I 

108TH CONGRESS 

1ST SESSION H. R. 2268

To amend titles XIX and XXI of the Social Security Act to expand or 

add coverage of pregnant women under the Medicaid and State children’s 

health insurance program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 22, 2003

Mr. STRICKLAND (for himself, Mr. NEY, Mrs. NAPOLITANO, Mr. TOWNS, Mrs. 

CHRISTENSEN, Mr. MCNULTY, and Mr. FARR) 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 titles XIX and XXI of the Social Security Act 

to expand or add coverage of pregnant women under 

the Medicaid and State 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 ‘‘Start Healthy, Stay 

5 Healthy Act of 2003’’. 
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1 SEC. 2. STATE OPTION TO EXPAND OR ADD COVERAGE OF 

2 CERTAIN PREGNANT WOMEN UNDER MED3 ICAID AND SCHIP. 

4 (a) MEDICAID.—

5 (1) AUTHORITY TO EXPAND COVERAGE.—Sec6 tion 1902(l)(2)(A)(i) of the Social Security Act (42 

7 U.S.C. 1396a(l)(2)(A)(i)) is amended by inserting 

8 ‘‘(or such higher percent as the State may elect for 

9 purposes of expenditures for medical assistance for 

10 pregnant women described in section 

11 1905(u)(4)(A))’’ after ‘‘185 percent’’. 

12 (2) ENHANCED MATCHING FUNDS AVAILABLE

13 IF CERTAIN CONDITIONS MET.—Section 1905 of the 

14 Social Security Act (42 U.S.C. 1396d) is amended—

15 (A) in the fourth sentence of subsection 

16 (b), by striking ‘‘or subsection (u)(3)’’ and in17 serting ‘‘, (u)(3), or (u)(4)’’; and 

18 (B) in subsection (u)—

19 (i) by redesignating paragraph (4) as 

20 paragraph (5); and 

21 (ii) by inserting after paragraph (3) 

22 the following: 

23 ‘‘(4) For purposes of the fourth sentence of sub24 section (b) and section 2105(a), the expenditures de25 scribed in this paragraph are the following: 
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1 ‘‘(A) CERTAIN PREGNANT WOMEN.—If the con2 ditions described in subparagraph (B) are met, ex3 penditures for medical assistance for pregnant 

4 women described in subsection (n) or under section 

5 1902(l)(1)(A) in a family the income of which ex6 ceeds the effective income level (expressed as a per7 cent of the poverty line and considering applicable 

8 income disregards) that has been specified under 

9 subsection (a)(10)(A)(i)(III) or (l)(2)(A) of section 

10 1902, as of January 1, 2003, but does not exceed 

11 the income eligibility level established under title 

12 XXI for a targeted low-income child. 

13 ‘‘(B) CONDITIONS.—The conditions described 

14 in this subparagraph are the following: 

15 ‘‘(i) The State plans under this title and 

16 title XXI do not provide coverage for pregnant 

17 women described in subparagraph (A) with 

18 higher family income without covering such 

19 pregnant women with a lower family income. 

20 ‘‘(ii) The State does not apply an effective 

21 income level for pregnant women that is lower 

22 than the effective income level (expressed as a 

23 percent of the poverty line and considering ap24 plicable income disregards) that has been speci25 fied under the State plan under subsection
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1 (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902, 

2 as of January 1, 2003, to be eligible for medical 

3 assistance as a pregnant woman. 

4 ‘‘(C) DEFINITION OF POVERTY LINE.—In this 

5 subsection, the term ‘poverty line’ has the meaning 

6 given such term in section 2110(c)(5).’’. 

7 (3) PAYMENT FROM TITLE XXI ALLOTMENT

8 FOR MEDICAID EXPANSION COSTS; ELIMINATION OF

9 COUNTING MEDICAID CHILD PRESUMPTIVE ELIGI10 BILITY COSTS AGAINST TITLE XXI ALLOTMENT.—

11 Section 2105(a)(1) of the Social Security Act (42 

12 U.S.C. 1397ee(a)(1)) is amended—

13 (A) in the matter preceding subparagraph 

14 (A), by striking ‘‘(or, in the case of expendi15 tures described in subparagraph (B), the Fed16 eral medical assistance percentage (as defined 

17 in the first sentence of section 1905(b)))’’; and 

18 (B) by striking subparagraph (B) and in19 serting the following: 

20 ‘‘(B) for the provision of medical assist21 ance that is attributable to expenditures de22 scribed in section 1905(u)(4)(A);’’. 

23 (4) ADDITIONAL AMENDMENTS TO MEDICAID.—

24 (A) ELIGIBILITY OF A NEWBORN.—Section 

25 1902(e)(4) of the Social Security Act (42 
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1 U.S.C. 1396a(e)(4)) is amended in the first 

2 sentence by striking ‘‘so long as the child is a 

3 member of the woman’s household and the 

4 woman remains (or would remain if pregnant) 

5 eligible for such assistance’’. 

6 (B) APPLICATION OF QUALIFIED ENTITIES

7 TO PRESUMPTIVE ELIGIBILITY FOR PREGNANT

8 WOMEN UNDER MEDICAID.—Section 1920(b) of 

9 the Social Security Act (42 U.S.C. 1396r–1(b)) 

10 is amended by adding at the end after and 

11 below paragraph (2) the following flush sen12 tence: 

13 ‘‘The term ‘qualified provider’ includes a qualified entity 

14 as defined in section 1920A(b)(3).’’. 

15 (b) SCHIP.—

16 (1) COVERAGE.—Title XXI of the Social Secu17 rity Act (42 U.S.C. 1397aa et seq.) is amended by 

18 adding at the end the following: 

19 ‘‘SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-IN20 COME PREGNANT WOMEN. 

21 ‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any 

22 other provision of this title, a State may provide for cov23 erage, through an amendment to its State child health 

24 plan under section 2102, of pregnancy-related assistance 

25 for targeted low-income pregnant women in accordance 
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1 with this section, but only if the State meets the conditions 

2 described in section 1905(u)(4)(B). 

3 ‘‘(b) DEFINITIONS.—For purposes of this title:

4 ‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The 

5 term ‘pregnancy-related assistance’ has the meaning 

6 given the term child health assistance in section 

7 2110(a) as if any reference to targeted low-income 

8 children were a reference to targeted low-income 

9 pregnant women, except that the assistance shall be 

10 limited to services related to pregnancy (which in11 clude prenatal, delivery, and postpartum services 

12 and services described in section 1905(a)(4)(C)) and 

13 to other conditions that may complicate pregnancy. 

14 ‘‘(2) TARGETED LOW-INCOME PREGNANT

15 WOMAN.—The term ‘targeted low-income pregnant 

16 woman’ means a woman—

17 ‘‘(A) during pregnancy and through the 

18 end of the month in which the 60-day period 

19 (beginning on the last day of her pregnancy) 

20 ends; 

21 ‘‘(B) whose family income exceeds the ef22 fective income level (expressed as a percent of 

23 the poverty line and considering applicable in24 come disregards) that has been specified under 

25 subsection (a)(10)(A)(i)(III) or (l)(2)(A) of sec-
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1 tion 1902, as of January 1, 2003, to be eligible 

2 for medical assistance as a pregnant woman 

3 under title XIX but does not exceed the income 

4 eligibility level established under the State child 

5 health plan under this title for a targeted low6 income child; and 

7 ‘‘(C) who satisfies the requirements of 

8 paragraphs (1)(A), (1)(C), (2), and (3) of sec9 tion 2110(b). 

10 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

11 RULES.—In the case of, and with respect to, a State pro12 viding for coverage of pregnancy-related assistance to tar13 geted low-income pregnant women under subsection (a), 

14 the following special rules apply: 

15 ‘‘(1) Any reference in this title (other than in 

16 subsection (b)) to a targeted low-income child is 

17 deemed to include a reference to a targeted low-in18 come pregnant woman. 

19 ‘‘(2) Any such reference to child health assist20 ance with respect to such women is deemed a ref21 erence to pregnancy-related assistance. 

22 ‘‘(3) Any such reference to a child is deemed a 

23 reference to a woman during pregnancy and the pe24 riod described in subsection (b)(2)(A). 
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1 ‘‘(4) In applying section 2102(b)(3)(B), any 

2 reference to children found through screening to be 

3 eligible for medical assistance under the State med4 icaid plan under title XIX is deemed a reference to 

5 pregnant women. 

6 ‘‘(5) There shall be no exclusion of benefits for 

7 services described in subsection (b)(1) based on any 

8 preexisting condition and no waiting period (includ9 ing any waiting period imposed to carry out section 

10 2102(b)(3)(C)) shall apply. 

11 ‘‘(6) Subsection (a) of section 2103 (relating to 

12 required scope of health insurance coverage) shall 

13 not apply insofar as a State limits coverage to serv14 ices described in subsection (b)(1) and the reference 

15 to such section in section 2105(a)(1)(C) is deemed 

16 not to require, in such case, compliance with the re17 quirements of section 2103(a). 

18 ‘‘(7) In applying section 2103(e)(3)(B) in the 

19 case of a pregnant woman provided coverage under 

20 this section, the limitation on total annual aggregate 

21 cost-sharing shall be applied to the entire family of 

22 such pregnant woman. 

23 ‘‘(d) AUTOMATIC ENROLLMENT FOR CHILDREN

24 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS25 SISTANCE.—If a child is born to a targeted low-income
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1 pregnant woman who was receiving pregnancy-related as2 sistance under this section on the date of the child’s birth, 

3 the child shall be deemed to have applied for child health 

4 assistance under the State child health plan and to have 

5 been found eligible for such assistance under such plan 

6 or to have applied for medical assistance under title XIX 

7 and to have been found eligible for such assistance under 

8 such title, as appropriate, on the date of such birth and 

9 to remain eligible for such assistance until the child at10 tains 1 year of age. During the period in which a child 

11 is deemed under the preceding sentence to be eligible for 

12 child health or medical assistance, the child health or med13 ical assistance eligibility identification number of the 

14 mother shall also serve as the identification number of the 

15 child, and all claims shall be submitted and paid under 

16 such number (unless the State issues a separate identifica17 tion number for the child before such period expires).’’. 

18 (2) ADDITIONAL ALLOTMENTS FOR PROVIDING

19 COVERAGE OF PREGNANT WOMEN.—

20 (A) IN GENERAL.—Section 2104 of the So21 cial Security Act (42 U.S.C. 1397dd) is amend22 ed by inserting after subsection (c) the fol23 lowing: 

24 ‘‘(d) ADDITIONAL ALLOTMENTS FOR PROVIDING

25 COVERAGE OF PREGNANT WOMEN.—
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1 ‘‘(1) APPROPRIATION; TOTAL ALLOTMENT.—

2 For the purpose of providing additional allotments 

3 to States under this title, there is appropriated, out

4 of any money in the Treasury not otherwise appro5 priated, for each of fiscal years 2004 through 2007, 

6 $200,000,000. 

7 ‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.—

8 In addition to the allotments provided under sub9 sections (b) and (c), subject to paragraphs (3) and 

10 (4), of the amount available for the additional allot11 ments under paragraph (1) for a fiscal year, the 

12 Secretary shall allot to each State with a State child 

13 health plan approved under this title—

14 ‘‘(A) in the case of such a State other than 

15 a commonwealth or territory described in sub16 paragraph (B), the same proportion as the pro17 portion of the State’s allotment under sub18 section (b) (determined without regard to sub19 section (f)) to the total amount of the allot20 ments under subsection (b) for such States eli21 gible for an allotment under this paragraph for 

22 such fiscal year; and 

23 ‘‘(B) in the case of a commonwealth or ter24 ritory described in subsection (c)(3), the same 

25 proportion as the proportion of the common-
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1 wealth’s or territory’s allotment under sub2 section (c) (determined without regard to sub3 section (f)) to the total amount of the allot4 ments under subsection (c) for commonwealths 

5 and territories eligible for an allotment under 

6 this paragraph for such fiscal year. 

7 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi8 tional allotments provided under this subsection are 

9 not available for amounts expended before October 

10 1, 2003. Such amounts are available for amounts ex11 pended on or after such date for child health assist12 ance for targeted low-income children, as well as for 

13 pregnancy-related assistance for targeted low-income 

14 pregnant women. 

15 ‘‘(4) NO PAYMENTS UNLESS ELECTION TO EX16 PAND COVERAGE OF PREGNANT WOMEN.—No pay17 ments may be made to a State under this title from 

18 an allotment provided under this subsection unless 

19 the State provides pregnancy-related assistance for 

20 targeted low-income pregnant women under this 

21 title, or provides medical assistance for pregnant 

22 women under title XIX, whose family income ex23 ceeds the effective income level applicable under sub24 section (a)(10)(A)(i)(III) or (l)(2)(A) of section 
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1 1902 to a family of the size involved as of January 

2 1, 2003.’’. 

3 (B) CONFORMING AMENDMENTS.—Section 

4 2104 of the Social Security Act (42 U.S.C. 

5 1397dd) is amended—

6 (i) in subsection (a), in the matter 

7 preceding paragraph (1), by inserting 

8 ‘‘subject to subsection (d),’’ after ‘‘under 

9 this section,’’; 

10 (ii) in subsection (b)(1), by inserting 

11 ‘‘and subsection (d)’’ after ‘‘Subject to 

12 paragraph (4)’’; and 

13 (iii) in subsection (c)(1), by inserting 

14 ‘‘subject to subsection (d),’’ after ‘‘for a 

15 fiscal year,’’. 

16 (3) PRESUMPTIVE ELIGIBILITY UNDER TITLE

17 XXI.—

18 (A) APPLICATION TO PREGNANT

19 WOMEN.—Section 2107(e)(1)(D) of the Social 

20 Security Act (42 U.S.C. 1397gg(e)(1)) is 

21 amended to read as follows: 

22 ‘‘(D) Sections 1920 and 1920A (relating to 

23 presumptive eligibility).’’. 

24 (B) EXCEPTION FROM LIMITATION ON AD25 MINISTRATIVE EXPENSES.—Section 2105(c)(2)
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1 of the Social Security Act (42 U.S.C. 

2 1397ee(c)(2)) is amended by adding at the end 

3 the following new subparagraph: 

4 ‘‘(C) EXCEPTION FOR PRESUMPTIVE ELI5 GIBILITY EXPENDITURES.—The limitation 

6 under subparagraph (A) on expenditures shall 

7 not apply to expenditures attributable to the 

8 application of section 1920 or 1920A (pursuant 

9 to section 2107(e)(1)(D)), regardless of whether 

10 the child or pregnant woman is determined to 

11 be ineligible for the program under this title or 

12 title XIX.’’. 

13 (4) ADDITIONAL AMENDMENTS TO TITLE

14 XXI.—

15 (A) NO COST-SHARING FOR PREGNANCY16 RELATED SERVICES.—Section 2103(e)(2) of the 

17 Social Security Act (42 U.S.C. 1397cc(e)(2)) is 

18 amended—

19 (i) in the heading, by inserting ‘‘OR

20 PREGNANCY-RELATED SERVICES’’ after 

21 ‘‘PREVENTIVE SERVICES’’; and 

22 (ii) by inserting before the period at 

23 the end the following: ‘‘or for pregnancy24 related services’’.
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1 (B) NO WAITING PERIOD.—Section 

2 2102(b)(1)(B) of the Social Security Act (42 

3 U.S.C. 1397bb(b)(1)(B)) is amended—

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

5 clause (i) and inserting a semicolon; 

6 (ii) by striking the period at the end 

7 of clause (ii) and inserting ‘‘; and’’; and 

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

10 ‘‘(iii) may not apply a waiting period 

11 (including a waiting period to carry out 

12 paragraph (3)(C)) in the case of a targeted 

13 low-income pregnant woman.’’. 

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

15 this section apply to items and services furnished on or 

16 after October 1, 2003, without regard to whether regula17 tions implementing such amendments have been promul18 gated. 

19 SEC. 3. COORDINATION WITH THE MATERNAL AND CHILD 

20 HEALTH PROGRAM. 

21 (a) IN GENERAL.—Section 2102(b)(3) of the Social 

22 Security Act (42 U.S.C. 1397bb(b)(3)) is amended—

23 (1) in subparagraph (D), by striking ‘‘and’’ at 

24 the end; 
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1 (2) in subparagraph (E), by striking the period 

2 and inserting ‘‘; and’’; and 

3 (3) by adding at the end the following new sub4 paragraph: 

5 ‘‘(F) that operations and activities under 

6 this title are developed and implemented in con7 sultation and coordination with the program op8 erated by the State under title V in areas in9 cluding outreach and enrollment, benefits and 

10 services, service delivery standards, public 

11 health and social service agency relationships, 

12 and quality assurance and data reporting.’’. 

13 (b) CONFORMING MEDICAID AMENDMENT.—Section 

14 1902(a)(11) of such Act (42 U.S.C. 1396a(a)(11)) is 

15 amended—

16 (1) by striking ‘‘and’’ before ‘‘(C)’’; and 

17 (2) by inserting before the semicolon at the end 

18 the following: ‘‘, and (D) provide that operations and 

19 activities under this title are developed and imple20 mented in consultation and coordination with the 

21 program operated by the State under title V in areas 

22 including outreach and enrollment, benefits and 

23 services, service delivery standards, public health 

24 and social service agency relationships, and quality 

25 assurance and data reporting’’. 
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1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section take effect on January 1, 2004. 

3 SEC. 4. INCREASE IN SCHIP INCOME ELIGIBILITY. 

4 (a) DEFINITION OF LOW-INCOME CHILD.—Section 

5 2110(c)(4) of the Social Security Act (42 U.S.C. 42 

6 U.S.C. 1397jj(c)(4)) is amended by striking ‘‘200’’ and 

7 inserting ‘‘250’’. 

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

9 subsection (a) applies to child health assistance provided, 

10 and allotments determined under section 2104 of the So11 cial Security Act (42 U.S.C. 1397dd), for fiscal years be12 ginning with fiscal year 2004. 

13 SEC. 5. REVIEW OF STATE AGENCY BLINDNESS AND DIS14 ABILITY DETERMINATIONS. 

15 Section 1633 of the Social Security Act (42 U.S.C. 

16 1383b) is amended by adding at the end the following: 

17 ‘‘(e)(1) The Commissioner of Social Security shall re18 view determinations, made by State agencies pursuant to 

19 subsection (a) in connection with applications for benefits 

20 under this title on the basis of blindness or disability, that 

21 individuals who have attained 18 years of age are blind 

22 or disabled as of a specified onset date. The Commissioner 

23 of Social Security shall review such a determination before 

24 any action is taken to implement the determination. 
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1 ‘‘(2)(A) In carrying out paragraph (1), the Commis2 sioner of Social Security shall review—

3 ‘‘(i) at least 25 percent of all determinations re4 ferred to in paragraph (1) that are made in fiscal 

5 year 2004; and 

6 ‘‘(ii) at least 50 percent of all such determina7 tions that are made in fiscal year 2005 or thereafter. 

8 ‘‘(B) In carrying out subparagraph (A), the Commis9 sioner of Social Security shall, to the extent feasible, select 

10 for review the determinations which the Commissioner of 

11 Social Security identifies as being the most likely to be 

12 incorrect.’’.

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