I 

109TH CONGRESS 

2D SESSION H. R. 4760 

To amend title XXI of the Social Security Act to make all uninsured children 

eligible for the State children’s health insurance program, to encourage 

States to increase the number of children enrolled in the Medicaid and 

State children’s health insurance programs by simplifying the enrollment 

and renewal procedures for those programs, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 15, 2006 

Mr. EMANUEL (for himself, Ms. SCHAKOWSKY, Mr. RUSH, Mr. GUTIERREZ, 

Mr. DAVIS of Illinois, and Mr. EVANS) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XXI of the Social Security Act to make 

all uninsured children eligible for the State children’s 

health insurance program, to encourage States to increase the number of children enrolled in the Medicaid 

and State children’s health insurance programs by simplifying the enrollment and renewal procedures for those 

programs, 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, 
2 

•HR 4760 IH 

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘All Kids Health Insur3 ance Coverage Act of 2006’’. 

4 SEC. 2. FINDINGS. 

5 The House of Representatives finds the following: 

6 (1) There are more than 9,000,000 children in 

7 the United States with no health insurance coverage. 

8 (2) Uninsured children, when compared to pri9 vately insured children, are— 

10 (A) 3.5 times more likely to have gone 

11 without needed medical, dental, or other health 

12 care; 

13 (B) 4 times more likely to have delayed 

14 seeking medical care; 

15 (C) 5 times more likely to go without need16 ed prescription drugs; and 

17 (D) 6.5 times less likely to have a regular 

18 source of care. 

19 (3) Children without health insurance coverage 

20 are at a disadvantage in the classroom, as shown by 

21 the following studies: 

22 (A) The Florida Healthy Kids Annual Re23 port published in 1997, found that children who 

24 do not have health care coverage are 25 percent 

25 more likely to miss school. 
3 

•HR 4760 IH 

1 (B) In a study of the California Health 

2 Families program, children enrolled in public 

3 health coverage experienced a 68 percent im4 provement in school performance and school at5 tendance. 

6 (C) A 2002 Building Bridges to Healthy 

7 Kids and Better Students study conducted by 

8 the Council of Chief State School Officers in 

9 Vermont concluded that children who started 

10 out without health insurance saw their reading 

11 scores more than double after obtaining health 

12 care coverage. 

13 (4) More than half of uninsured children in the 

14 United States are eligible for coverage under either 

15 the State Children’s Health Insurance Program 

16 (SCHIP) or Medicaid, but are not enrolled in those 

17 safety net programs. 

18 (5) Some States, seeing that the Federal Gov19 ernment is not providing assistance to middle class 

20 families who are unable to afford health insurance, 

21 are trying to extend health care coverage to some or 

22 all children in the State. 

23 (6) State efforts to cover all children may not 

24 be successful without financial assistance from the 

25 Federal Government. 
4 

•HR 4760 IH 

1 SEC. 3. ELIGIBILITY OF ALL UNINSURED CHILDREN FOR 

2 SCHIP. 

3 (a) IN GENERAL.—Section 2110(b) of the Social Se4 curity Act (42 U.S.C. 1397jj(b)) is amended— 

5 (1) in paragraph (1)— 

6 (A) by striking subparagraph (B); and 

7 (B) by redesignating subparagraph (C) as 

8 subparagraph (B); 

9 (2) in paragraph (2)— 

10 (A) by striking ‘‘include’’ and all that fol11 lows through ‘‘a child who is an’’ and inserting 

12 ‘‘include a child who is an’’; and 

13 (B) by striking the semicolon and all that 

14 follows through the period and inserting a pe15 riod; and 

16 (3) by striking paragraph (4). 

17 (b) NO EXCLUSION OF CHILDREN WITH ACCESS TO

18 HIGH-COST COVERAGE.—Section 2110(b)(3) of the Social 

19 Security Act (42 U.S.C. 1397jj(b)(3)) is amended— 

20 (1) in the paragraph heading, by striking 

21 ‘‘RULE’’ and inserting ‘‘RULES’’; 

22 (2) by striking ‘‘A child shall not be considered 

23 to be described in paragraph (1)(C)’’ and inserting 

24 the following: 
5 

•HR 4760 IH 

1 ‘‘(A) CERTAIN NON FEDERALLY FUNDED

2 COVERAGE.—A child shall not be considered to 

3 be described in paragraph (1)(C)’’; and 

4 (3) by adding at the end the following: 

5 ‘‘(B) NO EXCLUSION OF CHILDREN WITH

6 ACCESS TO HIGH-COST COVERAGE.—A State 

7 may include a child as a targeted vulnerable 

8 child if the child has access to coverage under 

9 a group health plan or health insurance cov10 erage and the total annual aggregate cost for 

11 premiums, deductibles, cost sharing, and similar 

12 charges imposed under the group health plan or 

13 health insurance coverage with respect to all 

14 targeted vulnerable children in the child’s fam15 ily exceeds 5 percent of such family’s income 

16 for the year involved.’’. 

17 (c) CONFORMING AMENDMENTS.— 

18 (1) Titles XIX and XXI of the Social Security 

19 Act (42 U.S.C. 1396 et seq.; 1397aa et. seq.) are 

20 amended by striking ‘‘targeted low-income’’ each 

21 place it appears and inserting ‘‘targeted vulnerable’’. 

22 (2) Section 2101(a) of such Act (42 U.S.C. 

23 1397aa(a)) is amended by striking ‘‘uninsured, low24 income’’ and inserting ‘‘low-income’’. 
6 

•HR 4760 IH 

1 (3) Section 2102(b)(3)(C) of such Act (42 

2 U.S.C. 1397bb(b)(3)(C)) is amended by inserting ‘‘, 

3 particularly with respect to children whose family in4 come exceeds 200 percent of the poverty line’’ before 

5 the semicolon. 

6 (4) Section 2102(b)(3)(E), section 

7 2105(a)(1)(D)(ii), paragraphs (1)(C) and (2) of sec8 tion 2107, and subsections (a)(1) and (d)(1)(B) of 

9 section 2108 of such Act (42 U.S.C. 

10 1397bb(b)(3)(E); 1397ee(a)(1)(D)(ii); 1397gg; 

11 1397hh) are amended by striking ‘‘low-income’’ each 

12 place it appears. 

13 (5) Section 2110(a)(27) of such Act (42 U.S.C. 

14 1397jj(a)(27)) is amended by striking ‘‘eligible low15 income individuals’’ and inserting ‘‘targeted vulner16 able individuals’’. 

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

18 this section take effect on October 1, 2006. 

19 SEC. 4. INCREASE IN FEDERAL FINANCIAL PARTICIPATION 

20 UNDER SCHIP AND MEDICAID FOR STATES 

21 WITH SIMPLIFIED ENROLLMENT AND RE22 NEWAL PROCEDURES FOR CHILDREN. 

23 (a) SCHIP.—Section 2105(c)(2) of the Social Secu24 rity Act (42 U.S.C. 1397ee(c)(2)) is amended by adding 

25 at the end the following: 
7 

•HR 4760 IH 

1 ‘‘(C) NONAPPLICATION OF LIMITATION

2 AND INCREASE IN FEDERAL PAYMENT FOR

3 STATES WITH SIMPLIFIED ENROLLMENT AND

4 RENEWAL PROCEDURES.— 

5 ‘‘(i) IN GENERAL.—Notwithstanding 

6 subsection (a)(1) and subparagraph (A)— 

7 ‘‘(I) the limitation under sub8 paragraph (A) on expenditures for 

9 items described in subsection 

10 (a)(1)(D) shall not apply with respect 

11 to expenditures incurred to carry out 

12 any of the outreach strategies de13 scribed in clause (ii), but only if the 

14 State carries out the same outreach 

15 strategies for children under title 

16 XIX; and 

17 ‘‘(II) the enhanced FMAP for a 

18 State for a fiscal year otherwise deter19 mined under subsection (b) shall be 

20 increased by 5 percentage points 

21 (without regard to the application of 

22 the 85 percent limitation under that 

23 subsection) with respect to such ex24 penditures. 
8 

•HR 4760 IH 

1 ‘‘(ii) OUTREACH STRATEGIES DE2 SCRIBED.—For purposes of clause (i), the 

3 outreach strategies described in this clause 

4 are the following: 

5 ‘‘(I) PRESUMPTIVE ELIGI6 BILITY.—The State provides for pre7 sumptive eligibility for children under 

8 this title and under title XIX. 

9 ‘‘(II) ADOPTION OF 12-MONTH

10 CONTINUOUS ELIGIBILITY.—The 

11 State provides that eligibility for chil12 dren shall not be redetermined more 

13 often than once every year under this 

14 title or under title XIX. 

15 ‘‘(III) ELIMINATION OF ASSET

16 TEST.—The State does not apply any 

17 asset test for eligibility under this title 

18 or title XIX with respect to children. 

19 ‘‘(IV) PASSIVE RENEWAL.—The 

20 State provides for the automatic re21 newal of the eligibility of children for 

22 assistance under this title and under 

23 title XIX if the family of which such 

24 a child is a member does not report 

25 any changes to family income or other 
9 

•HR 4760 IH 

1 relevant circumstances, subject to 

2 verification of information from State 

3 databases.’’. 

4 (b) MEDICAID.— 

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

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

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

8 to paragraph (5)’’, after ‘‘Notwithstanding sub9 section (a)(17),’’; and 

10 (B) by adding at the end the following: 

11 ‘‘(5)(A) Notwithstanding the first sentence of section 

12 1905(b), with respect to expenditures incurred to carry 

13 out any of the outreach strategies described in subpara14 graph (B) for individuals under 19 years of age who are 

15 eligible for medical assistance under subsection 

16 (a)(10)(A), the Federal medical assistance percentage is 

17 equal to the enhanced FMAP described in section 2105(b) 

18 and increased under section 2105(c)(2)(C)(i)(II), but only 

19 if the State carries out the same outreach strategies for 

20 children under title XXI. 

21 ‘‘(B) For purposes of subparagraph (A), the outreach 

22 strategies described in this subparagraph are the fol23 lowing: 
10 

•HR 4760 IH 

1 ‘‘(i) PRESUMPTIVE ELIGIBILITY.—The State 

2 provides for presumptive eligibility for such individ3 uals under this title and title XXI. 

4 ‘‘(ii) ADOPTION OF 12-MONTH CONTINUOUS ELI5 GIBILITY.—The State provides that eligibility for 

6 such individuals shall not be redetermined more 

7 often than once every year under this title or under 

8 title XXI. 

9 ‘‘(iii) ELIMINATION OF ASSET TEST.—The 

10 State does not apply any asset test for eligibility 

11 under this title or title XXI with respect to such in12 dividuals. 

13 ‘‘(iv) PASSIVE RENEWAL.—The State provides 

14 for the automatic renewal of the eligibility of such 

15 individuals for assistance under this title and under 

16 title XXI if the family of which such an individual 

17 is a member does not report any changes to family 

18 income or other relevant circumstances, subject to 

19 verification of information from State databases.’’. 

20 (2) CONFORMING AMENDMENT.—The first sen21 tence of section 1905(b) of the Social Security Act 

22 (42 U.S.C. 1396d(b)) is amended by striking ‘‘sec23 tion 1933(d)’’ and inserting ‘‘sections 1902(l)(5) 

24 and 1933(d)’’. 
11 

•HR 4760 IH 

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

2 this section take effect on October 1, 2006. 

3 SEC. 5. LIMITATION ON PAYMENTS TO STATES THAT HAVE 

4 AN ENROLLMENT CAP BUT HAVE NOT EX5 HAUSTED THE STATE’S AVAILABLE ALLOT6 MENTS. 

7 (a) IN GENERAL.—Section 2105 of the Social Secu8 rity Act (42 U.S.C. 1397ee) is amended by adding at the 

9 end the following: 

10 ‘‘(h) LIMITATION ON PAYMENTS TO STATES THAT

11 HAVE AN ENROLLMENT CAP BUT HAVE NOT EXHAUSTED

12 THE STATE’S AVAILABLE ALLOTMENTS.— 

13 ‘‘(1) IN GENERAL.—Notwithstanding any other 

14 provision of this section, payment shall not be made 

15 to a State under this section if the State has an en16 rollment freeze, enrollment cap, procedures to delay 

17 consideration of, or not to consider, submitted appli18 cations for child health assistance, or a waiting list 

19 for the submission or consideration of such applica20 tions or for such assistance, and the State has not 

21 fully expended the amount of all allotments available 

22 with respect to a fiscal year for expenditure by the 

23 State, including allotments for prior fiscal years that 

24 remain available for expenditure during the fiscal 

25 year under subsection (c) or (g) of section 2104 or 
12 

•HR 4760 IH 

1 that were redistributed to the State under subsection 

2 (f) or (g) of section 2104. 

3 ‘‘(2) RULE OF CONSTRUCTION.—Paragraph (1) 

4 shall not be construed as prohibiting a State from 

5 establishing regular open enrollment periods for the 

6 submission of applications for child health assist7 ance.’’. 

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

9 this section take effect on October 1, 2006. 

10 SEC. 6. ADDITIONAL ENHANCEMENT TO FMAP TO PRO11 MOTE EXPANSION OF COVERAGE TO ALL UN12 INSURED CHILDREN UNDER MEDICAID AND 

13 SCHIP. 

14 (a) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et 

15 seq.) is amended by adding at the end the following: 

16 ‘‘SEC. 2111. ADDITIONAL ENHANCEMENT TO FMAP TO PRO17 MOTE EXPANSION OF COVERAGE TO ALL UN18 INSURED CHILDREN UNDER MEDICAID AND 

19 SCHIP. 

20 ‘‘(a) IN GENERAL.—Notwithstanding subsection (b) 

21 of section 2105 (and without regard to the application of 

22 the 85 percent limitation under that subsection), the en23 hanced FMAP with respect to expenditures in a quarter 

24 for providing child health assistance to uninsured children 
13 

•HR 4760 IH 

1 whose family income exceeds 200 percent of the poverty 

2 line, shall be increased by 5 percentage points. 

3 ‘‘(b) UNINSURED CHILD DEFINED.— 

4 ‘‘(1) IN GENERAL.—For purposes of subsection 

5 (a), subject to paragraph (2), the term ‘uninsured 

6 child’ means an uncovered child who has been with7 out creditable coverage for a period determined by 

8 the Secretary, except that such period shall not be 

9 less than 6 months. 

10 ‘‘(2) SPECIAL RULE FOR NEWBORN CHIL11 DREN.—In the case of a child 12 months old or 

12 younger, the period determined under paragraph (1) 

13 shall be 0 months and such child shall be considered 

14 uninsured upon birth. 

15 ‘‘(3) SPECIAL RULE FOR CHILDREN LOSING

16 MEDICAID OR SCHIP COVERAGE DUE TO INCREASED

17 FAMILY INCOME.—In the case of a child who, due to 

18 an increase in family income, becomes ineligible for 

19 coverage under title XIX or this title during the pe20 riod beginning on the date that is 12 months prior 

21 to the date of enactment of the All Kids Health In22 surance Coverage Act of 2005 and ending on the 

23 date of enactment of such Act, the period deter24 mined under paragraph (1) shall be 0 months and 

25 such child shall be considered uninsured upon the 
14 

•HR 4760 IH 

1 date of enactment of the All Kids Health Insurance 

2 Coverage Act of 2005. 

3 ‘‘(4) MONITORING AND ADJUSTMENT OF PE4 RIOD REQUIRED TO BE UNINSURED.—The Secretary 

5 shall— 

6 ‘‘(A) monitor the availability and retention 

7 of employer-sponsored health insurance cov8 erage of dependent children; and 

9 ‘‘(B) adjust the period determined under 

10 paragraph (1) as needed for the purpose of pro11 moting the retention of private or employer12 sponsored health insurance coverage of depend13 ent children and timely access to health care 

14 services for such children.’’. 

15 (b) COST-SHARING FOR CHILDREN IN FAMILIES

16 WITH HIGH FAMILY INCOME.—Section 2103(e)(3) of the 

17 Social Security Act (42 U.S.C. 1397cc(e)(3)) is amended 

18 by adding at the end the following new subparagraph: 

19 ‘‘(C) CHILDREN IN FAMILIES WITH HIGH

20 FAMILY INCOME.— 

21 ‘‘(i) IN GENERAL.—For children not 

22 described in subparagraph (A) whose fam23 ily income exceeds 400 percent of the pov24 erty line for a family of the size involved, 

25 subject to paragraphs (1)(B) and (2), the 
15 

•HR 4760 IH 

1 State shall impose a premium that is not 

2 less than the cost of providing child health 

3 assistance to children in such families, and 

4 deductibles, cost sharing, or similar 

5 charges shall be imposed under the State 

6 child health plan (without regard to a slid7 ing scale based on income), except that the 

8 total annual aggregate cost-sharing with 

9 respect to all such children in a family 

10 under this title may not exceed 5 percent 

11 of such family’s income for the year in12 volved. 

13 ‘‘(ii) INFLATION ADJUSTMENT.—The 

14 dollar amount specified in clause (i) shall 

15 be increased, beginning with fiscal year 

16 2008, from year to year based on the per17 centage increase in the consumer price 

18 index for all urban consumers (all items; 

19 United States city average). Any dollar 

20 amount established under this clause that 

21 is not a multiple of $100 shall be rounded 

22 to the nearest multiple of $100.’’. 

23 (c) ADDITIONAL ALLOTMENTS FOR STATES PRO24 VIDING COVERAGE TO ALL UNINSURED CHILDREN IN

25 THE STATE.— 
16 

•HR 4760 IH 

1 (1) IN GENERAL.—Section 2104 of the Social 

2 Security Act (42 U.S.C. 1397dd) is amended by in3 serting after subsection (c) the following: 

4 ‘‘(d) ADDITIONAL ALLOTMENTS FOR STATES PRO5 VIDING COVERAGE TO ALL UNINSURED CHILDREN IN

6 THE STATE.— 

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

8 For the purpose of providing additional allotments 

9 to States to provide coverage of all uninsured chil10 dren (as defined in section 2111(b)) in the State 

11 under the State child health plan, there is appro12 priated, out of any money in the Treasury not other13 wise appropriated— 

14 ‘‘(A) for fiscal years 2007 and 2008, 

15 $3,000,000,000; 

16 ‘‘(B) for fiscal year 2009, $5,000,000,000; 

17 and 

18 ‘‘(C) for fiscal year 2010, $7,000,000,000. 

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

20 ‘‘(A) IN GENERAL.—In addition to the al21 lotments provided under subsections (b) and 

22 (c), subject to subparagraph (B) and para23 graphs (3) and (4), of the amount available for 

24 the additional allotments under paragraph (1) 

25 for a fiscal year, the Secretary shall allot to 
17 

•HR 4760 IH 

1 each State with a State child health plan that 

2 provides coverage of all uninsured children (as 

3 so defined) in the State approved under this 

4 title— 

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

6 than a commonwealth or territory de7 scribed in subsection (ii), the same propor8 tion as the proportion of the State’s allot9 ment under subsection (b) (determined 

10 without regard to subsection (f)) to 98.95 

11 percent of the total amount of the allot12 ments under such section for such States 

13 eligible for an allotment under this sub14 paragraph for such fiscal year; and 

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

16 territory described in subsection (c)(3), the 

17 same proportion as the proportion of the 

18 commonwealth’s or territory’s allotment 

19 under subsection (c) (determined without 

20 regard to subsection (f)) to 1.05 percent of 

21 the total amount of the allotments under 

22 such section for commonwealths and terri23 tories eligible for an allotment under this 

24 subparagraph for such fiscal year. 

25 ‘‘(B) MINIMUM ALLOTMENT.— 
18 

•HR 4760 IH 

1 ‘‘(i) IN GENERAL.—No allotment to a 

2 State for a fiscal year under this sub3 section shall be less than 50 percent of the 

4 amount of the allotment to the State deter5 mined under subsections (b) and (c) for 

6 the preceding fiscal year. 

7 ‘‘(ii) PRO RATA REDUCTIONS.—The 

8 Secretary shall make such pro rata reduc9 tions to the allotments determined under 

10 this subsection as are necessary to comply 

11 with the requirements of clause (i). 

12 ‘‘(C) AVAILABILITY AND REDISTRIBUTION

13 OF UNUSED ALLOTMENTS.—In applying sub14 sections (e) and (f) with respect to additional 

15 allotments made available under this subsection, 

16 the procedures established under such sub17 sections shall ensure such additional allotments 

18 are only made available to States which have 

19 elected to provide coverage under section 2111. 

20 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi21 tional allotments provided under this subsection are 

22 not available for amounts expended before October 

23 1, 2005. Such amounts are available for amounts ex24 pended on or after such date for child health assist-
19 

•HR 4760 IH 

1 ance for uninsured children (as defined in section 

2 2111(b)). 

3 ‘‘(4) REQUIRING ELECTION TO PROVIDE COV4 ERAGE.—No payments may be made to a State 

5 under this title from an allotment provided under 

6 this subsection unless the State has made an elec7 tion to provide child health assistance for all unin8 sured children (as so defined) in the State, including 

9 such children whose family income exceeds 200 per10 cent of the poverty line.’’. 

11 (2) CONFORMING AMENDMENTS.—Section 2104 

12 of the Social Security Act (42 U.S.C. 1397dd) is 

13 amended— 

14 (A) in subsection (a), by inserting ‘‘subject 

15 to subsection (d),’’ after ‘‘under this section,’’; 

16 (B) in subsection (b)(1), by inserting ‘‘and 

17 subsection (d)’’ after ‘‘Subject to paragraph 

18 (4)’’; and 

19 (C) in subsection (c)(1), by inserting ‘‘sub20 ject to subsection (d),’’ after ‘‘for a fiscal 

21 year,’’. 

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

23 this section take effect on October 1, 2006. 
20 

•HR 4760 IH 

1 SEC. 7. REPEAL OF THE SCHEDULED PHASEOUT OF THE 

2 LIMITATIONS ON PERSONAL EXEMPTIONS 

3 AND ITEMIZED DEDUCTIONS. 

4 (a) IN GENERAL.—The Internal Revenue Code of 

5 1986 is amended— 

6 (1) by striking subparagraphs (E) and (F) of 

7 section 151(d)(3), and 

8 (2) by striking subsections (f) and (g) of section 

9 68. 

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

11 this section shall apply to taxable years beginning after 

12 December 31, 2005. 

13 (c) APPLICATION OF EGTRRA SUNSET.—The 

14 amendments made by this section shall be subject to title 

15 IX of the Economic Growth and Tax Relief Reconciliation 

16 Act of 2001 to the same extent and in the same manner 

17 as the provision of such Act to which such amendment 

18 relates. 

Æ