragraph (18) of subsection (a) for the semi-annual period described in such paragraph, increased by the amount of the appropriation for such period under section 108 of the Children’s Health Insurance Program Reauthorization Act of 2009, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the first half ratio (described in subparagraph (D)) of the amount described in subparagraph (C).

(B)Subject to paragraphs (5) and (7), from the amount made available under subparagraph (B) of paragraph (18) of subsection (a) for the semi-annual period described in such paragraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made available under such subparagraph, multiplied by the ratio of—

(i)the amount of the allotment to such State under subparagraph (A); to

(ii)the total of the amount of all of the allotments made available under such subparagraph.

(C)The amount described in this subparagraph for a State is equal to the Federal payments to the State that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal year 2014 (including payments made to the State under subsection (n) for fiscal year 2014 as well as amounts redistributed to the State in fiscal year 2014), multiplied by the allotment increase factor under paragraph (6) for fiscal year 2015.

(D)The first half ratio described in this subparagraph is the ratio of—

(i)the sum of—

(I)the amount made available under subsection (a)(18)(A); and

(II)the amount of the appropriation for such period under section 108 of the Children’s Health Insurance Program Reauthorization Act of 2009; to

(ii)the sum of the 3 —

(I)amount described in clause (i); and

(II)the 3 amount made available under subsection (a)(18)(B).

(4)(A)Subject to paragraphs (5) and (7), from the amount made available under subparagraph (A) of paragraph (20) of subsection (a) for the semi-annual period described in such paragraph, increased by the amount of the appropriation for such period under section 301(b)(3) of the Medicare Access and CHIP Reauthorization Act of 2015, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the first half ratio (described in subparagraph (D)) of the amount described in subparagraph (C).

(B)Subject to paragraphs (5) and (7), from the amount made available under subparagraph (B) of paragraph (20) of subsection (a) for the semi-annual period described in such paragraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made available under such subparagraph, multiplied by the ratio of—

(i)the amount of the allotment to such State under subparagraph (A); to

(ii)the total of the amount of all of the allotments made available under such subparagraph.

(C)The amount described in this subparagraph for a State is equal to the Federal payments to the State that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal year 2016 (including payments made to the State under subsection (n) for fiscal year 2016 as well as amounts redistributed to the State in fiscal year 2016), multiplied by the allotment increase factor under paragraph (6) for fiscal year 2017.

(D)The first half ratio described in this subparagraph is the ratio of—

(i)the sum of—

(I)the amount made available under subsection (a)(20)(A); and

(II)the amount of the appropriation for such period under section 301(b)(3) of the Medicare Access and CHIP Reauthorization Act of 2015; to

(ii)the sum of the 3 —

(I)amount described in clause (i); and

(II)the 3 amount made available under subsection (a)(20)(B).

(5)If, after the application of this subsection without regard to this paragraph, the sum of the allotments determined under paragraph (1), (2), (3), (4), (10), or (11) for a fiscal year (or, in the case of fiscal year 2015, 2017, 2023, or 2029, for a semi-annual period in such fiscal year) exceeds the amount available under subsection (a) for such fiscal year or period, the Secretary shall reduce each allotment for any State under such paragraph for such fiscal year or period on a proportional basis.

(6)The allotment increase factor under this paragraph for a fiscal year is equal to the product of the following:

(A)1 plus the percentage increase in the projected per capita amount of National Health Expenditures from the calendar year in which the previous fiscal year ends to the calendar year in which the fiscal year involved ends, as most recently published by the Secretary before the beginning of the fiscal year.

(B)1 plus the percentage increase (if any) in the population of children in the State from July 1 in the previous fiscal year to July 1 in the fiscal year involved, as determined by the Secretary based on the most recent published estimates of the Bureau of the Census before the beginning of the fiscal year involved, plus 1 percentage point.

(7)In the case of one of the 50 States or the District of Columbia that—

(A)has submitted to the Secretary, and has approved by the Secretary, a State plan amendment or waiver request relating to an expansion of eligibility for children or benefits under this subchapter that becomes effective for a fiscal year (beginning with fiscal year 2010 and ending with fiscal year 2029); and

(B)has submitted to the Secretary, before the August 31 preceding the beginning of the fiscal year (or, in the case of fiscal year 2018, by not later than the date that is 60 days after January 22, 2018), a request for an expansion allotment adjustment under this paragraph for such fiscal year that specifies—

(i)the additional expenditures that are attributable to the eligibility or benefit expansion provided under the amendment or waiver described in subparagraph (A), as certified by the State and submitted to the Secretary by not later than August 31 preceding the beginning of the fiscal year; and

(ii)the extent to which such additional expenditures are projected to exceed the allotment of the State or District for the year,

(8)For purposes of recalculating the fiscal year 2010 allotment, in the case of one of the 50 States or the District of Columbia that has an approved State plan amendment effective January 1, 2006, to provide child health assistance through the provision of benefits under the State plan under subchapter XIX for children from birth through age 5 whose family income does not exceed 200 percent of the poverty line, the Secretary shall increase the allotment by an amount that would be equal to the Federal share of expenditures that would have been claimed at the enhanced FMAP rate rather than the Federal medical assistance percentage matching rate for such population.

(9)Each semi-annual allotment made under paragraph (3), (4), (10), or (11) for a period in fiscal year 2015, 2017, 2023, or 2029, shall remain available for expenditure under this subchapter for periods after the end of such fiscal year in the same manner as if the allotment had been made available for the entire fiscal year.

(10)(A)Subject to paragraphs (5) and (7), from the amount made available under subparagraph (A) of paragraph (26) of subsection (a) for the semi-annual period described in such subparagraph, increased by the amount of the appropriation for such period under section 3002(b)(2) of the HEALTHY KIDS Act, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the first half ratio (described in subparagraph (D)) of the amount described in subparagraph (C).

(B)Subject to paragraphs (5) and (7), from the amount made available under subparagraph (B) of paragraph (26) of subsection (a) for the semi-annual period described in such subparagraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made available under such subparagraph, multiplied by the ratio of—

(i)the amount of the allotment to such State under subparagraph (A); to

(ii)the total of the amount of all of the allotments made available under such subparagraph.

(C)The amount described in this subparagraph for a State is equal to the Federal payments to the State that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal year 2022 (including payments made to the State under subsection (n) for fiscal year 2022 as well as amounts redistributed to the State in fiscal year 2022), multiplied by the allotment increase factor under paragraph (6) for fiscal year 2023.

(D)The first half ratio described in this subparagraph is the ratio of—

(i)the sum of—

(I)the amount made available under subsection (a)(26)(A); and

(II)the amount of the appropriation for such period under section 3002(b)(2) of the HEALTHY KIDS Act; to

(ii)the sum of—

(I)the amount described in clause (i); and

(II)the amount made available under subsection (a)(26)(B).

(11)(A)Subject to paragraphs (5) and (7), from the amount made available under subparagraph (A) of paragraph (28) of subsection (a) for the semi-annual period described in such subparagraph, increased by the amount of the appropriation for such period under section 50101(b)(2) of the Advancing Chronic Care, Extenders, and Social Services Act, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the first half ratio (described in subparagraph (D)) of the amount described in subparagraph (C).

(B)Subject to paragraphs (5) and (7), from the amount made available under subparagraph (B) of paragraph (28) of subsection (a) for the semi-annual period described in such subparagraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made available under such subparagraph, multiplied by the ratio of—

(i)the amount of the allotment to such State under subparagraph (A); to

(ii)the total of the amount of all of the allotments made available under such subparagraph.

(C)The amount described in this subparagraph for a State is equal to the Federal payments to the State that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal year 2028 (including payments made to the State under subsection (n) for fiscal year 2028 as well as amounts redistributed to the State in fiscal year 2028), multiplied by the allotment increase factor under paragraph (6) for fiscal year 2029.

(D)The first half ratio described in this subparagraph is the ratio of—

(i)the sum of—

(I)the amount made available under subsection (a)(28)(A); and

(II)the amount of the appropriation for such period under section 50101(b)(2) of the Advancing Chronic Care, Extenders, and Social Services Act; to

(ii)the sum of—

(I)the amount described in clause (i); and

(II)the amount made available under subsection (a)(28)(B).

(12)If a State, commonwealth, or territory receives payment for a fiscal year (beginning with fiscal year 2021) under subsection (a) of section 1397ee of this title for expenditures that are subject to the enhanced FMAP specified under subsection (c)(12) of such section, the amount of the allotment determined for the State, commonwealth, or territory under this subsection—

(A)for such fiscal year shall be increased by the projected expenditures for such year by the State, commonwealth, or territory under the State child health plan (or a waiver of such plan) for vaccines described in section 1396d(a)(4)(E) of this title (and the administration of such vaccines); and

(B)once actual expenditures are available in the subsequent fiscal year, the fiscal year allotment that was adjusted by the amount described in subparagraph (A) shall be adjusted on the basis of the difference between—

(i)such projected amount of expenditures described in subparagraph (A) for such fiscal year described in such subparagraph by the State, commonwealth, or territory; and

(ii)the actual amount of expenditures for such fiscal year described in subparagraph (A) by the State, commonwealth, or territory under the State child health plan (or waiver of such plan) for vaccines described in section 1396d(a)(4)(E) of this title (and the administration of such vaccines).

(n)(1)There is hereby established in the Treasury of the United States a fund which shall be known as the “Child Enrollment Contingency Fund” (in this subsection referred to as the “Fund”). Amounts in the Fund shall be available without further appropriations for payments under this subsection.

(2)(A)Subject to subparagraphs (B) and (D), out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated to the Fund—

(i)for fiscal year 2009, an amount equal to 20 percent of the amount made available under paragraph (12) of subsection (a) for the fiscal year; and

(ii)for each of fiscal years 2010 through 2014, 2016, 2018 through 2022, and 2024 through 2028 (and for each of the semi-annual allotment periods for fiscal years 2015, 2017, 2023, and 2029), such sums as are necessary for making payments to eligible States for such fiscal year or period, but not in excess of the aggregate cap described in subparagraph (B).

(B)The total amount available for payment from the Fund for each of fiscal years 2010 through 2014, 2016, 2018 through 2022, and 2024 through 2028 (and for each of the semi-annual allotment periods for fiscal years 2015, 2017, 2023, and 2029), taking into account deposits made under subparagraph (C), shall not exceed 20 percent of the amount made available under subsection (a) for the fiscal year or period.

(C)The Secretary of the Treasury shall invest, in interest bearing securities of the United States, such currently available portions of the Fund as are not immediately required for payments from the Fund. The income derived from these investments constitutes a part of the Fund.

(D)Any amounts in excess of the aggregate cap described in subparagraph (B) for a fiscal year or period shall be made available for purposes of carrying out section 1397ee(a)(3) of this title for any succeeding fiscal year and the Secretary of the Treasury shall reduce the amount in the Fund by the amount so made available.

(3)(A)If a State’s expenditures under this subchapter in any of fiscal years 2009 through 2014, fiscal year 2016, fiscal years 2018 through 2022, or fiscal years 2024 through 2028 (or a semi-annual allotment period for fiscal year 2015, 2017, 2023, or 2027), exceed the total amount of allotments available under this section to the State in the fiscal year or period (determined without regard to any redistribution it receives under subsection (f) that is available for expenditure during such fiscal year or period, but including any carryover from a previous fiscal year) and if the average monthly unduplicated number of children enrolled under the State plan under this subchapter (including children receiving health care coverage through funds under this subchapter pursuant to a waiver under section 1315 of this title) during such fiscal year or period exceeds its target average number of such enrollees (as determined under subparagraph (B)) for that fiscal year or period, subject to subparagraph (D), the Secretary shall pay to the State from the Fund an amount equal to the product of—

(i)the amount by which such average monthly caseload exceeds such target number of enrollees; and

(ii)the projected per capita expenditures under the State child health plan (as determined under subparagraph (C) for the fiscal year), multiplied by the enhanced FMAP (as defined in section 1397ee(b) of this title) for the State and fiscal year involved (or in which the period occurs).

(B)In this paragraph, the target average number of child enrollees for a State—

(i)for fiscal year 2009 is equal to the monthly average unduplicated number of children enrolled in the State child health plan under this subchapter (including such children receiving health care coverage through funds under this subchapter pursuant to a waiver under section 1315 of this title) during fiscal year 2008 increased by the population growth for children in that State for the year ending on June 30, 2007 (as estimated by the Bureau of the Census) plus 1 percentage point; or

(ii)for a subsequent fiscal year (or semi-annual period occurring in a fiscal year) is equal to the target average number of child enrollees for the State for the previous fiscal year increased by the child population growth factor described in subsection (m)(6)(B) for the State for the prior fiscal year.

(C)For purposes of subparagraph (A)(ii), the projected per capita expenditures under a State child health plan—

(i)for fiscal year 2009 is equal to the average per capita expenditures (including both State and Federal financial participation) under such plan for the targeted low-income children counted in the average monthly caseload for purposes of this paragraph during fiscal year 2008, increased by the annual percentage increase in the projected per capita amount of National Health Expenditures (as estimated by the Secretary) for 2009; or

(ii)for a subsequent fiscal year (or semi-annual period occurring in a fiscal year) is equal to the projected per capita expenditures under such plan for the previous fiscal year (as determined under clause (i) or this clause) increased by the annual percentage increase in the projected per capita amount of National Health Expenditures (as estimated by the Secretary) for the year in which such subsequent fiscal year ends.

(D)If the amounts available for payment from the Fund for a fiscal year or period are less than the total amount of payments determined under subparagraph (A) for the fiscal year or period, the amount to be paid under such subparagraph to each eligible State shall be reduced proportionally.

(E)Payment under this paragraph for a fiscal year or period shall be made before the end of the fiscal year or period based upon the most recent data for expenditures and enrollment and the provisions of subsection (e) of section 1397ee of this title shall apply to payments under this subsection in the same manner as they apply to payments under such section.

(F)For purposes of this paragraph and subsection (f), the State shall submit to the Secretary the State’s projected Federal expenditures, even if the amount of such expenditures exceeds the total amount of allotments available to the State in such fiscal year or period.

(G)No payment shall be made under this paragraph to a commonwealth or territory described in subsection (c)(3) until such time as the Secretary determines that there are in effect methods, satisfactory to the Secretary, for the collection and reporting of reliable data regarding the enrollment of children described in subparagraphs (A) and (B) in order to accurately determine the commonwealth’s or territory’s eligibility for, and amount of payment, under this paragraph.

Notes & Related Subsidiaries

Editorial Notes

References in Text

Paragraphs (4) and (6), referred to in introductory provisions of subsec. (m)(2)(A), were redesignated (5) and (7), respectively, by Pub. L. 114–10, title III, § 301(b)(1)(F), Apr. 16, 2015, 129 Stat. 156. section 108 of the Children’s Health Insurance Program Reauthorization Act of 2009, referred to in subsec. (m)(3)(A), (D)(i)(II), is section 108 of title I of Pub. L. 111–3, Feb. 4, 2009, 123 Stat. 25, which is not classified to the Code. section 301(b)(3) of the Medicare Access and CHIP Reauthorization Act of 2015, referred to in subsec. (m)(4)(A), (D)(i)(II), is section 301(b)(3) of Pub. L. 114–10, title III, Apr. 16, 2015, 129 Stat. 157, which relates to a one-time appropriation for fiscal year 2017 and is not classified to the Code. section 3002(b)(2) of the HEALTHY KIDS Act, referred to in subsec. (m)(10)(A), (D)(i)(II), is section 3002(b)(2) of Pub. L. 115–120, div. C, Jan. 22, 2018, 132 Stat. 33, which relates to a one-time appropriation for fiscal year 2023 and is not classified to the Code. section 50101(b)(2) of the Advancing Chronic Care, Extenders, and Social Services Act, referred to in subsec. (m)(11)(A), (D)(i)(II), probably means section 50101(b)(2) of the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act, Pub. L. 115–123, div. E, title I, Feb. 9, 2018, 132 Stat. 173, which relates to a one-time appropriation for fiscal year 2027 and is not classified to the Code.

Amendments

2022—Subsec. (a)(27). Pub. L. 117–328, § 5111(a)(1), substituted “through 2028” for “through 2026”. Subsec. (a)(28). Pub. L. 117–328, § 5111(a)(2)(A), substituted “for fiscal year 2029” for “for fiscal year 2027” in introductory provisions. Subsec. (a)(28)(A). Pub. L. 117–328, § 5111(a)(2)(B), substituted “beginning on

October 1, 2028, and ending on

March 31, 2029” for “beginning on

October 1, 2026, and ending on

March 31, 2027”. Subsec. (a)(28)(B). Pub. L. 117–328, § 5111(a)(2)(C), substituted “beginning on

April 1, 2029, and ending on

September 30, 2029” for “beginning on

April 1, 2027, and ending on

September 30, 2027”. Subsec. (m)(2)(B)(i). Pub. L. 117–328, § 5111(b)(1)(A), substituted “2023, and 2029” for “, 2023, and 2027”. Subsec. (m)(5). Pub. L. 117–328, § 5111(b)(1)(B), substituted “or 2029” for “or 2027”. Subsec. (m)(7). Pub. L. 117–328, § 5111(b)(1)(C)(ii), substituted “fiscal year 2026, or fiscal year 2028.” for “or fiscal year 2026.” in concluding provisions. Subsec. (m)(7)(A). Pub. L. 117–328, § 5111(b)(1)(C)(i), substituted “fiscal year 2029” for “fiscal year 2027,”. Subsec. (m)(9). Pub. L. 117–328, § 5111(b)(1)(D), substituted “or 2029” for “or 2027”. Subsec. (m)(11). Pub. L. 117–328, § 5111(b)(1)(E)(i), substituted “fiscal year 2029” for “fiscal year 2027” in heading. Subsec. (m)(11)(C). Pub. L. 117–328, § 5111(b)(1)(E)(ii), substituted “fiscal year 2028” for “fiscal year 2026” wherever appearing and “fiscal year 2029” for “fiscal year 2027”. Subsec. (n)(2)(A)(ii). Pub. L. 117–328, § 5111(c)(5), substituted “2024 through 2028” for “2024 through 2026” and “2023, and 2029” for “2023, and 2027”. Subsec. (n)(2)(B). Pub. L. 117–328, § 5111(c)(5), substituted “2024 through 2028” for “2024 through 2026” and “2023, and 2029” for “2023, and 2027”. Subsec. (n)(3)(A). Pub. L. 117–328, § 5111(c)(5)(A), substituted “2024 through 2028” for “2024 through 2026” in introductory provisions. 2021—Subsec. (m)(2)(B). Pub. L. 117–2, § 9821(c)(1), substituted “paragraphs (5), (7), and (12)” for “paragraphs (5) and (7)” in introductory provisions. Subsec. (m)(12). Pub. L. 117–2, § 9821(c)(2), added par. (12). 2018—Subsec. (a)(21) to (26). Pub. L. 115–120, § 3002(a)(1), added pars. (21) to (26) and struck out former par. (21) which related to semi-annual allotment for fiscal year 2018 ending on

March 31, 2018. Subsec. (a)(27), (28). Pub. L. 115–123, § 50101(a), added pars. (27) and (28). Subsec. (f)(2)(B)(ii)(I). Pub. L. 115–120, § 3002(d)(2)(A), substituted “(as defined in subclause (II)) for the month” for “for the month (as defined in subclause (II))”. Subsec. (f)(2)(B)(ii)(II). Pub. L. 115–120, § 3002(d)(2)(B), inserted “, as in effect on the day before

January 22, 2018,” after “section 1397ee(g)(4)(A) of this title”. Subsec. (f)(2)(B)(ii)(VI). Pub. L. 115–120, § 3002(d)(2)(C), inserted “, as in effect on the day before

January 22, 2018,” after “, section 1397ee(g)(4) of this title” and “, as so in effect” after “under section 1397ee(g)(4) of this title”. Subsec. (m)(2)(B). Pub. L. 115–123, § 50101(b)(1)(A)(i), substituted “(27)” for “(25)” in introductory provisions. Pub. L. 115–120, § 3002(b)(1)(A)(i), substituted “(25)” for “(19)” in introductory provisions. Subsec. (m)(2)(B)(i). Pub. L. 115–123, § 50101(b)(1)(A)(ii), substituted “, 2023, and 2027” for “and 2023”. Pub. L. 115–120, § 3002(b)(1)(A)(ii), substituted “, 2017, and 2023” for “and 2017”. Subsec. (m)(2)(B)(ii). Pub. L. 115–120, § 3002(b)(1)(A)(iii)(I), struck out “and paragraph (10)” after “clauses (iii) and (iv)” in introductory provisions. Subsec. (m)(2)(B)(ii)(I). Pub. L. 115–123, § 50101(b)(1)(A)(iii), substituted “(or, in the case of fiscal year 2018 or 2024, under paragraph (4) or (10), respectively)” for “(or, in the case of fiscal year 2018, under paragraph (4))”. Pub. L. 115–120, § 3002(b)(1)(A)(iii)(II), inserted “(or, in the case of fiscal year 2018, under paragraph (4))” after “clause (i)”. Subsec. (m)(5). Pub. L. 115–123, § 50101(b)(1)(B), substituted “(10), or (11)” for “or (10)” and “2023, or 2027,” for “or 2023,”. Pub. L. 115–120, § 3002(b)(1)(B), substituted “2023” for “2018”. Subsec. (m)(7). Pub. L. 115–123, § 50101(b)(1)(C)(ii), substituted “fiscal year 2022, fiscal year 2024, or fiscal year 2026” for “or fiscal year 2022” in concluding provisions. Pub. L. 115–120, § 3002(b)(1)(C)(iii), substituted “fiscal year 2016, fiscal year 2018, fiscal year 2020, or fiscal year 2022” for “or fiscal year 2016” in concluding provisions. Subsec. (m)(7)(A). Pub. L. 115–123, § 50101(b)(1)(C)(i), substituted “2027,” for “2023”. Pub. L. 115–120, § 3002(b)(1)(C)(i), substituted “2023” for “2017”. Subsec. (m)(7)(B). Pub. L. 115–120, § 3002(b)(1)(C)(ii), inserted “(or, in the case of fiscal year 2018, by not later than the date that is 60 days after

January 22, 2018)” after “before the August 31 preceding the beginning of the fiscal year” in introductory provisions. Subsec. (m)(9). Pub. L. 115–123, § 50101(b)(1)(D)(ii), which directed amendment of par. (9) by substituting “2023, or 2027,” for “or 2023,”, was executed by making the substitution for “or 2023” to reflect the probable intent of Congress. Pub. L. 115–123, § 50101(b)(1)(D)(i), substituted “(10), or (11)” for “or (10)”. Pub. L. 115–120, § 3002(b)(1)(D), substituted “2023” for “2018”. Subsec. (m)(10). Pub. L. 115–120, § 3002(b)(1)(E), amended par. (10) generally. Prior to amendment, par. (10) related to State allotments for fiscal year 2018. Subsec. (m)(11). Pub. L. 115–123, § 50101(b)(1)(E), added par. (11). Subsec. (n)(2)(A)(ii). Pub. L. 115–123, § 50101(c)(1)(A), substituted “2018 through 2022, and 2024 through 2026” for “and 2018 through 2022” and “2023, and 2027” for “and 2023”. Pub. L. 115–120, § 3002(c)(1)(A), substituted “2010 through 2014, 2016, and 2018 through 2022” for “2010, 2011, 2012, 2013, 2014, and 2016” and “fiscal years 2015, 2017, and 2023” for “fiscal year 2015 and fiscal year 2017”. Subsec. (n)(2)(B). Pub. L. 115–123, § 50101(c)(1)(B), substituted “2018 through 2022, and 2024 through 2026” for “and 2018 through 2022” and “2023, and 2027” for “and 2023”. Pub. L. 115–120, § 3002(c)(1)(B), substituted “2010 through 2014, 2016, and 2018 through 2022” for “2010, 2011, 2012, 2013, 2014, and 2016” and “fiscal years 2015, 2017, and 2023” for “fiscal year 2015 and fiscal year 2017”. Subsec. (n)(3)(A). Pub. L. 115–123, § 50101(c)(2), substituted “fiscal years 2018 through 2022, or fiscal years 2024 through 2026” for “or in any of fiscal years 2018 through 2022” and “2023, or 2027” for “or 2023” in introductory provisions. Pub. L. 115–120, § 3002(c)(2), substituted “or in any of fiscal years 2018 through 2022 (or a semi-annual allotment period for fiscal year 2015, 2017, or 2023)” for “or a semi-annual allotment period for fiscal year 2015 or 2017” in introductory provisions. 2017—Subsec. (a)(21). Pub. L. 115–96, § 3201(a), added par. (21). Subsec. (f)(2)(B). Pub. L. 115–90, § 201(1), amended subpar. (B) generally. Prior to amendment, text read as follows: “If the amounts available for redistribution under paragraph (1) for a fiscal year are less than the total amounts of the estimated shortfalls determined for the year under subparagraph (A), the amount to be redistributed under such paragraph for each shortfall State shall be reduced proportionally.” Subsec. (f)(2)(B)(ii). Pub. L. 115–96, § 3201(c)(1)(A), substituted “first half” for “first quarter” in heading. Subsec. (f)(2)(B)(ii)(I) to (VI). Pub. L. 115–96, § 3201(c)(1)(B), (C), added subcls. (I) to (V), redesignated former subcl. (III) as (VI), and struck out former subcls. (I) and (II) which related to amounts available for redistribution under paragraph (1) and definition of emergency shortfall State, respectively. Subsec. (f)(2)(D). Pub. L. 115–90, § 201(2), added subpar. (D). Subsec. (m)(2). Pub. L. 115–96, § 3201(b)(2)(B), substituted “the allotment increase factor under paragraph (6)” for “the allotment increase factor under paragraph (5)” wherever appearing. Amendment by Pub. L. 114–10, §301(b)(2)(B)(ii), which made identical substitution but did not specify where it should occur, had already been executed by making the substitution wherever appearing to reflect the probable intent of Congress. See 2015 Amendment note below. Pub. L. 115–96, § 3201(b)(2)(A), substituted “beginning with fiscal year 2010” for “2010 through 2016” in heading. Subsec. (m)(2)(B)(ii). Pub. L. 115–96, § 3201(b)(1)(A), inserted “and paragraph (10)” after “clauses (iii) and (iv)” in introductory provisions. Subsec. (m)(5). Pub. L. 115–96, § 3201(b)(1)(B), substituted “(4), or (10)” for “or (4)” and “, 2017, or 2018” for “or 2017”. Subsec. (m)(9). Pub. L. 115–96, § 3201(b)(1)(C), substituted, in heading, “certain fiscal years” for “fiscal years 2015 and 2017” and, in text, “, (4), or (10)” for “or (4)” and “, 2017, or 2018” for “or fiscal year 2017”. Subsec. (m)(10). Pub. L. 115–96, § 3201(b)(1)(D), added par. (10). 2015—Subsec. (a)(19), (20). Pub. L. 114–10, § 301(a), added pars. (19) and (20). Subsec. (c)(1). Pub. L. 114–10, § 301(b)(2)(A), substituted “(m)(5)” for “(m)(4)”. Subsec. (m). Pub. L. 114–10, § 301(b)(1)(A), substituted “and thereafter” for “through 2015” in heading. Subsec. (m)(1). Pub. L. 114–10, § 301(b)(2)(B)(i)(II), substituted “the allotment increase factor determined under paragraph (6)” for “the allotment increase factor determined under paragraph (5)” wherever appearing. Subsec. (m)(1)(A), (B). Pub. L. 114–10, § 301(b)(2)(B)(i)(I), substituted “and paragraph (5)” for “and paragraph (4)”. Subsec. (m)(2). Pub. L. 114–10, § 301(b)(1)(B)(i), substituted “2016” for “2014” in heading. Subsec. (m)(2)(A). Pub. L. 114–10, § 301(b)(2)(B)(ii), which directed substitution in subpar. (A) of “the allotment increase factor under paragraph (6)” for “the allotment increase factor under paragraph (5)”, was executed by making the substitution wherever appearing in subpar. (A), to reflect the probable intent of Congress. Subsec. (m)(2)(B). Pub. L. 114–10, § 301(b)(1)(B)(ii), added subpar. (B) and struck out former subpar. (B) which related to State allotments for fiscal years 2013 and 2014. Subsec. (m)(3). Pub. L. 114–10, § 301(b)(2)(B)(iii), substituted “paragraphs (5) and (7)” for “paragraphs (4) and (6)” in subpars. (A) and (B) and “the allotment increase factor under paragraph (6)” for “the allotment increase factor under paragraph (5)” in subpar. (C). Subsec. (m)(4). Pub. L. 114–10, § 301(b)(1)(G), added par. (4). Former par. (4) redesignated (5). Pub. L. 114–10, § 301(b)(1)(C), inserted “or 2017” after “2015”. Subsec. (m)(5). Pub. L. 114–10, § 301(b)(2)(B)(iv), substituted “paragraph (1), (2), (3), or (4)” for “paragraph (1), (2), or (3)”. Pub. L. 114–10, § 301(b)(1)(F), redesignated par. (4) as (5). Former par. (5) redesignated (6). Subsec. (m)(6). Pub. L. 114–10, § 301(b)(1)(F), redesignated par. (5) as (6). Former par. (6) redesignated (7). Pub. L. 114–10, § 301(b)(1)(D)(ii), substituted “fiscal year 2014, or fiscal year 2016” for “or fiscal year 2014” in concluding provisions. Subsec. (m)(6)(A). Pub. L. 114–10, § 301(b)(1)(D)(i), substituted “2017” for “2015”. Subsec. (m)(7). Pub. L. 114–10, § 301(b)(2)(B)(v), substituted “subject to paragraph (5)” for “subject to paragraph (4)” in concluding provisions. Pub. L. 114–10, § 301(b)(1)(F), redesignated par. (6) as (7). Former par. (7) redesignated (8). Subsec. (m)(8). Pub. L. 114–10, § 301(b)(1)(F), redesignated par. (7) as (8). Former par. (8) redesignated (9). Pub. L. 114–10, § 301(b)(1)(E), substituted “fiscal years 2015 and 2017” for “fiscal year 2015” in heading and inserted “or fiscal year 2017” after “2015” in text. Subsec. (m)(9). Pub. L. 114–10, § 301(b)(2)(B)(vi), substituted “paragraph (3) or (4)” for “paragraph (3)”. Pub. L. 114–10, § 301(b)(1)(F), redesignated par. (8) as (9). Subsec. (n)(2)(A)(ii). Pub. L. 114–10, § 301(d)(1)(A)(i), substituted “2010, 2011, 2012, 2013, 2014, and 2016” for “2010 through 2014” and inserted “and fiscal year 2017” after “2015”. Subsec. (n)(2)(B). Pub. L. 114–10, § 301(d)(1)(A)(ii), substituted “2010, 2011, 2012, 2013, 2014, and 2016” for “2010 through 2014” and inserted “and fiscal year 2017” after “2015”. Subsec. (n)(3)(A). Pub. L. 114–10, § 301(d)(1)(B), substituted “any of fiscal years 2009 through 2014, fiscal year 2016, or a semi-annual allotment period for fiscal year 2015 or 2017” for “fiscal year 2009, fiscal year 2010, fiscal year 2011, fiscal year 2012, fiscal year 2013, fiscal year 2014, or a semi-annual allotment period for fiscal year 2015” in introductory provisions. Subsec. (n)(3)(B)(ii). Pub. L. 114–10, § 301(b)(2)(C), substituted “subsection (m)(6)(B)” for “subsection (m)(5)(B)”. 2010—Subsec. (a)(16) to (18). Pub. L. 111–148, § 10203(d)(1), added pars. (16) to (18) and struck out former par. (16) which read as follows: “for fiscal year 2013, for purposes of making 2 semi-annual allotments— “(A) $2,850,000,000 for the period beginning on

October 1, 2012, and ending on

March 31, 2013, and “(B) $2,850,000,000 for the period beginning on

April 1, 2013, and ending on

September 30, 2013.” Subsec. (m). Pub. L. 111–148, § 10203(d)(2)(A)(i), substituted “2015” for “2013” in heading. Subsec. (m)(2). Pub. L. 111–148, § 10203(d)(2)(A)(ii), substituted “2014” for “2012” in heading and added subpar. (B). Subsec. (m)(3). Pub. L. 111–148, § 10203(d)(2)(A)(iii)(I), substituted “2015” for “2013” in heading. Subsec. (m)(3)(A), (B). Pub. L. 111–148, § 10203(d)(2)(A)(iii)(II), substituted “paragraph (18)” for “paragraph (16)”. Subsec. (m)(3)(C). Pub. L. 111–148, § 10203(d)(2)(A)(iii)(III), substituted “2014” for “2012” wherever appearing and “2015” for “2013”. Subsec. (m)(3)(D)(i)(I). Pub. L. 111–148, § 10203(d)(2)(A)(iii)(IV)(aa), substituted “subsection (a)(18)(A)” for “subsection (a)(16)(A)”. Subsec. (m)(3)(D)(ii)(II). Pub. L. 111–148, § 10203(d)(2)(A)(iii)(IV)(bb), substituted “subsection (a)(18)(B)” for “subsection (a)(16)(B)”. Subsec. (m)(4). Pub. L. 111–148, § 10203(d)(2)(A)(iv), substituted “2015” for “2013”. Subsec. (m)(6). Pub. L. 111–148, § 10203(d)(2)(A)(v)(II), substituted “, fiscal year 2012, or fiscal year 2014” for “or fiscal year 2012” in concluding provisions. Subsec. (m)(6)(A). Pub. L. 111–148, § 10203(d)(2)(A)(v)(I), substituted “2015” for “2013”. Subsec. (m)(7). Pub. L. 111–148, § 2102(a)(1)(B), added par. (7). Former par. (7) redesignated (8). Subsec. (m)(8). Pub. L. 111–148, § 10203(d)(2)(A)(vi), substituted “2015” for “2013” in heading and text. Pub. L. 111–148, § 2102(a)(1)(A), redesignated par. (7) as (8). Subsec. (n)(2)(A)(ii), (B). Pub. L. 111–148, § 10203(d)(2)(B)(i), substituted “2014” for “2012” and “2015” for “2013”. Subsec. (n)(3)(A). Pub. L. 111–148, § 10203(d)(2)(B)(ii), substituted “fiscal year 2013, fiscal year 2014, or a semi-annual allotment period for fiscal year 2015” for “or a semi-annual allotment period for fiscal year 2013”. 2009—Subsec. (a)(11). Pub. L. 111–3, § 101(2), substituted “fiscal year 2008” for “each of fiscal years 2008 and 2009”. Subsec. (a)(12) to (16). Pub. L. 111–3, § 101(1), (3), added pars. (12) to (16). Subsec. (b)(1). Pub. L. 111–3, § 102(1), substituted “subsections (d) and (m)” for “subsection (d)” in introductory provisions. Subsec. (c)(1). Pub. L. 111–3, § 102(2), substituted “subsections (d) and (m)(4)” for “subsection (d)”. Subsec. (e). Pub. L. 111–3, § 105, amended subsec. (e) generally. Prior to amendment, text read as follows: “Amounts allotted to a State pursuant to this section for a fiscal year shall remain available for expenditure by the State through the end of the second succeeding fiscal year; except that amounts reallotted to a State under subsection (f) of this section shall be available for expenditure by the State through the end of the fiscal year in which they are reallotted.” Subsec. (f). Pub. L. 111–3, § 106(a)(1), designated existing provisions as par. (1), inserted heading, substituted “States that the Secretary determines with respect to the fiscal year for which unused allotments are available for redistribution under this subsection, are shortfall States described in paragraph (2) for such fiscal year, but not to exceed the amount of the shortfall described in paragraph (2)(A) for each such State (as may be adjusted under paragraph (2)(C)).” for “States that have fully expended the amount of their allotments under this section.”, and added par. (2). Subsec. (k). Pub. L. 111–3, § 106(b)(1), struck out “the first 2 quarters of” before “fiscal year 2009” in heading. Subsec. (k)(1). Pub. L. 111–3, § 106(b)(2), struck out “the first 2 quarters of” before “fiscal year 2009,”. Subsec. (k)(6). Pub. L. 111–3, § 106(b)(3), struck out “the first 2 quarters of” before “fiscal year 2009” and substituted “September 30” for “March 31”. Subsecs. (m), (n). Pub. L. 111–3, §§ 102(3), 103, added subsecs. (m) and (n). 2007—Subsec. (a)(11). Pub. L. 110–173, § 201(a)(1)(A), added par. (11). Subsec. (c)(4)(B). Pub. L. 110–173, § 201(a)(1)(B), substituted “for each of fiscal years 2007 through 2009” for “for fiscal year 2007”. Subsec. (h). Pub. L. 109–482 added subsec. (h). Subsec. (h)(1)(B). Pub. L. 110–28, § 7001(b)(1), struck out “subject to paragraph (4)(B) and” after “estimates,” in introductory provisions. Subsec. (h)(2). Pub. L. 110–28, § 7001(a)(1), (b)(2), substituted “part” for “remainder of reduction” in heading and struck out “subject to paragraph (4)(B) and” after “estimates,” in introductory provisions of subpar. (B). Subsec. (h)(4). Pub. L. 110–28, § 7001(a)(2), added par. (4) and struck out former par. (4). Former text read as follows: “(A) Expenditures limited to coverage for populations eligible on october 1, 2006.—A State shall use amounts redistributed under this subsection only for expenditures for providing child health assistance or other health benefits coverage for populations eligible for such assistance or benefits under the State child health plan (including under a waiver of such plan) on

October 1, 2006. “(B) Regular fmap for expenditures for coverage of nonchild populations.—To the extent a State uses amounts redistributed under this subsection for expenditures for providing child health assistance or other health benefits coverage to an individual who is not a child or a pregnant woman, the Federal medical assistance percentage (as defined in the first sentence of section 1396d(b) of this title) applicable to the State for the fiscal year shall apply to such expenditures for purposes of making payments to the State under subsection (a) of section 1397ee of this title from such amounts.” Subsec. (h)(5)(A). Pub. L. 110–28, § 7001(b)(3), substituted “(3), and (4)” for “and (3)”. Subsec. (h)(6). Pub. L. 110–28, § 7001(b)(4), inserted “or allotted” after “redistributed” and “or allotments” after “redistributions” in first sentence and substituted “(3), and (4)” for “and (3)” in second sentence. Subsec. (i). Pub. L. 110–92 added subsec. (i). Subsecs. (j) to (l). Pub. L. 110–173, § 201(c)(1), added subsecs. (j) to (l). 2006—Subsec. (a). Pub. L. 109–171, § 6101(b)(1), inserted “subject to subsection (d),” after “under this section,” in introductory provisions. Subsec. (b)(1). Pub. L. 109–171, § 6101(b)(2), inserted “and subsection (d)” after “Subject to paragraph (4)” in introductory provisions. Subsec. (c)(1). Pub. L. 109–171, § 6101(b)(3), inserted “subject to subsection (d),” after “for a fiscal year,”. Subsec. (d). Pub. L. 109–171, § 6101(a), added subsec. (d). 2003—Subsec. (g). Pub. L. 108–74, § 1(a)(2)(C)(i), (3)(C)(i), substituted “, 1999, 2000, and 2001” for “and 1999” in heading. Subsec. (g)(1)(A). Pub. L. 108–74, § 1(a)(3)(B)(i), (ii), inserted “or for fiscal year 2001 by the end of fiscal year 2003,” after “fiscal year 2002,” and substituted “1999, 2000, or 2001” for “1999, or 2000”. Pub. L. 108–74, § 1(a)(2)(B)(i), (ii), inserted “or for fiscal year 2000 by the end of fiscal year 2002,” after “fiscal year 2001,” and substituted “1998, 1999, or 2000” for “1998 or 1999”. Subsec. (g)(1)(A)(i)(III). Pub. L. 108–74, § 1(a)(2)(B)(iii), added subclause (III). Subsec. (g)(1)(A)(i)(IV). Pub. L. 108–74, § 1(a)(3)(B)(iii), added subcl. (IV). Subsec. (g)(1)(A)(ii). Pub. L. 108–74, § 1(a)(3)(B)(iv), substituted “2000, or 2001” for “or 2000”. Pub. L. 108–74, § 1(a)(2)(B)(iv), substituted “, 1999, or 2000” for “or 1999”. Subsec. (g)(1)(B). Pub. L. 108–74, § 1(a)(2)(B)(v), struck out “with respect to fiscal year 1998 or 1999” after “paragraph” in introductory provisions. Subsec. (g)(1)(B)(ii). Pub. L. 108–74, § 1(a)(2)(B)(vi), inserted “with respect to fiscal year 1998, 1999, or 2000” after “subsection (e),” and substituted “2004” for “2002”. Subsec. (g)(1)(B)(iii), (iv). Pub. L. 108–74, § 1(a)(3)(B)(v), added clause (iii) and redesignated former cl. (iii) as (iv). Subsec. (g)(1)(C). Pub. L. 108–74, § 1(a)(2)(B)(vii), added subpar. (C). Subsec. (g)(1)(D). Pub. L. 108–74, § 1(a)(3)(B)(vi), added subpar. (D). Subsec. (g)(2). Pub. L. 108–74, § 1(a)(2)(A)(i), (3)(A)(i), substituted “through 2001” for “and 1999” in heading. Subsec. (g)(2)(A)(i), (ii). Pub. L. 108–74, § 1(a)(1), substituted “fiscal year 2004” for “fiscal year 2002”. Subsec. (g)(2)(A)(iii). Pub. L. 108–74, § 1(a)(2)(A)(ii), added cl. (iii). Subsec. (g)(2)(A)(iv). Pub. L. 108–74, § 1(a)(3)(A)(ii), added cl. (iv). Subsec. (g)(3). Pub. L. 108–173 inserted “or CMS Form 64 or CMS Form 21, as the case may be,” after “HCFA Form 64 or HCFA Form 21”. Pub. L. 108–74, § 1(a)(3)(C)(ii), substituted “fiscal year 2000, or fiscal year 2001” for “or fiscal year 2000” and “

November 30, 2002, or

November 30, 2003,” for “or

November 30, 2002,”. Pub. L. 108–74, § 1(a)(2)(C)(ii), substituted “, fiscal year 1999, or fiscal year 2000” for “or fiscal year 1999” and “

November 30, 2001, or

November 30, 2002” for “or

November 30, 2001”. 2000—Subsec. (b)(1). Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(d)(3)(A)], in introductory provisions, struck out “and subsection (d) of this section” after “Subject to paragraph (4)”. Subsec. (c)(1). Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(d)(3)(B)], struck out “subject to subsection (d) of this section,” after “for a fiscal year,”. Subsec. (d). Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(b)], struck out heading and text of subsec. (d). Text read as follows: “The amount of the allotment otherwise provided to a State under subsection (b) or (c) of this section for a fiscal year shall be reduced by the sum of— “(1) the amount (if any) of the payments made to that State under section 1396b(a) of this title for expenditures claimed by the State during such fiscal year that is attributable to the provision of medical assistance to a child during a presumptive eligibility period under section 1396r–1a of this title, and “(2) the amount (if any) of the payments made to that State under section 1396b(a) of this title for expenditures claimed by the State during such fiscal year that is attributable to the provision of medical assistance to a child for which payment is made under section 1396b(a)(1) of this title on the basis of an enhanced FMAP under the fourth sentence of section 1396d(b) of this title.” Subsec. (g). Pub. L. 106–554, § 1(a)(6) [title VIII, § 801(a)], added subsec. (g). 1999—Subsec. (b)(2)(A)(i). Pub. L. 106–113, § 1000(a)(6) [title VII, § 701(a)(1)(A)], substituted “and 1999” for “through 2000”. Subsec. (b)(2)(A)(ii). Pub. L. 106–113, § 1000(a)(6) [title VII, § 701(a)(1)(B)], substituted “2000” for “2001” in introductory provisions. Subsec. (b)(2)(B). Pub. L. 106–113, § 1000(a)(6) [title VII, § 701(a)(3)], substituted “the calendar year in which such fiscal year begins” for “the fiscal year”. Subsec. (b)(3)(B). Pub. L. 106–113, § 1000(a)(6) [title VII, § 705(a)], substituted “all the States,” for “all the States.” Pub. L. 106–113, § 1000(a)(6) [title VII, § 701(a)(4)], substituted “the calendar year in which such fiscal year begins” for “the fiscal year involved”. Subsec. (b)(4). Pub. L. 106–113, § 1000(a)(6) [title VII, § 701(a)(2)], amended heading and text of par. (4) generally. Prior to amendment, text read as follows: “In no case shall the amount of the allotment under this subsection for one of the 50 States or the District of Columbia for a year be less than $2,000,000. To the extent that the application of the previous sentence results in an increase in the allotment to a State above the amount otherwise provided, the allotments for the other States and the District of Columbia under this subsection shall be reduced in a pro rata manner (but not below $2,000,000) so that the total of such allotments in a fiscal year does not exceed the amount otherwise provided for allotment under paragraph (1) for that fiscal year.” Subsec. (c)(4)(B). Pub. L. 106–113, § 1000(a)(6) [title VII, § 702], inserted before period at end “, $34,200,000 for each of fiscal years 2000 and 2001, $25,200,000 for each of fiscal years 2002 through 2004, $32,400,000 for each of fiscal years 2005 and 2006, and $40,000,000 for fiscal year 2007”. 1998—Subsec. (b)(1). Pub. L. 105–277, § 101(f) [title VII, § 706(b)], inserted “(determined without regard to paragraph (4) thereof)” after “subsection (c)”. Subsec. (c)(4). Pub. L. 105–277, § 101(f) [title VII, § 706(a)], added par. (4). 1997—Subsec. (a)(1). Pub. L. 105–100, § 162(8)(A), substituted “$4,295,000,000” for “$4,275,000,000”. Subsec. (b)(4). Pub. L. 105–100, § 162(8)(B), substituted “In” for “Subject to paragraph (5), in”. Subsec. (c)(2)(C). Pub. L. 105–100, § 162(8)(C), inserted “the” before “Virgin Islands”. Subsec. (c)(3)(C), (E). Pub. L. 105–100, § 162(8)(C), substituted “The” for “the”. Subsec. (d)(1). Pub. L. 105–100, § 162(6)(A), substituted “for expenditures claimed by the State” for “for calendar quarters”. Subsec. (d)(2). Pub. L. 105–100, § 162(6)(B), added par. (2) and struck out former par. (2) which read as follows: “the amount of payments under such section during such period that is attributable to the provision of medical assistance to a child for which payment is made under section 1396b(a)(1) of this title on the basis of an enhanced FMAP under section 1396d(b) of this title.”

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§1397dd Allotments

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