II

107TH CONGRESS

1ST SESSION S. 1016

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

health benefits coverage of infants and children under the medicaid

and State children’s health insurance program, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 12, 2001

Mr. BINGAMAN (for himself, Mr. LUGAR, Mr. MCCAIN, Mr. CORZINE, and

Mrs. LINCOLN) introduced the following bill; which was read twice and

referred to the Committee on Finance

A BILL

To amend titles XIX and XXI of the Social Security Act

to improve the health benefits coverage of infants and

children under the medicaid and State children’s health

insurance program, 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 ‘‘Start Healthy, Stay Healthy Act of 2001’’.

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

7 this Act is as follows:

Sec. 1. Short title; table of contents.
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TITLE I—START HEALTHY

Sec. 101. Enhanced Federal medicaid match for States that opt to continuously

enroll infants during the first year of life without regard to the

mother’s eligibility status.

Sec. 102. Optional coverage of low-income, uninsured pregnant women under a

State child health plan.

Sec. 103. Increase in SCHIP income eligibility.

TITLE II—STAY HEALTHY

Sec. 201. Enhanced Federal medicaid match for increased expenditures for

medical assistance for children.

Sec. 202. Increase in SCHIP appropriations.

Sec. 203. Optional coverage of children through age 20 under the medicaid program and SCHIP.

1 TITLE I—START HEALTHY

2 SEC. 101. ENHANCED FEDERAL MEDICAID MATCH FOR

3 STATES THAT OPT TO CONTINUOUSLY EN4 ROLL INFANTS DURING THE FIRST YEAR OF

5 LIFE WITHOUT REGARD TO THE MOTHER’S

6 ELIGIBILITY STATUS.

7 (a) STATE OPTION.—Section 1902(e)(4) of the Social

8 Security Act (42 U.S.C. 1396a(e)(4)) is amended by add9 ing at the end the following new sentence: ‘‘A State may

10 elect (through a State plan amendment) to apply the first

11 sentence of this paragraph without regard to the require12 ments that the child remain a member of the woman’s

13 household and the woman remains (or would remain if

14 pregnant) eligible for medical assistance.’’.

15 (b) ENHANCED FMAP.—The first sentence of sec16 tion 1905(b) of the Social Security Act (42 U.S.C.

17 1396d(b)) is amended—

18 (1) by inserting ‘‘(A)’’ after ‘‘only’’; and
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1 (2) by inserting ‘‘, or (B) on the basis of a

2 State election made under the third sentence of sec3 tion 1902(e)(4)’’ before the period.

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

5 this section apply to medical assistance provided on or

6 after October 1, 2001.

7 SEC. 102. OPTIONAL COVERAGE OF LOW-INCOME, UNIN8 SURED PREGNANT WOMEN UNDER A STATE

9 CHILD HEALTH PLAN.

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

11 Act (42 U.S.C. 1397aa et seq.) is amended by adding at

12 the end the following new section:

13 ‘‘SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNIN14 SURED PREGNANT WOMEN.

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

16 other provision of this title, a State child health plan

17 (whether implemented under this title or title XIX) may

18 provide for coverage of pregnancy-related assistance for

19 targeted low-income pregnant women in accordance with

20 this section, but only if the State has established an in21 come eligibility level under section 1902(l)(2)(A) for

22 women described in section 1902(l)(1)(A) that is 185 per23 cent of the income official poverty line.

24 ‘‘(b) DEFINITIONS.—For purposes of this section:
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1 ‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The

2 term ‘pregnancy-related assistance’ has the meaning

3 given the term child health assistance in section

4 2110(a) as if any reference to targeted low-income

5 children were a reference to targeted low-income

6 pregnant women, except that the assistance shall be

7 limited to services related to pregnancy (which in8 clude prenatal, delivery, and postpartum services)

9 and to other conditions that may complicate preg10 nancy.

11 ‘‘(2) TARGETED LOW-INCOME PREGNANT

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

13 woman’ has the meaning given the term targeted

14 low-income child in section 2110(b) as if any ref15 erence to a child were deemed a reference to a

16 woman during pregnancy and through the end of the

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

18 last day of her pregnancy) ends.

19 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

20 RULES.—In the case of, and with respect to, a State pro21 viding for coverage of pregnancy-related assistance to tar22 geted low-income pregnant women under subsection (a),

23 the following special rules apply:

24 ‘‘(1) Any reference in this title (other than sub25 section (b)) to a targeted low income child is deemed
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1 to include a reference to a targeted low-income preg2 nant woman.

3 ‘‘(2) Any such reference to child health assist4 ance with respect to such women is deemed a ref5 erence to pregnancy-related assistance.

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

7 reference to a woman during pregnancy and the pe8 riod described in subsection (b)(2).

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

10 deemed a reference to the income level established

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

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

13 required scope of health insurance coverage) shall

14 not apply insofar as a State limits coverage to serv15 ices described in subsection (b)(1) and the reference

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

17 to require, in such case, compliance with the require18 ments of section 2103(a).

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

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

21 pre-existing condition and no waiting period (includ22 ing any waiting period imposed to carry out section

23 2102(b)(3)(C)) shall apply.

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

25 section shall be construed as affecting the amount of any
6

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1 initial allotment provided to a State under section

2 2104(b).

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

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

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

6 ‘‘(f) AUTOMATIC ENROLLMENT FOR CHILDREN

7 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS8 SISTANCE.—Notwithstanding any other provision of this

9 title or title XIX, if a child is born to a targeted low-in10 come pregnant woman who was receiving pregnancy-re11 lated assistance under this section on the date of the chil12 dren’s birth, the child shall be deemed to have applied for

13 child health assistance under the State child health plan

14 and to have been found eligible for such assistance under

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

16 assistance through the provision of medical assistance

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

18 assistance under such title and to have been found eligible

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

20 birth and to remain eligible for such assistance until the

21 child attains 1 year of age. During the period in which

22 a child is deemed under the preceding sentence to be eligi23 ble for child health or medical assistance, the child health

24 or medical assistance eligibility identification number of

25 the mother shall also serve as the identification number
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1 of the child, and all claims shall be submitted and paid

2 under such number (unless the State issues a separate

3 identification number for the child before such period ex4 pires).’’.

5 (b) STATE OPTION TO USE ENHANCED FMAP AND

6 SCHIP ALLOTMENT FOR COVERAGE OF ADDITIONAL

7 PREGNANT WOMEN UNDER THE MEDICAID PROGRAM.—

8 Section 1905 of the Social Security Act (42 U.S.C. 1396d)

9 is amended—

10 (1) in the fourth sentence of subsection (b), by

11 inserting ‘‘and in the case of a State plan that meets

12 the condition described in subsections (u)(1) and

13 (u)(4)(A), with respect to expenditures described in

14 subsection (u)(4)(B) for the State for a fiscal year’’

15 after ‘‘for a fiscal year,’’; and

16 (2) in subsection (u)—

17 (A) by redesignating paragraph (4) as

18 paragraph (5); and

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

20 following new paragraph:

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

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

23 level under section 1902(l)(2)(A) with respect to individ24 uals described in section 1902(l)(1)(A) that is 185 percent

25 of the income official poverty line.
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1 ‘‘(B) For purposes of subsection (b), the expenditures

2 described in this paragraph are expenditures for medical

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

4 whose income exceeds the income level established for such

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

6 the enactment of this paragraph but does not exceed 185

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

8 (c) NO WAITING PERIODS OR COST-SHARING.—

9 (1) NO WAITING PERIOD.—Section

10 2102(b)(1)(B) of the Social Security Act (42 U.S.C.

11 1397bb(b)(1)(B)) is amended—

12 (A) by striking ‘‘, and’’ at the end of

13 clause (i) and inserting a semicolon;

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

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

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

17 clause:

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

19 (including a waiting period to carry out

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

21 low-income pregnant woman, if the State

22 provides for coverage of pregnancy-related

23 assistance for such women in accordance

24 with section 2111.’’.
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1 (2) NO COST-SHARING FOR PREGNANCY-RE2 LATED BENEFITS.—Section 2103(e)(2) of such Act

3 (42 U.S.C. 1397cc(e)(2)) is amended—

4 (A) in the heading, by inserting ‘‘AND

5 PREGNANCY-RELATED SERVICES’’ after ‘‘PRE6 VENTIVE SERVICES’’; and

7 (B) by inserting before the period at the

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

9 services, if the State provides for coverage of

10 pregnancy-related assistance for targeted low11 income pregnant women in accordance section

12 2111’’.

13 (d) PRESUMPTIVE ELIGIBILITY.—

14 (1) IN GENERAL.—Section

15 1920A(b)(3)(A)(i)(III) of the Social Security Act

16 (42 U.S.C. 1396r–1a(b)(3)(A)(i)(III)) is amended

17 by inserting ‘‘a child care resource and referral

18 agency,’’ after ‘‘a State or tribal child support en19 forcement agency,’’.

20 (2) APPLICATION TO PRESUMPTIVE ELIGIBILITY

21 FOR PREGNANT WOMEN UNDER MEDICAID.—Section

22 1920(b) of the Social Security Act (42 U.S.C.

23 1396r–1(b)) is amended by adding at the end after

24 and below paragraph (2) the following flush sen25 tence:
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1 ‘‘The term ‘qualified provider’ includes a qualified entity

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

3 (3) APPLICATION UNDER TITLE XXI.—

4 (A) IN GENERAL.—Section 2107(e)(1)(D)

5 of the Social Security Act (42 U.S.C.

6 1397gg(e)(1)) is amended to read as follows:

7 ‘‘(D) Sections 1920 and 1920A (relating to

8 presumptive eligibility).’’.

9 (B) EXCEPTION FROM LIMITATION ON AD10 MINISTRATIVE EXPENSES.—Section 2105(c)(2)

11 of the Social Security Act (42 U.S.C.

12 1397ee(c)(2)) is amended by adding at the end

13 the following new subparagraph:

14 ‘‘(C) EXCEPTION FOR PRESUMPTIVE ELI15 GIBILITY EXPENDITURES.—The limitation

16 under subparagraph (A) on expenditures shall

17 not apply to expenditures attributable to the

18 application of section 1920 or 1920A (pursuant

19 to section 2107(e)(1)(D)), regardless of whether

20 the child or pregnant woman is determined to

21 be ineligible for the program under this title or

22 title XIX.’’.

23 (e) PROGRAM COORDINATION WITH THE MATERNAL

24 AND CHILD HEALTH PROGRAM (TITLE V).—
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1 (1) IN GENERAL.—Section 2102(b)(3) of the

2 Social Security Act (42 U.S.C. 1397bb(b)(3)) is

3 amended—

4 (A) in subparagraph (D), by striking

5 ‘‘and’’ at the end;

6 (B) in subparagraph (E), by striking the

7 period and inserting ‘‘; and’’; and

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

9 subparagraph:

10 ‘‘(F) that operations and activities under

11 this title are developed and implemented in con12 sultation and coordination with the program op13 erated by the State under title V in areas in14 cluding outreach and enrollment, benefits and

15 services, service delivery standards, public

16 health and social service agency relationships,

17 and quality assurance and data reporting.’’.

18 (2) CONFORMING MEDICAID AMENDMENT.—

19 Section 1902(a)(11) of such Act (42 U.S.C.

20 1396a(a)(11)) is amended—

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

22 (B) by inserting before the semicolon at

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

24 operations and activities under this title are de25 veloped and implemented in consultation and
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1 coordination with the program operated by the

2 State under title V in areas including outreach

3 and enrollment, benefits and services, service

4 delivery standards, public health and social

5 service agency relationships, and quality assur6 ance and data reporting’’.

7 (3) EFFECTIVE DATE.—The amendments made

8 by this subsection take effect on January 1, 2002.

9 (f) APPLICATION OF ANNUAL AGGREGATE COST10 SHARING LIMIT.—Section 2103(e)(3)(B) of the Social Se11 curity Act (42 U.S.C. 1397cc(e)(3)(B)) is amended by

12 adding at the end the following new sentence: ‘‘In the case

13 of a targeted low-income pregnant woman provided cov14 erage under section 2111, or the parents of a targeted

15 low-income child provided coverage under this title under

16 an 1115 waiver or otherwise, the limitation on total an17 nual aggregate cost-sharing described in the preceding

18 sentence shall be applied to the entire family of such

19 woman or parents.’’.

20 (g) EFFECTIVE DATE.—Except as provided in sub21 section (e), the amendments made by this section take ef22 fect on the date of the enactment of this Act and apply

23 to expenditures incurred on or after that date.
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1 SEC. 103. INCREASE IN SCHIP INCOME ELIGIBILITY.

2 (a) DEFINITION OF LOW-INCOME CHILD.—Section

3 2110(c)(4) of the Social Security Act (42 U.S.C. 42

4 U.S.C. 1397jj(c)(4)) is amended by striking ‘‘200’’ and

5 inserting ‘‘250’’.

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

7 subsection (a) applies to child health assistance provided,

8 and allotments determined under section 2104 of the So9 cial Security Act (42 U.S.C. 1397dd), for fiscal years be10 ginning with fiscal year 2002.

11 TITLE II—STAY HEALTHY

12 SEC. 201. ENHANCED FEDERAL MEDICAID MATCH FOR IN13 CREASED EXPENDITURES FOR MEDICAL AS14 SISTANCE FOR CHILDREN.

15 (a) ENHANCED FMAP.—Section 1905(b) of the So16 cial Security Act (42 U.S.C. 1396d(b)) is amended by add17 ing at the end the following new sentence: ‘‘Notwith18 standing the first sentence of this subsection, in the case

19 of a State plan that meets at least 7 of the conditions

20 described in subsection (x)(1) (as determined by the Sec21 retary in consultation with States (including the State

22 agencies responsible for the administration of this title

23 and title V), beneficiaries under this title, providers of

24 services under this title, and advocates for children), with

25 respect to expenditures described in subsection (x)(2) for

26 the State for a fiscal year, the Federal medical assistance
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1 percentage is equal to the percentage determined for the

2 State under subsection (x)(3).’’.

3 (b) CONDITIONS AND EXPENDITURES DESCRIBED.—

4 Section 1905 of the Social Security Act (42 U.S.C. 1396d)

5 is amended by adding at the end the following new sub6 section:

7 ‘‘(x)(1) For purposes of subsection (b), the conditions

8 described in this subsection are the following:

9 ‘‘(A) HIGHEST SCHIP INCOME ELIGIBILITY.—

10 The State has a State child health plan under title

11 XXI which (whether implemented under such title or

12 under this title) has the highest income eligibility

13 standard permitted under title XXI as of January 1,

14 2001, does not limit the acceptance of applications,

15 and provides benefits to all children in the State who

16 apply for and meet eligibility standards.

17 ‘‘(B) UNIFORM, SIMPLIFIED APPLICATION

18 FORM.—With respect to children under age 19 (or

19 such higher age as the State has elected under sec20 tion 1902(l)(1)(D)) who are eligible for medical as21 sistance under section 1902(a)(10)(A), the State

22 uses the same uniform, simplified application form

23 (including, if applicable, permitting application other

24 than in person) for purposes of establishing eligi-
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1 bility for benefits under this title and also under title

2 XXI.

3 ‘‘(C) COORDINATED ENROLLMENT PROCESS.—

4 The State has an enrollment process that is coordi5 nated with that under title XXI so that a family

6 need only interact with a single agency in order to

7 determine whether a child is eligible for benefits

8 under this title or title XXI, and that allows for the

9 transfer of enrollment, without a gap in coverage,

10 for a child whose income eligibility status changes

11 but who remains eligible for benefits under either

12 title.

13 ‘‘(D) SAME VERIFICATION AND REDETERMINA14 TION POLICIES; AUTOMATIC REASSESSMENT OF ELI15 GIBILITY.—With respect to children under age 19

16 (or such higher age as the State has elected under

17 section 1902(l)(1)(D)) who are eligible for medical

18 assistance under section 1902(a)(10)(A), the State

19 provides for initial eligibility determinations and re20 determinations of eligibility using the same

21 verification policies (including with respect to face22 to-face interviews), forms, and frequency as the

23 State uses for such purposes under title XXI, and,

24 as part of such redeterminations, provides for the
16

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1 automatic reassessment of the eligibility of such chil2 dren for assistance under this title and title XXI.

3 ‘‘(E) NO ASSET TEST.—The State does not im4 pose an asset test for eligibility under section

5 1902(l) or title XXI with respect to children.

6 ‘‘(F) 12-MONTH CONTINUOUS ENROLLMENT.—

7 The State has elected the option of continuing en8 rollment under section 1902(e)(12) and has elected

9 a 12-month period under subparagraph (A) of such

10 section.

11 ‘‘(G) COMPLIANCE WITH OUTSTATIONING RE12 QUIREMENT.—The State is providing for the receipt

13 and initial processing of applications of children for

14 medical assistance under this title at facilities de15 fined as disproportionate share hospitals under sec16 tion 1923(a)(1)(A) and Federally-qualified health

17 centers described in subsection (l)(2)(B) of this sec18 tion consistent with the requirements of section

19 1902(a)(55).

20 ‘‘(H) NO WAITING PERIOD LONGER THAN 6

21 MONTHS.—The State does not impose a waiting pe22 riod for children who meet eligibility standards to

23 qualify for assistance under such plan that exceeds

24 6 months (and may impose a shorter period or no

25 period) for purposes of complying with regulations
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1 promulgated under title XXI to ensure that the in2 surance provided under the State child health plan

3 under such title does not substitute for coverage

4 under group health plans.

5 ‘‘(I) SUFFICIENT PROVIDER PAYMENT RATES.—

6 The State demonstrates that it is meeting the re7 quirements of section 1902(a)(30)(A) through pay8 ment rates sufficient to enlist enough providers so

9 that care and pediatric, obstetrical, gynecologic, and

10 dental services are available under the plan at least

11 to the extent that such care and services are avail12 able to the general population in the geographic

13 area.

14 ‘‘(2)(A) For purposes of subsection (b), the expendi15 tures described in this paragraph are expenditures for

16 medical assistance for children described in subparagraph

17 (B) for a fiscal year, but only to the extent that such ex18 penditures exceed the base expenditure amount, as defined

19 in subparagraph (C).

20 ‘‘(B) For purposes of subparagraph (A), the children

21 described in this subparagraph are—

22 ‘‘(i) individuals who are under 19 years of age

23 (or such higher age as the State may have elected

24 under section 1902(l)(1)(D)) who are eligible and

25 enrolled for medical assistance under this title; and
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1 ‘‘(ii) individuals who—

2 ‘‘(I) would be described in clause (i) but

3 for having family income that exceeds the high4 est income eligibility level applicable to such in5 dividuals under the State plan; and

6 ‘‘(II) would be considered disabled under

7 section 1614(a)(3)(C) (determined without re8 gard to the reference to age in that section but

9 for having earnings or deemed income or re10 sources (as determined under title XVI for chil11 dren) that exceed the requirements for receipt

12 of supplemental security income benefits.

13 ‘‘(C) For purposes of subparagraph (A), the term

14 ‘base expenditure amount’ means the total expenditures

15 for medical assistance for children described in subpara16 graph (B) for fiscal year 1996.

17 ‘‘(3) For purposes of subsection (b), the Federal med18 ical assistance percentage with respect to expenditures de19 scribed in paragraph (2) for a fiscal year is equal to the

20 following:

21 ‘‘(A) In the case of a State that meets 7 of the

22 conditions described in paragraph (1), the Federal

23 medical assistance percentage (as defined in the first

24 sentence of subsection (b)) for the State increased

25 by a number of percentage points equal to 50 per-
19

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1 cent of the number of percentage points by which

2 (1) such Federal medical assistance percentage for

3 the State is less than (2) the enhanced FMAP for

4 the State described in section 2105(b).

5 ‘‘(B) In the case of a State that meets 8 of the

6 conditions described in paragraph (1), the Federal

7 medical assistance percentage (as so defined) for the

8 State increased by a number of percentage points

9 equal to 75 percent of the number of percentage

10 points by which (1) such Federal medical assistance

11 percentage for the State is less than (2) the en12 hanced FMAP for the State (as so described).

13 ‘‘(C) In the case of a State that meets all of the

14 conditions described in paragraph (1), the enhanced

15 FMAP (as so described).’’.

16 (c) COLLECTION OF DATA.—The Secretary of Health

17 and Human Services shall modify such data collection and

18 reporting requirements under title XIX of the Social Secu19 rity Act as are necessary to determine the expenditures

20 and base expenditure amount described in section

21 1905(x)(2) of that Act (as added by subsection (b)), par22 ticularly with respect to expenditures and the base expend23 iture amount related to children described in section

24 1905(x)(2)(B)(ii) of that Act.
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1 (d) EFFECTIVE DATE.—The amendments made by

2 subsections (a) and (b) apply to medical assistance pro3 vided on or after October 1, 2001.

4 SEC. 202. INCREASE IN SCHIP APPROPRIATIONS.

5 Section 2104(a) of the Social Security Act (42 U.S.C.

6 1397dd(a)) is amended by striking paragraphs (5)

7 through (9) and inserting the following:

8 ‘‘(5) for fiscal year 2002, $3,500,000,000;

9 ‘‘(6) for fiscal year 2003, $4,000,000,000;

10 ‘‘(7) for fiscal year 2004, $4,300,000,000;

11 ‘‘(8) for fiscal year 2005, $4,500,000,000;

12 ‘‘(9) for fiscal year 2006, $4,500,000,000;

13 and’’.

14 SEC. 203. OPTIONAL COVERAGE OF CHILDREN THROUGH

15 AGE 20 UNDER THE MEDICAID PROGRAM AND

16 SCHIP.

17 (a) MEDICAID.—

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

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

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

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

22 age’’.

23 (2) CONFORMING AMENDMENTS.—

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

25 U.S.C. 1396a(e)(3)(A)) is amended by inserting
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1 ‘‘(or 1 year less than the age the State has

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

3 years of age’’.

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

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

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

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

8 age’’.

9 (C) Section 1920A(b)(1) of such Act (42

10 U.S.C. 1396r–1a(b)(1)) is amended by insert11 ing ‘‘or such higher age as the State has elected

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

13 age’’.

14 (D) Section 1928(h)(1) of such Act (42

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

16 ‘‘or 1 year less than the age the State has elect17 ed under section 1902(l)(1)(D)’’ before the pe18 riod at the end.

19 (E) Section 1932(a)(2)(A) of such Act (42

20 U.S.C. 1396u–2(a)(2)(A)) is amended by in21 serting ‘‘(or such higher age as the State has

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

23 years of age’’.

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

25 U.S.C. 1397jj(c)(1)) is amended by inserting ‘‘(or such
22

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1 higher age as the State has elected under section

2 1902(l)(1)(D))’’.

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

4 this section take effect on October 1, 2001, and apply to

5 medical assistance and child health assistance provided on

6 or after such date.

Æ