I 

108TH CONGRESS 

2D SESSION H. R. 4350

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

FamilyCare coverage for parents of enrolled children, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 12, 2004

Mr. DINGELL (for himself, Mr. BROWN of Ohio, Mr. RANGEL, Mr. STARK, 

Mr. WAXMAN, Ms. PELOSI, Mr. GEORGE MILLER of California, Mr. 

PALLONE, Mr. ABERCROMBIE, Mr. ALLEN, Mr. BACA, Mr. BOUCHER, 

Mrs. CAPPS, Ms. CARSON of Indiana, Mrs. CHRISTENSEN, Mr. CROWLEY, 

Mr. CUMMINGS, Mr. DAVIS of Florida, Ms. DEGETTE, Ms. DELAURO, 

Mr. DEUTSCH, Mr. DOYLE, Mr. EMANUEL, Mr. ENGEL, Ms. ESHOO, Mr. 

EVANS, Mr. FILNER, Mr. FRANK of Massachusetts, Mr. FROST, Mr. 

GEPHARDT, Mr. GONZALEZ, Mr. GORDON, Mr. GREEN of Texas, Mr. 

GRIJALVA, Mr. HINCHEY, Mr. HOEFFEL, Ms. JACKSON-LEE of Texas, 

Mrs. JONES of Ohio, Mr. KILDEE, Ms. KILPATRICK, Mr. KIND, Ms. LEE, 

Mr. LYNCH, Ms. MCCARTHY of Missouri, Ms. MCCOLLUM, Mr. 

MCDERMOTT, Mr. MCGOVERN, Mr. MCNULTY, Mr. MARKEY, Mr. MATSUI, Mr. MEEKS of New York, Mr. MENENDEZ, Mr. MOORE, Mr. MORAN

of Virginia, Mr. NADLER, Mrs. NAPOLITANO, Mr. PASTOR, Mr. PAYNE, 

Mr. RODRIGUEZ, Ms. ROYBAL-ALLARD, Mr. RUPPERSBERGER, Mr. 

RUSH, Mr. SANDLIN, Ms. SCHAKOWSKY, Mr. SCOTT of Virginia, Mr. 

SERRANO, Ms. SLAUGHTER, Ms. SOLIS, Mr. STRICKLAND, Mr. STUPAK, 

Mr. TIERNEY, Mr. WEINER, Mr. WYNN, Mr. JACKSON of Illinois, Mr. 

ANDREWS, Mr. LEVIN, Mr. KENNEDY of Rhode Island, Mr. OLVER, Mr. 

HOLT, Mr. KLECZKA, Ms. WATERS, Mr. BISHOP of New York, Ms. 

WOOLSEY, Mrs. DAVIS of California, Mr. RYAN of Ohio, Mr. VAN

HOLLEN, Mr. HONDA, Mr. MICHAUD, Mr. ALEXANDER, Mr. WEXLER, 

Ms. LINDA T. SA ́NCHEZ of California, Mr. DELAHUNT, Mr. CLAY, Mr. 

HOYER, and Mr. KUCINICH) 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 
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to provide for FamilyCare coverage for parents of enrolled children, 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; TABLE OF CONTENTS. 

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

5 ‘‘FamilyCare Act of 2004’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows:

Sec. 1. Short title; table of contents. 

Sec. 2. Renaming of title XXI program. 

Sec. 3. FamilyCare coverage of parents and pregnant women under the medicaid program and title XXI. 

Sec. 4. Automatic enrollment of children born to title XXI parents. 

Sec. 5. Optional coverage of legal immigrants under the medicaid program and 

title XXI. 

Sec. 6. Optional coverage of children through age 20 under the medicaid program and title XXI. 

Sec. 7. Allowing States to simplify rules for families. 

Sec. 8. Revision and simplification of the transitional medical assistance program (TMA). 

Sec. 9. Limitations on conflicts of interest. 

Sec. 10. Increase in CHIP allotment for each of fiscal years 2002 through 

2004. 

Sec. 11. Demonstration programs to improve medicaid and CHIP outreach to 

homeless individuals and families. 

Sec. 12. Additional CHIP revisions. 

Sec. 13. Increased federal reimbursement for language services under the medicaid program and title XXI.

8 SEC. 2. RENAMING OF TITLE XXI PROGRAM. 

9 (a) IN GENERAL.—The heading of title XXI of the 

10 Social Security Act (42 U.S.C. 1397aa et seq.) is amended 

11 to read as follows: 

12 ‘‘TITLE XXI—FAMILYCARE PROGRAM’’. 

13 (b) PROGRAM REFERENCES.—Any reference in any 

14 provision of Federal law or regulation to ‘‘SCHIP’’ or 
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1 ‘‘State children’s health insurance program’’ under title 

2 XXI of the Social Security Act shall be deemed a reference 

3 to the FamilyCare program under such title. 

4 SEC. 3. FAMILYCARE COVERAGE OF PARENTS AND PREG5 NANT WOMEN UNDER THE MEDICAID PRO6 GRAM AND TITLE XXI. 

7 (a) INCENTIVES TO IMPLEMENT FAMILYCARE COV8 ERAGE.—

9 (1) UNDER MEDICAID.—

10 (A) ESTABLISHMENT OF NEW OPTIONAL

11 ELIGIBILITY CATEGORY.—Section 

12 1902(a)(10)(A)(ii) of the Social Security Act 

13 (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended—

14 (i) by striking ‘‘or’’ at the end of sub15 clause (XVII); 

16 (ii) by adding ‘‘or’’ at the end of sub17 clause (XVIII); and 

18 (iii) by adding at the end the fol19 lowing: 

20 ‘‘(XIX) who are individuals de21 scribed in subsection (k)(1) (relating 

22 to parents of categorically eligible chil23 dren);’’. 
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1 (B) PARENTS DESCRIBED.—Section 1902 

2 of the Social Security Act is further amended 

3 by inserting after subsection (j) the following: 

4 ‘‘(k)(1)(A) Individuals described in this paragraph 

5 are individuals—

6 ‘‘(i) who are the parents of an individual who 

7 is under 19 years of age (or such higher age as the 

8 State may have elected under section 1902(l)(1)(D)) 

9 and who is eligible for medical assistance under sub10 section (a)(10)(A); 

11 ‘‘(ii) who are not otherwise eligible for medical 

12 assistance under such subsection or under a waiver 

13 approved under section 1115 or otherwise (except 

14 under section 1931 or under subsection 

15 (a)(10)(A)(ii)(XIX)); and 

16 ‘‘(iii) whose family income or resources exceeds 

17 the effective income level or resource level applicable 

18 under the State plan under part A of title IV as in 

19 effect as of July 16, 1996, but does not exceed the 

20 highest effective income or resource level (if any) ap21 plicable to a child in the family under this title. 

22 ‘‘(B) In establishing an income eligibility level for in23 dividuals described in this paragraph, a State may vary 

24 such level consistent with the various income levels estab25 lished under subsection (l)(2) in order to ensure, to the 
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1 maximum extent possible, that such individuals shall be 

2 enrolled in the same program as their children. 

3 ‘‘(C) An individual may not be treated as being de4 scribed in this paragraph unless, at the time of the individ5 ual’s enrollment under this title, the child referred to in 

6 subparagraph (A)(i) of the individual is also enrolled 

7 under this title or otherwise insured. 

8 ‘‘(D) In this subsection, the term ‘parent’ includes 

9 an individual treated as a caretaker for purposes of car10 rying out section 1931. 

11 ‘‘(E) In this subsection, the term ‘effective income 

12 level’ means the income level expressed as a percent of 

13 the poverty line and considering applicable income dis14 regards. 

15 ‘‘(2) The State shall provide for coverage of a parent 

16 described in paragraph (1) or section 2111 of a child who 

17 is covered under this title or title XXI under the same 

18 title as the title as such child is covered. In the case of 

19 a parent described in paragraph (1) who is also the parent 

20 of a child who is eligible for child health assistance under 

21 title XXI, the State may elect (on a uniform basis) to 

22 cover all such parents under section 2111 or under this 

23 title.’’.

24 (C) ENHANCED MATCHING FUNDS AVAIL25 ABLE IF CERTAIN CONDITIONS MET.—Section 
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1 1905 of the Social Security Act (42 U.S.C. 

2 1396d) is amended—

3 (i) in the fourth sentence of sub4 section (b), by striking ‘‘or subsection 

5 (u)(3)’’ and inserting ‘‘, (u)(3), or 

6 (u)(4)(A)’’; and 

7 (ii) in subsection (u)—

8 (I) by redesignating paragraph 

9 (4) as paragraph (6), and 

10 (II) by inserting after paragraph 

11 (3) the following:

12 ‘‘(4) For purposes of subsection (b) and section 

13 2105(a)(1): 

14 ‘‘(A) FAMILYCARE PARENTS.—The expendi15 tures described in this subparagraph are the expend16 itures described in the following clauses (i) and (ii): 

17 ‘‘(i) PARENTS.—If the conditions described 

18 in clauses (iii) and (iv) are met, expenditures 

19 for medical assistance for parents described in 

20 section 1902(k)(1) and for parents who would 

21 be described in such section but for the fact 

22 that they are eligible for medical assistance 

23 under section 1931 or under a waiver approved 

24 under section 1115. 
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1 ‘‘(ii) CERTAIN PREGNANT WOMEN.—If the 

2 conditions described in clause (v) are met, ex3 penditures for medical assistance for pregnant 

4 women described in subsection (n) or under sec5 tion 1902(l)(1)(A) in a family the income of 

6 which exceeds the effective income level applica7 ble under subsection (a)(10)(A)(i)(III) or 

8 (l)(2)(A) of section 1902 to a family of the size 

9 involved as of January 1, 2005. 

10 ‘‘(iii) CONDITIONS RELATING TO ENSURING

11 CHILDREN’S COVERAGE FOR ENHANCED MATCH

12 FOR PARENTS.—The conditions described in 

13 this clause are the following: 

14 ‘‘(I) The State has a State child 

15 health plan under title XXI which (wheth16 er implemented under such title or under 

17 this title) has an effective income level for 

18 children that is at least 200 percent of the 

19 poverty line. 

20 ‘‘(II) Such State child health plan 

21 does not limit the acceptance of applica22 tions, does not use a waiting list for chil23 dren who meet eligibility standards to 

24 qualify for assistance, and provides bene-
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1 fits to all children in the State who apply 

2 for and meet eligibility standards. 

3 ‘‘(III) Effective for determinations of 

4 eligibility made on or after the date that is 

5 1 year after the date of the enactment of 

6 this clause, the application and renewal 

7 procedures for individuals under 19 years 

8 of age (or such higher age as the State has 

9 elected under section 1902(l)(1)(D)) for 

10 medical assistance under section 

11 1902(a)(10)(A) are not to be more restric12 tive or burdensome than such procedures 

13 used for children with higher income under 

14 the State child health plan under title 

15 XXI. 

16 ‘‘(iv) CONDITIONS RELATING TO MINIMUM

17 COVERAGE FOR PARENTS FOR ENHANCED

18 MATCH FOR PARENTS.—The conditions de19 scribed in this clause are the following: 

20 ‘‘(I) The State does not apply an in21 come level for parents that is lower than 

22 the effective income level (expressed as a 

23 percent of the poverty line) that has been 

24 specified under the State plan under title 

25 XIX (including under a waiver authorized 
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1 by the Secretary or under section 

2 1902(r)(2)), as of January 1, 2005, to be 

3 eligible for medical assistance as a parent 

4 under this title. 

5 ‘‘(II) The State plans under this title 

6 and title XXI do not provide coverage for 

7 parents with higher family income without 

8 covering parents with a lower family in9 come. 

10 ‘‘(v) CONDITIONS FOR ENHANCED MATCH

11 FOR CERTAIN PREGNANT WOMEN.—The condi12 tions described in this clause are the following: 

13 ‘‘(I) The State has established an ef14 fective income eligibility level for pregnant 

15 women under subsection (a)(10)(A)(i)(III) 

16 or (l)(2)(A) of section 1902 that is at least 

17 185 percent of the poverty line. 

18 ‘‘(II) The State plans under this title 

19 and title XXI do not provide coverage for 

20 pregnant women described in subpara21 graph (A)(ii) with higher family income 

22 without covering such pregnant women 

23 with a lower family income. 

24 ‘‘(III) The State does not apply an in25 come level for pregnant women that is 
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1 lower than the effective income level that 

2 has been specified under the State plan 

3 under subsection (a)(10)(A)(i)(III) or 

4 (l)(2)(A) of section 1902, as of January 1, 

5 2005, to be eligible for medical assistance 

6 as a pregnant woman. 

7 ‘‘(IV) The State satisfies the condi8 tions described in subclauses (I) and (II) 

9 of clause (iii). 

10 ‘‘(vi) DEFINITIONS.—For purposes of this 

11 subsection: 

12 ‘‘(I) The term ‘parent’ has the mean13 ing given such term for purposes of section 

14 1902(k)(1). 

15 ‘‘(II) The term ‘poverty line’ has the 

16 meaning given such term in section 

17 2110(c)(5).’’. 

18 (D) APPROPRIATION FROM TITLE XXI AL19 LOTMENT FOR CERTAIN MEDICAID EXPANSION

20 COSTS.—Section 2105(a) of the Social Security 

21 Act (42 U.S.C. 1397ee(a)) is amended—

22 (i) in paragraph (1), by redesignating 

23 subparagraphs (B) through (D) as sub24 paragraphs (C) through (E), respectively,
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1 and by inserting after subparagraph (A) 

2 the following new subparagraph: 

3 ‘‘(B) for medical assistance that is attrib4 utable to expenditures described in section 

5 1905(u)(4)(A);’’; and 

6 (ii) in paragraph (2), by adding at the 

7 end the following new subparagraph: 

8 ‘‘(E) Fifth, for expenditures for items de9 scribed in paragraph (1)(E).’’. 

10 (E) INCREASING ENHANCED FMAP TO 100

11 PERCENT FOR FISCAL YEARS 2005 AND 2006 FOR

12 COVERAGE OF PARENTS.—Section 2105(b) of 

13 such Act (42 U.S.C. 1397ee(b)) is amended by 

14 adding at the end the following new sentence: 

15 ‘‘Notwithstanding the previous sentence, the 

16 ‘enhanced FMAP’ shall be 100 percent with re17 spect to medical assistance under title XIX for 

18 expenditures described in section 

19 1905(u)(4)(A)(i), but only for such assistance 

20 furnished during fiscal year 2005 and fiscal 

21 year 2006.’’. 

22 (2) UNDER TITLE XXI.—

23 (A) FAMILYCARE COVERAGE.—Title XXI 

24 of the Social Security Act (42 U.S.C. 1397aa et 
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1 seq.) is amended by adding at the end the fol2 lowing: 

3 ‘‘SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PAR4 ENTS OF TARGETED LOW-INCOME CHILDREN. 

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

6 other provision of this title, a State may provide for cov7 erage, through an amendment to its State child health 

8 plan under section 2102, of parent health assistance for 

9 targeted low-income parents, health care assistance for 

10 targeted low-income pregnant women, or both, in accord11 ance with this section, but only if—

12 ‘‘(1) with respect to the provision of parent 

13 health assistance, the State meets the conditions de14 scribed in clause (iii) of section 1905(u)(4)(A); 

15 ‘‘(2) with respect to the provision of health care 

16 assistance for pregnant women, the State meets the 

17 conditions described in clause (iv) of section 

18 1905(u)(4)(A); and 

19 ‘‘(3) in the case of parent health assistance for 

20 targeted low-income parents, the State elects to pro21 vide medical assistance under section 

22 1902(a)(10)(A)(ii)(XIX), under section 1931, or 

23 under a waiver under section 1115 to individuals de24 scribed in section 1902(k)(1)(A)(i) and elects an ef25 fective income level that, consistent with paragraphs 
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1 (1)(B) and (2) of section 1902(k), ensures to the 

2 maximum extent possible, that such individuals shall 

3 be enrolled in the same program as their children if 

4 their children are eligible for coverage under title 

5 XIX (including under a waiver authorized by the 

6 Secretary or under section 1902(r)(2)). 

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

8 ‘‘(1) PARENT HEALTH ASSISTANCE.—The term 

9 ‘parent health assistance’ has the meaning given the 

10 term child health assistance in section 2110(a) as if 

11 any reference to targeted low-income children were 

12 a reference to targeted low-income parents. 

13 ‘‘(2) PARENT.—The term ‘parent’ has the 

14 meaning given the term ‘caretaker relative’ for pur15 poses of carrying out section 1931. 

16 ‘‘(3) HEALTH CARE ASSISTANCE FOR PREG17 NANT WOMEN.—The term ‘health care assistance for 

18 pregnant women’ has the meaning given the term 

19 child health assistance in section 2110(a) as if any 

20 reference to targeted low-income children were a ref21 erence to targeted low-income pregnant women. 

22 ‘‘(4) TARGETED LOW-INCOME PARENT.—The 

23 term ‘targeted low-income parent’ has the meaning 

24 given the term targeted low-income child in section 

25 2110(b) as if the reference to a child were deemed 
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1 a reference to a parent (as defined in paragraph (3)) 

2 of the child; except that in applying such section—

3 ‘‘(A) there shall be substituted for the in4 come level described in paragraph (1)(B)(ii)(I) 

5 the applicable income level in effect for a tar6 geted low-income child; 

7 ‘‘(B) in paragraph (3), January 1, 2005, 

8 shall be substituted for July 1, 1997; and 

9 ‘‘(C) in paragraph (4), January 1, 2005, 

10 shall be substituted for March 31, 1997. 

11 ‘‘(5) TARGETED LOW-INCOME PREGNANT

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

13 woman’ has the meaning given the term targeted 

14 low-income child in section 2110(b) as if any ref15 erence to a child were a reference to a woman dur16 ing pregnancy and through the end of the month in 

17 which the 60-day period beginning on the last day 

18 of her pregnancy ends; except that in applying such 

19 section—

20 ‘‘(A) there shall be substituted for the in21 come level described in paragraph (1)(B)(ii)(I) 

22 the applicable income level in effect for a tar23 geted low-income child; 

24 ‘‘(B) in paragraph (3), January 1, 2005, 

25 shall be substituted for July 1, 1997; and 
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1 ‘‘(C) in paragraph (4), January 1, 2005, 

2 shall be substituted for March 31, 1997. 

3 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

4 RULES.—In the case of, and with respect to, a State pro5 viding for coverage of parent health assistance to targeted 

6 low-income parents or health care assistance to targeted 

7 low-income pregnant women under subsection (a), the fol8 lowing special rules apply: 

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

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

11 deemed to include a reference to a targeted low-in12 come parent or a targeted low-income pregnant 

13 woman (as applicable). 

14 ‘‘(2) Any such reference to child health assist15 ance—

16 ‘‘(A) with respect to such parents is 

17 deemed a reference to parent health assistance; 

18 and 

19 ‘‘(B) with respect to such pregnant women, 

20 is deemed a reference to health care assistance 

21 for pregnant women.

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

23 case of a family (consisting of a parent and one or 

24 more children) provided coverage under this section 

25 or a pregnant woman provided coverage under this
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1 section without covering other family members, the 

2 limitation on total annual aggregate cost-sharing 

3 shall be applied to such entire family or such preg4 nant woman, respectively. 

5 ‘‘(4) In applying section 2110(b)(4), any ref6 erence to ‘section 1902(l)(2) or 1905(n)(2) (as se7 lected by a State)’ is deemed a reference to the ef8 fective income level applicable to parents under sec9 tion 1931 or under a waiver approved under section 

10 1115, or, in the case of a pregnant woman, the in11 come level established under section 1902(l)(2)(A). 

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

13 reference to children found through screening to be 

14 eligible for medical assistance under the State med15 icaid plan under title XIX is deemed a reference to 

16 parents and pregnant women.’’. 

17 (B) ADDITIONAL ALLOTMENT FOR STATES

18 PROVIDING FAMILYCARE.—

19 (i) IN GENERAL.—Section 2104 of the 

20 Social Security Act (42 U.S.C. 1397dd) is 

21 amended by inserting after subsection (c) 

22 the following: 

23 ‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE PRO24 VIDING FAMILYCARE.—
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1 ‘‘(1) APPROPRIATION; TOTAL ALLOTMENT.—

2 For the purpose of providing additional allotments 

3 to States to provide FamilyCare coverage under sec4 tion 2111, there is appropriated, out of any money 

5 in the Treasury not otherwise appropriated—

6 ‘‘(A) for fiscal year 2005, $7,000,000,000; 

7 ‘‘(B) for fiscal year 2006, $7,000,000,000; 

8 ‘‘(C) for fiscal year 2007, $3,000,000,000; 

9 ‘‘(D) for fiscal year 2008, $3,000,000,000; 

10 ‘‘(E) for fiscal year 2009, $6,000,000,000; 

11 ‘‘(F) for fiscal year 2010, $7,000,000,000; 

12 ‘‘(G) for fiscal year 2011, $8,000,000,000; 

13 ‘‘(H) for fiscal year 2012, $9,000,000,000; 

14 and 

15 ‘‘(I) for fiscal year 2013 and each fiscal 

16 year thereafter, the amount of the allotment 

17 provided under this paragraph for the preceding 

18 fiscal year increased by the percentage increase 

19 (if any) in the medical care expenditure cat20 egory of the Consumer Price Index for All 

21 Urban Consumers (United States city average). 

22 ‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.—

23 ‘‘(A) IN GENERAL.—In addition to the al24 lotments provided under subsections (b) and 

25 (c), subject to paragraphs (3) and (4), of the 
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1 amount available for the additional allotments 

2 under paragraph (1) for a fiscal year, the Sec3 retary shall allot to each State with a State 

4 child health plan approved under this title—

5 ‘‘(i) in the case of such a State other 

6 than a commonwealth or territory de7 scribed in clause (ii), the same proportion 

8 as the proportion of the State’s allotment 

9 under subsection (b) (determined without 

10 regard to subsection (f)) to 98.95 percent 

11 of the total amount of the allotments 

12 under such section for such States eligible 

13 for an allotment under this subparagraph 

14 for such fiscal year; and 

15 ‘‘(ii) in the case of a commonwealth or 

16 territory described in subsection (c)(3), the 

17 same proportion as the proportion of the 

18 commonwealth’s or territory’s allotment 

19 under subsection (c) (determined without 

20 regard to subsection (f)) to 1.05 percent of 

21 the total amount of the allotments under 

22 such section for commonwealths and terri23 tories eligible for an allotment under this 

24 subparagraph for such fiscal year. 
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1 ‘‘(B) AVAILABILITY AND REDISTRIBUTION

2 OF UNUSED ALLOTMENTS.—In applying sub3 sections (e) and (f) with respect to additional 

4 allotments made available under this subsection, 

5 the procedures established under such sub6 sections shall ensure such additional allotments 

7 are only made available to States which have 

8 elected to provide coverage under section 2111. 

9 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi10 tional allotments provided under this subsection are 

11 not available for amounts expended before October 

12 1, 2004. Such amounts are available for amounts ex13 pended on or after such date for child health assist14 ance for targeted low-income children, as well as for 

15 parent health assistance for targeted low-income 

16 parents, and health care assistance for targeted low17 income pregnant women. 

18 ‘‘(4) REQUIRING ELECTION TO PROVIDE COV19 ERAGE.—No payments may be made to a State 

20 under this title from an allotment provided under 

21 this subsection unless the State has made an elec22 tion to provide parent health assistance for targeted 

23 low-income parents, or health care assistance for 

24 targeted low-income pregnant women.’’. 
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1 (ii) CONFORMING AMENDMENTS.—

2 Section 2104 of the Social Security Act 

3 (42 U.S.C. 1397dd) is amended—

4 (I) in subsection (a), by inserting 

5 ‘‘subject to subsection (d),’’ after 

6 ‘‘under this section,’’; 

7 (II) in subsection (b)(1), by in8 serting ‘‘and subsection (d)’’ after 

9 ‘‘Subject to paragraph (4)’’; and 

10 (III) in subsection (c)(1), by in11 serting ‘‘subject to subsection (d),’’ 

12 after ‘‘for a fiscal year,’’. 

13 (C) NO COST-SHARING FOR PREGNANCY14 RELATED BENEFITS.—Section 2103(e)(2) of 

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

16 1397cc(e)(2)) is amended—

17 (i) in the heading, by inserting ‘‘AND

18 PREGNANCY-RELATED SERVICES’’ after 

19 ‘‘PREVENTIVE SERVICES’’; and 

20 (ii) by inserting before the period at 

21 the end the following: ‘‘and for pregnancy22 related services’’. 

23 (3) EFFECTIVE DATE.—The amendments made 

24 by this subsection apply to items and services fur25 nished on or after October 1, 2004, whether or not
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1 regulations implementing such amendments have 

2 been issued. 

3 (b) RULES FOR IMPLEMENTATION BEGINNING WITH

4 FISCAL YEAR 2006.—

5 (1) EXPANSION OF AVAILABILITY OF EN6 HANCED MATCH UNDER MEDICAID FOR PRE-CHIP

7 EXPANSIONS.—Paragraph (4) of section 1905(u) of 

8 the Social Security Act (42 U.S.C. 1396d(u)), as in9 serted by subsection (a)(1)(C), is amended—

10 (A) by amending clause (ii) of subpara11 graph (A) to read as follows: 

12 ‘‘(ii) CERTAIN PREGNANT WOMEN.—Ex13 penditures for medical assistance for pregnant 

14 women under section 1902(l)(1)(A) in a family 

15 the income of which exceeds the 133 percent of 

16 the income official poverty line, but only if the 

17 income level established under section 

18 1902(l)(2) (or under a Statewide waiver under 

19 section 1115) for pregnant women is 185 per20 cent of the income official poverty line.’’; and 

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

22 ‘‘(B) CHILDREN IN FAMILIES WITH INCOME

23 ABOVE MEDICAID MANDATORY LEVEL NOT PRE24 VIOUSLY DESCRIBED.—The expenditures described 

25 in this subparagraph are expenditures (other than 
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1 expenditures described in paragraph (2) or (3)) for 

2 medical assistance made available to any child who 

3 is eligible for assistance under section 

4 1902(a)(10)(A) (other than under clause (i)) and 

5 the income of whose family exceeds the minimum in6 come level required under subsection 1902(l)(2) (or, 

7 if higher, the minimum level required under section 

8 1931 for that State) for a child of the age involved 

9 (treating any child who is 19 or 20 years of age as 

10 being 18 years of age).’’. 

11 (2) OFFSET OF ADDITIONAL EXPENDITURES

12 FOR ENHANCED MATCH FOR PRE-CHIP EXPAN13 SION.—Section 1905 of the Social Security Act (42 

14 U.S.C. 1396d) is amended—

15 (A) in the fourth sentence of subsection 

16 (b), by inserting ‘‘(except in the case of expend17 itures described in subsection (u)(5))’’ after ‘‘do 

18 not exceed’’; 

19 (B) in subsection (u), by inserting after 

20 paragraph (4) (as inserted by subparagraph 

21 (C)), the following: 

22 ‘‘(5) For purposes of the fourth sentence of sub23 section (b) and section 2105(a), the following payments 

24 under this title do not count against a State’s allotment 

25 under section 2104: 
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1 ‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR

2 PREGNANT WOMEN WITH INCOME ABOVE 133 PER3 CENT OF POVERTY.—The portion of the payments 

4 made for expenditures described in paragraph 

5 (4)(A)(ii) that represents the amount that would 

6 have been paid if the enhanced FMAP had not been 

7 substituted for the Federal medical assistance per8 centage. 

9 ‘‘(B) FAMILYCARE PARENTS.—Payments for 

10 expenditures described in paragraph (4)(A)(i). 

11 ‘‘(C) REGULAR FMAP FOR EXPENDITURES FOR

12 CERTAIN CHILDREN IN FAMILIES WITH INCOME

13 ABOVE MEDICAID MANDATORY LEVEL.—The portion 

14 of the payments made for expenditures described in 

15 paragraph (4)(B) that represents the amount that 

16 would have been paid if the enhanced FMAP had 

17 not been substituted for the Federal medical assist18 ance percentage.’’. 

19 (C) CONFORMING AMENDMENTS.—Sub20 paragraph (B) of section 2105(a)(1) of the So21 cial Security Act, as amended by subsection 

22 (a)(1)(D), is amended to read as follows: 

23 ‘‘(B) CERTAIN FAMILYCARE PARENTS AND

24 OTHERS.—Expenditures for medical assistance 

25 that is attributable to expenditures described in 
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1 section 1905(u)(4), except as provided in sec2 tion 1905(u)(5).’’.

3 (3) EFFECTIVE DATE.—The amendments made 

4 by this subsection apply as of October 1, 2005, to 

5 fiscal years beginning on or after such date and to 

6 expenditures under the State plan on and after such 

7 date, whether or not regulations implementing such 

8 amendments have been issued. 

9 (c) MAKING TITLE XXI BASE ALLOTMENTS PERMA10 NENT.—Section 2104(a) of the Social Security Act (42 

11 U.S.C. 1397dd(a)) is amended—

12 (1) by striking ‘‘and’’ at the end of paragraph 

13 (9); 

14 (2) by striking the period at the end of para15 graph (10) and inserting ‘‘; and’’; and 

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

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

18 thereafter, the amount of the allotment provided 

19 under this subsection for the preceding fiscal year 

20 increased by the percentage increase (if any) in the 

21 medical care expenditure category of the Consumer 

22 Price Index for All Urban Consumers (United States 

23 city average).’’.

24 (d) GAO STUDY.—
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1 (1) STUDY.—The Comptroller General of the 

2 United States shall conduct a study regarding fund3 ing under title XXI of the Social Security Act that 

4 examines—

5 (A) the adequacy of overall funding under 

6 such title; 

7 (B) the formula for determining allotments 

8 and for redistribution of unspent funds under 

9 such title; and 

10 (C) the effect of waiting lists and caps on 

11 enrollment under such title. 

12 (2) REPORT.—Not later than July 1, 2006, the 

13 Comptroller General shall submit a report on the 

14 study conducted under paragraph (1). Such report 

15 shall include recommendations regarding a better 

16 mechanism for determining State allotments and re17 distribution of unspent funds under such title in 

18 order to ensure all eligible families in need can ac19 cess coverage through such title. 

20 (e) CONFORMING AMENDMENTS.—

21 (1) ELIGIBILITY CATEGORIES.—Section 

22 1905(a) of the Social Security Act (42 U.S.C. 

23 1396d(a)) is amended, in the matter before para24 graph (1)—
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1 (A) by striking ‘‘or’’ at the end of clause 

2 (xii); 

3 (B) by inserting ‘‘or’’ at the end of clause 

4 (xiii); and 

5 (C) by inserting after clause (xiii) the fol6 lowing: 

7 ‘‘(xiv) who are parents described (or treated as 

8 if described) in section 1902(k)(1),’’. 

9 (2) INCOME LIMITATIONS.—Section 1903(f)(4) 

10 of the Social Security Act (42 U.S.C. 1396b(f)(4)) 

11 is amended—

12 (A) effective October 1, 2005, by inserting 

13 ‘‘1902(a)(10)(A)(i)(VIII),’’ after 

14 ‘‘1902(a)(10)(A)(i)(VII),’’; and 

15 (B) by inserting 

16 ‘‘1902(a)(10)(A)(ii)(XIX),’’ after 

17 ‘‘1902(a)(10)(A)(ii)(XVIII),’’.

18 (3) CONFORMING AMENDMENT RELATING TO

19 NO WAITING PERIOD FOR PREGNANT WOMEN.—Sec20 tion 2102(b)(1)(B) of the Social Security Act (42 

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

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

23 clause (i) and inserting a semicolon; 

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

25 clause (ii) and inserting ‘‘; and’’; and 
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1 (C) by adding at the end the following: 

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

3 (including a waiting period to carry out 

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

5 low-income parent who is pregnant.’’. 

6 SEC. 4. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO 

7 TITLE XXI PARENTS. 

8 Section 2102(b)(1) of the Social Security Act (42 

9 U.S.C. 1397bb(b)(1)) is amended by adding at the end 

10 the following: 

11 ‘‘(C) AUTOMATIC ELIGIBILITY OF CHIL12 DREN BORN TO A PARENT BEING PROVIDED

13 FAMILYCARE.—Such eligibility standards shall 

14 provide for automatic coverage of a child born 

15 to an individual who is provided assistance 

16 under this title in the same manner as medical 

17 assistance would be provided under section 

18 1902(e)(4) to a child described in such sec19 tion.’’. 

20 SEC. 5. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 

21 UNDER THE MEDICAID PROGRAM AND TITLE 

22 XXI. 

23 (a) MEDICAID PROGRAM.—Section 1903(v) of the 

24 Social Security Act (42 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: 

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

5 under this title) to provide medical assistance under this 

6 title for aliens who are lawfully residing in the United 

7 States (including battered aliens described in section 

8 431(c) of the Personal Responsibility and Work Oppor9 tunity Reconciliation Act of 1996) and who are otherwise 

10 eligible for such assistance, within any of the following eli11 gibility categories: 

12 ‘‘(i) PREGNANT WOMEN.—Women during preg13 nancy (and during the 60-day period beginning on 

14 the last day of the pregnancy). 

15 ‘‘(ii) CHILDREN.—Children (as defined under 

16 such plan), including optional targeted low-income 

17 children described in section 1905(u)(2)(B). 

18 ‘‘(iii) PARENTS.—If the State has elected the 

19 eligibility category described in clause (ii), caretaker 

20 relatives who are parents (including individuals 

21 treated as a caretaker for purposes of carrying out 

22 section 1931) of children (described in such clause 

23 or otherwise) who are eligible for medical assistance 

24 under the plan. 
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1 ‘‘(B)(i) In the case of a State that has elected to pro2 vide medical assistance to a category of aliens under sub3 paragraph (A), no debt shall accrue under an affidavit of 

4 support against any sponsor of such an alien on the basis 

5 of provision of assistance to such category and the cost 

6 of such assistance shall not be considered as an unreim7 bursed cost. 

8 ‘‘(ii) The provisions of sections 401(a), 402(b), 403, 

9 and 421 of the Personal Responsibility and Work Oppor10 tunity Reconciliation Act of 1996 shall not apply to a 

11 State that makes an election under subparagraph (A).’’. 

12 (b) TITLE XXI.—Section 2107(e)(1) of the Social 

13 Security Act (42 U.S.C. 1397gg(e)(1)) is amended by add14 ing at the end the following: 

15 ‘‘(E) Section 1903(v)(4) (relating to op16 tional coverage of permanent resident alien chil17 dren and parents), but only if the State has 

18 elected to apply such section to that category of 

19 children under title XIX.’’. 

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

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

22 medical assistance and child health assistance furnished 

23 on or after such date, whether or not regulations imple24 menting such amendments have been issued. 
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1 SEC. 6. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 

2 20 UNDER THE MEDICAID PROGRAM AND 

3 TITLE XXI. 

4 (a) MEDICAID.—

5 (1) IN GENERAL.—Section 1902(l)(1)(D) of the 

6 Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is 

7 amended by inserting ‘‘(or, at the election of a 

8 State, 20 or 21 years of age)’’ after ‘‘19 years of 

9 age’’. 

10 (2) CONFORMING AMENDMENTS.—

11 (A) Section 1902(e)(3)(A) of the Social Se12 curity Act (42 U.S.C. 1396a(e)(3)(A)) is 

13 amended by inserting ‘‘(or 1 year less than the 

14 age the State has elected under subsection 

15 (l)(1)(D))’’ after ‘‘18 years of age’’. 

16 (B) Section 1902(e)(12) of the Social Se17 curity Act (42 U.S.C. 1396a(e)(12)) is amend18 ed by inserting ‘‘or such higher age as the State 

19 has elected under subsection (l)(1)(D)’’ after 

20 ‘‘19 years of age’’. 

21 (C) Section 1920A(b)(1) of the Social Se22 curity Act (42 U.S.C. 1396r–1a(b)(1)) is 

23 amended by inserting ‘‘or such higher age as 

24 the State has elected under section 

25 1902(l)(1)(D)’’ after ‘‘19 years of age’’.
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1 (D) Section 1928(h)(1) of the Social Secu2 rity Act (42 U.S.C. 1396s(h)(1)) is amended by 

3 inserting ‘‘or 1 year less than the age the State 

4 has elected under section 1902(l)(1)(D)’’ before 

5 the period at the end. 

6 (E) Section 1932(a)(2)(A) of the Social 

7 Security Act (42 U.S.C. 1396u–2(a)(2)(A)) is 

8 amended by inserting ‘‘(or such higher age as 

9 the State has elected under section 

10 1902(l)(1)(D))’’ after ‘‘19 years of age’’. 

11 (b) TITLE XXI.—Section 2110(c)(1) of the Social 

12 Security Act (42 U.S.C. 1397jj(c)(1)) is amended by in13 serting ‘‘(or such higher age as the State has elected under 

14 section 1902(l)(1)(D))’’. 

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

16 this section take effect on January 1, 2005, and apply to 

17 medical assistance and child health assistance provided on 

18 or after such date, whether or not regulations imple19 menting such amendments have been issued. 

20 SEC. 7. ALLOWING STATES TO SIMPLIFY RULES FOR FAMI21 LIES. 

22 (a) PRESUMPTIVE ELIGIBILITY.—

23 (1) APPLICATION TO PRESUMPTIVE ELIGIBILITY

24 FOR PREGNANT WOMEN UNDER MEDICAID.—Section 

25 1920(b) of the Social Security Act (42 U.S.C. 
32

•HR 4350 IH 

1 1396r–1(b)) is amended by adding at the end after 

2 and below paragraph (2) the following flush sen3 tence: 

4 ‘‘The term ‘qualified provider’ includes a qualified entity 

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

6 (2) OPTIONAL APPLICATION OF PRESUMPTIVE

7 ELIGIBILITY PROVISIONS TO PARENTS.—Section 

8 1920A of the Social Security Act (42 U.S.C. 1396r–

9 1a) is amended by adding at the end the following: 

10 ‘‘(e) A State may elect to apply the previous provi11 sions of this section to provide for a period of presumptive 

12 eligibility for medical assistance for a parent of a child 

13 with respect to whom such a period is provided under this 

14 section.’’. 

15 (3) APPLICATION UNDER TITLE XXI.—Section 

16 2107(e)(1)(D) of the Social Security Act (42 U.S.C. 

17 1397gg(e)(1)) is amended to read as follows: 

18 ‘‘(D) Sections 1920 and 1920A (relating to 

19 presumptive eligibility).’’. 

20 (b) 12-MONTHS CONTINUOUS ELIGIBILITY.—

21 (1) MEDICAID.—Section 1902(e)(12) of the So22 cial Security Act (42 U.S.C. 1396a(e)(12)) is 

23 amended—

24 (A) by striking ‘‘At the option of the State, 

25 the plan may’’ and inserting ‘‘The plan shall’’; 
33

•HR 4350 IH 

1 (B) by striking ‘‘an age specified by the 

2 State (not to exceed 19 years of age)’’ and in3 serting ‘‘19 years of age (or such higher age as 

4 the State has elected under subsection 

5 (l)(1)(D)) or, at the option of the State, who is 

6 eligible for medical assistance as the parent of 

7 such a child’’; and 

8 (C) in subparagraph (A), by striking ‘‘a 

9 period (not to exceed 12 months) ’’ and insert10 ing ‘‘the 12-month period beginning on the 

11 date’’. 

12 (2) TITLE XXI.—Section 2102(b)(2) of such 

13 Act (42 U.S.C. 1397bb(b)(2)) is amended by adding 

14 at the end the following: ‘‘Such methods shall pro15 vide continuous eligibility for children under this 

16 title in a manner that is no less generous than the 

17 12-months continuous eligibility provided under sec18 tion 1902(e)(12) for children described in such sec19 tion under title XIX. If a State has elected to apply 

20 section 1902(e)(12) to parents, such methods may 

21 provide continuous eligibility for parents under this 

22 title in a manner that is no less generous than the 

23 12-months continuous eligibility provided under such 

24 section for parents described in such section under 

25 title XIX.’’. 
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1 (3) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall take effect on July 1, 2005, 

3 whether or not regulations implementing such 

4 amendments have been issued. 

5 (c) PROVISION OF MEDICAID AND CHIP APPLICA6 TIONS AND INFORMATION UNDER THE SCHOOL LUNCH

7 PROGRAM.—Section 9(b)(2)(B) of the Richard B. Russell 

8 National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is 

9 amended—

10 (1) by striking ‘‘(B) Applications’’ and inserting 

11 ‘‘(B)(i) Applications’’; and 

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

13 ‘‘(ii)(I) Applications for free and reduced price 

14 lunches that are distributed pursuant to clause (i) to par15 ents or guardians of children in attendance at schools par16 ticipating in the school lunch program under this Act shall 

17 also contain information on the availability of medical as18 sistance under title XIX of the Social Security Act (42 

19 U.S.C. 1396 et seq.) and of child health and FamilyCare 

20 assistance under title XXI of such Act, including informa21 tion on how to obtain an application for assistance under 

22 such programs. 

23 ‘‘(II) Information on the programs referred to in sub24 clause (I) shall be provided on a form separate from the 
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1 application form for free and reduced price lunches under 

2 clause (i).’’. 

3 SEC. 8. REVISION AND SIMPLIFICATION OF THE TRANSI4 TIONAL MEDICAL ASSISTANCE PROGRAM 

5 (TMA). 

6 (a) MAKING REPORTING REQUIREMENTS OPTIONAL; 

7 OPTION OF EXTENDED ELIGIBILITY.—

8 (1) OPTION FOR MAKING REPORTING REQUIRE9 MENTS OPTIONAL.—Section 1925(b) of the Social 

10 Security Act (42 U.S.C. 1396r–6(b)) is amended—

11 (A) in paragraph (1), by inserting ‘‘, at the 

12 option of a State,’’ after ‘‘and which’’; 

13 (B) in paragraph (2)(A), by inserting 

14 ‘‘Subject to subparagraph (C)—’’ after ‘‘(A) 

15 NOTICES.—’’; 

16 (C) in paragraph (2)(B), by inserting 

17 ‘‘Subject to subparagraph (C)—’’ after ‘‘(B) 

18 REPORTING REQUIREMENTS.—’’; 

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

20 subparagraph: 

21 ‘‘(C) STATE OPTION TO WAIVE NOTICE

22 AND REPORTING REQUIREMENTS.—A State 

23 may waive some or all of the reporting require24 ments under clauses (i) and (ii) of subpara25 graph (B). Insofar as it waives such a reporting
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•HR 4350 IH 

1 requirement, the State need not provide for a 

2 notice under subparagraph (A) relating to such 

3 requirement.’’; and 

4 (E) in paragraph (3)(A)(iii), by inserting 

5 ‘‘the State has not waived under paragraph 

6 (2)(C) the reporting requirement with respect 

7 to such month under paragraph (2)(B) and if’’ 

8 after ‘‘6-month period if’’. 

9 (2) STATE OPTION TO EXTEND ELIGIBILITY

10 FOR LOW-INCOME INDIVIDUALS FOR UP TO 12 ADDI11 TIONAL MONTHS.—Section 1925 of such Act (42 

12 U.S.C. 1396r–6) is further amended—

13 (A) by redesignating subsections (c) 

14 through (f) as subsections (d) through (g); and 

15 (B) by inserting after subsection (b) the 

16 following new subsection: 

17 ‘‘(c) STATE OPTION OF UP TO 12 MONTHS OF ADDI18 TIONAL ELIGIBILITY.—

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

20 provision of this title, each State plan approved 

21 under this title may provide, at the option of the 

22 State, that the State shall offer to each family which 

23 received assistance during the entire 6-month period 

24 under subsection (b) and which meets the applicable 

25 requirement of paragraph (2), in the last month of 
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1 the period the option of extending coverage under 

2 this subsection for the succeeding period not to ex3 ceed 12 months. 

4 ‘‘(2) INCOME RESTRICTION.—The option under 

5 paragraph (1) shall not be made available to a fam6 ily for a succeeding period unless the State deter7 mines that the family’s average gross monthly earn8 ings (less such costs for such child care as is nec9 essary for the employment of the caretaker relative) 

10 as of the end of the 6-month period under sub11 section (b) does not exceed 185 percent of the offi12 cial poverty line (as defined by the Office of Man13 agement and Budget, and revised annually in ac14 cordance with section 673(2) of the Omnibus Budget 

15 Reconciliation Act of 1981) applicable to a family of 

16 the size involved. 

17 ‘‘(3) APPLICATION OF EXTENSION RULES.—

18 The provisions of paragraphs (2), (3), (4), and (5) 

19 of subsection (b) shall apply to the extension pro20 vided under this subsection in the same manner as 

21 they apply to the extension provided under sub22 section (b)(1), except that for purposes of this sub23 section—

24 ‘‘(A) any reference to a 6-month period 

25 under subsection (b)(1) is deemed a reference 
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1 to the extension period provided under para2 graph (1) and any deadlines for any notices or 

3 reporting and the premium payment periods 

4 shall be modified to correspond to the appro5 priate calendar quarters of coverage provided 

6 under this subsection; and 

7 ‘‘(B) any reference to a provision of sub8 section (a) or (b) is deemed a reference to the 

9 corresponding provision of subsection (b) or of 

10 this subsection, respectively.’’. 

11 (b) STATE OPTION TO WAIVE RECEIPT OF MED12 ICAID FOR 3 OF PREVIOUS 6 MONTHS TO QUALIFY FOR

13 TMA.—Section 1925(a)(1) of such Act (42 U.S.C. 1396r–

14 6(a)(1)) is amended by adding at the end the following: 

15 ‘‘A State may, at its option, also apply the previous sen16 tence in the case of a family that was receiving such aid 

17 for fewer than 3 months, or that had applied for and was 

18 eligible for such aid for fewer than 3 months, during the 

19 6 immediately preceding months described in such sen20 tence.’’. 

21 (c) ELIMINATION OF SUNSET FOR TMA.—

22 (1) Subsection (g) of section 1925 of such Act 

23 (42 U.S.C. 1396r–6), as redesignated under sub24 section (a)(2), is repealed. 
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1 (2) Section 1902(e)(1) of such Act (42 U.S.C. 

2 1396a(e)(1)) is amended by striking ‘‘(A) 

3 Nothwithstanding’’ and all that follows through 

4 ‘‘During such period, for’’ in subparagraph (B) and 

5 inserting ‘‘For’’. 

6 (d) CMS REPORT ON ENROLLMENT AND PARTICIPA7 TION RATES UNDER TMA.—Section 1925 of such Act, 

8 as amended by subsections (a)(2) and (c)(1), is amended 

9 by adding at the end the following new subsection: 

10 ‘‘(g) ADDITIONAL PROVISIONS.—

11 ‘‘(1) COLLECTION AND REPORTING OF PARTICI12 PATION INFORMATION.—Each State shall—

13 ‘‘(A) collect and submit to the Secretary, 

14 in a format specified by the Secretary, informa15 tion on average monthly enrollment and average 

16 monthly participation rates for adults and chil17 dren under this section; and 

18 ‘‘(B) make such information publicly avail19 able. 

20 Such information shall be submitted under subpara21 graph (A) at the same time and frequency in which 

22 other enrollment information under this title is sub23 mitted to the Secretary. Using such information, the 

24 Secretary shall submit to Congress annual reports 

25 concerning such rates.’’. 
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1 (e) COORDINATION OF WORK.—Section 1925(g) of 

2 such Act, as added by subsection (d), is amended by add3 ing at the end the following new paragraph: 

4 ‘‘(2) COORDINATION WITH ADMINISTRATION

5 FOR CHILDREN AND FAMILIES.—The Administrator 

6 of the Centers for Medicare & Medicaid Services, in 

7 carrying out this section, shall work with the Assist8 ant Secretary for the Administration for Children 

9 and Families to develop guidance or other technical 

10 assistance for States regarding best practices in 

11 guaranteeing access to transitional medical assist12 ance under this section.’’. 

13 (f) ELIMINATION OF TMA REQUIREMENT FOR

14 STATES THAT EXTEND COVERAGE TO CHILDREN AND

15 PARENTS THROUGH 185 PERCENT OF POVERTY.—

16 (1) IN GENERAL.—Section 1925 of such Act is 

17 further amended by adding at the end the following 

18 new subsection: 

19 ‘‘(h) PROVISIONS OPTIONAL FOR STATES THAT EX20 TEND COVERAGE TO CHILDREN AND PARENTS THROUGH

21 185 PERCENT OF POVERTY.—A State may (but is not re22 quired to) meet the requirements of subsections (a) and 

23 (b) if it provides for medical assistance under section 1931 

24 to families (including both children and caretaker rel25 atives) the average gross monthly earning of which (less
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•HR 4350 IH 

1 such costs for such child care as is necessary for the em2 ployment of a caretaker relative) is at or below a level that 

3 is at least 185 percent of the official poverty line (as de4 fined by the Office of Management and Budget, and re5 vised annually in accordance with section 673(2) of the 

6 Omnibus Budget Reconciliation Act of 1981) applicable 

7 to a family of the size involved.’’. 

8 (2) CONFORMING AMENDMENTS.—Such section 

9 is further amended, in subsections (a)(1) and (b)(1), 

10 by inserting ‘‘, but subject to subsection (h),’’ after 

11 ‘‘Notwithstanding any other provision of this title,’’ 

12 each place it appears. 

13 (g) EXTENDING USE OF OUTSTATIONED WORKERS

14 TO ACCEPT APPLICATIONS FOR TRANSITIONAL MEDICAL

15 ASSISTANCE.—Section 1902(a)(55) of such Act (42 

16 U.S.C. 1396a(a)(55)) is amended by inserting ‘‘and under 

17 section 1931’’ after ‘‘(a)(10)(A)(ii)(IX)’’. 

18 (h) EFFECTIVE DATES.—(1) Except as provided in 

19 this subsection, the amendments made by this section shall 

20 apply to calendar quarters beginning on or after the date 

21 of the enactment of this Act, without regard to whether 

22 or not final regulations to carry out such amendments 

23 have been promulgated by such date. 

24 (2) In the case of a State plan for medical assistance 

25 under title XIX of the Social Security Act which the Sec-
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1 retary of Health and Human Services determines requires 

2 State legislation (other than legislation appropriating 

3 funds) in order for the plan to meet the additional require4 ments imposed by the amendments made by this section, 

5 the State plan shall not be regarded as failing to comply 

6 with the requirements of such title solely on the basis of 

7 its failure to meet these additional requirements before the 

8 first day of the first calendar quarter beginning after the 

9 close of the first regular session of the State legislature 

10 that begins after the date of the enactment of this Act. 

11 For purposes of the previous sentence, in the case of a 

12 State that has a 2-year legislative session, each year of 

13 such session shall be deemed to be a separate regular ses14 sion of the State legislature.

15 SEC. 9. LIMITATIONS ON CONFLICTS OF INTEREST. 

16 (a) LIMITATION ON CONFLICTS OF INTEREST IN

17 MARKETING ACTIVITIES.—

18 (1) TITLE XXI.—Section 2105(c) of the Social 

19 Security Act (42 U.S.C. 300aa–5(c)) is amended by 

20 adding at the end the following: 

21 ‘‘(8) LIMITATION ON EXPENDITURES FOR MAR22 KETING ACTIVITIES.—Amounts expended by a State 

23 for the use of an administrative vendor in marketing 

24 health benefits coverage to low-income children 

25 under this title shall not be considered, for purposes 
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1 of subsection (a)(2)(D), to be reasonable costs to ad2 minister the plan unless the following conditions are 

3 met with respect to the vendor: 

4 ‘‘(A) The vendor is independent of any en5 tity offering the coverage in the same area of 

6 the State in which the vendor is conducting 

7 marketing activities. 

8 ‘‘(B) No person who is an owner, em9 ployee, consultant, or has a contract with the 

10 vendor either has any direct or indirect finan11 cial interest with such an entity or has been ex12 cluded from participation in the program under 

13 this title or title XVIII or XIX or debarred by 

14 any Federal agency, or subject to a civil money 

15 penalty under this Act.’’. 

16 (b) PROHIBITION OF AFFILIATION WITH DEBARRED

17 INDIVIDUALS.—

18 (1) MEDICAID.—Section 1903(i) of the Social 

19 Security Act (42 U.S.C. 1396b(i))is amended—

20 (A) by striking the period at the end of 

21 paragraph (20) and inserting ‘‘; or’’; and 

22 (B) by inserting after paragraph (20) the 

23 following: 
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•HR 4350 IH 

1 ‘‘(21) with respect to any amounts expended for 

2 an entity that receives payments under the plan un3 less—

4 ‘‘(A) no person with an ownership or con5 trol interest (as defined in section 1124(a)(3)) 

6 in the entity is a person that is debarred, sus7 pended, or otherwise excluded from partici8 pating in procurement or non-procurement ac9 tivities under the Federal Acquisition Regula10 tion; and 

11 ‘‘(B) such entity has not entered into an 

12 employment, consulting, or other agreement for 

13 the provision of items or services that are mate14 rial to such entity’s obligations under the plan 

15 with a person described in subparagraph (A).’’. 

16 (2) TITLE XXI.—Section 2107(e)(1) of the So17 cial Security Act (42 U.S.C. 1397gg(e)(1)), as 

18 amended by section 5(b), is further amended—

19 (A) in subparagraph (B), by striking ‘‘and 

20 (17)’’ and inserting ‘‘(17), and (21)’’; and 

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

22 ‘‘(F) Section 1902(a)(67) (relating to pro23 hibition of affiliation with debarred individ24 uals).’’. 
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1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to expenditures made on or after 

3 July 1, 2005, whether or not regulations implementing 

4 such amendments have been issued. 

5 SEC. 10. INCREASE IN CHIP ALLOTMENT FOR EACH OF FIS6 CAL YEARS 2002 THROUGH 2004. 

7 Effective as if included in the enactment of the Bal8 anced Budget Act of 1997, paragraphs (5), (6), and (7) 

9 of section 2104(a) of the Social Security Act (42 U.S.C. 

10 1397dd(a)) are amended by striking ‘‘$3,150,000,000’’ 

11 each place it appears and inserting ‘‘$4,150,000,000’’. 

12 SEC. 11. DEMONSTRATION PROGRAMS TO IMPROVE MED13 ICAID AND CHIP OUTREACH TO HOMELESS 

14 INDIVIDUALS AND FAMILIES. 

15 (a) AUTHORITY.—The Secretary of Health and 

16 Human Services may award demonstration grants to not 

17 more than 7 States (or other qualified entities) to conduct 

18 innovative programs that are designed to improve out19 reach to homeless individuals and families under the pro20 grams described in subsection (b) with respect to enroll21 ment of such individuals and families under such pro22 grams and the provision of services (and coordinating the 

23 provision of such services) under such programs. 

24 (b) PROGRAMS FOR HOMELESS DESCRIBED.—The 

25 programs described in this subsection are as follows:
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1 (1) MEDICAID.—The program under title XIX 

2 of the Social Security Act (42 U.S.C. 1396 et seq.). 

3 (2) CHIP.—The program under title XXI of 

4 the Social Security Act (42 U.S.C. 1397aa et seq.). 

5 (3) TANF.—The program under part of A of 

6 title IV of the Social Security Act (42 U.S.C. 601 

7 et seq.). 

8 (4) SAMHSA BLOCK GRANTS.—The program 

9 of grants under part B of title XIX of the Public 

10 Health Service Act (42 U.S.C. 300x–1 et seq.). 

11 (5) FOOD STAMP PROGRAM.—The program 

12 under the Food Stamp Act of 1977 (7 U.S.C. 2011 

13 et seq.). 

14 (6) WORKFORCE INVESTMENT ACT.—The pro15 gram under the Workforce Investment Act of 1999 

16 (29 U.S.C. 2801 et seq.). 

17 (7) WELFARE-TO-WORK.—The welfare-to-work 

18 program under section 403(a)(5) of the Social Secu19 rity Act (42 U.S.C. 603(a)(5)). 

20 (8) OTHER PROGRAMS.—Other public and pri21 vate benefit programs that serve low-income individ22 uals. 

23 (c) APPROPRIATIONS.—For the purposes of carrying 

24 out this section, there is appropriated for fiscal year 2005, 
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1 out of any funds in the Treasury not otherwise appro2 priated, $10,000,000, to remain available until expended. 

3 SEC. 12. ADDITIONAL CHIP REVISIONS.

4 (a) LIMITING COST-SHARING TO 2.5 PERCENT FOR

5 FAMILIES WITH INCOME BELOW 150 PERCENT OF POV6 ERTY.—Section 2103(e)(3)(A) of the Social Security Act 

7 (42 U.S.C. 1397cc(e)(3)(A)) is amended—

8 (1) by striking ‘‘and’’ at the end of clause (i); 

9 (2) by striking the period at the end of clause 

10 (ii) and inserting ‘‘; and’’; and 

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

12 clause: 

13 ‘‘(iii) total annual aggregate cost14 sharing described in clauses (i) and (ii) 

15 with respect to all such targeted low-in16 come children in a family under this title 

17 that exceeds 2.5 percent of such family’s 

18 income for the year involved.’’. 

19 (b) EMPLOYER COVERAGE WAIVER CHANGES.—Sec20 tion 2105(c)(3) of such Act (42 U.S.C. 1397ee(c)(3)) is 

21 amended—

22 (1) by redesignating subparagraphs (A) and 

23 (B) as clauses (i) and (ii) and indenting appro24 priately; 
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1 (2) by designating the matter beginning with 

2 ‘‘Payment may be made’’ as a subparagraph (A) 

3 with the heading ‘‘IN GENERAL’’ and indenting ap4 propriately; and 

5 (3) by adding at the end the following new sub6 paragraph: 

7 ‘‘(B) APPLICATION OF REQUIREMENTS.—

8 In carrying out subparagraph (A)—

9 ‘‘(i) in determining cost-effectiveness, 

10 the Secretary shall measure against family 

11 coverage costs to the extent that a State 

12 has expanded coverage to parents pursuant 

13 to section 2111; 

14 ‘‘(ii) subject to clause (iii), the State 

15 shall provide satisfactory assurances that 

16 the minimum benefits and cost-sharing 

17 protections established under this title are 

18 provided, either through the coverage 

19 under subparagraph (A) or as a supple20 ment to such coverage; and 

21 ‘‘(iii) coverage under such subpara22 graph shall not be considered to violate 

23 clause (ii) because it does not comply with 

24 requirements relating to reviews of health 

25 service decisions if the enrollee involved is 
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1 provided the option of being provided bene2 fits directly under this title.’’. 

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

4 this section apply as of January 1, 2005, whether or not 

5 regulations implementing such amendments have been 

6 issued. 

7 SEC. 13. INCREASED FEDERAL REIMBURSEMENT FOR LAN8 GUAGE SERVICES UNDER THE MEDICAID 

9 PROGRAM AND TITLE XXI. 

10 (a) MEDICAID.—Section 1903(a)(3) of the Social Se11 curity Act (42 U.S.C. 1396b(a)(3)) is amended—

12 (1) in subparagraph (D), by striking ‘‘plus’’ at 

13 the end and inserting ‘‘and’’; and 

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

15 ‘‘(E) 90 percent of the sums expended with 

16 respect to costs incurred during such quarter as 

17 are attributable to the provision of language 

18 services, including oral interpretation, trans19 lations of written materials, and other language 

20 services, for individuals with limited English 

21 proficiency who apply for, or receive, medical 

22 assistance under the State plan; plus’’.

23 (b) SCHIP.—Section 2105(a)(1) of the Social Secu24 rity Act (42 U.S.C.1397ee(a)) is amended—
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1 (1) in the matter preceding subparagraph (A), 

2 by inserting ‘‘or, in the case of expenditures de3 scribed in subparagraph (D)(iv), 90 percent’’ after 

4 ‘‘enhanced FMAP’’; and 

5 (2) in subparagraph (D)—

6 (A) in clause (iii), by striking ‘‘and’’ at the 

7 end; 

8 (B) be redesignating clause (iv) as clause 

9 (v); and 

10 (C) by inserting after clause (iii) the fol11 lowing: 

12 ‘‘(iv) for expenditures attributable to 

13 the provision of language services, includ14 ing oral interpretation, translations of 

15 written materials, and other language serv16 ices, for individuals with limited English 

17 proficiency who apply for, or receive, child 

18 health assistance under the plan; and’’. 

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

20 this section take effect on January 1, 2005.

Æ