# Children's Health Insurance Program Reauthorization Act of 2009/Title II/Subtitle A
### SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUNDING FOR OUTREACH AND ENROLLMENT.

    (a) Grants.-
       Title XXI (42 U.S.C. 1397aa et seq.), as amended by section 111, is amended by adding at the end the following:
          SEC. 111. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN UNDER CHIP THROUGH A STATE PLAN AMENDMENT.
             (a) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et seq.), as amended by section 112(a), is amended by adding at the end the following new section:
                   ‘‘SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS; CONDITIONS FOR COVERAGE OF PARENTS.
                      ‘‘(a) TERMINATION OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS.—
                         ‘‘(1) NO NEW CHIP WAIVERS; AUTOMATIC EXTENSIONS AT STATE OPTION THROUGH FISCAL YEAR 2010.—Notwithstanding section 1115 or any other provision of this title, except as provided in this subsection—
                            ‘‘(A) the Secretary shall not on or after the date of the enactment of the Children’s Health Insurance Program Reauthorization Act of 2009, approve or renew a waiver, experimental, pilot, or demonstration project that would allow funds made available under this title to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult; and
                            ‘‘(B) notwithstanding the terms and conditions of an applicable existing waiver, the provisions of paragraphs (2) and (3) shall apply for purposes of any period beginning on or after October 1, 2010, in determining the period to which the waiver applies, the individuals eligible to be covered by the waiver, and the amount of the Federal payment under this title.
                         ‘‘(2) TERMINATION OF CHIP COVERAGE UNDER APPLICABLE EXISTING WAIVERS AT THE END OF FISCAL YEAR 2010.—
                            ‘‘(A) IN GENERAL.—No funds shall be available under this title for child health assistance or other health benefits coverage that is provided to a nonpregnant childless adult under an applicable existing waiver after September 30, 2010.
                            ‘‘(B) EXTENSION UPON STATE REQUEST.—If an applicable existing waiver described in subparagraph (A) would otherwise expire before October 1, 2010, and the State requests an extension of such waiver, the Secretary shall grant such an extension, but only through September 30, 2011.
                            ‘‘(C) APPLICATION OF ENHANCED FMAP.— The enhanced FMAP determined under section 2105(b) shall apply to expenditures under an applicable existing waiver for the provision of child health assistance or other health benefits coverage to a nonpregnant childless adult during fiscal year 2010.
                         ‘‘(3) OPTIONAL 1-YEAR TRANSITIONAL COVERAGE BLOCK GRANT FUNDED FROM STATE ALLOTMENT.—Subject to paragraph (4)(B), each State for which coverage under an applicable existing waiver is terminated under paragraph (2)(A) may elect to provide nonpregnant childless adults who were provided child health assistance or health benefits coverage under the applicable existing waiver at any time during fiscal year 2010 with such assistance or coverage during fiscal year 2011, as if the authority to provide such assistance or coverage under an applicable existing waiver was extended through that fiscal year, but subject to the following terms and conditions:
                            ‘‘(A) BLOCK GRANT SET ASIDE FROM STATE ALLOTMENT.—The Secretary shall set aside for the State an amount equal to the Federal share of the State’s projected expenditures under the applicable existing waiver for providing child health assistance or health benefits coverage to all nonpregnant childless adults under such waiver for fiscal year 2010 (as certified by the State and submitted to the Secretary by not later than August 31, 2010, and without regard to whether any such individual lost coverage during fiscal year 2010 and was later provided child health assistance or other health benefits coverage under the waiver in that fiscal year), increased by the annual adjustment for fiscal year 2011 determined under section 2104(m)(5)(A). The Secretary may adjust the amount set aside under the preceding sentence, as necessary, on the basis of the expenditure data for fiscal year 2010 reported by States on CMS Form 64 or CMS Form 21 not later than November 30, 2010, but in no case shall the Secretary adjust such amount after December 31, 2010.
                            ‘‘(B) NO COVERAGE FOR NONPREGNANT CHILDLESS ADULTS WHO WERE NOT COVERED DURING FISCAL YEAR 2010.—
                               ‘‘(i) FMAP APPLIED TO EXPENDITURES.—The Secretary shall pay the State for each quarter of fiscal year 2011, from the amount set aside under subparagraph (A), an amount equal to the Federal medical assistance percentage (as determined under section 1905(b) without regard to clause (4) of such section) of expenditures in the quarter for providing child health assistance or other health benefits coverage to a nonpregnant childless adult but only if such adult was enrolled in the State program under this title during fiscal year 2010 (without regard to whether the individual lost coverage during fiscal year 2010 and was reenrolled in that fiscal year or in fiscal year 2011).
                               ‘‘(ii) FEDERAL PAYMENTS LIMITED TO AMOUNT OF BLOCK GRANT SET-ASIDE.—No payments shall be made to a State for expenditures described in this subparagraph after the total amount set aside under subparagraph (A) for fiscal year 2011 has been paid to the State.
                         ‘‘(4) STATE OPTION TO APPLY FOR MEDICAID WAIVER TO CONTINUE COVERAGE FOR NONPREGNANT CHILDLESS ADULTS.—
                            ‘‘(A) IN GENERAL.—Each State for which coverage under an applicable existing waiver is terminated under paragraph (2)(A) may submit, not later than June 30, 2011, an application to the Secretary for a waiver under section 1115 of the State plan under title XIX to provide medical assistance to a nonpregnant childless adult whose coverage is so terminated (in this subsection referred to as a ‘Medicaid nonpregnant childless adults waiver’).
                            ‘‘(B) DEADLINE FOR APPROVAL.—The Secretary shall make a decision to approve or deny an application for a Medicaid nonpregnant childless adults waiver submitted under subparagraph (A) within 90 days of the date of the submission of the application. If no decision has been made by the Secretary as of September 30, 2011, on the application of a State for a Medicaid nonpregnant childless adults waiver that was submitted to the Secretary by June 30, 2011, the application shall be deemed approved.
                            ‘‘(C) STANDARD FOR BUDGET NEUTRALITY.—The budget neutrality requirement applicable with respect to expenditures for medical assistance under a Medicaid nonpregnant childless adults waiver shall—
                               ‘‘(i) in the case of fiscal year 2012, allow expenditures for medical assistance under title XIX for all such adults to not exceed the total amount of payments made to the State under paragraph (3)(B) for fiscal year 2011, increased by the percentage increase (if any) in the projected nominal per capita amount of National Health Expenditures for calendar year 2012 over 2011, as most recently published by the Secretary; and
                               ‘‘(ii) in the case of any succeeding fiscal year, allow such expenditures to not exceed the amount in effect under this subparagraph for the preceding fiscal year, increased by the percentage increase (if any) in the projected nominal per capita amount of National Health Expenditures for the calendar year that begins during the fiscal year involved over the preceding calendar year, as most recently published by the Secretary.
                      ‘‘(b) RULES AND CONDITIONS FOR COVERAGE OF PARENTS OF TARGETED LOW-INCOME CHILDREN.—
                         ‘‘(1) TWO-YEAR TRANSITION PERIOD; AUTOMATIC EXTENSION AT STATE OPTION THROUGH FISCAL YEAR 2011.—
                            ‘‘(A) NO NEW CHIP WAIVERS.—Notwithstanding section 1115 or any other provision of this title, except as provided in this subsection—
                               ‘‘(i) the Secretary shall not on or after the date of the enactment of the Children’s Health Insurance Program Reauthorization Act of 2009 approve or renew a waiver, experimental, pilot, or demonstration project that would allow funds made available under this title to be used to provide child health assistance or other health benefits coverage to a parent of a targeted low-income child; and
                               ‘‘(ii) notwithstanding the terms and conditions of an applicable existing waiver, the provisions of paragraphs (2) and (3) shall apply for purposes of any fiscal year beginning on or after October 1, 2011, in determining the period to which the waiver applies, the individuals eligible to be covered by the waiver, and the amount of the Federal payment under this title.
                            ‘‘(B) EXTENSION UPON STATE REQUEST.—If an applicable existing waiver described in subparagraph (A) would otherwise expire before October 1, 2011, and the State requests an extension of such waiver, the Secretary shall grant such an extension, but only, subject to paragraph (2)(A), through September 30, 2011.
                            ‘‘(C) APPLICATION OF ENHANCED FMAP.— The enhanced FMAP determined under section 2105(b) shall apply to expenditures under an applicable existing waiver for the provision of child health assistance or other health benefits coverage to a parent of a targeted low-income child during the third and fourth quarters of fiscal year 2009 and during fiscal years 2010 and 2011.
                         ‘‘(2) RULES FOR FISCAL YEARS 2012 THROUGH 2013.—
                            ‘‘(A) PAYMENTS FOR COVERAGE LIMITED TO BLOCK GRANT FUNDED FROM STATE ALLOTMENT.—Any State that provides child health assistance or health benefits coverage under an applicable existing waiver for a parent of a targeted low-income child may elect to continue to provide such assistance or coverage through fiscal year 2012 or 2013, subject to the same terms and conditions that applied under the applicable existing waiver, unless otherwise modified in subparagraph (B).
                            ‘‘(B) TERMS AND CONDITIONS.—
                               ‘‘(i) BLOCK GRANT SET ASIDE FROM STATE ALLOTMENT.—If the State makes an election under subparagraph (A), the Secretary shall set aside for the State for each such fiscal year an amount equal to the Federal share of 110 percent of the State’s projected expenditures under the applicable existing waiver for providing child health assistance or health benefits coverage to all parents of targeted low-income children enrolled under such waiver for the fiscal year (as certified by the State and submitted to the Secretary by not later than August 31 of the preceding fiscal year). In the case of fiscal year 2013, the set aside for any State shall be computed separately for each period described in subparagraphs (A) and (B) of section 2104(a)(16) and any reduction in the allotment for either such period under section 2104(m)(4) shall be allocated on a pro rata basis to such set aside.
                               ‘‘(ii) PAYMENTS FROM BLOCK GRANT.—The Secretary shall pay the State from the amount set aside under clause (i) for the fiscal year, an amount for each quarter of such fiscal year equal to the applicable percentage determined under clause (iii) or (iv) for expenditures in the quarter for providing child health assistance or other health benefits coverage to a parent of a targeted low-income child.
                               ‘‘(iii) ENHANCED FMAP ONLY IN FISCAL YEAR 2012 FOR STATES WITH SIGNIFICANT CHILD OUTREACH OR THAT ACHIEVE CHILD COVERAGE BENCHMARKS; FMAP FOR ANY OTHER STATES.—For purposes of clause (ii), the applicable percentage for any quarter of fiscal year 2012 is equal to—
                                  ‘‘(I) the enhanced FMAP determined under section 2105(b) in the case of a State that meets the outreach or coverage benchmarks described in any of subparagraph (A), (B), or (C) of paragraph (3) for fiscal year 2011; or
                                  ‘‘(II) the Federal medical assistance percentage (as determined under section 1905(b) without regard to clause (4) of such section) in the case of any other State.
                               ‘‘(iv) AMOUNT OF FEDERAL MATCHING PAYMENT IN 2013.—For purposes of clause (ii), the applicable percentage for any quarter of fiscal year 2013 is equal to—
                                  ‘‘(I) the REMAP percentage if—
                                     ‘‘(aa) the applicable percentage for the State under clause (iii) was the enhanced FMAP for fiscal year 2012; and
                                     ‘‘(bb) the State met either of the coverage benchmarks described in subparagraph (B) or (C) of paragraph (3) for 2012; or
                                  ‘‘(II) the Federal medical assistance percentage (as so determined) in the case of any State to which subclause (I) does not apply.
                               For purposes of subclause (I), the REMAP percentage is the percentage which is the sum of such Federal medical assistance percentage and a number of percentage points equal to one-half of the difference between such Federal medical assistance percentage and such enhanced FMAP.
                                  ‘‘(v) NO FEDERAL PAYMENTS OTHER THAN FROM BLOCK GRANT SET ASIDE.— No payments shall be made to a State for expenditures described in clause (ii) after the total amount set aside under clause (i) for a fiscal year has been paid to the State.
                                  ‘‘(vi) NO INCREASE IN INCOME ELIGIBILITY LEVEL FOR PARENTS.—No payments shall be made to a State from the amount set aside under clause (i) for a fiscal year for expenditures for providing child health assistance or health benefits coverage to a parent of a targeted low-income child whose family income exceeds the income eligibility level applied under the applicable existing waiver to parents of targeted low-income children on the date of enactment of the Children’s Health Insurance Program Reauthorization Act of 2009.
                         ‘‘(3) OUTREACH OR COVERAGE BENCHMARKS.—For purposes of paragraph (2), the outreach or coverage benchmarks described in this paragraph are as follows:
                            ‘‘(A) SIGNIFICANT CHILD OUTREACH CAMPAIGN.—The State—
                               ‘‘(i) was awarded a grant under section 2113 for fiscal year 2011;
                               ‘‘(ii) implemented 1 or more of the enrollment and retention provisions described in section 2105(a)(4) for such fiscal year; or
                               ‘‘(iii) has submitted a specific plan for outreach for such fiscal year.
                            ‘‘(B) HIGH-PERFORMING STATE.—The State, on the basis of the most timely and accurate published estimates of the Bureau of the Census, ranks in the lowest 1⁄3 of States in terms of the State’s percentage of low-income children without health insurance.
                            ‘‘(C) STATE INCREASING ENROLLMENT OF LOW-INCOME CHILDREN.—The State qualified for a performance bonus payment under section 2105(a)(3)(B) for the most recent fiscal year applicable under such section.
                         ‘‘(4) RULES OF CONSTRUCTION.—Nothing in this subsection shall be construed as prohibiting a State from submitting an application to the Secretary for a waiver under section 1115 of the State plan under title XIX to provide medical assistance to a parent of a targeted low-income child that was provided child health assistance or health benefits coverage under an applicable existing waiver.
                      ‘‘(c) APPLICABLE EXISTING WAIVER.—For purposes of this section—
                         ‘‘(1) IN GENERAL.—The term ‘applicable existing waiver’ means a waiver, experimental, pilot, or demonstration project under section 1115, grandfathered under section 6102(c)(3) of the Deficit Reduction Act of 2005, or otherwise conducted under authority that—
                            ‘‘(A) would allow funds made available under this title to be used to provide child health assistance or other health benefits coverage to—
                               ‘‘(i) a parent of a targeted low-income child;
                               ‘‘(ii) a nonpregnant childless adult; or
                               ‘‘(iii) individuals described in both clauses (i) and (ii); and
                            ‘‘(B) was in effect during fiscal year 2009.
                         ‘‘(2) DEFINITIONS.—
                            ‘‘(A) PARENT.—The term ‘parent’ includes a caretaker relative (as such term is used in carrying out section 1931) and a legal guardian.
                            ‘‘(B) NONPREGNANT CHILDLESS ADULT.— The term ‘nonpregnant childless adult’ has the meaning given such term by section 2107(f).’’.
             (b) ADDITIONAL CONFORMING AMENDMENTS.—
                (1) NO COST SHARING FOR PREGNANCY-RELATED BENEFITS.—Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended—
                   (A) in the heading, by inserting ‘‘OR PREGNANCY-RELATED ASSISTANCE’’ after ‘‘PREVENTIVE SERVICES’’; and
                   (B) by inserting before the period at the end the following: ‘‘or for pregnancy-related assistance’’.
                (2) NO WAITING PERIOD.—Section 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is amended—
                   (A) in clause (i), by striking ‘‘, and’’ at the end and inserting a semicolon;
                   (B) in clause (ii), by striking the period at the end and inserting ‘‘; and’’; and
                   (C) by adding at the end the following new clause:
                               ‘‘(iii) may not apply a waiting period (including a waiting period to carry out paragraph (3)(C)) in the case of a targeted low-income pregnant woman provided pregnancy-related assistance under section 2112.’’.
          SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS UNDER CHIP; CONDITIONS FOR COVERAGE OF PARENTS.
             (a) PHASE-OUT RULES.—
                (1) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et seq.) is amended by adding at the end the following new section:
                   `SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT.
                      `(a) Outreach and Enrollment Grants; National Campaign-
                         `(1) IN GENERAL- From the amounts appropriated under subsection (g), subject to paragraph (2), the Secretary shall award grants to eligible entities during the period of fiscal years 2009 through 2013 to conduct outreach and enrollment efforts that are designed to increase the enrollment and participation of eligible children under this title and title XIX.
                         `(2) TEN PERCENT SET ASIDE FOR NATIONAL ENROLLMENT CAMPAIGN- An amount equal to 10 percent of such amounts shall be used by the Secretary for expenditures during such period to carry out a national enrollment campaign in accordance with subsection (h).
                      `(b) Priority for Award of Grants-
                         `(1) IN GENERAL- In awarding grants under subsection (a), the Secretary shall give priority to eligible entities that--
                            `(A) propose to target geographic areas with high rates of--
                               `(i) eligible but unenrolled children, including such children who reside in rural areas; or
                               `(ii) racial and ethnic minorities and health disparity populations, including those proposals that address cultural and linguistic barriers to enrollment; and
                            `(B) submit the most demonstrable evidence required under paragraphs (1) and (2) of subsection (c).
                         `(2) TEN PERCENT SET ASIDE FOR OUTREACH TO INDIAN CHILDREN- An amount equal to 10 percent of the funds appropriated under subsection (g) shall be used by the Secretary to award grants to Indian Health Service providers and urban Indian organizations receiving funds under title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.) for outreach to, and enrollment of, children who are Indians.
                      `(c) Application- An eligible entity that desires to receive a grant under subsection (a) shall submit an application to the Secretary in such form and manner, and containing such information, as the Secretary may decide. Such application shall include--
                         `(1) evidence demonstrating that the entity includes members who have access to, and credibility with, ethnic or low-income populations in the communities in which activities funded under the grant are to be conducted;
                         `(2) evidence demonstrating that the entity has the ability to address barriers to enrollment, such as lack of awareness of eligibility, stigma concerns and punitive fears associated with receipt of benefits, and other cultural barriers to applying for and receiving child health assistance or medical assistance;
                         `(3) specific quality or outcomes performance measures to evaluate the effectiveness of activities funded by a grant awarded under this section; and
                         `(4) an assurance that the eligible entity shall--
                            `(A) conduct an assessment of the effectiveness of such activities against the performance measures;
                            `(B) cooperate with the collection and reporting of enrollment data and other information in order for the Secretary to conduct such assessments; and
                            `(C) in the case of an eligible entity that is not the State, provide the State with enrollment data and other information as necessary for the State to make necessary projections of eligible children and pregnant women.
                      `(d) Dissemination of Enrollment Data and Information Determined From Effectiveness Assessments; Annual Report- The Secretary shall--
                         `(1) make publicly available the enrollment data and information collected and reported in accordance with subsection (c)(4)(B); and
                         `(2) submit an annual report to Congress on the outreach and enrollment activities conducted with funds appropriated under this section.
                      `(e) Maintenance of Effort for States Awarded Grants; No Match Required for Any Eligible Entity Awarded a Grant-
                         `(1) STATE MAINTENANCE OF EFFORT- In the case of a State that is awarded a grant under this section, the State share of funds expended for outreach and enrollment activities under the State child health plan shall not be less than the State share of such funds expended in the fiscal year preceding the first fiscal year for which the grant is awarded.
                         `(2) NO MATCHING REQUIREMENT- No eligible entity awarded a grant under subsection (a) shall be required to provide any matching funds as a condition for receiving the grant.
                      `(f) Definitions- In this section:
                         `(1) ELIGIBLE ENTITY- The term `eligible entity' means any of the following:
                            `(A) A State with an approved child health plan under this title.
                            `(B) A local government.
                            `(C) An Indian tribe or tribal consortium, a tribal organization, an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.), or an Indian Health Service provider.
                            `(D) A Federal health safety net organization.
                            `(E) A national, State, local, or community-based public or nonprofit private organization, including organizations that use community health workers or community-based doula programs.
                            `(F) A faith-based organization or consortia, to the extent that a grant awarded to such an entity is consistent with the requirements of section 1955 of the Public Health Service Act (42 U.S.C. 300x-65) relating to a grant award to nongovernmental entities.
                            `(G) An elementary or secondary school.
                         `(2) FEDERAL HEALTH SAFETY NET ORGANIZATION- The term `Federal health safety net organization' means--
                            `(A) a Federally-qualified health center (as defined in section 1905(l)(2)(B));
                            `(B) a hospital defined as a disproportionate share hospital for purposes of section 1923;
                            `(C) a covered entity described in section 340B(a)(4) of the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
                            `(D) any other entity or consortium that serves children under a federally funded program, including the special supplemental nutrition program for women, infants, and children (WIC) established under section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786), the Head Start and Early Head Start programs under the Head Start Act (42 U.S.C. 9801 et seq.), the school lunch program established under the Richard B. Russell National School Lunch Act, and an elementary or secondary school.
                         `(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANIZATION; URBAN INDIAN ORGANIZATION- The terms `Indian', `Indian tribe', `tribal organization', and `urban Indian organization' have the meanings given such terms in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603).
                         `(4) COMMUNITY HEALTH WORKER- The term `community health worker' means an individual who promotes health or nutrition within the community in which the individual resides--
                            `(A) by serving as a liaison between communities and health care agencies;
                            `(B) by providing guidance and social assistance to community residents;
                            `(C) by enhancing community residents' ability to effectively communicate with health care providers;
                            `(D) by providing culturally and linguistically appropriate health or nutrition education;
                            `(E) by advocating for individual and community health or nutrition needs; and
                            `(F) by providing referral and followup services.
                      `(g) Appropriation- There is appropriated, out of any money in the Treasury not otherwise appropriated, $100,000,000 for the period of fiscal years 2009 through 2013, for the purpose of awarding grants under this section. Amounts appropriated and paid under the authority of this section shall be in addition to amounts appropriated under section 2104 and paid to States in accordance with section 2105, including with respect to expenditures for outreach activities in accordance with subsections (a)(1)(D)(iii) and (c)(2)(C) of that section.
                      `(h) National Enrollment Campaign- From the amounts made available under subsection (a)(2), the Secretary shall develop and implement a national enrollment campaign to improve the enrollment of underserved child populations in the programs established under this title and title XIX. Such campaign may include--
                         `(1) the establishment of partnerships with the Secretary of Education and the Secretary of Agriculture to develop national campaigns to link the eligibility and enrollment systems for the assistance programs each Secretary administers that often serve the same children;
                         `(2) the integration of information about the programs established under this title and title XIX in public health awareness campaigns administered by the Secretary;
                         `(3) increased financial and technical support for enrollment hotlines maintained by the Secretary to ensure that all States participate in such hotlines;
                         `(4) the establishment of joint public awareness outreach initiatives with the Secretary of Education and the Secretary of Labor regarding the importance of health insurance to building strong communities and the economy;
                         `(5) the development of special outreach materials for Native Americans or for individuals with limited English proficiency; and
                         `(6) such other outreach initiatives as the Secretary determines would increase public awareness of the programs under this title and title XIX.'.
                (2) CONFORMING AMENDMENTS.—
                (A) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended—
                   (i) by striking ‘‘, the Secretary’’ and inserting ‘‘:
                         ‘‘(1) The Secretary’’;
                   (ii) in the first sentence, by inserting ‘‘or a parent (as defined in section 2111(c)(2)(A)), who is not pregnant, of a targeted low-income child’’ before the peiod;
                   (iii) by striking the second sentence; and
                   (iv) by adding at the end the following new paragraph:
                         ‘‘(2) The Secretary may not approve, extend, renew, or amend a waiver, experimental, pilot, or demonstration project with respect to a State after the date of enactment of the Children’s Health Insurance Program Reauthorization Act of 2009 that would waive or modify the requirements of section 2111.’’.
                (B) Section 6102(c) of the Deficit Reduction Act of 2005 (Public Law 109–171; 120 Stat. 131) is amended by striking ‘‘Nothing’’ and inserting ‘‘Subject to section 2111 of the Social Security Act, as added by section 112 of the Children’s Health Insurance Program Reauthorization Act of 2009, nothing’’.
             (b) GAO STUDY AND REPORT.—
                (1) IN GENERAL.—The Comptroller General of the United States shall conduct a study of whether—
                   (A) the coverage of a parent, a caretaker relative (as such term is used in carrying out section 1931), or a legal guardian of a targeted low-income child under a State health plan under title XXI of the Social Security Act increases the enrollment of, or the quality of care for, children, and
                   (B) such parents, relatives, and legal guardians who enroll in such a plan are more likely to enroll their children in such a plan or in a State plan under title XIX of such Act.
                (2) REPORT.—Not later than 2 years after the date of the enactment of this Act, the Comptroller General shall report the results of the study to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives, including recommendations (if any) for changes in legislation.
          SEC. 113. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT.
             (a) IN GENERAL.—Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)) is amended—
                (1) in the matter preceding subparagraph (A), by striking ‘‘(or, in the case of expenditures described in subparagraph (B), the Federal medical assistance percentage (as defined in the first sentence of section 1905(b)))’’; and
                (2) by striking subparagraph (B) and inserting the following new subparagraph:
                            ‘‘(B) [reserved]’’.
             (b) AMENDMENTS TO MEDICAID.—
                (1) ELIGIBILITY OF A NEWBORN.—Section 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended in the first sentence by striking ‘‘so long as the child is a member of the woman’s household and the woman remains (or would remain if pregnant) eligible for such assistance’’.
                (2) APPLICATION OF QUALIFIED ENTITIES TO PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN UNDER MEDICAID.—Section 1920(b) (42 U.S.C. 1396r–1(b)) is amended by adding after paragraph (2) the following flush sentence:
                   ‘‘The term ‘qualified provider’ also includes a qualified entity, as defined in section 1920A(b)(3).’’.
          SEC. 114. LIMITATION ON MATCHING RATE FOR STATES THAT PROPOSE TO COVER CHILDREN WITH EFFECTIVE FAMILY INCOME THAT EXCEEDS 300 PERCENT OF THE POVERTY LINE.
             (a) FMAP APPLIED TO EXPENDITURES.—Section 2105(c) (42 U.S.C. 1397ee(c)) is amended by adding at the end the following new paragraph:
                         ‘‘(8) LIMITATION ON MATCHING RATE FOR EXPENDITURES FOR CHILD HEALTH ASSISTANCE PROVIDED TO CHILDREN WHOSE EFFECTIVE FAMILY INCOME EXCEEDS 300 PERCENT OF THE POVERTY LINE.—
                            ‘‘(A) FMAP APPLIED TO EXPENDITURES.—Except as provided in subparagraph (B), for fiscal years beginning with fiscal year 2009, the Federal medical assistance percentage (as determined under section 1905(b) without regard to clause (4) of such section) shall be substituted for the enhanced FMAP under subsection (a)(1) with respect to any expenditures for providing child health assistance or health benefits coverage for a targeted low-income child whose effective family income would exceed 300 percent of the poverty line but for the application of a general exclusion of a block of income that is not determined by type of expense or type of income.
                            ‘‘(B) EXCEPTION.—Subparagraph (A) shall not apply to any State that, on the date of enactment of the Children’s Health Insurance Program Reauthorization Act of 2009, has an approved State plan amendment or waiver to provide, or has enacted a State law to submit a State plan amendment to provide, expenditures described in such subparagraph under the State child health plan.’’.
             (b) RULE OF CONSTRUCTION.—Nothing in the amendments made by this section shall be construed as—
                (1) changing any income eligibility level for children under title XXI of the Social Security Act; or
                (2) changing the flexibility provided States under such title to establish the income eligibility level for targeted low-income children under a State child health plan and the methodologies used by the State to determine income or assets under such plan.
          SEC. 115. STATE AUTHORITY UNDER MEDICAID.
          Notwithstanding any other provision of law, including the fourth sentence of subsection (b) of section 1905 of the Social Security Act (42 U.S.C. 1396d) or subsection (u) of such section, at State option, the Secretary shall provide the State with the Federal medical assistance percentage determined for the State for Medicaid with respect to expenditures described in section 1905(u)(2)(A) of such Act or otherwise made to provide medical assistance under Medicaid to a child who could be covered by the State under CHIP.
    (b) Enhanced Administrative Funding for Translation or Interpretation Services Under CHIP and Medicaid-
       (1) CHIP- Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as amended by section 113, is amended--
          (A) in the matter preceding subparagraph (A), by inserting `(or, in the case of expenditures described in subparagraph (D)(iv), the higher of 75 percent or the sum of the enhanced FMAP plus 5 percentage points)' after `enhanced FMAP'; and
          (B) in subparagraph (D)--
             (i) in clause (iii), by striking `and' at the end;
             (ii) by redesignating clause (iv) as clause (v); and
             (iii) by inserting after clause (iii) the following new clause:
                      `(iv) for translation or interpretation services in connection with the enrollment of, retention of, and use of services under this title by, individuals for whom English is not their primary language (as found necessary by the Secretary for the proper and efficient administration of the State plan); and'.
       (2) MEDICAID-
          (A) USE OF MEDICAID FUNDS- Section 1903(a)(2) (42 U.S.C. 1396b(a)(2)) is amended by adding at the end the following new subparagraph:
                   `(E) an amount equal to 75 percent of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to translation or interpretation services in connection with the enrollment of, retention of, and use of services under this title by, children of families for whom English is not the primary language; plus'.
          (B) USE OF COMMUNITY HEALTH WORKERS FOR OUTREACH ACTIVITIES-
             (i) IN GENERAL- Section 2102(c)(1) of such Act (42 U.S.C. 1397bb(c)(1)) is amended by inserting `(through community health workers and others)' after `Outreach'.
             (ii) IN FEDERAL EVALUATION- Section 2108(c)(3)(B) of such Act (42 U.S.C. 1397hh(c)(3)(B)) is amended by inserting `(such as through community health workers and others)' after `including practices'.

### SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.

    (a) In General- Section 1139 (42 U.S.C. 1320b-9) is amended to read as follows:
          `SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR INDIANS UNDER TITLES XIX AND XXI.
             `(a) Agreements With States for Medicaid and CHIP Outreach On or Near Reservations To Increase the Enrollment of Indians in Those Programs-
                `(1) IN GENERAL- In order to improve the access of Indians residing on or near a reservation to obtain benefits under the Medicaid and State children's health insurance programs established under titles XIX and XXI, the Secretary shall encourage the State to take steps to provide for enrollment on or near the reservation. Such steps may include outreach efforts such as the outstationing of eligibility workers, entering into agreements with the Indian Health Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to provide outreach, education regarding eligibility and benefits, enrollment, and translation services when such services are appropriate.
                `(2) CONSTRUCTION- Nothing in paragraph (1) shall be construed as affecting arrangements entered into between States and the Indian Health Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations for such Service, Tribes, or Organizations to conduct administrative activities under such titles.
             `(b) Requirement To Facilitate Cooperation- The Secretary, acting through the Centers for Medicare & Medicaid Services, shall take such steps as are necessary to facilitate cooperation with, and agreements between, States and the Indian Health Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations with respect to the provision of health care items and services to Indians under the programs established under title XIX or XXI.
             `(c) Definition of Indian; Indian Tribe; Indian Health Program; Tribal Organization; Urban Indian Organization- In this section, the terms `Indian', `Indian Tribe', `Indian Health Program', `Tribal Organization', and `Urban Indian Organization' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act.'.
    (b) Nonapplication of 10 Percent Limit on Outreach and Certain Other Expenditures- Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is amended by adding at the end the following:
                   `(C) NONAPPLICATION TO CERTAIN EXPENDITURES- The limitation under subparagraph (A) shall not apply with respect to the following expenditures:
                      `(i) EXPENDITURES TO INCREASE OUTREACH TO, AND THE ENROLLMENT OF, INDIAN CHILDREN UNDER THIS TITLE AND TITLE xix- Expenditures for outreach activities to families of Indian children likely to be eligible for child health assistance under the plan or medical assistance under the State plan under title XIX (or under a waiver of such plan), to inform such families of the availability of, and to assist them in enrolling their children in, such plans, including such activities conducted under grants, contracts, or agreements entered into under section 1139(a).'.

### SEC. 203. STATE OPTION TO RELY ON FINDINGS FROM AN EXPRESS LANE AGENCY TO CONDUCT SIMPLIFIED ELIGIBILITY DETERMINATIONS.

    (a) Application Under Medicaid and CHIP Programs-
       (1) MEDICAID- Section 1902(e) (42 U.S.C. 1396a(e)) is amended by adding at the end the following:
          ``(13) Express Lane Option-
             ``(A) IN GENERAL-
                ``(i) OPTION TO USE A FINDING FROM AN EXPRESS LANE AGENCY- At the option of the State, the State plan may provide that in determining eligibility under this title for a child (as defined in subparagraph (G)), the State may rely on a finding made within a reasonable period (as determined by the State) from an Express Lane agency (as defined in subparagraph (F)) when it determines whether a child satisfies one or more components of eligibility for medical assistance under this title. The State may rely on a finding from an Express Lane agency notwithstanding sections 1902(a)(46)(B) and 1137(d) or any differences in budget unit, disregard, deeming or other methodology, if the following requirements are met:
                   ``(I) PROHIBITION ON DETERMINING CHILDREN INELIGIBLE FOR COVERAGE- If a finding from an Express Lane agency would result in a determination that a child does not satisfy an eligibility requirement for medical assistance under this title and for child health assistance under title XXI, the State shall determine eligibility for assistance using its regular procedures.
                   ``(II) NOTICE REQUIREMENT- For any child who is found eligible for medical assistance under the State plan under this title or child health assistance under title XXI and who is subject to premiums based on an Express Lane agency's finding of such child's income level, the State shall provide notice that the child may qualify for lower premium payments if evaluated by the State using its regular policies and of the procedures for requesting such an evaluation.
                   ``(III) COMPLIANCE WITH SCREEN AND ENROLL REQUIREMENT- The State shall satisfy the requirements under subparagraphs (A) and (B) of section 2102(b)(3) (relating to screen and enroll) before enrolling a child in child health assistance under title XXI. At its option, the State may fulfill such requirements in accordance with either option provided under subparagraph (C) of this paragraph.
                   ``(IV) VERIFICATION OF CITIZENSHIP OR NATIONALITY STATUS- The State shall satisfy the requirements of section 1902(a)(46)(B) or 2105(c)(9), as applicable for verifications of citizenship or nationality status.
                   ``(V) CODING- The State meets the requirements of subparagraph (E).
                ``(ii) OPTION TO APPLY TO RENEWALS AND REDETERMINATIONS- The State may apply the provisions of this paragraph when conducting initial determinations of eligibility, redeterminations of eligibility, or both, as described in the State plan.
             ``(B) RULES OF CONSTRUCTION- Nothing in this paragraph shall be construed--
                ``(i) to limit or prohibit a State from taking any actions otherwise permitted under this title or title XXI in determining eligibility for or enrolling children into medical assistance under this title or child health assistance under title XXI; or
                ``(ii) to modify the limitations in section 1902(a)(5) concerning the agencies that may make a determination of eligibility for medical assistance under this title.
             ``(C) OPTIONS FOR SATISFYING THE SCREEN AND ENROLL REQUIREMENT-
                ``(i) IN GENERAL- With respect to a child whose eligibility for medical assistance under this title or for child health assistance under title XXI has been evaluated by a State agency using an income finding from an Express Lane agency, a State may carry out its duties under subparagraphs (A) and (B) of section 2102(b)(3) (relating to screen and enroll) in accordance with either clause (ii) or clause (iii).
                ``(ii) ESTABLISHING A SCREENING THRESHOLD-
                   ``(I) IN GENERAL- Under this clause, the State establishes a screening threshold set as a percentage of the Federal poverty level that exceeds the highest income threshold applicable under this title to the child by a minimum of 30 percentage points or, at State option, a higher number of percentage points that reflects the value (as determined by the State and described in the State plan) of any differences between income methodologies used by the program administered by the Express Lane agency and the methodologies used by the State in determining eligibility for medical assistance under this title.
                   ``(II) CHILDREN WITH INCOME NOT ABOVE THRESHOLD- If the income of a child does not exceed the screening threshold, the child is deemed to satisfy the income eligibility criteria for medical assistance under this title regardless of whether such child would otherwise satisfy such criteria.
                   ``(III) CHILDREN WITH INCOME ABOVE THRESHOLD- If the income of a child exceeds the screening threshold, the child shall be considered to have an income above the Medicaid applicable income level described in section 2110(b)(4) and to satisfy the requirement under section 2110(b)(1)(C) (relating to the requirement that CHIP matching funds be used only for children not eligible for Medicaid). If such a child is enrolled in child health assistance under title XXI, the State shall provide the parent, guardian, or custodial relative with the following:
                      ``(aa) Notice that the child may be eligible to receive medical assistance under the State plan under this title if evaluated for such assistance under the State's regular procedures and notice of the process through which a parent, guardian, or custodial relative can request that the State evaluate the child's eligibility for medical assistance under this title using such regular procedures.
                      ``(bb) A description of differences between the medical assistance provided under this title and child health assistance under title XXI, including differences in cost-sharing requirements and covered benefits.
                ``(iii) TEMPORARY ENROLLMENT IN CHIP PENDING SCREEN AND ENROLL-
                   ``(I) IN GENERAL- Under this clause, a State enrolls a child in child health assistance under title XXI for a temporary period if the child appears eligible for such assistance based on an income finding by an Express Lane agency.
                   ``(II) DETERMINATION OF ELIGIBILITY- During such temporary enrollment period, the State shall determine the child's eligibility for child health assistance under title XXI or for medical assistance under this title in accordance with this clause.
                   ``(III) PROMPT FOLLOW UP- In making such a determination, the State shall take prompt action to determine whether the child should be enrolled in medical assistance under this title or child health assistance under title XXI pursuant to subparagraphs (A) and (B) of section 2102(b)(3) (relating to screen and enroll).
                   ``(IV) REQUIREMENT FOR SIMPLIFIED DETERMINATION- In making such a determination, the State shall use procedures that, to the maximum feasible extent, reduce the burden imposed on the individual of such determination. Such procedures may not require the child's parent, guardian, or custodial relative to provide or verify information that already has been provided to the State agency by an Express Lane agency or another source of information unless the State agency has reason to believe the information is erroneous.
                   ``(V) AVAILABILITY OF CHIP MATCHING FUNDS DURING TEMPORARY ENROLLMENT PERIOD- Medical assistance for items and services that are provided to a child enrolled in title XXI during a temporary enrollment period under this clause shall be treated as child health assistance under such title.
             ``(D) OPTION FOR AUTOMATIC ENROLLMENT-
                ``(i) IN GENERAL- The State may initiate and determine eligibility for medical assistance under the State Medicaid plan or for child health assistance under the State CHIP plan without a program application from, or on behalf of, the child based on data obtained from sources other than the child (or the child's family), but a child can only be automatically enrolled in the State Medicaid plan or the State CHIP plan if the child or the family affirmatively consents to being enrolled through affirmation in writing, by telephone, orally, through electronic signature, or through any other means specified by the Secretary or by signature on an Express Lane agency application, if the requirement of clause (ii) is met.
                ``(ii) INFORMATION REQUIREMENT- The requirement of this clause is that the State informs the parent, guardian, or custodial relative of the child of the services that will be covered, appropriate methods for using such services, premium or other cost sharing charges (if any) that apply, medical support obligations (under section 1912(a)) created by enrollment (if applicable), and the actions the parent, guardian, or relative must take to maintain enrollment and renew coverage.
             ``(E) CODING; APPLICATION TO ENROLLMENT ERROR RATES-
                ``(i) IN GENERAL- For purposes of subparagraph (A)(iv), the requirement of this subparagraph for a State is that the State agrees to--
                   ``(I) assign such codes as the Secretary shall require to the children who are enrolled in the State Medicaid plan or the State CHIP plan through reliance on a finding made by an Express Lane agency for the duration of the State's election under this paragraph;
                   ``(II) annually provide the Secretary with a statistically valid sample (that is approved by Secretary) of the children enrolled in such plans through reliance on such a finding by conducting a full Medicaid eligibility review of the children identified for such sample for purposes of determining an eligibility error rate (as described in clause (iv)) with respect to the enrollment of such children (and shall not include such children in any data or samples used for purposes of complying with a Medicaid Eligibility Quality Control (MEQC) review or a payment error rate measurement (PERM) requirement);
                   ``(III) submit the error rate determined under subclause (II) to the Secretary;
                   ``(IV) if such error rate exceeds 3 percent for either of the first 2 fiscal years in which the State elects to apply this paragraph, demonstrate to the satisfaction of the Secretary the specific corrective actions implemented by the State to improve upon such error rate; and
                   ``(V) if such error rate exceeds 3 percent for any fiscal year in which the State elects to apply this paragraph, a reduction in the amount otherwise payable to the State under section 1903(a) for quarters for that fiscal year, equal to the total amount of erroneous excess payments determined for the fiscal year only with respect to the children included in the sample for the fiscal year that are in excess of a 3 percent error rate with respect to such children.
                ``(ii) NO PUNITIVE ACTION BASED ON ERROR RATE- The Secretary shall not apply the error rate derived from the sample under clause (i) to the entire population of children enrolled in the State Medicaid plan or the State CHIP plan through reliance on a finding made by an Express Lane agency, or to the population of children enrolled in such plans on the basis of the State's regular procedures for determining eligibility, or penalize the State on the basis of such error rate in any manner other than the reduction of payments provided for under clause (i)(V).
                ``(iii) RULE OF CONSTRUCTION- Nothing in this paragraph shall be construed as relieving a State that elects to apply this paragraph from being subject to a penalty under section 1903(u), for payments made under the State Medicaid plan with respect to ineligible individuals and families that are determined to exceed the error rate permitted under that section (as determined without regard to the error rate determined under clause (i)(II)).
                ``(iv) ERROR RATE DEFINED- In this subparagraph, the term `error rate' means the rate of erroneous excess payments for medical assistance (as defined in section 1903(u)(1)(D)) for the period involved, except that such payments shall be limited to individuals for which eligibility determinations are made under this paragraph and except that in applying this paragraph under title XXI, there shall be substituted for references to provisions of this title corresponding provisions within title XXI.
             ``(F) EXPRESS LANE AGENCY-
                ``(i) IN GENERAL- In this paragraph, the term `Express Lane agency' means a public agency that--
                   ``(I) is determined by the State Medicaid agency or the State CHIP agency (as applicable) to be capable of making the determinations of one or more eligibility requirements described in subparagraph (A)(i);
                   ``(II) is identified in the State Medicaid plan or the State CHIP plan; and
                   ``(III) notifies the child's family--
                      ``(aa) of the information which shall be disclosed in accordance with this paragraph;
                      ``(bb) that the information disclosed will be used solely for purposes of determining eligibility for medical assistance under the State Medicaid plan or for child health assistance under the State CHIP plan; and
                      ``(cc) that the family may elect to not have the information disclosed for such purposes; and
                   ``(IV) enters into, or is subject to, an interagency agreement to limit the disclosure and use of the information disclosed.
                ``(ii) INCLUSION OF SPECIFIC PUBLIC AGENCIES- Such term includes the following:
                   ``(I) A public agency that determines eligibility for assistance under any of the following:
                      ``(aa) The temporary assistance for needy families program funded under part A of title IV.
                      ``(bb) A State program funded under part D of title IV.
                      ``(cc) The State Medicaid plan.
                      ``(dd) The State CHIP plan.
                      ``(ee) The Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.).
                      ``(ff) The Head Start Act (42 U.S.C. 9801 et seq.).
                      ``(gg) The [[Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.).
                      ``(hh) The Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.).
                      ``(ii) The Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858 et seq.).
                      ``(jj) The Stewart B. McKinney Homeless Assistance Act (42 U.S.C. 11301 et seq.).
                      ``(kk) The United States Housing Act of 1937 (42 U.S.C. 1437 et seq.).
                      ``(ll) The Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4101 et seq.).
                   ``(II) A State-specified governmental agency that has fiscal liability or legal responsibility for the accuracy of the eligibility determination findings relied on by the State.
                   ``(III) A public agency that is subject to an interagency agreement limiting the disclosure and use of the information disclosed for purposes of determining eligibility under the State Medicaid plan or the State CHIP plan.
                ``(iii) EXCLUSIONS- Such term does not include an agency that determines eligibility for a program established under the Social Services Block Grant established under title XX or a private, for-profit organization.
                ``(iv) RULES OF CONSTRUCTION- Nothing in this paragraph shall be construed as--
                   ``(I) exempting a State Medicaid agency from complying with the requirements of section 1902(a)(4) relating to merit-based personnel standards for employees of the State Medicaid agency and safeguards against conflicts of interest); or
                   ``(II) authorizing a State Medicaid agency that elects to use Express Lane agencies under this subparagraph to use the Express Lane option to avoid complying with such requirements for purposes of making eligibility determinations under the State Medicaid plan.
                ``(v) ADDITIONAL DEFINITIONS- In this paragraph:
                   ``(I) STATE- The term `State' means 1 of the 50 States or the District of Columbia.
                   ``(II) STATE CHIP AGENCY- The term `State CHIP agency' means the State agency responsible for administering the State CHIP plan.
                   ``(III) STATE CHIP PLAN- The term `State CHIP plan' means the State child health plan established under title XXI and includes any waiver of such plan.
                   ``(IV) STATE MEDICAID AGENCY- The term `State Medicaid agency' means the State agency responsible for administering the State Medicaid plan.
                   ``(V) STATE MEDICAID PLAN- The term `State Medicaid plan' means the State plan established under title XIX and includes any waiver of such plan.
             ``(G) CHILD DEFINED- For purposes of this paragraph, the term `child' means an individual under 19 years of age, or, at the option of a State, such higher age, not to exceed 21 years of age, as the State may elect.
             ``(H) STATE OPTION TO RELY ON STATE INCOME TAX DATA OR RETURN- At the option of the State, a finding from an Express Lane agency may include gross income or adjusted gross income shown by State income tax records or returns.
             ``(I) APPLICATION- This paragraph shall not apply with respect to eligibility determinations made after September 30, 2013.'.
       (2) CHIP- Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is amended by redesignating subparagraphs (B), (C), and (D) as subparagraphs (C), (D), and (E), respectively, and by inserting after subparagraph (A) the following new subparagraph:
                   `(B) Section 1902(e)(13) (relating to the State option to rely on findings from an Express Lane agency to help evaluate a child's eligibility for medical assistance).'.
    (b) Evaluation and Report-
       (1) EVALUATION- The Secretary shall conduct, by grant, contract, or interagency agreement, a comprehensive, independent evaluation of the option provided under the amendments made by subsection (a). Such evaluation shall include an analysis of the effectiveness of the option, and shall include--
          (A) obtaining a statistically valid sample of the children who were enrolled in the State Medicaid plan or the State CHIP plan through reliance on a finding made by an Express Lane agency and determining the percentage of children who were erroneously enrolled in such plans;
          (B) determining whether enrolling children in such plans through reliance on a finding made by an Express Lane agency improves the ability of a State to identify and enroll low-income, uninsured children who are eligible but not enrolled in such plans;
          (C) evaluating the administrative costs or savings related to identifying and enrolling children in such plans through reliance on such findings, and the extent to which such costs differ from the costs that the State otherwise would have incurred to identify and enroll low-income, uninsured children who are eligible but not enrolled in such plans; and
          (D) any recommendations for legislative or administrative changes that would improve the effectiveness of enrolling children in such plans through reliance on such findings.
       (2) REPORT TO CONGRESS- Not later than September 30, 2012, the Secretary shall submit a report to Congress on the results of the evaluation under paragraph (1).
       (3) FUNDING-
          (A) IN GENERAL- Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary to carry out the evaluation under this subsection $5,000,000 for the period of fiscal years 2009 through 2012.
          (B) BUDGET AUTHORITY- Subparagraph (A) constitutes budget authority in advance of appropriations Act and represents the obligation of the Federal Government to provide for the payment of such amount to conduct the evaluation under this subsection.
    (c) Electronic Transmission of Information- Section 1902 (42 U.S.C. 1396a) is amended by adding at the end the following new subsection:
                            `(dd) Electronic Transmission of Information- If the State agency determining eligibility for medical assistance under this title or child health assistance under title XXI verifies an element of eligibility based on information from an Express Lane Agency (as defined in subsection (e)(13)(F)), or from another public agency, then the applicant's signature under penalty of perjury shall not be required as to such element. Any signature requirement for an application for medical assistance may be satisfied through an electronic signature, as defined in section 1710(1) of the Government Paperwork Elimination Act (44 U.S.C. 3504 note). The requirements of subparagraphs (A) and (B) of section 1137(d)(2) may be met through evidence in digital or electronic form.'.
    (d) Authorization of Information Disclosure-
       (1) IN GENERAL- Title XIX is amended by adding at the end the following new section:
          `SEC. 1942. AUTHORIZATION TO RECEIVE RELEVANT INFORMATION.
             ``(a) In General- Notwithstanding any other provision of law, a Federal or State agency or private entity in possession of the sources of data directly relevant to eligibility determinations under this title (including eligibility files maintained by Express Lane agencies described in section 1902(e)(13)(F), information described in paragraph (2) or (3) of section 1137(a), vital records information about births in any State, and information described in sections 453(i) and 1902(a)(25)(I)) is authorized to convey such data or information to the State agency administering the State plan under this title, to the extent such conveyance meets the requirements of subsection (b).
             ``(b) Requirements for Conveyance- Data or information may be conveyed pursuant to subsection (a) only if the following requirements are met:
                ``(1) The individual whose circumstances are described in the data or information (or such individual's parent, guardian, caretaker relative, or authorized representative) has either provided advance consent to disclosure or has not objected to disclosure after receiving advance notice of disclosure and a reasonable opportunity to object.
                ``(2) Such data or information are used solely for the purposes of--
                   ``(A) identifying individuals who are eligible or potentially eligible for medical assistance under this title and enrolling or attempting to enroll such individuals in the State plan; and
                   ``(B) verifying the eligibility of individuals for medical assistance under the State plan.
                ``(3) An interagency or other agreement, consistent with standards developed by the Secretary--
                   ``(A) prevents the unauthorized use, disclosure, or modification of such data and otherwise meets applicable Federal requirements safeguarding privacy and data security; and
                   ``(B) requires the State agency administering the State plan to use the data and information obtained under this section to seek to enroll individuals in the plan.
             ``(c) Penalties for Improper Disclosure-
                ``(1) CIVIL MONEY PENALTY- A private entity described in the subsection (a) that publishes, discloses, or makes known in any manner, or to any extent not authorized by Federal law, any information obtained under this section is subject to a civil money penalty in an amount equal to $10,000 for each such unauthorized publication or disclosure. The provisions of section 1128A (other than subsections (a) and (b) and the second sentence of subsection (f)) shall apply to a civil money penalty under this paragraph in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).
                ``(2) CRIMINAL PENALTY- A private entity described in the subsection (a) that willfully publishes, discloses, or makes known in any manner, or to any extent not authorized by Federal law, any information obtained under this section shall be fined not more than $10,000 or imprisoned not more than 1 year, or both, for each such unauthorized publication or disclosure.
             ``(d) Rule of Construction- The limitations and requirements that apply to disclosure pursuant to this section shall not be construed to prohibit the conveyance or disclosure of data or information otherwise permitted under Federal law (without regard to this section).'.
       (2) CONFORMING AMENDMENT TO TITLE XXI- Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as amended by subsection (a)(2), is amended by adding at the end the following new subparagraph:
                   ``(F) Section 1942 (relating to authorization to receive data directly relevant to eligibility determinations).'.
       (3) CONFORMING AMENDMENT TO PROVIDE ACCESS TO DATA ABOUT ENROLLMENT IN INSURANCE FOR PURPOSES OF EVALUATING APPLICATIONS AND FOR CHIP- Section 1902(a)(25)(I)(i) (42 U.S.C. 1396a(a)(25)(I)(i)) is amended--
          (A) by inserting `(and, at State option, individuals who apply or whose eligibility for medical assistance is being evaluated in accordance with section 1902(e)(13)(D))' after `with respect to individuals who are eligible'; and
          (B) by inserting `under this title (and, at State option, child health assistance under title XXI)' after `the State plan'.
    (e) Authorization for States Electing Express Lane Option To Receive Certain Data Directly Relevant To Determining Eligibility and Correct Amount of Assistance- The Secretary shall enter into such agreements as are necessary to permit a State that elects the Express Lane option under section 1902(e)(13) of the Social Security Act to receive data directly relevant to eligibility determinations and determining the correct amount of benefits under a State child health plan under CHIP or a State plan under Medicaid from the following:
       (1) The National Directory of New Hires established under section 453(i) of the Social Security Act (42 U.S.C. 653(i)).
       (2) Data regarding enrollment in insurance that may help to facilitate outreach and enrollment under the State Medicaid plan, the State CHIP plan, and such other programs as the Secretary may specify.
    (f) Effective Date- The amendments made by this section are effective on the date of the enactment of this Act.