I

106TH CONGRESS

2D SESSION H. R. 4927

To amend title XIX and XXI of the Social Security Act to provide for

FamilyCare coverage for parents of enrolled children, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JULY 24, 2000

Mr. DINGELL (for himself, Mr. BROWN of Ohio, Mr. WAXMAN, Mr. STARK,

Mr. BERRY, Mr. GEPHARDT, Mr. ABERCROMBIE, Mr. ALLEN, MR. ANDREWS, Mr. BALDACCI, Ms. BALDWIN, Mr. CROWLEY, Ms. DELAURO,

Mr. DAVIS of Illinois, Mr. DEUTSCH, Mr. DOYLE, Mr. FRANK of Massachusetts, Mr. FROST, Mr. GONZALEZ, Mr. GREEN of Texas, Ms. HOOLEY

of Oregon, Ms. KILPATRICK, Mr. KLINK, Mr. MENENDEZ, Mr. MORAN

of Virginia, Mr. MOORE, Mr. PALLONE, Mr. PAYNE, Ms. ROYBAL-ALLARD, Mr. RAHALL, Mr. RODRIGUEZ, Ms. SCHAKOWSKY, Mrs. LOWEY,

and Mr. WEYGAND) introduced the following bill; which was referred to

the Committee on Commerce

A BILL

To amend title XIX and XXI of the Social Security Act

to provide for FamilyCare coverage for parents of enrolled children, 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; TABLE OF CONTENTS.

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

5 ‘‘FamilyCare Act of 2000’’.
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1 (b) TABLE OF CONTENTS.—The table of contents of

2 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Renaming of title XXI program.

Sec. 3. FamilyCare coverage of parents under the medicaid program and title

XXI.

Sec. 4. Automatic enrollment of children born to title XXI parents.

Sec. 5. Optional coverage of legal immigrants under the medicaid program and

title XXI.

Sec. 6. Optional coverage of children through age 20 under the medicaid program and title XXI.

Sec. 7. Application of simplified title XXI procedures under the medicaid program.

Sec. 8. Improving welfare-to-work transition under the medicaid program.

Sec. 9. Elimination of 100 hour rule and other AFDC-related eligibility restrictions.

Sec. 10. State grant program for market innovation.

Sec. 11. Limitations on conflicts of interest.

Sec. 12. Increase in CHIP allotment for each of fiscal years 2002 through

2004.

Sec. 13. Demonstration programs to improve medicaid and chip outreach to

homeless individuals and families.

Sec. 14. Authority to pay medicaid expansion costs from title XXI appropriation.

Sec. 15. Creation of community access program.

3 SEC. 2. RENAMING OF TITLE XXI PROGRAM.

4 (a) IN GENERAL.—The heading of title XXI of the

5 Social Security Act (42 U.S.C. 1397aa et seq.) is amended

6 to read as follows:

7 ‘‘TITLE XXI—FAMILYCARE PROGRAM’’.

8 (b) PROGRAM REFERENCES.—Any reference in any

9 provision of Federal law or regulation to ‘‘SCHIP’’ or

10 ‘‘State children’s health insurance program’’ under title

11 XXI of the Social Security Act shall be deemed a reference

12 to the FamilyCare program under such title.
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1 SEC. 3. FAMILYCARE COVERAGE OF PARENTS UNDER THE

2 MEDICAID PROGRAM AND TITLE XXI.

3 (a) INCENTIVES TO IMPLEMENT FAMILYCARE COV4 ERAGE.—

5 (1) UNDER MEDICAID.—

6 (A) ESTABLISHMENT OF NEW OPTIONAL

7 ELIGIBILITY CATEGORY.—Section

8 1902(a)(10)(A)(ii) of the Social Security Act

9 (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended—

10 (i) by striking ‘‘or’’ at the end of sub11 clause (XVI);

12 (ii) by adding ‘‘or’’ at the end of sub13 clause (XVII); and

14 (iii) by adding at the end the fol15 lowing new subclause:

16 ‘‘(XVIII) who are parents de17 scribed in subsection (k)(1), but only

18 if the State meets the conditions de19 scribed in subsection (k)(2);’’.

20 (B) CONDITIONS FOR COVERAGE.—Section

21 1902 of such Act is further amended by insert22 ing after subsection (j) the following new sub23 section:

24 ‘‘(k)(1)(A) Parents described in this paragraph are

25 the parents of an individual who is under 19 years of age

26 (or such higher age as the State may have elected under
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1 section 1902(l)(1)(D)) and who is eligible and enrolled for

2 medical assistance under subsection (a)(10)(A), if—

3 ‘‘(i) such parents are not otherwise eligible for

4 such assistance under such subsection; and

5 ‘‘(ii) the income of the family that includes such

6 parents does not exceed an income level specified by

7 the State consistent with paragraph (2)(B).

8 ‘‘(B) In this subsection, the term ‘parent’ has the

9 meaning given the term ‘caretaker’ for purposes of car10 rying out section 1931.

11 ‘‘(2) The conditions for a State to provide medical

12 assistance under subsection (a)(10)(A)(ii)(XVIII) are as

13 follows:

14 ‘‘(A) The State has a State child health plan

15 under title XXI which (whether implemented under

16 such title or under this title)—

17 ‘‘(i) has an income standard (or will estab18 lish an income standard that is effective at the

19 time additional allotments are available to the

20 State under section 2104(d), as amended by the

21 FamilyCare Act of 2000) for children that is at

22 least 200 percent of the poverty line; and

23 ‘‘(ii) does not limit the acceptance of appli24 cations, does not use a waiting list for children

25 who meet eligibility standards to qualify for as-
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1 sistance, and provides benefits to all children in

2 the State who apply for and meet eligibility

3 standards.

4 ‘‘(B) The income level specified under para5 graph (1)(A)(ii) for parents in a family exceeds the

6 income level applicable under section 1931 but does

7 not exceed the highest income level applicable to a

8 child in the family under this title. A State may not

9 cover such parents with higher family income with10 out covering parents with a lower family income.

11 ‘‘(3) In the case of a parent described in paragraph

12 (1) who is also the parent of a child who is eligible and

13 enrolled for child health assistance under title XXI, the

14 State may elect (on a uniform basis) to cover all such par15 ents under section 2111 or under subsection (a)(10)(A).’’.

16 (C) ENHANCED MATCHING FUNDS AVAIL17 ABLE.—Section 1905 of such Act (42 U.S.C.

18 1396d) is amended—

19 (i) in the fourth sentence of sub20 section (b), by striking ‘‘or subsection

21 (u)(3)’’ and inserting ‘‘, (u)(3), or (u)(4)’’;

22 and

23 (ii) in subsection (u)—

24 (I) by redesignating paragraph

25 (4) as paragraph (6), and
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1 (II) by inserting after paragraph

2 (3) the following new paragraph:

3 ‘‘(4) For purposes of subsection (b) and section

4 2105(a)(1):

5 ‘‘(A) FAMILYCARE PARENTS.—The expendi6 tures described in this subparagraph are the fol7 lowing:

8 ‘‘(i) PARENTS.—Expenditures for medical

9 assistance made available under section 1931,

10 or under section 1902(a)(10)(A)(ii)(XVIII) for

11 parents described in section 1902(k)(1), in a

12 family the income of which exceeds the income

13 level applicable under such section 1931 to a

14 family of the size involved as of January 1,

15 2000.

16 ‘‘(ii) CERTAIN PREGNANT WOMEN.—Ex17 penditures for medical assistance for pregnant

18 women under section 1902(l)(1)(A) in a family

19 the income of which exceeds the income level

20 applicable under section 1902(l)(2)(A) to a

21 family of the size involved as of January 1,

22 2000.’’.

23 (D) APPROPRIATION FROM TITLE XXI AL24 LOTMENT FOR CERTAIN MEDICAID EXPANSION

25 COSTS.—Subparagraph (C) of section
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1 2105(a)(1) of such Act, as inserted by section

2 14(a)(3), is amended to read as follows:

3 ‘‘(C) FAMILYCARE PARENTS.—Expendi4 tures for medical assistance that is attributable

5 to expenditures described in section

6 1905(u)(4)(A).’’.

7 (E) ONLY COUNTING ENHANCED PORTION

8 FOR COVERAGE OF ADDITIONAL PREGNANT

9 WOMEN.—Section 1905 of such Act (42 U.S.C.

10 1396d) is amended—

11 (i) in the fourth sentence of sub12 section (b), by inserting ‘‘(except in the

13 case of expenditures described in sub14 section (u)(5))’’ after ‘‘do not exceed’’;

15 (ii) in subsection (u), by inserting

16 after paragraph (4) (as inserted by sub17 paragraph (C)), the following new para18 graph:

19 ‘‘(5) For purposes of the fourth sentence of sub20 section (b) and section 2105(a), the following payments

21 under this title do not count against a State’s allotment

22 under section 2104:

23 ‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR

24 PREGNANT WOMEN WITH INCOME ABOVE JANUARY

25 1, 2000 INCOME LEVEL AND BELOW 185 PERCENT OF
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1 POVERTY.—The portion of the payments made for

2 expenditures described in paragraph (4)(A)(ii) that

3 represents the amount that would have been paid if

4 the enhanced FMAP had not been substituted for

5 the Federal medical assistance percentage.’’.

6 (2) UNDER TITLE XXI.—

7 (A) FAMILYCARE COVERAGE.—Title XXI

8 of such Act is amended by adding at the end

9 the following new section:

10 ‘‘SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PAR11 ENTS OF TARGETED LOW-INCOME CHILDREN.

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

13 other provision of this title, a State child health plan may

14 provide for coverage, through an amendment to its State

15 child health plan under section 2102, of FamilyCare as16 sistance for targeted low-income parents in accordance

17 with this section, but only if—

18 ‘‘(1) the State meets the conditions described in

19 section 1902(k)(2); and

20 ‘‘(2) the State elects to provide medical assist21 ance under section 1902(a)(10)(A)(ii)(XVIII) and

22 elects an applicable income limit that is not lower

23 than the limit described in subsection (b)(2)(A).

24 ‘‘(b) DEFINITIONS.—For purposes of this section:
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1 ‘‘(1) FAMILYCARE ASSISTANCE.—The term

2 ‘FamilyCare assistance’ has the meaning given the

3 term child health assistance in section 2110(a) as if

4 any reference to targeted low-income children were

5 a reference to targeted low-income parents.

6 ‘‘(2) TARGETED LOW-INCOME PARENT.—The

7 term ‘targeted low-income parent’ has the meaning

8 given the term targeted low-income child in section

9 2110(b) as if the reference to a child were deemed

10 a reference to a parent (as defined in paragraph (3))

11 of the child; except that in applying such section—

12 ‘‘(A) there shall be substituted for the in13 come limit described in paragraph (1)(B)(ii)(I)

14 the applicable income limit in effect for a tar15 geted low-income child;

16 ‘‘(B) in paragraph (3), January 1, 2000,

17 shall be substituted for July 1, 1997; and

18 ‘‘(C) in paragraph (4), January 1, 2000,

19 shall be substituted for March 31, 1997.

20 ‘‘(3) PARENT.—The term ‘parent’ has the

21 meaning given the term ‘caretaker’ for purposes of

22 carrying out section 1931.

23 ‘‘(4) OPTIONAL TREATMENT OF PREGNANT

24 WOMEN AS PARENTS.—A State child health plan

25 may treat a pregnant woman who is not otherwise
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1 a parent as a targeted low-income parent for pur2 poses of this section but only if the State has estab3 lished an income level under section 1902(l)(2)(A)(i)

4 for pregnant women that is at least 185 percent of

5 the income official poverty line described in such sec6 tion.

7 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

8 RULES.—In the case of, and with respect to, a State pro9 viding for coverage of FamilyCare assistance to targeted

10 low-income parents under subsection (a), the following

11 special rules apply:

12 ‘‘(1) Any reference in this title (other than sub13 section (b)) to a targeted low-income child is deemed

14 to include a reference to a targeted low-income par15 ent.

16 ‘‘(2) Any such reference to child health assist17 ance with respect to such parents is deemed a ref18 erence to FamilyCare assistance.

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

20 case of a family provided coverage under this sec21 tion, the limitation on total annual aggregate cost22 sharing shall be applied to the entire family.

23 ‘‘(4) In applying section 2110(b)(4), any ref24 erence to ‘section 1902(l)(2) or 1905(n)(2) (as se25 lected by a State)’ is deemed a reference to the in-
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1 come level applicable to parents under section 1931,

2 or, in the case of a pregnant woman described in

3 subsection (b)(4), the income level established under

4 section 1902(l)(2)(A).’’.

5 (B) ADDITIONAL ALLOTMENT FOR STATES

6 PROVIDING FAMILYCARE.—

7 (i) IN GENERAL.—Section 2104 of

8 such Act (42 U.S.C. 1397dd), as amended

9 by section 14(b), is amended by inserting

10 after subsection (c) the following new sub11 section:

12 ‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE PRO13 VIDING FAMILYCARE.—

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

15 For the purpose of providing additional allotments

16 to States electing to provide FamilyCare coverage

17 under section 2111, there is appropriated, out of any

18 money in the Treasury not otherwise appropriated—

19 ‘‘(A) for fiscal year 2002, $2,000,000,000;

20 ‘‘(B) for fiscal year 2003, $2,000,000,000;

21 ‘‘(C) for fiscal year 2004, $3,000,000,000;

22 ‘‘(D) for fiscal year 2005, $3,000,000,000;

23 ‘‘(E) for fiscal year 2006, $6,000,000,000;

24 ‘‘(F) for fiscal year 2007, $7,000,000,000;

25 ‘‘(G) for fiscal year 2008, $8,000,000,000;
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1 ‘‘(H) for fiscal year 2009, $9,000,000,000;

2 ‘‘(I) for fiscal year 2010, $10,000,000,000;

3 and

4 ‘‘(J) for fiscal year 2011 and each fiscal

5 year thereafter, the amount of the allotment

6 provided under this paragraph for the preceding

7 fiscal year increased by the percentage increase

8 (if any) in the medical care expenditure cat9 egory of the Consumer Price Index for All

10 Urban Consumers (United States city average).

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

12 ‘‘(A) IN GENERAL.—In addition to the al13 lotments provided under subsections (b) and

14 (c), subject to paragraph (3), of the amount

15 available for the additional allotments under

16 paragraph (1) for a fiscal year, the Secretary

17 shall allot to each State with a State child

18 health plan approved under this title and which

19 has elected to provide coverage under section

20 2111 during the fiscal year—

21 ‘‘(i) in the case of such a State other

22 than a commonwealth or territory de23 scribed in clause (ii), the same proportion

24 as the proportion of the State’s allotment

25 under section 2104(b) (determined without
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1 regard to section 2104(f)) to 98.95 percent

2 of the total amount of the allotments

3 under such section for such States eligible

4 for an allotment under this subparagraph

5 for such fiscal year; and

6 ‘‘(ii) in the case of a commonwealth or

7 territory described in section 2104(c)(3),

8 the same proportion as the proportion of

9 the commonwealth’s or territory’s allot10 ment under section 2104(c) (determined

11 without regard to section 2104(f)) to 1.05

12 percent of the total amount of the allot13 ments under such section for common14 wealths and territories eligible for an allot15 ment under this subparagraph for such fis16 cal year.

17 ‘‘(B) REDISTRIBUTION OF UNUSED ALLOT18 MENTS.—In applying subsection (f) with re19 spect to additional allotments made available

20 under this subsection, the procedures estab21 lished under such subsection shall ensure such

22 additional allotments are only made available to

23 States which have elected to provide coverage

24 under section 2111.
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1 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi2 tional allotments provided under this subsection are

3 not available for amounts expended before October

4 1, 2001. Such amounts are available for amounts ex5 pended on or after such date for child health assist6 ance for targeted low-income children, as well as for

7 FamilyCare assistance.’’.

8 (ii) CONFORMING AMENDMENTS.—

9 Section 2104 of such Act (42 U.S.C.

10 1397dd), as amended by section 14(d)(3),

11 is further amended—

12 (I) in subsection (a), by inserting

13 ‘‘subject to subsection (d),’’ after

14 ‘‘under this section,’’;

15 (II) in subsection (b)(1), by in16 serting ‘‘and subsection (d)’’ after

17 ‘‘Subject to paragraph (4)’’; and

18 (III) in subsection (c)(1), by in19 serting ‘‘subject to subsection (d),’’

20 after ‘‘for a fiscal year,’’.

21 (C) NO COST-SHARING FOR PREGNANCY22 RELATED BENEFITS.—Section 2103(e)(2) of

23 such Act (42 U.S.C. 1397cc(e)(2)) is

24 amended—
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1 (i) in the heading, by inserting ‘‘AND

2 PREGNANCY-RELATED SERVICES’’ after

3 ‘‘PREVENTIVE SERVICES’’; and

4 (ii) by inserting before the period at

5 the end the following: ‘‘and for pregnancy6 related services’’.

7 (3) EFFECTIVE DATE.—The amendments made

8 by this subsection apply to items and services fur9 nished on or after October 1, 2000.

10 (b) RULES FOR IMPLEMENTATION BEGINNING WITH

11 FISCAL YEAR 2006.—

12 (1) REQUIRED COVERAGE OF FAMILYCARE PAR13 ENTS.—Section 1902(a)(10)(A)(i) of the Social Se14 curity Act (42 U.S.C. 1396a(a)(10)(A)(i)) is

15 amended—

16 (A) by striking ‘‘or’’ at the end of sub17 clause (VI);

18 (B) by striking the semicolon at the end of

19 subclause (VII) and insert ‘‘, or’’; and

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

21 subclause:

22 ‘‘(VIII) who would be parents de23 scribed in subsection (k)(1) if the in24 come level specified in subsection

25 (k)(2)(B) were equal to at least 100
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1 percent of the poverty line referred to

2 in such subsection;’’.

3 (2) EXPANSION OF AVAILABILITY OF EN4 HANCED MATCH UNDER MEDICAID FOR PRE-CHIP

5 EXPANSIONS.—Paragraph (4) of section 1905(u) of

6 such Act (42 U.S.C. 1396d(u)), as inserted by sub7 section (a)(1)(C), is amended—

8 (A) by amending clause (ii) of subpara9 graph (A) to read as follows:

10 ‘‘(ii) CERTAIN PREGNANT WOMEN.—Ex11 penditures for medical assistance for pregnant

12 women under section 1902(l)(1)(A) in a family

13 the income of which exceeds the 133 percent of

14 the income official poverty line.’’; and

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

16 subparagraphs:

17 ‘‘(B) PARENTS WITH INCOME ABOVE 100 PER18 CENT OF POVERTY BUT BELOW JANUARY 1, 2000 IN19 COME LEVEL.—The expenditures described in this

20 subparagraph are expenditures for medical assist21 ance made available for any parents described in

22 section 1902(a)(10)(A)(i)(VIII), whose income ex23 ceeds 100 percent of the income official poverty line

24 applicable to a family of the size involved but does

25 not exceed the applicable income level established
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1 under this title (under section 1931 or otherwise) for

2 a parent in a family of the size involved as of Janu3 ary 1, 2000.

4 ‘‘(C) CHILDREN IN FAMILIES WITH INCOME

5 ABOVE MEDICAID MANDATORY LEVEL NOT PRE6 VIOUSLY DESCRIBED.—The expenditures described

7 in this subparagraph are expenditures (other than

8 expenditures described in paragraph (2) or (3)) for

9 medical assistance made available to any child who

10 is eligible for assistance under section

11 1902(a)(10)(A) and the income of whose family ex12 ceeds the minimum income level required under sub13 section 1902(l)(2) for a child of the age involved

14 (treating any child who is 19 or 20 years of age as

15 being 18 years of age).’’.

16 (3) OFFSET OF ADDITIONAL EXPENDITURES

17 FOR ENHANCED MATCH FOR PRE-CHIP EXPANSION;

18 ELIMINATION OF OFFSET FOR REQUIRED COVERAGE

19 OF FAMILYCARE PARENTS.—

20 (A) IN GENERAL.—Section 1905(u)(5) of

21 such Act (42 U.S.C. 1396d(u)(5)), as added by

22 subsection (a)(1)(E), is amended—

23 (i) by amending subparagraph (A) to

24 read as follows:
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1 ‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR

2 PREGNANT WOMEN WITH INCOME ABOVE 133 PER3 CENT OF POVERTY.—The portion of the payments

4 made for expenditures described in paragraph

5 (4)(A)(ii) that represents the amount that would

6 have been paid if the enhanced FMAP had not been

7 substituted for the Federal medical assistance per8 centage.’’; and

9 (ii) by adding at the end the following

10 new subparagraphs:

11 ‘‘(B) FAMILYCARE PARENTS UNDER 100 PER12 CENT OF POVERTY.—Payments for expenditures de13 scribed in paragraph (4)(A)(i) in the case of parents

14 whose income does not exceed 100 percent of the in15 come official poverty line applicable to a family of

16 the size involved.

17 ‘‘(C) REGULAR FMAP FOR EXPENDITURES FOR

18 PARENTS WITH INCOME ABOVE 100 PERCENT OF

19 POVERTY BUT BELOW JANUARY 1, 2000 INCOME

20 LEVEL.—The portion of the payments made for ex21 penditures described in paragraph (4)(B) that rep22 resents the amount that would have been paid if the

23 enhanced FMAP had not been substituted for the

24 Federal medical assistance percentage.
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1 ‘‘(D) REGULAR FMAP FOR EXPENDITURES FOR

2 CERTAIN CHILDREN IN FAMILIES WITH INCOME

3 ABOVE MEDICAID MANDATORY LEVEL.—The portion

4 of the payments made for expenditures described in

5 paragraph (4)(C) that represents the amount that

6 would have been paid if the enhanced FMAP had

7 not been substituted for the Federal medical assist8 ance percentage.’’.

9 (B) CONFORMING AMENDMENTS.—Sub10 paragraph (C) of section 2105(a)(1) of such

11 Act, as inserted by section 14(a)(3) and as

12 amended by subsection (a)(1)(D), is amended

13 to read as follows:

14 ‘‘(C) CERTAIN FAMILYCARE PARENTS AND

15 OTHERS.—Expenditures for medical assistance

16 that is attributable to expenditures described in

17 section 1905(u)(4), except as provided in sec18 tion 1905(u)(5).’’.

19 (3) EFFECTIVE DATE.—The amendments made

20 by this subsection apply as of October 1, 2005, to

21 fiscal years beginning on or after such date and to

22 expenditures under the State plan on and after such

23 date.
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1 (c) MAKING TITLE XXI BASE ALLOTMENTS PERMA2 NENT.—Section 2104(a) of such Act (42 U.S.C.

3 1397dd(a)) is amended—

4 (1) by striking ‘‘and’’ at the end of paragraph

5 (9);

6 (2) by striking the period at the end of para7 graph (10) and inserting ‘‘; and’’; and

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

9 paragraph:

10 ‘‘(11) for fiscal year 2008 and each fiscal year

11 thereafter, the amount of the allotment provided

12 under this subsection for the preceding fiscal year

13 increased by the percentage increase (if any) in the

14 medical care expenditure category of the Consumer

15 Price Index for All Urban Consumers (United States

16 city average).’’.

17 (d) OPTIONAL APPLICATION OF PRESUMPTIVE ELI18 GIBILITY PROVISIONS TO PARENTS.—Section 1920A of

19 such Act (42 U.S.C. 1396r–1a) is amended by adding at

20 the end the following new subsection:

21 ‘‘(e) In accordance with regulations, a State may

22 elect to apply the previous provisions of this section to pro23 vide for a period of presumptive eligibility for medical as24 sistance for a parent of a child with respect to whom such

25 a period is provided under this section.’’.
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1 (e) CONFORMING AMENDMENTS.—

2 (1) ELIGIBILITY CATEGORIES.—Section

3 1905(a) of such Act (42 U.S.C. 1396d(a)) is amend4 ed, in the matter before paragraph (1)—

5 (A) by striking ‘‘or’’ at the end of clause

6 (xi);

7 (B) by inserting ‘‘or’’ at the end of clause

8 (xii); and

9 (C) by inserting after clause (xii) the fol10 lowing new clause:

11 ‘‘(xiii) who are parents described (or treated as

12 if described) in section 1902(k)(1),’’.

13 (2) INCOME LIMITATIONS.—Section 1903(f)(4)

14 of such Act (42 U.S.C. 1396b(f)(4))—

15 (A) effective October 1, 2005, by inserting

16 ‘‘1902(a)(10)(A)(i)(VIII),’’ after

17 ‘‘1902(a)(10)(A)(i)(VII),’’; and

18 (B) by inserting

19 ‘‘1902(a)(10)(A)(ii)(XVII),

20 1902(a)(10)(A)(ii)(XVIII),’’ after

21 ‘‘1902(a)(10)(A)(ii)(XVI),’’.

22 (3) CONFORMING AMENDMENT RELATING TO

23 NO WAITING PERIOD FOR CERTAIN WOMEN.—Section

24 2102(b)(1)(B) of such Act (42 U.S.C.

25 1397bb(b)(1)(B)) is amended—
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1 (A) by striking ‘‘, and’’ at the end of

2 clause (i) and inserting a semicolon;

3 (B) by striking the period at the end of

4 clause (ii) and inserting ‘‘; and’’; and

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

6 clause:

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

8 (including a waiting period to carry out

9 paragraph (3)(C)) in the case of targeted

10 low-income women who are pregnant.’’.

11 SEC. 4. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO

12 TITLE XXI PARENTS.

13 Section 2102(b)(1) of the Social Security Act (42

14 U.S.C. 1397bb(b)(1)) is amended by adding at the end

15 the following new subparagraph:

16 ‘‘(C) AUTOMATIC ELIGIBILITY OF CHIL17 DREN BORN TO A PARENT BEING PROVIDED

18 FAMILYCARE.—Such eligibility standards shall

19 provide for automatic coverage of a child born

20 to an individual who is provided assistance

21 under this title in the same manner as medical

22 assistance would be provided under section

23 1902(e)(4) to a child described in such sec24 tion.’’.
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1 SEC. 5. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS

2 UNDER THE MEDICAID PROGRAM AND TITLE

3 XXI.

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

5 Social Security Act (42 U.S.C. 1396b(v)) is amended—

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

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

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

9 paragraph:

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

11 under this title) to provide medical assistance under this

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

13 421 of the Personal Responsibility and Work Opportunity

14 Reconciliation Act of 1996, for aliens who are lawfully re15 siding in the United States (including battered aliens de16 scribed in section 431(c) of such Act) and who are other17 wise eligible for such assistance, within any of the fol18 lowing eligibility categories:

19 ‘‘(i) PREGNANT WOMEN.—Women during preg20 nancy (and during the 60-day period beginning on

21 the last day of the pregnancy).

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

23 such plan), including optional targeted low-income

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

25 ‘‘(iii) PARENTS.—If the State has elected the

26 eligibility category described in clause (ii), caretaker
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1 relatives who are parents (as defined by the State)

2 of children (described in such clause or otherwise)

3 who are eligible for medical assistance under the

4 plan.

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

6 medical assistance to a category of aliens under subpara7 graph (A), no action may be brought under an affidavit

8 of support against any sponsor of such an alien on the

9 basis of provision of assistance to such category.’’.

10 (b) TITLE XXI.—Section 2107(e)(1) of such Act (42

11 U.S.C. 1397gg(e)(1)) is amended by adding at the end

12 the following new subparagraph:

13 ‘‘(D) Section 1903(v)(4) (relating to op14 tional coverage of categories of permanent resi15 dent alien children and parents), but only, with

16 respect to an eligibility category under this title,

17 if the same eligibility category has been elected

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

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

20 this section take effect on October 1, 2000, and apply to

21 medical assistance and child health assistance furnished

22 on or after such date.
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1 SEC. 6. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE

2 20 UNDER THE MEDICAID PROGRAM AND

3 TITLE XXI.

4 (a) MEDICAID.—

5 (1) IN GENERAL.—Section 1902(l)(1)(D) of the

6 Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is

7 amended by inserting ‘‘(or, at the election of a

8 State, 20 or 21 years of age)’’ after ‘‘19 years of

9 age’’.

10 (2) CONFORMING AMENDMENTS.—

11 (A) Section 1902(e)(3)(A) of such Act (42

12 U.S.C. 1396a(e)(3)(A)) is amended by inserting

13 ‘‘(or 1 year less than the age the State has

14 elected under subsection (l)(1)(D))’’ after ‘‘18

15 years of age’’.

16 (B) Section 1902(e)(12) of such Act (42

17 U.S.C. 1396a(e)(12)) is amended by inserting

18 ‘‘or such higher age as the State has elected

19 under subsection (l)(1)(D)’’ after ‘‘19 years of

20 age’’.

21 (C) Section 1902(l)(5) of such Act (42

22 U.S.C. 1396a(l)(5)), as added by section

23 7(a)(2), is amended by inserting ‘‘(or such

24 higher age as the State has elected under para25 graph (1)(D))’’ after ‘‘19 years of age’’.
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1 (D) Section 1920A(b)(1) of such Act (42

2 U.S.C. 1396r–1a(b)(1)) is amended by insert3 ing ‘‘or such higher age as the State has elected

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

5 age’’.

6 (E) Section 1928(h)(1) of such Act (42

7 U.S.C. 1396s(h)(1)) is amended by inserting

8 ‘‘or 1 year less than the age the State has elect9 ed under section 1902(l)(1)(D)’’ before the pe10 riod at the end.

11 (F) Section 1932(a)(2)(A) of such Act (42

12 U.S.C. 1396u–2(a)(2)(A)) is amended by in13 serting ‘‘(or such higher age as the State has

14 elected under section 1902(l)(1)(D))’’ after ‘‘19

15 years of age’’.

16 (b) TITLE XXI.—Section 2110(c)(1) of such Act (42

17 U.S.C. 1397jj(c)(1)) is amended by inserting ‘‘(or such

18 higher age as the State has elected under section

19 1902(l)(1)(D))’’.

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

21 this section take effect on October 1, 2000, and apply to

22 medical assistance and child health assistance provided on

23 or after such date.
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1 SEC. 7. APPLICATION OF SIMPLIFIED TITLE XXI PROCE2 DURES UNDER THE MEDICAID PROGRAM.

3 (a) APPLICATION UNDER MEDICAID.—

4 (1) IN GENERAL.—Section 1902(l) of the Social

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

6 (A) in paragraph (3), by inserting ‘‘subject

7 to paragraph (5)’’, after ‘‘Notwithstanding sub8 section (a)(17),’’; and

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

10 paragraph:

11 ‘‘(5) With respect to determining the eligibility of in12 dividuals under 19 years of age (or such higher age as

13 the State has elected under paragraph (1)(D)) for medical

14 assistance under subsection (a)(10)(A) and, separately,

15 with respect to determining the eligibility of individuals

16 for medical assistance under subsection

17 (a)(10)(A)(i)(VIII) or (a)(10)(A)(ii)(XVIII), notwith18 standing any other provision of this title, if the State has

19 established a State child health plan under title XXI—

20 ‘‘(A) the State may not apply a resource stand21 ard if the State does not apply such a standard

22 under such child health plan with respect to such in23 dividuals;

24 ‘‘(B) the State shall use the same simplified eli25 gibility form (including, if applicable, permitting ap26 plication other than in person) as the State uses
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1 under such State child health plan with respect to

2 such individuals;

3 ‘‘(C) the State shall provide for initial eligibility

4 determinations and redeterminations of eligibility

5 using the same verification policies, forms, and fre6 quency as the State uses for such purposes under

7 such State child health plan with respect to such in8 dividuals; and

9 ‘‘(D) the State shall not require a face-to-face

10 interview for purposes of initial eligibility determina11 tions and redeterminations unless the State requires

12 such an interview for such purposes under such child

13 health plan with respect to such individuals.’’.

14 (2) EFFECTIVE DATE.—The amendments made

15 by paragraph (1) apply to determinations of eligi16 bility made on or after the date that is 1 year after

17 the date of the enactment of this Act.

18 (b) ADDITIONAL ENTITIES QUALIFIED TO DETER19 MINE MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-IN20 COME CHILDREN.—

21 (1) IN GENERAL.—Section 1920A(b)(3)(A)(i) of

22 such Act (42 U.S.C. 1396r–1a(b)(3)(A)(i)) is

23 amended—

24 (A) by striking ‘‘or (II)’’ and inserting ‘‘,

25 (II)’’; and
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1 (B) by inserting ‘‘eligibility of a child for

2 medical assistance under the State plan under

3 this title, or eligibility of a child for child health

4 assistance under the program funded under

5 title XXI, (III) is an elementary school or sec6 ondary school, as such terms are defined in sec7 tion 14101 of the Elementary and Secondary

8 Education Act of 1965 (20 U.S.C. 8801), an el9 ementary or secondary school operated or sup10 ported by the Bureau of Indian Affairs, a State

11 child support enforcement agency, a child care

12 resource and referral agency, an organization

13 that is providing emergency food and shelter

14 under a grant under the Stewart B. McKinney

15 Homeless Assistance Act, or a State office or

16 entity involved in enrollment in the program

17 under this title, under part A of title IV, under

18 title XXI, or that determines eligibility for any

19 assistance or benefits provided under any pro20 gram of public or assisted housing that receives

21 Federal funds, including the program under

22 section 8 or any other section of the United

23 States Housing Act of 1937 (42 U.S.C. 1437 et

24 seq.), or (IV) any other entity the State so
30

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1 deems, as approved by the Secretary’’ before

2 the semicolon.

3 (2) TECHNICAL AMENDMENTS.—Section 1920A

4 of such Act (42 U.S.C. 1396r-1a) is amended—

5 (A) in subsection (b)(3)(A)(ii), by striking

6 ‘‘paragraph (1)(A)’’ and inserting ‘‘paragraph

7 (2)(A)’’; and

8 (B) in subsection (c)(2), in the matter pre9 ceding subparagraph (A), by striking ‘‘sub10 section (b)(1)(A)’’ and inserting ‘‘subsection

11 (b)(2)(A)’’.

12 (3) APPLICATION TO PRESUMPTIVE ELIGIBILITY

13 FOR PREGNANT WOMEN UNDER MEDICAID.—Section

14 1920(b) of such Act (42 U.S.C. 1396r-1(b)) is

15 amended by adding at the end after and below para16 graph (2) the following flush sentence:

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

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

19 (4) APPLICATION UNDER TITLE XXI.—

20 (A) IN GENERAL.—Section 2107(e)(1) of

21 such Act (42 U.S.C. 1397gg(e)(1)), as amended

22 by section 5(b), is amended by adding at the

23 end the following new subparagraph:

24 ‘‘(E) Sections 1920 and 1920A (relating to

25 presumptive eligibility).’’.
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1 (B) EXCEPTION FROM LIMITATION ON AD2 MINISTRATIVE EXPENSES.—Section 2105(c)(2)

3 of such Act (42 U.S.C. 1397ee(c)(2)) is amend4 ed by adding at the end the following new sub5 paragraph:

6 ‘‘(C) EXCEPTION FOR PRESUMPTIVE ELI7 GIBILITY EXPENDITURES.—The limitation

8 under subparagraph (A) on expenditures shall

9 not apply to expenditures attributable to the

10 application of section 1920A (pursuant to sec11 tion 2107(e)(1)(E)), regardless of whether the

12 child is determined to be ineligible for the pro13 gram under this title or title XIX.’’.

14 (c) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR

15 TITLE XXI AND MEDICAID BENEFITS FOR CHILDREN

16 LOSING MEDICAID OR TITLE XXI ELIGIBILITY.—

17 (1) LOSS OF MEDICAID ELIGIBILITY.—Section

18 1902(a) of the Social Security Act (42 U.S.C.

19 1396a(a)) is amended—

20 (A) by striking the period at the end of

21 paragraph (65) and inserting ‘‘; and’’, and

22 (B) by inserting after paragraph (65) the

23 following new paragraph:

24 ‘‘(66) provide, by not later than the first day of

25 the first month that begins more than 1 year after
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1 the date of the enactment of this paragraph and in

2 the case of a State with a State child health plan

3 under title XXI, that before medical assistance to a

4 child (or a parent of a child) is discontinued under

5 this title, a determination of whether the child (or

6 parent) is eligible for benefits under title XXI shall

7 be made and, if determined to be so eligible, the

8 child (or parent) shall be automatically enrolled in

9 the program under such title without the need for a

10 new application.’’.

11 (2) LOSS OF TITLE XXI ELIGIBILITY.—Section

12 2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended by

13 redesignating subparagraphs (D) and (E) as sub14 paragraphs (E) and (F), respectively, and by insert15 ing after subparagraph (C) the following new sub16 paragraph:

17 ‘‘(D) that before health assistance to a

18 child (or a parent of a child) is discontinued

19 under this title, a determination of whether the

20 child (or parent) is eligible for benefits under

21 title XIX is made and, if determined to be so

22 eligible, the child (or parent) is automatically

23 enrolled in the program under such title with24 out the need for a new application;’’.
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1 (3) EFFECTIVE DATE.—The amendments made

2 by paragraphs (1) and (2) apply to individuals who

3 lose eligibility under the medicaid program under

4 title XIX, or under a State child health insurance

5 plan under title XXI, respectively, of the Social Se6 curity Act on or after the date that is 60 days after

7 the date of the enactment of this Act.

8 (d) PROVISION OF MEDICAID AND CHIP APPLICA9 TIONS AND INFORMATION UNDER THE SCHOOL LUNCH

10 PROGRAM.—Section 9(b)(2)(B) of the Richard B. Russell

11 National School Lunch Act (42 U.S.C. 1758(b)(2)(B) is

12 amended—

13 (1) by striking ‘‘(B) Applications’’ and inserting

14 ‘‘(B)(i) Applications’’; and

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

16 clause:

17 ‘‘(ii)(I) Applications for free and reduced price

18 lunches that are distributed pursuant to clause (i) to par19 ents or guardians of children in attendance at schools par20 ticipating in the school lunch program under this Act shall

21 also contain information on the availability of medical as22 sistance under title XIX of the Social Security Act (42

23 U.S.C. 1396 et seq.) (commonly referred to as the ‘med24 icaid program’) and of child health assistance under title

25 XXI of such Act (commonly referred to as ‘CHIP’), in-
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1 cluding information on how to obtain an application for

2 assistance under such program.

3 ‘‘(II) Information on the medicaid program and

4 CHIP under subclause (I) shall be provided on a form sep5 arate from the application form for free and reduced price

6 lunches under clause (i).’’.

7 SEC. 8. IMPROVING WELFARE-TO-WORK TRANSITION

8 UNDER THE MEDICAID PROGRAM.

9 (a) MAKING PROVISION PERMANENT.—

10 (1) IN GENERAL.—Subsection (f) of section

11 1925 of the Social Security Act (42 U.S.C. 1396r–

12 6) is repealed.

13 (2) CONFORMING AMENDMENT.—Section

14 1902(e)(1) of such Act (42 U.S.C. 1396a(e)(1)) is

15 repealed.

16 (b) STATE OPTION OF INITIAL 12-MONTH ELIGI17 BILITY.—Section 1925 of such Act (42 U.S.C. 1396r–6)

18 is amended—

19 (1) in subsection (a), by adding at the end the

20 following new paragraph:

21 ‘‘(5) OPTION OF 12-MONTH INITIAL ELIGIBILITY

22 PERIOD.—A State may elect to treat any reference

23 in this subsection to a 6-month period (or 6 months)

24 as a reference to a 12-month period (or 12 months).
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1 In the case of such an election, subsection (b) shall

2 not apply.’’; and

3 (2) in subsection (b)(1), by inserting ‘‘and sub4 section (a)(5)’’ after ‘‘paragraph (3)’’.

5 (c) SIMPLIFICATION OPTIONS.—

6 (1) REMOVAL OF ADMINISTRATIVE REPORTING

7 REQUIREMENTS FOR ADDITIONAL 6-MONTH EXTEN8 SION.—Section 1925(b)(2) of such Act (42 U.S.C.

9 1396r–6(b)(2)) is amended—

10 (A) by striking subparagraph (B);

11 (B) in subparagraph (A)(i)—

12 (i) by striking ‘‘(I)’’ and all that fol13 lows through ‘‘(II)’’ and inserting ‘‘(i)’’;

14 (ii) by striking ‘‘, and (III)’’ and in15 serting ‘‘and (ii)’’; and

16 (iii) by redesignating such subpara17 graph as subparagraph (A) (with appro18 priate indentation); and

19 (C) in subparagraph (A)(ii)—

20 (i) by striking ‘‘notify the family of

21 the reporting requirement under subpara22 graph (B)(ii) and’’ and inserting ‘‘provide

23 the family with notification of’’; and
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1 (ii) by redesignating such subpara2 graph as subparagraph (B) (with appro3 priate indentation).

4 (2) REMOVAL OF REQUIREMENT FOR PREVIOUS

5 RECEIPT OF MEDICAL ASSISTANCE.—Section

6 1925(a)(1) of such Act (42 U.S.C. 1396r–6(a)(1)) is

7 amended—

8 (A) by redesignating the matter after ‘‘RE9 QUIREMENT.—’’ as a subparagraph (A) with

10 the heading ‘‘IN GENERAL.—’’ and with appro11 priate indentation; and

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

13 subparagraph:

14 ‘‘(B) STATE OPTION TO WAIVE REQUIRE15 MENT FOR PREVIOUS RECEIPT OF MEDICAL AS16 SISTANCE.—A State may elect to apply sub17 paragraph (A) to any family whose eligibility

18 for assistance under section 1931 would other19 wise terminate because of hours of, or income

20 from, employment, without regard to the period

21 of previous receipt of assistance or aid.’’.

22 (3) PERMITTING INCREASE OR WAIVER OF 185

23 PERCENT OF POVERTY EARNING LIMIT.—Section

24 1925(b)(3)(A)(iii)(III) of such Act (42 U.S.C.

25 1396r–6(b)(3)(A)(iii)(III)) is amended—
37

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1 (A) by inserting ‘‘(at its option)’’ after

2 ‘‘the State’’; and

3 (B) by inserting ‘‘(or such higher percent

4 as the State may specify)’’ after ‘‘185 percent’’.

5 (4) EXEMPTION FOR STATES COVERING NEEDY

6 FAMILIES UP TO 185 PERCENT OF POVERTY.—Sec7 tion 1925 of such Act (42 U.S.C. 1396r–6), as

8 amended by subsection (a), is amended—

9 (A) in each of subsections (a)(1) and

10 (b)(1), by inserting ‘‘but subject to subsection

11 (f),’’ after ‘‘Notwithstanding any other provi12 sion of this title,’’; and

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

14 subsection:

15 ‘‘(f) EXEMPTION FOR STATE COVERING NEEDY

16 FAMILIES UP TO 185 PERCENT OF POVERTY.—

17 ‘‘(1) IN GENERAL.—At State option, the provi18 sions of this section shall not apply to a State that

19 uses the authority under section 1931(b)(2)(C) to

20 make medical assistance available under the State

21 plan under this title, at a minimum, to all individ22 uals described in section 1931(b)(1) in families with

23 gross incomes (determined without regard to work24 related child care expenses of such individuals) at or

25 below 185 percent of the income official poverty line
38

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1 (as defined by the Office of Management and Budg2 et, and revised annually in accordance with section

3 673(2) of the Omnibus Budget Reconciliation Act of

4 1981) applicable to a family of the size involved.

5 ‘‘(2) APPLICATION TO OTHER PROVISIONS OF

6 THIS TITLE.—The State plan of a State described in

7 paragraph (1) shall be deemed to meet the require8 ments of sections 1902(a)(10)(A)(i)(I) and

9 1902(e)(1).’’.

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

11 this section take effect on October 1, 2000.

12 SEC. 9. ELIMINATION OF 100 HOUR RULE AND OTHER

13 AFDC-RELATED ELIGIBILITY RESTRICTIONS.

14 (a) IN GENERAL.—Section 1931(b)(1)(A)(ii) of the

15 Social Security Act (42 U.S.C. 1396u–1(b)(1)(A)(ii)) is

16 amended by inserting ‘‘other than the requirement that

17 the child be deprived of parental support or care by reason

18 of the death, continued absence from the home, incapacity,

19 or unemployment of a parent,’’ after ‘‘section 407(a),’’.

20 (b) CONFORMING AMENDMENT.—Section 1905(a) of

21 such Act (42 U.S.C. 1396d(a)) is amended, in the matter

22 before paragraph (1), in clause (ii), by striking ‘‘if such

23 child is (or would, if needy, be) a dependent child under

24 part A of title IV’’.
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1 (c) EFFECTIVE DATE.—The amendments made by

2 this section apply to eligibility determinations made on or

3 after October 1, 2000.

4 SEC. 10. STATE GRANT PROGRAM FOR MARKET INNOVA5 TION.

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

7 Human Services (in this section referred to as the ‘‘Sec8 retary’’) shall establish a program (in this section referred

9 to as the ‘‘program’’) to award demonstration grants

10 under this section to States to allow States to demonstrate

11 the effectiveness of innovative ways to increase access to

12 health insurance through market reforms and other inno13 vative means. Such innovative means may include any of

14 the following:

15 (1) Alternative group purchasing or pooling ar16 rangements, such as a purchasing cooperatives for

17 small businesses, reinsurance pools, or high risk

18 pools.

19 (2) Individual or small group market reforms.

20 (3) Consumer education and outreach.

21 (4) Subsidies to individuals, employers, or both,

22 in obtaining health insurance.

23 (b) SCOPE; DURATION.—The program shall be lim24 ited to not more than 10 States and to a total period of
40

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1 5 years, beginning on the date the first demonstration

2 grant is made.

3 (c) CONDITIONS FOR DEMONSTRATION GRANTS.—

4 (1) IN GENERAL.—The Secretary may not pro5 vide for a demonstration grant to a State under the

6 program unless the Secretary finds that under the

7 proposed demonstration grant—

8 (A) the State will provide for demonstrated

9 increase of access for some portion of the exist10 ing uninsured population through a market in11 novation (other than merely through a financial

12 expansion of a program initiated before the

13 date of the enactment of this Act);

14 (B) the State will comply with applicable

15 Federal laws;

16 (C) the State will not discriminate among

17 participants on the basis of any health status18 related factor (as defined in section 2791(d)(9)

19 of the Public Health Service Act), except to the

20 extent a State wishes to focus on populations

21 that otherwise would not obtain health insur22 ance because of such factors; and

23 (D) the State will provide for such evalua24 tion, in coordination with the evaluation re-
41

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1 quired under subsection (d), as the Secretary

2 may specify.

3 (2) APPLICATION.—The Secretary shall not

4 provide a demonstration grant under the program to

5 a State unless—

6 (A) the State submits to the Secretary

7 such an application, in such a form and man8 ner, as the Secretary specifies;

9 (B) the application includes information

10 regarding how the demonstration grant will ad11 dress issues such as governance, targeted popu12 lation, expected cost, and the continuation after

13 the completion of the demonstration grant pe14 riod; and

15 (B) the Secretary determines that the

16 demonstration grant will be used consistent

17 with this section.

18 (3) FOCUS.—A demonstration grant proposal

19 under section need not cover all uninsured individ20 uals in a State or all health care benefits with re21 spect to such individuals.

22 (d) EVALUATION.—The Secretary shall enter into a

23 contract with an appropriate entity outside the Depart24 ment of Health and Human Services to conduct an overall

25 evaluation of the program at the end of the program pe-
42

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1 riod. Such evaluation shall include an analysis of improve2 ments in access, costs, quality of care, or choice of cov3 erage, under different demonstration grants.

4 (e) OPTION TO PROVIDE FOR INITIAL PLANNING

5 GRANTS.—Notwithstanding the previous provisions of this

6 section, under the program the Secretary may provide for

7 a portion of the amounts appropriated under subsection

8 (f) (not to exceed $5,000,000) to be made available to any

9 State for initial planning grants to permit States to de10 velop demonstration grant proposals under the previous

11 provisions of this section.

12 (f) AUTHORIZATION OF APPROPRIATIONS.—There

13 are authorized to be appropriated $100,000,000 for each

14 fiscal year to carry out this section. Amounts appropriated

15 under this subsection shall remain available until ex16 pended.

17 (g) STATE DEFINED.—For purposes of this section,

18 the term ‘‘State’’ has the meaning given such term for

19 purposes of title XIX of the Social Security Act.

20 SEC. 11. LIMITATIONS ON CONFLICTS OF INTEREST.

21 (a) LIMITATION ON CONFLICTS OF INTEREST IN

22 MARKETING ACTIVITIES.—

23 (1) TITLE XXI.—Section 2105(c) of the Social

24 Security Act (42 U.S.C. 300aa–5(c)) is amended by

25 adding at the end the following new paragraph:
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1 ‘‘(8) LIMITATION ON EXPENDITURES FOR MAR2 KETING ACTIVITIES.—Amounts expended by a State

3 for the use of an administrative vendor in marketing

4 health benefits coverage to low-income children

5 under this title shall not be considered, for purposes

6 of subsection (a)(2)(D), to be reasonable costs to ad7 minister the plan unless the following conditions are

8 met with respect to the vendor:

9 ‘‘(A) The vendor is independent of any en10 tity offering the coverage in the same area of

11 the State in which the vendor is conducting

12 marketing activities.

13 ‘‘(B) No person who is an owner, em14 ployee, consultant, or has a contract with the

15 vendor either has any direct or indirect finan16 cial interest with such an entity or has been ex17 cluded from participation in the program under

18 this title or title XVIII or XIX or debarred by

19 any Federal agency, or subject to a civil money

20 penalty under this Act.’’.

21 (b) PROHIBITION OF AFFILIATION WITH DEBARRED

22 INDIVIDUALS.—

23 (1) MEDICAID.—Section 1903(i) of such Act

24 (42 U.S.C. 1396b(i))is amended—
44

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1 (A) by striking the period at the end of

2 paragraph (20) and inserting ‘‘; or’’; and

3 (B) by inserting after paragraph (20) the

4 following new paragraph:

5 ‘‘(21) with respect to any amounts expended for

6 an entity that receives payments under the plan

7 unless—

8 ‘‘(A) no person with an ownership or con9 trol interest (as defined in section 1124(a)(3))

10 in the entity is a person that is debarred, sus11 pended, or otherwise excluded from partici12 pating in procurement or non-procurement ac13 tivities under the Federal Acquisition Regula14 tion; and

15 ‘‘(B) such entity has not entered into an

16 employment, consulting, or other agreement for

17 the provision of items or services that are mate18 rial to such entity’s obligations under the plan

19 with a person described in subparagraph (A).’’.

20 (2) TITLE XXI.—Section 2107(e)(1) of such Act

21 (42 U.S.C. 1397gg(e)(1)), as amended by sections

22 5(b) and 7(c)(3), is further amended by adding at

23 the end the following new subparagraph:
45

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1 ‘‘(F) Section 1902(a)(67) (relating to pro2 hibition of affiliation with debarred individ3 uals).’’.

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

5 this section shall apply to expenditures made on or after

6 the date of the enactment of this Act.

7 SEC. 12. INCREASE IN CHIP ALLOTMENT FOR EACH OF FIS8 CAL YEARS 2002 THROUGH 2004.

9 Paragraphs (5), (6), and (7) of Section 2104(a) of

10 the Social Security Act (42 U.S.C. 1397dd(a)) are amend11 ed by striking ‘‘$3,150,000,000’’ each place it appears and

12 inserting ‘‘$4,150,000,000’’.

13 SEC. 13. DEMONSTRATION PROGRAMS TO IMPROVE MED14 ICAID AND CHIP OUTREACH TO HOMELESS

15 INDIVIDUALS AND FAMILIES.

16 (a) AUTHORITY.—The Secretary of Health and

17 Human Services may award demonstration grants to not

18 more than 7 States (or other qualified entities) to conduct

19 innovative programs that are designed to improve out20 reach to homeless individuals and families under the pro21 grams described in subsection (b) with respect to enroll22 ment of such individuals and families under such pro23 grams and the provision of services (and coordinating the

24 provision of such services) under such programs.
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1 (b) PROGRAMS FOR HOMELESS DESCRIBED.—The

2 programs described in this subsection are as follows:

3 (1) MEDICAID.—The program under title XIX

4 of the Social Security Act (42 U.S.C. 1396 et seq.).

5 (2) CHIP.—The program under title XXI of

6 such Act (42 U.S.C. 1397aa et seq.).

7 (3) TANF.—The program under part of A of

8 title IV of such Act (42 U.S.C. 601 et seq.).

9 (4) SAMHSA BLOCK GRANTS.—The program

10 of grants under part B of title XIX of the Public

11 Health Service Act (42 U.S.C. 300x–1 et seq.).

12 (5) FOOD STAMP PROGRAM.—The program

13 under the Food Stamp Act of 1977 (7 U.S.C. 2011

14 et seq.).

15 (6) WORKFORCE INVESTMENT ACT.—The pro16 gram under the Workforce Investment Act of 1999

17 (29 U.S.C. 2801 et seq.).

18 (7) WELFARE-TO-WORK.—The welfare-to-work

19 program under section 403(a)(5) of the Social Secu20 rity Act (42 U.S.C. 603(a)(5)).

21 (8) OTHER PROGRAMS.—Other public and pri22 vate benefit programs that serve low-income individ23 uals.

24 (c) APPROPRIATIONS.—For the purposes of carrying

25 out this section, there is appropriated, out of any funds
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1 in the Treasury not otherwise appropriated, $10,000,000,

2 to remain available until expended.

3 SEC. 14. AUTHORITY TO PAY MEDICAID EXPANSION COSTS

4 FROM TITLE XXI APPROPRIATION.

5 (a) AUTHORITY TO PAY MEDICAID EXPANSION

6 COSTS FROM TITLE XXI APPROPRIATION.—Section

7 2105(a) of the Social Security Act (42 U.S.C. 1397ee(a))

8 is amended—

9 (1) in paragraph (1)—

10 (A) by inserting ‘‘CHILD HEALTH ASSIST11 ANCE UNDER THIS TITLE.—Expenditures’’ be12 fore ‘‘for child health assistance’’;

13 (B) by striking ‘‘; and’’ at the end and in14 serting a period; and

15 (C) by redesignating such paragraph as

16 subparagraph (D) and indenting appropriately;

17 (2) in paragraph (2)—

18 (A) in subparagraph (A), by striking ‘‘for

19 payment’’;

20 (B) by inserting ‘‘ASSISTANCE AND ADMIN21 ISTRATIVE EXPENDITURES SUBJECT TO

22 LIMIT.—Expenditures’’ before ‘‘only to the ex23 tent’’;
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1 (C) by redesignating subparagraphs (A)

2 through (D) as clauses (i) through (iv), respec3 tively, and indenting appropriately; and

4 (D) by redesignating such paragraph as

5 subparagraph (E) and indenting appropriately;

6 (3) by striking ‘‘(a) IN GENERAL.—’’ and all

7 that follows up to subparagraph (D), as so redesig8 nated, and inserting the following:

9 ‘‘(a) ALLOWABLE EXPENDITURES.—

10 ‘‘(1) IN GENERAL.—Subject to the succeeding

11 provisions of this section, the Secretary shall pay to

12 each State with a plan approved under this title,

13 from its allotment under section 2104, an amount

14 for each quarter equal to the enhanced FMAP (or,

15 in the case of expenditures described in subpara16 graph (B), the Federal medical assistance percent17 age (as defined in the first sentence of section

18 1905(b))) of the following expenditures in the quar19 ter:

20 ‘‘(A) CHILD HEALTH ASSISTANCE UNDER

21 MEDICAID.—Expenditures for child health as22 sistance under the plan for targeted low-income

23 children in the form of providing medical assist24 ance for expenditures described in the fourth

25 sentence of section 1905(b).
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1 ‘‘(B) MEDICAID PRESUMPTIVE ELIGIBILITY

2 FOR CHILDREN.—Expenditures for the provi3 sion of medical assistance on behalf of a child

4 during a presumptive eligibility period under

5 section 1920A.

6 ‘‘(C) RESERVED.—[reserved].’’; and

7 (4) by adding at the end the following new

8 paragraphs:

9 ‘‘(2) ORDER OF PAYMENTS.—Payments under a

10 subparagraph of paragraph (1) from a State’s allot11 ment for expenditures described in each such sub12 paragraph shall be made on a quarterly basis in the

13 order of such subparagraph in such paragraph.

14 ‘‘(3) NO DUPLICATIVE PAYMENT.—In the case

15 of expenditures for which payment is made under

16 paragraph (1), no payment shall be made under title

17 XIX.’’.

18 (b) ELIMINATION OF REQUIREMENT TO REDUCE

19 TITLE XXI ALLOTMENT BY MEDICAID EXPANSION

20 COSTS.—Section 2104 of such Act (42 U.S.C. 1397dd)

21 is amended by striking subsection (d).

22 (c) AUTHORITY TO TRANSFER TITLE XXI APPRO23 PRIATIONS TO TITLE XIX APPROPRIATION ACCOUNT AS

24 REIMBURSEMENT FOR MEDICAID EXPENDITURES FOR

25 MEDICAID EXPANSION SERVICES.—Notwithstanding any
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1 other provision of law, all amounts appropriated under

2 title XXI of the Social Security Act and allotted to a State

3 pursuant to subsection (b) or (c) of section 2104 of such

4 Act (42 U.S.C. 1397dd) for fiscal years 1998 through

5 2000 (including any amounts that, but for this provision,

6 would be considered to no longer be available) and not ex7 pended in providing child health assistance or related serv8 ices for which payment may be made pursuant to subpara9 graph (D) or (E) of section 2105(a)(1) of such Act (42

10 U.S.C. 1397ee(a)(1)), as redesignated by subsection (a),

11 shall be available to reimburse the Grants to States for

12 Medicaid account in an amount equal to the total pay13 ments made to such State under section 1903(a) of such

14 Act (42 U.S.C. 1396b(a)) for expenditures in such years

15 for medical assistance described in subparagraphs (A) and

16 (B) of section 2105(a)(1) of such Act (42 U.S.C.

17 1397ee(a)(1)), as so amended.

18 (d) CONFORMING AMENDMENTS.—

19 (1) SECTION 1905(b).—Section 1905(b) of such

20 Act (42 U.S.C. 1396d(b)) is amended in the fourth

21 sentence by striking ‘‘the State’s allotment under

22 section 2104 (not taking into account reductions

23 under section 2104(d)(2)) for the fiscal year reduced

24 by the amount of any payments made under section

25 2105 to the State from such allotment for such fis-
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1 cal year’’ and inserting ‘‘the State’s allotment under

2 section 2104’’.

3 (2) SECTION 1905(u).—Section 1905(u)(1)(B)

4 of such Act (42 U.S.C. 1396d(u)(1)(B)) is amended

5 by striking ‘‘and section 2104(d)’’ and inserting

6 ‘‘and section 2105(a)(1)’’.

7 (3) SECTION 2104.—Section 2104 of such Act

8 (42 U.S.C. 1397dd), as amended by subsection (b),

9 is further amended—

10 (A) in subsection (b)(1), by striking ‘‘and

11 subsection (d)’’; and

12 (B) in subsection (c)(1), by striking ‘‘sub13 ject to subsection (d),’’.

14 (4) SECTION 2105(c).—Section 2105(c) of such

15 Act (42 U.S.C. 1397ee(c)) is amended—

16 (A) in paragraph (2)(A), by striking all

17 that follows ‘‘Except as provided in this para18 graph,’’ and inserting ‘‘the amount of payment

19 that may be made under subsection (a) for a

20 fiscal year for expenditures for items described

21 in paragraph (1)(E) of such subsection shall

22 not exceed 10 percent of the total amount of ex23 penditures for which payment is made under

24 paragraph (1) of such subsection (other than

25 subparagraph (B)).’’;
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1 (B) in paragraph (2)(B), by striking ‘‘de2 scribed in subsection (a)(2)’’ and inserting ‘‘de3 scribed in subsection (a)(1)(E)’’; and

4 (C) in paragraph (6)(B), by striking ‘‘Ex5 cept as otherwise provided by law,’’ and insert6 ing ‘‘Except as provided in subparagraph (A) or

7 (B) of subsection (a)(1) or any other provision

8 of law,’’.

9 (5) SECTION 2110(a).—Section 2110(a) of such

10 Act (42 U.S.C. 1397jj) is amended by striking ‘‘sec11 tion 2105(a)(2)(A)’’ and inserting ‘‘section

12 2105(a)(1)(E)(i)’’.

13 (e) TECHNICAL AMENDMENT.—Section

14 2105(d)(2)(B)(ii) of such Act (42 U.S.C.

15 1397ee(d)(2)(B)(ii)) is amended by striking ‘‘enhanced

16 FMAP under section 1905(u)’’ and inserting ‘‘enhanced

17 FMAP under the fourth sentence of section 1905(b)’’.

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

19 this section shall be effective as if included in the enact20 ment of the Balanced Budget Act of 1997.

21 SEC. 15. CREATION OF COMMUNITY ACCESS PROGRAM.

22 Part D of title III of the Public Health Service Act

23 (42 U.S.C. 254b et seq.) is amended by inserting after

24 subpart IV the following new subpart:
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1 ‘‘Subpart V—Community Access Program

2 ‘‘SEC. 340. GRANTS TO STRENGTHEN THE EFFECTIVENESS,

3 EFFICIENCY, AND COORDINATION OF SERV4 ICES FOR THE UNINSURED AND UNDER5 INSURED.

6 ‘‘(a) IN GENERAL.—The Secretary may make grants

7 for the purpose of assisting the development of integrated

8 health care delivery systems—

9 ‘‘(1) to serve communities of individuals who

10 are uninsured and individuals who are underinsured;

11 ‘‘(2) to expand the scope of services provided;

12 and

13 ‘‘(3) to improve the efficiency and coordination

14 among the providers of such services.

15 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive

16 a grant under this section, an entity must—

17 ‘‘(1) be a public or nonprofit private entity such

18 as—

19 ‘‘(A) a Federally qualified health center

20 (as defined under section 1861(aa)(4) of the

21 Social Security Act);

22 ‘‘(B) a hospital that meets the require23 ments of section 340B(a)(4)(L) (or, if none are

24 available in the area, a hospital that is a pro25 vider of a substantial volume of non-emergency
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1 health services to uninsured individuals and

2 families without regard to their ability to pay)

3 without regard to 340B (a)(4)(L)(iii); or

4 ‘‘(C) a public health department; and

5 ‘‘(2) represent a consortium of providers and,

6 as appropriate, related agencies or entities—

7 ‘‘(A) whose principal purpose is to provide

8 a broad range of coordinated health care serv9 ices for a community defined in the entity’s

10 grant application (which may be a special popu11 lation group such as migrant and seasonal farm

12 workers, homeless persons or individuals with

13 disabilities);

14 ‘‘(B) that includes all health care providers

15 that serve the community and that have tradi16 tionally provided care (beyond emergency serv17 ices) to uninsured and underinsured individuals

18 without regard to the individuals’ ability to pay

19 (if there are any such providers) unless any

20 such provider or providers declines to partici21 pate; and

22 ‘‘(C) that may include other health care

23 providers and related agencies and organiza24 tions; except that preference shall be given to
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1 applicants that are health care providers identi2 fied in paragraph (1).

3 ‘‘(c) APPLICATIONS.—To be eligible to receive a grant

4 under this section, an eligible entity shall submit to the

5 Secretary an application, in such form and manner as the

6 Secretary shall prescribe, that shall—

7 ‘‘(1) define a community of uninsured and

8 underinsured individuals that consists of all such

9 individuals—

10 ‘‘(A) in a specified geographical area; or

11 ‘‘(B) in a specified population within such

12 an area;

13 ‘‘(2) identify the providers who will participate

14 in the consortium’s program under the grant, and

15 specify each one’s contribution to the care of unin16 sured and underinsured individuals in the commu17 nity, including the volume of care it provides to

18 medicare and medicaid beneficiaries and to privately

19 paid patients;

20 ‘‘(3) describe the activities that the applicant

21 and the consortium propose to perform under the

22 grant to further the purposes of this section;

23 ‘‘(4) demonstrate the consortium’s ability to

24 build on the current system for serving uninsured

25 and underinsured individuals by involving providers
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1 who have traditionally provided a significant volume

2 of care for that community;

3 ‘‘(5) demonstrate the consortium’s ability to de4 velop coordinated systems of care that either directly

5 provide or ensure the prompt provision of a broad

6 range of high-quality, accessible services, including,

7 as appropriate, primary, secondary, and tertiary

8 services, as well as substance abuse treatment and

9 mental health services in a manner which assures

10 continuity of care in the community;

11 ‘‘(6) provide evidence of community involvement

12 in the development, implementation, and direction of

13 the program that it proposes to operate;

14 ‘‘(7) demonstrate the consortium’s ability to en15 sure that individuals participating in the program

16 are enrolled in public insurance programs for which

17 they are eligible;

18 ‘‘(8) present a plan for leveraging other sources

19 of revenue, which may include State and local

20 sources and private grant funds, and integrating

21 current and proposed new funding sources in a way

22 to assure long-term sustainability;

23 ‘‘(9) describe a plan for evaluation of the activi24 ties carried out under the grant, including measure-
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1 ment of progress toward the goals and objectives of

2 the program;

3 ‘‘(10) demonstrate fiscal responsibility through

4 the use of appropriate accounting procedures and

5 appropriate management systems;

6 ‘‘(11) include such other information as the

7 Secretary may prescribe; and

8 ‘‘(12) demonstrate the commitment to serve the

9 community without regard to the ability of the indi10 vidual or family to pay by arranging for or providing

11 free or reduced charge care for the poor.

12 ‘‘(d) PRIORITIES.—In awarding grants under this

13 section, the Secretary may accord priority to applicants—

14 ‘‘(1) whose consortium includes public hospitals,

15 Federally qualified health centers (as defined in sec16 tion 1905(l)(2)(B) of the Social Security Act), and

17 other providers that are covered entities as defined

18 by section 340B(a)(4) of this Act (or that would be

19 covered entities as so defined but for subparagraph

20 (L)(iii) of such section);

21 ‘‘(2) that identify a community whose geo22 graphical area has a high or increasing percentage

23 of individuals who are uninsured;

24 ‘‘(3) whose consortium includes other health

25 care providers that have a tradition of serving unin-
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1 sured individuals and underinsured individuals in

2 the community;

3 ‘‘(4) who show evidence that the program would

4 expand utilization of preventive and primary care

5 services for uninsured and underinsured individuals

6 and families in the community, including mental

7 health services or substance abuse services;

8 ‘‘(5) whose proposed program would improve

9 coordination between health care providers and ap10 propriate social service providers, including local and

11 regional human services agencies, school systems,

12 and agencies on aging;

13 ‘‘(6) that demonstrate collaboration with State

14 and local governments;

15 ‘‘(7) that make use of non-Federal contribu16 tions to the greatest extent possible; or

17 ‘‘(8) that demonstrate a likelihood that the pro18 posed program will continue after support under this

19 section ceases.

20 ‘‘(e) USE OF FUNDS.—

21 ‘‘(1) USE BY GRANTEES.—

22 ‘‘(A) IN GENERAL.—Except as provided in

23 paragraphs (2) and (3), a grantee may use

24 amounts provided under this section only for—
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1 ‘‘(i) direct expenses associated with

2 planning, developing, and operating the

3 greater integration of a health care deliv4 ery system so that it either directly pro5 vides or ensures the provision of a broad

6 range of services, as appropriate, including

7 primary, secondary, and tertiary services,

8 as well as substance abuse treatment and

9 mental health services; and

10 ‘‘(ii) direct patient care and service

11 expansions to fill identified or documented

12 gaps within an integrated delivery system.

13 ‘‘(B) SPECIFIC USES.—The following are

14 examples of purposes for which a grantee may

15 use grant funds, when such use meets the con16 ditions stated in subparagraph (A):

17 ‘‘(i) Increase in outreach activities.

18 ‘‘(ii) Improvements to case manage19 ment.

20 ‘‘(iii) Improvements to coordination of

21 transportation to health care facilities.

22 ‘‘(iv) Development of provider net23 works.

24 ‘‘(v) Recruitment, training, and com25 pensation of necessary personnel.
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1 ‘‘(vi) Acquisition of technology.

2 ‘‘(vii) Identifying and closing gaps in

3 services being provided.

4 ‘‘(viii) Improvements to provider com5 munication, including implementation of

6 shared information systems or shared clin7 ical systems.

8 ‘‘(ix) Other activities that may be ap9 propriate to a community that would in10 crease access to the uninsured.

11 ‘‘(2) DIRECT PATIENT CARE LIMITATION.—No

12 more than 15 percent of the funds provided under

13 a grant may be used for providing direct patient

14 care and services.

15 ‘‘(3) RESERVATION OF FUNDS FOR NATIONAL

16 PROGRAM PURPOSES.—The Secretary may use not

17 more than 3 percent of funds appropriated to carry

18 out this section for technical assistance to grantees,

19 obtaining assistance of experts and consultants,

20 meetings, dissemination of information, evaluation,

21 and activities that will extend the benefits of funded

22 programs to communities other than the one funded.

23 ‘‘(f) MAINTENANCE OF EFFORT.—With respect to

24 activities for which a grant under this section is author25 ized, the Secretary may award such a grant only if the
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1 recipient of the grant and each of the participating pro2 viders agree that each one will maintain its expenditures

3 of non-Federal funds for such activities at a level that is

4 not less than the level of such expenditures during the year

5 immediately preceding the fiscal year for which the appli6 cant is applying to receive such grant.

7 ‘‘(g) REPORTS TO THE SECRETARY.—The recipient

8 of a grant under this section shall report to the Secretary

9 annually regarding—

10 ‘‘(1) progress in meeting the goals stated in its

11 grant application; and

12 ‘‘(2) such additional information as the Sec13 retary may require.

14 The Secretary may not renew an annual grant under this

15 section unless the Secretary is satisfied that the consor16 tium has made reasonable and demonstrable progress in

17 meeting the goals set forth in its grant application for the

18 preceding year.

19 ‘‘(h) AUDITS.—Each entity which receives a grant

20 under this section shall provide for an independent annual

21 financial audit of all records that relate to the disposition

22 of funds received through this grant.

23 ‘‘(i) TECHNICAL ASSISTANCE.—The Secretary may,

24 either directly or by grant or contract, provide any funded
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1 entity with technical and other non-financial assistance

2 necessary to meet the requirements of this section.

3 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—For the

4 purpose of carrying out this section, there are authorized

5 to be appropriated $125,000,000 in fiscal year 2001 and

6 such sums as may be necessary for each of fiscal years

7 2002 through 2005.’’.

Æ