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[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 522 Introduced in Senate (IS)]

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting And Retaining Our 
Children's Health Insurance Program Act of 2015''.

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

    (a) Funding.--
            (1) In general.--Section 2104(a) of the Social Security Act 
        (42 U.S.C. 1397dd(a)) is amended--
                    (A) in paragraph (17), by striking ``and'' at the 
                end; and
                    (B) by striking paragraph (18) and inserting the 
                following new paragraphs:
            ``(18) for fiscal year 2015, $21,061,000,000;
            ``(19) for fiscal year 2016, $19,300,000,000;
            ``(20) for fiscal year 2017, $20,300,000,000;
            ``(21) for fiscal year 2018, $21,300,000,000; and
            ``(22) for fiscal year 2019, for purposes of making 2 semi-
        annual allotments--
                    ``(A) $2,850,000,000 for the period beginning on 
                October 1, 2018, and ending on March 31, 2019; and
                    ``(B) $2,850,000,000 for the period beginning on 
                April 1, 2019, and ending on September 30, 2019.''.
            (2) Prevention of duplicate appropriations for fiscal year 
        2015.--Notwithstanding any other provision of law, insofar as 
        funds have been appropriated under subsection (a)(18) or (m) of 
        section 2104 of the Social Security Act (42 U.S.C. 1397dd), or 
        under section 108 of the Children's Health Insurance Program 
        Reauthorization Act of 2009 (Public Law 111-3), as such 
        subsections and section are in effect on the day before the 
        date of the enactment of this Act, to provide allotments to 
        States under the State Children's Health Insurance Program 
        established under title XXI of the Social Security Act (42 
        U.S.C. 1397aa et seq.) (whether implemented under title XIX, 
        XXI, or both, of the Social Security Act) for fiscal year 
        2015--
                    (A) any amounts that are so appropriated that are 
                not so allotted and obligated before the date of the 
                enactment of this Act, are rescinded; and
                    (B) any amount provided for CHIP allotments to a 
                State under this section (and the amendments made by 
                this section) for such fiscal year shall be reduced by 
                the amount of such appropriations so allotted and 
                obligated before such date.
    (b) Allotments.--
            (1) In general.--Section 2104(m) of the Social Security Act 
        (42 U.S.C. 1397dd(m)) is amended--
                    (A) in the subsection heading, by striking 
                ``Through 2015'' and inserting ``and Thereafter'';
                    (B) in paragraph (2)--
                            (i) in the paragraph heading, by striking 
                        ``2014'' and inserting ``2018''; and
                            (ii) by striking subparagraph (B) and 
                        inserting the following new subparagraph:
                    ``(B) Fiscal year 2013 through 2018.--Subject to 
                paragraphs (4) and (6), from the amount made available 
                under paragraphs (16) through (21) of subsection (a) 
                for each of fiscal years 2013 through 2018, 
                respectively, the Secretary shall compute a State 
                allotment for each State (including the District of 
                Columbia and each commonwealth and territory) for each 
                such fiscal year as follows:
                            ``(i) Rebasing in fiscal year 2013 and each 
                        succeeding odd-numbered fiscal year.--For 
                        fiscal year 2013 and each succeeding odd-
                        numbered fiscal year, the allotment of the 
                        State is equal to the Federal payments to the 
                        State that are attributable to (and countable 
                        toward) the total amount of allotments 
                        available under this section to the State in 
                        the preceding fiscal year (including payments 
                        made to the State under subsection (n) for such 
                        preceding fiscal year as well as amounts 
                        redistributed to the State in such preceding 
                        fiscal year), multiplied by the allotment 
                        increase factor under paragraph (5) for such 
                        odd-numbered fiscal year.
                            ``(ii) Growth factor update for fiscal year 
                        2014 and each succeeding even-numbered fiscal 
                        year.--Except as provided in clause (iii), for 
                        fiscal year 2014 and each succeeding even-
                        numbered fiscal year, the allotment of the 
                        State is equal to the sum of--
                                    ``(I) the amount of the State 
                                allotment under clause (i) for the 
                                preceding fiscal year; and
                                    ``(II) the amount of any payments 
                                made to the State under subsection (n) 
                                for such preceding fiscal year,
                        multiplied by the allotment increase factor 
                        under paragraph (5) for such even-numbered 
                        fiscal year.
                            ``(iii) Special rule for fiscal year 
                        2016.--For fiscal year 2016, the allotment of 
                        the State is equal to the Federal payments to 
                        the State that are attributable to (and 
                        countable toward) the total amount of 
                        allotments available under this section to the 
                        State in the preceding fiscal year (including 
                        payments made to the State under subsection (n) 
                        for such preceding fiscal year as well as 
                        amounts redistributed to the State in such 
                        preceding fiscal year), but determined as if 
                        the last two sentences of section 2105(b) were 
                        in effect in such preceding fiscal year and 
                        then multiplying the result by the allotment 
                        increase factor under paragraph (5) for fiscal 
                        year 2016.'';
                    (C) in paragraph (3)--
                            (i) in the heading, by striking ``2015''and 
                        inserting ``2019'';
                            (ii) in subparagraph (A)--
                                    (I) by striking ``paragraph (18)'' 
                                and inserting ``paragraph (22)''; and
                                    (II) by striking ``section 108 of 
                                the Children's Health Insurance Program 
                                Reauthorization Act of 2009'' and 
                                inserting ``section 2(b)(2) of the 
                                Protecting And Retaining Our Children's 
                                Health Insurance Program Act of 2015'';
                            (iii) in subparagraph (B), by striking 
                        ``paragraph (18)'' and inserting ``paragraph 
                        (22)'';
                            (iv) in subparagraph (C)--
                                    (I) by striking ``2014'' each place 
                                it appears and inserting ``2018''; and
                                    (II) by striking ``2015'' and 
                                inserting ``2019''; and
                            (v) in subparagraph (D)--
                                    (I) in clause (i)--
                                            (aa) in subclause (I), by 
                                        striking ``subsection 
                                        (a)(18)(A)'' and inserting 
                                        ``subsection (a)(22)(A)''; and
                                            (bb) in subclause (II), by 
                                        striking ``section 108 of the 
                                        Children's Health Insurance 
                                        Program Reauthorization Act of 
                                        2009'' and inserting ``section 
                                        2(b)(2) of the Protecting And 
                                        Retaining Our Children's Health 
                                        Insurance Program Act of 
                                        2015''; and
                                    (II) in clause (ii)(II), by 
                                striking ``subsection (a)(18)(B)'' and 
                                inserting ``subsection (a)(22)(B)'';
                    (D) in paragraph (4), by striking ``2015'' and 
                inserting ``2019'';
                    (E) in paragraph (6)--
                            (i) in subparagraph (A), by striking 
                        ``2015'' and inserting ``2019''; and
                            (ii) in the second sentence, by striking 
                        ``or fiscal year 2014'' and inserting ``fiscal 
                        year 2014, fiscal year 2016, or fiscal year 
                        2018''; and
                    (F) in paragraph (8)--
                            (i) in the paragraph heading, by striking 
                        ``2015'' and inserting ``2019''; and
                            (ii) by striking ``for a period in fiscal 
                        year 2015'' and inserting ``for a period in 
                        fiscal year 2019''.
            (2) One-time appropriation for fiscal year 2019.--There is 
        appropriated to the Secretary of Health and Human Services, out 
        of any money in the Treasury not otherwise appropriated, 
        $16,700,000,000 to accompany the allotment made for the period 
        beginning on October 1, 2018, and ending on March 31, 2019, 
        under section 2104(a)(22)(A) of the Social Security Act (42 
        U.S.C. 1397dd(a)(22)(A)) (as added by subsection (a)(1)), to 
        remain available until expended. Such amount shall be used to 
        provide allotments to States under paragraph (3) of section 
        2104(m) of such Act (42 U.S.C. 1397dd(m)) (as amended by 
        paragraph (1)(C)) for the first 6 months of fiscal year 2019 in 
        the same manner as allotments are provided under subsection 
        (a)(22)(A) of such section 2104 and subject to the same terms 
        and conditions as apply to the allotments provided from such 
        subsection (a)(22)(A).
    (c) Child Enrollment Contingency Fund.--
            (1) In general.--Section 2104(n) of the Social Security Act 
        (42 U.S.C. 1397dd(n)) is amended--
                    (A) in paragraph (2)--
                            (i) in subparagraph (A)--
                                    (I) in the matter preceding clause 
                                (i), by striking ``and (D)'' and 
                                inserting ``, (D), and (E)''; and
                                    (II) by striking clause (ii) and 
                                inserting the following:
                            ``(ii) for each of--
                                    ``(I) fiscal years 2010 through 
                                2014, such sums as are necessary for 
                                making payments to eligible States for 
                                such fiscal year, but not in excess of 
                                the aggregate cap described in 
                                subparagraph (B); and
                                    ``(II) fiscal years 2015 through 
                                2018 (and for each of the semi-annual 
                                allotment periods for fiscal year 
                                2019), such sums as are necessary for 
                                making payments to eligible States for 
                                such fiscal year or period.''; and
                            (ii) by striking subparagraph (B) and 
                        inserting the following:
                    ``(B) Aggregate cap.--The total amount available 
                for payment from the Fund for each of fiscal years 2010 
                through 2014, taking into account deposits made under 
                subparagraph (C), shall not exceed 20 percent of the 
                amount made available under subsection (a) for the 
                fiscal year. In the case of fiscal years 2015 through 
                2018 (and for each of the semi-annual allotment periods 
                for fiscal year 2019), there shall be no limit on the 
                amount available for payment from the Fund.'';
                            (iii) in subparagraph (D)--
                                    (I) by inserting ``before fiscal 
                                year 2015'' after ``fiscal year or 
                                period''; and
                                    (II) by striking ``for any 
                                succeeding fiscal year''; and
                            (iv) by adding at the end the following 
                        subparagraph:
                    ``(E) Transfers.--Notwithstanding any other 
                provision of this title, the following amounts shall 
                also be available, without fiscal year limitation, for 
                making payments from the Fund:
                            ``(i) Unobligated national allotment for 
                        fiscal years beginning with fiscal year 2014.--
                                    ``(I) Fiscal year 2014 allotment.--
                                As of December 31 of fiscal year 2015, 
                                the portion, if any, of the amount 
                                appropriated under subsection (a) for 
                                fiscal year 2014 that is unobligated 
                                for allotment to a State under 
                                subsection (m) for such fiscal year.
                                    ``(II) Succeeding fiscal year 
                                allotments.--As of December 31 of 
                                fiscal year 2016, and each succeeding 
                                fiscal year, the portion, if any, of 
                                the amount appropriated under 
                                subsection (a) for the preceding fiscal 
                                year that is unobligated for allotment 
                                to a State under subsection (m) for 
                                such preceding fiscal year.
                            ``(ii) Unexpended allotments not used for 
                        redistribution.--As of December 31 of fiscal 
                        year 2015, and as of November 15 of each 
                        succeeding fiscal year, the total amount of 
                        allotments made to States under subsection (a) 
                        for the second preceding fiscal year that is 
                        not expended or redistributed under subsection 
                        (f) during the period in which such allotments 
                        are available for obligation.
                            ``(iii) Unexpended performance incentive 
                        funds.--As of January 1, 2016, and as of 
                        January 1 of each succeeding calendar year, the 
                        portion, if any, of the amount appropriated 
                        under section 2105(a)(3)(E)(iii) for the 
                        preceding fiscal year that is not expended or 
                        obligated under such section.''; and
                    (B) in paragraph (3)--
                            (i) in subparagraph (A)--
                                    (I) by redesignating clauses (i) 
                                and (ii) as subclauses (I) and (II), 
                                respectively, and realigning the left 
                                margins accordingly;
                                    (II) by striking ``If a State's'' 
                                and all that follows through ``2015,'' 
                                and inserting the following:
                            ``(i) For fiscal years 2009 through 2014.--
                        If a State's expenditures under this title in 
                        fiscal year 2009, fiscal year 2010, fiscal year 
                        2011, fiscal year 2012, fiscal year 2013, or 
                        fiscal year 2014'';
                                    (III) by striking ``or period'' 
                                each place it appears;
                                    (IV) in subclause (II) (as so 
                                redesignated), by striking ``(or in 
                                which the period occurs)''; and
                                    (V) by adding at the end the 
                                following clause:
                            ``(ii) For fiscal years after 2014.--
                                    ``(I) In general.--For each of 
                                fiscal years 2015 through 2018 (and for 
                                each of the semi-annual allotment 
                                periods for fiscal year 2019), if the 
                                Secretary determines that a State is a 
                                shortfall State described in subclause 
                                (II) for that fiscal year or period, 
                                the Secretary shall pay to the State 
                                from the Fund, in addition to any other 
                                payments made to the State under this 
                                title for the fiscal year or period, an 
                                amount equal to the amount described in 
                                subclause (III).
                                    ``(II) Shortfall states 
                                described.--For purposes of this 
                                clause, with respect to a fiscal year 
                                or semi-annual allotment period, a 
                                shortfall State is a State for which 
                                the Secretary estimates, on the basis 
                                of the most recent data available to 
                                the Secretary, that the projected 
                                expenditures for the State and fiscal 
                                year or period under this title 
                                (including in the form of coverage 
                                described in paragraph (1) or (2) of 
                                section 2101, or both) will exceed the 
                                sum of--
                                            ``(aa) the amount of the 
                                        State's allotments for any 
                                        preceding fiscal year that 
                                        remains available for 
                                        expenditure and that will not 
                                        be expended by the end of the 
                                        immediately preceding fiscal 
                                        year;
                                            ``(bb) the amount (if any) 
                                        that will be redistributed to 
                                        the State under subsection (f) 
                                        for the fiscal year or period;
                                            ``(cc) the amount (if any) 
                                        to be paid to the State in the 
                                        first quarter of the fiscal 
                                        year under section 2105(a)(3); 
                                        and
                                            ``(dd) the amount of the 
                                        State's allotment for the 
                                        fiscal year or period.
                                    ``(III) Amount described.--With 
                                respect to a State and fiscal year or 
                                period, the amount described in this 
                                subclause is equal to the amount by 
                                which the projected expenditures for 
                                the State under this title for the 
                                fiscal year or period (estimated by the 
                                Secretary on the basis of the most 
                                recent data available to the Secretary) 
                                exceed the sum determined under 
                                subclause (II) for the State and fiscal 
                                year or period.
                                    ``(IV) Retrospective adjustment.--
                                The Secretary may adjust the 
                                determinations made under this clause 
                                with respect to a State and fiscal year 
                                or period as necessary on the basis of 
                                the amounts reported by States not 
                                later than November 30 of the 
                                succeeding fiscal year, as approved by 
                                the Secretary.'';
                            (ii) in subparagraph (B)(ii), by striking 
                        ``(or semi-annual period occurring in a fiscal 
                        year)'';
                            (iii) in subparagraph (C)--
                                    (I) in the matter preceding clause 
                                (i), by striking ``subparagraph 
                                (A)(ii)'' and inserting ``subparagraph 
                                (A)(i)(II)''; and
                                    (II) in clause (ii), by striking 
                                ``(or semi-annual period occurring in a 
                                fiscal year)''; and
                            (iv) in subparagraph (G), by inserting 
                        ``the expenditures under the State child health 
                        plan and'' after ``regarding''.
            (2) Conforming amendment.--Section 2104(f)(2)(A)(ii) of the 
        Social Security Act (42 U.S.C. 13957dd(f)(2)(A)(ii)) is amended 
        by inserting ``only in the case of a fiscal year before fiscal 
        year 2015,'' before ``the amount''.
    (d) Extension and Update of Performance Incentive Payments.--
            (1) Extension through fiscal year 2019.--Section 2105(a)(3) 
        of the Social Security Act (42 U.S.C. 1397ee(a)(3)) is 
        amended--
                    (A) in subparagraph (A)--
                            (i) by striking ``2013'' and inserting 
                        ``2019''; and
                            (ii) in the second sentence, by inserting 
                        ``, except that payment under this paragraph 
                        may be made to a State for fiscal year 2014 as 
                        a single payment not later than December 31, 
                        2015'' before the period;
                    (B) in subparagraph (E)--
                            (i) in clause (ii)--
                                    (I) by striking subclause (I) and 
                                inserting the following:
                                    ``(I) Unobligated national 
                                allotment for fiscal years 2009 through 
                                2013.--As of December 31 of fiscal year 
                                2009, and as of December 31 of each 
                                succeeding fiscal year through fiscal 
                                year 2013, the portion, if any, of the 
                                amount appropriated under section 
                                2104(a) for such fiscal year that is 
                                unobligated for allotment to a State 
                                under section 2104(m) for such fiscal 
                                year or set aside under subsection 
                                (a)(3) or (b)(2) of section 2111 for 
                                such fiscal year.'';
                                    (II) in subclause (III), by 
                                striking ``2013'' and inserting 
                                ``2014'';
                            (ii) by redesignating clause (iii) as 
                        clause (iv); and
                            (iii) by inserting after clause (ii) the 
                        following new clause:
                            ``(iii) Appropriation for fiscal years 2015 
                        through 2019.--Out of any money in the Treasury 
                        not otherwise appropriated, there are 
                        appropriated $500,000,000 for each of fiscal 
                        years 2015 through 2019 for making payments 
                        under this paragraph. Amounts appropriated for 
                        a fiscal year under this clause shall remain 
                        available for making payments under this 
                        paragraph until January 1 of the following 
                        fiscal year. Any amounts of such appropriations 
                        that remain unexpended or unobligated as of 
                        such date shall be transferred and made 
                        available for making payments under section 
                        2104(n).''; and
                    (C) in subparagraph (F)(iii), by striking ``2013'' 
                and inserting ``2019''.
            (2) Updated performance incentive criteria for fiscal years 
        2015 through 2019.--Section 2105(a) of the Social Security Act 
        (42 U.S.C. 1397ee(a)) is amended--
                    (A) in paragraph (3)(A), by inserting ``or (5)'' 
                after ``paragraph (4)'';
                    (B) in paragraph (4)--
                            (i) in the heading, by inserting ``fiscal 
                        years 2009 through 2014'' after ``for 
                        children''; and
                            (ii) in the matter preceding subparagraph 
                        (A), by striking ``for a fiscal year if'' and 
                        inserting ``for fiscal years 2009 through 2014 
                        if''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(5) Enrollment and retention provisions for children for 
        fiscal year 2015 and succeeding fiscal years.--
                    ``(A) In general.--For purposes of paragraph 
                (3)(A), a State meets the condition of this paragraph 
                for fiscal year 2015 and any succeeding fiscal year if 
                it is implementing at least 4 of the enrollment and 
                retention provisions specified in subparagraph (B) 
                (treating each clause as a separate enrollment and 
                retention provision) throughout the entire fiscal year.
                    ``(B) Enrollment and retention provisions.--The 
                enrollment and retention provisions specified in this 
                subparagraph are the following:
                            ``(i) Continuous eligibility.--The State 
                        has elected the option of continuous 
                        eligibility for a full 12 months for all 
                        children described in section 1902(e)(12) under 
                        title XIX under 19 years of age, as well as 
                        applying such policy under its State child 
                        health plan under this title.
                            ``(ii) Express lane eligibility.--The State 
                        is implementing the option described in section 
                        1902(e)(13) under title XIX as well as, 
                        pursuant to section 2107(e)(1), under this 
                        title.
                            ``(iii) Presumptive eligibility.--The State 
                        provides medical assistance to children during 
                        a presumptive eligibility period by 
                        implementing section 1920A under title XIX as 
                        well as, pursuant to section 2107(e)(1), under 
                        this title, and ensures that such period begins 
                        with the determination by any qualified entity 
                        that the family income of the child does not 
                        exceed the applicable level of income 
                        eligibility under the State plan. A State shall 
                        not satisfy this provision if the only type of 
                        entity recognized by the State as a qualified 
                        entity is a hospital that has elected to be a 
                        qualified entity under section 1902(a)(47)(B).
                            ``(iv) Premium assistance for employer-
                        sponsored plans.--The State has opted to offer 
                        a premium assistance subsidy for qualified 
                        employer-sponsored coverage by implementing 
                        section 1906A under title XIX or the option 
                        described in section 2105(c)(10) under this 
                        title.
                            ``(v) Elimination of waiting periods.--The 
                        State does not impose a waiting period for 
                        coverage of any individual under the State 
                        child health plan and ensures that no waiting 
                        period applies in the case of coverage provided 
                        to any individual eligible for coverage under 
                        the State child health plan through coverage 
                        purchased by the State under section 2105(c)(3) 
                        or employer-sponsored coverage subsidized by 
                        the State under section 1906A of title XIX or 
                        section 2105(c)(10) of this title.
                            ``(vi) Automated tracking of cost sharing 
                        or lower cap on cost sharing.--In the case of a 
                        State child health plan that imposes premiums, 
                        deductibles, cost sharing, or similar charges 
                        that could (as determined by the Secretary) 
                        cause families that include an individual 
                        receiving assistance under the plan to have 
                        out-of-pocket expenses that exceed the limit 
                        imposed under section 2103(e)(3)(B), the State 
                        has either--
                                    ``(I) established, or, in the case 
                                of a State child health plan that 
                                provides child health assistance 
                                through managed care entities or 
                                organizations, required such entities 
                                or organizations to coordinate with the 
                                State agency responsible for 
                                implementing the State child health 
                                plan under this title in establishing--
                                            ``(aa) an electronic 
                                        process for tracking such 
                                        expenses that does not rely on 
                                        documentation provided by the 
                                        individual or the family; and
                                            ``(bb) a system for 
                                        notifying each such family of 
                                        the aggregate monthly or 
                                        quarterly limits on out-of-
                                        pocket expenses applicable to 
                                        the family under section 
                                        2103(e)(3)(B) and explaining to 
                                        each such family that no such 
                                        expenses shall be imposed on 
                                        any individual in the family 
                                        for the remainder of any month 
                                        or quarter with respect to 
                                        which the family has reached 
                                        the applicable aggregate 
                                        monthly or quarterly family 
                                        limit imposed under such 
                                        section; or
                                    ``(II) elected to eliminate 
                                deductibles, copayments, coinsurance, 
                                or other forms of cost-sharing (other 
                                than premiums) imposed under this title 
                                with respect to any individual 
                                receiving coverage under the State 
                                child health plan.
                            ``(vii) Real-time eligibility 
                        determinations through the use of enhanced data 
                        sources.--With respect to applications and 
                        renewals for medical assistance under title XIX 
                        or child health assistance under this title for 
                        a fiscal year, the State meets the following 
                        criteria for all income determinations made 
                        using modified adjusted gross income under 
                        section 1902(e)(14)(A):
                                    ``(I) The State relies on enhanced 
                                data sources (which may include, but 
                                shall not be limited to, the data 
                                sources available under section 1137 or 
                                the federal Data Services Hub) to make 
                                the determinations.
                                    ``(II) In the case of initial 
                                applications, the State makes at least 
                                50 percent of the determinations within 
                                24 hours of receiving the application. 
                                If a State successfully makes the 
                                required minimum percentage of timely 
                                determinations for a fiscal year, such 
                                State shall not receive credit for 
                                meeting this provision in any 
                                subsequent fiscal year unless the State 
                                makes a percentage of timely income 
                                determinations that is at least 5 
                                percentage points higher (or, if at 
                                least 75 percent of the State's 
                                determinations in a previous fiscal 
                                year were timely, 1 percentage point 
                                higher) than the percentage that the 
                                State achieved in the last fiscal year 
                                in which the State received credit for 
                                meeting this provision.
                                    ``(III) In the case of renewals, 
                                the State makes at least 50 percent of 
                                the determinations within 24 hours of 
                                receiving the renewal. If a State 
                                successfully makes the required minimum 
                                percentage of timely determinations for 
                                a fiscal year, such State shall not 
                                receive credit for meeting this 
                                provision in any subsequent fiscal year 
                                unless the State makes a percentage of 
                                timely income determinations that is at 
                                least 5 percentage points higher (or, 
                                if at least 75 percent of the State's 
                                determinations in a previous fiscal 
                                year were timely, 1 percentage point 
                                higher) than the percentage that the 
                                State achieved in the last fiscal year 
                                in which the State received credit for 
                                meeting this provision.
                            ``(viii) Elimination of premiums or 
                        retroactive reinstatement upon premium 
                        payment.--The State has elected to either--
                                    ``(I) impose no premiums for 
                                coverage under the State child health 
                                plan; or
                                    ``(II) in the case of an individual 
                                whose coverage under the State child 
                                health plan has been terminated for 
                                failure to make premium payments, 
                                provide assistance to such individual 
                                for purposes of immediate reenrollment 
                                of the individual upon payment of 
                                outstanding premiums, with coverage 
                                retroactive to the beginning of the 
                                most recent month for which an 
                                outstanding premium has been paid, and 
                                shall not impose any waiting period or 
                                fee as a condition of such 
                                reenrollment.''.
    (e) Extension of Qualifying States Option.--Section 2105(g)(4) of 
the Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
            (1) in the paragraph heading, by striking ``2015'' and 
        inserting ``2019''; and
            (2) in subparagraph (A), by striking ``2015'' and inserting 
        ``2019''.
    (f) Extension of Certain Programs and Demonstration Projects.--
            (1) Quality care for children demonstration project.--
        Section 1139A(d)(1) of the Social Security Act (42 U.S.C. 
        1320b-9a(d)(1)) is amended in the matter before subparagraph 
        (A) by inserting ``, and during the period of fiscal years 2016 
        through 2019, the Secretary shall award not more than 10 
        grants,'' before ``to States''.
            (2) Childhood obesity demonstration project.--Section 
        1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b-
        9a(e)(8)) is amended by inserting ``, and $25,000,000 for the 
        period of fiscal years 2015 though 2019'' after ``2014''.
            (3) Pediatric quality measures program.--Section 1139A(i) 
        of the Social Security Act (42 U.S.C. 1320b-9a(i)) is amended 
        in the first sentence by inserting before the period at the end 
        the following: ``, and there is appropriated for each of fiscal 
        years 2016 through 2019, $45,000,000 for the purpose of 
        carrying out this section (other than subsections (e), (f), and 
        (g)).''.
            (4) Outreach and enrollment grants; national campaign.--
        Section 2113 of the Social Security Act (42 U.S.C. 1397mm) is 
        amended--
                    (A) in subsection (a)(1), by striking ``2015'' and 
                inserting ``2019''; and
                    (B) in subsection (g), by inserting ``, and 
                $80,000,000 for the period of fiscal years 2016 through 
                2019, to remain available until expended,'' after 
                ``2015''.
    (g) Express Lane Eligibility.--Section 1902(e)(13)(I) of the Social 
Security Act (42 U.S.C. 1396a(e)(13)(I)) is amended by striking 
``September 30, 2015'' and inserting ``September 30, 2019''.
    (h) Authority To Use Income Determination Made Under Certain 
Programs.--Section 1902(e)(14) of the Social Security Act (42 U.S.C. 
1396a(e)(14)) is amended--
            (1) in subparagraph (A), in the first sentence, by striking 
        ``subparagraph (D)'' and inserting ``subparagraphs (D) and 
        (J)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(J) Use of income determination made under 
                certain other programs.--
                            ``(i) In general.--For purposes of 
                        determining income eligibility for medical 
                        assistance under the State plan or under any 
                        waiver of such plan, a State may use a 
                        determination of income made by--
                                    ``(I) the State program funded 
                                under part A of title IV; or
                                    ``(II) the supplemental nutrition 
                                assistance program established under 
                                the Food and Nutrition Act of 2008.
                            ``(ii) Sunset.--Clause (i) shall not apply 
                        after September 30, 2019.''.
                                 <all>
```