; (ii) is an essential community provider described in section 156.235 of title 45, Code of Federal Regulations (as in effect on the date of enactment of this Act), that is primarily engaged in family planning services, reproductive health, and related medical care; and (iii) provides for abortions, other than an abortion— (I) if the pregnancy is the result of an act of rape or incest; or (II) in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself; and (B) for which the total amount of Federal and State expenditures under the Medicaid program under title XIX of the Social Security Act in fiscal year 2014 made directly to the entity and to any affiliates, subsidiaries, successors, or clinics of the entity, or made to the entity and to any affiliates, subsidiaries, successors, or clinics of the entity as part of a nationwide health care provider network, exceeded $350,000,000. (2) Direct spending The term direct spending has the meaning given that term under section 250(c) of the Balanced Budget and Emergency Deficit Control Act of 1985 ( 2 U.S.C. 900(c) ). B Medicaid Program Enhancement 111. Repeal of Medicaid provisions The Social Security Act is amended— (1) in section 1902 ( 42 U.S.C. 1396a )— (A) in subsection (a)(47)(B), by inserting and provided that any such election shall cease to be effective on January 1, 2020, and no such election shall be made after that date before the semicolon at the end; and (B) in subsection (l)(2)(C), by inserting and ending December 31, 2019, after January 1, 2014, ; (2) in section 1915(k)(2) ( 42 U.S.C. 1396n(k)(2) ), by striking during the period described in paragraph (1) and inserting on or after the date referred to in paragraph (1) and before January 1, 2020