PRIA, Government Policy, Made Personal

Summary

A territory may choose to create an Exchange and be treated like a State for the rules in part B. To do that, the territory must follow the requirements in section 18041 and make the choice by October 1, 2013. The territory must sign an agreement with the Secretary saying the money will only pay for premium and cost-sharing help for people using the Exchange, and the help must be set up so there is no gap between where Medicaid ends and Exchange help begins. If a territory does not make that choice, it will get an increase in the dollar limit that applies under section 1108(f) and (g) of the Social Security Act for that period. Congress set aside $1,000,000,000 for this from 2014 through 2019. The Secretary must give Puerto Rico $925,000,000 and divide the remaining $75,000,000 among the other territories.

Title 42, §18043

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

(a)In general

A territory that—

(1)elects consistent with subsection (b) to establish an Exchange in accordance with part B of this subchapter and establishes such an Exchange in accordance with such part shall be treated as a State for purposes of such part and shall be entitled to payment from the amount allocated to the territory under subsection (c); or

(2)does not make such election shall be entitled to an increase in the dollar limitation applicable to the territory under subsections (f) and (g) of section 1108 of the Social Security Act (42 U.S.C. 1308) for such period in such amount for such territory and such increase shall not be taken into account in computing any other amount under such subsections.

(b)Terms and conditions

An election under subsection (a)(1) shall—

(1)not be effective unless the election is consistent with section 18041 of this title and is received not later than October 1, 2013; and

(2)be contingent upon entering into an agreement between the territory and the Secretary that requires that—

(A)funds provided under the agreement shall be used only to provide premium and cost-sharing assistance to residents of the territory obtaining health insurance coverage through the Exchange; and

(B)the premium and cost-sharing assistance provided under such agreement shall be structured in such a manner so as to prevent any gap in assistance for individuals between the income level at which medical assistance is available through the territory’s Medicaid plan under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] and the income level at which premium and cost-sharing assistance is available under the agreement.

(c)Appropriation and allocation

(1)Appropriation

Out of any funds in the Treasury not otherwise appropriated, there is appropriated for purposes of payment pursuant to subsection (a) $1,000,000,000, to be available during the period beginning with 2014 and ending with 2019.

(2)Allocation

The Secretary shall allocate the amount appropriated under paragraph (1) among the territories for purposes of carrying out this section as follows:

(A)For Puerto Rico, $925,000,000.

(B)For another territory, the portion of $75,000,000 specified by the Secretary.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Social Security Act, referred to in subsec. (b)(2)(B), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XIX of the Act is classified generally to subchapter XIX (§ 1396 et seq.) of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

Prior Provisions

A prior section 18043, Pub. L. 111–148, title I, § 1323, Mar. 23, 2010, 124 Stat. 192, which related to establishment of community health insurance option, was repealed by Pub. L. 111–148, title X, § 10104(m), Mar. 23, 2010, 124 Stat. 902.

§18043 Funding for the Territories