II 

110TH CONGRESS 

1ST SESSION S. 1213 

To give States the flexibility to reduce bureaucracy by streamlining enrollment 

processes for the medicaid and State children’s health insurance programs through better linkages with programs providing nutrition and 

related assistance to low-income families. 

IN THE SENATE OF THE UNITED STATES 

APRIL 25, 2007 

Mr. LUGAR (for himself, Mr. BINGAMAN, and Mrs. LINCOLN) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To give States the flexibility to reduce bureaucracy by 

streamlining enrollment processes for the medicaid and 

State children’s health insurance programs through better linkages with programs providing nutrition and related assistance to low-income families. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Children’s Express 

5 Lane to Health Coverage Act of 2007’’. 

6 SEC. 2. FINDINGS; PURPOSE. 

7 (a) FINDINGS.—Congress finds the following: 


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1 (1) Despite gains made in recent years, 

2 9,000,000 children in the United States are unin3 sured. At least 70 percent of those children are eligi4 ble for public health insurance coverage. 

5 (2) Most low-income uninsured children are en6 rolled in nutrition and related programs that operate 

7 under income guidelines similar to those of the Med8 icaid program. In fact, 71 percent of low-income un9 insured children are in families that receive benefits 

10 through the food stamps program, the National 

11 school lunch program, or the special supplemental 

12 nutrition program for women, infants and children 

13 (commonly referred to as ‘‘WIC’’). 

14 (3) The public would be well served if Federal 

15 means-tested public programs were able to improve 

16 administrative efficiency and coordination as well as 

17 reduce unnecessary bureaucracy. 

18 (4) Uninsured children would be well served if 

19 their enrollment in a nutrition-based or other means20 tested program could serve as a gateway to health 

21 coverage. 

22 (5) Existing law already allows children to be 

23 found income eligible for WIC based on their enroll24 ment in the Medicaid program. Current law does 

25 not, however, give States adequate flexibility to 


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1 make an income determination for eligibility for the 

2 Medicaid program or the State Children’s Health In3 surance Program based on an uninsured child’s en4 rollment in WIC or another public program. 

5 (b) PURPOSE.—The purpose of this Act is to give 

6 States the flexibility to find children income eligible for 

7 the Medicaid program or State Children’s Health Insur8 ance Program based on findings that have already been 

9 made by nutrition assistance or similar public programs 

10 with comparable income standards. 

11 SEC. 3. STATE OPTION TO PROVIDE FOR SIMPLIFIED DE12 TERMINATIONS OF A CHILD’S FINANCIAL ELI13 GIBILITY FOR MEDICAL ASSISTANCE UNDER 

14 MEDICAID OR CHILD HEALTH ASSISTANCE 

15 UNDER SCHIP. 

16 (a) MEDICAID.—Section 1902(e) of the Social Secu17 rity Act (42 U.S.C. 1396a(e)) is amended by adding at 

18 the end the following: 

19 ‘‘(13)(A) At the option of the State, the plan 

20 may provide that financial or other eligibility re21 quirements (including such requirements applicable 

22 to redeterminations or renewals of eligibility) for 

23 medical assistance are met for a child who is under 

24 19 years of age (or, at State option, 20 or 21 years 

25 of age) by using a determination made within a reaVerDate Aug 31 2005 05:00 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213

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1 sonable period (as determined by the State) before 

2 its use for this purpose, of the child’s family or 

3 household income, or if applicable for purposes of 

4 determining eligibility under this title or title XXI, 

5 assets, resources, or other factual determinations 

6 (notwithstanding any other provision of law, includ7 ing section 1903(x) and section 1137(d)), by a Fed8 eral or State agency, or a public or private entity 

9 making such determination on behalf of such agen10 cy, specified by the plan, including (but not limited 

11 to) an agency administering the State program 

12 funded under part A of title IV, the Food Stamp 

13 Act of 1977, the Richard B. Russell National School 

14 Lunch Act, or the Child Nutrition Act of 1966, not15 withstanding any differences in budget unit, dis16 regard, deeming, or other methodology, but only if— 

17 ‘‘(i) the agency has fiscal liabilities or re18 sponsibilities affected or potentially affected by 

19 such determination; 

20 ‘‘(ii) the agency or entity notifies the 

21 child’s family— 

22 ‘‘(I) of the information which shall be 

23 disclosed in accordance with this subpara24 graph; and 


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1 ‘‘(II) that the information disclosed 

2 will be used solely for purposes of deter3 mining eligibility for medical assistance 

4 under this title or for child health assist5 ance under title XXI; 

6 ‘‘(iii) interagency agreements limit the use 

7 of such information to that purpose; and 

8 ‘‘(iv) the requirements of section 1939 are 

9 satisfied. 

10 ‘‘(B) Nothing in this paragraph shall be con11 strued— 

12 ‘‘(i) to authorize the denial of medical as13 sistance under this title or of child health as14 sistance under title XXI to a child who, without 

15 the application of this paragraph, would qualify 

16 for such assistance; 

17 ‘‘(ii) to relieve a State of the obligation 

18 under subsection (a)(8) to furnish medical as19 sistance with reasonable promptness after the 

20 submission of an initial application that is eval21 uated or for which evaluation is requested pur22 suant to this paragraph, including an applica23 tion that is submitted through failure to decline 

24 enrollment, as provided in subparagraph (E); 


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1 ‘‘(iii) to relieve a State of the obligation to 

2 determine, on another basis, eligibility for med3 ical assistance under this title or for child 

4 health assistance under title XXI if a child is 

5 determined ineligible for such assistance on the 

6 basis of information furnished pursuant to this 

7 paragraph; or 

8 ‘‘(iv) as rendering subparagraph (A) inap9 plicable to redeterminations or renewals of eligi10 bility. 

11 ‘‘(C) If a State applies the eligibility process de12 scribed in subparagraph (A) to individuals eligible 

13 under this title and to individuals eligible under title 

14 XXI, the State may, at its option, implement its du15 ties under subparagraphs (A) and (B) of section 

16 2102(b)(3) using either or both of the following ap17 proaches: 

18 ‘‘(i) The State may— 

19 ‘‘(I) establish a threshold percentage of the 

20 Federal poverty level (that shall exceed the in21 come eligibility level applicable for a population 

22 of individuals under this title by 30 percentage 

23 points (as a fraction of the Federal poverty 

24 level) or such other higher number of percent25 age points as the State determines reflects the 


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1 typical application of income methodologies by 

2 the non-health program and the State plan 

3 under this title); 

4 ‘‘(II) provide that, with respect to any in5 dividual within such population whom a non6 health agency determines has income that does 

7 not exceed such threshold percentage for such 

8 population, such individual meets all income re9 quirements for eligibility for medical assistance 

10 under this title (regardless of whether such in11 dividual would otherwise be determined to be el12 igible to receive such assistance); and 

13 ‘‘(III) provide that, with respect to any in14 dividual within such population whom a non15 health agency determines has income that ex16 ceeds such threshold percentage for such popu17 lation, such individual has a family income that 

18 exceeds the Medicaid applicable income level 

19 under section 2110(b)(4), regardless of whether 

20 the individual would otherwise be determined to 

21 have such a family income. 

22 In exercising the approaches under this clause, a 

23 State shall inform families whose children are en24 rolled in a State child health plan under title XXI 

25 based on having family income above the threshold 


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1 described in subclause (I) that they may qualify for 

2 medical assistance under this title and, at their op3 tion, can seek a regular eligibility determination for 

4 such assistance for their child. 

5 ‘‘(ii) Regardless of whether a State otherwise 

6 provides for presumptive eligibility under section 

7 1920A, a State may provide presumptive eligibility 

8 under this title, consistent with subsection (e) of sec9 tion 1920A, to a child who, based on a determina10 tion by a non-health agency, would qualify for child 

11 health assistance under a State child health plan 

12 under title XXI. During such presumptive eligibility 

13 period, the State may determine the child’s eligibility 

14 for medical assistance under this title, pursuant to 

15 subparagraph (A) of section 2102(b)(3), based on 

16 telephone contact with family members, access to 

17 data available in electronic or paper form, and other 

18 means of gathering information that are less bur19 densome to the family than completing an applica20 tion form on behalf of the child. The procedures de21 scribed in the previous sentence may be used regard22 less of whether the State uses similar procedures 

23 under other circumstances for purposes of deter24 mining eligibility for medical assistance under this 

25 title. 


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1 ‘‘(D) At the option of a State, the eligibility 

2 process described in subparagraph (A) may apply to 

3 an individual who is not a child. 

4 ‘‘(E)(i) At the option of a State, an individual 

5 determined to be eligible for medical assistance or 

6 child health assistance pursuant to subparagraph 

7 (A) or (C) or other procedures through which eligi8 bility is determined based on data obtained from 

9 sources other than the individual may receive med10 ical assistance under this title if such individual (or, 

11 in the case of an individual under age 19 (or if the 

12 State elects the option under subparagraph (A), age 

13 20 or 21) who is not authorized to consent to med14 ical care, the individual’s parent, guardian, or other 

15 caretaker relative) fails to decline enrollment after 

16 receiving notice of eligibility and a reasonable oppor17 tunity to decline enrollment, in which case the State 

18 (at its option) may waive any otherwise applicable 

19 requirements for signatures by or on behalf of the 

20 individual. 

21 ‘‘(ii)(I) If the application of clause (i) results in 

22 the enrollment of individuals in managed care orga23 nizations that receive capitated payments to cover 

24 some or all of the cost of providing medical assist25 ance or child health assistance, the State shall estabVerDate Aug 31 2005 05:00 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213

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1 lish mechanisms (including full or partial with2 holding of capitated payments until the managed 

3 care organization documents the provision of serv4 ices to that individual and awarding of default en5 rollment shares based in significant part on such or6 ganization’s documentation of prior services fur7 nished to default enrollees) to ensure that individ8 uals enrolled pursuant to this subparagraph do not 

9 receive fewer preventive services (including well-child 

10 and well-baby visits) than do individuals enrolled in 

11 such managed care organizations who are eligible for 

12 medical assistance on the basis of the same general 

13 eligibility category but who are not determined to be 

14 so eligible pursuant to subparagraph (A) or (C). 

15 ‘‘(II) For purposes of subclause (I), the term 

16 ‘general eligibility category’ shall be construed as in17 cluding the following categories: low-income children 

18 who are eligible for medical assistance based on fac19 tors other than disability, adults eligible for such as20 sistance because they are parents or other caretaker 

21 relatives of dependent children, and women eligible 

22 for such assistance because of pregnancy. 

23 ‘‘(iii) In the case of an individual enrolled pur24 suant to clause (i), the State shall inform the indi25 vidual (or, in the case of an individual under age 18, 


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1 the individual’s parent, guardian, or other caretaker 

2 relative) about the significance of such enrollment, 

3 including appropriate methods to access covered 

4 services. 

5 ‘‘(iv) In the case of an individual enrolled pur6 suant to clause (i) who is charged premiums and 

7 who does not use any health care services during the 

8 first 90 days following enrollment, enrollment shall 

9 be considered declined if such individual fails to pay 

10 premiums during that 90 day period, in which case 

11 no financial liability or penalty may apply to such 

12 individual. Such an individual shall be sent a notice 

13 explaining the disenrollment and offering an oppor14 tunity to reenroll. 

15 ‘‘(F) For purposes of this paragraph— 

16 ‘‘(i) the term ‘non-health agency’ means an 

17 agency or entity described in subparagraph (A); 

18 and 

19 ‘‘(ii) the term ‘non-health benefits’ means 

20 the benefits or assistance provided by a non21 health agency.’’. 

22 (b) SCHIP.—Section 2107(e)(1) of the Social Secu23 rity Act (42 U.S.C. 1397gg(e)(1)) is amended by adding 

24 at the end the following: 


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1 ‘‘(E) Section 1902(e)(13) (relating to the 

2 State option to base a determination of a child’s 

3 eligibility for assistance on determinations made 

4 by a non-health agency administering a pro5 gram providing nutrition or other public assist6 ance (except that the State option under sub7 paragraph (D) of such section shall apply under 

8 this title only if an individual is pregnant)).’’. 

9 (c) PRESUMPTIVE ELIGIBILITY.— 

10 (1) IN GENERAL.—Section 1920A of the Social 

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

12 (A) in subsection (b)(3)(A)(i)(II) is amend13 ed— 

14 (i) by striking ‘‘or’’ before ‘‘eligibility 

15 of a child for child health assistance’’; and 

16 (ii) by inserting ‘‘or is an agency or 

17 entity described in section 

18 1902(e)(13)(A),’’ before ‘‘(III)’’; 

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

20 ‘‘(e) In the case of a State with a child health plan 

21 under title XXI that provides for presumptive eligibility 

22 under such plan and under this title, the State shall place 

23 each presumptively eligible child in the program under this 

24 title or title XXI for which the child appears most likely 

25 to qualify. During the child’s period of presumptive eligiVerDate Aug 31 2005 05:00 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213

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1 bility, the State shall receive Federal matching funds 

2 under section 1903 or section 2105, depending on the pro3 gram in which the child has been placed. If at the conclu4 sion of such period, the child is found to qualify for, and 

5 is enrolled in, the program established under this title or 

6 title XXI when the child was enrolled in the program 

7 under the other such title during such period, the State’s 

8 receipt of Federal matching funds shall be adjusted both 

9 retroactively and prospectively so that Federal matching 

10 funds are provided, both during and following such period 

11 of presumptive eligibility, based on the program in which 

12 the child is enrolled following the conclusion of the pre13 sumptive eligibility period.’’. 

14 (2) PAYMENT FOR PRESUMPTIVE ELIGIBILITY

15 FOR CHILDREN FROM THE MEDICAID OR SCHIP PRO16 GRAM IN WHICH THE CHILD IS ENROLLED.— 

17 (A) IN GENERAL.—Section 2105(a)(1)of 

18 such Act (42 U.S.C. 1397ee(a)(1)) is amend19 ed— 

20 (i) by striking subparagraph (B) and 

21 inserting the following: 

22 ‘‘(B) at State option, for the provision of 

23 medical assistance to a child described in sec24 tion 1902(a)(10)(A)(ii)(XIV) during a period of 


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1 presumptive eligibility under section 1920A;’’; 

2 and 

3 (ii) in subparagraph (C), by inserting 

4 ‘‘, including child health assistance pro5 vided during a period of presumptive eligi6 bility in accordance with section 

7 2107(e)(1)(D)’’ after ‘‘2103’’. 

8 (B) RULE OF CONSTRUCTION.—Section 

9 2105(a)(1)(B) of such Act (42 U.S.C. 

10 1397ee(a)(1)(B)), as amended by subparagraph 

11 (A)(i), shall not be construed as affecting in 

12 any way the application of section 1920A(d) of 

13 such Act (42 U.S.C. 1396r–1a(d)) for purposes 

14 of making payments to States under section 

15 1903 of such Act (42 U.S.C. 1396b) for med16 ical assistance provided during a period of pre17 sumptive eligibility in accordance with section 

18 1920A of such Act (42 U.S.C. 1396r–1a). 

19 (d) SIGNATURE REQUIREMENTS.—Section 1902(a) 

20 of such Act (42 U.S.C. 1396a(a)) is amended by adding 

21 at the end the following: ‘‘Notwithstanding any other pro22 vision of law, a signature under penalty of perjury shall 

23 not be required on an application form for medical assist24 ance as to any element of eligibility for which eligibility 

25 is based on information received from a source other than 


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1 applicant, rather than on representations from the appli2 cant. Notwithstanding any other provision of law, any sig3 nature requirement for an application for medical assist4 ance may be satisfied through an electronic signature, as 

5 defined in section 1710(1) of the Government Paperwork 

6 Elimination Act (44 U.S.C. 3504 note).’’. 

7 SEC. 4. INVESTMENTS TO PROMOTE ADMINISTRATIVE EF8 FICIENCY. 

9 (a) MANAGEMENT INFORMATION SYSTEMS.— 

10 (1) IN GENERAL.—Section 1903(a)(3)(A)(i) of 

11 the Social Security Act (42 U.S.C. 

12 1396b(a)(3)(A)(i)) is amended by inserting ‘‘(includ13 ing technology that enables inter-program connec14 tions, as defined in section 1905(y), and other tech15 nology that reduces the number of individuals who 

16 are inaccurately granted eligibility, that increases 

17 the number of individuals who are accurately grant18 ed eligibility, or that improves the efficiency of eligi19 bility determinations, under this title or title XXI)’’ 

20 after ‘‘mechanized claims processing and information 

21 retrieval systems’’. 

22 (2) INTER-PROGRAM CONNECTIONS DEFINED.— 

23 Section 1905 of such Act (42 U.S.C. 1396d) is 

24 amended by adding at the end the following: 


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1 ‘‘(y)(1) For purposes of section 1903(a)(3)(A)(i), the 

2 term ‘technology that enables inter-program connections’ 

3 means information technology (including software and 

4 hardware) that connects systems for determining eligi5 bility or storing eligibility-related data pursuant to this 

6 title or title XXI to other sources of data potentially perti7 nent to eligibility determinations under this title or title 

8 XXI, including— 

9 ‘‘(A) eligibility files maintained by programs de10 scribed in section 1902(e)(13)(A); 

11 ‘‘(B) information described in paragraph (2) or 

12 (3) of section 1137(a); 

13 ‘‘(C) vital records information about births in 

14 any State; and 

15 ‘‘(D) information described in sections 453(i) 

16 and 1902(a)(25)(I)(i). 

17 ‘‘(2) The technology described in paragraph (1) in18 cludes systems and activities involved in preparing, trans19 mitting, processing, matching, analyzing, inputting, and 

20 storing information from the other sources of data de21 scribed in that paragraph.’’. 

22 (b) AUTHORIZATION OF INFORMATION DISCLO23 SURE.— 

24 (1) IN GENERAL.—Title XIX of the Social Se25 curity Act (42 U.S.C. 1396 et seq.) is amended— 


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1 (A) by redesignating section 1939 as sec2 tion 1940; and 

3 (B) by inserting after section 1938 the fol4 lowing: 

5 ‘‘SEC. 1939. AUTHORIZATION TO RECEIVE PERTINENT IN6 FORMATION. 

7 ‘‘(a) IN GENERAL.—Notwithstanding any other pro8 vision of law, a Federal, State, or local agency or private 

9 entity in possession of the other sources of data described 

10 in section 1905(y) or the information described in section 

11 453(i) or 1902(a)(25)(I)(i) is authorized to convey such 

12 data or information to a person directly connected with 

13 the administration or enforcement of a State plan under 

14 this title or title XXI, consistent with the succeeding provi15 sions of this section. 

16 ‘‘(b) REQUIREMENTS FOR CONVEYANCE.—Data or 

17 information may be conveyed pursuant to this section only 

18 if the following requirements are met: 

19 ‘‘(1) The individual whose circumstances are 

20 described in the data or information (or such indi21 vidual’s parent, guardian, caretaker relative, or au22 thorized representative) has either provided advance 

23 consent to disclosure or has not objected to disclo24 sure after receiving advance notice of disclosure and 

25 a reasonable opportunity to object. 


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1 ‘‘(2) Such data or information are used solely 

2 for the purposes of— 

3 ‘‘(A) identifying individuals who are eligi4 ble or potentially eligible for assistance under 

5 this title or title XXI and enrolling such indi6 viduals in the State plans established under 

7 such titles; and 

8 ‘‘(B) verifying the eligibility of individuals 

9 for assistance under the State plans established 

10 under this title or title XXI. 

11 ‘‘(3) An interagency or other agreement, con12 sistent with standards developed by the Secretary— 

13 ‘‘(A) prevents the unauthorized use, disclo14 sure, or modification of such data and other15 wise meets applicable Federal requirements 

16 safeguarding privacy and data security; and 

17 ‘‘(B) requires the State agencies admin18 istering the State plans established under this 

19 title and title XXI to use the data and informa20 tion obtained under this section to seek to en21 roll individuals in such plans. 

22 ‘‘(c) CRIMINAL PENALTY.—A person described in the 

23 subsection (a) who publishes, divulges, discloses, or makes 

24 known in any manner, or to any extent not authorized by 

25 Federal law, any information obtained under this section 


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1 shall be fined not more than $1,000 or imprisoned not 

2 more than 1 year, or both. 

3 ‘‘(d) RULE OF CONSTRUCTION.—The limitations and 

4 requirements that apply to disclosure pursuant to this sec5 tion shall not be construed to prohibit the conveyance or 

6 disclosure of data or information otherwise permitted 

7 under Federal law (without regard to this section).’’. 

8 (2) CONFORMING AMENDMENT TO ASSURE AC9 CESS TO NATIONAL NEW HIRES DATABASE.—Section 

10 453(i)(1) of such Act (42 U.S.C. 653(i)(1)) is 

11 amended— 

12 (A) by striking ‘‘and programs’’ and in13 serting ‘‘, programs’’; and 

14 (B) by inserting ‘‘and State plans ap15 proved under title XIX or XXI’’ after ‘‘part 

16 A,’’. 

17 (3) CONFORMING AMENDMENT TO PROVIDE

18 SCHIP PROGRAMS WITH ACCESS TO NATIONAL IN19 COME DATA.—Section 6103(l)(7)(D)(ii) of the Inter20 nal Revenue Code of 1986 is amended by inserting 

21 ‘‘or title XXI’’ after ‘‘title XIX’’. 

22 (4) CONFORMING AMENDMENT TO PROVIDE AC23 CESS TO DATA ABOUT ENROLLMENT IN PRIVATE IN24 SURANCE.—Section 1902(a)(25)(I)(i) of the Social 


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1 Security Act (42 U.S.C. 1396a(a)(25)(I)(i)) is 

2 amended— 

3 (A) by inserting ‘‘(and, at State option, in4 dividuals who are potentially eligible or who 

5 apply)’’ after ‘‘with respect to individuals who 

6 are eligible’’; and 

7 (B) by inserting ‘‘under this title (and, at 

8 State option, child health assistance under title 

9 XXI)’’ after ‘‘the State plan’’. 

10 SEC. 5. EFFECTIVE DATE. 

11 The amendments made by this Act take effect on Oc12 tober 1, 2007. 

Æ 


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