carry out section 2102(b)(3)(C)) for receipt of such 
assistance. 
‘‘(6) APPLICATION OF COST-SHARING PROTEC-
TION.—The State provides pregnancy-related assist-
ance to a targeted low-income woman consistent 
with the cost-sharing protections under section 
2103(e) and applies the limitation on total annual 
aggregate cost sharing imposed under paragraph 
(3)(B) of such section to the family of such a 
woman. 
‘‘(7) NO WAITING LIST FOR CHILDREN.—The 
State does not impose, with respect to the enroll-
ment under the State child health plan of targeted 
low-income children during the quarter, any enroll-
ment cap or other numerical limitation on enroll-
ment, any waiting list, any procedures designed to 
delay the consideration of applications for enroll-
ment, or similar limitation with respect to enroll-
ment. 
‘‘(c) OPTION TO PROVIDE PRESUMPTIVE ELIGI-
BILITY.—A State that elects the option under subsection 
(a) and satisfies the conditions described in subsection (b) 
may elect to apply section 1920 (relating to presumptive 
eligibility for pregnant women) to the State child health
plan in the same manner as such section applies to the 
State plan under title XIX. 
‘‘(d) DEFINITIONS.—For purposes of this section: 
‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The 
term ‘pregnancy-related assistance’ has the meaning 
given the term ‘child health assistance’ in section 
2110(a) with respect to an individual during the pe-
riod described in paragraph (2)(A). 
‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT 
WOMAN.—The term ‘targeted low-income pregnant 
woman’ means an individual— 
‘‘(A) during pregnancy and through the 
end of the month in which the 60-day period 
(beginning on the last day of her pregnancy) 
ends; 
‘‘(B) whose family income exceeds 185 per-
cent (or, if higher, the percent applied under 
subsection (b)(1)(A)) of the poverty line appli-
cable to a family of the size involved, but does 
not exceed the income eligibility level estab-
lished under the State child health plan under 
this title for a targeted low-income child; and 
‘‘(C) who satisfies the requirements of 
paragraphs (1)(A), (1)(C), (2), and (3) of sec-
tion 2110(b) in the same manner as a child ap-
plying for child health assistance would have to 
satisfy such requirements. 
‘‘(e) AUTOMATIC
ENROLLMENT
FOR
CHILDREN 
BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS-
SISTANCE.—If a child is born to a targeted low-income 
pregnant woman who was receiving pregnancy-related as-
sistance under this section on the date of the child’s birth, 
the child shall be deemed to have applied for child health 
assistance under the State child health plan and to have 
been found eligible for such assistance under such plan 
or to have applied for medical assistance under title XIX 
and to have been found eligible for such assistance under 
such title, as appropriate, on the date of such birth and 
to remain eligible for such assistance until the child at-
tains 1 year of age. During the period in which a child 
is deemed under the preceding sentence to be eligible for 
child health or medical assistance, the child health or med-
ical assistance eligibility identification number of the 
mother shall also serve as the identification number of the 
child, and all claims shall be submitted and paid under 
such number (unless the State issues a separate identifica-
tion number for the child before such period expires). 
‘‘(f) STATES
PROVIDING
ASSISTANCE
THROUGH 
OTHER OPTIONS.—
‘‘(1) CONTINUATION OF OTHER OPTIONS FOR 
PROVIDING ASSISTANCE.—The option to provide as-
sistance in accordance with the preceding sub-
sections of this section shall not limit any other op-
tion for a State to provide— 
‘‘(A) child health assistance through the 
application of sections 457.10, 457.350(b)(2), 
457.622(c)(5), and 457.626(a)(3) of title 42, 
Code of Federal Regulations (as in effect after 
the final rule adopted by the Secretary and set 
forth at 67 Fed. Reg. 61956–61974 (October 2, 
2002)), or 
‘‘(B) pregnancy-related services through 
the application of any waiver authority (as in 
effect on June 1, 2007). 
‘‘(2) CLARIFICATION OF AUTHORITY TO PRO-
VIDE POSTPARTUM SERVICES.—Any State that pro-
vides child health assistance under any authority de-
scribed in paragraph (1) may continue to provide 
such assistance, as well as postpartum services, 
through the end of the month in which the 60-day 
period (beginning on the last day of the pregnancy) 
ends, in the same manner as such assistance and 
postpartum services would be provided if provided 
under the State plan under title XIX, but only if the
mother would otherwise satisfy the eligibility re-
quirements that apply under the State child health 
plan (other than with respect to age) during such 
period. 
‘‘(3) NO
INFERENCE.—Nothing in this sub-
section shall be construed— 
‘‘(A) to infer congressional intent regard-
ing the legality or illegality of the content of the 
sections specified in paragraph (1)(A); or 
‘‘(B) to modify the authority to provide 
pregnancy-related services under a waiver speci-
fied in paragraph (1)(B).’’. 
(b) ADDITIONAL CONFORMING AMENDMENTS.— 
(1) NO
COST
SHARING
FOR
PREGNANCY-RE-
LATED BENEFITS.—Section 2103(e)(2) (42 U.S.C. 
1397cc(e)(2)) is amended— 
(A) in the heading, by inserting ‘‘OR 
PREGNANCY-RELATED
ASSISTANCE’’ after 
‘‘PREVENTIVE SERVICES’’; and 
(B) by inserting before the period at the 
end the following: ‘‘or for pregnancy-related as-
sistance’’. 
(2) 
NO
WAITING
PERIOD.—Section 
2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is 
amended—
(A) in clause (i), by striking ‘‘, and’’ at the 
end and inserting a semicolon; 
(B) in clause (ii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(iii) may not apply a waiting period 
(including a waiting period to carry out 
paragraph (3)(C)) in the case of a targeted 
low-income pregnant woman provided preg-
nancy-related 
assistance 
under 
section 
2112.’’. 
SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT 
CHILDLESS ADULTS UNDER CHIP; CONDI-
TIONS FOR COVERAGE OF PARENTS. 
(a) PHASE-OUT RULES.— 
(1) IN
GENERAL.—Title XXI (42 U.S.C. 
1397aa et seq.) is amended by adding at the end the 
following new section: 
‘‘SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT 
CHILDLESS ADULTS; CONDITIONS FOR COV-
ERAGE OF PARENTS. 
‘‘(a) TERMINATION OF COVERAGE FOR NONPREG-
NANT CHILDLESS ADULTS.—
ical assistance under a Medicaid nonpregnant 
childless adults waiver shall— 
‘‘(i) in the case of 2009, allow expend-
itures for medical assistance under title 
XIX for all such adults to not exceed the 
total amount of payments made to the 
State under paragraph (3)(B) for 2008, 
increased by the percentage increase (if 
any) in the projected nominal per capita 
amount of National Health Expenditures 
for 2009 over 2008, as most recently pub-
lished by the Secretary; and 
‘‘(ii) in the case of any succeeding 
year, allow such expenditures to not exceed 
the amount in effect under this subpara-
graph for the preceding year, increased by 
the percentage increase (if any) in the pro-
jected nominal per capita amount of Na-
tional Health Expenditures for the year in-
volved over the preceding year, as most re-
cently published by the Secretary. 
‘‘(b) RULES AND CONDITIONS FOR COVERAGE OF 
PARENTS OF TARGETED LOW-INCOME CHILDREN.—
‘‘(1) TWO-YEAR
TRANSITION
PERIOD; AUTO-
MATIC EXTENSION AT STATE OPTION THROUGH FIS-
CAL YEAR 2009.— 
‘‘(A) NO NEW CHIP WAIVERS.—Notwith-
standing section 1115 or any other provision of 
this title, except as provided in this sub-
section— 
‘‘(i) the Secretary shall not on or after 
the date of the enactment of the Children’s 
Health Insurance Program Reauthoriza-
tion Act of 2007 approve or renew a waiv-
er, experimental, pilot, or demonstration 
project that would allow funds made avail-
able under this title to be used to provide 
child health assistance or other health ben-
efits coverage to a parent of a targeted 
low-income child; and 
‘‘(ii) notwithstanding the terms and 
conditions of an applicable existing waiver, 
the provisions of paragraphs (2) and (3) 
shall apply for purposes of any fiscal year 
beginning on or after October 1, 2009, in 
determining the period to which the waiver 
applies, the individuals eligible to be cov-
ered by the waiver, and the amount of the 
Federal payment under this title. 
‘‘(B) 
EXTENSION
UPON
STATE
RE-
QUEST.—If an applicable existing waiver de-
scribed in subparagraph (A) would otherwise 
expire before October 1, 2009, and the State 
requests an extension of such waiver, the Sec-
retary shall grant such an extension, but only, 
subject to paragraph (2)(A), through Sep-
tember 30, 2009. 
‘‘(C) APPLICATION OF ENHANCED FMAP.— 
The enhanced FMAP determined under section 
2105(b) shall apply to expenditures under an 
applicable existing waiver for the provision of 
child health assistance or other health benefits 
coverage to a parent of a targeted low-income 
child during fiscal years 2008 and 2009. 
‘‘(2) RULES FOR FISCAL YEARS 2010 THROUGH 
2012.— 
‘‘(A) PAYMENTS FOR COVERAGE LIMITED 
TO BLOCK GRANT FUNDED FROM STATE ALLOT-
MENT.—Any State that provides child health 
assistance or health benefits coverage under an 
applicable existing waiver for a parent of a tar-
geted low-income child may elect to continue to
provide such assistance or coverage through fis-
cal year 2010, 2011, or 2012, subject to the 
same terms and conditions that applied under 
the applicable existing waiver, unless otherwise 
modified in subparagraph (B). 
‘‘(B) TERMS AND CONDITIONS.— 
‘‘(i) BLOCK GRANT SET ASIDE FROM 
STATE ALLOTMENT.—If the State makes 
an election under subparagraph (A), the 
Secretary shall set aside for the State for 
each such fiscal year an amount equal to 
the Federal share of 110 percent of the 
State’s projected expenditures under the 
applicable existing waiver for providing 
child health assistance or health benefits 
coverage to all parents of targeted low-in-
come children enrolled under such waiver 
for the fiscal year (as certified by the State 
and submitted to the Secretary by not 
later than August 31 of the preceding fis-
cal year). In the case of fiscal year 2012, 
the set aside for any State shall be com-
puted separately for each period described 
in subparagraphs (A) and (B) of section 
2104(a)(15) and any reduction in the allot-
ment for either such period under section 
2104(i)(4) shall be allocated on a pro rata 
basis to such set aside. 
‘‘(ii) 
PAYMENTS
FROM
BLOCK 
GRANT.—The Secretary shall pay the State 
from the amount set aside under clause (i) 
for the fiscal year, an amount for each 
quarter of such fiscal year equal to the ap-
plicable 
percentage 
determined 
under 
clause (iii) or (iv) for expenditures in the 
quarter for providing child health assist-
ance or other health benefits coverage to a 
parent of a targeted low-income child. 
‘‘(iii) ENHANCED FMAP ONLY IN FIS-
CAL YEAR 2010 FOR STATES WITH SIGNIFI-
CANT CHILD OUTREACH OR THAT ACHIEVE 
CHILD
COVERAGE
BENCHMARKS; 
FMAP 
FOR ANY OTHER STATES.—For purposes 
of clause (ii), the applicable percentage for 
any quarter of fiscal year 2010 is equal 
to— 
‘‘(I) the enhanced FMAP deter-
mined under section 2105(b) in the 
case of a State that meets the out-
reach or coverage benchmarks de-
scribed in any of subparagraph (A), 
(B), or (C) of paragraph (3) for fiscal 
year 2009; or 
‘‘(II) the Federal medical assist-
ance percentage (as determined under 
section 1905(b) without regard to 
clause (4) of such section) in the case 
of any other State. 
‘‘(iv) AMOUNT OF FEDERAL MATCH-
ING PAYMENT IN 2011 OR 2012.—For pur-
poses of clause (ii), the applicable percent-
age for any quarter of fiscal year 2011 or 
2012 is equal to— 
‘‘(I) the REMAP percentage if— 
‘‘(aa) the applicable percent-
age for the State under clause 
(iii) was the enhanced FMAP for 
fiscal year 2009; and 
‘‘(bb) the State met either of 
the coverage benchmarks de-
scribed in subparagraph (B) or 
(C) of paragraph (3) for the pre-
ceding fiscal year; or 
‘‘(II) the Federal medical assist-
ance percentage (as so determined) in
the case of any State to which sub-
clause (I) does not apply. 
For purposes of subclause (I), the REMAP 
percentage is the percentage which is the 
sum of such Federal medical assistance 
percentage and a number of percentage 
points equal to one-half of the difference 
between such Federal medical assistance 
percentage and such enhanced FMAP. 
‘‘(v) NO FEDERAL PAYMENTS OTHER 
THAN FROM BLOCK GRANT SET ASIDE.— 
No payments shall be made to a State for 
expenditures described in clause (ii) after 
the total amount set aside under clause (i) 
for a fiscal year has been paid to the 
State. 
‘‘(vi) NO INCREASE IN INCOME ELIGI-
BILITY
LEVEL
FOR
PARENTS.—No pay-
ments shall be made to a State from the 
amount set aside under clause (i) for a fis-
cal year for expenditures for providing 
child health assistance or health benefits 
coverage to a parent of a targeted low-in-
come child whose family income exceeds 
the income eligibility level applied under
the applicable existing waiver to parents of 
targeted low-income children on the date of 
enactment of the Children’s Health Insur-
ance Program Reauthorization Act of 
2007. 
‘‘(3) 
OUTREACH
OR
COVERAGE
BENCH-
MARKS.—For purposes of paragraph (2), the out-
reach or coverage benchmarks described in this 
paragraph are as follows: 
‘‘(A) SIGNIFICANT CHILD OUTREACH CAM-
PAIGN.—The State— 
‘‘(i) was awarded a grant under sec-
tion 2113 for fiscal year 2009; 
‘‘(ii) implemented 1 or more of the en-
rollment and retention provisions described 
in section 2105(a)(4) for such fiscal year; 
or 
‘‘(iii) has submitted a specific plan for 
outreach for such fiscal year. 
‘‘(B) 
HIGH-PERFORMING
STATE.—The 
State, on the basis of the most timely and accu-
rate published estimates of the Bureau of the 
Census, ranks in the lowest 1⁄3 of States in 
terms of the State’s percentage of low-income 
children without health insurance.
‘‘(C) STATE INCREASING ENROLLMENT OF 
LOW-INCOME
CHILDREN.—The State qualified 
for a performance bonus payment under section 
2105(a)(3)(B) for the most recent fiscal year 
applicable under such section. 
‘‘(4) RULES
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed as prohibiting a 
State from submitting an application to the Sec-
retary for a waiver under section 1115 of the State 
plan under title XIX to provide medical assistance to 
a parent of a targeted low-income child that was 
provided child health assistance or health benefits 
coverage under an applicable existing waiver. 
‘‘(c) APPLICABLE EXISTING WAIVER.—For purposes 
of this section— 
‘‘(1) IN GENERAL.—The term ‘applicable exist-
ing waiver’ means a waiver, experimental, pilot, or 
demonstration project under section 1115, grand-
fathered under section 6102(c)(3) of the Deficit Re-
duction Act of 2005, or otherwise conducted under 
authority that— 
‘‘(A) would allow funds made available 
under this title to be used to provide child 
health assistance or other health benefits cov-
erage to—
‘‘(i) a parent of a targeted low-income 
child; 
‘‘(ii) a nonpregnant childless adult; or 
‘‘(iii) individuals described in both 
clauses (i) and (ii); and 
‘‘(B) was in effect on October 1, 2007. 
‘‘(2) DEFINITIONS.— 
‘‘(A) PARENT.—The term ‘parent’ includes 
a caretaker relative (as such term is used in 
carrying out section 1931) and a legal guard-
ian. 
‘‘(B) NONPREGNANT CHILDLESS ADULT.— 
The term ‘nonpregnant childless adult’ has the 
meaning given such term by section 2107(f).’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 2107(f) (42 U.S.C. 1397gg(f)) 
is amended— 
(i) by striking ‘‘, the Secretary’’ and 
inserting ‘‘: 
‘‘(1) The Secretary’’; 
(ii) in the first sentence, by inserting 
‘‘or a parent (as defined in section 
2111(c)(2)(A)), who is not pregnant, of a 
targeted low-income child’’ before the pe-
riod;
(iii) by striking the second sentence; 
and 
(iv) by adding at the end the following 
new paragraph: 
‘‘(2) The Secretary may not approve, extend, 
renew, or amend a waiver, experimental, pilot, or 
demonstration project with respect to a State after 
the date of enactment of the Children’s Health In-
surance Program Reauthorization Act of 2007 that 
would waive or modify the requirements of section 
2111.’’. 
(B) Section 6102(c) of the Deficit Reduc-
tion Act of 2005 (Public Law 109–171; 120 
Stat. 131) is amended by striking ‘‘Nothing’’ 
and inserting ‘‘Subject to section 2111 of the 
Social Security Act, as added by section 112 of 
the Children’s Health Insurance Program Re-
authorization Act of 2007, nothing’’. 
(b) GAO STUDY AND REPORT.— 
(1) IN GENERAL.—The Comptroller General of 
the United States shall conduct a study of wheth-
er— 
(A) the coverage of a parent, a caretaker 
relative (as such term is used in carrying out 
section 1931), or a legal guardian of a targeted
low-income child under a State health plan 
under title XXI of the Social Security Act in-
creases the enrollment of, or the quality of care 
for, children, and 
(B) such parents, relatives, and legal 
guardians who enroll in such a plan are more 
likely to enroll their children in such a plan or 
in a State plan under title XIX of such Act. 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Comptroller 
General shall report the results of the study to the 
Committee on Finance of the Senate and the Com-
mittee on Energy and Commerce of the House of 
Representatives, including recommendations (if any) 
for changes in legislation. 
SEC. 113. ELIMINATION OF COUNTING MEDICAID CHILD 
PRESUMPTIVE ELIGIBILITY COSTS AGAINST 
TITLE XXI ALLOTMENT. 
(a) IN GENERAL.—Section 2105(a)(1) (42 U.S.C. 
1397ee(a)(1)) is amended— 
(1) in the matter preceding subparagraph (A), 
by striking ‘‘(or, in the case of expenditures de-
scribed in subparagraph (B), the Federal medical 
assistance percentage (as defined in the first sen-
tence of section 1905(b)))’’; and
‘‘(8) DENIAL
OF
PAYMENTS
FOR
EXPENDI-
TURES FOR CHILD HEALTH ASSISTANCE FOR CHIL-
DREN WHOSE EFFECTIVE FAMILY INCOME EXCEEDS 
300 PERCENT OF THE POVERTY LINE.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), for child health assistance 
furnished after the date of the enactment of 
this paragraph, no payment shall be made 
under this section for any expenditures for pro-
viding child health assistance or health benefits 
coverage for a targeted low-income child whose 
effective family income would exceed 300 per-
cent of the poverty line but for the application 
of a general exclusion of a block of income that 
is not determined by type of expense or type of 
income. 
‘‘(B) 
EXCEPTION.—Subparagraph 
(A) 
shall not apply to any State that, on the date 
of enactment of the Children’s Health Insur-
ance Program Reauthorization Act of 2007, has 
an approved State plan amendment or waiver to 
provide expenditures described in such subpara-
graph under the State child health plan.’’. 
(b) RULE
OF
CONSTRUCTION.—Nothing in the 
amendments made by this section shall be construed as—
(1) changing any income eligibility level for chil-
dren under title XXI of the Social Security Act; or 
(2) changing the flexibility provided States 
under such title to establish the income eligibility 
level for targeted low-income children under a State 
child health plan and the methodologies used by the 
State to determine income or assets under such 
plan. 
SEC. 115. STATE AUTHORITY UNDER MEDICAID. 
(a) STATE AUTHORITY TO EXPAND INCOME OR RE-
SOURCE ELIGIBILITY LEVELS FOR CHILDREN.—Nothing 
in this Act, the amendments made by this Act, or title 
XIX of the Social Security Act, including paragraph 
(2)(B) of section 1905(u) of such Act, shall be construed 
as limiting the flexibility afforded States under such title 
to increase the income or resource eligibility levels for chil-
dren under a State plan or waiver under such title. 
(b) STATE AUTHORITY TO RECEIVE PAYMENTS 
UNDER MEDICAID FOR PROVIDING MEDICAL ASSISTANCE 
TO CHILDREN ELIGIBLE AS A RESULT OF AN INCOME OR 
RESOURCE ELIGIBILITY LEVEL EXPANSION.—A State 
may, notwithstanding the fourth sentence of subsection 
(b) of section 1905 of the Social Security Act (42 U.S.C. 
1396d) or subsection (u) of such section—
(1) cover individuals described in section 
1902(a)(10)(A)(ii)(IX) of the Social Security Act 
and thereby receive Federal financial participation 
for medical assistance for such individuals under 
title XIX of the Social Security Act; or 
(2) receive Federal financial participation for 
expenditures for medical assistance under Medicaid 
for children described in paragraph (2)(B) or (3) of 
section 1905(u) of such Act based on the Federal 
medical assistance percentage, as otherwise deter-
mined based on the first and third sentences of sub-
section (b) of section 1905 of the Social Security 
Act, rather than on the basis of an enhanced FMAP 
(as defined in section 2105(b) of such Act). 
SEC. 116. PREVENTING SUBSTITUTION OF CHIP COVERAGE 
FOR PRIVATE COVERAGE. 
(a) FINDINGS.— 
(1) Congress agrees with the President that 
low-income children should be the first priority of all 
States in providing child health assistance under 
CHIP. 
(2) Congress agrees with the President and the 
Congressional Budget Office that the substitution of 
CHIP coverage for private coverage occurs more fre-
quently for children in families at higher income lev-
els. 
(3) Congress agrees with the President that it 
is appropriate that States that expand CHIP eligi-
bility to children at higher income levels should have 
achieved a high level of health benefits coverage for 
low-income children and should implement strategies 
to address such substitution. 
(4) Congress concludes that the policies speci-
fied in this section (and the amendments made by 
this section) are the appropriate policies to address 
these issues. 
(b) ANALYSES OF BEST PRACTICES AND METHOD-
OLOGY IN ADDRESSING CROWD-OUT.— 
(1) GAO REPORT.—Not later than 18 months 
after the date of the enactment of this Act, the 
Comptroller General of the United States shall sub-
mit to the Committee on Finance of the Senate and 
the Committee on Energy and Commerce of the 
House of Representatives and the Secretary a report 
describing the best practices by States in addressing 
the issue of CHIP crowd-out. Such report shall in-
clude analyses of—
(A) the impact of different geographic 
areas, including urban and rural areas, on 
CHIP crowd-out; 
(B) the impact of different State labor 
markets on CHIP crowd-out; 
(C) the impact of different strategies for 
addressing CHIP crowd-out; 
(D) the incidence of crowd-out for children 
with different levels of family income; and 
(E) the relationship (if any) between 
changes in the availability and affordability of 
dependent coverage under employer-sponsored 
health insurance and CHIP crowd-out. 
(2) IOM REPORT
ON
METHODOLOGY.—The 
Secretary shall enter into an arrangement with the 
Institute of Medicine under which the Institute sub-
mits to the Committee on Finance of the Senate and 
the Committee on Energy and Commerce of the 
House of Representatives and the Secretary, not 
later than 18 months after the date of the enact-
ment of this Act, a report on— 
(A) the most accurate, reliable, and timely 
way to measure— 
(i) on a State-by-State basis, the rate 
of public and private health benefits cov-
erage among low-income children with 
family income that does not exceed 200 
percent of the poverty line; and 
(ii) CHIP crowd-out, including in the 
case of children with family income that 
exceeds 200 percent of the poverty line; 
and 
(B) the least burdensome way to gather 
the necessary data to conduct the measure-
ments described in subparagraph (A). 
Out of any money in the Treasury not otherwise ap-
propriated, 
there 
are 
hereby 
appropriated 
$2,000,000 to carry out this paragraph for the pe-
riod ending September 30, 2009. 
(3) INCORPORATION OF DEFINITIONS.—In this 
section, the terms ‘‘CHIP crowd-out’’, ‘‘children’’, 
‘‘poverty line’’, and ‘‘State’’ have the meanings given 
such terms for purposes of CHIP. 
(4) DEFINITION OF CHIP CROWD-OUT.—Section 
2110(c) (42 U.S.C. 1397jj(c)) is amended by adding 
at the end the following: 
‘‘(9) CHIP CROWD-OUT.—The term ‘CHIP 
crowd-out’ means the substitution of— 
‘‘(A) health benefits coverage for a child 
under this title, for
‘‘(B) health benefits coverage for the child 
other than under this title or title XIX.’’. 
(c) DEVELOPMENT
OF
BEST
PRACTICE
REC-
OMMENDATIONS.—Section 2107 (42 U.S.C. 1397gg) is 
amended by adding at the end the following: 
‘‘(g) DEVELOPMENT
OF
BEST
PRACTICE
REC-
OMMENDATIONS.—Within 6 months after the date of re-
ceipt of the reports under subsections (a) and (b) of sec-
tion 116 of the Children’s Health Insurance Program Re-
authorization Act of 2007, the Secretary, in consultation 
with States, including Medicaid and CHIP directors in 
States, shall publish in the Federal Register, and post on 
the public website for the Department of Health and 
Human Services— 
‘‘(1) recommendations regarding best practices 
for States to use to address CHIP crowd-out; and 
‘‘(2) uniform standards for data collection by 
States to measure and report— 
‘‘(A) health benefits coverage for children 
with family income below 200 percent of the 
poverty line; and 
‘‘(B) on CHIP crowd-out, including for 
children with family income that exceeds 200 
percent of the poverty line.
‘‘(i) of failure of the noncustodial par-
ent to comply with the order; 
‘‘(ii) of the failure of an employer, 
group health plan or health insurance 
issuer to comply with such order; or 
‘‘(iii) the child resides in a geographic 
area in which benefits under the health 
benefits coverage are generally unavail-
able.’’. 
(g) EFFECTIVE DATE OF AMENDMENTS; CONSIST-
ENCY OF POLICIES.—The amendments made by this sec-
tion shall take effect as if enacted on August 16, 2007. 
The Secretary may not impose (or continue in effect) any 
requirement, prevent the implementation of any provision, 
or condition the approval of any provision under any State 
child health plan, State plan amendment, or waiver re-
quest on the basis of any policy or interpretation relating 
to CHIP crowd-out, coordination with other sources of 
coverage, target rate of coverage, or medical support order 
other than under the amendments made by this section. 
In the case of a State plan amendment which was denied 
on or after August 16, 2007, on the basis of any such 
policy or interpretation in effect before the date of the en-
actment of this Act, if the State submits a modification 
of such State plan amendment that complies with title
XXI of the Social Security Act as amended by this Act, 
such submitted State plan amendment, as so modified, 
shall be considered as if it had been submitted (as so modi-
fied) as of the date of its original submission, but such 
State plan amendment shall not be effective before the 
date of the enactment of this Act and the exception de-
scribed in subparagraph (B) of section 2105(c)(8) of the 
Social Security Act, as added by section 114(a), shall not 
apply to such State plan amendment. 
TITLE II—OUTREACH AND 
ENROLLMENT 
Subtitle A—Outreach and 
Enrollment Activities 
SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUND-
ING FOR OUTREACH AND ENROLLMENT. 
(a) GRANTS.—Title XXI (42 U.S.C. 1397aa et seq.), 
as amended by section 111, is amended by adding at the 
end the following: 
‘‘SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLL-
MENT. 
‘‘(a) OUTREACH AND ENROLLMENT GRANTS; NA-
TIONAL CAMPAIGN.— 
‘‘(1) IN GENERAL.—From the amounts appro-
priated under subsection (g), subject to paragraph 
(2), the Secretary shall award grants to eligible enti-
ties during the period of fiscal years 2008 through 
2012 to conduct outreach and enrollment efforts 
that are designed to increase the enrollment and 
participation of eligible children under this title and 
title XIX. 
‘‘(2) TEN PERCENT SET ASIDE FOR NATIONAL 
ENROLLMENT CAMPAIGN.—An amount equal to 10 
percent of such amounts shall be used by the Sec-
retary for expenditures during such period to carry 
out a national enrollment campaign in accordance 
with subsection (h). 
‘‘(b) PRIORITY FOR AWARD OF GRANTS.— 
‘‘(1) IN GENERAL.—In awarding grants under 
subsection (a), the Secretary shall give priority to el-
igible entities that— 
‘‘(A) propose to target geographic areas 
with high rates of— 
‘‘(i) eligible but unenrolled children, 
including such children who reside in rural 
areas; or 
‘‘(ii) racial and ethnic minorities and 
health disparity populations, including 
those proposals that address cultural and 
linguistic barriers to enrollment; and
‘‘(B) submit the most demonstrable evi-
dence required under paragraphs (1) and (2) of 
subsection (c). 
‘‘(2) TEN PERCENT SET ASIDE FOR OUTREACH 
TO INDIAN CHILDREN.—An amount equal to 10 per-
cent of the funds appropriated under subsection (g) 
shall be used by the Secretary to award grants to 
Indian Health Service providers and urban Indian 
organizations receiving funds under title V of the In-
dian Health Care Improvement Act (25 U.S.C. 1651 
et seq.) for outreach to, and enrollment of, children 
who are Indians. 
‘‘(c) APPLICATION.—An eligible entity that desires to 
receive a grant under subsection (a) shall submit an appli-
cation to the Secretary in such form and manner, and con-
taining such information, as the Secretary may decide. 
Such application shall include— 
‘‘(1) evidence demonstrating that the entity in-
cludes members who have access to, and credibility 
with, ethnic or low-income populations in the com-
munities in which activities funded under the grant 
are to be conducted; 
‘‘(2) evidence demonstrating that the entity has 
the ability to address barriers to enrollment, such as 
lack of awareness of eligibility, stigma concerns and
punitive fears associated with receipt of benefits, 
and other cultural barriers to applying for and re-
ceiving child health assistance or medical assistance; 
‘‘(3) specific quality or outcomes performance 
measures to evaluate the effectiveness of activities 
funded by a grant awarded under this section; and 
‘‘(4) an assurance that the eligible entity 
shall— 
‘‘(A) conduct an assessment of the effec-
tiveness of such activities against the perform-
ance measures; 
‘‘(B) cooperate with the collection and re-
porting of enrollment data and other informa-
tion in order for the Secretary to conduct such 
assessments; and 
‘‘(C) in the case of an eligible entity that 
is not the State, provide the State with enroll-
ment data and other information as necessary 
for the State to make necessary projections of 
eligible children and pregnant women. 
‘‘(d) DISSEMINATION OF ENROLLMENT DATA AND 
INFORMATION DETERMINED FROM EFFECTIVENESS AS-
SESSMENTS; ANNUAL REPORT.—The Secretary shall—
‘‘(1) make publicly available the enrollment 
data and information collected and reported in ac-
cordance with subsection (c)(4)(B); and 
‘‘(2) submit an annual report to Congress on 
the outreach and enrollment activities conducted 
with funds appropriated under this section. 
‘‘(e) MAINTENANCE
OF
EFFORT
FOR
STATES 
AWARDED GRANTS; NO STATE MATCH REQUIRED.—In 
the case of a State that is awarded a grant under this 
section— 
‘‘(1) the State share of funds expended for out-
reach and enrollment activities under the State child 
health plan shall not be less than the State share of 
such funds expended in the fiscal year preceding the 
first fiscal year for which the grant is awarded; and 
‘‘(2) no State matching funds shall be required 
for the State to receive a grant under this section. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means any of the following: 
‘‘(A) A State with an approved child health 
plan under this title. 
‘‘(B) A local government. 
‘‘(C) An Indian tribe or tribal consortium, 
a tribal organization, an urban Indian organiza-
‘‘(C) a covered entity described in section 
340B(a)(4) of the Public Health Service Act 
(42 U.S.C. 256b(a)(4)); and 
‘‘(D) any other entity or consortium that 
serves children under a federally funded pro-
gram, including the special supplemental nutri-
tion program for women, infants, and children 
(WIC) established under section 17 of the Child 
Nutrition Act of 1966 (42 U.S.C. 1786), the 
Head Start and Early Head Start programs 
under the Head Start Act (42 U.S.C. 9801 et 
seq.), the school lunch program established 
under the Richard B. Russell National School 
Lunch Act, and an elementary or secondary 
school. 
‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANI-
ZATION; URBAN INDIAN ORGANIZATION.—The terms 
‘Indian’, ‘Indian tribe’, ‘tribal organization’, and 
‘urban Indian organization’ have the meanings given 
such terms in section 4 of the Indian Health Care 
Improvement Act (25 U.S.C. 1603). 
‘‘(4) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides—
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health or nutrition needs; and 
‘‘(F) by providing referral and followup 
services. 
‘‘(g) APPROPRIATION.—There is appropriated, out of 
any money in the Treasury not otherwise appropriated, 
$100,000,000 for the period of fiscal years 2008 through 
2012, for the purpose of awarding grants under this sec-
tion. Amounts appropriated and paid under the authority 
of this section shall be in addition to amounts appro-
priated under section 2104 and paid to States in accord-
ance with section 2105, including with respect to expendi-
tures for outreach activities in accordance with subsections 
(a)(1)(D)(iii) and (c)(2)(C) of that section.
‘‘(h) NATIONAL ENROLLMENT CAMPAIGN.—From 
the amounts made available under subsection (a)(2), the 
Secretary shall develop and implement a national enroll-
ment campaign to improve the enrollment of underserved 
child populations in the programs established under this 
title and title XIX. Such campaign may include— 
‘‘(1) the establishment of partnerships with the 
Secretary of Education and the Secretary of Agri-
culture to develop national campaigns to link the eli-
gibility and enrollment systems for the assistance 
programs each Secretary administers that often 
serve the same children; 
‘‘(2) the integration of information about the 
programs established under this title and title XIX 
in public health awareness campaigns administered 
by the Secretary; 
‘‘(3) increased financial and technical support 
for enrollment hotlines maintained by the Secretary 
to ensure that all States participate in such hotlines; 
‘‘(4) the establishment of joint public awareness 
outreach initiatives with the Secretary of Education 
and the Secretary of Labor regarding the impor-
tance of health insurance to building strong commu-
nities and the economy;
100 
‘‘(5) the development of special outreach mate-
rials for Native Americans or for individuals with 
limited English proficiency; and 
‘‘(6) such other outreach initiatives as the Sec-
retary determines would increase public awareness of 
the programs under this title and title XIX.’’. 
(b) ENHANCED
ADMINISTRATIVE
FUNDING
FOR 
TRANSLATION
OR INTERPRETATION SERVICES UNDER 
CHIP AND MEDICAID.— 
(1) CHIP.—Section 2105(a)(1) (42 U.S.C. 
1397ee(a)(1)), as amended by section 113, is 
amended— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘(or, in the case of expendi-
tures described in subparagraph (D)(iv), the 
higher of 75 percent or the sum of the en-
hanced FMAP plus 5 percentage points)’’ after 
‘‘enhanced FMAP’’; and 
(B) in subparagraph (D)— 
(i) in clause (iii), by striking ‘‘and’’ at 
the end; 
(ii) by redesignating clause (iv) as 
clause (v); and 
(iii) by inserting after clause (iii) the 
following new clause:
101 
‘‘(iv) for translation or interpretation 
services in connection with the enrollment 
of, retention of, and use of services under 
this title by, individuals for whom English 
is not their primary language (as found 
necessary by the Secretary for the proper 
and efficient administration of the State 
plan); and’’. 
(2) MEDICAID.— 
(A) USE
OF
MEDICAID
FUNDS.—Section 
1903(a)(2) (42 U.S.C. 1396b(a)(2)) is amended 
by adding at the end the following new sub-
paragraph: 
‘‘(E) an amount equal to 75 percent of so much 
of the sums expended during such quarter (as found 
necessary by the Secretary for the proper and effi-
cient administration of the State plan) as are attrib-
utable to translation or interpretation services in 
connection with the enrollment of, retention of, and 
use of services under this title by, children of fami-
lies for whom English is not the primary language; 
plus’’. 
(B) USE OF COMMUNITY HEALTH WORK-
ERS FOR OUTREACH ACTIVITIES.—
102 
(i) IN GENERAL.—Section 2102(c)(1) 
of such Act (42 U.S.C. 1397bb(c)(1)) is 
amended by inserting ‘‘(through commu-
nity health workers and others)’’ after 
‘‘Outreach’’. 
(ii) IN FEDERAL EVALUATION.—Sec-
tion 2108(c)(3)(B) of such Act (42 U.S.C. 
1397hh(c)(3)(B)) is amended by inserting 
‘‘(such as through community health work-
ers and others)’’ after ‘‘including prac-
tices’’. 
SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF IN-
DIANS. 
(a) IN GENERAL.—Section 1139 (42 U.S.C. 1320b– 
9) is amended to read as follows: 
‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 
HEALTH CARE FOR INDIANS UNDER TITLES 
XIX AND XXI. 
‘‘(a) AGREEMENTS WITH STATES
FOR MEDICAID 
AND CHIP OUTREACH ON OR NEAR RESERVATIONS TO 
INCREASE
THE ENROLLMENT
OF INDIANS
IN THOSE 
PROGRAMS.— 
‘‘(1) IN GENERAL.—In order to improve the ac-
cess of Indians residing on or near a reservation to 
obtain benefits under the Medicaid and State chil-
104 
and services to Indians under the programs established 
under title XIX or XXI. 
‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN 
HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN IN-
DIAN ORGANIZATION.—In this section, the terms ‘Indian’, 
‘Indian Tribe’, ‘Indian Health Program’, ‘Tribal Organi-
zation’, and ‘Urban Indian Organization’ have the mean-
ings given those terms in section 4 of the Indian Health 
Care Improvement Act.’’. 
(b) NONAPPLICATION
OF 10 PERCENT LIMIT
ON 
OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec-
tion 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is amended by 
adding at the end the following: 
‘‘(C) NONAPPLICATION
TO
CERTAIN
EX-
PENDITURES.—The limitation under subpara-
graph (A) shall not apply with respect to the 
following expenditures: 
‘‘(i) EXPENDITURES
TO
INCREASE 
OUTREACH TO, AND THE ENROLLMENT OF, 
INDIAN CHILDREN UNDER THIS TITLE AND 
TITLE xix.—Expenditures for outreach ac-
tivities to families of Indian children likely 
to be eligible for child health assistance 
under the plan or medical assistance under 
the State plan under title XIX (or under
105 
a waiver of such plan), to inform such 
families of the availability of, and to assist 
them in enrolling their children in, such 
plans, including such activities conducted 
under grants, contracts, or agreements en-
tered into under section 1139(a).’’. 
SEC. 203. STATE OPTION TO RELY ON FINDINGS FROM AN 
EXPRESS LANE AGENCY TO CONDUCT SIM-
PLIFIED ELIGIBILITY DETERMINATIONS. 
(a) APPLICATION UNDER MEDICAID AND CHIP PRO-
GRAMS.— 
(1) MEDICAID.—Section 1902(e) (42 U.S.C. 
1396a(e)) is amended by adding at the end the fol-
lowing: 
‘‘(13) EXPRESS LANE OPTION.— 
‘‘(A) IN GENERAL.— 
‘‘(i) OPTION TO USE A FINDING FROM AN 
EXPRESS LANE AGENCY.—At the option of the 
State, the State plan may provide that in deter-
mining eligibility under this title for a child (as 
defined in subparagraph (G)), the State may 
rely on a finding made within a reasonable pe-
riod (as determined by the State) from an Ex-
press Lane agency (as defined in subparagraph 
(F)) when it determines whether a child satis-
106 
fies one or more components of eligibility for 
medical assistance under this title. The State 
may rely on a finding from an Express Lane 
agency 
notwithstanding 
sections 
1902(a)(46)(B) and 1137(d) and any dif-
ferences in budget unit, disregard, deeming or 
other methodology, if the following require-
ments are met: 
‘‘(I) PROHIBITION ON DETERMINING 
CHILDREN INELIGIBLE FOR COVERAGE.— 
If a finding from an Express Lane agency 
would result in a determination that a 
child does not satisfy an eligibility require-
ment for medical assistance under this title 
and for child health assistance under title 
XXI, the State shall determine eligibility 
for assistance using its regular procedures. 
‘‘(II) NOTICE
REQUIREMENT.—For 
any child who is found eligible for medical 
assistance under the State plan under this 
title or child health assistance under title 
XXI and who is subject to premiums based 
on an Express Lane agency’s finding of 
such child’s income level, the State shall 
provide notice that the child may qualify
107 
for lower premium payments if evaluated 
by the State using its regular policies and 
of the procedures for requesting such an 
evaluation. 
‘‘(III) COMPLIANCE
WITH
SCREEN 
AND
ENROLL
REQUIREMENT.—The State 
shall satisfy the requirements under sub-
paragraphs 
(A) 
and 
(B) 
of 
section 
2102(b)(3) (relating to screen and enroll) 
before enrolling a child in child health as-
sistance under title XXI. At its option, the 
State may fulfill such requirements in ac-
cordance with either option provided under 
subparagraph (C) of this paragraph. 
‘‘(IV) VERIFICATION OF CITIZENSHIP 
OR NATIONALITY STATUS.—The State shall 
satisfy 
the 
requirements 
of 
section 
1902(a)(46)(B) or 2105(c)(10), as applica-
ble for verifications of citizenship or na-
tionality status. 
‘‘(V) CODING.—The State meets the 
requirements of subparagraph (E). 
‘‘(ii) OPTION TO APPLY TO RENEWALS AND 
REDETERMINATIONS.—The State may apply the 
provisions of this paragraph when conducting
108 
initial determinations of eligibility, redetermina-
tions of eligibility, or both, as described in the 
State plan. 
‘‘(B) RULES OF CONSTRUCTION.—Nothing in 
this paragraph shall be construed— 
‘‘(i) to limit or prohibit a State from tak-
ing any actions otherwise permitted under this 
title or title XXI in determining eligibility for 
or enrolling children into medical assistance 
under this title or child health assistance under 
title XXI; or 
‘‘(ii) to modify the limitations in section 
1902(a)(5) concerning the agencies that may 
make a determination of eligibility for medical 
assistance under this title. 
‘‘(C) OPTIONS FOR SATISFYING THE SCREEN 
AND ENROLL REQUIREMENT.— 
‘‘(i) IN GENERAL.—With respect to a child 
whose eligibility for medical assistance under 
this title or for child health assistance under 
title XXI has been evaluated by a State agency 
using an income finding from an Express Lane 
agency, a State may carry out its duties under 
subparagraphs 
(A) 
and 
(B) 
of 
section
109 
2102(b)(3) (relating to screen and enroll) in ac-
cordance with either clause (ii) or clause (iii). 
‘‘(ii) 
ESTABLISHING
A
SCREENING 
THRESHOLD.— 
‘‘(I) IN GENERAL.—Under this clause, 
the State establishes a screening threshold 
set as a percentage of the Federal poverty 
level that exceeds the highest income 
threshold applicable under this title to the 
child by a minimum of 30 percentage 
points or, at State option, a higher number 
of percentage points that reflects the value 
(as determined by the State and described 
in the State plan) of any differences be-
tween income methodologies used by the 
program administered by the Express Lane 
agency and the methodologies used by the 
State in determining eligibility for medical 
assistance under this title. 
‘‘(II) CHILDREN
WITH
INCOME
NOT 
ABOVE THRESHOLD.—If the income of a 
child does not exceed the screening thresh-
old, the child is deemed to satisfy the in-
come eligibility criteria for medical assist-
ance under this title regardless of whether
111 
ical assistance under this title using 
such regular procedures. 
‘‘(bb) A description of differences 
between the medical assistance pro-
vided under this title and child health 
assistance under title XXI, including 
differences in cost-sharing require-
ments and covered benefits. 
‘‘(iii) TEMPORARY ENROLLMENT IN CHIP 
PENDING SCREEN AND ENROLL.— 
‘‘(I) IN GENERAL.—Under this clause, 
a State enrolls a child in child health as-
sistance under title XXI for a temporary 
period if the child appears eligible for such 
assistance based on an income finding by 
an Express Lane agency. 
‘‘(II) 
DETERMINATION
OF
ELIGI-
BILITY.—During such temporary enroll-
ment period, the State shall determine the 
child’s eligibility for child health assistance 
under title XXI or for medical assistance 
under this title in accordance with this 
clause. 
‘‘(III) PROMPT FOLLOW UP.—In mak-
ing such a determination, the State shall
112 
take prompt action to determine whether 
the child should be enrolled in medical as-
sistance under this title or child health as-
sistance under title XXI pursuant to sub-
paragraphs 
(A) 
and 
(B) 
of 
section 
2102(b)(3) (relating to screen and enroll). 
‘‘(IV) REQUIREMENT FOR SIMPLIFIED 
DETERMINATION.—In making such a de-
termination, the State shall use procedures 
that, to the maximum feasible extent, re-
duce the burden imposed on the individual 
of such determination. Such procedures 
may not require the child’s parent, guard-
ian, or custodial relative to provide or 
verify information that already has been 
provided to the State agency by an Ex-
press Lane agency or another source of in-
formation unless the State agency has rea-
son to believe the information is erroneous. 
‘‘(V) AVAILABILITY OF CHIP MATCH-
ING FUNDS DURING TEMPORARY ENROLL-
MENT
PERIOD.—Medical assistance for 
items and services that are provided to a 
child enrolled in title XXI during a tem-
porary enrollment period under this clause
113 
shall be treated as child health assistance 
under such title. 
‘‘(D) OPTION FOR AUTOMATIC ENROLLMENT.— 
‘‘(i) IN GENERAL.—The State may initiate 
and determine eligibility for medical assistance 
under the State Medicaid plan or for child 
health assistance under the State CHIP plan 
without a program application from, or on be-
half of, the child based on data obtained from 
sources other than the child (or the child’s fam-
ily), but a child can only be automatically en-
rolled in the State Medicaid plan or the State 
CHIP plan if the child or the family affirma-
tively consents to being enrolled through affir-
mation and signature on an Express Lane 
agency application, if the requirement of clause 
(ii) is met. 
‘‘(ii) INFORMATION
REQUIREMENT.—The 
requirement of this clause is that the State in-
forms the parent, guardian, or custodial relative 
of the child of the services that will be covered, 
appropriate methods for using such services, 
premium or other cost sharing charges (if any) 
that apply, medical support obligations (under 
section 1912(a)) created by enrollment (if appli-
114 
cable), and the actions the parent, guardian, or 
relative must take to maintain enrollment and 
renew coverage. 
‘‘(E) CODING; APPLICATION TO ENROLLMENT 
ERROR RATES.— 
‘‘(i) IN GENERAL.—For purposes of sub-
paragraph (A)(iv), the requirement of this sub-
paragraph for a State is that the State agrees 
to— 
‘‘(I) assign such codes as the Sec-
retary shall require to the children who are 
enrolled in the State Medicaid plan or the 
State CHIP plan through reliance on a 
finding made by an Express Lane agency 
for the duration of the State’s election 
under this paragraph; 
‘‘(II) annually provide the Secretary 
with a statistically valid sample (that is ap-
proved by Secretary) of the children en-
rolled in such plans through reliance on 
such a finding by conducting a full Med-
icaid eligibility review of the children iden-
tified for such sample for purposes of de-
termining an eligibility error rate (as de-
scribed in clause (iv)) with respect to the
115 
enrollment of such children (and shall not 
include such children in any data or sam-
ples used for purposes of complying with a 
Medicaid 
Eligibility 
Quality 
Control 
(MEQC) review or a payment error rate 
measurement (PERM) requirement); 
‘‘(III) submit the error rate deter-
mined under subclause (II) to the Sec-
retary; 
‘‘(IV) if such error rate exceeds 3 per-
cent for either of the first 2 fiscal years in 
which the State elects to apply this para-
graph, demonstrate to the satisfaction of 
the Secretary the specific corrective actions 
implemented by the State to improve upon 
such error rate; and 
‘‘(V) if such error rate exceeds 3 per-
cent for any fiscal year in which the State 
elects to apply this paragraph, a reduction 
in the amount otherwise payable to the 
State under section 1903(a) for quarters 
for that fiscal year, equal to the total 
amount of erroneous excess payments de-
termined for the fiscal year only with re-
spect to the children included in the sam-
116 
ple for the fiscal year that are in excess of 
a 3 percent error rate with respect to such 
children. 
‘‘(ii) NO
PUNITIVE
ACTION
BASED
ON 
ERROR RATE.—The Secretary shall not apply 
the error rate derived from the sample under 
clause (i) to the entire population of children 
enrolled in the State Medicaid plan or the State 
CHIP plan through reliance on a finding made 
by an Express Lane agency, or to the popu-
lation of children enrolled in such plans on the 
basis of the State’s regular procedures for de-
termining eligibility, or penalize the State on 
the basis of such error rate in any manner 
other than the reduction of payments provided 
for under clause (i)(V). 
‘‘(iii) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as relieving 
a State that elects to apply this paragraph from 
being subject to a penalty under section 
1903(u), for payments made under the State 
Medicaid plan with respect to ineligible individ-
uals and families that are determined to exceed 
the error rate permitted under that section (as
118 
‘‘(III) notifies the child’s family— 
‘‘(aa) of the information which 
shall be disclosed in accordance with 
this paragraph; 
‘‘(bb) that the information dis-
closed will be used solely for purposes 
of determining eligibility for medical 
assistance under the State Medicaid 
plan or for child health assistance 
under the State CHIP plan; and 
‘‘(cc) that the family may elect to 
not have the information disclosed for 
such purposes; and 
‘‘(IV) enters into, or is subject to, an 
interagency agreement to limit the disclo-
sure and use of the information disclosed. 
‘‘(ii) INCLUSION
OF
SPECIFIC
PUBLIC 
AGENCIES.—Such term includes the following: 
‘‘(I) A public agency that determines 
eligibility for assistance under any of the 
following: 
‘‘(aa) The temporary assistance 
for needy families program funded 
under part A of title IV.
119 
‘‘(bb) A State program funded 
under part D of title IV. 
‘‘(cc) The State Medicaid plan. 
‘‘(dd) The State CHIP plan. 
‘‘(ee) The Food Stamp Act of 
1977 (7 U.S.C. 2011 et seq.). 
‘‘(ff) The Head Start Act (42 
U.S.C. 9801 et seq.). 
‘‘(gg) The Richard B. Russell 
National 
School 
Lunch 
Act 
(42 
U.S.C. 1751 et seq.). 
‘‘(hh) The Child Nutrition Act of 
1966 (42 U.S.C. 1771 et seq.). 
‘‘(ii) The Child Care and Devel-
opment Block Grant Act of 1990 (42 
U.S.C. 9858 et seq.). 
‘‘(jj) The Stewart B. McKinney 
Homeless Assistance Act (42 U.S.C. 
11301 et seq.). 
‘‘(kk) The United States Housing 
Act of 1937 (42 U.S.C. 1437 et seq.). 
‘‘(ll) The Native American Hous-
ing Assistance and Self-Determination 
Act of 1996 (25 U.S.C. 4101 et seq.).
120 
‘‘(II) A State-specified governmental 
agency that has fiscal liability or legal re-
sponsibility for the accuracy of the eligi-
bility determination findings relied on by 
the State. 
‘‘(III) A public agency that is subject 
to an interagency agreement limiting the 
disclosure and use of the information dis-
closed for purposes of determining eligi-
bility under the State Medicaid plan or the 
State CHIP plan. 
‘‘(iii) EXCLUSIONS.—Such term does not 
include an agency that determines eligibility for 
a program established under the Social Services 
Block Grant established under title XX or a 
private, for-profit organization. 
‘‘(iv) RULES OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as— 
‘‘(I) exempting a State Medicaid 
agency from complying with the require-
ments of section 1902(a)(4) relating to 
merit-based personnel standards for em-
ployees of the State Medicaid agency and 
safeguards against conflicts of interest); or
121 
‘‘(II) authorizing a State Medicaid 
agency that elects to use Express Lane 
agencies under this subparagraph to use 
the Express Lane option to avoid com-
plying with such requirements for purposes 
of making eligibility determinations under 
the State Medicaid plan. 
‘‘(v) ADDITIONAL
DEFINITIONS.—In this 
paragraph: 
‘‘(I) STATE.—The term ‘State’ means 
1 of the 50 States or the District of Co-
lumbia. 
‘‘(II) 
STATE
CHIP
AGENCY.—The 
term ‘State CHIP agency’ means the State 
agency responsible for administering the 
State CHIP plan. 
‘‘(III) STATE CHIP PLAN.—The term 
‘State CHIP plan’ means the State child 
health plan established under title XXI 
and includes any waiver of such plan. 
‘‘(IV) STATE
MEDICAID
AGENCY.— 
The term ‘State Medicaid agency’ means 
the State agency responsible for admin-
istering the State Medicaid plan.
122 
‘‘(V) STATE
MEDICAID
PLAN.—The 
term ‘State Medicaid plan’ means the 
State plan established under title XIX and 
includes any waiver of such plan. 
‘‘(G) CHILD DEFINED.—For purposes of this 
paragraph, the term ‘child’ means an individual 
under 19 years of age, or, at the option of a State, 
such higher age, not to exceed 21 years of age, as 
the State may elect. 
‘‘(H) APPLICATION.—This paragraph shall not 
apply to with respect to eligibility determinations 
made after September 30, 2012.’’. 
(2) CHIP.—Section 2107(e)(1) (42 U.S.C. 
1397gg(e)(1)) is amended by redesignating subpara-
graphs (B), (C), and (D) as subparagraphs (C), (D), 
and (E), respectively, and by inserting after sub-
paragraph (A) the following new subparagraph: 
‘‘(B) Section 1902(e)(13) (relating to the 
State option to rely on findings from an Ex-
press Lane agency to help evaluate a child’s eli-
gibility for medical assistance).’’. 
(b) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary shall con-
duct, by grant, contract, or interagency agreement, 
a comprehensive, independent evaluation of the op-
123 
tion provided under the amendments made by sub-
section (a). Such evaluation shall include an analysis 
of the effectiveness of the option, and shall include— 
(A) obtaining a statistically valid sample of 
the children who were enrolled in the State 
Medicaid plan or the State CHIP plan through 
reliance on a finding made by an Express Lane 
agency and determining the percentage of chil-
dren who were erroneously enrolled in such 
plans; 
(B) determining whether enrolling children 
in such plans through reliance on a finding 
made by an Express Lane agency improves the 
ability of a State to identify and enroll low-in-
come, uninsured children who are eligible but 
not enrolled in such plans; 
(C) evaluating the administrative costs or 
savings related to identifying and enrolling chil-
dren in such plans through reliance on such 
findings, and the extent to which such costs dif-
fer from the costs that the State otherwise 
would have incurred to identify and enroll low- 
income, uninsured children who are eligible but 
not enrolled in such plans; and
124 
(D) any recommendations for legislative or 
administrative changes that would improve the 
effectiveness of enrolling children in such plans 
through reliance on such findings. 
(2) REPORT
TO
CONGRESS.—Not later than 
September 30, 2011, the Secretary shall submit a 
report to Congress on the results of the evaluation 
under paragraph (1). 
(3) FUNDING.— 
(A) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there is 
appropriated to the Secretary to carry out the 
evaluation under this subsection $5,000,000 for 
the period of fiscal years 2008 through 2011. 
(B) BUDGET AUTHORITY.—Subparagraph 
(A) constitutes budget authority in advance of 
appropriations Act and represents the obliga-
tion of the Federal Government to provide for 
the payment of such amount to conduct the 
evaluation under this subsection. 
(c) ELECTRONIC TRANSMISSION OF INFORMATION.— 
Section 1902 (42 U.S.C. 1396a) is amended by adding 
at the end the following new subsection: 
‘‘(dd) ELECTRONIC TRANSMISSION
OF INFORMA-
TION.—If the State agency determining eligibility for med-
125 
ical assistance under this title or child health assistance 
under title XXI verifies an element of eligibility based on 
information from an Express Lane Agency (as defined in 
subsection (e)(13)(F)), or from another public agency, 
then the applicant’s signature under penalty of perjury 
shall not be required as to such element. Any signature 
requirement for an application for medical assistance may 
be satisfied through an electronic signature, as defined in 
section 1710(1) of the Government Paperwork Elimi-
nation Act (44 U.S.C. 3504 note). The requirements of 
subparagraphs (A) and (B) of section 1137(d)(2) may be 
met through evidence in digital or electronic form.’’. 
(d) AUTHORIZATION
OF
INFORMATION
DISCLO-
SURE.— 
(1) IN GENERAL.—Title XIX is amended— 
(A) by redesignating section 1939 as sec-
tion 1940; and 
(B) by inserting after section 1938 the fol-
lowing new section: 
‘‘SEC. 1939. AUTHORIZATION TO RECEIVE RELEVANT IN-
FORMATION. 
‘‘(a) IN GENERAL.—Notwithstanding any other pro-
vision of law, a Federal or State agency or private entity 
in possession of the sources of data directly relevant to 
eligibility determinations under this title (including eligi-
126 
bility files maintained by Express Lane agencies described 
in section 1902(e)(13)(F), information described in para-
graph (2) or (3) of section 1137(a), vital records informa-
tion about births in any State, and information described 
in sections 453(i) and 1902(a)(25)(I)) is authorized to 
convey such data or information to the State agency ad-
ministering the State plan under this title, to the extent 
such conveyance meets the requirements of subsection (b). 
‘‘(b) REQUIREMENTS FOR CONVEYANCE.—Data or 
information may be conveyed pursuant to subsection (a) 
only if the following requirements are met: 
‘‘(1) The individual whose circumstances are 
described in the data or information (or such indi-
vidual’s parent, guardian, caretaker relative, or au-
thorized representative) has either provided advance 
consent to disclosure or has not objected to disclo-
sure after receiving advance notice of disclosure and 
a reasonable opportunity to object. 
‘‘(2) Such data or information are used solely 
for the purposes of— 
‘‘(A) identifying individuals who are eligi-
ble or potentially eligible for medical assistance 
under this title and enrolling or attempting to 
enroll such individuals in the State plan; and
127 
‘‘(B) verifying the eligibility of individuals 
for medical assistance under the State plan. 
‘‘(3) An interagency or other agreement, con-
sistent with standards developed by the Secretary— 
‘‘(A) prevents the unauthorized use, disclo-
sure, or modification of such data and other-
wise meets applicable Federal requirements 
safeguarding privacy and data security; and 
‘‘(B) requires the State agency admin-
istering the State plan to use the data and in-
formation obtained under this section to seek to 
enroll individuals in the plan. 
‘‘(c) PENALTIES FOR IMPROPER DISCLOSURE.— 
‘‘(1) CIVIL MONEY PENALTY.—A private entity 
described in the subsection (a) that publishes, dis-
closes, or makes known in any manner, or to any ex-
tent not authorized by Federal law, any information 
obtained under this section is subject to a civil 
money penalty in an amount equal to $10,000 for 
each such unauthorized publication or disclosure. 
The provisions of section 1128A (other than sub-
sections (a) and (b) and the second sentence of sub-
section (f)) shall apply to a civil money penalty 
under this paragraph in the same manner as such
128 
provisions apply to a penalty or proceeding under 
section 1128A(a). 
‘‘(2) CRIMINAL PENALTY.—A private entity de-
scribed in the subsection (a) that willfully publishes, 
discloses, or makes known in any manner, or to any 
extent not authorized by Federal law, any informa-
tion obtained under this section shall be fined not 
more than $10,000 or imprisoned not more than 1 
year, or both, for each such unauthorized publication 
or disclosure. 
‘‘(d) RULE OF CONSTRUCTION.—The limitations and 
requirements that apply to disclosure pursuant to this sec-
tion shall not be construed to prohibit the conveyance or 
disclosure of data or information otherwise permitted 
under Federal law (without regard to this section).’’. 
(2) CONFORMING AMENDMENT TO TITLE XXI.— 
Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as 
amended by subsection (a)(2), is amended by adding 
at the end the following new subparagraph: 
‘‘(F) Section 1939 (relating to authoriza-
tion to receive data directly relevant to eligi-
bility determinations).’’. 
(3) CONFORMING AMENDMENT TO PROVIDE AC-
CESS TO DATA ABOUT ENROLLMENT IN INSURANCE 
FOR PURPOSES OF EVALUATING APPLICATIONS AND
129 
FOR
CHIP.—Section 1902(a)(25)(I)(i) (42 U.S.C. 
1396a(a)(25)(I)(i)) is amended— 
(A) by inserting ‘‘(and, at State option, in-
dividuals who apply or whose eligibility for med-
ical assistance is being evaluated in accordance 
with section 1902(e)(13)(D))’’ after ‘‘with re-
spect to individuals who are eligible’’; and 
(B) by inserting ‘‘under this title (and, at 
State option, child health assistance under title 
XXI)’’ after ‘‘the State plan’’. 
(e) AUTHORIZATION
FOR STATES ELECTING EX-
PRESS LANE OPTION TO RECEIVE CERTAIN DATA DI-
RECTLY RELEVANT TO DETERMINING ELIGIBILITY AND 
CORRECT AMOUNT OF ASSISTANCE.—The Secretary shall 
enter into such agreements as are necessary to permit a 
State that elects the Express Lane option under section 
1902(e)(13) of the Social Security Act to receive data di-
rectly relevant to eligibility determinations and deter-
mining the correct amount of benefits under a State child 
health plan under CHIP or a State plan under Medicaid 
from the following: 
(1) The National Directory of New Hires estab-
lished under section 453(i) of the Social Security 
Act (42 U.S.C. 653(i)).
130 
(2) Data regarding enrollment in insurance that 
may help to facilitate outreach and enrollment under 
the State Medicaid plan, the State CHIP plan, and 
such other programs as the Secretary may specify. 
(f) EFFECTIVE DATE.—The amendments made by 
this section are effective on January 1, 2008. 
Subtitle B—Reducing Barriers to 
Enrollment 
SEC. 211. VERIFICATION OF DECLARATION OF CITIZENSHIP 
OR NATIONALITY FOR PURPOSES OF ELIGI-
BILITY FOR MEDICAID AND CHIP. 
(a) 
ALTERNATIVE
STATE
PROCESS
FOR 
VERIFICATION OF DECLARATION OF CITIZENSHIP OR NA-
TIONALITY FOR PURPOSES OF ELIGIBILITY FOR MED-
ICAID.— 
(1) ALTERNATIVE
TO
DOCUMENTATION
RE-
QUIREMENT.— 
(A) IN
GENERAL.—Section 1902 (42 
U.S.C. 1396a), as amended by section 203(c), 
is amended— 
(i) in subsection (a)(46)— 
(I) by inserting ‘‘(A)’’ after 
‘‘(46)’’; 
(II) by adding ‘‘and’’ after the 
semicolon; and
131 
(III) by adding at the end the 
following new subparagraph: 
‘‘(B) provide, with respect to an individual de-
claring to be a citizen or national of the United 
States for purposes of establishing eligibility under 
this title, that the State shall satisfy the require-
ments of— 
‘‘(i) section 1903(x); or 
‘‘(ii) subsection (ee);’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(ee)(1) For purposes of subsection (a)(46)(B)(ii), 
the requirements of this subsection with respect to an indi-
vidual declaring to be a citizen or national of the United 
States for purposes of establishing eligibility under this 
title, are, in lieu of requiring the individual to present sat-
isfactory documentary evidence of citizenship or nation-
ality under section 1903(x) (if the individual is not de-
scribed in paragraph (2) of that section), as follows: 
‘‘(A) The State submits the name and social se-
curity number of the individual to the Commissioner 
of Social Security as part of the program established 
under paragraph (2). 
‘‘(B) If the State receives notice from the Com-
missioner of Social Security that the name or social
132 
security number, or the declaration of citizenship or 
nationality, of the individual is inconsistent with in-
formation in the records maintained by the Commis-
sioner— 
‘‘(i) the State makes a reasonable effort to 
identify and address the causes of such incon-
sistency, including through typographical or 
other clerical errors, by contacting the indi-
vidual to confirm the accuracy of the name or 
social security number submitted or declaration 
of citizenship or nationality and by taking such 
additional actions as the Secretary, through 
regulation or other guidance, or the State may 
identify, and continues to provide the individual 
with medical assistance while making such ef-
fort; and 
‘‘(ii) in the case such inconsistency is not 
resolved under clause (i), the State— 
‘‘(I) notifies the individual of such 
fact; 
‘‘(II) provides the individual with a 
period of 90 days from the date on which 
the notice required under subclause (I) is 
received by the individual to either present 
satisfactory documentary evidence of citi-
133 
zenship or nationality (as defined in sec-
tion 1903(x)(3)) or resolve the inconsist-
ency with the Commissioner of Social Se-
curity (and continues to provide the indi-
vidual with medical assistance during such 
90-day period); and 
‘‘(III) disenrolls the individual from 
the State plan under this title within 30 
days after the end of such 90-day period if 
no such documentary evidence is presented 
or if such inconsistency is not resolved. 
‘‘(2)(A) Each State electing to satisfy the require-
ments of this subsection for purposes of section 
1902(a)(46)(B) shall establish a program under which the 
State submits at least monthly to the Commissioner of So-
cial Security for comparison of the name and social secu-
rity number, of each individual newly enrolled in the State 
plan under this title that month who is not described in 
section 1903(x)(2) and who declares to be a United States 
citizen or national, with information in records maintained 
by the Commissioner. 
‘‘(B) In establishing the State program under this 
paragraph, the State may enter into an agreement with 
the Commissioner of Social Security—
134 
‘‘(i) to provide, through an on-line system or 
otherwise, for the electronic submission of, and re-
sponse to, the information submitted under subpara-
graph (A) for an individual enrolled in the State 
plan under this title who declares to be citizen or na-
tional on at least a monthly basis; or 
‘‘(ii) to provide for a determination of the con-
sistency of the information submitted with the infor-
mation maintained in the records of the Commis-
sioner through such other method as agreed to by 
the State and the Commissioner and approved by 
the Secretary, provided that such method is no more 
burdensome for individuals to comply with than any 
burdens that may apply under a method described in 
clause (i). 
‘‘(C) The program established under this paragraph 
shall provide that, in the case of any individual who is 
required to submit a social security number to the State 
under subparagraph (A) and who is unable to provide the 
State with such number, shall be provided with at least 
the reasonable opportunity to present satisfactory docu-
mentary evidence of citizenship or nationality (as defined 
in section 1903(x)(3)) as is provided under clauses (i) and 
(ii) of section 1137(d)(4)(A) to an individual for the sub-
139 
(1) ACCEPTANCE OF DOCUMENTARY EVIDENCE 
ISSUED
BY
A
FEDERALLY
RECOGNIZED
INDIAN 
TRIBE.—Section 
1903(x)(3)(B) 
(42 
U.S.C. 
1396b(x)(3)(B)) is amended— 
(A) by redesignating clause (v) as clause 
(vi); and 
(B) by inserting after clause (iv), the fol-
lowing new clause: 
‘‘(v)(I) Except as provided in subclause (II), a 
document issued by a federally recognized Indian 
tribe evidencing membership or enrollment in, or af-
filiation with, such tribe (such as a tribal enrollment 
card or certificate of degree of Indian blood). 
‘‘(II) With respect to those federally recognized 
Indian tribes located within States having an inter-
national border whose membership includes individ-
uals who are not citizens of the United States, the 
Secretary shall, after consulting with such tribes, 
issue regulations authorizing the presentation of 
such other forms of documentation (including tribal 
documentation, if appropriate) that the Secretary 
determines to be satisfactory documentary evidence 
of citizenship or nationality for purposes of satis-
fying the requirement of this subsection.’’.
140 
(2) REQUIREMENT
TO
PROVIDE
REASONABLE 
OPPORTUNITY
TO
PRESENT
SATISFACTORY
DOCU-
MENTARY EVIDENCE.—Section 1903(x) (42 U.S.C. 
1396b(x)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(4) In the case of an individual declaring to be a 
citizen or national of the United States with respect to 
whom a State requires the presentation of satisfactory 
documentary evidence of citizenship or nationality under 
section 1902(a)(46)(B)(i), the individual shall be provided 
at least the reasonable opportunity to present satisfactory 
documentary evidence of citizenship or nationality under 
this subsection as is provided under clauses (i) and (ii) 
of section 1137(d)(4)(A) to an individual for the submittal 
to the State of evidence indicating a satisfactory immigra-
tion status.’’. 
(3) CHILDREN BORN IN THE UNITED STATES 
TO MOTHERS ELIGIBLE FOR MEDICAID.— 
(A) CLARIFICATION
OF
RULES.—Section 
1903(x) (42 U.S.C. 1396b(x)), as amended by 
paragraph (2), is amended— 
(i) in paragraph (2)— 
(I) in subparagraph (C), by strik-
ing ‘‘or’’ at the end;
141 
(II) by redesignating subpara-
graph (D) as subparagraph (E); and 
(III) by inserting after subpara-
graph (C) the following new subpara-
graph: 
‘‘(D) pursuant to the application of section 
1902(e)(4) (and, in the case of an individual who is 
eligible for medical assistance on such basis, the in-
dividual shall be deemed to have provided satisfac-
tory documentary evidence of citizenship or nation-
ality and shall not be required to provide further 
documentary evidence on any date that occurs dur-
ing or after the period in which the individual is eli-
gible for medical assistance on such basis); or’’; and 
(ii) by adding at the end the following 
new paragraph: 
‘‘(5) Nothing in subparagraph (A) or (B) of section 
1902(a)(46), the preceding paragraphs of this subsection, 
or the Deficit Reduction Act of 2005, including section 
6036 of such Act, shall be construed as changing the re-
quirement of section 1902(e)(4) that a child born in the 
United States to an alien mother for whom medical assist-
ance for the delivery of such child is available as treatment 
of an emergency medical condition pursuant to subsection
142 
(v) shall be deemed eligible for medical assistance during 
the first year of such child’s life.’’. 
(B) STATE REQUIREMENT TO ISSUE SEPA-
RATE
IDENTIFICATION
NUMBER.—Section 
1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended 
by adding at the end the following new sen-
tence: ‘‘Notwithstanding the preceding sentence, 
in the case of a child who is born in the United 
States to an alien mother for whom medical as-
sistance for the delivery of the child is made 
available pursuant to section 1903(v), the State 
immediately shall issue a separate identification 
number for the child upon notification by the 
facility at which such delivery occurred of the 
child’s birth.’’. 
(4) 
TECHNICAL
AMENDMENTS.—Section 
1903(x)(2) (42 U.S.C. 1396b(x)) is amended— 
(A) in subparagraph (B)— 
(i) by realigning the left margin of the 
matter preceding clause (i) 2 ems to the 
left; and 
(ii) by realigning the left margins of 
clauses (i) and (ii), respectively, 2 ems to 
the left; and 
(B) in subparagraph (C)—
143 
(i) by realigning the left margin of the 
matter preceding clause (i) 2 ems to the 
left; and 
(ii) by realigning the left margins of 
clauses (i) and (ii), respectively, 2 ems to 
the left. 
(c) APPLICATION OF DOCUMENTATION SYSTEM TO 
CHIP.— 
(1) IN GENERAL.—Section 2105(c) (42 U.S.C. 
1397ee(c)), as amended by sections 114(a) and 
116(c), is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(10) CITIZENSHIP DOCUMENTATION REQUIRE-
MENTS.— 
‘‘(A) IN GENERAL.—No payment may be 
made under this section with respect to an indi-
vidual who has, or is, declared to be a citizen 
or national of the United States for purposes of 
establishing eligibility under this title unless the 
State meets the requirements of section 
1902(a)(46)(B) with respect to the individual. 
‘‘(B) ENHANCED
PAYMENTS.—Notwith-
standing subsection (b), the enhanced FMAP 
with respect to payments under subsection (a) 
for expenditures described in clause (i) or (ii) of
144 
section 1903(a)(3)(F) necessary to comply with 
subparagraph (A) shall in no event be less than 
90 percent and 75 percent, respectively.’’. 
(2) NONAPPLICATION OF ADMINISTRATIVE EX-
PENDITURES
CAP.—Section 
2105(c)(2)(C) 
(42 
U.S.C. 1397ee(c)(2)(C)), as amended by section 
202(b), is amended by adding at the end the fol-
lowing: 
‘‘(ii) 
EXPENDITURES
TO
COMPLY 
WITH
CITIZENSHIP
OR
NATIONALITY 
VERIFICATION
REQUIREMENTS.—Expendi-
tures necessary for the State to comply 
with paragraph (9)(A).’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the amendments made by 
this section shall take effect on October 1, 
2008. 
(B) 
TECHNICAL
AMENDMENTS.—The 
amendments made by— 
(i) paragraphs (1), (2), and (3) of 
subsection (b) shall take effect as if in-
cluded in the enactment of section 6036 of
145 
the Deficit Reduction Act of 2005 (Public 
Law 109–171; 120 Stat. 80); and 
(ii) paragraph (4) of subsection (b) 
shall take effect as if included in the enact-
ment of section 405 of division B of the 
Tax Relief and Health Care Act of 2006 
(Public Law 109–432; 120 Stat. 2996). 
(2) RESTORATION
OF
ELIGIBILITY.—In the 
case of an individual who, during the period that 
began on July 1, 2006, and ends on October 1, 
2008, was determined to be ineligible for medical as-
sistance under a State Medicaid plan, including any 
waiver of such plan, solely as a result of the applica-
tion of subsections (i)(22) and (x) of section 1903 
of the Social Security Act (as in effect during such 
period), but who would have been determined eligible 
for such assistance if such subsections, as amended 
by subsection (b), had applied to the individual, a 
State may deem the individual to be eligible for such 
assistance as of the date that the individual was de-
termined to be ineligible for such medical assistance 
on such basis. 
(3) SPECIAL TRANSITION RULE FOR INDIANS.— 
During the period that begins on July 1, 2006, and 
ends on the effective date of final regulations issued
146 
under subclause (II) of section 1903(x)(3)(B)(v) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(x)(3)(B)(v)) 
(as 
added 
by 
subsection 
(b)(1)(B)), an individual who is a member of a fed-
erally-recognized Indian tribe described in subclause 
(II) of that section who presents a document de-
scribed in subclause (I) of such section that is issued 
by such Indian tribe, shall be deemed to have pre-
sented satisfactory evidence of citizenship or nation-
ality for purposes of satisfying the requirement of 
subsection (x) of section 1903 of such Act. 
SEC. 212. REDUCING ADMINISTRATIVE BARRIERS TO EN-
ROLLMENT. 
Section 2102(b) (42 U.S.C. 1397bb(b)) is amended— 
(1) by redesignating paragraph (4) as para-
graph (5); and 
(2) by inserting after paragraph (3) the fol-
lowing new paragraph: 
‘‘(4) REDUCTION
OF
ADMINISTRATIVE
BAR-
RIERS TO ENROLLMENT.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the plan shall include a description 
of the procedures used to reduce administrative 
barriers to the enrollment of children and preg-
nant women who are eligible for medical assist-
147 
ance under title XIX or for child health assist-
ance or health benefits coverage under this title. 
Such procedures shall be established and re-
vised as often as the State determines appro-
priate to take into account the most recent in-
formation available to the State identifying 
such barriers. 
‘‘(B) DEEMED COMPLIANCE IF JOINT AP-
PLICATION AND RENEWAL PROCESS THAT PER-
MITS APPLICATION OTHER THAN IN PERSON.— 
A State shall be deemed to comply with sub-
paragraph (A) if the State’s application and re-
newal forms and supplemental forms (if any) 
and information verification process is the same 
for purposes of establishing and renewing eligi-
bility for children and pregnant women for 
medical assistance under title XIX and child 
health assistance under this title, and such 
process does not require an application to be 
made in person or a face-to-face interview.’’. 
SEC. 213. MODEL OF INTERSTATE COORDINATED ENROLL-
MENT AND COVERAGE PROCESS. 
(a) IN GENERAL.—In order to assure continuity of 
coverage of low-income children under the Medicaid pro-
gram and the State Children’s Health Insurance Program
148 
(CHIP), not later than 18 months after the date of the 
enactment of this Act, the Secretary of Health and 
Human Services, in consultation with State Medicaid and 
CHIP directors and organizations representing program 
beneficiaries, shall develop a model process for the coordi-
nation of the enrollment, retention, and coverage under 
such programs of children who, because of migration of 
families, emergency evacuations, natural or other disas-
ters, public health emergencies, educational needs, or oth-
erwise, frequently change their State of residency or other-
wise are temporarily located outside of the State of their 
residency. 
(b) REPORT TO CONGRESS.—After development of 
such model process, the Secretary of Health and Human 
Services shall submit to Congress a report describing addi-
tional steps or authority needed to make further improve-
ments to coordinate the enrollment, retention, and cov-
erage under CHIP and Medicaid of children described in 
subsection (a).
149 
TITLE III—REDUCING BARRIERS 
TO PROVIDING PREMIUM AS-
SISTANCE 
Subtitle A—Additional State Op-
tion for Providing Premium As-
sistance 
SEC. 301. ADDITIONAL STATE OPTION FOR PROVIDING 
PREMIUM ASSISTANCE. 
(a) CHIP.— 
(1) IN GENERAL.—Section 2105(c) (42 U.S.C. 
1397ee(c)), as amended by sections 114(a), 116(c), 
and 211(c), is amended by adding at the end the fol-
lowing: 
‘‘(11) STATE OPTION TO OFFER PREMIUM AS-
SISTANCE.— 
‘‘(A) IN GENERAL.—A State may elect to 
offer a premium assistance subsidy (as defined 
in subparagraph (C)) for qualified employer- 
sponsored coverage (as defined in subparagraph 
(B)) to all targeted low-income children who are 
eligible for child health assistance under the 
plan and have access to such coverage in ac-
cordance with the requirements of this para-
graph. No subsidy shall be provided to a tar-
geted low-income child under this paragraph
150 
unless the child (or the child’s parent) volun-
tarily elects to receive such a subsidy. A State 
may not require such an election as a condition 
of receipt of child health assistance. 
‘‘(B) QUALIFIED
EMPLOYER-SPONSORED 
COVERAGE.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), in this paragraph, the term ‘qualified 
employer-sponsored coverage’ means a 
group health plan or health insurance cov-
erage offered through an employer— 
‘‘(I) that qualifies as creditable 
coverage as a group health plan under 
section 2701(c)(1) of the Public 
Health Service Act; 
‘‘(II) for which the employer con-
tribution toward any premium for 
such coverage is at least 40 percent; 
and 
‘‘(III) that is offered to all indi-
viduals in a manner that would be 
considered a nondiscriminatory eligi-
bility classification for purposes of 
paragraph (3)(A)(ii) of section 105(h) 
of the Internal Revenue Code of 1986
151 
(but determined without regard to 
clause (i) of subparagraph (B) of such 
paragraph). 
‘‘(ii) EXCEPTION.—Such term does 
not include coverage consisting of— 
‘‘(I) benefits provided under a 
health flexible spending arrangement 
(as defined in section 106(c)(2) of the 
Internal Revenue Code of 1986); or 
‘‘(II) a high deductible health 
plan (as defined in section 223(c)(2) 
of such Code), without regard to 
whether the plan is purchased in con-
junction with a health savings account 
(as defined under section 223(d) of 
such Code). 
‘‘(C) PREMIUM ASSISTANCE SUBSIDY.— 
‘‘(i) IN GENERAL.—In this paragraph, 
the term ‘premium assistance subsidy’ 
means, with respect to a targeted low-in-
come child, the amount equal to the dif-
ference between the employee contribution 
required for enrollment only of the em-
ployee under qualified employer-sponsored 
coverage and the employee contribution re-
152 
quired for enrollment of the employee and 
the child in such coverage, less any appli-
cable premium cost-sharing applied under 
the State child health plan (subject to the 
limitations imposed under section 2103(e), 
including the requirement to count the 
total amount of the employee contribution 
required for enrollment of the employee 
and the child in such coverage toward the 
annual aggregate cost-sharing limit applied 
under paragraph (3)(B) of such section). 
‘‘(ii) STATE
PAYMENT
OPTION.—A 
State may provide a premium assistance 
subsidy either as reimbursement to an em-
ployee for out-of-pocket expenditures or, 
subject to clause (iii), directly to the em-
ployee’s employer. 
‘‘(iii) EMPLOYER OPT-OUT.—An em-
ployer may notify a State that it elects to 
opt-out of being directly paid a premium 
assistance subsidy on behalf of an em-
ployee. In the event of such a notification, 
an employer shall withhold the total 
amount of the employee contribution re-
quired for enrollment of the employee and
161 
involved or the family involved (as applica-
ble); or 
‘‘(ii) the aggregate amount of expendi-
tures that the State would have made 
under the State child health plan, includ-
ing administrative expenditures, for pro-
viding coverage under such plan for all 
such children or families.’’. 
(B) NONAPPLICATION TO PREVIOUSLY AP-
PROVED COVERAGE.—The amendment made by 
subparagraph (A) shall not apply to coverage 
the purchase of which has been approved by the 
Secretary under section 2105(c)(3) of the Social 
Security Act prior to the date of enactment of 
this Act. 
(b) MEDICAID.—Title XIX is amended by inserting 
after section 1906 the following new section: 
‘‘PREMIUM ASSISTANCE OPTION FOR CHILDREN 
‘‘SEC. 1906A. (a) IN GENERAL.—A State may elect 
to offer a premium assistance subsidy (as defined in sub-
section (c)) for qualified employer-sponsored coverage (as 
defined in subsection (b)) to all individuals under age 19 
who are entitled to medical assistance under this title (and 
to the parent of such an individual) who have access to 
such coverage if the State meets the requirements of this 
section.
162 
‘‘(b) 
QUALIFIED
EMPLOYER-SPONSORED
COV-
ERAGE.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2)), 
in this paragraph, the term ‘qualified employer-spon-
sored coverage’ means a group health plan or health 
insurance coverage offered through an employer— 
‘‘(A) that qualifies as creditable coverage 
as a group health plan under section 2701(c)(1) 
of the Public Health Service Act; 
‘‘(B) for which the employer contribution 
toward any premium for such coverage is at 
least 40 percent; and 
‘‘(C) that is offered to all individuals in a 
manner that would be considered a nondiscrim-
inatory eligibility classification for purposes of 
paragraph (3)(A)(ii) of section 105(h) of the 
Internal Revenue Code of 1986 (but determined 
without regard to clause (i) of subparagraph 
(B) of such paragraph). 
‘‘(2) EXCEPTION.—Such term does not include 
coverage consisting of— 
‘‘(A) benefits provided under a health flexi-
ble spending arrangement (as defined in section 
106(c)(2) of the Internal Revenue Code of 
1986); or
163 
‘‘(B) a high deductible health plan (as de-
fined in section 223(c)(2) of such Code), with-
out regard to whether the plan is purchased in 
conjunction with a health savings account (as 
defined under section 223(d) of such Code). 
‘‘(3) TREATMENT
AS
THIRD
PARTY
LIABIL-
ITY.—The State shall treat the coverage provided 
under qualified employer-sponsored coverage as a 
third party liability under section 1902(a)(25). 
‘‘(c) PREMIUM ASSISTANCE SUBSIDY.—In this sec-
tion, the term ‘premium assistance subsidy’ means the 
amount of the employee contribution for enrollment in the 
qualified employer-sponsored coverage by the individual 
under age 19 or by the individual’s family. Premium as-
sistance subsidies under this section shall be considered, 
for purposes of section 1903(a), to be a payment for med-
ical assistance. 
‘‘(d) VOLUNTARY PARTICIPATION.— 
‘‘(1) EMPLOYERS.—Participation by an em-
ployer in a premium assistance subsidy offered by a 
State under this section shall be voluntary. An em-
ployer may notify a State that it elects to opt-out of 
being directly paid a premium assistance subsidy on 
behalf of an employee.
164 
‘‘(2) BENEFICIARIES.—No subsidy shall be pro-
vided to an individual under age 19 under this sec-
tion unless the individual (or the individual’s parent) 
voluntarily elects to receive such a subsidy. A State 
may not require such an election as a condition of 
receipt of medical assistance. State may not require, 
as a condition of an individual under age 19 (or the 
individual’s parent) being or remaining eligible for 
medical assistance under this title, apply for enroll-
ment in qualified employer-sponsored coverage under 
this section. 
‘‘(3) OPT-OUT PERMITTED FOR ANY MONTH.— 
A State shall establish a process for permitting the 
parent of an individual under age 19 receiving a pre-
mium assistance subsidy to disenroll the individual 
from the qualified employer-sponsored coverage. 
‘‘(e) REQUIREMENT TO PAY PREMIUMS AND COST- 
SHARING AND PROVIDE SUPPLEMENTAL COVERAGE.—In 
the case of the participation of an individual under age 
19 (or the individual’s parent) in a premium assistance 
subsidy under this section for qualified employer-spon-
sored coverage, the State shall provide for payment of all 
enrollee premiums for enrollment in such coverage and all 
deductibles, coinsurance, and other cost-sharing obliga-
tions for items and services otherwise covered under the
165 
State plan under this title (exceeding the amount other-
wise permitted under section 1916 or, if applicable, section 
1916A). The fact that an individual under age 19 (or a 
parent) elects to enroll in qualified employer-sponsored 
coverage under this section shall not change the individ-
ual’s (or parent’s) eligibility for medical assistance under 
the State plan, except insofar as section 1902(a)(25) pro-
vides that payments for such assistance shall first be made 
under such coverage.’’. 
(c) GAO STUDY AND REPORT.—Not later than Janu-
ary 1, 2009, the Comptroller General of the United States 
shall study cost and coverage issues relating to any State 
premium assistance programs for which Federal matching 
payments are made under title XIX or XXI of the Social 
Security Act, including under waiver authority, and shall 
submit a report to the Committee on Finance of the Sen-
ate and the Committee on Energy and Commerce of the 
House of Representatives on the results of such study. 
SEC. 302. OUTREACH, EDUCATION, AND ENROLLMENT AS-
SISTANCE. 
(a) REQUIREMENT TO INCLUDE DESCRIPTION OF 
OUTREACH, EDUCATION, AND ENROLLMENT EFFORTS 
RELATED TO PREMIUM ASSISTANCE SUBSIDIES IN STATE 
CHILD HEALTH PLAN.—Section 2102(c) (42 U.S.C.
166 
1397bb(c)) is amended by adding at the end the following 
new paragraph: 
‘‘(3) PREMIUM ASSISTANCE SUBSIDIES.—In the 
case of a State that provides for premium assistance 
subsidies under the State child health plan in ac-
cordance with paragraph (2)(B), (3), or (10) of sec-
tion 2105(c), or a waiver approved under section 
1115, outreach, education, and enrollment assistance 
for families of children likely to be eligible for such 
subsidies, to inform such families of the availability 
of, and to assist them in enrolling their children in, 
such subsidies, and for employers likely to provide 
coverage that is eligible for such subsidies, including 
the specific, significant resources the State intends 
to apply to educate employers about the availability 
of premium assistance subsidies under the State 
child health plan.’’. 
(b) NONAPPLICATION
OF 10 PERCENT LIMIT
ON 
OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec-
tion 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as 
amended by section 301(c)(2), is amended by adding at 
the end the following new clause: 
‘‘(iv) EXPENDITURES FOR OUTREACH 
TO INCREASE THE ENROLLMENT OF CHIL-
DREN UNDER THIS TITLE AND TITLE xix
167 
THROUGH
PREMIUM
ASSISTANCE
SUB-
SIDIES.—Expenditures for outreach activi-
ties to families of children likely to be eligi-
ble for premium assistance subsidies in ac-
cordance with paragraph (2)(B), (3), or 
(10), or a waiver approved under section 
1115, to inform such families of the avail-
ability of, and to assist them in enrolling 
their children in, such subsidies, and to 
employers likely to provide qualified em-
ployer-sponsored coverage (as defined in 
subparagraph (B) of such paragraph), but 
not to exceed an amount equal to 1.25 per-
cent of the maximum amount permitted to 
be expended under subparagraph (A) for 
items described in subsection (a)(1)(D).’’.
168 
Subtitle B—Coordinating Premium 
Assistance With Private Coverage 
SEC. 311. SPECIAL ENROLLMENT PERIOD UNDER GROUP 
HEALTH PLANS IN CASE OF TERMINATION OF 
MEDICAID OR CHIP COVERAGE OR ELIGI-
BILITY FOR ASSISTANCE IN PURCHASE OF 
EMPLOYMENT-BASED COVERAGE; COORDINA-
TION OF COVERAGE. 
(a) AMENDMENTS TO INTERNAL REVENUE CODE OF 
1986.—Section 9801(f) of the Internal Revenue Code of 
1986 (relating to special enrollment periods) is amended 
by adding at the end the following new paragraph: 
‘‘(3) SPECIAL RULES RELATING TO MEDICAID 
AND CHIP.— 
‘‘(A) IN GENERAL.—A group health plan 
shall permit an employee who is eligible, but 
not enrolled, for coverage under the terms of 
the plan (or a dependent of such an employee 
if the dependent is eligible, but not enrolled, for 
coverage under such terms) to enroll for cov-
erage under the terms of the plan if either of 
the following conditions is met: 
‘‘(i) TERMINATION OF MEDICAID OR 
CHIP
COVERAGE.—The employee or de-
pendent is covered under a Medicaid plan
169 
under title XIX of the Social Security Act 
or under a State child health plan under 
title XXI of such Act and coverage of the 
employee or dependent under such a plan 
is terminated as a result of loss of eligi-
bility for such coverage and the employee 
requests coverage under the group health 
plan not later than 60 days after the date 
of termination of such coverage. 
‘‘(ii) ELIGIBILITY FOR EMPLOYMENT 
ASSISTANCE UNDER MEDICAID OR CHIP.— 
The employee or dependent becomes eligi-
ble for assistance, with respect to coverage 
under the group health plan under such 
Medicaid plan or State child health plan 
(including under any waiver or demonstra-
tion project conducted under or in relation 
to such a plan), if the employee requests 
coverage under the group health plan not 
later than 60 days after the date the em-
ployee or dependent is determined to be el-
igible for such assistance. 
‘‘(B) EMPLOYEE OUTREACH AND DISCLO-
SURE.—
170 
‘‘(i) OUTREACH TO EMPLOYEES RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.— 
‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity Act, or child health assistance 
under a State child health plan under 
title XXI of such Act, in the form of 
premium assistance for the purchase 
of coverage under a group health 
plan, shall provide to each employee a 
written notice informing the employee 
of potential opportunities then cur-
rently available in the State in which 
the employee resides for premium as-
sistance under such plans for health 
coverage of the employee or the em-
ployee’s dependents. For purposes of 
compliance with this clause, the em-
ployer may use any State-specific 
model notice developed in accordance 
with section 701(f)(3)(B)(i)(II) of the
171 
Employee Retirement Income Security 
Act 
of 
1974 
(29 
U.S.C. 
1181(f)(3)(B)(i)(II)). 
‘‘(II) OPTION TO PROVIDE CON-
CURRENT WITH PROVISION OF PLAN 
MATERIALS
TO
EMPLOYEE.—An em-
ployer may provide the model notice 
applicable to the State in which an 
employee resides concurrent with the 
furnishing of materials notifying the 
employee of health plan eligibility, 
concurrent with materials provided to 
the employee in connection with an 
open season or election process con-
ducted under the plan, or concurrent 
with the furnishing of the summary 
plan description as provided in section 
104(b) of the Employee Retirement 
Income Security Act of 1974 (29 
U.S.C. 1024). 
‘‘(ii) 
DISCLOSURE
ABOUT
GROUP 
HEALTH PLAN BENEFITS TO STATES FOR 
MEDICAID
AND
CHIP
ELIGIBLE
INDIVID-
UALS.—In the case of a participant or ben-
eficiary of a group health plan who is cov-
174 
under title XIX of the Social Security Act 
or under a State child health plan under 
title XXI of such Act and coverage of the 
employee or dependent under such a plan 
is terminated as a result of loss of eligi-
bility for such coverage and the employee 
requests coverage under the group health 
plan (or health insurance coverage) not 
later than 60 days after the date of termi-
nation of such coverage. 
‘‘(ii) ELIGIBILITY FOR EMPLOYMENT 
ASSISTANCE UNDER MEDICAID OR CHIP.— 
The employee or dependent becomes eligi-
ble for assistance, with respect to coverage 
under the group health plan or health in-
surance coverage, under such Medicaid 
plan or State child health plan (including 
under any waiver or demonstration project 
conducted under or in relation to such a 
plan), if the employee requests coverage 
under the group health plan or health in-
surance coverage not later than 60 days 
after the date the employee or dependent is 
determined to be eligible for such assist-
ance.
175 
‘‘(B) COORDINATION WITH MEDICAID AND 
CHIP.— 
‘‘(i) OUTREACH TO EMPLOYEES RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.— 
‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity Act, or child health assistance 
under a State child health plan under 
title XXI of such Act, in the form of 
premium assistance for the purchase 
of coverage under a group health 
plan, shall provide to each employee a 
written notice informing the employee 
of potential opportunities then cur-
rently available in the State in which 
the employee resides for premium as-
sistance under such plans for health 
coverage of the employee or the em-
ployee’s dependents. 
‘‘(II) MODEL NOTICE.—Not later 
than 1 year after the date of enact-
176 
ment of the Children’s Health Insur-
ance Program Reauthorization Act of 
2007, the Secretary and the Secretary 
of Health and Human Services, in 
consultation with Directors of State 
Medicaid agencies under title XIX of 
the Social Security Act and Directors 
of State CHIP agencies under title 
XXI of such Act, shall jointly develop 
national and State-specific model no-
tices for purposes of subparagraph 
(A). The Secretary shall provide em-
ployers with such model notices so as 
to enable employers to timely comply 
with the requirements of subpara-
graph (A). Such model notices shall 
include information regarding how an 
employee may contact the State in 
which the employee resides for addi-
tional information regarding potential 
opportunities for such premium assist-
ance, including how to apply for such 
assistance. 
‘‘(III) OPTION TO PROVIDE CON-
CURRENT WITH PROVISION OF PLAN
177 
MATERIALS
TO
EMPLOYEE.—An em-
ployer may provide the model notice 
applicable to the State in which an 
employee resides concurrent with the 
furnishing of materials notifying the 
employee of health plan eligibility, 
concurrent with materials provided to 
the employee in connection with an 
open season or election process con-
ducted under the plan, or concurrent 
with the furnishing of the summary 
plan description as provided in section 
104(b). 
‘‘(ii) 
DISCLOSURE
ABOUT
GROUP 
HEALTH PLAN BENEFITS TO STATES FOR 
MEDICAID
AND
CHIP
ELIGIBLE
INDIVID-
UALS.—In the case of a participant or ben-
eficiary of a group health plan who is cov-
ered under a Medicaid plan of a State 
under title XIX of the Social Security Act 
or under a State child health plan under 
title XXI of such Act, the plan adminis-
trator of the group health plan shall dis-
close to the State, upon request, informa-
tion about the benefits available under the
178 
group health plan in sufficient specificity, 
as determined under regulations of the 
Secretary of Health and Human Services 
in consultation with the Secretary that re-
quire use of the model coverage coordina-
tion disclosure form developed under sec-
tion 311(b)(1)(C) of the Children’s Health 
Insurance Program Reauthorization Act of 
2007, so as to permit the State to make a 
determination (under paragraph (2)(B), 
(3), or (10) of section 2105(c) of the So-
cial Security Act or otherwise) concerning 
the cost-effectiveness of the State pro-
viding medical or child health assistance 
through premium assistance for the pur-
chase of coverage under such group health 
plan and in order for the State to provide 
supplemental benefits required under para-
graph (10)(E) of such section or other au-
thority.’’. 
(B) CONFORMING
AMENDMENT.—Section 
102(b) of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1022(b)) is 
amended—
179 
(i) by striking ‘‘and the remedies’’ 
and inserting ‘‘, the remedies’’; and 
(ii) by inserting before the period the 
following: ‘‘, and if the employer so elects 
for purposes of complying with section 
701(f)(3)(B)(i), the model notice applicable 
to the State in which the participants and 
beneficiaries reside’’. 
(C) WORKING GROUP TO DEVELOP MODEL 
COVERAGE
COORDINATION
DISCLOSURE 
FORM.— 
(i) MEDICAID, CHIP, AND EMPLOYER- 
SPONSORED
COVERAGE
COORDINATION 
WORKING GROUP.— 
(I) IN GENERAL.—Not later than 
60 days after the date of enactment of 
this Act, the Secretary of Health and 
Human Services and the Secretary of 
Labor shall jointly establish a Med-
icaid, CHIP, and Employer-Sponsored 
Coverage 
Coordination 
Working 
Group (in this subparagraph referred 
to as the ‘‘Working Group’’). The 
purpose of the Working Group shall 
be to develop the model coverage co-
180 
ordination disclosure form described 
in subclause (II) and to identify the 
impediments to the effective coordina-
tion of coverage available to families 
that include employees of employers 
that maintain group health plans and 
members who are eligible for medical 
assistance under title XIX of the So-
cial Security Act or child health as-
sistance or other health benefits cov-
erage under title XXI of such Act. 
(II) MODEL COVERAGE COORDI-
NATION
DISCLOSURE
FORM
DE-
SCRIBED.—The model form described 
in this subclause is a form for plan 
administrators of group health plans 
to complete for purposes of permitting 
a State to determine the availability 
and cost-effectiveness of the coverage 
available under such plans to employ-
ees who have family members who are 
eligible for premium assistance offered 
under a State plan under title XIX or 
XXI of such Act and to allow for co-
ordination of coverage for enrollees of
181 
such plans. Such form shall provide 
the following information in addition 
to such other information as the 
Working Group determines appro-
priate: 
(aa) 
A 
determination 
of 
whether the employee is eligible 
for coverage under the group 
health plan. 
(bb) The name and contract 
information of the plan adminis-
trator of the group health plan. 
(cc) The benefits offered 
under the plan. 
(dd) The premiums and 
cost-sharing required under the 
plan. 
(ee) Any other information 
relevant to coverage under the 
plan. 
(ii) 
MEMBERSHIP.—The 
Working 
Group shall consist of not more than 30 
members and shall be composed of rep-
resentatives of— 
(I) the Department of Labor;
182 
(II) the Department of Health 
and Human Services; 
(III) State directors of the Med-
icaid program under title XIX of the 
Social Security Act; 
(IV) State directors of the State 
Children’s Health Insurance Program 
under title XXI of the Social Security 
Act; 
(V) employers, including owners 
of small businesses and their trade or 
industry representatives and certified 
human resource and payroll profes-
sionals; 
(VI) plan administrators and 
plan sponsors of group health plans 
(as defined in section 607(1) of the 
Employee Retirement Income Security 
Act of 1974); 
(VII) health insurance issuers; 
and 
(VIII) children and other bene-
ficiaries of medical assistance under 
title XIX of the Social Security Act or 
child health assistance or other health
183 
benefits coverage under title XXI of 
such Act. 
(iii) COMPENSATION.—The members 
of the Working Group shall serve without 
compensation. 
(iv) ADMINISTRATIVE SUPPORT.—The 
Department of Health and Human Serv-
ices and the Department of Labor shall 
jointly provide appropriate administrative 
support to the Working Group, including 
technical assistance. The Working Group 
may use the services and facilities of either 
such Department, with or without reim-
bursement, as jointly determined by such 
Departments. 
(v) REPORT.— 
(I) REPORT BY WORKING GROUP 
TO
THE
SECRETARIES.—Not later 
than 18 months after the date of the 
enactment of this Act, the Working 
Group shall submit to the Secretary of 
Labor and the Secretary of Health 
and Human Services the model form 
described in clause (i)(II) along with a 
report containing recommendations
184 
for appropriate measures to address 
the impediments to the effective co-
ordination of coverage between group 
health plans and the State plans 
under titles XIX and XXI of the So-
cial Security Act. 
(II) REPORT BY SECRETARIES TO 
THE
CONGRESS.—Not later than 2 
months after receipt of the report 
pursuant to subclause (I), the Secre-
taries shall jointly submit a report to 
each House of the Congress regarding 
the recommendations contained in the 
report under such subclause. 
(vi) 
TERMINATION.—The 
Working 
Group shall terminate 30 days after the 
date of the issuance of its report under 
clause (v). 
(D) EFFECTIVE DATES.—The Secretary of 
Labor and the Secretary of Health and Human 
Services shall develop the initial model notices 
under section 701(f)(3)(B)(i)(II) of the Em-
ployee Retirement Income Security Act of 1974, 
and the Secretary of Labor shall provide such 
notices to employers, not later than the date
185 
that is 1 year after the date of enactment of 
this Act, and each employer shall provide the 
initial annual notices to such employer’s em-
ployees beginning with the first plan year that 
begins after the date on which such initial 
model notices are first issued. The model cov-
erage coordination disclosure form developed 
under subparagraph (C) shall apply with re-
spect to requests made by States beginning 
with the first plan year that begins after the 
date on which such model coverage coordination 
disclosure form is first issued. 
(E) ENFORCEMENT.—Section 502 of the 
Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1132) is amended— 
(i) in subsection (a)(6), by striking 
‘‘or (8)’’ and inserting ‘‘(8), or (9)’’; and 
(ii) in subsection (c), by redesignating 
paragraph (9) as paragraph (10), and by 
inserting after paragraph (8) the following: 
‘‘(9)(A) The Secretary may assess a civil penalty 
against any employer of up to $100 a day from the date 
of the employer’s failure to meet the notice requirement 
of section 701(f)(3)(B)(i)(I). For purposes of this sub-
186 
paragraph, each violation with respect to any single em-
ployee shall be treated as a separate violation. 
‘‘(B) The Secretary may assess a civil penalty against 
any plan administrator of up to $100 a day from the date 
of the plan administrator’s failure to timely provide to any 
State the information required to be disclosed under sec-
tion 701(f)(3)(B)(ii). For purposes of this subparagraph, 
each violation with respect to any single participant or 
beneficiary shall be treated as a separate violation.’’. 
(2) AMENDMENTS TO PUBLIC HEALTH SERVICE 
ACT.—Section 2701(f) of the Public Health Service 
Act (42 U.S.C. 300gg(f)) is amended by adding at 
the end the following new paragraph: 
‘‘(3) SPECIAL RULES FOR APPLICATION IN CASE 
OF MEDICAID AND CHIP.— 
‘‘(A) IN GENERAL.—A group health plan, 
and a health insurance issuer offering group 
health insurance coverage in connection with a 
group health plan, shall permit an employee 
who is eligible, but not enrolled, for coverage 
under the terms of the plan (or a dependent of 
such an employee if the dependent is eligible, 
but not enrolled, for coverage under such 
terms) to enroll for coverage under the terms of
187 
the plan if either of the following conditions is 
met: 
‘‘(i) TERMINATION OF MEDICAID OR 
CHIP
COVERAGE.—The employee or de-
pendent is covered under a Medicaid plan 
under title XIX of the Social Security Act 
or under a State child health plan under 
title XXI of such Act and coverage of the 
employee or dependent under such a plan 
is terminated as a result of loss of eligi-
bility for such coverage and the employee 
requests coverage under the group health 
plan (or health insurance coverage) not 
later than 60 days after the date of termi-
nation of such coverage. 
‘‘(ii) ELIGIBILITY FOR EMPLOYMENT 
ASSISTANCE UNDER MEDICAID OR CHIP.— 
The employee or dependent becomes eligi-
ble for assistance, with respect to coverage 
under the group health plan or health in-
surance coverage, under such Medicaid 
plan or State child health plan (including 
under any waiver or demonstration project 
conducted under or in relation to such a 
plan), if the employee requests coverage
188 
under the group health plan or health in-
surance coverage not later than 60 days 
after the date the employee or dependent is 
determined to be eligible for such assist-
ance. 
‘‘(B) COORDINATION WITH MEDICAID AND 
CHIP.— 
‘‘(i) OUTREACH TO EMPLOYEES RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.— 
‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity Act, or child health assistance 
under a State child health plan under 
title XXI of such Act, in the form of 
premium assistance for the purchase 
of coverage under a group health 
plan, shall provide to each employee a 
written notice informing the employee 
of potential opportunities then cur-
rently available in the State in which 
the employee resides for premium as-
189 
sistance under such plans for health 
coverage of the employee or the em-
ployee’s dependents. For purposes of 
compliance with this subclause, the 
employer may use any State-specific 
model notice developed in accordance 
with section 701(f)(3)(B)(i)(II) of the 
Employee Retirement Income Security 
Act 
of 
1974 
(29 
U.S.C. 
1181(f)(3)(B)(i)(II)). 
‘‘(II) OPTION TO PROVIDE CON-
CURRENT WITH PROVISION OF PLAN 
MATERIALS
TO
EMPLOYEE.—An em-
ployer may provide the model notice 
applicable to the State in which an 
employee resides concurrent with the 
furnishing of materials notifying the 
employee of health plan eligibility, 
concurrent with materials provided to 
the employee in connection with an 
open season or election process con-
ducted under the plan, or concurrent 
with the furnishing of the summary 
plan description as provided in section
190 
104(b) of the Employee Retirement 
Income Security Act of 1974. 
‘‘(ii) 
DISCLOSURE
ABOUT
GROUP 
HEALTH PLAN BENEFITS TO STATES FOR 
MEDICAID
AND
CHIP
ELIGIBLE
INDIVID-
UALS.—In the case of an enrollee in a 
group health plan who is covered under a 
Medicaid plan of a State under title XIX 
of the Social Security Act or under a State 
child health plan under title XXI of such 
Act, the plan administrator of the group 
health plan shall disclose to the State, 
upon request, information about the bene-
fits available under the group health plan 
in sufficient specificity, as determined 
under regulations of the Secretary of 
Health and Human Services in consulta-
tion with the Secretary that require use of 
the model coverage coordination disclosure 
form developed under section 311(b)(1)(C) 
of the Children’s Health Insurance Reau-
thorization Act of 2007, so as to permit 
the State to make a determination (under 
paragraph (2)(B), (3), or (10) of section 
2105(c) of the Social Security Act or oth-
191 
erwise) concerning the cost-effectiveness of 
the State providing medical or child health 
assistance through premium assistance for 
the purchase of coverage under such group 
health plan and in order for the State to 
provide supplemental benefits required 
under paragraph (10)(E) of such section 
or other authority.’’. 
TITLE 
IV—STRENGTHENING 
QUALITY 
OF 
CARE 
AND 
HEALTH OUTCOMES 
SEC. 401. CHILD HEALTH QUALITY IMPROVEMENT ACTIVI-
TIES FOR CHILDREN ENROLLED IN MED-
ICAID OR CHIP. 
(a) DEVELOPMENT
OF CHILD HEALTH QUALITY 
MEASURES FOR CHILDREN ENROLLED IN MEDICAID OR 
CHIP.—Title XI (42 U.S.C. 1301 et seq.) is amended by 
inserting after section 1139 the following new section: 
‘‘SEC. 1139A. CHILD HEALTH QUALITY MEASURES. 
‘‘(a) DEVELOPMENT OF AN INITIAL CORE SET OF 
HEALTH CARE QUALITY MEASURES FOR CHILDREN EN-
ROLLED IN MEDICAID OR CHIP.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2009, the Secretary shall identify and publish for 
general comment an initial, recommended core set of
192 
child health quality measures for use by State pro-
grams administered under titles XIX and XXI, 
health insurance issuers and managed care entities 
that enter into contracts with such programs, and 
providers of items and services under such pro-
grams. 
‘‘(2) IDENTIFICATION OF INITIAL CORE MEAS-
URES.—In consultation with the individuals and en-
tities described in subsection (b)(3), the Secretary 
shall identify existing quality of care measures for 
children that are in use under public and privately 
sponsored health care coverage arrangements, or 
that are part of reporting systems that measure both 
the presence and duration of health insurance cov-
erage over time. 
‘‘(3) 
RECOMMENDATIONS
AND
DISSEMINA-
TION.—Based on such existing and identified meas-
ures, the Secretary shall publish an initial core set 
of child health quality measures that includes (but 
is not limited to) the following: 
‘‘(A) The duration of children’s health in-
surance coverage over a 12-month time period. 
‘‘(B) The availability and effectiveness of a 
full range of—
193 
‘‘(i) preventive services, treatments, 
and services for acute conditions, including 
services to promote healthy birth, prevent 
and treat premature birth, and detect the 
presence or risk of physical or mental con-
ditions that could adversely affect growth 
and development; and 
‘‘(ii) treatments to correct or amelio-
rate the effects of physical and mental con-
ditions, including chronic conditions, in in-
fants, young children, school-age children, 
and adolescents. 
‘‘(C) The availability of care in a range of 
ambulatory and inpatient health care settings 
in which such care is furnished. 
‘‘(D) The types of measures that, taken to-
gether, can be used to estimate the overall na-
tional quality of health care for children, includ-
ing children with special needs, and to perform 
comparative analyses of pediatric health care 
quality and racial, ethnic, and socioeconomic 
disparities in child health and health care for 
children. 
‘‘(4) ENCOURAGE VOLUNTARY AND STANDARD-
IZED REPORTING.—Not later than 2 years after the
194 
date of enactment of the Children’s Health Insur-
ance Program Reauthorization Act of 2007, the Sec-
retary, in consultation with States, shall develop a 
standardized format for reporting information and 
procedures and approaches that encourage States to 
use the initial core measurement set to voluntarily 
report information regarding the quality of pediatric 
health care under titles XIX and XXI. 
‘‘(5) ADOPTION OF BEST PRACTICES IN IMPLE-
MENTING QUALITY PROGRAMS.—The Secretary shall 
disseminate information to States regarding best 
practices among States with respect to measuring 
and reporting on the quality of health care for chil-
dren, and shall facilitate the adoption of such best 
practices. In developing best practices approaches, 
the Secretary shall give particular attention to State 
measurement techniques that ensure the timeliness 
and accuracy of provider reporting, encourage pro-
vider reporting compliance, encourage successful 
quality improvement strategies, and improve effi-
ciency in data collection using health information 
technology. 
‘‘(6) REPORTS TO CONGRESS.—Not later than 
January 1, 2010, and every 3 years thereafter, the 
Secretary shall report to Congress on—
195 
‘‘(A) the status of the Secretary’s efforts 
to improve— 
‘‘(i) quality related to the duration 
and stability of health insurance coverage 
for children under titles XIX and XXI; 
‘‘(ii) the quality of children’s health 
care under such titles, including preventive 
health services, health care for acute condi-
tions, chronic health care, and health serv-
ices to ameliorate the effects of physical 
and mental conditions and to aid in growth 
and development of infants, young chil-
dren, school-age children, and adolescents 
with special health care needs; and 
‘‘(iii) the quality of children’s health 
care under such titles across the domains 
of quality, including clinical quality, health 
care safety, family experience with health 
care, health care in the most integrated 
setting, and elimination of racial, ethnic, 
and socioeconomic disparities in health and 
health care; 
‘‘(B) the status of voluntary reporting by 
States under titles XIX and XXI, utilizing the 
initial core quality measurement set; and
196 
‘‘(C) any recommendations for legislative 
changes needed to improve the quality of care 
provided to children under titles XIX and XXI, 
including recommendations for quality reporting 
by States. 
‘‘(7) TECHNICAL ASSISTANCE.—The Secretary 
shall provide technical assistance to States to assist 
them in adopting and utilizing core child health 
quality measures in administering the State plans 
under titles XIX and XXI. 
‘‘(8) DEFINITION OF CORE SET.—In this sec-
tion, the term ‘core set’ means a group of valid, reli-
able, and evidence-based quality measures that, 
taken together— 
‘‘(A) provide information regarding the 
quality of health coverage and health care for 
children; 
‘‘(B) 
address 
the 
needs 
of 
children 
throughout the developmental age span; and 
‘‘(C) allow purchasers, families, and health 
care providers to understand the quality of care 
in relation to the preventive needs of children, 
treatments aimed at managing and resolving 
acute conditions, and diagnostic and treatment 
services whose purpose is to correct or amelio-
197 
rate physical, mental, or developmental condi-
tions that could, if untreated or poorly treated, 
become chronic. 
‘‘(b) ADVANCING AND IMPROVING PEDIATRIC QUAL-
ITY MEASURES.— 
‘‘(1) ESTABLISHMENT OF PEDIATRIC QUALITY 
MEASURES PROGRAM.—Not later than January 1, 
2010, the Secretary shall establish a pediatric qual-
ity measures program to— 
‘‘(A) improve and strengthen the initial 
core child health care quality measures estab-
lished by the Secretary under subsection (a); 
‘‘(B) expand on existing pediatric quality 
measures used by public and private health care 
purchasers and advance the development of 
such new and emerging quality measures; and 
‘‘(C) increase the portfolio of evidence- 
based, consensus pediatric quality measures 
available to public and private purchasers of 
children’s health care services, providers, and 
consumers. 
‘‘(2) EVIDENCE-BASED MEASURES.—The meas-
ures developed under the pediatric quality measures 
program shall, at a minimum, be—
201 
for the development of pediatric quality measures 
described in subsection paragraphs (1) through (4). 
‘‘(6) DEFINITION
OF
PEDIATRIC
QUALITY 
MEASURE.—In this subsection, the term ‘pediatric 
quality measure’ means a measurement of clinical 
care that is capable of being examined through the 
collection and analysis of relevant information, that 
is developed in order to assess 1 or more aspects of 
pediatric health care quality in various institutional 
and ambulatory health care settings, including the 
structure of the clinical care system, the process of 
care, the outcome of care, or patient experiences in 
care. 
‘‘(7) CONSTRUCTION.—Nothing in this section 
shall be construed as supporting the restriction of 
coverage, under title XIX or XXI or otherwise, to 
only those services that are evidence-based. 
‘‘(c) ANNUAL STATE REPORTS REGARDING STATE- 
SPECIFIC QUALITY OF CARE MEASURES APPLIED UNDER 
MEDICAID OR CHIP.— 
‘‘(1) ANNUAL
STATE
REPORTS.—Each State 
with a State plan approved under title XIX or a 
State child health plan approved under title XXI 
shall annually report to the Secretary on the—
202 
‘‘(A) State-specific child health quality 
measures applied by the States under such 
plans, including measures described in subpara-
graphs (A) and (B) of subsection (a)(6); and 
‘‘(B) State-specific information on the 
quality of health care furnished to children 
under such plans, including information col-
lected through external quality reviews of man-
aged care organizations under section 1932 of 
the Social Security Act (42 U.S.C. 1396u–4) 
and benchmark plans under sections 1937 and 
2103 of such Act (42 U.S.C. 1396u–7, 1397cc). 
‘‘(2) PUBLICATION.—Not later than September 
30, 2009, and annually thereafter, the Secretary 
shall collect, analyze, and make publicly available the 
information reported by States under paragraph (1). 
‘‘(d) DEMONSTRATION PROJECTS
FOR IMPROVING 
THE QUALITY OF CHILDREN’S HEALTH CARE AND THE 
USE OF HEALTH INFORMATION TECHNOLOGY.— 
‘‘(1) IN GENERAL.—During the period of fiscal 
years 2008 through 2012, the Secretary shall award 
not more than 10 grants to States and child health 
providers to conduct demonstration projects to 
evaluate promising ideas for improving the quality of
203 
children’s health care provided under title XIX or 
XXI, including projects to— 
‘‘(A) experiment with, and evaluate the use 
of, new measures of the quality of children’s 
health care under such titles (including testing 
the validity and suitability for reporting of such 
measures); 
‘‘(B) promote the use of health information 
technology in care delivery for children under 
such titles; 
‘‘(C) evaluate provider-based models which 
improve the delivery of children’s health care 
services under such titles, including care man-
agement for children with chronic conditions 
and the use of evidence-based approaches to im-
prove the effectiveness, safety, and efficiency of 
health care services for children; or 
‘‘(D) demonstrate the impact of the model 
electronic health record format for children de-
veloped and disseminated under subsection (f) 
on improving pediatric health, including the ef-
fects of chronic childhood health conditions, and 
pediatric health care quality as well as reducing 
health care costs.
204 
‘‘(2) REQUIREMENTS.—In awarding grants 
under this subsection, the Secretary shall ensure 
that— 
‘‘(A) only 1 demonstration project funded 
under a grant awarded under this subsection 
shall be conducted in a State; and 
‘‘(B) demonstration projects funded under 
grants awarded under this subsection shall be 
conducted evenly between States with large 
urban areas and States with large rural areas. 
‘‘(3) 
AUTHORITY
FOR
MULTISTATE 
PROJECTS.—A demonstration project conducted with 
a grant awarded under this subsection may be con-
ducted on a multistate basis, as needed. 
‘‘(4) FUNDING.—$20,000,000 of the amount 
appropriated under subsection (i) for a fiscal year 
shall be used to carry out this subsection. 
‘‘(e) 
CHILDHOOD
OBESITY
DEMONSTRATION 
PROJECT.— 
‘‘(1) AUTHORITY
TO
CONDUCT
DEMONSTRA-
TION.—The Secretary, in consultation with the Ad-
ministrator of the Centers for Medicare & Medicaid 
Services, shall conduct a demonstration project to 
develop a comprehensive and systematic model for 
reducing childhood obesity by awarding grants to eli-
205 
gible entities to carry out such project. Such model 
shall— 
‘‘(A) identify, through self-assessment, be-
havioral risk factors for obesity among children; 
‘‘(B) identify, through self-assessment, 
needed clinical preventive and screening benefits 
among those children identified as target indi-
viduals on the basis of such risk factors; 
‘‘(C) provide ongoing support to such tar-
get individuals and their families to reduce risk 
factors and promote the appropriate use of pre-
ventive and screening benefits; and 
‘‘(D) be designed to improve health out-
comes, satisfaction, quality of life, and appro-
priate use of items and services for which med-
ical assistance is available under title XIX or 
child health assistance is available under title 
XXI among such target individuals. 
‘‘(2) ELIGIBILITY ENTITIES.—For purposes of 
this subsection, an eligible entity is any of the fol-
lowing: 
‘‘(A) A city, county, or Indian tribe. 
‘‘(B) A local or tribal educational agency. 
‘‘(C) An accredited university, college, or 
community college.
206 
‘‘(D) A Federally-qualified health center. 
‘‘(E) A local health department. 
‘‘(F) A health care provider. 
‘‘(G) A community-based organization. 
‘‘(H) Any other entity determined appro-
priate by the Secretary, including a consortia or 
partnership of entities described in any of sub-
paragraphs (A) through (G). 
‘‘(3) USE OF FUNDS.—An eligible entity award-
ed a grant under this subsection shall use the funds 
made available under the grant to— 
‘‘(A) carry out community-based activities 
related to reducing childhood obesity, including 
by— 
‘‘(i) forming partnerships with enti-
ties, including schools and other facilities 
providing recreational services, to establish 
programs for after school and weekend 
community activities that are designed to 
reduce childhood obesity; 
‘‘(ii) 
forming 
partnerships 
with 
daycare facilities to establish programs 
that promote healthy eating behaviors and 
physical activity; and
207 
‘‘(iii) developing and evaluating com-
munity educational activities targeting 
good nutrition and promoting healthy eat-
ing behaviors; 
‘‘(B) carry out age-appropriate school- 
based activities that are designed to reduce 
childhood obesity, including by— 
‘‘(i) developing and testing edu-
cational curricula and intervention pro-
grams designed to promote healthy eating 
behaviors and habits in youth, which may 
include— 
‘‘(I) after hours physical activity 
programs; and 
‘‘(II) science-based interventions 
with multiple components to prevent 
eating disorders including nutritional 
content, understanding and respond-
ing to hunger and satiety, positive 
body image development, positive self- 
esteem development, and learning life 
skills (such as stress management, 
communication skills, problemsolving 
and decisionmaking skills), as well as 
consideration of cultural and develop-
208 
mental issues, and the role of family, 
school, and community; 
‘‘(ii) providing education and training 
to educational professionals regarding how 
to promote a healthy lifestyle and a 
healthy school environment for children; 
‘‘(iii) planning and implementing a 
healthy lifestyle curriculum or program 
with an emphasis on healthy eating behav-
iors and physical activity; and 
‘‘(iv) 
planning 
and 
implementing 
healthy lifestyle classes or programs for 
parents or guardians, with an emphasis on 
healthy eating behaviors and physical ac-
tivity for children; 
‘‘(C) carry out educational, counseling, 
promotional, and training activities through the 
local health care delivery systems including 
by— 
‘‘(i) promoting healthy eating behav-
iors and physical activity services to treat 
or prevent eating disorders, being over-
weight, and obesity;
209 
‘‘(ii) providing patient education and 
counseling to increase physical activity and 
promote healthy eating behaviors; 
‘‘(iii) training health professionals on 
how to identify and treat obese and over-
weight individuals which may include nu-
trition and physical activity counseling; 
and 
‘‘(iv) providing community education 
by a health professional on good nutrition 
and physical activity to develop a better 
understanding of the relationship between 
diet, physical activity, and eating disorders, 
obesity, or being overweight; and 
‘‘(D) provide, through qualified health pro-
fessionals, training and supervision for commu-
nity health workers to— 
‘‘(i) educate families regarding the re-
lationship between nutrition, eating habits, 
physical activity, and obesity; 
‘‘(ii) educate families about effective 
strategies to improve nutrition, establish 
healthy eating patterns, and establish ap-
propriate levels of physical activity; and
210 
‘‘(iii) educate and guide parents re-
garding the ability to model and commu-
nicate positive health behaviors. 
‘‘(4) PRIORITY.—In awarding grants under 
paragraph (1), the Secretary shall give priority to 
awarding grants to eligible entities— 
‘‘(A) that demonstrate that they have pre-
viously applied successfully for funds to carry 
out activities that seek to promote individual 
and community health and to prevent the inci-
dence of chronic disease and that can cite pub-
lished 
and 
peer-reviewed 
research 
dem-
onstrating that the activities that the entities 
propose to carry out with funds made available 
under the grant are effective; 
‘‘(B) that will carry out programs or ac-
tivities that seek to accomplish a goal or goals 
set by the State in the Healthy People 2010 
plan of the State; 
‘‘(C) that provide non-Federal contribu-
tions, either in cash or in-kind, to the costs of 
funding activities under the grants; 
‘‘(D) that develop comprehensive plans 
that include a strategy for extending program 
activities developed under grants in the years
211 
following the fiscal years for which they receive 
grants under this subsection; 
‘‘(E) located in communities that are medi-
cally underserved, as determined by the Sec-
retary; 
‘‘(F) located in areas in which the average 
poverty rate is at least 150 percent or higher of 
the average poverty rate in the State involved, 
as determined by the Secretary; and 
‘‘(G) that submit plans that exhibit multi-
sectoral, cooperative conduct that includes the 
involvement of a broad range of stakeholders, 
including— 
‘‘(i) community-based organizations; 
‘‘(ii) local governments; 
‘‘(iii) local educational agencies; 
‘‘(iv) the private sector; 
‘‘(v) State or local departments of 
health; 
‘‘(vi) accredited colleges, universities, 
and community colleges; 
‘‘(vii) health care providers; 
‘‘(viii) State and local departments of 
transportation and city planning; and
212 
‘‘(ix) other entities determined appro-
priate by the Secretary. 
‘‘(5) PROGRAM DESIGN.— 
‘‘(A) INITIAL DESIGN.—Not later than 1 
year after the date of enactment of the Chil-
dren’s Health Insurance Program Reauthoriza-
tion Act of 2007, the Secretary shall design the 
demonstration 
project. 
The 
demonstration 
should draw upon promising, innovative models 
and incentives to reduce behavioral risk factors. 
The Administrator of the Centers for Medicare 
& Medicaid Services shall consult with the Di-
rector of the Centers for Disease Control and 
Prevention, the Director of the Office of Minor-
ity Health, the heads of other agencies in the 
Department of Health and Human Services, 
and such professional organizations, as the Sec-
retary determines to be appropriate, on the de-
sign, conduct, and evaluation of the demonstra-
tion. 
‘‘(B) NUMBER AND PROJECT AREAS.—Not 
later than 2 years after the date of enactment 
of the Children’s Health Insurance Program 
Reauthorization Act of 2007, the Secretary 
shall award 1 grant that is specifically designed
213 
to determine whether programs similar to pro-
grams to be conducted by other grantees under 
this subsection should be implemented with re-
spect to the general population of children who 
are eligible for child health assistance under 
State child health plans under title XXI in 
order to reduce the incidence of childhood obe-
sity among such population. 
‘‘(6) REPORT TO CONGRESS.—Not later than 3 
years after the date the Secretary implements the 
demonstration project under this subsection, the 
Secretary shall submit to Congress a report that de-
scribes the project, evaluates the effectiveness and 
cost effectiveness of the project, evaluates the bene-
ficiary satisfaction under the project, and includes 
any such other information as the Secretary deter-
mines to be appropriate. 
‘‘(7) DEFINITIONS.—In this subsection: 
‘‘(A) 
FEDERALLY-QUALIFIED
HEALTH 
CENTER.—The term ‘Federally-qualified health 
center’ has the meaning given that term in sec-
tion 1905(l)(2)(B). 
‘‘(B) INDIAN
TRIBE.—The term ‘Indian 
tribe’ has the meaning given that term in sec-
214 
tion 4 of the Indian Health Care Improvement 
Act (25 U.S.C. 1603). 
‘‘(C) SELF-ASSESSMENT.—The term ‘self- 
assessment’ means a form that— 
‘‘(i) includes questions regarding— 
‘‘(I) behavioral risk factors; 
‘‘(II) 
needed 
preventive 
and 
screening services; and 
‘‘(III) target individuals’ pref-
erences for receiving follow-up infor-
mation; 
‘‘(ii) is assessed using such computer 
generated assessment programs; and 
‘‘(iii) allows for the provision of such 
ongoing support to the individual as the 
Secretary determines appropriate. 
‘‘(D) ONGOING SUPPORT.—The term ‘on-
going support’ means— 
‘‘(i) to provide any target individual 
with information, feedback, health coach-
ing, and recommendations regarding— 
‘‘(I) the results of a self-assess-
ment given to the individual; 
‘‘(II) behavior modification based 
on the self-assessment; and
215 
‘‘(III) any need for clinical pre-
ventive and screening services or 
treatment including medical nutrition 
therapy; 
‘‘(ii) to provide any target individual 
with referrals to community resources and 
programs available to assist the target in-
dividual in reducing health risks; and 
‘‘(iii) to provide the information de-
scribed in clause (i) to a health care pro-
vider, if designated by the target individual 
to receive such information. 
‘‘(8) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this subsection, $25,000,000 for the period of fiscal 
years 2008 through 2012. 
‘‘(f) 
DEVELOPMENT
OF
MODEL
ELECTRONIC 
HEALTH RECORD FORMAT FOR CHILDREN ENROLLED IN 
MEDICAID OR CHIP.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2009, the Secretary shall establish a program to en-
courage the development and dissemination of a 
model electronic health record format for children 
enrolled in the State plan under title XIX or the 
State child health plan under title XXI that is—
216 
‘‘(A) subject to State laws, accessible to 
parents, caregivers, and other consumers for 
the sole purpose of demonstrating compliance 
with school or leisure activity requirements, 
such as appropriate immunizations or physicals; 
‘‘(B) designed to allow interoperable ex-
changes that conform with Federal and State 
privacy and security requirements; 
‘‘(C) structured in a manner that permits 
parents and caregivers to view and understand 
the extent to which the care their children re-
ceive is clinically appropriate and of high qual-
ity; and 
‘‘(D) capable of being incorporated into, 
and otherwise compatible with, other standards 
developed for electronic health records. 
‘‘(2) FUNDING.—$5,000,000 of the amount ap-
propriated under subsection (i) for a fiscal year shall 
be used to carry out this subsection. 
‘‘(g) STUDY OF PEDIATRIC HEALTH AND HEALTH 
CARE QUALITY MEASURES.— 
‘‘(1) IN
GENERAL.—Not later than July 1, 
2009, the Institute of Medicine shall study and re-
port to Congress on the extent and quality of efforts 
to measure child health status and the quality of
217 
health care for children across the age span and in 
relation to preventive care, treatments for acute con-
ditions, and treatments aimed at ameliorating or 
correcting physical, mental, and developmental con-
ditions in children. In conducting such study and 
preparing such report, the Institute of Medicine 
shall— 
‘‘(A) consider all of the major national 
population-based reporting systems sponsored 
by the Federal Government that are currently 
in place, including reporting requirements 
under Federal grant programs and national 
population surveys and estimates conducted di-
rectly by the Federal Government; 
‘‘(B) identify the information regarding 
child health and health care quality that each 
system is designed to capture and generate, the 
study and reporting periods covered by each 
system, and the extent to which the information 
so generated is made widely available through 
publication; 
‘‘(C) identify gaps in knowledge related to 
children’s health status, health disparities 
among subgroups of children, the effects of so-
cial conditions on children’s health status and
218 
use and effectiveness of health care, and the re-
lationship between child health status and fam-
ily income, family stability and preservation, 
and children’s school readiness and educational 
achievement and attainment; and 
‘‘(D) make recommendations regarding im-
proving and strengthening the timeliness, qual-
ity, and public transparency and accessibility of 
information about child health and health care 
quality. 
‘‘(2) FUNDING.—Up to $1,000,000 of the 
amount appropriated under subsection (i) for a fis-
cal year shall be used to carry out this subsection. 
‘‘(h) RULE
OF CONSTRUCTION.—Notwithstanding 
any other provision in this section, no evidence based qual-
ity measure developed, published, or used as a basis of 
measurement or reporting under this section may be used 
to establish an irrebuttable presumption regarding either 
the medical necessity of care or the maximum permissible 
coverage for any individual child who is eligible for and 
receiving medical assistance under title XIX or child 
health assistance under title XXI. 
‘‘(i) APPROPRIATION.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
priated for each of fiscal years 2008 through 2012,
220 
SEC. 402. IMPROVED AVAILABILITY OF PUBLIC INFORMA-
TION REGARDING ENROLLMENT OF CHIL-
DREN IN CHIP AND MEDICAID. 
(a) INCLUSION OF PROCESS AND ACCESS MEASURES 
IN ANNUAL STATE REPORTS.—Section 2108 (42 U.S.C. 
1397hh) is amended— 
(1) in subsection (a), in the matter preceding 
paragraph (1), by striking ‘‘The State’’ and insert-
ing ‘‘Subject to subsection (e), the State’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(e) INFORMATION REQUIRED FOR INCLUSION IN 
STATE ANNUAL REPORT.—The State shall include the fol-
lowing information in the annual report required under 
subsection (a): 
‘‘(1) Eligibility criteria, enrollment, and reten-
tion data (including data with respect to continuity 
of coverage or duration of benefits). 
‘‘(2) Data regarding the extent to which the 
State uses process measures with respect to deter-
mining the eligibility of children under the State 
child health plan, including measures such as 12- 
month continuous eligibility, self-declaration of in-
come for applications or renewals, or presumptive 
eligibility.
221 
‘‘(3) Data regarding denials of eligibility and 
redeterminations of eligibility. 
‘‘(4) Data regarding access to primary and spe-
cialty services, access to networks of care, and care 
coordination provided under the State child health 
plan, using quality care and consumer satisfaction 
measures included in the Consumer Assessment of 
Healthcare Providers and Systems (CAHPS) survey. 
‘‘(5) If the State provides child health assist-
ance in the form of premium assistance for the pur-
chase of coverage under a group health plan, data 
regarding the provision of such assistance, including 
the extent to which employer-sponsored health insur-
ance coverage is available for children eligible for 
child health assistance under the State child health 
plan, the range of the monthly amount of such as-
sistance provided on behalf of a child or family, the 
number of children or families provided such assist-
ance on a monthly basis, the income of the children 
or families provided such assistance, the benefits 
and cost-sharing protection provided under the State 
child health plan to supplement the coverage pur-
chased with such premium assistance, the effective 
strategies the State engages in to reduce any admin-
istrative barriers to the provision of such assistance,
222 
and, the effects, if any, of the provision of such as-
sistance on preventing the coverage provided under 
the State child health plan from substituting for cov-
erage provided under employer-sponsored health in-
surance offered in the State. 
‘‘(6) To the extent applicable, a description of 
any State activities that are designed to reduce the 
number of uncovered children in the State, including 
through a State health insurance connector program 
or support for innovative private health coverage ini-
tiatives.’’. 
(b) STANDARDIZED REPORTING FORMAT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary 
shall specify a standardized format for States to use 
for reporting the information required under section 
2108(e) of the Social Security Act, as added by sub-
section (a)(2). 
(2) TRANSITION
PERIOD
FOR
STATES.—Each 
State that is required to submit a report under sub-
section (a) of section 2108 of the Social Security Act 
that includes the information required under sub-
section (e) of such section may use up to 3 reporting 
periods to transition to the reporting of such infor-
223 
mation in accordance with the standardized format 
specified by the Secretary under paragraph (1). 
(c) ADDITIONAL FUNDING FOR THE SECRETARY TO 
IMPROVE TIMELINESS OF DATA REPORTING AND ANAL-
YSIS FOR PURPOSES OF DETERMINING ENROLLMENT IN-
CREASES UNDER MEDICAID AND CHIP.— 
(1) APPROPRIATION.—There is appropriated, 
out of any money in the Treasury not otherwise ap-
propriated, $5,000,000 to the Secretary for fiscal 
year 2008 for the purpose of improving the timeli-
ness of the data reported and analyzed from the 
Medicaid Statistical Information System (MSIS) for 
purposes of providing more timely data on enroll-
ment and eligibility of children under Medicaid and 
CHIP and to provide guidance to States with re-
spect to any new reporting requirements related to 
such improvements. Amounts appropriated under 
this paragraph shall remain available until expended. 
(2) REQUIREMENTS.—The improvements made 
by the Secretary under paragraph (1) shall be de-
signed and implemented (including with respect to 
any necessary guidance for States to report such in-
formation in a complete and expeditious manner) so 
that, beginning no later than October 1, 2008, data 
regarding the enrollment of low-income children (as
224 
defined in section 2110(c)(4) of the Social Security 
Act (42 U.S.C. 1397jj(c)(4)) of a State enrolled in 
the State plan under Medicaid or the State child 
health plan under CHIP with respect to a fiscal year 
shall be collected and analyzed by the Secretary 
within 6 months of submission. 
(d) GAO STUDY AND REPORT ON ACCESS TO PRI-
MARY AND SPECIALITY SERVICES.— 
(1) IN GENERAL.—The Comptroller General of 
the United States shall conduct a study of children’s 
access to primary and specialty services under Med-
icaid and CHIP, including— 
(A) the extent to which providers are will-
ing to treat children eligible for such programs; 
(B) information on such children’s access 
to networks of care; 
(C) geographic availability of primary and 
specialty services under such programs; 
(D) the extent to which care coordination 
is provided for children’s care under Medicaid 
and CHIP; and 
(E) as appropriate, information on the de-
gree of availability of services for children under 
such programs.
225 
(2) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Comptroller Gen-
eral shall submit a report to the Committee on Fi-
nance of the Senate and the Committee on Energy 
and Commerce of the House of Representatives on 
the study conducted under paragraph (1) that in-
cludes recommendations for such Federal and State 
legislative and administrative changes as the Comp-
troller General determines are necessary to address 
any barriers to access to children’s care under Med-
icaid and CHIP that may exist. 
SEC. 403. APPLICATION OF CERTAIN MANAGED CARE 
QUALITY SAFEGUARDS TO CHIP. 
(a) IN GENERAL.—Section 2103(f) of Social Security 
Act (42 U.S.C. 1397bb(f)) is amended by adding at the 
end the following new paragraph: 
‘‘(3) COMPLIANCE WITH MANAGED CARE RE-
QUIREMENTS.—The State child health plan shall 
provide for the application of subsections (a)(4), 
(a)(5), (b), (c), (d), and (e) of section 1932 (relating 
to requirements for managed care) to coverage, 
State agencies, enrollment brokers, managed care 
entities, and managed care organizations under this 
title in the same manner as such subsections apply
226 
to coverage and such entities and organizations 
under title XIX.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to contract years for health 
plans beginning on or after July 1, 2008. 
TITLE V—IMPROVING ACCESS 
TO BENEFITS 
SEC. 501. DENTAL BENEFITS. 
(a) COVERAGE.— 
(1) IN
GENERAL.—Section 2103 (42 U.S.C. 
1397cc) is amended— 
(A) in subsection (a)— 
(i) in the matter before paragraph 
(1), by striking ‘‘subsection (c)(5)’’ and in-
serting ‘‘paragraphs (5) and (7) of sub-
section (c)’’; and 
(ii) in paragraph (1), by inserting ‘‘at 
least’’ after ‘‘that is’’; and 
(B) in subsection (c)— 
(i) by redesignating paragraph (5) as 
paragraph (7); and 
(ii) by inserting after paragraph (4), 
the following: 
‘‘(5) DENTAL BENEFITS.—
227 
‘‘(A) IN GENERAL.—The child health as-
sistance provided to a targeted low-income child 
shall include coverage of dental services nec-
essary to prevent disease and promote oral 
health, restore oral structures to health and 
function, and treat emergency conditions. 
‘‘(B) 
PERMITTING
USE
OF
DENTAL 
BENCHMARK
PLANS
BY
CERTAIN
STATES.—A 
State may elect to meet the requirement of sub-
paragraph (A) through dental coverage that is 
equivalent to a benchmark dental benefit pack-
age described in subparagraph (C). 
‘‘(C) BENCHMARK DENTAL BENEFIT PACK-
AGES.—The benchmark dental benefit packages 
are as follows: 
‘‘(i) FEHBP CHILDREN’S
DENTAL 
COVERAGE.—A dental benefits plan under 
chapter 89A of title 5, United States Code, 
that has been selected most frequently by 
employees seeking dependent coverage, 
among such plans that provide such de-
pendent coverage, in either of the previous 
2 plan years. 
‘‘(ii) STATE
EMPLOYEE
DEPENDENT 
DENTAL
COVERAGE.—A dental benefits
228 
plan that is offered and generally available 
to State employees in the State involved 
and that has been selected most frequently 
by employees seeking dependent coverage, 
among such plans that provide such de-
pendent coverage, in either of the previous 
2 plan years. 
‘‘(iii) COVERAGE OFFERED THROUGH 
COMMERCIAL
DENTAL
PLAN.—A dental 
benefits plan that has the largest insured 
commercial, non-medicaid enrollment of 
dependent covered lives of such plans that 
is offered in the State involved.’’. 
(2) ASSURING
ACCESS
TO
CARE.—Section 
2102(a)(7)(B) (42 U.S.C. 1397bb(c)(2)) is amended 
by inserting ‘‘and services described in section 
2103(c)(5)’’ after ‘‘emergency services’’. 
(3) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to coverage of items 
and services furnished on or after October 1, 2008. 
(b) 
DENTAL
EDUCATION
FOR
PARENTS
OF 
NEWBORNS.—The Secretary shall develop and implement, 
through entities that fund or provide perinatal care serv-
ices to targeted low-income children under a State child 
health plan under title XXI of the Social Security Act,
229 
a program to deliver oral health educational materials that 
inform new parents about risks for, and prevention of, 
early childhood caries and the need for a dental visit with-
in their newborn’s first year of life. 
(c) PROVISION
OF DENTAL SERVICES THROUGH 
FQHCS.— 
(1) MEDICAID.—Section 1902(a) (42 U.S.C. 
1396a(a)) is amended— 
(A) by striking ‘‘and’’ at the end of para-
graph (69); 
(B) by striking the period at the end of 
paragraph (70) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (70) the 
following new paragraph: 
‘‘(71) provide that the State will not prevent a 
Federally-qualified health center from entering into 
contractual relationships with private practice dental 
providers in the provision of Federally-qualified 
health center services.’’. 
(2) CHIP.—Section 2107(e)(1) (42 U.S.C. 
1397g(e)(1)), as amended by subsections (a)(2) and 
(d)(2) of section 203, is amended by inserting after 
subparagraph (B) the following new subparagraph 
(and redesignating the succeeding subparagraphs ac-
cordingly):
230 
‘‘(C) Section 1902(a)(71) (relating to lim-
iting FQHC contracting for provision of dental 
services).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on January 1, 
2008. 
(d) 
REPORTING
INFORMATION
ON
DENTAL 
HEALTH.— 
(1) 
MEDICAID.—Section 
1902(a)(43)(D)(iii) 
(42 U.S.C. 1396a(a)(43)(D)(iii)) is amended by in-
serting ‘‘and other information relating to the provi-
sion of dental services to such children described in 
section 2108(e)’’ after ‘‘receiving dental services,’’. 
(2) CHIP.—Section 2108 (42 U.S.C. 1397hh) 
is amended by adding at the end the following new 
subsection: 
‘‘(e) INFORMATION ON DENTAL CARE FOR CHIL-
DREN.— 
‘‘(1) IN GENERAL.—Each annual report under 
subsection (a) shall include the following information 
with respect to care and services described in section 
1905(r)(3) provided to targeted low-income children 
enrolled in the State child health plan under this 
title at any time during the year involved:
231 
‘‘(A) The number of enrolled children by 
age grouping used for reporting purposes under 
section 1902(a)(43). 
‘‘(B) For children within each such age 
grouping, information of the type contained in 
questions 12(a)–(c) of CMS Form 416 (that 
consists of the number of enrolled targeted low 
income children who receive any, preventive, or 
restorative dental care under the State plan). 
‘‘(C) For the age grouping that includes 
children 8 years of age, the number of such 
children who have received a protective sealant 
on at least one permanent molar tooth. 
‘‘(2) INCLUSION OF INFORMATION ON ENROLL-
EES IN MANAGED CARE PLANS.—The information 
under paragraph (1) shall include information on 
children who are enrolled in managed care plans and 
other private health plans and contracts with such 
plans under this title shall provide for the reporting 
of such information by such plans to the State.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall be effective for annual re-
ports submitted for years beginning after date of en-
actment.
234 
networks that serve special needs children; 
and 
(iii) geographic availability of oral 
health care, including preventive and re-
storative services, under such programs; 
and 
(C) the feasibility and appropriateness of 
using qualified mid-level dental health pro-
viders, in coordination with dentists, to improve 
access for children to oral health services and 
public health overall. 
(2) REPORT.—Not later than 18 months year 
after the date of the enactment of this Act, the 
Comptroller General shall submit to Congress a re-
port on the study conducted under paragraph (1). 
The report shall include recommendations for such 
Federal and State legislative and administrative 
changes as the Comptroller General determines are 
necessary to address any barriers to access to oral 
health care, including preventive and restorative 
services, under Medicaid and CHIP that may exist. 
SEC. 502. MENTAL HEALTH PARITY IN CHIP PLANS. 
(a) ASSURANCE OF PARITY.—Section 2103(c) (42 
U.S.C. 1397cc(c)), as amended by section 501(a)(1)(B), 
is amended by inserting after paragraph (5), the following:
235 
‘‘(6) MENTAL HEALTH SERVICES PARITY.— 
‘‘(A) IN GENERAL.—In the case of a State 
child health plan that provides both medical 
and surgical benefits and mental health or sub-
stance abuse benefits, such plan shall ensure 
that the financial requirements and treatment 
limitations applicable to such mental health or 
substance abuse benefits are no more restrictive 
than the financial requirements and treatment 
limitations applied to substantially all medical 
and surgical benefits covered by the plan. 
‘‘(B) DEEMED COMPLIANCE.—To the ex-
tent that a State child health plan includes cov-
erage with respect to an individual described in 
section 1905(a)(4)(B) and covered under the 
State plan under section 1902(a)(10)(A) of the 
services described in section 1905(a)(4)(B) (re-
lating to early and periodic screening, diag-
nostic, and treatment services defined in section 
1905(r)) and provided in accordance with sec-
tion 1902(a)(43), such plan shall be deemed to 
satisfy the requirements of subparagraph (A).’’. 
(b) CONFORMING AMENDMENTS.—Section 2103 (42 
U.S.C. 1397cc) is amended—
236 
(1) in subsection (a), as amended by section 
501(a)(1)(A)(i), in the matter preceding paragraph 
(1), by inserting ‘‘, (6),’’ after ‘‘(5)’’; and 
(2) in subsection (c)(2), by striking subpara-
graph (B) and redesignating subparagraphs (C) and 
(D) as subparagraphs (B) and (C), respectively. 
SEC. 503. APPLICATION OF PROSPECTIVE PAYMENT SYS-
TEM FOR SERVICES PROVIDED BY FEDER-
ALLY-QUALIFIED 
HEALTH 
CENTERS 
AND 
RURAL HEALTH CLINICS. 
(a) APPLICATION OF PROSPECTIVE PAYMENT SYS-
TEM.— 
(1) IN
GENERAL.—Section 2107(e)(1) (42 
U.S.C. 1397gg(e)(1)), as amended by section 
501(c)(2) is amended by inserting after subpara-
graph (C) the following new subparagraph (and re-
designating the succeeding subparagraphs accord-
ingly): 
‘‘(D) Section 1902(bb) (relating to pay-
ment for services provided by Federally-quali-
fied health centers and rural health clinics).’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to services provided on 
or after October 1, 2008. 
(b) TRANSITION GRANTS.—
237 
(1) APPROPRIATION.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
priated to the Secretary for fiscal year 2008, 
$5,000,000, to remain available until expended, for 
the purpose of awarding grants to States with State 
child health plans under CHIP that are operated 
separately from the State Medicaid plan under title 
XIX of the Social Security Act (including any waiver 
of such plan), or in combination with the State Med-
icaid plan, for expenditures related to transitioning 
to compliance with the requirement of section 
2107(e)(1)(D) of the Social Security Act (as added 
by subsection (a)) to apply the prospective payment 
system established under section 1902(bb) of the 
such Act (42 U.S.C. 1396a(bb)) to services provided 
by Federally-qualified health centers and rural 
health clinics. 
(2) MONITORING AND REPORT.—The Secretary 
shall monitor the impact of the application of such 
prospective payment system on the States described 
in paragraph (1) and, not later than October 1, 
2010, shall report to Congress on any effect on ac-
cess to benefits, provider payment rates, or scope of 
benefits offered by such States as a result of the ap-
plication of such payment system.
238 
SEC. 504. PREMIUM GRACE PERIOD. 
(a) IN GENERAL.—Section 2103(e)(3) (42 U.S.C. 
1397cc(e)(3)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(C) PREMIUM GRACE PERIOD.—The State 
child health plan— 
‘‘(i) shall afford individuals enrolled 
under the plan a grace period of at least 
30 days from the beginning of a new cov-
erage period to make premium payments 
before the individual’s coverage under the 
plan may be terminated; and 
‘‘(ii) shall provide to such an indi-
vidual, not later than 7 days after the first 
day of such grace period, notice— 
‘‘(I) that failure to make a pre-
mium payment within the grace pe-
riod will result in termination of cov-
erage under the State child health 
plan; and 
‘‘(II) of the individual’s right to 
challenge the proposed termination 
pursuant to the applicable Federal 
regulations. 
For purposes of clause (i), the term ‘new cov-
erage period’ means the month immediately fol-
239 
lowing the last month for which the premium 
has been paid.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to new coverage periods begin-
ning on or after January 1, 2009. 
SEC. 505. DEMONSTRATION PROJECTS RELATING TO DIA-
BETES PREVENTION. 
There is authorized to be appropriated $15,000,000 
during the period of fiscal years 2008 through 2012 to 
fund demonstration projects in up to 10 States over 3 
years for voluntary incentive programs to promote chil-
dren’s receipt of relevant screenings and improvements in 
healthy eating and physical activity with the aim of reduc-
ing the incidence of type 2 diabetes. Such programs may 
involve reductions in cost-sharing or premiums when chil-
dren receive regular screening and reach certain bench-
marks in healthy eating and physical activity. Under such 
programs, a State may also provide financial bonuses for 
partnerships with entities, such as schools, which increase 
their education and efforts with respect to reducing the 
incidence of type 2 diabetes and may also devise incentives 
for providers serving children covered under this title and 
title XIX to perform relevant screening and counseling re-
garding healthy eating and physical activity. Upon comple-
tion of these demonstrations, the Secretary shall provide
246 
cific sample sizes for application of the PERM require-
ments with respect to State child health plans for fiscal 
years beginning with fiscal year 2009, on the basis of such 
information as the Secretary determines appropriate. In 
establishing such sample sizes, the Secretary shall, to the 
greatest extent practicable— 
(1) minimize the administrative cost burden on 
States under Medicaid and CHIP; and 
(2) maintain State flexibility to manage such 
programs. 
SEC. 602. IMPROVING DATA COLLECTION. 
(a) 
INCREASED
APPROPRIATION.—Section 
2109(b)(2) (42 U.S.C. 1397ii(b)(2)) is amended by strik-
ing ‘‘$10,000,000 for fiscal year 2000’’ and inserting 
‘‘$20,000,000 for fiscal year 2008’’. 
(b) USE OF ADDITIONAL FUNDS.—Section 2109(b) 
(42 U.S.C. 1397ii(b)), as amended by subsection (a), is 
amended— 
(1) by redesignating paragraph (2) as para-
graph (4); and 
(2) by inserting after paragraph (1), the fol-
lowing new paragraphs: 
‘‘(2) ADDITIONAL REQUIREMENTS.—In addition 
to making the adjustments required to produce the 
data described in paragraph (1), with respect to
247 
data collection occurring for fiscal years beginning 
with fiscal year 2008, in appropriate consultation 
with the Secretary of Health and Human Services, 
the Secretary of Commerce shall do the following: 
‘‘(A) Make appropriate adjustments to the 
Current Population Survey to develop more ac-
curate State-specific estimates of the number of 
children enrolled in health coverage under title 
XIX or this title. 
‘‘(B) Make appropriate adjustments to the 
Current Population Survey to improve the sur-
vey estimates used to determine the child popu-
lation 
growth 
factor 
under 
section 
2104(i)(5)(B) and any other data necessary for 
carrying out this title. 
‘‘(C) Include health insurance survey infor-
mation in the American Community Survey re-
lated to children. 
‘‘(D) Assess whether American Community 
Survey estimates, once such survey data are 
first available, produce more reliable estimates 
than the Current Population Survey with re-
spect to the purposes described in subparagraph 
(B).
248 
‘‘(E) On the basis of the assessment re-
quired under subparagraph (D), recommend to 
the Secretary of Health and Human Services 
whether American Community Survey estimates 
should be used in lieu of, or in some combina-
tion with, Current Population Survey estimates 
for the purposes described in subparagraph (B). 
‘‘(F) Continue making the adjustments de-
scribed in the last sentence of paragraph (1) 
with respect to expansion of the sample size 
used in State sampling units, the number of 
sampling units in a State, and using an appro-
priate verification element. 
‘‘(3) AUTHORITY
FOR
THE
SECRETARY
OF 
HEALTH AND HUMAN SERVICES TO TRANSITION TO 
THE USE OF ALL, OR SOME COMBINATION OF, ACS 
ESTIMATES UPON RECOMMENDATION OF THE SEC-
RETARY OF COMMERCE.—If, on the basis of the as-
sessment required under paragraph (2)(D), the Sec-
retary of Commerce recommends to the Secretary of 
Health and Human Services that American Commu-
nity Survey estimates should be used in lieu of, or 
in some combination with, Current Population Sur-
vey estimates for the purposes described in para-
graph (2)(B), the Secretary of Health and Human
249 
Services, in consultation with the States, may pro-
vide for a period during which the Secretary may 
transition from carrying out such purposes through 
the use of Current Population Survey estimates to 
the use of American Community Survey estimates 
(in lieu of, or in combination with the Current Popu-
lation Survey estimates, as recommended), provided 
that any such transition is implemented in a manner 
that is designed to avoid adverse impacts upon 
States with approved State child health plans under 
this title.’’. 
SEC. 603. UPDATED FEDERAL EVALUATION OF CHIP. 
Section 2108(c) (42 U.S.C. 1397hh(c)) is amended 
by striking paragraph (5) and inserting the following: 
‘‘(5) SUBSEQUENT
EVALUATION
USING
UP-
DATED INFORMATION.— 
‘‘(A) IN
GENERAL.—The Secretary, di-
rectly or through contracts or interagency 
agreements, shall conduct an independent sub-
sequent evaluation of 10 States with approved 
child health plans. 
‘‘(B) SELECTION
OF
STATES
AND
MAT-
TERS INCLUDED.—Paragraphs (2) and (3) shall 
apply to such subsequent evaluation in the
250 
same manner as such provisions apply to the 
evaluation conducted under paragraph (1). 
‘‘(C) SUBMISSION
TO
CONGRESS.—Not 
later than December 31, 2010, the Secretary 
shall submit to Congress the results of the eval-
uation conducted under this paragraph. 
‘‘(D) FUNDING.—Out of any money in the 
Treasury of the United States not otherwise ap-
propriated, there are appropriated $10,000,000 
for fiscal year 2009 for the purpose of con-
ducting the evaluation authorized under this 
paragraph. Amounts appropriated under this 
subparagraph shall remain available for expend-
iture through fiscal year 2011.’’. 
SEC. 604. ACCESS TO RECORDS FOR IG AND GAO AUDITS 
AND EVALUATIONS. 
Section 2108(d) (42 U.S.C. 1397hh(d)) is amended 
to read as follows: 
‘‘(d) ACCESS TO RECORDS FOR IG AND GAO AUDITS 
AND EVALUATIONS.—For the purpose of evaluating and 
auditing the program established under this title, or title 
XIX, the Secretary, the Office of Inspector General, and 
the Comptroller General shall have access to any books, 
accounts, records, correspondence, and other documents 
that are related to the expenditure of Federal funds under
251 
this title and that are in the possession, custody, or control 
of States receiving Federal funds under this title or polit-
ical subdivisions thereof, or any grantee or contractor of 
such States or political subdivisions.’’. 
SEC. 605. NO FEDERAL FUNDING FOR ILLEGAL ALIENS; DIS-
ALLOWANCE FOR UNAUTHORIZED EXPENDI-
TURES. 
Nothing in this Act allows Federal payment for indi-
viduals who are not legal residents. Titles XI, XIX, and 
XXI of the Social Security Act provide for the disallow-
ance of Federal financial participation for erroneous ex-
penditures under Medicaid and under CHIP, respectively. 
Subtitle B—Miscellaneous Health 
Provisions 
SEC. 611. DEFICIT REDUCTION ACT TECHNICAL CORREC-
TIONS. 
(a) CLARIFICATION OF REQUIREMENT TO PROVIDE 
EPSDT SERVICES FOR ALL CHILDREN IN BENCHMARK 
BENEFIT
PACKAGES
UNDER
MEDICAID.—Section 
1937(a)(1) (42 U.S.C. 1396u–7(a)(1)), as inserted by sec-
tion 6044(a) of the Deficit Reduction Act of 2005 (Public 
Law 109–171, 120 Stat. 88), is amended— 
(1) in subparagraph (A)— 
(A) in the matter before clause (i)—
252 
(i) by striking ‘‘Notwithstanding any 
other provision of this title’’ and inserting 
‘‘Notwithstanding section 1902(a)(1) (re-
lating 
to 
statewideness), 
section 
1902(a)(10)(B) (relating to comparability) 
and any other provision of this title which 
would be directly contrary to the authority 
under this section and subject to sub-
section (E)’’; and 
(ii) by striking ‘‘enrollment in cov-
erage that provides’’ and inserting ‘‘cov-
erage that’’; 
(B) in clause (i), by inserting ‘‘provides’’ 
after ‘‘(i)’’; and 
(C) by striking clause (ii) and inserting the 
following: 
‘‘(ii) for any individual described in 
section 1905(a)(4)(B) who is eligible under 
the State plan in accordance with para-
graphs (10) and (17) of section 1902(a), 
consists of the items and services described 
in section 1905(a)(4)(B) (relating to early 
and periodic screening, diagnostic, and 
treatment 
services 
defined 
in 
section
253 
1905(r)) and provided in accordance with 
the requirements of section 1902(a)(43).’’; 
(2) in subparagraph (C)— 
(A) in the heading, by striking ‘‘WRAP- 
AROUND’’ and inserting ‘‘ADDITIONAL’’; and 
(B) by striking ‘‘wrap-around or’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(E) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as— 
‘‘(i) requiring a State to offer all or 
any of the items and services required by 
subparagraph (A)(ii) through an issuer of 
benchmark coverage described in sub-
section (b)(1) or benchmark equivalent 
coverage described in subsection (b)(2); 
‘‘(ii) preventing a State from offering 
all or any of the items and services re-
quired by subparagraph (A)(ii) through an 
issuer of benchmark coverage described in 
subsection (b)(1) or benchmark equivalent 
coverage described in subsection (b)(2); or 
‘‘(iii) affecting a child’s entitlement to 
care and services described in subsections 
(a)(4)(B) and (r) of section 1905 and pro-
254 
vided 
in 
accordance 
with 
section 
1902(a)(43) whether provided through 
benchmark coverage, benchmark equivalent 
coverage, or otherwise.’’. 
(b) CORRECTION OF REFERENCE TO CHILDREN IN 
FOSTER CARE RECEIVING CHILD WELFARE SERVICES.— 
Section 
1937(a)(2)(B)(viii) 
(42 
U.S.C. 
1396u– 
7(a)(2)(B)(viii), as inserted by section 6044(a) of the Def-
icit Reduction Act of 2005, is amended by striking ‘‘aid 
or assistance is made available under part B of title IV 
to children in foster care and individuals’’ and inserting 
‘‘child welfare services are made available under part B 
of title IV on the basis of being a child in foster care or’’. 
(c) TRANSPARENCY.—Section 1937 (42 U.S.C. 
1396u–7), as inserted by section 6044(a) of the Deficit 
Reduction Act of 2005, is amended by adding at the end 
the following: 
‘‘(c) PUBLICATION
OF PROVISIONS AFFECTED.— 
With respect to a State plan amendment to provide bench-
mark benefits in accordance with subsections (a) and (b) 
that is approved by the Secretary, the Secretary shall pub-
lish on the Internet website of the Centers for Medicare 
& Medicaid Services, a list of the provisions of this title 
that the Secretary has determined do not apply in order 
to enable the State to carry out the plan amendment and
255 
the reason for each such determination on the date such 
approval is made, and shall publish such list in the Fed-
eral Register and not later than 30 days after such date 
of approval.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
subsections (a), (b), and (c) of this section shall take effect 
as if included in the amendment made by section 6044(a) 
of the Deficit Reduction Act of 2005. 
SEC. 612. REFERENCES TO TITLE XXI. 
Section 704 of the Medicare, Medicaid, and SCHIP 
Balanced Budget Refinement Act of 1999, as enacted into 
law by division B of Public Law 106–113 (113 Stat. 
1501A–402) is repealed. 
SEC. 613. PROHIBITING INITIATION OF NEW HEALTH OP-
PORTUNITY ACCOUNT DEMONSTRATION PRO-
GRAMS. 
After the date of the enactment of this Act, the Sec-
retary of Health and Human Services may not approve 
any new demonstration programs under section 1938 of 
the Social Security Act (42 U.S.C. 1396u–8). 
SEC. 614. COUNTY MEDICAID HEALTH INSURING ORGANI-
ZATIONS; GAO REPORT ON MEDICAID MAN-
AGED CARE PAYMENT RATES. 
(a) IN GENERAL.—Section 9517(c)(3) of the Consoli-
dated Omnibus Budget Reconciliation Act of 1985 (42
256 
U.S.C. 1396b note), as added by section 4734 of the Om-
nibus Budget Reconciliation Act of 1990 and as amended 
by section 704 of the Medicare, Medicaid, and SCHIP 
Benefits Improvement and Protection Act of 2000, is 
amended— 
(1) in subparagraph (A), by inserting ‘‘, in the 
case of any health insuring organization described in 
such subparagraph that is operated by a public enti-
ty established by Ventura County, and in the case 
of any health insuring organization described in such 
subparagraph that is operated by a public entity es-
tablished by Merced County’’ after ‘‘described in 
subparagraph (B)’’; and 
(2) in subparagraph (C), by striking ‘‘14 per-
cent’’ and inserting ‘‘16 percent’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act. 
(c) GAO REPORT ON ACTUARIAL SOUNDNESS OF 
MEDICAID MANAGED CARE PAYMENT RATES.—Not later 
than 18 months after the date of the enactment of this 
Act, the Comptroller General of the United States shall 
submit a report to the Committee on Finance of the Sen-
ate and the Committee on Energy and Commerce of the 
House of Representatives analyzing the extent to which
257 
State payment rates for medicaid managed care organiza-
tions under title XIX of the Social Security Act are actu-
arially sound. 
SEC. 615. ADJUSTMENT IN COMPUTATION OF MEDICAID 
FMAP TO DISREGARD AN EXTRAORDINARY 
EMPLOYER PENSION CONTRIBUTION. 
(a) IN GENERAL.—Only for purposes of computing 
the FMAP (as defined in subsection (e)) for a State for 
a fiscal year (beginning with fiscal year 2006) and apply-
ing the FMAP under title XIX of the Social Security Act, 
any significantly disproportionate employer pension or in-
surance fund contribution described in subsection (b) shall 
be disregarded in computing the per capita income of such 
State, but shall not be disregarded in computing the per 
capita income for the continental United States (and Alas-
ka) and Hawaii. 
(b) SIGNIFICANTLY DISPROPORTIONATE EMPLOYER 
PENSION AND INSURANCE FUND CONTRIBUTION.— 
(1) IN GENERAL.—For purposes of this section, 
a significantly disproportionate employer pension 
and insurance fund contribution described in this 
subsection with respect to a State is any identifiable 
employer contribution towards pension or other em-
ployee insurance funds that is estimated to accrue to 
residents of such State for a calendar year (begin-