II

106TH CONGRESS

1ST SESSION S. 365

To amend title XIX of the Social Security Act to allow States to use the

funds available under the State children’s health insurance program

for an enhanced matching rate for coverage of additional children under

the medicaid program.

IN THE SENATE OF THE UNITED STATES

FEBRUARY 3, 1999

Mr. GORTON (for himself and Mrs. MURRAY) introduced the following bill;

which was read twice and referred to the Committee on Finance

A BILL

To amend title XIX of the Social Security Act to allow

States to use the funds available under the State children’s health insurance program for an enhanced matching rate for coverage of additional children under the

medicaid program.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Children’s Health Eq5 uity Act of 1999’’.
2

•S 365 IS

1 SEC. 2. USE OF STATE CHILDREN’S HEALTH INSURANCE

2 PROGRAM FUNDS FOR ENHANCED MATCH3 ING RATE FOR COVERAGE OF ADDITIONAL

4 CHILDREN UNDER THE MEDICAID PROGRAM.

5 (a) IN GENERAL.—Section 1905 of the Social Secu6 rity Act (42 U.S.C. 1396d) is amended—

7 (1) in subsection (b), by striking ‘‘or subsection

8 (u)(3)’’ and inserting ‘‘, subsection (u)(3), or sub9 section (u)(4)(A)’’; and

10 (2) in subsection (u) (as added by section

11 4911(a)(2) of the Balanced Budget Act of 1997 and

12 as amended by section 162 of Public Law 105–

13 100)—

14 (A) by redesignating paragraph (4) as

15 paragraph (5); and

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

17 following new paragraph:

18 ‘‘(4)(A) For purposes of subsection (b), the expendi19 tures described in this subparagraph are expenditures for

20 medical assistance for waivered low-income children de21 scribed in subparagraph (B) but—

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

23 State described in subparagraph (C); and

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

25 equivalent waivered low-income children enrolled

26 under the State plan under this title for the fiscal
3

•S 365 IS

1 year exceeds the number of waivered low-income

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

3 State for the fiscal year.

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

5 ‘waivered low-income child’ means a child whose family in6 come exceeds the minimum income level required to be es7 tablished for the age of such child under section

8 1902(l)(2) in order for the child to be eligible for medical

9 assistance under this title, but does not exceed the medic10 aid applicable income level (as defined in section

11 2110(b)(4) but determined as if ‘June 1, 1997’ were sub12 stituted for ‘March 31, 1997’) for that child.

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

14 State that—

15 ‘‘(i) has under a waiver authorized by the Sec16 retary or under section 1902(r)(2) established a

17 medicaid applicable income level (as defined in sec18 tion 2110(b)(4) but determined as if ‘June 1, 1997’

19 were substituted for ‘March 31, 1997’) for children

20 under 19 years of age residing in the State that is

21 at or above 200 percent of the poverty line; and

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

23 Secretary a commitment to reach and enroll children

24 who are eligible for, but not enrolled under, the

25 State plan through means, such as the following:
4

•S 365 IS

1 ‘‘(I) Eliminating the assets test for eligi2 bility of waivered low-income children.

3 ‘‘(II) Using shortened and simplified appli4 cations for such children.

5 ‘‘(III) Allowing applications for such chil6 dren to be submitted by mail or through tele7 phone.

8 ‘‘(IV) Outstationing State eligibility work9 ers at sites that are frequented by families with

10 children, including schools, child care centers,

11 churches, centers providing Head Start services,

12 local offices of the special supplemental food

13 program for women, infants and young children

14 (WIC) established under section 17 of the Child

15 Nutrition Act of 1966, community centers, Job

16 Corps centers established under part B of title

17 IV of the Job Training Partnership Act or sub18 title C of title I of the Workforce Investment

19 Act of 1998, sites offering the recognized equiv20 alent of a secondary school degree, offices of

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

22 of the Indian Self-Determination and Education

23 Assistance Act), and Social Security Adminis24 tration field offices.
5

•S 365 IS

1 ‘‘(V) Using presumptive eligibility for

2 waivered low-income children.

3 ‘‘(VI) Collaborating with public and private

4 entities to conduct outreach campaigns to enroll

5 such children.

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

7 number of waivered low-income children for a State de8 scribed in this clause for—

9 ‘‘(I) fiscal year 1998, is equal to the number of

10 full-year equivalent waivered low-income children en11 rolled under the State plan under this title for fiscal

12 year 1997; and

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

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

15 children determined under this clause for the preced16 ing fiscal year increased by the number of percent17 age points determined under clause (ii) for the State

18 for the fiscal year involved.

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

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

21 the number of percentage points by which—

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

23 of children in the State set forth in the 3 most re24 cent March supplements to the Current Population
6

•S 365 IS

1 Survey of the Bureau of the Census before the be2 ginning of the fiscal year; exceeds

3 ‘‘(II) the arithmetic average of such total num4 ber set forth in the second, third, and fourth most

5 recent March supplements to such Survey before the

6 beginning of the fiscal year.

7 ‘‘(E) For purposes of section 2104(d) (regarding the

8 reduction of an allotment under title XXI) the amount de9 termined under paragraph (2) of that section shall, with

10 respect to expenditures described in subparagraph (A),

11 only take into account the amount by which—

12 ‘‘(i) the payments made to a State for such ex13 penditures for a fiscal year on the basis of an en14 hanced FMAP under the fourth sentence of sub15 section (b); exceed

16 ‘‘(ii) the amount of payments that would have

17 been made for the expenditures if the enhanced

18 FMAP did not apply.

19 ‘‘(F) Each State shall submit to the Secretary such

20 information, at such time and in such manner, as the Sec21 retary determines is necessary to ensure that the require22 ments of this paragraph are satisfied. The Secretary shall

23 ensure that information is provided under this subsection

24 in a manner that is consistent with other reporting re25 quirements for information required to be submitted by
7

•S 365 IS

1 a State under this title and title XXI, and avoids duplica2 tion of reporting requirements.

3 ‘‘(G) The Secretary shall regularly examine the pay4 ments made to a State for the expenditures described in

5 subparagraph (A) to confirm that the payments are attrib6 utable to expenditures described in such subparagraph.’’.

7 (b) CONFORMING AMENDMENTS.—

8 (1) Section 1902(a)(10)(A)(ii)(XIV) of the So9 cial Security Act (42 U.S.C.

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

11 ‘‘1905(u)(2)(C)’’ and inserting ‘‘1905(u)(2)(B)’’.

12 (2) Section 2104(d)(2) of the Social Security

13 Act (42 U.S.C. 1397dd(d)(2)) is amended by insert14 ing ‘‘subject to section 1905(u)(4)(E),’’ after ‘‘(2)’’.

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

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

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

19 SEC. 3. EXPANSION OF PRESUMPTIVE ELIGIBILITY OPTION

20 FOR CHILDREN UNDER THE MEDICAID PRO21 GRAM.

22 (a) IN GENERAL.—Section 1920A(b)(3)(A)(i) of the

23 Social Security Act (42 U.S.C. 1396r–1a(b)(3)(A)(i)) is

24 amended—
8

•S 365 IS

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

2 and

3 (2) by inserting before the semicolon ‘‘, eligi4 bility for assistance under the State plan under part

5 A of title IV, eligibility of a child to receive medical

6 assistance under the State plan under this title or

7 title XXI, (III) is a staff member of an elementary

8 school or secondary school, as such terms are de9 fined in section 14101 of the Elementary and Sec10 ondary Education Act of 1965 (20 U.S.C. 8801), a

11 child care resource and referral center, or an agency

12 administering a State plan under part D of title IV,

13 or (IV) is so designated by the State’’.

14 (b) CONFORMING AMENDMENTS.—Section 1920A of

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

16 (1) in subsection (b)(3)(A)(ii), by striking

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

18 (2)(A)’’; and

19 (2) in subsection (c)(2), in the matter preceding

20 subparagraph (A), by striking ‘‘subsection

21 (b)(1)(A)’’ and inserting ‘‘subsection (b)(2)(A)’’.

Æ