I 

108TH CONGRESS 

1ST SESSION H. R. 1811

To amend title XIX of the Social Security Act to provide families of disabled 

children with the opportunity to purchase coverage under the Medicaid 

Program for such children, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 11, 2003

Mr. SESSIONS (for himself, Mr. WAXMAN, Mr. ABERCROMBIE, Mr. BACHUS, 

Mr. BARTLETT of Maryland, Mr. BROWN of Ohio, Mr. CAMP, Mrs. 

CAPPS, Mrs. CHRISTENSEN, Mr. CROWLEY, Mrs. JO ANN DAVIS of Virginia, Ms. DEGETTE, Mr. DEUTSCH, Mr. DINGELL, Mr. DOYLE, Mr. 

ENGEL, Mr. FARR, Mr. FROST, Mr. GORDON, Mr. GREEN of Texas, Mr. 

HINCHEY, Mr. HOEFFEL, Mr. INSLEE, Mr. ISAKSON, Mr. KILDEE, Ms. 

KILPATRICK, Mr. LANTOS, Mrs. MALONEY, Mr. MARKEY, Mr. MATSUI, 

Mr. MCNULTY, Mr. GEORGE MILLER of California, Mr. MOORE, Mr. 

MORAN of Virginia, Mr. MURTHA, Mrs. NORTHUP, Mr. OXLEY, Mr. 

PALLONE, Mr. PAUL, Mr. PAYNE, Mr. RAHALL, Ms. SCHAKOWSKY, Mr. 

SCHIFF, Mr. SCOTT of Virginia, Mr. SHAYS, Ms. SOLIS, Mr. SOUDER, 

Mr. STARK, Mr. STRICKLAND, Mr. TERRY, Mr. THORNBERRY, Mr. 

TOWNS, Mr. UDALL of Colorado, Mr. WOLF, Mrs. CAPITO, Mrs. JOHNSON of Connecticut, Mr. JOHN, Mr. REYNOLDS, and Mr. KUCINICH) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL

To amend title XIX of the Social Security Act to provide 

families of disabled children with the opportunity to purchase coverage under the Medicaid Program for such 

children, and for other purposes.
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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; AMENDMENTS TO SOCIAL SECU4 RITY ACT; TABLE OF CONTENTS. 

5 (a) SHORT TITLE.—This Act may be cited as the 

6 ‘‘Family Opportunity Act of 2003’’ or the ‘‘Dylan Lee 

7 James Act’’. 

8 (b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex9 cept as otherwise specifically provided, whenever in this 

10 Act an amendment is expressed in terms of an amendment 

11 to or repeal of a section or other provision, the reference 

12 shall be considered to be made to that section or other 

13 provision of the Social Security Act. 

14 (c) TABLE OF CONTENTS.—The table of contents of 

15 this Act is as follows:

Sec. 1. Short title; amendments to Social Security Act; table of contents. 

Sec. 2. Opportunity for families of disabled children to purchase medicaid coverage for such children. 

Sec. 3. Treatment of inpatient psychiatric hospital services for individuals 

under age 21 in home or community-based services waivers. 

Sec. 4. Development and support of family-to-family health information centers. 

Sec. 5. Restoration of medicaid eligibility for certain SSI beneficiaries.

16 SEC. 2. OPPORTUNITY FOR FAMILIES OF DISABLED CHIL17 DREN TO PURCHASE MEDICAID COVERAGE 

18 FOR SUCH CHILDREN. 

19 (a) STATE OPTION TO ALLOW FAMILIES OF DIS20 ABLED CHILDREN TO PURCHASE MEDICAID COVERAGE

21 FOR SUCH CHILDREN.—
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1 (1) IN GENERAL.—Section 1902 (42 U.S.C. 

2 1396a) is amended—

3 (A) in subsection (a)(10)(A)(ii)—

4 (i) by striking ‘‘or’’ at the end of sub5 clause (XVII); 

6 (ii) by adding ‘‘or’’ at the end of sub7 clause (XVIII); and 

8 (iii) by adding at the end the fol9 lowing new subclause: 

10 ‘‘(XIX) who are disabled children 

11 described in subsection (cc)(1);’’; and 

12 (B) by adding at the end the following new 

13 subsection: 

14 ‘‘(cc)(1) Individuals described in this paragraph are 

15 individuals—

16 ‘‘(A) who have not attained 18 years of age; 

17 ‘‘(B) who would be considered disabled under 

18 section 1614(a)(3)(C) but for having earnings or 

19 deemed income or resources (as determined under 

20 title XVI for children) that exceed the requirements 

21 for receipt of supplemental security income benefits; 

22 and 

23 ‘‘(C) whose family income does not exceed such 

24 income level as the State establishes and does not 

25 exceed—
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1 ‘‘(i) 250 percent of the income official pov2 erty line (as defined by the Office of Manage3 ment and Budget, and revised annually in ac4 cordance with section 673(2) of the Omnibus 

5 Budget Reconciliation Act of 1981) applicable 

6 to a family of the size involved; or 

7 ‘‘(ii) such higher percent of such poverty 

8 line as a State may establish, except that—

9 ‘‘(I) any medical assistance provided 

10 to an individual whose family income ex11 ceeds 250 percent of such poverty line may 

12 only be provided with State funds; and 

13 ‘‘(II) no Federal financial participa14 tion shall be provided under section 

15 1903(a) for any medical assistance pro16 vided to such an individual.’’. 

17 (2) INTERACTION WITH EMPLOYER-SPONSORED

18 FAMILY COVERAGE.—Section 1902(cc) (42 U.S.C. 

19 1396a(cc)), as added by paragraph (1)(B), is 

20 amended by adding at the end the following new 

21 paragraph: 

22 ‘‘(2)(A) If an employer of a parent of an individual 

23 described in paragraph (1) offers family coverage under 

24 a group health plan (as defined in section 2791(a) of the 

25 Public Health Service Act), the State shall—
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1 ‘‘(i) require such parent to apply for, enroll in, 

2 and pay premiums for, such coverage as a condition 

3 of such parent’s child being or remaining eligible for 

4 medical assistance under subsection 

5 (a)(10)(A)(ii)(XIX) if the parent is determined eligi6 ble for such coverage and the employer contributes 

7 at least 50 percent of the total cost of annual pre8 miums for such coverage; and 

9 ‘‘(ii) if such coverage is obtained—

10 ‘‘(I) subject to paragraph (2) of section 

11 1916(h), reduce the premium imposed by the 

12 State under that section in an amount that rea13 sonably reflects the premium contribution made 

14 by the parent for private coverage on behalf of 

15 a child with a disability; and 

16 ‘‘(II) treat such coverage as a third party 

17 liability under subsection (a)(25). 

18 ‘‘(B) In the case of a parent to which subparagraph 

19 (A) applies, a State, subject to paragraph (1)(C)(ii), may 

20 provide for payment of any portion of the annual premium 

21 for such family coverage that the parent is required to 

22 pay. Any payments made by the State under this subpara23 graph shall be considered, for purposes of section 1903(a), 

24 to be payments for medical assistance.’’. 
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1 (b) STATE OPTION TO IMPOSE INCOME-RELATED

2 PREMIUMS.—Section 1916 (42 U.S.C. 1396o) is amend3 ed—

4 (1) in subsection (a), by striking ‘‘subsection 

5 (g)’’ and inserting ‘‘subsections (g) and (h)’’; and 

6 (2) by adding at the end the following new sub7 section: 

8 ‘‘(h)(1) With respect to disabled children provided 

9 medical assistance under section 1902(a)(10)(A)(ii)(XIX), 

10 subject to paragraph (2), a State may (in a uniform man11 ner for such children) require the families of such children 

12 to pay monthly premiums set on a sliding scale based on 

13 family income. 

14 ‘‘(2) A premium requirement imposed under para15 graph (1) may only apply to the extent that—

16 ‘‘(A) the aggregate amount of such premium 

17 and any premium that the parent is required to pay 

18 for family coverage under section 1902(cc)(2)(A)(i) 

19 does not exceed 5 percent of the family’s income; 

20 and 

21 ‘‘(B) the requirement is imposed consistent with 

22 section 1902(cc)(2)(A)(ii)(I). 

23 ‘‘(3) A State shall not require prepayment of a pre24 mium imposed pursuant to paragraph (1) and shall not 

25 terminate eligibility of a child under section 
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1 1902(a)(10)(A)(ii)(XIX) for medical assistance under this 

2 title on the basis of failure to pay any such premium until 

3 such failure continues for a period of not less than 60 days 

4 from the date on which the premium became past due. 

5 The State may waive payment of any such premium in 

6 any case where the State determines that requiring such 

7 payment would create an undue hardship.’’. 

8 (c) CONFORMING AMENDMENTS.—Section 

9 1903(f)(4) (42 U.S.C. 1396b(f)(4)) is amended in the 

10 matter preceding subparagraph (A), by inserting 

11 ‘‘1902(a)(10)(A)(ii)(XIX),’’ after 

12 ‘‘1902(a)(10)(A)(ii)(XVIII),’’. 

13 (d) EFFECTIVE DATE.—The amendments made by 

14 this section shall apply to medical assistance for items and 

15 services furnished on or after October 1, 2005. 

16 SEC. 3. TREATMENT OF INPATIENT PSYCHIATRIC HOS17 PITAL SERVICES FOR INDIVIDUALS UNDER 

18 AGE 21 IN HOME OR COMMUNITY-BASED 

19 SERVICES WAIVERS. 

20 (a) IN GENERAL.—Section 1915(c) (42 U.S.C. 

21 1396n(c)) is amended—

22 (1) in paragraph (1)—

23 (A) in the first sentence, by inserting ‘‘, or 

24 would require inpatient psychiatric hospital 

25 services for individuals under age 21,’’ after 
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1 ‘‘intermediate care facility for the mentally re2 tarded’’; and 

3 (B) in the second sentence, by inserting ‘‘, 

4 or would require inpatient psychiatric hospital 

5 services for individuals under age 21’’ before 

6 the period; 

7 (2) in paragraph (2)(B), by striking ‘‘or serv8 ices in an intermediate care facility for the mentally 

9 retarded’’ each place it appears and inserting ‘‘serv10 ices in an intermediate care facility for the mentally 

11 retarded, or inpatient psychiatric hospital services 

12 for individuals under age 21’’; 

13 (3) in paragraph (2)(C)—

14 (A) by inserting ‘‘, or who are determined 

15 to be likely to require inpatient psychiatric hos16 pital services for individuals under age 21,’’ 

17 after ‘‘, or intermediate care facility for the 

18 mentally retarded’’; and 

19 (B) by striking ‘‘or services in an inter20 mediate care facility for the mentally retarded’’ 

21 and inserting ‘‘services in an intermediate care 

22 facility for the mentally retarded, or inpatient 

23 psychiatric hospital services for individuals 

24 under age 21’’; and 

25 (4) in paragraph (7)(A)—
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1 (A) by inserting ‘‘or would require inpa2 tient psychiatric hospital services for individuals 

3 under age 21,’’ after ‘‘intermediate care facility 

4 for the mentally retarded,’’; and 

5 (B) by inserting ‘‘or who would require in6 patient psychiatric hospital services for individ7 uals under age 21’’ before the period. 

8 (b) EFFECTIVE DATE.—The amendments made by 

9 subsection (a) apply with respect to medical assistance 

10 provided on or after January 1, 2004. 

11 SEC. 4. DEVELOPMENT AND SUPPORT OF FAMILY-TO-FAM12 ILY HEALTH INFORMATION CENTERS. 

13 Section 501 (42 U.S.C. 701) is amended by adding 

14 at the end the following new subsection: 

15 ‘‘(c)(1)(A) For the purpose of enabling the Secretary 

16 (through grants, contracts, or otherwise) to provide for 

17 special projects of regional and national significance for 

18 the development and support of family-to-family health in19 formation centers described in paragraph (2)—

20 ‘‘(i) there is appropriated to the Secretary, out 

21 of any money in the Treasury not otherwise appro22 priated—

23 ‘‘(I) $3,000,000 for fiscal year 2004; 

24 ‘‘(II) $4,000,000 for fiscal year 2005; and 

25 ‘‘(III) $5,000,000 for fiscal year 2006; and 
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1 ‘‘(ii) there is authorized to be appropriated to 

2 the Secretary, $5,000,000 for each of fiscal years 

3 2007 and 2008. 

4 ‘‘(B) Funds appropriated or authorized to be appro5 priated under subparagraph (A) shall—

6 ‘‘(i) be in addition to amounts appropriated 

7 under subsection (a) and retained under section 

8 502(a)(1) for the purpose of carrying out activities 

9 described in subsection (a)(2); and 

10 ‘‘(ii) remain available until expended. 

11 ‘‘(2) The family-to-family health information centers 

12 described in this paragraph are centers that—

13 ‘‘(A) assist families of children with disabilities 

14 or special health care needs to make informed 

15 choices about health care in order to promote good 

16 treatment decisions, cost-effectiveness, and improved 

17 health outcomes for such children; 

18 ‘‘(B) provide information regarding the health 

19 care needs of, and resources available for, children 

20 with disabilities or special health care needs; 

21 ‘‘(C) identify successful health delivery models 

22 for such children; 

23 ‘‘(D) develop with representatives of health care 

24 providers, managed care organizations, health care 

25 purchasers, and appropriate State agencies a model
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1 for collaboration between families of such children 

2 and health professionals; 

3 ‘‘(E) provide training and guidance regarding 

4 caring for such children; 

5 ‘‘(F) conduct outreach activities to the families 

6 of such children, health professionals, schools, and 

7 other appropriate entities and individuals; and 

8 ‘‘(G) are staffed by families of children with 

9 disabilities or special health care needs who have ex10 pertise in Federal and State public and private 

11 health care systems and health professionals. 

12 ‘‘(3) The Secretary shall develop family-to-family 

13 health information centers described in paragraph (2) 

14 under this subsection in accordance with the following: 

15 ‘‘(A) With respect to fiscal year 2004, such cen16 ters shall be developed in not less than 25 States. 

17 ‘‘(B) With respect to fiscal year 2005, such 

18 centers shall be developed in not less than 40 States. 

19 ‘‘(C) With respect to fiscal year 2006, such cen20 ters shall be developed in not less than 50 States 

21 and the District of Columbia. 

22 ‘‘(4) The provisions of this title that are applicable 

23 to the funds made available to the Secretary under section 

24 502(a)(1) apply in the same manner to funds made avail25 able to the Secretary under paragraph (1)(A). 
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1 ‘‘(5) For purposes of this subsection, the term ‘State’ 

2 means each of the 50 States and the District of Colum3 bia.’’. 

4 SEC. 5. RESTORATION OF MEDICAID ELIGIBILITY FOR CER5 TAIN SSI BENEFICIARIES. 

6 (a) IN GENERAL.—Section 1902(a)(10)(A)(i)(II) (42 

7 U.S.C. 1396a(a)(10)(A)(i)(II)) is amended—

8 (1) by inserting ‘‘(aa)’’ after ‘‘(II)’’; 

9 (2) by striking ‘‘) and’’ and inserting ‘‘and’’; 

10 (3) by striking ‘‘section or who are’’ and insert11 ing ‘‘section), (bb) who are’’; and 

12 (4) by inserting before the comma at the end 

13 the following: ‘‘, or (cc) who are under 21 years of 

14 age and with respect to whom supplemental security 

15 income benefits would be paid under title XVI if 

16 subparagraphs (A) and (B) of section 1611(c)(7) 

17 were applied without regard to the phrase ‘the first 

18 day of the month following’ ’’. 

19 (b) EFFECTIVE DATE.—The amendments made by 

20 subsection (a) shall apply to medical assistance for items 

21 and services furnished on or after the first day of the first 

22 calendar quarter that begins after the date of enactment 

23 of this Act.

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