H. R. 976—26 
‘‘(A) NO NEW CHIP WAIVERS.—Notwithstanding section 
1115 or any other provision of this title, except as provided 
in this subsection— 
‘‘(i) the Secretary shall not on or after the date 
of the enactment of the Children’s Health Insurance 
Program Reauthorization Act of 2007 approve or renew 
a waiver, experimental, pilot, or demonstration project 
that would allow funds made available under this title 
to be used to provide child health assistance or other 
health benefits 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 para-
graphs (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 covered by the waiver, 
and the amount of the Federal payment under this 
title. 
‘‘(B) EXTENSION UPON STATE REQUEST.—If an applicable 
existing waiver described in subparagraph (A) would other-
wise expire before October 1, 2009, and the State requests 
an extension of such waiver, the Secretary shall grant 
such an extension, but only, subject to paragraph (2)(A), 
through September 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 ALLOTMENT.—Any State that provides 
child health assistance or health benefits coverage under 
an applicable existing waiver for a parent of a targeted 
low-income child may elect to continue to provide such 
assistance or coverage through fiscal 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 ALLOT-
MENT.—If the State makes an election under subpara-
graph (A), the Secretary shall set aside for the State 
for each such fiscal year an amount equal to the Fed-
eral 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-income children 
enrolled under such waiver for the fiscal year (as cer-
tified by the State and submitted to the Secretary 
by not later than August 31 of the preceding fiscal 
year). In the case of fiscal year 2012, the set aside 
for any State shall be computed separately for each 
period described in subparagraphs (A) and (B) of sec-
tion 2104(a)(15) and any reduction in the allotment
H. R. 976—27 
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 applicable percentage 
determined under clause (iii) or (iv) for expenditures 
in the quarter for providing child health assistance 
or other health benefits coverage to a parent of a 
targeted low-income child. 
‘‘(iii) ENHANCED FMAP ONLY IN FISCAL YEAR 2010 
FOR
STATES
WITH
SIGNIFICANT
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 determined under 
section 2105(b) in the case of a State that meets 
the outreach or coverage benchmarks described 
in any of subparagraph (A), (B), or (C) of paragraph 
(3) for fiscal year 2009; or 
‘‘(II) the Federal medical assistance 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 MATCHING PAYMENT IN 
2011 OR 2012.—For purposes of clause (ii), the applicable 
percentage for any quarter of fiscal year 2011 or 2012 
is equal to— 
‘‘(I) the REMAP percentage if— 
‘‘(aa) the applicable percentage for the 
State under clause (iii) was the enhanced 
FMAP for fiscal year 2009; and 
‘‘(bb) the State met either of the coverage 
benchmarks described in subparagraph (B) or 
(C) of paragraph (3) for the preceding fiscal 
year; or 
‘‘(II) the Federal medical assistance percentage 
(as so determined) in the case of any State to 
which subclause (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 ELIGIBILITY LEVEL 
FOR PARENTS.—No payments shall be made to a State 
from the amount set aside under clause (i) for a fiscal 
year for expenditures for providing child health assist-
ance or health benefits coverage to a parent of a tar-
geted low-income child whose family income exceeds
H. R. 976—28 
the income eligibility level applied under the applicable 
existing waiver to parents of targeted low-income chil-
dren on the date of enactment of the Children’s Health 
Insurance Program Reauthorization Act of 2007. 
‘‘(3) OUTREACH OR COVERAGE BENCHMARKS.—For purposes 
of paragraph (2), the outreach or coverage benchmarks 
described in this paragraph are as follows: 
‘‘(A) SIGNIFICANT
CHILD
OUTREACH
CAMPAIGN.—The 
State— 
‘‘(i) was awarded a grant under section 2113 for 
fiscal year 2009; 
‘‘(ii) implemented 1 or more of the enrollment 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 accurate 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 Secretary 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 sec-
tion— 
‘‘(1) IN
GENERAL.—The term ‘applicable existing waiver’ 
means a waiver, experimental, pilot, or demonstration project 
under section 1115, grandfathered under section 6102(c)(3) of 
the Deficit Reduction 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 coverage 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 during fiscal year 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 guardian. 
‘‘(B) NONPREGNANT CHILDLESS ADULT.—The term ‘non-
pregnant 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 ‘‘:
H. R. 976—29 
‘‘(1) The Secretary’’; 
(ii) in the first sentence, by inserting ‘‘or a parent 
(as defined in section 2111(c)(2)(A)), who is not preg-
nant, of a targeted low-income child’’ before the period; 
(iii) by striking the second sentence; and 
(iv) by adding at the end the following new para-
graph: 
‘‘(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 Insurance Program Reauthorization Act of 
2007 that would waive or modify the requirements of section 
2111.’’. 
(B) Section 6102(c) of the Deficit Reduction 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 Reauthoriza-
tion Act of 2007, nothing’’. 
(b) GAO STUDY AND REPORT.— 
(1) IN GENERAL.—The Comptroller General of the United 
States shall conduct a study of whether— 
(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 
increases 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 Committee 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 described in subparagraph 
(B), the Federal medical assistance percentage (as defined in 
the first sentence of section 1905(b)))’’; and 
(2) by striking subparagraph (B) and inserting the following 
new subparagraph: 
‘‘(B) [reserved]’’. 
(b) AMENDMENTS TO MEDICAID.— 
(1) ELIGIBILITY
OF
A
NEWBORN.—Section 1902(e)(4) (42 
U.S.C. 1396a(e)(4)) is amended in the first sentence by striking 
‘‘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’’.
H. R. 976—30 
(2) APPLICATION OF QUALIFIED ENTITIES TO PRESUMPTIVE 
ELIGIBILITY FOR PREGNANT WOMEN UNDER MEDICAID.—Section 
1920(b) (42 U.S.C. 1396r–1(b)) is amended by adding after 
paragraph (2) the following flush sentence: 
‘‘The term ‘qualified provider’ also includes a qualified entity, as 
defined in section 1920A(b)(3).’’. 
SEC. 114. LIMITATION ON MATCHING RATE FOR STATES THAT PRO-
POSE TO COVER CHILDREN WITH EFFECTIVE FAMILY 
INCOME THAT EXCEEDS 300 PERCENT OF THE POVERTY 
LINE. 
(a) FMAP APPLIED
TO EXPENDITURES.—Section 2105(c) (42 
U.S.C. 1397ee(c)) is amended by adding at the end the following 
new paragraph: 
‘‘(8) LIMITATION ON MATCHING RATE FOR EXPENDITURES FOR 
CHILD
HEALTH
ASSISTANCE
PROVIDED
TO
CHILDREN
WHOSE 
EFFECTIVE FAMILY INCOME EXCEEDS 300 PERCENT OF THE POV-
ERTY LINE.— 
‘‘(A) FMAP APPLIED TO EXPENDITURES.—Except as pro-
vided in subparagraph (B), for fiscal years beginning with 
fiscal year 2008, the Federal medical assistance percentage 
(as determined under section 1905(b) without regard to 
clause (4) of such section) shall be substituted for the 
enhanced FMAP under subsection (a)(1) with respect to 
any expenditures for providing child health assistance or 
health benefits coverage for a targeted low-income child 
whose effective family income would exceed 300 percent 
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 Insurance Program Reauthorization Act of 2007, 
has an approved State plan amendment or waiver to pro-
vide, or has enacted a State law to submit a State plan 
amendment to provide, expenditures described in such 
subparagraph 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 children 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 meth-
odologies 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 RESOURCE ELIGI-
BILITY LEVELS FOR CHILDREN.—Nothing in this Act, the amend-
ments 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 children 
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
H. R. 976—31 
A RESULT OF AN INCOME OR RESOURCE ELIGIBILITY LEVEL EXPAN-
SION.—A State may, notwithstanding the fourth sentence of sub-
section (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 
determined based on the first and third sentences of subsection 
(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 PRI-
VATE 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 Congres-
sional Budget Office that the substitution of CHIP coverage 
for private coverage occurs more frequently for children in 
families at higher income levels. 
(3) Congress agrees with the President that it is appro-
priate that States that expand CHIP eligibility 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 specified in this 
section (and the amendments made by this section) are the 
appropriate policies to address these issues. 
(b) ANALYSES
OF
BEST
PRACTICES
AND
METHODOLOGY
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 submit 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 include 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 dif-
ferent 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.
H. R. 976—32 
(2) IOM REPORT ON METHODOLOGY.—The Secretary shall 
enter into an arrangement with the Institute of Medicine under 
which the Institute submits 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 enactment 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 coverage 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 chil-
dren 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 measurements described in subpara-
graph (A). 
Out of any money in the Treasury not otherwise appropriated, 
there are hereby appropriated $2,000,000 to carry out this 
paragraph for the period 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 RECOMMENDATIONS.—Sec-
tion 2107 (42 U.S.C. 1397gg) is amended by adding at the end 
the following: 
‘‘(g) DEVELOPMENT
OF BEST PRACTICE RECOMMENDATIONS.— 
Within 6 months after the date of receipt of the reports under 
subsections (a) and (b) of section 116 of the Children’s Health 
Insurance Program Reauthorization 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. 
The Secretary, in consultation with States, including Medicaid and 
CHIP directors in States, may from time to time update the best 
practice recommendations and uniform standards set published 
under paragraphs (1) and (2) and shall provide for publication 
and posting of such updated recommendations and standards.’’.
H. R. 976—33 
(d) REQUIREMENT TO ADDRESS CHIP CROWD-OUT; SECRETARIAL 
REVIEW.—Section 2106 (42 U.S.C. 1397ff) is amended by adding 
at the end the following: 
‘‘(f) REQUIREMENT TO ADDRESS CHIP CROWD-OUT; SECRETARIAL 
REVIEW.— 
‘‘(1) IN GENERAL.—Each State that, on or after the best 
practice application date described in paragraph (3), submits 
a plan amendment (or waiver request) to provide for eligibility 
for child health assistance under the State child health plan 
for higher income children described in section 2105(c)(9)(D) 
(relating to children whose effective family income exceeds 300 
percent of the poverty line) shall include with such plan amend-
ment or request a description of how the State— 
‘‘(A) will address CHIP crowd-out for such children; 
and 
‘‘(B) will incorporate recommended best practices 
referred to in such paragraph. 
‘‘(2) APPLICATION TO CERTAIN STATES.—Each State that, 
as of the best practice application date described in paragraph 
(3), has a State child health plan that provides (whether under 
the plan or through a waiver) for eligibility for child health 
assistance for children referred to in paragraph (1) shall submit 
to the Secretary, not later than 6 months after the date of 
such application, a State plan amendment describing how the 
State— 
‘‘(A) will address CHIP crowd-out for such children; 
and 
‘‘(B) will incorporate recommended best practices 
referred to in such paragraph. 
‘‘(3) BEST PRACTICE APPLICATION DATE.—The best practice 
application date described in this paragraph is the date that 
is 6 months after the date of publication of recommendations 
regarding best practices under section 2107(g)(1). 
‘‘(4) SECRETARIAL REVIEW.—The Secretary shall— 
‘‘(A) review each State plan amendment or waiver 
request submitted under paragraph (1) or (2); 
‘‘(B) determine whether the amendment or request 
incorporates recommended best practices referred to in 
paragraph (3); 
‘‘(C) determine whether the State meets the enrollment 
targets required under reference section 2105(c)(9)(C); and 
‘‘(D) notify the State of such determinations.’’. 
(e) LIMITATION ON PAYMENTS FOR STATES COVERING HIGHER 
INCOME
CHILDREN.—Section 2105(c) (42 U.S.C. 1397ee(c)), as 
amended by section 114(a), is amended by adding at the end the 
following new subsection: 
‘‘(9) LIMITATION ON PAYMENTS FOR STATES COVERING HIGHER 
INCOME CHILDREN.— 
‘‘(A) DETERMINATIONS.— 
‘‘(i) IN GENERAL.—The Secretary shall determine, 
for each State that is a higher income eligibility State 
as of April 1 of 2010 and each subsequent year, 
whether the State meets the target rate of coverage 
of low-income children required under subparagraph 
(C) and shall notify the State in that month of such 
determination.
H. R. 976—34 
‘‘(ii) DETERMINATION OF FAILURE.—If the Secretary 
determines in such month that a higher income eligi-
bility State does not meet such target rate of coverage, 
subject to subparagraph (E), no payment shall be made 
as of October 1 of such year on or after October 1, 
2010, under this section for child health assistance 
provided for higher-income children (as defined in 
subparagraph (D)) under the State child health plan 
unless and until the State establishes it is in compli-
ance with such requirement. 
‘‘(B) HIGHER
INCOME
ELIGIBILITY
STATE.—A higher 
income eligibility State described in this clause is a State 
that— 
‘‘(i) applies under its State child health plan an 
eligibility income standard for targeted low-income 
children that exceeds 300 percent of the poverty line; 
or 
‘‘(ii) because of the application of a general exclu-
sion of a block of income that is not determined by 
type of expense or type of income, applies an effective 
income standard under the State child health plan 
for such children that exceeds 300 percent of the pov-
erty line. 
‘‘(C) REQUIREMENT FOR TARGET RATE OF COVERAGE OF 
LOW-INCOME CHILDREN.— 
‘‘(i) IN GENERAL.—The requirement of this subpara-
graph for a State is that the rate of health benefits 
coverage (both private and public) for low-income chil-
dren in the State is not statistically significantly (at 
a p=0.05 level) less than the target rate of coverage 
specified in clause (ii). 
‘‘(ii) TARGET RATE.—The target rate of coverage 
specified in this clause is the average rate (determined 
by the Secretary) of health benefits coverage (both 
private and public) as of January 1, 2010, among the 
10 of the 50 States and the District of Columbia with 
the highest percentage of health benefits coverage (both 
private and public) for low-income children. 
‘‘(iii) STANDARDS
FOR
DATA.— In applying this 
subparagraph, rates of health benefits coverage for 
States shall be determined using the uniform stand-
ards identified by the Secretary under section 
2107(g)(2). 
‘‘(D) HIGHER-INCOME CHILD.—For purposes of this para-
graph, the term ‘higher income child’ means, with respect 
to a State child health plan, a targeted low-income child 
whose family income— 
‘‘(i) exceeds 300 percent of the poverty line; or 
‘‘(ii) would exceed 300 percent of the poverty line 
if there were not taken into account any general exclu-
sion described in subparagraph (B)(ii). 
‘‘(E) NOTICE AND OPPORTUNITY TO COMPLY WITH TARGET 
RATE.—If the Secretary makes a determination described 
in subparagraph (A)(ii) in April of a year, the Secretary— 
‘‘(i) shall provide the State with the opportunity 
to submit and implement a corrective action plan for
H. R. 976—35 
the State to come into compliance with the requirement 
of subparagraph (C) before October 1 of such year; 
‘‘(ii) shall not effect a denial of payment under 
subparagraph (A) on the basis of such determination 
before October 1 of such year; and 
‘‘(iii) shall not effect such a denial if the Secretary 
determines that there is a reasonable likelihood that 
the implementation of such a correction action plan 
will bring the State into compliance with the require-
ment of subparagraph (C).’’. 
(f) TREATMENT OF MEDICAL SUPPORT ORDERS.—Section 2102(b) 
(42 U.S.C. 1397bb(c)) is amended by adding at the end the following: 
‘‘(5) TREATMENT OF MEDICAL SUPPORT ORDERS.— 
‘‘(A) IN GENERAL.—Nothing in this title shall be con-
strued to allow the Secretary to require that a State deny 
eligibility for child health assistance to a child who is 
otherwise eligible on the basis of the existence of a valid 
medical support order being in effect. 
‘‘(B) STATE ELECTION.—A State may elect to limit eligi-
bility for child health assistance to a targeted low-income 
child on the basis of the existence of a valid medical support 
order on the child’s behalf, but only if the State does 
not deny such eligibility for a child on such basis if the 
child asserts that the order is not being complied with 
for any of the reasons described in subparagraph (C) unless 
the State demonstrates that none of such reasons applies 
in the case involved. 
‘‘(C) REASONS
FOR
NONCOMPLIANCE.—The reasons 
described in this subparagraph for noncompliance with a 
medical support order with respect to a child are that 
the child is not being provided health benefits coverage 
pursuant to such order because— 
‘‘(i) of failure of the noncustodial parent 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 gen-
erally unavailable.’’. 
(g) EFFECTIVE DATE OF AMENDMENTS; CONSISTENCY OF POLI-
CIES.—The amendments made by this section 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 
request on the basis of any policy or interpretation relating to 
CHIP crowd-out or medical support order other than under the 
amendments made by this section.
H. R. 976—36 
TITLE II—OUTREACH AND 
ENROLLMENT 
Subtitle A—Outreach and Enrollment 
Activities 
SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUNDING FOR 
OUTREACH AND ENROLLMENT. 
(a) GRANTS.—Title XXI (42 U.S.C. 1397aa et seq.), as amended 
by section 107, is amended by adding at the end the following: 
‘‘SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT. 
‘‘(a) OUTREACH
AND ENROLLMENT GRANTS; NATIONAL CAM-
PAIGN.— 
‘‘(1) IN GENERAL.—From the amounts appropriated under 
subsection (g), subject to paragraph (2), the Secretary shall 
award grants to eligible entities during the period of fiscal 
years 2008 through 2012 to conduct outreach and enrollment 
efforts that are designed to increase the enrollment and partici-
pation 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 Secretary for expenditures during such 
period to carry out a national enrollment campaign in accord-
ance with subsection (h). 
‘‘(b) PRIORITY FOR AWARD OF GRANTS.— 
‘‘(1) IN GENERAL.—In awarding grants under subsection 
(a), the Secretary shall give priority to eligible 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 dis-
parity populations, including those proposals that 
address cultural and linguistic barriers to enrollment; 
and 
‘‘(B) submit the most demonstrable evidence required 
under paragraphs (1) and (2) of subsection (c). 
‘‘(2) TEN
PERCENT
SET
ASIDE
FOR
OUTREACH
TO
INDIAN 
CHILDREN.—An amount equal to 10 percent of the funds appro-
priated 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 Indian 
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 application to the 
Secretary in such form and manner, and containing such informa-
tion, as the Secretary may decide. Such application shall include— 
‘‘(1) evidence demonstrating that the entity includes mem-
bers who have access to, and credibility with, ethnic or low- 
income populations in the communities 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
H. R. 976—37 
of eligibility, stigma concerns and punitive fears associated 
with receipt of benefits, and other cultural barriers to applying 
for and receiving 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 effectiveness of such 
activities against the performance measures; 
‘‘(B) cooperate with the collection and reporting of 
enrollment data and other information 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 enrollment 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
ASSESSMENTS; 
ANNUAL 
REPORT.—The Secretary shall— 
‘‘(1) make publicly available the enrollment data and 
information collected and reported in accordance with sub-
section (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 outreach 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 entity’ 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 organization receiving funds 
under title V of the Indian Health Care Improvement Act 
(25 U.S.C. 1651 et seq.), or an Indian Health Service pro-
vider. 
‘‘(D) A Federal health safety net organization. 
‘‘(E) A national, State, local, or community-based public 
or nonprofit private organization, including organizations 
that use community health workers or community-based 
doula programs. 
‘‘(F) A faith-based organization or consortia, to the 
extent that a grant awarded to such an entity is consistent 
with the requirements of section 1955 of the Public Health 
Service Act (42 U.S.C. 300x–65) relating to a grant award 
to nongovernmental entities. 
‘‘(G) An elementary or secondary school.
H. R. 976—38 
‘‘(2) FEDERAL
HEALTH
SAFETY
NET
ORGANIZATION.—The 
term ‘Federal health safety net organization’ means— 
‘‘(A) a Federally-qualified health center (as defined in 
section 1905(l)(2)(B)); 
‘‘(B) a hospital defined as a disproportionate share 
hospital for purposes of section 1923; 
‘‘(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 program, including the special 
supplemental nutrition 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 ORGANIZATION; 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 communities and 
health care agencies; 
‘‘(B) by providing guidance and social assistance to 
community residents; 
‘‘(C) by enhancing community residents’ ability to effec-
tively communicate with health care providers; 
‘‘(D) by providing culturally and linguistically appro-
priate health or nutrition education; 
‘‘(E) by advocating for individual and community 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 section. 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 accordance with 
section 2105, including with respect to expenditures 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 enrollment campaign to improve the 
enrollment of underserved child populations in the programs estab-
lished under this title and title XIX. Such campaign may include— 
‘‘(1) the establishment of partnerships with the Secretary 
of Education and the Secretary of Agriculture to develop 
national campaigns to link the eligibility and enrollment sys-
tems for the assistance programs each Secretary administers 
that often serve the same children;
H. R. 976—39 
‘‘(2) the integration of information about the programs 
established under this title and title XIX in public health aware-
ness campaigns administered by the Secretary; 
‘‘(3) increased financial and technical support for enroll-
ment 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 importance of health insurance to 
building strong communities and the economy; 
‘‘(5) the development of special outreach materials for 
Native Americans or for individuals with limited English pro-
ficiency; and 
‘‘(6) such other outreach initiatives as the Secretary deter-
mines 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 expenditures described in 
subparagraph (D)(iv), the higher of 75 percent or the sum 
of the enhanced 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: 
‘‘(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 nec-
essary 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 subparagraph: 
‘‘(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 efficient administration of 
the State plan) as are attributable to translation or interpreta-
tion services in connection with the enrollment of, retention 
of, and use of services under this title by, children of families 
for whom English is not the primary language; plus’’. 
(B) USE OF COMMUNITY HEALTH WORKERS FOR OUT-
REACH ACTIVITIES.— 
(i) 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’’. 
(ii) 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’’.