I 

111TH CONGRESS 

1ST SESSION H. R. 688 

To amend title XXI of the Social Security Act to reauthorize the State 

Children’s Health Insurance Program through fiscal year 2013, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 26, 2009 

Ms. GRANGER introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend title XXI of the Social Security Act to reauthorize 

the State Children’s Health Insurance Program through 

fiscal year 2013, 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 ‘‘Kids First Act’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Reauthorization through fiscal year 2013. 

Sec. 3. Allotments for the 50 States and the District of Columbia based on expenditures and numbers of low-income children. 


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Sec. 4. Limitations on matching rates for populations other than low-income 

children or pregnant women covered through a section 1115 

waiver. 

Sec. 5. Prohibition on new section 1115 waivers for coverage of adults other 

than pregnant women. 

Sec. 6. Standardization of determination of family income for targeted low-income children under title XXI and optional targeted low-income children under title XIX. 

Sec. 7. Grants for outreach and enrollment. 

Sec. 8. Improved State option for offering premium assistance for coverage of 

children through private plans under SCHIP and Medicaid. 

Sec. 9. Treatment of unborn children. 

Sec. 10. 50 percent matching rate for all Medicaid administrative costs. 

Sec. 11. Reduction in payments for Medicaid administrative costs to prevent 

duplication of such payments under TANF. 

Sec. 12. Elimination of waiver of certain Medicaid provider tax provisions. 

Sec. 13. Elimination of special payments for certain public hospitals. 

Sec. 14. Effective date; coordination of funding for fiscal year 2009. 

1 SEC. 2. REAUTHORIZATION THROUGH FISCAL YEAR 2013. 

2 (a) INCREASE IN NATIONAL ALLOTMENT.—Section 

3 2104 of the Social Security Act (42 U.S.C. 1397dd(a)) 

4 is amended— 

5 (1) in subsection (a)— 

6 (A) by striking ‘‘and’’ at the end of para7 graph (10); 

8 (B) in paragraph (11)— 

9 (i) by striking ‘‘each of fiscal years 

10 2008 and 2009’’ and inserting ‘‘fiscal year 

11 2008’’; and 

12 (ii) by striking the period at the end 

13 and inserting a semicolon; and 

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

15 paragraphs: 

16 ‘‘(12) for fiscal year 2009, $7,780,000,000; 

17 ‘‘(13) for fiscal year 2010, $8,044,000,000; 


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1 ‘‘(14) for fiscal year 2011, $8,568,000,000; 

2 ‘‘(15) for fiscal year 2012, $9,032,000,000; and 

3 ‘‘(16) for fiscal year 2013, $9,505,000,000.’’; 

4 and 

5 (2) in subsection (c)(4)(B), by striking ‘‘2009’’ 

6 and inserting ‘‘2008, $62,000,000 for fiscal year 

7 2009, $64,000,000 for fiscal year 2010, 

8 $68,000,000 for fiscal year 2011, $72,000,000 for 

9 fiscal year 2012, and $75,000,000 for fiscal year 

10 2013’’. 

11 (b) REPEAL OF LIMITATION ON AVAILABILITY OF

12 FUNDING FOR FISCAL YEARS 2008 AND 2009.—Section 

13 201 of the Medicare, Medicaid, and SCHIP Extension Act 

14 of 2007 (Public Law 110–173) is amended— 

15 (1) in subsection (a), by striking paragraph (2) 

16 and redesignating paragraphs (3) and (4), as para17 graphs (2) and (3) respectively; and 

18 (2) in subsection (b), by striking paragraph (2). 

19 SEC. 3. ALLOTMENTS FOR THE 50 STATES AND THE DIS20 TRICT OF COLUMBIA BASED ON EXPENDI21 TURES AND NUMBERS OF LOW-INCOME CHIL22 DREN. 

23 (a) IN GENERAL.—Section 2104 of the Social Secu24 rity Act (42 U.S.C. 1397dd) is amended by adding at the 

25 end the following new subsection: 


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1 ‘‘(m) DETERMINATION OF ALLOTMENTS FOR THE 50 

2 STATES AND THE DISTRICT OF COLUMBIA FOR FISCAL

3 YEARS 2009 THROUGH 2013.— 

4 ‘‘(1) IN GENERAL.—Notwithstanding the pre5 ceding provisions of this subsection and subject to 

6 paragraph (3), the Secretary shall allot to each sub7 section (b) State for each of fiscal years 2009 

8 through 2013, the amount determined for the fiscal 

9 year that is equal to the product of— 

10 ‘‘(A) the amount available for allotment 

11 under subsection (a) for the fiscal year, reduced 

12 by the amount of allotments made under sub13 section (c) (determined without regard to para14 graph (4) thereof) for the fiscal year; and 

15 ‘‘(B) the sum of the State allotment fac16 tors determined under paragraph (2) with re17 spect to the State and weighted in accordance 

18 with subparagraph (B) of that paragraph for 

19 the fiscal year. 

20 ‘‘(2) STATE ALLOTMENT FACTORS.— 

21 ‘‘(A) IN GENERAL.—For purposes of para22 graph (1)(B), the State allotment factors are 

23 the following: 

24 ‘‘(i) The ratio of the projected expend25 itures for targeted low-income children 


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1 under the State child health plan and preg2 nant women under a waiver of such plan 

3 for the fiscal year to the sum of such pro4 jected expenditures for all States for the 

5 fiscal year, multiplied by the applicable 

6 percentage weight assigned under subpara7 graph (B). 

8 ‘‘(ii) The ratio of the number of low9 income children who have not attained age 

10 19 with no health insurance coverage in 

11 the State, as determined by the Secretary 

12 on the basis of the arithmetic average of 

13 the number of such children for the 3 most 

14 recent Annual Social and Economic Sup15 plements to the Current Population Survey 

16 of the Bureau of the Census available be17 fore the beginning of the calendar year be18 fore such fiscal year begins, to the sum of 

19 the number of such children determined 

20 for all States for such fiscal year, multi21 plied by the applicable percentage weight 

22 assigned under subparagraph (B). 

23 ‘‘(iii) The ratio of the projected ex24 penditures for targeted low-income children 

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1 nant women under a waiver of such plan 

2 for the preceding fiscal year to the sum of 

3 such projected expenditures for all States 

4 for such preceding fiscal year, multiplied 

5 by the applicable percentage weight as6 signed under subparagraph (B). 

7 ‘‘(iv) The ratio of the actual expendi8 tures for targeted low-income children 

9 under the State child health plan and preg10 nant women under a waiver of such plan 

11 for the second preceding fiscal year to the 

12 sum of such actual expenditures for all 

13 States for such second preceding fiscal 

14 year, multiplied by the applicable percent15 age weight assigned under subparagraph 

16 (B). 

17 ‘‘(B) ASSIGNMENT OF WEIGHTS.—For 

18 each of fiscal years 2009 through 2013, the fol19 lowing percentage weights shall be applied to 

20 the ratios determined under subparagraph (A) 

21 for each such fiscal year: 

22 ‘‘(i) 40 percent for the ratio deter23 mined under subparagraph (A)(i). 

24 ‘‘(ii) 5 percent for the ratio deter25 mined under subparagraph (A)(ii). 


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1 ‘‘(iii) 50 percent for the ratio deter2 mined under subparagraph (A)(iii). 

3 ‘‘(iv) 5 percent for the ratio deter4 mined under subparagraph (A)(iv). 

5 ‘‘(C) DETERMINATION OF PROJECTED AND

6 ACTUAL EXPENDITURES.—For purposes of sub7 paragraph (A): 

8 ‘‘(i) PROJECTED EXPENDITURES.— 

9 The projected expenditures described in 

10 clauses (i) and (iii) of such subparagraph 

11 with respect to a fiscal year shall be deter12 mined on the basis of amounts reported by 

13 States to the Secretary on the May 15th 

14 submission of Form CMS–37 and Form 

15 CMS–21B submitted not later than June 

16 30th of the fiscal year preceding such year. 

17 ‘‘(ii) ACTUAL EXPENDITURES.—The 

18 actual expenditures described in clause (iv) 

19 of such subparagraph with respect to a 

20 second preceding fiscal year shall be deter21 mined on the basis of amounts reported by 

22 States to the Secretary on Form CMS–64 

23 and Form CMS–21 submitted not later 

24 than November 30 of the preceding fiscal 

25 year.’’. 


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1 (b) 2-YEAR AVAILABILITY OF ALLOTMENTS; EX2 PENDITURES COUNTED AGAINST OLDEST ALLOT3 MENTS.—Section 2104(e) of the Social Security Act (42 

4 U.S.C. 1397dd(e)) is amended to read as follows: 

5 ‘‘(e) AVAILABILITY OF AMOUNTS ALLOTTED.— 

6 ‘‘(1) IN GENERAL.—Except as provided in the 

7 succeeding paragraphs of this subsection, amounts 

8 allotted to a State pursuant to this section— 

9 ‘‘(A) for each of fiscal years 1998 through 

10 2008, shall remain available for expenditure by 

11 the State through the end of the second suc12 ceeding fiscal year; and 

13 ‘‘(B) for each of fiscal years 2009 through 

14 2013, shall remain available for expenditure by 

15 the State only through the end of the fiscal 

16 year succeeding the fiscal year for which such 

17 amounts are allotted. 

18 ‘‘(2) ELIMINATION OF REDISTRIBUTION OF AL19 LOTMENTS NOT EXPENDED WITHIN 3 YEARS.—Not20 withstanding subsection (f), amounts allotted to a 

21 State under this section for fiscal years beginning 

22 with fiscal year 2009 that remain unexpended as of 

23 the end of the fiscal year succeeding the fiscal year 

24 for which the amounts are allotted shall not be re25 distributed to other States and shall revert to the 


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1 Treasury on October 1 of the third succeeding fiscal 

2 year. 

3 ‘‘(3) RULE FOR COUNTING EXPENDITURES

4 AGAINST FISCAL YEAR ALLOTMENTS.—Expenditures 

5 under the State child health plan made on or after 

6 April 1, 2009, shall be counted against allotments 

7 for the earliest fiscal year for which funds are avail8 able for expenditure under this subsection.’’. 

9 (c) CONFORMING AMENDMENTS.— 

10 (1) Section 2104(b)(1) of the Social Security 

11 Act (42 U.S.C. 1397dd(b)(1)) is amended by strik12 ing ‘‘subsection (d)’’ and inserting ‘‘the succeeding 

13 subsections of this section’’. 

14 (2) Section 2104(f) of such Act (42 U.S.C. 

15 1397dd(f)) is amended by striking ‘‘The’’ and in16 serting ‘‘Subject to subsection (e)(2), the’’. 

17 SEC. 4. LIMITATIONS ON MATCHING RATES FOR POPU18 LATIONS OTHER THAN LOW-INCOME CHIL19 DREN OR PREGNANT WOMEN COVERED 

20 THROUGH A SECTION 1115 WAIVER. 

21 (a) LIMITATION ON PAYMENTS.—Section 2105(c) of 

22 the Social Security Act (42 U.S.C. 1397ee(c)) is amended 

23 by adding at the end the following new paragraph: 

24 ‘‘(8) LIMITATIONS ON MATCHING RATE FOR

25 POPULATIONS OTHER THAN TARGETED LOW-INCOME


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1 CHILDREN OR PREGNANT WOMEN COVERED

2 THROUGH A SECTION 1115 WAIVER.—For child 

3 health assistance or health benefits coverage fur4 nished in any fiscal year beginning with fiscal year 

5 2010: 

6 ‘‘(A) FMAP APPLIED TO PAYMENTS FOR

7 COVERAGE OF CHILDREN OR PREGNANT WOMEN

8 COVERED THROUGH A SECTION 1115 WAIVER

9 ENROLLED IN THE STATE CHILD HEALTH PLAN

10 ON THE DATE OF ENACTMENT OF THE KIDS

11 FIRST ACT AND WHOSE GROSS FAMILY INCOME

12 IS DETERMINED TO EXCEED THE INCOME ELI13 GIBILITY LEVEL SPECIFIED FOR A TARGETED

14 LOW-INCOME CHILD.—Notwithstanding sub15 sections (b)(1)(B) and (d) of section 2110, in 

16 the case of any individual described in sub17 section (c) of section 105 of the Kids First Act 

18 who the State elects to continue to provide child 

19 health assistance for under the State child 

20 health plan in accordance with the requirements 

21 of such subsection, the Federal medical assist22 ance percentage (as determined under section 

23 1905(b) without regard to clause (4) of such 

24 section) shall be substituted for the enhanced 


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1 FMAP under subsection (a)(1) with respect to 

2 such assistance. 

3 ‘‘(B) FMAP APPLIED TO PAYMENTS ONLY

4 FOR NONPREGNANT CHILDLESS ADULTS AND

5 PARENTS AND CARETAKER RELATIVES EN6 ROLLED UNDER A SECTION 1115 WAIVER ON

7 THE DATE OF ENACTMENT OF THE KIDS FIRST

8 ACT.—The Federal medical assistance percent9 age (as determined under section 1905(b) with10 out regard to clause (4) of such section) shall 

11 be substituted for the enhanced FMAP under 

12 subsection (a)(1) with respect to payments for 

13 child health assistance or health benefits cov14 erage provided under the State child health 

15 plan for any of the following: 

16 ‘‘(i) PARENTS OR CARETAKER REL17 ATIVES ENROLLED UNDER A WAIVER ON

18 THE DATE OF ENACTMENT OF THE KIDS

19 FIRST ACT.—A nonpregnant parent or a 

20 nonpregnant caretaker relative of a tar21 geted low-income child who is enrolled in 

22 the State child health plan under a waiver, 

23 experimental, pilot, or demonstration 

24 project on the date of enactment of the 

25 Kids First Act and whose family income 


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1 does not exceed the income eligibility ap2 plied under such waiver with respect to 

3 that population on such date. 

4 ‘‘(ii) NONPREGNANT CHILDLESS

5 ADULTS ENROLLED UNDER A WAIVER ON

6 SUCH DATE.—A nonpregnant childless 

7 adult enrolled in the State child health 

8 plan under a waiver, experimental, pilot, or 

9 demonstration project described in section 

10 6102(c)(3) of the Deficit Reduction Act of 

11 2005 (42 U.S.C. 1397gg note) on the date 

12 of enactment of the Kids First Act and 

13 whose family income does not exceed the 

14 income eligibility applied under such waiv15 er with respect to that population on such 

16 date. 

17 ‘‘(iii) NO REPLACEMENT ENROLL18 EES.—Nothing in clauses (i) or (ii) shall 

19 be construed as authorizing a State to pro20 vide child health assistance or health bene21 fits coverage under a waiver described in 

22 either such clause to a nonpregnant parent 

23 or a nonpregnant caretaker relative of a 

24 targeted low-income child, or a nonpreg25 nant childless adult, who is not enrolled 


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1 under the waiver on the date of enactment 

2 of the Kids First Act. 

3 ‘‘(C) NO FEDERAL PAYMENT FOR ANY

4 NEW NONPREGNANT ADULT ENROLLEES OR

5 FOR SUCH ENROLLEES WHO NO LONGER SAT6 ISFY INCOME ELIGIBILITY REQUIREMENTS.— 

7 Payment shall not be made under this section 

8 for child health assistance or other health bene9 fits coverage provided under the State child 

10 health plan or under a waiver under section 

11 1115 for any of the following: 

12 ‘‘(i) PARENTS OR CARETAKER REL13 ATIVES UNDER A SECTION 1115 WAIVER

14 APPROVED AFTER THE DATE OF ENACT15 MENT OF THE KIDS FIRST ACT.—A non16 pregnant parent or a nonpregnant care17 taker relative of a targeted low-income 

18 child under a waiver, experimental, pilot, 

19 or demonstration project that is approved 

20 on or after the date of enactment of the 

21 Kids First Act. 

22 ‘‘(ii) PARENTS, CARETAKER REL23 ATIVES, AND NONPREGNANT CHILDLESS

24 ADULTS WHOSE FAMILY INCOME EXCEEDS

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1 FIED UNDER A SECTION 1115 WAIVER AP2 PROVED PRIOR TO THE KIDS FIRST ACT.— 

3 Any nonpregnant parent or a nonpregnant 

4 caretaker relative of a targeted low-income 

5 child whose family income exceeds the in6 come eligibility level referred to in subpara7 graph (B)(i), and any nonpregnant child8 less adult whose family income exceeds the 

9 income eligibility level referred to in sub10 paragraph (B)(ii). 

11 ‘‘(iii) NONPREGNANT CHILDLESS

12 ADULTS, PARENTS, OR CARETAKER REL13 ATIVES NOT ENROLLED UNDER A SECTION

14 1115 WAIVER ON THE DATE OF ENACT15 MENT OF THE KIDS FIRST ACT.—Any non16 pregnant parent or a nonpregnant care17 taker relative of a targeted low-income 

18 child who is not enrolled in the State child 

19 health plan under a section 1115 waiver, 

20 experimental, pilot, or demonstration 

21 project referred to in subparagraph (B)(i) 

22 on the date of enactment of the Kids First 

23 Act, and any nonpregnant childless adult 

24 who is not enrolled in the State child 

25 health plan under a section 1115 waiver, 


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1 experimental, pilot, or demonstration 

2 project referred to in subparagraph 

3 (B)(ii)(I) on such date. 

4 ‘‘(D) DEFINITION OF CARETAKER REL5 ATIVE.—In this subparagraph, the term ‘care6 taker relative’ has the meaning given that term 

7 for purposes of carrying out section 1931. 

8 ‘‘(E) RULE OF CONSTRUCTION.—Nothing 

9 in this paragraph shall be construed as imply10 ing that payments for coverage of populations 

11 for which the Federal medical assistance per12 centage (as so determined) is to be substituted 

13 for the enhanced FMAP under subsection 

14 (a)(1) in accordance with this paragraph are to 

15 be made from funds other than the allotments 

16 determined for a State under section 2104.’’. 

17 (b) CONFORMING AMENDMENT.—Section 2105(a)(1) 

18 of the Social Security Act (42 U.S.C. 1397dd(a)(1)) is 

19 amended, in the matter preceding subparagraph (A), by 

20 inserting ‘‘or subsection (c)(8)’’ after ‘‘subparagraph 

21 (B)’’. 


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1 SEC. 5. PROHIBITION ON NEW SECTION 1115 WAIVERS FOR 

2 COVERAGE OF ADULTS OTHER THAN PREG3 NANT WOMEN. 

4 (a) IN GENERAL.—Section 2107(f) of the Social Se5 curity Act (42 U.S.C. 1397gg(f)) is amended— 

6 (1) by striking ‘‘, the Secretary’’ and inserting 

7 ‘‘: 

8 ‘‘(1) The Secretary’’; and 

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

10 paragraphs: 

11 ‘‘(2) The Secretary may not approve, extend, 

12 renew, or amend a waiver, experimental, pilot, or 

13 demonstration project with respect to a State after 

14 the date of enactment of the Kids First Act that 

15 would allow funds made available under this title to 

16 be used to provide child health assistance or other 

17 health benefits coverage for any other adult other 

18 than a pregnant woman whose family income does 

19 not exceed the income eligibility level specified for a 

20 targeted low-income child in that State under a 

21 waiver or project approved as of such date. 

22 ‘‘(3) The Secretary may not approve, extend, 

23 renew, or amend a waiver, experimental, pilot, or 

24 demonstration project with respect to a State after 

25 the date of enactment of the Kids First Act that 


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1 would waive or modify the requirements of section 

2 2105(c)(8).’’. 

3 (b) CLARIFICATION OF AUTHORITY FOR COVERAGE

4 OF PREGNANT WOMEN.—Section 2106 of the Social Secu5 rity Act (42 U.S.C. 1397ff) is amended by adding at the 

6 end the following new subsection: 

7 ‘‘(f) NO AUTHORITY TO COVER PREGNANT WOMEN

8 THROUGH STATE PLAN.—For purposes of this title, a 

9 State may provide assistance to a pregnant woman under 

10 the State child health plan only— 

11 ‘‘(1) by virtue of a waiver under section 1115; 

12 or 

13 ‘‘(2) through the application of sections 457.10, 

14 457.350(b)(2), 457.622(c)(5), and 457.626(a)(3) of 

15 title 42, Code of Federal Regulations (as in effect on 

16 the date of enactment of the Kids First Act).’’. 

17 (c) ASSURANCE OF NOTICE TO AFFECTED ENROLL18 EES.—The Secretary of Health and Human Services shall 

19 establish procedures to ensure that States provide ade20 quate public notice for parents, caretaker relatives, and 

21 nonpregnant childless adults whose eligibility for child 

22 health assistance or health benefits coverage under a waiv23 er under section 1115 of the Social Security Act will be 

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1 tions of the Secretary relating to procedures for termi2 nating waivers under section 1115 of the Social Security 

3 Act. 

4 SEC. 6. STANDARDIZATION OF DETERMINATION OF FAMILY 

5 INCOME FOR TARGETED LOW-INCOME CHIL6 DREN UNDER TITLE XXI AND OPTIONAL TAR7 GETED LOW-INCOME CHILDREN UNDER 

8 TITLE XIX. 

9 (a) ELIGIBILITY BASED ON GROSS INCOME.— 

10 (1) IN GENERAL.—Section 2110 of the Social 

11 Security Act (42 U.S.C. 1397jj) is amended— 

12 (A) in subsection (b)(1)(A), by inserting 

13 ‘‘in accordance with subsection (d)’’ after 

14 ‘‘State plan’’; and 

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

16 subsection: 

17 ‘‘(d) STANDARDIZATION OF DETERMINATION OF

18 FAMILY INCOME.—A State shall determine family income 

19 for purposes of determining income eligibility for child 

20 health assistance or other health benefits coverage under 

21 the State child health plan (or under a waiver of such plan 

22 under section 1115) solely on the basis of the gross income 

23 (as defined by the Secretary) of the family.’’. 

24 (2) PROHIBITION ON WAIVER OF REQUIRE25 MENTS.—Section 2107(f) (42 U.S.C. 1397gg(f)), as 


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1 amended by section 5(a), is amended by adding at 

2 the end the following new paragraph: 

3 ‘‘(4) The Secretary may not approve a waiver, 

4 experimental, pilot, or demonstration project with re5 spect to a State after the date of enactment of the 

6 Kids First Act that would waive or modify the re7 quirements of section 2110(d) (relating to deter8 mining income eligibility on the basis of gross in9 come) and regulations promulgated to carry out 

10 such requirements.’’. 

11 (b) REGULATIONS.—Not later than 90 days after the 

12 date of enactment of this Act, the Secretary of Health and 

13 Human Services shall promulgate interim final regulations 

14 defining gross income for purposes of section 2110(d) of 

15 the Social Security Act, as added by subsection (a). 

16 (c) APPLICATION TO CURRENT ENROLLEES.—The 

17 interim final regulations promulgated under subsection (b) 

18 shall not be used to determine the income eligibility of any 

19 individual enrolled in a State child health plan under title 

20 XXI of the Social Security Act on the date of enactment 

21 of this Act before the date on which such eligibility of the 

22 individual is required to be redetermined under the plan 

23 as in effect on such date. In the case of any individual 

24 enrolled in such plan on such date who, solely as a result 

25 of the application of subsection (d) of section 2110 of the 


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1 Social Security Act (as added by subsection (a)) and the 

2 regulations promulgated under subsection (b), is deter3 mined to be ineligible for child health assistance under the 

4 State child health plan, a State may elect, subject to sub5 stitution of the Federal medical assistance percentage for 

6 the enhanced FMAP under section 2105(c)(8)(A) of the 

7 Social Security Act (as added by section 4(a)), to continue 

8 to provide the individual with such assistance for so long 

9 as the individual otherwise would be eligible for such as10 sistance and the individual’s family income, if determined 

11 under the income and resource standards and methodolo12 gies applicable under the State child health plan on Sep13 tember 30, 2008, would not exceed the income eligibility 

14 level applicable to the individual under the State child 

15 health plan. 

16 SEC. 7. GRANTS FOR OUTREACH AND ENROLLMENT. 

17 (a) GRANTS.—Title XXI of the Social Security Act 

18 (42 U.S.C. 1397aa et seq.) is amended by adding at the 

19 end the following: 

20 ‘‘SEC. 2111. GRANTS TO IMPROVE OUTREACH AND ENROLL21 MENT. 

22 ‘‘(a) OUTREACH AND ENROLLMENT GRANTS; NA23 TIONAL CAMPAIGN.— 

24 ‘‘(1) IN GENERAL.—From the amounts appro25 priated for a fiscal year under subsection (f), subject 


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1 to paragraph (2), the Secretary shall award grants 

2 to eligible entities to conduct outreach and enroll3 ment efforts that are designed to increase the enroll4 ment and participation of eligible children under this 

5 title and title XIX. 

6 ‘‘(2) 10 PERCENT SET ASIDE FOR NATIONAL

7 ENROLLMENT CAMPAIGN.—An amount equal to 10 

8 percent of such amounts for the fiscal year shall be 

9 used by the Secretary for expenditures during the 

10 fiscal year to carry out a national enrollment cam11 paign in accordance with subsection (g). 

12 ‘‘(b) AWARD OF GRANTS.— 

13 ‘‘(1) PRIORITY FOR AWARDING.— 

14 ‘‘(A) IN GENERAL.—In awarding grants 

15 under subsection (a), the Secretary shall give 

16 priority to eligible entities that— 

17 ‘‘(i) propose to target geographic 

18 areas with high rates of— 

19 ‘‘(I) eligible but unenrolled chil20 dren, including such children who re21 side in rural areas; or 

22 ‘‘(II) racial and ethnic minorities 

23 and health disparity populations, in24 cluding those proposals that address 


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1 cultural and linguistic barriers to en2 rollment; and 

3 ‘‘(ii) submit the most demonstrable 

4 evidence required under paragraphs (1) 

5 and (2) of subsection (c). 

6 ‘‘(B) 10 PERCENT SET ASIDE FOR OUT7 REACH TO INDIAN CHILDREN.—An amount 

8 equal to 10 percent of the funds appropriated 

9 under subsection (f) for a fiscal year shall be 

10 used by the Secretary to award grants to In11 dian Health Service providers and urban Indian 

12 organizations receiving funds under title V of 

13 the Indian Health Care Improvement Act (25 

14 U.S.C. 1651 et seq.) for outreach to, and en15 rollment of, children who are Indians. 

16 ‘‘(2) 2-YEAR AVAILABILITY.—A grant awarded 

17 under this section for a fiscal year shall remain 

18 available for expenditure through the end of the suc19 ceeding fiscal year. 

20 ‘‘(c) APPLICATION.—An eligible entity that desires to 

21 receive a grant under subsection (a) shall submit an appli22 cation to the Secretary in such form and manner, and con23 taining such information, as the Secretary may decide. 

24 Such application shall include— 


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1 ‘‘(1) evidence demonstrating that the entity in2 cludes members who have access to, and credibility 

3 with, ethnic or low-income populations in the com4 munities in which activities funded under the grant 

5 are to be conducted; 

6 ‘‘(2) evidence demonstrating that the entity has 

7 the ability to address barriers to enrollment, such as 

8 lack of awareness of eligibility, stigma concerns and 

9 punitive fears associated with receipt of benefits, 

10 and other cultural barriers to applying for and re11 ceiving child health assistance or medical assistance; 

12 ‘‘(3) specific quality or outcomes performance 

13 measures to evaluate the effectiveness of activities 

14 funded by a grant awarded under this section; and 

15 ‘‘(4) an assurance that the eligible entity 

16 shall— 

17 ‘‘(A) conduct an assessment of the effec18 tiveness of such activities against the perform19 ance measures; 

20 ‘‘(B) cooperate with the collection and re21 porting of enrollment data and other informa22 tion in order for the Secretary to conduct such 

23 assessments; and 

24 ‘‘(C) in the case of an eligible entity that 

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1 ment data and other information as necessary 

2 for the State to make necessary projections of 

3 eligible children and pregnant women. 

4 ‘‘(d) SUPPLEMENT, NOT SUPPLANT.—Federal funds 

5 awarded under this section shall be used to supplement, 

6 not supplant, non-Federal funds that are otherwise avail7 able for activities funded under this section. 

8 ‘‘(e) DEFINITIONS.—In this section: 

9 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en10 tity’ means any of the following: 

11 ‘‘(A) A State with an approved child health 

12 plan under this title. 

13 ‘‘(B) A local government. 

14 ‘‘(C) An Indian tribe or tribal consortium, 

15 a tribal organization, an urban Indian organiza16 tion receiving funds under title V of the Indian 

17 Health Care Improvement Act (25 U.S.C. 1651 

18 et seq.), or an Indian Health Service provider. 

19 ‘‘(D) A Federal health safety net organiza20 tion. 

21 ‘‘(E) A State, national, local, or commu22 nity-based public or nonprofit private organiza23 tion. 

24 ‘‘(F) A faith-based organization or con25 sortia, to the extent that a grant awarded to 


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1 such an entity is consistent with the require2 ments of section 1955 of the Public Health 

3 Service Act (42 U.S.C. 300x–65) relating to a 

4 grant award to non-governmental entities. 

5 ‘‘(G) An elementary or secondary school. 

6 ‘‘(H) A national, local, or community-based 

7 public or nonprofit private organization, includ8 ing organizations that use community health 

9 workers or community-based doula programs. 

10 ‘‘(2) FEDERAL HEALTH SAFETY NET ORGANI11 ZATION.—The term ‘Federal health safety net orga12 nization’ means— 

13 ‘‘(A) a federally-qualified health center (as 

14 defined in section 1905(l)(2)(B)); 

15 ‘‘(B) a hospital defined as a dispropor16 tionate share hospital for purposes of section 

17 1923; 

18 ‘‘(C) a covered entity described in section 

19 340B(a)(4) of the Public Health Service Act 

20 (42 U.S.C. 256b(a)(4)); and 

21 ‘‘(D) any other entity or consortium that 

22 serves children under a federally-funded pro23 gram, including the special supplemental nutri24 tion program for women, infants, and children 

25 (WIC) established under section 17 of the Child 


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1 Nutrition Act of 1966 (42 U.S.C. 1786), the 

2 head start and early head start programs under 

3 the Head Start Act (42 U.S.C. 9801 et seq.), 

4 the school lunch program established under the 

5 Richard B. Russell National School Lunch Act, 

6 and an elementary or secondary school. 

7 ‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANI8 ZATION; URBAN INDIAN ORGANIZATION.—The terms 

9 ‘Indian’, ‘Indian tribe’, ‘tribal organization’, and 

10 ‘urban Indian organization’ have the meanings given 

11 such terms in section 4 of the Indian Health Care 

12 Improvement Act (25 U.S.C. 1603). 

13 ‘‘(4) COMMUNITY HEALTH WORKER.—The term 

14 ‘community health worker’ means an individual who 

15 promotes health or nutrition within the community 

16 in which the individual resides— 

17 ‘‘(A) by serving as a liaison between com18 munities and health care agencies; 

19 ‘‘(B) by providing guidance and social as20 sistance to community residents; 

21 ‘‘(C) by enhancing community residents’ 

22 ability to effectively communicate with health 

23 care providers; 


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1 ‘‘(D) by providing culturally and linguis2 tically appropriate health or nutrition edu3 cation; 

4 ‘‘(E) by advocating for individual and com5 munity health or nutrition needs; and 

6 ‘‘(F) by providing referral and followup 

7 services. 

8 ‘‘(f) APPROPRIATION.— 

9 ‘‘(1) IN GENERAL.—There is appropriated, out 

10 of any money in the Treasury not otherwise appro11 priated, for the purpose of awarding grants under 

12 this section— 

13 ‘‘(A) $100,000,000 for each of fiscal years 

14 2009 and 2010; 

15 ‘‘(B) $75,000,000 for each of fiscal years 

16 2011 and 2012; and 

17 ‘‘(C) $50,000,000 for fiscal year 2013. 

18 ‘‘(2) GRANTS IN ADDITION TO OTHER AMOUNTS

19 PAID.—Amounts appropriated and paid under the 

20 authority of this section shall be in addition to 

21 amounts appropriated under section 2104 and paid 

22 to States in accordance with section 2105, including 

23 with respect to expenditures for outreach activities 

24 in accordance with subsections (a)(1)(D)(iii) and 

25 (c)(2)(C) of that section. 


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1 ‘‘(g) NATIONAL ENROLLMENT CAMPAIGN.—From 

2 the amounts made available under subsection (a)(2) for 

3 a fiscal year, the Secretary shall develop and implement 

4 a national enrollment campaign to improve the enrollment 

5 of underserved child populations in the programs estab6 lished under this title and title XIX. Such campaign may 

7 include— 

8 ‘‘(1) the establishment of partnerships with the 

9 Secretary of Education and the Secretary of Agri10 culture to develop national campaigns to link the eli11 gibility and enrollment systems for the assistance 

12 programs each Secretary administers that often 

13 serve the same children; 

14 ‘‘(2) the integration of information about the 

15 programs established under this title and title XIX 

16 in public health awareness campaigns administered 

17 by the Secretary; 

18 ‘‘(3) increased financial and technical support 

19 for enrollment hotlines maintained by the Secretary 

20 to ensure that all States participate in such hotlines; 

21 ‘‘(4) the establishment of joint public awareness 

22 outreach initiatives with the Secretary of Education 

23 and the Secretary of Labor regarding the impor24 tance of health insurance to building strong commu25 nities and the economy; 


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1 ‘‘(5) the development of special outreach mate2 rials for Native Americans or for individuals with 

3 limited English proficiency; and 

4 ‘‘(6) such other outreach initiatives as the Sec5 retary determines would increase public awareness of 

6 the programs under this title and title XIX.’’. 

7 (b) NONAPPLICATION OF ADMINISTRATIVE EXPENDI8 TURES CAP.—Section 2105(c)(2) of the Social Security 

9 Act (42 U.S.C. 1397ee(c)(2)) is amended by adding at the 

10 end the following: 

11 ‘‘(C) NONAPPLICATION TO EXPENDITURES

12 FOR OUTREACH AND ENROLLMENT.—The limi13 tation under subparagraph (A) shall not apply 

14 with respect to expenditures for outreach activi15 ties under section 2102(c)(1), or for enrollment 

16 activities, for children eligible for child health 

17 assistance under the State child health plan or 

18 medical assistance under the State plan under 

19 title XIX.’’. 


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1 SEC. 8. IMPROVED STATE OPTION FOR OFFERING PRE2 MIUM ASSISTANCE FOR COVERAGE OF CHIL3 DREN THROUGH PRIVATE PLANS UNDER 

4 SCHIP AND MEDICAID. 

5 (a) IN GENERAL.—Section 2105(c) of the Social Se6 curity Act (42 U.S.C. 1397ee(c)), as amended by section 

7 4(a) is amended by adding at the end the following: 

8 ‘‘(9) ADDITIONAL STATE OPTION FOR OFFER9 ING PREMIUM ASSISTANCE.— 

10 ‘‘(A) IN GENERAL.—Subject to the suc11 ceeding provisions of this paragraph, a State 

12 may elect to offer a premium assistance subsidy 

13 (as defined in subparagraph (C)) for qualified 

14 coverage (as defined in subparagraph (B)) to 

15 all targeted low-income children who are eligible 

16 for child health assistance under the plan and 

17 have access to such coverage in accordance with 

18 the requirements of this paragraph. 

19 ‘‘(B) QUALIFIED COVERAGE.—In this 

20 paragraph, the term ‘qualified coverage’ means 

21 the following: 

22 ‘‘(i) QUALIFIED EMPLOYER SPON23 SORED COVERAGE.— 

24 ‘‘(I) IN GENERAL.—A group 

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1 erage offered through an employer 

2 that is— 

3 ‘‘(aa) substantially equiva4 lent to the benefits coverage in a 

5 benchmark benefit package de6 scribed in section 2103(b) or 

7 benchmark-equivalent coverage 

8 that meets the requirements of 

9 section 2103(a)(2); 

10 ‘‘(bb) made similarly avail11 able to all of the employer’s em12 ployees and for which the em13 ployer makes a contribution to 

14 the premium that is not less for 

15 employees receiving a premium 

16 assistance subsidy under any op17 tion available under the State 

18 child health plan under this title 

19 or the State plan under title XIX 

20 to provide such assistance than 

21 the employer contribution pro22 vided for all other employees; and 

23 ‘‘(cc) cost-effective, as deter24 mined under subclause (II). 


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1 ‘‘(II) COST-EFFECTIVENESS.—A 

2 group health plan or health insurance 

3 coverage offered through an employer 

4 shall be considered to be cost-effective 

5 if— 

6 ‘‘(aa) the marginal premium 

7 cost to purchase family coverage 

8 through the employer is less than 

9 the State cost of providing child 

10 health assistance through the 

11 State child health plan for all the 

12 children in the family who are 

13 targeted low-income children; or 

14 ‘‘(bb) the marginal premium 

15 cost between individual coverage 

16 and purchasing family coverage 

17 through the employer is not 

18 greater than 175 percent of the 

19 cost to the State to provide child 

20 health assistance through the 

21 State child health plan for a tar22 geted low-income child. 

23 ‘‘(ii) QUALIFIED NON-GROUP COV24 ERAGE.—Health insurance coverage of25 fered to individuals in the non-group 


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1 health insurance market that is substan2 tially equivalent to the benefits coverage in 

3 a benchmark benefit package described in 

4 section 2103(b) or benchmark-equivalent 

5 coverage that meets the requirements of 

6 section 2103(a)(2). 

7 ‘‘(iii) HIGH DEDUCTIBLE HEALTH

8 PLAN.—A high deductible health plan (as 

9 defined in section 223(c)(2) of the Internal 

10 Revenue Code of 1986) purchased through 

11 a health savings account (as defined under 

12 section 223(d) of such Code). 

13 ‘‘(C) PREMIUM ASSISTANCE SUBSIDY.— 

14 ‘‘(i) IN GENERAL.—In this paragraph, 

15 the term ‘premium assistance subsidy’ 

16 means, with respect to a targeted low-in17 come child, the amount equal to the dif18 ference between the employee contribution 

19 required for enrollment only of the em20 ployee under qualified employer sponsored 

21 coverage and the employee contribution re22 quired for enrollment of the employee and 

23 the child in such coverage, less any appli24 cable premium cost-sharing applied under 

25 the State child health plan, subject to the 


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1 annual aggregate cost-sharing limit applied 

2 under section 2103(e)(3)(B). 

3 ‘‘(ii) STATE PAYMENT OPTION.—Sub4 ject to clause (iii), a State may provide a 

5 premium assistance subsidy directly to an 

6 employer or as reimbursement to an em7 ployee for out-of-pocket expenditures. 

8 ‘‘(iii) REQUIREMENT FOR DIRECT

9 PAYMENT TO EMPLOYEE.—A State shall 

10 not pay a premium assistance subsidy di11 rectly to the employee, unless the State has 

12 established procedures to ensure that the 

13 targeted low-income child on whose behalf 

14 such payments are made are actually en15 rolled in the qualified employer sponsored 

16 coverage. 

17 ‘‘(iv) TREATMENT AS CHILD HEALTH

18 ASSISTANCE.—Expenditures for the provi19 sion of premium assistance subsidies shall 

20 be considered child health assistance de21 scribed in paragraph (1)(C) of subsection 

22 (a) for purposes of making payments 

23 under that subsection. 

24 ‘‘(v) STATE OPTION TO REQUIRE AC25 CEPTANCE OF SUBSIDY.—A State may 


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1 condition the provision of child health as2 sistance under the State child health plan 

3 for a targeted low-income child on the re4 ceipt of a premium assistance subsidy for 

5 enrollment in qualified employer sponsored 

6 coverage if the State determines the provi7 sion of such a subsidy to be more cost-ef8 fective in accordance with subparagraph 

9 (B)(ii). 

10 ‘‘(vi) NOT TREATED AS INCOME.— 

11 Notwithstanding any other provision of 

12 law, a premium assistance subsidy pro13 vided in accordance with this paragraph 

14 shall not be treated as income to the child 

15 or the parent of the child for whom such 

16 subsidy is provided. 

17 ‘‘(D) NO REQUIREMENT TO PROVIDE SUP18 PLEMENTAL COVERAGE FOR BENEFITS AND AD19 DITIONAL COST-SHARING PROTECTION PRO20 VIDED UNDER THE STATE CHILD HEALTH

21 PLAN.— 

22 ‘‘(i) IN GENERAL.—A State that 

23 elects the option to provide a premium as24 sistance subsidy under this paragraph shall 

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1 income child enrolled in qualified employer 

2 sponsored coverage with supplemental cov3 erage for items or services that are not 

4 covered, or are only partially covered, 

5 under the qualified employer sponsored 

6 coverage or cost-sharing protection other 

7 than the protection required under section 

8 2103(e)(3)(B). 

9 ‘‘(ii) NOTICE OF COST-SHARING RE10 QUIREMENTS.—A State shall provide a tar11 geted low-income child or the parent of 

12 such a child (as appropriate) who is pro13 vided with a premium assistance subsidy in 

14 accordance with this paragraph with notice 

15 of the cost-sharing requirements and limi16 tations imposed under the qualified em17 ployer sponsored coverage in which the 

18 child is enrolled upon the enrollment of the 

19 child in such coverage and annually there20 after. 

21 ‘‘(iii) RECORD KEEPING REQUIRE22 MENTS.—A State may require a parent of 

23 a targeted low-income child that is enrolled 

24 in qualified employer-sponsored coverage to 

25 bear the responsibility for keeping track of 


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1 out-of-pocket expenditures incurred for 

2 cost-sharing imposed under such coverage 

3 and to notify the State when the limit on 

4 such expenditures imposed under section 

5 2103(e)(3)(B) has been reached for a year 

6 from the effective date of enrollment for 

7 such year. 

8 ‘‘(iv) STATE OPTION FOR REIMBURSE9 MENT.—A State may retroactively reim10 burse a parent of a targeted low-income 

11 child for out-of-pocket expenditures in12 curred after reaching the 5 percent cost13 sharing limitation imposed under section 

14 2103(e)(3)(B) for a year. 

15 ‘‘(E) 6-MONTH WAITING PERIOD RE16 QUIRED.—A State shall impose at least a 6- 

17 month waiting period from the time an indi18 vidual is enrolled in private health insurance 

19 prior to the provision of a premium assistance 

20 subsidy for a targeted low-income child in ac21 cordance with this paragraph. 

22 ‘‘(F) NON APPLICATION OF WAITING PE23 RIOD FOR ENROLLMENT IN THE STATE MED24 ICAID PLAN OR THE STATE CHILD HEALTH

25 PLAN.—A targeted low-income child provided a 


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1 premium assistance subsidy in accordance with 

2 this paragraph who loses eligibility for such 

3 subsidy shall not be treated as having been en4 rolled in private health insurance coverage for 

5 purposes of applying any waiting period im6 posed under the State child health plan or the 

7 State plan under title XIX for the enrollment of 

8 the child under such plan. 

9 ‘‘(G) ASSURANCE OF SPECIAL ENROLL10 MENT PERIOD UNDER GROUP HEALTH PLANS

11 IN CASE OF ELIGIBILITY FOR PREMIUM SUB12 SIDY ASSISTANCE.—No payment shall be made 

13 under subsection (a) for amounts expended for 

14 the provision of premium assistance subsidies 

15 under this paragraph unless a State provides 

16 assurances to the Secretary that the State has 

17 in effect laws requiring a group health plan, a 

18 health insurance issuer offering group health 

19 insurance coverage in connection with a group 

20 health plan, and a self-funded health plan, to 

21 permit an employee who is eligible, but not en22 rolled, for coverage under the terms of the plan 

23 (or a child of such an employee if the child is 

24 eligible, but not enrolled, for coverage under 

25 such terms) to enroll for coverage under the 


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1 terms of the plan if the employee’s child be2 comes eligible for a premium assistance subsidy 

3 under this paragraph. 

4 ‘‘(H) NO EFFECT ON PREVIOUSLY AP5 PROVED PREMIUM ASSISTANCE PROGRAMS.— 

6 Nothing in this paragraph shall be construed as 

7 limiting the authority of a State to offer pre8 mium assistance under section 1906, a waiver 

9 described in paragraph (2)(B) or (3), a waiver 

10 approved under section 1115, or other authority 

11 in effect on February 1, 2009. 

12 ‘‘(I) NOTICE OF AVAILABILITY.—A State 

13 shall— 

14 ‘‘(i) include on any application or en15 rollment form for child health assistance a 

16 notice of the availability of premium assist17 ance subsidies for the enrollment of tar18 geted low-income children in qualified em19 ployer sponsored coverage; 

20 ‘‘(ii) provide, as part of the applica21 tion and enrollment process under the 

22 State child health plan, information de23 scribing the availability of such subsidies 

24 and how to elect to obtain such a subsidy; 

25 and 


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1 ‘‘(iii) establish such other procedures 

2 as the State determines necessary to en3 sure that parents are informed of the 

4 availability of such subsidies under the 

5 State child health plan.’’. 

6 (b) APPLICATION TO MEDICAID.—Section 1906 of 

7 the Social Security Act (42 U.S.C. 1396e) is amended by 

8 inserting after subsection (c) the following: 

9 ‘‘(d) The provisions of section 2105(c)(9) shall apply 

10 to a child who is eligible for medical assistance under the 

11 State plan in the same manner as such provisions apply 

12 to a targeted low-income child under a State child health 

13 plan under title XXI. Section 1902(a)(34) shall not apply 

14 to a child who is provided a premium assistance subsidy 

15 under the State plan in accordance with the preceding sen16 tence.’’. 

17 SEC. 9. TREATMENT OF UNBORN CHILDREN. 

18 (a) CODIFICATION OF CURRENT REGULATIONS.— 

19 Section 2110(c)(1) of the Social Security Act (42 U.S.C. 

20 1397jj(c)(1)) is amended by striking the period at the end 

21 and inserting the following: ‘‘, and includes, at the option 

22 of a State, an unborn child. For purposes of the previous 

23 sentence, the term ‘unborn child’ means a member of the 

24 species Homo sapiens, at any stage of development, who 

25 is carried in the womb.’’. 


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1 (b) CLARIFICATIONS REGARDING COVERAGE OF

2 MOTHERS.—Section 2103 (42 U.S.C. 1397cc) is amended 

3 by adding at the end the following new subsection: 

4 ‘‘(g) CLARIFICATIONS REGARDING AUTHORITY TO

5 PROVIDE POSTPARTUM SERVICES AND MATERNAL

6 HEALTH CARE.—Any State that provides child health as7 sistance to an unborn child under the option described in 

8 section 2110(c)(1) may— 

9 ‘‘(1) continue to provide such assistance to the 

10 mother, as well as postpartum services, through the 

11 end of the month in which the 60-day period (begin12 ning on the last day of pregnancy) ends; and 

13 ‘‘(2) in the interest of the child to be born, have 

14 flexibility in defining and providing services to ben15 efit either the mother or unborn child consistent 

16 with the health of both.’’. 

17 SEC. 10. 50 PERCENT MATCHING RATE FOR ALL MEDICAID 

18 ADMINISTRATIVE COSTS. 

19 Section 1903(a) of the Social Security Act (42 U.S.C. 

20 1396b(a)) is amended— 

21 (1) by striking paragraph (2); 

22 (2) by redesignating paragraph (3)(E) as para23 graph (2) and re-locating and indenting it appro24 priately; 


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1 (3) in paragraph (2), as so redesignated, by re2 designating clauses (i) and (ii) as subparagraphs (A) 

3 and (B), and indenting them appropriately; 

4 (4) by striking paragraphs (3) and (4); 

5 (5) in paragraph (5), by striking ‘‘which are at6 tributable to the offering, arranging, and fur7 nishing’’ and inserting ‘‘which are for the medical 

8 assistance costs of furnishing’’; 

9 (6) by striking paragraph (6); 

10 (7) in paragraph (7), by striking ‘‘subject to 

11 section 1919(g)(3)(B),’’; and 

12 (8) by redesignating paragraphs (5) and (7) as 

13 paragraphs (3) and (4), respectively. 

14 SEC. 11. REDUCTION IN PAYMENTS FOR MEDICAID ADMIN15 ISTRATIVE COSTS TO PREVENT DUPLICATION 

16 OF SUCH PAYMENTS UNDER TANF. 

17 Section 1903 of the Social Security Act (42 U.S.C. 

18 1396b) is amended— 

19 (1) in subsection (a)(7), by striking ‘‘section 

20 1919(g)(3)(B)’’ and inserting ‘‘subsection (h)’’; 

21 (2) in subsection (a)(2)(D) by inserting ‘‘, sub22 ject to subsection (g)(3)(C) of such section’’ after 

23 ‘‘as are attributable to State activities under section 

24 1919(g)’’; and 


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1 (3) by adding after subsection (g) the following 

2 new subsection: 

3 ‘‘(h) REDUCTION IN PAYMENTS FOR ADMINISTRA4 TIVE COSTS TO PREVENT DUPLICATION OF PAYMENTS

5 UNDER TITLE IV.—Beginning with the calendar quarter 

6 commencing April 1, 2009, the Secretary shall reduce the 

7 amount paid to each State under subsection (a)(7) for 

each quarter by an amount equal to 1 8 ⁄4 of the annualized 

9 amount determined for the Medicaid program under sec10 tion 16(k)(2)(B) of the Food Stamp Act of 1977 (7 U.S.C. 

11 2025(k)(2)(B)).’’. 

12 SEC. 12. ELIMINATION OF WAIVER OF CERTAIN MEDICAID 

13 PROVIDER TAX PROVISIONS. 

14 Effective October 1, 2009, subsection (c) of section 

15 4722 of the Balanced Budget Act of 1997 (Public Law 

16 105–33; 111 Stat. 515) is repealed. 

17 SEC. 13. ELIMINATION OF SPECIAL PAYMENTS FOR CER18 TAIN PUBLIC HOSPITALS. 

19 Effective October 1, 2009, subsection (d) of section 

20 701 of the Medicare, Medicaid, and SCHIP Benefits Im21 provement and Protection Act of 2000, as enacted into 

22 law by section 1(a)(6) of Public Law 106–554 (42 U.S.C. 

23 1396r–4 note), is repealed. 


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1 SEC. 14. EFFECTIVE DATE; COORDINATION OF FUNDING 

2 FOR FISCAL YEAR 2009. 

3 (a) IN GENERAL.—Unless otherwise specified, sub4 ject to subsection (b), the amendments made by this Act 

5 shall take effect on the date of enactment of this Act. 

6 (b) DELAY IF STATE LEGISLATION REQUIRED.—In 

7 the case of a State child health plan under title XXI of 

8 the Social Security Act or a waiver of such plan under 

9 section 1115 of such Act which the Secretary of Health 

10 and Human Services determines requires State legislation 

11 (other than legislation appropriating funds) in order for 

12 the plan or waiver to meet the additional requirements im13 posed by the amendments made by this Act, the State 

14 child health plan or waiver shall not be regarded as failing 

15 to comply with the requirements of such title XXI solely 

16 on the basis of its failure to meet such additional require17 ments before the first day of the first calendar quarter 

18 beginning after the close of the first regular session of the 

19 State legislature that begins after the date of the enact20 ment of this Act. For purposes of the previous sentence, 

21 in the case of a State that has a 2-year legislative session, 

22 each year of such session shall be deemed to be a separate 

23 regular session of the State legislature. 

24 (c) COORDINATION OF FUNDING FOR FISCAL YEAR

25 2009.—Notwithstanding any other provision of law, inso26 far as funds have been appropriated under section 


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1 2104(a)(11) of the Social Security Act, as amended by 

2 section 201(a) of Public Law 110–173 and in effect on 

3 January 1, 2009, to provide allotments to States under 

4 title XXI of the Social Security Act for fiscal year 2009— 

5 (1) any amounts that are so appropriated that 

6 are not so allotted and obligated before the date of 

7 the enactment of this Act are rescinded; and 

8 (2) any amount provided for allotments under 

9 title XXI of such Act to a State under the amend10 ments made by this Act for such fiscal year shall be 

11 reduced by the amount of such appropriations so al12 lotted and obligated before such date. 

Æ 


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