I

106TH CONGRESS

2D SESSION H. R. 4932

To amend titles XIX and XXI of the Social Security Act to expand access

of children to health care.

IN THE HOUSE OF REPRESENTATIVES

JULY 24, 2000

Mr. KLINK introduced the following bill; which was referred to the Committee

on Commerce

A BILL

To amend titles XIX and XXI of the Social Security Act

to expand access of children to health care.

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 ‘‘Medikid Health Care Expansion Act of 2000’’.

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

7 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Permitting States to increase SCHIP eligibility to up to 250 percent of

poverty line.

Sec. 3. Allowing higher income families to buy into program.

Sec. 4. Simplified outreach and enrollment.

Sec. 5. Expediting eligibility process.
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Sec. 6. Availability of enrollment performance incentive bonuses from reallotment.

Sec. 7. Encouraging school-based outreach.

Sec. 8. Extending authorization of graduate medical education funding for children’s hospitals.

Sec. 9. Optional coverage of low-income, uninsured pregnant women under a

state child health plan.

1 SEC. 2. PERMITTING STATES TO INCREASE SCHIP ELIGI2 BILITY TO UP TO 250 PERCENT OF POVERTY

3 LINE.

4 (a) IN GENERAL.—Section 2110(c)(4) of the Social

5 Security Act (42 U.S.C. 1397jj(c)(4)) is amended by in6 serting ‘‘(or, at the option of the State, a higher percent

7 not to exceed 250 percent)’’ after ‘‘200 percent’’.

8 (b) EFFECTIVE DATE.—The amendment made by

9 subsection (a) takes effect as of the date of the enactment

10 of this Act.

11 SEC. 3. ALLOWING HIGHER INCOME FAMILIES TO BUY INTO

12 PROGRAM.

13 Title XXI of the Social Security Act is amended by

14 adding at the end the following new section:

15 ‘‘SEC. 2111. OPTIONAL STATE BUY-IN PERMITTED FOR

16 OTHER CHILDREN.

17 ‘‘Nothing in this title shall be construed as preventing

18 a State from permitting families of children who are not

19 low-income children to enroll in the State child health plan

20 in return for payment of such premium as the State may

21 establish.’’.
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1 SEC. 4. SIMPLIFIED OUTREACH AND ENROLLMENT.

2 Section 2102 of the Social Security Act (42 U.S.C.

3 1397bb) is amended by adding at the end the following

4 new subsection:

5 ‘‘(d) DEVELOPMENT AND USE OF UNIFORM APPLI6 CATION FORMS AND COORDINATED ENROLLMENT PROC7 ESS.—A State child health plan shall provide, by not later

8 than the first day of the first month that begins more than

9 6 months after the date of the enactment of this sub10 section, for—

11 ‘‘(1) the development and use of a uniform, sim12 plified application form which is used both for pur13 poses of establishing eligibility for benefits under

14 this title and also under title XIX; and

15 ‘‘(2) an enrollment process that is coordinated

16 with that under title XIX so that a family need only

17 interact with a single agency in order to determine

18 whether a child is eligible for benefits under this

19 title or title XIX.’’.

20 SEC. 5. EXPEDITING ELIGIBILITY PROCESS.

21 (a) APPLICATION OF PRESUMPTIVE ELIGIBILITY

22 UNDER SCHIP AND REDUCTION OF STATE MATCH FOR

23 OUTREACH IF ELECT PRESUMPTIVE ELIGIBILITY.—

24 (1) IN GENERAL.—Section 2102 of the Social

25 Security Act (42 U.S.C. 1397bb), as amended by
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1 section 4, is further amended by adding at the end

2 the following new subsection:

3 ‘‘(e) APPLICATION OF PRESUMPTIVE ELIGIBILITY

4 PROVISIONS.—A State may elect to apply the provisions

5 of section 1920A under this title in the same manner as

6 the State may elect to apply such provisions under title

7 XIX.’’.

8 (2) REDUCTION OF STATE MATCHING REQUIRE9 MENT.—Section 2105 of such Act (42 U.S.C.

10 1397ee) is amended—

11 (A) in subsection (b), by inserting ‘‘subject

12 to subsection (g),’’ after ‘‘For purposes of sub13 section (a),’’; and

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

15 subsection:

16 ‘‘(g) 90 PERCENT FEDERAL MATCH FOR ADDI17 TIONAL OUTREACH EXPENDITURES IF STATE ELECTS TO

18 USE PRESUMPTIVE ELIGIBILITY FOR BOTH MEDICAID

19 AND SCHIP.—The enhanced FMAP with respect to child

20 health assistance for outreach services described in section

21 2102(c)(1) for a State shall be, with respect to expendi22 tures for such services above the level of such expenditures

23 in fiscal year 2000, equal to 90 percent if the State has

24 both—
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1 ‘‘(1) elected to apply the provisions of section

2 1920A under title XIX for the entire fiscal year; and

3 ‘‘(2) elected under section 2102(e) to apply the

4 provisions of section 1920A under this title for the

5 entire fiscal year.’’.

6 (3) EFFECTIVE DATE.—The amendments made

7 by this subsection take effect on the date of the en8 actment of this Act and apply to fiscal years begin9 ning on or after such date.

10 (b) CLARIFICATION OF USE OF SCHIP FUNDS TO

11 PROVIDE ENROLLING CENTERS WITH INCENTIVES TO

12 ENROLL LOW-INCOME CHILDREN.—

13 (1) IN GENERAL.—Section 2105 of such Act

14 (42 U.S.C. 1397ee), as amended by subsection (b),

15 is further amended—

16 (A) in subsection (g), by inserting ‘‘and for

17 expenditures described in subsection (h)’’ after

18 ‘‘described in section 2102(c)(1)’’; and

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

20 subsection:

21 ‘‘(h) TREATMENT OF ENROLLMENT INCENTIVES.—

22 Reasonable expenditures to enrolling centers to provide an

23 incentive to enroll targeted low-income children under this

24 title shall be treated as reasonable costs incurred by the
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1 State to administer the plan for purposes of subsection

2 (a)(2)(D).’’.

3 (2) EFFECTIVE DATE.—The amendments made

4 by paragraph (1) apply to expenditures made on or

5 after the date of the enactment of this Act.

6 SEC. 6. AVAILABILITY OF ENROLLMENT PERFORMANCE IN7 CENTIVE BONUSES FROM REALLOTMENT.

8 Section 2105 of the Social Security Act (42 U.S.C.

9 1397ee), as amended by section 5(a)(2), is amended by

10 adding at the end the following new subsection:

11 ‘‘(h) ENROLLMENT PERFORMANCE INCENTIVE

12 BONUS PAYMENTS.—

13 ‘‘(1) IN GENERAL.—In the case of a bonus eli14 gible State described in paragraph (2), the Secretary

15 shall pay to the State, from the amount of an allot16 ment redistributed to the State under section

17 2104(f) during a fiscal year (beginning with fiscal

18 year 2001), an incentive performance bonus pay19 ment equal to such percent (not less than 2 percent,

20 and not to exceed 5 percent) of the amount of such

21 allotment as the Secretary determines appropriate

22 based on the State’s performance in meeting or ex23 ceeding objectives referred to in paragraph (2)(B).
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1 ‘‘(2) BONUS ELIGIBLE STATE.—A bonus eligible

2 State described in this paragraph for a fiscal year is

3 a State that—

4 ‘‘(A) has not had any allotment for any

5 previous fiscal year redistributed to another

6 State under section 2104(f); and

7 ‘‘(B) meets or exceeds reasonable objec8 tives established by the Secretary for the enroll9 ment of low-income children under this title

10 (and title XIX).

11 ‘‘(3) TREATMENT OF PAYMENT.—The amount

12 paid under paragraph (1)—

13 ‘‘(A) shall be paid without the need for any

14 non-Federal contribution under subsection (a);

15 ‘‘(B) may be used for any expenditures

16 permitted under subsection (b)(1) and without

17 regard to any limitations under paragraphs (2)

18 and (3) of subsection (b); but

19 ‘‘(C) may not be included in determining

20 the amount of non-Federal contributions other21 wise required under subsection (a).’’.

22 SEC. 7. ENCOURAGING SCHOOL-BASED OUTREACH.

23 (a) IN GENERAL.—Section 2102(c)(1) of such Act

24 (42 U.S.C. 1397bb(c)(1)) is amended by adding at the end

25 the following: ‘‘Such outreach shall include school-based
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1 programs targeted at schools with high rates of uninsured

2 children.’’.

3 (b) EFFECTIVE DATE.—The amendment made by

4 subsection (a) takes effect on October 1, 2000.

5 SEC. 8. EXTENDING AUTHORIZATION OF GRADUATE MED6 ICAL EDUCATION FUNDING FOR CHILDREN’S

7 HOSPITALS.

8 Section 340E of the Public Health Service Act (42

9 U.S.C. 256e) is amended—

10 (1) in subsection (a), by striking ‘‘and 2001’’

11 and inserting ‘‘through 2005’’; and

12 (2) in subsection (f)—

13 (A) in paragraph (1)(A)(ii), by striking

14 ‘‘for fiscal year 2001’’ and inserting ‘‘for each

15 of fiscal years 2001 through 2005’’;

16 (B) in paragraph (1)(B), by striking ‘‘for

17 fiscal year 2000 shall remain available for obli18 gation through the end of fiscal year 2001’’ and

19 inserting ‘‘for a fiscal year shall remain avail20 able for obligation through the end of the suc21 ceeding fiscal year’’; and

22 (C) in paragraph (2)(B), by striking ‘‘for

23 fiscal year 2001’’ and inserting ‘‘for each of fis24 cal years 2001 through 2005’’.
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1 SEC. 9. OPTIONAL COVERAGE OF LOW-INCOME, UNIN2 SURED PREGNANT WOMEN UNDER A STATE

3 CHILD HEALTH PLAN.

4 (a) IN GENERAL.—Title XXI of the Social Security

5 Act, as amended by section 3, is further amended by add6 ing at the end the following new section:

7 ‘‘SEC. 2112. OPTIONAL COVERAGE OF LOW-INCOME, UNIN8 SURED PREGNANT WOMEN.

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

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

11 provide for coverage of pregnancy-related assistance for

12 targeted low-income pregnant women in accordance with

13 this section, but only if the State has established an in14 come eligibility level under section 1902(l)(2)(A) for

15 women described in section 1902(l)(1)(A) that is 185 per16 cent of the income official poverty line.

17 ‘‘(b) DEFINITIONS.—For purposes of this section:

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

19 term ‘pregnancy-related assistance’ has the meaning

20 given the term child health assistance in section

21 2110(a) as if any reference to targeted low-income

22 children were a reference to targeted low-income

23 pregnant women, except that the assistance shall be

24 limited to services related to pregnancy (which in25 clude prenatal, delivery, and postpartum services)

26 and to other conditions that may complicate preg-
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1 nancy and shall not include prepregnancy services

2 and supplies.

3 ‘‘(2) TARGETED LOW-INCOME PREGNANT

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

5 woman’ has the meaning given the term ‘targeted

6 low-income child’ in section 2110(b) as if any ref7 erence to a child were deemed a reference to a

8 woman during pregnancy and through the end of the

9 month in which the 60-day period (beginning on the

10 last day of her pregnancy) ends.

11 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

12 RULES.—In the case of, and with respect to, a State pro13 viding for coverage of pregnancy-related assistance to tar14 geted low-income pregnant women under subsection (a),

15 the following special rules apply:

16 ‘‘(1) Any reference in this title (other than sub17 section (b)) to a targeted low-income child is deemed

18 to include a reference to a targeted low-income preg19 nant woman.

20 ‘‘(2) Any such reference to child health assist21 ance with respect to such women is deemed a ref22 erence to pregnancy-related assistance.

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

24 reference to a woman during pregnancy and the pe25 riod described in subsection (b)(2).
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1 ‘‘(4) The medicaid applicable income level is

2 deemed a reference to the income level established

3 under section 1902(l)(2)(A).

4 ‘‘(5) Subsection (a) of section 2103 (relating to

5 required scope of health insurance coverage) shall

6 not apply insofar as a State limits coverage to serv7 ices described in subsection (b)(1) and the reference

8 to such section in section 2105(a)(1) is deemed not

9 to require, in such case, compliance with the require10 ments of section 2103(a).

11 ‘‘(6) There shall be no exclusion of benefits for

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

13 pre-existing condition and no waiting period (includ14 ing any waiting period imposed to carry out section

15 2102(b)(3)(C)) shall apply.

16 ‘‘(d) NO IMPACT ON ALLOTMENTS.—Nothing in this

17 section shall be construed as affecting the amount of any

18 initial allotment provided to a State under section

19 2104(b).

20 ‘‘(e) APPLICATION OF FUNDING RESTRICTIONS.—

21 The coverage under this section (and the funding of such

22 coverage) is subject to the restrictions of section 2105(c).

23 ‘‘(f) AUTOMATIC ENROLLMENT FOR CHILDREN

24 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS25 SISTANCE.—Notwithstanding any other provision of this
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1 title or title XIX, if a child is born to a targeted low-in2 come pregnant woman who was receiving pregnancy-re3 lated assistance under this section on the date of the chil4 dren’s birth, the child shall be deemed to have applied for

5 child health assistance under the State child health plan

6 and to have been found eligible for such assistance under

7 such plan (or, in the case of a State that provides such

8 assistance through the provision of medical assistance

9 under a plan under title XIX, to have applied for medical

10 assistance under such title and to have been found eligible

11 for such assistance under such title) on the date of such

12 birth and to remain eligible for such assistance until the

13 child attains 1 year of age so long as the child is a member

14 of the woman’s household and the woman remains (or

15 would remain if pregnant) eligible for such assistance.

16 During the period in which a child is deemed under the

17 preceding sentence to be eligible for child health or med18 ical assistance, the child health or medical assistance eligi19 bility identification number of the mother shall also serve

20 as the identification number of the child, and all claims

21 shall be submitted and paid under such number (unless

22 the State issues a separate identification number for the

23 child before such period expires).’’.

24 (b) STATE OPTION TO USE ENHANCED FMAP FOR

25 COVERAGE OF ADDITIONAL PREGNANT WOMEN UNDER
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1 THE MEDICAID PROGRAM.—Section 1905 of the Social

2 Security Act (42 U.S.C. 1396d) is amended—

3 (1) in subsection (b), by inserting ‘‘and in the

4 case of a State plan that meets the condition de5 scribed in subsections (u)(1) and (u)(4)(A), with re6 spect to expenditures described in subsection

7 (u)(4)(B) for the State for a fiscal year’’ after ‘‘for

8 a fiscal year,’’;

9 (2) by redesignating paragraph (4) of sub10 section (u) as paragraph (5); and

11 (3) by inserting after paragraph (3) of sub12 section (u) the following new paragraph:

13 ‘‘(4)(A) The condition described in this subparagraph

14 for a State plan is that the plan has established an income

15 level under section 1902(l)(2)(A) with respect to individ16 uals described in section 1902(l)(1)(A) that is 185 percent

17 of the income official poverty line.

18 ‘‘(B) For purposes of subsection (b), the expenditures

19 described in this paragraph are expenditures for medical

20 assistance for women described in section 1902(l)(1)(A)

21 whose income exceeds the income level established for such

22 women under section 1902(l)(2)(A)(i) as of the date of

23 the enactment of this paragraph but does not exceed than

24 185 percent of the income official poverty line.’’.
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1 (c) CONFORMING AMENDMENTS.—Section

2 2102(b)(1)(B) of the Social Security Act (42 U.S.C.

3 1397bb(b)(1)(B)) is amended—

4 (1) by striking ‘‘and’’ at the end of clause (i);

5 (2) by striking the period at the end of clause

6 (ii) and inserting ‘‘; and’’; and

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

8 clause:

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

10 (including a waiting period to carry out

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

12 low-income child who is pregnant, if the

13 State provides for coverage of pregnancy14 related assistance for targeted low-income

15 pregnant women in accordance section

16 2112.’’.

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

18 this section take effect on the date of the enactment of

19 this Act and apply to allotments for all fiscal years.

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