Title IV, SEC. 4211. SPENDDOWN ELIGIBILITY FOR NURSING FACILITY RESIDENTS. 
      (a) In General. Section 1902(a)(10)(A)(i) (42 U.S.C. 1396a(a)(10)(A)(i)) 
    is amended 

        (1) by striking ``or'' at the end of subclause (VI); 

        (2) by striking the semicolon at the end of subclause (VII) and 
      inserting ``, or''; and 

        (3) by inserting after subclause (VII) the following new subclause: 

        ``(VIII) who are individuals who would meet the income and resource 
      requirements of the appropriate State plan described in subclause (I) or 
      the supplemental security income program (as the case may be), if 
      incurred expenses for medical care as recognized under State law were 
      deducted from income;''. 

      (b) Limitation to Benefits for Nursing Facility Services. Section 
    1902(a)(10)(A) of such Act (42 U.S.C. 1396a(a)(10)(A)), as amended by 
    section 13603(c)(1) of OBRA	1993, is amended in the matter following 
    subparagraph (F) 

        (1) by striking ``and (XIII)'' and inserting ``(XIII)''; and 

        (2) by inserting before the semicolon at the end the following: ``, and 
      (XIV) the medical assistance made available to an individual described in 
      subparagraph (A)(i)(VIII) shall be limited to medical assistance for 
      nursing facility services, except to the extent that assistance is 
      provided in accordance with the option described in section 1932 in the 
      case of a State exercising such option''. 

      (c) Effective Date. The amendments made by subsections (a) and (b) shall 
    apply with respect to a State as of January 1, 1996.