I 

108TH CONGRESS 

1ST SESSION H. R. 449

To amend title XXI of the Social Security Act to permit the use of unexpended allotments under the State children’s health care program for 

an additional fiscal year, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 29, 2003

Ms. DUNN (for herself, Mrs. WILSON of New Mexico, Mr. NETHERCUTT, Mr. 

DICKS, Mr. HASTINGS of Washington, Mr. BAIRD, Mr. MCDERMOTT, and 

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

Committee on Energy and Commerce 

A BILL

To amend title XXI of the Social Security Act to permit 

the use of unexpended allotments under the State children’s health care program for an additional fiscal year, 

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 ‘‘Children First SCHIP 

5 Improvement Act of 2003’’. 
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1 SEC. 2. PERMITTING USE OF RETAINED FISCAL YEARS 1998, 

2 1999, AND 2000 SCHIP ALLOTMENTS THROUGH 

3 FISCAL YEAR 2004. 

4 (a) RETAINED AND REDISTRIBUTED ALLOTMENTS

5 FOR FISCAL YEARS 1998 AND 1999.—Paragraphs 

6 (1)(B)(ii), (2)(A)(i), and (2)(A)(ii) of section 2104(g) of 

7 the Social Security Act (42 U.S.C. 1397dd(g)) are each 

8 amended by striking ‘‘fiscal year 2002’’ and inserting ‘‘fis9 cal year 2004’’. 

10 (b) FISCAL YEAR 2000.—Section 2104(g)(2) of such 

11 Act (42 U.S.C. 1397dd(g)(2)) is amended—

12 (1) in the heading, by striking ‘‘AND 1999’’ and 

13 inserting ‘‘THROUGH 2000’’; 

14 (2) by adding at the end of subparagraph (A) 

15 the following: 

16 ‘‘(iii) FISCAL YEAR 2000 ALLOT17 MENT.—

18 ‘‘(I) IN GENERAL.—Except as 

19 provided in subclause (II) with respect 

20 to high unemployment States, of the 

21 amounts allotted to a State pursuant 

22 to this section for fiscal year 2000 

23 that were not expended by the State 

24 by the end of fiscal year 2002, the 

25 amount specified in subparagraph (B) 

26 for fiscal year 2000 for such State 
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1 shall remain available for expenditure 

2 by the State through the end of fiscal 

3 year 2004. 

4 ‘‘(II) SPECIAL RULE FOR HIGH

5 UNEMPLOYMENT STATES.—With re6 spect only to high unemployment 

7 States (as defined in subparagraph 

8 (D)), of the amounts allotted to such 

9 a State pursuant to this section for 

10 fiscal year 2000 that were not ex11 pended by the State by the end of fis12 cal year 2002, all such amounts for 

13 fiscal year 2000 for such State shall 

14 remain available for expenditure by 

15 the State through the end of fiscal 

16 year 2004.’’; and 

17 (3) by adding at the end the following new sub18 paragraph: 

19 ‘‘(D) HIGH UNEMPLOYMENT STATE DE20 FINED.— For purposes of subparagraph 

21 (A)(iii), the term ‘high unemployment State’ 

22 means a State that is any of the 50 States or 

23 the District of Columbia and that had an unem24 ployment rate (seasonally adjusted) of at least 
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1 6 percent in each of two consecutive months in 

2 2002.’’. 

3 (c) USE OF UNUSED FISCAL YEAR 1998 THROUGH

4 2000 FUNDS.—Section 2104(g) of such Act (42 U.S.C. 

5 1397dd(g)), as amended by subsection (b), is further 

6 amended by adding at the end the following new para7 graph: 

8 ‘‘(5) USE OF UNEXPENDED FISCAL YEARS 1998

9 THROUGH 2000 ALLOTMENTS.—Notwithstanding any 

10 waiver granted under section 1115 or otherwise for 

11 the use of funds under title XIX or this title that 

12 is approved as of December 31, 2002, amounts 

13 made available for expenditure under this subsection 

14 to provide child health assistance under this title 

15 shall be expended in accordance with the following 

16 priority: 

17 ‘‘(A) First to children who are eligible for 

18 child health assistance under this title. 

19 ‘‘(B) Second to children who are eligible 

20 for medical assistance under title XIX.’’. 

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

22 this section shall be effective as if this section had been 

23 enacted on December 31, 2002, and amounts under title 

24 XXI of the Social Security Act (42 U.S.C. 1397 et seq.) 

25 from allotments for fiscal years 1998 through 2000 are
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1 available for expenditure on and after October 1, 2002, 

2 under the amendments made by this section as if this sec3 tion had been enacted on December 31, 2002. 

4 SEC. 3. SCHIP COVERAGE OF CHILDREN ABOVE THE MED5 ICAID MANDATORY LEVEL FOR CERTAIN 

6 STATES MEETING ADDITIONAL REQUIRE7 MENTS. 

8 Section 2110(b) of the Social Security Act (42 U.S.C. 

9 1397jj(b)) is amended—

10 (1) in paragraph (1)(B)(ii)—

11 (A) by striking ‘‘or’’ at the end of sub12 clause (II); 

13 (B) by by striking ‘‘and’’ at the end of 

14 subclause (III) and inserting ‘‘or’’; and 

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

16 subclause: 

17 ‘‘(IV) who is residing in an eligible 

18 State (as defined in paragraph (5))) and 

19 whose family income (as determined under 

20 the State child health plan) exceeds 133 

21 percent of the poverty line but does not ex22 ceed 50 percentage points above the med23 icaid applicable income level; and’’; 

24 (2) in paragraph (1)(C), by striking ‘‘who is not 

25 found to be eligible for medical assistance under title 
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1 XIX or’’ and inserting ‘‘who (i) is not found to be 

2 eligible for medical assistance under title XIX or is 

3 so eligible but is described in subparagraph 

4 (B)(ii)(IV), and (ii) is not found to be’’; and 

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

6 paragraph: 

7 ‘‘(5) ELIGIBLE STATE.—For purposes of para8 graph (1)(B)(ii)(IV), an eligible State is a State 

9 that, with respect to the fiscal year involved, meets 

10 all of the following conditions: 

11 ‘‘(A) EXPANDED ELIGIBILITY OF CHIL12 DREN UNDER MEDICAID.—The State’s plan for 

13 medical assistance under title XIX provides, in 

14 effect as of March 31, 1997, for eligibility for 

15 medical assistance of children who are under 19 

16 years of age and whose family income equals or 

17 exceeds 185 percent of the poverty line. 

18 ‘‘(B) HIGHEST SCHIP INCOME ELIGI19 BILITY.—The State child health plan (whether 

20 implemented under this title or under title 

21 XIX)—

22 ‘‘(i) has the highest income eligibility 

23 standard permitted under this title as of 

24 January 1, 2001; 
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1 ‘‘(ii) does not impose any waiting list, 

2 numerical limitation, or similar limitation 

3 on the eligibility of children for child 

4 health assistance; and 

5 ‘‘(iii) provides benefits to all children 

6 in the State who apply for and meet eligi7 bility standards. 

8 ‘‘(C) NO LOSS OF MEDICAID OR SCHIP

9 COVERAGE DUE TO INABILITY TO PAYMENT

10 PREMIUMS AND COST-SHARING.—The State’s 

11 plan for medical assistance under title XIX and 

12 the State child health plan do not deny an eligi13 ble child coverage or needed care because of an 

14 inability to pay premiums or cost-sharing other15 wise imposed under the respective plan. 

16 ‘‘(D) UNIFORM, SIMPLIFIED APPLICATION

17 FORM.—With respect to children who are eligi18 ble for medical assistance under section 

19 1902(a)(10)(A), the State uses the same uni20 form, simplified application form (including, if 

21 applicable, permitting application other than in 

22 person) for purposes of establishing eligibility 

23 for benefits under this title and also under title 

24 XIX. 
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1 ‘‘(E) NO ASSET TEST.—The State does not 

2 impose an asset test for eligibility under this 

3 title or under section 1902(l) with respect to 

4 children. 

5 ‘‘(F) 12-MONTH CONTINUOUS ENROLL6 MENT.—The State has elected the option of 

7 continuing eligibility under section 1902(e)(12) 

8 and has elected a 12-month period under sub9 paragraph (A) of such section and provides for 

10 a similar period of continuous eligibility under 

11 the State child health plan. 

12 ‘‘(G) COORDINATED ENROLLMENT PROC13 ESS.—The State’s enrollment process under 

14 this title is coordinated with such process under 

15 title XIX so that—

16 ‘‘(i) a family need only interact with a 

17 single agency in order to determine wheth18 er a child is eligible for benefits under this 

19 title or title XIX; and 

20 ‘‘(ii) transfers of enrollment, without 

21 a gap in coverage, automatically occur for 

22 a child in a family the income of which 

23 changes so that the child is no longer eligi24 ble for benefits under one such title but be-
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1 comes eligible for benefits under the other 

2 title. 

3 ‘‘(H) SAME VERIFICATION AND REDETER4 MINATION POLICIES; AUTOMATIC REASSESS5 MENT OF ELIGIBILITY.—With respect to chil6 dren who are eligible for medical assistance 

7 under section 1902(a)(10)(A), the State pro8 vides for initial eligibility determinations and 

9 redeterminations of eligibility using the same 

10 verification policies (including policies respect11 ing face-to-face interviews), forms, and fre12 quency as the State uses for such purposes 

13 under this title, and, as part of such redeter14 minations, provides for the automatic reassess15 ment of the eligibility of such children for as16 sistance under this title and title XIX.’’.

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