† HR 2 EAS 
child enrollees (as determined under sub-
paragraph (C)(i)) under title XIX for the 
State and fiscal year, multiplied by 15 per-
cent of the projected per capita State Med-
icaid expenditures (as determined under 
subparagraph (D)) for the State and fiscal 
year under title XIX. 
‘‘(ii) SECOND TIER ABOVE BASELINE 
MEDICAID ENROLLEES.—An amount equal 
to the number of second tier above baseline 
child enrollees (as determined under sub-
paragraph (C)(ii)) under title XIX for the 
State and fiscal year, multiplied by 62.5 
percent of the projected per capita State 
Medicaid expenditures (as determined under 
subparagraph (D)) for the State and fiscal 
year under title XIX. 
‘‘(C) NUMBER OF FIRST AND SECOND TIER 
ABOVE BASELINE CHILD ENROLLEES; BASELINE 
NUMBER OF CHILD ENROLLEES.—For purposes 
of this paragraph: 
‘‘(i) FIRST
TIER
ABOVE
BASELINE 
CHILD
ENROLLEES.—The number of first 
tier above baseline child enrollees for a 
State for a fiscal year under title XIX is
† HR 2 EAS 
equal to the number (if any, as determined 
by the Secretary) by which— 
‘‘(I) 
the 
monthly 
average 
unduplicated number of qualifying 
children (as defined in subparagraph 
(F)) enrolled during the fiscal year 
under the State plan under title XIX, 
respectively; exceeds 
‘‘(II) the baseline number of en-
rollees described in clause (iii) for the 
State and fiscal year under title XIX, 
respectively; 
but not to exceed 10 percent of the baseline 
number of enrollees described in subclause 
(II). 
‘‘(ii) SECOND TIER ABOVE BASELINE 
CHILD ENROLLEES.—The number of second 
tier above baseline child enrollees for a 
State for a fiscal year under title XIX is 
equal to the number (if any, as determined 
by the Secretary) by which— 
‘‘(I) 
the 
monthly 
average 
unduplicated number of qualifying 
children (as defined in subparagraph 
(F)) enrolled during the fiscal year
† HR 2 EAS 
under title XIX as described in clause 
(i)(I); exceeds 
‘‘(II) the sum of the baseline num-
ber of child enrollees described in 
clause (iii) for the State and fiscal 
year under title XIX, as described in 
clause (i)(II), and the maximum num-
ber of first tier above baseline child en-
rollees for the State and fiscal year 
under title XIX, as determined under 
clause (i). 
‘‘(iii) BASELINE
NUMBER
OF
CHILD 
ENROLLEES.—Subject to subparagraph (H), 
the baseline number of child enrollees for a 
State under title XIX— 
‘‘(I) for fiscal year 2009 is equal 
to the monthly average unduplicated 
number of qualifying children enrolled 
in the State plan under title XIX dur-
ing fiscal year 2007 increased by the 
population growth for children in that 
State from 2007 to 2008 (as estimated 
by the Bureau of the Census) plus 4 
percentage points, and further in-
creased by the population growth for
† HR 2 EAS 
children in that State from 2008 to 
2009 (as estimated by the Bureau of 
the Census) plus 4 percentage points; 
‘‘(II) for each of fiscal years 2010, 
2011, and 2012, is equal to the base-
line number of child enrollees for the 
State for the previous fiscal year under 
title XIX, increased by the population 
growth for children in that State from 
the calendar year in which the respec-
tive fiscal year begins to the succeeding 
calendar year (as estimated by the Bu-
reau of the Census) plus 3.5 percentage 
points; 
‘‘(III) for each of fiscal years 
2013, 2014, and 2015, is equal to the 
baseline number of child enrollees for 
the State for the previous fiscal year 
under title XIX, increased by the popu-
lation growth for children in that State 
from the calendar year in which the re-
spective fiscal year begins to the suc-
ceeding calendar year (as estimated by 
the Bureau of the Census) plus 3 per-
centage points; and
† HR 2 EAS 
‘‘(IV) for a subsequent fiscal year 
is equal to the baseline number of child 
enrollees for the State for the previous 
fiscal year under title XIX, increased 
by the population growth for children 
in that State from the calendar year in 
which the fiscal year involved begins to 
the succeeding calendar year (as esti-
mated by the Bureau of the Census) 
plus 2 percentage points. 
‘‘(D) PROJECTED PER CAPITA STATE MED-
ICAID
EXPENDITURES.—For purposes of sub-
paragraph (B), the projected per capita State 
Medicaid expenditures for a State and fiscal 
year under title XIX is equal to the average per 
capita expenditures (including both State and 
Federal financial participation) for children 
under the State plan under such title, including 
under waivers but not including such children 
eligible for assistance by virtue of the receipt of 
benefits under title XVI, for the most recent fiscal 
year for which actual data are available (as de-
termined by the Secretary), increased (for each 
subsequent fiscal year up to and including the 
fiscal year involved) by the annual percentage
† HR 2 EAS 
increase in per capita amount of National 
Health Expenditures (as estimated by the Sec-
retary) for the calendar year in which the respec-
tive subsequent fiscal year ends and multiplied 
by a State matching percentage equal to 100 per-
cent minus the Federal medical assistance per-
centage (as defined in section 1905(b)) for the 
fiscal year involved. 
‘‘(E) 
AMOUNTS
AVAILABLE
FOR
PAY-
MENTS.— 
‘‘(i) INITIAL APPROPRIATION.—Out of 
any money in the Treasury not otherwise 
appropriated, 
there 
are 
appropriated 
$3,225,000,000 for fiscal year 2009 for mak-
ing payments under this paragraph, to be 
available until expended. 
‘‘(ii) 
TRANSFERS.—Notwithstanding 
any other provision of this title, the fol-
lowing amounts shall also be available, 
without fiscal year limitation, for making 
payments under this paragraph: 
‘‘(I) UNOBLIGATED NATIONAL AL-
LOTMENT.— 
‘‘(aa) FISCAL
YEARS
2009 
THROUGH 2012.—As of December
† HR 2 EAS 
31 of fiscal year 2009, and as of 
December 31 of each succeeding 
fiscal year through fiscal year 
2012, the portion, if any, of the 
amount appropriated under sub-
section (a) for such fiscal year 
that is unobligated for allotment 
to a State under subsection (m) 
for such fiscal year or set aside 
under subsection (a)(3) or (b)(2) 
of section 2111 for such fiscal 
year. 
‘‘(bb) FIRST HALF OF FISCAL 
YEAR 2013.—As of December 31 of 
fiscal year 2013, the portion, if 
any, of the sum of the amounts 
appropriated 
under 
subsection 
(a)(16)(A) and under section 108 
of the Children’s Health Insurance 
Reauthorization Act of 2009 for 
the period beginning on October 1, 
2012, and ending on March 31, 
2013, that is unobligated for allot-
ment to a State under subsection 
(m) for such fiscal year or set
† HR 2 EAS 
aside under subsection (b)(2) of 
section 2111 for such fiscal year. 
‘‘(cc) SECOND HALF OF FIS-
CAL YEAR 2013.—As of June 30 of 
fiscal year 2013, the portion, if 
any, of the amount appropriated 
under subsection (a)(16)(B) for 
the period beginning on April 1, 
2013, and ending on September 
30, 2013, that is unobligated for 
allotment to a State under sub-
section (m) for such fiscal year or 
set aside under subsection (b)(2) 
of section 2111 for such fiscal 
year. 
‘‘(II) UNEXPENDED
ALLOTMENTS 
NOT USED FOR REDISTRIBUTION.—As 
of November 15 of each of fiscal years 
2010 through 2013, the total amount of 
allotments made to States under sec-
tion 2104 for the second preceding fis-
cal year (third preceding fiscal year in 
the case of the fiscal year 2006, 2007, 
and 2008 allotments) that is not ex-
pended or redistributed under section
† HR 2 EAS 
2104(f) during the period in which 
such allotments are available for obli-
gation. 
‘‘(III) EXCESS
CHILD
ENROLL-
MENT CONTINGENCY FUNDS.—As of Oc-
tober 1 of each of fiscal years 2010 
through 2013, any amount in excess of 
the aggregate cap applicable to the 
Child Enrollment Contingency Fund 
for the fiscal year under section 
2104(n). 
‘‘(IV) 
UNEXPENDED
TRANSI-
TIONAL COVERAGE BLOCK GRANT FOR 
NONPREGNANT
CHILDLESS
ADULTS.— 
As of October 1, 2011, any amounts set 
aside under section 2111(a)(3) that are 
not expended by September 30, 2011. 
‘‘(iii) PROPORTIONAL REDUCTION.—If 
the sum of the amounts otherwise payable 
under this paragraph for a fiscal year ex-
ceeds the amount available for the fiscal 
year under this subparagraph, the amount 
to be paid under this paragraph to each 
State shall be reduced proportionally. 
‘‘(F) QUALIFYING CHILDREN DEFINED.—
† HR 2 EAS 
‘‘(i) IN
GENERAL.—For purposes of 
this subsection, subject to clauses (ii) and 
(iii), the term ‘qualifying children’ means 
children who meet the eligibility criteria 
(including income, categorical eligibility, 
age, and immigration status criteria) in ef-
fect as of July 1, 2008, for enrollment under 
title XIX, taking into account criteria ap-
plied as of such date under title XIX pursu-
ant to a waiver under section 1115. 
‘‘(ii) LIMITATION.—A child described 
in clause (i) who is provided medical assist-
ance during a presumptive eligibility period 
under section 1920A shall be considered to 
be a ‘qualifying child’ only if the child is 
determined to be eligible for medical assist-
ance under title XIX. 
‘‘(iii) EXCLUSION.—Such term does 
not include any children for whom the State 
has made an election to provide medical as-
sistance under paragraph (4) of section 
1903(v). 
‘‘(G) APPLICATION
TO
COMMONWEALTHS 
AND TERRITORIES.—The provisions of subpara-
graph (G) of section 2104(n)(3) shall apply with
† HR 2 EAS 
respect to payment under this paragraph in the 
same manner as such provisions apply to pay-
ment under such section. 
‘‘(H) APPLICATION TO STATES THAT IMPLE-
MENT A MEDICAID EXPANSION FOR CHILDREN 
AFTER FISCAL YEAR 2008.—In the case of a State 
that provides coverage under section 115 of the 
Children’s Health Insurance Program Reauthor-
ization Act of 2009 for any fiscal year after fis-
cal year 2008— 
‘‘(i) any child enrolled in the State 
plan under title XIX through the applica-
tion of such an election shall be disregarded 
from the determination for the State of the 
monthly average unduplicated number of 
qualifying children enrolled in such plan 
during the first 3 fiscal years in which such 
an election is in effect; and 
‘‘(ii) in determining the baseline num-
ber of child enrollees for the State for any 
fiscal year subsequent to such first 3 fiscal 
years, the baseline number of child enrollees 
for the State under title XIX for the third 
of such fiscal years shall be the monthly av-
erage unduplicated number of qualifying
† HR 2 EAS 
children enrolled in the State plan under 
title XIX for such third fiscal year. 
‘‘(4) ENROLLMENT AND RETENTION PROVISIONS 
FOR CHILDREN.—For purposes of paragraph (3)(A), 
a State meets the condition of this paragraph for a 
fiscal year if it is implementing at least 5 of the fol-
lowing enrollment and retention provisions (treating 
each subparagraph as a separate enrollment and re-
tention provision) throughout the entire fiscal year: 
‘‘(A) CONTINUOUS ELIGIBILITY.—The State 
has elected the option of continuous eligibility for 
a full 12 months for all children described in sec-
tion 1902(e)(12) under title XIX under 19 years 
of age, as well as applying such policy under its 
State child health plan under this title. 
‘‘(B) LIBERALIZATION OF ASSET REQUIRE-
MENTS.—The State meets the requirement speci-
fied in either of the following clauses: 
‘‘(i) ELIMINATION OF ASSET TEST.— 
The State does not apply any asset or re-
source test for eligibility for children under 
title XIX or this title. 
‘‘(ii) ADMINISTRATIVE
VERIFICATION 
OF ASSETS.—The State—
† HR 2 EAS 
‘‘(I) permits a parent or caretaker 
relative who is applying on behalf of a 
child for medical assistance under title 
XIX or child health assistance under 
this title to declare and certify by sig-
nature under penalty of perjury infor-
mation relating to family assets for 
purposes of determining and redeter-
mining financial eligibility; and 
‘‘(II) takes steps to verify assets 
through means other than by requiring 
documentation from parents and ap-
plicants except in individual cases of 
discrepancies or where otherwise justi-
fied. 
‘‘(C) ELIMINATION
OF
IN-PERSON
INTER-
VIEW REQUIREMENT.—The State does not require 
an application of a child for medical assistance 
under title XIX (or for child health assistance 
under this title), including an application for re-
newal of such assistance, to be made in person 
nor does the State require a face-to-face inter-
view, unless there are discrepancies or individual 
circumstances justifying an in-person applica-
tion or face-to-face interview.
† HR 2 EAS 
‘‘(D) USE OF JOINT APPLICATION FOR MED-
ICAID
AND
CHIP.—The application form and 
supplemental forms (if any) and information 
verification process is the same for purposes of 
establishing and renewing eligibility for children 
for medical assistance under title XIX and child 
health assistance under this title. 
‘‘(E) AUTOMATIC RENEWAL (USE OF ADMIN-
ISTRATIVE RENEWAL).— 
‘‘(i) IN GENERAL.—The State provides, 
in the case of renewal of a child’s eligibility 
for medical assistance under title XIX or 
child health assistance under this title, a 
pre-printed form completed by the State 
based on the information available to the 
State and notice to the parent or caretaker 
relative of the child that eligibility of the 
child will be renewed and continued based 
on such information unless the State is pro-
vided other information. Nothing in this 
clause shall be construed as preventing a 
State from verifying, through electronic and 
other means, the information so provided. 
‘‘(ii) SATISFACTION
THROUGH
DEM-
ONSTRATED USE OF EX PARTE PROCESS.—
† HR 2 EAS 
A State shall be treated as satisfying the re-
quirement of clause (i) if renewal of eligi-
bility of children under title XIX or this 
title is determined without any requirement 
for an in-person interview, unless sufficient 
information is not in the State’s possession 
and cannot be acquired from other sources 
(including other State agencies) without the 
participation of the applicant or the appli-
cant’s parent or caretaker relative. 
‘‘(F) PRESUMPTIVE ELIGIBILITY FOR CHIL-
DREN.—The State is implementing section 
1920A under title XIX as well as, pursuant to 
section 2107(e)(1), under this title. 
‘‘(G) EXPRESS LANE.—The State is imple-
menting 
the 
option 
described 
in 
section 
1902(e)(13) under title XIX as well as, pursuant 
to section 2107(e)(1), under this title. 
‘‘(H) PREMIUM ASSISTANCE SUBSIDIES.— 
The State is implementing the option of pro-
viding premium assistance subsidies under sec-
tion 2105(c)(10) or section 1906A.’’.
† HR 2 EAS 
SEC. 105. TWO-YEAR INITIAL AVAILABILITY OF CHIP ALLOT-
MENTS. 
Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to 
read as follows: 
‘‘(e) AVAILABILITY OF AMOUNTS ALLOTTED.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), amounts allotted to a State pursuant to 
this section— 
‘‘(A) for each of fiscal years 1998 through 
2008, shall remain available for expenditure by 
the State through the end of the second suc-
ceeding fiscal year; and 
‘‘(B) for fiscal year 2009 and each fiscal 
year thereafter, shall remain available for ex-
penditure by the State through the end of the 
succeeding fiscal year. 
‘‘(2) AVAILABILITY
OF
AMOUNTS
REDISTRIB-
UTED.—Amounts redistributed to a State under sub-
section (f) shall be available for expenditure by the 
State through the end of the fiscal year in which they 
are redistributed.’’. 
SEC. 106. REDISTRIBUTION OF UNUSED ALLOTMENTS. 
(a) BEGINNING WITH FISCAL YEAR 2007.— 
(1) IN
GENERAL.—Section 2104(f) (42 U.S.C. 
1397dd(f)) is amended—
† HR 2 EAS 
(A) by striking ‘‘The Secretary’’ and insert-
ing the following: 
‘‘(1) IN GENERAL.—The Secretary’’; 
(B) by striking ‘‘States that have fully ex-
pended the amount of their allotments under this 
section.’’ and inserting ‘‘States that the Sec-
retary determines with respect to the fiscal year 
for which unused allotments are available for re-
distribution under this subsection, are shortfall 
States described in paragraph (2) for such fiscal 
year, but not to exceed the amount of the short-
fall described in paragraph (2)(A) for each such 
State (as may be adjusted under paragraph 
(2)(C)).’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(2) SHORTFALL STATES DESCRIBED.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), with respect to a fiscal year, a short-
fall State described in this subparagraph is a 
State with a State child health plan approved 
under this title for which the Secretary estimates 
on the basis of the most recent data available to 
the Secretary, that the projected expenditures
† HR 2 EAS 
under such plan for the State for the fiscal year 
will exceed the sum of— 
‘‘(i) the amount of the State’s allot-
ments for any preceding fiscal years that 
remains available for expenditure and that 
will not be expended by the end of the im-
mediately preceding fiscal year; 
‘‘(ii) the amount (if any) of the child 
enrollment contingency fund payment under 
subsection (n); and 
‘‘(iii) the amount of the State’s allot-
ment for the fiscal year. 
‘‘(B) PRORATION
RULE.—If the amounts 
available for redistribution under paragraph (1) 
for a fiscal year are less than the total amounts 
of the estimated shortfalls determined for the 
year under subparagraph (A), the amount to be 
redistributed under such paragraph for each 
shortfall State shall be reduced proportionally. 
‘‘(C) RETROSPECTIVE
ADJUSTMENT.—The 
Secretary may adjust the estimates and deter-
minations made under paragraph (1) and this 
paragraph with respect to a fiscal year as nec-
essary on the basis of the amounts reported by 
States not later than November 30 of the suc-
† HR 2 EAS 
ceeding fiscal year, as approved by the Sec-
retary.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to redistribution of al-
lotments made for fiscal year 2007 and subsequent 
fiscal years. 
(b) REDISTRIBUTION OF UNUSED ALLOTMENTS FOR 
FISCAL
YEAR
2006.—Section 
2104(k) 
(42 
U.S.C. 
1397dd(k)) is amended— 
(1) in the subsection heading, by striking ‘‘THE 
FIRST 2 QUARTERS OF’’; 
(2) in paragraph (1), by striking ‘‘the first 2 
quarters of’’; and 
(3) in paragraph (6)— 
(A) by striking ‘‘the first 2 quarters of’’; 
and 
(B) by striking ‘‘March 31’’ and inserting 
‘‘September 30’’. 
SEC. 107. OPTION FOR QUALIFYING STATES TO RECEIVE 
THE ENHANCED PORTION OF THE CHIP 
MATCHING RATE FOR MEDICAID COVERAGE 
OF CERTAIN CHILDREN. 
(a) IN
GENERAL.—Section 2105(g) (42 U.S.C. 
1397ee(g)) is amended—
† HR 2 EAS 
(1) in paragraph (1)(A), as amended by section 
201(b)(1) of Public Law 110–173— 
(A) by inserting ‘‘subject to paragraph (4),’’ 
after ‘‘Notwithstanding any other provision of 
law,’’; and 
(B) by striking ‘‘2008, or 2009’’ and insert-
ing ‘‘or 2008’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(4) OPTION
FOR
ALLOTMENTS
FOR
FISCAL 
YEARS 2009 THROUGH 2013.— 
‘‘(A) PAYMENT OF ENHANCED PORTION OF 
MATCHING RATE FOR CERTAIN EXPENDITURES.— 
In the case of expenditures described in subpara-
graph (B), a qualifying State (as defined in 
paragraph (2)) may elect to be paid from the 
State’s allotment made under section 2104 for 
any of fiscal years 2009 through 2013 (insofar as 
the allotment is available to the State under sub-
sections (e) and (m) of such section) an amount 
each quarter equal to the additional amount that 
would have been paid to the State under title 
XIX with respect to such expenditures if the en-
hanced FMAP (as determined under subsection 
(b)) had been substituted for the Federal medical
† HR 2 EAS 
assistance percentage (as defined in section 
1905(b)). 
‘‘(B) 
EXPENDITURES
DESCRIBED.—For 
purposes of subparagraph (A), the expenditures 
described in this subparagraph are expenditures 
made after the date of the enactment of this 
paragraph and during the period in which funds 
are available to the qualifying State for use 
under subparagraph (A), for the provision of 
medical assistance to individuals residing in the 
State who are eligible for medical assistance 
under the State plan under title XIX or under 
a waiver of such plan and who have not attained 
age 19 (or, if a State has so elected under the 
State plan under title XIX, age 20 or 21), and 
whose family income equals or exceeds 133 per-
cent of the poverty line but does not exceed the 
Medicaid applicable income level.’’. 
(b) REPEAL OF LIMITATION ON AVAILABILITY OF FIS-
CAL YEAR 2009 ALLOTMENTS.—Paragraph (2) of section 
201(b) of the Medicare, Medicaid, and SCHIP Extension 
Act of 2007 (Public Law 110–173) is repealed. 
SEC. 108. ONE-TIME APPROPRIATION. 
There is appropriated to the Secretary, out of any 
money in the Treasury not otherwise appropriated,
† HR 2 EAS 
$11,706,000,000 to accompany the allotment made for the 
period beginning on October 1, 2012, and ending on March 
31, 2013, under section 2104(a)(16)(A) of the Social Secu-
rity Act (42 U.S.C. 1397dd(a)(16)(A)) (as added by section 
101), to remain available until expended. Such amount 
shall be used to provide allotments to States under para-
graph (3) of section 2104(m) of the Social Security Act (42 
U.S.C. 1397dd(i)), as added by section 102, for the first 
6 months of fiscal year 2013 in the same manner as allot-
ments are provided under subsection (a)(16)(A) of such sec-
tion 2104 and subject to the same terms and conditions as 
apply to the allotments provided from such subsection 
(a)(16)(A). 
SEC. 109. IMPROVING FUNDING FOR THE TERRITORIES 
UNDER CHIP AND MEDICAID. 
Section 1108(g) (42 U.S.C. 1308(g)) is amended by 
adding at the end the following new paragraph: 
‘‘(4) EXCLUSION
OF
CERTAIN
EXPENDITURES 
FROM PAYMENT LIMITS.—With respect to fiscal years 
beginning with fiscal year 2009, if Puerto Rico, the 
Virgin Islands, Guam, the Northern Mariana Islands, 
or American Samoa qualify for a payment under 
subparagraph (A)(i), (B), or (F) of section 1903(a)(3) 
for a calendar quarter of such fiscal year, the pay-
ment shall not be taken into account in applying sub-
† HR 2 EAS 
section (f) (as increased in accordance with para-
graphs (1), (2), and (3) of this subsection) to such 
commonwealth or territory for such fiscal year.’’. 
Subtitle B—Focus on Low-Income 
Children and Pregnant Women 
SEC. 111. STATE OPTION TO COVER LOW-INCOME PREG-
NANT WOMEN UNDER CHIP THROUGH A 
STATE PLAN AMENDMENT. 
(a) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et 
seq.), as amended by section 112(a), is amended by adding 
at the end the following new section: 
‘‘SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-IN-
COME PREGNANT WOMEN THROUGH A STATE 
PLAN AMENDMENT. 
‘‘(a) IN GENERAL.—Subject to the succeeding provi-
sions of this section, a State may elect through an amend-
ment to its State child health plan under section 2102 to 
provide pregnancy-related assistance under such plan for 
targeted low-income pregnant women. 
‘‘(b) CONDITIONS.—A State may only elect the option 
under subsection (a) if the following conditions are satis-
fied: 
‘‘(1) MINIMUM INCOME ELIGIBILITY LEVELS FOR 
PREGNANT WOMEN AND CHILDREN.—The State has es-
tablished an income eligibility level—
† HR 2 EAS 
‘‘(A) for pregnant women under subsection 
(a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) 
of section 1902 that is at least 185 percent (or 
such higher percent as the State has in effect 
with regard to pregnant women under this title) 
of the poverty line applicable to a family of the 
size involved, but in no case lower than the per-
cent in effect under any such subsection as of 
July 1, 2008; 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. 
‘‘(2) NO CHIP INCOME ELIGIBILITY LEVEL FOR 
PREGNANT WOMEN LOWER THAN THE STATE’S MED-
ICAID LEVEL.—The State does not apply an effective 
income level for pregnant women under the State 
plan amendment that is lower than the effective in-
come level (expressed as a percent of the poverty line 
and considering applicable income disregards) speci-
fied 
under 
subsection 
(a)(10)(A)(i)(III), 
(a)(10)(A)(i)(IV), or (l)(1)(A) of section 1902, on the 
date of enactment of this paragraph to be eligible for 
medical assistance as a pregnant woman.
† HR 2 EAS 
‘‘(3) NO COVERAGE FOR HIGHER INCOME PREG-
NANT
WOMEN
WITHOUT
COVERING
LOWER
INCOME 
PREGNANT WOMEN.—The State does not provide cov-
erage for pregnant women with higher family income 
without covering pregnant women with a lower fam-
ily income. 
‘‘(4) APPLICATION OF REQUIREMENTS FOR COV-
ERAGE OF TARGETED LOW-INCOME CHILDREN.—The 
State provides pregnancy-related assistance for tar-
geted low-income pregnant women in the same man-
ner, and subject to the same requirements, as the 
State provides child health assistance for targeted 
low-income children under the State child health 
plan, and in addition to providing child health as-
sistance for such women. 
‘‘(5) NO PREEXISTING CONDITION EXCLUSION OR 
WAITING PERIOD.—The State does not apply any ex-
clusion of benefits for pregnancy-related assistance 
based on any preexisting condition or any waiting 
period (including any waiting period imposed to 
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
† HR 2 EAS 
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 sec-
tion to the family of such a woman. 
‘‘(7) NO
WAITING
LIST
FOR
CHILDREN.—The 
State does not impose, with respect to the enrollment 
under the State child health plan of targeted low-in-
come children during the quarter, any enrollment cap 
or other numerical limitation on enrollment, any 
waiting list, any procedures designed to delay the 
consideration of applications for enrollment, or simi-
lar limitation with respect to enrollment. 
‘‘(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 eligi-
bility 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).
† HR 2 EAS 
‘‘(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 (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 (b)(1)(A)) of the poverty line 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) in the same manner as a child applying 
for child health assistance would have to satisfy 
such requirements. 
‘‘(e) AUTOMATIC ENROLLMENT FOR CHILDREN BORN 
TO
WOMEN
RECEIVING
PREGNANCY-RELATED
ASSIST-
ANCE.—If a child is born to a targeted low-income pregnant 
woman who was receiving pregnancy-related assistance 
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
† HR 2 EAS 
eligible for such assistance under such plan or to have ap-
plied 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 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 child health or medical 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 identification 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 subsections 
of this section shall not limit any other option for a 
State to provide— 
‘‘(A) child health assistance through the ap-
plication 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
† HR 2 EAS 
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, 2008). 
‘‘(2) CLARIFICATION OF AUTHORITY TO PROVIDE 
POSTPARTUM
SERVICES.—Any State that provides 
child health assistance under any authority described 
in paragraph (1) may continue to provide such as-
sistance, as well as postpartum services, through the 
end of the month in which the 60-day period (begin-
ning on the last day of the pregnancy) ends, in the 
same manner as such assistance and postpartum serv-
ices would be provided if provided under the State 
plan under title XIX, but only if the mother would 
otherwise satisfy the eligibility requirements that 
apply under the State child health plan (other than 
with respect to age) during such period. 
‘‘(3) NO INFERENCE.—Nothing in this subsection 
shall be construed— 
‘‘(A) to infer congressional intent regarding 
the legality or illegality of the content of the sec-
tions specified in paragraph (1)(A); or
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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 NONPREGNANT 
CHILDLESS ADULTS.— 
‘‘(1) NO NEW CHIP WAIVERS; AUTOMATIC EXTEN-
SIONS AT STATE OPTION THROUGH 2009.—Notwith-
standing section 1115 or any other provision of this 
title, except as provided in this subsection— 
‘‘(A) the Secretary shall not on or after the 
date of the enactment of the Children’s Health 
Insurance Program Reauthorization Act of 2009, 
approve or renew a waiver, experimental, pilot, 
or demonstration project that would allow funds 
made available under this title to be used to pro-
vide child health assistance or other health bene-
† HR 2 EAS 
fits coverage to a nonpregnant childless adult; 
and 
‘‘(B) notwithstanding the terms and condi-
tions of an applicable existing waiver, the provi-
sions of paragraph (2) shall apply for purposes 
of any period beginning on or after January 1, 
2010, in determining the period to which the 
waiver applies, the individuals eligible to be cov-
ered by the waiver, and the amount of the Fed-
eral payment under this title. 
‘‘(2) TERMINATION OF CHIP COVERAGE UNDER 
APPLICABLE
EXISTING
WAIVERS
AT
THE
END
OF 
2009.— 
‘‘(A) IN GENERAL.—No funds shall be avail-
able under this title for child health assistance or 
other health benefits coverage that is provided to 
a nonpregnant childless adult under an applica-
ble existing waiver after December 31, 2009. 
‘‘(B) EXTENSION UPON STATE REQUEST.— 
If an applicable existing waiver described in 
subparagraph (A) would otherwise expire before 
January 1, 2010, notwithstanding the require-
ments of subsections (e) and (f) of section 1115, 
a State may submit, not later than September 
30, 2009, a request to the Secretary for an exten-
† HR 2 EAS 
sion of the waiver. The Secretary shall approve 
a request for an extension of an applicable exist-
ing waiver submitted pursuant to this subpara-
graph, but only through December 31, 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 nonpregnant childless adult during 
the period beginning on the date of the enact-
ment of this subsection and ending on December 
31, 2009. 
‘‘(3) STATE
OPTION
TO
APPLY
FOR
MEDICAID 
WAIVER TO CONTINUE COVERAGE FOR NONPREGNANT 
CHILDLESS ADULTS.— 
‘‘(A) IN GENERAL.—Each State for which 
coverage under an applicable existing waiver is 
terminated under paragraph (2)(A) may submit, 
not later than September 30, 2009, an applica-
tion to the Secretary for a waiver under section 
1115 of the State plan under title XIX to provide 
medical assistance to a nonpregnant childless 
adult whose coverage is so terminated (in this
† HR 2 EAS 
subsection referred to as a ‘Medicaid nonpreg-
nant childless adults waiver’). 
‘‘(B) DEADLINE FOR APPROVAL.—The Sec-
retary shall make a decision to approve or deny 
an application for a Medicaid nonpregnant 
childless adults waiver submitted under subpara-
graph (A) within 90 days of the date of the sub-
mission of the application. If no decision has 
been made by the Secretary as of December 31, 
2009, on the application of a State for a Med-
icaid nonpregnant childless adults waiver that 
was submitted to the Secretary by September 30, 
2009, the application shall be deemed approved. 
‘‘(C) 
STANDARD
FOR
BUDGET
NEU-
TRALITY.—The budget neutrality requirement 
applicable with respect to expenditures for med-
ical assistance under a Medicaid nonpregnant 
childless adults waiver shall— 
‘‘(i) in the case of fiscal year 2010, 
allow expenditures for medical assistance 
under title XIX for all such adults to not 
exceed the total amount of payments made 
to the State under paragraph (2)(B) for fis-
cal year 2009, increased by the percentage 
increase (if any) in the projected nominal
† HR 2 EAS 
per capita amount of National Health Ex-
penditures for 2010 over 2009, as most re-
cently published by the Secretary; and 
‘‘(ii) in the case of any succeeding fis-
cal year, allow such expenditures to not ex-
ceed the amount in effect under this sub-
paragraph for the preceding fiscal year, in-
creased by the percentage increase (if any) 
in the projected nominal per capita amount 
of National Health Expenditures for the 
calendar year that begins during the year 
involved over the preceding calendar year, 
as most recently published by the Secretary. 
‘‘(b) RULES AND CONDITIONS FOR COVERAGE OF PAR-
ENTS OF TARGETED LOW-INCOME CHILDREN.— 
‘‘(1) TWO-YEAR PERIOD; AUTOMATIC EXTENSION 
AT STATE OPTION THROUGH FISCAL YEAR 2011.— 
‘‘(A) NO
NEW
CHIP
WAIVERS.—Notwith-
standing 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 2009 approve or renew a waiver, ex-
perimental, pilot, or demonstration project
† HR 2 EAS 
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-in-
come 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, 2011, 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 REQUEST.— 
If an applicable existing waiver described in 
subparagraph (A) would otherwise expire before 
October 1, 2011, and the State requests an exten-
sion of such waiver, the Secretary shall grant 
such an extension, but only, subject to paragraph 
(2)(A), through September 30, 2011. 
‘‘(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