I 

110TH CONGRESS 

1ST SESSION H. R. 1535 

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

every child in the United States has access to affordable, quality health 

insurance coverage, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 15, 2007 

Mr. DINGELL (for himself, Ms. DEGETTE, Mr. PALLONE, Mr. WAXMAN, Ms. 

BALDWIN, Mr. ENGEL, Ms. SCHAKOWSKY, Mr. BOUCHER, Ms. ESHOO, 

Mr. GENE GREEN of Texas, Mr. GONZALEZ, Mr. GORDON of Tennessee, 

Mrs. CAPPS, Mr. BUTTERFIELD, Mr. MARKEY, Mr. WEINER, Mr. ALLEN, 

Mr. WYNN, Mr. MELANCON, Ms. MATSUI, Mr. MCNULTY, Ms. HIRONO, 

and Mr. ROSS) introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to ensure that every child in the United States has 

access to affordable, quality health insurance coverage, 

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; AMENDMENTS TO SOCIAL SECU4 RITY ACT; TABLE OF CONTENTS. 

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

6 ‘‘Children’s Health First Act’’. 


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1 (b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex2 cept as otherwise specifically provided, whenever in this 

3 Act an amendment is expressed in terms of an amendment 

4 to or repeal of a section or other provision, the reference 

5 shall be considered to be made to that section or other 

6 provision of the Social Security Act. 

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

8 this Act is as follows: 

Sec. 1. Short title; amendments to Social Security Act; table of contents. 

TITLE I—OPTIONS FOR AFFORDABLE COVERAGE FOR ALL 

CHILDREN 

Subtitle A—Expanded Coverage of Children Under SCHIP and Through 

Employer-Sponsored Coverage 

Sec. 101. State option to expand coverage of children under SCHIP. 

Sec. 102. Authority for States to offer purchase of coverage for uncovered children under SCHIP. 

Sec. 103. Support for employment-based coverage of children eligible for 

SCHIP or Medicaid. 

Sec. 104. Modification of prohibition on coverage of children of State employees. 

Subtitle B—Ensuring Dependable Coverage for All Children 

Sec. 111. Improving benchmark coverage options. 

Sec. 112. Requiring coverage of EPSDT services, including dental services, and 

federally-qualified health services and improving coverage of 

additional categories of services. 

Sec. 113. Clarification of requirement to provide EPSDT services for all children in benchmark benefit packages under Medicaid. 

Sec. 114. Medicaid-SCHIP Payment Advisory Commission. 

Subtitle C—Ensuring a Fair Partnership 

Sec. 121. Increase in FMAP for medical assistance for children for States that 

expand coverage of children. 

Subtitle D—State Options for Additional Coverage Expansions 

Sec. 131. Optional coverage of older children under Medicaid and SCHIP. 

Sec. 132. Optional coverage of legal immigrants under the Medicaid program 

and SCHIP. 

Sec. 133. State option to expand or add coverage of certain pregnant women 

under SCHIP. 

TITLE II—REMOVAL OF OTHER BARRIERS TO COVERAGE 


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Sec. 201. Establishment of new base SCHIP allotments that are responsive to 

increases in health care costs and enrollment expansions. 

Sec. 202. 2-year initial availability of SCHIP allotments. 

Sec. 203. Redistribution of unused allotments to address State funding shortfalls. 

Sec. 204. Incentives for school-based outreach and enrollment. 

Sec. 205. Medicaid citizenship documentation requirements. 

Sec. 206. State option to provide for ‘‘express lane’’ and simplified determinations of a child’s financial eligibility for medical assistance 

under Medicaid or child health assistance under SCHIP. 

Sec. 207. Information technology connections to improve health coverage determinations. 

Sec. 208. Encouraging culturally appropriate enrollment practices. 

Sec. 209. Model of Interstate coordinated enrollment and coverage process. 

Sec. 210. Elimination of counting medicaid child presumptive eligibility costs 

against title XXI allotment. 

Sec. 211. Authority for qualifying States to use portion of SCHIP allotment for 

any fiscal year for certain medicaid expenditures. 

Sec. 212. Application of Medicaid outreach procedures to all pregnant women 

and children. 

TITLE III—EFFECTIVE DATE 

Sec. 301. Effective date. 

1 TITLE I—OPTIONS FOR AFFORD2 ABLE COVERAGE FOR ALL 

3 CHILDREN 

4 Subtitle A—Expanded Coverage of 

5 Children Under SCHIP and 

6 Through Employer-Sponsored 

7 Coverage 

8 SEC. 101. STATE OPTION TO EXPAND COVERAGE OF CHIL9 DREN UNDER SCHIP. 

10 (a) OPTION FOR COVERAGE OF CHILDREN UP TO 400 

11 PERCENT OF POVERTY LINE.—Section 2110(c)(4) (42 

12 U.S.C. 1397jj(c)(4)) is amended by inserting ‘‘(or, at the 

13 option of the State, any percentage up to 400 percent)’’ 

14 after ‘‘200 percent’’. 


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1 (b) ENSURING FUNDING FOR STATE ELIGIBILITY

2 EXPANSION.— 

3 (1) IN GENERAL.—Section 2105 (42 U.S.C. 

4 1397dd) is amended by adding at the end the fol5 lowing new subsection: 

6 ‘‘(i) FUNDING FOR CHILD HEALTH ASSISTANCE FOR

7 COVERAGE EXPANSION STATES.— 

8 ‘‘(1) IN GENERAL.—Notwithstanding section 

9 2104, in the case of a State that has elected the op10 tion under section 2110(c)(4) to apply for a calendar 

11 quarter in a fiscal year a percentage that is 400 per12 cent and that meets the requirement of paragraph 

13 (2) (relating to no limitation on enrollment), the al14 lotment determined for the State for such fiscal year 

15 under section 2104 shall be increased by such sums 

16 as are necessary for making payments to the State 

17 for expenditures described in subsection (a)(1). 

18 ‘‘(2) NO LIMITATION ON ENROLLMENT.—The 

19 requirement of this paragraph with respect to a 

20 State for a calendar quarter is that the State does 

21 not impose, with respect to the enrollment under the 

22 State child health plan of targeted low-income chil23 dren during the quarter, any enrollment cap or other 

24 numerical limitation on enrollment, any waiting list, 

25 any procedures designed to delay the consideration 


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1 of applications for enrollment, or similar limitation 

2 with respect to enrollment. 

3 ‘‘(3) APPROPRIATION.—There is appropriated, 

4 out of any money in the Treasury not otherwise ap5 propriated, such sums as may be necessary for the 

6 purpose of paying a State described in paragraph 

7 (1) for each calendar quarter described in such para8 graph, an amount equal to the enhanced FMAP of 

9 expenditures described in such paragraph and in10 curred during such quarter.’’. 

11 (2) CONFORMING AMENDMENTS.—Section 2104 

12 (42 U.S.C. 1397dd) is amended— 

13 (A) in subsection (a), by striking ‘‘sub14 section (d)’’ and inserting ‘‘ subsections (d) and 

15 (h) and section 2105(i)’’; 

16 (B) in subsection (b)(1), by striking ‘‘sub17 section (d)’’ and inserting ‘‘ subsections (d) and 

18 (h) and section 2105(i)’’; and 

19 (C) in subsection (c)(1), by striking ‘‘sub20 section (d)’’ and inserting ‘‘ subsections (d) and 

21 (h) and section 2105(i)’’. 


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1 SEC. 102. AUTHORITY FOR STATES TO OFFER PURCHASE 

2 OF COVERAGE FOR UNCOVERED CHILDREN 

3 UNDER SCHIP. 

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

5 seq.) is amended by adding at the end the following new 

6 section: 

7 ‘‘SEC. 2111. AUTHORITY FOR STATES TO OFFER PURCHASE 

8 OF COVERAGE FOR UNCOVERED CHILDREN 

9 WHO ARE NOT OTHERWISE ELIGIBLE FOR AS10 SISTANCE UNDER SCHIP OR MEDICAID. 

11 ‘‘(a) AUTHORITY TO OFFER PURCHASE OF COV12 ERAGE.— 

13 ‘‘(1) OPTION FOR STATES WITH INCOME ELIGI14 BILITY LEVEL OF AT LEAST 200, BUT NOT 400, PER15 CENT.—Subject to the succeeding provisions of this 

16 section, in the case of a State that meets the re17 quirement of section 2105(i)(2) for a calendar quar18 ter and that has elected to apply an income eligi19 bility level under section 2110(c)(4) that is at least 

20 200 percent, but not 400 percent, of the poverty line 

21 for the calendar quarter, the State may permit dur22 ing the calendar quarter the purchase of coverage 

23 under this title by families, employers, or others 

24 (under the same terms of the plan that apply to tar25 geted low-income children) for an uncovered child 


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1 who would be eligible to be a targeted low-income 

2 child but whose family income exceeds such level. 

3 ‘‘(2) REQUIREMENT FOR STATES WITH 400 PER4 CENT INCOME ELIGIBILITY LEVEL.—In the case of a 

5 State that meets the requirement of section 

6 2105(i)(2) for a calendar quarter and that has elect7 ed to apply an income eligibility level under section 

8 2110(c)(4) that is 400 percent of the poverty line 

9 for the calendar quarter, the State shall permit dur10 ing the quarter the purchase of coverage described 

11 in paragraph (1). 

12 ‘‘(b) COMMUNITY-RATED, ACTUARIALLY BASED

13 PREMIUM.—The premium imposed for coverage of a child 

14 pursuant to subsection (a) shall not exceed a community15 rated premium that reflects the actuarial average cost of 

16 providing coverage under the State child health plan to 

17 enrollees who are children. 

18 ‘‘(c) STATE OPTION REGARDING LIMITATION ON

19 COST-SHARING.— 

20 ‘‘(1) IN GENERAL.—In the case of children cov21 ered under the plan by reason of purchasing such 

22 coverage pursuant to subsection (a), the State may 

23 elect in applying the limitation on cost-sharing de24 scribed in section 2103(e)(3)(B) (including to chil25 dren who are provided benefits in the manner deVerDate Aug 31 2005 00:50 Mar 17, 2007 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1535.IH H1535

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1 scribed in section 2103(e)(4)) not to apply such limi2 tation with respect to some or all of the premiums 

3 imposed for the purchase of such coverage. 

4 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

5 paragraph (1) shall be construed as prohibiting an 

6 employer from providing an employee with financial 

7 benefits to offset the cost of premiums and cost8 sharing imposed with respect to the purchase of cov9 erage of a child pursuant to subsection (a). 

10 ‘‘(d) NO FEDERAL MATCHING PAYMENT AVAIL11 ABLE.—No payments shall be made under section 2105(a) 

12 (other than under clauses (iii) and (iv) of paragraph 

13 (1)(D)) with respect to child health assistance provided 

14 under the State child health plan to children covered 

15 under the plan by reason of purchasing such coverage pur16 suant to this section.’’. 

17 (b) CONFORMING AMENDMENTS.— 

18 (1) Section 2110(b)(1)(B) (42 U.S.C. 

19 1397jj(b)(1)(B)) is amended— 

20 (A) in clause (i), by striking ‘‘or’’ at the 

21 end; 

22 (B) in clause (ii), in the matter before sub23 clause (I), by inserting ‘‘who’’ before ‘‘is’’; 

24 (C) in clause (ii)(III), by striking ‘‘and’’ 

25 and inserting ‘‘or’’; and 


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1 (D) by adding at the end the following new 

2 clause: 

3 ‘‘(iii) who is a child with respect to whom 

4 coverage is purchased under section 2111(a); 

5 and’’. 

6 (2) Section 2103(e) (42 U.S.C. 1397cc) is 

7 amended— 

8 (A) in paragraph (3)(B), by striking ‘‘and 

9 (2)’’ and inserting ‘‘, (2), and section 2111(d)’’; 

10 and 

11 (B) in paragraph (4), by striking ‘‘Noth12 ing’’ and inserting ‘‘Subject to 2111(d)(2), 

13 nothing’’. 

14 SEC. 103. SUPPORT FOR EMPLOYMENT-BASED COVERAGE 

15 OF CHILDREN ELIGIBLE FOR SCHIP OR MED16 ICAID. 

17 (a) SUBSIDIES FOR EMPLOYMENT-BASED COV18 ERAGE.— 

19 (1) UNDER SCHIP.—Section 2105 (42 U.S.C. 

20 1397ee) is amended— 

21 (A) in subsection (a)(1)(D)— 

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

23 clause (iii); 

24 (ii) by redesignating clause (iv) as 

25 clause (v); and 


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1 (iii) by inserting after clause (iii) the 

2 following new clause: 

3 ‘‘(iv) payments for employment-based 

4 coverage under subsection (c)(2)(C); and’’; 

5 (B) in subsection (c)(2)(A), by inserting 

6 ‘‘(other than under clause (iv) of such para7 graph)’’ after ‘‘of such subsection’’; and 

8 (C) in subsection (c)(2), by adding at the 

9 end the following new subparagraph: 

10 ‘‘(C) SUBSIDIES FOR EMPLOYMENT-BASED

11 COVERAGE.— 

12 ‘‘(i) IN GENERAL.—In the case of a 

13 State that has elected the option under 

14 section 2110(c)(4) to apply for a calendar 

15 quarter a percentage that is 400 percent 

16 and that meets the requirement of sub17 section (i)(2) for the calendar quarter, sub18 ject to clause (ii), the limitation under sub19 paragraph (A) on expenditures shall not 

20 apply to a payment for the provision of 

21 health benefits coverage during the cal22 endar quarter under a group health plan 

23 for an employer premium assistance eligi24 ble child (and to supplemental benefits de25 scribed in subclause (II)) if the State demVerDate Aug 31 2005 00:50 Mar 17, 2007 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1535.IH H1535

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1 onstrates to the satisfaction of the Sec2 retary that— 

3 ‘‘(I) the actuarial value of the 

4 health benefits coverage (as deter5 mined pursuant to section 2103(c)(4)) 

6 is at least equal to the actuarial value 

7 of the child health assistance provided 

8 under the State child health plan for 

9 children with the same (or com10 parable) family income and the group 

11 health plan does not discriminate in 

12 its coverage of employer premium as13 sistance eligible children on the basis 

14 of health status; and 

15 ‘‘(II) the State will provide sup16 plemental benefits for employer pre17 mium assistance eligible children 

18 under the State child health plan in 

19 accordance with section 2110(b)(5) in 

20 order that such supplemental benefits, 

21 in combination with such coverage, 

22 provides the same benefits as would 

23 be available under the child health 

24 plan to the child if section 


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1 2110(b)(1)(C) did not apply to the 

2 child. 

3 ‘‘(ii) LIMITATION ON FEDERAL

4 MATCHING PAYMENTS.—No payment shall 

5 be made under subsection (a) with respect 

6 to a payment described in clause (i) for 

7 coverage of a child insofar as the payment 

8 exceeds 50 percent of the amount of ex9 penditures that the State would have oth10 erwise incurred for providing child health 

11 assistance for such child if the child were 

12 a targeted low-income child. 

13 ‘‘(iii) EMPLOYER PREMIUM ASSIST14 ANCE ELIGIBLE CHILD DEFINED.—For 

15 purposes of clause (i), the term ‘employer 

16 premium assistance eligible child’ means a 

17 child who is covered under a group health 

18 plan, who is not eligible for medical assist19 ance under the State plan under title XIX, 

20 and who would satisfy the requirements for 

21 being a targeted low-income child under 

22 the State child health plan if the condition 

23 described in subparagraph (C) of section 

24 2110(b)(1) did not apply.’’. 


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1 (2) REFERENCE TO EXISTING MEDICAID AU2 THORITY.—For provisions relating to authority of 

3 State Medicaid plan to provide payment to employ4 ers for enrollment of Medicaid-eligible children in a 

5 group health plan, and requiring the continued pro6 vision of medical assistance to supplement coverage 

7 under such plan, see section 1906 of the Social Se8 curity Act (42 U.S.C. 1396e). 

9 (b) STATE PROVISION OF SUPPLEMENTAL SCHIP 

10 BENEFITS IN CASE OF CHILDREN COVERED UNDER

11 GROUP HEALTH PLANS.— 

12 (1) IN GENERAL.—Section 2110(b) (42 U.S.C. 

13 1397jj(b)) is amended— 

14 (A) in paragraph (1)(C), by inserting ‘‘, 

15 subject to paragraph (5),’’ after ‘‘under title 

16 XIX or’’; and 

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

18 paragraph: 

19 ‘‘(5) STATE PROVISION OF SUPPLEMENTAL

20 BENEFITS IN CASE OF CHILDREN COVERED UNDER

21 GROUP HEALTH PLANS.— 

22 ‘‘(A) REQUIREMENT FOR CHILDREN EN23 ROLLED UNDER SUBSIDIZED EMPLOYMENT24 BASED COVERAGE.—In the case of a State that 

25 provides payment under section 2105(c)(2)(C) 


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1 for health benefits coverage for a child enrolled 

2 in a group health plan, the requirement of 

3 paragraph (1)(C) shall not apply to such child, 

4 but the child health assistance under this title 

5 shall be limited to— 

6 ‘‘(i) benefits for items or services that 

7 are not covered, or are only partially cov8 ered, under such plan; and 

9 ‘‘(ii) protection against incurring out10 of-pocket costs (including premiums) in ex11 cess of the limitations otherwise applicable 

12 to a targeted low-income child with the 

13 same family income. 

14 ‘‘(B) OPTION FOR OTHER CHILDREN.— 

15 For children not described in subparagraph (A), 

16 a State may waive the requirement of para17 graph (1)(C), with respect to children within 

18 one or more classes or categories of children 

19 specified by the State, in the case of a child 

20 covered under a group health plan in order to 

21 provide child health assistance— 

22 ‘‘(i) for items or services that are not 

23 covered, or are only partially covered, 

24 under such plan; or 


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1 ‘‘(ii) to protect against incurred out2 of-pocket costs (including premiums) ex3 ceeding the limitations otherwise applicable 

4 to a targeted low-income child with the 

5 same family income. 

6 ‘‘(C) ELIGIBILITY.—In applying subpara7 graph (B), a State may limit the application of 

8 the waiver under such subparagraph to children 

9 whose family income does not exceed a level 

10 specified by the State, which may not exceed 

11 the maximum income level otherwise established 

12 for other children under the State child health 

13 plan. 

14 ‘‘(D) CONTINUED APPLICATION OF DUTY

15 TO PREVENT SUBSTITUTION OF EXISTING COV16 ERAGE.—Nothing in this paragraph shall be 

17 construed as modifying the application of sec18 tion 2102(b)(3)(C) to a State.’’. 

19 (2) APPLICATION OF ENHANCED MATCH UNDER

20 MEDICAID.—Section 1905 (42 U.S.C. 1396d) is 

21 amended— 

22 (A) in subsection (b), in the fourth sen23 tence, by striking ‘‘subsection (u)(3)’’ and in24 serting ‘‘(u)(3), or (u)(4)’’; and 


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1 (B) in subsection (u), by redesignating 

2 paragraph (4) as paragraph (5) and by insert3 ing after paragraph (3) the following new para4 graph: 

5 ‘‘(4) For purposes of subsection (b), the expenditures 

6 described in this paragraph are expenditures for items and 

7 services for children described in section 2110(b)(5).’’. 

8 (3) APPLICATION OF SECONDARY PAYOR PROVI9 SIONS.—Section 2107(e)(1) (42 U.S.C. 

10 1397gg(e)(1)) is amended— 

11 (A) by redesignating subparagraphs (B) 

12 through (D) as subparagraphs (C) through (E), 

13 respectively; and 

14 (B) by inserting after subparagraph (A) 

15 the following new subparagraph: 

16 ‘‘(B) Section 1902(a)(25) (relating to co17 ordination of benefits and secondary payor pro18 visions) with respect to benefits provided under 

19 section 2110(b)(5).’’. 

20 SEC. 104. MODIFICATION OF PROHIBITION ON COVERAGE 

21 OF CHILDREN OF STATE EMPLOYEES. 

22 Section 2110(b)(2)(B) (42 U.S.C. 1397jj(b)(2)) is 

23 amended— 

24 (1) by striking ‘‘is eligible’’ and inserting 

25 ‘‘would be eligible’’; and 


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1 (2) by inserting ‘‘(as in effect on March 1, 

2 2007)’’ after ‘‘plan’’. 

3 Subtitle B—Ensuring Dependable 

4 Coverage for All Children 

5 SEC. 111. IMPROVING BENCHMARK COVERAGE OPTIONS. 

6 (a) LIMITATION ON USE OF SECRETARY-APPROVED

7 COVERAGE.—Section 2103(a)(4) (42 U.S.C. 

8 1397cc(a)(4)) is amended by striking the period at the end 

9 and inserting ‘‘, but only if such determination was made 

10 before March 1, 2007.’’. 

11 (b) REQUIREMENT FOR MOST POPULAR FAMILY

12 COVERAGE FOR STATE EMPLOYEE COVERAGE BENCH13 MARK.—Section 2103(b)(2) (42 U.S.C. 1397(b)(2)) is 

14 amended— 

15 (1) by striking ‘‘A health benefits coverage 

16 plan’’ and inserting ‘‘The health benefits coverage 

17 plan’’; and 

18 (2) by inserting ‘‘and that has been selected the 

19 most, by employees seeking dependent coverage, 

20 among such plans that provide such dependent cov21 erage, in either of the previous 2 plan years’’ before 

22 the period. 


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1 SEC. 112. REQUIRING COVERAGE OF EPSDT SERVICES, IN2 CLUDING DENTAL SERVICES, AND FEDER3 ALLY-QUALIFIED HEALTH SERVICES AND IM4 PROVING COVERAGE OF ADDITIONAL CAT5 EGORIES OF SERVICES. 

6 (a) ADDITIONAL REQUIRED SERVICES.— 

7 (1) REQUIRED COVERAGE OF EPSDT SERVICES, 

8 INCLUDING DENTAL SERVICES.—Section 2103(c) 

9 (42 U.S.C. 1397cc(c)) is amended— 

10 (A) by redesignating paragraph (5) as 

11 paragraph (6); and 

12 (B) by inserting after paragraph (4), the 

13 following: 

14 ‘‘(5) OTHER REQUIRED SERVICES.—The child 

15 health assistance provided to a targeted low-income 

16 child shall include coverage of the following: 

17 ‘‘(A) EPSDT SERVICES, INCLUDING DEN18 TAL SERVICES.—Early and periodic screening, 

19 diagnostic, and treatment services described in 

20 subsections (a)(4)(B) and (r) of section 1905 

21 and provided in accordance with section 

22 1903(a)(43) (including dental services that are 

23 necessary to prevent disease and promote oral 

24 health, restore oral structures to health and 

25 function, and treat emergency conditions).’’. 


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1 (2) REQUIRED COVERAGE OF FQHC AND RHC

2 SERVICES.—Section 2103(c)(5) (42 U.S.C. 

3 1397cc(c)(5)) (as added by subsection (a)), is 

4 amended by adding at the end the following: 

5 ‘‘(B) FQHC AND RHC SERVICES.—Feder6 ally-qualified health center services (as defined 

7 in section 1905(l)(2)) and rural health clinic 

8 services (as defined in section 1905(l)(1)).’’. 

9 (3) ASSURING ACCESS TO CARE.— 

10 (A) STATE CHILD HEALTH PLAN REQUIRE11 MENT.—Section 2102(a)(7)(B) (42 U.S.C. 

12 1397bb(c)(2)) is amended by inserting ‘‘and 

13 services described in section 2103(c)(5)’’ after 

14 ‘‘emergency services’’. 

15 (B) ANNUAL REPORT.—Section 2108(a)(1) 

16 (42 U.S.C. 1397hh(a)(1)) is amended— 

17 (i) by striking ‘‘including the 

18 progress’’ and inserting ‘‘including— 

19 ‘‘(A) the progress’’; and 

20 (ii) by adding at the end the fol21 lowing: 

22 ‘‘(B) the extent to which the operation of 

23 such plan ensures access, comparable to access 

24 under employer-sponsored or other private 

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1 erally-qualified health center services (as de2 fined in section 1905(l) (2)) and rural health 

3 clinic services (as defined in section 1905(l)(1)), 

4 access comparable to the access to such services 

5 under title XIX), for child health assistance to 

6 targeted low-income children consistent with the 

7 provisions of this title; and’’. 

8 (4) CONFORMING AMENDMENT.—Section 

9 2103(a) (42 U.S.C. 1397cc(a)) is amended, in the 

10 matter preceding paragraph (1), by striking ‘‘sub11 section (c)(5)’’ and inserting ‘‘paragraphs (5) and 

12 (6) of subsection (c)’’. 

13 (b) 100 PERCENT ACTUARIAL VALUE FOR ADDI14 TIONAL SERVICES INCLUDED IN BENCHMARK PACK15 AGE.—Section 2103(a)(2)(C) (42 U.S.C. 

16 1397cc(a)(2)(C)) is amended by striking ‘‘75 percent’’ and 

17 inserting ‘‘100 percent’’. 

18 SEC. 113. CLARIFICATION OF REQUIREMENT TO PROVIDE 

19 EPSDT SERVICES FOR ALL CHILDREN IN 

20 BENCHMARK BENEFIT PACKAGES UNDER 

21 MEDICAID. 

22 (a) IN GENERAL.—Section 1937(a)(1), as inserted by 

23 section 6044(a) of the Deficit Reduction Act of 2005, is 

24 amended— 

25 (1) in subparagraph (A)— 


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1 (A) in the matter before clause (i), by in2 serting ‘‘subject to subparagraph (E),’’ after 

3 ‘‘Notwithstanding any other provision of this 

4 title’’; and 

5 (B) by striking ‘‘enrollment in coverage 

6 that provides’’ and all that follows and inserting 

7 ‘‘benchmark coverage described in subsection 

8 (b)(1) or benchmark equivalent coverage de9 scribed in subsection (b)(2).’’; 

10 (2) by striking subparagraph (C) and inserting 

11 the following new subparagraph: 

12 ‘‘(C) STATE OPTION TO PROVIDE ADDI13 TIONAL BENEFITS.—A State, at its option, may 

14 provide such additional benefits to benchmark 

15 coverage described in subsection (b)(1) or 

16 benchmark equivalent coverage described in 

17 subsection (b)(2) as the State may specify.’’; 

18 and 

19 (3) by adding at the end the following new sub20 paragraph: 

21 ‘‘(E) REQUIRING COVERAGE OF EPSDT

22 SERVICES.—Nothing in this paragraph shall be 

23 construed as affecting a child’s entitlement to 

24 care and services described in subsections 

25 (a)(4)(B) and (r) of section 1905 and provided 


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1 in accordance with section 1903(a)(43) whether 

2 provided through benchmark coverage, bench3 mark equivalent coverage, or otherwise.’’. 

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

5 this subsection shall take effect as if included in the 

6 amendment made by section 6044(a) of the Deficit Reduc7 tion Act of 2005. 

8 SEC. 114. MEDICAID-SCHIP PAYMENT ADVISORY COMMIS9 SION. 

10 Title XIX (42 U.S.C. 1396 et seq.) is amended by 

11 inserting before section 1901 the following new section: 

12 ‘‘MEDICAID-SCHIP PAYMENT ADVISORY COMMISSION

13 ‘‘SEC. 1900. (a) ESTABLISHMENT.—There is hereby 

14 established the Medicaid-SCHIP Payment Advisory Com15 mission (in this section referred to as the ‘Commission’). 

16 ‘‘(b) DUTIES.— 

17 ‘‘(1) REVIEW OF PAYMENT POLICIES AND AN18 NUAL REPORTS.—The Commission shall— 

19 ‘‘(A) review payment policies of the Med20 icaid program established under this title (in 

21 this section referred to as ‘Medicaid’) and the 

22 State Children’s Health Insurance Program es23 tablished under title XXI (in this section re24 ferred to as ‘SCHIP’), including topics de25 scribed in paragraph (2); 


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1 ‘‘(B) make recommendations to Congress 

2 concerning such payment policies; 

3 ‘‘(C) by not later than March 1 of each 

4 year, submit a report to Congress containing 

5 the results of such reviews and its recommenda6 tions concerning such policies; and 

7 ‘‘(D) by not later than June 1 of each 

8 year, submit a report to Congress containing an 

9 examination of issues affecting Medicaid and 

10 SCHIP, including the implications of changes 

11 in health care delivery in the United States and 

12 in the market for health care services on such 

13 programs. 

14 ‘‘(2) SPECIFIC TOPICS TO BE REVIEWED.—Spe15 cifically, the Commission shall review the following: 

16 ‘‘(A) The factors affecting expenditures for 

17 services in different sectors (such as physician, 

18 hospital and other sectors), payment methodolo19 gies, and their relationship to access and qual20 ity of care for Medicaid and SCHIP bene21 ficiaries. 

22 ‘‘(B) The affects of Medicaid and SCHIP 

23 payment policies on access to services for chil24 dren and other Medicaid and SCHIP popu25 lations. 


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1 ‘‘(3) COMMENTS ON CERTAIN SECRETARIAL RE2 PORTS.—If the Secretary submits to Congress (or a 

3 committee of Congress) a report that is required by 

4 law and that relates to payment policies under Med5 icaid or SCHIP, the Secretary shall transmit a copy 

6 of the report to the Commission. The Commission 

7 shall review the report and, not later than 6 months 

8 after the date of submittal of the Secretary’s report 

9 to Congress, shall submit to the appropriate commit10 tees of Congress written comments on such report. 

11 Such comments may include such recommendations 

12 as the Commission deems appropriate. 

13 ‘‘(4) AGENDA AND ADDITIONAL REVIEWS.—The 

14 Commission shall consult periodically with the 

15 Chairmen and Ranking Minority Members of the ap16 propriate committees of Congress regarding the 

17 Commission’s agenda and progress towards achiev18 ing the agenda. The Commission may conduct addi19 tional reviews, and submit additional reports to the 

20 appropriate committees of Congress, from time to 

21 time on such topics relating to the program under 

22 this title or title XXI as may be requested by such 

23 Chairmen and Members and as the Commission 

24 deems appropriate. 


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1 ‘‘(5) AVAILABILITY OF REPORTS.—The Com2 mission shall transmit to the Secretary a copy of 

3 each report submitted under this subsection and 

4 shall make such reports available to the public. 

5 ‘‘(6) APPROPRIATE COMMITTEE OF CON6 GRESS.—For purposes of this section, the term ‘ap7 propriate committees of Congress’ means the Com8 mittees on Energy and Commerce of the House of 

9 Representatives and the Committee on Finance of 

10 the Senate. 

11 ‘‘(7) VOTING AND REPORTING REQUIRE12 MENTS.—With respect to each recommendation con13 tained in a report submitted under paragraph (1), 

14 each member of the Commission shall vote on the 

15 recommendation, and the Commission shall include, 

16 by member, the results of that vote in the report 

17 containing the recommendation. 

18 ‘‘(8) EXAMINATION OF BUDGET CON19 SEQUENCES.—Before making any recommendations, 

20 the Commission shall examine the budget con21 sequences of such recommendations, directly or 

22 through consultation with appropriate expert enti23 ties. 

24 ‘‘(c) APPLICATION OF PROVISIONS.—The following 

25 provisions of section 1805 shall apply to the Commission 


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1 in the same manner as they apply to the Medicare Pay2 ment Advisory Commission: 

3 ‘‘(1) Subsection (c) (relating to membership). 

4 ‘‘(2) Subsection (d) (relating to staff and con5 sultants). 

6 ‘‘(3) Subsection (e) (relating to powers). 

7 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— 

8 ‘‘(1) REQUEST FOR APPROPRIATIONS.—The 

9 Commission shall submit requests for appropriations 

10 in the same manner as the Comptroller General sub11 mits requests for appropriations, but amounts ap12 propriated for the Commission shall be separate 

13 from amounts appropriated for the Comptroller Gen14 eral. 

15 ‘‘(2) AUTHORIZATION.—There are authorized to 

16 be appropriated such sums as may be necessary to 

17 carry out the provisions of this section.’’. 

18 Subtitle C—Ensuring a Fair 

19 Partnership 

20 SEC. 121. INCREASE IN FMAP FOR MEDICAL ASSISTANCE 

21 FOR CHILDREN FOR STATES THAT EXPAND 

22 COVERAGE OF CHILDREN. 

23 Section 1905 (42 U.S.C. 1396d) is amended— 

24 (1) in subsection (b), in the first sentence— 


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1 (A) by striking ‘‘and (4)’’ and inserting 

2 ‘‘(4)’’; and 

3 (B) by inserting ‘‘, and (5) in the case of 

4 a State that is described in subsection (y)(1) 

5 and section 2105(i)(1) for a calendar quarter, 

6 notwithstanding the previous clauses of this 

7 sentence, the Federal medical assistance per8 centage with respect to medical assistance pro9 vided to children shall be increased by the num10 ber of percentage points determined under sub11 section (y)(4)’’ before the period; and 

12 (2) by adding at the end the following new sub13 section: 

14 ‘‘(y) DETERMINATION OF INCREASE IN FMAP FOR

15 MEDICAL ASSISTANCE FOR CHILDREN FOR STATES THAT

16 EXPAND COVERAGE OF CHILDREN.— 

17 ‘‘(1) STATE DESCRIBED.—For purposes of 

18 clause (5) of the first sentence of subsection (b), a 

19 State described in this paragraph is a State that— 

20 ‘‘(A) meets the continuous eligibility re21 quirement of paragraph (2); and 

22 ‘‘(B) has implemented model outreach and 

23 enrollment practices in accordance with at least 

24 3 subparagraphs of paragraph (3) (relating to 


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1 coverage of children under this title and title 

2 XXI). 

3 ‘‘(2) CONTINUOUS ELIGIBILITY REQUIRE4 MENT.—The requirement of this paragraph is that 

5 the State has elected the option of continuous eligi6 bility for a full 12 months for children described in 

7 section 1902(e)(12) under this title, as well as ap8 plying such policy under its State child health plan 

9 under title XXI. 

10 ‘‘(3) MODEL OUTREACH AND ENROLLMENT

11 PRACTICES.— 

12 ‘‘(A) APPLICATION OUTREACH PROCESS.— 

13 The State makes available to parents and care14 taker relatives of children, in English and other 

15 languages that shall be required by the Sec16 retary to comply with title VI of the Civil 

17 Rights Act of 1964, information regarding ap18 plying, and upon request, an application, for 

19 medical assistance for children under this title 

20 and for child health assistance under title XXI 

21 consistent with the following: 

22 ‘‘(i) POSTING OF AVAILABILITY OF IN23 FORMATION.—An announcement con24 cerning the availability of such information 

25 and applications is posted in a conspicuous 


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1 manner at a location that is easily acces2 sible to the public— 

3 ‘‘(I) in each hospital in the State 

4 that is a participating provider under 

5 the State child health plan under title 

6 XXI or under the State plan under 

7 this title; 

8 ‘‘(II) in each public elementary 

9 and secondary school in the State; 

10 and 

11 ‘‘(III) in the facility of each pub12 lic health care provider in the State, 

13 including federally-qualified health 

14 centers and rural health centers, par15 ticipating under such State child 

16 health plan or under this title. 

17 ‘‘(ii) YEAR-ROUND AVAILABILITY OF

18 APPLICATIONS.—Such applications are 

19 made available in such locations on an on20 going basis. 

21 ‘‘(iii) ANNUAL ENROLLMENT CAM22 PAIGN IN SCHOOLS.—An outreach and en23 rollment campaign is conducted at least 

24 annually in such public elementary and 

25 secondary schools, during which informaVerDate Aug 31 2005 00:50 Mar 17, 2007 Jkt 059200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H1535.IH H1535

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1 tion concerning enrollment of children is 

2 sent to the homes of children. 

3 ‘‘(iv) OUTSTATIONING OR TRAINING

4 OF STAFF FOR INITIAL PROCESSING.—Pro5 viding for the receipt and initial processing 

6 of any such application at each facility 

7 specified in section 1902(a)(55) and at 

8 each school described in clause (i)(II) in 

9 which not less than 30 percent of the stu10 dents are eligible for free or reduced lunch 

11 under the Richard D. Russell National 

12 School Lunch Act, through— 

13 ‘‘(I) the stationing at such facil14 ity or school of State or local agency 

15 personnel to determine eligibility for 

16 such assistance; or 

17 ‘‘(II) upon request of the facility 

18 or school, the training and certifi19 cation of personnel of such facility or 

20 school (and access to necessary auto21 mated data systems) to make such 

22 initial eligibility determinations. 

23 ‘‘(B) ONE-STEP APPLICATION PROCESS.— 

24 ‘‘(i) IN GENERAL.—The State pro25 vides for either or both of the following: 


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1 ‘‘(I) The one-step enrollment 

2 process described in clause (ii). 

3 ‘‘(II) The express lane process 

4 described in clause (iii). 

5 ‘‘(ii) ONE-STEP APPLICATION PROC6 ESS (SINGLE APPLICATION FOR MULTIPLE

7 PUBLIC ASSISTANCE PROGRAMS).—The 

8 State treats an application for assistance 

9 for or on behalf of a child (who has not 

10 otherwise been determined eligible for as11 sistance under this title or title XXI) 

12 under any public assistance program ad13 ministered by another Federal or State 

14 agency, including the agencies admin15 istering the Food Stamp Act of 1977, the 

16 Richard B. Russell National School Lunch 

17 Act, and the Child Nutrition Act of 1966, 

18 notwithstanding any differences in budget 

19 unit, disregard, deeming, or other method20 ology, as an application for medical assist21 ance under this title for the child, or for 

22 child health assistance under title XXI, but 

23 only if— 

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1 fected or potentially affected by such 

2 determinations; and 

3 ‘‘(II) any information furnished 

4 by such agency pursuant to this 

5 clause is kept confidential (except 

6 from the applicant and the applicant’s 

7 parent or caretaker relative) and is 

8 used solely for purposes of deter9 mining eligibility for medical assist10 ance under this title or for child 

11 health assistance under title XXI. 

12 ‘‘(iii) EXPRESS LANE PROCESS (AC13 CEPTANCE OF INCOME-RELATED DETER14 MINATIONS FOR OTHER ASSISTANCE PRO15 GRAMS).—The State is implementing the 

16 option provided under section 1902(e)(13) 

17 under title XIX, as well as under this title 

18 pursuant to section 2107(e)(1)(C). 

19 ‘‘(C) ADMINISTRATIVE VERIFICATION OF

20 INCOME.—The State permits a parent or care21 taker relative of a child applying for medical as22 sistance under this title or child health assist23 ance under title XXI to declare and certify by 

24 signature under penalty of perjury information 

25 relating to family income, assets, expenses, and 


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1 other financial information for purposes of de2 termining and redetermining financial eligibility 

3 and not to routinely require an in-person inter4 view, except in cases justified by individual cir5 cumstances. Nothing in this subparagraph shall 

6 be construed as preventing a State from taking 

7 steps to verify information provided or to seek 

8 further information and documentation from 

9 applicants in individual cases in the case of dis10 crepancies or where otherwise justified. 

11 ‘‘(D) SIMPLIFIED, CONSISTENT APPLICA12 TION FORM AND PROCESS.—The State uses an 

13 application form and process consistent with 

14 the following: 

15 ‘‘(i) The application forms and mate16 rials are in such languages in addition to 

17 English as shall be required by the Sec18 retary to comply with title VI of the Civil 

19 Rights Act of 1964. 

20 ‘‘(ii) The application form and supple21 mental forms (if any) and information 

22 verification process is the same for pur23 poses of establishing and renewing eligi24 bility for children for medical assistance 


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1 under this title and child health assistance 

2 under title XXI. 

3 ‘‘(iii) The process does not require an 

4 application to be made in person or a face5 to-face interview, unless there are discrep6 ancies or individual circumstances justi7 fying an in-person application or face-to8 face interview. 

9 ‘‘(E) USE OF ADMINISTRATIVE RE10 NEWAL.— 

11 ‘‘(i) IN GENERAL.—The State pro12 vides, in the case of renewal of a child’s 

13 eligibility for medical assistance under this 

14 title or child health assistance under title 

15 XXI, that notice is provided to the parent 

16 or caretaker relative of the child that eligi17 bility of the child will be renewed and con18 tinued based on the information available 

19 to the State unless the State is provided 

20 other information. 

21 ‘‘(ii) SATISFACTION THROUGH DEM22 ONSTRATED USE OF EX PARTE PROCESS.— 

23 A State shall be treated as satisfying the 

24 requirement of clause (i) if renewal of eli25 gibility of children under this title or title 


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1 XXI is determined on an ex parte basis, 

2 without any requirement for an in-person 

3 interview, unless sufficient information is 

4 not in the State’s possession and cannot be 

5 acquired from other sources (including 

6 other State agencies) without the partici7 pation of the applicant or the applicant’s 

8 parent or caretaker relative. 

9 ‘‘(F) APPLICATION OF PRESUMPTIVE ELI10 GIBILITY.—The State has implemented the op11 tion, for purposes of both this title and title 

12 XXI, of applying presumptive eligibility provi13 sions under sections 1920, 1920A, and 

14 2107(e)(1)(G). 

15 ‘‘(4) DETERMINATION OF INCREASE.— 

16 ‘‘(A) IN GENERAL.—For purposes of 

17 clause (5) of the first sentence of subsection 

18 (b), in the case of a State described in such 

19 clause, the number of percentage points deter20 mined under this paragraph is equal to the 

21 product of the phase-in percentage for the State 

22 (specified under subparagraph (B)) multiplied 

23 by the number of percentage points by which 

24 the Federal medical assistance percentage de25 termined for the State under subsection (b) 


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1 (without regard to clause (5) of such sub2 section) is less than the enhanced FMAP de3 scribed in section 2105(b). 

4 ‘‘(B) PHASE-IN PERCENTAGE.—For pur5 poses of subparagraph (A), the phase-in per6 centage specified in this subparagraph for a 

7 State for a fiscal year is equal to— 

8 ‘‘(i) the number of percentage points 

9 by which— 

10 ‘‘(I) the income level established 

11 by the State under the most recent 

12 plan amendment of such State re13 ferred to in section 1905(b)(5), ex14 pressed in terms of a number of per15 centage points of the official poverty 

16 line; exceeds 

17 ‘‘(II) the applicable income level 

18 established by the State as of January 

19 1, 2007, expressed in terms of a num20 ber of percentage points of the official 

21 poverty line, in order to be a targeted 

22 low-income child under the State plan 

23 under title XXI; divided by 

24 ‘‘(ii) the number of percentage points 

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1 come level (expressed in percentage points) 

2 described in clause (i)(II). 

3 ‘‘(5) INCREASE IN CAP ON PAYMENTS TO TER4 RITORIES.—If Puerto Rico, the Virgin Islands, 

5 Guam, the Northern Mariana Islands, or American 

6 Samoa qualify for an increase under subsection 

7 (b)(5) for a calendar quarter for a fiscal year, the 

8 additional Federal financial participation under this 

9 title that results from enrollment of additional chil10 dren under this title for such fiscal year because of 

11 the exercise of such option shall not be counted to12 wards the limitation on expenditures under this title 

13 for such commonwealth or territory otherwise deter14 mined under subsections (f) and (g) of section 1108. 

15 ‘‘(6) SCOPE OF APPLICATION.—The increase in 

16 the Federal medical assistance percentage under 

17 subsection (b)(5) shall only apply for purposes of 

18 payments under section 1903 with respect to med19 ical assistance provided to children and shall not 

20 apply with respect to— 

21 ‘‘(A) disproportionate share hospital pay22 ments described in section 1923; 

23 ‘‘(B) payments under title IV or XXI; or 


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1 ‘‘(C) any payments under this title that 

2 are based on the enhanced FMAP described in 

3 section 2105(b). 

4 ‘‘(7) RULE OF CONSTRUCTION.—Nothing in 

5 this subsection shall be construed as preventing a 

6 State from implementing any of the model outreach 

7 and enrollment practices described in paragraph (3), 

8 notwithstanding that the State may not qualify for 

9 an increase in the Federal medical assistance per10 centage under subsection (b)(5).’’. 

11 Subtitle D—State Options for 

12 Additional Coverage Expansions 

13 SEC. 131. OPTIONAL COVERAGE OF OLDER CHILDREN 

14 UNDER MEDICAID AND SCHIP. 

15 (a) MEDICAID.— 

16 (1) IN GENERAL.—Section 1902(l)(1)(D) (42 

17 U.S.C. 1396a(l)(1)(D)) is amended by inserting 

18 ‘‘(or, at the election of a State, 20, 21, 22, 23, 24, 

19 or 25 years of age)’’ after ‘‘19 years of age’’. 

20 (2) CONFORMING AMENDMENTS.— 

21 (A) Section 1902(e)(3)(A) (42 U.S.C. 

22 1396a(e)(3)(A)) is amended by inserting ‘‘(or 1 

23 year less than the age the State has elected 

24 under subsection (l)(1)(D))’’ after ‘‘18 years of 

25 age’’. 


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1 (B) Section 1902(e)(12) (42 U.S.C. 

2 1396a(e)(12)) is amended by inserting ‘‘or such 

3 higher age as the State has elected under sub4 section (l)(1)(D)’’ after ‘‘19 years of age’’. 

5 (C) Section 1920A(b)(1) (42 U.S.C. 

6 1396r–1a(b)(1)) is amended by inserting ‘‘or 

7 such higher age as the State has elected under 

8 section 1902(l)(1)(D)’’ after ‘‘19 years of age’’. 

9 (D) Section 1928(h)(1) (42 U.S.C. 

10 1396s(h)(1)) is amended by inserting ‘‘or 1 

11 year less than the age the State has elected 

12 under section 1902(l)(1)(D)’’ before the period 

13 at the end. 

14 (E) Section 1932(a)(2)(A) (42 U.S.C. 

15 1396u–2(a)(2)(A)) is amended by inserting 

16 ‘‘(or such higher age as the State has elected 

17 under section 1902(l)(1)(D))’’ after ‘‘19 years 

18 of age’’. 

19 (b) TITLE XXI.—Section 2110(c)(1) (42 U.S.C. 

20 1397jj(c)(1)) is amended by inserting ‘‘(or such higher age 

21 as the State has elected under section 1902(l)(1)(D))’’. 

22 SEC. 132. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 

23 UNDER THE MEDICAID PROGRAM AND SCHIP. 

24 (a) MEDICAID PROGRAM.—Section 1903(v) (42 

25 U.S.C. 1396b(v)) is amended— 


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

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

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

4 paragraph: 

5 ‘‘(4)(A) A State may elect (in a plan amendment 

6 under this title) to provide medical assistance under this 

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

8 421 of the Personal Responsibility and Work Opportunity 

9 Reconciliation Act of 1996, for aliens who are lawfully re10 siding in the United States (including battered aliens de11 scribed in section 431(c) of such Act) and who are other12 wise eligible for such assistance, within either or both of 

13 the following eligibility categories: 

14 ‘‘(i) PREGNANT WOMEN.—Women during preg15 nancy (and during the 60-day period beginning on 

16 the last day of the pregnancy). 

17 ‘‘(ii) CHILDREN.—Individuals under 21 years of 

18 age, including optional targeted low-income children 

19 described in section 1905(u)(2)(B). 

20 ‘‘(B) In the case of a State that has elected to provide 

21 medical assistance to a category of aliens under subpara22 graph (A), no debt shall accrue under an affidavit of sup23 port against any sponsor of such an alien on the basis 

24 of provision of assistance to such category and the cost 


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1 of such assistance shall not be considered as an unreim2 bursed cost.’’. 

3 (b) SCHIP.—Section 2107(e)(1) (42 U.S.C. 

4 1397gg(e)(1)), as amended by section 103(b)(3), is 

5 amended by redesignating subparagraphs (D) and (E) as 

6 subparagraph (E) and (F), respectively, and by inserting 

7 after subparagraph (C) the following new subparagraph: 

8 ‘‘(D) Section 1903(v)(4)(A)(ii) (relating to 

9 optional coverage of categories of lawfully resid10 ing immigrant children), but only if the State 

11 has elected to apply such section to the cat12 egory of children under title XIX.’’. 

13 SEC. 133. STATE OPTION TO EXPAND OR ADD COVERAGE 

14 OF CERTAIN PREGNANT WOMEN UNDER 

15 SCHIP. 

16 (a) SCHIP.— 

17 (1) COVERAGE.—Title XXI (42 U.S.C. 1397aa 

18 et seq.), as amended by section 102, is amended by 

19 adding at the end the following new section: 

20 ‘‘SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-IN21 COME PREGNANT WOMEN. 

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

23 other provision of this title, a State may provide for cov24 erage, through an amendment to its State child health 

25 plan under section 2102, of pregnancy-related assistance 


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1 for targeted low-income pregnant women in accordance 

2 with this section, but only if— 

3 ‘‘(1) the State has established an income eligi4 bility level— 

5 ‘‘(A) for pregnant women under subsection 

6 (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 

7 that is at least 185 percent of the poverty line; 

8 and 

9 ‘‘(B) for children under this title that is at 

10 least 200 percent of the poverty line; and 

11 ‘‘(2) the State meets the requirement of section 

12 2105(i)(2) (relating to no waiting list for children). 

13 ‘‘(b) DEFINITIONS.—For purposes of this title: 

14 ‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The 

15 term ‘pregnancy-related assistance’ has the meaning 

16 given the term child health assistance in section 

17 2110(a) as if any reference to targeted low-income 

18 children were a reference to targeted low-income 

19 pregnant women. 

20 ‘‘(2) TARGETED LOW-INCOME PREGNANT

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

22 woman’ means a woman— 

23 ‘‘(A) during pregnancy and through the 

24 end of the month in which the 60-day period 


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1 (beginning on the last day of her pregnancy) 

2 ends; 

3 ‘‘(B) whose family income exceeds 185 per4 cent of the poverty level applicable to a family 

5 of the size involved, but does not exceed the in6 come eligibility level established under the State 

7 child health plan under this title for a targeted 

8 low-income child; and 

9 ‘‘(C) who satisfies the requirements of 

10 paragraphs (1)(A), (1)(C), (2), and (3) of sec11 tion 2110(b). 

12 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

13 RULES.—In the case of, and with respect to, a State pro14 viding for coverage of pregnancy-related assistance to tar15 geted low-income pregnant women under subsection (a), 

16 the following special rules apply: 

17 ‘‘(1) Any reference in this title (other than in 

18 subsection (b)) to a targeted low-income child is 

19 deemed to include a reference to a targeted low-in20 come pregnant woman. 

21 ‘‘(2) Any such reference to child health assist22 ance with respect to such women is deemed a ref23 erence to pregnancy-related assistance. 


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

2 reference to a woman during pregnancy and the pe3 riod described in subsection (b)(2)(A). 

4 ‘‘(4) In applying section 2102(b)(3)(B), any 

5 reference to children found through screening to be 

6 eligible for medical assistance under the State med7 icaid plan under title XIX is deemed a reference to 

8 pregnant women. 

9 ‘‘(5) There shall be no exclusion of benefits for 

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

11 preexisting condition and no waiting period (includ12 ing any waiting period imposed to carry out section 

13 2102(b)(3)(C)) shall apply. 

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

15 case of a pregnant woman provided coverage under 

16 this section, the limitation on total annual aggregate 

17 cost-sharing shall be applied to such pregnant 

18 woman. 

19 ‘‘(7) In applying section 2104(i)— 

20 ‘‘(A) in the case of State which did not 

21 provide for coverage for pregnant women under 

22 this title (under a waiver or otherwise) during 

23 fiscal year 2007, the allotment amount other24 wise computed for the first fiscal year in which 

25 the State elects to provide coverage under this 


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1 section shall be increased by an amount (deter2 mined by the Secretary) equal to the enhanced 

3 FMAP of the expenditures under this title for 

4 such coverage, based upon projected enrollment 

5 and per capita costs of such enrollment; and 

6 ‘‘(B) in the case of a State which provided 

7 for coverage of pregnant women under this title 

8 for the previous fiscal year— 

9 ‘‘(i) in applying paragraph (1)(B)(ii) 

10 of such section, there shall also be taken 

11 into account (in an appropriate proportion) 

12 the percentage increase in births in the 

13 United States for the relevant period; and 

14 ‘‘(ii) in applying paragraph (1)(C), 

15 pregnant women (and per capita expendi16 tures for such women) shall be accounted 

17 for separately from children, but shall be 

18 included in the total amount of any allot19 ment adjustment under such paragraph. 

20 ‘‘(d) AUTOMATIC ENROLLMENT FOR CHILDREN

21 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS22 SISTANCE.—If a child is born to a targeted low-income 

23 pregnant woman who was receiving pregnancy-related as24 sistance under this section on the date of the child’s birth, 

25 the child shall be deemed to have applied for child health 


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1 assistance under the State child health plan and to have 

2 been found eligible for such assistance under such plan 

3 or to have applied for medical assistance under title XIX 

4 and to have been found eligible for such assistance under 

5 such title, as appropriate, on the date of such birth and 

6 to remain eligible for such assistance until the child at7 tains 1 year of age. During the period in which a child 

8 is deemed under the preceding sentence to be eligible for 

9 child health or medical assistance, the child health or med10 ical assistance eligibility identification number of the 

11 mother shall also serve as the identification number of the 

12 child, and all claims shall be submitted and paid under 

13 such number (unless the State issues a separate identifica14 tion number for the child before such period expires).’’. 

15 (2) NO COST-SHARING FOR PREGNANCY-RE16 LATED BENEFITS.—Section 2103(e)(2) (42 U.S.C. 

17 1397cc(e)(2)) is amended— 

18 (A) in the heading, by inserting ‘‘or preg19 nancy-related services’’ after ‘‘preventive serv20 ices’’; and 

21 (B) by inserting before the period at the 

22 end the following: ‘‘or for pregnancy-related 

23 services’’. 

24 (3) ADDITIONAL AMENDMENT.—Section 

25 2107(e)(1)(G) (42 U.S.C. 1397gg(e)(1)(G)), as reVerDate Aug 31 2005 00:50 Mar 17, 2007 Jkt 059200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H1535.IH H1535

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1 designated by sections 103(b), 132(b), and 207, is 

2 amended to read as follows: 

3 ‘‘(G) Sections 1920 and 1920A (relating to 

4 presumptive eligibility for pregnant women and 

5 children).’’. 

6 (b) AMENDMENTS TO MEDICAID.— 

7 (1) ELIGIBILITY OF ANEWBORN.—Section 

8 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended in 

9 the first sentence by striking ‘‘so long as the child 

10 is a member of the woman’s household and the 

11 woman remains (or would remain if pregnant) eligi12 ble for such assistance’’. 

13 (2) APPLICATION OF QUALIFIED ENTITIES TO

14 PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN

15 UNDER MEDICAID.—Section 1920(b) (42 U.S.C. 

16 1396r–1(b)) is amended by adding after paragraph 

17 (2) the following flush sentence: 

18 ‘‘The term ‘qualified provider’ includes a qualified entity, 

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


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1 TITLE II—REMOVAL OF OTHER 

2 BARRIERS TO COVERAGE 

3 SEC. 201. ESTABLISHMENT OF NEW BASE SCHIP ALLOT4 MENTS THAT ARE RESPONSIVE TO IN5 CREASES IN HEALTH CARE COSTS AND EN6 ROLLMENT EXPANSIONS. 

7 Section 2104 (42 U.S.C. 1397dd), as amended by 

8 section 101(b), is amended— 

9 (1) in subsection (a)— 

10 (A) in paragraph (9), by striking ‘‘and’’ at 

11 the end; 

12 (B) in paragraph (10), by striking the pe13 riod at the end and inserting ‘‘; and’’; and 

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

15 paragraph: 

16 ‘‘(11) for fiscal year 2008 and each succeeding 

17 fiscal year, the sum of the State allotments provided 

18 under subsection (i) for such fiscal year.’’; 

19 (2) in subsection (b)(1), by striking ‘‘and (h)’’ 

20 and inserting ‘‘(h), and (i)’’; and 

21 (3) in subsection (c)(1), by striking ‘‘and (h)’’ 

22 and inserting ‘‘(h), and (i)’’. 

23 (4) by adding at the end the following new sub24 section: 


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1 ‘‘(i) ALLOTMENTS FOR STATES AND TERRITORIES

2 BEGINNING WITH FISCAL YEAR 2008.— 

3 ‘‘(1) GENERAL ALLOTMENT COMPUTATION.— 

4 ‘‘(A) IN GENERAL.—Subject to the suc5 ceeding provisions of this subsection, the Sec6 retary shall compute a State allotment for each 

7 State for each fiscal year as follows: 

8 ‘‘(i) REBASING IN FISCAL YEAR 2008

9 AND EACH SECOND SUCCEEDING FISCAL

10 YEAR.—For fiscal year 2008 and each sec11 ond succeeding fiscal year, the allotment of 

12 a State is equal to the Federal payments 

13 to the State that are attributable to (and 

14 countable towards) the allotment under 

15 this section for the State for the previous 

16 fiscal year multiplied by the allotment in17 crease factor under subparagraph (B) for 

18 the fiscal year involved. 

19 ‘‘(ii) USING PROJECTIONS FOR FISCAL

20 YEAR 2009 AND EACH SECOND SUCCEEDING

21 FISCAL YEAR.—For fiscal year 2009 and 

22 each second succeeding fiscal year, the al23 lotment of a State is equal to the amount 

24 of the State allotment under this subpara25 graph for the previous fiscal year multiVerDate Aug 31 2005 00:50 Mar 17, 2007 Jkt 059200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H1535.IH H1535

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1 plied by the allotment increase factor 

2 under subparagraph (B) for the fiscal year 

3 involved. 

4 ‘‘(B) ALLOTMENT INCREASE FACTOR.— 

5 The allotment increase factor under this sub6 paragraph for a fiscal year is equal to the prod7 uct of the following: 

8 ‘‘(i) PER CAPITA HEALTH CARE

9 GROWTH FACTOR.—One plus the percent10 age increase in the projected per capita 

11 amount of National Health Expenditures 

12 from the second previous fiscal year to the 

13 previous fiscal year, as most recently pub14 lished by the Secretary before the begin15 ning of the fiscal year involved. 

16 ‘‘(ii) CHILD POPULATION GROWTH

17 FACTOR.—One plus the percentage in18 crease in the population of children under 

19 20 years of age in the State from July 1 

20 in such second previous fiscal year to July 

21 1 in the previous fiscal year, as determined 

22 by the Secretary based on the most recent 

23 published estimates of the Bureau of the 

24 Census before the beginning of the fiscal 

25 year involved. 


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1 ‘‘(C) OUTREACH ADJUSTMENT.— 

2 ‘‘(i) IN GENERAL.—If a State’s ex3 penditures under this title in a fiscal year 

4 (beginning with fiscal year 2008) exceeds 

5 the allotment provided under this section 

6 (determined without regard to any reallot7 ment it receives that is available for ex8 penditure during such fiscal year) and if 

9 the average number of enrollees in the 

10 State under this title for such fiscal year 

11 exceeds its target number of enrollees for 

12 that year, for the subsequent fiscal year 

13 the allotment under this section for the 

14 State shall be increased by the amount by 

15 which— 

16 ‘‘(I) the product of— 

17 ‘‘(aa) such additional num18 ber of enrollees; and 

19 ‘‘(bb) the projected per cap20 ita Federal expenditures under 

21 the State child health plan (as 

22 determined under clause (iii) for 

23 such subsequent fiscal year); re24 duced by 


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1 ‘‘(II) the amount of any allot2 ment redistributed to the State under 

3 this section for such subsequent fiscal 

4 year. 

5 ‘‘(ii) TARGET NUMBER OF ENROLL6 EES.—In this subsection, the target num7 ber of enrollees for a State for a fiscal year 

8 is equal to the average number of enrollees 

9 enrolled in the State child health plan 

10 under this title during fiscal year 2007 in11 creased (for each subsequent fiscal year 

12 through the fiscal year involved) by the 

13 population growth for children in that 

14 State for the year ending on June 30 be15 fore the beginning of the fiscal year (as es16 timated by the Bureau of the Census). 

17 ‘‘(iii) PROJECTED PER CAPITA FED18 ERAL EXPENDITURES.—For purposes of 

19 subparagraph (A)(i)(II), the projected per 

20 capita Federal expenditures under a State 

21 child health plan for a fiscal year is equal 

22 to the average per capita Federal expendi23 tures under such plan for fiscal year 2007, 

24 increased (for each subsequent fiscal year 

25 up to and including the fiscal year inVerDate Aug 31 2005 00:50 Mar 17, 2007 Jkt 059200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H1535.IH H1535

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1 volved) by the annual percentage increase 

2 in per capita amount of National Health 

3 Expenditures (as estimated by the Sec4 retary) for the respective subsequent fiscal 

5 year. 

6 ‘‘(iv) AVAILABILITY.—Notwith7 standing subsection (e), an increase in al8 lotment under this paragraph shall only be 

9 available for expenditure during the fiscal 

10 year in which it is provided. 

11 ‘‘(v) INTERACTION WITH OTHER PRO12 VISIONS.— 

13 ‘‘(I) COVERAGE EXPANSION

14 STATES.—In the case of a State that 

15 has an increased allotment under sec16 tion 2105(i)— 

17 ‘‘(aa) there shall be no in18 creased allotment under para19 graph (2); and 

20 ‘‘(bb) the allotment under 

21 this subsection shall not be sub22 ject to reallotment or redistribu23 tion to other States. 

24 ‘‘(II) NO REALLOTMENT OF OUT25 REACH ADJUSTMENT.—In no case 


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1 shall any increase in allotment under 

2 paragraph (2) for a State be subject 

3 to reallotment or redistribution to 

4 other States.’’. 

5 SEC. 202. 2-YEAR INITIAL AVAILABILITY OF SCHIP ALLOT6 MENTS. 

7 Section 2104(e) (42 U.S.C. 1397dd(e)) is amended 

8 to read as follows: 

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

10 ‘‘(1) IN GENERAL.—Except as provided in para11 graph (2), amounts allotted to a State pursuant to 

12 this section— 

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

14 2007, shall remain available for expenditure by 

15 the State through the end of the second suc16 ceeding fiscal year; and 

17 ‘‘(B) for fiscal year 2008 and each fiscal 

18 year thereafter, shall remain available for ex19 penditure by the State through the end of the 

20 succeeding fiscal year. 

21 ‘‘(2) AVAILABILITY OF AMOUNTS REALLOT22 TED.—Amounts reallotted to a State under sub23 section (f) shall be available for expenditure by the 

24 State through the end of the fiscal year in which 

25 they are reallotted.’’. 


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1 SEC. 203. REDISTRIBUTION OF UNUSED ALLOTMENTS TO 

2 ADDRESS STATE FUNDING SHORTFALLS. 

3 Section 2104(f) (42 U.S.C. 1397dd(f)) is amended— 

4 (1) by striking ‘‘The Secretary’’ and inserting 

5 the following: 

6 ‘‘(1) IN GENERAL.—The Secretary’’; 

7 (2) by striking ‘‘States that have fully expended 

8 the amount of their allotments under this section’’ 

9 and inserting ‘‘States that the Secretary determines 

10 with respect to the fiscal year for which unused al11 lotments are available for redistribution under this 

12 subsection, are shortfall States described in para13 graph (2) for such fiscal year’’; and 

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

15 paragraph: 

16 ‘‘(2) SHORTFALL STATES DESCRIBED.— 

17 ‘‘(A) IN GENERAL.—For purposes of para18 graph (1), with respect to a fiscal year, a short19 fall State described in this subparagraph is a 

20 State with a State child health plan approved 

21 under this title for which the Secretary esti22 mates on the basis of the most recent data 

23 available to the Secretary, that the projected ex24 penditures under such plan for the State for the 

25 fiscal year will exceed the sum of— 


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1 ‘‘(i) the amount of the State’s allot2 ments for any preceding fiscal years that 

3 remain available for expenditure and that 

4 will not be expended by the end of the im5 mediately preceding fiscal year; and 

6 ‘‘(ii) the amount of the State’s allot7 ment for the fiscal year. 

8 ‘‘(B) PRORATION RULE.—If the amounts 

9 available for redistribution under paragraph (1) 

10 for a fiscal year are less than the total amounts 

11 of the estimated shortfalls determined for the 

12 year under subparagraph (A), the amount to be 

13 reallotted under such paragraph for each short14 fall State shall be reduced proportionally. 

15 ‘‘(C) RETROSPECTIVE ADJUSTMENT.—The 

16 Secretary may adjust the estimates and deter17 minations made under paragraph (1) and this 

18 paragraph with respect to a fiscal year as nec19 essary on the basis of the amounts reported by 

20 States not later than November 30 of the suc21 ceeding fiscal year, as approved by the Sec22 retary.’’. 


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1 SEC. 204. INCENTIVES FOR SCHOOL-BASED OUTREACH AND 

2 ENROLLMENT. 

3 Section 2105(a) (42 U.S.C. 1397ee(a)) is amended 

4 by adding at the end the following new paragraph: 

5 ‘‘(3) SPECIAL RULE FOR SCHOOL-BASED OUT6 REACH AND ENROLLMENT ACTIVITIES.—With re7 spect to expenditures in a quarter for school-based 

8 outreach and enrollment activities— 

9 ‘‘(A) the ‘enhanced FMAP’ for purposes of 

10 paragraph (1) is equal to 90 percent; and 

11 ‘‘(B) the limitation under subsection 

12 (c)(2)(A) shall not apply to such expendi13 tures.’’. 

14 SEC. 205. MEDICAID CITIZENSHIP DOCUMENTATION RE15 QUIREMENTS. 

16 (a) STATE OPTION TO REQUIRE CERTAIN INDIVID17 UALS TO PRESENT SATISFACTORY DOCUMENTARY EVI18 DENCE OF PROOF OF CITIZENSHIP OR NATIONALITY FOR

19 PURPOSES OF ELIGIBILITY FOR MEDICAID.— 

20 (1) IN GENERAL.—Section 1902(a)(46) (42 

21 U.S.C. 1396a(a)(46)) is amended— 

22 (A) by inserting ‘‘(A)’’ after ‘‘(46)’’; 

23 (B) by adding ‘‘and’’ after the semicolon; 

24 and 

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

26 subparagraph: 


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1 ‘‘(B) at the option of the State and subject to 

2 section 1903(x), require that, with respect to an in3 dividual (other than an individual described in sec4 tion 1903(x)(1)) who declares to be a citizen or na5 tional of the United States for purposes of estab6 lishing initial eligibility for medical assistance under 

7 this title (or, at State option, for purposes of renew8 ing or redetermining such eligibility to the extent 

9 that such satisfactory documentary evidence of citi10 zenship or nationality has not yet been presented), 

11 there is presented satisfactory documentary evidence 

12 of citizenship or nationality of the individual (using 

13 criteria determined by the State, which shall be no 

14 more restrictive than the criteria used by the Social 

15 Security Administration to determine citizenship, 

16 and which shall accept as such evidence a document 

17 issued by a federally-recognized Indian tribe evidenc18 ing membership or enrollment in, or affiliation with, 

19 such tribe (such as a tribal enrollment card or cer20 tificate of degree of Indian blood, and, with respect 

21 to those federally-recognized Indian tribes located 

22 within States having an international border whose 

23 membership includes individuals who are not citizens 

24 of the United States, such other forms of docu25 mentation (including tribal documentation, if approVerDate Aug 31 2005 00:50 Mar 17, 2007 Jkt 059200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\H1535.IH H1535

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1 priate) that the Secretary, after consulting with such 

2 tribes, determines to be satisfactory documentary 

3 evidence of citizenship or nationality for purposes of 

4 satisfying the requirement of this subparagraph));’’. 

5 (2) LIMITATION ON WAIVER AUTHORITY.—Not6 withstanding any provision of section 1115 of the 

7 Social Security Act (42 U.S.C. 1315), or any other 

8 provision of law, the Secretary of Health and 

9 Human Services may not waive the requirements of 

10 section 1902(a)(46)(B) of such Act (42 U.S.C. 

11 1396a(a)(46)(B)) with respect to a State. 

12 (3) CONFORMING AMENDMENTS.—Section 1903 

13 (42 U.S.C. 1396b) is amended— 

14 (A) in subsection (i)— 

15 (i) in paragraph (20), by adding ‘‘or’’ 

16 after the semicolon; 

17 (ii) in paragraph (21), by striking ‘‘; 

18 or’’ and inserting a period; and 

19 (iii) by striking paragraph (22); and 

20 (B) in subsection (x) (as amended by sec21 tion 405(c)(1)(A) of division B of the Tax Re22 lief and Health Care Act of 2006 (Public Law 

23 109–432))— 

24 (i) by striking paragraphs (1) and (3); 


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1 (ii) by redesignating paragraph (2) as 

2 paragraph (1); 

3 (iii) in paragraph (1), as so redesig4 nated, by striking ‘‘paragraph (1)’’ and in5 serting ‘‘section 1902(a)(46)(B)’’; and 

6 (iv) by adding at the end the following 

7 new paragraph: 

8 ‘‘(2) In the case of an individual declaring to be a 

9 citizen or national of the United States with respect to 

10 whom a State requires the presentation of satisfactory 

11 documentary evidence of citizenship or nationality under 

12 section 1902(a)(46)(B), the individual shall be provided 

13 at least the reasonable opportunity to present satisfactory 

14 documentary evidence of citizenship or nationality under 

15 this subsection as is provided under clauses (i) and (ii) 

16 of section 1137(d)(4)(A) to an individual for the submittal 

17 to the State of evidence indicating a satisfactory immigra18 tion status.’’. 

19 (b) CLARIFICATION OF RULES FOR CHILDREN BORN

20 IN THE UNITED STATES TO MOTHERS ELIGIBLE FOR

21 MEDICAID.—Section 1903(x) (42 U.S.C. 1396b(x)), as 

22 amended by subsection (a)(3)(B), is amended— 

23 (1) in paragraph (1)— 

24 (A) in subparagraph (C), by striking ‘‘or’’ 

25 at the end; 


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1 (B) by redesignating subparagraph (D) as 

2 subparagraph (E); and 

3 (C) by inserting after subparagraph (C) 

4 the following new subparagraph: 

5 ‘‘(D) pursuant to the application of section 

6 1902(e)(4) (and, in the case of an individual who is 

7 eligible for medical assistance on such basis, the in8 dividual shall be deemed to have provided satisfac9 tory documentary evidence of citizenship or nation10 ality and shall not be required to provide further 

11 documentary evidence on any date that occurs dur12 ing or after the period in which the individual is eli13 gible for medical assistance on such basis); or’’; and 

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

15 paragraph: 

16 ‘‘(3) Nothing in subparagraph (A) or (B) of section 

17 1902(a)(46), the preceding paragraphs of this subsection, 

18 or the Deficit Reduction Act of 2005, including section 

19 6036 of such Act, shall be construed as changing the re20 quirement of section 1902(e)(4) that a child born in the 

21 United States to an alien mother for whom medical assist22 ance for the delivery of such child is available as treatment 

23 of an emergency medical condition pursuant to subsection 

24 (v) shall be deemed eligible for medical assistance during 

25 the first year of such child’s life.’’. 


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1 (c) EFFECTIVE DATE.— 

2 (1) RETROACTIVE APPLICATION.—The amend3 ments made by this section shall take effect as if in4 cluded in the enactment of the Deficit Reduction Act 

5 of 2005 (Public Law 109–171; 120 Stat. 4). 

6 (2) RESTORATION OF ELIGIBILITY.—In the 

7 case of an individual who, during the period that 

8 began on July 1, 2006, and ends on the date of en9 actment of this Act, was determined to be ineligible 

10 for medical assistance under a State Medicaid pro11 gram solely as a result of the application of sub12 sections (i)(22) and (x) of section 1903 of the Social 

13 Security Act (as in effect during such period), but 

14 who would have been determined eligible for such as15 sistance if such subsections, as amended by sub16 sections (a) and (b), had applied to the individual, 

17 a State may deem the individual to be eligible for 

18 such assistance as of the date that the individual 

19 was determined to be ineligible for such medical as20 sistance on such basis. 


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1 SEC. 206. STATE OPTION TO PROVIDE FOR ‘‘EXPRESS LANE’’

2 AND SIMPLIFIED DETERMINATIONS OF A 

3 CHILD’S FINANCIAL ELIGIBILITY FOR MED4 ICAL ASSISTANCE UNDER MEDICAID OR 

5 CHILD HEALTH ASSISTANCE UNDER SCHIP. 

6 (a) MEDICAID.—Section 1902(e) (42 U.S.C. 

7 1396a(e)) is amended by adding at the end the following: 

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

9 provide that eligibility requirements (including such re10 quirements applicable to redeterminations or renewals of 

11 eligibility) for medical assistance relating to income, assets 

12 (or resources), or citizenship status are met for a child 

13 who is under an age specified by the State (not to exceed 

14 21 years of age) by using a determination made within 

15 a reasonable period (as determined by the State) before 

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

17 income, or if applicable for purposes of determining eligi18 bility under this title or title XXI, assets or resources, or 

19 citizenship status, respectively, (notwithstanding any other 

20 provision of law, including sections 1902(a)(46)(B), 

21 1903(x), and 1137(d)), by a Federal or State agency, or 

22 a public or private entity making such determination on 

23 behalf of such agency, specified by the plan, including an 

24 agency administering the State program funded under 

25 part A of title IV, the Food Stamp Act of 1977, the Rich26 ard B. Russell National School Lunch Act, or the Child 


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1 Nutrition Act of 1966, notwithstanding any differences in 

2 budget unit, disregard, deeming, or other methodology, 

3 but only if— 

4 ‘‘(i) the agency has fiscal liabilities or respon5 sibilities affected by such determination; and 

6 ‘‘(ii) the agency or entity notifies the child’s 

7 family— 

8 ‘‘(I) of the information which shall be dis9 closed in accordance with this subparagraph; 

10 ‘‘(II) that the information disclosed will be 

11 used solely for purposes of determining eligi12 bility for medical assistance under this title or 

13 for child health assistance under title XXI; and 

14 ‘‘(III) that interagency agreements limit 

15 the use of such information to that purpose; 

16 and 

17 ‘‘(iii) the requirements of section 1939 are sat18 isfied. 

19 ‘‘(B) Nothing in this paragraph shall be construed 

20 to relieve a State of the obligation to determine, on an21 other basis, eligibility for medical assistance under this 

22 title or for child health assistance under title XXI if a 

23 child is determined ineligible for such assistance on the 

24 basis of information furnished pursuant to this paragraph. 


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1 ‘‘(C) If a State applies the eligibility process de2 scribed in subparagraph (A) to individuals eligible under 

3 this title and to individuals eligible under title XXI, the 

4 State may, at its option, implement its duties under sub5 paragraphs (A) and (B) of section 2102(b)(3) using either 

6 or both of the following approaches: 

7 ‘‘(i) The State may— 

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

9 Federal poverty level (that shall exceed the in10 come eligibility level applicable for a population 

11 of individuals under this title by 30 percentage 

12 points (as a fraction of the Federal poverty 

13 level) or such other higher number of percent14 age points as the State determines reflects the 

15 typical application of income methodologies by 

16 the non-health program and the State plan 

17 under this title); and 

18 ‘‘(II) provide that, with respect to any in19 dividual within such population whom a non20 health agency determines has income that does 

21 not exceed such threshold percentage for such 

22 population, such individual is eligible for med23 ical assistance under this title (regardless of 

24 whether such individual would otherwise be deVerDate Aug 31 2005 00:50 Mar 17, 2007 Jkt 059200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\H1535.IH H1535

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1 termined to be eligible to receive such assist2 ance). 

3 In exercising the approach under this clause, a State 

4 shall inform families whose children are enrolled in 

5 a State child health plan under title XXI based on 

6 having family income above the threshold described 

7 in subclause (I) that they may qualify for medical 

8 assistance under this title and, at their option, can 

9 seek a regular eligibility determination for such as10 sistance for their child. 

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

12 provides for presumptive eligibility under section 

13 1920A, a State may provide presumptive eligibility 

14 under this title, consistent with subsection (e) of sec15 tion 1920A, to a child who, based on a determina16 tion by a non-health agency, would qualify for child 

17 health assistance under a State child health plan 

18 under title XXI. During such presumptive eligibility 

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

20 for medical assistance under this title, pursuant to 

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

22 telephone contact with family members, access to 

23 data available in electronic or paper form, and other 

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1 tion form on behalf of the child. The procedures de2 scribed in the previous sentence may be used regard3 less of whether the State uses similar procedures 

4 under other circumstances for purposes of deter5 mining eligibility for medical assistance under this 

6 title. 

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

8 described in subparagraph (A) may apply to an individual 

9 who is not a child. 

10 ‘‘(E)(i) At the option of a State, an individual deter11 mined to be eligible for medical assistance or child health 

12 assistance pursuant to subparagraph (A), (C), or (D) or 

13 other procedures through which eligibility is determined 

14 based on data obtained from sources other than the indi15 vidual may receive medical assistance under this title if 

16 such individual (or, in the case of an individual under age 

17 19 (or if the State elects the option under subparagraph 

18 (A), age 20 or 21) who is not authorized to consent to 

19 medical care, the individual’s parent, guardian, or other 

20 caretaker relative) has acknowledged notice of such deter21 mination and has consented to such eligibility determina22 tion. The State (at its option) may waive any otherwise 

23 applicable requirements for signatures by or on behalf of 

24 an individual who has so consented. 


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1 ‘‘(ii) In the case of an individual enrolled pursuant 

2 to clause (i), the State shall inform the individual (or, in 

3 the case of an individual under age 19 (or if the State 

4 elects the option under subparagraph (A), age 20 or 21), 

5 the individual’s parent, guardian, or other caretaker rel6 ative) about the significance of such enrollment, including 

7 appropriate methods to access covered services. 

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

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

10 agency or entity described in subparagraph (A); and 

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

12 benefits or assistance provided by a non-health agen13 cy.’’. 

14 (b) SCHIP.—Section 2107(e)(1) (42 U.S.C. 

15 1397gg(e)(1)), as amended by sections 103(b) and 132(b), 

16 is amended by redesignating subparagraphs (C) through 

17 (F) as subparagraphs (D) through (G) and by inserting 

18 after subparagraph (B) the following new subparagraph: 

19 ‘‘(C) Section 1902(e)(13) (relating to the 

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

21 eligibility for assistance on determinations made 

22 by a program providing nutrition or other pub23 lic assistance (except that the State option 

24 under subparagraph (D) of such section shall 


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1 apply under this title only if an individual is 

2 pregnant)).’’. 

3 (c) PRESUMPTIVE ELIGIBILITY.—Section 1920A (42 

4 U.S.C. 1396r–1a) is amended— 

5 (1) in subsection (b)(3)(A)(i), is amended by 

6 striking ‘‘or (IV)’’ and inserting ‘‘(IV) is an agency 

7 or entity described in section 1902(e)(13)(A), or 

8 (V)’’; and 

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

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

11 under title XXI that provides for presumptive eligibility 

12 under such plan for children, the State shall make a rea13 sonable effort to place each presumptively eligible child in 

14 the program under this title or title XXI for which the 

15 child appears most likely to qualify. During the child’s pe16 riod of presumptive eligibility, the State shall receive Fed17 eral matching funds under section 1903 or section 2105, 

18 depending on the program in which the child has been 

19 placed. If at the conclusion of such period, the child is 

20 found to qualify for, and is enrolled in, the program estab21 lished under this title or title XXI when the child was en22 rolled in the program under the other such title during 

23 such period, the State’s receipt of Federal matching funds 

24 shall be adjusted both retroactively and prospectively so 

25 that Federal matching funds are provided, both during 


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1 and following such period of presumptive eligibility, based 

2 on the program in which the child is enrolled.’’. 

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

4 (42 U.S.C. 1396a(a)) is amended by adding at the end 

5 the following: ‘‘Notwithstanding any other provision of 

6 law, a signature under penalty of perjury shall not be re7 quired on an application form for medical assistance as 

8 to any element of eligibility for which eligibility is based 

9 on information received from a source other than appli10 cant, rather than on representations from the applicant. 

11 Notwithstanding any other provision of law, any signature 

12 requirement for an application for medical assistance may 

13 be satisfied through an electronic signature, as defined in 

14 section 1710(1) of the Government Paperwork Elimi15 nation Act (44 U.S.C. 3504 note).’’. 

16 SEC. 207. INFORMATION TECHNOLOGY CONNECTIONS TO 

17 IMPROVE HEALTH COVERAGE DETERMINA18 TIONS. 

19 (a) ENHANCED FEDERAL FUNDING FOR IMPROVE20 MENTS RELATED TO IMPLEMENTATION OF CERTAIN

21 MODEL OUTREACH AND ENROLLMENT PRACTICES.— 

22 (1) IN GENERAL.—Section 1903(a)(3)(A) (42 

23 U.S.C. 1396b(a)(3)(A)) is amended— 

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

25 (i); and 


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

2 clause: 

3 ‘‘(iii) 75 percent of so much of the sums 

4 expended during such quarter as are attrib5 utable to the design, development, or installa6 tion of such mechanized claims processing and 

7 information retrieval systems and the imple8 mentation of administrative systems and proc9 esses (including modification of eligibility com10 puter systems to permit the exchange of elec11 tronic information with other Federal or State 

12 programs) as the Secretary determines are di13 rectly related to the implementation of a model 

14 outreach and enrollment practice described in 

15 subparagraph (B), (C), (D), (E), or (F) of sec16 tion 1905(y)(3), and’’. 

17 (2) CONFORMING AMENDMENT TO ENSURE

18 AVAILABILITY FOR TERRITORIES.—Section 1108(g) 

19 (42 U.S.C. 1308(g)) is amended by adding at the 

20 end the following new paragraph: 

21 ‘‘(4) ADDITIONAL INCREASE FOR CERTAIN EX22 PENDITURES.—With respect to fiscal year 2008 and 

23 each fiscal year thereafter, if Puerto Rico, the Virgin 

24 Islands, Guam, the Northern Mariana Islands, or 

25 American Samoa qualify for a payment under secVerDate Aug 31 2005 00:50 Mar 17, 2007 Jkt 059200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\H1535.IH H1535

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1 tion 1903(a)(3)(A)(iii) for a calendar quarter of 

2 such fiscal year, the additional Federal financial par3 ticipation under such section shall not be counted to4 wards the limitation on expenditures under title XIX 

5 for such commonwealth or territory otherwise deter6 mined under subsection (f) and this subsection for 

7 such fiscal year.’’. 

8 (b) AUTHORIZATION OF INFORMATION DISCLO9 SURE.— 

10 (1) IN GENERAL.—Title XIX (42 U.S.C. 1396 

11 et seq.) is amended— 

12 (A) by redesignating section 1939 as sec13 tion 1940; and 

14 (B) by inserting after section 1938 the fol15 lowing: 

16 ‘‘AUTHORIZATION TO RECEIVE PERTINENT INFORMATION

17 ‘‘SEC. 1939. (a) IN GENERAL.—Notwithstanding any 

18 other provision of law, a Federal or State agency or pri19 vate entity in possession of the sources of data potentially 

20 pertinent to eligibility determinations under this title or 

21 title XXI (including eligibility files maintained by pro22 grams described in section 1902(e)(13)(A), information 

23 described in paragraph (2) or (3) of section 1137(a), vital 

24 records information about births in any State, and infor25 mation described in sections 453(i) and 1902(a)(25)(I)) 

26 is authorized to convey such data or information to a State 


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1 agency administering a State plan under this title or title 

2 XXI, if— 

3 ‘‘(1) such data or information are used only to 

4 establish or verify eligibility or provide coverage 

5 under this title or title XXI; and 

6 ‘‘(2) an interagency or other agreement, con7 sistent with standards developed by the Secretary, 

8 prevents the unauthorized use, disclosure, or modi9 fication of such data and otherwise meets applicable 

10 Federal requirements safeguarding privacy and data 

11 security. 

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

13 information may be conveyed pursuant to this section only 

14 if the following requirements are met: 

15 ‘‘(1) The individual whose circumstances are 

16 described in the data or information (or such indi17 vidual’s parent, guardian, caretaker relative, or au18 thorized representative) has either provided advance 

19 consent to disclosure or has not objected to disclo20 sure after receiving advance notice of disclosure and 

21 a reasonable opportunity to object. 

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

23 for the purposes of— 

24 ‘‘(A) identifying individuals who are eligi25 ble or potentially eligible for assistance under 


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1 this title or title XXI and enrolling such indi2 viduals in the State plans established under 

3 such titles; and 

4 ‘‘(B) verifying the eligibility of individuals 

5 for assistance under the State plans established 

6 under this title or title XXI. 

7 ‘‘(3) An interagency or other agreement, con8 sistent with standards developed by the Secretary— 

9 ‘‘(A) prevents the unauthorized use, disclo10 sure, or modification of such data and other11 wise meets applicable Federal requirements 

12 safeguarding privacy and data security; and 

13 ‘‘(B) requires the State agencies admin14 istering the State plans established under this 

15 title and title XXI to use the data and informa16 tion obtained under this section to seek to en17 roll individuals in such plans. 

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

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

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

21 Federal law, any information obtained under this section 

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

23 more than 1 year, or both for each such unauthorized ac24 tivity. 


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

2 requirements that apply to disclosure pursuant to this sec3 tion shall not be construed to prohibit the conveyance or 

4 disclosure of data or information otherwise permitted 

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

6 (2) CONFORMING AMENDMENT TO ASSURE AC7 CESS TO NATIONAL NEW HIRES DATABASE.—Section 

8 453(i)(1) (42 U.S.C. 653(i)(1)) is amended by strik9 ing ‘‘and programs funded under part A’’ and in10 serting ‘‘, programs funded under part A, and State 

11 plans approved under title XIX or XXI’’. 

12 (3) CONFORMING AMENDMENT TO PROVIDE

13 SCHIP PROGRAMS WITH ACCESS TO NATIONAL IN14 COME DATA.—Section 6103(l)(7)(D)(ii) of the Inter15 nal Revenue Code of 1986 is amended by inserting 

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

17 (4) CONFORMING AMENDMENT TO PROVIDE AC18 CESS TO DATA ABOUT ENROLLMENT IN INSURANCE

19 FOR PURPOSES OF EVALUATING APPLICATIONS AND

20 FOR SCHIP.—Section 1902(a)(25)(I)(i) (42 U.S.C. 

21 1396a(a)(25)(I)(i)) is amended— 

22 (A) by inserting ‘‘(and, at State option, in23 dividuals who are potentially eligible or who 

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

25 are eligible’’; and 


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

2 State option, child health assistance under title 

3 XXI)’’ after ‘‘the State plan’’. 

4 SEC. 208. ENCOURAGING CULTURALLY APPROPRIATE EN5 ROLLMENT PRACTICES. 

6 Section 1903(a)(2) (42 U.S.C. 1396b(a)(2)) is 

7 amended by adding at the end the following new subpara8 graph: 

9 ‘‘(E) an amount equal to 75 percent of so much 

10 of the sums expended during such quarter (as found 

11 necessary by the Secretary for the proper and effi12 cient administration of the State plan) as are attrib13 utable to translation or interpretation services in 

14 connection with the enrollment under this title of 

15 children of families for whom English is not their 

16 primary language; plus’’. 

17 SEC. 209. MODEL OF INTERSTATE COORDINATED ENROLL18 MENT AND COVERAGE PROCESS. 

19 In order to assure continuity of coverage of low-in20 come children under the Medicaid program and the State 

21 Children’s Health Insurance Program (SCHIP), the Sec22 retary of Health and Human Services, in consultation with 

23 State Medicaid and SCHIP directors, shall develop and 

24 disseminate a model process for the coordination of the 

25 enrollment and coverage under such programs of children 


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1 who, because of migration of families, emergency evacu2 ations, educational needs, or otherwise, frequently change 

3 their State of residency or otherwise are temporarily 

4 present outside of the State of their residency. 

5 SEC. 210. ELIMINATION OF COUNTING MEDICAID CHILD 

6 PRESUMPTIVE ELIGIBILITY COSTS AGAINST 

7 TITLE XXI ALLOTMENT. 

8 Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)) is 

9 amended— 

10 (1) in the matter preceding subparagraph (A), 

11 by striking ‘‘(or, in the case of expenditures de12 scribed in subparagraph (B), the Federal medical 

13 assistance percentage (as defined in the first sen14 tence of section 1905(b)))’’; and 

15 (2) by amending subparagraph (B) to read as 

16 follows: 

17 ‘‘(B) [reserved]’’. 

18 SEC. 211. AUTHORITY FOR QUALIFYING STATES TO USE 

19 PORTION OF SCHIP ALLOTMENT FOR ANY 

20 FISCAL YEAR FOR CERTAIN MEDICAID EX21 PENDITURES. 

22 Section 2105(g)(1)(A) (42 U.S.C. 1397ee(g)(1)(A)), 

23 as amended by section 201(b) of the National Institutes 

24 of Health Reform Act of 2006 (Public Law 109–482) is 


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1 amended by striking ‘‘fiscal year 1998, 1999, 2000, 2001, 

2 2004, 2005, 2006, or 2007’’ and inserting ‘‘a fiscal year’’. 

3 SEC. 212. APPLICATION OF MEDICAID OUTREACH PROCE4 DURES TO ALL PREGNANT WOMEN AND CHIL5 DREN. 

6 (a) IN GENERAL.—Section 1902(a)(55) (42 U.S.C. 

7 1396a(a)(55)) is amended by striking ‘‘individuals for 

8 medical assistance under subsection (a)(10)(A)(i)(IV), 

9 (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or 

10 (a)(10)(A)(ii)(IX)’’ and inserting ‘‘child and pregnant 

11 women for medical assistance (including under clauses 

12 (i)(IV), (i)(VI), (i)(VII), and (ii)(IX) of paragraph 

13 (10)(A))’’. 

14 (b) EFFECTIVE DATE.— 

15 (1) IN GENERAL.—Except as provided in para16 graph (2), the amendment made by subsection (a) 

17 takes effect on January 1, 2008. 

18 (2) EXCEPTION FOR STATE LEGISLATION.—In 

19 the case of a State plan under title XIX of the So20 cial Security Act, which the Secretary of Health and 

21 Human Services determines requires State legisla22 tion in order for the plan to meet the additional re23 quirements imposed by the amendment made by 

24 subsection (a), the State plan shall not be regarded 

25 as failing to comply with the requirements of such 


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1 Act solely on the basis of its failure to meet these 

2 additional requirements before the first day of the 

3 first calendar quarter beginning after the close of 

4 the first regular session of the State legislature that 

5 begins after the date of enactment of this Act. For 

6 purposes of the previous sentence, in the case of a 

7 State that has a 2-year legislative session, each year 

8 of the session shall be considered to be a separate 

9 regular session of the State legislature. 

10 TITLE III—EFFECTIVE DATE 

11 SEC. 301. EFFECTIVE DATE. 

12 Unless otherwise provided, the amendments made by 

13 this Act shall take effect on October 1, 2007, and shall 

14 apply to child health assistance and medical assistance 

15 provided on or after that date without regard to whether 

16 or not final regulations to carry out such amendments 

17 have been promulgated by such date. 

Æ 


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