II 

117TH CONGRESS 

1ST SESSION S. 646 

To amend titles XIX and XXI of the Social Security Act to provide for 

12-month continuous enrollment under Medicaid and the Children’s 

Health Insurance Program, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 9, 2021 

Mr. BROWN (for himself, Ms. BALDWIN, Ms. WARREN, and Mr. WHITEHOUSE) introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to provide for 12-month continuous enrollment under 

Medicaid and the Children’s Health Insurance Program, 

and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Stabilize Medicaid and 

5 CHIP Coverage Act of 2021’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Every year millions of people are enrolled in 

2 Medicaid and the Children’s Health Insurance Pro3 gram (in this section referred to as ‘‘CHIP’’), but 

4 subsequently lose their coverage, despite still being 

5 eligible, because of inefficient and cumbersome pa6 perwork and logistical requirements. 

7 (2) Data show that the typical enrollee receives 

Medicaid coverage for about 3 8 ⁄4 of the year and that 

9 coverage periods are lower for non-elderly, non-dis10 abled adults than for those with disabilities, seniors, 

11 and children. 

12 (3) Medicaid enrollees with coverage disruption 

13 are more likely to be hospitalized for illnesses, like 

14 asthma, diabetes, or cardiovascular disease, that can 

15 be effectively managed through ongoing primary 

16 medical care and medication, are less likely to be 

17 screened for breast cancer, and may have poorer 

18 cancer outcomes. 

19 (4) Children enrolled in CHIP also experience 

20 disruptions in health coverage and care. For example, during just a 1-year period, over 1 21 ⁄3 of CHIP 

22 enrollees were also enrolled in a State’s Medicaid 

23 program. Transitions between Medicaid and CHIP 

24 can cause disruptions in care because the health care 


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1 coverage and participating providers vary between 

2 the two programs. 

3 (5) Interruptions in coverage can impair the re4 ceipt of effective primary care and lead to expensive 

5 hospitalizations or emergency room visits. 

6 (6) Unnecessary enrollment, disenrollment, and 

7 reenrollment in Medicaid and CHIP result in higher 

8 administrative expenses for reenrollment and result 

9 in more people uninsured at any given time. 

10 (7) Stable coverage under Medicaid and CHIP 

11 lowers average monthly medical costs. Continuous 

12 enrollment also permits better prevention and dis13 ease management, leading to fewer serious illnesses 

14 and hospitalizations. 

15 (8) Children with stable coverage are less likely 

16 to have unmet medical needs, allowing children to 

17 receive the preventive care that is necessary to help 

18 them grow into healthy adults. 

19 SEC. 3. 12-MONTH CONTINUOUS ENROLLMENT. 

20 (a) REQUIREMENT OF 12-MONTH CONTINUOUS EN21 ROLLMENT UNDER MEDICAID.— 

22 (1) IN GENERAL.—Section 1902(e)(12) of the 

23 Social Security Act (42 U.S.C. 1396a(e)), is amend24 ed to read as follows: 

25 ‘‘(12) 12-MONTH CONTINUOUS ENROLLMENT.— 


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1 ‘‘(A) IN GENERAL.—Notwithstanding any 

2 other provision of this title, a State plan ap3 proved under this title or under any waiver of 

4 such plan approved pursuant to section 1115 or 

5 section 1915, shall provide that an individual 

6 who is determined to be eligible for benefits 

7 under such plan (or waiver) shall be considered 

8 to meet the eligibility requirements met on the 

9 date of application and shall remain eligible and 

10 enrolled for such benefits through the end of 

11 the month in which the 12-month period (begin12 ning on the date of determination of eligibility) 

13 ends. 

14 ‘‘(B) PROMOTING RETENTION OF ELIGI15 BLE AND ENROLLED PERSONS BEYOND 12

16 MONTHS.—The Secretary shall— 

17 ‘‘(i) identify methods that promote the 

18 retention of individuals who are enrolled 

19 under the State plan or under a waiver of 

20 such plan and who remain eligible for med21 ical assistance beyond the 12-month period 

22 described in subparagraph (A); and 

23 ‘‘(ii) actively promote the adoption of 

24 such enrollment retention methods by 

25 States, which shall include, but not be limVerDate Sep 11 2014 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S646.IS S646

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1 ited to, issuing guidance and developing re2 sources on State best practices. 

3 ‘‘(C) ENROLLMENT AND RETENTION RE4 PORTING.— 

5 ‘‘(i) IN GENERAL.—Not later than 1 

6 year after the date of enactment of the 

7 Stabilize Medicaid and CHIP Coverage Act 

8 of 2021, the Secretary shall publish the 

9 procedures that States are expected to use 

10 to provide annual enrollment and retention 

11 reports beginning not later than 2 years 

12 after the date of enactment of such Act. 

13 ‘‘(ii) STATE REPORTING REQUIRE14 MENTS.—At a minimum, the reporting 

15 procedures published under clause (i) shall 

16 include a description of State eligibility cri17 teria and enrollment procedures under this 

18 title and data regarding enrollment and re19 tention using standardized reporting for20 mats determined by the Secretary. 

21 ‘‘(iii) SECRETARY REPORT AND PUB22 LICATION.— 

23 ‘‘(I) IN GENERAL.—The Sec24 retary annually shall publish enroll25 ment and retention performance reVerDate Sep 11 2014 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S646.IS S646

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1 sults for all States not later than 6 

2 months after the deadline for each an3 nual State enrollment and retention 

4 reporting period. 

5 ‘‘(II) ESTIMATED ENROLLMENT

6 CONTINUITY RATIOS.—Each annual 

7 report published by the Secretary 

8 under subclause (I) shall include esti9 mates of Medicaid enrollment con10 tinuity ratios for each State in accord11 ance with the requirements of sub12 clause (III). 

13 ‘‘(III) REQUIREMENTS.—The 

14 Secretary shall develop both overall 

15 enrollment continuity ratios for all en16 rollees and separate enrollment con17 tinuity ratios for each of the following 

18 categories: 

19 ‘‘(aa) Children. 

20 ‘‘(bb) Individuals whose eli21 gibility category is related to hav22 ing attained age 65. 

23 ‘‘(cc) Individuals whose eli24 gibility category is related to dis25 ability or blindness. 


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1 ‘‘(dd) Individuals whose eli2 gibility category is related to 

3 their status as parents and care4 taker relatives of children under 

5 19 or who are otherwise not el6 derly, blind or disabled adults.’’. 

7 (b) REQUIREMENT OF 12-MONTH CONTINUOUS EN8 ROLLMENT UNDER CHIP.— 

9 (1) IN GENERAL.—Section 2102(b) of the So10 cial Security Act (42 U.S.C. 1397bb(b)) is amended 

11 by adding at the end the following new paragraph: 

12 ‘‘(6) REQUIREMENT FOR 12-MONTH CONTIN13 UOUS ENROLLMENT.—Notwithstanding any other 

14 provision of this title, a State child health plan that 

15 provides child health assistance under this title 

16 through a means other than that described in sec17 tion 2101(a)(2), shall provide that an individual who 

18 is determined to be eligible for benefits under such 

19 plan shall be considered to meet the eligibility re20 quirements met on the date of application and shall 

21 remain eligible and enrolled for such benefits 

22 through the end of the month in which the 12-month 

23 period (beginning on the date of determination of 

24 eligibility) ends.’’. 

25 (2) CONFORMING AMENDMENTS.— 


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1 (A) ENROLLMENT AND RETENTION PROVI2 SIONS.—Section 2105(a)(4)(A) of the Social Se3 curity Act (42 U.S.C. 1397ee(a)(4)(A)) is 

4 amended— 

5 (i) by striking ‘‘has elected the option 

6 of’’ and inserting ‘‘is in compliance with 

7 the requirement for’’; and 

8 (ii) by striking ‘‘applying such policy 

9 under its State child health plan under this 

10 title’’ and inserting ‘‘in compliance with 

11 section 2102(b)’’. 

12 (B) APPLICATION OF MEDICAID RETEN13 TION AND REPORTING REQUIREMENTS.—Sec14 tion 2107(e)(1) of the Social Security Act (42 

15 U.S.C. 1397gg(e)(1)) is amended— 

16 (i) by redesignating subparagraphs 

17 (H) through (S) as subparagraphs (I) 

18 through (T), respectively; and 

19 (ii) by inserting after subparagraph 

20 (G), the following: 

21 ‘‘(H) Subparagraphs (B) and (C) of sec22 tion 1902(e)(12) (relating to promotion of en23 rollment beyond 12 months and reporting re24 quirements)(without regard to items (bb), (cc), 


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1 and (dd) of subparagraph (C)(iii)(III) of that 

2 section).’’. 

3 (c) EFFECTIVE DATE.— 

4 (1) IN GENERAL.—Except as provided in para5 graph (2) or (3), the amendments made by sub6 sections (a) and (b) shall apply to determinations 

7 (and redeterminations) of eligibility made on or after 

8 the date that is 18 months after the date of the en9 actment of this Act. 

10 (2) EXTENSION OF EFFECTIVE DATE FOR

11 STATE LAW AMENDMENT.—In the case of a State 

12 plan under title XIX or State child health plan 

13 under title XXI of the Social Security Act (42 

14 U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) 

15 which the Secretary of Health and Human Services 

16 determines requires State legislation (other than leg17 islation appropriating funds) in order for the respec18 tive plan to meet the additional requirements im19 posed by the amendments made by subsections (a) 

20 or (b), respectively, the respective plan shall not be 

21 regarded as failing to comply with the requirements 

22 of such title solely on the basis of its failure to meet 

23 such applicable additional requirements before the 

24 first day of the first calendar quarter beginning 

25 after the close of the first regular session of the 


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1 State legislature that begins after the date of enact2 ment of this Act. For purposes of the previous sen3 tence, in the case of a State that has a 2-year legis4 lative session, each year of the session is considered 

5 to be a separate regular session of the State legisla6 ture. 

7 (3) OPTION TO IMPLEMENT 12-MONTH CONTIN8 UOUS ELIGIBILITY PRIOR TO EFFECTIVE DATE.—A 

9 State may elect through a State plan amendment 

10 under title XIX or XXI of the Social Security Act 

11 (42 U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) 

12 to apply the amendments made by subsection (a) or 

13 (b), respectively, on any date prior to the 18-month 

14 date specified in paragraph (1), but not sooner than 

15 the date of the enactment of this Act. 

16 SEC. 4. PREVENTING THE APPLICATION UNDER CHIP OF 

17 COVERAGE WAITING PERIODS. 

18 (a) IN GENERAL.—Section 2102(b)(1)(B) of the So19 cial Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amend20 ed— 

21 (1) in clause (iii)— 

22 (A) by striking ‘‘in the case of’’ and insert23 ing ‘‘in the case of a targeted low-income child 

24 (including a child provided dental-only suppleVerDate Sep 11 2014 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S646.IS S646

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1 mental coverage under section 2110(b)(5)) or in 

2 the case of’’; and 

3 (B) by adding ‘‘and’’ after the semicolon; 

4 (2) by striking clause (iv); and 

5 (3) by redesignating clause (v) as clause (iv). 

6 (b) CONFORMING AMENDMENTS.—Section 

7 2105(c)(10) of the Social Security Act (42 U.S.C. 

8 1397ee(c)(10)) is amended by striking subparagraph (F) 

9 and redesignating subparagraphs (G) through (M) as sub10 paragraphs (F) through (L), respectively. 

11 (c) EFFECTIVE DATE.—The amendments made by 

12 this section shall take effect on the date of enactment of 

13 this Act. 

14 SEC. 5. MEDICAID PERFORMANCE BONUSES FOR ENROLL15 MENT AND RETENTION IMPROVEMENTS FOR 

16 CERTAIN INDIVIDUALS. 

17 Section 1903 of the Social Security Act (42 U.S.C. 

18 1396b) is amended by adding at the end the following new 

19 subsection: 

20 ‘‘(cc) PERFORMANCE BONUSES FOR ENROLLMENT

21 AND RETENTION OF LOW-INCOME INDIVIDUALS.— 

22 ‘‘(1) IN GENERAL.—A State may qualify for 

23 performance bonuses related to the enrollment and 

24 retention of individuals (including children) de25 scribed in section 1902(e)(12)(C)(iii)(III). For purVerDate Sep 11 2014 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S646.IS S646

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1 poses of this paragraph, a State meets the condition 

2 of this paragraph for such individuals if, for each 

3 category of individuals specified in section 

4 1902(e)(12)(C)(iii)(III), the State is implementing 

5 at least 3 of the following enrollment and retention 

6 provisions (treating each subparagraph as a separate 

7 enrollment and retention provision) throughout the 

8 entire fiscal year: 

9 ‘‘(A) ALIGNING TREATMENT OF INCOME

10 UNDER MEDICAID WITH THAT OF OTHER IN11 SURANCE AFFORDABILITY PROGRAMS.—The 

12 State implements policies, including prorating 

13 income over annual periods, so as to align its 

14 treatment of income for purposes of a deter15 mination of eligibility for medical assistance 

16 with that of other affordability insurance pro17 grams with the goal of eliminating inconsistent 

18 determinations among these programs. 

19 ‘‘(B) MAINTAINING COVERAGE FOR INDI20 VIDUALS DURING PERIODS OF TRANSITION.— 

21 The State implements the following policies: 

22 ‘‘(i) IN GENERAL.—Upon determina23 tion that an individual is no longer eligible 

24 for medical assistance, the State imple25 ments policies to maintain eligibility for 


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1 medical assistance, including enrollment in 

2 the managed care organization in which 

3 the individual was enrolled at the time of 

4 the determination of ineligibility, during 

5 the period of time in which— 

6 ‘‘(I) eligibility-related information 

7 is transmitted to the other insurance 

8 affordability programs; 

9 ‘‘(II) a determination is made as 

10 to for which other insurance afford11 ability program the individual is eligi12 ble, if any; and 

13 ‘‘(III) coverage in such program 

14 and any related managed care organi15 zation becomes effective. 

16 ‘‘(ii) MANAGED CARE ORGANIZATION

17 CONTINUITY.—The State implements poli18 cies to enroll the individual in the managed 

19 care organization in which the individual 

20 was a member prior to the loss of medical 

21 assistance eligibility, if such managed care 

22 organization participates in the other in23 surance affordability program, unless the 

24 individual voluntarily selects a separate 

25 managed care organization. 


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1 ‘‘(C) ENHANCED DATA-SHARING BETWEEN

2 THE STATE AND AN AMERICAN HEALTH BEN3 EFIT EXCHANGE AND AGENCIES.—The State 

4 utilizes findings from an American Health Ben5 efit Exchange, an Express Lane Agency (as 

6 identified by the State and as described in sec7 tion 1902(e)(13)(F)), the Social Security Ad8 ministration, or other agencies administering 

9 employment, educational, or social services pro10 grams as identified by the State, to document 

11 income, residency, age, or other relevant infor12 mation in determining or renewing eligibility. 

13 ‘‘(D) ELIGIBILITY BASED ON PENDING

14 STATUS.—The State maintains eligibility for 

15 enrollees whose renewal status has not yet been 

16 determined and for whom eligibility based on 

17 alternative eligibility criteria has not yet been 

18 ruled out. 

19 ‘‘(E) DEFAULT REENROLLMENT IN MAN20 AGED CARE ORGANIZATION.—In the case of in21 dividuals who are determined to be eligible for 

22 medical assistance under this title after the loss 

23 of eligibility for fewer than 6 months, and who 

24 previously had been members of a managed 

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1 vidual in the managed care organization in 

2 which the individual was a member prior to the 

3 loss of eligibility, unless the individual volun4 tarily selects a separate managed care organiza5 tion. 

6 ‘‘(2) PERFORMANCE BONUS PAYMENT TO SUP7 PORT 12-MONTH CONTINUOUS ENROLLMENT FOR

8 MEDICAID ENROLLEES.— 

9 ‘‘(A) AUTHORITY TO MAKE BONUS PAY10 MENTS.— 

11 ‘‘(i) IN GENERAL.—The Secretary 

12 shall make a bonus payment for fiscal 

13 years beginning with the first fiscal year 

14 that begins on or after the date that is 3 

15 years after the date of enactment of the 

16 Stabilize Medicaid and CHIP Coverage Act 

17 of 2021, and annually thereafter to the ex18 tent there are funds available under para19 graph (3)(A), to each State that satisfies 

20 the requirements of subparagraph (B). 

21 ‘‘(ii) REGULATIONS.—Payments to 

22 States under this subsection for a fiscal 

23 year shall be allocated annually among eli24 gible States in accordance with regulations 

25 promulgated by the Secretary not later 


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1 than the date that is 6 months prior to Oc2 tober 1 of the first fiscal year for which 

3 payments are made under this paragraph. 

4 ‘‘(iii) TIMING.—A payment to a State 

5 under this subsection for a fiscal year shall 

6 be made as a single payment not later 

7 than the last day of the first calendar 

8 quarter of the succeeding fiscal year. 

9 ‘‘(B) STATE ELIGIBILITY FOR BONUS PAY10 MENTS.—A State shall be eligible for bonus 

11 payments under this subsection if— 

12 ‘‘(i) the State has adopted at least 3 

13 of the 5 policies described in subpara14 graphs (A) through (E) of paragraph (1) 

15 for each category of individuals specified in 

16 section 1902(e)(12)(C)(iii)(III); and 

17 ‘‘(ii) the State is able to demonstrate 

18 improvement in the continuity of enroll19 ment by child, aged, blind, and disabled, 

20 and adult populations, compared to the 

21 State’s baseline performance with respect 

22 to continuity of enrollment for such popu23 lations in fiscal year 2021 or such later 

24 year as the Secretary, by regulation, shall 

25 specify. 


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1 ‘‘(3) AMOUNTS AVAILABLE FOR PAYMENTS.— 

2 ‘‘(A) IN GENERAL.—The total amount of 

3 bonus payments made under this subsection for 

4 all fiscal years shall be equal to $500,000,000, 

5 to be available until expended. 

6 ‘‘(B) BUDGET AUTHORITY.—This para7 graph constitutes budget authority in advance 

8 of appropriations Acts and represents the obli9 gation of the Secretary to provide for the pay10 ment of amounts provided under this para11 graph. 

12 ‘‘(4) USES OF ENROLLMENT AND RETENTION

13 PERFORMANCE BONUSES.—Nothing in this sub14 section shall prohibit a State from establishing cri15 teria which would permit the State to distribute a 

16 portion of the proceeds of any bonus payments re17 ceived pursuant to this subsection to financially sup18 port providers and managed care entities partici19 pating under the State plan or under a waiver of 

20 such plan who have contributed to improved enroll21 ment and retention activities.’’. 

Æ 


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