I 

108TH CONGRESS 

1ST SESSION H. R. 3293

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

with the option to expand or add coverage of pregnant women under 

the Medicaid and State children’s health insurance programs, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 15, 2003

Ms. DEGETTE 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 provide States with the option to expand or add coverage of pregnant women under the Medicaid and State 

children’s health insurance programs, 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 ‘‘Prevent Prematurity 

5 and Improve Child Health 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 percentage as the State may elect 

9 for purposes of expenditures for medical assistance 

10 for 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 new paragraph: 

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 185 percent of the poverty line, but does not 

7 exceed the income eligibility level established under 

8 title XXI for a targeted low-income child. 

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

10 in this subparagraph are the following: 

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

12 title XXI do not provide coverage for pregnant 

13 women described in subparagraph (A) with 

14 higher family income without covering such 

15 pregnant women with a lower family income. 

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

17 income level for pregnant women that is lower 

18 than the effective income level (expressed as a 

19 percent of the poverty line and considering ap20 plicable income disregards) that has been speci21 fied under the State plan under subsection 

22 (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902, 

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

24 assistance as a pregnant woman. 
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1 ‘‘(C) DEFINITION OF POVERTY LINE.—In this 

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

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

4 (3) PAYMENT FROM TITLE XXI ALLOTMENT

5 FOR MEDICAID EXPANSION COSTS; ELIMINATION OF

6 COUNTING MEDICAID CHILD PRESUMPTIVE ELIGI7 BILITY COSTS AGAINST TITLE XXI ALLOTMENT.—

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

9 U.S.C. 1397ee(a)(1)) is amended—

10 (A) in the matter preceding subparagraph 

11 (A), by striking ‘‘(or, in the case of expendi12 tures described in subparagraph (B), the Fed13 eral medical assistance percentage (as defined 

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

15 (B) by striking subparagraph (B) and in16 serting the following new subparagraph: 

17 ‘‘(B) for the provision of medical assist18 ance that is attributable to expenditures de19 scribed in section 1905(u)(4)(A);’’. 

20 (b) SCHIP.—

21 (1) COVERAGE.—Title XXI of the Social Secu22 rity Act (42 U.S.C. 1397aa et seq.) is amended by 

23 adding at the end the following new section: 
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1 ‘‘SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-IN2 COME PREGNANT WOMEN. 

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

4 other provision of this title, a State may provide for cov5 erage, through an amendment to its State child health 

6 plan under section 2102, of pregnancy-related assistance 

7 for targeted low-income pregnant women in accordance 

8 with this section, but only if—

9 ‘‘(1) the State has established an income eligi10 bility level for pregnant women under subsection 

11 (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 that is 

12 at least 185 percent of the income official poverty 

13 line; and 

14 ‘‘(2) the State meets the conditions described in 

15 section 1905(u)(4)(B). 

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

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

18 term ‘pregnancy-related assistance’ has the meaning 

19 given the term child health assistance in section 

20 2110(a) as if any reference to targeted low-income 

21 children were a reference to targeted low-income 

22 pregnant women, except that the assistance shall be 

23 limited to services related to pregnancy (which in24 clude prenatal, delivery, and postpartum services 

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

26 to other conditions that may complicate pregnancy.
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1 ‘‘(2) TARGETED LOW-INCOME PREGNANT

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

3 woman’ means a woman—

4 ‘‘(A) during pregnancy and through the 

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

6 (beginning on the last day of her pregnancy) 

7 ends; 

8 ‘‘(B) whose family income exceeds the ef9 fective income level (expressed as a percent of 

10 the poverty line and considering applicable in11 come disregards) that has been specified under 

12 subsection (a)(10)(A)(i)(III) or (l)(2)(A) of sec13 tion 1902, as of January 1, 2003, to be eligible 

14 for medical assistance as a pregnant woman 

15 under title XIX but does not exceed the income 

16 eligibility level established under the State child 

17 health plan under this title for a targeted low18 income child; and 

19 ‘‘(C) who satisfies the requirements of 

20 paragraphs (1)(A), (1)(C), (2), and (3) of sec21 tion 2110(b). 

22 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

23 RULES.—In the case of, and with respect to, a State pro24 viding for coverage of pregnancy-related assistance to tar-
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1 geted low-income pregnant women under subsection (a), 

2 the following special rules apply: 

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

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

5 deemed to include a reference to a targeted low-in6 come pregnant woman. 

7 ‘‘(2) Any such reference to child health assist8 ance with respect to such women is deemed a ref9 erence to pregnancy-related assistance. 

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

11 reference to a woman during pregnancy and the pe12 riod described in subsection (b)(2)(A). 

13 ‘‘(4) In applying section 2102(b)(3)(B), any 

14 reference to children found through screening to be 

15 eligible for medical assistance under the State med16 icaid plan under title XIX is deemed a reference to 

17 pregnant women. 

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

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

20 preexisting condition and no waiting period (includ21 ing any waiting period imposed to carry out section 

22 2102(b)(3)(C)) shall apply. 

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

24 required scope of health insurance coverage) shall 

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

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

3 not to require, in such case, compliance with the re4 quirements of section 2103(a). 

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

6 case of a pregnant woman provided coverage under 

7 this section, the limitation on total annual aggregate 

8 cost-sharing shall be applied to such pregnant 

9 woman. 

10 ‘‘(8) The reference in section 2107(e)(1)(D) to 

11 section 1920A (relating to presumptive eligibility for 

12 children) is deemed a reference to section 1920 (re13 lating to presumptive eligibility for pregnant 

14 women). 

15 ‘‘(d) AUTOMATIC ENROLLMENT FOR CHILDREN

16 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS17 SISTANCE.—If a child is born to a targeted low-income 

18 pregnant woman who was receiving pregnancy-related as19 sistance under this section on the date of the child’s birth, 

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

21 assistance under the State child health plan and to have 

22 been found eligible for such assistance under such plan 

23 or to have applied for medical assistance under title XIX 

24 and to have been found eligible for such assistance under 

25 such title, as appropriate, on the date of such birth and 
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1 to remain eligible for such assistance until the child at2 tains 1 year of age. During the period in which a child 

3 is deemed under the preceding sentence to be eligible for 

4 child health or medical assistance, the child health or med5 ical assistance eligibility identification number of the 

6 mother shall also serve as the identification number of the 

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

8 such number (unless the State issues a separate identifica9 tion number for the child before such period expires).’’. 

10 (2) ADDITIONAL ALLOTMENTS FOR PROVIDING

11 COVERAGE OF PREGNANT WOMEN.—

12 (A) IN GENERAL.—Section 2104 of the So13 cial Security Act (42 U.S.C. 1397dd) is amend14 ed by inserting after subsection (c) the fol15 lowing new subsection: 

16 ‘‘(d) ADDITIONAL ALLOTMENTS FOR PROVIDING

17 COVERAGE OF PREGNANT WOMEN.—

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

19 For the purpose of providing additional allotments 

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

21 of any money in the Treasury not otherwise appro22 priated, for each of fiscal years 2004 through 2007, 

23 $200,000,000. 

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

25 In addition to the allotments provided under sub-
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1 sections (b) and (c), subject to paragraphs (3) and 

2 (4), of the amount available for the additional allot3 ments under paragraph (1) for a fiscal year, the 

4 Secretary shall allot to each State with a State child 

5 health plan approved under this title—

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

7 a commonwealth or territory described in sub8 paragraph (B), the same proportion as the pro9 portion of the State’s allotment under sub10 section (b) (determined without regard to sub11 section (f)) to the total amount of the allot12 ments under subsection (b) for such States eli13 gible for an allotment under this paragraph for 

14 such fiscal year; and 

15 ‘‘(B) in the case of a commonwealth or ter16 ritory described in subsection (c)(3), the same 

17 proportion as the proportion of the common18 wealth’s or territory’s allotment under sub19 section (c) (determined without regard to sub20 section (f)) to the total amount of the allot21 ments under subsection (c) for commonwealths 

22 and territories eligible for an allotment under 

23 this paragraph for such fiscal year. 

24 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi25 tional allotments provided under this subsection are
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1 not available for amounts expended before October 

2 1, 2003. Such amounts are available for amounts ex3 pended on or after such date for child health assist4 ance for targeted low-income children, as well as for 

5 pregnancy-related assistance for targeted low-income 

6 pregnant women. 

7 ‘‘(4) NO PAYMENTS UNLESS ELECTION TO EX8 PAND COVERAGE OF PREGNANT WOMEN.—No pay9 ments may be made to a State under this title from 

10 an allotment provided under this subsection unless 

11 the State provides pregnancy-related assistance for 

12 targeted low-income pregnant women under this 

13 title, or provides medical assistance for pregnant 

14 women under title XIX, whose family income ex15 ceeds the effective income level applicable under sub16 section (a)(10)(A)(i)(III) or (l)(2)(A) of section 

17 1902 to a family of the size involved as of January 

18 1, 2003.’’. 

19 (B) CONFORMING AMENDMENTS.—Section 

20 2104 of the Social Security Act (42 U.S.C. 

21 1397dd) is amended—

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

23 preceding paragraph (1), by inserting 

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

25 this section,’’; 
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1 (ii) in subsection (b)(1), by inserting 

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

3 paragraph (4)’’; and 

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

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

6 fiscal year,’’. 

7 (3) ADDITIONAL CONFORMING AMENDMENTS.—

8 (A) NO COST-SHARING FOR PREGNANCY9 RELATED BENEFITS.—Section 2103(e)(2) of 

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

11 1397cc(e)(2)) is amended—

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

13 PREGNANCY-RELATED SERVICES’’ after 

14 ‘‘PREVENTIVE SERVICES’’; and 

15 (ii) by inserting before the period at 

16 the end the following: ‘‘or for pregnancy17 related services’’. 

18 (B) NO WAITING PERIOD.—Section 

19 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is 

20 amended—

21 (i) in clause (i), by striking ‘‘, and’’ at 

22 the end and inserting a semicolon; 

23 (ii) in clause (ii), by striking the pe24 riod at the end and inserting ‘‘; and’’; and 
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1 (iii) by adding at the end the fol2 lowing new clause: 

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

4 (including a waiting period to carry out 

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

6 low-income pregnant woman.’’. 

7 (c) AUTHORITY FOR STATES THAT PROVIDE MED8 ICAID OR SCHIP COVERAGE FOR PREGNANT WOMEN

9 WITH INCOME ABOVE 185 PERCENT OF THE POVERTY

10 LINE TO USE PORTION OF SCHIP FUNDS FOR MEDICAID

11 EXPENDITURES.—Section 2105(g) of the Social Security 

12 Act (42 U.S.C. 1397ee(g)), as added by section 1(b) of 

13 Public Law 108–74, is amended—

14 (1) in the subsection heading, by inserting 

15 ‘‘AND CERTAIN PREGNANCY COVERAGE EXPANSION

16 STATES’’ after ‘‘QUALIFYING STATES’’; 

17 (2) by adding at the end the following: 

18 ‘‘(4) SPECIAL AUTHORITY FOR CERTAIN PREG19 NANCY COVERAGE EXPANSION STATES.—

20 ‘‘(A) IN GENERAL.—In the case of a State 

21 that, as of the date of enactment of the Prevent 

22 Prematurity and Improve Child Health Act of 

23 2003, has an income eligibility standard under 

24 title XIX or this title (under section 

25 1902(a)(10)(A) or under a statewide waiver in 
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1 effect under section 1115 with respect to title 

2 XIX or this title) that is at least 185 percent 

3 of the poverty line with respect to pregnant 

4 women, the State may elect to use not more 

5 than 20 percent of any allotment under section 

6 2104 for any fiscal year (insofar as it is avail7 able under subsections (e) and (g) of such sec8 tion) for payments under title XIX in accord9 ance with subparagraph (B), instead of for ex10 penditures under this title. 

11 ‘‘(B) PAYMENTS TO STATES.—

12 ‘‘(i) IN GENERAL.—In the case of a 

13 State described in subparagraph (A) that 

14 has elected the option described in that 

15 subparagraph, subject to the availability of 

16 funds under such subparagraph and, if ap17 plicable, paragraph (1)(A), with respect to 

18 the State, the Secretary shall pay the State 

19 an amount each quarter equal to the addi20 tional amount that would have been paid 

21 to the State under title XIX with respect 

22 to expenditures described in clause (ii) if 

23 the enhanced FMAP (as determined under 

24 subsection (b)) had been substituted for 
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1 the Federal medical assistance percentage 

2 (as defined in section 1905(b)). 

3 ‘‘(ii) EXPENDITURES DESCRIBED.—

4 For purposes of this subparagraph, the ex5 penditures described in this clause are ex6 penditures, made after the date of the en7 actment of this paragraph and during the 

8 period in which funds are available to the 

9 State for use under subparagraph (A), for 

10 medical assistance under title XIX for 

11 pregnant women whose family income is at 

12 least 185 percent of the poverty line. 

13 ‘‘(iii) NO IMPACT ON DETERMINATION

14 OF BUDGET NEUTRALITY FOR WAIVERS.—

15 In the case of a State described in sub16 paragraph (A) that uses amounts paid 

17 under this paragraph for expenditures de18 scribed in clause (ii) that are incurred 

19 under a waiver approved for the State, any 

20 budget neutrality determinations with re21 spect to such waiver shall be determined 

22 without regard to such amounts paid.’’; 

23 and 

24 (3) in paragraph (3), by striking ‘‘and (2)’’ and 

25 inserting ‘‘(2), and (4)’’.
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1 (d) OTHER AMENDMENTS TO MEDICAID.—

2 (1) ELIGIBILITY OF A NEWBORN.—Section 

3 1902(e)(4) of the Social Security Act (42 U.S.C. 

4 1396a(e)(4)) is amended in the first sentence by 

5 striking ‘‘so long as the child is a member of the 

6 woman’s household and the woman remains (or 

7 would remain if pregnant) eligible for such assist8 ance’’. 

9 (2) APPLICATION OF QUALIFIED ENTITIES TO

10 PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN

11 UNDER MEDICAID.—Section 1920(b) of the Social 

12 Security Act (42 U.S.C. 1396r–1(b)) is amended by 

13 adding after paragraph (2) the following flush sen14 tence: 

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

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

17 (e) EFFECTIVE DATE.—The amendments made by 

18 this section apply to items and services furnished on or 

19 after October 1, 2003, without regard to whether regula20 tions implementing such amendments have been promul21 gated.

22 SEC. 3. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 

23 UNDER THE MEDICAID PROGRAM AND SCHIP. 

24 (a) MEDICAID PROGRAM.—Section 1903(v) of the 

25 Social Security Act (42 U.S.C. 1396b(v)) is amended—
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1 (1) in paragraph (1), by striking ‘‘paragraph 

2 (2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and 

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

4 paragraph: 

5 ‘‘(4)(A) A State may elect (in a plan amendment 

6 under this title) to provide medical assistance under this 

7 title for aliens who are lawfully residing in the United 

8 States (including battered aliens described in section 

9 431(c) of the Personal Responsibility and Work Oppor10 tunity Reconciliation Act of 1996) and who are otherwise 

11 eligible for such assistance, within any of the following eli12 gibility categories: 

13 ‘‘(i) PREGNANT WOMEN.—Women during preg14 nancy (and during the 60-day period beginning on 

15 the last day of the pregnancy). 

16 ‘‘(ii) CHILDREN.—Children (as defined under 

17 such plan), including optional targeted low-income 

18 children described in section 1905(u)(2)(B). 

19 ‘‘(B)(i) In the case of a State that has elected to pro20 vide medical assistance to a category of aliens under sub21 paragraph (A), no debt shall accrue under an affidavit of 

22 support against any sponsor of such an alien on the basis 

23 of provision of assistance to such category and the cost 

24 of such assistance shall not be considered as an unreim25 bursed cost. 
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1 ‘‘(ii) The provisions of sections 401(a), 402(b), 403, 

2 and 421 of the Personal Responsibility and Work Oppor3 tunity Reconciliation Act of 1996 shall not apply to a 

4 State that makes an election under subparagraph (A).’’. 

5 (b) TITLE XXI.—Section 2107(e)(1) of the Social 

6 Security Act (42 U.S.C. 1397gg(e)(1)) is amended by add7 ing at the end the following new subparagraph: 

8 ‘‘(E) Section 1903(v)(4) (relating to op9 tional coverage of permanent resident alien 

10 pregnant women and children), but only with 

11 respect to an eligibility category under this title, 

12 if the same eligibility category has been elected 

13 under such section for purposes of title XIX.’’. 

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

15 this section take effect on October 1, 2003, and apply to 

16 medical assistance and child health assistance furnished 

17 on or after such date. 

18 SEC. 4. PROMOTING CESSATION OF TOBACCO USE UNDER 

19 THE MEDICAID PROGRAM. 

20 (a) DROPPING EXCEPTION FROM MEDICAID PRE21 SCRIPTION DRUG COVERAGE FOR TOBACCO CESSATION

22 MEDICATIONS.—Section 1927(d)(2) of the Social Security 

23 Act (42 U.S.C. 1396r–8(d)(2)) is amended—

24 (1) by striking subparagraph (E); 
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1 (2) by redesignating subparagraphs (F) 

2 through (J) as subparagraphs (E) through (I), re3 spectively; and 

4 (3) in subparagraph (F) (as redesignated by 

5 paragraph (2)), by inserting before the period at the 

6 end the following: ‘‘, except agents approved by the 

7 Food and Drug Administration for purposes of pro8 moting, and when used to promote, tobacco ces9 sation’’. 

10 (b) REQUIRING COVERAGE OF TOBACCO CESSATION

11 COUNSELING SERVICES FOR PREGNANT WOMEN.—Sec12 tion 1905 of the Social Security Act (42 U.S.C. 

13 1396d(a)(4)) is amended—

14 (1) in subsection (a)(4)—

15 (A) by striking ‘‘and’’ before ‘‘(C)’’; and 

16 (B) by inserting before the semicolon at 

17 the end the following new subparagraph: ‘‘; and 

18 (D) counseling for cessation of tobacco use (as 

19 defined in subsection (x)) for pregnant women’’; 

20 and 

21 (2) by adding at the end the following: 

22 ‘‘(x)(1) For purposes of this title, the term ‘coun23 seling for cessation of tobacco use’ means therapy and 

24 counseling for cessation of tobacco use for pregnant 
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1 women who use tobacco products or who are being treated 

2 for tobacco use that is furnished—

3 ‘‘(A) by or under the supervision of a physician; 

4 or 

5 ‘‘(B) by any other health care professional 

6 who— 

7 ‘‘(i) is legally authorized to furnish such 

8 services under State law (or the State regu9 latory mechanism provided by State law) of the 

10 State in which the services are furnished; and 

11 ‘‘(ii) is authorized to receive payment for 

12 other services under this title or is designated 

13 by the Secretary for this purpose. 

14 ‘‘(2) Subject to paragraph (3), such term is limited 

15 to—

16 ‘‘(A) therapy and counseling services rec17 ommended in ‘Treating Tobacco Use and Depend18 ence: A Clinical Practice Guideline’, published by the 

19 Public Health Service in June 2000, or any subse20 quent modification of such Guideline; and 

21 ‘‘(B) such other therapy and counseling services 

22 that the Secretary recognizes to be effective. 

23 ‘‘(3) Such term shall not include coverage for drugs 

24 or biologicals that are not otherwise covered under this 

25 title.’’.
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1 (c) REMOVAL OF COST-SHARING FOR TOBACCO CES2 SATION COUNSELING SERVICES FOR PREGNANT

3 WOMEN.—Section 1916 of the Social Security Act (42 

4 U.S.C. 1396o) is amended in each of subsections (a)(2)(B) 

5 and (b)(2)(B) by inserting ‘‘, and counseling for cessation 

6 of tobacco use (as defined in section 1905(x))’’ after ‘‘com7 plicate the pregnancy’’. 

8 (d) EFFECTIVE DATE.—The amendments made by 

9 this section shall apply to services furnished on or after 

10 the date that is 1 year after the date of enactment of this 

11 Act. 

12 SEC. 5. PROMOTING CESSATION OF TOBACCO USE UNDER 

13 THE MATERNAL AND CHILD HEALTH SERV14 ICES BLOCK GRANT PROGRAM. 

15 (a) QUALITY MATERNAL AND CHILD HEALTH SERV16 ICES INCLUDES TOBACCO CESSATION COUNSELING AND

17 MEDICATIONS.—

18 (1) IN GENERAL.—Section 501 of the Social 

19 Security Act (42 U.S.C. 701) is amended by adding 

20 at the end the following new subsection: 

21 ‘‘(c) For purposes of this title, counseling for ces22 sation of tobacco use (as defined in section 1905(x)), 

23 drugs and biologicals used to promote smoking cessation, 

24 and the inclusion of antitobacco messages in health pro-
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1 motion counseling shall be considered to be part of quality 

2 maternal and child health services.’’. 

3 (2) EFFECTIVE DATE.—The amendment made 

4 by paragraph (1) shall take effect on the date that 

5 is 1 year after the date of enactment of this Act. 

6 (b) EVALUATION OF NATIONAL CORE PERFORMANCE

7 MEASURES.—

8 (1) IN GENERAL.—The Administrator of the 

9 Health Resources and Services Administration shall 

10 assess the current national core performance meas11 ures and national core outcome measures utilized 

12 under the Maternal and Child Health Block Grant 

13 under title V of the Social Security Act (42 U.S.C. 

14 701 et seq.) for purposes of expanding such meas15 ures to include some of the known causes of low 

16 birthweight and prematurity, including the percent17 age of infants born to pregnant women who smoked 

18 during pregnancy. 

19 (2) REPORT.—Not later than 1 year after the 

20 date of enactment of this Act, the Administrator of 

21 the Health Resources and Services Administration 

22 shall submit to the appropriate committees of Con23 gress a report concerning the results of the evalua24 tion conducted under paragraph (1). 
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1 SEC. 6. STATE OPTION TO PROVIDE FAMILY PLANNING 

2 SERVICES AND SUPPLIES TO INDIVIDUALS 

3 WITH INCOMES THAT DO NOT EXCEED A 

4 STATE’S INCOME ELIGIBILITY LEVEL FOR 

5 MEDICAL ASSISTANCE. 

6 (a) IN GENERAL.—Title XIX of the Social Security 

7 Act (42 U.S.C. 1396 et seq.) is amended—

8 (1) by redesignating section 1935 as section 

9 1936; and 

10 (2) by inserting after section 1934 the following 

11 new section: 

12 ‘‘STATE OPTION TO PROVIDE FAMILY PLANNING

13 SERVICES AND SUPPLIES

14 ‘‘SEC. 1935. (a) IN GENERAL.—Subject to sub15 sections (b) and (c), a State may elect (through a State 

16 plan amendment) to make medical assistance described in 

17 section 1905(a)(4)(C) available to any individual whose 

18 family income does not exceed the greater of—

19 ‘‘(1) 185 percent of the income official poverty 

20 line (as defined by the Office of Management and 

21 Budget, and revised annually in accordance with sec22 tion 673(2) of the Omnibus Budget Reconciliation 

23 Act of 1981) applicable to a family of the size in24 volved; or 

25 ‘‘(2) the eligibility income level (expressed as a 

26 percentage of such poverty line) that has been speci-
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1 fied under a waiver authorized by the Secretary or 

2 under section 1902(r)(2)), as of October 1, 2003, 

3 for an individual to be eligible for medical assistance 

4 under the State plan. 

5 ‘‘(b) COMPARABILITY.—Medical assistance described 

6 in section 1905(a)(4)(C) that is made available under a 

7 State plan amendment under subsection (a) shall—

8 ‘‘(1) not be less in amount, duration, or scope 

9 than the medical assistance described in that section 

10 that is made available to any other individual under 

11 the State plan; and 

12 ‘‘(2) be provided in accordance with the restric13 tions on deductions, cost sharing, or similar charges 

14 imposed under section 1916(a)(2)(D). 

15 ‘‘(c) OPTION TO EXTEND COVERAGE DURING A

16 POST-ELIGIBILITY PERIOD.—

17 ‘‘(1) INITIAL PERIOD.—A State plan amend18 ment made under subsection (a) may provide that 

19 any individual who was receiving medical assistance 

20 described in section 1905(a)(4)(C) as a result of 

21 such amendment, and who becomes ineligible for 

22 such assistance because of hours of, or income from, 

23 employment, may remain eligible for such medical 

24 assistance through the end of the 6-month period 
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1 that begins on the first day the individual becomes 

2 so ineligible. 

3 ‘‘(2) ADDITIONAL EXTENSION.—A State plan 

4 amendment made under subsection (a) may provide 

5 that any individual who has received medical assist6 ance described in section 1905(a)(4)(C) during the 

7 entire 6-month period described in paragraph (1) 

8 may be extended coverage for such assistance for a 

9 succeeding 6-month period.’’. 

10 (b) EFFECTIVE DATE.—The amendments made by 

11 subsection (a) apply to medical assistance provided on and 

12 after October 1, 2003. 

13 SEC. 7. STATE OPTION TO EXTEND THE POSTPARTUM PE14 RIOD FOR PROVISION OF FAMILY PLANNING 

15 SERVICES AND SUPPLIES. 

16 (a) IN GENERAL.—Section 1902(e)(5) of the Social 

17 Security Act (42 U.S.C. 1396a(e)(5)) is amended—

18 (1) by striking ‘‘eligible under the plan, as 

19 though’’ and inserting ‘‘eligible under the plan—

20 ‘‘(A) as though’’; 

21 (2) by striking the period and inserting ‘‘; 

22 and’’; and 

23 (3) by adding at the end the following new sub24 paragraph:
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1 ‘‘(B) for medical assistance described in section 

2 1905(a)(4)(C) for so long as the family income of 

3 such woman does not exceed the maximum income 

4 level established by the State for the woman to be 

5 eligible for medical assistance under the State plan 

6 (as a result of pregnancy or otherwise).’’. 

7 (b) EFFECTIVE DATE.—The amendments made by 

8 subsection (a) apply to medical assistance provided on and 

9 after October 1, 2003. 

10 SEC. 8. STATE OPTION TO PROVIDE WRAP-AROUND SCHIP 

11 COVERAGE TO CHILDREN WHO HAVE OTHER 

12 HEALTH COVERAGE. 

13 (a) IN GENERAL.—

14 (1) SCHIP.—

15 (A) STATE OPTION TO PROVIDE WRAP16 AROUND COVERAGE.—Section 2110(b) of the 

17 Social Security Act (42 U.S.C. 1397jj(b)) is 

18 amended—

19 (i) in paragraph (1)(C), by inserting 

20 ‘‘, subject to paragraph (5),’’ after ‘‘under 

21 title XIX or’’; and 

22 (ii) by adding at the end the fol23 lowing: 

24 ‘‘(5) STATE OPTION TO PROVIDE WRAP-AROUND

25 COVERAGE.—A State may waive the requirement of 
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1 paragraph (1)(C) that a targeted low-income child 

2 may not be covered under a group health plan or 

3 under health insurance coverage, if the State satis4 fies the conditions described in subsection (c)(8). 

5 The State may waive such requirement in order to 

6 provide—

7 ‘‘(A) services for a child with special health 

8 care needs; or 

9 ‘‘(B) all services. 

10 In waiving such requirement, a State may limit the 

11 application of the waiver to children whose family in12 come does not exceed a level specified by the State, 

13 so long as the level so specified does not exceed the 

14 maximum income level otherwise established for 

15 other children under the State child health plan .’’. 

16 (B) CONDITIONS DESCRIBED.—Section 

17 2105(c) of the Social Security Act (42 U.S.C. 

18 1397ee(c)) is amended by adding at the end the 

19 following: 

20 ‘‘(8) CONDITIONS FOR PROVISION OF WRAP21 AROUND COVERAGE.—For purposes of section 

22 2110(b)(5), the conditions described in this para23 graph are the following: 
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1 ‘‘(A) INCOME ELIGIBILITY.—The State 

2 child health plan (whether implemented under 

3 title XIX or this XXI)—

4 ‘‘(i) has the highest income eligibility 

5 standard permitted under this title as of 

6 January 1, 2003; 

7 ‘‘(ii) subject to subparagraph (B), 

8 does not limit the acceptance of applica9 tions for children; and 

10 ‘‘(iii) provides benefits to all children 

11 in the State who apply for and meet eligi12 bility standards. 

13 ‘‘(B) NO WAITING LIST IMPOSED.—With 

14 respect to children whose family income is at or 

15 below 200 percent of the poverty line, the State 

16 does not impose any numerical limitation, wait17 ing list, or similar limitation on the eligibility of 

18 such children for child health assistance under 

19 such State plan. 

20 ‘‘(C) NO MORE FAVORABLE TREATMENT.—

21 The State child health plan may not provide 

22 more favorable coverage of dental services to 

23 the children covered under section 2110(b)(5) 

24 than to children otherwise covered under this 

25 title.’’. 
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1 (C) STATE OPTION TO WAIVE WAITING PE2 RIOD.—Section 2102(b)(1)(B) of the Social Se3 curity Act (42 U.S.C. 1397bb(b)(1)(B)), as 

4 amended by section 2(b)(3)(B), is amended—

5 (i) in clause (ii), by striking ‘‘, and’’ 

6 at the end and inserting a semicolon; 

7 (ii) in clause (iii), by striking the pe8 riod at the end and inserting ‘‘; and’’; and 

9 (iii) by adding at the end the fol10 lowing new clause: 

11 ‘‘(iv) at State option, may not apply a 

12 waiting period in the case of a child de13 scribed in section 2110(b)(5), if the State 

14 satisfies the requirements of section 

15 2105(c)(8).’’. 

16 (2) APPLICATION OF ENHANCED MATCH UNDER

17 MEDICAID.—Section 1905 of the Social Security Act 

18 (42 U.S.C. 1396d), as amended by section 2(a)(2), 

19 is amended—

20 (A) in subsection (b), in the fourth sen21 tence, by striking ‘‘or (u)(4)’’ and inserting 

22 ‘‘(u)(4), or (u)(5)’’; and 

23 (B) in subsection (u)—

24 (i) by redesignating paragraph (5) as 

25 paragraph (6); and 
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1 (ii) by inserting after paragraph (4) 

2 the following: 

3 ‘‘(5) For purposes of subsection (b), the ex4 penditures described in this paragraph are expendi5 tures for items and services for children described in 

6 section 2110(b)(5), but only in the case of a State 

7 that satisfies the requirements of section 

8 2105(c)(8).’’. 

9 (3) APPLICATION OF SECONDARY PAYOR PROVI10 SIONS.—Section 2107(e)(1) of the Social Security 

11 Act (42 U.S.C. 1397gg(e)(1)), as amended by sec12 tion 3(b), is amended by adding at the end the fol13 lowing: 

14 ‘‘(F) Section 1902(a)(25) (relating to co15 ordination of benefits and secondary payor pro16 visions) with respect to children covered under 

17 a waiver described in section 2110(b)(5).’’. 

18 (b) EFFECTIVE DATE.—The amendments made by 

19 subsection (a) shall take effect on January 1, 2003, and 

20 shall apply to child health assistance and medical assist21 ance provided on or after that date.

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