[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4063 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 4063
To establish a State public option through Medicaid to provide
Americans with the choice of a high-quality, low-cost health insurance
plan.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 22, 2024
Mr. Schatz (for himself, Mr. Lujan, Mr. Blumenthal, Mr. Booker, Mr.
Merkley, Ms. Klobuchar, Mr. Heinrich, Mr. Reed, Mr. Welch, Ms. Smith,
Ms. Hirono, Mrs. Shaheen, Mr. Murphy, Mr. Markey, Ms. Rosen, Mr.
Whitehouse, and Ms. Warren) introduced the following bill; which was
read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To establish a State public option through Medicaid to provide
Americans with the choice of a high-quality, low-cost health insurance
plan.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``State Public Option Act''.
SEC. 2. MEDICAID BUY-IN OPTION.
(a) In General.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(1) in subsection (a)(10)--
(A) in subparagraph (A)(ii)--
(i) in subclause (XXII), by striking ``;
or'' and inserting a semicolon;
(ii) in subclause (XXIII), by adding ``or''
at the end; and
(iii) by adding at the end the following
new subclause:
``(XXIV) beginning January 1, 2025,
who are residents of the State and are
not concurrently enrolled in another
health insurance coverage plan,
subject, in the case of individuals
described in subsection (uu) and
notwithstanding section 1916 (except
for subsection (k) of such section), to
payment of premiums or other cost-
sharing charges;''; and
(B) in the matter following subparagraph (G), by
inserting ``or subparagraph (A)(ii)(XXIV)'' after
``described in subparagraph (A)(i)(VIII)''; and
(2) by adding at the end the following new subsection:
``(uu) Previously Undescribed Individuals.--Individuals described
in this subsection are individuals who are--
``(1) described in subclause (XXIV) of subsection
(a)(10)(A)(ii); and
``(2) are not described in any other subclause of such
subsection or any other provision in this Act which provides
for eligibility for medical assistance.''.
(b) Provision of at Least Minimum Coverage.--
(1) In general.--Section 1902(k)(1) of the Social Security
Act (42 U.S.C. 1396a(k)(1)) is amended by inserting ``or an
individual described in subclause (XXIV) of subsection
(a)(10)(A)(ii)'' after ``an individual described in subclause
(VIII) of subsection (a)(10)(A)(i)'' each place it appears.
(2) Conforming amendment.--Section 1903(i)(26) of the
Social Security Act (42 U.S.C. 1396b(i)(26)) is amended by
striking ``individuals described in subclause (VIII) of
subsection (a)(10)(A)(i)'' and inserting ``individuals
described in subsections (a)(10)(A)(i)(VIII) or
(a)(10)(A)(ii)(XXIV) of section 1902''.
(c) Federal Financial Participation in Buy-In Program.--
(1) Enhanced match for administrative expenses.--Section
1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) is
amended--
(A) by redesignating paragraph (7) as paragraph
(8); and
(B) by inserting after paragraph (6) the following
new paragraph:
``(7) an amount equal to 90 percent of the sums expended
during such quarter which are attributable to reasonable
administrative expenses related to the administration of a
Medicaid buy-in program for individuals described in section
1902(a)(10)(A)(ii)(XXIV) (as found necessary by the Secretary
for the proper and efficient administration of such a program);
plus''.
(2) Treatment of premium and cost-sharing revenues from
medicaid buy-in program.--
(A) In general.--For purposes of section 1903(a)(1)
of the Social Security Act (42 U.S.C. 1396b(a)(1)), for
any fiscal quarter during which a State collects
premiums, cost-sharing, or similar charges under
subsection (k) of section 1916 of such Act (42 U.S.C.
1396o) (as added by this Act), including any advance
payments of premium tax credits under section 1412 of
the Patient Protection and Affordable Care Act or
payments for cost-sharing reductions under section 1402
of such Act that are received by the State, the total
amount expended during such quarter as medical
assistance for individuals who buy into Medicaid
coverage under subclause (XXIV) of section
1902(a)(10)(A)(ii) of the Social Security Act (as added
by this Act) shall be reduced by the amount of such
premiums or charges.
(B) Treatment of excess premiums.--Each State that
collects premiums or similar charges under subsection
(k) of section 1916 of the Social Security Act (42
U.S.C. 1396o) (as added by this Act) in a fiscal year
shall pay to the Secretary of Health and Human
Services, at such time and in such form and manner as
the Secretary shall specify, an amount equal to 50
percent of the amount, if any, by which--
(i) the total amount of such premiums and
charges collected by the State for such year;
exceeds
(ii) the total amount expended by the State
during such year as medical assistance for
individuals who buy into Medicaid coverage
under subclause (XXIV) of section
1902(a)(10)(A)(ii) of such Act (as added by
this Act).
(d) Cost-Sharing Requirement.--Section 1916 of the Social Security
Act (42 U.S.C. 1396o) is amended by adding at the end the following new
subsection:
``(k) Premiums and Cost-Sharing for Individuals Participating in
Medicaid Buy-In Program.--
``(1) In general.--Subject to paragraph (2), with respect
to individuals who are eligible for medical assistance under
subsection (a)(10)(A)(ii)(XXIV) of section 1902 and are
described in subsection (uu) of such section, a State may--
``(A) impose premiums, deductibles, cost-sharing,
or other similar charges that are determined on an
actuarially sound basis; and
``(B) vary the premium rate imposed on an
individual based only on the factors described in
section 2701(a)(1)(A) of the Public Health Service Act
and subject to the same limitations on the weight which
may be given to such factors under such section.
``(2) Limitations.--
``(A) Premiums.--The total amount of premiums
imposed for a year under this subsection with respect
to all individuals described in paragraph (1) in a
family shall not exceed an amount equal to 8.5 percent
of the family's household income (as defined in section
36B(d)(2) of the Internal Revenue Code of 1986) for the
year involved.
``(B) Other cost-sharing.--
``(i) In general.--The cost-sharing
limitations described in section 1302(c) of the
Patient Protection and Affordable Care Act
shall apply to cost-sharing (as defined in such
section) for medical assistance provided under
section 1902(a)(10)(A)(ii)(XXIV) in the same
manner as such limitations apply to cost-
sharing under qualified health plans under
title I of such Act.
``(ii) Availability of cost-sharing
reductions.--Individuals provided medical
assistance under section
1902(a)(10)(A)(ii)(XXIV) and subject to cost-
sharing under this subsection are eligible for
cost-sharing reductions under section 1402 of
the Patient Protection and Affordable Care Act
(subject to the income eligibility threshold in
subsection (b)(2) of such section), and in
applying such section--
``(I) enrollment in a State plan
under section 1902(a)(10)(A)(ii)(XXIV)
shall be treated as coverage under a
qualified health plan in the silver
level of coverage in the individual
market offered through an Exchange
established for or by the State under
title I of the Patient Protection and
Affordable Care Act; and
``(II) the State agency
administering such plan shall be
treated as the issuer of such plan.
``(3) Premiums and cost-sharing for certain other
individuals.--If an individual is eligible for medical
assistance under subsection (a)(10)(A)(ii)(XXIV) of section
1902 and is not described in subsection (uu) of such section, a
State--
``(A) shall not impose premiums and cost-sharing on
the individual under this subsection; and
``(B) may impose premiums and cost-sharing on the
individual to the extent allowed by another provision
of this Act (other than section
1902(a)(10)(A)(ii)(XXIV)) which provides for
eligibility for medical assistance, but only if the
individual is described in such other provision.
``(4) Application of premium assistance tax credits.--An
individual who is required to pay premiums under this
subsection for a year for medical assistance shall be eligible
for a premium assistance credit under section 36B of the
Internal Revenue Code to the same extent that such individual
would be eligible for a premium assistance credit under such
section if such individual had paid the same amount in premiums
for coverage under a qualified health plan for such year.''.
(e) Managed Care.--Section 1932(a)(1)(A)(i) of the Social Security
Act (42 U.S.C. 1396u-2(a)(1)(A)(i)) is amended by inserting ``,
including an individual who is eligible for such assistance after
buying into such coverage under section 1902(a)(10)(A)(ii)(XXIV),''
after ``the State plan under this title''.
(f) Offering Buy-In Program on State Exchange; Enrollment
Periods.--
(1) In general.--A State that has elected to allow
individuals to buy into Medicaid coverage under section
1902(a)(10)(A)(ii)(XXIV) of the Social Security Act (as added
by this Act) shall allow individuals to enroll in such coverage
through an Exchange established by or for the State under title
I of the Patient Protection and Affordable Care Act.
(2) Enrollment periods.--A State may limit the enrollment
of individuals into Medicaid coverage under section
1902(a)(10)(A)(ii)(XXIV) of the Social Security Act (as added
by this Act) to the enrollment periods provided for under
section 1311(c)(6) of the Patient Protection and Affordable
Care Act.
(g) Application of Advanced Premium Tax Credits to Medicaid Buy-In
Plans.--
(1) In general.--Section 36B of the Internal Revenue Code
of 1986 is amended--
(A) in subsection (b)(3)(B), by adding at the end
the following new sentence:
``If an applicable taxpayer resides in a rating area in
which no silver plan is offered on the individual
market but the taxpayer buys into Medicaid coverage
under section 1902(a)(10)(A)(ii)(XXIV) of the Social
Security Act, such Medicaid coverage shall be deemed to
be the applicable second lowest cost silver plan with
respect to such taxpayer.''; and
(B) by redesignating subsection (h) as subsection
(i); and
(C) by inserting after subsection (g) the following
new subsection:
``(h) Application to Individuals Purchasing Medicaid Coverage.--In
the case of any individual who buys into Medicaid coverage under
section 1902(a)(10)(A)(ii)(XXIV) of the Social Security Act, this
section shall be applied with the following modifications:
``(1) The amount determined under subsection (b)(2)(A)
shall be increased by the amount of the monthly premiums paid
for such coverage.
``(2) Subsection (c)(2)(A)(i) shall be applied by treating
coverage under the Medicaid program under title XIX of the
Social Security Act in the same manner as a qualified health
plan that was enrolled in through an Exchange.
``(3) In applying subsection (c)(2)(B)--
``(A) an individual shall not be considered to be
eligible for minimum essential coverage described in
section 5000A(f)(1)(A)(ii) by reason of eligibility for
medical assistance under a State Medicaid program under
section 1902(a)(10)(A)(ii)(XXIV); and
``(B) an individual who is not covered by minimum
essential coverage described in section 5000A(f)(1)(B)
shall not be considered to be eligible for such
coverage.''.
(2) Advanced payment of credit.--
(A) In general.--The Secretary of Health and Human
Services, in consultation with the Secretary of the
Treasury, shall establish a program under which--
(i) upon request of a State agency
administering a State Medicaid program under
title XIX of the Social Security Act, advance
determinations are made in a manner similar to
advanced determinations under section 1412 of
the Patient Protection and Affordable Care Act
with respect to the income eligibility of
individuals enrolling in such program for the
premium tax credit allowable under section 36B
of the Internal Revenue Code of 1986 and the
cost-sharing reductions under section 1402 of
the Patient Protection and Affordable Care Act;
(ii) the Secretary notifies--
(I) the State agency administering
the program and the Secretary of the
Treasury of the advance determinations;
and
(II) the Secretary of the Treasury
of the name and employer identification
number of each employer with respect to
whom 1 or more employees of the
employer were determined to be eligible
for the premium tax credit under
section 36B of the Internal Revenue
Code of 1986 and the cost-sharing
reductions under section 1402 of the
Patient Protection and Affordable Care
Act because--
(aa) the employer did not
provide minimum essential
coverage; or
(bb) the employer provided
such minimum essential coverage
but it was determined under
section 36B(c)(2)(C) of such
Code to either be unaffordable
to the employee or not provide
the required minimum actuarial
value; and
(iii) the Secretary of the Treasury makes
advance payments of such credit or reductions
to the State agency administering the program
in order to reduce the premiums payable by
individuals eligible for such credit.
(B) Determinations and payments.--Rules similar to
subsections (b) and (c) of section 1412 of the Patient
Protection and Affordable Care Act shall apply for
purposes of this subsection.
(C) Coordination with credit.--
(i) In general.--Section 36B of the
Internal Revenue Code of 1986 is amended by
inserting ``and under section 2(g)(2) of the
State Public Option Act'' after ``section 1412
of the Patient Protection and Affordable Care
Act'' each place it appears in subsections
(f)(1), (f)(2), and (g)(1).
(ii) Information reporting.--Section
36B(f)(3) of such Code is amended by adding at
the end the following flush sentence: ``In the
case of any coverage under the Medicaid program
under title XIX of the Social Security Act for
which a credit under this section is allowable
by reason of subsection (h), the State agency
administering the Medicaid program shall be
treated as an Exchange for purposes of this
paragraph and subparagraph (A) shall not
apply.''.
(3) Conforming amendment relating to employer
responsibility.--Paragraph (6) of section 4980H(c) of the
Internal Revenue Code of 1986 is amended by inserting ``,
except that for purposes of subsections (a)(2) and (b)(2), the
term `qualified health plan' shall include any plan described
in section 36B(h)'' after ``such Act''.
(h) Conforming Amendments.--
(1) Section 1902(a)(10) of the Social Security Act (42
U.S.C. 1396a(a)(10)), as amended by subsection (a), is further
amended, in the matter following subparagraph (G)--
(A) by striking ``and (XVIII)'' and inserting ``,
(XVIII)''; and
(B) by inserting ``, and (XIX) the medical
assistance made available to an individual described in
subparagraph (A)(ii)(XXIV) shall be limited to medical
assistance described in subsection (k)(1)'' before the
semicolon.
(2) Section 1903(f)(4) of the Social Security Act (42
U.S.C. 1396b(f)(4)) is amended by inserting
``1902(a)(10)(A)(ii)(XXIV),'' after
``1902(a)(10)(A)(ii)(XXII),''.
(3) Section 1905(a) of the Social Security Act (42 U.S.C.
1396d(a)) is amended, in the matter preceding paragraph (1)--
(A) by striking ``or'' at the end of clause (xvi);
(B) by inserting ``or'' at the end of clause
(xvii); and
(C) by inserting after clause (xvii) the following
new clause:
``(xviii) individuals described in section
1902(a)(10)(A)(ii)(XXIV),''.
(4) Section 1916A(a)(1) of the Social Security Act (42
U.S.C. 1396o-1(a)(1)) is amended by striking ``or (j)'' and
inserting ``(j), or (k)''.
(5) Section 1937(a)(1)(B) of the Social Security Act (42
U.S.C. 1396u-7(a)(1)(B)) is amended by inserting ``, subclause
(XXIV) of section 1902(a)(10)(A)(ii),'' after
``1902(a)(10)(A)(i)''.
SEC. 3. REVIEWING AND UPDATING MEDICAID QUALITY MEASURES.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall review quality
measures that are in use under the Medicaid program and, not later than
January 1, 2029, shall update such measures to the extent necessary to
ensure that such quality measures are appropriate for the population of
individuals who are eligible to buy into Medicaid coverage under
subclause (XXIV) of section 1902(a)(10)(A)(ii) of the Social Security
Act (42 U.S.C. 1396a(a)(10)(A)(ii)), as added by section 2.
(b) Reporting.--The Secretary shall review, and, not later than
January 1, 2031, update any corresponding State reporting requirements
to include the quality measures under subsection (a).
(c) State Implementation Funding.--The Secretary may award funds,
from the amount appropriated under subsection (d), to States for the
purpose of updating and implementing the metrics developed under this
section.
(d) Appropriation.--There is appropriated to the Secretary, out of
any funds in the Treasury not otherwise appropriated, $50,000,000 for
fiscal year 2025, to remain available until expended, for the purpose
of carrying out this section.
SEC. 4. RENEWAL OF APPLICATION OF MEDICARE PAYMENT RATE FLOOR TO
PRIMARY CARE SERVICES FURNISHED UNDER MEDICAID AND
INCLUSION OF ADDITIONAL PROVIDERS.
(a) Renewal of Payment Floor; Additional Providers.--
(1) In general.--Section 1902(a)(13) of the Social Security
Act (42 U.S.C. 1396a(a)(13)) is amended by striking
subparagraph (C) and inserting the following:
``(C) payment for primary care services (as defined
in subsection (jj)) at a rate that is not less than 100
percent of the payment rate that applies to such
services and physician under part B of title XVIII (or,
if greater, the payment rate that would be applicable
under such part if the conversion factor under section
1848(d) for the year involved were the conversion
factor under such section for 2009), and that is not
less than the rate that would otherwise apply to such
services under this title if the rate were determined
without regard to this subparagraph, and that are--
``(i) furnished in 2013 and 2014, by a
physician with a primary specialty designation
of family medicine, general internal medicine,
or pediatric medicine; or
``(ii) furnished in the period that begins
on the first day of the first month that begins
after the date of enactment of the State Public
Option Act--
``(I) by a physician with a primary
specialty designation of family
medicine, general internal medicine, or
pediatric medicine, but only if the
physician self-attests that the
physician is Board certified in family
medicine, general internal medicine, or
pediatric medicine;
``(II) by a physician with a
primary specialty designation of
obstetrics and gynecology, but only if
the physician self-attests that the
physician is Board certified in
obstetrics and gynecology;
``(III) by an advanced practice
clinician, as defined by the Secretary,
that works under the supervision of--
``(aa) a physician that
satisfies the criteria
specified in subclause (I) or
(II); or
``(bb) a nurse practitioner
or a physician assistant (as
such terms are defined in
section 1861(aa)(5)(A)) who is
working in accordance with
State law, or a certified
nurse-midwife (as defined in
section 1861(gg)) who is
working in accordance with
State law;
``(IV) by a rural health clinic,
federally qualified health center, or
other health clinic that receives
reimbursement on a fee schedule
applicable to a physician, a nurse
practitioner or a physician assistant
(as such terms are defined in section
1861(aa)(5)(A)) who is working in
accordance with State law, or a
certified nurse-midwife (as defined in
section 1861(gg)) who is working in
accordance with State law, for services
furnished by a physician, nurse
practitioner, physician assistant, or
certified nurse-midwife, or services
furnished by an advanced practice
clinician supervised by a physician
described in subclause (I)(aa) or
(II)(aa), another advanced practice
clinician, or a certified nurse-
midwife; or
``(V) by a nurse practitioner or a
physician assistant (as such terms are
defined in section 1861(aa)(5)(A)) who
is working in accordance with State
law, or a certified nurse-midwife (as
defined in section 1861(gg)) who is
working in accordance with State law,
in accordance with procedures that
ensure that the portion of the payment
for such services that the nurse
practitioner, physician assistant, or
certified nurse-midwife is paid is not
less than the amount that the nurse
practitioner, physician assistant, or
certified nurse-midwife would be paid
if the services were provided under
part B of title XVIII;''.
(2) Conforming amendments.--Section 1905(dd) of the Social
Security Act (42 U.S.C. 1396d(dd)) is amended--
(A) by striking ``Notwithstanding'' and inserting
the following:
``(1) In general.--Notwithstanding'';
(B) by inserting ``or furnished during the
additional period specified in paragraph (2),'' after
``2015,''; and
(C) by adding at the end the following:
``(2) Additional period.--For purposes of paragraph (1),
the additional period specified in this paragraph is the period
that begins on the date that is 1 year after the date of
enactment of the State Public Option Act.''.
(b) Improved Targeting of Primary Care.--Section 1902(jj) of the
Social Security Act (42 U.S.C. 1396a(jj)) is amended--
(1) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively and realigning the left
margins accordingly;
(2) by striking ``For purposes of'' and inserting the
following:
``(1) In general.--For purposes of''; and
(3) by adding at the end the following:
``(2) Exclusions.--Such term does not include any services
described in subparagraph (A) or (B) of paragraph (1) if such
services are provided in an emergency department of a
hospital.''.
(c) Ensuring Payment by Managed Care Entities.--
(1) In general.--Section 1903(m)(2)(A) of the Social
Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
(A) in clause (xii), by striking ``and'' after the
semicolon;
(B) in clause (xiii)--
(i) by realigning the left margin so as to
align with the left margin of clause (xii); and
(ii) by striking the period at the end of
clause (xiii) and inserting ``; and''; and
(C) by inserting after clause (xiii) the following:
``(xiv) such contract provides that (I) payments to
providers specified in section 1902(a)(13)(C) for primary care
services defined in section 1902(jj) that are furnished during
a year or period specified in section 1902(a)(13)(C) and
section 1905(dd) are at least equal to the amounts set forth
and required by the Secretary by regulation, (II) the entity
shall, upon request, provide documentation to the State,
sufficient to enable the State and the Secretary to ensure
compliance with subclause (I), and (III) the Secretary shall
approve payments described in subclause (I) that are furnished
through an agreed upon capitation, partial capitation, or other
value-based payment arrangement if the capitation, partial
capitation, or other value-based payment arrangement is based
on a reasonable methodology and the entity provides
documentation to the State sufficient to enable the State and
the Secretary to ensure compliance with subclause (I).''.
(2) Conforming amendment.--Section 1932(f) of the Social
Security Act (42 U.S.C. 1396u-2(f)) is amended by inserting
``and clause (xiv) of section 1903(m)(2)(A)'' before the
period.
SEC. 5. INCREASED FMAP FOR MEDICAL ASSISTANCE TO NEWLY ELIGIBLE
INDIVIDUALS.
(a) In General.--Section 1905(y)(1) of the Social Security Act (42
U.S.C. 1396d(y)(1)) is amended--
(1) in subparagraph (A), by striking ``2014, 2015, and
2016'' and inserting ``each of the first 3 consecutive 12-month
periods in which the State provides medical assistance to newly
eligible individuals'';
(2) in subparagraph (B), by striking ``2017'' and inserting
``the fourth consecutive 12-month period in which the State
provides medical assistance to newly eligible individuals'';
(3) in subparagraph (C), by striking ``2018'' and inserting
``the fifth consecutive 12-month period in which the State
provides medical assistance to newly eligible individuals'';
(4) in subparagraph (D), by striking ``2019'' and inserting
``the sixth consecutive 12-month period in which the State
provides medical assistance to newly eligible individuals'';
and
(5) in subparagraph (E), by striking ``2020 and each year
thereafter'' and inserting ``the seventh consecutive 12-month
period in which the State provides medical assistance to newly
eligible individuals and each such period thereafter''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect as if included in the enactment of Public Law 111-148.
SEC. 6. MEDICAID COVERAGE OF COMPREHENSIVE SEXUAL AND REPRODUCTIVE
HEALTH CARE SERVICES.
(a) Inclusion of Comprehensive Sexual and Reproductive Health Care
Services as Medical Assistance.--Section 1905(a) of the Social Security
Act (42 U.S.C. 1396d(a)), as amended by section 2(h) and section 209(a)
of title I of division G of the Consolidated Appropriations Act, 2024,
is further amended--
(1) in paragraph (31), by striking ``and'' at the end;
(2) by redesignating paragraph (32) as paragraph (33); and
(3) by inserting after paragraph (31) the following new
paragraph:
``(32) comprehensive sexual and reproductive health care
services, including abortion services and abortion-related
services; and''.
(b) Requiring Coverage of Comprehensive Sexual and Reproductive
Health Care Services as Condition of State Plan Approval.--Section
1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)),
as amended by subsections (a) and (h) of section 2, is further amended,
in the matter preceding clause (i), by striking ``and (30)'' and
inserting ``(30), and (32)''.
(c) Conforming Amendments.--
(1) Section 1932(e)(1)(B) of the Social Security Act (42
U.S.C. 1396u-2(e)(1)(B)) is amended by striking ``Clause (i)''
and inserting ``With respect to the period beginning before
January 1, 2023, clause (i)''.
(2) Section 1937(b) of the Social Security Act (42 U.S.C.
1396u-7(b)) is amended by adding at the end the following new
paragraph:
``(9) Coverage of comprehensive sexual and reproductive
health services.--Notwithstanding the previous provisions of
this section, a State may not provide for medical assistance
through enrollment of an individual with benchmark coverage or
benchmark-equivalent coverage under this section unless such
coverage includes medical assistance for comprehensive sexual
and reproductive health care services, including abortion
services and abortion-related services.''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to medical assistance furnished on or after January
1, 2025.
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