II

106TH CONGRESS

1ST SESSION S. 1646

To amend titles XIX and XXI of the Social Security Act to improve the

coverage of needy children under the State Children’s Health Insurance

Program (SCHIP) and the Medicaid Program.

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 28, 1999

Mrs. LINCOLN (for herself, Ms. LANDRIEU, Mr. SMITH of Oregon, Mr. BAYH,

and Mrs. FEINSTEIN) introduced the following bill; which was read twice

and referred to the Committee on Finance

A BILL

To amend titles XIX and XXI of the Social Security Act

to improve the coverage of needy children under the

State Children’s Health Insurance Program (SCHIP)

and the Medicaid Program.

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

3 SECTION 1. SHORT TITLE; REFERENCES IN ACT; TABLE OF

4 CONTENTS.

5 (a) SHORT TITLE.—This Act may be cited as the

6 ‘‘Improved Maternal and Children’s Health Coverage

7 Act’’.
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1 (b) REFERENCES TO SOCIAL SECURITY ACT.—Ex2 cept as otherwise expressly provided, whenever in this Act

3 an amendment or repeal is expressed in terms of an

4 amendment to, or repeal of, a section or other provision,

5 the reference shall be considered to be made to a section

6 or other provision of the Social Security Act.

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

8 this Act is as follows:

Sec. 1. Short title; references in Act; table of contents.

Sec. 2. Simplified outreach and enrollment.

Sec. 3. Family friendly coverage and enrollment.

Sec. 4. Expanded coverage options.

9 SEC. 2. SIMPLIFIED OUTREACH AND ENROLLMENT.

10 (a) USE OF UNIFORM APPLICATION AND COORDI11 NATED ENROLLMENT PROCESS.—

12 (1) SCHIP PROGRAM.—Section 2102 (42

13 U.S.C. 1397bb) is amended by adding at the end the

14 following new subsection:

15 ‘‘(d) DEVELOPMENT AND USE OF UNIFORM APPLI16 CATION FORMS AND COORDINATED ENROLLMENT PROC17 ESS.—A State child health plan shall provide, by not later

18 than the first day of the first month that begins more than

19 6 months after the date of the enactment of this sub20 section, for—

21 ‘‘(1) the development and use of a uniform,

22 simplified application form which is used both for
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1 purposes of establishing eligibility for benefits under

2 this title and also under title XIX; and

3 ‘‘(2) an enrollment process that is coordinated

4 with that under title XIX so that a family need only

5 interact with a single agency in order to determine

6 whether a child is eligible for benefits under this

7 title or title XIX.’’.

8 (2) MEDICAID CONFORMING AMENDMENT.—

9 (A) IN GENERAL.—Section 1902(a) (42

10 U.S.C. 1396a(a)) is amended—

11 (i) by striking the period at the end of

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

13 (ii) by inserting after paragraph (65)

14 the following new paragraph:

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

16 the first month that begins more than 6 months

17 after the date of the enactment of this paragraph,

18 in the case of a State with a State child health plan

19 under title XXI for—

20 ‘‘(A) the development and use of a uni21 form, simplified application form which is used

22 both for purposes of establishing eligibility for

23 benefits under this title and also under title

24 XXI; and
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1 ‘‘(B) establishment and operation of an en2 rollment process that is coordinated with that

3 under title XXI so that a family need only

4 interact with a single agency in order to deter5 mine whether a child is eligible for benefits

6 under this title or title XXI.’’.

7 (B) EFFECTIVE DATE.—The amendments

8 made by subparagraph (A) apply to calendar

9 quarters beginning more than 6 months after

10 the date of the enactment of this Act.

11 (b) FINANCIAL INCENTIVES TO PROMOTE APPRO12 PRIATE ENROLLMENT.—

13 (1) EXPANDED AVAILABILITY OF FUNDING FOR

14 ADMINISTRATIVE COSTS RELATED TO OUTREACH

15 AND ELIGIBILITY DETERMINATIONS.—Section

16 1931(h) (42 U.S.C. 1396u–1(h)) is amended—

17 (A) in the matter preceding paragraph (1),

18 by striking ‘‘TRANSITIONAL’’ and all that fol19 lows through ‘‘COSTS’’ and inserting ‘‘IN20 CREASED FEDERAL MATCHING RATE FOR AD21 MINISTRATIVE COSTS RELATED TO CERTAIN

22 OUTREACH AND ELIGIBILITY DETERMINA23 TIONS’’;

24 (B) in paragraph (2), by inserting ‘‘either’’

25 after ‘‘attributable’’ and by inserting before the
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1 period at the end the following: ‘‘or to adminis2 trative costs of determinations of the eligibility

3 of children and pregnant women for benefits

4 under the State plan under this title or title

5 XXI, outreach to children and pregnant women

6 likely to be eligible for such benefits, and such

7 other outreach- and eligibility-related activities

8 as the Secretary may approve’’;

9 (C) in paragraph (3), by striking ‘‘and

10 ending with fiscal year 2000’’; and

11 (D) by striking paragraph (4) and insert12 ing the following:

13 ‘‘(4) ENCOURAGING USE OF LOCAL AND COM14 MUNITY-BASED ORGANIZATIONS IN OUTREACH AND

15 ENROLLMENT ACTIVITIES.—The Secretary shall es16 tablish a procedure under which, if States do not

17 otherwise obligate the amounts made available under

18 this subsection, local and community-based public or

19 nonprofit organizations (including local and county

20 governments, public health departments, community

21 health centers, children’s hospitals, and dispropor22 tionate share hospitals) may seek to have adminis23 trative costs relating to outreach and enrollment of

24 children and pregnant women under this title and

25 title XXI be treated as administrative costs of a
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1 State described in section 1903(a)(7), if such orga2 nizations have the permission of the State involved.

3 A State may require such an organization to provide

4 payment of such amounts as the State would other5 wise be responsible for in order to obtain payment

6 under this paragraph.’’.

7 (2) USE OF 3 PERCENT OF SCHIP FUNDS AT 90

8 PERCENT FEDERAL MATCH FOR ENROLLMENT AND

9 OUTREACH ACTIVITIES.—Section 2105(b) (42

10 U.S.C. 1397ee(b)) is amended—

11 (A) by designating the matter following the

12 dash as a paragraph (1) with appropriate in13 dentation and with the heading ‘‘(1) IN GEN14 ERAL’’;

15 (B) by inserting ‘‘subject to paragraph

16 (2),’’ after ‘‘(a),’’;

17 (C) by striking ‘‘(1)’’ and ‘‘(2)’’ and in18 serting ‘‘(A)’’ and ‘‘(B)’’, respectively; and

19 (D) by adding at the end the following

20 paragraph:

21 ‘‘(2) SPECIAL RULE FOR CERTAIN ENROLL22 MENT AND OUTREACH ACTIVITIES.—

23 ‘‘(A) IN GENERAL.—For purposes of sub24 section (a), in the case of a State that meets

25 the requirement of subparagraph (B), and sub-
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1 ject to subparagraph (C), the ‘enhanced FMAP’

2 is equal to 90 percent with respect to amounts

3 expended on enrollment and outreach activities.

4 ‘‘(B) REQUIREMENTS.—Subparagraph (A)

5 shall only apply to a State if the State meets

6 the following requirements:

7 ‘‘(i) NO ASSET TEST.—The State does

8 not impose an asset test for eligibility

9 under the State child health plan or under

10 section 1902(l) with respect to children.

11 ‘‘(ii) COMPLIANCE WITH

12 OUTSTATIONING REQUIREMENT.—The Sec13 retary finds that the State is providing for

14 the receipt and initial processing of appli15 cations of certain individuals at facilities

16 defined as disproportionate share hospitals

17 under section 1923(a)(1)(A) and Feder18 ally-qualified health centers described in

19 section 1905(l)(2)(B) consistent with the

20 requirements of section 1902(a)(55).

21 ‘‘(iii) COMPLIANCE WITH SIMPLIFIED

22 OUTREACH AND ENROLLMENT PROVI23 SIONS.—The Secretary finds that the State

24 is providing for outreach and enrollment

25 under this title and title XIX consistent
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1 with the requirements of sections 2102(c),

2 2102(d), and 1902(a)(66).

3 ‘‘(C) LIMITATION TO 3 PERCENT OF AN4 NUAL ALLOTMENT.—Subparagraph (A) shall

5 not apply to amounts expended by a State in a

6 fiscal year in excess of 3 percent of the amount

7 of the amount of its allotment under section

8 2104 for that fiscal year.’’.

9 (3) EFFECTIVE DATE.—The amendments made

10 by this subsection take effect on the date of the en11 actment of this Act and apply to expenditures made

12 on or after the date of the enactment of this Act.

13 (c) ADDITIONAL ENTITIES QUALIFIED TO DETER14 MINE MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-IN15 COME CHILDREN.—Section 1920A(b)(3)(A)(i) (42 U.S.C.

16 1396r–1a(b)(3)(A)(i)) is amended—

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

18 and

19 (2) by inserting ‘‘eligibility of a child for med20 ical assistance under the State plan under this title,

21 or eligibility of a child for child health assistance

22 under the program funded under title XXI, (III) is

23 an elementary school or secondary school, as such

24 terms are defined in section 14101 of the Elemen25 tary and Secondary Education Act of 1965 (20
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1 U.S.C. 8801), an elementary or secondary school op2 erated or supported by the Bureau of Indian Affairs,

3 a State child support enforcement agency, a child

4 care resource and referral agency, or a State office

5 or private contractor that accepts applications for or

6 administers a program funded under part A of title

7 IV or that determines eligibility for any assistance

8 or benefits provided under any program of public or

9 assisted housing that receives Federal funds, includ10 ing the program under section 8 or any other section

11 of the United States Housing Act of 1937 (42

12 U.S.C. 1437 et seq.), or (IV) any other entity the

13 State so deems’’ before the semicolon.

14 SEC. 3. FAMILY FRIENDLY COVERAGE AND ENROLLMENT.

15 (a) ASSURING COORDINATION OF PEDIATRIC PRO16 VIDERS WITHIN A FAMILY.—

17 (1) IN GENERAL.—Section 2103 (42 U.S.C.

18 1397cc) is amended by adding at the end the fol19 lowing new subsection:

20 ‘‘(g) STEPS TAKEN TO COORDINATE PROVISION OF

21 PEDIATRIC CARE WITHIN A FAMILY.—To the extent a

22 State child health plan provides coverage other than

23 through providing benefits under the State’s medicaid

24 plan under title XIX, the State child health plan—
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1 ‘‘(1) shall specify methods being used to ensure

2 that children within a family who are eligible for as3 sistance under the plan are allowed to be seen by the

4 same pediatric provider or group of pediatric pro5 viders in a manner that permits the coordinated re6 ceipt of care by children in the same family; and

7 ‘‘(2) shall include a description of such methods

8 in each annual report submitted under section

9 2108(a).’’.

10 (2) EFFECTIVE DATE.—The amendment made

11 by paragraph (1) applies on the date of the enact12 ment of this Act and to reports submitted for years

13 beginning with 2000.

14 (b) REDUCTION IN BURDEN OF ADMINISTERING

15 COST-SHARING PROVISIONS.—

16 (1) STATE RESPONSIBLE FOR ASSURING CAP

17 ON COST-SHARING NOT EXCEEDED.—Section

18 2103(e)(3) (42 U.S.C. 1397cc(e)(3)) is amended by

19 adding at the end the following new subparagraph:

20 ‘‘(C) STATE AND CONTRACTORS RESPON21 SIBLE FOR APPLYING LIMITATIONS ON COST22 SHARING.—The State child health plan shall

23 provide that responsibility for assuring compli24 ance with the limitations on cost-sharing under

25 this paragraph falls on the State and on its
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1 contractors, and not on beneficiaries and their

2 families.’’.

3 (2) STATE OPTION OF FLAT LIMIT ON OUT-OF4 POCKET EXPENDITURES.—Section 2103(e)(3)(B)

5 (42 U.S.C. 1397cc(e)(3)(B)) is amended by insert6 ing before the period at the end the following: ‘‘(or,

7 at the option of a State, a limiting amount which is

8 not greater $500)’’.

9 (3) EFFECTIVE DATE.—The amendments made

10 by this subsection take effect on the date that is 30

11 days after the date of the enactment of this Act.

12 (c) PROHIBITION OF WAITING PERIODS.—

13 (1) IN GENERAL.—Section 2102(b)(1)(B) (42

14 U.S.C. 1397bb(b)(1)(B)) is amended—

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

16 clause (i) and inserting a semicolon;

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

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

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

20 clause:

21 ‘‘(iii) shall not permit the use of any

22 mandatory waiting period (including any

23 such period in order to carry out para24 graph (3)(C)), unless the Secretary finds

25 that the imposition of such a period would
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1 not be contrary to the provisions of this

2 title.’’.

3 (2) EFFECTIVE DATE.—The amendments made

4 by paragraph (1) apply to assistance furnished on or

5 after the date of the enactment of this Act.

6 (d) GRACE PERIOD BEFORE DISENROLLMENT FOR

7 NONPAYMENT OF PREMIUMS.—

8 (1) IN GENERAL.—Section 2103(e) (42 U.S.C.

9 1397ee(e)) is amended by adding at the end the fol10 lowing new paragraph:

11 ‘‘(5) DISENROLLMENT FOR NONPAYMENT OF

12 PREMIUMS.—

13 ‘‘(A) NOTICE OF NONPAYMENT.—If a

14 State child health plan requires the payment of

15 a premium for enrollment and such a premium

16 is not paid on a timely basis, the State shall

17 provide, before terminating coverage under the

18 plan, for—

19 ‘‘(i) notice of nonpayment at such

20 time and at the beginning of the last

21 month of the State specified enrollment pe22 riod described in subparagraph (C) if the

23 premium is still unpaid at that time; and

24 ‘‘(ii) an opportunity for a hearing and

25 a grace period (described in subparagraph
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1 (B)) in which the premium may be paid

2 and no penalty will apply for the late pay3 ment.

4 ‘‘(B) GRACE PERIOD.—The grace period

5 under this subparagraph, in the case of non6 payment for a month—

7 ‘‘(i) before the last month of a State

8 specified enrollment period described in

9 subparagraph (C), is for the remainder of

10 the State specified enrollment period; or

11 ‘‘(ii) for the last month of such pe12 riod, is for a period of at least 1 month.

13 ‘‘(C) STATE SPECIFIED ENROLLMENT PE14 RIOD.—For purposes of applying this

15 paragraph—

16 ‘‘(i) the State child health plan shall

17 specify an enrollment period, which shall

18 be a period of at least 3 months; and

19 ‘‘(ii) after each such enrollment period

20 for an individual (if coverage is not termi21 nated under the plan during such period),

22 a new enrollment period (of the length

23 specified in clause (i)) shall start again for

24 the individual at the end of the previously

25 specified enrollment period.
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1 ‘‘(D) GOOD CAUSE WAIVER.—The State

2 child health plan shall establish rules allowing

3 waiver for good cause of termination of enroll4 ment for nonpayment of premiums.

5 ‘‘(E) PERMITTING APPLICATION OF WAIT6 ING PERIOD IN CERTAIN REENROLLMENT

7 CASES.—In the case of a child whose coverage

8 under a State child health plan has been termi9 nated under this paragraph for nonpayment of

10 premiums and whose period of coverage under

11 the plan without premium payment exceeded 1

12 month, the plan may require, as a condition of

13 reenrollment under the plan, a waiting period

14 that equals the number of months of such cov15 erage without premium payment, but in no case

16 may such a waiting period exceed 3 months.’’.

17 (2) EFFECTIVE DATE.—The amendment made

18 by paragraph (1) applies to disenrollments occurring

19 on or after the date that is 30 days after the date

20 of the enactment of this Act.

21 SEC. 4. EXPANDED COVERAGE OPTIONS.

22 (a) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR

23 SCHIP AND MEDICAID BENEFITS FOR CHILDREN LOS24 ING MEDICAID OR SCHIP ELIGIBILITY.—
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1 (1) LOSS OF MEDICAID ELIGIBILITY.—Section

2 1902(a)(66) (42 U.S.C. 1396a(a)(66)), as inserted

3 by section 2(a)(2), is amended—

4 (A) by striking ‘‘and’’ at the end of sub5 paragraph (B),

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

7 subparagraph (C) and inserting ‘‘; and’’; and

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

9 subparagraph:

10 ‘‘(D) the automatic assessment, in the case

11 of a child who loses eligibility for medical assist12 ance under this title on the basis of changes in

13 income, assets, or age, of whether the child is

14 eligible for benefits under title XXI.’’.

15 (2) LOSS OF SCHIP ELIGIBILITY.—Section

16 2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended by

17 redesignating subparagraphs (D) and (E) as sub18 paragraphs (E) and (F), respectively, and by insert19 ing after subparagraph (C) the following new sub20 paragraph:

21 ‘‘(D) that there is an automatic assess22 ment, in the case of a child who loses eligibility

23 for child health assistance under this title on

24 the basis of changes in income, assets, or age,
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1 of whether the child is eligible for medical as2 sistance under title XIX;’’.

3 (3) EFFECTIVE DATE.—The amendments made

4 by paragraphs (1) and (2) apply to children who lose

5 eligibility under the medicaid program under title

6 XIX, or under a State child health insurance plan

7 under title XXI, respectively, of the Social Security

8 Act on or after the date that is 30 days after the

9 date of the enactment of this Act.

10 (b) OPTIONAL COVERAGE OF LOW-INCOME, UNIN11 SURED PREGNANT WOMEN UNDER A STATE CHILD

12 HEALTH PLAN.—

13 (1) IN GENERAL.—Title XXI is amended by

14 adding at the end the following new section:

15 ‘‘SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNIN16 SURED PREGNANT WOMEN.

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

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

19 provide for coverage of pregnancy-related assistance for

20 targeted low-income pregnant women in accordance with

21 this section, but only if the State has established an in22 come eligibility level under section 1902(l)(2)(A) for

23 women described in section 1902(l)(1)(A) that is 185 per24 cent of the income official poverty line.

25 ‘‘(b) DEFINITIONS.—For purposes of this section:
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1 ‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The

2 term ‘pregnancy-related assistance’ has the meaning

3 given the term child health assistance in section

4 2110(a) as if any reference to targeted low-income

5 children were a reference to targeted low-income

6 pregnant women, except that the assistance shall be

7 limited to services related to pregnancy (which in8 clude prenatal, delivery, and postpartum services)

9 and to other conditions that may complicate preg10 nancy and shall not include prepregnancy services

11 and supplies.

12 ‘‘(2) TARGETED LOW-INCOME PREGNANT

13 WOMAN.—The term ‘targeted low-income pregnant

14 woman’ has the meaning given the term targeted

15 low-income child in section 2110(b) as if any ref16 erence to a child were deemed a reference to a

17 woman during pregnancy and through the end of the

18 month in which the 60-day period (beginning on the

19 last day of her pregnancy) ends.

20 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

21 RULES.—In the case of, and with respect to, a State pro22 viding for coverage of pregnancy-related assistance to tar23 geted low-income pregnant women under subsection (a),

24 the following special rules apply:
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1 ‘‘(1) Any reference in this title (other than sub2 section (b)) to a targeted low income child is deemed

3 to include a reference to a targeted low-income preg4 nant woman.

5 ‘‘(2) Any such reference to child health assist6 ance with respect to such women is deemed a ref7 erence to pregnancy-related assistance.

8 ‘‘(3) Any such reference to a child is deemed a

9 reference to a woman during pregnancy and the pe10 riod described in subsection (b)(2).

11 ‘‘(4) The medicaid applicable income level is

12 deemed a reference to the income level established

13 under section 1902(l)(2)(A).

14 ‘‘(5) Subsection (a) of section 2103 (relating to

15 required scope of health insurance coverage) shall

16 not apply insofar as a State limits coverage to serv17 ices described in subsection (b)(1) and the reference

18 to such section in section 2105(a)(1) is deemed not

19 to require, in such case, compliance with the require20 ments of section 2103(a).

21 ‘‘(6) There shall be no exclusion of benefits for

22 services described in subsection (b)(1) based on any

23 pre-existing condition and no waiting period (includ24 ing any waiting period imposed to carry out section

25 2102(b)(3)(C)) shall apply.
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1 ‘‘(d) NO IMPACT ON ALLOTMENTS.—Nothing in this

2 section shall be construed as affecting the amount of any

3 initial allotment provided to a State under section

4 2104(b).

5 ‘‘(e) APPLICATION OF FUNDING RESTRICTIONS.—

6 The coverage under this section (and the funding of such

7 coverage) is subject to the restrictions of section 2105(c).

8 ‘‘(f) AUTOMATIC ENROLLMENT FOR CHILDREN

9 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS10 SISTANCE.—Notwithstanding any other provision of this

11 title or title XIX, if a child is born to a targeted low-in12 come pregnant woman who was receiving pregnancy-re13 lated assistance under this section on the date of the chil14 dren’s birth, the child shall be deemed to have applied for

15 child health assistance under the State child health plan

16 and to have been found eligible for such assistance under

17 such plan (or, in the case of a State that provides such

18 assistance through the provision of medical assistance

19 under a plan under title XIX, to have applied for medical

20 assistance under such title and to have been found eligible

21 for such assistance under such title) on the date of such

22 birth and to remain eligible for such assistance until the

23 child attains 1 year of age so long as the child is a member

24 of the woman’s household and the woman remains (or

25 would remain if pregnant) eligible for such assistance.
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1 During the period in which a child is deemed under the

2 preceding sentence to be eligible for child health or med3 ical assistance, the child health or medical assistance eligi4 bility identification number of the mother shall also serve

5 as the identification number of the child, and all claims

6 shall be submitted and paid under such number (unless

7 the State issues a separate identification number for the

8 child before such period expires).’’.

9 (2) STATE OPTION TO USE ENHANCED FMAP

10 FOR COVERAGE OF ADDITIONAL PREGNANT WOMEN

11 UNDER THE MEDICAID PROGRAM.—Section 1905 (42

12 U.S.C. 1396d) is amended—

13 (A) in subsection (b), by inserting ‘‘and in

14 the case of a State plan that meets the condi15 tion described in subsections (u)(1) and

16 (u)(4)(A), with respect to expenditures de17 scribed in subsection (u)(4)(B) for the State for

18 a fiscal year’’ after ‘‘for a fiscal year,’’;

19 (B) by redesignating paragraph (4) of sub20 section (u) as paragraph (5); and

21 (C) by inserting after paragraph (3) of

22 subsection (u) the following new paragraph:

23 ‘‘(4)(A) The condition described in this subparagraph

24 for a State plan is that the plan has established an income

25 level under section 1902(l)(2)(A) with respect to individ-
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1 uals described in section 1902(l)(1)(A) that is 185 percent

2 of the income official poverty line.

3 ‘‘(B) For purposes of subsection (b), the expenditures

4 described in this paragraph are expenditures for medical

5 assistance for women described in section 1902(l)(1)(A)

6 whose income exceeds the income level established for such

7 women under section 1902(l)(2)(A)(i) as of the date of

8 the enactment of this paragraph but does not exceed than

9 185 percent of the income official poverty line.’’.

10 (3) CONFORMING AMENDMENTS.—Section

11 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is

12 amended—

13 (A) by striking ‘‘and’’ at the end of clause

14 (i);

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

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

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

18 clause:

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

20 (including a waiting period to carry out

21 paragraph (3)(C)) in the case of a targeted

22 low-income child who is pregnant, if the

23 State provides for coverage of pregnancy24 related assistance for targeted low-income
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1 pregnant women in accordance section

2 2111.’’.

3 (4) EFFECTIVE DATE.—The amendments made

4 by this subsection take effect on the date of the en5 actment of this Act and apply to allotments for all

6 fiscal years.

7 (c) CLARIFICATION OF COVERAGE UNDER VACCINE

8 FOR CHILDREN PROGRAM.—

9 (1) IN GENERAL.—Section 1928(b)(2)(A)(ii)

10 (42 U.S.C. 1396s(b)(2)(A)(ii) is amended by insert11 ing ‘‘, except that for purposes of this paragraph a

12 child who is only insured under title XXI shall be

13 considered as being not insured’’ after ‘‘not in14 sured’’.

15 (2) EFFECTIVE DATE.—The amendment made

16 by paragraph (1) shall take effect as if included in

17 the enactment of the Balanced Budget Act of 1997.

18 (d) ELIMINATION OF FUNDING OFFSET FOR EXER19 CISE OF PRESUMPTIVE ELIGIBILITY OPTION.—

20 (1) IN GENERAL.—Section 2104(d) (42 U.S.C.

21 1397dd(d)) is amended by striking ‘‘shall be reduced

22 by the sum of’’ and all that follows through ‘‘(2) the

23 amount (if any) of the payments made to that State

24 under section 1903(a) and inserting ‘‘shall be re-
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1 duced by the amount of payments under section

2 1903(a)(1)’’.

3 (2) EFFECTIVE DATE.—The amendment made

4 by paragraph (1) first applies for allotments for fis5 cal year 2000.

6 (e) PROGRAM COORDINATION WITH THE MATERNAL

7 AND CHILD HEALTH PROGRAM (TITLE V).—

8 (1) IN GENERAL.—Section 2102(b)(3) (42

9 U.S.C. 1397bb(b)(3)) is amended—

10 (A) by striking ‘‘and’’ at the end of sub11 paragraph (D);

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

13 subparagraph (E) and inserting ‘‘; and’’; and

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

15 subparagraph:

16 ‘‘(F) that operations and activities under

17 this title are developed and implemented in con18 sultation and coordination with the program op19 erated by the State under title V in areas in20 cluding outreach and enrollment, benefits and

21 services, service delivery standards, public

22 health and social service agency relationships,

23 and quality assurance and data reporting.’’.
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1 (2) CONFORMING MEDICAID AMENDMENT.—

2 Section 1902(a)(11) (42 U.S.C. 1306a(a)(11)) is

3 amended—

4 (A) by striking ‘‘and’’ before ‘‘(C)’’; and

5 (B) by inserting before the semicolon at

6 the end the following: ‘‘, and (D) provide that

7 operations and activities under this title are de8 veloped and implemented in consultation and

9 coordination with the program operated by the

10 State under title V in areas including outreach

11 and enrollment, benefits and services, service

12 delivery standards, public health and social

13 service agency relationships, and quality assur14 ance and data reporting’’.

15 (3) EFFECTIVE DATE.—The amendments made

16 by this subsection take effect on January 1, 2000.

Æ