II 

109TH CONGRESS 

2D SESSION S. 2916 

To amend title XIX of the Social Security Act to expand access to contraceptive services for women and men under the Medicaid program, help 

low income women and couples prevent unintended pregnancies and reduce abortion, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 19, 2006 

Mrs. CLINTON (for herself, Mr. REID, Mr. KERRY, Mrs. BOXER, Mr. HARKIN, 

Mr. LAUTENBERG, Mr. OBAMA, Mr. JEFFORDS, Mr. BINGAMAN, and Ms. 

CANTWELL) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to expand 

access to contraceptive services for women and men 

under the Medicaid program, help low income women 

and couples prevent unintended pregnancies and reduce 

abortion, 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 ‘‘Unintended Pregnancy 

5 Reduction Act of 2006’’. 


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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) Rates of unintended pregnancy in the 

4 United States increased by nearly 30 percent among 

5 low-income women between 1994 and 2002, and a 

6 low-income woman today is 4 times as likely to have 

7 an unintended pregnancy as her higher income coun8 terpart. 

9 (2) Abortion rates decreased among higher in10 come women but increased among low income 

11 women between 1994 and 2002, and a low income 

12 woman is more than 4 times as likely to have an 

13 abortion as her higher income counterpart. 

14 (3) Contraceptive use reduces a woman’s prob15 ability of having an abortion by 85 percent. 

16 (4) Levels of contraceptive use among low-in17 come women at risk of unintended pregnancy de18 clined significantly between 1994 and 2002, from 92 

19 percent to 86 percent. 

20 (5) Publicly funded contraceptive services have 

21 been shown to prevent 1,300,000 unintended preg22 nancies each year, and in the absence of these serv23 ices the United States abortion rate would likely be 

24 40 percent higher than it is. 

25 (6) By helping couples avoid unintended preg26 nancy, Medicaid-funded contraceptive services are 


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1 highly cost-effective, and every public dollar spent on 

2 family planning saves $3 in the cost of pregnancy3 related care alone. 

4 (7) Federal law requires State Medicaid pro5 grams to cover pregnancy-related care for women 

6 with incomes up to 133 percent of poverty, and 17 

7 States have expanded this coverage to women with 

8 incomes up to 200 percent of poverty. 

9 (8) 18 States have expanded Medicaid coverage 

10 for family planning services to the same level at 

11 which they provide Medicaid funded pregnancy-re12 lated care. 

13 (9) Equalizing the eligibility levels for family 

14 planning and pregnancy-related care nationwide 

15 would maximize the cost-savings to both the Federal 

16 and State Governments. 

17 (10) A woman should have equal access to con18 traceptive services to help prevent an unintended 

19 pregnancy and to pregnancy-related care if she does 

20 become pregnant. 

21 SEC. 3. CLARIFICATION OF COVERAGE OF FAMILY PLAN22 NING SERVICES AND SUPPLIES. 

23 Section 1937(b) of the Social Security Act (42 U.S.C. 

24 1396u–7(b)) is amended by adding at the end the fol25 lowing: 


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1 ‘‘(5) COVERAGE OF FAMILY PLANNING SERV2 ICES AND SUPPLIES.—Notwithstanding the previous 

3 provisions of this section, a State may not provide 

4 for medical assistance through enrollment of an indi5 vidual with benchmark coverage or benchmark-equiv6 alent coverage under this section unless that cov7 erage includes family planning services and supplies 

8 as described in section 1905(a)(4)(C).’’. 

9 SEC. 4. EXPANSION OF FAMILY PLANNING SERVICES. 

10 (a) COVERAGE AS MANDATORY CATEGORICALLY

11 NEEDY GROUP.— 

12 (1) IN GENERAL.—Section 1902(a)(10)(A)(i) of 

13 the Social Security Act (42 U.S.C. 

14 1396a(a)(10)(A)(i)) is amended— 

15 (A) in subclause (VI), by striking ‘‘or’’ at 

16 the end; 

17 (B) in subclause (VII), by adding ‘‘or’’ at 

18 the end; and 

19 (C) by adding at the end the following new 

20 subclause: 

21 ‘‘(VIII) who are described in sub22 section (dd) (relating to individuals 

23 who meet the income standards for 

24 pregnant women);’’. 


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1 (2) GROUP DESCRIBED.—Section 1902 of the 

2 Social Security Act (42 U.S.C. 1396a) is amended 

3 by adding at the end the following new subsection: 

4 ‘‘(dd)(1) Individuals described in this subsection are 

5 individuals who— 

6 ‘‘(A) meet at least the income eligibility stand7 ards established under the State plan as of May 1, 

8 2006, for pregnant women or such higher income 

9 eligibility standard for such women as the State may 

10 establish; and 

11 ‘‘(B) are not pregnant. 

12 ‘‘(2) At the option of a State, individuals described 

13 in this subsection may include individuals who are deter14 mined to meet the income eligibility standards referred to 

15 in paragraph (1)(A) under the terms and conditions appli16 cable to making eligibility determinations for medical as17 sistance under this title under a waiver to provide the ben18 efits described in clause (XV) of the matter following sub19 paragraph (G) of section 1902(a)(10) granted to the State 

20 under section 1115 as of May 1, 2006.’’. 

21 (3) LIMITATION ON BENEFITS.—Section 

22 1902(a)(10) of the Social Security Act (42 U.S.C. 

23 1396a(a)(10)) is amended in the matter following 

24 subparagraph (G)— 


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1 (A) by striking ‘‘and (XIV)’’ and inserting 

2 ‘‘(XIV)’’; and 

3 (B) by inserting ‘‘, and (XV) the medical 

4 assistance made available to an individual de5 scribed in subsection (dd) who is eligible for 

6 medical assistance only because of subpara7 graph (A)(10)(i)(VIII) shall be limited to family 

8 planning services and supplies described in 

9 1905(a)(4)(C) and, at the State’s option, med10 ical diagnosis or treatment services that are 

11 provided in conjunction with a family planning 

12 service in a family planning setting provided 

13 during the period in which such an individual is 

14 eligible;’’ after ‘‘cervical cancer’’. 

15 (4) CONFORMING AMENDMENTS.—Section 

16 1905(a) of the Social Security Act (42 U.S.C. 

17 1396d(a)) is amended in the matter preceding para18 graph (1)— 

19 (A) in clause (xii), by striking ‘‘or’’ at the 

20 end; 

21 (B) in clause (xii), by adding ‘‘or’’ at the 

22 end; and 

23 (C) by inserting after clause (xiii) the fol24 lowing: 


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1 ‘‘(xiv) individuals described in section 

2 1902(dd),’’. 

3 (b) PRESUMPTIVE ELIGIBILITY.— 

4 (1) IN GENERAL.—Title XIX of the Social Se5 curity Act (42 U.S.C. 1396 et seq.) is amended by 

6 inserting after section 1920B the following: 

7 ‘‘PRESUMPTIVE ELIGIBILITY FOR FAMILY PLANNING

8 SERVICES

9 ‘‘SEC. 1902C. (a) STATE OPTION.—A State plan ap10 proved under section 1902 may provide for making med11 ical assistance available to an individual described in sec12 tion 1902(dd) (relating to individuals who meet the in13 come eligibility standard for pregnant women in the State) 

14 during a presumptive eligibility period. In the case of an 

15 individual described in section 1902(dd) who is eligible for 

16 medical assistance only because of subparagraph 

17 (A)(10)(i)(VIII), such medical assistance may be limited 

18 to family planning services and supplies described in 

19 1905(a)(4)(C) and, at the State’s option, medical diag20 nosis or treatment services that are provided in conjunc21 tion with a family planning service in a family planning 

22 setting provided during the period in which such an indi23 vidual is eligible. 

24 ‘‘(b) DEFINITIONS.—For purposes of this section: 

25 ‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The 

26 term ‘presumptive eligibility period’ means, with reVerDate Aug 31 2005 00:04 May 23, 2006 Jkt 049200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2916.IS S2916

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1 spect to an individual described in subsection (a), 

2 the period that— 

3 ‘‘(A) begins with the date on which a 

4 qualified entity determines, on the basis of pre5 liminary information, that the individual is de6 scribed in section 1902(dd); and 

7 ‘‘(B) ends with (and includes) the earlier 

8 of— 

9 ‘‘(i) the day on which a determination 

10 is made with respect to the eligibility of 

11 such individual for services under the State 

12 plan; or 

13 ‘‘(ii) in the case of such an individual 

14 who does not file an application by the last 

15 day of the month following the month dur16 ing which the entity makes the determina17 tion referred to in subparagraph (A), such 

18 last day. 

19 ‘‘(2) QUALIFIED ENTITY.— 

20 ‘‘(A) IN GENERAL.—Subject to subpara21 graph (B), the term ‘qualified entity’ means 

22 any entity that— 

23 ‘‘(i) is eligible for payments under a 

24 State plan approved under this title; and 


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1 ‘‘(ii) is determined by the State agen2 cy to be capable of making determinations 

3 of the type described in paragraph (1)(A). 

4 ‘‘(B) REGULATIONS.—The Secretary may 

5 issue regulations further limiting those entities 

6 that may become qualified entities in order to 

7 prevent fraud and abuse and for other reasons. 

8 ‘‘(C) RULE OF CONSTRUCTION.—Nothing 

9 in this paragraph shall be construed as pre10 venting a State from limiting the classes of en11 tities that may become qualified entities, con12 sistent with any limitations imposed under sub13 paragraph (B). 

14 ‘‘(c) ADMINISTRATION.— 

15 ‘‘(1) IN GENERAL.—The State agency shall pro16 vide qualified entities with— 

17 ‘‘(A) such forms as are necessary for an 

18 application to be made by an individual de19 scribed in subsection (a) for medical assistance 

20 under the State plan; and 

21 ‘‘(B) information on how to assist such in22 dividuals in completing and filing such forms. 

23 ‘‘(2) NOTIFICATION REQUIREMENTS.—A quali24 fied entity that determines under subsection 

25 (b)(1)(A) that an individual described in subsection 


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1 (a) is presumptively eligible for medical assistance 

2 under a State plan shall— 

3 ‘‘(A) notify the State agency of the deter4 mination within 5 working days after the date 

5 on which determination is made; and 

6 ‘‘(B) inform such individual at the time 

7 the determination is made that an application 

8 for medical assistance is required to be made by 

9 not later than the last day of the month fol10 lowing the month during which the determina11 tion is made. 

12 ‘‘(3) APPLICATION FOR MEDICAL ASSIST13 ANCE.—In the case of an individual described in 

14 subsection (a) who is determined by a qualified enti15 ty to be presumptively eligible for medical assistance 

16 under a State plan, the individual shall apply for 

17 medical assistance by not later than the last day of 

18 the month following the month during which the de19 termination is made. 

20 ‘‘(d) PAYMENT.—Notwithstanding any other provi21 sion of this title, medical assistance that— 

22 ‘‘(1) is furnished to an individual described in 

23 subsection (a)— 

24 ‘‘(A) during a presumptive eligibility pe25 riod; 


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1 ‘‘(B) by a entity that is eligible for pay2 ments under the State plan; and 

3 ‘‘(2) is included in the care and services covered 

4 by the State plan, shall be treated as medical assist5 ance provided by such plan for purposes of clause 

6 (4) of the first sentence of section 1905(b).’’. 

7 (2) CONFORMING AMENDMENTS.— 

8 (A) Section 1902(a)(47) of the Social Se9 curity Act (42 U.S.C. 1396a(a)(47)) is amend10 ed by inserting before the semicolon at the end 

11 the following: ‘‘and provide for making medical 

12 assistance available to individuals described in 

13 subsection (a) of section 1920C during a pre14 sumptive eligibility period in accordance with 

15 such section.’’. 

16 (B) Section 1903(u)(1)(D)(v) of such Act 

17 (42 U.S.C. 1396b(u)(1)(D)(v)) is amended— 

18 (i) by striking ‘‘or for’’ and inserting 

19 ‘‘, for’’; and 

20 (ii) by inserting before the period the 

21 following: ‘‘, or for medical assistance pro22 vided to an individual described in sub23 section (a) of section 1920C during a pre24 sumptive eligibility period under such sec25 tion’’. 


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1 SEC. 5. EFFECTIVE DATE. 

2 (a) IN GENERAL.—Except as provided in paragraph 

3 (2), the amendments made by this Act take effect on Octo4 ber 1, 2006. 

5 (b) EXTENSION OF EFFECTIVE DATE FOR STATE

6 LAW AMENDMENT.—In the case of a State plan under 

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

8 seq.) which the Secretary of Health and Human Services 

9 determines requires State legislation in order for the plan 

10 to meet the additional requirements imposed by the 

11 amendments made by this Act, the State plan shall not 

12 be regarded as failing to comply with the requirements of 

13 such title solely on the basis of its failure to meet these 

14 additional requirements before the first day of the first 

15 calendar quarter beginning after the close of the first reg16 ular session of the State legislature that begins after the 

17 date of enactment of this Act. For purposes of the pre18 vious sentence, in the case of a State that has a 2-year 

19 legislative session, each year of the session is considered 

20 to be a separate regular session of the State legislature. 

Æ 


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