[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4931 Introduced in House (IH)]
<DOC>
115th CONGRESS
2d Session
H. R. 4931
To establish the Transition to Independence demonstration program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 5, 2018
Mr. Langevin (for himself, Mr. Harper, Mr. Beyer, Mr. Sessions, and Mr.
Foster) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To establish the Transition to Independence demonstration program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Transition to Independence Act of
2018''.
SEC. 2. TRANSITION TO INDEPENDENCE DEMONSTRATION PROGRAM.
(a) Establishment.--The Secretary shall establish a demonstration
program under which a State that is a Medicaid Buy-In State and meets
certain criteria may receive bonus payments for meeting specific
measurable benchmarks in expanding individual integrated employment and
reducing subminimum wage work, congregate setting work, or facility-
based day habilitation placements for working-age individuals with a
disability receiving Medicaid-funded home or community-based services
and for taking other actions conducive to expanding employment
opportunities for individuals with disabilities within the State.
(b) Requirements for the Transition to Independence Demonstration
Program.--
(1) Minimum standards.--The Secretary shall establish
minimum standards for Medicaid Buy-In States participating in
the demonstration program to comply with in establishing
eligibility requirements for individual participants, benefits,
and administrative requirements for the Transition to
Independence Medicaid Buy-In Option offered under the
demonstration program.
(2) Preference given to certain states for demonstration
participation.--The Secretary shall give preference in
selecting States to participate in the demonstration program to
States that have Medicaid Buy-In programs that--
(A) establish an assets or resources test for
participation by an individual in the Medicaid Buy-In
Option that is not less than $20,000;
(B) establish an income requirement for
participation by an individual in the Medicaid Buy-In
Option that is at least up to 400 percent of the
poverty line;
(C) offer home and community-based services,
including employment-based services and supports, in
the Medicaid Buy-In Option; and
(D) establish such other requirements for an
individual's participation in the Medicaid Buy-In
Option as the Secretary shall specify.
(3) Work incentives coordinator.--The minimum standards
shall require a Medicaid Buy-In State participating in the
demonstration program to provide work incentives coordinators
who have been trained as work incentive specialists under a
community-based work incentives planning and assistance program
established under section 1149 of the Social Security Act (42
U.S.C. 1320b-20) to assist the individuals who elect to
participate in the Medicaid Buy-In Option in order to ensure
the individuals are provided with appropriate items and
services.
(c) Application and Selection Requirements.--
(1) In general.--Not later than June 30, 2019, the
Secretary shall solicit applications from Medicaid Buy-In
States and select 15 Medicaid Buy-In States to participate in
the demonstration program.
(2) Application requirements.--An application to
participate in the demonstration program shall include the
following:
(A) Data and information regarding the numbers of
working-age individuals with disabilities who are
receiving Medicaid-funded home or community-based
services in the Medicaid Buy-In State who are in
individual integrated employment, subminimum wage work,
congregate setting work, or facility-based day
habilitation or day treatment, respectively.
(B) Data and information verifying that the
Medicaid Buy-In State is prepared to meet the minimum
standards established by the Secretary for the Medicaid
Buy-In Option.
(C) A plan for promoting the Medicaid Buy-In Option
to potentially eligible individuals that includes--
(i) clear and easy-to-understand, multi-
media information on how to enroll in the
Medicaid Buy-In Option on the Web sites for the
Medicaid Buy-In State's Medicaid and Disability
Determination Services Agencies; and
(ii) a ``no-wrong door'' policy under which
individuals who apply for a determination of
eligibility for the Medicaid Buy-In Option are
also determined if they are eligible for an
applicable State health subsidy program in
accordance with section 1413 of the Patient
Protection and Affordable Care Act (42 U.S.C.
18083) (including the State Medicaid program
under another eligibility pathway), informed of
the results of such determinations and,
depending on their eligibility, provided with
the option to voluntarily elect to participate
in the Medicaid Buy-In Option or an applicable
State health subsidy program.
(D)(i) An assurance that the State will establish
and build capacity for an eligibility process to make
eligibility determinations for the Medicaid Buy-In
program. Such process shall provide for a determination
of eligibility not later than 90 days after the date
that an application to participate in the program is
filed, including for individuals who are not receiving
disability insurance benefits under title II of the
Social Security Act (42 U.S.C. 401 et seq.) or
supplemental security income benefits under title XVI
of such Act (42 U.S.C. 1381 et seq.).
(ii) A description of the eligibility criteria the
State will use, the process it will use to determine
eligibility, for individuals who do not qualify for
such title II or SSI benefits and the staff who will be
responsible for making those determinations. This
eligibility process shall not use the disability
determination process used by the Social Security
Administration for such title II and SSI benefits.
(E) Verification that the Medicaid Buy-In State
shall establish a Stakeholder Advisory Committee that
meets the requirements of paragraph (3) and shall
consult with and consider recommendations of the
Committee while conducting the demonstration program.
(F) A description of the person-centered planning
process that the State intends to use for participants
in the demonstration program.
(G) Such other information as the Secretary may
require relating to the demonstration program.
(3) Stakeholder advisory committee requirements.--
(A) Membership.--In establishing the Stakeholder
Advisory Committee required for the demonstration
program, the Medicaid Buy-In State shall ensure that--
(i) at least 50 percent of the members of
the Stakeholder Advisory Committee are
individuals with disabilities; and
(ii) at least 1 member of the Committee is
a provider of services to individuals with
disabilities.
(B) Duties.--The Stakeholder Advisory Committee
shall--
(i) analyze outcomes data and other
information related to the conduct of the
demonstration program; and
(ii) regularly submit recommendations,
including for specific actions by the Medicaid
Buy-In State participating in the demonstration
program, that the Committee determines
appropriate with respect to the conduct of the
demonstration program by the State.
(d) Requirement for Selecting States.--In selecting Medicaid Buy-In
States to participate in the demonstration program, the Secretary shall
ensure that the Medicaid Buy-In States selected include Medicaid Buy-In
States with low, medium, and high numbers of working-age individuals
with disabilities who are receiving Medicaid-funded home or community-
based services and are in individual integrated employment, subminimum
wage work, congregate setting work, or facility-based day habilitation
or day treatment, respectively.
(e) Length of Demonstration Program.--The demonstration program
shall be conducted for a period of 5 fiscal years, beginning with
fiscal year 2020.
(f) Performance Bonus Payments.--
(1) In general.--For each fiscal year in which the
demonstration program is conducted, a Medicaid Buy-In State
participating in the demonstration program during that fiscal
year may qualify for a performance bonus payment.
(2) State-specified criteria and performance plans.--In
order to participate in the demonstration program, a Medicaid
Buy-In State shall submit criteria and a plan for achieving
each of the mandatory benchmarks described in paragraph (3) and
a selection of the additional benchmarks described in paragraph
(4) as determined by the Secretary. The Secretary shall
establish a methodology for assessing State performance with
respect to the State-specified criteria for the mandatory and
additional benchmarks.
(3) Mandatory benchmarks.--The mandatory benchmarks
described in this paragraph are the following:
(A) Reduced participation in segregated programs
and increased participation in individual integrated
employment.--
(i) Reduced population census of segregated
programs.--
(I) In general.--Achieving a
reduction in the population in the
State of working-age individuals with
disabilities who are receiving
Medicaid-funded home or community-based
services or who are receiving services
through an Intermediate Care Facility
for Persons with Developmental
Disabilities (ICF-DD), a nursing
facility, an institution for
individuals with mental illness, or
other congregate facilities and are in
subminimum wage work, congregate
setting work, or facility-based day
habilitation or day treatment.
(II) Minimum percent reductions;
bonus based on achievement of differing
tiers.--In order to receive a bonus
payment for a fiscal year under this
clause, a Medicaid Buy-In State shall
achieve a reduction of the population
described in subclause (I) of at least
10 percent below the State's most
recent prior fiscal year's census of
the eligible population in subminimum
wage work, congregate setting work, or
facility-based day habilitation or day
treatment. Subject to paragraph (5)(B),
the Secretary shall award an increased
bonus payment for a fiscal year to a
Medicaid Buy-In State that achieves a
percentage reduction of 20, 30, 40 or
more with respect to the prior fiscal
year's census of such population.
(III) Requirements for meeting
benchmark.--A working-age individual
with a disability shall be deemed as
counting towards a percentage reduction
for purposes of this clause if the
individual is--
(aa) employed in a
competitive, integrated
employment setting for at least
10 hours a week on average over
a 120-day period during the
year involved;
(bb) receiving integrated
day services that reach the
level of care required in the
individual's person-centered
plan; or
(cc) a combination of items
(aa) and (bb),
enabling the individual to achieve, if
desired, a comparable level of benefit
as before the change in placement. The
State must report aggregate data to the
Secretary on the outcome of all
individuals transitioning out of
congregate settings being counted
towards fulfillment of this benchmark.
(ii) Increased population census of
individual integrated employment.--
(I) In general.--Achieving an
increase in the population in the State
of working-age individuals with
disabilities who are receiving
Medicaid-funded home or community-based
services and are in individual
integrated employment.
(II) Minimum percent increases;
bonus based on achievement of certain
tiers.--In order to receive a bonus
payment for a fiscal year under this
clause, a Medicaid Buy-In State shall
achieve an increase in the population
described in subclause (I) of at least
10 percent above the State's most
recent prior fiscal year's census of
the eligible population in individual
integrated employment. Subject to
paragraph (5)(B), the Secretary shall
award an increased bonus payment for a
fiscal year to a Medicaid Buy-In State
that achieves a percentage increase of
20, 30, 40 or more with respect to the
prior fiscal year's census of such
population.
(III) Requirements for meeting
benchmark.--A working-age individual
with a disability shall be deemed as
counting towards a percentage increase
for purposes of this clause if the
individual is employed in an integrated
individual employment setting for at
least 10 hours a week on average over a
120-day period during the fiscal year
involved.
(B) Meeting the medicaid buy-in standards.--Meeting
the minimum standards established by the Secretary for
the Medicaid Buy-In Option.
(4) Additional benchmarks.--The additional benchmarks
described in this paragraph are the following:
(A) Elimination of new placement approvals.--
Eliminating new approvals for placement in the State of
working-age individuals with disabilities who are
receiving Medicaid-funded home or community-based
services in subminimum wage work, congregate setting
work, or facility-based day habilitation or day
treatment, in accordance with criteria established by
the Secretary.
(B) Demonstration of inter-agency collaboration.--
Demonstrating inter-agency collaboration between the
State agencies responsible for administering Medicaid,
vocational rehabilitation, and education (and, if the
State is participating the Promoting Readiness of
Minors in Supplemental Security Income initiative
(PROMISE), including coordination with that
initiative), in determining payer of last resort rules
and rules for providing individuals with a seamless
transition of services provided under such agencies, in
accordance with criteria established by the Secretary.
(C) Termination of vocational rehabilitation
funding.--Ending the use of vocational rehabilitation
funding for subminimum wage work, congregate setting
work, or facility-based day habilitation or day
treatment, in accordance with criteria established by
the Secretary.
(D) Workforce development.--Demonstrating in
accordance with criteria established by the Secretary
satisfaction of at least two of the following
strategies to promote workforce development:
(i) Increasing Medicaid payments for
supported employment providers for individuals
with disabilities by an amount necessary to
ensure an adequately supported employment
network, as determined by the Secretary.
(ii) Adopting employment strategies that
result in working-age individuals with
disabilities who are receiving Medicaid-funded
home or community-based services being
recruited, hired, and retained as full-time
employees of State government or by contractors
of State government.
(iii) Developing a State equivalent of
section 503 of the Rehabilitation Act of 1973
(29 U.S.C. 793) to recruit, hire, promote, and
retain working-age individuals with
disabilities who are receiving Medicaid-funded
home or community-based services with a
utilization goal of at least 7 percent of the
State government workforce.
(iv) Developing a special hiring authority
mechanism akin to the Schedule A appointing
authority under section 213.3102(u) of title 5
of the Code of Federal Regulations (commonly
referred to as the ``Schedule A Hiring
Authority'') to assist in easing the hiring of
working-age individuals with disabilities who
are receiving Medicaid-funded home or
community-based services within the State
government with an accompanying plan submitted
to the Secretary outlining targeted
implementation goals for the amount of
individuals with disabilities within State
government.
(v) Increasing the hiring of working-age
individuals with disabilities who are receiving
Medicaid-funded home or community-based
services in employment for which the individual
is compensated at or above the minimum wage,
through collaboration with the State vocational
rehabilitation and workforce development
programs and Federal contractors.
(vi) Providing State tax credits to
employers for hiring new workers who are
working-age individuals with disabilities who
are receiving Medicaid-funded home or
community-based services.
(5) Payment to states.--
(A) In general.--Subject to the succeeding
provisions of this paragraph, the Secretary shall make
a performance bonus payment to each Medicaid Buy-In
State participating in the demonstration program that
qualifies for such a payment with respect to a fiscal
year as a single payment not later than the last day of
the first calendar quarter of the fiscal year following
the fiscal year to which the performance bonus payments
applies. Payments to States made under this paragraph
shall be considered to have been made under, and are
subject to the requirements of, section 1903 of the
Social Security Act (42 U.S.C. 1396b).
(B) Determination of payment.--The performance
bonus payment for a Medicaid Buy-In State shall consist
of the additional amount that the State would have been
paid for providing medical assistance to individuals
enrolled in the State's Medicaid Buy-In Option during
the preceding fiscal year if the regular FMAP
applicable to such assistance were increased (subject
to subparagraph (C)) as follows:
(i) Two percentage points for achieving the
minimum 10 percent reduction in the mandatory
benchmark described in paragraph (3)(A) during
the preceding fiscal year (or 2.4 percentage
points for achieving a reduction of at least 20
percent (but not more than 30 percent), 2.6
percentage points for achieving a reduction of
at least 30 percent (but not more than 40
percent), and 2.8 percentage points for
achieving a reduction of at least 40 percent).
(ii) Two percentage points for achieving
the minimum 10 percent increase in the
mandatory benchmark described in paragraph
(3)(B) during the preceding fiscal year (or 2.4
percentage points for achieving an increase of
at least 20 percent (but not more than 30
percent), 2.6 percentage points for achieving
an increase of at least 30 percent (but not
more than 40 percent), and 2.8 percentage
points for achieving an increase of at least 40
percent).
(iii) One-half percentage points for each
additional benchmark described in paragraph (4)
that the State achieves during the preceding
fiscal year.
(C) Limitations.--In no case may--
(i) the increase in the regular FMAP
resulting from the application of subparagraph
(B) for any Medicaid Buy-In State exceed 100
percent of the costs for providing medical
assistance to individuals enrolled in the
Medicaid Buy-In Option with respect to each
fiscal year of the 5-fiscal-year period in
which the demonstration project is conducted;
or
(ii) payments be made to a Medicaid Buy-In
State under this paragraph after December 31,
2023.
(D) Use of payments.--A Medicaid Buy-In State
receiving a performance bonus payment under this
paragraph shall use the payment only to expand
individual integrated employment and community
integration for working-age individuals with
disabilities who are receiving Medicaid-funded home or
community-based services.
(g) Reports; Recommendations.--
(1) Annual state reports.--
(A) In general.--Each Medicaid Buy-In State
participating in the demonstration program annually
shall submit a detailed report to the Secretary
regarding the State's conduct of the demonstration
program.
(B) Information to be included.--Such annual
reports shall include, in addition to data and
information regarding State performance with respect
the mandatory and additional benchmarks described in
paragraphs (3) and (4) of subsection (f) and such other
information as the Secretary may require, data and
information regarding the extent to which, since the
start of the demonstration program--
(i) the State has reduced the State
population of individuals with disabilities who
have attained age 18 but have not attained age
31, are receiving Medicaid-funded home or
community-based services or services through an
Intermediate Care Facility for Persons with
Developmental Disabilities (ICF-DD), a nursing
facility, an institution for individuals with
mental illness, or other congregate facilities,
and were in subminimum wage work, congregate
setting work, or facility-based day
habilitation or day treatment; and
(ii) the State has increased the State
population of individuals with disabilities who
have attained age 18 but have not attained age
31, are receiving Medicaid-funded home or
community-based services, and are engaged in
individual integrated employment.
(C) Additional information on transitioning
individuals to integrated employment.--Each such annual
report shall include information regarding--
(i) the State's efforts to transition
individuals with disabilities who are
participating in the demonstration program to
individual integrated employment during the
preceding fiscal year;
(ii) the full spectrum of employment
outcomes for such individuals;
(iii) best practices for successfully
achieving such transitions; and
(iv) lessons learned.
(D) Promoting public participation.--To promote
transparency with respect to such annual reports, each
Medicaid Buy-In State shall--
(i) provide, before submission of each such
report--
(I) for posting of a draft of the
report for review by the public on a
publicly accessible Web site of the
State;
(II) for providing a period of not
less than 30 days for the receipt of
public comments on the draft report;
and
(III) for at least two public
hearings regarding the draft report;
and
(ii) include in the report so submitted a
response to public comments received during
such period (along with a description of
whether changes have been made in the report in
response to such comments).
With respect to each such State report submitted, the
Secretary, at the Federal level, shall provide for
another 30-day public comment period to receive
comments on such report.
(E) Posting of reports on publicly accessible web
site.--The Secretary shall post each of the annual
reports submitted under this paragraph, with a summary
of the comments received under subparagraph (D), on a
publicly accessible Web site.
(2) Reports and recommendations to congress.--
(A) In general.--Not later than January 1, 2020,
and January 1 of each of the 6 years thereafter, the
Secretary shall submit to Congress a report on the
demonstration program. Each such report shall include
data and information regarding State performance with
respect to each of the mandatory and additional
benchmarks described in paragraphs (3) and (4) of
subsection (f) and other data and information reported
by States under paragraph (1) and an assessment of the
extent to which the demonstration program is successful
in transitioning working-age individuals with
disabilities to independent living and work in their
communities.
(B) Recommendations.--Not later than December 31,
2021, the Secretary shall submit to Congress
recommendations regarding whether the demonstration
program should be continued, expanded, modified, or
terminated.
(3) Research and evaluation.--
(A) In general.--The Secretary, acting through the
Administration on Community Living, directly or through
grant or contract, shall provide for research on, and a
national evaluation of, the demonstration program,
including assistance to the Secretary in preparing the
final report required under subparagraph (C).
(B) Contents of evaluation.--Such national
evaluation shall include an analysis of the
characteristics and outcomes of the individuals
participating in the demonstration program and the best
practices developed to achieve the goals of the
demonstration program.
(C) Final report.--Not later than June 30, 2022,
the Secretary shall submit to the President and
Congress a final report that reflects the evaluation
under subparagraph (A), that provides findings and
conclusions on the conduct and effectiveness of
demonstration program, and that includes a summary of
the public comments received under paragraph (1)(D).
(h) Definitions.--In this section:
(1) Congregate setting work.--The term ``congregate setting
work'' means a nonprofit, for-profit, or State agency entity
that employs a majority of individuals with disabilities and
receives Medicaid or other State funds for the purpose of
providing employment services, or a facility or sub-unit of any
such agency that meets such criteria.
(2) Demonstration program.--The term ``demonstration
program'' means the Transition to Independence Demonstration
Program established under this section.
(3) Facility-based day habilitation or day treatment.--The
term ``facility-based day habilitation or day treatment'' has
the meaning established by the Secretary for that term for
purposes of the demonstration program and shall include non-
residential day services which take place predominantly or in
large part at a single site, fixed site, or center-based
program for individuals with disabilities. In establishing the
meaning of such term, the Secretary shall provide clear
instructions distinguishing facility-based day habilitation or
day treatment from integrated day habilitation or day treatment
programs taking place in settings within the broader community
and which do not isolate individuals participating in such
integrated day habilitation or day treatment programs from
mainstream life.
(4) Individual integrated employment.--
(A) In general.--The term ``individual integrated
employment'' means the ongoing supports to an
individual who, because of the individual's
disabilities, needs intensive on-going supports to
obtain and maintain an individual job in competitive or
customized employment, self-employment, or in an
integrated working setting in the general workforce for
which the individual is compensated at or above the
minimum wage, but not less than the customary wage and
level of benefits paid by the employer for the same or
similar work performed by an individual without a
disability.
(B) Customized employment services included.--Such
term includes customized employment services in which
an individual receives support to craft a job
description around their strengths and challenges.
(C) Exclusions.--Such term does not include
segregated enclaves, segregated mobile work crews, or
other employment scenarios where an individual is
placed solely based on the individual's disability. In
this subparagraph, the term ``segregated'' means, with
respect to a setting or work crew, a setting or work
crew in which individuals with disabilities are
separated (in place or in rates of pay) from
individuals without disabilities.
(5) Integrated day habilitation services.--The term
``integrated day habilitation services'' means services that
are provided outside of disability specific programs or
facilities, in a setting that supports the full access of
individuals with disabilities to the greater community to the
same degree as individuals not receiving services, and
consistent with the following:
(A) Each individual receiving such services has an
individually tailored schedule that is directly related
to and reflects the individual's specific interests and
goals.
(B) Activities take place on an individual basis or
in small groups of individuals who choose to be served
together.
(C) The majority of time spent receiving such
services takes place within the broader community
rather than within a single-site, fixed site, or
center-based program for individuals with disabilities,
regardless of the program size.
(D) The services are provided consistent with the
requirements of section 441.710 of title 42, Code of
Federal Regulations.
(6) Medicaid.--The term ``Medicaid'' means the program for
medical assistance established under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(7) Medicaid buy-in state.--The term ``Medicaid Buy-In
State'' means a State that, under subclause (XIII), (XV), or
(XVI) of section 1902(a)(10)(A)(ii) of the Social Security Act
(42 U.S.C. 1396a(a)(10)(A)(ii)), a waiver approved under
section 1115 or 1915 of such Act (42 U.S.C. 1315, 1396n), or
other authority, has a program under which individuals with
disabilities with earnings and assets that would otherwise make
them ineligible for medical assistance under the State's
Medicaid program are able to maintain their eligibility for
such assistance.
(8) Nursing facility.--The term ``nursing facility'' has
the meaning given that term in section 1919(a) of the Social
Security Act (42 U.S.C. 1396r(a)).
(9) Poverty line.--The term ``poverty line'' has the
meaning given that term in section 2110(c)(5) of the Social
Security Act (42 U.S.C. 1397jj(c)(5)).
(10) Regular fmap.--The term ``regular FMAP'' means the
Federal medical assistance percentage applicable to the State
(as determined under section 1905(b) of the Social Security Act
(42 U.S.C. 1396d(b))) without regard to any increases in that
percentage applicable under subsection (y), (z), (aa), or (dd)
of section 1905 of such Act or under any other provision of
law.
(11) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(12) Subminimum wage work.--The term ``subminimum wage
work'' means any setting in which individuals with disabilities
are paid less than minimum wage under a certificate issued in
accordance with section 14(c) of the Fair Labor Standards Act
of 1938 (29 U.S.C. 214(c)).
(13) Supported employment.--The term ``supported
employment'' has the meaning given that term in section 7 of
the Rehabilitation Act of 1973 (29 U.S.C. 705).
(14) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(15) Title ii disability beneficiary.--The term ``title II
disability beneficiary'' means an individual entitled to
disability insurance benefits under section 223 of the Social
Security Act (42 U.S.C. 423) or to monthly insurance benefits
under section 202 of such Act (42 U.S.C. 402) based on such
individual's disability (as defined in section 223(d) of such
Act (42 U.S.C. 423(d))).
(16) Title xvi disability beneficiary.--The term ``title
XVI disability beneficiary'' means an individual eligible for
supplemental security income benefits under title XVI of the
Social Security Act (42 U.S.C. 1381 et seq.) on the basis of
blindness (within the meaning of section 1614(a)(2) of such Act
(42 U.S.C. 1382c(a)(2))) or disability (within the meaning of
section 1614(a)(3) of such Act (42 U.S.C. 1382c(a)(3))).
(17) Working-age individual with a disability receiving
medicaid-funded home or community-based services.--The term
``working-age individual with a disability receiving Medicaid-
funded home or community-based services'' means a title II
disability beneficiary or a title XVI disability beneficiary
who has attained age 18, but has not attained age 65, and is
receiving home or community-based services--
(A) under a waiver approved under subsection (c) or
(d) of section 1915 the Social Security Act (42 U.S.C.
1396n);
(B) under the State Medicaid plan in accordance
with subsection (i), (j), or (k) of such section; or
(C) under a Medicaid waiver approved under section
1115 of the Social Security Act (42 U.S.C. 1315).
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