Appropriation

(A) In general There are appropriated, out of any money in the Treasury not otherwise appropriated, to the Administrator of the Centers for Medicare & Medicaid Services (in this subsection referred to as the “Administrator”), to provide allotments to States for purposes of carrying out the activities described in paragraph (6)— (i) $10,000,000,000 for fiscal year 2026; (ii) $10,000,000,000 for fiscal year 2027; (iii) $10,000,000,000 for fiscal year 2028; (iv) $10,000,000,000 for fiscal year 2029; and (v) $10,000,000,000 for fiscal year 2030.

(B) Unexpended or unobligated funds (i) In general Any amounts appropriated under subparagraph (A) that are unexpended or unobligated as of October 1, 2032 , shall be returned to the Treasury of the United States. (ii) Redistribution of unexpended or unobligated funds In carrying out subparagraph (A), the Administrator shall, not later than March 31, 2028 , and annually thereafter through March 31, 2032 , determine the amount of funds, if any, that are available under such subparagraph for a previous fiscal year, are unexpended or unobligated with respect to such fiscal year, and will not be available to a State in the current fiscal year, pursuant to clause (iii). (iii) Availability of funds (I) In general Amounts allotted to a State under this subsection for a year shall be available for expenditure by the State through the end of the fiscal year following the fiscal year in which such amounts are allotted. (II) Availability of amounts redistributed Amounts redistributed to a State under clause (ii) with respect to a fiscal year shall be available for expenditure by the State through the end of the fiscal year following the fiscal year in which such amounts are redistributed (except in the case of amounts redistributed in fiscal year 2032 which shall only be available for expenditure through September 30, 2032 ). (iv) Misuse of funds If the Administrator determines that a State is not using amounts allotted or redistributed to the State under this subsection in a manner consistent with the description provided by the State in its application approved under paragraph (2), the Administrator may withhold payments to, or reduce payments to, or recover previous payments from, the State under this subsection as the Administrator deems appropriate, and any amounts so withheld, or that remain after any such reduction, or so recovered, shall be returned to the Treasury of the United States.