1. Short title This Act may be cited as the Medicaid Services Investment and Accountability Act of 2019 . 2. Extension of protection for Medicaid recipients of home and community-based services against spousal impoverishment (a) In general Section 2404 of Public Law 111–148 ( 42 U.S.C. 1396r–5 note), as amended by section 3(a) of the Medicaid Extenders Act of 2019 ( Public Law 116–3 ), is amended by striking March 31, 2019 and inserting September 30, 2019 . (b) Rule of construction (1) Protecting State spousal income and asset disregard flexibility under waivers and plan amendments Nothing in section 2404 of Public Law 111–148 ( 42 U.S.C. 1396r–5 note) or section 1924 of the Social Security Act ( 42 U.S.C. 1396r–5 ) shall be construed as prohibiting a State from disregarding an individual’s spousal income and assets under a State waiver or plan amendment described in paragraph (2) for purposes of making determinations of eligibility for home and community-based services or home and community-based attendant services and supports under such waiver or plan amendment. (2) State waiver or plan amendment described A State waiver or plan amendment described in this paragraph is any of the following: (A) A waiver or plan amendment to provide medical assistance for home and community-based services under a waiver or plan amendment under subsection (c), (d), or (i) of section 1915 of the Social Security Act ( 42 U.S.C. 1396n ) or under section 1115 of such Act ( 42 U.S.C. 1315 ). (B) A plan amendment to provide medical assistance for home and community-based services for individuals by reason of being determined eligible under section 1902(a)(10)(C) of such Act ( 42 U.S.C. 1396a(a)(10)(C) ) or by reason of section 1902(f) of such Act ( 42 U.S.C. 1396a(f) ) or otherwise on the basis of a reduction of income based on costs incurred for medical or other remedial care under which the State disregarded the income and assets of the individual’s spouse in determining the initial and ongoing financial eligibility of an