II 

114TH CONGRESS 

1ST SESSION S. 522 

To amend title XXI of the Social Security Act to extend the Children’s 

Health Insurance Program, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 12, 2015 

Mr. BROWN (for himself, Ms. STABENOW, Mr. WYDEN, Mr. CASEY, Mr. REID, 

Mr. DURBIN, Ms. BALDWIN, Mr. BENNET, Mr. BLUMENTHAL, Mr. 

BOOKER, Mrs. BOXER, Ms. CANTWELL, Mr. CARDIN, Mr. CARPER, Mr. 

COONS, Mr. DONNELLY, Mr. FRANKEN, Mrs. GILLIBRAND, Mr. HEINRICH, Ms. HEITKAMP, Ms. HIRONO, Mr. KAINE, Mr. KING, Ms. KLOBUCHAR, Mr. LEAHY, Mr. MARKEY, Mr. MANCHIN, Mrs. MCCASKILL, 

Mr. MENENDEZ, Mr. MERKLEY, Ms. MIKULSKI, Mr. MURPHY, Mrs. 

MURRAY, Mr. NELSON, Mr. PETERS, Mr. REED, Mr. SANDERS, Mr. 

SCHATZ, Mr. SCHUMER, Mrs. SHAHEEN, Mr. TESTER, Mr. UDALL, Mr. 

WARNER, Ms. WARREN, Mr. WHITEHOUSE, and Mrs. FEINSTEIN) 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 extend 

the Children’s Health Insurance Program, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Protecting And Retain3 ing Our Children’s Health Insurance Program Act of 

4 2015’’. 

5 SEC. 2. 4-YEAR EXTENSION OF CHIP FUNDING. 

6 (a) FUNDING.— 

7 (1) IN GENERAL.—Section 2104(a) of the So8 cial Security Act (42 U.S.C. 1397dd(a)) is amend9 ed— 

10 (A) in paragraph (17), by striking ‘‘and’’ 

11 at the end; and 

12 (B) by striking paragraph (18) and insert13 ing the following new paragraphs: 

14 ‘‘(18) for fiscal year 2015, $21,061,000,000; 

15 ‘‘(19) for fiscal year 2016, $19,300,000,000; 

16 ‘‘(20) for fiscal year 2017, $20,300,000,000; 

17 ‘‘(21) for fiscal year 2018, $21,300,000,000; 

18 and 

19 ‘‘(22) for fiscal year 2019, for purposes of mak20 ing 2 semi-annual allotments— 

21 ‘‘(A) $2,850,000,000 for the period begin22 ning on October 1, 2018, and ending on March 

23 31, 2019; and 

24 ‘‘(B) $2,850,000,000 for the period begin25 ning on April 1, 2019, and ending on Sep26 tember 30, 2019.’’. 


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1 (2) PREVENTION OF DUPLICATE APPROPRIA2 TIONS FOR FISCAL YEAR 2015.—Notwithstanding 

3 any other provision of law, insofar as funds have 

4 been appropriated under subsection (a)(18) or (m) 

5 of section 2104 of the Social Security Act (42 

6 U.S.C. 1397dd), or under section 108 of the Chil7 dren’s Health Insurance Program Reauthorization 

8 Act of 2009 (Public Law 111–3), as such sub9 sections and section are in effect on the day before 

10 the date of the enactment of this Act, to provide al11 lotments to States under the State Children’s Health 

12 Insurance Program established under title XXI of 

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

14 (whether implemented under title XIX, XXI, or 

15 both, of the Social Security Act) for fiscal year 

16 2015— 

17 (A) any amounts that are so appropriated 

18 that are not so allotted and obligated before the 

19 date of the enactment of this Act, are re20 scinded; and 

21 (B) any amount provided for CHIP allot22 ments to a State under this section (and the 

23 amendments made by this section) for such fis24 cal year shall be reduced by the amount of such 


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1 appropriations so allotted and obligated before 

2 such date. 

3 (b) ALLOTMENTS.— 

4 (1) IN GENERAL.—Section 2104(m) of the So5 cial Security Act (42 U.S.C. 1397dd(m)) is amend6 ed— 

7 (A) in the subsection heading, by striking 

8 ‘‘THROUGH 2015’’ and inserting ‘‘AND THERE9 AFTER’’; 

10 (B) in paragraph (2)— 

11 (i) in the paragraph heading, by strik12 ing ‘‘2014’’ and inserting ‘‘2018’’; and 

13 (ii) by striking subparagraph (B) and 

14 inserting the following new subparagraph: 

15 ‘‘(B) FISCAL YEAR 2013 THROUGH 2018.— 

16 Subject to paragraphs (4) and (6), from the 

17 amount made available under paragraphs (16) 

18 through (21) of subsection (a) for each of fiscal 

19 years 2013 through 2018, respectively, the Sec20 retary shall compute a State allotment for each 

21 State (including the District of Columbia and 

22 each commonwealth and territory) for each 

23 such fiscal year as follows: 

24 ‘‘(i) REBASING IN FISCAL YEAR 2013

25 AND EACH SUCCEEDING ODD-NUMBERED


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1 FISCAL YEAR.—For fiscal year 2013 and 

2 each succeeding odd-numbered fiscal year, 

3 the allotment of the State is equal to the 

4 Federal payments to the State that are at5 tributable to (and countable toward) the 

6 total amount of allotments available under 

7 this section to the State in the preceding 

8 fiscal year (including payments made to 

9 the State under subsection (n) for such 

10 preceding fiscal year as well as amounts 

11 redistributed to the State in such pre12 ceding fiscal year), multiplied by the allot13 ment increase factor under paragraph (5) 

14 for such odd-numbered fiscal year. 

15 ‘‘(ii) GROWTH FACTOR UPDATE FOR

16 FISCAL YEAR 2014 AND EACH SUCCEEDING

17 EVEN-NUMBERED FISCAL YEAR.—Except 

18 as provided in clause (iii), for fiscal year 

19 2014 and each succeeding even-numbered 

20 fiscal year, the allotment of the State is 

21 equal to the sum of— 

22 ‘‘(I) the amount of the State al23 lotment under clause (i) for the pre24 ceding fiscal year; and 


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1 ‘‘(II) the amount of any pay2 ments made to the State under sub3 section (n) for such preceding fiscal 

4 year, 

5 multiplied by the allotment increase factor 

6 under paragraph (5) for such even-num7 bered fiscal year. 

8 ‘‘(iii) SPECIAL RULE FOR FISCAL

9 YEAR 2016.—For fiscal year 2016, the al10 lotment of the State is equal to the Fed11 eral payments to the State that are attrib12 utable to (and countable toward) the total 

13 amount of allotments available under this 

14 section to the State in the preceding fiscal 

15 year (including payments made to the 

16 State under subsection (n) for such pre17 ceding fiscal year as well as amounts redis18 tributed to the State in such preceding fis19 cal year), but determined as if the last two 

20 sentences of section 2105(b) were in effect 

21 in such preceding fiscal year and then mul22 tiplying the result by the allotment in23 crease factor under paragraph (5) for fis24 cal year 2016.’’; 

25 (C) in paragraph (3)— 


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1 (i) in the heading, by striking 

2 ‘‘2015’’and inserting ‘‘2019’’; 

3 (ii) in subparagraph (A)— 

4 (I) by striking ‘‘paragraph (18)’’ 

5 and inserting ‘‘paragraph (22)’’; and 

6 (II) by striking ‘‘section 108 of 

7 the Children’s Health Insurance Pro8 gram Reauthorization Act of 2009’’ 

9 and inserting ‘‘section 2(b)(2) of the 

10 Protecting And Retaining Our Chil11 dren’s Health Insurance Program Act 

12 of 2015’’; 

13 (iii) in subparagraph (B), by striking 

14 ‘‘paragraph (18)’’ and inserting ‘‘para15 graph (22)’’; 

16 (iv) in subparagraph (C)— 

17 (I) by striking ‘‘2014’’ each place 

18 it appears and inserting ‘‘2018’’; and 

19 (II) by striking ‘‘2015’’ and in20 serting ‘‘2019’’; and 

21 (v) in subparagraph (D)— 

22 (I) in clause (i)— 

23 (aa) in subclause (I), by 

24 striking ‘‘subsection (a)(18)(A)’’ 


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1 and inserting ‘‘subsection 

2 (a)(22)(A)’’; and 

3 (bb) in subclause (II), by 

4 striking ‘‘section 108 of the Chil5 dren’s Health Insurance Program 

6 Reauthorization Act of 2009’’ 

7 and inserting ‘‘section 2(b)(2) of 

8 the Protecting And Retaining 

9 Our Children’s Health Insurance 

10 Program Act of 2015’’; and 

11 (II) in clause (ii)(II), by striking 

12 ‘‘subsection (a)(18)(B)’’ and inserting 

13 ‘‘subsection (a)(22)(B)’’; 

14 (D) in paragraph (4), by striking ‘‘2015’’ 

15 and inserting ‘‘2019’’; 

16 (E) in paragraph (6)— 

17 (i) in subparagraph (A), by striking 

18 ‘‘2015’’ and inserting ‘‘2019’’; and 

19 (ii) in the second sentence, by striking 

20 ‘‘or fiscal year 2014’’ and inserting ‘‘fiscal 

21 year 2014, fiscal year 2016, or fiscal year 

22 2018’’; and 

23 (F) in paragraph (8)— 

24 (i) in the paragraph heading, by strik25 ing ‘‘2015’’ and inserting ‘‘2019’’; and 


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1 (ii) by striking ‘‘for a period in fiscal 

2 year 2015’’ and inserting ‘‘for a period in 

3 fiscal year 2019’’. 

4 (2) ONE-TIME APPROPRIATION FOR FISCAL

5 YEAR 2019.—There is appropriated to the Secretary 

6 of Health and Human Services, out of any money in 

7 the Treasury not otherwise appropriated, 

8 $16,700,000,000 to accompany the allotment made 

9 for the period beginning on October 1, 2018, and 

10 ending on March 31, 2019, under section 

11 2104(a)(22)(A) of the Social Security Act (42 

12 U.S.C. 1397dd(a)(22)(A)) (as added by subsection 

13 (a)(1)), to remain available until expended. Such 

14 amount shall be used to provide allotments to States 

15 under paragraph (3) of section 2104(m) of such Act 

16 (42 U.S.C. 1397dd(m)) (as amended by paragraph 

17 (1)(C)) for the first 6 months of fiscal year 2019 in 

18 the same manner as allotments are provided under 

19 subsection (a)(22)(A) of such section 2104 and sub20 ject to the same terms and conditions as apply to 

21 the allotments provided from such subsection 

22 (a)(22)(A). 

23 (c) CHILD ENROLLMENT CONTINGENCY FUND.— 


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1 (1) IN GENERAL.—Section 2104(n) of the So2 cial Security Act (42 U.S.C. 1397dd(n)) is amend3 ed— 

4 (A) in paragraph (2)— 

5 (i) in subparagraph (A)— 

6 (I) in the matter preceding clause 

7 (i), by striking ‘‘and (D)’’ and insert8 ing ‘‘, (D), and (E)’’; and 

9 (II) by striking clause (ii) and in10 serting the following: 

11 ‘‘(ii) for each of— 

12 ‘‘(I) fiscal years 2010 through 

13 2014, such sums as are necessary for 

14 making payments to eligible States for 

15 such fiscal year, but not in excess of 

16 the aggregate cap described in sub17 paragraph (B); and 

18 ‘‘(II) fiscal years 2015 through 

19 2018 (and for each of the semi-annual 

20 allotment periods for fiscal year 

21 2019), such sums as are necessary for 

22 making payments to eligible States for 

23 such fiscal year or period.’’; and 

24 (ii) by striking subparagraph (B) and 

25 inserting the following: 


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1 ‘‘(B) AGGREGATE CAP.—The total amount 

2 available for payment from the Fund for each 

3 of fiscal years 2010 through 2014, taking into 

4 account deposits made under subparagraph (C), 

5 shall not exceed 20 percent of the amount made 

6 available under subsection (a) for the fiscal 

7 year. In the case of fiscal years 2015 through 

8 2018 (and for each of the semi-annual allot9 ment periods for fiscal year 2019), there shall 

10 be no limit on the amount available for pay11 ment from the Fund.’’; 

12 (iii) in subparagraph (D)— 

13 (I) by inserting ‘‘before fiscal 

14 year 2015’’ after ‘‘fiscal year or pe15 riod’’; and 

16 (II) by striking ‘‘for any suc17 ceeding fiscal year’’; and 

18 (iv) by adding at the end the following 

19 subparagraph: 

20 ‘‘(E) TRANSFERS.—Notwithstanding any 

21 other provision of this title, the following 

22 amounts shall also be available, without fiscal 

23 year limitation, for making payments from the 

24 Fund: 


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1 ‘‘(i) UNOBLIGATED NATIONAL ALLOT2 MENT FOR FISCAL YEARS BEGINNING WITH

3 FISCAL YEAR 2014.— 

4 ‘‘(I) FISCAL YEAR 2014 ALLOT5 MENT.—As of December 31 of fiscal 

6 year 2015, the portion, if any, of the 

7 amount appropriated under subsection 

8 (a) for fiscal year 2014 that is unobli9 gated for allotment to a State under 

10 subsection (m) for such fiscal year. 

11 ‘‘(II) SUCCEEDING FISCAL YEAR

12 ALLOTMENTS.—As of December 31 of 

13 fiscal year 2016, and each succeeding 

14 fiscal year, the portion, if any, of the 

15 amount appropriated under subsection 

16 (a) for the preceding fiscal year that 

17 is unobligated for allotment to a State 

18 under subsection (m) for such pre19 ceding fiscal year. 

20 ‘‘(ii) UNEXPENDED ALLOTMENTS NOT

21 USED FOR REDISTRIBUTION.—As of De22 cember 31 of fiscal year 2015, and as of 

23 November 15 of each succeeding fiscal 

24 year, the total amount of allotments made 

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1 ond preceding fiscal year that is not ex2 pended or redistributed under subsection 

3 (f) during the period in which such allot4 ments are available for obligation. 

5 ‘‘(iii) UNEXPENDED PERFORMANCE

6 INCENTIVE FUNDS.—As of January 1, 

7 2016, and as of January 1 of each suc8 ceeding calendar year, the portion, if any, 

9 of the amount appropriated under section 

10 2105(a)(3)(E)(iii) for the preceding fiscal 

11 year that is not expended or obligated 

12 under such section.’’; and 

13 (B) in paragraph (3)— 

14 (i) in subparagraph (A)— 

15 (I) by redesignating clauses (i) 

16 and (ii) as subclauses (I) and (II), re17 spectively, and realigning the left mar18 gins accordingly; 

19 (II) by striking ‘‘If a State’s’’ 

20 and all that follows through ‘‘2015,’’ 

21 and inserting the following: 

22 ‘‘(i) FOR FISCAL YEARS 2009

23 THROUGH 2014.—If a State’s expenditures 

24 under this title in fiscal year 2009, fiscal 

25 year 2010, fiscal year 2011, fiscal year 


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1 2012, fiscal year 2013, or fiscal year 

2 2014’’; 

3 (III) by striking ‘‘or period’’ each 

4 place it appears; 

5 (IV) in subclause (II) (as so re6 designated), by striking ‘‘(or in which 

7 the period occurs)’’; and 

8 (V) by adding at the end the fol9 lowing clause: 

10 ‘‘(ii) FOR FISCAL YEARS AFTER

11 2014.— 

12 ‘‘(I) IN GENERAL.—For each of 

13 fiscal years 2015 through 2018 (and 

14 for each of the semi-annual allotment 

15 periods for fiscal year 2019), if the 

16 Secretary determines that a State is a 

17 shortfall State described in subclause 

18 (II) for that fiscal year or period, the 

19 Secretary shall pay to the State from 

20 the Fund, in addition to any other 

21 payments made to the State under 

22 this title for the fiscal year or period, 

23 an amount equal to the amount de24 scribed in subclause (III). 


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1 ‘‘(II) SHORTFALL STATES DE2 SCRIBED.—For purposes of this 

3 clause, with respect to a fiscal year or 

4 semi-annual allotment period, a short5 fall State is a State for which the Sec6 retary estimates, on the basis of the 

7 most recent data available to the Sec8 retary, that the projected expenditures 

9 for the State and fiscal year or period 

10 under this title (including in the form 

11 of coverage described in paragraph (1) 

12 or (2) of section 2101, or both) will 

13 exceed the sum of— 

14 ‘‘(aa) the amount of the 

15 State’s allotments for any pre16 ceding fiscal year that remains 

17 available for expenditure and 

18 that will not be expended by the 

19 end of the immediately preceding 

20 fiscal year; 

21 ‘‘(bb) the amount (if any) 

22 that will be redistributed to the 

23 State under subsection (f) for the 

24 fiscal year or period; 


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1 ‘‘(cc) the amount (if any) to 

2 be paid to the State in the first 

3 quarter of the fiscal year under 

4 section 2105(a)(3); and 

5 ‘‘(dd) the amount of the 

6 State’s allotment for the fiscal 

7 year or period. 

8 ‘‘(III) AMOUNT DESCRIBED.— 

9 With respect to a State and fiscal 

10 year or period, the amount described 

11 in this subclause is equal to the 

12 amount by which the projected ex13 penditures for the State under this 

14 title for the fiscal year or period (esti15 mated by the Secretary on the basis 

16 of the most recent data available to 

17 the Secretary) exceed the sum deter18 mined under subclause (II) for the 

19 State and fiscal year or period. 

20 ‘‘(IV) RETROSPECTIVE ADJUST21 MENT.—The Secretary may adjust the 

22 determinations made under this clause 

23 with respect to a State and fiscal year 

24 or period as necessary on the basis of 

25 the amounts reported by States not 


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1 later than November 30 of the suc2 ceeding fiscal year, as approved by the 

3 Secretary.’’; 

4 (ii) in subparagraph (B)(ii), by strik5 ing ‘‘(or semi-annual period occurring in a 

6 fiscal year)’’; 

7 (iii) in subparagraph (C)— 

8 (I) in the matter preceding clause 

9 (i), by striking ‘‘subparagraph (A)(ii)’’ 

10 and inserting ‘‘subparagraph 

11 (A)(i)(II)’’; and 

12 (II) in clause (ii), by striking 

13 ‘‘(or semi-annual period occurring in a 

14 fiscal year)’’; and 

15 (iv) in subparagraph (G), by inserting 

16 ‘‘the expenditures under the State child 

17 health plan and’’ after ‘‘regarding’’. 

18 (2) CONFORMING AMENDMENT.—Section 

19 2104(f)(2)(A)(ii) of the Social Security Act (42 

20 U.S.C. 13957dd(f)(2)(A)(ii)) is amended by insert21 ing ‘‘only in the case of a fiscal year before fiscal 

22 year 2015,’’ before ‘‘the amount’’. 

23 (d) EXTENSION AND UPDATE OF PERFORMANCE IN24 CENTIVE PAYMENTS.— 


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1 (1) EXTENSION THROUGH FISCAL YEAR

2 2019.—Section 2105(a)(3) of the Social Security 

3 Act (42 U.S.C. 1397ee(a)(3)) is amended— 

4 (A) in subparagraph (A)— 

5 (i) by striking ‘‘2013’’ and inserting 

6 ‘‘2019’’; and 

7 (ii) in the second sentence, by insert8 ing ‘‘, except that payment under this 

9 paragraph may be made to a State for fis10 cal year 2014 as a single payment not 

11 later than December 31, 2015’’ before the 

12 period; 

13 (B) in subparagraph (E)— 

14 (i) in clause (ii)— 

15 (I) by striking subclause (I) and 

16 inserting the following: 

17 ‘‘(I) UNOBLIGATED NATIONAL

18 ALLOTMENT FOR FISCAL YEARS 2009

19 THROUGH 2013.—As of December 31 

20 of fiscal year 2009, and as of Decem21 ber 31 of each succeeding fiscal year 

22 through fiscal year 2013, the portion, 

23 if any, of the amount appropriated 

24 under section 2104(a) for such fiscal 

25 year that is unobligated for allotment 


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1 to a State under section 2104(m) for 

2 such fiscal year or set aside under 

3 subsection (a)(3) or (b)(2) of section 

4 2111 for such fiscal year.’’; 

5 (II) in subclause (III), by strik6 ing ‘‘2013’’ and inserting ‘‘2014’’; 

7 (ii) by redesignating clause (iii) as 

8 clause (iv); and 

9 (iii) by inserting after clause (ii) the 

10 following new clause: 

11 ‘‘(iii) APPROPRIATION FOR FISCAL

12 YEARS 2015 THROUGH 2019.—Out of any 

13 money in the Treasury not otherwise ap14 propriated, there are appropriated 

15 $500,000,000 for each of fiscal years 2015 

16 through 2019 for making payments under 

17 this paragraph. Amounts appropriated for 

18 a fiscal year under this clause shall remain 

19 available for making payments under this 

20 paragraph until January 1 of the following 

21 fiscal year. Any amounts of such appro22 priations that remain unexpended or unob23 ligated as of such date shall be transferred 

24 and made available for making payments 

25 under section 2104(n).’’; and 


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1 (C) in subparagraph (F)(iii), by striking 

2 ‘‘2013’’ and inserting ‘‘2019’’. 

3 (2) UPDATED PERFORMANCE INCENTIVE CRI4 TERIA FOR FISCAL YEARS 2015 THROUGH 2019.—Sec5 tion 2105(a) of the Social Security Act (42 U.S.C. 

6 1397ee(a)) is amended— 

7 (A) in paragraph (3)(A), by inserting ‘‘or 

8 (5)’’ after ‘‘paragraph (4)’’; 

9 (B) in paragraph (4)— 

10 (i) in the heading, by inserting ‘‘FIS11 CAL YEARS 2009 THROUGH 2014’’ after 

12 ‘‘FOR CHILDREN’’; and 

13 (ii) in the matter preceding subpara14 graph (A), by striking ‘‘for a fiscal year if’’ 

15 and inserting ‘‘for fiscal years 2009 

16 through 2014 if’’; and 

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

18 paragraph: 

19 ‘‘(5) ENROLLMENT AND RETENTION PROVI20 SIONS FOR CHILDREN FOR FISCAL YEAR 2015 AND

21 SUCCEEDING FISCAL YEARS.— 

22 ‘‘(A) IN GENERAL.—For purposes of para23 graph (3)(A), a State meets the condition of 

24 this paragraph for fiscal year 2015 and any 

25 succeeding fiscal year if it is implementing at 


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1 least 4 of the enrollment and retention provi2 sions specified in subparagraph (B) (treating 

3 each clause as a separate enrollment and reten4 tion provision) throughout the entire fiscal year. 

5 ‘‘(B) ENROLLMENT AND RETENTION PRO6 VISIONS.—The enrollment and retention provi7 sions specified in this subparagraph are the fol8 lowing: 

9 ‘‘(i) CONTINUOUS ELIGIBILITY.—The 

10 State has elected the option of continuous 

11 eligibility for a full 12 months for all chil12 dren described in section 1902(e)(12) 

13 under title XIX under 19 years of age, as 

14 well as applying such policy under its State 

15 child health plan under this title. 

16 ‘‘(ii) EXPRESS LANE ELIGIBILITY.— 

17 The State is implementing the option de18 scribed in section 1902(e)(13) under title 

19 XIX as well as, pursuant to section 

20 2107(e)(1), under this title. 

21 ‘‘(iii) PRESUMPTIVE ELIGIBILITY.— 

22 The State provides medical assistance to 

23 children during a presumptive eligibility 

24 period by implementing section 1920A 

25 under title XIX as well as, pursuant to 


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1 section 2107(e)(1), under this title, and 

2 ensures that such period begins with the 

3 determination by any qualified entity that 

4 the family income of the child does not ex5 ceed the applicable level of income eligi6 bility under the State plan. A State shall 

7 not satisfy this provision if the only type of 

8 entity recognized by the State as a quali9 fied entity is a hospital that has elected to 

10 be a qualified entity under section 

11 1902(a)(47)(B). 

12 ‘‘(iv) PREMIUM ASSISTANCE FOR EM13 PLOYER-SPONSORED PLANS.—The State 

14 has opted to offer a premium assistance 

15 subsidy for qualified employer-sponsored 

16 coverage by implementing section 1906A 

17 under title XIX or the option described in 

18 section 2105(c)(10) under this title. 

19 ‘‘(v) ELIMINATION OF WAITING PERI20 ODS.—The State does not impose a wait21 ing period for coverage of any individual 

22 under the State child health plan and en23 sures that no waiting period applies in the 

24 case of coverage provided to any individual 

25 eligible for coverage under the State child 


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1 health plan through coverage purchased by 

2 the State under section 2105(c)(3) or em3 ployer-sponsored coverage subsidized by 

4 the State under section 1906A of title XIX 

5 or section 2105(c)(10) of this title. 

6 ‘‘(vi) AUTOMATED TRACKING OF COST

7 SHARING OR LOWER CAP ON COST SHAR8 ING.—In the case of a State child health 

9 plan that imposes premiums, deductibles, 

10 cost sharing, or similar charges that could 

11 (as determined by the Secretary) cause 

12 families that include an individual receiv13 ing assistance under the plan to have out14 of-pocket expenses that exceed the limit 

15 imposed under section 2103(e)(3)(B), the 

16 State has either— 

17 ‘‘(I) established, or, in the case 

18 of a State child health plan that pro19 vides child health assistance through 

20 managed care entities or organiza21 tions, required such entities or organi22 zations to coordinate with the State 

23 agency responsible for implementing 

24 the State child health plan under this 

25 title in establishing— 


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1 ‘‘(aa) an electronic process 

2 for tracking such expenses that 

3 does not rely on documentation 

4 provided by the individual or the 

5 family; and 

6 ‘‘(bb) a system for notifying 

7 each such family of the aggregate 

8 monthly or quarterly limits on 

9 out-of-pocket expenses applicable 

10 to the family under section 

11 2103(e)(3)(B) and explaining to 

12 each such family that no such ex13 penses shall be imposed on any 

14 individual in the family for the 

15 remainder of any month or quar16 ter with respect to which the 

17 family has reached the applicable 

18 aggregate monthly or quarterly 

19 family limit imposed under such 

20 section; or 

21 ‘‘(II) elected to eliminate 

22 deductibles, copayments, coinsurance, 

23 or other forms of cost-sharing (other 

24 than premiums) imposed under this 

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1 ceiving coverage under the State child 

2 health plan. 

3 ‘‘(vii) REAL-TIME ELIGIBILITY DETER4 MINATIONS THROUGH THE USE OF EN5 HANCED DATA SOURCES.—With respect to 

6 applications and renewals for medical as7 sistance under title XIX or child health as8 sistance under this title for a fiscal year, 

9 the State meets the following criteria for 

10 all income determinations made using 

11 modified adjusted gross income under sec12 tion 1902(e)(14)(A): 

13 ‘‘(I) The State relies on enhanced 

14 data sources (which may include, but 

15 shall not be limited to, the data 

16 sources available under section 1137 

17 or the federal Data Services Hub) to 

18 make the determinations. 

19 ‘‘(II) In the case of initial appli20 cations, the State makes at least 50 

21 percent of the determinations within 

22 24 hours of receiving the application. 

23 If a State successfully makes the re24 quired minimum percentage of timely 

25 determinations for a fiscal year, such 


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1 State shall not receive credit for meet2 ing this provision in any subsequent 

3 fiscal year unless the State makes a 

4 percentage of timely income deter5 minations that is at least 5 percentage 

6 points higher (or, if at least 75 per7 cent of the State’s determinations in a 

8 previous fiscal year were timely, 1 

9 percentage point higher) than the per10 centage that the State achieved in the 

11 last fiscal year in which the State re12 ceived credit for meeting this provi13 sion. 

14 ‘‘(III) In the case of renewals, 

15 the State makes at least 50 percent of 

16 the determinations within 24 hours of 

17 receiving the renewal. If a State suc18 cessfully makes the required minimum 

19 percentage of timely determinations 

20 for a fiscal year, such State shall not 

21 receive credit for meeting this provi22 sion in any subsequent fiscal year un23 less the State makes a percentage of 

24 timely income determinations that is 

25 at least 5 percentage points higher 


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1 (or, if at least 75 percent of the 

2 State’s determinations in a previous 

3 fiscal year were timely, 1 percentage 

4 point higher) than the percentage that 

5 the State achieved in the last fiscal 

6 year in which the State received credit 

7 for meeting this provision. 

8 ‘‘(viii) ELIMINATION OF PREMIUMS OR

9 RETROACTIVE REINSTATEMENT UPON PRE10 MIUM PAYMENT.—The State has elected to 

11 either— 

12 ‘‘(I) impose no premiums for cov13 erage under the State child health 

14 plan; or 

15 ‘‘(II) in the case of an individual 

16 whose coverage under the State child 

17 health plan has been terminated for 

18 failure to make premium payments, 

19 provide assistance to such individual 

20 for purposes of immediate reenroll21 ment of the individual upon payment 

22 of outstanding premiums, with cov23 erage retroactive to the beginning of 

24 the most recent month for which an 

25 outstanding premium has been paid, 


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1 and shall not impose any waiting pe2 riod or fee as a condition of such re3 enrollment.’’. 

4 (e) EXTENSION OF QUALIFYING STATES OPTION.— 

5 Section 2105(g)(4) of the Social Security Act (42 U.S.C. 

6 1397ee(g)(4)) is amended— 

7 (1) in the paragraph heading, by striking 

8 ‘‘2015’’ and inserting ‘‘2019’’; and 

9 (2) in subparagraph (A), by striking ‘‘2015’’ 

10 and inserting ‘‘2019’’. 

11 (f) EXTENSION OF CERTAIN PROGRAMS AND DEM12 ONSTRATION PROJECTS.— 

13 (1) QUALITY CARE FOR CHILDREN DEM14 ONSTRATION PROJECT.—Section 1139A(d)(1) of the 

15 Social Security Act (42 U.S.C. 1320b–9a(d)(1)) is 

16 amended in the matter before subparagraph (A) by 

17 inserting ‘‘, and during the period of fiscal years 

18 2016 through 2019, the Secretary shall award not 

19 more than 10 grants,’’ before ‘‘to States’’. 

20 (2) CHILDHOOD OBESITY DEMONSTRATION

21 PROJECT.—Section 1139A(e)(8) of the Social Secu22 rity Act (42 U.S.C. 1320b–9a(e)(8)) is amended by 

23 inserting ‘‘, and $25,000,000 for the period of fiscal 

24 years 2015 though 2019’’ after ‘‘2014’’. 


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1 (3) PEDIATRIC QUALITY MEASURES PRO2 GRAM.—Section 1139A(i) of the Social Security Act 

3 (42 U.S.C. 1320b–9a(i)) is amended in the first sen4 tence by inserting before the period at the end the 

5 following: ‘‘, and there is appropriated for each of 

6 fiscal years 2016 through 2019, $45,000,000 for the 

7 purpose of carrying out this section (other than sub8 sections (e), (f), and (g)).’’. 

9 (4) OUTREACH AND ENROLLMENT GRANTS; NA10 TIONAL CAMPAIGN.—Section 2113 of the Social Se11 curity Act (42 U.S.C. 1397mm) is amended— 

12 (A) in subsection (a)(1), by striking 

13 ‘‘2015’’ and inserting ‘‘2019’’; and 

14 (B) in subsection (g), by inserting ‘‘, and 

15 $80,000,000 for the period of fiscal years 2016 

16 through 2019, to remain available until ex17 pended,’’ after ‘‘2015’’. 

18 (g) EXPRESS LANE ELIGIBILITY.—Section 

19 1902(e)(13)(I) of the Social Security Act (42 U.S.C. 

20 1396a(e)(13)(I)) is amended by striking ‘‘September 30, 

21 2015’’ and inserting ‘‘September 30, 2019’’. 

22 (h) AUTHORITY TO USE INCOME DETERMINATION

23 MADE UNDER CERTAIN PROGRAMS.—Section 

24 1902(e)(14) of the Social Security Act (42 U.S.C. 

25 1396a(e)(14)) is amended— 


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1 (1) in subparagraph (A), in the first sentence, 

2 by striking ‘‘subparagraph (D)’’ and inserting ‘‘sub3 paragraphs (D) and (J)’’; and 

4 (2) by adding at the end the following new sub5 paragraph: 

6 ‘‘(J) USE OF INCOME DETERMINATION

7 MADE UNDER CERTAIN OTHER PROGRAMS.— 

8 ‘‘(i) IN GENERAL.—For purposes of 

9 determining income eligibility for medical 

10 assistance under the State plan or under 

11 any waiver of such plan, a State may use 

12 a determination of income made by— 

13 ‘‘(I) the State program funded 

14 under part A of title IV; or 

15 ‘‘(II) the supplemental nutrition 

16 assistance program established under 

17 the Food and Nutrition Act of 2008. 

18 ‘‘(ii) SUNSET.—Clause (i) shall not 

19 apply after September 30, 2019.’’. 

Æ 


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