I 

110TH CONGRESS 

1ST SESSION H. R. 2055 

To improve children’s access to health care coverage under the Medicaid 

Program and the State Children’s Health Insurance Program (SCHIP). 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 26, 2007 

Ms. CASTOR introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To improve children’s access to health care coverage under 

the Medicaid Program and the State Children’s Health 

Insurance Program (SCHIP). 

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; TABLE OF CONTENTS; FINDINGS. 

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

5 ‘‘Improving Children’s Access to Health Care Act of 

6 2007’’. 

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

8 this Act is as follows: 

Sec. 1. Short title; table of contents; findings. 

Sec. 2. State options for ‘‘express lane’’ eligibility. 

Sec. 3. Medicaid citizenship documentation requirements. 


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Sec. 4. Give States the option to allow children of low-income state employees 

to enroll in SCHIP. 

Sec. 5. Establishment of new base SCHIP allotments that are responsive to increases in health care costs and enrollment expansions. 

Sec. 6. 2-year initial availability of SCHIP allotments. 

Sec. 7. SCHIP Premium grace period. 

1 (c) FINDINGS.—Congress finds the following: 

2 (1) 9 million children in the United States 

3 under the age of 19 are uninsured. 

4 (2) 6.8 million of these children are eligible for, 

5 but not enrolled in, the Medicaid program or the 

6 State Children’s Health Insurance Program 

7 (SCHIP). 

8 (3) Two-thirds of the 9 million uninsured chil9 dren come from working families in which one or 

10 both parents are working but were not offered em11 ployer-based health insurance or were unable to buy 

12 private health insurance. 

13 (4) Uninsured children are five times less likely 

14 than insured children to have a primary care physi15 cian, or to have visited a doctor or dentist in the 

16 past two years. 

17 SEC. 2. STATE OPTIONS FOR ‘‘EXPRESS LANE’’ ELIGIBILITY. 

18 Notwithstanding any other provision of law, any 

19 State with a plan under title XIX or XXI of the Social 

20 Security Act has the option of doing any or all of the fol21 lowing in order to promote enrollment of eligible children 

22 under the programs under those titles: 


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1 (1) The option to create ‘‘express lane eligi2 bility’’ so that children who meet other low-income 

3 public program eligibility requirements (such as the 

4 WIC program, the school lunch program, and other 

5 means-tested programs) are automatically enrolled 

6 for benefits under the appropriate plan under such 

7 titles, with appropriate notice to the parents of chil8 dren so enrolled. 

9 (2) The option to create one enrollment form 

10 for all low-income public programs, including such 

11 programs. 

12 (3) The option to receive a 75 percent Federal 

13 matching percentage under such titles for expenses 

14 relating to the implementation of electronic tech15 nology needed to make their information and com16 puter system infrastructure facilitate Express Lane 

17 eligibility, presumptive eligibility, continuous eligi18 bility, and automatic renewals of coverage for chil19 dren for whom the State already has data from 

20 other programs on income. 

21 SEC. 3. MEDICAID CITIZENSHIP DOCUMENTATION RE22 QUIREMENTS. 

23 (a) STATE OPTION TO REQUIRE CERTAIN INDIVID24 UALS TO PRESENT SATISFACTORY DOCUMENTARY EVIVerDate Aug 31 2005 21:58 Apr 27, 2007 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2055.IH H2055

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1 DENCE OF PROOF OF CITIZENSHIP OR NATIONALITY FOR

2 PURPOSES OF ELIGIBILITY FOR MEDICAID.— 

3 (1) IN GENERAL.—Section 1902(a)(46) of the 

4 Social Security Act (42 U.S.C. 1396a(a)(46)) is 

5 amended— 

6 (A) by inserting ‘‘(A)’’ after ‘‘(46)’’; 

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

8 and 

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

10 subparagraph: 

11 ‘‘(B) at the option of the State and subject to 

12 section 1903(x), require that, with respect to an in13 dividual (other than an individual described in sec14 tion 1903(x)(1)) who declares to be a citizen or na15 tional of the United States for purposes of estab16 lishing initial eligibility for medical assistance under 

17 this title (or, at State option, for purposes of renew18 ing or redetermining such eligibility to the extent 

19 that such satisfactory documentary evidence of citi20 zenship or nationality has not yet been presented), 

21 there is presented satisfactory documentary evidence 

22 of citizenship or nationality of the individual (using 

23 criteria determined by the State, which shall be no 

24 more restrictive than the criteria used by the Social 

25 Security Administration to determine citizenship, 


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1 and which shall accept as such evidence a document 

2 issued by a federally-recognized Indian tribe evidenc3 ing membership or enrollment in, or affiliation with, 

4 such tribe (such as a tribal enrollment card or cer5 tificate of degree of Indian blood, and, with respect 

6 to those federally-recognized Indian tribes located 

7 within States having an international border whose 

8 membership includes individuals who are not citizens 

9 of the United States, such other forms of docu10 mentation (including tribal documentation, if appro11 priate) that the Secretary, after consulting with such 

12 tribes, determines to be satisfactory documentary 

13 evidence of citizenship or nationality for purposes of 

14 satisfying the requirement of this subparagraph));’’. 

15 (2) LIMITATION ON WAIVER AUTHORITY.—Not16 withstanding any provision of section 1115 of the 

17 Social Security Act (42 U.S.C. 1315), or any other 

18 provision of law, the Secretary of Health and 

19 Human Services may not waive the requirements of 

20 section 1902(a)(46)(B) of such Act (42 U.S.C. 

21 1396a(a)(46)(B)) with respect to a State. 

22 (3) CONFORMING AMENDMENTS.—Section 1903 

23 of such Act (42 U.S.C. 1396b) is amended— 

24 (A) in subsection (i)— 


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1 (i) in paragraph (20), by adding ‘‘or’’ 

2 after the semicolon; 

3 (ii) in paragraph (21), by striking ‘‘; 

4 or’’ and inserting a period; and 

5 (iii) by striking paragraph (22); and 

6 (B) in subsection (x) (as amended by sec7 tion 405(c)(1)(A) of division B of the Tax Re8 lief and Health Care Act of 2006 (Public Law 

9 109–432))— 

10 (i) by striking paragraphs (1) and (3); 

11 (ii) by redesignating paragraph (2) as 

12 paragraph (1); 

13 (iii) in paragraph (1), as so redesig14 nated, by striking ‘‘paragraph (1)’’ and in15 serting ‘‘section 1902(a)(46)(B)’’; and 

16 (iv) by adding at the end the following 

17 new paragraph: 

18 ‘‘(2) In the case of an individual declaring to be a 

19 citizen or national of the United States with respect to 

20 whom a State requires the presentation of satisfactory 

21 documentary evidence of citizenship or nationality under 

22 section 1902(a)(46)(B), the individual shall be provided 

23 at least the reasonable opportunity to present satisfactory 

24 documentary evidence of citizenship or nationality under 

25 this subsection as is provided under clauses (i) and (ii) 


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1 of section 1137(d)(4)(A) to an individual for the submittal 

2 to the State of evidence indicating a satisfactory immigra3 tion status.’’. 

4 (b) CLARIFICATION OF RULES FOR CHILDREN BORN

5 IN THE UNITED STATES TO MOTHERS ELIGIBLE FOR

6 MEDICAID.—Section 1903(x) of such Act (42 U.S.C. 

7 1396b(x)), as amended by subsection (a)(3)(B), is amend8 ed— 

9 (1) in paragraph (1)— 

10 (A) in subparagraph (C), by striking ‘‘or’’ 

11 at the end; 

12 (B) by redesignating subparagraph (D) as 

13 subparagraph (E); and 

14 (C) by inserting after subparagraph (C) 

15 the following new subparagraph: 

16 ‘‘(D) pursuant to the application of section 

17 1902(e)(4) (and, in the case of an individual who is 

18 eligible for medical assistance on such basis, the in19 dividual shall be deemed to have provided satisfac20 tory documentary evidence of citizenship or nation21 ality and shall not be required to provide further 

22 documentary evidence on any date that occurs dur23 ing or after the period in which the individual is eli24 gible for medical assistance on such basis); or’’; and 


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

2 paragraph: 

3 ‘‘(3) Nothing in subparagraph (A) or (B) of section 

4 1902(a)(46), the preceding paragraphs of this subsection, 

5 or the Deficit Reduction Act of 2005, including section 

6 6036 of such Act, shall be construed as changing the re7 quirement of section 1902(e)(4) that a child born in the 

8 United States to an alien mother for whom medical assist9 ance for the delivery of such child is available as treatment 

10 of an emergency medical condition pursuant to subsection 

11 (v) shall be deemed eligible for medical assistance during 

12 the first year of such child’s life.’’. 

13 (c) EFFECTIVE DATE.— 

14 (1) RETROACTIVE APPLICATION.—The amend15 ments made by this section shall take effect as if in16 cluded in the enactment of the Deficit Reduction Act 

17 of 2005 (Public Law 109–171; 120 Stat. 4). 

18 (2) RESTORATION OF ELIGIBILITY.—In the 

19 case of an individual who, during the period that 

20 began on July 1, 2006, and ends on the date of en21 actment of this Act, was determined to be ineligible 

22 for medical assistance under a State Medicaid pro23 gram solely as a result of the application of sub24 sections (i)(22) and (x) of section 1903 of the Social 

25 Security Act (as in effect during such period), but 


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1 who would have been determined eligible for such as2 sistance if such subsections, as amended by sub3 sections (a) and (b), had applied to the individual, 

4 a State may deem the individual to be eligible for 

5 such assistance as of the date that the individual 

6 was determined to be ineligible for such medical as7 sistance on such basis. 

8 SEC. 4. GIVE STATES THE OPTION TO ALLOW CHILDREN OF 

9 LOW-INCOME STATE EMPLOYEES TO ENROLL 

10 IN SCHIP. 

11 (a) IN GENERAL.—Section 2110(b)(2)(B) of the So12 cial Security Act (42 U.S.C. 1397jj(b)(2)(B)) is amended 

13 by inserting ‘‘at the option of a State,’’ after ‘‘(B)’’. 

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

15 subsection (a) shall take effect on the date of the enact16 ment of this Act. 

17 SEC. 5. ESTABLISHMENT OF NEW BASE SCHIP ALLOT18 MENTS THAT ARE RESPONSIVE TO IN19 CREASES IN HEALTH CARE COSTS AND EN20 ROLLMENT EXPANSIONS. 

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

22 1397dd) is amended— 

23 (1) in subsection (a)— 

24 (A) in paragraph (9), by striking ‘‘and’’ at 

25 the end; 


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1 (B) in paragraph (10), by striking the pe2 riod at the end and inserting ‘‘; and’’; and 

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

4 paragraph: 

5 ‘‘(11) for fiscal year 2008 and each succeeding 

6 fiscal year, the sum of the State allotments provided 

7 under subsection (i) for such fiscal year.’’; 

8 (2) in each of subsections (b)(1) and (c)(1), by 

9 striking ‘‘subsection (d)’’ and inserting ‘‘subsections 

10 (d) and (i)’’; and 

11 (3) by adding at the end the following new sub12 section: 

13 ‘‘(i) ALLOTMENTS FOR STATES AND TERRITORIES

14 BEGINNING WITH FISCAL YEAR 2008.— 

15 ‘‘(1) GENERAL ALLOTMENT COMPUTATION.— 

16 ‘‘(A) IN GENERAL.—Subject to the suc17 ceeding provisions of this subsection, the Sec18 retary shall compute a State allotment for each 

19 State for each fiscal year as follows: 

20 ‘‘(i) REBASING IN FISCAL YEAR 2008

21 AND EACH SECOND SUCCEEDING FISCAL

22 YEAR.—For fiscal year 2008 and each sec23 ond succeeding fiscal year, the allotment of 

24 a State is equal to the Federal payments 

25 to the State that are attributable to (and 


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1 countable towards) the allotment under 

2 this section for the State for the previous 

3 fiscal year multiplied by the allotment in4 crease factor under subparagraph (B) for 

5 the fiscal year involved. 

6 ‘‘(ii) USING PROJECTIONS FOR FISCAL

7 YEAR 2009 AND EACH SECOND SUCCEEDING

8 FISCAL YEAR.—For fiscal year 2009 and 

9 each second succeeding fiscal year, the al10 lotment of a State is equal to the amount 

11 of the State allotment under this subpara12 graph for the previous fiscal year multi13 plied by the allotment increase factor 

14 under subparagraph (B) for the fiscal year 

15 involved. 

16 ‘‘(B) ALLOTMENT INCREASE FACTOR.— 

17 The allotment increase factor under this sub18 paragraph for a fiscal year is equal to the prod19 uct of the following: 

20 ‘‘(i) PER CAPITA HEALTH CARE

21 GROWTH FACTOR.—One plus the percent22 age increase in the projected per capita 

23 amount of National Health Expenditures 

24 from the second previous fiscal year to the 

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1 lished by the Secretary before the begin2 ning of the fiscal year involved. 

3 ‘‘(ii) CHILD POPULATION GROWTH

4 FACTOR.—One plus the percentage in5 crease in the population of children under 

6 20 years of age in the State from July 1 

7 in such second previous fiscal year to July 

8 1 in the previous fiscal year, as determined 

9 by the Secretary based on the most recent 

10 published estimates of the Bureau of the 

11 Census before the beginning of the fiscal 

12 year involved. 

13 ‘‘(C) OUTREACH ADJUSTMENT.— 

14 ‘‘(i) IN GENERAL.—If a State’s ex15 penditures under this title in a fiscal year 

16 (beginning with fiscal year 2008) exceeds 

17 the allotment provided under this section 

18 (determined without regard to any reallot19 ment it receives that is available for ex20 penditure during such fiscal year) and if 

21 the average number of enrollees in the 

22 State under this title for such fiscal year 

23 exceeds its target number of enrollees for 

24 that year, for the subsequent fiscal year 

25 the allotment under this section for the 


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1 State shall be increased by the amount by 

2 which— 

3 ‘‘(I) the product of— 

4 ‘‘(aa) such additional num5 ber of enrollees; and 

6 ‘‘(bb) the projected per cap7 ita Federal expenditures under 

8 the State child health plan (as 

9 determined under clause (iii) for 

10 such subsequent fiscal year); re11 duced by 

12 ‘‘(II) the amount of any allot13 ment redistributed to the State under 

14 this section for such subsequent fiscal 

15 year. 

16 ‘‘(ii) TARGET NUMBER OF ENROLL17 EES.—In this subsection, the target num18 ber of enrollees for a State for a fiscal year 

19 is equal to the average number of enrollees 

20 enrolled in the State child health plan 

21 under this title during fiscal year 2007 in22 creased (for each subsequent fiscal year 

23 through the fiscal year involved) by the 

24 population growth for children in that 

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1 fore the beginning of the fiscal year (as es2 timated by the Bureau of the Census). 

3 ‘‘(iii) PROJECTED PER CAPITA FED4 ERAL EXPENDITURES.—For purposes of 

5 subparagraph (A)(i)(II), the projected per 

6 capita Federal expenditures under a State 

7 child health plan for a fiscal year is equal 

8 to the average per capita Federal expendi9 tures under such plan for fiscal year 2007, 

10 increased (for each subsequent fiscal year 

11 up to and including the fiscal year in12 volved) by the annual percentage increase 

13 in per capita amount of National Health 

14 Expenditures (as estimated by the Sec15 retary) for the respective subsequent fiscal 

16 year. 

17 ‘‘(iv) AVAILABILITY.—Notwith18 standing subsection (e), an increase in al19 lotment under this paragraph shall only be 

20 available for expenditure during the fiscal 

21 year in which it is provided. 

22 ‘‘(v) INTERACTION WITH OTHER PRO23 VISIONS.— 

24 ‘‘(I) COVERAGE EXPANSION

25 STATES.—In the case of a State that 


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1 has an increased allotment under sec2 tion 2105(i)— 

3 ‘‘(aa) there shall be no in4 creased allotment under para5 graph (2); and 

6 ‘‘(bb) the allotment under 

7 this subsection shall not be sub8 ject to reallotment or redistribu9 tion to other States. 

10 ‘‘(II) NO REALLOTMENT OF OUT11 REACH ADJUSTMENT.—In no case 

12 shall any increase in allotment under 

13 paragraph (2) for a State be subject 

14 to reallotment or redistribution to 

15 other States.’’. 

16 SEC. 6. 2-YEAR INITIAL AVAILABILITY OF SCHIP ALLOT17 MENTS. 

18 Section 2104(e) of the Social Security Act (42 U.S.C. 

19 1397dd(e)) is amended to read as follows: 

20 ‘‘(e) AVAILABILITY OF AMOUNTS ALLOTTED.— 

21 ‘‘(1) IN GENERAL.—Except as provided in para22 graph (2), amounts allotted to a State pursuant to 

23 this section— 

24 ‘‘(A) for each of fiscal years 1998 through 

25 2007, shall remain available for expenditure by 


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1 the State through the end of the second suc2 ceeding fiscal year; and 

3 ‘‘(B) for fiscal year 2008 and each fiscal 

4 year thereafter, shall remain available for ex5 penditure by the State through the end of the 

6 succeeding fiscal year. 

7 ‘‘(2) AVAILABILITY OF AMOUNTS REALLOT8 TED.—Amounts reallotted to a State under sub9 section (f) shall be available for expenditure by the 

10 State through the end of the fiscal year in which 

11 they are reallotted.’’. 

12 SEC. 7. SCHIP PREMIUM GRACE PERIOD. 

13 (a) IN GENERAL.—Section 2103(e)(3) of the Social 

14 Security Act (42 U.S.C. 1397bb(e)(3)) is amended by add15 ing at the end the following new subparagraph: 

16 ‘‘(C) PREMIUM GRACE PERIOD.— 

17 ‘‘(i) IN GENERAL.—The State child 

18 health plan shall provide a grace period of 

19 at least 30 days from the beginning of a 

20 new coverage period to make premium pay21 ments before coverage under this title may 

22 be terminated. For purposes of this clause, 

23 the term ‘new coverage period’ means the 

24 month following the last month for which 

25 the premium has been paid. 


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1 ‘‘(ii) NOTICE.—The State child health 

2 plan shall provide, not later than 7 days 

3 after the first day of a grace period de4 scribed in clause (i), individual notice in5 forming the enrollee involved— 

6 ‘‘(I) that failure to make a pre7 mium payment within the grace pe8 riod will result in termination from 

9 the State child health plan; and 

10 ‘‘(II) of the enrollee’s right to 

11 challenge the proposed termination 

12 pursuant to the applicable Federal 

13 regulations, in effect as of January 1, 

14 2007.’’. 

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

16 subsection (a) shall apply to new coverage periods begin17 ning on and after such date, not later than October 1, 

18 2007, as the Secretary of Health and Human Services 

19 shall specify. 

Æ 


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