Medicaid in the territories

(a) Elimination of general Medicaid funding limitations (CAP) for territories (1) In general Section 1108 of the Social Security Act (42 U.S.C. 1308) is amended— (A) in subsection (f), in the matter preceding paragraph (1), by striking subsections (g) and (h) and inserting subsections (g), (h), and (j); (B) in subsection (g)(2), in the matter preceding subparagraph (A), by inserting subsection (j) and after subject to; (C) in subsection (i)— (i) by striking paragraph (4); and (ii) by redesignating paragraph (5) as paragraph (4); and (D) by adding at the end the following new subsection: (j) Sunset of medicaid funding limitations for puerto rico, the virgin islands, guam, the northern mariana islands, and american samoa Subsections (f) and (g) shall not apply to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa beginning with fiscal year 2027.. (2) Conforming amendments (A) Section 1902(j) of the Social Security Act (42 U.S.C. 1396a(j)) is amended by striking, the limitation in section 1108(f),,. (B) Section 1903(u) of the Social Security Act (42 U.S.C. 1396b(u)) is amended by striking paragraph (4). (3) Effective date The amendments made by this subsection shall apply beginning with fiscal year 2027. (b) Elimination of specific Federal medical assistance percentage (FMAP) limitation for Puerto Rico Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended— (1) in subsection (b), in the first sentence, by inserting for fiscal years before fiscal year 2027 after American Samoa; and (2) in subsection (ff)(2), by striking 2027 and inserting 2026. (c) Permitting medicaid DSH allotments for territories Section 1923(f) of the Social Security Act (42 U.S.C. 1396r–4(f)) is amended— (1) in paragraph (6), by adding at the end the following new subparagraph: (C) Territories (i) Fiscal year 2027 For fiscal year 2027, the DSH allotment for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa shall bear the same ratio to $300,000,000 as the ratio of the number of individuals who are low-income or uninsured and residing in such respective territory (as estimated from time to time by the Secretary) bears to the sums of the number of such individuals residing in all of the territories. (ii) Subsequent fiscal year For each subsequent fiscal year, the DSH allotment for each such territory is subject to an increase in accordance with paragraph (3).; and (2) in paragraph (9), by inserting before the period at the end the following:, and includes, beginning with fiscal year 2027, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.