I 

108TH CONGRESS 

1ST SESSION H. R. 2000

To amend title XIX of the Social Security Act to provide fiscal relief and 

program simplification to States, to improve coverage and services to 

Medicaid beneficiaries, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 7, 2003

Mr. DINGELL (for himself, Mr. BROWN of Ohio, Mr. WAXMAN, Mr. BOUCHER, 

Mr. PALLONE, Mr. TOWNS, Ms. MCCARTHY of Missouri, Mr. RUSH, Mr. 

MARKEY, Ms. SCHAKOWSKY, Mr. ALLEN, Mrs. CAPPS, Mr. STRICKLAND, 

Mr. GORDON, and Mr. ENGEL) introduced the following bill; which was 

referred to the Committee on Energy and Commerce, and in addition to 

the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

A BILL

To amend title XIX of the Social Security Act to provide 

fiscal relief and program simplification to States, to improve coverage and services to Medicaid beneficiaries, 

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,
2

•HR 2000 IH 

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Strengthening Our States Act of 2003’’ or the ‘‘SOS Act 

4 of 2003’’. 

5 (b) TABLE OF CONTENTS.—The table of contents of 

6 this Act is as follows:

Sec. 1. Short title; table of contents. 

TITLE I—STRENGTHENING FEDERAL RESPONSIBILITY FOR 

MEDICARE BENEFICIARIES 

Sec. 101. Assuming Federal responsibility for all medicare cost-sharing. 

Sec. 102. Expanded protections for low income medicare beneficiaries. 

TITLE II—PROVIDING STATES FISCAL RELIEF 

Sec. 201. Temporary increase of medicaid FMAP. 

Sec. 202. Temporary grants for State fiscal relief. 

Sec. 203. Increasing medicaid DSH allotments. 

Sec. 204. Increased State access to unspent SCHIP funds. 

Sec. 205. Federal responsibility for emergency care for illegal immigrants. 

Sec. 206. Increased Federal responsibility for translation services. 

Sec. 207. Increased Federal matching rates for certain services. 

TITLE III—HELPING STATES WITH COMMITMENT TO ELDERLY 

AND DISABLED; FAMILY OPPORTUNITY ACT 

Subtitle A—Elderly and Persons With Disabilities 

Sec. 301. Full accounting of savings in determining cost-effectiveness. 

Sec. 302. Extension of medicaid coverage under the ticket to work program to 

cover spouses. 

Sec. 303. Encouraging transition to home and community care. 

Sec. 304. Enhanced matching rate for disabled individuals awaiting medicare 

eligibility. 

Sec. 305. Providing initial term of 5 years for section 1915 waivers. 

Sec. 306. Optional coverage of community-based attendant services and supports under the medicaid program. 

Subtitle B—Family Opportunity Act 

Sec. 311. Short title. 

Sec. 312. Opportunity for families of disabled children to purchase medicaid 

coverage for such children. 

Sec. 313. Treatment of inpatient psychiatric hospital services for individuals 

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

Sec. 314. Demonstration of coverage under the medicaid program of children 

with potentially severe disabilities. 

Sec. 315. Development and support of family-to-family health information centers. 
3

•HR 2000 IH 

Sec. 316. Restoration of medicaid eligibility for certain SSI beneficiaries. 

TITLE IV—FACILITATING PROGRAM ADMINISTRATION AND 

PRESERVING COVERAGE 

Sec. 401. Allowing uniform coverage of all low income Americans. 

Sec. 402. Facilitating coverage of families. 

Sec. 403. Assistance with coverage of legal immigrants under the medicaid program and SCHIP. 

Sec. 404. Flexibility in eligibility determinations.

1 TITLE I—STRENGTHENING FED2 ERAL RESPONSIBILITY FOR 

3 MEDICARE BENEFICIARIES 

4 SEC. 101. ASSUMING FEDERAL RESPONSIBILITY FOR ALL 

5 MEDICARE COST-SHARING. 

6 (a) IN GENERAL.—Section 1905(b) of the Social Se7 curity Act (42 U.S.C. 1396d(b)) is amended—

8 (1) by striking ‘‘and’’ before ‘‘(4)’’; and 

9 (2) by inserting before the period the following: 

10 ‘‘, and (5) the Federal medical assistance percentage 

11 shall be 100 percent with respect to medical assist12 ance provided with costs described in section 

13 1905(p)(3)’’. 

14 (b) CONFORMING AMENDMENT.—Section 1902 of 

15 such Act (42 U.S.C. 1396a) is amended by striking sub16 section (n). 

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

18 this section shall apply to medical assistance for medicare 

19 cost-sharing for months beginning with July 2003. 
4

•HR 2000 IH 

1 SEC. 102. EXPANDED PROTECTIONS FOR LOW INCOME 

2 MEDICARE BENEFICIARIES. 

3 (a) IN GENERAL.—Section 1902(a)(10)(E) of the So4 cial Security Act (42 U.S.C. 1396a(a)(10)(E)) is amend5 ed—

6 (1) by adding ‘‘and’’ at the end of clause (ii); 

7 (2) in clause (iii), by striking ‘‘110 percent in 

8 1993 and 1994, and 120 percent in 1995 and 

9 years’’ and inserting ‘‘135 percent’’; and 

10 (3) by striking clause (iv). 

11 (b) CONFORMING AMENDMENT.—Section 1933 of 

12 such Act (42 U.S.C. 1396v) is repealed. 

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

14 subsection (a), and the repeal made by subsection (b), 

15 shall apply to months after September 2003. 

16 TITLE II—PROVIDING STATES 

17 FISCAL RELIEF 

18 SEC. 201. TEMPORARY INCREASE OF MEDICAID FMAP. 

19 (a) PERMITTING MAINTENANCE OF FISCAL YEAR

20 2002 FMAP FOR LAST 2 CALENDAR QUARTERS OF FIS21 CAL YEAR 2003.—Notwithstanding any other provision of 

22 law, but subject to subsection (e), if the FMAP deter23 mined without regard to this section for a State for fiscal 

24 year 2003 is less than the FMAP as so determined for 

25 fiscal year 2002, the FMAP for the State for fiscal year 

26 2002 shall be substituted for the State’s FMAP for the
5

•HR 2000 IH 

1 third and fourth calendar quarters of fiscal year 2003, be2 fore the application of this section. 

3 (b) PERMITTING MAINTENANCE OF FISCAL YEAR

4 2003 FMAP FOR FISCAL YEAR 2004.—Notwithstanding 

5 any other provision of law, but subject to subsection (e), 

6 if the FMAP determined without regard to this section 

7 for a State for fiscal year 2004 is less than the FMAP 

8 as so determined for fiscal year 2003, the FMAP for the 

9 State for fiscal year 2003 shall be substituted for the 

10 State’s FMAP for each calendar quarter of fiscal year 

11 2004, before the application of this section. 

12 (c) GENERAL 3.73 PERCENTAGE POINTS INCREASE

13 FOR LAST 2 CALENDAR QUARTERS OF FISCAL YEAR 2003 

14 AND FISCAL YEAR 2004.—Notwithstanding any other 

15 provision of law, but subject to subsections (e) and (f), 

16 for each State for the third and fourth calendar quarters 

17 of fiscal year 2003 and each calendar quarter of fiscal year 

18 2004, the FMAP (taking into account the application of 

19 subsections (a) and (b)) shall be increased by 3.73 per20 centage points. 

21 (d) INCREASE IN CAP ON MEDICAID PAYMENTS TO

22 TERRITORIES.—Notwithstanding any other provision of 

23 law, but subject to subsection (f), with respect to the third 

24 and fourth calendar quarters of fiscal year 2003 and each 

25 calendar quarter of fiscal year 2004, the amounts other-
6

•HR 2000 IH 

1 wise determined for Puerto Rico, the Virgin Islands, 

2 Guam, the Northern Mariana Islands, and American 

3 Samoa under subsections (f) and (g) of section 1108 of 

4 the Social Security Act (42 U.S.C. 1308) shall each be 

5 increased by an amount equal to 7.46 percent of such 

6 amounts. 

7 (e) SCOPE OF APPLICATION.—The increases in the 

8 FMAP for a State under this section shall apply only for 

9 purposes of title XIX of the Social Security Act and shall 

10 not apply with respect to—

11 (1) disproportionate share hospital payments 

12 described in section 1923 of such Act (42 U.S.C. 

13 1396r–4); or 

14 (2) payments under title IV or XXI of such Act 

15 (42 U.S.C. 601 et seq. and 1397aa et seq.). 

16 (f) STATE ELIGIBILITY.—

17 (1) IN GENERAL.—Subject to paragraph (2), a 

18 State is eligible for an increase in its FMAP under 

19 subsection (c) or an increase in a cap amount under 

20 subsection (d) only if the eligibility under its State 

21 plan under title XIX of the Social Security Act (in22 cluding any waiver under such title or under section 

23 1115 of such Act (42 U.S.C. 1315)) is no more re24 strictive than the eligibility under such plan (or 

25 waiver) as in effect on September 2, 2003. 
7

•HR 2000 IH 

1 (2) STATE REINSTATEMENT OF ELIGIBILITY

2 PERMITTED.—A State that has restricted eligibility 

3 under its State plan under title XIX of the Social 

4 Security Act (including any waiver under such title 

5 or under section 1115 of such Act (42 U.S.C. 

6 1315)) after September 2, 2003, but prior to the 

7 date of enactment of this Act is eligible for an in8 crease in its FMAP under subsection (c) or an in9 crease in a cap amount under subsection (d) in the 

10 first calendar quarter (and subsequent calendar 

11 quarters) in which the State has reinstated eligibility 

12 that is no more restrictive than the eligibility under 

13 such plan (or waiver) as in effect on September 2, 

14 2003. 

15 (3) RULE OF CONSTRUCTION.—Nothing in 

16 paragraph (1) or (2) shall be construed as affecting 

17 a State’s flexibility with respect to benefits offered 

18 under the State medicaid program under title XIX 

19 of the Social Security Act (42 U.S.C. 1396 et seq.) 

20 (including any waiver under such title or under sec21 tion 1115 of such Act (42 U.S.C. 1315)). 

22 (g) DEFINITIONS.—In this section: 

23 (1) FMAP.—The term ‘‘FMAP’’ means the 

24 Federal medical assistance percentage, as defined in 
8

•HR 2000 IH 

1 section 1905(b) of the Social Security Act (42 

2 U.S.C. 1396d(b)). 

3 (2) STATE.—The term ‘‘State’’ has the mean4 ing given such term for purposes of title XIX of the 

5 Social Security Act (42 U.S.C. 1396 et seq.). 

6 (h) REPEAL.—Effective as of October 1, 2004, this 

7 section is repealed. 

8 SEC. 202. TEMPORARY GRANTS FOR STATE FISCAL RELIEF. 

9 (a) IN GENERAL.—Title XX of the Social Security 

10 Act (42 U.S.C. 1397–1397f) is amended by adding at the 

11 end the following:

12 ‘‘SEC. 2008. ADDITIONAL TEMPORARY GRANTS FOR STATE 

13 FISCAL RELIEF. 

14 ‘‘(a) IN GENERAL.—For the purpose of providing 

15 State fiscal relief allotments to States under this section, 

16 there are hereby appropriated, out of any funds in the 

17 Treasury not otherwise appropriated, $15,000,000,000. 

18 Such funds shall be available for obligation by the State 

19 through June 30, 2005, and for expenditure by the State 

20 through September 30, 2005. This section constitutes 

21 budget authority in advance of appropriations Acts and 

22 represents the obligation of the Federal Government to 

23 provide for the payment to States of amounts provided 

24 under this section. 
9

•HR 2000 IH 

1 ‘‘(b) ALLOTMENT.—Funds appropriated under sub2 section (a) shall be allotted by the Secretary among the 

3 States in accordance with the following table:

‘‘State Allotment (in 

dollars) 

Alabama $170,940,139

Alaska $42,076,374

Amer. Samoa $414,007

Arizona $261,264,449

Arkansas $133,398,723

California $1,583,851,051

Colorado $143,030,332

Connecticut $207,204,156

Delaware $38,537,434

District of Columbia $65,034,813

Florida $624,655,953

Georgia $368,582,068

Guam $669,845

Hawaii $46,337,939

Idaho $48,659,904

Illinois $543,631,283

Indiana $271,629,605

Iowa $130,309,854

Kansas $94,370,028

Kentucky $212,122,967

Louisiana $239,827,085

Maine $92,781,591

Maryland $236,000,265

Massachusetts $472,765,757

Michigan $435,451,207

Minnesota $302,429,550

Mississippi $176,956,163

Missouri $302,534,081

Montana $36,437,168

Nebraska $79,550,313

Nevada $52,331,624

New Hampshire $54,101,351

New Jersey $411,954,920

New Mexico $112,850,197

New York $2,383,327,447

North Carolina $439,742,488

North Dakota $27,253,781

N. Mariana Islands $233,880

Ohio $616,448,513

Oklahoma $146,240,811

Oregon $167,002,460

Pennsylvania $745,862,667

Puerto Rico $18,916,230

Rhode Island $80,098,624

South Carolina $184,217,430

South Dakota $30,302,145

Tennessee $350,273,887

Texas $814,722,031

Utah $63,422,131

Vermont $40,549,714

Virgin Islands $624,499

Virginia $215,155,129

Washington $298,697,312

West Virginia $95,818,709

Wisconsin $270,901,128

Wyoming $17,496,788

Total $15,000,000,000

4 ‘‘(c) USE OF FUNDS.—Funds appropriated under 

5 this section may be used by a State for services directed
10

•HR 2000 IH 

1 at the goals set forth in section 2001, subject to the re2 quirements of this title. 

3 ‘‘(d) PAYMENT TO STATES.—Not later than 30 days 

4 after amounts are appropriated under subsection (a), in 

5 addition to any payment made under section 2002 or 

6 2007, the Secretary shall make a lump sum payment to 

7 a State of the total amount of the allotment for the State 

8 as specified in subsection (b). 

9 ‘‘(e) DEFINITION.—For purposes of this section, the 

10 term ‘State’ means the 50 States, the District of Colum11 bia, and the territories contained in the list under sub12 section (b).’’. 

13 (b) REPEAL.—Effective as of October 1, 2005, sec14 tion 2008 of the Social Security Act, as added by sub15 section (a), is repealed. 

16 (c) GAO STUDY AND REPORT.—

17 (1) STUDY.—The Comptroller General of the 

18 United States shall conduct a study to determine an 

19 appropriate index that could be used to temporarily 

20 adjust the Federal medical assistance percentage for 

21 purposes of programs authorized under the Social 

22 Security Act either with respect to all States during 

23 a period of national recession or with respect to a 

24 specific State when the State’s economy takes a sig25 nificant turn for the worse. 
11

•HR 2000 IH 

1 (2) REPORT.—Not later than 1 year after the 

2 date of the enactment of this Act, the Comptroller 

3 General of the United States shall submit a report 

4 to Congress on the study conducted under para5 graph (1). 

6 SEC. 203. INCREASING MEDICAID DSH ALLOTMENTS. 

7 (a) CONTINUATION OF MEDICAID DSH ALLOTMENT

8 ADJUSTMENTS UNDER BIPA 2000.—

9 (1) IN GENERAL.—Section 1923(f) of the Social 

10 Security Act (42 U.S.C. 1396r–4(f))—

11 (A) in paragraph (2)—

12 (i) in the heading, by striking 

13 ‘‘THROUGH 2002’’ and inserting ‘‘THROUGH

14 2000’’; 

15 (ii) by striking ‘‘ending with fiscal 

16 year 2002’’ and inserting ‘‘ending with fis17 cal year 2000’’; and 

18 (iii) in the table in such paragraph, by 

19 striking the columns labeled ‘‘FY 01’’ and 

20 ‘‘FY02’’; 

21 (B) in paragraph (3)(A), by striking 

22 ‘‘paragraph (2)’’ and inserting ‘‘paragraph 

23 (4)’’; and 

24 (C) in paragraph (4), as added by section 

25 701(a)(1) of the Medicare, Medicaid, and 
12

•HR 2000 IH 

1 SCHIP Benefits Improvement and Protection 

2 Act of 2000 (as enacted into law by section 

3 1(a)(6) of Public Law 106–554)—

4 (i) by striking ‘‘FOR FISCAL YEARS

5 2001 AND 2002’’ in the heading; 

6 (ii) in subparagraph (A), by striking 

7 ‘‘Notwithstanding paragraph (2), the’’ and 

8 inserting ‘‘The’’; 

9 (iii) in subparagraph (C)—

10 (I) by striking ‘‘NO APPLICA11 TION’’ and inserting ‘‘APPLICATION’’; 

12 and 

13 (II) by striking ‘‘without regard 

14 to’’ and inserting ‘‘taking into ac15 count’’. 

16 (2) INCREASE IN MEDICAID DSH ALLOTMENT

17 FOR THE DISTRICT OF COLUMBIA.—

18 (A) IN GENERAL.—Effective for DSH al19 lotments beginning with fiscal year 2003, the 

20 item in the table contained in section 

21 1923(f)(2) of the Social Security Act (42 

22 U.S.C. 1396r–4(f)(2)) for the District of Co23 lumbia for the DSH allotment for FY 00 (fiscal 

24 year 2000) is amended by striking ‘‘32’’ and in25 serting ‘‘49’’. 
13

•HR 2000 IH 

1 (B) CONSTRUCTION.—Nothing in subpara2 graph (A) shall be construed as preventing the 

3 application of section 1923(f)(4) of the Social 

4 Security Act (as amended by subsection (a)) to 

5 the District of Columbia for fiscal year 2003 

6 and subsequent fiscal years. 

7 (3) EFFECTIVE DATE.—The amendments made 

8 by this subsection shall apply to DSH allotments for 

9 fiscal years beginning with fiscal year 2003. 

10 (b) INCREASE IN FLOOR FOR TREATMENT AS AN EX11 TREMELY LOW DSH STATE TO 3 PERCENT IN FISCAL

12 YEAR 2003.—

13 (1) INCREASE IN DSH FLOOR.—Section 

14 1923(f)(5) of the Social Security Act (42 U.S.C. 

15 1396r–4(f)(5)) is amended—

16 (A) by striking ‘‘fiscal year 1999’’ and in17 serting ‘‘fiscal year 2001’’; 

18 (B) by striking ‘‘August 31, 2000’’ and in19 serting ‘‘August 31, 2002’’; 

20 (C) by striking ‘‘1 percent’’ each place it 

21 appears and inserting ‘‘3 percent’’; and 

22 (D) by striking ‘‘fiscal year 2001’’ and in23 serting ‘‘fiscal year 2003’’. 

24 (2) EFFECTIVE DATE.—The amendments made 

25 by paragraph (1) take effect as if enacted on Octo-
14

•HR 2000 IH 

1 ber 1, 2002, and apply to DSH allotments under 

2 title XIX of the Social Security Act for fiscal year 

3 2003 and each fiscal year thereafter. 

4 SEC. 204. INCREASED STATE ACCESS TO UNSPENT SCHIP 

5 FUNDS. 

6 (a) RETAINED AND REDISTRIBUTED ALLOTMENTS

7 FOR FISCAL YEARS 1998 AND 1999.—Paragraphs 

8 (2)(A)(i) and (2)(A)(ii) of section 2104(g) of the Social 

9 Security Act (42 U.S.C. 1397dd(g)) are each amended by 

10 striking ‘‘fiscal year 2002’’ and inserting ‘‘fiscal year 

11 2004’’. 

12 (b) EXTENSION AND REVISION OF RETAINED AND

13 REDISTRIBUTED ALLOTMENTS FOR FISCAL YEAR

14 2000.—

15 (1) PERMITTING AND EXTENDING RETENTION

16 OF PORTION OF FISCAL YEAR 2000 ALLOTMENT.—

17 Paragraph (2) of such section 2104(g) is amended—

18 (A) in the heading, by striking ‘‘AND 1999’’ 

19 and inserting ‘‘THROUGH 2000’’; and 

20 (B) by adding at the end of subparagraph 

21 (A) the following: 

22 ‘‘(iii) FISCAL YEAR 2000 ALLOT23 MENT.—Of the amounts allotted to a State 

24 pursuant to this section for fiscal year 

25 2000 that were not expended by the State
15

•HR 2000 IH 

1 by the end of fiscal year 2002, 50 percent 

2 of that amount shall remain available for 

3 expenditure by the State through the end 

4 of fiscal year 2004.’’. 

5 (2) REDISTRIBUTED ALLOTMENTS.—Paragraph 

6 (1) of such section 2104(g) is amended—

7 (A) in subparagraph (A), by inserting ‘‘or 

8 for fiscal year 2000 by the end of fiscal year 

9 2002,’’ after ‘‘fiscal year 2001,’’; 

10 (B) in subparagraph (A), by striking 

11 ‘‘1998 or 1999’’ and inserting ‘‘1998, 1999, or 

12 2000’’; 

13 (C) in subparagraph (A)(i)—

14 (i) by striking ‘‘or’’ at the end of sub15 clause (I), 

16 (ii) by striking the period at the end 

17 of subclause (II) and inserting ‘‘; or’’; and 

18 (iii) by adding at the end the fol19 lowing new subclause: 

20 ‘‘(III) the fiscal year 2000 allot21 ment, the amount specified in sub22 paragraph (C)(i) (less the total of the 

23 amounts under clause (ii) for such fis24 cal year), multiplied by the ratio of 

25 the amount specified in subparagraph 
16

•HR 2000 IH 

1 (C)(ii) for the State to the amount 

2 specified in subparagraph (C)(iii).’’; 

3 (D) in subparagraph (A)(ii), by striking 

4 ‘‘or 1999’’ and inserting ‘‘, 1999, or 2000’’; 

5 (E) in subparagraph (B), by striking ‘‘with 

6 respect to fiscal year 1998 or 1999’’; 

7 (F) in subparagraph (B)(ii)—

8 (i) by inserting ‘‘with respect to fiscal 

9 year 1998, 1999, or 2000,’’ after ‘‘sub10 section (e),’’; and 

11 (ii) by striking ‘‘2002’’ and inserting 

12 ‘‘2004’’; and 

13 (G) by adding at the end the following new 

14 subparagraph: 

15 ‘‘(C) AMOUNTS USED IN COMPUTING RE16 DISTRIBUTIONS FOR FISCAL YEAR 2000.—For 

17 purposes of subparagraph (A)(i)(III)—

18 ‘‘(i) the amount specified in this 

19 clause is the amount specified in para20 graph (2)(B)(i)(I) for fiscal year 2000, less 

21 the total amount remaining available pur22 suant to paragraph (2)(A)(iii); 

23 ‘‘(ii) the amount specified in this 

24 clause for a State is the amount by which 

25 the State’s expenditures under this title in 
17

•HR 2000 IH 

1 fiscal years 2000, 2001, and 2002 exceed 

2 the State’s allotment for fiscal year 2000 

3 under subsection (b); and 

4 ‘‘(iii) the amount specified in this 

5 clause is the sum, for all States entitled to 

6 a redistribution under subparagraph (A) 

7 from the allotments for fiscal year 2000, of 

8 the amounts specified in clause (ii).’’. 

9 (3) CONFORMING AMENDMENTS.—Such section 

10 2104(g) is further amended—

11 (A) in its heading, by striking ‘‘AND 1999’’ 

12 and inserting ‘‘, 1999, AND 2000’’; and 

13 (B) in paragraph (3)—

14 (i) by striking ‘‘or fiscal year 1999’’ 

15 and inserting ‘‘, fiscal year 1999, or fiscal 

16 year 2000’’; and 

17 (ii) by striking ‘‘or November 30, 

18 2001’’ and inserting ‘‘November 30, 2001, 

19 or November 30, 2002’’, respectively. 

20 (c) EXTENSION AND REVISION OF RETAINED AND

21 REDISTRIBUTED ALLOTMENTS FOR FISCAL YEAR

22 2001.—

23 (1) PERMITTING AND EXTENDING RETENTION

24 OF PORTION OF FISCAL YEAR 2001 ALLOTMENT.—
18

•HR 2000 IH 

1 Paragraph (2) of such section 2104(g), as amended 

2 in subsection (b)(1)(B), is further amended—

3 (A) in the heading, by striking ‘‘2000’’ and 

4 inserting ‘‘2001’’; and 

5 (B) by adding at the end of subparagraph 

6 (A) the following: 

7 ‘‘(iv) FISCAL YEAR 2001 ALLOT8 MENT.—Of the amounts allotted to a State 

9 pursuant to this section for fiscal year 

10 2001 that were not expended by the State 

11 by the end of fiscal year 2003, 50 percent 

12 of that amount shall remain available for 

13 expenditure by the State through the end 

14 of fiscal year 2005.’’. 

15 (2) REDISTRIBUTED ALLOTMENTS.—Paragraph 

16 (1) of such section 2104(g), as amended in sub17 section (b)(2), is further amended—

18 (A) in subparagraph (A), by inserting ‘‘or 

19 for fiscal year 2001 by the end of fiscal year 

20 2003,’’ after ‘‘fiscal year 2002,’’; 

21 (B) in subparagraph (A), by striking 

22 ‘‘1999, or 2000’’ and inserting ‘‘1999, 2000, or 

23 2001’’; 

24 (C) in subparagraph (A)(i)—
19

•HR 2000 IH 

1 (i) by striking ‘‘or’’ at the end of sub2 clause (II), 

3 (ii) by striking the period at the end 

4 of subclause (III) and inserting ‘‘; or’’; and 

5 (iii) by adding at the end the fol6 lowing new subclause: 

7 ‘‘(IV) the fiscal year 2001 allot8 ment, the amount specified in sub9 paragraph (D)(i) (less the total of the 

10 amounts under clause (ii) for such fis11 cal year), multiplied by the ratio of 

12 the amount specified in subparagraph 

13 (D)(ii) for the State to the amount 

14 specified in subparagraph (D)(iii).’’; 

15 (D) in subparagraph (A)(ii), by striking 

16 ‘‘or 2000’’ and inserting ‘‘2000, or 2001’’; 

17 (E) in subparagraph (B)—

18 (i) by striking ‘‘and’’ at the end of 

19 clause (ii); 

20 (ii) by redesignating clause (iii) as 

21 clause (iv); and 

22 (iii) by inserting after clause (ii) the 

23 following new clause: 

24 ‘‘(iii) notwithstanding subsection (e), 

25 with respect to fiscal year 2001, shall re-
20

•HR 2000 IH 

1 main available for expenditure by the State 

2 through the end of fiscal year 2005; and’’; 

3 and 

4 (F) by adding at the end the following new 

5 subparagraph: 

6 ‘‘(D) AMOUNTS USED IN COMPUTING RE7 DISTRIBUTIONS FOR FISCAL YEAR 2001.—For 

8 purposes of subparagraph (A)(i)(IV)—

9 ‘‘(i) the amount specified in this 

10 clause is the amount specified in para11 graph (2)(B)(i)(I) for fiscal year 2001, less 

12 the total amount remaining available pur13 suant to paragraph (2)(A)(iv); 

14 ‘‘(ii) the amount specified in this 

15 clause for a State is the amount by which 

16 the State’s expenditures under this title in 

17 fiscal years 2001, 2002, and 2003 exceed 

18 the State’s allotment for fiscal year 2001 

19 under subsection (b); and 

20 ‘‘(iii) the amount specified in this 

21 clause is the sum, for all States entitled to 

22 a redistribution under subparagraph (A) 

23 from the allotments for fiscal year 2001, of 

24 the amounts specified in clause (ii).’’. 
21

•HR 2000 IH 

1 (3) CONFORMING AMENDMENTS.—Such section 

2 2104(g) is further amended—

3 (A) in its heading, by striking ‘‘AND 2000’’ 

4 and inserting ‘‘2000, AND 2001’’; and 

5 (B) in paragraph (3)—

6 (i) by striking ‘‘or fiscal year 2000’’ 

7 and inserting ‘‘fiscal year 2000, or fiscal 

8 year 2001’’; and 

9 (ii) by striking ‘‘or November 30, 

10 2002,’’ and inserting ‘‘November 30, 2002, 

11 or November 30, 2003,’’, respectively. 

12 (d) AUTHORITY FOR QUALIFYING STATES TO USE

13 PORTION OF SCHIP FUNDS FOR MEDICAID EXPENDI14 TURES.—Section 2105 of the Social Security Act (42 

15 U.S.C. 1397ee) is amended by adding at the end the fol16 lowing: 

17 ‘‘(g) AUTHORITY FOR QUALIFYING STATES TO USE

18 CERTAIN FUNDS FOR MEDICAID EXPENDITURES.—

19 ‘‘(1) STATE OPTION.—

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

21 other provision of law, with respect to allot22 ments for fiscal years 1998, 1999, 2000, 2001, 

23 for fiscal years in which such allotments are 

24 available under subsections (e) and (g) of sec25 tion 2104, a qualifying State (as defined in 
22

•HR 2000 IH 

1 paragraph (2)) may elect to use not more than 

2 20 percent of such allotments (instead of for 

3 expenditures under this title) for payments for 

4 such fiscal year under title XIX in accordance 

5 with subparagraph (B). 

6 ‘‘(B) PAYMENTS TO STATES.—

7 ‘‘(i) IN GENERAL.—In the case of a 

8 qualifying State that has elected the option 

9 described in subparagraph (A), subject to 

10 the total amount of funds described with 

11 respect to the State in subparagraph (A), 

12 the Secretary shall pay the State an 

13 amount each quarter equal to the addi14 tional amount that would have been paid 

15 to the State under title XIX for expendi16 tures of the State for the fiscal year de17 scribed in clause (ii) if the enhanced 

18 FMAP (as determined under subsection 

19 (b)) had been substituted for the Federal 

20 medical assistance percentage (as defined 

21 in section 1905(b)) of such expenditures. 

22 ‘‘(ii) EXPENDITURES DESCRIBED.—

23 For purposes of clause (i), the expendi24 tures described in this clause are expendi25 tures for such fiscal years for providing 
23

•HR 2000 IH 

1 medical assistance under title XIX to indi2 viduals who have not attained age 19 and 

3 whose family income exceeds 150 percent 

4 of the poverty line. 

5 ‘‘(iii) NO IMPACT ON DETERMINATION

6 OF BUDGET NEUTRALITY FOR WAIVERS.—

7 In the case of a qualifying State that uses 

8 amounts paid under this subsection for ex9 penditures described in clause (ii) that are 

10 incurred under a waiver approved for the 

11 State, any budget neutrality determina12 tions with respect to such waiver shall be 

13 determined without regard to such 

14 amounts paid. 

15 ‘‘(2) QUALIFYING STATE.—In this subsection, 

16 the term ‘qualifying State’ means a State that—

17 ‘‘(A) as of April 15, 1997, has an income 

18 eligibility standard with respect to any 1 or 

19 more categories of children (other than infants) 

20 who are eligible for medical assistance under 

21 section 1902(a)(10)(A) or under a waiver under 

22 section 1115 implemented on January 1, 1994, 

23 that is up to 185 percent of the poverty line or 

24 above; and
24

•HR 2000 IH 

1 ‘‘(B) satisfies the requirements described 

2 in paragraph (3). 

3 ‘‘(3) REQUIREMENTS.—The requirements de4 scribed in this paragraph are the following: 

5 ‘‘(A) SCHIP INCOME ELIGIBILITY.—The 

6 State has a State child health plan that (wheth7 er implemented under title XIX or this title)—

8 ‘‘(i) as of January 1, 2001, has an in9 come eligibility standard that is at least 

10 200 percent of the poverty line or has an 

11 income eligibility standard that exceeds 

12 200 percent of the poverty line under a 

13 waiver under section 1115 that is based on 

14 a child’s lack of health insurance; 

15 ‘‘(ii) subject to subparagraph (B), 

16 does not limit the acceptance of applica17 tions for children; and 

18 ‘‘(iii) provides benefits to all children 

19 in the State who apply for and meet eligi20 bility standards on a statewide basis. 

21 ‘‘(B) NO WAITING LIST IMPOSED.—With 

22 respect to children whose family income is at or 

23 below 200 percent of the poverty line, the State 

24 does not impose any numerical limitation, wait25 ing list, or similar limitation on the eligibility of 
25

•HR 2000 IH 

1 such children for child health assistance under 

2 such State plan. 

3 ‘‘(C) ADDITIONAL REQUIREMENTS.—The 

4 State has implemented at least 3 of the fol5 lowing policies and procedures (relating to cov6 erage of children under title XIX and this title): 

7 ‘‘(i) UNIFORM, SIMPLIFIED APPLICA8 TION FORM.—With respect to children who 

9 are eligible for medical assistance under 

10 section 1902(a)(10)(A), the State uses the 

11 same uniform, simplified application form 

12 (including, if applicable, permitting appli13 cation other than in person) for purposes 

14 of establishing eligibility for benefits under 

15 title XIX and this title. 

16 ‘‘(ii) ELIMINATION OF ASSET TEST.—

17 The State does not apply any asset test for 

18 eligibility under section 1902(l) or this title 

19 with respect to children. 

20 ‘‘(iii) ADOPTION OF 12-MONTH CON21 TINUOUS ENROLLMENT.—The State pro22 vides that eligibility shall not be regularly 

23 redetermined more often than once every 

24 year under this title or for children de25 scribed in section 1902(a)(10)(A). 
26

•HR 2000 IH 

1 ‘‘(iv) SAME VERIFICATION AND REDE2 TERMINATION POLICIES; AUTOMATIC REAS3 SESSMENT OF ELIGIBILITY.—With respect 

4 to children who are eligible for medical as5 sistance under section 1902(a)(10)(A), the 

6 State provides for initial eligibility deter7 minations and redeterminations of eligi8 bility using the same verification policies 

9 (including with respect to face-to-face 

10 interviews), forms, and frequency as the 

11 State uses for such purposes under this 

12 title, and, as part of such redetermina13 tions, provides for the automatic reassess14 ment of the eligibility of such children for 

15 assistance under title XIX and this title. 

16 ‘‘(v) OUTSTATIONING ENROLLMENT

17 STAFF.—The State provides for the receipt 

18 and initial processing of applications for 

19 benefits under this title and for children 

20 under title XIX at facilities defined as dis21 proportionate share hospitals under section 

22 1923(a)(1)(A) and Federally-qualified 

23 health centers described in section 

24 1905(l)(2)(B) consistent with section 

25 1902(a)(55).’’. 
27

•HR 2000 IH 

1 (e) EFFECTIVE DATE.—Subsections (a) through (c), 

2 and the amendments made by such subsections, shall be 

3 effective as if this section had been enacted on September 

4 30, 2002, and amounts under title XXI of the Social Secu5 rity Act (42 U.S.C. 1397aa et seq.) from allotments for 

6 fiscal years 1998 through 2000 are available for expendi7 ture on and after October 1, 2002, under the amendments 

8 made by such subsections as if this section had been en9 acted on September 30, 2002. 

10 SEC. 205. FEDERAL RESPONSIBILITY FOR EMERGENCY 

11 CARE FOR ILLEGAL IMMIGRANTS. 

12 (a) IN GENERAL.—Section 1903(a)(3) of the Social 

13 Security Act (42 U.S.C. 1396b(a)(3)) is amended—

14 (1) in subparagraph (D), by striking ‘‘plus’’ at 

15 the end and inserting ‘‘and’’; and 

16 (2) by adding at the end the following: 

17 ‘‘(E) 100 percent of the sums expended 

18 with respect to costs incurred during such quar19 ter as are attributable to the provision of care 

20 and services that are furnished to an alien de21 scribed in subsection (v)(1) that are necessary 

22 for the treatment of an emergency medical con23 dition, as defined in subsection (v)(3); and’’. 

24 (b) EFFECTIVE DATE.—The amendment made by 

25 subsection (a) shall take effect on July 1, 2003. 
28

•HR 2000 IH 

1 SEC. 206. INCREASED FEDERAL RESPONSIBILITY FOR 

2 TRANSLATION SERVICES. 

3 (a) IN GENERAL.—Section 1903(a)(3) of the Social 

4 Security Act (42 U.S.C. 1396b(a)(3)), as amended by sec5 tion 205(a), is amended by adding at the end the fol6 lowing: 

7 ‘‘(F) 90 percent of the sums expended with 

8 respect to costs incurred during such quarter as 

9 are attributable to the provision of language 

10 services, including oral interpretation, trans11 lations of written materials, and other language 

12 services, for individuals with limited English 

13 proficiency who apply for, or receive, medical 

14 assistance under the State plan; and’’. 

15 (b) SCHIP.—Section 2105(A)(1) of the Social Secu16 rity Act (42 U.S.C.1397ee(a)(1)) is amended—

17 (1) in the matter preceding subparagraph (A), 

18 by striking ‘‘section 1905(b))’’ and inserting ‘‘sec19 tion 1905(b)) or, in the case of expenditures de20 scribed in subparagraph (D)(iv), 90 percent’’; and 

21 (2) in subparagraph (D)—

22 (A) in clause (iii), by striking ‘‘and’’ at the 

23 end; 

24 (B) by redesignating clause (iv) as clause 

25 (v); and
29

•HR 2000 IH 

1 (C) by inserting after clause (iii) the fol2 lowing: 

3 ‘‘(D) for expenditures attributable to the 

4 provision of language services, including oral in5 terpretation, translations of written materials, 

6 and other language services, for individuals 

7 with limited English proficiency who apply for, 

8 or receive, child health assistance under the 

9 plan; and’’. 

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

11 this section shall take effect on July 1, 2003. 

12 SEC. 207. INCREASED FEDERAL MATCHING RATES FOR 

13 CERTAIN SERVICES. 

14 (a) OUTSTATIONED WORKERS.—Section 1903(a)(3) 

15 of the Social Security Act (42 U.S.C. 1396b(a)(3)), as 

16 amended by sections 205(a) and 206(a), is amended by 

17 adding at the end the following: 

18 ‘‘(G) 90 percent of the sums expended with 

19 respect to costs incurred during such quarter as 

20 are attributable to providing for the receipt and 

21 initial processing of applications of children and 

22 pregnant women for medical assistance con23 sistent with the requirements of section 

24 1902(a)(55); plus’’. 
30

•HR 2000 IH 

1 (b) 100 PERCENT MATCHING RATE FOR URBAN IN2 DIAN HEALTH SERVICES.—The third sentence of section 

3 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 

4 is amended—

5 (1) by inserting ‘‘or program’’ after ‘‘facility’’; 

6 (2) by striking ‘‘or by’’ and inserting ‘‘, by’’; 

7 and 

8 (3) by inserting ‘‘, or by an urban Indian orga9 nization pursuant to a grant or contract with the In10 dian Health Service under title V of the Indian 

11 Health Care Improvement Act’’ before the period. 

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

13 this section shall take effect on July 1, 2003. 

14 TITLE III—STRENGTHENING 

15 STATE AND FEDERAL COM16 MITMENT TO THE ELDERLY 

17 AND PERSONS WITH DISABIL18 ITIES; FAMILY OPPORTUNITY 

19 ACT 

20 Subtitle A—Elderly and Persons 

21 With Disabilities 

22 SEC. 301. FULL ACCOUNTING OF SAVINGS IN DETERMINING 

23 COST-EFFECTIVENESS. 

24 (a) IN GENERAL.—Section 1915(c)(2)(D) of the So25 cial Security Act (42 U.S.C. 1396n(c)(2)(D)) is amended 
31

•HR 2000 IH 

1 by inserting ‘‘(reduced by average per capita reductions 

2 in spending under other Federal mandatory spending pro3 grams resulting from operation of the waiver)’’ after ‘‘with 

4 respect to such individuals’’. 

5 (b) EFFECTIVE DATE.—The amendment made by 

6 subsection shall take effect on the date of the enactment 

7 of this Act.

8 SEC. 302. EXTENSION OF MEDICAID COVERAGE UNDER THE 

9 TICKET TO WORK PROGRAM TO COVER 

10 SPOUSES. 

11 (a) IN GENERAL.—Section 1902(a)(10)(A)(ii) of the 

12 Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is 

13 amended—

14 (1) in clause (i)(II), by inserting before the 

15 comma at the end the following: ‘‘, and at the option 

16 of a State, any individual who is the spouse of such 

17 an individual’’; 

18 (2) in clause (ii)(XIII), by inserting before the 

19 semicolon at the end the following: ‘‘, and at the op20 tion of a State, any individual who is the spouse of 

21 such an individual’’; 

22 (3) in subclause (XV), by inserting before the 

23 semicolon at the end the following: ‘‘, and at the op24 tion of a State, any individual who is the spouse of 

25 such an individual’’; and 
32

•HR 2000 IH 

1 (4) in subclause (XVI), by inserting before the 

2 semicolon at the end the following: ‘‘, and at the op3 tion of a State, any individual who is the spouse of 

4 such an individual’’. 

5 (b) CONFORMING AMENDMENT.—Section 

6 1905(a)(xii) of such Act (42 U.S.C. 1396d(a)(xii)) is 

7 amended by inserting ‘‘and spouses described in clauses 

8 (i)(II), (ii)(XIII), (ii)(XV), and (ii)(XVI) of section 

9 1902(a)(10)(A)’’ after ‘‘subsection (v))’’. 

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

11 this section take effect on October 1, 2003, whether or 

12 not regulations implementing such amendments have been 

13 issued. 

14 SEC. 303. ENCOURAGING TRANSITION TO HOME AND COM15 MUNITY CARE. 

16 (a) IN GENERAL.—Section 1905(b) of the Social Se17 curity Act (42 U.S.C. 1396d(b)), as amended by section 

18 101(a), is amended—

19 (1) by striking ‘‘and’’ before ‘‘(5)’’; and 

20 (2) by inserting before the period the following: 

21 ‘‘, and (6) the Federal medical assistance percentage 

22 shall be equal to the enhanced FMAP described in 

23 section 2105(b) with respect to medical assistance 

24 provided under a waiver under section 1915(c)’’. 
33

•HR 2000 IH 

1 (b) CONFORMING AMENDMENT.—Section 1915(c) of 

2 such Act (42 U.S.C. 1396n(c)) is amended by adding at 

3 the end the following new paragraph: 

4 ‘‘(11) For purposes of determining the amount of ex5 penditures under this section or a State plan for purposes 

6 of applying any test of cost-effectiveness or similar test 

7 in carrying out this subsection, the provisions of section 

8 1905(b)(6) shall not be taken into account.’’. 

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

10 this section shall apply to medical assistance for items and 

11 services furnished on or after July 1, 2003, regardless of 

12 whether the waiver under which such assistance is pro13 vided was approved before, on, or after the date of the 

14 enactment of this Act. 

15 SEC. 304. ENHANCED MATCHING RATE FOR DISABLED INDI16 VIDUALS AWAITING MEDICARE ELIGIBILITY. 

17 (a) IN GENERAL.—Section 1905(b) of the Social Se18 curity Act (42 U.S.C. 1396d(b)), as amended by sections 

19 101(a) and 303(a), is amended—

20 (1) by striking ‘‘and’’ before ‘‘(6)’’; and 

21 (2) by inserting before the period the following: 

22 ‘‘, and (7) the Federal medical assistance percentage 

23 shall be equal to 100 percent with respect to medical 

24 assistance provided to individuals who are not enti25 tled to benefits under part A of title XVIII pursuant
34

•HR 2000 IH 

1 to section 226(b) but who would be entitled to such 

2 benefits pursuant to such section but for the appli3 cation of a 24-month waiting period under such sec4 tion’’. 

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

6 this section shall apply to medical assistance for items and 

7 services furnished on or after October 1, 2003. 

8 SEC. 305. PROVIDING INITIAL TERM OF 5 YEARS FOR SEC9 TION 1915 WAIVERS. 

10 (a) IN GENERAL.—Subsections (d)(3) and (e)(3) of 

11 section 1915 of the Social Security Act (42 U.S.C. 1396n) 

12 are each amended by striking ‘‘3 years’’ and inserting ‘‘5 

13 years’’. 

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

15 subsection (a) shall apply to waivers granted on or after 

16 the date of the enactment of this Act. 

17 SEC. 306. OPTIONAL COVERAGE OF COMMUNITY-BASED AT18 TENDANT SERVICES AND SUPPORTS UNDER 

19 THE MEDICAID PROGRAM. 

20 (a) OPTIONAL COVERAGE.—Section 1902(a)(10)(D) 

21 of the Social Security Act (42 U.S.C. 1396a(a)(10)(D)) 

22 is amended—

23 (1) by inserting ‘‘(i)’’ after ‘‘(D)’’; 

24 (2) by adding ‘‘and’’ after the semicolon; and 
35

•HR 2000 IH 

1 (3) by adding at the end the following new 

2 clause: 

3 ‘‘(ii) at the option of the State and subject 

4 to section 1935, for the inclusion of community5 based attendant services and supports for any 

6 individual who—

7 ‘‘(I) is eligible for medical assistance 

8 under the State plan; 

9 ‘‘(II) with respect to whom there has 

10 been a determination that the individual 

11 requires the level of care provided in a 

12 nursing facility or an intermediate care fa13 cility for the mentally retarded (whether or 

14 not coverage of such intermediate care fa15 cility is provided under the State plan); 

16 and 

17 ‘‘(III) who chooses to receive such 

18 services and supports; 

19 insofar as such services are appropriate for the 

20 individual’s condition according to the individ21 ual’s plan of care;’’. 

22 (b) COMMUNITY-BASED ATTENDANT SERVICES AND

23 SUPPORTS OPTION.—

24 (1) IN GENERAL.—Title XIX of the Social Se25 curity Act (42 U.S.C. 1396 et seq.) is amended—
36

•HR 2000 IH 

1 (A) by redesignating section 1935 as sec2 tion 1936; and 

3 (B) by inserting after section 1934 the fol4 lowing: 

5 ‘‘COMMUNITY-BASED ATTENDANT SERVICES AND

6 SUPPORTS

7 ‘‘SEC. 1935. (a) COVERAGE.—

8 ‘‘(1) IN GENERAL.—A State may provide 

9 through a plan amendment for the inclusion of com10 munity-based attendant services and supports (as 

11 defined in subsection (g)(1)) for individuals de12 scribed in section 1902(a)(10)(D)(ii) in accordance 

13 with this section. 

14 ‘‘(2) ENHANCED FMAP FOR COVERAGE.—Not15 withstanding section 1905(b), in the case of a State 

16 with an approved plan amendment under this section 

17 during that period that also satisfies the require18 ments of subsection (c) the Federal medical assist19 ance percentage shall be equal to the enhanced 

20 FMAP described in section 2105(b) with respect to 

21 medical assistance in the form of community-based 

22 attendant services and supports provided to individ23 uals described in section 1902(a)(10)(D)(ii) in ac24 cordance with this section. 

25 ‘‘(b) DEVELOPMENT AND IMPLEMENTATION OF BEN26 EFIT.—In order for a State plan amendment to be ap-
37

•HR 2000 IH 

1 proved under this section, a State shall develop and imple2 ment the proposal through a public process which includes 

3 individuals with disabilities, elderly individuals, their rep4 resentatives, and providers, and include in that proposed 

5 plan amendment—

6 ‘‘(1) a State process to notify and inform indi7 viduals (including individuals who live in nursing fa8 cilities, individuals who live in intermediate care fa9 cilities for the mentally retarded, and individuals 

10 who live in the community and who have an unmet 

11 need for such services) of the availability of such 

12 services and supports under the this title, and of 

13 other items and services that may be provided to the 

14 individual under this title or title XVIII; and 

15 ‘‘(2) a quality assurance program that will 

16 maximize consumer independence and consumer con17 trol and will—

18 ‘‘(A) train consumers to appropriately 

19 manage their own attendant; 

20 ‘‘(B) provide a quality review process; and 

21 ‘‘(C) provide for investigation and resolu22 tion of allegations of neglect, abuse, or exploi23 tation in connection with the provision of such 

24 services and supports. 
38

•HR 2000 IH 

1 ‘‘(c) NO EFFECT ON ABILITY TO PROVIDE COV2 ERAGE UNDER A WAIVER.—

3 ‘‘(1) IN GENERAL.—Nothing in this section 

4 shall be construed as affecting the ability of a State 

5 to provide coverage under the State plan for commu6 nity-based attendant services and supports (or simi7 lar coverage) under a waiver approved under section 

8 1915, section 1115, or otherwise. 

9 ‘‘(2) ELIGIBILITY FOR ENHANCED MATCH.—In 

10 the case of a State that provides coverage for such 

11 services and supports under a waiver, the State shall 

12 not be eligible under section 1935 for the enhanced 

13 FMAP for the provision of such coverage under this 

14 unless the State submits a plan amendment to the 

15 Secretary that meets the requirements of this sec16 tion. 

17 ‘‘(d) DEFINITIONS.—In this title: 

18 ‘‘(1) COMMUNITY-BASED ATTENDANT SERVICES

19 AND SUPPORTS.—

20 ‘‘(A) IN GENERAL.—The term ‘community21 based attendant services and supports’ may in22 clude one or more of the following: attendant 

23 services and supports furnished to an indi24 vidual, as needed, to assist in accomplishing ac25 tivities of daily living, instrumental activities of
39

•HR 2000 IH 

1 daily living, and health-related functions 

2 through hands-on assistance, supervision, or 

3 cueing—

4 ‘‘(i) under a plan of services and sup5 ports that is based on an assessment of 

6 functional need and that is agreed to by 

7 the individual or, as appropriate, the indi8 vidual’s representative; 

9 ‘‘(ii) in a home or community setting, 

10 which may include a school, workplace, or 

11 recreation or religious facility, but does not 

12 include a nursing facility or an inter13 mediate care facility for the mentally re14 tarded; 

15 ‘‘(iii) under an agency-provider model 

16 or other model (as defined in paragraph 

17 (2)(C)); and 

18 ‘‘(iv) the furnishing of which is se19 lected, managed, and dismissed by the in20 dividual, or, as appropriate, with assistance 

21 from the individual’s representative. 

22 ‘‘(B) INCLUDED SERVICES AND SUP23 PORTS.—Such term may include one or more of 

24 the following: 
40

•HR 2000 IH 

1 ‘‘(i) Tasks necessary to assist an indi2 vidual in accomplishing activities of daily 

3 living, instrumental activities of daily liv4 ing, and health-related functions. 

5 ‘‘(ii) The acquisition, maintenance, 

6 and enhancement of skills necessary for 

7 the individual to accomplish activities of 

8 daily living, instrumental activities of daily 

9 living, and health-related functions. 

10 ‘‘(iii) Backup systems or mechanisms 

11 (such as the use of beepers), as defined by 

12 the State according to the client’s needs, to 

13 ensure continuity of services and supports. 

14 ‘‘(iv) Voluntary training on how to se15 lect, manage, and dismiss attendants. 

16 ‘‘(C) EXCLUDED SERVICES AND SUP17 PORTS.—Subject to subparagraph (D), such 

18 term does not include—

19 ‘‘(i) the provision of room and board 

20 for the individual; 

21 ‘‘(ii) special education and related 

22 services provided under the Individuals 

23 with Disabilities Education Act and voca24 tional rehabilitation services provided 

25 under the Rehabilitation Act of 1973; 
41

•HR 2000 IH 

1 ‘‘(iii) assistive technology devices and 

2 assistive technology services; 

3 ‘‘(iv) durable medical equipment; or 

4 ‘‘(v) home modifications. 

5 ‘‘(D) FLEXIBILITY IN TRANSITION TO

6 COMMUNITY-BASED HOME SETTING.—Such 

7 term may include expenditures for transitional 

8 costs required for an individual to make the 

9 transition from a nursing facility or inter10 mediate care facility for the mentally retarded 

11 to a community-based home setting where the 

12 individual resides. 

13 ‘‘(E) CLARIFICATION OF PERMITTING PAY14 MENT OF RELATIVES FOR PROVIDING SERVICES

15 AND SUPPORTS.—Nothing in this section shall 

16 be construed as preventing community-based at17 tendant services and supports from being fur18 nished to an individual by others who are re19 lated to that individual and for such others 

20 being paid for so furnishing such services and 

21 supports. 

22 ‘‘(2) ADDITIONAL DEFINITIONS.—

23 ‘‘(A) ACTIVITIES OF DAILY LIVING.—The 

24 term ‘activities of daily living’ includes eating, 
42

•HR 2000 IH 

1 toileting, grooming, dressing, bathing, and 

2 transferring. 

3 ‘‘(B) CONSUMER CONTROLLED.—The term 

4 ‘consumer controlled’ means a method of pro5 viding services and supports that allow the indi6 vidual, or where appropriate, the individual’s 

7 representative, maximum control of the commu8 nity-based attendant services and supports, re9 gardless of who acts as the employer of record. 

10 ‘‘(C) DELIVERY MODELS.—

11 ‘‘(i) AGENCY-PROVIDER MODEL.—The 

12 term ‘agency-provider model’ means, with 

13 respect to the provision of community14 based attendant services and supports for 

15 an individual, a method of providing con16 sumer controlled services and supports 

17 under which entities contract for the provi18 sion of such services and supports. 

19 ‘‘(ii) OTHER MODELS.—The term 

20 ‘other models’ means methods, other than 

21 an agency-provider model, for the provision 

22 of consumer controlled services and sup23 ports. Such models may include direct cash 

24 payments or use of a fiscal agent to assist 

25 in obtaining services.
43

•HR 2000 IH 

1 ‘‘(D) HEALTH-RELATED FUNCTIONS.—The 

2 term ‘health-related functions’ means functions 

3 that can be delegated or assigned by licensed 

4 health-care professionals under State law to be 

5 performed by an attendant. 

6 ‘‘(E) INSTRUMENTAL ACTIVITIES OF DAILY

7 LIVING.—The term ‘instrumental activities of 

8 daily living’ includes meal planning and prepa9 ration, managing finances, shopping for food, 

10 clothing, and other essential items, performing 

11 essential household chores, communicating by 

12 phone and other media, and other activities 

13 needed to participate in the community, as ap14 propriate. 

15 ‘‘(F) INDIVIDUAL’S REPRESENTATIVE.—

16 The term ‘individual’s representative’ means a 

17 parent, a family member, a guardian, an advo18 cate, or an authorized representative of an indi19 vidual.’’. 

20 (c) INVESTIGATION BY STATE.—Section 

21 1903(q)(4)(A)(i) of such Act (42 U.S.C. 

22 1396b(q)(4)(A)(i)) is amended by inserting ‘‘and for in23 vestigation and resolution of allegations of neglect, abuse, 

24 or exploitation in connection with the provision of commu-
44

•HR 2000 IH 

1 nity-based attendant services and supports under section 

2 1935(b)(2)(C)’’ before the semicolon. 

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

4 this section take effect on October 1, 2003, and apply to 

5 medical assistance provided for community-based attend6 ant services and supports described in section 1935 of the 

7 Social Security Act furnished on or after that date. 

8 Subtitle B—Family Opportunity 

9 Act 

10 SEC. 311. SHORT TITLE. 

11 This subtitle may be cited as the ‘‘Family Oppor12 tunity Act of 2003’’ or the ‘‘Dylan Lee James Act’’. 

13 SEC. 312. OPPORTUNITY FOR FAMILIES OF DISABLED CHIL14 DREN TO PURCHASE MEDICAID COVERAGE 

15 FOR SUCH CHILDREN. 

16 (a) STATE OPTION TO ALLOW FAMILIES OF DIS17 ABLED CHILDREN TO PURCHASE MEDICAID COVERAGE

18 FOR SUCH CHILDREN.—

19 (1) IN GENERAL.—Section 1902 (42 U.S.C. 

20 1396a) is amended—

21 (A) in subsection (a)(10)(A)(ii)—

22 (i) by striking ‘‘or’’ at the end of sub23 clause (XVII); 

24 (ii) by adding ‘‘or’’ at the end of sub25 clause (XVIII); and 
45

•HR 2000 IH 

1 (iii) by adding at the end the fol2 lowing new subclause: 

3 ‘‘(XIX) who are disabled children 

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

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

6 subsection: 

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

8 individuals—

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

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

11 section 1614(a)(3)(C) (determined without regard to 

12 the reference to age in that section) but for having 

13 earnings or deemed income or resources (as deter14 mined under title XVI for children) that exceed the 

15 requirements for receipt of supplemental security in16 come benefits; and 

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

18 income level as the State establishes and does not 

19 exceed—

20 ‘‘(i) 300 percent of the income official pov21 erty line (as defined by the Office of Manage22 ment and Budget, and revised annually in ac23 cordance with section 673(2) of the Omnibus 

24 Budget Reconciliation Act of 1981) applicable 

25 to a family of the size involved; or 
46

•HR 2000 IH 

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

2 line as a State may establish, except that no 

3 Federal financial participation shall be provided 

4 under section 1903(a) for any medical assist5 ance provided to an individual who would not be 

6 described in this subsection but for this 

7 clause.’’. 

8 (2) INTERACTION WITH EMPLOYER-SPONSORED

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

10 1396a(cc)), as added by paragraph (1), is amended 

11 by adding at the end the following new paragraph: 

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

13 described in paragraph (1) offers family coverage under 

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

15 Public Health Service Act), the State may—

16 ‘‘(i) require such parent to apply for, enroll in, 

17 and pay premiums for, such coverage as a condition 

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

19 medical assistance under subsection 

20 (a)(10)(A)(ii)(XIX) if the parent is determined eligi21 ble for such coverage and the employer contributes 

22 at least 50 percent of the total cost of annual pre23 miums for such coverage; and 

24 ‘‘(ii) if such coverage is obtained—
47

•HR 2000 IH 

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

2 1916(h), reduce the premium imposed by the 

3 State under that section (if any) in an amount 

4 that reasonably reflects the premium contribu5 tion made by the parent for private coverage on 

6 behalf of a child with a disability; and 

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

8 liability under subsection (a)(25). 

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

10 (A) applies, if the family income of such parent does not 

11 exceed 300 percent of the income official poverty line (re12 ferred to in paragraph (1)(C)(i)), a State may provide for 

13 payment of any portion of the annual premium for such 

14 family coverage that the parent is required to pay. Any 

15 payments made by the State under this subparagraph 

16 shall be considered, for purposes of section 1903(a), to 

17 be payments for medical assistance.’’.

18 (b) STATE OPTION TO IMPOSE INCOME-RELATED

19 PREMIUMS.—Section 1916 (42 U.S.C. 1396o) is amend20 ed—

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

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

23 (2) by adding at the end the following new sub24 section:
48

•HR 2000 IH 

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

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

3 subject to paragraph (2), a State may (in a uniform man4 ner for such children) require the families of such children 

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

6 family income. 

7 ‘‘(2) A premium requirement imposed under para8 graph (1) may only apply to the extent that—

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

10 and any premium that the parent is required to pay 

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

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

13 and 

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

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

16 ‘‘(3) A State shall not require prepayment of a pre17 mium imposed pursuant to paragraph (1) and shall not 

18 terminate eligibility of a child under section 

19 1902(a)(10)(A)(ii)(XIX) for medical assistance under this 

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

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

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

23 The State may waive payment of any such premium in 

24 any case where the State determines that requiring such 

25 payment would create an undue hardship.’’. 
49

•HR 2000 IH 

1 (c) CONFORMING AMENDMENT.—Section 1903(f)(4) 

2 (42 U.S.C. 1396b(f)(4)) is amended in the matter pre3 ceding subparagraph (A) by inserting 

4 ‘‘1902(a)(10)(A)(ii)(XIX),’’ after 

5 ‘‘1902(a)(10)(A)(ii)(XVIII),’’. 

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

7 this section shall apply to medical assistance for items and 

8 services furnished on or after January 1, 2004. 

9 SEC. 313. TREATMENT OF INPATIENT PSYCHIATRIC HOS10 PITAL SERVICES FOR INDIVIDUALS UNDER 

11 AGE 21 IN HOME OR COMMUNITY-BASED 

12 SERVICES WAIVERS. 

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

14 1396n(c)) is amended—

15 (1) in paragraph (1)—

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

17 inpatient psychiatric hospital services for indi18 viduals under age 21,’’ after ‘‘intermediate care 

19 facility for the mentally retarded’’; and 

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

21 or inpatient psychiatric hospital services for in22 dividuals under age 21’’ before the period; 

23 (2) in paragraph (2)(B), by striking ‘‘or serv24 ices in an intermediate care facility for the mentally 

25 retarded’’ each place it appears and inserting ‘‘, 
50

•HR 2000 IH 

1 services in an intermediate care facility for the men2 tally retarded, or inpatient psychiatric hospital serv3 ices for individuals under age 21’’; 

4 (3) by striking paragraph (2)(C) and inserting 

5 the following: 

6 ‘‘(C) such individuals who are determined to be 

7 likely to require the level of care provided in a hos8 pital, nursing facility, or intermediate care facility 

9 for the mentally retarded, or inpatient psychiatric 

10 hospital services for individuals under age 21, are 

11 informed of the feasible alternatives, if available 

12 under the waiver, at the choice of such individuals, 

13 to the provision of inpatient hospital services, nurs14 ing facility services, services in an intermediate care 

15 facility for the mentally retarded, or inpatient psy16 chiatric hospital services for individuals under age 

17 21;’’; and 

18 (4) in paragraph (7)(A)—

19 (A) by inserting ‘‘, or inpatient psychiatric 

20 hospital services for individuals under age 21,’’ 

21 after ‘‘intermediate care facility for the men22 tally retarded’’; and 

23 (B) by inserting ‘‘, or who would require 

24 inpatient psychiatric hospital services for indi25 viduals under age 21’’ before the period. 
51

•HR 2000 IH 

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

2 subsection (a) apply with respect to medical assistance 

3 provided on or after January 1, 2003. 

4 SEC. 314. DEMONSTRATION OF COVERAGE UNDER THE 

5 MEDICAID PROGRAM OF CHILDREN WITH PO6 TENTIALLY SEVERE DISABILITIES. 

7 (a) STATE APPLICATION.—A State may apply to the 

8 Secretary of Health and Human Services (in this section 

9 referred to as the ‘‘Secretary’’) for approval of a dem10 onstration project (in this section referred to as a ‘‘dem11 onstration project’’) under which up to a specified max12 imum number of children with a potentially severe dis13 ability (as defined in subsection (b)) are provided medical 

14 assistance under the State medicaid plan under title XIX 

15 of the Social Security Act (42 U.S.C. 1396 et seq.). 

16 (b) CHILD WITH A POTENTIALLY SEVERE DIS17 ABILITY DEFINED.—

18 (1) IN GENERAL.—In this section, the term 

19 ‘‘child with a potentially severe disability’’ means, 

20 with respect to a demonstration project, an indi21 vidual who—

22 (A) has not attained 21 years of age; 

23 (B) has a physical or mental condition, 

24 disease, disorder (including a congenital birth 

25 defect or a metabolic condition), injury, or de-
52

•HR 2000 IH 

1 velopmental disability that was incurred before 

2 the individual attained such age; and 

3 (C) is reasonably expected, but for the re4 ceipt of medical assistance under the State 

5 medicaid plan, to reach the level of disability 

6 defined under section 1614(a)(3) of the Social 

7 Security Act (42 U.S.C. 1382c(a)(3)), (deter8 mined without regard to the reference to age in 

9 subparagraph (C) of that section). 

10 (2) EXCEPTION.—Such term does not include 

11 an individual who would be considered disabled 

12 under section 1614(a)(3)(C) of the Social Security 

13 Act (42 U.S.C. 1382c(a)(3)(C)) (determined without 

14 regard to the reference to age in that section). 

15 (c) APPROVAL OF DEMONSTRATION PROJECTS.—

16 (1) IN GENERAL.—Subject to paragraph (3), 

17 the Secretary shall approve applications under sub18 section (a) that meet the requirements of paragraph 

19 (2) and such additional terms and conditions as the 

20 Secretary may require. The Secretary may waive the 

21 requirement of section 1902(a)(1) of the Social Se22 curity Act (42 U.S.C. 1396a(a)(1)) to allow for sub23 State demonstrations. 

24 (2) TERMS AND CONDITIONS OF DEMONSTRA25 TION PROJECTS.—The Secretary may not approve a
53

•HR 2000 IH 

1 demonstration project under this section unless the 

2 State provides assurances satisfactory to the Sec3 retary that the following conditions are or will be 

4 met: 

5 (A) INDEPENDENT EVALUATION.—The 

6 State provides for an independent evaluation of 

7 the project to be conducted during fiscal year 

8 2006. 

9 (B) CONSULTATION FOR DEVELOPMENT

10 OF CRITERIA.—The State consults with appro11 priate pediatric health professionals in estab12 lishing the criteria for determining whether a 

13 child has a potentially severe disability. 

14 (C) ANNUAL REPORT.—The State submits 

15 an annual report to the Secretary (in a uniform 

16 form and manner established by the Secretary) 

17 on the use of funds provided under the grant 

18 that includes the following: 

19 (i) Enrollment and financial statistics 

20 on—

21 (I) the total number of children 

22 with a potentially severe disability en23 rolled in the demonstration project, 

24 disaggregated by disability; 
54

•HR 2000 IH 

1 (II) the services provided by cat2 egory or code and the cost of each 

3 service so categorized or coded; and 

4 (III) the number of children en5 rolled in the demonstration project 

6 who also receive services through pri7 vate insurance. 

8 (ii) With respect to the report sub9 mitted for fiscal year 2006, the results of 

10 the independent evaluation conducted 

11 under subparagraph (A). 

12 (iii) Such additional information as 

13 the Secretary may require. 

14 (3) LIMITATIONS ON FEDERAL FUNDING.—

15 (A) APPROPRIATION.—

16 (i) IN GENERAL.—Out of any funds in 

17 the Treasury not otherwise appropriated, 

18 there is appropriated to carry out this sec19 tion—

20 (I) $16,666,000 for each of fiscal 

21 years 2002 and 2003; and 

22 (II) $16,667,000 for each of fis23 cal years 2004 through 2007. 

24 (ii) BUDGET AUTHORITY.—Clause (i) 

25 constitutes budget authority in advance of 
55

•HR 2000 IH 

1 appropriations Acts and represents the ob2 ligation of the Federal Government to pro3 vide for the payment of the amounts ap4 propriated under clause (i). 

5 (B) LIMITATION ON PAYMENTS.—In no 

6 case may—

7 (i) the aggregate amount of payments 

8 made by the Secretary to States under this 

9 section exceed $100,000,000; 

10 (ii) the aggregate amount of payments 

11 made by the Secretary to States for ad12 ministrative expenses relating to the eval13 uations and annual reports required under 

14 subparagraphs (A) and (C) of paragraph 

15 (2) exceed $2,000,000 of such 

16 $100,000,000; or 

17 (iii) payments be provided by the Sec18 retary for a fiscal year after fiscal year 

19 2010. 

20 (C) FUNDS ALLOCATED TO STATES.—

21 (i) IN GENERAL.—The Secretary shall 

22 allocate funds to States based on their ap23 plications and the availability of funds. In 

24 making such allocations, the Secretary 

25 shall ensure an equitable distribution of 
56

•HR 2000 IH 

1 funds among States with large populations 

2 and States with small populations. 

3 (ii) AVAILABILITY.—Funds allocated 

4 to a State under a grant made under this 

5 section for a fiscal year shall remain avail6 able until expended. 

7 (D) FUNDS NOT ALLOCATED TO STATES.—

8 Funds not allocated to States in the fiscal year 

9 for which they are appropriated shall remain 

10 available in succeeding fiscal years for alloca11 tion by the Secretary using the allocation for12 mula established under this section. 

13 (E) PAYMENTS TO STATES.—The Sec14 retary shall pay to each State with a dem15 onstration project approved under this section, 

16 from its allocation under subparagraph (C), an 

17 amount for each quarter equal to the Federal 

18 medical assistance percentage (as defined in 

19 section 1905(b) of the Social Security Act (42 

20 U.S.C. 1395d(b))) of expenditures in the quar21 ter for medical assistance provided to children 

22 with a potentially severe disability. 

23 (d) RECOMMENDATION.—Not later than October 1, 

24 2005, the Secretary shall submit a recommendation to the 

25 Committee on Commerce of the House of Representatives 
57

•HR 2000 IH 

1 and the Committee on Finance of the Senate regarding 

2 whether the demonstration project established under this 

3 section should be continued after fiscal year 2007. 

4 (e) STATE DEFINED.—In this section, the term 

5 ‘‘State’’ has the meaning given such term for purposes of 

6 title XIX of the Social Security Act (42 U.S.C. 1396 et 

7 seq.). 

8 SEC. 315. DEVELOPMENT AND SUPPORT OF FAMILY-TO9 FAMILY HEALTH INFORMATION CENTERS. 

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

11 at the end the following new subsection: 

12 ‘‘(c)(1) In addition to amounts appropriated under 

13 subsection (a) and retained under section 502(a)(1) for 

14 the purpose of carrying out activities described in sub15 section (a)(2), there is appropriated to the Secretary, out 

16 of any money in the Treasury not otherwise appropriated, 

17 for the purpose of enabling the Secretary (through grants, 

18 contracts, or otherwise) to provide for special projects of 

19 regional and national significance for the development and 

20 support of family-to-family health information centers de21 scribed in paragraph (2), $10,000,000 for each of fiscal 

22 years 2002 through 2007. Funds appropriated under this 

23 paragraph shall remain available until expended. 

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

25 described in this paragraph are centers that—
58

•HR 2000 IH 

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

2 or special health care needs to make informed 

3 choices about health care in order to promote good 

4 treatment decisions, cost-effectiveness, and improved 

5 health outcomes for such children; 

6 ‘‘(B) provide information regarding the health 

7 care needs of, and resources available for, children 

8 with disabilities or special health care needs; 

9 ‘‘(C) identify successful health delivery models 

10 for such children; 

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

12 providers, managed care organizations, health care 

13 purchasers, and appropriate State agencies a model 

14 for collaboration between families of such children 

15 and health professionals; 

16 ‘‘(E) provide training and guidance regarding 

17 caring for such children; 

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

19 of such children, health professionals, schools, and 

20 other appropriate entities and individuals; and 

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

22 disabilities or special health care needs who have ex23 pertise in Federal and State public and private 

24 health care systems and health professionals. 
59

•HR 2000 IH 

1 ‘‘(3) The provisions of this title that are applicable 

2 to the funds made available to the Secretary under section 

3 502(a)(1) apply in the same manner to funds made avail4 able to the Secretary under paragraph (1).’’. 

5 SEC. 316. RESTORATION OF MEDICAID ELIGIBILITY FOR 

6 CERTAIN SSI BENEFICIARIES. 

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

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

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

10 (2) by striking ‘‘or who are’’ and inserting ‘‘, 

11 (bb) who are’’; and 

12 (3) 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. 
60

•HR 2000 IH 

1 TITLE IV—FACILITATING PRO2 GRAM ADMINISTRATION AND 

3 PRESERVING COVERAGE 

4 SEC. 401. ALLOWING UNIFORM COVERAGE OF ALL LOW IN5 COME AMERICANS. 

6 (a) IN GENERAL.—Section 1902(a)(10)(A)(ii) of the 

7 Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is 

8 amended—

9 (1) by striking ‘‘or’’ at the end of subclause 

10 (XVII); 

11 (2) by adding ‘‘or’’ at the end of subclause 

12 (XVIII); and 

13 (3) by adding at the end the following new sub14 clause: 

15 ‘‘(XIX) any individual age 21 

16 through 64 whose family income does 

17 not exceed 200 percent of the income 

18 official poverty line (as defined by the 

19 Office of Management and Budget, 

20 and revised annually in accordance 

21 with section 673(2) of the Omnibus 

22 Budget Reconciliation Act of 1981) 

23 applicable to a family of the size in24 volved;’’. 

25 (b) CONFORMING AMENDMENTS.—
61

•HR 2000 IH 

1 (1) Section 1905(a) of such Act (42 U.S.C. 

2 1396d(a)) is amended, in the matter before para3 graph (1)—

4 (A) by striking ‘‘or’’ at the end of clause 

5 (xii); 

6 (B) by adding ‘‘or’’ at the end of clause 

7 (xiii); and 

8 (C) by inserting after clause (xiii) the fol9 lowing new clause: 

10 ‘‘(xii) individuals described in section 

11 1902(a)(10)(A)(ii)(XIX),’’. 

12 (2) Section 1903(f)(4) of such Act (42 U.S.C. 

13 1396b(f)(4)) is amended by inserting 

14 ‘‘1902(a)(10)(A)(ii)(XIX),’’ after 

15 ‘‘1902(a)(10)(A)(ii)(XVIII),’’. 

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

17 this section shall take effect on October 1, 2003. 

18 SEC. 402. FACILITATING COVERAGE OF FAMILIES. 

19 (a) IN GENERAL.—Section 1905(b) of the Social Se20 curity Act (42 U.S.C. 1396d(b)), as amended by sections 

21 101(a), 303(a), and 304(a), is amended—

22 (1) by striking ‘‘and’’ before ‘‘(7)’’; and 

23 (2) by inserting before the period the following: 

24 ‘‘, and (8) the Federal medical assistance percentage 

25 shall be equal to the enhanced FMAP described in 
62

•HR 2000 IH 

1 section 2105(b) with respect to medical assistance 

2 provided for individuals who are covered under sec3 tion 1925 or section 1931 by virtue of being a par4 ent or other caretaker relative (as defined for pur5 poses of such section) of a child and whose income 

6 does not exceed the percentage of the income official 

7 poverty line applicable under section 1902(l)(2)(C) 

8 to children who are eligible for medical assistance 

9 under section 1902(l)(1)(D)’’. 

10 (b) CONSTRUCTION.—Nothing in section 1905(b)(8) 

11 of the Social Security Act, as added by subsection (a)(2), 

12 shall be construed as preventing a State from providing 

13 medicaid benefits for individuals whose income exceeds 

14 100 percent of the Federal poverty line at the regular 

15 FMAP. 

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

17 this section shall apply to medical assistance for items and 

18 services furnished on or after July 1, 2003. 

19 SEC. 403. ASSISTANCE WITH COVERAGE OF LEGAL IMMI20 GRANTS UNDER THE MEDICAID PROGRAM 

21 AND SCHIP. 

22 (a) MEDICAID PROGRAM.—Section 1903(v) of the 

23 Social Security Act (42 U.S.C. 1396b(v)) is amended—

24 (1) in paragraph (1), by striking ‘‘paragraph 

25 (2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and
63

•HR 2000 IH 

1 (2) by adding at the end the following new 

2 paragraph: 

3 ‘‘(4)(A) A State may elect (in a plan amendment 

4 under this title) to provide medical assistance under this 

5 title, notwithstanding sections 401(a), 402(b), 403, and 

6 421 of the Personal Responsibility and Work Opportunity 

7 Reconciliation Act of 1996, for aliens who are lawfully re8 siding in the United States (including battered aliens de9 scribed in section 431(c) of such Act) and who are other10 wise eligible for such assistance, within either or both of 

11 the following eligibility categories: 

12 ‘‘(i) PREGNANT WOMEN.—Women during preg13 nancy (and during the 60-day period beginning on 

14 the last day of the pregnancy). 

15 ‘‘(ii) CHILDREN.—Children (as defined under 

16 such plan), including optional targeted low-income 

17 children described in section 1905(u)(2)(B). 

18 ‘‘(B) In the case of a State that has elected to provide 

19 medical assistance to a category of aliens under subpara20 graph (A), no debt shall accrue under an affidavit of sup21 port against any sponsor of such an alien on the basis 

22 of provision of assistance to such category and the cost 

23 of such assistance shall not be considered as an unreim24 bursed cost.’’. 
64

•HR 2000 IH 

1 (b) SCHIP.—Section 2107(e)(1) of such Act (42 

2 U.S.C. 1397gg(e)(1)) is amended by redesignating sub3 paragraphs (C) and (D) as subparagraph (D) and (E), 

4 respectively, and by inserting after subparagraph (B) the 

5 following new subparagraph: 

6 ‘‘(C) Section 1903(v)(4) (relating to op7 tional coverage of categories of permanent resi8 dent alien children), but only if the State has 

9 elected to apply such section to the category of 

10 children under title XIX.’’. 

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

12 this section take effect on October 1, 2003, and apply to 

13 medical assistance and child health assistance furnished 

14 on or after such date. 

15 SEC. 404. FLEXIBILITY IN ELIGIBILITY DETERMINATIONS. 

16 (a) IN GENERAL.—Section 1902(e) of the Social Se17 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 

18 the end the following: 

19 ‘‘(13)(A) Subject to the requirements of this para20 graph, at the option of the State, the plan may provide 

21 that financial eligibility requirements for medical assist22 ance are met for an individual under 19 years of age (or 

23 such higher age as determined by the State) by using a 

24 determination (made within a reasonable period, as found 

25 by the State, before its use for this purpose) of the individ-
65

•HR 2000 IH 

1 ual’s family or household income and resources, notwith2 standing any differences in budget unit, disregards, deem3 ing, or other methodology, by a Federal or State agency 

4 (or a public or private entity making such determination 

5 on behalf of such agency) specified by the plan, provided 

6 that such agency has fiscal liabilities or responsibilities af7 fected or potentially affected by such determinations, pro8 vided that all information furnished by such agency pursu9 ant to this subparagraph is used solely for purposes of 

10 determining eligibility for medical assistance under the 

11 State plan approved under this title or for child health 

12 assistance under a State plan approved under title XXI. 

13 ‘‘(B) Any State electing the option under subpara14 graph (A) shall—

15 ‘‘(i) ensure that if an individual is determined 

16 under such subparagraph to be not eligible for med17 ical assistance under the State plan approved under 

18 this title or for child health assistance under a State 

19 plan under title XXI, the State must subsequently 

20 determine if such individual is eligible for such as21 sistance using the methodology that would otherwise 

22 be applicable in determining eligibility for such an 

23 individual; and 

24 ‘‘(ii) ensure that any information furnished by 

25 an agency specified in such subparagraph shall be 
66

•HR 2000 IH 

1 furnished with reasonable promptness to the agency 

2 determining eligibility for medical assistance under 

3 the State plan approved under this title or for child 

4 health assistance under a State plan approved under 

5 Title XXI. 

6 ‘‘(C) Nothing in subparagraph (A) shall be construed 

7 to restrict the ability of an individual under 19 years of 

8 age (or such higher age as specified by the State) to apply 

9 for medical assistance under a State plan approved under 

10 this title or for child health assistance under a State plan 

11 approved under title XXI under the methodology that 

12 would otherwise be applicable in determining eligibility for 

13 such an individual.’’. 

14 (b) EFFECTIVE DATE.—The amendment made by 

15 subsection (a) takes effect on October 1, 2003.

Æ