I

106TH CONGRESS

2D SESSION H. R. 5192

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

coverage of needy children under the State Children’s Health Insurance

Program (SCHIP) and the Medicaid Program.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 14, 2000

Mr. WEYGAND 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 improve the coverage of needy children under the

State Children’s Health Insurance Program (SCHIP)

and the Medicaid Program.

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; REFERENCES IN ACT; TABLE OF

4 CONTENTS.

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

6 ‘‘Medicaid and SCHIP Improvement and Flexibility Act

7 of 2000’’.
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1 (b) REFERENCES TO SOCIAL SECURITY ACT.—Ex2 cept as otherwise expressly provided, whenever in this Act

3 an amendment or repeal is expressed in terms of an

4 amendment to, or repeal of, a section or other provision,

5 the reference shall be considered to be made to a section

6 or other provision of the Social Security Act.

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

8 this Act is as follows:

Sec. 1. Short title; references in Act; table of contents.

Sec. 2. Simplified outreach and enrollment.

Sec. 3. Family friendly coverage and enrollment.

Sec. 4. Expanded coverage options.

Sec. 5. Availability of fiscal year 1998 and fiscal year 1999 allotments under

SCHIP.

Sec. 6. Permitting increased share of SCHIP funds to be expended for prevention programs that ensure healthy childhoods and quality prenatal health care.

Sec. 7. Use of SCHIP funds for enhanced matching rate for coverage of additional children under the medicaid program.

9 SEC. 2. SIMPLIFIED OUTREACH AND ENROLLMENT.

10 (a) USE OF UNIFORM APPLICATION AND COORDI11 NATED ENROLLMENT PROCESS.—

12 (1) SCHIP PROGRAM.—Section 2102 (42

13 U.S.C. 1397bb) is amended by adding at the end the

14 following new subsection:

15 ‘‘(d) DEVELOPMENT AND USE OF UNIFORM APPLI16 CATION FORMS AND COORDINATED ENROLLMENT PROC17 ESS.—A State child health plan shall provide, by not later

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

19 6 months after the date of the enactment of this sub20 section, for—
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1 ‘‘(1) the development and use of a uniform,

2 simplified application form which is used both for

3 purposes of establishing eligibility for benefits under

4 this title and also under title XIX; and

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

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

7 interact with a single State agency in order to deter8 mine whether a child is eligible for benefits under

9 this title or title XIX and to apply for such bene10 fits.’’.

11 (2) MEDICAID CONFORMING AMENDMENT.—

12 (A) IN GENERAL.—Section 1902(a) (42

13 U.S.C. 1396a(a)) is amended—

14 (i) by striking the period at the end of

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

16 (ii) by inserting after paragraph (65)

17 the following new paragraph:

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

19 the first month that begins more than 6 months

20 after the date of the enactment of this paragraph,

21 in the case of a State with a State child health plan

22 under title XXI for—

23 ‘‘(A) the development and use of a uni24 form, simplified application form which is used

25 both for purposes of establishing eligibility for
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1 benefits under this title and also under title

2 XXI; and

3 ‘‘(B) establishment and operation of an en4 rollment process that is coordinated with that

5 under title XXI so that a family need only

6 interact with a single State agency in order to

7 determine whether a child is eligible for benefits

8 under this title or title XXI and to apply for

9 such benefits.’’.

10 (B) EFFECTIVE DATE.—The amendments

11 made by subparagraph (A) apply to calendar

12 quarters beginning more than 6 months after

13 the date of the enactment of this Act.

14 (b) FINANCIAL INCENTIVES TO PROMOTE APPRO15 PRIATE ENROLLMENT.—

16 (1) EXPANDED AVAILABILITY OF FUNDING FOR

17 ADMINISTRATIVE COSTS RELATED TO OUTREACH

18 AND ELIGIBILITY DETERMINATIONS.—Section

19 1931(h) (42 U.S.C. 1396u–1(h)), as amended by

20 section 602 of the Medicare, Medicaid, and SCHIP

21 Balanced Budget Refinement Act of 1999 (113 Stat.

22 1501A–394), as enacted into law by section

23 1000(a)(6) of Public Law 106–113 is amended—

24 (A) in the matter preceding paragraph (1),

25 by striking ‘‘TRANSITIONAL’’ and all that fol-
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1 lows through ‘‘COSTS’’ and inserting ‘‘IN2 CREASED FEDERAL MATCHING RATE FOR AD3 MINISTRATIVE COSTS RELATED TO CERTAIN

4 OUTREACH AND ELIGIBILITY DETERMINA5 TIONS’’;

6 (B) in paragraph (2), by inserting ‘‘either’’

7 after ‘‘attributable’’ and by inserting before the

8 period at the end the following: ‘‘or to adminis9 trative costs of determinations of the eligibility

10 of children and pregnant women for benefits

11 under the State plan under this title or title

12 XXI, outreach to children and pregnant women

13 likely to be eligible for such benefits, and such

14 other outreach- and eligibility-related activities

15 as the Secretary may approve’’; and

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

17 paragraph:

18 ‘‘(4) ENCOURAGING USE OF LOCAL AND COM19 MUNITY-BASED ORGANIZATIONS IN OUTREACH AND

20 ENROLLMENT ACTIVITIES.—The Secretary shall es21 tablish a procedure under which, if States do not

22 otherwise obligate the amounts made available under

23 this subsection, local and community-based public or

24 nonprofit organizations (including local and county

25 governments, public health departments, community
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1 health centers, children’s hospitals, and dispropor2 tionate share hospitals) may seek to have adminis3 trative costs relating to outreach and enrollment of

4 children and pregnant women under this title and

5 title XXI be treated and reimbursed as administra6 tive costs of a State described in section 1903(a)(7),

7 if such organizations have the permission of the

8 State involved. A State may require such an organi9 zation to provide payment of such amounts as the

10 State would otherwise be responsible for in order to

11 obtain payment under this paragraph.’’.

12 (2) USE OF 3 PERCENT OF SCHIP FUNDS AT 90

13 PERCENT FEDERAL MATCH FOR ENROLLMENT AND

14 OUTREACH ACTIVITIES.—Section 2105(b) (42

15 U.S.C. 1397ee(b)) is amended—

16 (A) by designating the matter following the

17 dash as a paragraph (1) with appropriate in18 dentation and with the heading ‘‘(1) IN GEN19 ERAL’’;

20 (B) by inserting ‘‘subject to paragraph

21 (2)’’ after ‘‘(a)’’;

22 (C) by striking ‘‘(1)’’ and ‘‘(2)’’ and in23 serting ‘‘(A)’’ and ‘‘(B)’’, respectively; and

24 (D) by adding at the end the following

25 paragraph:
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1 ‘‘(2) SPECIAL RULE FOR CERTAIN ENROLL2 MENT AND OUTREACH ACTIVITIES.—

3 ‘‘(A) IN GENERAL.—For purposes of sub4 section (a), in the case of a State that meets

5 the requirement of subparagraph (B), and sub6 ject to subparagraph (C), the ‘enhanced FMAP’

7 is equal to 90 percent with respect to amounts

8 expended on enrollment and outreach activities.

9 ‘‘(B) REQUIREMENTS.—Subparagraph (A)

10 shall only apply to a State if the State meets

11 the following requirements:

12 ‘‘(i) NO ASSET TEST.—The State does

13 not impose an asset test for eligibility

14 under the State child health plan or under

15 section 1902(l) with respect to children.

16 ‘‘(ii) COMPLIANCE WITH

17 OUTSTATIONING REQUIREMENT.—The Sec18 retary finds that the State is providing for

19 the receipt and initial processing of appli20 cations of certain individuals at facilities

21 defined as disproportionate share hospitals

22 under section 1923(a)(1)(A) and Feder23 ally-qualified health centers described in

24 section 1905(1)(2)(B) consistent with the

25 requirements of section 1902(a)(55).
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1 ‘‘(iii) COMPLIANCE WITH SIMPLIFIED

2 OUTREACH AND ENROLLMENT PROVI3 SIONS.—The Secretary finds that the State

4 is providing for outreach and enrollment

5 under this title and title XIX consistent

6 with the requirements of sections 2102(c),

7 2102(d), and 1902(a)(66).

8 ‘‘(iv) ALLOWING MAIL AND TELE9 PHONE APPLICATIONS.—The State allows

10 applications for children under this title

11 and title XIX to be submitted by mail or

12 through telephone.

13 ‘‘(C) LIMITATION TO 3 PERCENT OF AN14 NUAL ALLOTMENT.—Subparagraph (A) shall

15 not apply to amounts expended by a State in a

16 fiscal year in excess of 3 percent of the amount

17 of the amount of its allotment under section

18 2104 for that fiscal year.’’.

19 (3) EFFECTIVE DATE.—The amendments made

20 by this subsection take effect on the date of the en21 actment of this Act and apply to expenditures made

22 on or after the date of the enactment of this Act.

23 (d) ADDITIONAL ENTITIES QUALIFIED TO DETER24 MINE MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-IN-
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1 COME CHILDREN.—Section 1920A(b)(3)(A)(i) (42 U.S.C.

2 1396r–1a(b)(3)(A)(i)) is amended—

3 (1) by striking ‘‘or (II)’’ and inserting ‘‘, (II)’’;

4 and

5 (2) by inserting ‘‘eligibility of a child for med6 ical assistance under the State plan under this title,

7 or eligibility of a child for child health assistance

8 under the program funded under title XXI, (III) is

9 an elementary school or secondary school, as such

10 terms are defined in section 14101 of the Elemen11 tary and Secondary Education Act of 1965 (20

12 U.S.C. 8801), an elementary or secondary school op13 erated or supported by the Bureau of Indian Affairs,

14 a State child support enforcement agency, a child

15 care resource and referral agency, or a State office

16 or private contractor that accepts applications for or

17 administers a program funded under part A of title

18 IV or that determines eligibility for any assistance

19 or benefits provided under any program of public or

20 assisted housing that receives Federal funds, includ21 ing the program under section 8 or any other section

22 of the United States Housing Act of 1937 (42

23 U.S.C. 1437 et seq.), or (IV) any other entity the

24 State so deems’’ before the semicolon.
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1 SEC. 3. FAMILY FRIENDLY COVERAGE AND ENROLLMENT.

2 (a) PROHIBITION OF WAITING PERIODS.—

3 (1) IN GENERAL.—Section 2102(b)(1)(B) (42

4 U.S.C. 1397bb(b)(1)(B)) is amended—

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

6 (i);

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

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

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

10 clause:

11 ‘‘(iii) shall not permit the use of any

12 mandatory waiting period (including any

13 such period in order to carry out para14 graph (3)(C)), unless the Secretary finds

15 that the imposition of such a period would

16 not be contrary to the provisions of this

17 title.’’.

18 (2) EFFECTIVE DATE.—The amendments made

19 by paragraph (1) apply to assistance furnished on or

20 after the date of the enactment of this Act.

21 (b) GRACE PERIOD BEFORE DISENROLLMENT FOR

22 NONPAYMENT OF PREMIUMS.—

23 (1) IN GENERAL.—Section 2103(e) (42 U.S.C.

24 1397ee(e)) is amended by adding at the end the fol25 lowing new paragraph:
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1 ‘‘(5) GOOD CAUSE WAIVER OF DISENROLLMENT

2 FOR NONPAYMENT OF PREMIUMS.—The State child

3 health plan shall establish rules allowing waiver for

4 good cause of termination of enrollment for non5 payment of premiums and shall establish an appeals

6 process that includes a hearing and a 3-month grace

7 period prior to termination of coverage and includes

8 waiver of any late payment penalties when premium

9 payments are made in full.’’.

10 (2) EFFECTIVE DATE.—The amendment made

11 by paragraph (1) applies to disenrollments occurring

12 on or after the date that is 30 days after the date

13 of the enactment of this Act.

14 SEC. 4. EXPANDED COVERAGE OPTIONS.

15 (a) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR

16 SCHIP AND MEDICAID BENEFITS FOR CHILDREN LOS17 ING MEDICAID OR SCHIP ELIGIBILITY.—

18 (1) LOSS OF MEDICAID ELIGIBILITY.—Section

19 1902(a)(66) (42 U.S.C. 1396a(a)(66)), as inserted

20 by section 2(a)(2), is amended—

21 (A) by striking ‘‘and’’ at the end of sub22 paragraph (B),

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

24 subparagraph (C) and inserting ‘‘; and’’; and
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1 (C) by adding at the end the following new

2 subparagraph:

3 ‘‘(D) the automatic assessment, in the case

4 of a child who loses eligibility for medical assist5 ance under this title on the basis of changes in

6 income, assets, or age, of whether the child is

7 eligible for benefits under title XXI.’’.

8 (2) LOSS OF SCHIP ELIGIBILITY.—Section

9 2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended by

10 redesignating subparagraphs (D) and (E) as sub11 paragraphs (E) and (F), respectively, and by insert12 ing after subparagraph (C) the following new sub13 paragraph:

14 ‘‘(D) that there is an automatic assess15 ment, in the case of a child who loses eligibility

16 for child health assistance under this title on

17 the basis of changes in income, assets, or age,

18 of whether the child is eligible for medical as19 sistance under title XIX;’’.

20 (3) EFFECTIVE DATE.—The amendments made

21 by paragraphs (1) and (2) apply to children who lose

22 eligibility under the medicaid program under title

23 XIX, or under a State child health insurance plan

24 under title XXI, respectively, of the Social Security
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1 Act on or after the date that is 30 days after the

2 date of the enactment of this Act.

3 (b) OPTIONAL COVERAGE OF LOW-INCOME, UNIN4 SURED PREGNANT WOMEN UNDER A STATE CHILD

5 HEALTH PLAN.—

6 (1) IN GENERAL.—Title XXI is amended by

7 adding at the end the following new section:

8 ‘‘SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNIN9 SURED PREGNANT WOMEN.

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

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

12 provide for coverage of pregnancy-related assistance for

13 targeted low-income pregnant women in accordance with

14 this section, but only if the State has established an in15 come eligibility level under section 1902(l)(2)(A) for

16 women described in section 1902(l)(1)(A) that is 185 per17 cent of the income official poverty line.

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

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

20 term ‘pregnancy-related assistance’ has the meaning

21 given the term child health assistance in section

22 2110(a) as if any reference to targeted low-income

23 children were a reference to targeted low-income

24 pregnant women, except that the assistance shall be

25 limited to services related to pregnancy (which in-
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1 clude prenatal, delivery, and postpartum services)

2 and to other conditions that may complicate preg3 nancy and shall not include prepregnancy services

4 and supplies.

5 ‘‘(2) TARGETED LOW-INCOME PREGNANT

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

7 woman’ has the meaning given the term targeted

8 low-income child in section 2110(b) as if any ref9 erence to a child were deemed a reference to a

10 woman during pregnancy and through the end of the

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

12 last day of her pregnancy) ends.

13 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

14 RULES.—In the case of, and with respect to, a State pro15 viding for coverage of pregnancy-related assistance to tar16 geted low-income pregnant women under subsection (a),

17 the following special rules apply:

18 ‘‘(1) Any reference in this title (other than sub19 section (b)) to a targeted low income child is deemed

20 to include a reference to a targeted low-income preg21 nant woman.

22 ‘‘(2) Any such reference to child health assist23 ance with respect to such women is deemed a ref24 erence to pregnancy-related assistance.
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1 ‘‘(3) Any such reference to a child is deemed a

2 reference to a woman during pregnancy and the pe3 riod described in subsection (b)(2).

4 ‘‘(4) The medicaid applicable income level is

5 deemed a reference to the income level established

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

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

8 required scope of health insurance coverage) shall

9 not apply insofar as a State limits coverage to serv10 ices described in subsection (b)(1) and the reference

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

12 to require, in such case, compliance with the require13 ments of section 2103(a).

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

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

16 pre-existing condition and no waiting period (includ17 ing any waiting period imposed to carry out section

18 2102(b)(3)(C)) shall apply.

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

20 section shall be construed as affecting the amount of any

21 initial allotment provided to a State under section

22 2104(b).

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

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

25 coverage) is subject to the restrictions of section 2105(c).
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1 ‘‘(f) AUTOMATIC ENROLLMENT FOR CHILDREN

2 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS3 SISTANCE.—Notwithstanding any other provision of this

4 title or title XIX, if a child is born to a targeted low-in5 come pregnant woman who was receiving pregnancy-re6 lated assistance under this section on the date of the chil7 dren’s birth, the child shall be deemed to have applied for

8 child health assistance under the State child health plan

9 and to have been found eligible for such assistance under

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

11 assistance through the provision of medical assistance

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

13 assistance under such title and to have been found eligible

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

15 birth and to remain eligible for such assistance until the

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

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

18 would remain if pregnant) eligible for such assistance.’’.

19 (2) STATE OPTION TO USE ENHANCED FMAP

20 FOR COVERAGE OF ADDITIONAL PREGNANT WOMEN

21 UNDER THE MEDICAID PROGRAM.—Section 1905 (42

22 U.S.C. 1396d) is amended—

23 (A) in subsection (b), by inserting ‘‘and in

24 the case of a State plan that meets the condi25 tion described in subsections (u)(1) and
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1 (u)(4)(A), with respect to expenditures de2 scribed in subsection (u)(4)(B) for the State for

3 a fiscal year’’ after ‘‘for a fiscal year,’’;

4 (B) by redesignating paragraph (4) of sub5 section (u) as paragraph (5); and

6 (C) by inserting after paragraph (3) of

7 subsection (u) the following new paragraph:

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

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

10 level under section 1902(l)(2)(A) with respect to individ11 uals described in section 1902(l)(1)(A) that is 185 percent

12 of the income official poverty line.

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

14 described in this paragraph are expenditures for medical

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

16 whose income exceeds the income level established for such

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

18 the enactment of this paragraph but does not exceed 185

19 percent of the income official poverty line.’’.

20 (3) CONFORMING AMENDMENTS.—Section

21 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is

22 amended—

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

24 (i);
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1 (B) by striking the period at the end of

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

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

4 clause:

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

6 (including a waiting period to carry out

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

8 low-income child who is pregnant, if the

9 State provides for coverage of pregnancy10 related assistance for targeted low-income

11 pregnant women in accordance section

12 2111.’’.

13 (4) EFFECTIVE DATE.—The amendments made

14 by this subsection take effect on the date of the en15 actment of this Act and apply to allotments for all

16 fiscal years.

17 (c) STATE OPTION FOR COVERAGE OF QUALIFIED

18 ALIEN CHILDREN UNDER MEDICAID AND CHILDREN’S

19 HEALTH INSURANCE PROGRAMS.—

20 (1) MEDICAID.—

21 (A) CATEGORICALLY NEEDY.—Section

22 1902(a)(10)(a)(ii) (42 U.S.C.

23 1396a(a)(10)(A)(ii)) is amended—

24 (i) by striking ‘‘or’’ at the end of sub25 clause (XIII);
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1 (ii) by adding ‘‘or’’ at the end of sub2 clause (XIV); and

3 (iii) by adding at the end the fol4 lowing new subclause:

5 ‘‘(XV) who are described in sec6 tion 1905(a)(i) and who would be eli7 gible for medical assistance (or for a

8 greater amount of medical assistance)

9 under the State plan under this title

10 but for the provisions of section 403

11 or section 421 of Public Law 104–

12 193, but the State may not exercise

13 the option of providing medical assist14 ance under this subclause with respect

15 to a subcategory of individuals de16 scribed in this subclause;’’.

17 (B) MEDICALLY NEEDY.—Section

18 1902(a)(10)(C)(i)(I) (42 U.S.C.

19 1396a(a)(10)(C)(i)(I)) is amended by inserting

20 ‘‘(and such criteria may provide for eligibility of

21 individuals described in subparagraph

22 (A)(ii)(XV))’’ after ‘‘medical assistance’’.

23 (2) CHILDREN’S HEALTH INSURANCE PRO24 GRAM.—Section 2110(b) (42 U.S.C. 1397jj(b)) is

25 amended—
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1 (A) in paragraph (1)(A), by inserting be2 fore the semicolon ‘‘(including, at the option of

3 the State, a child described in paragraph

4 (3)(B))’’; and

5 (B) in paragraph (3)—

6 (i) by striking ‘‘SPECIAL RULE.—’’

7 and inserting ‘‘SPECIAL RULES.—

8 ‘‘(i) HEALTH INSURANCE COV9 ERAGE.—’’ by indenting the remainder of

10 the text accordingly; and

11 (ii) by adding at the end the following

12 new subparagraph:

13 ‘‘(B) ELIGIBILITY FOR QUALIFIED ALIEN

14 CHILDREN.—For purposes of paragraph (1)(A),

15 a child is described in this subparagraph if—

16 ‘‘(i) the child would be determined eli17 gible for child health assistance under this

18 title but for any or all of the provisions of

19 sections 403 and 421 of Public Law 104–

20 193; and

21 ‘‘(ii) the State exercises the option to

22 provide medical assistance to the category

23 of individuals described in section

24 1902(a)(10)(A)(ii)(XV).’’.
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1 (3) PROHIBITION ON SEEKING SUPPORT FROM

2 SPONSOR.—Section 213A(b) of the Immigration and

3 Nationality Act (8 U.S.C. 1183a(b)) is amended by

4 adding at the end the following new paragraph:

5 ‘‘(4) EXCEPTION FOR CHILD MEDICAID OR

6 SCHIP ASSISTANCE.—The preceding provisions of

7 this subsection shall not apply to—

8 ‘‘(A) medical assistance furnished under

9 the State plan under title XIX of the Social Se10 curity Act to an individual eligible for such as11 sistance because of subclause (XV) of para12 graph (10)(A)(ii) of section 1902(a) of such Act

13 (42 U.S.C. 1396a(a)) or because of the ref14 erence to such subclause in paragraph (10)(C)

15 of such section; or

16 ‘‘(B) child health assistance furnished

17 under the State child health plan under title

18 XXI of such Act to a child eligible for such as19 sistance because of the provisions of section

20 2110(b)(3)(B) of such Act (42 U.S.C.

21 1397jj(b)(3)(B)).’’.

22 (d) ELIMINATION OF FUNDING OFFSET FOR EXER23 CISE OF PRESUMPTIVE ELIGIBILITY OPTION.—

24 (1) IN GENERAL.—Section 2104(d) (42 U.S.C.

25 1397dd(d)) is amended by striking ‘‘shall be reduced
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1 by the sum of’’ and all that follows through ‘‘(2) the

2 amount of payments under such section’’ and insert3 ing ‘‘shall be reduced by the amount of payments

4 under section 1903(a)(1)’’.

5 (2) EFFECTIVE DATE.—The amendment made

6 by paragraph (1) first applies for allotments for fis7 cal year 2001.

8 (f) PROGRAM COORDINATION WITH THE MATERNAL

9 AND CHILD HEALTH PROGRAM (TITLE V).—

10 (1) IN GENERAL.—Section 2102(b)(3) (42

11 U.S.C. 1397bb(b)(3)) is amended—

12 (A) by striking ‘‘and’’ at the end of sub13 paragraph (D);

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

15 subparagraph (E) and inserting ‘‘; and’’; and

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

17 subparagraph:

18 ‘‘(F) that operations and activities under

19 this title are developed and implemented in con20 sultation and coordination with the program op21 erated by the State under title V in areas in22 cluding outreach and enrollment, benefits and

23 services, service delivery standards, public

24 health and social service agency relationships,

25 and quality assurance and data reporting.’’.
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1 (2) CONFORMING MEDICAID AMENDMENT.—

2 Section 1902(a)(11) (42 U.S.C. 1306a(a)(11)) is

3 amended—

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

5 (B) by inserting before the semicolon at

6 the end the following: ‘‘, and (D) provide that

7 operations and activities under this title are de8 veloped and implemented in consultation and

9 coordination with the program operated by the

10 State under title V in areas including outreach

11 and enrollment, benefits and services, service

12 delivery standards, public health and social

13 service agency relationships, and quality assur14 ance and data reporting’’.

15 (3) EFFECTIVE DATE.—The amendments made

16 by this subsection take effect on January 1, 2001.

17 SEC. 5. AVAILABILITY OF FISCAL YEAR 1998 AND FISCAL

18 YEAR 1999 ALLOTMENTS UNDER SCHIP.

19 Notwithstanding subsection (e) of section 2104 of the

20 Social Security Act (42 U.S.C. 1397dd), amounts allotted

21 to a State under that section for each of fiscal years 1998

22 and 1999 shall remain available through September 30,

23 2002.
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1 SEC. 6. PERMITTING INCREASED SHARE OF SCHIP FUNDS

2 TO BE EXPENDED FOR PREVENTION PRO3 GRAMS THAT ENSURE HEALTHY CHILD4 HOODS AND QUALITY PRENATAL HEALTH

5 CARE.

6 Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is

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

9 ‘‘(C) EXCEPTION FOR OUTREACH AND

10 PREVENTION PROGRAMS IN STATES WITH SUB11 STANTIAL ENROLLMENT AND THAT WOULD NOT

12 OTHERWISE USE FULL ALLOTMENT.—

13 ‘‘(i) IN GENERAL.—In the case of a

14 State described in clause (ii)—

15 ‘‘(I) the limitation under sub16 paragraph (A) on expenditures for

17 items described in subparagraphs (B)

18 or (C) of subsection (a)(2) shall not

19 apply, but only up to 30 percent of

20 the sum described in subparagraph

21 (A); and

22 ‘‘(II) in applying subparagraph

23 (B) of subsection (a)(2), activities un24 dertaken by the State in conjunction

25 with the Centers for Disease Control

26 and Prevention to carry out activities
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1 to promote health pregnancies and

2 healthy children shall be treated as

3 expenditures described in such sub4 paragraph, subject to the limitation

5 under subclause (I) of this clause.

6 ‘‘(ii) STATE DESCRIBED.—A State de7 scribed in this clause is a State that estab8 lishes to the satisfaction of the Secretary

9 that—

10 ‘‘(I) the State provides for an in11 come level under section

12 2110(b)(1)(B)(i)(I) that is not less

13 than 200 percent of the poverty line;

14 ‘‘(II) the State does not provide

15 for any waiting list for enrollment

16 under this title;

17 ‘‘(III) the State has enrolled

18 under this title and title XIX at least

19 70 percent of the children eligible for

20 enrollment under such titles; and

21 ‘‘(IV) without the application of

22 this subparagraph, the State will not

23 be able to expend all the funds allot24 ted to it under this title.
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1 The Secretary may waive the requirement

2 of subclause (III) where the State dem3 onstrates to the satisfaction of the Sec4 retary that the State has made all possible

5 efforts to achieve the enrollment level spec6 ified in the subclause.

7 ‘‘(iii) PUBLIC-PRIVATE PARTNER8 SHIPS.—In conducting activities under

9 clause (i), a State may build partnerships

10 with outside organization whose primary

11 goal involves the healthy development of

12 mothers and children and may act to oth13 erwise eradicate illnesses and environ14 mental factors that impact these groups.

15 ‘‘(iv) ADDITIONAL PAYMENTS.—The

16 provisions of this subparagraph apply in

17 addition to the expenditures permitted

18 under subparagraph (A) for items de19 scribed in subparagraphs (B) and (C) of

20 subsection (a)(2).’’.

21 SEC. 7. USE OF SCHIP FUNDS FOR ENHANCED MATCHING

22 RATE FOR COVERAGE OF ADDITIONAL CHIL23 DREN UNDER THE MEDICAID PROGRAM.

24 (a) IN GENERAL.—Section 1905 (42 U.S.C. 1396d),

25 as amended by section 4(b)(2), is amended—
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1 (1) in subsection (b), by striking ‘‘or subsection

2 (u)(3)’’ and inserting ‘‘, subsection (u)(3), or sub3 section (u)(5)(A)’’; and

4 (2) in subsection (u)—

5 (A) by redesignating paragraph (5) as

6 paragraph (6); and

7 (B) by inserting after paragraph (4) the

8 following new paragraph:

9 ‘‘(5)(A) For purposes of subsection (b), the expendi10 tures described in this subparagraph are expenditures for

11 medical assistance for waivered low-income children de12 scribed in subparagraph (B) but—

13 ‘‘(i) only in the case of children residing in a

14 State described in subparagraph (C); and

15 ‘‘(ii) only to the extent the number of full-year

16 equivalent waivered low-income children enrolled

17 under the State plan under this title for the fiscal

18 year exceeds the number of waivered low-income

19 children described in subparagraph (D)(i) for the

20 State for the fiscal year.

21 ‘‘(B) For purposes of this paragraph, the term

22 ‘waivered low-income child’ means a child whose family in23 come exceeds the minimum income level required to be es24 tablished for the age of such child under section

25 1902(l)(2) in order for the child to be eligible for medical
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1 assistance under this title, but does not exceed the med2 icaid applicable income level (as defined in section

3 2110(b)(4) but determined as if ‘June 1, 1997’ were sub4 stituted for ‘March 31, 1997’) for that child.

5 ‘‘(C) A State described in this subparagraph is a

6 State that—

7 ‘‘(i) has under a waiver authorized by the Sec8 retary or under section 1902(r)(2) established and is

9 using a medicaid applicable income level (as defined

10 in section 2110(b)(4) but determined as if ‘June 1,

11 1997’ were substituted for ‘March 31, 1997’) for

12 children under 19 years of age residing in the State

13 that is at or above 200 percent of the poverty line;

14 and

15 ‘‘(ii) demonstrates to the satisfaction of the

16 Secretary that the State has taken all of the fol17 lowing actions to reach and enroll children who are

18 eligible for, but not enrolled under, the State plan:

19 ‘‘(I) Eliminating the assets test for eligi20 bility of waivered low-income children.

21 ‘‘(II) Using shortened and simplified appli22 cations for such children.

23 ‘‘(III) Allowing applications for such chil24 dren to be submitted by mail or through tele25 phone.
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1 ‘‘(IV) Outstationing State eligibility work2 ers at sites that are frequented by families with

3 children, including schools, child care centers,

4 churches, centers providing Head Start services,

5 local offices of the special supplemental food

6 program for women, infants and young children

7 (WIC) established under section 17 of the Child

8 Nutrition Act of 1966, community centers, Job

9 Corps centers established under part B of title

10 IV of the Job Training Partnership Act or sub11 title C of title I of the Workforce Investment

12 Act of 1998, sites offering the recognized equiv13 alent of a secondary school degree, offices of

14 tribal organizations (as defined in section 4(l)

15 of the Indian Self-Determination and Education

16 Assistance Act), and Social Security Adminis17 tration field offices.

18 ‘‘(V) Using presumptive eligibility for

19 waivered low-income children.

20 ‘‘(VI) Collaborating with public and private

21 entities to conduct outreach campaigns to enroll

22 such children.

23 ‘‘(D)(i) For purposes of subparagraph (A)(ii), the

24 number of waivered low-income children for a State de25 scribed in this clause for—
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1 ‘‘(I) fiscal year 1998, is equal to the number of

2 full-year equivalent waivered low-income children en3 rolled under the State plan under this title for fiscal

4 year 1997; and

5 ‘‘(II) fiscal year 1999 or a succeeding fiscal

6 year, is equal to the number of waivered low-income

7 children determined under this clause for the pre8 ceding fiscal year increased by the number of per9 centage points determined under clause (ii) for the

10 State for the fiscal year involved.

11 ‘‘(ii) The number of percentage points determined

12 under this clause for a State for a fiscal year is equal to

13 the number of percentage points by which—

14 ‘‘(I) the arithmetic average of the total number

15 of children in the State set forth in the 3 most re16 cent March supplements to the Current Population

17 Survey of the Bureau of the Census before the be18 ginning of the fiscal year; exceeds

19 ‘‘(II) the arithmetic average of such total num20 ber set forth in the second, third, and fourth most

21 recent March supplements to such Survey before the

22 beginning of the fiscal year.

23 ‘‘(E) Each State shall submit to the Secretary such

24 information, at such time and in such manner, as the Sec25 retary determines is necessary to ensure that the require-
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1 ments of this paragraph are satisfied. The Secretary shall

2 ensure that information is provided under this subsection

3 in a manner that is consistent with other reporting re4 quirements for information required to be submitted by

5 a State under this title and title XXI, and avoids duplica6 tion of reporting requirements.

7 ‘‘(F) The Secretary shall regularly examine the pay8 ments made to a State for the expenditures described in

9 subparagraph (A) to confirm that the payments are attrib10 utable to expenditures described in such subparagraph.’’.

11 (b) CONFORMING AMENDMENT.—Section

12 1902(a)(10)(A)(ii)(XIV) (42 U.S.C.

13 1396a(a)(10)(A)(ii)(XIV)) is amended by striking

14 ‘‘1905(u)(2)(C)’’ and inserting ‘‘1905(u)(2)(B)’’.

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

16 this section shall be effective as if included in the enact17 ment of section 4911 of the Balanced Budget Act of 1997

18 (Public Law 105–33; 111 Stat. 570).

Æ