II 

111TH CONGRESS 

1ST SESSION S. 326 

To amend title XXI of the Social Security Act to reauthorize the State 

Children’s Health Insurance Program through fiscal year 2013, and 

for other purposes 

IN THE SENATE OF THE UNITED STATES 

JANUARY 26, 2009 

Mr. MCCONNELL (for himself, Mr. KYL, Mr. VITTER, Mr. CHAMBLISS, Mr. 

BUNNING, Mr. GREGG, Mr. COBURN, Mr. BURR, Mr. ISAKSON, Mr. 

GRAHAM, Mr. INHOFE, Mr. CORNYN, Mr. BROWNBACK, Mr. COCHRAN, 

Mr. ENSIGN, Mr. THUNE, Mr. DEMINT, Mr. BENNETT, and Mr. 

BARRASSO) 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 reauthorize 

the State Children’s Health Insurance Program through 

fiscal year 2013, 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 ‘‘Kids First Act’’. 

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

7 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

Sec. 2. Reauthorization through fiscal year 2013. 

Sec. 3. Allotments for the 50 States and the District of Columbia based on expenditures and numbers of low-income children. 

Sec. 4. Limitations on matching rates for populations other than low-income 

children or pregnant women covered through a section 1115 

waiver. 

Sec. 5. Prohibition on new section 1115 waivers for coverage of adults other 

than pregnant women. 

Sec. 6. Standardization of determination of family income for targeted low-income children under title XXI and optional targeted low-income children under title XIX. 

Sec. 7. Grants for outreach and enrollment. 

Sec. 8. Improved State option for offering premium assistance for coverage of 

children through private plans under SCHIP and Medicaid. 

Sec. 9. Treatment of unborn children. 

Sec. 10. 50 percent matching rate for all Medicaid administrative costs. 

Sec. 11. Reduction in payments for Medicaid administrative costs to prevent 

duplication of such payments under TANF. 

Sec. 12. Elimination of waiver of certain Medicaid provider tax provisions. 

Sec. 13. Elimination of special payments for certain public hospitals. 

Sec. 14. Effective date; coordination of funding for fiscal year 2009. 

1 SEC. 2. REAUTHORIZATION THROUGH FISCAL YEAR 2013. 

2 (a) INCREASE IN NATIONAL ALLOTMENT.—Section 

3 2104 of the Social Security Act (42 U.S.C. 1397dd(a)) 

4 is amended— 

5 (1) in subsection (a)— 

6 (A) by striking ‘‘and’’ at the end of para7 graph (10); 

8 (B) in paragraph (11)— 

9 (i) by striking ‘‘each of fiscal years 

10 2008 and 2009’’ and inserting ‘‘fiscal year 

11 2008’’; and 

12 (ii) by striking the period at the end 

13 and inserting a semicolon; and 

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

15 paragraphs: 


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1 ‘‘(12) for fiscal year 2009, $7,780,000,000; 

2 ‘‘(13) for fiscal year 2010, $8,044,000,000; 

3 ‘‘(14) for fiscal year 2011, $8,568,000,000; 

4 ‘‘(15) for fiscal year 2012, $9,032,000,000; and 

5 ‘‘(16) for fiscal year 2013, $9,505,000,000.’’; 

6 and 

7 (2) in subsection (c)(4)(B), by striking ‘‘2009’’ 

8 and inserting ‘‘2008, $62,000,000 for fiscal year 

9 2009, $64,000,000 for fiscal year 2010, 

10 $68,000,000 for fiscal year 2011, $72,000,000 for 

11 fiscal year 2012, and $75,000,000 for fiscal year 

12 2013’’. 

13 (b) REPEAL OF LIMITATION ON AVAILABILITY OF

14 FUNDING FOR FISCAL YEARS 2008 AND 2009.—Section 

15 201 of the Medicare, Medicaid, and SCHIP Extension Act 

16 of 2007 (Public Law 110–173) is amended— 

17 (1) in subsection (a), by striking paragraph (2) 

18 and redesignating paragraphs (3) and (4), as para19 graphs (2) and (3) respectively; and 

20 (2) in subsection (b), by striking paragraph (2). 


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1 SEC. 3. ALLOTMENTS FOR THE 50 STATES AND THE DIS2 TRICT OF COLUMBIA BASED ON EXPENDI3 TURES AND NUMBERS OF LOW-INCOME CHIL4 DREN. 

5 (a) IN GENERAL.—Section 2104 of the Social Secu6 rity Act (42 U.S.C. 1397dd) is amended by adding at the 

7 end the following new subsection: 

8 ‘‘(m) DETERMINATION OF ALLOTMENTS FOR THE 50 

9 STATES AND THE DISTRICT OF COLUMBIA FOR FISCAL

10 YEARS 2009 THROUGH 2013.— 

11 ‘‘(1) IN GENERAL.—Notwithstanding the pre12 ceding provisions of this subsection and subject to 

13 paragraph (3), the Secretary shall allot to each sub14 section (b) State for each of fiscal years 2009 

15 through 2013, the amount determined for the fiscal 

16 year that is equal to the product of— 

17 ‘‘(A) the amount available for allotment 

18 under subsection (a) for the fiscal year, reduced 

19 by the amount of allotments made under sub20 section (c) (determined without regard to para21 graph (4) thereof) for the fiscal year; and 

22 ‘‘(B) the sum of the State allotment fac23 tors determined under paragraph (2) with re24 spect to the State and weighted in accordance 

25 with subparagraph (B) of that paragraph for 

26 the fiscal year. 


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1 ‘‘(2) STATE ALLOTMENT FACTORS.— 

2 ‘‘(A) IN GENERAL.—For purposes of para3 graph (1)(B), the State allotment factors are 

4 the following: 

5 ‘‘(i) The ratio of the projected expend6 itures for targeted low-income children 

7 under the State child health plan and preg8 nant women under a waiver of such plan 

9 for the fiscal year to the sum of such pro10 jected expenditures for all States for the 

11 fiscal year, multiplied by the applicable 

12 percentage weight assigned under subpara13 graph (B). 

14 ‘‘(ii) The ratio of the number of low15 income children who have not attained age 

16 19 with no health insurance coverage in 

17 the State, as determined by the Secretary 

18 on the basis of the arithmetic average of 

19 the number of such children for the 3 most 

20 recent Annual Social and Economic Sup21 plements to the Current Population Survey 

22 of the Bureau of the Census available be23 fore the beginning of the calendar year be24 fore such fiscal year begins, to the sum of 

25 the number of such children determined 


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1 for all States for such fiscal year, multi2 plied by the applicable percentage weight 

3 assigned under subparagraph (B). 

4 ‘‘(iii) The ratio of the projected ex5 penditures for targeted low-income children 

6 under the State child health plan and preg7 nant women under a waiver of such plan 

8 for the preceding fiscal year to the sum of 

9 such projected expenditures for all States 

10 for such preceding fiscal year, multiplied 

11 by the applicable percentage weight as12 signed under subparagraph (B). 

13 ‘‘(iv) The ratio of the actual expendi14 tures for targeted low-income children 

15 under the State child health plan and preg16 nant women under a waiver of such plan 

17 for the second preceding fiscal year to the 

18 sum of such actual expenditures for all 

19 States for such second preceding fiscal 

20 year, multiplied by the applicable percent21 age weight assigned under subparagraph 

22 (B). 

23 ‘‘(B) ASSIGNMENT OF WEIGHTS.—For 

24 each of fiscal years 2009 through 2013, the fol25 lowing percentage weights shall be applied to 


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1 the ratios determined under subparagraph (A) 

2 for each such fiscal year: 

3 ‘‘(i) 40 percent for the ratio deter4 mined under subparagraph (A)(i). 

5 ‘‘(ii) 5 percent for the ratio deter6 mined under subparagraph (A)(ii). 

7 ‘‘(iii) 50 percent for the ratio deter8 mined under subparagraph (A)(iii). 

9 ‘‘(iv) 5 percent for the ratio deter10 mined under subparagraph (A)(iv). 

11 ‘‘(C) DETERMINATION OF PROJECTED AND

12 ACTUAL EXPENDITURES.—For purposes of sub13 paragraph (A): 

14 ‘‘(i) PROJECTED EXPENDITURES.— 

15 The projected expenditures described in 

16 clauses (i) and (iii) of such subparagraph 

17 with respect to a fiscal year shall be deter18 mined on the basis of amounts reported by 

19 States to the Secretary on the May 15th 

20 submission of Form CMS–37 and Form 

21 CMS–21B submitted not later than June 

22 30th of the fiscal year preceding such year. 

23 ‘‘(ii) ACTUAL EXPENDITURES.—The 

24 actual expenditures described in clause (iv) 

25 of such subparagraph with respect to a 


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1 second preceding fiscal year shall be deter2 mined on the basis of amounts reported by 

3 States to the Secretary on Form CMS–64 

4 and Form CMS–21 submitted not later 

5 than November 30 of the preceding fiscal 

6 year.’’. 

7 (b) 2-YEAR AVAILABILITY OF ALLOTMENTS; EX8 PENDITURES COUNTED AGAINST OLDEST ALLOT9 MENTS.—Section 2104(e) of the Social Security Act (42 

10 U.S.C. 1397dd(e)) is amended to read as follows: 

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

12 ‘‘(1) IN GENERAL.—Except as provided in the 

13 succeeding paragraphs of this subsection, amounts 

14 allotted to a State pursuant to this section— 

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

16 2008, shall remain available for expenditure by 

17 the State through the end of the second suc18 ceeding fiscal year; and 

19 ‘‘(B) for each of fiscal years 2009 through 

20 2013, shall remain available for expenditure by 

21 the State only through the end of the fiscal 

22 year succeeding the fiscal year for which such 

23 amounts are allotted. 

24 ‘‘(2) ELIMINATION OF REDISTRIBUTION OF AL25 LOTMENTS NOT EXPENDED WITHIN 3 YEARS.—NotVerDate Nov 24 2008 06:14 Jan 27, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S326.IS S326

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1 withstanding subsection (f), amounts allotted to a 

2 State under this section for fiscal years beginning 

3 with fiscal year 2009 that remain unexpended as of 

4 the end of the fiscal year succeeding the fiscal year 

5 for which the amounts are allotted shall not be re6 distributed to other States and shall revert to the 

7 Treasury on October 1 of the third succeeding fiscal 

8 year. 

9 ‘‘(3) RULE FOR COUNTING EXPENDITURES

10 AGAINST FISCAL YEAR ALLOTMENTS.—Expenditures 

11 under the State child health plan made on or after 

12 April 1, 2009, shall be counted against allotments 

13 for the earliest fiscal year for which funds are avail14 able for expenditure under this subsection.’’. 

15 (c) CONFORMING AMENDMENTS.— 

16 (1) Section 2104(b)(1) of the Social Security 

17 Act (42 U.S.C. 1397dd(b)(1)) is amended by strik18 ing ‘‘subsection (d)’’ and inserting ‘‘the succeeding 

19 subsections of this section’’. 

20 (2) Section 2104(f) of such Act (42 U.S.C. 

21 1397dd(f)) is amended by striking ‘‘The’’ and in22 serting ‘‘Subject to subsection (e)(2), the’’. 


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1 SEC. 4. LIMITATIONS ON MATCHING RATES FOR POPU2 LATIONS OTHER THAN LOW-INCOME CHIL3 DREN OR PREGNANT WOMEN COVERED 

4 THROUGH A SECTION 1115 WAIVER. 

5 (a) LIMITATION ON PAYMENTS.—Section 2105(c) of 

6 the Social Security Act (42 U.S.C. 1397ee(c)) is amended 

7 by adding at the end the following new paragraph: 

8 ‘‘(8) LIMITATIONS ON MATCHING RATE FOR

9 POPULATIONS OTHER THAN TARGETED LOW-INCOME

10 CHILDREN OR PREGNANT WOMEN COVERED

11 THROUGH A SECTION 1115 WAIVER.—For child 

12 health assistance or health benefits coverage fur13 nished in any fiscal year beginning with fiscal year 

14 2010: 

15 ‘‘(A) FMAP APPLIED TO PAYMENTS FOR

16 COVERAGE OF CHILDREN OR PREGNANT WOMEN

17 COVERED THROUGH A SECTION 1115 WAIVER

18 ENROLLED IN THE STATE CHILD HEALTH PLAN

19 ON THE DATE OF ENACTMENT OF THE KIDS

20 FIRST ACT AND WHOSE GROSS FAMILY INCOME

21 IS DETERMINED TO EXCEED THE INCOME ELI22 GIBILITY LEVEL SPECIFIED FOR A TARGETED

23 LOW-INCOME CHILD.—Notwithstanding sub24 sections (b)(1)(B) and (d) of section 2110, in 

25 the case of any individual described in sub26 section (c) of section 105 of the Kids First Act 


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1 who the State elects to continue to provide child 

2 health assistance for under the State child 

3 health plan in accordance with the requirements 

4 of such subsection, the Federal medical assist5 ance percentage (as determined under section 

6 1905(b) without regard to clause (4) of such 

7 section) shall be substituted for the enhanced 

8 FMAP under subsection (a)(1) with respect to 

9 such assistance. 

10 ‘‘(B) FMAP APPLIED TO PAYMENTS ONLY

11 FOR NONPREGNANT CHILDLESS ADULTS AND

12 PARENTS AND CARETAKER RELATIVES EN13 ROLLED UNDER A SECTION 1115 WAIVER ON

14 THE DATE OF ENACTMENT OF THE KIDS FIRST

15 ACT.—The Federal medical assistance percent16 age (as determined under section 1905(b) with17 out regard to clause (4) of such section) shall 

18 be substituted for the enhanced FMAP under 

19 subsection (a)(1) with respect to payments for 

20 child health assistance or health benefits cov21 erage provided under the State child health 

22 plan for any of the following: 

23 ‘‘(i) PARENTS OR CARETAKER REL24 ATIVES ENROLLED UNDER A WAIVER ON

25 THE DATE OF ENACTMENT OF THE KIDS


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1 FIRST ACT.—A nonpregnant parent or a 

2 nonpregnant caretaker relative of a tar3 geted low-income child who is enrolled in 

4 the State child health plan under a waiver, 

5 experimental, pilot, or demonstration 

6 project on the date of enactment of the 

7 Kids First Act and whose family income 

8 does not exceed the income eligibility ap9 plied under such waiver with respect to 

10 that population on such date. 

11 ‘‘(ii) NONPREGNANT CHILDLESS

12 ADULTS ENROLLED UNDER A WAIVER ON

13 SUCH DATE.—A nonpregnant childless 

14 adult enrolled in the State child health 

15 plan under a waiver, experimental, pilot, or 

16 demonstration project described in section 

17 6102(c)(3) of the Deficit Reduction Act of 

18 2005 (42 U.S.C. 1397gg note) on the date 

19 of enactment of the Kids First Act and 

20 whose family income does not exceed the 

21 income eligibility applied under such waiv22 er with respect to that population on such 

23 date. 

24 ‘‘(iii) NO REPLACEMENT ENROLL25 EES.—Nothing in clauses (i) or (ii) shall 


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1 be construed as authorizing a State to pro2 vide child health assistance or health bene3 fits coverage under a waiver described in 

4 either such clause to a nonpregnant parent 

5 or a nonpregnant caretaker relative of a 

6 targeted low-income child, or a nonpreg7 nant childless adult, who is not enrolled 

8 under the waiver on the date of enactment 

9 of the Kids First Act. 

10 ‘‘(C) NO FEDERAL PAYMENT FOR ANY

11 NEW NONPREGNANT ADULT ENROLLEES OR

12 FOR SUCH ENROLLEES WHO NO LONGER SAT13 ISFY INCOME ELIGIBILITY REQUIREMENTS.— 

14 Payment shall not be made under this section 

15 for child health assistance or other health bene16 fits coverage provided under the State child 

17 health plan or under a waiver under section 

18 1115 for any of the following: 

19 ‘‘(i) PARENTS OR CARETAKER REL20 ATIVES UNDER A SECTION 1115 WAIVER

21 APPROVED AFTER THE DATE OF ENACT22 MENT OF THE KIDS FIRST ACT.—A non23 pregnant parent or a nonpregnant care24 taker relative of a targeted low-income 

25 child under a waiver, experimental, pilot, 


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1 or demonstration project that is approved 

2 on or after the date of enactment of the 

3 Kids First Act. 

4 ‘‘(ii) PARENTS, CARETAKER REL5 ATIVES, AND NONPREGNANT CHILDLESS

6 ADULTS WHOSE FAMILY INCOME EXCEEDS

7 THE INCOME ELIGIBILITY LEVEL SPECI8 FIED UNDER A SECTION 1115 WAIVER AP9 PROVED PRIOR TO THE KIDS FIRST ACT.— 

10 Any nonpregnant parent or a nonpregnant 

11 caretaker relative of a targeted low-income 

12 child whose family income exceeds the in13 come eligibility level referred to in subpara14 graph (B)(i), and any nonpregnant child15 less adult whose family income exceeds the 

16 income eligibility level referred to in sub17 paragraph (B)(ii). 

18 ‘‘(iii) NONPREGNANT CHILDLESS

19 ADULTS, PARENTS, OR CARETAKER REL20 ATIVES NOT ENROLLED UNDER A SECTION

21 1115 WAIVER ON THE DATE OF ENACT22 MENT OF THE KIDS FIRST ACT.—Any non23 pregnant parent or a nonpregnant care24 taker relative of a targeted low-income 

25 child who is not enrolled in the State child 


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1 health plan under a section 1115 waiver, 

2 experimental, pilot, or demonstration 

3 project referred to in subparagraph (B)(i) 

4 on the date of enactment of the Kids First 

5 Act, and any nonpregnant childless adult 

6 who is not enrolled in the State child 

7 health plan under a section 1115 waiver, 

8 experimental, pilot, or demonstration 

9 project referred to in subparagraph 

10 (B)(ii)(I) on such date. 

11 ‘‘(D) DEFINITION OF CARETAKER REL12 ATIVE.—In this subparagraph, the term ‘care13 taker relative’ has the meaning given that term 

14 for purposes of carrying out section 1931. 

15 ‘‘(E) RULE OF CONSTRUCTION.—Nothing 

16 in this paragraph shall be construed as imply17 ing that payments for coverage of populations 

18 for which the Federal medical assistance per19 centage (as so determined) is to be substituted 

20 for the enhanced FMAP under subsection 

21 (a)(1) in accordance with this paragraph are to 

22 be made from funds other than the allotments 

23 determined for a State under section 2104.’’. 

24 (b) CONFORMING AMENDMENT.—Section 2105(a)(1) 

25 of the Social Security Act (42 U.S.C. 1397dd(a)(1)) is 


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1 amended, in the matter preceding subparagraph (A), by 

2 inserting ‘‘or subsection (c)(8)’’ after ‘‘subparagraph 

3 (B)’’. 

4 SEC. 5. PROHIBITION ON NEW SECTION 1115 WAIVERS FOR 

5 COVERAGE OF ADULTS OTHER THAN PREG6 NANT WOMEN. 

7 (a) IN GENERAL.—Section 2107(f) of the Social Se8 curity Act (42 U.S.C. 1397gg(f)) is amended— 

9 (1) by striking ‘‘, the Secretary’’ and inserting 

10 ‘‘: 

11 ‘‘(1) The Secretary’’; and 

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

13 paragraphs: 

14 ‘‘(2) The Secretary may not approve, extend, 

15 renew, or amend a waiver, experimental, pilot, or 

16 demonstration project with respect to a State after 

17 the date of enactment of the Kids First Act that 

18 would allow funds made available under this title to 

19 be used to provide child health assistance or other 

20 health benefits coverage for any other adult other 

21 than a pregnant woman whose family income does 

22 not exceed the income eligibility level specified for a 

23 targeted low-income child in that State under a 

24 waiver or project approved as of such date. 


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1 ‘‘(3) The Secretary may not approve, extend, 

2 renew, or amend a waiver, experimental, pilot, or 

3 demonstration project with respect to a State after 

4 the date of enactment of the Kids First Act that 

5 would waive or modify the requirements of section 

6 2105(c)(8).’’. 

7 (b) CLARIFICATION OF AUTHORITY FOR COVERAGE

8 OF PREGNANT WOMEN.—Section 2106 of the Social Secu9 rity Act (42 U.S.C. 1397ff) is amended by adding at the 

10 end the following new subsection: 

11 ‘‘(f) NO AUTHORITY TO COVER PREGNANT WOMEN

12 THROUGH STATE PLAN.—For purposes of this title, a 

13 State may provide assistance to a pregnant woman under 

14 the State child health plan only— 

15 ‘‘(1) by virtue of a waiver under section 1115; 

16 or 

17 ‘‘(2) through the application of sections 457.10, 

18 457.350(b)(2), 457.622(c)(5), and 457.626(a)(3) of 

19 title 42, Code of Federal Regulations (as in effect on 

20 the date of enactment of the Kids First Act).’’. 

21 (c) ASSURANCE OF NOTICE TO AFFECTED ENROLL22 EES.—The Secretary of Health and Human Services shall 

23 establish procedures to ensure that States provide ade24 quate public notice for parents, caretaker relatives, and 

25 nonpregnant childless adults whose eligibility for child 


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1 health assistance or health benefits coverage under a waiv2 er under section 1115 of the Social Security Act will be 

3 terminated as a result of the amendments made by sub4 section (a), and that States otherwise adhere to regula5 tions of the Secretary relating to procedures for termi6 nating waivers under section 1115 of the Social Security 

7 Act. 

8 SEC. 6. STANDARDIZATION OF DETERMINATION OF FAMILY 

9 INCOME FOR TARGETED LOW-INCOME CHIL10 DREN UNDER TITLE XXI AND OPTIONAL TAR11 GETED LOW-INCOME CHILDREN UNDER 

12 TITLE XIX. 

13 (a) ELIGIBILITY BASED ON GROSS INCOME.— 

14 (1) IN GENERAL.—Section 2110 of the Social 

15 Security Act (42 U.S.C. 1397jj) is amended— 

16 (A) in subsection (b)(1)(A), by inserting 

17 ‘‘in accordance with subsection (d)’’ after 

18 ‘‘State plan’’; and 

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

20 subsection: 

21 ‘‘(d) STANDARDIZATION OF DETERMINATION OF

22 FAMILY INCOME.—A State shall determine family income 

23 for purposes of determining income eligibility for child 

24 health assistance or other health benefits coverage under 

25 the State child health plan (or under a waiver of such plan 


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1 under section 1115) solely on the basis of the gross income 

2 (as defined by the Secretary) of the family.’’. 

3 (2) PROHIBITION ON WAIVER OF REQUIRE4 MENTS.—Section 2107(f) (42 U.S.C. 1397gg(f)), as 

5 amended by section 5(a), is amended by adding at 

6 the end the following new paragraph: 

7 ‘‘(4) The Secretary may not approve a waiver, 

8 experimental, pilot, or demonstration project with re9 spect to a State after the date of enactment of the 

10 Kids First Act that would waive or modify the re11 quirements of section 2110(d) (relating to deter12 mining income eligibility on the basis of gross in13 come) and regulations promulgated to carry out 

14 such requirements.’’. 

15 (b) REGULATIONS.—Not later than 90 days after the 

16 date of enactment of this Act, the Secretary of Health and 

17 Human Services shall promulgate interim final regulations 

18 defining gross income for purposes of section 2110(d) of 

19 the Social Security Act, as added by subsection (a). 

20 (c) APPLICATION TO CURRENT ENROLLEES.—The 

21 interim final regulations promulgated under subsection (b) 

22 shall not be used to determine the income eligibility of any 

23 individual enrolled in a State child health plan under title 

24 XXI of the Social Security Act on the date of enactment 

25 of this Act before the date on which such eligibility of the 


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1 individual is required to be redetermined under the plan 

2 as in effect on such date. In the case of any individual 

3 enrolled in such plan on such date who, solely as a result 

4 of the application of subsection (d) of section 2110 of the 

5 Social Security Act (as added by subsection (a)) and the 

6 regulations promulgated under subsection (b), is deter7 mined to be ineligible for child health assistance under the 

8 State child health plan, a State may elect, subject to sub9 stitution of the Federal medical assistance percentage for 

10 the enhanced FMAP under section 2105(c)(8)(A) of the 

11 Social Security Act (as added by section 4(a)), to continue 

12 to provide the individual with such assistance for so long 

13 as the individual otherwise would be eligible for such as14 sistance and the individual’s family income, if determined 

15 under the income and resource standards and methodolo16 gies applicable under the State child health plan on Sep17 tember 30, 2008, would not exceed the income eligibility 

18 level applicable to the individual under the State child 

19 health plan. 

20 SEC. 7. GRANTS FOR OUTREACH AND ENROLLMENT. 

21 (a) GRANTS.—Title XXI of the Social Security Act 

22 (42 U.S.C. 1397aa et seq.) is amended by adding at the 

23 end the following: 


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1 ‘‘SEC. 2111. GRANTS TO IMPROVE OUTREACH AND ENROLL2 MENT. 

3 ‘‘(a) OUTREACH AND ENROLLMENT GRANTS; NA4 TIONAL CAMPAIGN.— 

5 ‘‘(1) IN GENERAL.—From the amounts appro6 priated for a fiscal year under subsection (f), subject 

7 to paragraph (2), the Secretary shall award grants 

8 to eligible entities to conduct outreach and enroll9 ment efforts that are designed to increase the enroll10 ment and participation of eligible children under this 

11 title and title XIX. 

12 ‘‘(2) 10 PERCENT SET ASIDE FOR NATIONAL

13 ENROLLMENT CAMPAIGN.—An amount equal to 10 

14 percent of such amounts for the fiscal year shall be 

15 used by the Secretary for expenditures during the 

16 fiscal year to carry out a national enrollment cam17 paign in accordance with subsection (g). 

18 ‘‘(b) AWARD OF GRANTS.— 

19 ‘‘(1) PRIORITY FOR AWARDING.— 

20 ‘‘(A) IN GENERAL.—In awarding grants 

21 under subsection (a), the Secretary shall give 

22 priority to eligible entities that— 

23 ‘‘(i) propose to target geographic 

24 areas with high rates of— 


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1 ‘‘(I) eligible but unenrolled chil2 dren, including such children who re3 side in rural areas; or 

4 ‘‘(II) racial and ethnic minorities 

5 and health disparity populations, in6 cluding those proposals that address 

7 cultural and linguistic barriers to en8 rollment; and 

9 ‘‘(ii) submit the most demonstrable 

10 evidence required under paragraphs (1) 

11 and (2) of subsection (c). 

12 ‘‘(B) 10 PERCENT SET ASIDE FOR OUT13 REACH TO INDIAN CHILDREN.—An amount 

14 equal to 10 percent of the funds appropriated 

15 under subsection (f) for a fiscal year shall be 

16 used by the Secretary to award grants to In17 dian Health Service providers and urban Indian 

18 organizations receiving funds under title V of 

19 the Indian Health Care Improvement Act (25 

20 U.S.C. 1651 et seq.) for outreach to, and en21 rollment of, children who are Indians. 

22 ‘‘(2) 2-YEAR AVAILABILITY.—A grant awarded 

23 under this section for a fiscal year shall remain 

24 available for expenditure through the end of the suc25 ceeding fiscal year. 


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1 ‘‘(c) APPLICATION.—An eligible entity that desires to 

2 receive a grant under subsection (a) shall submit an appli3 cation to the Secretary in such form and manner, and con4 taining such information, as the Secretary may decide. 

5 Such application shall include— 

6 ‘‘(1) evidence demonstrating that the entity in7 cludes members who have access to, and credibility 

8 with, ethnic or low-income populations in the com9 munities in which activities funded under the grant 

10 are to be conducted; 

11 ‘‘(2) evidence demonstrating that the entity has 

12 the ability to address barriers to enrollment, such as 

13 lack of awareness of eligibility, stigma concerns and 

14 punitive fears associated with receipt of benefits, 

15 and other cultural barriers to applying for and re16 ceiving child health assistance or medical assistance; 

17 ‘‘(3) specific quality or outcomes performance 

18 measures to evaluate the effectiveness of activities 

19 funded by a grant awarded under this section; and 

20 ‘‘(4) an assurance that the eligible entity 

21 shall— 

22 ‘‘(A) conduct an assessment of the effec23 tiveness of such activities against the perform24 ance measures; 


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1 ‘‘(B) cooperate with the collection and re2 porting of enrollment data and other informa3 tion in order for the Secretary to conduct such 

4 assessments; and 

5 ‘‘(C) in the case of an eligible entity that 

6 is not the State, provide the State with enroll7 ment data and other information as necessary 

8 for the State to make necessary projections of 

9 eligible children and pregnant women. 

10 ‘‘(d) SUPPLEMENT, NOT SUPPLANT.—Federal funds 

11 awarded under this section shall be used to supplement, 

12 not supplant, non-Federal funds that are otherwise avail13 able for activities funded under this section. 

14 ‘‘(e) DEFINITIONS.—In this section: 

15 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en16 tity’ means any of the following: 

17 ‘‘(A) A State with an approved child health 

18 plan under this title. 

19 ‘‘(B) A local government. 

20 ‘‘(C) An Indian tribe or tribal consortium, 

21 a tribal organization, an urban Indian organiza22 tion receiving funds under title V of the Indian 

23 Health Care Improvement Act (25 U.S.C. 1651 

24 et seq.), or an Indian Health Service provider. 


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1 ‘‘(D) A Federal health safety net organiza2 tion. 

3 ‘‘(E) A State, national, local, or commu4 nity-based public or nonprofit private organiza5 tion. 

6 ‘‘(F) A faith-based organization or con7 sortia, to the extent that a grant awarded to 

8 such an entity is consistent with the require9 ments of section 1955 of the Public Health 

10 Service Act (42 U.S.C. 300x–65) relating to a 

11 grant award to non-governmental entities. 

12 ‘‘(G) An elementary or secondary school. 

13 ‘‘(H) A national, local, or community-based 

14 public or nonprofit private organization, includ15 ing organizations that use community health 

16 workers or community-based doula programs. 

17 ‘‘(2) FEDERAL HEALTH SAFETY NET ORGANI18 ZATION.—The term ‘Federal health safety net orga19 nization’ means— 

20 ‘‘(A) a federally-qualified health center (as 

21 defined in section 1905(l)(2)(B)); 

22 ‘‘(B) a hospital defined as a dispropor23 tionate share hospital for purposes of section 

24 1923; 


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1 ‘‘(C) a covered entity described in section 

2 340B(a)(4) of the Public Health Service Act 

3 (42 U.S.C. 256b(a)(4)); and 

4 ‘‘(D) any other entity or consortium that 

5 serves children under a federally funded pro6 gram, including the special supplemental nutri7 tion program for women, infants, and children 

8 (WIC) established under section 17 of the Child 

9 Nutrition Act of 1966 (42 U.S.C. 1786), the 

10 head start and early head start programs under 

11 the Head Start Act (42 U.S.C. 9801 et seq.), 

12 the school lunch program established under the 

13 Richard B. Russell National School Lunch Act, 

14 and an elementary or secondary school. 

15 ‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANI16 ZATION; URBAN INDIAN ORGANIZATION.—The terms 

17 ‘Indian’, ‘Indian tribe’, ‘tribal organization’, and 

18 ‘urban Indian organization’ have the meanings given 

19 such terms in section 4 of the Indian Health Care 

20 Improvement Act (25 U.S.C. 1603). 

21 ‘‘(4) COMMUNITY HEALTH WORKER.—The term 

22 ‘community health worker’ means an individual who 

23 promotes health or nutrition within the community 

24 in which the individual resides— 


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1 ‘‘(A) by serving as a liaison between com2 munities and health care agencies; 

3 ‘‘(B) by providing guidance and social as4 sistance to community residents; 

5 ‘‘(C) by enhancing community residents’ 

6 ability to effectively communicate with health 

7 care providers; 

8 ‘‘(D) by providing culturally and linguis9 tically appropriate health or nutrition edu10 cation; 

11 ‘‘(E) by advocating for individual and com12 munity health or nutrition needs; and 

13 ‘‘(F) by providing referral and followup 

14 services. 

15 ‘‘(f) APPROPRIATION.— 

16 ‘‘(1) IN GENERAL.—There is appropriated, out 

17 of any money in the Treasury not otherwise appro18 priated, for the purpose of awarding grants under 

19 this section— 

20 ‘‘(A) $100,000,000 for each of fiscal years 

21 2009 and 2010; 

22 ‘‘(B) $75,000,000 for each of fiscal years 

23 2011 and 2012; and 

24 ‘‘(C) $50,000,000 for fiscal year 2013. 


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1 ‘‘(2) GRANTS IN ADDITION TO OTHER AMOUNTS

2 PAID.—Amounts appropriated and paid under the 

3 authority of this section shall be in addition to 

4 amounts appropriated under section 2104 and paid 

5 to States in accordance with section 2105, including 

6 with respect to expenditures for outreach activities 

7 in accordance with subsections (a)(1)(D)(iii) and 

8 (c)(2)(C) of that section. 

9 ‘‘(g) NATIONAL ENROLLMENT CAMPAIGN.—From 

10 the amounts made available under subsection (a)(2) for 

11 a fiscal year, the Secretary shall develop and implement 

12 a national enrollment campaign to improve the enrollment 

13 of underserved child populations in the programs estab14 lished under this title and title XIX. Such campaign may 

15 include— 

16 ‘‘(1) the establishment of partnerships with the 

17 Secretary of Education and the Secretary of Agri18 culture to develop national campaigns to link the eli19 gibility and enrollment systems for the assistance 

20 programs each Secretary administers that often 

21 serve the same children; 

22 ‘‘(2) the integration of information about the 

23 programs established under this title and title XIX 

24 in public health awareness campaigns administered 

25 by the Secretary; 


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1 ‘‘(3) increased financial and technical support 

2 for enrollment hotlines maintained by the Secretary 

3 to ensure that all States participate in such hotlines; 

4 ‘‘(4) the establishment of joint public awareness 

5 outreach initiatives with the Secretary of Education 

6 and the Secretary of Labor regarding the impor7 tance of health insurance to building strong commu8 nities and the economy; 

9 ‘‘(5) the development of special outreach mate10 rials for Native Americans or for individuals with 

11 limited English proficiency; and 

12 ‘‘(6) such other outreach initiatives as the Sec13 retary determines would increase public awareness of 

14 the programs under this title and title XIX.’’. 

15 (b) NONAPPLICATION OF ADMINISTRATIVE EXPENDI16 TURES CAP.—Section 2105(c)(2) of the Social Security 

17 Act (42 U.S.C. 1397ee(c)(2)) is amended by adding at the 

18 end the following: 

19 ‘‘(C) NONAPPLICATION TO EXPENDITURES

20 FOR OUTREACH AND ENROLLMENT.—The limi21 tation under subparagraph (A) shall not apply 

22 with respect to expenditures for outreach activi23 ties under section 2102(c)(1), or for enrollment 

24 activities, for children eligible for child health 

25 assistance under the State child health plan or 


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1 medical assistance under the State plan under 

2 title XIX.’’. 

3 SEC. 8. IMPROVED STATE OPTION FOR OFFERING PRE4 MIUM ASSISTANCE FOR COVERAGE OF CHIL5 DREN THROUGH PRIVATE PLANS UNDER 

6 SCHIP AND MEDICAID. 

7 (a) IN GENERAL.—Section 2105(c) of the Social Se8 curity Act (42 U.S.C. 1397ee(c)), as amended by section 

9 4(a) is amended by adding at the end the following: 

10 ‘‘(9) ADDITIONAL STATE OPTION FOR OFFER11 ING PREMIUM ASSISTANCE.— 

12 ‘‘(A) IN GENERAL.—Subject to the suc13 ceeding provisions of this paragraph, a State 

14 may elect to offer a premium assistance subsidy 

15 (as defined in subparagraph (C)) for qualified 

16 coverage (as defined in subparagraph (B)) to 

17 all targeted low-income children who are eligible 

18 for child health assistance under the plan and 

19 have access to such coverage in accordance with 

20 the requirements of this paragraph. 

21 ‘‘(B) QUALIFIED COVERAGE.—In this 

22 paragraph, the term ‘qualified coverage’ means 

23 the following: 

24 ‘‘(i) QUALIFIED EMPLOYER SPON25 SORED COVERAGE.— 


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1 ‘‘(I) IN GENERAL.—A group 

2 health plan or health insurance cov3 erage offered through an employer 

4 that is— 

5 ‘‘(aa) substantially equiva6 lent to the benefits coverage in a 

7 benchmark benefit package de8 scribed in section 2103(b) or 

9 benchmark-equivalent coverage 

10 that meets the requirements of 

11 section 2103(a)(2); 

12 ‘‘(bb) made similarly avail13 able to all of the employer’s em14 ployees and for which the em15 ployer makes a contribution to 

16 the premium that is not less for 

17 employees receiving a premium 

18 assistance subsidy under any op19 tion available under the State 

20 child health plan under this title 

21 or the State plan under title XIX 

22 to provide such assistance than 

23 the employer contribution pro24 vided for all other employees; and 


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1 ‘‘(cc) cost-effective, as deter2 mined under subclause (II). 

3 ‘‘(II) COST-EFFECTIVENESS.—A 

4 group health plan or health insurance 

5 coverage offered through an employer 

6 shall be considered to be cost-effective 

7 if— 

8 ‘‘(aa) the marginal premium 

9 cost to purchase family coverage 

10 through the employer is less than 

11 the State cost of providing child 

12 health assistance through the 

13 State child health plan for all the 

14 children in the family who are 

15 targeted low-income children; or 

16 ‘‘(bb) the marginal premium 

17 cost between individual coverage 

18 and purchasing family coverage 

19 through the employer is not 

20 greater than 175 percent of the 

21 cost to the State to provide child 

22 health assistance through the 

23 State child health plan for a tar24 geted low-income child. 


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1 ‘‘(ii) QUALIFIED NON-GROUP COV2 ERAGE.—Health insurance coverage of3 fered to individuals in the non-group 

4 health insurance market that is substan5 tially equivalent to the benefits coverage in 

6 a benchmark benefit package described in 

7 section 2103(b) or benchmark-equivalent 

8 coverage that meets the requirements of 

9 section 2103(a)(2). 

10 ‘‘(iii) HIGH DEDUCTIBLE HEALTH

11 PLAN.—A high deductible health plan (as 

12 defined in section 223(c)(2) of the Internal 

13 Revenue Code of 1986) purchased through 

14 a health savings account (as defined under 

15 section 223(d) of such Code). 

16 ‘‘(C) PREMIUM ASSISTANCE SUBSIDY.— 

17 ‘‘(i) IN GENERAL.—In this paragraph, 

18 the term ‘premium assistance subsidy’ 

19 means, with respect to a targeted low-in20 come child, the amount equal to the dif21 ference between the employee contribution 

22 required for enrollment only of the em23 ployee under qualified employer sponsored 

24 coverage and the employee contribution re25 quired for enrollment of the employee and 


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1 the child in such coverage, less any appli2 cable premium cost-sharing applied under 

3 the State child health plan, subject to the 

4 annual aggregate cost-sharing limit applied 

5 under section 2103(e)(3)(B). 

6 ‘‘(ii) STATE PAYMENT OPTION.—Sub7 ject to clause (iii), a State may provide a 

8 premium assistance subsidy directly to an 

9 employer or as reimbursement to an em10 ployee for out-of-pocket expenditures. 

11 ‘‘(iii) REQUIREMENT FOR DIRECT

12 PAYMENT TO EMPLOYEE.—A State shall 

13 not pay a premium assistance subsidy di14 rectly to the employee, unless the State has 

15 established procedures to ensure that the 

16 targeted low-income child on whose behalf 

17 such payments are made are actually en18 rolled in the qualified employer sponsored 

19 coverage. 

20 ‘‘(iv) TREATMENT AS CHILD HEALTH

21 ASSISTANCE.—Expenditures for the provi22 sion of premium assistance subsidies shall 

23 be considered child health assistance de24 scribed in paragraph (1)(C) of subsection 


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1 (a) for purposes of making payments 

2 under that subsection. 

3 ‘‘(v) STATE OPTION TO REQUIRE AC4 CEPTANCE OF SUBSIDY.—A State may 

5 condition the provision of child health as6 sistance under the State child health plan 

7 for a targeted low-income child on the re8 ceipt of a premium assistance subsidy for 

9 enrollment in qualified employer sponsored 

10 coverage if the State determines the provi11 sion of such a subsidy to be more cost-ef12 fective in accordance with subparagraph 

13 (B)(ii). 

14 ‘‘(vi) NOT TREATED AS INCOME.— 

15 Notwithstanding any other provision of 

16 law, a premium assistance subsidy pro17 vided in accordance with this paragraph 

18 shall not be treated as income to the child 

19 or the parent of the child for whom such 

20 subsidy is provided. 

21 ‘‘(D) NO REQUIREMENT TO PROVIDE SUP22 PLEMENTAL COVERAGE FOR BENEFITS AND AD23 DITIONAL COST-SHARING PROTECTION PRO24 VIDED UNDER THE STATE CHILD HEALTH

25 PLAN.— 


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1 ‘‘(i) IN GENERAL.—A State that 

2 elects the option to provide a premium as3 sistance subsidy under this paragraph shall 

4 not be required to provide a targeted low5 income child enrolled in qualified employer 

6 sponsored coverage with supplemental cov7 erage for items or services that are not 

8 covered, or are only partially covered, 

9 under the qualified employer sponsored 

10 coverage or cost-sharing protection other 

11 than the protection required under section 

12 2103(e)(3)(B). 

13 ‘‘(ii) NOTICE OF COST-SHARING RE14 QUIREMENTS.—A State shall provide a tar15 geted low-income child or the parent of 

16 such a child (as appropriate) who is pro17 vided with a premium assistance subsidy in 

18 accordance with this paragraph with notice 

19 of the cost-sharing requirements and limi20 tations imposed under the qualified em21 ployer sponsored coverage in which the 

22 child is enrolled upon the enrollment of the 

23 child in such coverage and annually there24 after. 


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1 ‘‘(iii) RECORD KEEPING REQUIRE2 MENTS.—A State may require a parent of 

3 a targeted low-income child that is enrolled 

4 in qualified employer-sponsored coverage to 

5 bear the responsibility for keeping track of 

6 out-of-pocket expenditures incurred for 

7 cost-sharing imposed under such coverage 

8 and to notify the State when the limit on 

9 such expenditures imposed under section 

10 2103(e)(3)(B) has been reached for a year 

11 from the effective date of enrollment for 

12 such year. 

13 ‘‘(iv) STATE OPTION FOR REIMBURSE14 MENT.—A State may retroactively reim15 burse a parent of a targeted low-income 

16 child for out-of-pocket expenditures in17 curred after reaching the 5 percent cost18 sharing limitation imposed under section 

19 2103(e)(3)(B) for a year. 

20 ‘‘(E) 6-MONTH WAITING PERIOD RE21 QUIRED.—A State shall impose at least a 6- 

22 month waiting period from the time an indi23 vidual is enrolled in private health insurance 

24 prior to the provision of a premium assistance 


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1 subsidy for a targeted low-income child in ac2 cordance with this paragraph. 

3 ‘‘(F) NON APPLICATION OF WAITING PE4 RIOD FOR ENROLLMENT IN THE STATE MED5 ICAID PLAN OR THE STATE CHILD HEALTH

6 PLAN.—A targeted low-income child provided a 

7 premium assistance subsidy in accordance with 

8 this paragraph who loses eligibility for such 

9 subsidy shall not be treated as having been en10 rolled in private health insurance coverage for 

11 purposes of applying any waiting period im12 posed under the State child health plan or the 

13 State plan under title XIX for the enrollment of 

14 the child under such plan. 

15 ‘‘(G) ASSURANCE OF SPECIAL ENROLL16 MENT PERIOD UNDER GROUP HEALTH PLANS

17 IN CASE OF ELIGIBILITY FOR PREMIUM SUB18 SIDY ASSISTANCE.—No payment shall be made 

19 under subsection (a) for amounts expended for 

20 the provision of premium assistance subsidies 

21 under this paragraph unless a State provides 

22 assurances to the Secretary that the State has 

23 in effect laws requiring a group health plan, a 

24 health insurance issuer offering group health 

25 insurance coverage in connection with a group 


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1 health plan, and a self-funded health plan, to 

2 permit an employee who is eligible, but not en3 rolled, for coverage under the terms of the plan 

4 (or a child of such an employee if the child is 

5 eligible, but not enrolled, for coverage under 

6 such terms) to enroll for coverage under the 

7 terms of the plan if the employee’s child be8 comes eligible for a premium assistance subsidy 

9 under this paragraph. 

10 ‘‘(H) NO EFFECT ON PREVIOUSLY AP11 PROVED PREMIUM ASSISTANCE PROGRAMS.— 

12 Nothing in this paragraph shall be construed as 

13 limiting the authority of a State to offer pre14 mium assistance under section 1906, a waiver 

15 described in paragraph (2)(B) or (3), a waiver 

16 approved under section 1115, or other authority 

17 in effect on February 1, 2009. 

18 ‘‘(I) NOTICE OF AVAILABILITY.—A State 

19 shall— 

20 ‘‘(i) include on any application or en21 rollment form for child health assistance a 

22 notice of the availability of premium assist23 ance subsidies for the enrollment of tar24 geted low-income children in qualified em25 ployer sponsored coverage; 


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1 ‘‘(ii) provide, as part of the applica2 tion and enrollment process under the 

3 State child health plan, information de4 scribing the availability of such subsidies 

5 and how to elect to obtain such a subsidy; 

6 and 

7 ‘‘(iii) establish such other procedures 

8 as the State determines necessary to en9 sure that parents are informed of the 

10 availability of such subsidies under the 

11 State child health plan.’’. 

12 (b) APPLICATION TO MEDICAID.—Section 1906 of 

13 the Social Security Act (42 U.S.C. 1396e) is amended by 

14 inserting after subsection (c) the following: 

15 ‘‘(d) The provisions of section 2105(c)(9) shall apply 

16 to a child who is eligible for medical assistance under the 

17 State plan in the same manner as such provisions apply 

18 to a targeted low-income child under a State child health 

19 plan under title XXI. Section 1902(a)(34) shall not apply 

20 to a child who is provided a premium assistance subsidy 

21 under the State plan in accordance with the preceding sen22 tence.’’. 

23 SEC. 9. TREATMENT OF UNBORN CHILDREN. 

24 (a) CODIFICATION OF CURRENT REGULATIONS.— 

25 Section 2110(c)(1) of the Social Security Act (42 U.S.C. 


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1 1397jj(c)(1)) is amended by striking the period at the end 

2 and inserting the following: ‘‘, and includes, at the option 

3 of a State, an unborn child. For purposes of the previous 

4 sentence, the term ‘unborn child’ means a member of the 

5 species Homo sapiens, at any stage of development, who 

6 is carried in the womb.’’. 

7 (b) CLARIFICATIONS REGARDING COVERAGE OF

8 MOTHERS.—Section 2103 (42 U.S.C. 1397cc) is amended 

9 by adding at the end the following new subsection: 

10 ‘‘(g) CLARIFICATIONS REGARDING AUTHORITY TO

11 PROVIDE POSTPARTUM SERVICES AND MATERNAL

12 HEALTH CARE.—Any State that provides child health as13 sistance to an unborn child under the option described in 

14 section 2110(c)(1) may— 

15 ‘‘(1) continue to provide such assistance to the 

16 mother, as well as postpartum services, through the 

17 end of the month in which the 60-day period (begin18 ning on the last day of pregnancy) ends; and 

19 ‘‘(2) in the interest of the child to be born, have 

20 flexibility in defining and providing services to ben21 efit either the mother or unborn child consistent 

22 with the health of both.’’. 


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1 SEC. 10. 50 PERCENT MATCHING RATE FOR ALL MEDICAID 

2 ADMINISTRATIVE COSTS. 

3 Section 1903(a) of the Social Security Act (42 U.S.C. 

4 1396b(a)) is amended— 

5 (1) by striking paragraph (2); 

6 (2) by redesignating paragraph (3)(E) as para7 graph (2) and re-locating and indenting it appro8 priately; 

9 (3) in paragraph (2), as so redesignated, by re10 designating clauses (i) and (ii) as subparagraphs (A) 

11 and (B), and indenting them appropriately; 

12 (4) by striking paragraphs (3) and (4); 

13 (5) in paragraph (5), by striking ‘‘which are at14 tributable to the offering, arranging, and fur15 nishing’’ and inserting ‘‘which are for the medical 

16 assistance costs of furnishing’’; 

17 (6) by striking paragraph (6); 

18 (7) in paragraph (7), by striking ‘‘subject to 

19 section 1919(g)(3)(B),’’; and 

20 (8) by redesignating paragraphs (5) and (7) as 

21 paragraphs (3) and (4), respectively. 

22 SEC. 11. REDUCTION IN PAYMENTS FOR MEDICAID ADMIN23 ISTRATIVE COSTS TO PREVENT DUPLICATION 

24 OF SUCH PAYMENTS UNDER TANF. 

25 Section 1903 of the Social Security Act (42 U.S.C. 

26 1396b) is amended— 


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1 (1) in subsection (a)(7), by striking ‘‘section 

2 1919(g)(3)(B)’’ and inserting ‘‘subsection (h)’’; 

3 (2) in subsection (a)(2)(D) by inserting ‘‘, sub4 ject to subsection (g)(3)(C) of such section’’ after 

5 ‘‘as are attributable to State activities under section 

6 1919(g)’’; and 

7 (3) by adding after subsection (g) the following 

8 new subsection: 

9 ‘‘(h) REDUCTION IN PAYMENTS FOR ADMINISTRA10 TIVE COSTS TO PREVENT DUPLICATION OF PAYMENTS

11 UNDER TITLE IV.—Beginning with the calendar quarter 

12 commencing April 1, 2009, the Secretary shall reduce the 

13 amount paid to each State under subsection (a)(7) for 

each quarter by an amount equal to 1 14 ⁄4 of the annualized 

15 amount determined for the Medicaid program under sec16 tion 16(k)(2)(B) of the Food Stamp Act of 1977 (7 U.S.C. 

17 2025(k)(2)(B)).’’. 

18 SEC. 12. ELIMINATION OF WAIVER OF CERTAIN MEDICAID 

19 PROVIDER TAX PROVISIONS. 

20 Effective October 1, 2009, subsection (c) of section 

21 4722 of the Balanced Budget Act of 1997 (Public Law 

22 105–33; 111 Stat. 515) is repealed. 


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1 SEC. 13. ELIMINATION OF SPECIAL PAYMENTS FOR CER2 TAIN PUBLIC HOSPITALS. 

3 Effective October 1, 2009, subsection (d) of section 

4 701 of the Medicare, Medicaid, and SCHIP Benefits Im5 provement and Protection Act of 2000, as enacted into 

6 law by section 1(a)(6) of Public Law 106–554 (42 U.S.C. 

7 1396r–4 note), is repealed. 

8 SEC. 14. EFFECTIVE DATE; COORDINATION OF FUNDING 

9 FOR FISCAL YEAR 2009. 

10 (a) IN GENERAL.—Unless otherwise specified, sub11 ject to subsection (b), the amendments made by this Act 

12 shall take effect on the date of enactment of this Act. 

13 (b) DELAY IF STATE LEGISLATION REQUIRED.—In 

14 the case of a State child health plan under title XXI of 

15 the Social Security Act or a waiver of such plan under 

16 section 1115 of such Act which the Secretary of Health 

17 and Human Services determines requires State legislation 

18 (other than legislation appropriating funds) in order for 

19 the plan or waiver to meet the additional requirements im20 posed by the amendments made by this Act, the State 

21 child health plan or waiver shall not be regarded as failing 

22 to comply with the requirements of such title XXI solely 

23 on the basis of its failure to meet such additional require24 ments before the first day of the first calendar quarter 

25 beginning after the close of the first regular session of the 

26 State legislature that begins after the date of the enactVerDate Nov 24 2008 06:14 Jan 27, 2009 Jkt 079200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\S326.IS S326

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1 ment of this Act. For purposes of the previous sentence, 

2 in the case of a State that has a 2-year legislative session, 

3 each year of such session shall be deemed to be a separate 

4 regular session of the State legislature. 

5 (c) COORDINATION OF FUNDING FOR FISCAL YEAR

6 2009.—Notwithstanding any other provision of law, inso7 far as funds have been appropriated under section 

8 2104(a)(11) of the Social Security Act, as amended by 

9 section 201(a) of Public Law 110–173 and in effect on 

10 January 1, 2009, to provide allotments to States under 

11 title XXI of the Social Security Act for fiscal year 2009— 

12 (1) any amounts that are so appropriated that 

13 are not so allotted and obligated before the date of 

14 the enactment of this Act are rescinded; and 

15 (2) any amount provided for allotments under 

16 title XXI of such Act to a State under the amend17 ments made by this Act for such fiscal year shall be 

18 reduced by the amount of such appropriations so al19 lotted and obligated before such date. 

Æ 


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