42 U.S.C. § 1396w–1: Medicaid Improvement Fund

Summary

Creates a Medicaid Improvement Fund to help the Secretary improve how the Centers for Medicare & Medicaid Services runs Medicaid. The Fund can pay for things like overseeing contracts, managing contractors, and checking demonstration projects. Payments from this Fund are extra on top of any other payments for those same activities. For fiscal year 2023 and after, the Fund is shown as having $0 available. The Fund can be used before Congress formally appropriates money, but only up to the amount actually available. The Secretary may commit money from the Fund only after the Secretary, the CMS Chief Actuary, and the appropriate budget officer certify there is enough money. In addition, for fiscal year 2028 and after there is an extra $0 set aside (to remain available until spent) to pay States for work on automated claims systems. Those State payments start for quarters beginning in or after fiscal year 2025 and equal 100 percent minus the percentages set elsewhere in the Medicaid rules for three specific types of State spending on those systems.

Title 42, §1396w–1

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

(a)Establishment

The Secretary shall establish under this subchapter a Medicaid Improvement Fund (in this section referred to as the “Fund”) which shall be available to the Secretary to improve the management of the Medicaid program by the Centers for Medicare & Medicaid Services, including oversight of contracts and contractors and evaluation of demonstration projects, and, in accordance with subsection (b)(3), for the purposes of subparagraph (B) of such subsection. Payments made for activities under this subsection shall be in addition to payments that would otherwise be made for such activities.

(b)Funding

(1)In general

There shall be available to the Fund, for expenditures from the Fund for fiscal year 2023 and thereafter, $0.

(2)Funding limitation

Amounts in the Fund pursuant to paragraph (1) shall be available in advance of appropriations but only if the total amount obligated from the Fund does not exceed the amount available to the Fund under paragraph (1). Amounts in the Fund pursuant to paragraph (3) shall be available in advance of appropriations but only if the total amount obligated from the Fund does not exceed the amount available to the Fund under such paragraph (3). The Secretary may obligate funds from the Fund only if the Secretary determines (and the Chief Actuary of the Centers for Medicare & Medicaid Services and the appropriate budget officer certify) that there are available in the Fund sufficient amounts to cover all such obligations incurred consistent with the previous sentences.

(3)Additional funding for State activities relating to mechanized claims systems

(A)In general

In addition to the amount made available under paragraph (1), there shall be available to the Fund, for expenditures from the Fund in accordance with subparagraph (B), for fiscal year 2028 and thereafter, $0, to remain available until expended.

(B)Purposes

The Secretary shall use amounts made available to the Fund under subparagraph (A) to pay to each State which has a plan approved under this subchapter, for each quarter beginning during or after fiscal year 2025 an amount equal to—

(i)100 percent minus the percent specified in clause (i) of section 1396b(a)(3)(A) of this title of so much of the sums expended by the State during such quarter as are attributable to the activities described in such clause;

(ii)100 percent minus the Federal medical assistance percentage applied under clause (iii) of such section of so much of the sums expended during such quarter (as found necessary by the Secretary under such clause) by the State as are attributable to the activities described in such clause; and

(iii)100 percent minus the percent specified in section 1396b(a)(3)(B) of this title of so much of the sums expended by the State during such quarter as are attributable to the activities described in such section.

Notes & Related Subsidiaries

Editorial Notes

Amendments

2024—Subsec. (b)(3)(A). Pub. L. 118–42 substituted “$0” for “$5,140,428,729”. Pub. L. 118–35 substituted “$5,140,428,729” for “$5,796,117,810”. 2023—Subsec. (b)(3)(A). Pub. L. 118–22 substituted “$5,796,117,810” for “$6,357,117,810”. Pub. L. 118–15 substituted “$6,357,117,810” for “$7,000,000,000”. 2022—Subsec. (b)(3)(A). Pub. L. 117–328 substituted “for fiscal year 2028 and thereafter, $7,000,000,000” for “for fiscal year 2025 and thereafter, $0”. 2020—Subsec. (b)(1). Pub. L. 116–159, § 2602(1), substituted “2023” for “2021”. Subsec. (b)(3)(A). Pub. L. 116–260 substituted “$0” for “$3,464,000,000”. Pub. L. 116–215 substituted “$3,464,000,000” for “$3,446,000,000”. Pub. L. 116–159, § 2602(2), substituted “$3,446,000,000” for “$1,960,000,000”. 2019—Subsec. (b)(1). Pub. L. 116–59, § 1604(1), substituted “$0” for “$1,000,000”. Pub. L. 116–29 substituted “$1,000,000” for “$6,000,000”. Pub. L. 116–3 substituted “$6,000,000” for “$31,000,000”. Subsec. (b)(3). Pub. L. 116–59, § 1604(2)(A), substituted “2025” for “2023” in subpars. (A) and (B). Subsec. (b)(3)(A). Pub. L. 116–69 substituted “$1,960,000,000” for “$2,387,000,000”. Pub. L. 116–59, § 1604(2)(B), substituted “$2,387,000,000” for “$0”. 2018—Subsec. (a). Pub. L. 115–120, § 3006(1), inserted before period at end of first sentence “, and, in accordance with subsection (b)(3), for the purposes of subparagraph (B) of such subsection”. Subsec. (b)(1). Pub. L. 115–271 substituted “$31,000,000” for “$0”. Pub. L. 115–123, § 53105(1), substituted “$0” for “$5,000,000”. Subsec. (b)(2). Pub. L. 115–120, § 3006(2)(A), inserted “pursuant to paragraph (1)” after “in the Fund” in first sentence and “Amounts in the Fund pursuant to paragraph (3) shall be available in advance of appropriations but only if the total amount obligated from the Fund does not exceed the amount available to the Fund under such paragraph (3).” after first sentence and substituted “the previous sentences” for “the previous sentence” in last sentence. Subsec. (b)(3). Pub. L. 115–120, § 3006(2)(B), added par. (3). Subsec. (b)(3)(A). Pub. L. 115–123, § 53105(2), substituted “$0” for “$980,000,000”. 2016—Subsec. (b)(1). Pub. L. 114–198 amended par. (1) generally. Prior to amendment, text read as follows: “There shall be available to the Fund, for expenditures from the Fund— “(A) for fiscal year 2014, $0; and “(B) for each of fiscal years 2015 through 2018, $0.” 2010—Subsec. (b)(1)(A). Pub. L. 111–148, § 2007(b)(1), which directed substitution of “$0” for “$100,000,000”, was executed by making the substitution for “$10,000,000”, to reflect the probable intent of Congress and intervening amendment by Pub. L. 111–127. See below. Pub. L. 111–127 substituted “$10,000,000” for “$100,000,000”. Subsec. (b)(1)(B). Pub. L. 111–148, § 2007(b)(2), substituted “$0” for “$150,000,000”. 2009—Subsec. (b)(1)(B). Pub. L. 111–8 inserted “each of” after “for”.

§1396w–1 Medicaid Improvement Fund

Summary

Title 42, §1396w–1

Notes & Related Subsidiaries

Editorial Notes

Amendments

Citations & Metadata