; and (B) in subsection (d)(1), by striking to which and inserting to which, subject to section 1903A(a), ; and (2) by inserting after such section 1903 the following new section: 1903A. Per capita-based cap on payments for medical assistance (a) Application of per capita cap on payments for medical assistance expenditures (1) In general If a State has excess aggregate medical assistance expenditures (as defined in paragraph (2)) for a fiscal year (beginning with fiscal year 2020), the amount of payment to the State under section 1903(a)(1) for each quarter in the following fiscal year shall be reduced by ¼ of the excess aggregate medical assistance payments (as defined in paragraph (3)) for that previous fiscal year. In this section, the term State means only the 50 States and the District of Columbia. (2) Excess aggregate medical assistance expenditures In this subsection, the term excess aggregate medical assistance expenditures means, for a State for a fiscal year, the amount (if any) by which— (A) the amount of the adjusted total medical assistance expenditures (as defined in subsection (b)(1)) for the State and fiscal year; exceeds (B) the amount of the target total medical assistance expenditures (as defined in subsection (c)) for the State and fiscal year. (3) Excess aggregate medical assistance payments In this subsection, the term excess aggregate medical assistance payments means, for a State for a fiscal year, the product of— (A) the excess aggregate medical assistance expenditures (as defined in paragraph (2)) for the State for the fiscal year