II 

108TH CONGRESS 

2D SESSION S. 2420 

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

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

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

State children’s health insurance programs by simplifying the enrollment 

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

IN THE SENATE OF THE UNITED STATES 

MAY 13, 2004 

Mr. GRAHAM of Florida introduced the following bill; which was read twice 

and referred to the Committee on Finance 

A BILL 

To amend title XXI of the Social Security Act to make 

all uninsured children eligible for the State children’s 

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

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

programs, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘SCHIP Expansion Act 

5 of 2004’’. 
2 

•S 2420 IS 

1 SEC. 2. ELIGIBILITY OF ALL UNINSURED CHILDREN FOR 

2 SCHIP. 

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

5 (1) in paragraph (1)— 

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

7 (B) by redesignating subparagraph (C) as 

8 subparagraph (B); 

9 (2) in paragraph (2)— 

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

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

13 (B) by striking the semicolon and all that 

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

16 (3) by striking paragraph (4). 

17 (b) NO EXCLUSION OF CHILDREN WITH ACCESS TO

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

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

20 (1) in the paragraph heading, by striking 

21 ‘‘RULE’’ and inserting ‘‘RULES’’; 

22 (2) by striking ‘‘A child’’ and inserting the fol23 lowing: 

24 ‘‘(A) CERTAIN NON FEDERALLY FUNDED

25 COVERAGE.—A child’’; and 

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

•S 2420 IS 

1 ‘‘(B) NO EXCLUSION OF CHILDREN WITH

2 ACCESS TO HIGH-COST COVERAGE.—A State 

3 shall not exclude a child from being treated as 

4 a targeted vulnerable child who has access to 

5 coverage under a group health plan or health 

6 insurance coverage if the total annual aggregate 

7 cost for premiums, deductibles, cost sharing, 

8 and similar charges imposed under the group 

9 health plan or health insurance coverage with 

10 respect to all targeted vulnerable children in the 

11 child’s family exceeds 5 percent of such family’s 

12 income for the year involved.’’. 

13 (c) CONFORMING AMENDMENTS.— 

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

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

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

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

18 (2) Section 2102(b)(3)(C) of the Social Security 

19 Act (42 U.S.C. 1397bb(b)(3)(C)) is amended by in20 serting ‘‘particularly with respect to children whose 

21 family income exceeds 200 percent of the poverty 

22 line’’ before the semicolon. 

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

24 this section take effect on October 1, 2004. 
4 

•S 2420 IS 

1 SEC. 3. INCREASE IN FEDERAL FINANCIAL PARTICIPATION 

2 UNDER SCHIP AND MEDICAID FOR STATES 

3 WITH SIMPLIFIED ENROLLMENT AND RE4 NEWAL PROCEDURES FOR CHILDREN. 

5 (a) SCHIP.—Section 2105(c)(2) of the Social Secu6 rity Act (42 U.S.C. 1397ee(c)(2)) is amended by adding 

7 at the end the following: 

8 ‘‘(C) NONAPPLICATION OF LIMITATION

9 AND INCREASE IN FEDERAL PAYMENT FOR

10 STATES WITH SIMPLIFIED ENROLLMENT AND

11 RENEWAL PROCEDURES.— 

12 ‘‘(i) IN GENERAL.—Notwithstanding 

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

14 ‘‘(I) the limitation under sub15 paragraph (A) on expenditures for 

16 items described in subsection 

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

18 to expenditures incurred to carry out 

19 any of the outreach strategies de20 scribed in clause (ii), but only if the 

21 State carries out the same outreach 

22 strategies for children under title 

23 XIX; and 

24 ‘‘(II) the enhanced FMAP for a 

25 State for a fiscal year otherwise deter26 mined under subsection (b) shall be 
5 

•S 2420 IS 

1 increased by 5 percentage points 

2 (without regard to the application of 

3 the 85 percent limitation under that 

4 subsection)) with respect to such ex5 penditures. 

6 ‘‘(ii) OUTREACH STRATEGIES DE7 SCRIBED.—For purposes of clause (i), the 

8 outreach strategies described in this clause 

9 are the following: 

10 ‘‘(I) PRESUMPTIVE ELIGI11 BILITY.—The State provides for pre12 sumptive eligibility for children under 

13 this title and under title XIX. 

14 ‘‘(II) ADOPTION OF 12-MONTH

15 CONTINUOUS ELIGIBILITY.—The 

16 State provides that eligibility for chil17 dren shall not be redetermined more 

18 often than once every year under this 

19 title or under title XIX. 

20 ‘‘(III) ELIMINATION OF ASSET

21 TEST.—The State does not apply any 

22 asset test for eligibility under this title 

23 or title XIX with respect to children. 

24 ‘‘(IV) PASSIVE RENEWAL.—The 

25 State provides for the automatic re-
6 

•S 2420 IS 

1 newal of the eligibility of children for 

2 assistance under this title and under 

3 title XIX if the family of which such 

4 a child is a member does not report 

5 any changes to family income or other 

6 relevant circumstances, subject to 

7 verification of information from State 

8 databases.’’. 

9 (b) MEDICAID.— 

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

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

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

13 to paragraph (5)’’, after ‘‘Notwithstanding sub14 section (a)(17),’’; and 

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

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

17 1905(b), with respect to expenditures incurred to carry 

18 out any of the outreach strategies described in subpara19 graph (B) for individuals under 19 years of age who are 

20 eligible for medical assistance under subsection 

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

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

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

24 if the State carries out the same outreach strategies for 

25 children under title XXI. 
7 

•S 2420 IS 

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

2 strategies described in this subparagraph are the fol3 lowing: 

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

5 provides for presumptive eligibility for such individ6 uals under this title and title XXI. 

7 ‘‘(ii) ADOPTION OF 12-MONTH CONTINUOUS ELI8 GIBILITY.—The State provides that eligibility for 

9 such individuals shall not be redetermined more 

10 often than once every year under this title or under 

11 title XXI. 

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

13 State does not apply any asset test for eligibility 

14 under this title or title XXI with respect to such in15 dividuals. 

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

17 for the automatic renewal of the eligibility of such 

18 individuals for assistance under this title and under 

19 title XXI if the family of which such an individual 

20 is a member does not report any changes to family 

21 income or other relevant circumstances, subject to 

22 verification of information from State databases.’’. 

23 (2) CONFORMING AMENDMENT.—The first sen24 tence of section 1905(b) of the Social Security Act 

25 (42 U.S.C. 1396d(b)) is amended by striking ‘‘sec-
8 

•S 2420 IS 

1 tion 1933(d)’’ and inserting ‘‘sections 1902(l)(5) 

2 and 1933(d)’’. 

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

4 this section take effect on October 1, 2004. 

5 SEC. 4. ELIMINATION OF SCHIP DIP AND INCREASE IN 

6 FUNDING. 

7 (a) IN GENERAL.—Section 2104(a) of the Social Se8 curity Act (42 U.S.C. 1397dd(a)) is amended— 

9 (1) in paragraphs (5), (6), and (7), by striking 

10 ‘‘$3,150,000,000’’ each place it appears and insert11 ing ‘‘$4,275,000,000’’; 

12 (2) in paragraphs (8) and (9), by striking 

13 ‘‘$4,050,000,000’’ each place it appears and insert14 ing ‘‘$9,050,000,000’’; and 

15 (3) in paragraph (10), by striking 

16 ‘‘$5,000,000,000’’ and inserting ‘‘$10,000,000,000’’. 

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

18 this section take effect on October 1, 2004, and apply to 

19 allotments and redistributions of unused allotments made 

20 on or after that date. 
9 

•S 2420 IS 

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

2 AN ENROLLMENT CAP BUT HAVE NOT EX3 HAUSTED THE STATE’S AVAILABLE ALLOT4 MENTS. 

5 (a) IN GENERAL.—Section 2105 of the Social Secu6 rity Act (42 U.S.C. 1397ee) is amended by adding at the 

7 end the following: 

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

9 HAVE AN ENROLLMENT CAP BUT HAVE NOT EX10 HAUSTED THE STATE’S AVAILABLE ALLOTMENTS.— 

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

12 provision of this section, payment shall not be made 

13 to a State under this section if the State has an en14 rollment freeze, enrollment cap, procedures to delay 

15 consideration of, or not to consider, submitted appli16 cations for child health assistance, or a waiting list 

17 for the submission or consideration of such applica18 tions or for such assistance, and the State has not 

19 fully expended the amount of all allotments available 

20 with respect to a fiscal year for expenditure by the 

21 State, including allotments for prior fiscal years that 

22 remain available for expenditure during the fiscal 

23 year under subsection (c) or (g) of section 2104 or 

24 that were redistributed to the State under subsection 

25 (f) or (g) of section 2104. 
10 

•S 2420 IS 

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

2 shall not be construed as prohibiting a State from 

3 establishing regular open enrollment periods for the 

4 submission of applications for child health assist5 ance.’’. 

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

7 this section take effect on October 1, 2004. 

8 SEC. 6. APPLICATION OF MEDICAID MANAGED CARE RE9 QUIREMENTS TO SCHIP. 

10 (a) IN GENERAL.—Section 2107(e)(1) of the Social 

11 Security Act (42 U.S.C. 1397gg(e)(1)) is amended by add12 ing at the end the following: 

13 ‘‘(E) Sections 1903(m) and 1932 (relating 

14 to requirements for managed care).’’. 

15 (b) EFFECTIVE DATE.—The amendment made by 

16 subsection (a) takes effect on October 1, 2004. 

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