42 U.S.C. § 1397dd — Allotments

Page 4460 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd 1 So in original. The period probably should be a semicolon. Amendment by section 501(a)(1) of Pub. L. 111–3 appli- cable to coverage of items and services furnished on or after Oct. 1, 2009, see section 501(a)(3) of Pub. L. 111–3, set out as a note under section 1397bb of this title. Pub. L. 111–3, title V, § 504(b), Feb. 4, 2009, 123 Stat. 90, provided that: ‘‘The amendment made by subsection (a) [amending this section] shall apply to new coverage pe- riods beginning on or after the date of the enactment of this Act [Feb. 4, 2009].’’ § 1397dd. Allotments (a) Appropriation; total allotment 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, $5,000,000,000.1 (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 mak- ing 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 mak- ing 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 mak- ing 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 mak- ing 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) Allotments to 50 States and District of Colum- bia (1) In general 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 sub- section (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 chil- dren described in paragraph (2) for the State for the fiscal year and (ii) the State cost fac- tor for that State (established under para- graph (3)); to (B) the sum of the products computed under subparagraph (A). (2) Number of children (A) In general 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 chil- dren 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-in- come children in the State for the fiscal year with no health insurance coverage, plus (II) 25 percent of the number of low-in- come 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-in- come children in the State for the fiscal year with no health insurance coverage, plus (II) 50 percent of the number of low-in- come children in the State for the fiscal year. (B) Determination of number of children For purposes of subparagraph (A), a deter- mination of the number of low-income chil- dren (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 Cur- rent Population Survey of the Bureau of the Census before the beginning of the calendar year in which such fiscal year begins. (3) Adjustment for geographic variations in health costs (A) In general For purposes of paragraph (1)(A)(ii), the ‘‘State cost factor’’ for a State for a fiscal year equal to the sum of— Page 4461 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd (i) 0.15, and (ii) 0.85 multiplied by the ratio of— (I) the annual average wages per em- ployee for the State for such year (as de- termined under subparagraph (B)), to (II) the annual average wages per em- ployee for the 50 States and the District of Columbia. (B) Annual average wages per employee For purposes of subparagraph (A), the ‘‘an- nual 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 em- ployees 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) Floors and ceilings in State allotments (A) In general The proportion of the allotment under this subsection for a subsection (b) State (as de- fined in subparagraph (D)) for fiscal year 2000 and each fiscal year thereafter shall be subject to the following floors and ceilings: (i) Floor of $2,000,000 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) Annual floor of 10 percent below pre- ceding fiscal year’s proportion A floor of 90 percent of the proportion for the State for the preceding fiscal year. (iii) Cumulative floor of 30 percent below the FY 1999 proportion A floor of 70 percent of the proportion for the State for fiscal year 1999. (iv) Cumulative ceiling of 45 percent above FY 1999 proportion A ceiling of 145 percent of the proportion for the State for fiscal year 1999. (B) Reconciliation (i) Elimination of any deficit by estab- lishing a percentage increase ceiling for States with highest annual percent- age increases 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 per- centage increase in such proportions for all subsection (b) States for the fiscal year in a manner so that such sum equals 1.0. (ii) Allocation of surplus through pro rata increase 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 subpara- graph (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) Construction This paragraph shall not be construed as applying to (or taking into account) amounts of allotments redistributed under subsection (f). (D) Definitions In this paragraph: (i) Proportion of allotment The term ‘‘proportion’’ means, with re- spect to the allotment of a subsection (b) State for a fiscal year, the amount of the allotment of such State under this sub- section for the fiscal year divided by the total of the amount available under this subsection for all such allotments for the fiscal year. (ii) Subsection (b) State The term ‘‘subsection (b) State’’ means one of the 50 States or the District of Co- lumbia. (c) Allotments to territories (1) In general Of the amount available for allotment under subsection (a) for a fiscal year, subject to sub- sections (d) and (m)(5), the Secretary shall allot 0.25 percent among each of the common- wealths and territories described in paragraph (3) in the same proportion as the percentage specified in paragraph (2) for such common- wealth or territory bears to the sum of such percentages for all such commonwealths or territories so described. (2) Percentage 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) Commonwealths and territories 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) Additional allotment (A) In general In addition to the allotment under para- graph (1), the Secretary shall allot each commonwealth and territory described in paragraph (3) the applicable percentage spec- Page 4462 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd 2 So in original. Probably should be ‘‘Child Enrollment Contin- gency Fund’’. ified in paragraph (2) of the amount appro- priated under subparagraph (B). (B) Appropriations For purposes of providing allotments pur- suant to subparagraph (A), there is appro- priated, out of any money in the Treasury not otherwise appropriated $32,000,000 for fis- cal year 1999, $34,200,000 for each of fiscal years 2000 and 2001, $25,200,000 for each of fis- cal 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) Additional allotments to eliminate funding shortfalls (1) Appropriation; allotment authority For the purpose of providing additional al- lotments to shortfall States described in para- graph (2), there is appropriated, out of any money in the Treasury not otherwise appro- priated, $283,000,000 for fiscal year 2006. (2) Shortfall States described 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 esti- mates, 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 redis- tributed 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) Allotments 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 de- scribed in subsection (c)(3), the same propor- tion as the proportion of the common- wealth’s or territory’s allotment under sub- section (c) (determined without regard to subsection (f)) to 1.05 percent of the amount appropriated under paragraph (1). (4) Use of additional allotment Additional allotments provided under this subsection are only available for amounts ex- pended under a State plan approved under this subchapter for child health assistance for tar- geted low-income children. (5) 1-year availability; no redistribution of un- expended additional allotments Notwithstanding subsections (e) and (f), amounts allotted to a State pursuant to this subsection for fiscal year 2006 shall only re- main 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) Availability of amounts allotted (1) In general 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 ex- penditure by the State through the end of the succeeding fiscal year. (2) Availability of amounts redistributed Amounts redistributed to a State under sub- section (f) shall be available for expenditure by the State through the end of the fiscal year in which they are redistributed. (f) Procedure for redistribution of unused allot- ments (1) In general The Secretary shall determine an appro- priate procedure for redistribution of allot- ments from States that were provided allot- ments 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 al- lotments 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 re- distribution under this subsection, are short- fall 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) Shortfall States described (A) In general 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 sub- chapter for which the Secretary estimates on the basis of the most recent data avail- able to the Secretary, that the projected ex- penditures 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 en- rollment contingency fund 2 payment under subsection (n); and (iii) the amount of the State’s allotment for the fiscal year. Page 4463 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd (B) Determination of redistributed amounts if insufficient amounts available (i) Proration rule Subject to clause (ii), if the amounts available for redistribution under para- graph (1) for a fiscal year are less than the total amounts of the estimated shortfalls determined for the year under subpara- graph (A), the amount to be redistributed under such paragraph for each shortfall State shall be reduced proportionally. (ii) Special rule for first half of fiscal year 2018 (I) In general For each month beginning during the period beginning on October 1, 2017, and ending March 31, 2018, subject to the suc- ceeding 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 sub- clause (II) for such State for the month (as may be adjusted under subparagraph (C)) before the Secretary may redis- tribute such amounts to any shortfall State that is not an emergency shortfall State. In the case of any amounts redis- tributed under this subclause to a State that is not an emergency shortfall State, such amounts shall be determined in ac- cordance with clause (i). (II) Emergency shortfall State defined For purposes of this clause, the term ‘‘emergency shortfall State’’ means, with respect to a month beginning dur- ing the period beginning October 1, 2017, and ending March 31, 2018, a shortfall State for which the Secretary estimates, in accordance with subparagraph (A) (un- less otherwise specified in this sub- clause) and on a monthly basis using the most recent data available to the Sec- retary as of such month, that the pro- jected 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 ref- erence to ‘‘2018’’ and insofar as the allot- ments 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 para- graph (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) Funds redistributed in the order in which States realize funding short- falls The Secretary shall redistribute the amounts available for redistribution under paragraph (1) to emergency short- fall States described in subclause (II) in the order in which such States realize monthly funding shortfalls under this subchapter for fiscal year 2018. The Sec- retary shall only make redistributions under this clause to the extent that such amounts are available for such redis- tributions. (IV) Proration rule If the amounts available for redistribu- tion 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 re- duced proportionally. (V) Unobligated redistributed funds 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 sub- clauses of this clause. (VI) Application of qualifying State op- tion During the period described in sub- clause (I), section 1397ee(g)(4) of this title, as in effect on the day before Janu- ary 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 sub- sections (e) and (m) of such section’’ were a reference to ‘‘under subsections (e), (f), and (m) of such section’’. (C) Retrospective adjustment The Secretary may adjust the estimates and determinations made under paragraph (1) and this paragraph with respect to a fis- cal 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) Rule of construction Nothing in this paragraph may be con- strued as preventing a commonwealth or territory described in subsection (c)(3) from being treated as a shortfall State or an emergency shortfall State. Page 4464 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd (g) Rule for redistribution and extended avail- ability of fiscal years 1998, 1999, 2000, and 2001 allotments (1) Amount redistributed (A) In general 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 fis- cal year) the following amount: (i) State 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 expendi- tures 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 expendi- tures 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), multi- plied by the ratio of the amount speci- fied 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), multi- plied by the ratio of the amount speci- fied in subparagraph (D)(ii) for the State to the amount specified in subparagraph (D)(iii). (ii) Territory In the case of a commonwealth or terri- tory 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 sub- section (c) (as the case may be) bears to the total of all such allotments for such fiscal year under such subsection. (B) Expenditure rules An amount redistributed to a State under this paragraph— (i) shall not be included in the deter- mination 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) Amounts used in computing redistribu- tions for fiscal year 2000 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 pursu- ant 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 re- distribution under subparagraph (A) from the allotments for fiscal year 2000, of the amounts specified in clause (ii). (D) Amounts used in computing redistribu- tions for fiscal year 2001 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 pursu- ant 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 re- distribution under subparagraph (A) from the allotments for fiscal year 2001, of the amounts specified in clause (ii). (2) Extension of availability of portion of unex- pended fiscal years 1998 through 2001 al- lotments (A) In general Notwithstanding subsection (e): (i) Fiscal year 1998 allotment Of the amounts allotted to a State pur- suant 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 avail- able for expenditure by the State through the end of fiscal year 2004. (ii) Fiscal year 1999 allotment Of the amounts allotted to a State pur- suant to this subsection for fiscal year 1999 that were not expended by the State by Page 4465 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd 3 So in original. the end of fiscal year 2001, the amount specified in subparagraph (B) for fiscal year 1999 for such State shall remain avail- able for expenditure by the State through the end of fiscal year 2004. (iii) Fiscal year 2000 allotment Of the amounts allotted to a State pur- suant 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 ex- penditure by the State through the end of fiscal year 2004. (iv) Fiscal year 2001 allotment Of the amounts allotted to a State pur- suant 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 ex- penditure by the State through the end of fiscal year 2005. (B) Amount remaining available for expendi- ture 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 fis- cal year to the total amount described in clause (i)(I) for that fiscal year. (C) Use of up to 10 percent of retained 1998 allotments for outreach activities Notwithstanding section 1397ee(c)(2)(A) of this title, with respect to any State de- scribed in subparagraph (A)(i), the State may use up to 10 percent of the amount spec- ified in subparagraph (B) for fiscal year 1998 for expenditures for outreach activities ap- proved by the Secretary. (3) Determination of amounts For purposes of calculating the amounts de- scribed 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 No- vember 30, 2003, respectively, on HCFA Form 64 or HCFA Form 21 or CMS Form 64 or CMS Form 21, as the case may be,,3 as approved by the Secretary. (h) Special rules to address fiscal year 2007 shortfalls (1) Redistribution of unused fiscal year 2004 al- lotments (A) In general 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 sub- paragraph (B), such amount as the Secretary determines will eliminate the estimated shortfall described in such subparagraph for such State for the month. (B) Shortfall State described For purposes of this paragraph, a shortfall State described in this subparagraph is a State with a State child health plan ap- proved 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 pro- jected 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) Funds redistributed in the order in which States realize funding shortfalls The Secretary shall redistribute the amounts available for redistribution under subparagraph (A) to shortfall States de- scribed 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 re- distributions under this paragraph to the ex- tent that there are unexpended fiscal year 2004 allotments under subsection (b) avail- able for such redistributions. (D) Proration rule 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) Funding part of shortfall for fiscal year 2007 through redistribution of certain un- used fiscal year 2005 allotments (A) In general Subject to subparagraphs (C) and (D) and paragraph (5)(B), with respect to months be- ginning during fiscal year 2007 after March 31, 2007, the Secretary shall provide for a re- distribution 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) Shortfall State described For purposes of this paragraph, a shortfall State described in this subparagraph is a State with a State child health plan ap- proved under this subchapter for which the Page 4466 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd 4 So in original. The comma probably should not appear. Secretary estimates, on a monthly basis using the most recent data available to the Secretary as of March 31, 2007, that the pro- jected 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 re- distributed to the State in accordance with paragraph (1); and (iii) the amount of the State’s allotment for fiscal year 2007. (C) Funds redistributed in the order in which States realize funding shortfalls The Secretary shall redistribute the amounts available for redistribution under subparagraph (A) to shortfall States de- scribed 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 re- distributions under this paragraph to the ex- tent that such amounts are available for such redistributions. (D) Proration rule 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) Treatment of certain States with fiscal year 2005 allotments unexpended at the end of the first half of fiscal year 2007 (A) Identification of States The Secretary, on the basis of the most re- cent data available to the Secretary as of March 31, 2007— (i) shall identify those States that re- ceived an allotment for fiscal year 2005 under subsection (b) which have not ex- pended 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) States with funds in excess of 200 percent of need A State described in this subparagraph is a State for which the Secretary determines, on the basis of the most recent data avail- able 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,4 is at least equal to 200 percent of the total projected expenditures under this sub- chapter for the State for fiscal year 2007. (C) Redistribution and limitation on avail- ability of portion of unused allotments for certain States (i) In general In the case of a State identified under subparagraph (A)(i) that is also described in subparagraph (B), notwithstanding sub- section (e), the applicable amount de- scribed 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) Applicable amount For purposes of clause (i), the applicable amount described in this clause is the less- er of— (I) 50 percent of the amount described in subparagraph (A)(ii)(I); or (II) $20,000,000. (4) Additional amounts to eliminate remainder of fiscal year 2007 funding shortfalls (A) In general From the amounts provided in advance in appropriations Acts, the Secretary shall allot to each remaining shortfall State de- scribed in subparagraph (B) such amount as the Secretary determines will eliminate the estimated shortfall described in such sub- paragraph for the State for fiscal year 2007. (B) Remaining shortfall State described For purposes of subparagraph (A), a re- maining shortfall State is a State with a State child health plan approved under this subchapter for which the Secretary esti- mates, 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) Retrospective adjustment (A) In general 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 ap- proved by the Secretary, but in no case may the applicable amount described in para- graph (3)(C)(ii) exceed the amount deter- mined by the Secretary on the basis of the most recent data available to the Secretary as of March 31, 2007. (B) Funding of any retrospective adjustments only from unexpended 2005 allotments Notwithstanding subsections (e) and (f), to the extent the Secretary determines it nec- Page 4467 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd essary to adjust the estimates and deter- minations made for purposes of paragraphs (1), (2), and (3), the Secretary may use only the allotments for fiscal year 2005 under sub- section (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) Rules of construction Nothing in this subsection shall be con- strued 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 fund- ing shortfall for such States for fiscal year 2007; or (ii) limiting the authority of the Sec- retary to redistribute the allotments for fiscal year 2005 under subsection (b) that remain unexpended through the end of fis- cal year 2007 and are available for redis- tribution under subsection (f) after the ap- plication of subparagraph (B). (6) 1-year availability; no further redistribu- tion 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 sub- section (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) Definition of State For purposes of this subsection, the term ‘‘State’’ means a State that receives an allot- ment for fiscal year 2007 under subsection (b). (i) Redistribution of unused fiscal year 2005 al- lotments to States with estimated funding shortfalls for fiscal year 2008 (1) In general 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 short- fall described in such paragraph for such State for the month. (2) Fiscal year 2008 shortfall State described 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 pro- jected 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) Funds redistributed in the order in which States realize funding shortfalls 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 redis- tributions under this subsection to the extent that there are unexpended fiscal year 2005 al- lotments under subsection (b) available for such redistributions. (4) Proration rule If the amounts available for redistribution under paragraph (1) are less than the total amounts of the estimated shortfalls deter- mined 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) Retrospective adjustment The Secretary may adjust the estimates and determinations made to carry out this sub- section as necessary on the basis of the amounts reported by States not later than No- vember 30, 2007, on CMS Form 64 or CMS Form 21, as the case may be, and as approved by the Secretary. (6) 1–year availability; no further redistribu- tion 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 unex- pended as of such date, shall not be subject to redistribution under subsection (f). (j) Additional allotments to eliminate funding shortfalls for fiscal year 2008 (1) Appropriation; allotment authority For the purpose of providing additional al- lotments 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) Shortfall States described 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 esti- mates, on the basis of the most recent data available to the Secretary as of November 30, Page 4468 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd 2007, that the Federal share amount of the pro- jected 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 redis- tributed 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. (3) Allotments 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 2008, the Secretary shall allot— (A) to each shortfall State described in paragraph (2) not described in subparagraph (B), such amount as the Secretary deter- mines will eliminate the estimated shortfall described in such paragraph for the State; and (B) to each commonwealth or territory de- scribed 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) Proration rule If the amounts available for additional allot- ments under paragraph (1) are less than the total of the amounts determined under sub- paragraphs (A) and (B) of paragraph (3), the amounts computed under such subparagraphs shall be reduced proportionally. (5) Retrospective adjustment The Secretary may adjust the estimates and determinations made to carry out this sub- section as necessary on the basis of the amounts reported by States not later than No- vember 30, 2008, on CMS Form 64 or CMS Form 21, as the case may be, and as approved by the Secretary. (6) One-year availability; no redistribution of unexpended additional allotments Notwithstanding subsections (e) and (f), amounts allotted to a State pursuant to this subsection for fiscal year 2008, subject to para- graph (5), shall only remain available for ex- penditure by the State through September 30, 2008. Any amounts of such allotments that re- main unexpended as of such date shall not be subject to redistribution under subsection (f). (k) Redistribution of unused fiscal year 2006 al- lotments to States with estimated funding shortfalls during fiscal year 2009 (1) In general 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 short- fall described in such paragraph for such State for the month. (2) Fiscal year 2009 shortfall State described 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 Fed- eral share amount of the projected expendi- tures 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) Funds redistributed in the order in which States realize funding shortfalls 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 redis- tributions under this subsection to the extent that there are unexpended fiscal year 2006 al- lotments under subsection (b) available for such redistributions. (4) Proration rule If the amounts available for redistribution under paragraph (1) are less than the total amounts of the estimated shortfalls deter- mined 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) Retrospective adjustment The Secretary may adjust the estimates and determinations made to carry out this sub- section 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) Availability; no further redistribution 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 unex- pended as of such date, shall not be subject to redistribution under subsection (f). (l) Additional allotments to eliminate funding shortfalls for the first 2 quarters of fiscal year 2009 (1) Appropriation; allotment authority For the purpose of providing additional al- lotments described in subparagraphs (A) and Page 4469 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd 5 See References in Text note below. (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 quar- ters of fiscal year 2009. (2) Shortfall States described 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 esti- mates, 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 redis- tributed 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. (3) Allotments 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 the first 2 quarters of fiscal year 2009, the Secretary shall allot— (A) to each shortfall State described in paragraph (2) not described in subparagraph (B) such amount as the Secretary deter- mines will eliminate the estimated shortfall described in such paragraph for the State; and (B) to each commonwealth or territory de- scribed 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) Proration rule If the amounts available for additional allot- ments under paragraph (1) are less than the total of the amounts determined under sub- paragraphs (A) and (B) of paragraph (3), the amounts computed under such subparagraphs shall be reduced proportionally. (5) Retrospective adjustment The Secretary may adjust the estimates and determinations made to carry out this sub- section 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) Availability; no redistribution of unex- pended additional allotments Notwithstanding subsections (e) and (f), amounts allotted to a State pursuant to this subsection for fiscal year 2009, subject to para- graph (5), shall only remain available for ex- penditure by the State through March 31, 2009. Any amounts of such allotments that remain unexpended as of such date shall not be sub- ject to redistribution under subsection (f). (m) Allotments for fiscal years 2009 and there- after (1) For fiscal year 2009 (A) For the 50 States and the District of Co- lumbia Subject to the succeeding provisions of this paragraph and paragraph (5), the Sec- retary shall allot for fiscal year 2009 from the amount made available under subsection (a)(12), to each of the 50 States and the Dis- trict 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), mul- tiplied by the allotment increase factor de- termined under paragraph (6) for fiscal year 2009. (iii) The projected total Federal pay- ments to the State under this subchapter for fiscal year 2009, as determined on the basis of the February 2009 projections cer- tified by the State to the Secretary by not later than March 31, 2009. (B) For the commonwealths and territories Subject to the succeeding provisions of this paragraph and paragraph (5), the Sec- retary 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 Fed- eral payments to the commonwealth or ter- ritory under this subchapter for any fiscal year occurring during the period of fiscal years 1999 through 2008, multiplied by the al- lotment 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) Adjustment for qualifying States 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 sub- paragraph (A)(iii) in order to take into ac- count changes in such projections attrib- utable to the application of paragraph (4) of such section. (2) For fiscal years beginning with fiscal year 2010 (A) In general Subject to paragraphs (4) and (6),5 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 allot- Page 4470 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd ment for each State (including the District of Columbia and each commonwealth and territory) for each such fiscal year as fol- lows: (i) Growth factor update for fiscal year 2010 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, multiplied by the allotment increase fac- tor under paragraph (6) for fiscal year 2010. (ii) Rebasing in fiscal year 2011 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 al- lotments available under this section to the State in fiscal year 2010 (including payments made to the State under sub- section (n) for fiscal year 2010 as well as amounts redistributed to the State in fis- cal year 2010), multiplied by the allotment increase factor under paragraph (6) for fis- cal year 2011. (iii) Growth factor update for fiscal year 2012 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 fis- cal year 2011, multiplied by the allotment increase fac- tor under paragraph (6) for fiscal year 2012. (B) Fiscal year 2013 and each succeeding fis- cal year Subject to paragraphs (5), (7), and (12), from the amount made available under para- graphs (16) through (27) of subsection (a) for fiscal year 2013 and each succeeding fiscal year, respectively, the Secretary shall com- pute a State allotment for each State (in- cluding the District of Columbia and each commonwealth and territory) for each such fiscal year as follows: (i) Rebasing in fiscal year 2013 and each succeeding odd-numbered fiscal year For fiscal year 2013 and each succeeding odd-numbered fiscal year (other than fiscal years 2015, 2017, 2023, and 2029), the allot- ment of the State is equal to the Federal payments to the State that are attrib- utable 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 pre- ceding fiscal year as well as amounts re- distributed to the State in such preceding fiscal year), multiplied by the allotment increase factor under paragraph (6) for such odd-numbered fiscal year. (ii) Growth factor update for fiscal year 2014 and each succeeding even-num- bered fiscal year Except as provided in clauses (iii) and (iv), for fiscal year 2014 and each suc- ceeding even-numbered fiscal year, the al- lotment 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, multiplied by the allotment increase fac- tor under paragraph (6) for such even-num- bered fiscal year. (iii) Special rule for 2016 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 al- lotments available under this section to the State in the preceding fiscal year (in- cluding 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 ef- fect in such preceding fiscal year and then multiplying the result by the allotment increase factor under paragraph (6) for fis- cal year 2016. (iv) Reduction in 2018 For fiscal year 2018, with respect to the allotment of the State for fiscal year 2017, any amounts of such allotment that re- main available for expenditure by the State in fiscal year 2018 shall be reduced by one-third. (3) For fiscal year 2015 (A) First half 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 para- graph, increased by the amount of the appro- priation 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 subpara- graph (D)) of the amount described in sub- paragraph (C). (B) Second half 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 para- graph, the Secretary shall compute a State allotment for each State (including the Dis- Page 4471 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd trict of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made avail- able 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 sub- paragraph. (C) Full year amount based on rebased amount The amount described in this subpara- graph 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 pay- ments made to the State under subsection (n) for fiscal year 2014 as well as amounts re- distributed to the State in fiscal year 2014), multiplied by the allotment increase factor under paragraph (6) for fiscal year 2015. (D) First half ratio The first half ratio described in this sub- paragraph 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 Re- authorization 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) For fiscal year 2017 (A) First half 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 para- graph, increased by the amount of the appro- priation 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 subpara- graph (D)) of the amount described in sub- paragraph (C). (B) Second half 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 para- graph, the Secretary shall compute a State allotment for each State (including the Dis- trict of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made avail- able 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 sub- paragraph. (C) Full year amount based on rebased amount The amount described in this subpara- graph 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 pay- ments made to the State under subsection (n) for fiscal year 2016 as well as amounts re- distributed to the State in fiscal year 2016), multiplied by the allotment increase factor under paragraph (6) for fiscal year 2017. (D) First half ratio The first half ratio described in this sub- paragraph 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 Reauthor- ization 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) Proration rule 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 sub- section (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) Allotment increase factor The allotment increase factor under this paragraph for a fiscal year is equal to the product of the following: (A) Per capita health care growth factor 1 plus the percentage increase in the pro- jected 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 in- volved ends, as most recently published by the Secretary before the beginning of the fis- cal year. (B) Child population growth factor 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 pub- lished estimates of the Bureau of the Census before the beginning of the fiscal year in- volved, plus 1 percentage point. (7) Increase in allotment to account for ap- proved program expansions In the case of one of the 50 States or the Dis- trict of Columbia that— Page 4472 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd (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 bene- fits under this subchapter that becomes ef- fective for a fiscal year (beginning with fis- cal 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 ex- pansion allotment adjustment under this paragraph for such fiscal year that speci- fies— (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 pre- ceding 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, subject to paragraph (5), the amount of the al- lotment of the State or District under this subsection for such fiscal year shall be in- creased by the excess amount described in sub- paragraph (B)(i). A State or District may only obtain an increase under this paragraph for an allotment for fiscal year 2010, fiscal year 2012, fiscal year 2014, fiscal year 2016, fiscal year 2018, fiscal year 2020, fiscal year 2022, fiscal year 2024, fiscal year 2026, or fiscal year 2028. (8) Adjustment of fiscal year 2010 allotments to account for changes in projected spending for certain previously approved expansion programs 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 Jan- uary 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 percent- age matching rate for such population. (9) Availability of amounts for semi-annual pe- riods in certain fiscal years 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 sub- chapter 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) For fiscal year 2023 (A) First half 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 sub- paragraph, 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 Co- lumbia and each commonwealth and terri- tory) for such semi-annual period in an amount equal to the first half ratio (de- scribed in subparagraph (D)) of the amount described in subparagraph (C). (B) Second half.— 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 sub- paragraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each common- wealth 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 sub- paragraph. (C) Full year amount based on rebased amount.— The amount described in this subpara- graph 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 pay- ments made to the State under subsection (n) for fiscal year 2022 as well as amounts re- distributed to the State in fiscal year 2022), multiplied by the allotment increase factor under paragraph (6) for fiscal year 2023. (D) First half ratio.— The first half ratio described in this sub- paragraph 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) For fiscal year 2029 (A) First half 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 sub- paragraph, 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 Sec- retary shall compute a State allotment for each State (including the District of Colum- Page 4473 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd bia 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) Second half 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 sub- paragraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each common- wealth 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 sub- paragraph. (C) Full year amount based on rebased amount The amount described in this subpara- graph 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 pay- ments made to the State under subsection (n) for fiscal year 2028 as well as amounts re- distributed to the State in fiscal year 2028), multiplied by the allotment increase factor under paragraph (6) for fiscal year 2029. (D) First half ratio The first half ratio described in this sub- paragraph 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, Extend- ers, 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) Adjusting allotments to account for in- creased Federal payments for coverage and administration of COVID–19 vaccines If a State, commonwealth, or territory re- ceives 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 speci- fied 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 waiv- er of such plan) for vaccines described in sec- tion 1396d(a)(4)(E) of this title (and the ad- ministration 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 ad- justed on the basis of the difference be- tween— (i) such projected amount of expendi- tures described in subparagraph (A) for such fiscal year described in such subpara- graph by the State, commonwealth, or ter- ritory; and (ii) the actual amount of expenditures for such fiscal year described in subpara- graph (A) by the State, commonwealth, or territory under the State child health plan (or waiver of such plan) for vaccines de- scribed in section 1396d(a)(4)(E) of this title (and the administration of such vac- cines). (n) Child Enrollment Contingency Fund (1) Establishment 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 avail- able without further appropriations for pay- ments under this subsection. (2) Deposits into Fund (A) Initial and subsequent appropriations 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-an- nual 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 de- scribed in subparagraph (B). (B) Aggregate cap 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-an- nual allotment periods for fiscal years 2015, 2017, 2023, and 2029), taking into account de- posits made under subparagraph (C), shall not exceed 20 percent of the amount made available under subsection (a) for the fiscal year or period. (C) Investment of Fund 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 de- rived from these investments constitutes a part of the Fund. Page 4474 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd (D) Availability of excess funds for perform- ance bonuses 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 re- duce the amount in the Fund by the amount so made available. (3) Child Enrollment Contingency Fund pay- ments (A) In general If a State’s expenditures under this sub- chapter 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 sub- section (f) that is available for expenditure during such fiscal year or period, but includ- ing 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 sub- chapter 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 subpara- graph (B)) for that fiscal year or period, sub- ject 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 de- termined 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 in- volved (or in which the period occurs). (B) Target average number of child enrollees In this paragraph, the target average num- ber 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 pur- suant 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 pre- vious fiscal year increased by the child population growth factor described in sub- section (m)(6)(B) for the State for the prior fiscal year. (C) Projected per capita expenditures 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 av- erage per capita expenditures (including both State and Federal financial participa- tion) under such plan for the targeted low- income children counted in the average monthly caseload for purposes of this paragraph during fiscal year 2008, in- creased by the annual percentage increase in the projected per capita amount of Na- tional 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 expendi- tures under such plan for the previous fis- cal year (as determined under clause (i) or this clause) increased by the annual per- centage increase in the projected per cap- ita amount of National Health Expendi- tures (as estimated by the Secretary) for the year in which such subsequent fiscal year ends. (D) Proration rule If the amounts available for payment from the Fund for a fiscal year or period are less than the total amount of payments deter- mined 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) Timely payment; reconciliation 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 en- rollment 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) Continued reporting For purposes of this paragraph and sub- section (f), the State shall submit to the Secretary the State’s projected Federal ex- penditures, even if the amount of such ex- penditures exceeds the total amount of al- lotments available to the State in such fis- cal year or period. (G) Application to commonwealths and terri- tories No payment shall be made under this para- graph to a commonwealth or territory de- scribed in subsection (c)(3) until such time as the Secretary determines that there are in effect methods, satisfactory to the Sec- retary, for the collection and reporting of re- liable data regarding the enrollment of chil- dren described in subparagraphs (A) and (B) in order to accurately determine the com- monwealth’s or territory’s eligibility for, and amount of payment, under this para- graph. Page 4475 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd (Aug. 14, 1935, ch. 531, title XXI, § 2104, as added Pub. L. 105–33, title IV, § 4901(a), Aug. 5, 1997, 111 Stat. 558; amended Pub. L. 105–100, title I, § 162(6), (8), Nov. 19, 1997, 111 Stat. 2189, 2190; Pub. L. 105–277, div. A, § 101(f) [title VII, § 706], Oct. 21, 1998, 112 Stat. 2681–337, 2681–389; Pub. L. 106–113, div. B, § 1000(a)(6) [title VII, §§ 701(a), 702, 705(a)], Nov. 29, 1999, 113 Stat. 1536, 1501A–399, 1501A–400, 1501A–402; Pub. L. 106–554, § 1(a)(6) [title VIII, §§ 801(a), 802(b), (d)(3)], Dec. 21, 2000, 114 Stat. 2763, 2763A–578, 2763A–581; Pub. L. 108–74, § 1(a)(1)–(3), Aug. 15, 2003, 117 Stat. 892, 893; Pub. L. 108–173, title IX, § 900(e)(1)(M), Dec. 8, 2003, 117 Stat. 2372; Pub. L. 109–171, title VI, § 6101(a), (b), Feb. 8, 2006, 120 Stat. 130, 131; Pub. L. 109–482, title II, § 201(a), Jan. 15, 2007, 120 Stat. 3698; Pub. L. 110–28, title VII, § 7001, May 25, 2007, 121 Stat. 186; Pub. L. 110–92, § 136(c), Sept. 29, 2007, 121 Stat. 994; Pub. L. 110–173, title II, § 201(a)(1), (c)(1), Dec. 29, 2007, 121 Stat. 2509, 2510; Pub. L. 111–3, title I, §§ 101–103, 105, 106(a)(1), (b), Feb. 4, 2009, 123 Stat. 11, 15, 23, 24; Pub. L. 111–148, title II, § 2102(a)(1), title X, § 10203(d)(1)–(2)(B), Mar. 23, 2010, 124 Stat. 288, 928–930; Pub. L. 114–10, title III, § 301(a)–(b)(2)(C), (d)(1), Apr. 16, 2015, 129 Stat. 154–158; Pub. L. 115–90, div. B, § 201, Dec. 8, 2017, 131 Stat. 1280; Pub. L. 115–96, div. C, title II, § 3201(a)–(b)(2), (c)(1), Dec. 22, 2017, 131 Stat. 2050, 2051; Pub. L. 115–120, div. C, § 3002(a)(1), (b)(1), (c), (d)(2), Jan. 22, 2018, 132 Stat. 31–34; Pub. L. 115–123, div. E, title I, § 50101(a), (b)(1), (c), Feb. 9, 2018, 132 Stat. 172, 174; Pub. L. 117–2, title IX, § 9821(c), Mar. 11, 2021, 135 Stat. 220; Pub. L. 117–328, div. FF, title V, § 5111(a), (b)(1), (c)(5), Dec. 29, 2022, 136 Stat. 5938, 5939.) 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 Pro- gram 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 Re- authorization 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, re- ferred 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, Ex- tenders, 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), sub- stituted ‘‘through 2028’’ for ‘‘through 2026’’. Subsec. (a)(28). Pub. L. 117–328, § 5111(a)(2)(A), sub- stituted ‘‘for fiscal year 2029’’ for ‘‘for fiscal year 2027’’ in introductory provisions. Subsec. (a)(28)(A). Pub. L. 117–328, § 5111(a)(2)(B), sub- stituted ‘‘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), sub- stituted ‘‘beginning on April 1, 2029, and ending on Sep- tember 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), sub- stituted ‘‘or 2029’’ for ‘‘or 2027’’. Subsec. (m)(7). Pub. L. 117–328, § 5111(b)(1)(C)(ii), sub- stituted ‘‘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), sub- stituted ‘‘or 2029’’ for ‘‘or 2027’’. Subsec. (m)(11). Pub. L. 117–328, § 5111(b)(1)(E)(i), sub- stituted ‘‘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), sub- stituted ‘‘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), sub- stituted ‘‘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), sub- stituted ‘‘2024 through 2028’’ for ‘‘2024 through 2026’’ in introductory provisions. 2021—Subsec. (m)(2)(B). Pub. L. 117–2, § 9821(c)(1), sub- stituted ‘‘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), respec- tively)’’ 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), sub- stituted ‘‘(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’’. Page 4476 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd Subsec. (m)(7). Pub. L. 115–123, § 50101(b)(1)(C)(ii), sub- stituted ‘‘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), in- serted ‘‘(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 in- tent 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), amend- ed par. (10) generally. Prior to amendment, par. (10) re- lated 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), sub- stituted ‘‘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), sub- stituted ‘‘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 intro- ductory provisions. Pub. L. 115–120, § 3002(c)(2), substituted ‘‘or in any of fiscal years 2018 through 2022 (or a semi-annual allot- ment 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 sub- par. (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), sub- stituted ‘‘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 re- distribution under paragraph (1) and definition of emer- gency 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), sub- stituted ‘‘the allotment increase factor under para- graph (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 head- ing. Subsec. (m)(2)(B)(ii). Pub. L. 115–96, § 3201(b)(1)(A), in- serted ‘‘and paragraph (10)’’ after ‘‘clauses (iii) and (iv)’’ in introductory provisions. Subsec. (m)(5). Pub. L. 115–96, § 3201(b)(1)(B), sub- stituted ‘‘(4), or (10)’’ for ‘‘or (4)’’ and ‘‘, 2017, or 2018’’ for ‘‘or 2017’’. Subsec. (m)(9). Pub. L. 115–96, § 3201(b)(1)(C), sub- stituted, 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), sub- stituted ‘‘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), sub- stituted ‘‘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 allot- ment increase factor under paragraph (6)’’ for ‘‘the al- lotment increase factor under paragraph (5)’’, was exe- cuted by making the substitution wherever appearing in subpar. (A), to reflect the probable intent of Con- gress. 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), sub- stituted ‘‘paragraphs (5) and (7)’’ for ‘‘paragraphs (4) and (6)’’ in subpars. (A) and (B) and ‘‘the allotment in- crease 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), sub- stituted ‘‘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), redesig- nated 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), sub- stituted ‘‘2017’’ for ‘‘2015’’. Subsec. (m)(7). Pub. L. 114–10, § 301(b)(2)(B)(v), sub- stituted ‘‘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), redesig- nated 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 in- serted ‘‘or fiscal year 2017’’ after ‘‘2015’’ in text. Subsec. (m)(9). Pub. L. 114–10, § 301(b)(2)(B)(vi), sub- stituted ‘‘paragraph (3) or (4)’’ for ‘‘paragraph (3)’’. Pub. L. 114–10, § 301(b)(1)(F), redesignated par. (8) as (9). Page 4477 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd 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), sub- stituted ‘‘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), sub- stituted ‘‘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), sub- stituted ‘‘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 Octo- ber 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), sub- stituted ‘‘2015’’ for ‘‘2013’’ in heading. Subsec. (m)(2). Pub. L. 111–148, § 10203(d)(2)(A)(ii), sub- stituted ‘‘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), sub- stituted ‘‘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), sub- stituted ‘‘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 ‘‘sub- sections (d) and (m)’’ for ‘‘subsection (d)’’ in introduc- tory provisions. Subsec. (c)(1). Pub. L. 111–3, § 102(2), substituted ‘‘sub- sections (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 fis- cal year in which they are reallotted.’’ Subsec. (f). Pub. L. 111–3, § 106(a)(1), designated exist- ing provisions as par. (1), inserted heading, substituted ‘‘States that the Secretary determines with respect to the fiscal year for which unused allotments are avail- able for redistribution under this subsection, are short- fall States described in paragraph (2) for such fiscal year, but not to exceed the amount of the shortfall de- scribed 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), sub- stituted ‘‘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 ‘‘esti- mates,’’ in introductory provisions. Subsec. (h)(2). Pub. L. 110–28, § 7001(a)(1), (b)(2), sub- stituted ‘‘part’’ for ‘‘remainder of reduction’’ in head- ing 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 fol- lows: ‘‘(A) EXPENDITURES LIMITED TO COVERAGE FOR POPU- LATIONS 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 ex- penditures 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 sub- section (a) of section 1397ee of this title from such amounts.’’ Subsec. (h)(5)(A). Pub. L. 110–28, § 7001(b)(3), sub- stituted ‘‘(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 sub- stituted ‘‘(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. Page 4478 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397dd Subsec. (g)(1)(A). Pub. L. 108–74, § 1(a)(3)(B)(i), (ii), in- serted ‘‘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 fis- cal year 2000 by the end of fiscal year 2002,’’ after ‘‘fis- cal 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), in- serted ‘‘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), sub- stituted ‘‘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 No- vember 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 ex- penditures 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 ex- penditures 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 sec- tion 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 in- troductory 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)], sub- stituted ‘‘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) gen- erally. 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 Co- lumbia 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 allot- ments in a fiscal year does not exceed the amount oth- erwise 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 fis- cal 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 para- graph (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), sub- stituted ‘‘$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), sub- stituted ‘‘The’’ for ‘‘the’’. Subsec. (d)(1). Pub. L. 105–100, § 162(6)(A), substituted ‘‘for expenditures claimed by the State’’ for ‘‘for cal- endar 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.’’ Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2010 AMENDMENT Pub. L. 111–148, title II, § 2102(a), Mar. 23, 2010, 124 Stat. 288, provided that the amendment made by sec- tion 2102(a)(1) of Pub. L. 111–148 is effective as if in- cluded in the enactment of the Children’s Health Insur- ance Program Reauthorization Act of 2009 (Pub. L. 111–3). EFFECTIVE DATE OF 2009 AMENDMENT Amendment by sections 101–103, 105, and 106(b) of Pub. L. 111–3 effective Apr. 1, 2009, and applicable to child health assistance and medical assistance provided on or after that date, with certain exceptions, see section 3 of Pub. L. 111–3, set out as an Effective Date note under section 1396 of this title. Pub. L. 111–3, title I, § 106(a)(2), Feb. 4, 2009, 123 Stat. 24, provided that: ‘‘The amendments made by para- graph (1) [amending this section] shall apply to redis- tribution of allotments made for fiscal year 2007 and subsequent fiscal years.’’ Page 4479 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397ee TERMINATION DATE OF 2007 AMENDMENT Pub. L. 110–92, § 136(e), Sept. 29, 2007, 121 Stat. 995, which provided that the amendments made by subsecs. (c) and (d) of section 136, amending this section and sec- tion 1397ee of this title, were effective through Dec. 31, 2007, or, if earlier, the date of the enactment of an Act that provides funding for fiscal year 2008 and for one or more subsequent fiscal years for the Children’s Health Insurance Program under this subchapter, was repealed by Pub. L. 110–173, title II, § 201(b)(3), Dec. 29, 2007, 121 Stat. 2510. EFFECTIVE DATE OF 2006 AMENDMENT Pub. L. 109–171, title VI, § 6101(c), Feb. 8, 2006, 120 Stat. 131, provided that: ‘‘The amendments made by this sec- tion [amending this section] apply to items and serv- ices furnished on or after October 1, 2005, without re- gard to whether or not regulations implementing such amendments have been issued.’’ EFFECTIVE DATE OF 2003 AMENDMENT Pub. L. 108–74, § 1(a)(4), Aug. 15, 2003, 117 Stat. 895, pro- vided that: ‘‘This subsection [amending this section], and the amendments made by this subsection, shall be effective as if this subsection had been enacted on Sep- tember 30, 2002, and amounts under title XXI of the So- cial Security Act (42 U.S.C. 1397aa et seq.) from allot- ments for fiscal years 1998 through 2000 are available for expenditure on and after October 1, 2002, under the amendments made by this subsection as if this sub- section had been enacted on September 30, 2002.’’ EFFECTIVE DATE OF 2000 AMENDMENT Pub. L. 106–554, § 1(a)(6) [title VIII, § 801(b)], Dec. 21, 2000, 114 Stat. 2763, 2763A–580, provided that: ‘‘The amendments made by this section [amending this sec- tion] shall take effect as if included in the enactment of section 4901 of BBA [Pub. L. 105–33] (111 Stat. 552).’’ Amendment by section 802(b), (d)(3) of Pub. L. 106–554 effective as if included in the enactment of section 4901 of Pub. L. 105–33, see section 1(a)(6) [title VIII, § 802(f)] of Pub. L. 106–554, set out as a note under section 1396d of this title. EFFECTIVE DATE OF 1999 AMENDMENT Pub. L. 106–113, div. B, § 1000(a)(6) [title VII, § 701(b)], Nov. 29, 1999, 113 Stat. 1536, 1501A–400, provided that: ‘‘The amendments made by this section [amending this section] apply to allotments determined under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) for fiscal year 2000 and each fiscal year thereafter.’’ EFFECTIVE DATE OF 1997 AMENDMENT Pub. L. 105–100, title I, § 162, Nov. 19, 1997, 111 Stat. 2188, provided that the amendment made by that sec- tion is effective as if included in the enactment of sub- title J (§§ 4901–4923) of title IV of the Balanced Budget Act of 1997, Pub. L. 105–33. CONSTRUCTION OF 2017 AMENDMENT Pub. L. 115–96, div. C, title II, § 3201(c)(2), Dec. 22, 2017, 131 Stat. 2052, provided that: ‘‘Nothing in the amend- ments made by paragraph (1) [amending this section] shall be construed as authorizing the Secretary of Health and Human Services to de-obligate any funds re- distributed under clause (ii) of section 2104(f)(2)(B) of the Social Security Act (42 U.S.C. 1397dd(f)(2)(B)) that have been obligated for amounts expended by an emer- gency shortfall State described in such clause as of January 1, 2018.’’ APPLICATION OF REGULAR EXPENDITURE RULES Pub. L. 115–96, div. C, title II, § 3201(b)(3), Dec. 22, 2017, 131 Stat. 2051, provided that: ‘‘Amounts allotted to a State under section 2104(m)(10)(A) of the Social Secu- rity Act (42 U.S.C. 1397dd(m)(10)(A)) (as added by para- graph (1)) shall be subject to the same requirements of title XXI of such Act [42 U.S.C. 1397aa et seq.] and ap- plicable regulations of the Secretary of Health and Human Services as apply to other allotments made to States for a fiscal year under section 2104 of such Act [42 U.S.C. 1397dd].’’ AUTHORITY TO TRANSFER SUBCHAPTER XXI APPROPRIA- TIONS TO SUBCHAPTER XIX APPROPRIATION ACCOUNT AS REIMBURSEMENT FOR MEDICAID EXPENDITURES FOR MEDICAID EXPANSION SCHIP SERVICES Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(c)], Dec. 21, 2000, 114 Stat. 2763, 2763A–581, provided that: ‘‘Notwith- standing any other provision of law, all amounts appro- priated under title XXI [of the Social Security Act, 42 U.S.C. 1397aa et seq.] and allotted to a State pursuant to subsection (b) or (c) of section 2104 of the Social Se- curity Act (42 U.S.C. 1397dd) for fiscal years 1998 through 2000 (including any amounts that, but for this provision, would be considered to have expired) and not expended in providing child health assistance or related services for which payment may be made pursuant to subparagraph (C) or (D) of section 2105(a)(1) of such Act (42 U.S.C. 1397ee(a)(1)) (as amended by subsection (a)), shall be available to reimburse the Grants to States for Medicaid account in an amount equal to the total pay- ments made to such State under section 1903(a) of such Act (42 U.S.C. 1396b(a)) for expenditures in such years for medical assistance described in subparagraphs (A) and (B) of section 2105(a)(1) of such Act (42 U.S.C. 1397ee(a)(1)) (as so amended).’’ DETERMINATION OF NUMBER OF CHILDREN AND STATE COST FACTORS FOR FISCAL YEARS 1998 AND 1999 Pub. L. 105–277, div. A, § 101(f) [title VII, § 707], Oct. 21, 1998, 112 Stat. 2681–337, 2681–389, provided that: ‘‘Not- withstanding any other provision of law, for purposes of determining the product under section 2104(b)(1)(A) of the Social Security Act (42 U.S.C. 1397dd(b)(1)(A)) for a State for each of fiscal years 1998 and 1999— ‘‘(1) the number of children under clause (i) of such section shall be the number of low-income children specified for the State in Column B of the table on pages 48101–48102 of the Federal Register published on September 12, 1997, adjusted by the Census Bureau as necessary to treat children as being without health insurance if they have access to health care funded by the Indian Health Service but do not have health insurance; and ‘‘(2) the State cost factor under clause (ii) of such section shall be the State cost factor specified for the State in Column C of such table.’’ § 1397ee. Payments to States (a) Payments (1) In general Subject to the succeeding provisions of this section, the Secretary shall pay to each State with a plan approved under this subchapter, from its allotment under section 1397dd of this title, an amount for each quarter equal to the enhanced FMAP (or, in the case of expendi- tures described in subparagraph (D)(iv), the higher of 75 percent or the sum of the en- hanced FMAP plus 5 percentage points) of ex- penditures in the quarter— (A) for child health assistance under the plan for targeted low-income children in the form of providing medical assistance for which payment is made on the basis of an enhanced FMAP under the fourth sentence of section 1396d(b) of this title; (B) [reserved] (C) for child health assistance under the plan for targeted low-income children in the form of providing health benefits coverage that meets the requirements of section 1397cc of this title; and