42 U.S.C. § 1308. Additional grants to Puerto Rico, Virgin Islands, Guam, and American Samoa; limitation on total payments

1. (a)
   (a)

   Limitation on total payments to each territory

   1. (1)
      (a)(1)

      In general

      Notwithstanding any other provision of this chapter (except for paragraph (2) of this subsection), the total amount certified by the Secretary of Health and Human Services under subchapters I, X, XIV, and XVI, under parts A and E of subchapter IV, and under subsection (b) of this section, for payment to any territory for a fiscal year shall not exceed the ceiling amount for the territory for the fiscal year.
   2. (2)
      (a)(2)

      Certain payments disregarded

      Paragraph (1) of this subsection shall be applied without regard to any payment made under section 603(a)(2), 603(a)(4), 603(a)(5), 606, 613(f), or 674(a)(6) of this title.
2. (b)
   (b)

   Entitlement to matching grant

   1. (1)
      (b)(1)

      In general

      Each territory shall be entitled to receive from the Secretary for each fiscal year a grant in an amount equal to 75 percent of the amount (if any) by which—

      1. (A)
         (b)(1)(A)the total expenditures of the territory during the fiscal year under the territory programs funded under parts A and E of subchapter IV, including any amount paid to the State under part A of subchapter IV that is transferred in accordance with section 604(d) of this title and expended under the program to which transferred; exceeds
      2. (B)
         (b)(1)(B)

         the sum of—

         1. (i)
            (b)(1)(B)(i)the amount of the family assistance grant payable to the territory without regard to section 609 of this title; and
         2. (ii)
            (b)(1)(B)(ii)the total amount expended by the territory during fiscal year 1995 pursuant to parts A and F of subchapter IV (as so in effect), other than for child care.
   2. (2)
      (b)(2)

      Appropriation

      Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated for each of fiscal years 2017 and 2018, such sums as are necessary for grants under this paragraph.
3. (c)
   (c)

   Definitions

   As used in this section:

   1. (1)
      (c)(1)

      Territory

      The term “territory” means Puerto Rico, the Virgin Islands, Guam, and American Samoa.
   2. (2)
      (c)(2)

      Ceiling amount

      The term “ceiling amount” means, with respect to a territory and a fiscal year, the mandatory ceiling amount with respect to the territory, reduced for the fiscal year in accordance with subsection (e),¹ and reduced by the amount of any penalty imposed on the territory under any provision of law specified in subsection (a) during the fiscal year.
   3. (3)
      (c)(3)

      Family assistance grant

      The term “family assistance grant” has the meaning given such term by section 603(a)(1)(B) of this title.
   4. (4)
      (c)(4)

      Mandatory ceiling amount

      The term “mandatory ceiling amount” means—

      1. (A)
         (c)(4)(A)$107,255,000 with respect to Puerto Rico;
      2. (B)
         (c)(4)(B)$4,686,000 with respect to Guam;
      3. (C)
         (c)(4)(C)$3,554,000 with respect to the Virgin Islands; and
      4. (D)
         (c)(4)(D)$1,000,000 with respect to American Samoa.
   5. (5)
      (c)(5)

      Total amount expended by the territory

      The term “total amount expended by the territory”—

      1. (A)
         (c)(5)(A)does not include expenditures during the fiscal year from amounts made available by the Federal Government; and
      2. (B)
         (c)(5)(B)

         when used with respect to fiscal year 1995, also does not include—

         1. (i)
            (c)(5)(B)(i)expenditures during fiscal year 1995 under subsection (g) or (i) of section 602 of this title (as in effect on September 30, 1995); or
         2. (ii)
            (c)(5)(B)(ii)any expenditures during fiscal year 1995 for which the territory (but for this section, as in effect on September 30, 1995) would have received reimbursement from the Federal Government.
4. (d)
   (d)

   Authority to transfer funds to certain programs

   A territory to which an amount is paid under subsection (b) of this section may use the amount in accordance with section 604(d) of this title.
5. (e)
   (e)

   Repealed. Pub. L. 105–33, title V, § 5512(c), Aug. 5, 1997, 111 Stat. 619

6. (f)
   (f)

   Total amount certified under subchapter XIX

   Subject to subsection (g) and section 1396u–5(e)(1)(B) of this title, the total amount certified by the Secretary under subchapter XIX with respect to a fiscal year for payment to—

   1. (1)
      (f)(1)Puerto Rico shall not exceed (A) $116,500,000 for fiscal year 1994 and (B) for each succeeding fiscal year the amount provided in this paragraph for the preceding fiscal year increased by the percentage increase in the medical care component of the consumer price index for all urban consumers (as published by the Bureau of Labor Statistics) for the twelve-month period ending in March preceding the beginning of the fiscal year, rounded to the nearest $100,000;
   2. (2)
      (f)(2)the Virgin Islands shall not exceed (A) $3,837,500 for fiscal year 1994, and (B) for each succeeding fiscal year the amount provided in this paragraph for the preceding fiscal year increased by the percentage increase referred to in paragraph (1)(B), rounded to the nearest $10,000;
   3. (3)
      (f)(3)Guam shall not exceed (A) $3,685,000 for fiscal year 1994, and (B) for each succeeding fiscal year the amount provided in this paragraph for the preceding fiscal year increased by the percentage increase referred to in paragraph (1)(B), rounded to the nearest $10,000;
   4. (4)
      (f)(4)Northern Mariana Islands shall not exceed (A) $1,110,000 for fiscal year 1994, and (B) for each succeeding fiscal year the amount provided in this paragraph for the preceding fiscal year increased by the percentage increase referred to in paragraph (1)(B), rounded to the nearest $10,000; and
   5. (5)
      (f)(5)American Samoa shall not exceed (A) $2,140,000 for fiscal year 1994, and (B) for each succeeding fiscal year the amount provided in this paragraph for the preceding fiscal year increased by the percentage increase referred to in paragraph (1)(B), rounded to the nearest $10,000.
7. (g)
   (g)

   Medicaid payments to territories for fiscal year 1998 and thereafter

   1. (1)
      (g)(1)

      Fiscal year 1998

      With respect to fiscal year 1998, the amounts otherwise determined for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa under subsection (f) for such fiscal year shall be increased by the following amounts:

      1. (A)
         (g)(1)(A)For Puerto Rico, $30,000,000.
      2. (B)
         (g)(1)(B)For the Virgin Islands, $750,000.
      3. (C)
         (g)(1)(C)For Guam, $750,000.
      4. (D)
         (g)(1)(D)For the Northern Mariana Islands, $500,000.
      5. (E)
         (g)(1)(E)For American Samoa, $500,000.
   2. (2)
      (g)(2)

      Fiscal year 1999 and thereafter

      Notwithstanding subsection (f) and subject to and section 18043(a)(2) of this title paragraphs (3) and (5),² with respect to fiscal year 1999 and any fiscal year thereafter, the total amount certified by the Secretary under subchapter XIX for payment to—

      1. (A)
         (g)(2)(A)Puerto Rico shall not exceed the sum of the amount provided in this subsection for the preceding fiscal year increased by the percentage increase in the medical care component of the Consumer Price Index for all urban consumers (as published by the Bureau of Labor Statistics) for the 12-month period ending in March preceding the beginning of the fiscal year, rounded to the nearest $100,000;
      2. (B)
         (g)(2)(B)the Virgin Islands shall not exceed the sum of the amount provided in this subsection for the preceding fiscal year increased by the percentage increase referred to in subparagraph (A), rounded to the nearest $10,000;
      3. (C)
         (g)(2)(C)Guam shall not exceed the sum of the amount provided in this subsection for the preceding fiscal year increased by the percentage increase referred to in subparagraph (A), rounded to the nearest $10,000;
      4. (D)
         (g)(2)(D)the Northern Mariana Islands shall not exceed the sum of the amount provided in this subsection for the preceding fiscal year increased by the percentage increase referred to in subparagraph (A), rounded to the nearest $10,000; and
      5. (E)
         (g)(2)(E)American Samoa shall not exceed the sum of the amount provided in this subsection for the preceding fiscal year increased by the percentage increase referred to in subparagraph (A), rounded to the nearest $10,000.
   3. (3)
      (g)(3)

      Fiscal years 2006 and 2007 for certain insular areas

      The amounts otherwise determined under this subsection for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa for fiscal year 2006 and fiscal year 2007 shall be increased by the following amounts:

      1. (A)
         (g)(3)(A)For Puerto Rico, $12,000,000 for fiscal year 2006 and $12,000,000 for fiscal year 2007.
      2. (B)
         (g)(3)(B)For the Virgin Islands, $2,500,000 for fiscal year 2006 and $5,000,000 for fiscal year 2007.
      3. (C)
         (g)(3)(C)For Guam, $2,500,000 for fiscal year 2006 and $5,000,000 for fiscal year 2007.
      4. (D)
         (g)(3)(D)For the Northern Mariana Islands, $1,000,000 for fiscal year 2006 and $2,000,000 for fiscal year 2007.
      5. (E)
         (g)(3)(E)For American Samoa, $2,000,000 for fiscal year 2006 and $4,000,000 for fiscal year 2007.

      Such amounts shall not be taken into account in applying paragraph (2) for fiscal year 2007 but shall be taken into account in applying such paragraph for fiscal year 2008 and subsequent fiscal years.
   4. (4)
      (g)(4)

      Exclusion of certain expenditures from payment limits

      With respect to fiscal years beginning with fiscal year 2009, if Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa qualify for a payment under subparagraph (A)(i), (B), or (F) of section 1396b(a)(3) of this title for a calendar quarter of such fiscal year, and with respect to fiscal years beginning with fiscal year 2017, if Puerto Rico qualifies for a payment under section 1396b(a)(6) of this title for a calendar quarter (beginning on or after July 1, 2017) of such fiscal year, and with respect to fiscal years beginning with fiscal year 2018, if the Virgin Islands qualifies for a payment under section 1396b(a)(6) of this title for a calendar quarter (beginning on or after January 1, 2018) of such fiscal year, the payment shall not be taken into account in applying subsection (f) (as increased in accordance with paragraphs (1), (2), (3), and (4) of this subsection) to such commonwealth or territory for such fiscal year.
   5. (5)
      (g)(5)

      Additional increase

      1. (A)
         (g)(5)(A)Subject to subparagraphs (B), (C), (D), (E), and (F), the Secretary shall increase the amounts otherwise determined under this subsection for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa (after the application of subsection (f) and the preceding paragraphs of this subsection) for the period beginning July 1, 2011, and ending on September 30, 2019, by such amounts that the total additional payments under subchapter XIX to such territories equals $6,300,000,000 for such period. The Secretary shall increase such amounts in proportion to the amounts applicable to such territories under this subsection and subsection (f) on March 30, 2010.
      2. (B)
         (g)(5)(B)The amount of the increase otherwise provided under subparagraph (A) for Puerto Rico shall be further increased by $295,900,000.
      3. (C)
         (g)(5)(C)

         Subject to subparagraphs (D) and (F), for the period beginning January 1, 2018, and ending September 30, 2019—

         1. (i)
            (g)(5)(C)(i)the amount of the increase otherwise provided under subparagraphs (A) and (B) for Puerto Rico shall be further increased by $3,600,000,000; and
         2. (ii)
            (g)(5)(C)(ii)the amount of the increase otherwise provided under subparagraph (A) for the Virgin Islands shall be further increased by $106,931,000.
      4. (D)
         (g)(5)(D)

         For the period described in subparagraph (C), the amount of the increase otherwise provided under subparagraph (A)—

         1. (i)
            (g)(5)(D)(i)

            for Puerto Rico shall be further increased by $1,200,000,000 if the Secretary certifies that Puerto Rico has taken reasonable and appropriate steps during such period, in accordance with a timeline established by the Secretary, to—

            1. (I)
               (g)(5)(D)(i)(I)implement methods, satisfactory to the Secretary, for the collection and reporting of reliable data to the Transformed Medicaid Statistical Information System (T–MSIS) (or a successor system); and
            2. (II)
               (g)(5)(D)(i)(II)demonstrate progress in establishing a State medicaid fraud control unit described in section 1396b(q) of this title; and
         2. (ii)
            (g)(5)(D)(ii)for the Virgin Islands shall be further increased by $35,644,000 if the Secretary certifies that the Virgin Islands has taken reasonable and appropriate steps during such period, in accordance with a timeline established by the Secretary, to meet the conditions for certification specified in subclauses (I) and (II) of clause (i).
      5. (E)
         (g)(5)(E)Subject to subparagraph (F), for the period beginning January 1, 2019, and ending September 30, 2019, the amount of the increase otherwise provided under subparagraph (A) for the Northern Mariana Islands shall be further increased by $36,000,000.
      6. (F)
         (g)(5)(F)

         Notwithstanding any other provision of subchapter XIX—

         1. (i)
            (g)(5)(F)(i)during the period in which the additional funds provided under subparagraphs (C), (D), and (E) are available for Puerto Rico, the Virgin Islands, and the Northern Mariana Islands, respectively, with respect to payments from such additional funds for amounts expended by Puerto Rico, the Virgin Islands, and the Northern Mariana Islands under such subchapter, the Secretary shall increase the Federal medical assistance percentage or other rate that would otherwise apply to such payments to 100 percent; and
         2. (ii)
            (g)(5)(F)(ii)for the period beginning January 1, 2019, and ending September 30, 2019, with respect to payments to Guam and American Samoa from the additional funds provided under subparagraph (A), the Secretary shall increase the Federal medical assistance percentage or other rate that would otherwise apply to such payments to 100 percent.
      7. (G)
         (g)(5)(G)Not later than September 30, 2019, Guam and American Samoa shall each submit a plan to the Secretary outlining the steps each such territory shall take to collect and report reliable data to the Transformed Medicaid Statistical Information System (T–MSIS) (or a successor system).