; to (ii) the sum of all States’ total expenditures under all State plans under this title in the fiscal year described in clause (i). (D) Funds not used by the State If the Secretary determines, on the basis of information available on the first day of a fiscal year, that any allocation under subparagraph (C) to a State for such fiscal year will not be required because a State does not have a State plan amendment approved under subsection (b) for such fiscal year, then such State’s allocation shall be treated as an unused allocation for such fiscal year and re-allocated in accordance with subparagraph (E)(i). (E) Qualifying States (i) Re-allocation to qualifying States In addition to the allocation available to a State under subparagraph (C), the Secretary shall allocate to each qualifying State for a fiscal year, out of the sum of unused allocations, as described in subparagraph (D), for such fiscal year, an amount in proportion to the ratio of— (I) each such State’s total expenditures under the State plan under this title in the most recent fiscal year for which complete expenditure data is available; to (II) the sum of all such States’ total expenditures under all State plans of such States under this title in the fiscal year described in subclause (I). (ii) Availability of funds Allocations made to a qualifying State under clause (i) and subparagraph (C) shall remain available until expended. (iii) Definitions In this section, the term qualifying State means a State with a State plan amendment approved under this section that— (I) has in effect an agreement with one or more qualified community health system initiatives