II

106TH CONGRESS

2D SESSION S. 2923

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 SENATE OF THE UNITED STATES

JULY 26, 2000

Mr. KENNEDY (for himself, Mr. ROCKEFELLER, Mr. DASCHLE, Mr. MOYNIHAN, Mr. REED, Mr. L. CHAFEE, Ms. COLLINS, Ms. SNOWE, Mr. BAUCUS, Mr. BREAUX, Mr. CONRAD, Mr. GRAHAM, Mr. BRYAN, Mr. KERREY,

Mr. ROBB, Mr. INOUYE, Mr. LAUTENBERG, Mr. AKAKA, Mr. SCHUMER,

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

referred to the Committee on Finance

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’’.

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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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.

1 SEC. 2. RENAMING OF TITLE XXI PROGRAM.

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

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

4 to read as follows:

5 ‘‘TITLE XXI—FAMILYCARE PROGRAM’’.

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

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

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

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

10 to the FamilyCare program under such title.

11 SEC. 3. FAMILYCARE COVERAGE OF PARENTS UNDER THE

12 MEDICAID PROGRAM AND TITLE XXI.

13 (a) INCENTIVES TO IMPLEMENT FAMILYCARE COV14 ERAGE.—

15 (1) UNDER MEDICAID.—
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1 (A) ESTABLISHMENT OF NEW OPTIONAL

2 ELIGIBILITY CATEGORY.—Section

3 1902(a)(10)(A)(ii) of the Social Security Act

4 (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended—

5 (i) by striking ‘‘or’’ at the end of sub6 clause (XVI);

7 (ii) by adding ‘‘or’’ at the end of sub8 clause (XVII); and

9 (iii) by adding at the end the fol10 lowing new subclause:

11 ‘‘(XVIII) who are parents de12 scribed in subsection (k)(1), but only

13 if the State meets the conditions de14 scribed in subsection (k)(2);’’.

15 (B) CONDITIONS FOR COVERAGE.—Section

16 1902 of such Act is further amended by insert17 ing after subsection (j) the following new sub18 section:

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

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

21 (or such higher age as the State may have elected under

22 section 1902(l)(1)(D)) and who is eligible and enrolled for

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

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

25 such assistance under such subsection; and
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1 ‘‘(ii) the income of the family that includes such

2 parents does not exceed an income level specified by

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

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

5 meaning given the term ‘caretaker’ for purposes of car6 rying out section 1931.

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

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

9 follows:

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

11 under title XXI which (whether implemented under

12 such title or under this title)—

13 ‘‘(i) has an income standard (or will estab14 lish an income standard that is effective at the

15 time additional allotments are available to the

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

17 FamilyCare Act of 2000) for children that is at

18 least 200 percent of the poverty line; and

19 ‘‘(ii) does not limit the acceptance of appli20 cations, does not use a waiting list for children

21 who meet eligibility standards to qualify for as22 sistance, and provides benefits to all children in

23 the State who apply for and meet eligibility

24 standards.
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1 ‘‘(B) The income level specified under para2 graph (1)(A)(ii) for parents in a family exceeds the

3 income level applicable under section 1931 but does

4 not exceed the highest income level applicable to a

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

6 cover such parents with higher family income with7 out covering parents with a lower family income.

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

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

10 enrolled for child health assistance under title XXI, the

11 State may elect (on a uniform basis) to cover all such par12 ents under section 2111 or under subsection (a)(10)(A).’’.

13 (C) ENHANCED MATCHING FUNDS AVAIL14 ABLE.—Section 1905 of such Act (42 U.S.C.

15 1396d) is amended—

16 (i) in the fourth sentence of sub17 section (b), by striking ‘‘or subsection

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

19 and

20 (ii) in subsection (u)—

21 (I) by redesignating paragraph

22 (4) as paragraph (6), and

23 (II) by inserting after paragraph

24 (3) the following new paragraph:
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1 ‘‘(4) For purposes of subsection (b) and section

2 2105(a)(1):

3 ‘‘(A) FAMILYCARE PARENTS.—The expendi4 tures described in this subparagraph are the fol5 lowing:

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

7 assistance made available under section 1931,

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

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

10 family the income of which exceeds the income

11 level applicable under such section 1931 to a

12 family of the size involved as of January 1,

13 2000.

14 ‘‘(ii) CERTAIN PREGNANT WOMEN.—Ex15 penditures for medical assistance for pregnant

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

17 the income of which exceeds the income level

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

19 family of the size involved as of January 1,

20 2000.’’.

21 (D) APPROPRIATION FROM TITLE XXI AL22 LOTMENT FOR CERTAIN MEDICAID EXPANSION

23 COSTS.—Subparagraph (C) of section

24 2105(a)(1) of such Act, as inserted by section

25 14(a)(3), is amended to read as follows:
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1 ‘‘(C) FAMILYCARE PARENTS.—Expendi2 tures for medical assistance that is attributable

3 to expenditures described in section

4 1905(u)(4)(A).’’.

5 (E) ONLY COUNTING ENHANCED PORTION

6 FOR COVERAGE OF ADDITIONAL PREGNANT

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

8 1396d) is amended—

9 (i) in the fourth sentence of sub10 section (b), by inserting ‘‘(except in the

11 case of expenditures described in sub12 section (u)(5))’’ after ‘‘do not exceed’’;

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

14 after paragraph (4) (as inserted by sub15 paragraph (C)), the following new para16 graph:

17 ‘‘(5) For purposes of the fourth sentence of sub18 section (b) and section 2105(a), the following payments

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

20 under section 2104:

21 ‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR

22 PREGNANT WOMEN WITH INCOME ABOVE JANUARY

23 1, 2000 INCOME LEVEL AND BELOW 185 PERCENT OF

24 POVERTY.—The portion of the payments made for

25 expenditures described in paragraph (4)(A)(ii) that
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1 represents the amount that would have been paid if

2 the enhanced FMAP had not been substituted for

3 the Federal medical assistance percentage.’’.

4 (2) UNDER TITLE XXI.—

5 (A) FAMILYCARE COVERAGE.—Title XXI

6 of such Act is amended by adding at the end

7 the following new section:

8 ‘‘SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PAR9 ENTS OF TARGETED LOW-INCOME CHILDREN.

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

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

12 provide for coverage, through an amendment to its State

13 child health plan under section 2102, of FamilyCare as14 sistance for targeted low-income parents in accordance

15 with this section, but only if—

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

17 section 1902(k)(2); and

18 ‘‘(2) the State elects to provide medical assist19 ance under section 1902(a)(10)(A)(ii)(XVIII) and

20 elects an applicable income limit that is not lower

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

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

23 ‘‘(1) FAMILYCARE ASSISTANCE.—The term

24 ‘FamilyCare assistance’ has the meaning given the

25 term child health assistance in section 2110(a) as if
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1 any reference to targeted low-income children were

2 a reference to targeted low-income parents.

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

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

5 given the term targeted low-income child in section

6 2110(b) as if the reference to a child were deemed

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

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

9 ‘‘(A) there shall be substituted for the in10 come limit described in paragraph (1)(B)(ii)(I)

11 the applicable income limit in effect for a tar12 geted low-income child;

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

14 shall be substituted for July 1, 1997; and

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

16 shall be substituted for March 31, 1997.

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

18 meaning given the term ‘caretaker’ for purposes of

19 carrying out section 1931.

20 ‘‘(4) OPTIONAL TREATMENT OF PREGNANT

21 WOMEN AS PARENTS.—A State child health plan

22 may treat a pregnant woman who is not otherwise

23 a parent as a targeted low-income parent for pur24 poses of this section but only if the State has estab25 lished an income level under section 1902(l)(2)(A)(i)
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1 for pregnant women that is at least 185 percent of

2 the income official poverty line described in such sec3 tion.

4 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

5 RULES.—In the case of, and with respect to, a State pro6 viding for coverage of FamilyCare assistance to targeted

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

8 special rules apply:

9 ‘‘(1) Any reference in this title (other than sub10 section (b)) to a targeted low-income child is deemed

11 to include a reference to a targeted low-income par12 ent.

13 ‘‘(2) Any such reference to child health assist14 ance with respect to such parents is deemed a ref15 erence to FamilyCare assistance.

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

17 case of a family provided coverage under this sec18 tion, the limitation on total annual aggregate cost19 sharing shall be applied to the entire family.

20 ‘‘(4) In applying section 2110(b)(4), any ref21 erence to ‘section 1902(l)(2) or 1905(n)(2) (as se22 lected by a State)’ is deemed a reference to the in23 come level applicable to parents under section 1931,

24 or, in the case of a pregnant woman described in
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1 subsection (b)(4), the income level established under

2 section 1902(l)(2)(A).’’.

3 (B) ADDITIONAL ALLOTMENT FOR STATES

4 PROVIDING FAMILYCARE.—

5 (i) IN GENERAL.—Section 2104 of

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

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

8 after subsection (c) the following new sub9 section:

10 ‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE PRO11 VIDING FAMILYCARE.—

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

13 For the purpose of providing additional allotments

14 to States electing to provide FamilyCare coverage

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

16 money in the Treasury not otherwise appropriated—

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

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

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

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

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

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

23 ‘‘(G) for fiscal year 2008, $8,000,000,000;

24 ‘‘(H) for fiscal year 2009, $9,000,000,000;
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1 ‘‘(I) for fiscal year 2010, $10,000,000,000;

2 and

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

4 year thereafter, the amount of the allotment

5 provided under this paragraph for the preceding

6 fiscal year increased by the percentage increase

7 (if any) in the medical care expenditure cat8 egory of the Consumer Price Index for All

9 Urban Consumers (United States city average).

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

11 ‘‘(A) IN GENERAL.—In addition to the al12 lotments provided under subsections (b) and

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

14 available for the additional allotments under

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

16 shall allot to each State with a State child

17 health plan approved under this title and which

18 has elected to provide coverage under section

19 2111 during the fiscal year—

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

21 than a commonwealth or territory de22 scribed in clause (ii), the same proportion

23 as the proportion of the State’s allotment

24 under section 2104(b) (determined without

25 regard to section 2104(f)) to 98.95 percent
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1 of the total amount of the allotments

2 under such section for such States eligible

3 for an allotment under this subparagraph

4 for such fiscal year; and

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

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

7 the same proportion as the proportion of

8 the commonwealth’s or territory’s allot9 ment under section 2104(c) (determined

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

11 percent of the total amount of the allot12 ments under such section for common13 wealths and territories eligible for an allot14 ment under this subparagraph for such fis15 cal year.

16 ‘‘(B) REDISTRIBUTION OF UNUSED ALLOT17 MENTS.—In applying subsection (f) with re18 spect to additional allotments made available

19 under this subsection, the procedures estab20 lished under such subsection shall ensure such

21 additional allotments are only made available to

22 States which have elected to provide coverage

23 under section 2111.

24 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi25 tional allotments provided under this subsection are
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1 not available for amounts expended before October

2 1, 2001. Such amounts are available for amounts ex3 pended on or after such date for child health assist4 ance for targeted low-income children, as well as for

5 FamilyCare assistance.’’.

6 (ii) CONFORMING AMENDMENTS.—

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

8 1397dd), as amended by section 14(d)(3),

9 is further amended—

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

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

12 ‘‘under this section,’’;

13 (II) in subsection (b)(1), by in14 serting ‘‘and subsection (d)’’ after

15 ‘‘Subject to paragraph (4)’’; and

16 (III) in subsection (c)(1), by in17 serting ‘‘subject to subsection (d),’’

18 after ‘‘for a fiscal year,’’.

19 (C) NO COST-SHARING FOR PREGNANCY20 RELATED BENEFITS.—Section 2103(e)(2) of

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

22 amended—

23 (i) in the heading, by inserting ‘‘AND

24 PREGNANCY-RELATED SERVICES’’ after

25 ‘‘PREVENTIVE SERVICES’’; and
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1 (ii) by inserting before the period at

2 the end the following: ‘‘and for pregnancy3 related services’’.

4 (3) EFFECTIVE DATE.—The amendments made

5 by this subsection apply to items and services fur6 nished on or after October 1, 2000.

7 (b) RULES FOR IMPLEMENTATION BEGINNING WITH

8 FISCAL YEAR 2006.—

9 (1) REQUIRED COVERAGE OF FAMILYCARE PAR10 ENTS.—Section 1902(a)(10)(A)(i) of the Social Se11 curity Act (42 U.S.C. 1396a(a)(10)(A)(i)) is

12 amended—

13 (A) by striking ‘‘or’’ at the end of sub14 clause (VI);

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

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

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

18 subclause:

19 ‘‘(VIII) who would be parents de20 scribed in subsection (k)(1) if the in21 come level specified in subsection

22 (k)(2)(B) were equal to at least 100

23 percent of the poverty line referred to

24 in such subsection;’’.
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1 (2) EXPANSION OF AVAILABILITY OF EN2 HANCED MATCH UNDER MEDICAID FOR PRE-CHIP

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

4 such Act (42 U.S.C. 1396d(u)), as inserted by sub5 section (a)(1)(C), is amended—

6 (A) by amending clause (ii) of subpara7 graph (A) to read as follows:

8 ‘‘(ii) CERTAIN PREGNANT WOMEN.—Ex9 penditures for medical assistance for pregnant

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

11 the income of which exceeds the 133 percent of

12 the income official poverty line.’’; and

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

14 subparagraphs:

15 ‘‘(B) PARENTS WITH INCOME ABOVE 100 PER16 CENT OF POVERTY BUT BELOW JANUARY 1, 2000 IN17 COME LEVEL.—The expenditures described in this

18 subparagraph are expenditures for medical assist19 ance made available for any parents described in

20 section 1902(a)(10)(A)(i)(VIII), whose income ex21 ceeds 100 percent of the income official poverty line

22 applicable to a family of the size involved but does

23 not exceed the applicable income level established

24 under this title (under section 1931 or otherwise) for
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1 a parent in a family of the size involved as of Janu2 ary 1, 2000.

3 ‘‘(C) CHILDREN IN FAMILIES WITH INCOME

4 ABOVE MEDICAID MANDATORY LEVEL NOT PRE5 VIOUSLY DESCRIBED.—The expenditures described

6 in this subparagraph are expenditures (other than

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

8 medical assistance made available to any child who

9 is eligible for assistance under section

10 1902(a)(10)(A) and the income of whose family ex11 ceeds the minimum income level required under sub12 section 1902(l)(2) for a child of the age involved

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

14 being 18 years of age).’’.

15 (3) OFFSET OF ADDITIONAL EXPENDITURES

16 FOR ENHANCED MATCH FOR PRE-CHIP EXPANSION;

17 ELIMINATION OF OFFSET FOR REQUIRED COVERAGE

18 OF FAMILYCARE PARENTS.—

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

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

21 subsection (a)(1)(E), is amended—

22 (i) by amending subparagraph (A) to

23 read as follows:

24 ‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR

25 PREGNANT WOMEN WITH INCOME ABOVE 133 PER-
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1 CENT OF POVERTY.—The portion of the payments

2 made for expenditures described in paragraph

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

4 have been paid if the enhanced FMAP had not been

5 substituted for the Federal medical assistance per6 centage.’’; and

7 (ii) by adding at the end the following

8 new subparagraphs:

9 ‘‘(B) FAMILYCARE PARENTS UNDER 100 PER10 CENT OF POVERTY.—Payments for expenditures de11 scribed in paragraph (4)(A)(i) in the case of parents

12 whose income does not exceed 100 percent of the in13 come official poverty line applicable to a family of

14 the size involved.

15 ‘‘(C) REGULAR FMAP FOR EXPENDITURES FOR

16 PARENTS WITH INCOME ABOVE 100 PERCENT OF

17 POVERTY BUT BELOW JANUARY 1, 2000 INCOME

18 LEVEL.—The portion of the payments made for ex19 penditures described in paragraph (4)(B) that rep20 resents the amount that would have been paid if the

21 enhanced FMAP had not been substituted for the

22 Federal medical assistance percentage.

23 ‘‘(D) REGULAR FMAP FOR EXPENDITURES FOR

24 CERTAIN CHILDREN IN FAMILIES WITH INCOME

25 ABOVE MEDICAID MANDATORY LEVEL.—The portion
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1 of the payments made for expenditures described in

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

3 would have been paid if the enhanced FMAP had

4 not been substituted for the Federal medical assist5 ance percentage.’’.

6 (B) CONFORMING AMENDMENTS.—Sub7 paragraph (C) of section 2105(a)(1) of such

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

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

10 to read as follows:

11 ‘‘(C) CERTAIN FAMILYCARE PARENTS AND

12 OTHERS.—Expenditures for medical assistance

13 that is attributable to expenditures described in

14 section 1905(u)(4), except as provided in sec15 tion 1905(u)(5).’’.

16 (3) EFFECTIVE DATE.—The amendments made

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

18 fiscal years beginning on or after such date and to

19 expenditures under the State plan on and after such

20 date.

21 (c) MAKING TITLE XXI BASE ALLOTMENTS PERMA22 NENT.—Section 2104(a) of such Act (42 U.S.C.

23 1397dd(a)) is amended—

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

25 (9);
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1 (2) by striking the period at the end of para2 graph (10) and inserting ‘‘; and’’; and

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

4 paragraph:

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

6 thereafter, the amount of the allotment provided

7 under this subsection for the preceding fiscal year

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

9 medical care expenditure category of the Consumer

10 Price Index for All Urban Consumers (United States

11 city average).’’.

12 (d) OPTIONAL APPLICATION OF PRESUMPTIVE ELI13 GIBILITY PROVISIONS TO PARENTS.—Section 1920A of

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

15 the end the following new subsection:

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

17 elect to apply the previous provisions of this section to pro18 vide for a period of presumptive eligibility for medical as19 sistance for a parent of a child with respect to whom such

20 a period is provided under this section.’’.

21 (e) CONFORMING AMENDMENTS.—

22 (1) ELIGIBILITY CATEGORIES.—Section

23 1905(a) of such Act (42 U.S.C. 1396d(a)) is amend24 ed, in the matter before paragraph (1)—
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1 (A) by striking ‘‘or’’ at the end of clause

2 (xi);

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

4 (xii); and

5 (C) by inserting after clause (xii) the fol6 lowing new clause:

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

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

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

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

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

12 ‘‘1902(a)(10)(A)(i)(VIII),’’ after

13 ‘‘1902(a)(10)(A)(i)(VII),’’; and

14 (B) by inserting

15 ‘‘1902(a)(10)(A)(ii)(XVII),

16 1902(a)(10)(A)(ii)(XVIII),’’ after

17 ‘‘1902(a)(10)(A)(ii)(XVI),’’.

18 (3) CONFORMING AMENDMENT RELATING TO

19 NO WAITING PERIOD FOR CERTAIN WOMEN.—Section

20 2102(b)(1)(B) of such Act (42 U.S.C.

21 1397bb(b)(1)(B)) is amended—

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

23 clause (i) and inserting a semicolon;

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

25 clause (ii) and inserting ‘‘; and’’; and
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1 (C) by adding at the end the following new

2 clause:

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

4 (including a waiting period to carry out

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

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

7 SEC. 4. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO

8 TITLE XXI PARENTS.

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

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

11 the following new subparagraph:

12 ‘‘(C) AUTOMATIC ELIGIBILITY OF CHIL13 DREN BORN TO A PARENT BEING PROVIDED

14 FAMILYCARE.—Such eligibility standards shall

15 provide for automatic coverage of a child born

16 to an individual who is provided assistance

17 under this title in the same manner as medical

18 assistance would be provided under section

19 1902(e)(4) to a child described in such sec20 tion.’’.

21 SEC. 5. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS

22 UNDER THE MEDICAID PROGRAM AND TITLE

23 XXI.

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

25 Social Security Act (42 U.S.C. 1396b(v)) is amended—
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1 (1) in paragraph (1), by striking ‘‘paragraph

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

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

4 paragraph:

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

6 under this title) to provide medical assistance under this

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

8 421 of the Personal Responsibility and Work Opportunity

9 Reconciliation Act of 1996, for aliens who are lawfully re10 siding in the United States (including battered aliens de11 scribed in section 431(c) of such Act) and who are other12 wise eligible for such assistance, within any of the fol13 lowing eligibility categories:

14 ‘‘(i) PREGNANT WOMEN.—Women during preg15 nancy (and during the 60-day period beginning on

16 the last day of the pregnancy).

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

18 such plan), including optional targeted low-income

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

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

21 eligibility category described in clause (ii), caretaker

22 relatives who are parents (as defined by the State)

23 of children (described in such clause or otherwise)

24 who are eligible for medical assistance under the

25 plan.
24

•S 2923 IS

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

2 medical assistance to a category of aliens under subpara3 graph (A), no action may be brought under an affidavit

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

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

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

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

8 the following new subparagraph:

9 ‘‘(D) Section 1903(v)(4) (relating to op10 tional coverage of categories of permanent resi11 dent alien children and parents), but only, with

12 respect to an eligibility category under this title,

13 if the same eligibility category has been elected

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

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

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

17 medical assistance and child health assistance furnished

18 on or after such date.

19 SEC. 6. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE

20 20 UNDER THE MEDICAID PROGRAM AND

21 TITLE XXI.

22 (a) MEDICAID.—

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

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

25 amended by inserting ‘‘(or, at the election of a
25

•S 2923 IS

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

2 age’’.

3 (2) CONFORMING AMENDMENTS.—

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

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

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

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

8 years of age’’.

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

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

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

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

13 age’’.

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

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

16 7(a)(2), is amended by inserting ‘‘(or such

17 higher age as the State has elected under para18 graph (1)(D))’’ after ‘‘19 years of age’’.

19 (D) Section 1920A(b)(1) of such Act (42

20 U.S.C. 1396r–1a(b)(1)) is amended by insert21 ing ‘‘or such higher age as the State has elected

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

23 age’’.

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

25 U.S.C. 1396s(h)(1)) is amended by inserting
26

•S 2923 IS

1 ‘‘or 1 year less than the age the State has elect2 ed under section 1902(l)(1)(D)’’ before the pe3 riod at the end.

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

5 U.S.C. 1396u–2(a)(2)(A)) is amended by in6 serting ‘‘(or such higher age as the State has

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

8 years of age’’.

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

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

11 higher age as the State has elected under section

12 1902(l)(1)(D))’’.

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

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

15 medical assistance and child health assistance provided on

16 or after such date.

17 SEC. 7. APPLICATION OF SIMPLIFIED TITLE XXI PROCE18 DURES UNDER THE MEDICAID PROGRAM.

19 (a) APPLICATION UNDER MEDICAID.—

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

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

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

23 to paragraph (5)’’, after ‘‘Notwithstanding sub24 section (a)(17),’’; and
27

•S 2923 IS

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

2 paragraph:

3 ‘‘(5) With respect to determining the eligibility of in4 dividuals under 19 years of age (or such higher age as

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

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

7 with respect to determining the eligibility of individuals

8 for medical assistance under subsection

9 (a)(10)(A)(i)(VIII) or (a)(10)(A)(ii)(XVIII), notwith10 standing any other provision of this title, if the State has

11 established a State child health plan under title XXI—

12 ‘‘(A) the State may not apply a resource stand13 ard if the State does not apply such a standard

14 under such child health plan with respect to such in15 dividuals;

16 ‘‘(B) the State shall use the same simplified eli17 gibility form (including, if applicable, permitting ap18 plication other than in person) as the State uses

19 under such State child health plan with respect to

20 such individuals;

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

22 determinations and redeterminations of eligibility

23 using the same verification policies, forms, and fre24 quency as the State uses for such purposes under
28

•S 2923 IS

1 such State child health plan with respect to such in2 dividuals; and

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

4 interview for purposes of initial eligibility determina5 tions and redeterminations unless the State requires

6 such an interview for such purposes under such child

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

8 (2) EFFECTIVE DATE.—The amendments made

9 by paragraph (1) apply to determinations of eligi10 bility made on or after the date that is 1 year after

11 the date of the enactment of this Act.

12 (b) ADDITIONAL ENTITIES QUALIFIED TO DETER13 MINE MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-IN14 COME CHILDREN.—

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

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

17 amended—

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

19 (II)’’; and

20 (B) by inserting ‘‘eligibility of a child for

21 medical assistance under the State plan under

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

23 assistance under the program funded under

24 title XXI, (III) is an elementary school or sec25 ondary school, as such terms are defined in sec-
29

•S 2923 IS

1 tion 14101 of the Elementary and Secondary

2 Education Act of 1965 (20 U.S.C. 8801), an el3 ementary or secondary school operated or sup4 ported by the Bureau of Indian Affairs, a State

5 child support enforcement agency, a child care

6 resource and referral agency, an organization

7 that is providing emergency food and shelter

8 under a grant under the Stewart B. McKinney

9 Homeless Assistance Act, or a State office or

10 entity involved in enrollment in the program

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

12 title XXI, or that determines eligibility for any

13 assistance or benefits provided under any pro14 gram of public or assisted housing that receives

15 Federal funds, including the program under

16 section 8 or any other section of the United

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

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

19 deems, as approved by the Secretary’’ before

20 the semicolon.

21 (2) TECHNICAL AMENDMENTS.—Section 1920A

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

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

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

25 (2)(A)’’; and
30

•S 2923 IS

1 (B) in subsection (c)(2), in the matter pre2 ceding subparagraph (A), by striking ‘‘sub3 section (b)(1)(A)’’ and inserting ‘‘subsection

4 (b)(2)(A)’’.

5 (3) APPLICATION TO PRESUMPTIVE ELIGIBILITY

6 FOR PREGNANT WOMEN UNDER MEDICAID.—Section

7 1920(b) of such Act (42 U.S.C. 1396r–1(b)) is

8 amended by adding at the end after and below para9 graph (2) the following flush sentence:

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

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

12 (4) APPLICATION UNDER TITLE XXI.—

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

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

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

16 end the following new subparagraph:

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

18 presumptive eligibility).’’.

19 (B) EXCEPTION FROM LIMITATION ON AD20 MINISTRATIVE EXPENSES.—Section 2105(c)(2)

21 of such Act (42 U.S.C. 1397ee(c)(2)) is amend22 ed by adding at the end the following new sub23 paragraph:

24 ‘‘(C) EXCEPTION FOR PRESUMPTIVE ELI25 GIBILITY EXPENDITURES.—The limitation
31

•S 2923 IS

1 under subparagraph (A) on expenditures shall

2 not apply to expenditures attributable to the

3 application of section 1920A (pursuant to sec4 tion 2107(e)(1)(E)), regardless of whether the

5 child is determined to be ineligible for the pro6 gram under this title or title XIX.’’.

7 (c) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR

8 TITLE XXI AND MEDICAID BENEFITS FOR CHILDREN

9 LOSING MEDICAID OR TITLE XXI ELIGIBILITY.—

10 (1) LOSS OF MEDICAID ELIGIBILITY.—Section

11 1902(a) of the Social Security Act (42 U.S.C.

12 1396a(a)) is amended—

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

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

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

16 following new paragraph:

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

18 the first month that begins more than 1 year after

19 the date of the enactment of this paragraph and in

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

21 under title XXI, that before medical assistance to a

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

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

24 parent) is eligible for benefits under title XXI shall

25 be made and, if determined to be so eligible, the
32

•S 2923 IS

1 child (or parent) shall be automatically enrolled in

2 the program under such title without the need for a

3 new application.’’.

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

5 2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended by

6 redesignating subparagraphs (D) and (E) as sub7 paragraphs (E) and (F), respectively, and by insert8 ing after subparagraph (C) the following new sub9 paragraph:

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

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

12 under this title, a determination of whether the

13 child (or parent) is eligible for benefits under

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

15 eligible, the child (or parent) is automatically

16 enrolled in the program under such title with17 out the need for a new application;’’.

18 (3) EFFECTIVE DATE.—The amendments made

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

20 lose eligibility under the medicaid program under

21 title XIX, or under a State child health insurance

22 plan under title XXI, respectively, of the Social Se23 curity Act on or after the date that is 60 days after

24 the date of the enactment of this Act.
33

•S 2923 IS

1 (d) PROVISION OF MEDICAID AND CHIP APPLICA2 TIONS AND INFORMATION UNDER THE SCHOOL LUNCH

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

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

5 amended—

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

7 ‘‘(B)(i) Applications’’; and

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

9 clause:

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

11 lunches that are distributed pursuant to clause (i) to par12 ents or guardians of children in attendance at schools par13 ticipating in the school lunch program under this Act shall

14 also contain information on the availability of medical as15 sistance under title XIX of the Social Security Act (42

16 U.S.C. 1396 et seq.) (commonly referred to as the ‘med17 icaid program’) and of child health assistance under title

18 XXI of such Act (commonly referred to as ‘CHIP’), in19 cluding information on how to obtain an application for

20 assistance under such program.

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

22 CHIP under subclause (I) shall be provided on a form sep23 arate from the application form for free and reduced price

24 lunches under clause (i).’’.
34

•S 2923 IS

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

2 UNDER THE MEDICAID PROGRAM.

3 (a) MAKING PROVISION PERMANENT.—

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

5 1925 of the Social Security Act (42 U.S.C. 1396r–

6 6) is repealed.

7 (2) CONFORMING AMENDMENT.—Section

8 1902(e)(1) of such Act (42 U.S.C. 1396a(e)(1)) is

9 repealed.

10 (b) STATE OPTION OF INITIAL 12-MONTH ELIGI11 BILITY.—Section 1925 of such Act (42 U.S.C. 1396r–6)

12 is amended—

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

14 following new paragraph:

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

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

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

18 as a reference to a 12-month period (or 12 months).

19 In the case of such an election, subsection (b) shall

20 not apply.’’; and

21 (2) in subsection (b)(1), by inserting ‘‘and sub22 section (a)(5)’’ after ‘‘paragraph (3)’’.

23 (c) SIMPLIFICATION OPTIONS.—

24 (1) REMOVAL OF ADMINISTRATIVE REPORTING

25 REQUIREMENTS FOR ADDITIONAL 6-MONTH EXTEN-
35

•S 2923 IS

1 SION.—Section 1925(b)(2) of such Act (42 U.S.C.

2 1396r–6(b)(2)) is amended—

3 (A) by striking subparagraph (B);

4 (B) in subparagraph (A)(i)—

5 (i) by striking ‘‘(I)’’ and all that fol6 lows through ‘‘(II)’’ and inserting ‘‘(i)’’;

7 (ii) by striking ‘‘, and (III)’’ and in8 serting ‘‘and (ii)’’; and

9 (iii) by redesignating such subpara10 graph as subparagraph (A) (with appro11 priate indentation); and

12 (C) in subparagraph (A)(ii)—

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

14 the reporting requirement under subpara15 graph (B)(ii) and’’ and inserting ‘‘provide

16 the family with notification of’’; and

17 (ii) by redesignating such subpara18 graph as subparagraph (B) (with appro19 priate indentation).

20 (2) REMOVAL OF REQUIREMENT FOR PREVIOUS

21 RECEIPT OF MEDICAL ASSISTANCE.—Section

22 1925(a)(1) of such Act (42 U.S.C. 1396r–6(a)(1)) is

23 amended—

24 (A) by redesignating the matter after ‘‘RE25 QUIREMENT.—’’ as a subparagraph (A) with
36

•S 2923 IS

1 the heading ‘‘IN GENERAL.—’’ and with appro2 priate indentation; and

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

4 subparagraph:

5 ‘‘(B) STATE OPTION TO WAIVE REQUIRE6 MENT FOR PREVIOUS RECEIPT OF MEDICAL AS7 SISTANCE.—A State may elect to apply sub8 paragraph (A) to any family whose eligibility

9 for assistance under section 1931 would other10 wise terminate because of hours of, or income

11 from, employment, without regard to the period

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

13 (3) PERMITTING INCREASE OR WAIVER OF 185

14 PERCENT OF POVERTY EARNING LIMIT.—Section

15 1925(b)(3)(A)(iii)(III) of such Act (42 U.S.C.

16 1396r–6(b)(3)(A)(iii)(III)) is amended—

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

18 ‘‘the State’’; and

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

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

21 (4) EXEMPTION FOR STATES COVERING NEEDY

22 FAMILIES UP TO 185 PERCENT OF POVERTY.—Sec23 tion 1925 of such Act (42 U.S.C. 1396r–6), as

24 amended by subsection (a), is amended—
37

•S 2923 IS

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

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

3 (f),’’ after ‘‘Notwithstanding any other provi4 sion of this title,’’; and

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

6 subsection:

7 ‘‘(f) EXEMPTION FOR STATE COVERING NEEDY

8 FAMILIES UP TO 185 PERCENT OF POVERTY.—

9 ‘‘(1) IN GENERAL.—At State option, the provi10 sions of this section shall not apply to a State that

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

12 make medical assistance available under the State

13 plan under this title, at a minimum, to all individ14 uals described in section 1931(b)(1) in families with

15 gross incomes (determined without regard to work16 related child care expenses of such individuals) at or

17 below 185 percent of the income official poverty line

18 (as defined by the Office of Management and Budg19 et, and revised annually in accordance with section

20 673(2) of the Omnibus Budget Reconciliation Act of

21 1981) applicable to a family of the size involved.

22 ‘‘(2) APPLICATION TO OTHER PROVISIONS OF

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

24 paragraph (1) shall be deemed to meet the require-
38

•S 2923 IS

1 ments of sections 1902(a)(10)(A)(i)(I) and

2 1902(e)(1).’’.

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

4 this section take effect on October 1, 2000.

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

6 AFDC-RELATED ELIGIBILITY RESTRICTIONS.

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

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

9 amended by inserting ‘‘other than the requirement that

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

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

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

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

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

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

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

17 part A of title IV’’.

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

19 this section apply to eligibility determinations made on or

20 after October 1, 2000.

21 SEC. 10. STATE GRANT PROGRAM FOR MARKET INNOVA22 TION.

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

24 Human Services (in this section referred to as the ‘‘Sec25 retary’’) shall establish a program (in this section referred
39

•S 2923 IS

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

2 under this section to States to allow States to demonstrate

3 the effectiveness of innovative ways to increase access to

4 health insurance through market reforms and other inno5 vative means. Such innovative means may include any of

6 the following:

7 (1) Alternative group purchasing or pooling ar8 rangements, such as purchasing cooperatives for

9 small businesses, reinsurance pools, or high risk

10 pools.

11 (2) Individual or small group market reforms.

12 (3) Consumer education and outreach.

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

14 in obtaining health insurance.

15 (b) SCOPE; DURATION.—The program shall be lim16 ited to not more than 10 States and to a total period of

17 5 years, beginning on the date the first demonstration

18 grant is made.

19 (c) CONDITIONS FOR DEMONSTRATION GRANTS.—

20 (1) IN GENERAL.—The Secretary may not pro21 vide for a demonstration grant to a State under the

22 program unless the Secretary finds that under the

23 proposed demonstration grant—

24 (A) the State will provide for demonstrated

25 increase of access for some portion of the exist-
40

•S 2923 IS

1 ing uninsured population through a market in2 novation (other than merely through a financial

3 expansion of a program initiated before the

4 date of the enactment of this Act);

5 (B) the State will comply with applicable

6 Federal laws;

7 (C) the State will not discriminate among

8 participants on the basis of any health status9 related factor (as defined in section 2791(d)(9)

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

11 extent a State wishes to focus on populations

12 that otherwise would not obtain health insur13 ance because of such factors; and

14 (D) the State will provide for such evalua15 tion, in coordination with the evaluation re16 quired under subsection (d), as the Secretary

17 may specify.

18 (2) APPLICATION.—The Secretary shall not

19 provide a demonstration grant under the program to

20 a State unless—

21 (A) the State submits to the Secretary

22 such an application, in such a form and man23 ner, as the Secretary specifies;

24 (B) the application includes information

25 regarding how the demonstration grant will ad-
41

•S 2923 IS

1 dress issues such as governance, targeted popu2 lation, expected cost, and the continuation after

3 the completion of the demonstration grant pe4 riod; and

5 (C) the Secretary determines that the dem6 onstration grant will be used consistent with

7 this section.

8 (3) FOCUS.—A demonstration grant proposal

9 under this section need not cover all uninsured indi10 viduals in a State or all health care benefits with re11 spect to such individuals.

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

13 contract with an appropriate entity outside the Depart14 ment of Health and Human Services to conduct an overall

15 evaluation of the program at the end of the program pe16 riod. Such evaluation shall include an analysis of improve17 ments in access, costs, quality of care, or choice of cov18 erage, under different demonstration grants.

19 (e) OPTION TO PROVIDE FOR INITIAL PLANNING

20 GRANTS.—Notwithstanding the previous provisions of this

21 section, under the program the Secretary may provide for

22 a portion of the amounts appropriated under subsection

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

24 State for initial planning grants to permit States to de-
42

•S 2923 IS

1 velop demonstration grant proposals under the previous

2 provisions of this section.

3 (f) AUTHORIZATION OF APPROPRIATIONS.—There

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

5 fiscal year to carry out this section. Amounts appropriated

6 under this subsection shall remain available until ex7 pended.

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

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

10 purposes of title XIX of the Social Security Act.

11 SEC. 11. LIMITATIONS ON CONFLICTS OF INTEREST.

12 (a) LIMITATION ON CONFLICTS OF INTEREST IN

13 MARKETING ACTIVITIES.—

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

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

16 adding at the end the following new paragraph:

17 ‘‘(8) LIMITATION ON EXPENDITURES FOR MAR18 KETING ACTIVITIES.—Amounts expended by a State

19 for the use of an administrative vendor in marketing

20 health benefits coverage to low-income children

21 under this title shall not be considered, for purposes

22 of subsection (a)(2)(D), to be reasonable costs to ad23 minister the plan unless the following conditions are

24 met with respect to the vendor:
43

•S 2923 IS

1 ‘‘(A) The vendor is independent of any en2 tity offering the coverage in the same area of

3 the State in which the vendor is conducting

4 marketing activities.

5 ‘‘(B) No person who is an owner, em6 ployee, consultant, or has a contract with the

7 vendor either has any direct or indirect finan8 cial interest with such an entity or has been ex9 cluded from participation in the program under

10 this title or title XVIII or XIX or debarred by

11 any Federal agency, or subject to a civil money

12 penalty under this Act.’’.

13 (b) PROHIBITION OF AFFILIATION WITH DEBARRED

14 INDIVIDUALS.—

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

16 (42 U.S.C. 1396b(i))is amended—

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

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

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

20 following new paragraph:

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

22 an entity that receives payments under the plan

23 unless—

24 ‘‘(A) no person with an ownership or con25 trol interest (as defined in section 1124(a)(3))
44

•S 2923 IS

1 in the entity is a person that is debarred, sus2 pended, or otherwise excluded from partici3 pating in procurement or non-procurement ac4 tivities under the Federal Acquisition Regula5 tion; and

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

7 employment, consulting, or other agreement for

8 the provision of items or services that are mate9 rial to such entity’s obligations under the plan

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

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

12 (42 U.S.C. 1397gg(e)(1)), as amended by sections

13 5(b) and 7(c)(3), is further amended by adding at

14 the end the following new subparagraph:

15 ‘‘(F) Section 1902(a)(67) (relating to pro16 hibition of affiliation with debarred individ17 uals).’’.

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

19 this section shall apply to expenditures made on or after

20 the date of the enactment of this Act.

21 SEC. 12. INCREASE IN CHIP ALLOTMENT FOR EACH OF FIS22 CAL YEARS 2002 THROUGH 2004.

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

24 the Social Security Act (42 U.S.C. 1397dd(a)) are amend-
45

•S 2923 IS

1 ed by striking ‘‘$3,150,000,000’’ each place it appears and

2 inserting ‘‘$4,150,000,000’’.

3 SEC. 13. DEMONSTRATION PROGRAMS TO IMPROVE MED4 ICAID AND CHIP OUTREACH TO HOMELESS

5 INDIVIDUALS AND FAMILIES.

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

7 Human Services may award demonstration grants to not

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

9 innovative programs that are designed to improve out10 reach to homeless individuals and families under the pro11 grams described in subsection (b) with respect to enroll12 ment of such individuals and families under such pro13 grams and the provision of services (and coordinating the

14 provision of such services) under such programs.

15 (b) PROGRAMS FOR HOMELESS DESCRIBED.—The

16 programs described in this subsection are as follows:

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

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

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

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

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

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

23 (4) SAMHSA BLOCK GRANTS.—The program

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

25 Health Service Act (42 U.S.C. 300x–1 et seq.).
46

•S 2923 IS

1 (5) FOOD STAMP PROGRAM.—The program

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

3 et seq.).

4 (6) WORKFORCE INVESTMENT ACT.—The pro5 gram under the Workforce Investment Act of 1999

6 (29 U.S.C. 2801 et seq.).

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

8 program under section 403(a)(5) of the Social Secu9 rity Act (42 U.S.C. 603(a)(5)).

10 (8) OTHER PROGRAMS.—Other public and pri11 vate benefit programs that serve low-income individ12 uals.

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

14 out this section, there is appropriated, out of any funds

15 in the Treasury not otherwise appropriated, $10,000,000,

16 to remain available until expended.

17 SEC. 14. AUTHORITY TO PAY MEDICAID EXPANSION COSTS

18 FROM TITLE XXI APPROPRIATION.

19 (a) AUTHORITY TO PAY MEDICAID EXPANSION

20 COSTS FROM TITLE XXI APPROPRIATION.—Section

21 2105(a) of the Social Security Act (42 U.S.C. 1397ee(a))

22 is amended—

23 (1) in paragraph (1)—
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1 (A) by inserting ‘‘CHILD HEALTH ASSIST2 ANCE UNDER THIS TITLE.—Expenditures’’ be3 fore ‘‘for child health assistance’’;

4 (B) by striking ‘‘; and’’ at the end and in5 serting a period; and

6 (C) by redesignating such paragraph as

7 subparagraph (D) and indenting appropriately;

8 (2) in paragraph (2)—

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

10 payment’’;

11 (B) by inserting ‘‘ASSISTANCE AND ADMIN12 ISTRATIVE EXPENDITURES SUBJECT TO

13 LIMIT.—Expenditures’’ before ‘‘only to the ex14 tent’’;

15 (C) by redesignating subparagraphs (A)

16 through (D) as clauses (i) through (iv), respec17 tively, and indenting appropriately; and

18 (D) by redesignating such paragraph as

19 subparagraph (E) and indenting appropriately;

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

21 that follows up to subparagraph (D), as so redesig22 nated, and inserting the following:

23 ‘‘(a) ALLOWABLE EXPENDITURES.—

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

25 provisions of this section, the Secretary shall pay to
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1 each State with a plan approved under this title,

2 from its allotment under section 2104, an amount

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

4 in the case of expenditures described in subpara5 graph (B), the Federal medical assistance percent6 age (as defined in the first sentence of section

7 1905(b))) of the following expenditures in the quar8 ter:

9 ‘‘(A) CHILD HEALTH ASSISTANCE UNDER

10 MEDICAID.—Expenditures for child health as11 sistance under the plan for targeted low-income

12 children in the form of providing medical assist13 ance for expenditures described in the fourth

14 sentence of section 1905(b).

15 ‘‘(B) MEDICAID PRESUMPTIVE ELIGIBILITY

16 FOR CHILDREN.—Expenditures for the provi17 sion of medical assistance on behalf of a child

18 during a presumptive eligibility period under

19 section 1920A.

20 ‘‘(C) RESERVED.—[reserved].’’; and

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

22 paragraphs:

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

24 subparagraph of paragraph (1) from a State’s allot25 ment for expenditures described in each such sub-
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1 paragraph shall be made on a quarterly basis in the

2 order of such subparagraph in such paragraph.

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

4 of expenditures for which payment is made under

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

6 XIX.’’.

7 (b) ELIMINATION OF REQUIREMENT TO REDUCE

8 TITLE XXI ALLOTMENT BY MEDICAID EXPANSION

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

10 is amended by striking subsection (d).

11 (c) AUTHORITY TO TRANSFER TITLE XXI APPRO12 PRIATIONS TO TITLE XIX APPROPRIATION ACCOUNT AS

13 REIMBURSEMENT FOR MEDICAID EXPENDITURES FOR

14 MEDICAID EXPANSION SERVICES.—Notwithstanding any

15 other provision of law, all amounts appropriated under

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

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

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

19 2000 (including any amounts that, but for this provision,

20 would be considered to no longer be available) and not ex21 pended in providing child health assistance or related serv22 ices for which payment may be made pursuant to subpara23 graph (D) or (E) of section 2105(a)(1) of such Act (42

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

25 shall be available to reimburse the Grants to States for
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1 Medicaid account in an amount equal to the total pay2 ments made to such State under section 1903(a) of such

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

4 for medical assistance described in subparagraphs (A) and

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

6 1397ee(a)(1)), as so amended.

7 (d) CONFORMING AMENDMENTS.—

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

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

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

11 section 2104 (not taking into account reductions

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

13 by the amount of any payments made under section

14 2105 to the State from such allotment for such fis15 cal year’’ and inserting ‘‘the State’s allotment under

16 section 2104’’.

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

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

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

20 ‘‘and section 2105(a)(1)’’.

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

22 (42 U.S.C. 1397dd), as amended by subsection (b),

23 is further amended—

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

25 subsection (d)’’; and
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1 (B) in subsection (c)(1), by striking ‘‘sub2 ject to subsection (d),’’.

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

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

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

6 that follows ‘‘Except as provided in this para7 graph,’’ and inserting ‘‘the amount of payment

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

9 fiscal year for expenditures for items described

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

11 not exceed 10 percent of the total amount of ex12 penditures for which payment is made under

13 paragraph (1) of such subsection (other than

14 subparagraph (B)).’’;

15 (B) in paragraph (2)(B), by striking ‘‘de16 scribed in subsection (a)(2)’’ and inserting ‘‘de17 scribed in subsection (a)(1)(E)’’; and

18 (C) in paragraph (6)(B), by striking ‘‘Ex19 cept as otherwise provided by law,’’ and insert20 ing ‘‘Except as provided in subparagraph (A) or

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

22 of law,’’.

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

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

2 2105(a)(1)(E)(i)’’.

3 (e) TECHNICAL AMENDMENT.—Section

4 2105(d)(2)(B)(ii) of such Act (42 U.S.C.

5 1397ee(d)(2)(B)(ii)) is amended by striking ‘‘enhanced

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

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

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

9 this section shall be effective as if included in the enact10 ment of the Balanced Budget Act of 1997.

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