II 

110TH CONGRESS 

1ST SESSION S. 895 

To amend titles XIX and XXI of the Social Security Act to ensure that 

every child in the United States has access to affordable, quality health 

insurance coverage, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 15, 2007 

Mrs. CLINTON introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to ensure that every child in the United States has 

access to affordable, quality health insurance coverage, 

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; AMENDMENTS TO SOCIAL SECU4 RITY ACT; TABLE OF CONTENTS. 

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

6 ‘‘Children’s Health First Act’’. 

7 (b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex8 cept as otherwise specifically provided, whenever in this 


ycherry on PROD1PC64 with BILLS
2 

•S 895 IS

1 Act an amendment is expressed in terms of an amendment 

2 to or repeal of a section or other provision, the reference 

3 shall be considered to be made to that section or other 

4 provision of the Social Security Act. 

5 (c) TABLE OF CONTENTS.—The table of contents for 

6 this Act is as follows: 

Sec. 1. Short title; amendments to Social Security Act; table of contents. 

TITLE I—OPTIONS FOR AFFORDABLE COVERAGE FOR ALL 

CHILDREN 

Subtitle A—Expanded Coverage of Children Under SCHIP and Through 

Employer-Sponsored Coverage 

Sec. 101. State option to expand coverage of children under SCHIP. 

Sec. 102. Authority for States to offer purchase of coverage for uncovered children under SCHIP. 

Sec. 103. Support for employment-based coverage of children eligible for 

SCHIP or Medicaid. 

Sec. 104. Modification of prohibition on coverage of children of State employees. 

Subtitle B—Ensuring Dependable Coverage for All Children 

Sec. 111. Improving benchmark coverage options. 

Sec. 112. Requiring coverage of EPSDT services, including dental services, and 

federally-qualified health services and improving coverage of 

additional categories of services. 

Sec. 113. Clarification of requirement to provide EPSDT services for all children in benchmark benefit packages under Medicaid. 

Sec. 114. Medicaid-SCHIP Payment Advisory Commission. 

Subtitle C—Ensuring a Fair Partnership 

Sec. 121. Increase in FMAP for medical assistance for children for States that 

expand coverage of children. 

Subtitle D—State Options for Additional Coverage Expansions 

Sec. 131. Optional coverage of older children under Medicaid and SCHIP. 

Sec. 132. Optional coverage of legal immigrants under the Medicaid program 

and SCHIP. 

Sec. 133. State option to expand or add coverage of certain pregnant women 

under SCHIP. 

TITLE II—REMOVAL OF OTHER BARRIERS TO COVERAGE 

Sec. 201. Establishment of new base SCHIP allotments that are responsive to 

increases in health care costs and enrollment expansions. 

Sec. 202. 2-year initial availability of SCHIP allotments. 

Sec. 203. Redistribution of unused allotments to address State funding shortfalls. 


ycherry on PROD1PC64 with BILLS
3 

•S 895 IS

Sec. 204. Incentives for school-based outreach and enrollment. 

Sec. 205. Medicaid citizenship documentation requirements. 

Sec. 206. State option to provide for ‘‘express lane’’ and simplified determinations of a child’s financial eligibility for medical assistance 

under Medicaid or child health assistance under SCHIP. 

Sec. 207. Information technology connections to improve health coverage determinations. 

Sec. 208. Encouraging culturally appropriate enrollment practices. 

Sec. 209. Model of Interstate coordinated enrollment and coverage process. 

Sec. 210. Elimination of counting medicaid child presumptive eligibility costs 

against title XXI allotment. 

Sec. 211. Authority for qualifying States to use portion of SCHIP allotment for 

any fiscal year for certain medicaid expenditures. 

Sec. 212. Application of Medicaid outreach procedures to all pregnant women 

and children. 

TITLE III—EFFECTIVE DATE 

Sec. 301. Effective date. 

1 TITLE I—OPTIONS FOR AFFORD2 ABLE COVERAGE FOR ALL 

3 CHILDREN 

4 Subtitle A—Expanded Coverage of 

5 Children Under SCHIP and 

6 Through Employer-Sponsored 

7 Coverage 

8 SEC. 101. STATE OPTION TO EXPAND COVERAGE OF CHIL9 DREN UNDER SCHIP. 

10 (a) OPTION FOR COVERAGE OF CHILDREN UP TO 400 

11 PERCENT OF POVERTY LINE.—Section 2110(c)(4) (42 

12 U.S.C. 1397jj(c)(4)) is amended by inserting ‘‘(or, at the 

13 option of the State, any percentage up to 400 percent)’’ 

14 after ‘‘200 percent’’. 

15 (b) ENSURING FUNDING FOR STATE ELIGIBILITY

16 EXPANSION.— 


ycherry on PROD1PC64 with BILLS
4 

•S 895 IS

1 (1) IN GENERAL.—Section 2105 (42 U.S.C. 

2 1397dd) is amended by adding at the end the fol3 lowing new subsection: 

4 ‘‘(i) FUNDING FOR CHILD HEALTH ASSISTANCE FOR

5 COVERAGE EXPANSION STATES.— 

6 ‘‘(1) IN GENERAL.—Notwithstanding section 

7 2104, in the case of a State that has elected the op8 tion under section 2110(c)(4) to apply for a calendar 

9 quarter in a fiscal year a percentage that is 400 per10 cent and that meets the requirement of paragraph 

11 (2) (relating to no limitation on enrollment), the al12 lotment determined for the State for such fiscal year 

13 under section 2104 shall be increased by such sums 

14 as are necessary for making payments to the State 

15 for expenditures described in subsection (a)(1). 

16 ‘‘(2) NO LIMITATION ON ENROLLMENT.—The 

17 requirement of this paragraph with respect to a 

18 State for a calendar quarter is that the State does 

19 not impose, with respect to the enrollment under the 

20 State child health plan of targeted low-income chil21 dren during the quarter, any enrollment cap or other 

22 numerical limitation on enrollment, any waiting list, 

23 any procedures designed to delay the consideration 

24 of applications for enrollment, or similar limitation 

25 with respect to enrollment. 


ycherry on PROD1PC64 with BILLS
5 

•S 895 IS

1 ‘‘(3) APPROPRIATION.—There is appropriated, 

2 out of any money in the Treasury not otherwise ap3 propriated, such sums as may be necessary for the 

4 purpose of paying a State described in paragraph 

5 (1) for each calendar quarter described in such para6 graph, an amount equal to the enhanced FMAP of 

7 expenditures described in such paragraph and in8 curred during such quarter.’’. 

9 (2) CONFORMING AMENDMENTS.—Section 2104 

10 (42 U.S.C. 1397dd) is amended— 

11 (A) in subsection (a), by striking ‘‘sub12 section (d)’’ and inserting ‘‘ subsections (d) and 

13 (h) and section 2105(i)’’; 

14 (B) in subsection (b)(1), by striking ‘‘sub15 section (d)’’ and inserting ‘‘ subsections (d) and 

16 (h) and section 2105(i)’’; and 

17 (C) in subsection (c)(1), by striking ‘‘sub18 section (d)’’ and inserting ‘‘ subsections (d) and 

19 (h) and section 2105(i)’’. 

20 SEC. 102. AUTHORITY FOR STATES TO OFFER PURCHASE 

21 OF COVERAGE FOR UNCOVERED CHILDREN 

22 UNDER SCHIP. 

23 (a) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et 

24 seq.) is amended by adding at the end the following new 

25 section: 


ycherry on PROD1PC64 with BILLS
6 

•S 895 IS

1 ‘‘SEC. 2111. AUTHORITY FOR STATES TO OFFER PURCHASE 

2 OF COVERAGE FOR UNCOVERED CHILDREN 

3 WHO ARE NOT OTHERWISE ELIGIBLE FOR AS4 SISTANCE UNDER SCHIP OR MEDICAID. 

5 ‘‘(a) AUTHORITY TO OFFER PURCHASE OF COV6 ERAGE.— 

7 ‘‘(1) OPTION FOR STATES WITH INCOME ELIGI8 BILITY LEVEL OF AT LEAST 200, BUT NOT 400, PER9 CENT.—Subject to the succeeding provisions of this 

10 section, in the case of a State that meets the re11 quirement of section 2105(i)(2) for a calendar quar12 ter and that has elected to apply an income eligi13 bility level under section 2110(c)(4) that is at least 

14 200 percent, but not 400 percent, of the poverty line 

15 for the calendar quarter, the State may permit dur16 ing the calendar quarter the purchase of coverage 

17 under this title by families, employers, or others 

18 (under the same terms of the plan that apply to tar19 geted low-income children) for an uncovered child 

20 who would be eligible to be a targeted low-income 

21 child but whose family income exceeds such level. 

22 ‘‘(2) REQUIREMENT FOR STATES WITH 400 PER23 CENT INCOME ELIGIBILITY LEVEL.—In the case of a 

24 State that meets the requirement of section 

25 2105(i)(2) for a calendar quarter and that has elect26 ed to apply an income eligibility level under section 


ycherry on PROD1PC64 with BILLS
7 

•S 895 IS

1 2110(c)(4) that is 400 percent of the poverty line 

2 for the calendar quarter, the State shall permit dur3 ing the quarter the purchase of coverage described 

4 in paragraph (1). 

5 ‘‘(b) COMMUNITY-RATED, ACTUARIALLY BASED

6 PREMIUM.—The premium imposed for coverage of a child 

7 pursuant to subsection (a) shall not exceed a community8 rated premium that reflects the actuarial average cost of 

9 providing coverage under the State child health plan to 

10 enrollees who are children. 

11 ‘‘(c) STATE OPTION REGARDING LIMITATION ON

12 COST-SHARING.— 

13 ‘‘(1) IN GENERAL.—In the case of children cov14 ered under the plan by reason of purchasing such 

15 coverage pursuant to subsection (a), the State may 

16 elect in applying the limitation on cost-sharing de17 scribed in section 2103(e)(3)(B) (including to chil18 dren who are provided benefits in the manner de19 scribed in section 2103(e)(4)) not to apply such limi20 tation with respect to some or all of the premiums 

21 imposed for the purchase of such coverage. 

22 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

23 paragraph (1) shall be construed as prohibiting an 

24 employer from providing an employee with financial 

25 benefits to offset the cost of premiums and costVerDate Aug 31 2005 22:22 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S895.IS S895

ycherry on PROD1PC64 with BILLS
8 

•S 895 IS

1 sharing imposed with respect to the purchase of cov2 erage of a child pursuant to subsection (a). 

3 ‘‘(d) NO FEDERAL MATCHING PAYMENT AVAIL4 ABLE.—No payments shall be made under section 2105(a) 

5 (other than under clauses (iii) and (iv) of paragraph 

6 (1)(D)) with respect to child health assistance provided 

7 under the State child health plan to children covered 

8 under the plan by reason of purchasing such coverage pur9 suant to this section.’’. 

10 (b) CONFORMING AMENDMENTS.— 

11 (1) Section 2110(b)(1)(B) (42 U.S.C. 

12 1397jj(b)(1)(B)) is amended— 

13 (A) in clause (i), by striking ‘‘or’’ at the 

14 end; 

15 (B) in clause (ii), in the matter before sub16 clause (I), by inserting ‘‘who’’ before ‘‘is’’; 

17 (C) in clause (ii)(III), by striking ‘‘and’’ 

18 and inserting ‘‘or’’; and 

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

20 clause: 

21 ‘‘(iii) who is a child with respect to whom 

22 coverage is purchased under section 2111(a); 

23 and’’. 

24 (2) Section 2103(e) (42 U.S.C. 1397cc) is 

25 amended— 


ycherry on PROD1PC64 with BILLS
9 

•S 895 IS

1 (A) in paragraph (3)(B), by striking ‘‘and 

2 (2)’’ and inserting ‘‘, (2), and section 2111(d)’’; 

3 and 

4 (B) in paragraph (4), by striking ‘‘Noth5 ing’’ and inserting ‘‘Subject to 2111(d)(2), 

6 nothing’’. 

7 SEC. 103. SUPPORT FOR EMPLOYMENT-BASED COVERAGE 

8 OF CHILDREN ELIGIBLE FOR SCHIP OR MED9 ICAID. 

10 (a) SUBSIDIES FOR EMPLOYMENT-BASED COV11 ERAGE.— 

12 (1) UNDER SCHIP.—Section 2105 (42 U.S.C. 

13 1397ee) is amended— 

14 (A) in subsection (a)(1)(D)— 

15 (i) by striking ‘‘and’’ at the end of 

16 clause (iii); 

17 (ii) by redesignating clause (iv) as 

18 clause (v); and 

19 (iii) by inserting after clause (iii) the 

20 following new clause: 

21 ‘‘(iv) payments for employment-based 

22 coverage under subsection (c)(2)(C); and’’; 

23 (B) in subsection (c)(2)(A), by inserting 

24 ‘‘(other than under clause (iv) of such para25 graph)’’ after ‘‘of such subsection’’; and 


ycherry on PROD1PC64 with BILLS
10 

•S 895 IS

1 (C) in subsection (c)(2), by adding at the 

2 end the following new subparagraph: 

3 ‘‘(C) SUBSIDIES FOR EMPLOYMENT-BASED

4 COVERAGE.— 

5 ‘‘(i) IN GENERAL.—In the case of a 

6 State that has elected the option under 

7 section 2110(c)(4) to apply for a calendar 

8 quarter a percentage that is 400 percent 

9 and that meets the requirement of sub10 section (i)(2) for the calendar quarter, sub11 ject to clause (ii), the limitation under sub12 paragraph (A) on expenditures shall not 

13 apply to a payment for the provision of 

14 health benefits coverage during the cal15 endar quarter under a group health plan 

16 for an employer premium assistance eligi17 ble child (and to supplemental benefits de18 scribed in subclause (II)) if the State dem19 onstrates to the satisfaction of the Sec20 retary that— 

21 ‘‘(I) the actuarial value of the 

22 health benefits coverage (as deter23 mined pursuant to section 2103(c)(4)) 

24 is at least equal to the actuarial value 

25 of the child health assistance provided 


ycherry on PROD1PC64 with BILLS
11 

•S 895 IS

1 under the State child health plan for 

2 children with the same (or com3 parable) family income and the group 

4 health plan does not discriminate in 

5 its coverage of employer premium as6 sistance eligible children on the basis 

7 of health status; and 

8 ‘‘(II) the State will provide sup9 plemental benefits for employer pre10 mium assistance eligible children 

11 under the State child health plan in 

12 accordance with section 2110(b)(5) in 

13 order that such supplemental benefits, 

14 in combination with such coverage, 

15 provides the same benefits as would 

16 be available under the child health 

17 plan to the child if section 

18 2110(b)(1)(C) did not apply to the 

19 child. 

20 ‘‘(ii) LIMITATION ON FEDERAL

21 MATCHING PAYMENTS.—No payment shall 

22 be made under subsection (a) with respect 

23 to a payment described in clause (i) for 

24 coverage of a child insofar as the payment 

25 exceeds 50 percent of the amount of exVerDate Aug 31 2005 22:22 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S895.IS S895

ycherry on PROD1PC64 with BILLS
12 

•S 895 IS

1 penditures that the State would have oth2 erwise incurred for providing child health 

3 assistance for such child if the child were 

4 a targeted low-income child. 

5 ‘‘(iii) EMPLOYER PREMIUM ASSIST6 ANCE ELIGIBLE CHILD DEFINED.—For 

7 purposes of clause (i), the term ‘employer 

8 premium assistance eligible child’ means a 

9 child who is covered under a group health 

10 plan, who is not eligible for medical assist11 ance under the State plan under title XIX, 

12 and who would satisfy the requirements for 

13 being a targeted low-income child under 

14 the State child health plan if the condition 

15 described in subparagraph (C) of section 

16 2110(b)(1) did not apply.’’. 

17 (2) REFERENCE TO EXISTING MEDICAID AU18 THORITY.—For provisions relating to authority of 

19 State Medicaid plan to provide payment to employ20 ers for enrollment of Medicaid-eligible children in a 

21 group health plan, and requiring the continued pro22 vision of medical assistance to supplement coverage 

23 under such plan, see section 1906 of the Social Se24 curity Act (42 U.S.C. 1396e). 


ycherry on PROD1PC64 with BILLS
13 

•S 895 IS

1 (b) STATE PROVISION OF SUPPLEMENTAL SCHIP 

2 BENEFITS IN CASE OF CHILDREN COVERED UNDER

3 GROUP HEALTH PLANS.— 

4 (1) IN GENERAL.—Section 2110(b) (42 U.S.C. 

5 1397jj(b)) is amended— 

6 (A) in paragraph (1)(C), by inserting ‘‘, 

7 subject to paragraph (5),’’ after ‘‘under title 

8 XIX or’’; and 

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

10 paragraph: 

11 ‘‘(5) STATE PROVISION OF SUPPLEMENTAL

12 BENEFITS IN CASE OF CHILDREN COVERED UNDER

13 GROUP HEALTH PLANS.— 

14 ‘‘(A) REQUIREMENT FOR CHILDREN EN15 ROLLED UNDER SUBSIDIZED EMPLOYMENT16 BASED COVERAGE.—In the case of a State that 

17 provides payment under section 2105(c)(2)(C) 

18 for health benefits coverage for a child enrolled 

19 in a group health plan, the requirement of 

20 paragraph (1)(C) shall not apply to such child, 

21 but the child health assistance under this title 

22 shall be limited to— 

23 ‘‘(i) benefits for items or services that 

24 are not covered, or are only partially cov25 ered, under such plan; and 


ycherry on PROD1PC64 with BILLS
14 

•S 895 IS

1 ‘‘(ii) protection against incurring out2 of-pocket costs (including premiums) in ex3 cess of the limitations otherwise applicable 

4 to a targeted low-income child with the 

5 same family income. 

6 ‘‘(B) OPTION FOR OTHER CHILDREN.— 

7 For children not described in subparagraph (A), 

8 a State may waive the requirement of para9 graph (1)(C), with respect to children within 

10 one or more classes or categories of children 

11 specified by the State, in the case of a child 

12 covered under a group health plan in order to 

13 provide child health assistance— 

14 ‘‘(i) for items or services that are not 

15 covered, or are only partially covered, 

16 under such plan; or 

17 ‘‘(ii) to protect against incurred out18 of-pocket costs (including premiums) ex19 ceeding the limitations otherwise applicable 

20 to a targeted low-income child with the 

21 same family income. 

22 ‘‘(C) ELIGIBILITY.—In applying subpara23 graph (B), a State may limit the application of 

24 the waiver under such subparagraph to children 

25 whose family income does not exceed a level 


ycherry on PROD1PC64 with BILLS
15 

•S 895 IS

1 specified by the State, which may not exceed 

2 the maximum income level otherwise established 

3 for other children under the State child health 

4 plan. 

5 ‘‘(D) CONTINUED APPLICATION OF DUTY

6 TO PREVENT SUBSTITUTION OF EXISTING COV7 ERAGE.—Nothing in this paragraph shall be 

8 construed as modifying the application of sec9 tion 2102(b)(3)(C) to a State.’’. 

10 (2) APPLICATION OF ENHANCED MATCH UNDER

11 MEDICAID.—Section 1905 (42 U.S.C. 1396d) is 

12 amended— 

13 (A) in subsection (b), in the fourth sen14 tence, by striking ‘‘subsection (u)(3)’’ and in15 serting ‘‘(u)(3), or (u)(4)’’; and 

16 (B) in subsection (u), by redesignating 

17 paragraph (4) as paragraph (5) and by insert18 ing after paragraph (3) the following new para19 graph: 

20 ‘‘(4) For purposes of subsection (b), the expenditures 

21 described in this paragraph are expenditures for items and 

22 services for children described in section 2110(b)(5).’’. 

23 (3) APPLICATION OF SECONDARY PAYOR PROVI24 SIONS.—Section 2107(e)(1) (42 U.S.C. 

25 1397gg(e)(1)) is amended— 


ycherry on PROD1PC64 with BILLS
16 

•S 895 IS

1 (A) by redesignating subparagraphs (B) 

2 through (D) as subparagraphs (C) through (E), 

3 respectively; and 

4 (B) by inserting after subparagraph (A) 

5 the following new subparagraph: 

6 ‘‘(B) Section 1902(a)(25) (relating to co7 ordination of benefits and secondary payor pro8 visions) with respect to benefits provided under 

9 section 2110(b)(5).’’. 

10 SEC. 104. MODIFICATION OF PROHIBITION ON COVERAGE 

11 OF CHILDREN OF STATE EMPLOYEES. 

12 Section 2110(b)(2)(B) (42 U.S.C. 1397jj(b)(2)) is 

13 amended— 

14 (1) by striking ‘‘is eligible’’ and inserting 

15 ‘‘would be eligible’’; and 

16 (2) by inserting ‘‘(as in effect on March 1, 

17 2007)’’ after ‘‘plan’’. 

18 Subtitle B—Ensuring Dependable 

19 Coverage for All Children 

20 SEC. 111. IMPROVING BENCHMARK COVERAGE OPTIONS. 

21 (a) LIMITATION ON USE OF SECRETARY-APPROVED

22 COVERAGE.—Section 2103(a)(4) (42 U.S.C. 

23 1397cc(a)(4)) is amended by striking the period at the end 

24 and inserting ‘‘, but only if such determination was made 

25 before March 1, 2007.’’. 


ycherry on PROD1PC64 with BILLS
17 

•S 895 IS

1 (b) REQUIREMENT FOR MOST POPULAR FAMILY

2 COVERAGE FOR STATE EMPLOYEE COVERAGE BENCH3 MARK.—Section 2103(b)(2) (42 U.S.C. 1397(b)(2)) is 

4 amended— 

5 (1) by striking ‘‘A health benefits coverage 

6 plan’’ and inserting ‘‘The health benefits coverage 

7 plan’’; and 

8 (2) by inserting ‘‘and that has been selected the 

9 most, by employees seeking dependent coverage, 

10 among such plans that provide such dependent cov11 erage, in either of the previous 2 plan years’’ before 

12 the period. 

13 SEC. 112. REQUIRING COVERAGE OF EPSDT SERVICES, IN14 CLUDING DENTAL SERVICES, AND FEDER15 ALLY-QUALIFIED HEALTH SERVICES AND IM16 PROVING COVERAGE OF ADDITIONAL CAT17 EGORIES OF SERVICES. 

18 (a) ADDITIONAL REQUIRED SERVICES.— 

19 (1) REQUIRED COVERAGE OF EPSDT SERVICES, 

20 INCLUDING DENTAL SERVICES.—Section 2103(c) 

21 (42 U.S.C. 1397cc(c)) is amended— 

22 (A) by redesignating paragraph (5) as 

23 paragraph (6); and 

24 (B) by inserting after paragraph (4), the 

25 following: 


ycherry on PROD1PC64 with BILLS
18 

•S 895 IS

1 ‘‘(5) OTHER REQUIRED SERVICES.—The child 

2 health assistance provided to a targeted low-income 

3 child shall include coverage of the following: 

4 ‘‘(A) EPSDT SERVICES, INCLUDING DEN5 TAL SERVICES.—Early and periodic screening, 

6 diagnostic, and treatment services described in 

7 subsections (a)(4)(B) and (r) of section 1905 

8 and provided in accordance with section 

9 1903(a)(43) (including dental services that are 

10 necessary to prevent disease and promote oral 

11 health, restore oral structures to health and 

12 function, and treat emergency conditions).’’. 

13 (2) REQUIRED COVERAGE OF FQHC AND RHC

14 SERVICES.—Section 2103(c)(5) (42 U.S.C. 

15 1397cc(c)(5)) (as added by subsection (a)), is 

16 amended by adding at the end the following: 

17 ‘‘(B) FQHC AND RHC SERVICES.—Feder18 ally-qualified health center services (as defined 

19 in section 1905(l)(2)) and rural health clinic 

20 services (as defined in section 1905(l)(1)).’’. 

21 (3) ASSURING ACCESS TO CARE.— 

22 (A) STATE CHILD HEALTH PLAN REQUIRE23 MENT.—Section 2102(a)(7)(B) (42 U.S.C. 

24 1397bb(c)(2)) is amended by inserting ‘‘and 


ycherry on PROD1PC64 with BILLS
19 

•S 895 IS

1 services described in section 2103(c)(5)’’ after 

2 ‘‘emergency services’’. 

3 (B) ANNUAL REPORT.—Section 2108(a)(1) 

4 (42 U.S.C. 1397hh(a)(1)) is amended— 

5 (i) by striking ‘‘including the 

6 progress’’ and inserting ‘‘including— 

7 ‘‘(A) the progress’’; and 

8 (ii) by adding at the end the fol9 lowing: 

10 ‘‘(B) the extent to which the operation of 

11 such plan ensures access, comparable to access 

12 under employer-sponsored or other private 

13 health insurance coverage (or in the case of fed14 erally-qualified health center services (as de15 fined in section 1905(l) (2)) and rural health 

16 clinic services (as defined in section 1905(l)(1)), 

17 access comparable to the access to such services 

18 under title XIX), for child health assistance to 

19 targeted low-income children consistent with the 

20 provisions of this title; and’’. 

21 (4) CONFORMING AMENDMENT.—Section 

22 2103(a) (42 U.S.C. 1397cc(a)) is amended, in the 

23 matter preceding paragraph (1), by striking ‘‘sub24 section (c)(5)’’ and inserting ‘‘paragraphs (5) and 

25 (6) of subsection (c)’’. 


ycherry on PROD1PC64 with BILLS
20 

•S 895 IS

1 (b) 100 PERCENT ACTUARIAL VALUE FOR ADDI2 TIONAL SERVICES INCLUDED IN BENCHMARK PACK3 AGE.—Section 2103(a)(2)(C) (42 U.S.C. 

4 1397cc(a)(2)(C)) is amended by striking ‘‘75 percent’’ and 

5 inserting ‘‘100 percent’’. 

6 SEC. 113. CLARIFICATION OF REQUIREMENT TO PROVIDE 

7 EPSDT SERVICES FOR ALL CHILDREN IN 

8 BENCHMARK BENEFIT PACKAGES UNDER 

9 MEDICAID. 

10 (a) IN GENERAL.—Section 1937(a)(1), as inserted by 

11 section 6044(a) of the Deficit Reduction Act of 2005, is 

12 amended— 

13 (1) in subparagraph (A)— 

14 (A) in the matter before clause (i), by in15 serting ‘‘subject to subparagraph (E),’’ after 

16 ‘‘Notwithstanding any other provision of this 

17 title’’; and 

18 (B) by striking ‘‘enrollment in coverage 

19 that provides’’ and all that follows and inserting 

20 ‘‘benchmark coverage described in subsection 

21 (b)(1) or benchmark equivalent coverage de22 scribed in subsection (b)(2).’’; 

23 (2) by striking subparagraph (C) and inserting 

24 the following new subparagraph: 


ycherry on PROD1PC64 with BILLS
21 

•S 895 IS

1 ‘‘(C) STATE OPTION TO PROVIDE ADDI2 TIONAL BENEFITS.—A State, at its option, may 

3 provide such additional benefits to benchmark 

4 coverage described in subsection (b)(1) or 

5 benchmark equivalent coverage described in 

6 subsection (b)(2) as the State may specify.’’; 

7 and 

8 (3) by adding at the end the following new sub9 paragraph: 

10 ‘‘(E) REQUIRING COVERAGE OF EPSDT

11 SERVICES.—Nothing in this paragraph shall be 

12 construed as affecting a child’s entitlement to 

13 care and services described in subsections 

14 (a)(4)(B) and (r) of section 1905 and provided 

15 in accordance with section 1903(a)(43) whether 

16 provided through benchmark coverage, bench17 mark equivalent coverage, or otherwise.’’. 

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

19 this subsection shall take effect as if included in the 

20 amendment made by section 6044(a) of the Deficit Reduc21 tion Act of 2005. 

22 SEC. 114. MEDICAID-SCHIP PAYMENT ADVISORY COMMIS23 SION. 

24 Title XIX (42 U.S.C. 1396 et seq.) is amended by 

25 inserting before section 1901 the following new section: 


ycherry on PROD1PC64 with BILLS
22 

•S 895 IS

1 ‘‘MEDICAID-SCHIP PAYMENT ADVISORY COMMISSION

2 ‘‘SEC. 1900. (a) ESTABLISHMENT.—There is hereby 

3 established the Medicaid-SCHIP Payment Advisory Com4 mission (in this section referred to as the ‘Commission’). 

5 ‘‘(b) DUTIES.— 

6 ‘‘(1) REVIEW OF PAYMENT POLICIES AND AN7 NUAL REPORTS.—The Commission shall— 

8 ‘‘(A) review payment policies of the Med9 icaid program established under this title (in 

10 this section referred to as ‘Medicaid’) and the 

11 State Children’s Health Insurance Program es12 tablished under title XXI (in this section re13 ferred to as ‘SCHIP’), including topics de14 scribed in paragraph (2); 

15 ‘‘(B) make recommendations to Congress 

16 concerning such payment policies; 

17 ‘‘(C) by not later than March 1 of each 

18 year, submit a report to Congress containing 

19 the results of such reviews and its recommenda20 tions concerning such policies; and 

21 ‘‘(D) by not later than June 1 of each 

22 year, submit a report to Congress containing an 

23 examination of issues affecting Medicaid and 

24 SCHIP, including the implications of changes 

25 in health care delivery in the United States and 


ycherry on PROD1PC64 with BILLS
23 

•S 895 IS

1 in the market for health care services on such 

2 programs. 

3 ‘‘(2) SPECIFIC TOPICS TO BE REVIEWED.—Spe4 cifically, the Commission shall review the following: 

5 ‘‘(A) The factors affecting expenditures for 

6 services in different sectors (such as physician, 

7 hospital and other sectors), payment methodolo8 gies, and their relationship to access and qual9 ity of care for Medicaid and SCHIP bene10 ficiaries. 

11 ‘‘(B) The affects of Medicaid and SCHIP 

12 payment policies on access to services for chil13 dren and other Medicaid and SCHIP popu14 lations. 

15 ‘‘(3) COMMENTS ON CERTAIN SECRETARIAL RE16 PORTS.—If the Secretary submits to Congress (or a 

17 committee of Congress) a report that is required by 

18 law and that relates to payment policies under Med19 icaid or SCHIP, the Secretary shall transmit a copy 

20 of the report to the Commission. The Commission 

21 shall review the report and, not later than 6 months 

22 after the date of submittal of the Secretary’s report 

23 to Congress, shall submit to the appropriate commit24 tees of Congress written comments on such report. 


ycherry on PROD1PC64 with BILLS
24 

•S 895 IS

1 Such comments may include such recommendations 

2 as the Commission deems appropriate. 

3 ‘‘(4) AGENDA AND ADDITIONAL REVIEWS.—The 

4 Commission shall consult periodically with the 

5 Chairmen and Ranking Minority Members of the ap6 propriate committees of Congress regarding the 

7 Commission’s agenda and progress towards achiev8 ing the agenda. The Commission may conduct addi9 tional reviews, and submit additional reports to the 

10 appropriate committees of Congress, from time to 

11 time on such topics relating to the program under 

12 this title or title XXI as may be requested by such 

13 Chairmen and Members and as the Commission 

14 deems appropriate. 

15 ‘‘(5) AVAILABILITY OF REPORTS.—The Com16 mission shall transmit to the Secretary a copy of 

17 each report submitted under this subsection and 

18 shall make such reports available to the public. 

19 ‘‘(6) APPROPRIATE COMMITTEE OF CON20 GRESS.—For purposes of this section, the term ‘ap21 propriate committees of Congress’ means the Com22 mittees on Energy and Commerce of the House of 

23 Representatives and the Committee on Finance of 

24 the Senate. 


ycherry on PROD1PC64 with BILLS
25 

•S 895 IS

1 ‘‘(7) VOTING AND REPORTING REQUIRE2 MENTS.—With respect to each recommendation con3 tained in a report submitted under paragraph (1), 

4 each member of the Commission shall vote on the 

5 recommendation, and the Commission shall include, 

6 by member, the results of that vote in the report 

7 containing the recommendation. 

8 ‘‘(8) EXAMINATION OF BUDGET CON9 SEQUENCES.—Before making any recommendations, 

10 the Commission shall examine the budget con11 sequences of such recommendations, directly or 

12 through consultation with appropriate expert enti13 ties. 

14 ‘‘(c) APPLICATION OF PROVISIONS.—The following 

15 provisions of section 1805 shall apply to the Commission 

16 in the same manner as they apply to the Medicare Pay17 ment Advisory Commission: 

18 ‘‘(1) Subsection (c) (relating to membership). 

19 ‘‘(2) Subsection (d) (relating to staff and con20 sultants). 

21 ‘‘(3) Subsection (e) (relating to powers). 

22 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— 

23 ‘‘(1) REQUEST FOR APPROPRIATIONS.—The 

24 Commission shall submit requests for appropriations 

25 in the same manner as the Comptroller General subVerDate Aug 31 2005 22:22 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S895.IS S895

ycherry on PROD1PC64 with BILLS
26 

•S 895 IS

1 mits requests for appropriations, but amounts ap2 propriated for the Commission shall be separate 

3 from amounts appropriated for the Comptroller Gen4 eral. 

5 ‘‘(2) AUTHORIZATION.—There are authorized to 

6 be appropriated such sums as may be necessary to 

7 carry out the provisions of this section.’’. 

8 Subtitle C—Ensuring a Fair 

9 Partnership 

10 SEC. 121. INCREASE IN FMAP FOR MEDICAL ASSISTANCE 

11 FOR CHILDREN FOR STATES THAT EXPAND 

12 COVERAGE OF CHILDREN. 

13 Section 1905 (42 U.S.C. 1396d) is amended— 

14 (1) in subsection (b), in the first sentence— 

15 (A) by striking ‘‘and (4)’’ and inserting 

16 ‘‘(4)’’; and 

17 (B) by inserting ‘‘, and (5) in the case of 

18 a State that is described in subsection (y)(1) 

19 and section 2105(i)(1) for a calendar quarter, 

20 notwithstanding the previous clauses of this 

21 sentence, the Federal medical assistance per22 centage with respect to medical assistance pro23 vided to children shall be increased by the num24 ber of percentage points determined under sub25 section (y)(4)’’ before the period; and 


ycherry on PROD1PC64 with BILLS
27 

•S 895 IS

1 (2) by adding at the end the following new sub2 section: 

3 ‘‘(y) DETERMINATION OF INCREASE IN FMAP FOR

4 MEDICAL ASSISTANCE FOR CHILDREN FOR STATES THAT

5 EXPAND COVERAGE OF CHILDREN.— 

6 ‘‘(1) STATE DESCRIBED.—For purposes of 

7 clause (5) of the first sentence of subsection (b), a 

8 State described in this paragraph is a State that— 

9 ‘‘(A) meets the continuous eligibility re10 quirement of paragraph (2); and 

11 ‘‘(B) has implemented model outreach and 

12 enrollment practices in accordance with at least 

13 3 subparagraphs of paragraph (3) (relating to 

14 coverage of children under this title and title 

15 XXI). 

16 ‘‘(2) CONTINUOUS ELIGIBILITY REQUIRE17 MENT.—The requirement of this paragraph is that 

18 the State has elected the option of continuous eligi19 bility for a full 12 months for children described in 

20 section 1902(e)(12) under this title, as well as ap21 plying such policy under its State child health plan 

22 under title XXI. 

23 ‘‘(3) MODEL OUTREACH AND ENROLLMENT

24 PRACTICES.— 


ycherry on PROD1PC64 with BILLS
28 

•S 895 IS

1 ‘‘(A) APPLICATION OUTREACH PROCESS.— 

2 The State makes available to parents and care3 taker relatives of children, in English and other 

4 languages that shall be required by the Sec5 retary to comply with title VI of the Civil 

6 Rights Act of 1964, information regarding ap7 plying, and upon request, an application, for 

8 medical assistance for children under this title 

9 and for child health assistance under title XXI 

10 consistent with the following: 

11 ‘‘(i) POSTING OF AVAILABILITY OF IN12 FORMATION.—An announcement con13 cerning the availability of such information 

14 and applications is posted in a conspicuous 

15 manner at a location that is easily acces16 sible to the public— 

17 ‘‘(I) in each hospital in the State 

18 that is a participating provider under 

19 the State child health plan under title 

20 XXI or under the State plan under 

21 this title; 

22 ‘‘(II) in each public elementary 

23 and secondary school in the State; 

24 and 


ycherry on PROD1PC64 with BILLS
29 

•S 895 IS

1 ‘‘(III) in the facility of each pub2 lic health care provider in the State, 

3 including federally-qualified health 

4 centers and rural health centers, par5 ticipating under such State child 

6 health plan or under this title. 

7 ‘‘(ii) YEAR-ROUND AVAILABILITY OF

8 APPLICATIONS.—Such applications are 

9 made available in such locations on an on10 going basis. 

11 ‘‘(iii) ANNUAL ENROLLMENT CAM12 PAIGN IN SCHOOLS.—An outreach and en13 rollment campaign is conducted at least 

14 annually in such public elementary and 

15 secondary schools, during which informa16 tion concerning enrollment of children is 

17 sent to the homes of children. 

18 ‘‘(iv) OUTSTATIONING OR TRAINING

19 OF STAFF FOR INITIAL PROCESSING.—Pro20 viding for the receipt and initial processing 

21 of any such application at each facility 

22 specified in section 1902(a)(55) and at 

23 each school described in clause (i)(II) in 

24 which not less than 30 percent of the stu25 dents are eligible for free or reduced lunch 


ycherry on PROD1PC64 with BILLS
30 

•S 895 IS

1 under the Richard D. Russell National 

2 School Lunch Act, through— 

3 ‘‘(I) the stationing at such facil4 ity or school of State or local agency 

5 personnel to determine eligibility for 

6 such assistance; or 

7 ‘‘(II) upon request of the facility 

8 or school, the training and certifi9 cation of personnel of such facility or 

10 school (and access to necessary auto11 mated data systems) to make such 

12 initial eligibility determinations. 

13 ‘‘(B) ONE-STEP APPLICATION PROCESS.— 

14 ‘‘(i) IN GENERAL.—The State pro15 vides for either or both of the following: 

16 ‘‘(I) The one-step enrollment 

17 process described in clause (ii). 

18 ‘‘(II) The express lane process 

19 described in clause (iii). 

20 ‘‘(ii) ONE-STEP APPLICATION PROC21 ESS (SINGLE APPLICATION FOR MULTIPLE

22 PUBLIC ASSISTANCE PROGRAMS).—The 

23 State treats an application for assistance 

24 for or on behalf of a child (who has not 

25 otherwise been determined eligible for asVerDate Aug 31 2005 22:22 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S895.IS S895

ycherry on PROD1PC64 with BILLS
31 

•S 895 IS

1 sistance under this title or title XXI) 

2 under any public assistance program ad3 ministered by another Federal or State 

4 agency, including the agencies admin5 istering the Food Stamp Act of 1977, the 

6 Richard B. Russell National School Lunch 

7 Act, and the Child Nutrition Act of 1966, 

8 notwithstanding any differences in budget 

9 unit, disregard, deeming, or other method10 ology, as an application for medical assist11 ance under this title for the child, or for 

12 child health assistance under title XXI, but 

13 only if— 

14 ‘‘(I) such agency has fiscal liabil15 ities under such program that are af16 fected or potentially affected by such 

17 determinations; and 

18 ‘‘(II) any information furnished 

19 by such agency pursuant to this 

20 clause is kept confidential (except 

21 from the applicant and the applicant’s 

22 parent or caretaker relative) and is 

23 used solely for purposes of deter24 mining eligibility for medical assistVerDate Aug 31 2005 22:22 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S895.IS S895

ycherry on PROD1PC64 with BILLS
32 

•S 895 IS

1 ance under this title or for child 

2 health assistance under title XXI. 

3 ‘‘(iii) EXPRESS LANE PROCESS (AC4 CEPTANCE OF INCOME-RELATED DETER5 MINATIONS FOR OTHER ASSISTANCE PRO6 GRAMS).—The State is implementing the 

7 option provided under section 1902(e)(13) 

8 under title XIX, as well as under this title 

9 pursuant to section 2107(e)(1)(C). 

10 ‘‘(C) ADMINISTRATIVE VERIFICATION OF

11 INCOME.—The State permits a parent or care12 taker relative of a child applying for medical as13 sistance under this title or child health assist14 ance under title XXI to declare and certify by 

15 signature under penalty of perjury information 

16 relating to family income, assets, expenses, and 

17 other financial information for purposes of de18 termining and redetermining financial eligibility 

19 and not to routinely require an in-person inter20 view, except in cases justified by individual cir21 cumstances. Nothing in this subparagraph shall 

22 be construed as preventing a State from taking 

23 steps to verify information provided or to seek 

24 further information and documentation from 


ycherry on PROD1PC64 with BILLS
33 

•S 895 IS

1 applicants in individual cases in the case of dis2 crepancies or where otherwise justified. 

3 ‘‘(D) SIMPLIFIED, CONSISTENT APPLICA4 TION FORM AND PROCESS.—The State uses an 

5 application form and process consistent with 

6 the following: 

7 ‘‘(i) The application forms and mate8 rials are in such languages in addition to 

9 English as shall be required by the Sec10 retary to comply with title VI of the Civil 

11 Rights Act of 1964. 

12 ‘‘(ii) The application form and supple13 mental forms (if any) and information 

14 verification process is the same for pur15 poses of establishing and renewing eligi16 bility for children for medical assistance 

17 under this title and child health assistance 

18 under title XXI. 

19 ‘‘(iii) The process does not require an 

20 application to be made in person or a face21 to-face interview, unless there are discrep22 ancies or individual circumstances justi23 fying an in-person application or face-to24 face interview. 


ycherry on PROD1PC64 with BILLS
34 

•S 895 IS

1 ‘‘(E) USE OF ADMINISTRATIVE RE2 NEWAL.— 

3 ‘‘(i) IN GENERAL.—The State pro4 vides, in the case of renewal of a child’s 

5 eligibility for medical assistance under this 

6 title or child health assistance under title 

7 XXI, that notice is provided to the parent 

8 or caretaker relative of the child that eligi9 bility of the child will be renewed and con10 tinued based on the information available 

11 to the State unless the State is provided 

12 other information. 

13 ‘‘(ii) SATISFACTION THROUGH DEM14 ONSTRATED USE OF EX PARTE PROCESS.— 

15 A State shall be treated as satisfying the 

16 requirement of clause (i) if renewal of eli17 gibility of children under this title or title 

18 XXI is determined on an ex parte basis, 

19 without any requirement for an in-person 

20 interview, unless sufficient information is 

21 not in the State’s possession and cannot be 

22 acquired from other sources (including 

23 other State agencies) without the partici24 pation of the applicant or the applicant’s 

25 parent or caretaker relative. 


ycherry on PROD1PC64 with BILLS
35 

•S 895 IS

1 ‘‘(F) APPLICATION OF PRESUMPTIVE ELI2 GIBILITY.—The State has implemented the op3 tion, for purposes of both this title and title 

4 XXI, of applying presumptive eligibility provi5 sions under sections 1920, 1920A, and 

6 2107(e)(1)(G). 

7 ‘‘(4) DETERMINATION OF INCREASE.— 

8 ‘‘(A) IN GENERAL.—For purposes of 

9 clause (5) of the first sentence of subsection 

10 (b), in the case of a State described in such 

11 clause, the number of percentage points deter12 mined under this paragraph is equal to the 

13 product of the phase-in percentage for the State 

14 (specified under subparagraph (B)) multiplied 

15 by the number of percentage points by which 

16 the Federal medical assistance percentage de17 termined for the State under subsection (b) 

18 (without regard to clause (5) of such sub19 section) is less than the enhanced FMAP de20 scribed in section 2105(b). 

21 ‘‘(B) PHASE-IN PERCENTAGE.—For pur22 poses of subparagraph (A), the phase-in per23 centage specified in this subparagraph for a 

24 State for a fiscal year is equal to— 


ycherry on PROD1PC64 with BILLS
36 

•S 895 IS

1 ‘‘(i) the number of percentage points 

2 by which— 

3 ‘‘(I) the income level established 

4 by the State under the most recent 

5 plan amendment of such State re6 ferred to in section 1905(b)(5), ex7 pressed in terms of a number of per8 centage points of the official poverty 

9 line; exceeds 

10 ‘‘(II) the applicable income level 

11 established by the State as of January 

12 1, 2007, expressed in terms of a num13 ber of percentage points of the official 

14 poverty line, in order to be a targeted 

15 low-income child under the State plan 

16 under title XXI; divided by 

17 ‘‘(ii) the number of percentage points 

18 by which 400 exceeds the applicable in19 come level (expressed in percentage points) 

20 described in clause (i)(II). 

21 ‘‘(5) INCREASE IN CAP ON PAYMENTS TO TER22 RITORIES.—If Puerto Rico, the Virgin Islands, 

23 Guam, the Northern Mariana Islands, or American 

24 Samoa qualify for an increase under subsection 

25 (b)(5) for a calendar quarter for a fiscal year, the 


ycherry on PROD1PC64 with BILLS
37 

•S 895 IS

1 additional Federal financial participation under this 

2 title that results from enrollment of additional chil3 dren under this title for such fiscal year because of 

4 the exercise of such option shall not be counted to5 wards the limitation on expenditures under this title 

6 for such commonwealth or territory otherwise deter7 mined under subsections (f) and (g) of section 1108. 

8 ‘‘(6) SCOPE OF APPLICATION.—The increase in 

9 the Federal medical assistance percentage under 

10 subsection (b)(5) shall only apply for purposes of 

11 payments under section 1903 with respect to med12 ical assistance provided to children and shall not 

13 apply with respect to— 

14 ‘‘(A) disproportionate share hospital pay15 ments described in section 1923; 

16 ‘‘(B) payments under title IV or XXI; or 

17 ‘‘(C) any payments under this title that 

18 are based on the enhanced FMAP described in 

19 section 2105(b). 

20 ‘‘(7) RULE OF CONSTRUCTION.—Nothing in 

21 this subsection shall be construed as preventing a 

22 State from implementing any of the model outreach 

23 and enrollment practices described in paragraph (3), 

24 notwithstanding that the State may not qualify for 


ycherry on PROD1PC64 with BILLS
38 

•S 895 IS

1 an increase in the Federal medical assistance per2 centage under subsection (b)(5).’’. 

3 Subtitle D—State Options for 

4 Additional Coverage Expansions 

5 SEC. 131. OPTIONAL COVERAGE OF OLDER CHILDREN 

6 UNDER MEDICAID AND SCHIP. 

7 (a) MEDICAID.— 

8 (1) IN GENERAL.—Section 1902(l)(1)(D) (42 

9 U.S.C. 1396a(l)(1)(D)) is amended by inserting 

10 ‘‘(or, at the election of a State, 20, 21, 22, 23, 24, 

11 or 25 years of age)’’ after ‘‘19 years of age’’. 

12 (2) CONFORMING AMENDMENTS.— 

13 (A) Section 1902(e)(3)(A) (42 U.S.C. 

14 1396a(e)(3)(A)) is amended by inserting ‘‘(or 1 

15 year less than the age the State has elected 

16 under subsection (l)(1)(D))’’ after ‘‘18 years of 

17 age’’. 

18 (B) Section 1902(e)(12) (42 U.S.C. 

19 1396a(e)(12)) is amended by inserting ‘‘or such 

20 higher age as the State has elected under sub21 section (l)(1)(D)’’ after ‘‘19 years of age’’. 

22 (C) Section 1920A(b)(1) (42 U.S.C. 

23 1396r–1a(b)(1)) is amended by inserting ‘‘or 

24 such higher age as the State has elected under 

25 section 1902(l)(1)(D)’’ after ‘‘19 years of age’’. 


ycherry on PROD1PC64 with BILLS
39 

•S 895 IS

1 (D) Section 1928(h)(1) (42 U.S.C. 

2 1396s(h)(1)) is amended by inserting ‘‘or 1 

3 year less than the age the State has elected 

4 under section 1902(l)(1)(D)’’ before the period 

5 at the end. 

6 (E) Section 1932(a)(2)(A) (42 U.S.C. 

7 1396u–2(a)(2)(A)) is amended by inserting 

8 ‘‘(or such higher age as the State has elected 

9 under section 1902(l)(1)(D))’’ after ‘‘19 years 

10 of age’’. 

11 (b) TITLE XXI.—Section 2110(c)(1) (42 U.S.C. 

12 1397jj(c)(1)) is amended by inserting ‘‘(or such higher age 

13 as the State has elected under section 1902(l)(1)(D))’’. 

14 SEC. 132. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 

15 UNDER THE MEDICAID PROGRAM AND SCHIP. 

16 (a) MEDICAID PROGRAM.—Section 1903(v) (42 

17 U.S.C. 1396b(v)) is amended— 

18 (1) in paragraph (1), by striking ‘‘paragraph 

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

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

21 paragraph: 

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

23 under this title) to provide medical assistance under this 

24 title, notwithstanding sections 401(a), 402(b), 403, and 

25 421 of the Personal Responsibility and Work Opportunity 


ycherry on PROD1PC64 with BILLS
40 

•S 895 IS

1 Reconciliation Act of 1996, for aliens who are lawfully re2 siding in the United States (including battered aliens de3 scribed in section 431(c) of such Act) and who are other4 wise eligible for such assistance, within either or both of 

5 the following eligibility categories: 

6 ‘‘(i) PREGNANT WOMEN.—Women during preg7 nancy (and during the 60-day period beginning on 

8 the last day of the pregnancy). 

9 ‘‘(ii) CHILDREN.—Individuals under 21 years of 

10 age, including optional targeted low-income children 

11 described in section 1905(u)(2)(B). 

12 ‘‘(B) In the case of a State that has elected to provide 

13 medical assistance to a category of aliens under subpara14 graph (A), no debt shall accrue under an affidavit of sup15 port against any sponsor of such an alien on the basis 

16 of provision of assistance to such category and the cost 

17 of such assistance shall not be considered as an unreim18 bursed cost.’’. 

19 (b) SCHIP.—Section 2107(e)(1) (42 U.S.C. 

20 1397gg(e)(1)), as amended by section 103(b)(3), is 

21 amended by redesignating subparagraphs (D) and (E) as 

22 subparagraph (E) and (F), respectively, and by inserting 

23 after subparagraph (C) the following new subparagraph: 

24 ‘‘(D) Section 1903(v)(4)(A)(ii) (relating to 

25 optional coverage of categories of lawfully residVerDate Aug 31 2005 22:22 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S895.IS S895

ycherry on PROD1PC64 with BILLS
41 

•S 895 IS

1 ing immigrant children), but only if the State 

2 has elected to apply such section to the cat3 egory of children under title XIX.’’. 

4 SEC. 133. STATE OPTION TO EXPAND OR ADD COVERAGE 

5 OF CERTAIN PREGNANT WOMEN UNDER 

6 SCHIP. 

7 (a) SCHIP.— 

8 (1) COVERAGE.—Title XXI (42 U.S.C. 1397aa 

9 et seq.), as amended by section 102, is amended by 

10 adding at the end the following new section: 

11 ‘‘SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-IN12 COME PREGNANT WOMEN. 

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

14 other provision of this title, a State may provide for cov15 erage, through an amendment to its State child health 

16 plan under section 2102, of pregnancy-related assistance 

17 for targeted low-income pregnant women in accordance 

18 with this section, but only if— 

19 ‘‘(1) the State has established an income eligi20 bility level— 

21 ‘‘(A) for pregnant women under subsection 

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

23 that is at least 185 percent of the poverty line; 

24 and 


ycherry on PROD1PC64 with BILLS
42 

•S 895 IS

1 ‘‘(B) for children under this title that is at 

2 least 200 percent of the poverty line; and 

3 ‘‘(2) the State meets the requirement of section 

4 2105(i)(2) (relating to no waiting list for children). 

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

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

7 term ‘pregnancy-related assistance’ has the meaning 

8 given the term child health assistance in section 

9 2110(a) as if any reference to targeted low-income 

10 children were a reference to targeted low-income 

11 pregnant women. 

12 ‘‘(2) TARGETED LOW-INCOME PREGNANT

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

14 woman’ means a woman— 

15 ‘‘(A) during pregnancy and through the 

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

17 (beginning on the last day of her pregnancy) 

18 ends; 

19 ‘‘(B) whose family income exceeds 185 per20 cent of the poverty level applicable to a family 

21 of the size involved, but does not exceed the in22 come eligibility level established under the State 

23 child health plan under this title for a targeted 

24 low-income child; and 


ycherry on PROD1PC64 with BILLS
43 

•S 895 IS

1 ‘‘(C) who satisfies the requirements of 

2 paragraphs (1)(A), (1)(C), (2), and (3) of sec3 tion 2110(b). 

4 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

5 RULES.—In the case of, and with respect to, a State pro6 viding for coverage of pregnancy-related assistance to tar7 geted low-income pregnant women under subsection (a), 

8 the following special rules apply: 

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

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

11 deemed to include a reference to a targeted low-in12 come pregnant woman. 

13 ‘‘(2) Any such reference to child health assist14 ance with respect to such women is deemed a ref15 erence to pregnancy-related assistance. 

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

17 reference to a woman during pregnancy and the pe18 riod described in subsection (b)(2)(A). 

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

20 reference to children found through screening to be 

21 eligible for medical assistance under the State med22 icaid plan under title XIX is deemed a reference to 

23 pregnant women. 

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

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


ycherry on PROD1PC64 with BILLS
44 

•S 895 IS

1 preexisting condition and no waiting period (includ2 ing any waiting period imposed to carry out section 

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

4 ‘‘(6) In applying section 2103(e)(3)(B) in the 

5 case of a pregnant woman provided coverage under 

6 this section, the limitation on total annual aggregate 

7 cost-sharing shall be applied to such pregnant 

8 woman. 

9 ‘‘(7) In applying section 2104(i)— 

10 ‘‘(A) in the case of State which did not 

11 provide for coverage for pregnant women under 

12 this title (under a waiver or otherwise) during 

13 fiscal year 2007, the allotment amount other14 wise computed for the first fiscal year in which 

15 the State elects to provide coverage under this 

16 section shall be increased by an amount (deter17 mined by the Secretary) equal to the enhanced 

18 FMAP of the expenditures under this title for 

19 such coverage, based upon projected enrollment 

20 and per capita costs of such enrollment; and 

21 ‘‘(B) in the case of a State which provided 

22 for coverage of pregnant women under this title 

23 for the previous fiscal year— 

24 ‘‘(i) in applying paragraph (1)(B)(ii) 

25 of such section, there shall also be taken 


ycherry on PROD1PC64 with BILLS
45 

•S 895 IS

1 into account (in an appropriate proportion) 

2 the percentage increase in births in the 

3 United States for the relevant period; and 

4 ‘‘(ii) in applying paragraph (1)(C), 

5 pregnant women (and per capita expendi6 tures for such women) shall be accounted 

7 for separately from children, but shall be 

8 included in the total amount of any allot9 ment adjustment under such paragraph. 

10 ‘‘(d) AUTOMATIC ENROLLMENT FOR CHILDREN

11 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS12 SISTANCE.—If a child is born to a targeted low-income 

13 pregnant woman who was receiving pregnancy-related as14 sistance under this section on the date of the child’s birth, 

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

16 assistance under the State child health plan and to have 

17 been found eligible for such assistance under such plan 

18 or to have applied for medical assistance under title XIX 

19 and to have been found eligible for such assistance under 

20 such title, as appropriate, on the date of such birth and 

21 to remain eligible for such assistance until the child at22 tains 1 year of age. During the period in which a child 

23 is deemed under the preceding sentence to be eligible for 

24 child health or medical assistance, the child health or med25 ical assistance eligibility identification number of the 


ycherry on PROD1PC64 with BILLS
46 

•S 895 IS

1 mother shall also serve as the identification number of the 

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

3 such number (unless the State issues a separate identifica4 tion number for the child before such period expires).’’. 

5 (2) NO COST-SHARING FOR PREGNANCY-RE6 LATED BENEFITS.—Section 2103(e)(2) (42 U.S.C. 

7 1397cc(e)(2)) is amended— 

8 (A) in the heading, by inserting ‘‘or preg9 nancy-related services’’ after ‘‘preventive serv10 ices’’; and 

11 (B) by inserting before the period at the 

12 end the following: ‘‘or for pregnancy-related 

13 services’’. 

14 (3) ADDITIONAL AMENDMENT.—Section 

15 2107(e)(1)(G) (42 U.S.C. 1397gg(e)(1)(G)), as re16 designated by sections 103(b), 132(b), and 207, is 

17 amended to read as follows: 

18 ‘‘(G) Sections 1920 and 1920A (relating to 

19 presumptive eligibility for pregnant women and 

20 children).’’. 

21 (b) AMENDMENTS TO MEDICAID.— 

22 (1) ELIGIBILITY OF ANEWBORN.—Section 

23 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended in 

24 the first sentence by striking ‘‘so long as the child 

25 is a member of the woman’s household and the 


ycherry on PROD1PC64 with BILLS
47 

•S 895 IS

1 woman remains (or would remain if pregnant) eligi2 ble for such assistance’’. 

3 (2) APPLICATION OF QUALIFIED ENTITIES TO

4 PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN

5 UNDER MEDICAID.—Section 1920(b) (42 U.S.C. 

6 1396r–1(b)) is amended by adding after paragraph 

7 (2) the following flush sentence: 

8 ‘‘The term ‘qualified provider’ includes a qualified entity, 

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

10 TITLE II—REMOVAL OF OTHER 

11 BARRIERS TO COVERAGE 

12 SEC. 201. ESTABLISHMENT OF NEW BASE SCHIP ALLOT13 MENTS THAT ARE RESPONSIVE TO IN14 CREASES IN HEALTH CARE COSTS AND EN15 ROLLMENT EXPANSIONS. 

16 Section 2104 (42 U.S.C. 1397dd), as amended by 

17 section 101(b), is amended— 

18 (1) in subsection (a)— 

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

20 the end; 

21 (B) in paragraph (10), by striking the pe22 riod at the end and inserting ‘‘; and’’; and 

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

24 paragraph: 


ycherry on PROD1PC64 with BILLS
48 

•S 895 IS

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

2 fiscal year, the sum of the State allotments provided 

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

4 (2) in subsection (b)(1), by striking ‘‘and (h)’’ 

5 and inserting ‘‘(h), and (i)’’; and 

6 (3) in subsection (c)(1), by striking ‘‘and (h)’’ 

7 and inserting ‘‘(h), and (i)’’. 

8 (4) by adding at the end the following new sub9 section: 

10 ‘‘(i) ALLOTMENTS FOR STATES AND TERRITORIES

11 BEGINNING WITH FISCAL YEAR 2008.— 

12 ‘‘(1) GENERAL ALLOTMENT COMPUTATION.— 

13 ‘‘(A) IN GENERAL.—Subject to the suc14 ceeding provisions of this subsection, the Sec15 retary shall compute a State allotment for each 

16 State for each fiscal year as follows: 

17 ‘‘(i) REBASING IN FISCAL YEAR 2008

18 AND EACH SECOND SUCCEEDING FISCAL

19 YEAR.—For fiscal year 2008 and each sec20 ond succeeding fiscal year, the allotment of 

21 a State is equal to the Federal payments 

22 to the State that are attributable to (and 

23 countable towards) the allotment under 

24 this section for the State for the previous 

25 fiscal year multiplied by the allotment inVerDate Aug 31 2005 22:22 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S895.IS S895

ycherry on PROD1PC64 with BILLS
49 

•S 895 IS

1 crease factor under subparagraph (B) for 

2 the fiscal year involved. 

3 ‘‘(ii) USING PROJECTIONS FOR FISCAL

4 YEAR 2009 AND EACH SECOND SUCCEEDING

5 FISCAL YEAR.—For fiscal year 2009 and 

6 each second succeeding fiscal year, the al7 lotment of a State is equal to the amount 

8 of the State allotment under this subpara9 graph for the previous fiscal year multi10 plied by the allotment increase factor 

11 under subparagraph (B) for the fiscal year 

12 involved. 

13 ‘‘(B) ALLOTMENT INCREASE FACTOR.— 

14 The allotment increase factor under this sub15 paragraph for a fiscal year is equal to the prod16 uct of the following: 

17 ‘‘(i) PER CAPITA HEALTH CARE

18 GROWTH FACTOR.—One plus the percent19 age increase in the projected per capita 

20 amount of National Health Expenditures 

21 from the second previous fiscal year to the 

22 previous fiscal year, as most recently pub23 lished by the Secretary before the begin24 ning of the fiscal year involved. 


ycherry on PROD1PC64 with BILLS
50 

•S 895 IS

1 ‘‘(ii) CHILD POPULATION GROWTH

2 FACTOR.—One plus the percentage in3 crease in the population of children under 

4 20 years of age in the State from July 1 

5 in such second previous fiscal year to July 

6 1 in the previous fiscal year, as determined 

7 by the Secretary based on the most recent 

8 published estimates of the Bureau of the 

9 Census before the beginning of the fiscal 

10 year involved. 

11 ‘‘(C) OUTREACH ADJUSTMENT.— 

12 ‘‘(i) IN GENERAL.—If a State’s ex13 penditures under this title in a fiscal year 

14 (beginning with fiscal year 2008) exceeds 

15 the allotment provided under this section 

16 (determined without regard to any reallot17 ment it receives that is available for ex18 penditure during such fiscal year) and if 

19 the average number of enrollees in the 

20 State under this title for such fiscal year 

21 exceeds its target number of enrollees for 

22 that year, for the subsequent fiscal year 

23 the allotment under this section for the 

24 State shall be increased by the amount by 

25 which— 


ycherry on PROD1PC64 with BILLS
51 

•S 895 IS

1 ‘‘(I) the product of— 

2 ‘‘(aa) such additional num3 ber of enrollees; and 

4 ‘‘(bb) the projected per cap5 ita Federal expenditures under 

6 the State child health plan (as 

7 determined under clause (iii) for 

8 such subsequent fiscal year); re9 duced by 

10 ‘‘(II) the amount of any allot11 ment redistributed to the State under 

12 this section for such subsequent fiscal 

13 year. 

14 ‘‘(ii) TARGET NUMBER OF ENROLL15 EES.—In this subsection, the target num16 ber of enrollees for a State for a fiscal year 

17 is equal to the average number of enrollees 

18 enrolled in the State child health plan 

19 under this title during fiscal year 2007 in20 creased (for each subsequent fiscal year 

21 through the fiscal year involved) by the 

22 population growth for children in that 

23 State for the year ending on June 30 be24 fore the beginning of the fiscal year (as es25 timated by the Bureau of the Census). 


ycherry on PROD1PC64 with BILLS
52 

•S 895 IS

1 ‘‘(iii) PROJECTED PER CAPITA FED2 ERAL EXPENDITURES.—For purposes of 

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

4 capita Federal expenditures under a State 

5 child health plan for a fiscal year is equal 

6 to the average per capita Federal expendi7 tures under such plan for fiscal year 2007, 

8 increased (for each subsequent fiscal year 

9 up to and including the fiscal year in10 volved) by the annual percentage increase 

11 in per capita amount of National Health 

12 Expenditures (as estimated by the Sec13 retary) for the respective subsequent fiscal 

14 year. 

15 ‘‘(iv) AVAILABILITY.—Notwith16 standing subsection (e), an increase in al17 lotment under this paragraph shall only be 

18 available for expenditure during the fiscal 

19 year in which it is provided. 

20 ‘‘(v) INTERACTION WITH OTHER PRO21 VISIONS.— 

22 ‘‘(I) COVERAGE EXPANSION

23 STATES.—In the case of a State that 

24 has an increased allotment under sec25 tion 2105(i)— 


ycherry on PROD1PC64 with BILLS
53 

•S 895 IS

1 ‘‘(aa) there shall be no in2 creased allotment under para3 graph (2); and 

4 ‘‘(bb) the allotment under 

5 this subsection shall not be sub6 ject to reallotment or redistribu7 tion to other States. 

8 ‘‘(II) NO REALLOTMENT OF OUT9 REACH ADJUSTMENT.—In no case 

10 shall any increase in allotment under 

11 paragraph (2) for a State be subject 

12 to reallotment or redistribution to 

13 other States.’’. 

14 SEC. 202. 2-YEAR INITIAL AVAILABILITY OF SCHIP ALLOT15 MENTS. 

16 Section 2104(e) (42 U.S.C. 1397dd(e)) is amended 

17 to read as follows: 

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

19 ‘‘(1) IN GENERAL.—Except as provided in para20 graph (2), amounts allotted to a State pursuant to 

21 this section— 

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

23 2007, shall remain available for expenditure by 

24 the State through the end of the second suc25 ceeding fiscal year; and 


ycherry on PROD1PC64 with BILLS
54 

•S 895 IS

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

2 year thereafter, shall remain available for ex3 penditure by the State through the end of the 

4 succeeding fiscal year. 

5 ‘‘(2) AVAILABILITY OF AMOUNTS REALLOT6 TED.—Amounts reallotted to a State under sub7 section (f) shall be available for expenditure by the 

8 State through the end of the fiscal year in which 

9 they are reallotted.’’. 

10 SEC. 203. REDISTRIBUTION OF UNUSED ALLOTMENTS TO 

11 ADDRESS STATE FUNDING SHORTFALLS. 

12 Section 2104(f) (42 U.S.C. 1397dd(f)) is amended— 

13 (1) by striking ‘‘The Secretary’’ and inserting 

14 the following: 

15 ‘‘(1) IN GENERAL.—The Secretary’’; 

16 (2) by striking ‘‘States that have fully expended 

17 the amount of their allotments under this section’’ 

18 and inserting ‘‘States that the Secretary determines 

19 with respect to the fiscal year for which unused al20 lotments are available for redistribution under this 

21 subsection, are shortfall States described in para22 graph (2) for such fiscal year’’; and 

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

24 paragraph: 

25 ‘‘(2) SHORTFALL STATES DESCRIBED.— 


ycherry on PROD1PC64 with BILLS
55 

•S 895 IS

1 ‘‘(A) IN GENERAL.—For purposes of para2 graph (1), with respect to a fiscal year, a short3 fall State described in this subparagraph is a 

4 State with a State child health plan approved 

5 under this title for which the Secretary esti6 mates on the basis of the most recent data 

7 available to the Secretary, that the projected ex8 penditures under such plan for the State for the 

9 fiscal year will exceed the sum of— 

10 ‘‘(i) the amount of the State’s allot11 ments for any preceding fiscal years that 

12 remain available for expenditure and that 

13 will not be expended by the end of the im14 mediately preceding fiscal year; and 

15 ‘‘(ii) the amount of the State’s allot16 ment for the fiscal year. 

17 ‘‘(B) PRORATION RULE.—If the amounts 

18 available for redistribution under paragraph (1) 

19 for a fiscal year are less than the total amounts 

20 of the estimated shortfalls determined for the 

21 year under subparagraph (A), the amount to be 

22 reallotted under such paragraph for each short23 fall State shall be reduced proportionally. 

24 ‘‘(C) RETROSPECTIVE ADJUSTMENT.—The 

25 Secretary may adjust the estimates and deterVerDate Aug 31 2005 22:22 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\S895.IS S895

ycherry on PROD1PC64 with BILLS
56 

•S 895 IS

1 minations made under paragraph (1) and this 

2 paragraph with respect to a fiscal year as nec3 essary on the basis of the amounts reported by 

4 States not later than November 30 of the suc5 ceeding fiscal year, as approved by the Sec6 retary.’’. 

7 SEC. 204. INCENTIVES FOR SCHOOL-BASED OUTREACH AND 

8 ENROLLMENT. 

9 Section 2105(a) (42 U.S.C. 1397ee(a)) is amended 

10 by adding at the end the following new paragraph: 

11 ‘‘(3) SPECIAL RULE FOR SCHOOL-BASED OUT12 REACH AND ENROLLMENT ACTIVITIES.—With re13 spect to expenditures in a quarter for school-based 

14 outreach and enrollment activities— 

15 ‘‘(A) the ‘enhanced FMAP’ for purposes of 

16 paragraph (1) is equal to 90 percent; and 

17 ‘‘(B) the limitation under subsection 

18 (c)(2)(A) shall not apply to such expendi19 tures.’’. 

20 SEC. 205. MEDICAID CITIZENSHIP DOCUMENTATION RE21 QUIREMENTS. 

22 (a) STATE OPTION TO REQUIRE CERTAIN INDIVID23 UALS TO PRESENT SATISFACTORY DOCUMENTARY EVI24 DENCE OF PROOF OF CITIZENSHIP OR NATIONALITY FOR

25 PURPOSES OF ELIGIBILITY FOR MEDICAID.— 


ycherry on PROD1PC64 with BILLS
57 

•S 895 IS

1 (1) IN GENERAL.—Section 1902(a)(46) (42 

2 U.S.C. 1396a(a)(46)) is amended— 

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

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

5 and 

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

7 subparagraph: 

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

9 section 1903(x), require that, with respect to an in10 dividual (other than an individual described in sec11 tion 1903(x)(1)) who declares to be a citizen or na12 tional of the United States for purposes of estab13 lishing initial eligibility for medical assistance under 

14 this title (or, at State option, for purposes of renew15 ing or redetermining such eligibility to the extent 

16 that such satisfactory documentary evidence of citi17 zenship or nationality has not yet been presented), 

18 there is presented satisfactory documentary evidence 

19 of citizenship or nationality of the individual (using 

20 criteria determined by the State, which shall be no 

21 more restrictive than the criteria used by the Social 

22 Security Administration to determine citizenship, 

23 and which shall accept as such evidence a document 

24 issued by a federally-recognized Indian tribe evidenc25 ing membership or enrollment in, or affiliation with, 


ycherry on PROD1PC64 with BILLS
58 

•S 895 IS

1 such tribe (such as a tribal enrollment card or cer2 tificate of degree of Indian blood, and, with respect 

3 to those federally-recognized Indian tribes located 

4 within States having an international border whose 

5 membership includes individuals who are not citizens 

6 of the United States, such other forms of docu7 mentation (including tribal documentation, if appro8 priate) that the Secretary, after consulting with such 

9 tribes, determines to be satisfactory documentary 

10 evidence of citizenship or nationality for purposes of 

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

12 (2) LIMITATION ON WAIVER AUTHORITY.—Not13 withstanding any provision of section 1115 of the 

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

15 provision of law, the Secretary of Health and 

16 Human Services may not waive the requirements of 

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

18 1396a(a)(46)(B)) with respect to a State. 

19 (3) CONFORMING AMENDMENTS.—Section 1903 

20 (42 U.S.C. 1396b) is amended— 

21 (A) in subsection (i)— 

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

23 after the semicolon; 

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

25 or’’ and inserting a period; and 


ycherry on PROD1PC64 with BILLS
59 

•S 895 IS

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

2 (B) in subsection (x) (as amended by sec3 tion 405(c)(1)(A) of division B of the Tax Re4 lief and Health Care Act of 2006 (Public Law 

5 109–432))— 

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

7 (ii) by redesignating paragraph (2) as 

8 paragraph (1); 

9 (iii) in paragraph (1), as so redesig10 nated, by striking ‘‘paragraph (1)’’ and in11 serting ‘‘section 1902(a)(46)(B)’’; and 

12 (iv) by adding at the end the following 

13 new paragraph: 

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

15 citizen or national of the United States with respect to 

16 whom a State requires the presentation of satisfactory 

17 documentary evidence of citizenship or nationality under 

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

19 at least the reasonable opportunity to present satisfactory 

20 documentary evidence of citizenship or nationality under 

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

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

23 to the State of evidence indicating a satisfactory immigra24 tion status.’’. 


ycherry on PROD1PC64 with BILLS
60 

•S 895 IS

1 (b) CLARIFICATION OF RULES FOR CHILDREN BORN

2 IN THE UNITED STATES TO MOTHERS ELIGIBLE FOR

3 MEDICAID.—Section 1903(x) (42 U.S.C. 1396b(x)), as 

4 amended by subsection (a)(3)(B), is amended— 

5 (1) in paragraph (1)— 

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

7 at the end; 

8 (B) by redesignating subparagraph (D) as 

9 subparagraph (E); and 

10 (C) by inserting after subparagraph (C) 

11 the following new subparagraph: 

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

13 1902(e)(4) (and, in the case of an individual who is 

14 eligible for medical assistance on such basis, the in15 dividual shall be deemed to have provided satisfac16 tory documentary evidence of citizenship or nation17 ality and shall not be required to provide further 

18 documentary evidence on any date that occurs dur19 ing or after the period in which the individual is eli20 gible for medical assistance on such basis); or’’; and 

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

22 paragraph: 

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

24 1902(a)(46), the preceding paragraphs of this subsection, 

25 or the Deficit Reduction Act of 2005, including section 


ycherry on PROD1PC64 with BILLS
61 

•S 895 IS

1 6036 of such Act, shall be construed as changing the re2 quirement of section 1902(e)(4) that a child born in the 

3 United States to an alien mother for whom medical assist4 ance for the delivery of such child is available as treatment 

5 of an emergency medical condition pursuant to subsection 

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

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

8 (c) EFFECTIVE DATE.— 

9 (1) RETROACTIVE APPLICATION.—The amend10 ments made by this section shall take effect as if in11 cluded in the enactment of the Deficit Reduction Act 

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

13 (2) RESTORATION OF ELIGIBILITY.—In the 

14 case of an individual who, during the period that 

15 began on July 1, 2006, and ends on the date of en16 actment of this Act, was determined to be ineligible 

17 for medical assistance under a State Medicaid pro18 gram solely as a result of the application of sub19 sections (i)(22) and (x) of section 1903 of the Social 

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

21 who would have been determined eligible for such as22 sistance if such subsections, as amended by sub23 sections (a) and (b), had applied to the individual, 

24 a State may deem the individual to be eligible for 

25 such assistance as of the date that the individual 


ycherry on PROD1PC64 with BILLS
62 

•S 895 IS

1 was determined to be ineligible for such medical as2 sistance on such basis. 

3 SEC. 206. STATE OPTION TO PROVIDE FOR ‘‘EXPRESS LANE’’

4 AND SIMPLIFIED DETERMINATIONS OF A 

5 CHILD’S FINANCIAL ELIGIBILITY FOR MED6 ICAL ASSISTANCE UNDER MEDICAID OR 

7 CHILD HEALTH ASSISTANCE UNDER SCHIP. 

8 (a) MEDICAID.—Section 1902(e) (42 U.S.C. 

9 1396a(e)) is amended by adding at the end the following: 

10 ‘‘(13)(A) At the option of the State, the plan may 

11 provide that eligibility requirements (including such re12 quirements applicable to redeterminations or renewals of 

13 eligibility) for medical assistance relating to income, assets 

14 (or resources), or citizenship status are met for a child 

15 who is under an age specified by the State (not to exceed 

16 21 years of age) by using a determination made within 

17 a reasonable period (as determined by the State) before 

18 its use for this purpose, of the child’s family or household 

19 income, or if applicable for purposes of determining eligi20 bility under this title or title XXI, assets or resources, or 

21 citizenship status, respectively, (notwithstanding any other 

22 provision of law, including sections 1902(a)(46)(B), 

23 1903(x), and 1137(d)), by a Federal or State agency, or 

24 a public or private entity making such determination on 

25 behalf of such agency, specified by the plan, including an 


ycherry on PROD1PC64 with BILLS
63 

•S 895 IS

1 agency administering the State program funded under 

2 part A of title IV, the Food Stamp Act of 1977, the Rich3 ard B. Russell National School Lunch Act, or the Child 

4 Nutrition Act of 1966, notwithstanding any differences in 

5 budget unit, disregard, deeming, or other methodology, 

6 but only if— 

7 ‘‘(i) the agency has fiscal liabilities or respon8 sibilities affected by such determination; and 

9 ‘‘(ii) the agency or entity notifies the child’s 

10 family— 

11 ‘‘(I) of the information which shall be dis12 closed in accordance with this subparagraph; 

13 ‘‘(II) that the information disclosed will be 

14 used solely for purposes of determining eligi15 bility for medical assistance under this title or 

16 for child health assistance under title XXI; and 

17 ‘‘(III) that interagency agreements limit 

18 the use of such information to that purpose; 

19 and 

20 ‘‘(iii) the requirements of section 1939 are sat21 isfied. 

22 ‘‘(B) Nothing in this paragraph shall be construed 

23 to relieve a State of the obligation to determine, on an24 other basis, eligibility for medical assistance under this 

25 title or for child health assistance under title XXI if a 


ycherry on PROD1PC64 with BILLS
64 

•S 895 IS

1 child is determined ineligible for such assistance on the 

2 basis of information furnished pursuant to this paragraph. 

3 ‘‘(C) If a State applies the eligibility process de4 scribed in subparagraph (A) to individuals eligible under 

5 this title and to individuals eligible under title XXI, the 

6 State may, at its option, implement its duties under sub7 paragraphs (A) and (B) of section 2102(b)(3) using either 

8 or both of the following approaches: 

9 ‘‘(i) The State may— 

10 ‘‘(I) establish a threshold percentage of the 

11 Federal poverty level (that shall exceed the in12 come eligibility level applicable for a population 

13 of individuals under this title by 30 percentage 

14 points (as a fraction of the Federal poverty 

15 level) or such other higher number of percent16 age points as the State determines reflects the 

17 typical application of income methodologies by 

18 the non-health program and the State plan 

19 under this title); and 

20 ‘‘(II) provide that, with respect to any in21 dividual within such population whom a non22 health agency determines has income that does 

23 not exceed such threshold percentage for such 

24 population, such individual is eligible for med25 ical assistance under this title (regardless of 


ycherry on PROD1PC64 with BILLS
65 

•S 895 IS

1 whether such individual would otherwise be de2 termined to be eligible to receive such assist3 ance). 

4 In exercising the approach under this clause, a State 

5 shall inform families whose children are enrolled in 

6 a State child health plan under title XXI based on 

7 having family income above the threshold described 

8 in subclause (I) that they may qualify for medical 

9 assistance under this title and, at their option, can 

10 seek a regular eligibility determination for such as11 sistance for their child. 

12 ‘‘(ii) Regardless of whether a State otherwise 

13 provides for presumptive eligibility under section 

14 1920A, a State may provide presumptive eligibility 

15 under this title, consistent with subsection (e) of sec16 tion 1920A, to a child who, based on a determina17 tion by a non-health agency, would qualify for child 

18 health assistance under a State child health plan 

19 under title XXI. During such presumptive eligibility 

20 period, the State may determine the child’s eligibility 

21 for medical assistance under this title, pursuant to 

22 subparagraph (A) of section 2102(b)(3), based on 

23 telephone contact with family members, access to 

24 data available in electronic or paper form, and other 

25 means of gathering information that are less burVerDate Aug 31 2005 22:22 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\S895.IS S895

ycherry on PROD1PC64 with BILLS
66 

•S 895 IS

1 densome to the family than completing an applica2 tion form on behalf of the child. The procedures de3 scribed in the previous sentence may be used regard4 less of whether the State uses similar procedures 

5 under other circumstances for purposes of deter6 mining eligibility for medical assistance under this 

7 title. 

8 ‘‘(D) At the option of a State, the eligibility process 

9 described in subparagraph (A) may apply to an individual 

10 who is not a child. 

11 ‘‘(E)(i) At the option of a State, an individual deter12 mined to be eligible for medical assistance or child health 

13 assistance pursuant to subparagraph (A), (C), or (D) or 

14 other procedures through which eligibility is determined 

15 based on data obtained from sources other than the indi16 vidual may receive medical assistance under this title if 

17 such individual (or, in the case of an individual under age 

18 19 (or if the State elects the option under subparagraph 

19 (A), age 20 or 21) who is not authorized to consent to 

20 medical care, the individual’s parent, guardian, or other 

21 caretaker relative) has acknowledged notice of such deter22 mination and has consented to such eligibility determina23 tion. The State (at its option) may waive any otherwise 

24 applicable requirements for signatures by or on behalf of 

25 an individual who has so consented. 


ycherry on PROD1PC64 with BILLS
67 

•S 895 IS

1 ‘‘(ii) In the case of an individual enrolled pursuant 

2 to clause (i), the State shall inform the individual (or, in 

3 the case of an individual under age 19 (or if the State 

4 elects the option under subparagraph (A), age 20 or 21), 

5 the individual’s parent, guardian, or other caretaker rel6 ative) about the significance of such enrollment, including 

7 appropriate methods to access covered services. 

8 ‘‘(F) For purposes of this paragraph— 

9 ‘‘(i) the term ‘non-health agency’ means an 

10 agency or entity described in subparagraph (A); and 

11 ‘‘(ii) the term ‘non-health benefits’ means the 

12 benefits or assistance provided by a non-health agen13 cy.’’. 

14 (b) SCHIP.—Section 2107(e)(1) (42 U.S.C. 

15 1397gg(e)(1)), as amended by sections 103(b) and 132(b), 

16 is amended by redesignating subparagraphs (C) through 

17 (F) as subparagraphs (D) through (G) and by inserting 

18 after subparagraph (B) the following new subparagraph: 

19 ‘‘(C) Section 1902(e)(13) (relating to the 

20 State option to base a determination of a child’s 

21 eligibility for assistance on determinations made 

22 by a program providing nutrition or other pub23 lic assistance (except that the State option 

24 under subparagraph (D) of such section shall 


ycherry on PROD1PC64 with BILLS
68 

•S 895 IS

1 apply under this title only if an individual is 

2 pregnant)).’’. 

3 (c) PRESUMPTIVE ELIGIBILITY.—Section 1920A (42 

4 U.S.C. 1396r–1a) is amended— 

5 (1) in subsection (b)(3)(A)(i), is amended by 

6 striking ‘‘or (IV)’’ and inserting ‘‘(IV) is an agency 

7 or entity described in section 1902(e)(13)(A), or 

8 (V)’’; and 

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

10 ‘‘(e) In the case of a State with a child health plan 

11 under title XXI that provides for presumptive eligibility 

12 under such plan for children, the State shall make a rea13 sonable effort to place each presumptively eligible child in 

14 the program under this title or title XXI for which the 

15 child appears most likely to qualify. During the child’s pe16 riod of presumptive eligibility, the State shall receive Fed17 eral matching funds under section 1903 or section 2105, 

18 depending on the program in which the child has been 

19 placed. If at the conclusion of such period, the child is 

20 found to qualify for, and is enrolled in, the program estab21 lished under this title or title XXI when the child was en22 rolled in the program under the other such title during 

23 such period, the State’s receipt of Federal matching funds 

24 shall be adjusted both retroactively and prospectively so 

25 that Federal matching funds are provided, both during 


ycherry on PROD1PC64 with BILLS
69 

•S 895 IS

1 and following such period of presumptive eligibility, based 

2 on the program in which the child is enrolled.’’. 

3 (d) SIGNATURE REQUIREMENTS.—Section 1902(a) 

4 (42 U.S.C. 1396a(a)) is amended by adding at the end 

5 the following: ‘‘Notwithstanding any other provision of 

6 law, a signature under penalty of perjury shall not be re7 quired on an application form for medical assistance as 

8 to any element of eligibility for which eligibility is based 

9 on information received from a source other than appli10 cant, rather than on representations from the applicant. 

11 Notwithstanding any other provision of law, any signature 

12 requirement for an application for medical assistance may 

13 be satisfied through an electronic signature, as defined in 

14 section 1710(1) of the Government Paperwork Elimi15 nation Act (44 U.S.C. 3504 note).’’. 

16 SEC. 207. INFORMATION TECHNOLOGY CONNECTIONS TO 

17 IMPROVE HEALTH COVERAGE DETERMINA18 TIONS. 

19 (a) ENHANCED FEDERAL FUNDING FOR IMPROVE20 MENTS RELATED TO IMPLEMENTATION OF CERTAIN

21 MODEL OUTREACH AND ENROLLMENT PRACTICES.— 

22 (1) IN GENERAL.—Section 1903(a)(3)(A) (42 

23 U.S.C. 1396b(a)(3)(A)) is amended— 

24 (A) by striking ‘‘and’’ at the end of clause 

25 (i); and 


ycherry on PROD1PC64 with BILLS
70 

•S 895 IS

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

2 clause: 

3 ‘‘(iii) 75 percent of so much of the sums 

4 expended during such quarter as are attrib5 utable to the design, development, or installa6 tion of such mechanized claims processing and 

7 information retrieval systems and the imple8 mentation of administrative systems and proc9 esses (including modification of eligibility com10 puter systems to permit the exchange of elec11 tronic information with other Federal or State 

12 programs) as the Secretary determines are di13 rectly related to the implementation of a model 

14 outreach and enrollment practice described in 

15 subparagraph (B), (C), (D), (E), or (F) of sec16 tion 1905(y)(3), and’’. 

17 (2) CONFORMING AMENDMENT TO ENSURE

18 AVAILABILITY FOR TERRITORIES.—Section 1108(g) 

19 (42 U.S.C. 1308(g)) is amended by adding at the 

20 end the following new paragraph: 

21 ‘‘(4) ADDITIONAL INCREASE FOR CERTAIN EX22 PENDITURES.—With respect to fiscal year 2008 and 

23 each fiscal year thereafter, if Puerto Rico, the Virgin 

24 Islands, Guam, the Northern Mariana Islands, or 

25 American Samoa qualify for a payment under secVerDate Aug 31 2005 22:22 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\S895.IS S895

ycherry on PROD1PC64 with BILLS
71 

•S 895 IS

1 tion 1903(a)(3)(A)(iii) for a calendar quarter of 

2 such fiscal year, the additional Federal financial par3 ticipation under such section shall not be counted to4 wards the limitation on expenditures under title XIX 

5 for such commonwealth or territory otherwise deter6 mined under subsection (f) and this subsection for 

7 such fiscal year.’’. 

8 (b) AUTHORIZATION OF INFORMATION DISCLO9 SURE.— 

10 (1) IN GENERAL.—Title XIX (42 U.S.C. 1396 

11 et seq.) is amended— 

12 (A) by redesignating section 1939 as sec13 tion 1940; and 

14 (B) by inserting after section 1938 the fol15 lowing: 

16 ‘‘AUTHORIZATION TO RECEIVE PERTINENT INFORMATION

17 ‘‘SEC. 1939. (a) IN GENERAL.—Notwithstanding any 

18 other provision of law, a Federal or State agency or pri19 vate entity in possession of the sources of data potentially 

20 pertinent to eligibility determinations under this title or 

21 title XXI (including eligibility files maintained by pro22 grams described in section 1902(e)(13)(A), information 

23 described in paragraph (2) or (3) of section 1137(a), vital 

24 records information about births in any State, and infor25 mation described in sections 453(i) and 1902(a)(25)(I)) 

26 is authorized to convey such data or information to a State 


ycherry on PROD1PC64 with BILLS
72 

•S 895 IS

1 agency administering a State plan under this title or title 

2 XXI, if— 

3 ‘‘(1) such data or information are used only to 

4 establish or verify eligibility or provide coverage 

5 under this title or title XXI; and 

6 ‘‘(2) an interagency or other agreement, con7 sistent with standards developed by the Secretary, 

8 prevents the unauthorized use, disclosure, or modi9 fication of such data and otherwise meets applicable 

10 Federal requirements safeguarding privacy and data 

11 security. 

12 ‘‘(b) REQUIREMENTS FOR CONVEYANCE.—Data or 

13 information may be conveyed pursuant to this section only 

14 if the following requirements are met: 

15 ‘‘(1) The individual whose circumstances are 

16 described in the data or information (or such indi17 vidual’s parent, guardian, caretaker relative, or au18 thorized representative) has either provided advance 

19 consent to disclosure or has not objected to disclo20 sure after receiving advance notice of disclosure and 

21 a reasonable opportunity to object. 

22 ‘‘(2) Such data or information are used solely 

23 for the purposes of— 

24 ‘‘(A) identifying individuals who are eligi25 ble or potentially eligible for assistance under 


ycherry on PROD1PC64 with BILLS
73 

•S 895 IS

1 this title or title XXI and enrolling such indi2 viduals in the State plans established under 

3 such titles; and 

4 ‘‘(B) verifying the eligibility of individuals 

5 for assistance under the State plans established 

6 under this title or title XXI. 

7 ‘‘(3) An interagency or other agreement, con8 sistent with standards developed by the Secretary— 

9 ‘‘(A) prevents the unauthorized use, disclo10 sure, or modification of such data and other11 wise meets applicable Federal requirements 

12 safeguarding privacy and data security; and 

13 ‘‘(B) requires the State agencies admin14 istering the State plans established under this 

15 title and title XXI to use the data and informa16 tion obtained under this section to seek to en17 roll individuals in such plans. 

18 ‘‘(c) CRIMINAL PENALTY.—A person described in the 

19 subsection (a) who publishes, divulges, discloses, or makes 

20 known in any manner, or to any extent not authorized by 

21 Federal law, any information obtained under this section 

22 shall be fined not more than $1,000 or imprisoned not 

23 more than 1 year, or both for each such unauthorized ac24 tivity. 


ycherry on PROD1PC64 with BILLS
74 

•S 895 IS

1 ‘‘(d) RULE OF CONSTRUCTION.—The limitations and 

2 requirements that apply to disclosure pursuant to this sec3 tion shall not be construed to prohibit the conveyance or 

4 disclosure of data or information otherwise permitted 

5 under Federal law (without regard to this section).’’. 

6 (2) CONFORMING AMENDMENT TO ASSURE AC7 CESS TO NATIONAL NEW HIRES DATABASE.—Section 

8 453(i)(1) (42 U.S.C. 653(i)(1)) is amended by strik9 ing ‘‘and programs funded under part A’’ and in10 serting ‘‘, programs funded under part A, and State 

11 plans approved under title XIX or XXI’’. 

12 (3) CONFORMING AMENDMENT TO PROVIDE

13 SCHIP PROGRAMS WITH ACCESS TO NATIONAL IN14 COME DATA.—Section 6103(l)(7)(D)(ii) of the Inter15 nal Revenue Code of 1986 is amended by inserting 

16 ‘‘or title XXI’’ after ‘‘title XIX’’. 

17 (4) CONFORMING AMENDMENT TO PROVIDE AC18 CESS TO DATA ABOUT ENROLLMENT IN INSURANCE

19 FOR PURPOSES OF EVALUATING APPLICATIONS AND

20 FOR SCHIP.—Section 1902(a)(25)(I)(i) (42 U.S.C. 

21 1396a(a)(25)(I)(i)) is amended— 

22 (A) by inserting ‘‘(and, at State option, in23 dividuals who are potentially eligible or who 

24 apply)’’ after ‘‘with respect to individuals who 

25 are eligible’’; and 


ycherry on PROD1PC64 with BILLS
75 

•S 895 IS

1 (B) by inserting ‘‘under this title (and, at 

2 State option, child health assistance under title 

3 XXI)’’ after ‘‘the State plan’’. 

4 SEC. 208. ENCOURAGING CULTURALLY APPROPRIATE EN5 ROLLMENT PRACTICES. 

6 Section 1903(a)(2) (42 U.S.C. 1396b(a)(2)) is 

7 amended by adding at the end the following new subpara8 graph: 

9 ‘‘(E) an amount equal to 75 percent of so much 

10 of the sums expended during such quarter (as found 

11 necessary by the Secretary for the proper and effi12 cient administration of the State plan) as are attrib13 utable to translation or interpretation services in 

14 connection with the enrollment under this title of 

15 children of families for whom English is not their 

16 primary language; plus’’. 

17 SEC. 209. MODEL OF INTERSTATE COORDINATED ENROLL18 MENT AND COVERAGE PROCESS. 

19 In order to assure continuity of coverage of low-in20 come children under the Medicaid program and the State 

21 Children’s Health Insurance Program (SCHIP), the Sec22 retary of Health and Human Services, in consultation with 

23 State Medicaid and SCHIP directors, shall develop and 

24 disseminate a model process for the coordination of the 

25 enrollment and coverage under such programs of children 


ycherry on PROD1PC64 with BILLS
76 

•S 895 IS

1 who, because of migration of families, emergency evacu2 ations, educational needs, or otherwise, frequently change 

3 their State of residency or otherwise are temporarily 

4 present outside of the State of their residency. 

5 SEC. 210. ELIMINATION OF COUNTING MEDICAID CHILD 

6 PRESUMPTIVE ELIGIBILITY COSTS AGAINST 

7 TITLE XXI ALLOTMENT. 

8 Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)) is 

9 amended— 

10 (1) in the matter preceding subparagraph (A), 

11 by striking ‘‘(or, in the case of expenditures de12 scribed in subparagraph (B), the Federal medical 

13 assistance percentage (as defined in the first sen14 tence of section 1905(b)))’’; and 

15 (2) by amending subparagraph (B) to read as 

16 follows: 

17 ‘‘(B) [reserved]’’. 

18 SEC. 211. AUTHORITY FOR QUALIFYING STATES TO USE 

19 PORTION OF SCHIP ALLOTMENT FOR ANY 

20 FISCAL YEAR FOR CERTAIN MEDICAID EX21 PENDITURES. 

22 Section 2105(g)(1)(A) (42 U.S.C. 1397ee(g)(1)(A)), 

23 as amended by section 201(b) of the National Institutes 

24 of Health Reform Act of 2006 (Public Law 109–482) is 


ycherry on PROD1PC64 with BILLS
77 

•S 895 IS

1 amended by striking ‘‘fiscal year 1998, 1999, 2000, 2001, 

2 2004, 2005, 2006, or 2007’’ and inserting ‘‘a fiscal year’’. 

3 SEC. 212. APPLICATION OF MEDICAID OUTREACH PROCE4 DURES TO ALL PREGNANT WOMEN AND CHIL5 DREN. 

6 (a) IN GENERAL.—Section 1902(a)(55) (42 U.S.C. 

7 1396a(a)(55)) is amended by striking ‘‘individuals for 

8 medical assistance under subsection (a)(10)(A)(i)(IV), 

9 (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or 

10 (a)(10)(A)(ii)(IX)’’ and inserting ‘‘child and pregnant 

11 women for medical assistance (including under clauses 

12 (i)(IV), (i)(VI), (i)(VII), and (ii)(IX) of paragraph 

13 (10)(A))’’. 

14 (b) EFFECTIVE DATE.— 

15 (1) IN GENERAL.—Except as provided in para16 graph (2), the amendment made by subsection (a) 

17 takes effect on January 1, 2008. 

18 (2) EXCEPTION FOR STATE LEGISLATION.—In 

19 the case of a State plan under title XIX of the So20 cial Security Act, which the Secretary of Health and 

21 Human Services determines requires State legisla22 tion in order for the plan to meet the additional re23 quirements imposed by the amendment made by 

24 subsection (a), the State plan shall not be regarded 

25 as failing to comply with the requirements of such 


ycherry on PROD1PC64 with BILLS
78 

•S 895 IS

1 Act solely on the basis of its failure to meet these 

2 additional requirements before the first day of the 

3 first calendar quarter beginning after the close of 

4 the first regular session of the State legislature that 

5 begins after the date of enactment of this Act. For 

6 purposes of the previous sentence, in the case of a 

7 State that has a 2-year legislative session, each year 

8 of the session shall be considered to be a separate 

9 regular session of the State legislature. 

10 TITLE III—EFFECTIVE DATE 

11 SEC. 301. EFFECTIVE DATE. 

12 Unless otherwise provided, the amendments made by 

13 this Act shall take effect on October 1, 2007, and shall 

14 apply to child health assistance and medical assistance 

15 provided on or after that date without regard to whether 

16 or not final regulations to carry out such amendments 

17 have been promulgated by such date. 

Æ 


ycherry on PROD1PC64 with BILLS