I 

108TH CONGRESS 

1ST SESSION H. R. 2979

To amend the Social Security Act to provide grants and flexibility through 

demonstration projects for States to provide universal, comprehensive, 

cost-effective systems of health care coverage, with simplified administration. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 25, 2003

Mr. TIERNEY (for himself, Mr. SANDERS, Ms. MILLENDER-MCDONALD, Ms. 

JACKSON-LEE of Texas, Mr. KILDEE, Mr. KUCINICH, Mr. OWENS, Mr. 

NADLER, Ms. NORTON, Mr. CONYERS, Mr. HINCHEY, Mr. GEORGE MILLER of California, Ms. SCHAKOWSKY, Mr. MCDERMOTT, Mr. STARK, Mr. 

OLVER, Mr. BRADY of Pennsylvania, Mr. EVANS, Ms. WATERS, Ms. 

BALDWIN, Mr. UDALL of New Mexico, Mr. MARKEY, Ms. LEE, Mrs. 

CHRISTENSEN, Mr. CAPUANO, Mr. MCGOVERN, Mr. KENNEDY of Rhode 

Island, Mrs. MALONEY, Mr. DAVIS of Illinois, Ms. SOLIS, Mr. WEINER, 

Mr. LANTOS, Mr. PAYNE, Ms. CARSON of Indiana, Mr. FILNER, Mr. 

MEEHAN, Mr. LYNCH, Mr. THOMPSON of Mississippi, Mr. HASTINGS of 

Florida, Mr. DEFAZIO, Mr. GUTIERREZ, Mr. LEWIS of Georgia, Mr. 

DELAHUNT, Mr. FATTAH, and Mrs. JONES of Ohio) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL

To amend the Social Security Act to provide grants and 

flexibility through demonstration projects for States to 

provide universal, comprehensive, cost-effective systems 

of health care coverage, with simplified administration.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
2

•HR 2979 IH 

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘States’ Right To Innovate in Health Care Act of 2003’’. 

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

5 this Act is as follows:

Sec. 1. Short title; table of contents. 

Sec. 2. Findings and purposes. 

Sec. 3. Amendment to Social Security Act. 

‘‘TITLE XXII—STATE COMPREHENSIVE HEALTH CARE AND COST 

CONTAINMENT DEMONSTRATION PROJECTS 

‘‘Sec. 2201. Planning grants. 

‘‘Sec. 2202. Demonstration grants. 

‘‘Sec. 2203. State plan requirements. 

‘‘Sec. 2204. Interstate arrangements. 

‘‘Sec. 2205. Definitions.’’.

6 SEC. 2. FINDINGS AND PURPOSES. 

7 (a) FINDINGS.—Congress finds the following: 

8 (1) In 1998, annual health care expenditures in 

9 the United States totaled $1.15 trillion, or $4,094 

10 per person. 

11 (2) In 1998, health care expenditures rep12 resented 13.5 percent of the gross domestic product 

13 (GDP) in the United States and grew at the rate of 

14 5.6 percent while the gross domestic product grew 

15 only at the rate of 4.9 percent. 

16 (3) Businesses, and consumers, would save ap17 proximately $562.8 billion over 7 years if health care 

18 expenditures were increasing at the same rate as 

19 GDP growth. 
3

•HR 2979 IH 

1 (4) Because many individuals do not have 

2 health insurance coverage, they may incur health 

3 care costs which they do not fully reimburse, result4 ing in cost-shifting to others. 

5 (5) As a consequence of the piecemeal health 

6 care system in the United States, administrative 

7 overhead costs approximately $1,000 per person an8 nually while other Western industrialized nations 

9 with universal health care systems spend approxi10 mately $200 per person annually for administrative 

11 overhead. 

12 (b) PURPOSE.—It is the purpose of this Act to en13 courage States—

14 (1) to develop plans for universal, comprehen15 sive, cost-effective systems of health care with sim16 plified administration to individuals residing in such 

17 States; and 

18 (2) to implement such plans by offering transi19 tional grants and by removing Federal statutory and 

20 administrative barriers that may inhibit or discour21 age efforts by States to provide such health care 

22 while maintaining Federal payments for health care 

23 under Federal health care programs. 
4

•HR 2979 IH 

1 SEC. 3. AMENDMENT TO SOCIAL SECURITY ACT. 

2 The Social Security Act (42 U.S.C. 301 et seq.) is 

3 amended by adding at the end the following new title: 

4 ‘‘TITLE XXII—STATE COMPREHENSIVE 

5 HEALTH CARE AND COST CONTAINMENT 

6 DEMONSTRATION PROJECTS 

7 ‘‘SEC. 2201. PLANNING GRANTS. 

8 ‘‘(a) APPLICATION.—A State may apply to the Sec9 retary for a State planning grant under this section to 

10 develop a State plan to offer universal comprehensive 

11 health care, with simplified administration, and to improve 

12 the cost-effectiveness of the health care delivery system. 

13 ‘‘(b) CONTENTS.—The Secretary may not approve 

14 such a State planning grant for a State unless the applica15 tion for the grant includes or provides for the following: 

16 ‘‘(1) BUDGET.—A budget and a budget jus17 tification. 

18 ‘‘(2) PLANNING PROCESS.—A description of 

19 how under the grant the State shall—

20 ‘‘(A) identify options to provide a uni21 versal, comprehensive, and cost-effective system 

22 of health care, with simplified administration, 

23 that is affordable and accessible to all eligible 

24 beneficiaries in the State; and 

25 ‘‘(B) conduct an analysis that compares 

26 projected overall health expenditures over a 7-
5

•HR 2979 IH 

1 year period under the proposed system with the 

2 projected overall health expenditures that would 

3 otherwise occur during such period. 

4 ‘‘(3) OPPORTUNITY FOR PUBLIC PARTICIPA5 TION.—Assurances that the State will include a 

6 process for public contribution and participation in 

7 the planning process. 

8 ‘‘(c) NUMBER OF STATES; PERIOD OF GRANT.—The 

9 Secretary may not award State planning grants under this 

10 section to more than 10 States. A State planning grant 

11 under this section shall be effective for a period of up to 

12 30 months. In awarding State planning grants under this 

13 section the Secretary shall give preference to States from 

14 a variety of geographic areas in the United States. 

15 ‘‘(d) AMOUNT.—The amount of a State planning 

16 grant under this section to a State may not exceed 

17 $3,750,000. 

18 ‘‘(e) TECHNICAL ASSISTANCE.—The Secretary shall 

19 provide States with technical assistance in applying for 

20 and implementing State planning grants under this sec21 tion. At the request of the Secretary, other Departments 

22 and Offices of the Federal Government shall provide 

23 States with such technical assistance.
6

•HR 2979 IH 

1 ‘‘SEC. 2202. DEMONSTRATION GRANTS. 

2 ‘‘(a) APPLICATION.—A State that has developed a 

3 State plan may apply to the Secretary for approval of a 

4 demonstration grant under this section to achieve a cost5 effective delivery system of universal, comprehensive 

6 health care with simplified administration. The Secretary 

7 shall notify the chief executive officer of all States of the 

8 availability of demonstration grants under this section. 

9 ‘‘(b) APPROVAL.—The Secretary shall approve the 

10 applications of not more than 5 States under this section. 

11 In approving grants under this section the Secretary shall 

12 give preference to States from a variety of geographic 

13 areas in the United States. If the Secretary determines 

14 that a State no longer meets the conditions for approval 

15 of the grant, the Secretary shall notify the State of such 

16 determination and provide the State with an opportunity 

17 to correct deficiencies in a timely manner. If the Secretary 

18 further determines that a State has not corrected such de19 ficiencies in a timely manner, the Secretary shall termi20 nate the grant (including waivers authorized under the 

21 grant). 

22 ‘‘(c) PERIOD.—A demonstration grant approved 

23 under this section shall be effective for 7 years from the 

24 date of final approval of the demonstration grant applica25 tion under subsection (b). 
7

•HR 2979 IH 

1 ‘‘(d) STATE PLAN REQUIRED.—The Secretary may 

2 not approve a demonstration grant under this section un3 less the State has a State plan to carry out the grant con4 sistent with the requirements of section 2203. 

5 ‘‘(e) FUNDING.—

6 ‘‘(1) TRANSITIONAL GRANT AMOUNT.—The 

7 amount awarded under this section to a State with 

8 a demonstration grant approved under this section 

9 may not exceed an aggregate amount of 

10 $10,000,000 plus $3 multiplied by the number of el11 igible State residents of the State, to assist the 

12 State in the transition of the health care delivery 

13 and financing infrastructure. Such amount shall be 

14 made available to a State during the period of tran15 sition, as provided in the State plan. The number of 

16 eligible State residents of a State shall be deter17 mined based on the best available Census Bureau 

18 data as of the July 1 before the date the grant 

19 under this section is approved. 

20 ‘‘(2) MAINTENANCE OF FEDERAL FUNDS

21 UNDER WAIVERS.—Pursuant to the waivers under 

22 subsection (f), the Federal Government shall pay to 

23 a State amounts for health care under Federal 

24 health care programs that would otherwise have 

25 been payable by the Federal Government but for the 
8

•HR 2979 IH 

1 State’s universal, comprehensive health care system 

2 under this section. 

3 ‘‘(3) GENERAL 3 PERCENTAGE POINTS IN4 CREASE IN FMAP FOR CALENDAR QUARTERS OCCUR5 RING DURING THE PERIOD OF THE DEMONSTRATION

6 GRANT.—

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

8 other provision of law, for each State for which 

9 a demonstration grant is approved under this 

10 section, the FMAP of the State shall be in11 creased by 3 percentage points for each cal12 endar quarter occurring during the period re13 ferred to in subsection (c). 

14 ‘‘(B) FMAP.—In this paragraph, the term 

15 ‘FMAP’ means the Federal medical assistance 

16 percentage, as defined in section 1905(b) of the 

17 Social Security Act (42 U.S.C. 1396d(b)). 

18 ‘‘(f) WAIVER OF ERISA PREEMPTION AND WAIVERS

19 TO POOL FUNDS.—As part of a demonstration grant 

20 under this section and subject to the benefit maintenance 

21 requirements applicable under section 2203(b), a State 

22 may request (and the Secretary may grant) the following 

23 waivers of requirements and provisions to the extent nec24 essary to carry out the State plan under section 2203: 
9

•HR 2979 IH 

1 ‘‘(1) ERISA.—Waiving application of section 

2 514 of the Employee Retirement Income Security 

3 Act of 1974. 

4 ‘‘(2) MEDICARE.—Waiving provisions necessary 

5 to permit the State—

6 ‘‘(A) to use funds otherwise paid under 

7 title XVIII for beneficiaries residing in the 

8 State; and 

9 ‘‘(B) to permit the State to enter into an 

10 arrangement with the Secretary under which el11 igible State residents who are not otherwise en12 rolled for benefits under parts A and B of such 

13 title are enrolled for such benefits under such 

14 title and the State provides for such actuarially 

15 appropriate reimbursement to the Secretary 

16 with respect to coverage of such benefits for 

17 such residents as is necessary to assure that the 

18 Trust Funds under such title are not adversely 

19 affected by virtue of such waiver, such reim20 bursement subject to—

21 ‘‘(i) an independent audit, to be re22 viewed by the Comptroller General of the 

23 United States, assuring that such reim24 bursement does not adversely affect in any 
10

•HR 2979 IH 

1 way the Trust Funds for medicare eligible 

2 beneficiaries, and 

3 ‘‘(ii) in the case that the audit deter4 mines that additional reimbursement to the 

5 Secretary is required, such additional reim6 bursement, with appropriate adjustments 

7 for interest attributable to the late reim8 bursement. 

9 ‘‘(3) MEDICAID.—Waiving provisions necessary 

10 to permit the State to use funds otherwise paid to 

11 the State under title XIX. 

12 ‘‘(4) SCHIP.—Waiving provisions necessary to 

13 permit the State to use funds otherwise paid to the 

14 State under title XXI. 

15 ‘‘(5) FEHBP.—Waiving provisions necessary to 

16 permit the State to use funds otherwise paid under 

17 chapter 89 of title 5, United States Code, or allow18 ing the Office of Personnel Management to purchase 

19 health care coverage for Federal employees and re20 tirees in the State under the State plan. 

21 ‘‘(6) USE OF OTHER FUNDS.—Waiving provi22 sions necessary to permit the State to use funds oth23 erwise provided under other Federal programs for 

24 the provision of health care coverage or services, 

25 identified by the State.
11

•HR 2979 IH 

1 ‘‘(7) OTHER LAWS.—Waiving of other provi2 sions of Federal law identified by the State under 

3 section 2203(e)(3) only if the Secretary determines 

4 such a waiver to be appropriate after consultation 

5 with the head of the Federal agency or department 

6 concerned. 

7 The Secretary may grant a waiver under this subsection 

8 only if the State provides the Secretary with satisfactory 

9 assurances that necessary safeguards have been taken to 

10 protect the health and welfare of individuals provided serv11 ices under the waiver and that financial accountability is 

12 maintained for any funds expended under the waiver. The 

13 Secretary may grant a waiver under paragraph (1) only 

14 with the concurrence of the Secretary of Labor. 

15 ‘‘(g) REENROLLMENT OF ELIGIBLE STATE RESI16 DENTS WHO MOVE FROM A PARTICIPATING STATE.—In 

17 the case of an eligible State resident who is covered under 

18 a State plan under section 2203, who (but for such cov19 erage) is eligible to be enrolled in a program described in 

20 subsection (f) (including the medicare and medicaid pro21 grams), and who is not enrolled in such a program because 

22 of such coverage, if the resident leaves the State to reside 

23 in a State that does not have such a State plan in effect, 

24 the resident shall be permitted, notwithstanding any other 

25 provision of law, to enroll immediately in such a program 
12

•HR 2979 IH 

1 if the resident is still otherwise eligible to be so enrolled. 

2 In the case of such enrollment in the medicare program, 

3 the resident shall be treated for purposes of section 

4 1882(s)(2) (relating to availability of medigap policies 

5 without underwriting) as if the resident had turned 65 

6 years of age on the date the resident enrolls in the medi7 care program. 

8 ‘‘(h) DUTIES OF THE SECRETARY.—

9 ‘‘(1) GUIDANCE AND INFORMATION.—The Sec10 retary shall—

11 ‘‘(A) provide guidance to State health care 

12 authorities regarding applications for grants 

13 under this title and exchange information with, 

14 and otherwise assist, such authorities upon the 

15 request of the authorities; 

16 ‘‘(B) set application procedures; 

17 ‘‘(C) review and approve applications for 

18 demonstration grants under this section, includ19 ing providing for appropriate waivers described 

20 in subsection (f); 

21 ‘‘(D) provide appropriate levels of funding 

22 for such approved applications consistent with 

23 such section; 
13

•HR 2979 IH 

1 ‘‘(E) conduct such evaluation, monitoring, 

2 compliance, and other review functions as may 

3 be appropriate; 

4 ‘‘(F) develop guidelines, standards, and 

5 formats for States to follow in evaluating, re6 porting, and collecting data in order to enable 

7 the Commission to monitor State plan adminis8 tration and compliance, and to evaluate and 

9 compare the effectiveness of State plans; and 

10 ‘‘(G) implement any other requirements or 

11 activities necessary and appropriate under this 

12 title. 

13 ‘‘(2) ANNUAL REPORT.—The Secretary shall 

14 submit to the President and the Congress an annual 

15 report. Such report shall be submitted not later than 

16 March 30 of each year and shall include information 

17 concerning States that receive grants under this title 

18 and the effectiveness of any health care programs 

19 assisted by such grants during the previous year. 

20 ‘‘(3) APPROVAL PROCESS.—The provisions of 

21 section 2106(c) shall apply to State plans and the 

22 Secretary under this title in the same manner as 

23 they apply to State plans and the Secretary under 

24 such section. 
14

•HR 2979 IH 

1 ‘‘SEC. 2203. STATE PLAN REQUIREMENTS. 

2 ‘‘(a) COVERAGE.—

3 ‘‘(1) IN GENERAL.—A State plan shall provide 

4 a process and a timeline for achieving coverage of all 

5 eligible State residents statewide, without regard to 

6 employment status, income, health status or pre7 existing condition, or location of residency within the 

8 State. 

9 ‘‘(2) OUTREACH MECHANISMS.—A State plan 

10 shall describe the outreach mechanisms to be used to 

11 assure coverage of all eligible individuals, including 

12 measures to assure coverage of individuals in hard13 to-reach populations and to assure benefits are pro14 vided to eligible individuals located in underserved 

15 areas. 

16 ‘‘(b) BENEFITS.—

17 ‘‘(1) BASIC BENEFITS.—A State plan shall pro18 vide for health benefits that—

19 ‘‘(A) are at least actuarially equivalent to 

20 the standard Blue Cross/Blue Shield preferred 

21 provider option service benefit plan, described 

22 in and offered under section 8903(1) of title 5, 

23 United States Code; and 

24 ‘‘(B) include benefits for at least the fol25 lowing items and services: 
15

•HR 2979 IH 

1 ‘‘(i) Inpatient and outpatient hospital 

2 services, including emergency services 

3 available 24 hours a day. 

4 ‘‘(ii) Long term, acute, and chronic 

5 care services, including skilled nursing fa6 cility services, intermediate care facility 

7 services home health services, home and 

8 community-based long-term care services, 

9 hospice care, and services in intermediate 

10 care facilities for individuals diagnosed 

11 with mental retardation. 

12 ‘‘(iii) Professional services of health 

13 care practitioners authorized to provide 

14 health care services under State law. 

15 ‘‘(iv) Community-based primary 

16 health care services, including rural health 

17 clinic services and Federally-qualified 

18 health center services. 

19 ‘‘(v) Laboratory, x-ray services, and 

20 diagnostic tests. 

21 ‘‘(vi) Preventive care, including pre22 natal, well-baby, and well-child care, appro23 priate immunizations, pap smears, screen24 ing mammography, colorectal cancer 
16

•HR 2979 IH 

1 screening, physical examinations, and fam2 ily planning. 

3 ‘‘(vii) Prescription drugs and 

4 biologicals, including insulin and medical 

5 foods. 

6 ‘‘(viii) Mental health services. 

7 ‘‘(ix) Substance abuse treatment serv8 ices. 

9 ‘‘(x) Vision services, including routine 

10 eye examinations, eyeglasses, and contact 

11 lenses. 

12 ‘‘(xi) Hearing services, including hear13 ing aids. 

14 ‘‘(xii) Dental services, including rou15 tine check ups. 

16 ‘‘(xiii) Durable medical equipment, in17 cluding home dialysis supplies and equip18 ment. 

19 ‘‘(xiv) Emergency ambulance services.

20 ‘‘(xv) Prosthetics. 

21 ‘‘(xvi) Outpatient therapy, including 

22 physical therapy, occupational therapy, and 

23 speech language pathology services and re24 lated services.
17

•HR 2979 IH 

1 ‘‘(2) ASSURANCE THAT BENEFITS ARE NOT RE2 DUCED FOR INDIVIDUALS COVERED UNDER FED3 ERAL PROGRAMS.—Insofar as the State under the 

4 plan incorporates funding provided by Federal pro5 grams described in section 2202(f), the State plan 

6 may not provide for a reduction in benefits (includ7 ing coverage, access, availability, duration, and bene8 ficiary rights, and, if applicable, vaccine benefits 

9 under section 1928) otherwise provided for under 

10 such programs or an increase in cost-sharing and 

11 premiums otherwise provided for under such pro12 grams. 

13 ‘‘(3) CONTINUATION OF BENEFITS FOR CER14 TAIN ALIENS.—Nothing in this title shall be con15 strued as affecting the access of aliens described in 

16 section 2204(1)(D) to health care services provided 

17 under law for such aliens as of the date of the enact18 ment of this title. 

19 ‘‘(c) QUALITY ASSURANCE.—

20 ‘‘(1) IN GENERAL.—A State plan shall provide, 

21 and describe, mechanisms to be used to assure, mon22 itor, and maintain the quality of items and services 

23 furnished under the plan. 

24 ‘‘(2) HEALTH OUTCOMES.—A State plan shall 

25 describe the plan’s projected effect on health out-
18

•HR 2979 IH 

1 comes in the State, including estimates of health 

2 benefits, decreased morbidity and mortality, and im3 proved productivity resulting from reduction in the 

4 number of individuals without health benefits. 

5 ‘‘(d) PROGRAMS FOR MEDICAL EDUCATION.—A 

6 State plan shall describe health professions training and 

7 graduate medical education activities applicable under the 

8 plan, and shall provide, under the State plan, for payment 

9 from Federal, State, and local governments for such train10 ing and education activities in the amounts that would 

11 otherwise be payable by such governments but for the 

12 State’s universal, comprehensive health care system under 

13 the State plan. 

14 ‘‘(e) FINANCING.—

15 ‘‘(1) BUDGET.—A State plan shall incorporate 

16 a budget which contains—

17 ‘‘(A) detailed projections of health care ex18 penditures presently and under the proposed 

19 system, including an identification and calcula20 tion of the amount of funding to be provided by 

21 the Federal, State, and local governments under 

22 the plan and an assurance that the amount of 

23 expenditures made by the State and local gov24 ernments will not be reduced as a result of the 

25 implementation of the plan; and 
19

•HR 2979 IH 

1 ‘‘(B) a description (and an estimate of 

2 costs) of transitional activities to be undertaken 

3 in implementing the proposed system. 

4 ‘‘(2) COST CONTAINMENT.—A State plan shall 

5 describe the means to be used to contain costs under 

6 the plan, including when and how the plan will in7 crease efficiencies. 

8 ‘‘(3) FEDERAL EXPENDITURE LIMIT.—A State 

9 plan shall contain assurances that aggregate Federal 

10 expenditures on health care (including Federal ex11 penditures under titles 5, 10, and 38 of the United 

12 States Code, and under this Act) under the plan will 

13 not exceed aggregate Federal expenditures that 

14 would have been incurred in the absence of such 

15 plan. 

16 ‘‘(f) IMPLEMENTATION.—

17 ‘‘(1) IN GENERAL.—A State plan shall describe 

18 the method (including a timetable and period of 

19 transition) for implementing the plan. 

20 ‘‘(2) COORDINATION.—A State plan shall iden21 tify all Federal, State, and local programs that pro22 vide health care services in the State and describe 

23 how such programs would be incorporated in, or co24 ordinated with, the health coverage system under the 

25 plan. 
20

•HR 2979 IH 

1 ‘‘(3) FEDERAL WAIVERS REQUIRED.—A State 

2 plan shall identify any waivers of Federal law re3 quired to implement the plan, including the use of 

4 any pooled Federal funds and other waivers de5 scribed in section 2202(f). 

6 ‘‘(4) APPROVAL OF STATE LEGISLATURE.—A 

7 State plan shall provide that State approvals and 

8 commitments (including approval of the State legis9 lature) necessary for the implementation of the plan 

10 will be obtained by not later than 1 year after the 

11 date of the Secretary’s approval of the plan. Any ap12 proval of a grant is conditioned upon the timely 

13 completion of such approvals and commitments. 

14 ‘‘(g) EVALUATION.—A State plan shall provide for a 

15 process for its evaluation, and shall comply with any eval16 uation reporting or data collection requirements imposed 

17 by the Secretary. 

18 ‘‘(h) CONSTRUCTION.—Nothing in this title shall be 

19 construed as preempting State laws that provide greater 

20 protections or benefits than the protections or benefits re21 quired under this title. 

22 ‘‘SEC. 2204. INTERSTATE ARRANGEMENTS. 

23 ‘‘(a) IN GENERAL.—One or more contiguous States 

24 in a geographic region may file a joint application for 

25 planning and demonstration grants under this title. 
21

•HR 2979 IH 

1 ‘‘(b) CONGRESSIONAL APPROVAL.—Congress hereby 

2 authorizes and approves States entering into Interstate 

3 Compacts in order to conduct joint health care programs 

4 under such a grant. 

5 ‘‘(c) REFERENCES TO STATE.—In the case of a joint 

6 application described in subsection (a), any reference in 

7 this title to a State is deemed to refer to all of the States, 

8 and the approval of a grant with respect to such a joint 

9 application shall be counted as 1 State for purposes of 

10 applying sections 2201(c) and 2202(b). 

11 ‘‘SEC. 2205. DEFINITIONS. 

12 ‘‘As used in this title: 

13 ‘‘(1) ELIGIBLE STATE RESIDENT.—The term 

14 ‘eligible State resident’ means any resident of the 

15 United States who is a citizen or national of the 

16 United States, or lawful resident alien, and who re17 sides in any particular State. Such term may in18 clude, at the option of a State, the following:

19 ‘‘(A) State employees and dependents of 

20 such employees. 

21 ‘‘(B) Employees, and dependents of such 

22 employees, working in a work site of a business 

23 located in the State. 

24 ‘‘(C) One or more classes of non25 immigrants (as defined in section 101(a)(15) of 
22

•HR 2979 IH 

1 the Immigration and Nationality Act) specified 

2 in the State plan. 

3 ‘‘(D) Aliens unlawfully present in the 

4 United States. 

5 ‘‘(2) LAWFUL RESIDENT ALIEN.—The term 

6 ‘lawful resident alien’ means an alien lawfully admit7 ted for permanent residence and any other alien law8 fully residing permanently in the United States 

9 under color of law, including an alien granted asy10 lum or with lawful temporary resident status under 

11 section 210, 210A, or 245A of the Immigration and 

12 Nationality Act. 

13 ‘‘(3) SECRETARY.—The term ‘Secretary’ means 

14 the Secretary of Health and Human Services. 

15 ‘‘(4) STATE.—Subject to section 2204(c), the 

16 term ‘State’ means a State, the District of Colum17 bia, the Commonwealth of Puerto Rico, the United 

18 States Virgin Islands, Guam, American Samoa, and 

19 the Commonwealth of the Northern Mariana Is20 lands. 

21 ‘‘(5) STATE PLAN.—The term ‘State plan’ 

22 means a comprehensive health care plan of a State 

23 participating in a State Care demonstration project 
23

•HR 2979 IH 

1 under this title that meets the requirements of sec2 tion 2203.’’.

Æ