I 

108TH CONGRESS 

1ST SESSION H. R. 3192

To amend titles XIX and XXI of the Social Security Act to permit States 

to cover low-income youth up to age 23 with an enhanced matching rate. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 25, 2003

Mr. SNYDER (for himself, Mr. ALLEN, Mr. HINCHEY, Mr. SERRANO, Mr. 

ROSS, Mr. MCDERMOTT, and Mr. EMANUEL) introduced the following 

bill; which was referred to the Committee on Energy and Commerce 

A BILL

To amend titles XIX and XXI of the Social Security Act 

to permit States to cover low-income youth up to age 

23 with an enhanced matching rate.

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 ‘‘Medicaid/SCHIP Optional 

5 Coverage for Young Adults Act of 2003’’. 

6 SEC. 2. PROVIDING STATE OPTION FOR SCHIP AND MED7 ICAID COVERAGE OF YOUNG ADULTS UP TO 

8 AGE 23. 

9 (a) IN GENERAL.—
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1 (1) MEDICAID.—(A) Section 1902(l)(1)(D) of 

2 the Social Security Act (42 U.S.C. 1396a(l)(1)(D)) 

3 is amended by inserting ‘‘(or, at the option of the 

4 State, who have not attained 20, 21, or 22 years of 

5 age, as the State may elect)’’ after ‘‘have not at6 tained 19 years of age’’. 

7 (B) Clause (i) of section 1905(a) of the Social 

8 Security Act (42 U.S.C. 1396d(a)) is amended by 

9 striking ‘‘under the age of 21, or, at the option of 

10 the State, under the age of 20, 19, or 18 as the 

11 State may choose’’ and inserting ‘‘under the age of 

12 23, or, at the option of the State, under the age of 

13 22, 21, 20, 19, or 18 as the State may elect’’. 

14 (2) SCHIP.—Section 2110(c)(1) of such Act 

15 (42 U.S.C. 1397jj(c)(1)) is amended by inserting 

16 after ‘‘19 years of age’’ the following: ‘‘(or, at the 

17 option of the State and subject to the availability of 

18 additional allotments under section 2104(d), 20, 21, 

19 22, or 23 years of age)’’. 

20 (b) AVAILABILITY OF ENHANCED MATCHING

21 FUNDS.—

22 (1) UNDER MEDICAID.—Section 1905 of the 

23 Social Security Act (42 U.S.C. 1396d) is amended—
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1 (A) in the fourth sentence of subsection 

2 (b), by striking ‘‘or subsection (u)(3)’’ and in3 serting ‘‘, (u)(3), or (u)(4)(A)’’; and 

4 (B) in subsection (u)—

5 (i) by adding at the end of paragraph 

6 (1) the following new subparagraph: 

7 ‘‘(C) Only with respect to expenditures de8 scribed in paragraph (4)(A), if the State is providing 

9 for benefits under its State child health plan under 

10 title XXI for children under 19 years of age exclu11 sively through benefits under its State plan under 

12 this title, the State is also providing under such plan 

13 the benefits for individuals over 18 years of age who 

14 are eligible for such benefits only because of an elec15 tion referred to in such paragraph.’’; 

16 (ii) by redesignating paragraph (4) as 

17 paragraph (5); and 

18 (iii) by inserting after paragraph (3) 

19 the following new paragraph: 

20 ‘‘(4) For purposes of the fourth sentence of sub21 section (b) and section 2105(a), the expenditures de22 scribed in this paragraph are expenditures for medical as23 sistance for individuals who are over 18 (and less than 

24 23) years of age and who are eligible for such medical 
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1 assistance because of an election by the State under sec2 tion 1902(l)(1)(D) or clause (i) of section 1905(a).’’. 

3 (2) ADDITIONAL ALLOTMENTS FOR PROVIDING

4 COVERAGE OF OPTIONAL YOUNG ADULTS.—

5 (A) IN GENERAL.—Section 2104 of such 

6 Act (42 U.S.C. 1397dd) is amended by insert7 ing after subsection (c) the following: 

8 ‘‘(d) ADDITIONAL ALLOTMENTS FOR THE PROVISION

9 OF COVERAGE TO OPTIONAL YOUNG ADULTS.—

10 ‘‘(1) APPROPRIATION; TOTAL ALLOTMENT.—

11 For the purpose of providing additional allotments 

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

13 of any money in the Treasury not otherwise appro14 priated, for each of fiscal years 2004 through 2007, 

15 $200,000,000. 

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

17 In addition to the allotments provided under sub18 sections (b) and (c), subject to paragraph (3), of the 

19 amount available for the additional allotments under 

20 paragraph (1) for a fiscal year, the Secretary shall 

21 allot to each State with a State child health plan ap22 proved under this title—

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

24 a commonwealth or territory described in sub25 paragraph (B), the same proportion as the pro-
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1 portion of the State’s allotment under sub2 section (b) (determined without regard to sub3 section (f)) to the total amount of the allot4 ments under subsection (b) for such States eli5 gible for an allotment under this paragraph for 

6 such fiscal year; and 

7 ‘‘(B) in the case of a commonwealth or ter8 ritory described in subsection (c)(3), the same 

9 proportion as the proportion of the common10 wealth’s or territory’s allotment under sub11 section (c) (determined without regard to sub12 section (f)) to the total amount of the allot13 ments under subsection (c) for commonwealths 

14 and territories eligible for an allotment under 

15 this paragraph for such fiscal year. 

16 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi17 tional allotments provided under this subsection are 

18 not available for amounts expended before October 

19 1, 2003. Such amounts are available for amounts ex20 pended on or after such date only for—

21 ‘‘(A) expenditures described in section 

22 1905(u)(4)(A); and 

23 ‘‘(B) child health assistance for individuals 

24 who are targeted low-income children and over 

25 18 years of age and who are low-income chil-
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1 dren only because of an election by the State 

2 under section 2110(c)(1).’’. 

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 (c) EFFECTIVE DATE.—The amendments made by 

17 this section apply to items and services furnished on or 

18 after October 1, 2003, without regard to whether regula19 tions implementing such amendments have been promul20 gated. 

21 SEC. 3. GRANTS TO IMPLEMENT MEDICAID AND SCHIP EX22 PANSIONS. 

23 (a) IN GENERAL.—The Secretary of Health and 

24 Human Services shall provide for grants to small and 

25 rural States (as defined by the Secretary) in order to en-
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1 able such States to implement expansions of eligibility for 

2 children and young adults their State medicaid plans 

3 under title XIX of the Social Security Act and State child 

4 health plans under title XXI of such Act. Such grants 

5 shall be available for planning, implementation, and out6 reach with respect to such expanded eligibility populations. 

7 (b) TERMS AND CONDITIONS.—Grants under this 

8 section shall be made available under such terms and con9 ditions, including the approval of a grant application, as 

10 the Secretary shall specify. 

11 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated such sums as may be 

13 necessary to provide for grants under this section.

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