(1) IN GENERAL.—Section 2102(c)(1) of such Act 
(42 U.S.C. 1397bb(c)(1)) is amended by inserting 
‘‘(through community health workers and others)’’ 
after ‘‘Outreach’’. 
(2) 
IN
FEDERAL
EVALUATION.—Section 
2108(c)(3)(B) 
of 
such 
Act 
(42 
U.S.C. 
1397hh(c)(3)(B)) is amended by inserting ‘‘(such as 
through community health workers and others)’’ after 
‘‘including practices’’. 
Subtitle C—Coverage 
SEC. 121. ENSURING CHILD-CENTERED COVERAGE. 
(a) ADDITIONAL REQUIRED SERVICES.— 
(1) CHILD-CENTERED COVERAGE.—Section 2103 
of the Social Security Act (42 U.S.C. 1397cc) is 
amended—— 
(A) in subsection (a)— 
(i) in the matter before paragraph (1), 
by striking ‘‘subsection (c)(5)’’ and insert-
ing ‘‘paragraphs (5) and (6) of subsection 
(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 (6); and 
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(ii) by inserting after paragraph (4), 
the following: 
‘‘(5) DENTAL, FQHC, AND RHC SERVICES.—The 
child health assistance provided to a targeted low-in-
come child (whether through benchmark coverage or 
benchmark-equivalent coverage or otherwise) shall in-
clude coverage of the following: 
‘‘(A) Dental services necessary to prevent 
disease and promote oral health, restore oral 
structures to health and function, and treat 
emergency conditions. 
‘‘(B) Federally-qualified health center serv-
ices (as defined in section 1905(l)(2)) and rural 
health clinic services (as defined in section 
1905(l)(1)). 
Nothing in this section shall be construed as pre-
venting a State child health plan from providing such 
services as part of benchmark coverage or in addition 
to the benefits provided through benchmark coverage.’’. 
(2) REQUIRED
PAYMENT
FOR
FQHC
AND
RHC 
SERVICES.—Section 2107(e)(1) of such Act (42 U.S.C. 
1397gg(e)(1)), as amended by sections 112(b) and 
112(d)(2), is amended by inserting after subpara-
graph (C) the following new subparagraph: 
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‘‘(D) Section 1902(bb) (relating to payment 
for services provided by Federally-qualified 
health centers and rural health clinics).’’. 
(3) 
MENTAL
HEALTH
PARITY.—Section 
2103(a)(2)(C) 
of 
such 
Act 
(42 
U.S.C. 
1397aa(a)(2)(C)) is amended by inserting ‘‘(or 100 
percent in the case of the category of services described 
in subparagraph (B) of such subsection)’’ after ‘‘75 
percent’’. 
(4) EFFECTIVE DATE.—The amendments made 
by this subsection and subsection (d) shall apply to 
health benefits coverage provided on or after October 
1, 2008. 
(b) CLARIFICATION OF REQUIREMENT TO PROVIDE 
EPSDT SERVICES FOR ALL CHILDREN IN BENCHMARK 
BENEFIT PACKAGES UNDER MEDICAID .— 
(1) IN GENERAL.—Section 1937(a)(1) of the So-
cial Security Act (42 U.S.C. 1396u–7(a)(1)) is 
amended— 
(A) in subparagraph (A)— 
(i) in the matter before clause (i), by 
striking ‘‘Notwithstanding any other provi-
sion of this title’’ and inserting ‘‘Subject to 
subparagraph (E)’’; and 
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(ii) by striking ‘‘enrollment in coverage 
that provides’’ and all that follows and in-
serting ‘‘benchmark coverage described in 
subsection (b)(1) or benchmark equivalent 
coverage described in subsection (b)(2).’’; 
(B) by striking subparagraph (C) and in-
serting the following new subparagraph: 
‘‘(C) STATE
OPTION
TO
PROVIDE
ADDI-
TIONAL BENEFITS.—A State, at its option, may 
provide such additional benefits to benchmark 
coverage described in subsection (b)(1) or bench-
mark equivalent coverage described in subsection 
(b)(2) as the State may specify.’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(E) REQUIRING
COVERAGE
OF
EPSDT 
SERVICES.—Nothing in this paragraph shall be 
construed as affecting a child’s entitlement to 
care and services described in subsections 
(a)(4)(B) and (r) of section 1905 and provided 
in accordance with section 1902(a)(43) whether 
provided through benchmark coverage, bench-
mark equivalent coverage, or otherwise.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall take effect as if included in 
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the amendment made by section 6044(a) of the Deficit 
Reduction Act of 2005. 
(c) CLARIFICATION OF COVERAGE OF SERVICES IN 
SCHOOL-BASED HEALTH CENTERS INCLUDED AS CHILD 
HEALTH ASSISTANCE.— 
(1) IN
GENERAL.—Section 2110(a)(5) of such 
Act (42 U.S.C. 1397jj(a)(5)) is amended by inserting 
after ‘‘health center services’’ the following: ‘‘and 
school-based health center services for which coverage 
is otherwise provided under this title when furnished 
by a school-based health center that is authorized to 
furnish such services under State law’’. 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall apply to child health assistance 
furnished on or after the date of the enactment of this 
Act. 
(d) ASSURING ACCESS TO CARE.— 
(1) STATE
CHILD
HEALTH
PLAN
REQUIRE-
MENT.—Section 2102(a)(7)(B) of such Act (42 U.S.C. 
1397bb(c)(2)) is amended by inserting ‘‘and services 
described in section 2103(c)(5)’’ after ‘‘emergency 
services’’. 
(2) REFERENCE TO EFFECTIVE DATE.—For the 
effective date for the amendments made by this sub-
section, see subsection (a)(5). 
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SEC. 122. IMPROVING BENCHMARK COVERAGE OPTIONS. 
(a) LIMITATION
ON
SECRETARY-APPROVED
COV-
ERAGE.— 
(1) UNDER CHIP.—Section 2103(a)(4) of the So-
cial Security Act (42 U.S.C. 1397cc(a)(4)) is amend-
ed by inserting before the period at the end the fol-
lowing: ‘‘if the health benefits coverage is at least 
equivalent to the benefits coverage in a benchmark 
benefit package described in subsection (b)’’. 
(2) UNDER MEDICAID.—Section 1937(b)(1)(D) of 
the Social Security Act (42 U.S.C. 1396u–7(b)(1)(D)) 
is amended by inserting before the period at the end 
the following: ‘‘if the health benefits coverage is at 
least equivalent to the benefits coverage in benchmark 
coverage described in subparagraph (A), (B), or (C)’’. 
(b) REQUIREMENT FOR MOST POPULAR FAMILY COV-
ERAGE FOR STATE EMPLOYEE COVERAGE BENCHMARK.— 
(1) CHIP.—Section 2103(b)(2) of such Act (42 
U.S.C. 1397(b)(2)) is amended by inserting ‘‘and that 
has been selected most frequently by employees seeking 
dependent coverage, among such plans that provide 
such dependent coverage, in either of the previous 2 
plan years’’ before the period at the end. 
(2) MEDICAID.—Section 1937(b)(1)(B) of such 
Act is amended by inserting ‘‘and that has been se-
lected most frequently, by employees seeking depend-
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ent coverage, among such plans that provide such de-
pendent coverage, in either of the previous 2 plan 
years’’ before the period at the end. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to health benefits coverage provided on 
or after October 1, 2008. 
SEC. 123. PREMIUM GRACE PERIOD. 
(a) IN GENERAL.—Section 2103(e)(3) of the Social Se-
curity Act (42 U.S.C. 1397cc(e)(3)) is amended by adding 
at the end the following 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 coverage 
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 period 
will result in termination of coverage 
under the State child health plan; and 
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‘‘(II) of the individual’s right to 
challenge the proposed termination 
pursuant to the applicable Federal reg-
ulations. 
For purposes of clause (i), the term ‘new cov-
erage period’ means the month immediately fol-
lowing the last month for which the premium 
has been paid.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply to new coverage periods beginning 
on or after January 1, 2009. 
Subtitle D—Populations 
SEC. 131. OPTIONAL COVERAGE OF OLDER CHILDREN 
UNDER MEDICAID AND CHIP. 
(a) MEDICAID.— 
(1) IN GENERAL.—Section 1902(l)(1)(D) of the 
Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is 
amended by striking ‘‘but have not attained 19 years 
of age’’ and inserting ‘‘but is under 19 years of age 
(or, at the option of a State and subject to section 
131(d) of the Children’s Health and Medicare Protec-
tion Act of 2007, under such higher age, not to exceed 
25 years of age, as the State may elect)’’. 
(2) CONFORMING AMENDMENTS.— 
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(A) Section 1902(e)(3)(A) of such Act (42 
U.S.C. 1396a(e)(3)(A)) is amended by striking 
‘‘18 years of age or younger’’ and inserting 
‘‘under 19 years of age (or under such higher age 
as the State has elected under subsection 
(l)(1)(D))’’. 
(B) Section 1902(e)(12) of such Act (42 
U.S.C. 1396a(e)(12)) is amended by inserting 
‘‘or such higher age as the State has elected 
under subsection (l)(1)(D)’’ after ‘‘19 years of 
age’’. 
(C) Section 1905(a) of such Act (42 U.S.C. 
1396d(a)) is amended, in clause (i), by inserting 
‘‘or under such higher age as the State has elect-
ed under subsection (l)(1)(D)’’ after ‘‘as the State 
may choose’’. 
(D) Section 1920A(b)(1) of such Act (42 
U.S.C. 1396r–1a(b)(1)) is amended by inserting 
‘‘or under such higher age as the State has elect-
ed under section 1902(l)(1)(D)’’ after ‘‘19 years 
of age’’. 
(E) Section 1928(h)(1) of such Act (42 
U.S.C. 1396s(h)(1)) is amended by striking ‘‘18 
years of age or younger’’ and inserting ‘‘under 
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19 years of age or under such higher age as the 
State has elected under section 1902(l)(1)(D)’’. 
(F) Section 1932(a)(2)(A) of such Act (42 
U.S.C. 1396u–2(a)(2)(A)) is amended by insert-
ing ‘‘(or under such higher age as the State has 
elected under section 1902(l)(1)(D))’’ after ‘‘19 
years of age’’. 
(b) TITLE XXI.—Section 2110(c)(1) of such Act (42 
U.S.C. 1397jj(c)(1)) is amended by inserting ‘‘(or, at the 
option of the State and subject to section 131(d) of the Chil-
dren’s Health and Medicare Protection Act of 2007, under 
such higher age as the State has elected under section 
1902(l)(1)(D))’’ after ‘‘19 years of age’’. 
(c) EFFECTIVE DATE.—Subject to subsection (d), the 
amendments made by this section take effect on January 
1, 2010. 
(d) TRANSITION.—In carrying out the amendments 
made by subsections (a) and (b)— 
(1) for 2010, a State election under section 
1902(l)(1)(D) shall only apply with respect to title 
XXI of such Act and the age elected may not exceed 
21 years of age; 
(2) for 2011, a State election under section 
1902(l)(1)(D) may apply under titles XIX and XXI 
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of such Act and the age elected may not exceed 23 
years of age; 
(3) for 2012, a State election under section 
1902(l)(1)(D) may apply under titles XIX and XXI 
of such Act and the age elected may not exceed 24 
years of age; and 
(4) for 2013 and each subsequent year, a State 
election under section 1902(l)(1)(D) may apply under 
titles XIX and XXI of such Act and the age elected 
may not exceed 25 years of age. 
SEC. 132. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 
UNDER THE MEDICAID PROGRAM AND CHIP. 
(a) MEDICAID PROGRAM.—Section 1903(v) of the So-
cial Security Act (42 U.S.C. 1396b(v)) is amended— 
(1) in paragraph (1), by striking ‘‘paragraph 
(2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(4)(A) A State may elect (in a plan amendment 
under this title) to provide medical assistance under this 
title, notwithstanding sections 401(a), 402(b), 403, and 421 
of the Personal Responsibility and Work Opportunity Rec-
onciliation Act of 1996, for aliens who are lawfully residing 
in the United States (including battered aliens described 
in section 431(c) of such Act) and who are otherwise eligible 
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for such assistance, within either or both of the following 
eligibility categories: 
‘‘(i) PREGNANT WOMEN.—Women during preg-
nancy (and during the 60-day period beginning on 
the last day of the pregnancy). 
‘‘(ii) CHILDREN.—Individuals under age 19 (or 
such higher age as the State has elected under section 
1902(l)(1)(D)), including optional targeted low-in-
come children described in section 1905(u)(2)(B). 
‘‘(B) In the case of a State that has elected to provide 
medical assistance to a category of aliens under subpara-
graph (A), no debt shall accrue under an affidavit of sup-
port against any sponsor of such an alien on the basis of 
provision of medical assistance to such category and the cost 
of such assistance shall not be considered as an unreim-
bursed cost.’’. 
(b) CHIP.—Section 2107(e)(1) of such Act (42 U.S.C. 
1397gg(e)(1)), as amended by section 112(b), 112(d)(2),and 
121(a)(2), is amended by inserting after subparagraph (E) 
the following new subparagraphs: 
‘‘(F) Section 1903(v)(4)(A) (relating to op-
tional coverage of certain categories of lawfully 
residing immigrants), insofar as it relates to the 
category of pregnant women described in clause 
(i) of such section, but only if the State has elect-
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ed to apply such section with respect to such 
women under title XIX and the State has elected 
the option under section 2111 to provide assist-
ance for pregnant women under this title. 
‘‘(G) Section 1903(v)(4)(A) (relating to op-
tional coverage of categories of lawfully residing 
immigrants), insofar as it relates to the category 
of children described in clause (ii) of such sec-
tion, but only if the State has elected to apply 
such section with respect to such children under 
title XIX.’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section take effect on the date of the enactment of this Act. 
SEC. 133. STATE OPTION TO EXPAND OR ADD COVERAGE OF 
CERTAIN PREGNANT WOMEN UNDER CHIP. 
(a) CHIP.— 
(1) COVERAGE.—Title XXI (42 U.S.C. 1397aa et 
seq.) of the Social Security Act is amended by adding 
at the end the following new section: 
‘‘SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-IN-
COME PREGNANT WOMEN. 
‘‘(a) OPTIONAL
COVERAGE.—Notwithstanding any 
other provision of this title, a State may provide for cov-
erage, through an amendment to its State child health plan 
under section 2102, of assistance for pregnant women for 
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targeted low-income pregnant women in accordance with 
this section, but only if— 
‘‘(1) the State has established an income eligi-
bility level— 
‘‘(A) for pregnant women, under any of 
clauses (i)(III), (i)(IV), or (ii)(IX) of section 
1902(a)(10)(A), that is at least 185 percent (or 
such higher percent as the State has in effect for 
pregnant women under this title) of the poverty 
line applicable to a family of the size involved, 
but in no case a percent lower than the percent 
in effect under any such clause as of July 1, 
2007; and 
‘‘(B) for children under 19 years of age 
under this title (or title XIX) that is at least 200 
percent of the poverty line applicable to a family 
of the size involved; and 
‘‘(2) the State does not impose, with respect to 
the enrollment under the State child health plan of 
targeted low-income children during the quarter, any 
enrollment cap or other numerical limitation on en-
rollment, any waiting list, any procedures designed to 
delay the consideration of applications for enrollment, 
or similar limitation with respect to enrollment. 
‘‘(b) DEFINITIONS.—For purposes of this title: 
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‘‘(1) ASSISTANCE FOR PREGNANT WOMEN.—The 
term ‘assistance for pregnant women’ has the mean-
ing given the term child health assistance in section 
2110(a) as if any reference to targeted low-income 
children were a reference to targeted low-income preg-
nant women. 
‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT 
WOMAN.—The term ‘targeted low-income pregnant 
woman’ means a woman— 
‘‘(A) during pregnancy and through the end 
of the month in which the 60-day period (begin-
ning on the last day of her pregnancy) ends; 
‘‘(B) whose family income exceeds 185 per-
cent (or, if higher, the percent applied under sub-
section (a)(1)(A)) of the poverty level applicable 
to a family of the size involved, but does not ex-
ceed the income eligibility level established under 
the State child health plan under this title for a 
targeted low-income child; and 
‘‘(C) who satisfies the requirements of para-
graphs (1)(A), (1)(C), (2), and (3) of section 
2110(b), applied as if any reference to a child 
was a reference to a pregnant woman. 
‘‘(c) REFERENCES TO TERMS AND SPECIAL RULES.— 
In the case of, and with respect to, a State providing for 
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coverage of assistance for pregnant women to targeted low- 
income pregnant women under subsection (a), the following 
special rules apply: 
‘‘(1) Any reference in this title (other than in 
subsection (b)) to a targeted low-income child is 
deemed to include a reference to a targeted low-in-
come pregnant woman. 
‘‘(2) Any reference in this title to child health as-
sistance (other than with respect to the provision of 
early and periodic screening, diagnostic, and treat-
ment services) with respect to such women is deemed 
a reference to assistance for pregnant women. 
‘‘(3) Any such reference (other than in section 
2105(d)) to a child is deemed a reference to a woman 
during pregnancy and the period described in sub-
section (b)(2)(A). 
‘‘(4) In applying section 2102(b)(3)(B), any ref-
erence to children found through screening to be eligi-
ble for medical assistance under the State medicaid 
plan under title XIX is deemed a reference to preg-
nant women. 
‘‘(5) There shall be no exclusion of benefits for 
services described in subsection (b)(1) based on any 
preexisting condition and no waiting period (includ-
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ing any waiting period imposed to carry out section 
2102(b)(3)(C)) shall apply. 
‘‘(6) In applying section 2103(e)(3)(B) in the 
case of a pregnant woman provided coverage under 
this section, the limitation on total annual aggregate 
cost-sharing shall be applied to such pregnant 
woman. 
‘‘(7) In applying section 2104(i)— 
‘‘(A) in the case of a State which did not 
provide for coverage for pregnant women under 
this title (under a waiver or otherwise) during 
fiscal year 2007, the allotment amount otherwise 
computed for the first fiscal year in which the 
State elects to provide coverage under this section 
shall be increased by an amount (determined by 
the Secretary) equal to the enhanced FMAP of 
the expenditures under this title for such cov-
erage, based upon projected enrollment and per 
capita costs of such enrollment; and 
‘‘(B) in the case of a State which provided 
for coverage of pregnant women under this title 
for the previous fiscal year— 
‘‘(i) in applying paragraph (2)(B) of 
such section, there shall also be taken into 
account (in an appropriate proportion) the 
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percentage increase in births in the State 
for the relevant period; and 
‘‘(ii) in applying paragraph (3), preg-
nant women (and per capita expenditures 
for such women) shall be accounted for sepa-
rately from children, but shall be included 
in the total amount of any allotment adjust-
ment under such paragraph. 
‘‘(d) AUTOMATIC ENROLLMENT FOR CHILDREN BORN 
TO
WOMEN
RECEIVING
ASSISTANCE
FOR
PREGNANT 
WOMEN.—If a child is born to a targeted low-income preg-
nant woman who was receiving assistance for pregnant 
women 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 on the date of such birth, based on the mother’s reported 
income as of the time of her enrollment under this section 
and applicable income eligibility levels under this title and 
title XIX, and to remain eligible for such assistance until 
the child attains 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 assistance for 
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pregnant women or medical assistance eligibility identifica-
tion number of the mother shall also serve as the identifica-
tion number of the child, and all claims shall be submitted 
and paid under such number (unless the State issues a sep-
arate identification number for the child before such period 
expires).’’. 
(2) 
ADDITIONAL
AMENDMENT.—Section 
2107(e)(1)(I) 
of 
such 
Act 
(42 
U.S.C. 
1397gg(e)(1)(H)), as redesignated by section 112(b), 
is amended to read as follows: 
‘‘(I) Sections 1920 and 1920A (relating to 
presumptive eligibility for pregnant women and 
children).’’. 
(b) AMENDMENTS TO MEDICAID.— 
(1) 
ELIGIBILITY
OF
A
NEWBORN.—Section 
1902(e)(4) of the Social Security Act (42 U.S.C. 
1396a(e)(4)) is amended in the first sentence by strik-
ing ‘‘so long as the child is a member of the woman’s 
household and the woman remains (or would remain 
if pregnant) eligible for such assistance’’. 
(2) APPLICATION
OF
QUALIFIED
ENTITIES
TO 
PRESUMPTIVE
ELIGIBILITY
FOR
PREGNANT
WOMEN 
UNDER MEDICAID.—Section 1920(b) of the Social Se-
curity Act (42 U.S.C. 1396r–1(b)) is amended by 
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adding after paragraph (2) the following flush sen-
tence: 
‘‘The term ‘qualified provider’ also includes a qualified en-
tity, as defined in section 1920A(b)(3).’’. 
SEC. 134. LIMITATION ON WAIVER AUTHORITY TO COVER 
ADULTS. 
Section 2102 of the Social Security Act (42 U.S.C. 
1397bb) is amended by adding at the end the following new 
subsection: 
‘‘(d) LIMITATION ON COVERAGE OF ADULTS.—Not-
withstanding any other provision of this title, the Secretary 
may not, through the exercise of any waiver authority on 
or after January 1, 2008, provide for Federal financial par-
ticipation to a State under this title for health care services 
for individuals who are not targeted low-income children 
or pregnant women unless the Secretary determines that no 
eligible targeted low-income child in the State would be de-
nied coverage under this title for health care services because 
of such eligibility. In making such determination, the Sec-
retary must receive assurances that— 
‘‘(1) there is no waiting list under this title in 
the State for targeted low-income children to receive 
child health assistance under this title; and 
‘‘(2) the State has in place an outreach program 
to reach all targeted low-income children in families 
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with incomes less than 200 percent of the poverty 
line.’’. 
Subtitle E—Access 
SEC. 141. CHILDREN’S ACCESS, PAYMENT, AND EQUALITY 
COMMISSION. 
Title XIX of the Social Security Act is amended by 
inserting before section 1901 the following new section: 
‘‘CHILDREN’S ACCESS, PAYMENT, AND EQUALITY 
COMMISSION 
‘‘SEC. 1900. (a) ESTABLISHMENT.—There is hereby es-
tablished as an agency of Congress the Children’s Access, 
Payment, and Equality Commission (in this section re-
ferred to as the ‘Commission’). 
‘‘(b) DUTIES.— 
‘‘(1) REVIEW OF PAYMENT POLICIES AND ANNUAL 
REPORTS.—The Commission shall— 
‘‘(A) review Federal and State payment 
policies of the Medicaid program established 
under this title (in this section referred to as 
‘Medicaid’) and the State Children’s Health In-
surance Program established under title XXI (in 
this section referred to as ‘CHIP’), including 
topics described in paragraph (2); 
‘‘(B) review access to, and affordability of, 
coverage and services for enrollees under Med-
icaid and CHIP; 
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‘‘(C) make recommendations to Congress 
concerning such policies; 
‘‘(D) by not later than March 1 of each 
year, submit to Congress a report containing the 
results of such reviews and its recommendations 
concerning such policies; and 
‘‘(E) by not later than June 1 of each year, 
submit to Congress a report containing an exam-
ination of issues affecting Medicaid and CHIP, 
including the implications of changes in health 
care delivery in the United States and in the 
market for health care services on such programs. 
‘‘(2) SPECIFIC TOPICS TO BE REVIEWED.—Spe-
cifically, the Commission shall review the following: 
‘‘(A) The factors affecting expenditures for 
services in different sectors (such as physician, 
hospital and other sectors), payment methodolo-
gies, and their relationship to access and quality 
of care for Medicaid and CHIP beneficiaries. 
‘‘(B) The impact of Federal and State Med-
icaid and CHIP payment policies on access to 
services (including dental services) for children 
(including children with disabilities) and other 
Medicaid and CHIP populations. 
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‘‘(C) The impact of Federal and State Med-
icaid and CHIP policies on reducing health dis-
parities, including geographic disparities and 
disparities among minority populations. 
‘‘(D) The overall financial stability of the 
health care safety net, including Federally-quali-
fied health centers, rural health centers, school- 
based clinics, disproportionate share hospitals, 
public hospitals, providers and grantees under 
section 2612(a)(5) of the Public Health Service 
Act (popularly known as the Ryan White CARE 
Act), and other providers that have a patient 
base which includes a disproportionate number 
of uninsured or low-income individuals and the 
impact of CHIP and Medicaid policies on such 
stability. 
‘‘(E) The relation (if any) between payment 
rates for providers and improvement in care for 
children as measured under the children’s health 
quality measurement program established under 
section 151 of the Children’s Health and Medi-
care Protection Act of 2007. 
‘‘(F) The affordability, cost effectiveness, 
and accessibility of services needed by special 
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populations under Medicaid and CHIP as com-
pared with private-sector coverage. 
‘‘(G) The extent to which the operation of 
Medicaid and CHIP ensures access, comparable 
to access under employer-sponsored or other pri-
vate health insurance coverage (or in the case of 
federally-qualified health center services (as de-
fined in section 1905(l)(2)) and rural health 
clinic services (as defined in section 1905(l)(1)), 
access comparable to the access to such services 
under title XIX), for targeted low-income chil-
dren. 
‘‘(H) The effect of demonstrations under sec-
tion 1115, benchmark coverage under section 
1937, and other coverage under section 1938, on 
access to care, affordability of coverage, provider 
ability to achieve children’s health quality per-
formance measures, and access to safety net serv-
ices. 
‘‘(3) COMMENTS ON CERTAIN SECRETARIAL RE-
PORTS.—If the Secretary submits to Congress (or a 
committee of Congress) a report that is required by 
law and that relates to payment policies under Med-
icaid or CHIP, the Secretary shall transmit a copy 
of the report to the Commission. The Commission 
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shall review the report and, not later than 6 months 
after the date of submittal of the Secretary’s report to 
Congress, shall submit to the appropriate committees 
of Congress written comments on such report. Such 
comments may include such recommendations as the 
Commission deems appropriate. 
‘‘(4) AGENDA AND ADDITIONAL REVIEWS.—The 
Commission shall consult periodically with the Chair-
men and Ranking Minority Members of the appro-
priate committees of Congress regarding the Commis-
sion’s agenda and progress towards achieving the 
agenda. The Commission may conduct additional re-
views, and submit additional reports to the appro-
priate committees of Congress, from time to time on 
such topics relating to the program under this title or 
title XXI as may be requested by such Chairmen and 
Members and as the Commission deems appropriate. 
‘‘(5) AVAILABILITY OF REPORTS.—The Commis-
sion shall transmit to the Secretary a copy of each re-
port submitted under this subsection and shall make 
such reports available to the public. 
‘‘(6) APPROPRIATE COMMITTEE OF CONGRESS.— 
For purposes of this section, the term ‘appropriate 
committees of Congress’ means the Committees on En-
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ergy and Commerce of the House of Representatives 
and the Committee on Finance of the Senate. 
‘‘(7) VOTING AND REPORTING REQUIREMENTS.— 
With respect to each recommendation contained in a 
report submitted under paragraph (1), each member 
of the Commission shall vote on the recommendation, 
and the Commission shall include, by member, the re-
sults of that vote in the report containing the rec-
ommendation. 
‘‘(8) 
EXAMINATION
OF
BUDGET
CON-
SEQUENCES.—Before making any recommendations, 
the Commission shall examine the budget con-
sequences of such recommendations, directly or 
through consultation with appropriate expert entities. 
‘‘(c) APPLICATION
OF PROVISIONS.—The following 
provisions of section 1805 shall apply to the Commission 
in the same manner as they apply to the Medicare Payment 
Advisory Commission: 
‘‘(1) Subsection (c) (relating to membership), ex-
cept that the membership of the Commission shall also 
include representatives of children, pregnant women, 
individuals with disabilities, seniors, low-income fam-
ilies, and other groups of CHIP and Medicaid bene-
ficiaries. 
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‘‘(2) Subsection (d) (relating to staff and con-
sultants). 
‘‘(3) Subsection (e) (relating to powers). 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) 
REQUEST
FOR
APPROPRIATIONS.—The 
Commission shall submit requests for appropriations 
in the same manner as the Comptroller General sub-
mits requests for appropriations, but amounts appro-
priated for the Commission shall be separate from 
amounts appropriated for the Comptroller General. 
‘‘(2) AUTHORIZATION.—There are authorized to 
be appropriated such sums as may be necessary to 
carry out the provisions of this section.’’. 
SEC. 142. 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 
(CHIP), not later than 18 months after the date of the en-
actment of this Act, the Comptroller General of the United 
States, in consultation with State Medicaid and CHIP di-
rectors and organizations representing program bene-
ficiaries, shall develop a model process for the coordination 
of the enrollment, retention, and coverage under such pro-
grams of children who, because of migration of families, 
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emergency evacuations, educational needs, or otherwise, fre-
quently change their State of residency or otherwise are 
temporarily located outside of the State of their residency. 
(b) REPORT TO CONGRESS.—After development of such 
model process, the Comptroller General shall submit to Con-
gress a report describing additional steps or authority need-
ed to make further improvements to coordinate the enroll-
ment, retention, and coverage under CHIP and Medicaid 
of children described in subsection (a). 
SEC. 143. MEDICAID CITIZENSHIP DOCUMENTATION RE-
QUIREMENTS. 
(a) STATE
OPTION
TO
REQUIRE
CHILDREN
TO 
PRESENT SATISFACTORY DOCUMENTARY EVIDENCE
OF 
PROOF OF CITIZENSHIP OR NATIONALITY FOR PURPOSES 
OF ELIGIBILITY FOR MEDICAID; REQUIREMENT FOR AUDIT-
ING.— 
(1) IN GENERAL.—Section 1902 of the Social Se-
curity Act (42 U.S.C. 1396a) is amended— 
(A) in subsection (a)(46)— 
(i) by inserting ‘‘(A)’’ after ‘‘(46)’’; 
and 
(ii) by adding at the end the following 
new subparagraphs: 
‘‘(B) at the option of the State, require that, 
with respect to a child under 21 years of age (other 
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