II

107TH CONGRESS

1ST SESSION S. 1266

To amend title XXI of the Social Security Act to expand the provision

of child health assistance to children with family income up to 300

percent of poverty.

IN THE SENATE OF THE UNITED STATES

JULY 27, 2001

Mrs. CLINTON (for herself, Mr. SCHUMER, Mr. CORZINE, Mr. TORRICELLI,

and Mr. LEVIN) introduced the following bill; which was read twice and

referred to the Committee on Finance

A BILL

To amend title XXI of the Social Security Act to expand

the provision of child health assistance to children with

family income up to 300 percent of poverty.

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.

4 This Act may be cited as the ‘‘SCHIP Enhancement

5 Act of 2001’’.

6 SEC. 2. FINDINGS.

7 Congress makes the following findings:

8 (1) The State children’s health insurance pro9 gram (SCHIP) established under title XXI of the
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1 Social Security Act (42 U.S.C. 1397aa et seq.) cur2 rently limits coverage of children under that pro3 gram to children whose family income does not ex4 ceed 200 percent of the Federal poverty line or 50

5 percentage points above the State’s medicaid appli6 cable income level.

7 (2) Three million uninsured children (over 1 of

8 every 4 such children) have family incomes that ex9 ceed 200 percent of the Federal poverty line, and

10 1,400,000 of those uninsured children would be pro11 vided health insurance coverage if the income eligi12 bility level for SCHIP were increased to 300 percent

13 of the Federal poverty line.

14 SEC. 3. STATE OPTION TO EXPAND INCOME ELIGIBILITY

15 UNDER SCHIP.

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

17 2110(c)(4) of the Social Security Act (42 U.S.C. 42

18 U.S.C. 1397jj(c)(4)) is amended—

19 (1) by striking ‘‘The term’’ and inserting the

20 following:

21 ‘‘(A) IN GENERAL.—The term’’; and

22 (2) by adding at the end the following new sub23 paragraph:

24 ‘‘(B) STATE OPTION TO EXPAND ELIGI25 BILITY.—
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1 ‘‘(i) IN GENERAL.—A State may elect

2 through a plan amendment to apply sub3 paragraph (A) as if ‘300 percent’ were

4 substituted for ‘200 percent’.

5 ‘‘(ii) NO EFFECT ON DETERMINATION

6 OF SECTION 2104 ALLOTMENTS.—An elec7 tion under clause (i) shall have no effect

8 on the determination of a State’s allotment

9 under subsection (b) or (c) of section

10 2104.’’.

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

12 subsection (a) apply to child health assistance provided on

13 or after October 1, 2001.

14 SEC. 4. ADDITIONAL ALLOTMENTS FOR STATES THAT EX15 PAND INCOME ELIGIBILITY UNDER SCHIP.

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

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

18 the end the following new section:

19 ‘‘SEC. 2111. ADDITIONAL ALLOTMENTS FOR STATES THAT

20 OPT TO EXPAND INCOME ELIGIBILITY.

21 ‘‘(a) ELIGIBILITY FOR ADDITIONAL ALLOTMENTS.—

22 A State that, not later than December 31 of any fiscal

23 year, meets the following requirements shall be eligible for

24 the additional allotments determined for the State under

25 subsection (b) for that fiscal year:
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1 ‘‘(1) INCREASE IN INCOME ELIGIBILITY.—The

2 State submits to the Secretary a certification by the

3 chief executive officer of the State that, during the

4 fiscal year, the State child health plan (whether im5 plemented under title XIX or under this title) will

6 have an income standard for children that is at

7 least—

8 ‘‘(A) with respect to the additional allot9 ment determined under subsection (b)(1), 250

10 percent of the poverty line; and

11 ‘‘(B) with respect to the additional allot12 ment determined under subsection (b)(2), 300

13 percent of the poverty line.

14 ‘‘(2) SUBMISSION OF INFORMATION REQUIRED

15 FOR CERTAIN USES OF THE ADDITIONAL ALLOT16 MENT.—In the case of a State that intends to use

17 the additional allotment provided under subsection

18 (b)(2) for the purpose described in subsection (c)(3),

19 the State submits to the Secretary a description of

20 the reasonable planning and implementation costs

21 the State expects to incur in providing premium as22 sistance for family coverage under an employer-spon23 sored group health plan in accordance with sub24 section (d).
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1 ‘‘(b) DETERMINATION OF ADDITIONAL ALLOT2 MENTS.—

3 ‘‘(1) STATES THAT INCREASE INCOME STAND4 ARD TO 250 PERCENT.—With respect to

5 $617,000,000 of the amount available for the addi6 tional allotments under subsection (e) for a fiscal

7 year, the Secretary shall allot an amount to each

8 State with a State child health plan approved under

9 this title that satisfies the requirements of para10 graph (1)(A) and, if applicable, paragraph (2) of

11 subsection (a)—

12 ‘‘(A) in the case of such a State other than

13 a commonwealth or territory described in sub14 paragraph (B), an amount determined to bear

15 the same ratio to $617,000,000 as the State’s

16 allotment under section 2104(b) (determined

17 without regard to section 2104(f)) bears to

18 98.95 percent of the total amount of the allot19 ments determined under section 2104(b) for

20 such States for such fiscal year; and

21 ‘‘(B) in the case of a commonwealth or ter22 ritory described in section 2104(c)(3), deter23 mined to bear the same ratio to $617,000,000

24 as the commonwealth’s or territory’s allotment

25 under section 2104(c) (determined without re-
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1 gard to section 2104(f)) bears to 1.05 percent

2 of the total amount of the allotments deter3 mined under section 2104(c) for common4 wealths and territories for such fiscal year.

5 ‘‘(2) STATES THAT INCREASE INCOME STAND6 ARD TO 300 PERCENT.—

7 ‘‘(A) IN GENERAL.—With respect to

8 $383,000,000 of the amount available for the

9 additional allotments under subsection (e) for a

10 fiscal year, the Secretary shall allot an amount

11 to each State with a State child health plan ap12 proved under this title that satisfies the require13 ments of paragraph (1)(B) and, if applicable,

14 paragraph (2) of subsection (a) determined in

15 the same manner as the additional allotments

16 under paragraph (1).

17 ‘‘(B) ALLOTMENTS IN ADDITION TO 250

18 PERCENT ALLOTMENTS.—The allotments pro19 vided under this paragraph to a State shall be

20 in addition to the allotments provided to the

21 State under paragraph (1).

22 ‘‘(3) AVAILABILITY.—

23 ‘‘(A) 3-YEAR AVAILABILITY.—Except as

24 provided in subparagraph (B), amounts allotted

25 to a State under paragraph (1) and, if applica-
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1 ble, paragraph (2) for a fiscal year shall remain

2 available for expenditure by the State through

3 the end of the second succeeding fiscal year.

4 ‘‘(B) RETURN OF UNUSED ALLOT5 MENTS.—The allotments set-aside under para6 graphs (1) and (2) for a fiscal year for any

7 State that has not met the requirements of sub8 section (a) on January 1 of that fiscal year

9 shall be returned to the Treasury.

10 ‘‘(c) USE OF ADDITIONAL ALLOTMENTS.—The addi11 tional allotments provided under subsection (b) to a State

12 for a fiscal year may be—

13 ‘‘(1) combined with the State’s allotment for

14 the fiscal year determined under section 2104 and

15 used to provide child health assistance to all tar16 geted low-income children under the State child

17 health plan; or

18 ‘‘(2) used for—

19 ‘‘(A) a premium assistance program under

20 which the State pays part of the premiums for

21 coverage of a child who is eligible for child

22 health assistance under group health insurance

23 or a group health plan in accordance with sub24 section (d); and
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1 ‘‘(B) reasonable planning and implementa2 tion costs specified by the State under sub3 section (a)(2) without regard to the limitation

4 on such costs under section 2105(c)(2)(A).

5 ‘‘(d) PREMIUM ASSISTANCE FOR FAMILY COVERAGE

6 UNDER AN EMPLOYER-SPONSORED GROUP HEALTH

7 PLAN.—The additional allotments provided under sub8 section (b) to a State for a fiscal year may be used for

9 a premium assistance program that meets the following

10 requirements:

11 ‘‘(1) The premium assistance program is cost12 effective.

13 ‘‘(2) The State provides assurances that a child

14 provided such assistance will receive the minimum

15 benefits and cost-sharing protections established

16 under this title either through the employer-spon17 sored group health plan or as a supplement to such

18 coverage.

19 ‘‘(3) Employees eligible for employer-sponsored

20 health coverage apply for the full premium contribu21 tion available from the employer.

22 ‘‘(4) The State evaluates the amount of substi23 tution that occurs as a result of the premium assist24 ance program and the effect of the program on ac25 cess to health coverage.
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1 ‘‘(e) APPROPRIATION.—For the purpose of providing

2 additional allotments under this section to States that

3 meet the requirements of subsection (a), there is appro4 priated, out of any money in the Treasury not otherwise

5 appropriated, for each of fiscal years 2002 through 2011,

6 $1,000,000,000.’’.

7 SEC. 5. EVALUATION AND REPORT ON PREMIUM ASSIST8 ANCE FOR FAMILY COVERAGE.

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

10 Human Services shall conduct an evaluation of any pre11 mium assistance programs conducted with the allotments

12 provided to States under section 2111(b) of the Social Se13 curity Act (as added by section 4). Such evaluation shall

14 identify any implementation problems with the provision

15 of such assistance and whether the assistance has sup16 planted health insurance coverage that otherwise would be

17 provided to such children.

18 (b) REPORT.—Not later than January 1, 2006, the

19 Secretary of Health and Human Services shall submit to

20 Congress a report on the evaluation conducted under sub21 section (a), together with any recommendations for legisla22 tion that the Secretary determines to be appropriate as

23 a result of such evaluation.

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