II

106TH CONGRESS

2D SESSION S. 3172

To provide access to affordable health care for all Americans.

IN THE SENATE OF THE UNITED STATES

OCTOBER 5 (legislative day, SEPTEMBER 22), 2000

Mr. KENNEDY introduced the following bill; which was read twice and referred

to the Committee on Finance

A BILL

To provide access to affordable health care for all Americans.

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 ‘‘Basic Access to Secure Health Insurance Coverage

6 Health Plan (BASIC Health Plan) Act’’.

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

8 this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—AFFORDABLE HEALTH INSURANCE FOR PARENTS AND

CHILDREN

Sec. 101. Coverage of parents and children under the medicaid program and

CHIP.

Sec. 102. Coverage of legal immigrants under the medicaid program.
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Sec. 103. Coverage of children through age 20 under the medicaid program and

title XXI.

Sec. 104. Application of simplified title XXI procedures under the medicaid

program.

Sec. 105. Expansion of basic services required for benchmark-equivalent coverage under CHIP.

Sec. 106. Elimination of 100 hour rule and other AFDC-related eligibility restrictions.

Sec. 107. Limitations on conflicts of interest.

Sec. 108. Demonstration programs to improve medicaid and CHIP outreach to

homeless individuals and families.

TITLE II—ACCESS TO AFFORDABLE CARE FOR ALL AMERICANS

Sec. 201. Extension of coverage to single individuals.

TITLE III—ADDITIONAL PROVISIONS

Sec. 301. Availability of unsubsidized coverage.

1 TITLE I—AFFORDABLE HEALTH

2 INSURANCE FOR PARENTS

3 AND CHILDREN

4 SEC. 101. COVERAGE OF PARENTS AND CHILDREN UNDER

5 THE MEDICAID PROGRAM AND CHIP.

6 (a) REQUIREMENT TO PROVIDE COVERAGE FOR

7 MEDICAID PARTICIPATION.—Section 1902(a) of the So8 cial Security Act (42 U.S.C. 1396a(a)) is amended—

9 (1) in paragraph (64), by striking ‘‘and’’ at the

10 end;

11 (2) in paragraph (65), by striking the period

12 and inserting a semicolon; and

13 (3) by inserting after paragraph (65), the fol14 lowing new paragraph:

15 ‘‘(66) provide that the State will provide med16 ical assistance under paragraph (10)(A)(ii)((XVIII)

17 or health coverage under section 2111 for families
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1 described in subsection (k)(1) in accordance with the

2 conditions described in subsection (k)(2).’’.

3 (b) COVERAGE UNDER MEDICAID.—

4 (1) IN GENERAL.—Section 1902(a)(10)(A)(ii)

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

6 1396a(a)(10)(A)(ii)) is amended—

7 (A) by striking ‘‘or’’ at the end of sub8 clause (XVI);

9 (B) by adding ‘‘or’’ at the end of subclause

10 (XVII); and

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

12 subclause:

13 ‘‘(XVIII) who are families de14 scribed in subsection (k)(1);’’.

15 (2) CONDITIONS FOR COVERAGE.—Section

16 1902 of such Act is further amended by inserting

17 after subsection (j) the following new subsection:

18 ‘‘(k)(1) The families described in this paragraph are

19 families (consisting of individuals who are under 21 years

20 of age and parents of such individuals)—

21 ‘‘(i) who are not otherwise eligible for medical

22 assistance under subsection(a)(10)(A); and

23 ‘‘(ii) whose income is at least—

24 ‘‘(I) with respect to fiscal year 2001, 200

25 percent of the poverty line; and
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1 ‘‘(II) with respect to each subsequent fiscal

2 year, 300 percent of the poverty line.

3 ‘‘(2) The conditions described in this paragraph are

4 as follows:

5 ‘‘(A) The State provides that families described

6 in paragraph (1) remain eligible for medical assist7 ance for a period (of at least 12 months) following

8 the eligibility determination required under such

9 paragraph.

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

11 under title XXI which (whether implemented under

12 such title or under this title) does not limit the ac13 ceptance of applications for families described in

14 paragraph (1), does not use a waiting list for such

15 families who meet eligibility standards to qualify for

16 assistance (under this title or under title XXI), and

17 provides benefits to all families in the State who

18 apply for and meet eligibility standards.

19 ‘‘(C) The State does not cover families de20 scribed in paragraph (1) with higher family income

21 without covering families with a lower family income.

22 ‘‘(3) In the case of a parent in a family described

23 in paragraph (1) who is also the parent of a child who

24 is eligible and enrolled for medical assistance under this

25 title or for child health assistance under title XXI, the
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1 State may elect (on a uniform basis) to enroll the parent

2 in the same program as the child. If such a parent has

3 children enrolled under both programs, the State may

4 elect (on such basis) which program to enroll the parent

5 in.’’.

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

7 meaning given the term ‘caretaker’ for purposes of car8 rying out section 1931.’’.

9 (3) APPLICATION OF PRESUMPTIVE ELIGIBILITY

10 PROVISIONS.—Section 1920A of such Act (42 U.S.C.

11 1396r–1a) is amended by adding at the end the fol12 lowing new subsection:

13 ‘‘(e) In accordance with regulations, a State shall

14 apply the previous provisions of this section to provide for

15 a period of presumptive eligibility for medical assistance

16 for a parent of a child with respect to whom such a period

17 is provided under this section.’’.

18 (4) CONFORMING AMENDMENTS.—

19 (A) ELIGIBILITY CATEGORIES.—Section

20 1905(a) of such Act (42 U.S.C. 1396d(a)) is

21 amended in the matter before paragraph (1)—

22 (i) by striking ‘‘or’’ at the end of

23 clause (x);

24 (ii) by inserting ‘‘or’’ at the end of

25 clause (xi); and
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1 (iii) by inserting after clause (xi) the

2 following new clause:

3 ‘‘(xii) who are families described in section

4 1902(k)(1),’’.

5 (B) INCOME LIMITATIONS.—Section

6 1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4))

7 is amended by inserting

8 ‘‘1902(a)(10)(A)(ii)(XVIII),’’ after

9 ‘‘1902(a)(10)(A)(ii)(XVI),’’.

10 (c) COVERAGE UNDER CHIP.—

11 (1) IN GENERAL.—Title XXI of such Act (42

12 U.S.C. 1397aa et seq.) is amended by adding at the

13 end the following new section:

14 ‘‘SEC. 2111. COVERAGE OF FAMILIES.

15 ‘‘(a) IN GENERAL.—Notwithstanding any other pro16 vision of this title, with respect to a State that does not

17 provide medical assistance under section

18 1902(a)(10)(A)(ii)(XVIII) for families described in section

19 1902(k)(1), the State shall provide health coverage under

20 this title for such families through an amendment to its

21 State child health plan under section 2102 in accordance

22 with this section and the conditions described in section

23 1902(k)(2).

24 ‘‘(b) DEFINITIONS.—For purposes of this section:
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1 ‘‘(1) HEALTH COVERAGE.—The term ‘health

2 coverage’ has the meaning given the term child

3 health assistance in section 2110(a) as if any ref4 erence to targeted low-income children were a ref5 erence to families described in section 1902(k)(1).

6 ‘‘(2) TREATMENT OF PREGNANT WOMEN AS

7 PARENTS.—A State child health plan shall treat a

8 pregnant woman who is not otherwise a parent as a

9 parent in a family described in section 1902(k)(1)

10 for purposes of this section.

11 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

12 RULES.—In the case of, and with respect to, a State pro13 viding health coverage for families described in section

14 1902(k)(1) under subsection (a), the following special

15 rules apply:

16 ‘‘(1) Any reference in this title (other than sub17 section (b)) to a targeted low-income child is deemed

18 to include a reference to a family described in sec19 tion 1902(k)(1).

20 ‘‘(2) Any such reference to child health assist21 ance with respect to such families is deemed a ref22 erence to health coverage (as defined in subsection

23 (b)(1)).

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

25 case of a family provided coverage under this sec-
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1 tion, the limitation on total annual aggregate cost2 sharing shall be applied to the entire family.

3 ‘‘(4) Section 1905(u)(2)(A) shall be applied as

4 if any reference to optional targeted low-income chil5 dren includes a reference to a family described in

6 section 1902(k)(1).’’.

7 (2) ENHANCED MATCHING FUNDS.—

8 (A) IN GENERAL.—Section 1905 of such

9 Act (42 U.S.C. 1396d) is amended—

10 (i) in the fourth sentence of sub11 section (b), by striking ‘‘or subsection

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

13 and

14 (ii) in subsection (u)—

15 (I) by redesignating paragraph

16 (4) as paragraph (5), and

17 (II) by inserting after paragraph

18 (3) the following new paragraph:

19 ‘‘(4) For purposes of subsection (b) and section

20 2105(a)(1):

21 ‘‘(A) FAMILIES.—The expenditures described in

22 this subparagraph are the following:

23 ‘‘(i) FAMILIES.—Expenditures for medical

24 assistance made available under section

25 1902(a)(10)(A)(ii)(XVIII) for families de-
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1 scribed in section 1902(k)(1), the income of

2 which exceeds the income level applicable under

3 such section 1931 to a family of the size in4 volved as of January 1, 2000.

5 ‘‘(ii) CERTAIN PREGNANT WOMEN.—Ex6 penditures for medical assistance for pregnant

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

8 the income of which exceeds the income level

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

10 family of the size involved as of January 1,

11 2000.’’.

12 (B) POST FY 2006 EXPANSION OF AVAIL13 ABILITY OF ENHANCED MATCH UNDER MED14 ICAID FOR PRE-CHIP EXPANSIONS.—Effective

15 October 1, 2005, paragraph (4) of section

16 1905(u) of such Act (42 U.S.C. 1396d(u)), as

17 inserted by subparagraph (A)(ii)(II), is

18 amended—

19 (i) by amending clause (ii) of subpara20 graph (A) to read as follows:

21 ‘‘(ii) CERTAIN PREGNANT WOMEN.—Ex22 penditures for medical assistance for pregnant

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

24 the income of which exceeds the 133 percent of

25 the income official poverty line.’’; and
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1 (ii) by adding at the end the following

2 new subparagraphs:

3 ‘‘(B) PARENTS WITH INCOME ABOVE 100 PER4 CENT OF POVERTY BUT BELOW JANUARY 1, 2000 IN5 COME LEVEL.—The expenditures described in this

6 subparagraph are expenditures for medical assist7 ance made available for any parents described in

8 section 1902(a)(10)(A)(i)(VIII), whose income ex9 ceeds 100 percent of the income official poverty line

10 applicable to a family of the size involved but does

11 not exceed the applicable income level established

12 under this title (under section 1931 or otherwise) for

13 a parent in a family of the size involved as of Janu14 ary 1, 2000.

15 ‘‘(C) CHILDREN IN FAMILIES WITH INCOME

16 ABOVE MEDICAID MANDATORY LEVEL NOT PRE17 VIOUSLY DESCRIBED.—The expenditures described

18 in this subparagraph are expenditures (other than

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

20 medical assistance made available to any child who

21 is eligible for assistance under section

22 1902(a)(10)(A) and the income of whose family ex23 ceeds the minimum income level required under sub24 section 1902(l)(2) for a child of the age involved
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1 (treating any child who is 19 or 20 years of age

2 as being 18 years of age).’’.

3 (3) TRANSFORMATION OF CHIP INTO PERMA4 NENT ENTITLEMENT.—

5 (A) ELIMINATION OF ALLOTMENTS AND

6 CAPPED APPROPRIATIONS.—Section 2104 of the

7 Social Security Act (42 U.S.C. 1397dd) is

8 amended to read as follows:

9 ‘‘SEC. 2104. APPROPRIATION.

10 ‘‘For the purpose of making payments to States

11 under this title, there is appropriated, out of any money

12 in the Treasury not otherwise appropriated, such sums as

13 may be necessary for fiscal year 2001 and each fiscal year

14 thereafter.’’.

15 (B) CONFORMING AMENDMENTS.—

16 (i) Section 1905 of the Social Security

17 Act (42 U.S.C. 1396d) is amended—

18 (I) in subsection (b), in the

19 fourth sentence, by striking ‘‘, and

20 that do not exceed the amount of the

21 State’s allotment under section 2104

22 (not taking into account reductions

23 under section 2104(d)(2)) for the fis24 cal year reduced by the amount of any

25 payments made under section 2105 to
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1 the State from such allotment for

2 such fiscal year’’; and

3 (II) by striking subsection (u)(1)

4 and inserting the following:

5 ‘‘(u)(1) The condition described in this paragraph for

6 a State plan is that the State is complying with the re7 quirement of section 2105(d)(1).’’.

8 (ii) Section 2105(a) of such Act (42

9 U.S.C. 1397ee(a)) is amended by striking

10 ‘‘from its allotment under section 2104

11 (taking into account any adjustment under

12 section 2104(d)),’’.

13 (4) NO COST-SHARING FOR PREGNANCY-RE14 LATED BENEFITS.—Section 2103(e)(2) of such Act

15 (42 U.S.C. 1397cc(e)(2)) is amended—

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

17 PREGNANCY-RELATED SERVICES’’ after ‘‘PRE18 VENTIVE SERVICES’’; and

19 (B) by inserting before the period at the

20 end the following: ‘‘and for pregnancy-related

21 services’’.

22 (5) CONFORMING AMENDMENT RELATING TO

23 NO WAITING PERIOD FOR CERTAIN WOMEN.—Section

24 2102(b)(1)(B) of such Act (42 U.S.C.

25 1397bb(b)(1)(B)) is amended—
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1 (A) by striking ‘‘, and’’ at the end of

2 clause (i) and inserting a semicolon;

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

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

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

6 clause:

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

8 (including a waiting period to carry out

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

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

11 (6) AUTOMATIC ENROLLMENT OF CHILDREN

12 BORN TO TITLE XXI PARENTS.—Section 2102(b)(1)

13 of the Social Security Act (42 U.S.C. 1397bb(b)(1))

14 is amended by adding at the end the following new

15 subparagraph:

16 ‘‘(C) AUTOMATIC ELIGIBILITY OF CHIL17 DREN BORN TO A PARENT BEING PROVIDED

18 HEALTH COVERAGE.—Such eligibility standards

19 shall provide for automatic coverage of a child

20 born to an individual who is provided health

21 coverage (as defined in section 2111(b)(1))

22 under this title in the same manner as medical

23 assistance would be provided under section

24 1902(e)(4) to a child described in such sec25 tion.’’.
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1 (7) APPLICATION OF PRESUMPTIVE ELIGI2 BILITY.—

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

4 such Act (42 U.S.C. 1397gg(e)(1)) is amended

5 by adding at the end the following new sub6 paragraph:

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 such Act (42 U.S.C. 1397ee(c)(2)) is amend12 ed by adding at the end the following new sub13 paragraph:

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 1920A (pursuant to sec19 tion 2107(e)(1)(D)), regardless of whether the

20 child is determined to be ineligible for the pro21 gram under this title or title XIX.’’.

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

23 this section take effect on October 1, 2000.
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1 SEC. 102. COVERAGE OF LEGAL IMMIGRANTS UNDER THE

2 MEDICAID PROGRAM.

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

4 Social Security Act (42 U.S.C. 1396b(v)) is amended—

5 (1) in paragraph (1), by striking ‘‘paragraph

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

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

8 paragraph:

9 ‘‘(4)(A) A State shall (through a plan amendment

10 under this title) provide medical assistance under this

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

12 421 of the Personal Responsibility and Work Opportunity

13 Reconciliation Act of 1996, for aliens who are lawfully re14 siding in the United States (including battered aliens de15 scribed in section 431(c) of such Act) and who are other16 wise eligible for such assistance.

17 ‘‘(B) No debt may be accrued under an affidavit of

18 support against any sponsor of an alien provided medical

19 assistance under subparagraph (A).’’.

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

21 U.S.C. 1397gg(e)(1)), as amended by section

22 101(c)(7)(A), is amended by adding at the end the fol23 lowing new subparagraph:

24 ‘‘(E) Section 1903(v)(4) (relating to op25 tional coverage of categories of lawfully residing

26 alien children and parents).’’.
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1 (c) EFFECTIVE DATE.—The amendments made by

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

3 medical assistance furnished on or after such date.

4 SEC. 103. COVERAGE OF CHILDREN THROUGH AGE 20

5 UNDER THE MEDICAID PROGRAM AND TITLE

6 XXI.

7 (a) MEDICAID.—

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

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

10 amended by striking ‘‘19’’ and inserting ‘‘20’’.

11 (2) CONFORMING AMENDMENTS.—

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

13 U.S.C. 1396a(e)(3)(A)) is amended by striking

14 ‘‘18’’ and inserting ‘‘20’’.

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

16 U.S.C. 1396a(e)(12)) is amended by striking

17 ‘‘19’’ and inserting ‘‘20’’.

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

19 U.S.C. 1396r–1a(b)(1)) is amended by striking

20 ‘‘19’’ and inserting ‘‘20’’.

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

22 U.S.C. 1396s(h)(1)) is amended by striking

23 ‘‘18’’ and inserting ‘‘20’’.
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1 (E) Section 1932(a)(2)(A) of such Act (42

2 U.S.C. 1396u–2(a)(2)(A)) is amended by strik3 ing ‘‘19’’ and inserting ‘‘20’’.

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

5 U.S.C. 1397jj(c)(1)) is amended by striking ‘‘19’’ and in6 serting ‘‘20’’.

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

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

9 medical assistance and child health assistance provided on

10 or after such date.

11 SEC. 104. APPLICATION OF SIMPLIFIED TITLE XXI PROCE12 DURES UNDER THE MEDICAID PROGRAM.

13 (a) APPLICATION UNDER MEDICAID.—

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

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

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

17 to paragraph (5)’’, after ‘‘Notwithstanding sub18 section (a)(17),’’; and

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

20 paragraph:

21 ‘‘(5) With respect to determining the eligibility of in22 dividuals under 20 years of age for medical assistance

23 under subsection (a)(10)(A) and, separately, with respect

24 to determining the eligibility of individuals for medical as25 sistance under subsection (a)(10)(A)(i)(VIII) or
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1 (a)(10)(A)(ii)(XVIII), notwithstanding any other provi2 sion of this title, if the State has established a State child

3 health plan under title XXI—

4 ‘‘(A) the State may not apply a resource stand5 ard if the State does not apply such a standard

6 under such child health plan with respect to such in7 dividuals;

8 ‘‘(B) the State shall use the same simplified eli9 gibility form (including, if applicable, permitting ap10 plication other than in person) as the State uses

11 under such State child health plan with respect to

12 such individuals;

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

14 determinations and redeterminations of eligibility

15 using the same verification policies, forms, and fre16 quency as the State uses for such purposes under

17 such State child health plan with respect to such in18 dividuals; and

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

20 interview for purposes of initial eligibility determina21 tions and redeterminations unless the State requires

22 such an interview for such purposes under such child

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

24 (2) EFFECTIVE DATE.—The amendments made

25 by paragraph (1) apply to determinations of eligi-
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1 bility made on or after the date that is 1 year after

2 the date of the enactment of this Act.

3 (b) ADDITIONAL ENTITIES QUALIFIED TO DETER4 MINE MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-IN5 COME CHILDREN.—

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

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

8 amended—

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

10 (II)’’; and

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

12 medical assistance under the State plan under

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

14 assistance under the program funded under

15 title XXI, (III) is an elementary school or sec16 ondary school, as such terms are defined in sec17 tion 14101 of the Elementary and Secondary

18 Education Act of 1965 (20 U.S.C. 8801), an el19 ementary or secondary school operated or sup20 ported by the Bureau of Indian Affairs, a State

21 or tribal child support enforcement agency, a

22 child care resource and referral agency, an or23 ganization that is providing emergency food and

24 shelter under a grant under the Stewart B.

25 McKinney Homeless Assistance Act, or a State
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1 or tribal office or entity involved in enrollment

2 in the program under this title, under part A

3 of title IV, under title XXI, or that determines

4 eligibility for any assistance or benefits provided

5 under any program of public or assisted hous6 ing that receives Federal funds, including the

7 program under section 8 or any other section of

8 the United States Housing Act of 1937 (42

9 U.S.C. 1437 et seq.), or under the Native

10 American Housing Assistance and Self-Deter11 mination Act of 1996 (25 U.S.C. 4101 et seq.),

12 or (IV) any other entity the State so deems, as

13 approved by the Secretary’’ before the semi14 colon.

15 (2) TECHNICAL AMENDMENTS.—Section 1920A

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

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

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

19 (2)(A)’’; and

20 (B) in subsection (c)(2), in the matter pre21 ceding subparagraph (A), by striking ‘‘sub22 section (b)(1)(A)’’ and inserting ‘‘subsection

23 (b)(2)(A)’’.

24 (3) APPLICATION TO PRESUMPTIVE ELIGIBILITY

25 FOR PREGNANT WOMEN UNDER MEDICAID.—Section
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1 1920(b) of such Act (42 U.S.C. 1396r–1(b)) is

2 amended by adding at the end after and below para3 graph (2) the following flush sentence:

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

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

6 (c) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR

7 TITLE XXI AND MEDICAID BENEFITS FOR CHILDREN

8 LOSING MEDICAID OR TITLE XXI ELIGIBILITY.—

9 (1) LOSS OF MEDICAID ELIGIBILITY.—Section

10 1902(a) of the Social Security Act (42 U.S.C.

11 1396a(a)), as amended by section 101(a), is

12 amended—

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

14 paragraph (66) and inserting ‘‘; and’’, and

15 (B) by inserting after paragraph (66) the

16 following new paragraph:

17 ‘‘(67) 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
22

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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 child health assistance to

11 a child (or health coverage to a parent of a

12 child) is discontinued under this title, a deter13 mination of whether the child (or parent) is eli14 gible for benefits under title XIX is made and,

15 if determined to be so eligible, the child (or par16 ent) is automatically enrolled in the program

17 under such title without the need for a new ap18 plication;’’.

19 (3) EFFECTIVE DATE.—The amendments made

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

21 lose eligibility under the medicaid program under

22 title XIX, or under a State child health insurance

23 plan under title XXI, respectively, of the Social Se24 curity Act on or after the date that is 60 days after

25 the date of the enactment of this Act.
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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 and health

18 coverage under title XXI of such Act (commonly referred

19 to as ‘CHIP’), including information on how to obtain an

20 application for 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).’’.
24

•S 3172 IS

1 SEC. 105. EXPANSION OF BASIC SERVICES REQUIRED FOR

2 BENCHMARK-EQUIVALENT COVERAGE

3 UNDER CHIP.

4 (a) ADDITION OF VISION, HEARING, AND DENTAL

5 SERVICES.—

6 (1) IN GENERAL.—Section 2103(c)(1) of the

7 Social Security Act (42 U.S.C. 1397cc(c)(1)) is

8 amended by adding at the end the following:

9 ‘‘(E) Vision services for children.

10 ‘‘(F) Hearing services for children.

11 ‘‘(G) Dental services for children.’’.

12 (2) EXCLUSION FROM DETERMINATION OF AC13 TUARIAL VALUE.—Section 2103(c)(4) of such Act

14 (42 U.S.C. 1397cc(c)(4)) is amended by adding at

15 the end the following new sentence: ‘‘The categories

16 of basic services described in subparagraphs (E),

17 (F), and (G) of paragraph (1) shall not be taken

18 into account for purposes of determining the actu19 arial value of coverage under this paragraph.’’.

20 (3) CONFORMING AMENDMENTS.—Section

21 2103(c)(2) of such Act (42 U.S.C. 1397cc(c)(2)) is

22 amended by striking subparagraphs (C) and (D).

23 (b) NO LIMITATION ON SCOPE OR DURATION FOR

24 CERTAIN SERVICES.—Section 2103(a) of such Act (42

25 U.S.C. 1397cc(a)) is amended by adding at the end the

26 following new paragraph:
25

•S 3172 IS

1 ‘‘(5) NO LIMITATION ON SCOPE OR DURATION

2 FOR FEHBP-EQUIVALENT CHILDREN’S HEALTH IN3 SURANCE COVERAGE.—With respect to coverage that

4 is equivalent to the benchmark benefit package de5 scribed in subsection (b)(1), or that is actuarially

6 equivalent to such package and otherwise meets the

7 requirements of paragraph (2)—

8 ‘‘(A) services otherwise provided under

9 such coverage that are medically necessary to

10 maintain, improve, or prevent the deterioration

11 of the physical, developmental, or mental health

12 of the child may not be limited with respect to

13 scope or duration, except to the degree that

14 such services are not medically necessary; and

15 ‘‘(B) such coverage shall include the option

16 to identify medically necessary appropriate al17 ternatives to traditional care or extra contrac18 tual services determined by the health plan to

19 be a more cost effective alternative than covered

20 items or services.’’.

21 SEC. 106. ELIMINATION OF 100 HOUR RULE AND OTHER

22 AFDC-RELATED ELIGIBILITY RESTRICTIONS.

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

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

25 amended by inserting ‘‘other than the requirement that
26

•S 3172 IS

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

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

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

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

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

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

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

8 part A of title IV’’.

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

10 this section apply to eligibility determinations made on or

11 after October 1, 2000.

12 SEC. 107. LIMITATIONS ON CONFLICTS OF INTEREST.

13 (a) LIMITATION ON CONFLICTS OF INTEREST IN

14 MARKETING ACTIVITIES.—

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

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

17 adding at the end the following new paragraph:

18 ‘‘(8) LIMITATION ON EXPENDITURES FOR MAR19 KETING ACTIVITIES.—Amounts expended by a State

20 for the use of an administrative vendor in marketing

21 health benefits coverage to low-income children

22 under this title shall not be considered, for purposes

23 of subsection (a)(2)(D), to be reasonable costs to ad24 minister the plan unless the following conditions are

25 met with respect to the vendor:
27

•S 3172 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))
28

•S 3172 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 section

13 102(b), is further amended by adding at the end the

14 following new subparagraph:

15 ‘‘(F) Section 1903(i)(21) (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. 108. DEMONSTRATION PROGRAMS TO IMPROVE MED22 ICAID AND CHIP OUTREACH TO HOMELESS

23 INDIVIDUALS AND FAMILIES.

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

25 Human Services may award demonstration grants to not
29

•S 3172 IS

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

2 innovative programs that are designed to improve out3 reach to homeless individuals and families under the pro4 grams described in subsection (b) with respect to enroll5 ment of such individuals and families under such pro6 grams and the provision of services (and coordinating the

7 provision of such services) under such programs.

8 (b) PROGRAMS FOR HOMELESS DESCRIBED.—The

9 programs described in this subsection are as follows:

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

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

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

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

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

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

16 (4) SAMHSA BLOCK GRANTS.—The program

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

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

19 (5) FOOD STAMP PROGRAM.—The program

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

21 et seq.).

22 (6) WORKFORCE INVESTMENT ACT.—The pro23 gram under the Workforce Investment Act of 1999

24 (29 U.S.C. 2801 et seq.).
30

•S 3172 IS

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

2 program under section 403(a)(5) of the Social Secu3 rity Act (42 U.S.C. 603(a)(5)).

4 (8) OTHER PROGRAMS.—Other public and pri5 vate benefit programs that serve low-income individ6 uals.

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

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

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

10 to remain available until expended.

11 TITLE II—ACCESS TO AFFORD12 ABLE CARE FOR ALL AMERI13 CANS

14 SEC. 201. EXTENSION OF COVERAGE TO SINGLE INDIVID15 UALS.

16 (a) REQUIREMENT TO EXTEND COVERAGE TO SIN17 GLE INDIVIDUALS.—Section 1902(a)(66) of the Social Se18 curity Act (42 U.S.C. 1396a(a)(66)), as added by section

19 101(a), is amended—

20 (1) by striking ‘‘under paragraph

21 (10)(A)(ii)((XVIII)’’ and inserting ‘‘under—

22 ‘‘(A) paragraph (10)(A)(ii)((XVIII)’’;

23 (2) by striking the period and inserting ‘‘;

24 and’’; and

25 (3) by adding at the end the following:
31

•S 3172 IS

1 ‘‘(B) paragraph (10)(A)(ii)(XIX) for indi2 viduals described in subsection (aa)(1) in ac3 cordance with the conditions described in para4 graphs (2), (3), (4), (5), and (6) of subsection

5 (aa).’’.

6 (b) COVERAGE UNDER MEDICAID.—

7 (1) IN GENERAL.—Section 1902(a)(10)(A)(ii)

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

9 1396a(a)(10)(A)(ii)), as amended by section 101(b),

10 is amended—

11 (A) by striking ‘‘or’’ at the end of sub12 clause (XVII);

13 (B) by adding ‘‘or’’ at the end of subclause

14 (XVIII); and

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

16 subclause:

17 ‘‘(XIX) who are individuals de18 scribed in subsection (aa)(1);’’.

19 (2) CONDITIONS FOR COVERAGE.—Section

20 1902 of such Act is amended by adding at the end

21 the following new subsection:

22 ‘‘(aa)(1) The individuals described in this paragraph

23 are individuals—

24 ‘‘(A) who are not otherwise eligible for medical

25 assistance under subsection (a)(10)(A); and
32

•S 3172 IS

1 ‘‘(B) whose income is at least—

2 ‘‘(i) with respect to fiscal year 2003, 50

3 percent of the poverty line;

4 ‘‘(ii) with respect to fiscal year, 2004, 100

5 percent of the poverty line;

6 ‘‘(iii) with respect to fiscal year 2005, 150

7 percent of the poverty line;

8 ‘‘(iv) with respect to fiscal year 2006, 200

9 percent of the poverty line;

10 ‘‘(v) with respect to fiscal year 2007, 250

11 percent of the poverty line; and

12 ‘‘(vi) with respect to fiscal year 2008, 300

13 percent of the poverty line.

14 ‘‘(2) At State option, clause (iii), (iv), (v), or (vi) of

15 paragraph (1)(B) shall not apply but only if the State pro16 vides health coverage for an individual who would be de17 scribed in any such clause in accordance with section

18 2111.

19 ‘‘(3) The State provides that individuals described in

20 paragraph (1) remain eligible for medical assistance for

21 a period (of at least 12 months) following the eligibility

22 determination required under such paragraph.

23 ‘‘(4) The State has a State child health plan under

24 title XXI which (whether implemented under such title or

25 under this title) does not limit the acceptance of applica-
33

•S 3172 IS

1 tions for individuals described in paragraph (1), does not

2 use a waiting list for such individuals who meet eligibility

3 standards to qualify for assistance (under this title or, if

4 the State offers such individuals assistance under section

5 2111(a)(2), title XXI), and provides benefits to all such

6 individuals in the State who apply for and meet eligibility

7 standards.

8 ‘‘(5) The State does not cover individuals described

9 in paragraph (1) with higher family income without cov10 ering such individuals with a lower family income.

11 ‘‘(6) Section 1920A(e) shall apply to individuals de12 scribed in paragraph (1) in the same manner as such sec13 tion applies to parents described in that section.’’.

14 (3) CONFORMING AMENDMENTS.—

15 (A) ELIGIBILITY CATEGORIES.—Section

16 1905(a) of such Act (42 U.S.C. 1396d(a)), as

17 amended by section 101(b)(4)(A), is amended,

18 in the matter before paragraph (1)—

19 (i) by striking ‘‘or’’ at the end of

20 clause (xi);

21 (ii) by inserting ‘‘or’’ at the end of

22 clause (xii); and

23 (iii) by inserting after clause (xii) the

24 following new clause:
34

•S 3172 IS

1 ‘‘(xiii) who are individuals described in section

2 1902(aa)(1),’’.

3 (B) INCOME LIMITATIONS.—Section

4 1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4)),

5 as amended by section 101(b)(4)(B), is amend6 ed by inserting ‘‘1902(a)(10)(A)(ii)(XIX),’’

7 after ‘‘1902(a)(10)(A)(ii)(XVIII),’’.

8 (c) COVERAGE UNDER SCHIP.—

9 (1) IN GENERAL.—Section 2111 of such Act, as

10 added by section 101(c), is amended—

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

12 SINGLE ADULTS’’ before the period;

13 (B) in subsection (a)—

14 (i) by striking ‘‘Notwithstanding’’ and

15 inserting the following:

16 ‘‘(1) FAMILIES.—Notwithstanding’’; and

17 (ii) by adding at the end the fol18 lowing:

19 ‘‘(2) CERTAIN SINGLE INDIVIDUALS.—Notwith20 standing any other provision of this title, with re21 spect to a State that does not provide medical assist22 ance under section 1902(a)(10)(A)(ii)(XIX) for an

23 individual described in clause (iii), (iv), (v), or (vi)

24 of section 1902(aa)(1)(B), the State shall provide

25 health coverage under this title for such an indi-
35

•S 3172 IS

1 vidual through an amendment to its State child

2 health plan under section 2102 in accordance with

3 this section and the conditions described in para4 graphs (3) and (4) of section 1902(aa).’’; and

5 (C) in subsection (b), by adding at the end

6 the following new paragraph:

7 ‘‘(3) TREATMENT OF CERTAIN SINGLE INDIVID8 UALS.—A State child health plan shall treat, and

9 shall apply this section to, an individual described in

10 subsection (a)(2) in the same manner as such plan

11 treats and applies this section to a family described

12 in section 1902(k)(1).’’.

13 TITLE III—ADDITIONAL

14 PROVISIONS

15 SEC. 301. AVAILABILITY OF UNSUBSIDIZED COVERAGE.

16 (a) REQUIREMENT TO OFFER COVERAGE.—

17 (1) IN GENERAL.—Title XIX of the Social Se18 curity Act (42 U.S.C. 1396 et seq.) is amended—

19 (A) by redesignating section 1935 as sec20 tion 1936; and

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

22 section:

23 ‘‘AVAILABILITY OF COVERAGE

24 ‘‘SEC. 1936. (a) IN GENERAL.—Beginning with cal25 endar year 2002, each State with a plan approved under

26 this title shall make available to any individual or family
36

•S 3172 IS

1 with income that exceeds 300 percent of the poverty line

2 (as defined in section 673(2) of the Community Services

3 Block Grant Act (42 U.S.C. 9902(2)), including any revi4 sion required by such section) medical assistance provided

5 under this title or health coverage under section 2111

6 through payment of a premium determined in accordance

7 with subsection (b).

8 ‘‘(b) DETERMINATION OF PREMIUMS.—

9 ‘‘(1) IN GENERAL.—Premiums for coverage

10 under this title shall be based on the pooled average

11 cost of medical assistance provided under this title

12 for the relevant comparison group for the individual

13 purchasing such coverage.

14 ‘‘(2) NO ADJUSTMENT FOR HEALTH STATUS.—

15 Premiums imposed under this section may not be

16 adjusted for the health status of the individual.

17 ‘‘(3) APPLICATION OF HIPAA.—The provisions

18 of title XXVII of the Public Health Service Act (42

19 U.S.C. 300gg et seq.) apply to coverage made avail20 able under this section.

21 ‘‘(c) COMPARABILITY OF COVERAGE.—Medical as22 sistance made available under this section shall be pro23 vided to an individual or family purchasing such coverage

24 in the same amount, duration, and scope as such assist-
37

•S 3172 IS

1 ance is made available for an individual or family who is

2 eligible for such assistance under section 1902(a)(10)(A).

3 ‘‘(d) PRESUMPTIVE ELIGIBILITY.—Each individual

4 that indicates on a form described in paragraph (2) of sec5 tion 301(c) of Basic Access to Secure Health Insurance

6 Coverage Health Plan (BASIC Health Plan) Act that the

7 individual believes he or she (and the individual’s family,

8 if applicable) is eligible for medical assistance under this

9 section, and that is forwarded to a State agency in accord10 ance with paragraph (1)(B) of such section, shall be pro11 vided with a period of presumptive eligibility for coverage

12 under this section (in the same manner as such a period

13 is imposed under sections 1920 and 1920A) until such

14 time as the State makes a determination as to such eligi15 bility.

16 ‘‘(e) NO EFFECT ON COVERAGE OFFERED UNDER

17 A WAIVER.—Nothing in this section shall be construed as

18 affecting any medical assistance made available under a

19 waiver of the requirements of this title (under section

20 1115 or otherwise) to an individual or family described

21 in subsection (a).’’.

22 (2) ESTABLISHMENT OF OPTIONAL ELIGIBILITY

23 CATEGORY.—

24 (A) IN GENERAL.—Section

25 1902(a)(10)(A)(ii) of the Social Security Act
38

•S 3172 IS

1 (42 U.S.C. 1396a(a)(10)(A)(ii)), as amended by

2 section 201(b)(1)(C), is amended—

3 (i) by striking ‘‘or’’ at the end of sub4 clause (XVIII);

5 (ii) by striking the semicolon at the

6 end of subclause (XIX) and inserting ‘‘,

7 or’’; and

8 (iii) by adding at the end the fol9 lowing new subclause:

10 ‘‘(XX) who are individuals de11 scribed in section 1936 (subject to

12 payment of a premium determined in

13 accordance with that section);’’.

14 (B) CONFORMING AMENDMENTS.—

15 (i) ELIGIBILITY CATEGORIES.—Sec16 tion 1905(a) of such Act (42 U.S.C.

17 1396d(a)), as amended by section

18 201(b)(3), is amended, in the matter be19 fore paragraph (1)—

20 (I) by striking ‘‘or’’ at the end of

21 clause (xii);

22 (II) by inserting ‘‘or’’ at the end

23 of clause (xiii); and

24 (III) by inserting after clause

25 (xiii) the following new clause:
39

•S 3172 IS

1 ‘‘(xiv) who are individuals described in section

2 1902(aa)(1),’’.

3 (ii) INCOME LIMITATIONS.—Section

4 1903(f)(4) of such Act (42 U.S.C.

5 1396b(f)(4)), as amended by section

6 201(b)(3)(B), is amended by inserting

7 ‘‘1902(a)(10)(A)(ii)(XX),’’ after

8 ‘‘1902(a)(10)(A)(ii)(XIX),’’.

9 (b) COVERAGE UNDER SCHIP.—Section 2111 of

10 such Act, as amended by section 201(c), is amended—

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

12 following new paragraph:

13 ‘‘(3) OTHER INDIVIDUALS AND FAMILIES.—

14 ‘‘(A) IN GENERAL.—Notwithstanding any

15 other provision of this title, with respect to a

16 State that does not provide medical assistance

17 under section 1936 for an individual or family

18 described in subsection (a) of that section, the

19 State shall make available through the payment

20 of a premium determined in accordance with

21 section 1936(b), health coverage under this title

22 for such an individual or family through an

23 amendment to its State child health plan under

24 section 2102 in accordance with this section

25 and the requirements of section 1936.
40

•S 3172 IS

1 ‘‘(B) DETERMINATION OF PREMIUM.—For

2 purposes of determining a premium for the pur3 chase of health coverage under this title, para4 graph (1) of section 1936(b) shall be applied by

5 substituting ‘pooled average cost of health cov6 erage’ for ‘pooled average cost of medical assist7 ance’.’’; and

8 (2) in subsection (b), by adding at the end the

9 following new paragraph:

10 ‘‘(4) TREATMENT OF OTHER INDIVIDUALS AND

11 FAMILIES.—A State child health plan shall treat,

12 and shall apply this section to, an individual or fam13 ily described in subsection (a)(3) in the same man14 ner as such plan treats and applies this section to

15 a family described in section 1902(k)(1).’’.

16 (c) EMPLOYER RESPONSIBILITIES.—

17 (1) IN GENERAL.—Beginning with calendar

18 year 2002, each covered employer shall—

19 (A) inform, through the use of the form

20 described in paragraph (2), each individual in

21 the person’s employ who is not eligible for

22 health benefits coverage provided by such em23 ployer, of the opportunity to purchase health

24 benefits coverage under section 1936 or 2111 of

25 the Social Security Act;
41

•S 3172 IS

1 (B) forward all such forms on which an in2 dividual indicates that the individual believes

3 they are eligible for coverage under such sec4 tions of the Social Security Act to the appro5 priate State agency, unless the individual spe6 cifically declines such coverage on such form;

7 and

8 (C) with respect to each such individual

9 who purchases such coverage (for such indi10 vidual or their family), withhold an amount

11 equal to the premium required by the State for

12 the coverage from the individual’s wages and

13 forward such amount to the appropriate place

14 (as determined by the State).

15 (2) FORM DESCRIBED.—The form described in

16 this paragraph is a form that—

17 (A) is developed by the State in which the

18 covered employer resides in accordance with

19 guidelines issued by the Secretary of Health

20 and Human Services;

21 (B) describes the health benefits coverage

22 available under sections 1936 and 2111 of the

23 Social Security Act; and

24 (C) provides an individual with an oppor25 tunity to indicate on the form if the individual
42

•S 3172 IS

1 believes that they are eligible for such coverage

2 or to decline such coverage.

3 (3) ANNUAL PROVISION.—In the case of any

4 employee who declines coverage under section 1936

5 or 2111 of the Social Security Act on the form de6 scribed in paragraph (2), a covered employer shall

7 provide such form to each such individual not less

8 than annually to allow the individual to revoke such

9 declination.

10 (4) DEFINITION OF COVERED EMPLOYER.—In

11 this section, the term ‘covered employer’ means, for

12 any calendar year, any person on whom an excise

13 tax is imposed under section 3111 or 1401 of the

14 Internal Revenue Code of 1986 with respect to hav15 ing an individual in the person’s employ to whom

16 wages are paid by such person during such calendar

17 year.

Æ