I 

108TH CONGRESS 

2D SESSION H. R. 4031

To give States the flexibility to reduce bureaucracy by streamlining enrollment 

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

related assistance to low-income families. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 25, 2004

Ms. CARSON of Indiana (for herself, Mr. FATTAH, Mr. WEXLER, Mr. EMANUEL, Ms. MILLENDER-MCDONALD, Mr. OWENS, Mr. FILNER, Mr. 

FROST, and Ms. EDDIE BERNICE JOHNSON of Texas) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL

To give States the flexibility to reduce bureaucracy by 

streamlining enrollment processes for the Medicaid and 

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

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

3 SECTION 1. SHORT TITLE. 

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

5 Lane to Health Coverage Act of 2004’’. 
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1 SEC. 2. FINDINGS; PURPOSE. 

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

3 (1) Despite gains made in recent years, 

4 8,900,000 children in the United States are unin5 sured. Of those, 6,900,000 are eligible for public 

6 health insurance coverage. 

7 (2) Most low-income uninsured children are en8 rolled in nutrition and related programs that operate 

9 under income guidelines similar to those of the med10 icaid program. In fact, 63 percent, or 4,300,000, 

11 low-income uninsured children are in families that 

12 receive benefits through the food stamps program, 

13 the National school lunch program, or the special 

14 supplemental nutrition program for women, infants 

15 and children (commonly referred to as ‘‘WIC’’). 

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

17 means-tested public programs were able to improve 

18 administrative efficiency and coordination as well as 

19 reduce unnecessary bureaucracy. 

20 (4) Uninsured children would be well served if 

21 their enrollment in a nutrition-based or other means22 tested program could serve as a gateway to health 

23 coverage. 

24 (5) Existing law already allows children to be 

25 found income eligible for WIC based on their enroll26 ment in the medicaid program. Current law does 
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1 not, however, give States adequate flexibility to 

2 make an income determination for eligibility for the 

3 medicaid or State children’s health insurance pro4 gram based on an uninsured child’s enrollment in 

5 WIC or another public program. 

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

7 States the flexibility to find children income eligible for 

8 the medicaid program or State children’s health insurance 

9 program based on the fact that the children are eligible 

10 for nutrition assistance or similar public programs with 

11 comparable income standards and methodologies. 

12 SEC. 3. STATE OPTION TO PROVIDE FOR SIMPLIFIED DE13 TERMINATIONS OF A CHILD’S FINANCIAL ELI14 GIBILITY FOR MEDICAL ASSISTANCE UNDER 

15 MEDICAID OR CHILD HEALTH ASSISTANCE 

16 UNDER SCHIP. 

17 (a) MEDICAID.—Section 1902(e) of the Social Secu18 rity Act (42 U.S.C. 1396a(e)) is amended by adding at 

19 the end the following: 

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

21 may provide that financial eligibility requirements 

22 for medical assistance are met for an individual who 

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

24 21 years of age) by using a determination (made 

25 within a reasonable period, as found by the State, 
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1 before its use for this purpose) of the individual’s 

2 family or household income or resources, notwith3 standing any differences in budget unit, disregard, 

4 deeming, or other methodology, by a Federal or 

5 State agency (or a public or private entity making 

6 such determination on behalf of such agency) speci7 fied by the plan, including but not limited to the 

8 agencies administering the Food Stamp Act of 1977, 

9 the Richard B. Russell National School Lunch Act, 

10 and the Child Nutrition Act of 1966, provided that 

11 such agency has fiscal liabilities or responsibilities 

12 affected or potentially affected by such determina13 tions and provided that all information furnished by 

14 such agency pursuant to this subparagraph is used 

15 solely for purposes of determining eligibility for med16 ical assistance under the State plan approved under 

17 this title or for child health assistance under a State 

18 plan approved under title XXI. 

19 ‘‘(B) Nothing in subparagraph (A) shall be con20 strued—

21 ‘‘(i) to authorize the denial of medical as22 sistance under a State plan approved under this 

23 title or of child health assistance under a State 

24 plan approved under title XXI to an individual 

25 who, without the application of this paragraph 
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1 or an option exercised thereunder, would qualify 

2 for such assistance; 

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

4 under subsection (a)(8) to furnish assistance 

5 with reasonable promptness after the submis6 sion of an initial application that is evaluated or 

7 for which evaluation is requested pursuant to 

8 this paragraph; or 

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

10 determine eligibility on other grounds for an in11 dividual found to be ineligible under this para12 graph. 

13 ‘‘(C) At the option of a State, the financial eli14 gibility process described in subparagraph (A) may 

15 apply to an individual who is older than age 21 if 

16 such individual’s eligibility for medical assistance is 

17 based on pregnancy or if such individual is a parent, 

18 guardian, or other caretaker relative of an individual 

19 found eligible under subparagraph (A).’’. 

20 (b) SCHIP.—Section 2107(e)(1) of the Social Secu21 rity Act (42 U.S.C. 1397gg(e)(1)) is amended by adding 

22 at the end the following: 

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

24 State option to base a child’s eligibility for as25 sistance on financial determinations made by a 
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1 program providing nutrition or other public as2 sistance).’’. 

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

4 this section take effect on October 1, 2003.

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