I 
111TH CONGRESS 
1ST SESSION H. R. 2680 
To amend the Social Security Act to provide for payment parity for Puerto 
Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and 
American Samoa under the Medicaid Program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 3, 2009 
Ms. BORDALLO (for herself, Mr. SERRANO, Mr. FALEOMAVAEGA, Mrs. 
CHRISTENSEN, Mr. PIERLUISI, and Mr. SABLAN) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To amend the Social Security Act to provide for payment 
parity for Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands, and American Samoa under 
the Medicaid Program, and for other purposes. 
Be it enacted by the Senate and House of Representa-
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tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
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This Act may be cited as the ‘‘Territorial Health Par-
4
ity Act of 2009’’. 
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•HR 2680 IH
SEC. 2. MEDICAID PAYMENT PARITY FOR THE TERRI-
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TORIES. 
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(a) ELIMINATION OF FUNDING LIMITATIONS FOR 
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PUERTO RICO, THE VIRGIN ISLANDS, GUAM, THE NORTH-
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ERN MARIANA ISLANDS, AND AMERICAN SAMOA.— 
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(1) IN GENERAL.—Section 1108 of the Social 
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Security Act (42 U.S.C. 1308) is amended— 
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(A) in subsection (f), in the matter before 
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paragraph (1), by striking ‘‘subsection (g)’’ and 
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inserting ‘‘subsections (g) and (h)’’; 
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(B) in subsection (g)(2), in the matter be-
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fore subparagraph (A), by inserting ‘‘and sub-
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section (h)’’ after ‘‘paragraph (3)’’; and 
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(C) by adding at the end the following new 
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subsection: 
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‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER-
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TO RICO, THE VIRGIN ISLANDS, GUAM, THE NORTHERN 
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MARIANA ISLANDS, AND AMERICAN SAMOA.—Subsections 
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(f) and (g) shall not apply to Puerto Rico, the Virgin Is-
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lands, Guam, the Northern Mariana Islands, and Amer-
20
ican Samoa for any fiscal year after fiscal year 2009.’’. 
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(2) 
CONFORMING
AMENDMENT.—Section 
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1903(u) of such Act (42 U.S.C. 1396c(u)) is amend-
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ed by striking paragraph (4). 
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•HR 2680 IH
(3) EFFECTIVE DATE.—The amendments made 
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by this subsection shall apply beginning with fiscal 
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year 2010. 
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(b) PARITY IN FMAP.— 
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(1) IN GENERAL.—Section 1905(b)(2) of such 
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Act (42 U.S.C. 1396d(b)(2)) is amended by insert-
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ing after ‘‘50 per centum’’ the following: ‘‘(except 
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that, beginning with fiscal year 2012, the Federal 
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medical assistance percentage for Puerto Rico, the 
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Virgin Islands, Guam, the Northern Mariana Is-
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lands, and American Samoa shall be the Federal 
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medical assistance percentage determined by the 
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Secretary in consultation (for the Virgin Islands, 
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Guam, the Northern Mariana Islands, and American 
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Samoa) with the Secretary of the Interior)’’. 
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(2) 
2-FISCAL-YEAR
TRANSITION.—Notwith-
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standing any other provision of law, during fiscal 
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years 2010 and 2011, the Federal medical assist-
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ance percentage established under section 1905(b) of 
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the Social Security Act (42 U.S.C. 1396d(b)) for 
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Puerto Rico, the Virgin Islands, Guam, the North-
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ern Mariana Islands, and American Samoa shall be 
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the highest such Federal medical assistance percent-
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age applicable to any of the 50 States or the District 
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of Columbia for the fiscal year involved, taking into 
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•HR 2680 IH
account the application of subsections (a) and (b)(1) 
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of 5001 of division B of the American Recovery and 
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Reinvestment Act of 2009 (Public Law 111–5) to 
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such States and District for calendar quarters dur-
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ing such fiscal years for which such subsections 
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apply respectively. 
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(3) PER CAPITA INCOME DATA.— 
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(A) REPORT
TO
CONGRESS.—Not later 
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than October 1, 2010, the Secretary of Health 
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and Human Services shall submit to Congress 
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a report that describes the per capita income 
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data used to promulgate the Federal medical 
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assistance percentage in the territories and how 
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such data differ from the per capita income 
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data used to promulgate Federal medical assist-
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ance percentages for the 50 States and the Dis-
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trict of Columbia. The report should include 
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recommendations on how the Federal medical 
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assistance percentages can be calculated for the 
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territories to ensure parity with the 50 States 
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and the District of Columbia. 
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(B) APPLICATION.—Section 1101(a)(8)(B) 
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of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
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1308(a)(8)(B)) is amended— 
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•HR 2680 IH
(i) by striking ‘‘(other than Puerto 
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Rico, the Virgin Islands, and Guam)’’ and 
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inserting ‘‘(including Puerto Rico, the Vir-
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gin Islands, Guam, the Northern Mariana 
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Islands, and American Samoa)’’; and 
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(ii) by inserting ‘‘(or, if such satisfac-
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tory data are not available in the case of 
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the Virgin Islands, Guam, the Northern 
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Mariana Islands, or American Samoa, sat-
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isfactory data available from the Depart-
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ment of the Interior for the same period, 
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or if such satisfactory data are not avail-
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able in the case of Puerto Rico, satisfac-
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tory data available from the Government of 
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the Commonwealth of Puerto Rico for the 
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same period)’’ after ‘‘Department of Com-
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merce’’. 
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(4) RELATION
TO
AMERICAN
RECOVERY
AND 
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REINVESTMENT ACT OF 2009.—For any period and 
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territory in which the provisions of this subsection 
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apply to a territory, the provisions of section 
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5001(b)(2) of division B of the American Recovery 
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and Reinvestment Act of 2009 (Public Law 111–5) 
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shall not apply (except as otherwise specifically pro-
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vided in paragraph (2)). 
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•HR 2680 IH
SEC. 3. CLARIFICATION OF MEDICAID COVERAGE FOR CITI-
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ZENS OF FREELY ASSOCIATED STATES. 
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(a) IN GENERAL.—Section 402(b)(2) of the Personal 
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Responsibility and Work Opportunity Reconciliation Act 
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of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 
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the end the following: 
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‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 
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OF FREELY ASSOCIATED STATES.—With respect 
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to eligibility for benefits for the program de-
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fined in paragraph (3)(C) (relating to the Med-
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icaid program), paragraph (1) shall not apply 
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to any individual who lawfully resides in the 
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United States (including territories and posses-
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sions of the United States) in accordance with 
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the Compacts of Free Association between the 
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Government of the United States and the Gov-
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ernments of the Federated States of Micro-
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nesia, the Republic of the Marshall Islands, and 
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the Republic of Palau.’’. 
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(b) 
CONFORMING
DEFINITION
OF
QUALIFIED 
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ALIEN.—Section 431(b) of such Act (8 U.S.C. 1641(b)) 
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is amended— 
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(1) in paragraph (6), by striking ‘‘or’’ at the 
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end; 
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(2) in paragraph (7), by striking the period at 
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the end and inserting ‘‘; or’’; and 
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•HR 2680 IH
(3) by adding at the end the following: 
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‘‘(8) an individual who lawfully resides in the 
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United States (including territories and possessions 
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of the United States) in accordance with a Compact 
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of 
Free 
Association 
referred 
to 
in 
section 
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402(b)(2)(G), but only with respect to the program 
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defined in section 402(b)(3)(C) (relating to the Med-
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icaid program).’’. 
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(c) SETTING FMAP AT 100 PERCENT.—The third 
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sentence of section 1905(b) of the Social Security Act (42 
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U.S.C. 1396d(b)) is amended by inserting before the pe-
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riod at the end the following: ‘‘and as medical assistance 
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for individuals described in section 402(b)(2)(G) of the 
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Personal Responsibility and Work Opportunity Reconcili-
14
ation Act of 1996’’. 
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(d) EFFECTIVE DATE.—The amendments made by 
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this Act take effect on October 1, 2009, Act and apply 
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to benefits and assistance provided on or after that date. 
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Æ 
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