I
106TH CONGRESS
2D SESSION
H. R. 4932
To amend titles XIX and XXI of the Social Security Act to expand access
of children to health care.
IN THE HOUSE OF REPRESENTATIVES
JULY 24, 2000
Mr. KLINK introduced the following bill; which was referred to the Committee
on Commerce
A BILL
To amend titles XIX and XXI of the Social Security Act
to expand access of children to health care.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medikid Health Care Expansion Act of 2000’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Permitting States to increase SCHIP eligibility to up to 250 percent of
poverty line.
Sec. 3. Allowing higher income families to buy into program.
Sec. 4. Simplified outreach and enrollment.
Sec. 5. Expediting eligibility process.
Sec. 6. Availability of enrollment performance incentive bonuses from reallot-
ment.
Sec. 7. Encouraging school-based outreach.
Sec. 8. Extending authorization of graduate medical education funding for chil-
dren’s hospitals.
Sec. 9. Optional coverage of low-income, uninsured pregnant women under a
state child health plan.
SEC. 2. PERMITTING STATES TO INCREASE SCHIP ELIGI-
BILITY TO UP TO 250 PERCENT OF POVERTY
LINE.
(a) IN GENERAL.—Section 2110(c)(4) of the Social
Security Act (42 U.S.C. 1397jj(c)(4)) is amended by in-
serting ‘‘(or, at the option of the State, a higher percent
not to exceed 250 percent)’’ after ‘‘200 percent’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) takes effect as of the date of the enactment
of this Act.
SEC. 3. ALLOWING HIGHER INCOME FAMILIES TO BUY INTO
PROGRAM.
Title XXI of the Social Security Act is amended by
adding at the end the following new section:
‘‘SEC. 2111. OPTIONAL STATE BUY-IN PERMITTED FOR
OTHER CHILDREN.
‘‘Nothing in this title shall be construed as preventing
a State from permitting families of children who are not
low-income children to enroll in the State child health plan
in return for payment of such premium as the State may
establish.’’.
SEC. 4. SIMPLIFIED OUTREACH AND ENROLLMENT.
Section 2102 of the Social Security Act (42 U.S.C.
1397bb) is amended by adding at the end the following
new subsection:
‘‘(d) DEVELOPMENT AND USE OF UNIFORM APPLI-
CATION FORMS AND COORDINATED ENROLLMENT PROC-
ESS.—A State child health plan shall provide, by not later
than the first day of the first month that begins more than
6 months after the date of the enactment of this sub-
section, for—
‘‘(1) the development and use of a uniform, sim-
plified application form which is used both for pur-
poses of establishing eligibility for benefits under
this title and also under title XIX; and
‘‘(2) an enrollment process that is coordinated
with that under title XIX so that a family need only
interact with a single agency in order to determine
whether a child is eligible for benefits under this
title or title XIX.’’.
SEC. 5. EXPEDITING ELIGIBILITY PROCESS.
(a) APPLICATION
OF PRESUMPTIVE ELIGIBILITY
UNDER SCHIP AND REDUCTION OF STATE MATCH FOR
OUTREACH IF ELECT PRESUMPTIVE ELIGIBILITY.—
(1) IN GENERAL.—Section 2102 of the Social
Security Act (42 U.S.C. 1397bb), as amended by
section 4, is further amended by adding at the end
the following new subsection:
‘‘(e) APPLICATION
OF PRESUMPTIVE ELIGIBILITY
PROVISIONS.—A State may elect to apply the provisions
of section 1920A under this title in the same manner as
the State may elect to apply such provisions under title
XIX.’’.
(2) REDUCTION OF STATE MATCHING REQUIRE-
MENT.—Section 2105 of such Act (42 U.S.C.
1397ee) is amended—
(A) in subsection (b), by inserting ‘‘subject
to subsection (g),’’ after ‘‘For purposes of sub-
section (a),’’; and
(B) by adding at the end the following new
subsection:
‘‘(g) 90 PERCENT FEDERAL MATCH
FOR ADDI-
TIONAL OUTREACH EXPENDITURES IF STATE ELECTS TO
USE PRESUMPTIVE ELIGIBILITY FOR BOTH MEDICAID
AND SCHIP.—The enhanced FMAP with respect to child
health assistance for outreach services described in section
2102(c)(1) for a State shall be, with respect to expendi-
tures for such services above the level of such expenditures
in fiscal year 2000, equal to 90 percent if the State has
both—
‘‘(1) elected to apply the provisions of section
1920A under title XIX for the entire fiscal year; and
‘‘(2) elected under section 2102(e) to apply the
provisions of section 1920A under this title for the
entire fiscal year.’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection take effect on the date of the en-
actment of this Act and apply to fiscal years begin-
ning on or after such date.
(b) CLARIFICATION OF USE OF SCHIP FUNDS TO
PROVIDE ENROLLING CENTERS WITH INCENTIVES TO
ENROLL LOW-INCOME CHILDREN.—
(1) IN GENERAL.—Section 2105 of such Act
(42 U.S.C. 1397ee), as amended by subsection (b),
is further amended—
(A) in subsection (g), by inserting ‘‘and for
expenditures described in subsection (h)’’ after
‘‘described in section 2102(c)(1)’’; and
(B) by adding at the end the following new
subsection:
‘‘(h) TREATMENT OF ENROLLMENT INCENTIVES.—
Reasonable expenditures to enrolling centers to provide an
incentive to enroll targeted low-income children under this
title shall be treated as reasonable costs incurred by the
State to administer the plan for purposes of subsection
(a)(2)(D).’’.
(2) EFFECTIVE DATE.—The amendments made
by paragraph (1) apply to expenditures made on or
after the date of the enactment of this Act.
SEC. 6. AVAILABILITY OF ENROLLMENT PERFORMANCE IN-
CENTIVE BONUSES FROM REALLOTMENT.
Section 2105 of the Social Security Act (42 U.S.C.
1397ee), as amended by section 5(a)(2), is amended by
adding at the end the following new subsection:
‘‘(h) 
ENROLLMENT
PERFORMANCE
INCENTIVE
BONUS PAYMENTS.—
‘‘(1) IN GENERAL.—In the case of a bonus eli-
gible State described in paragraph (2), the Secretary
shall pay to the State, from the amount of an allot-
ment redistributed to the State under section
2104(f) during a fiscal year (beginning with fiscal
year 2001), an incentive performance bonus pay-
ment equal to such percent (not less than 2 percent,
and not to exceed 5 percent) of the amount of such
allotment as the Secretary determines appropriate
based on the State’s performance in meeting or ex-
ceeding objectives referred to in paragraph (2)(B).
‘‘(2) BONUS ELIGIBLE STATE.—A bonus eligible
State described in this paragraph for a fiscal year is
a State that—
‘‘(A) has not had any allotment for any
previous fiscal year redistributed to another
State under section 2104(f); and
‘‘(B) meets or exceeds reasonable objec-
tives established by the Secretary for the enroll-
ment of low-income children under this title
(and title XIX).
‘‘(3) TREATMENT OF PAYMENT.—The amount
paid under paragraph (1)—
‘‘(A) shall be paid without the need for any
non-Federal contribution under subsection (a);
‘‘(B) may be used for any expenditures
permitted under subsection (b)(1) and without
regard to any limitations under paragraphs (2)
and (3) of subsection (b); but
‘‘(C) may not be included in determining
the amount of non-Federal contributions other-
wise required under subsection (a).’’.
SEC. 7. ENCOURAGING SCHOOL-BASED OUTREACH.
(a) IN GENERAL.—Section 2102(c)(1) of such Act
(42 U.S.C. 1397bb(c)(1)) is amended by adding at the end
the following: ‘‘Such outreach shall include school-based
programs targeted at schools with high rates of uninsured
children.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) takes effect on October 1, 2000.
SEC. 8. EXTENDING AUTHORIZATION OF GRADUATE MED-
ICAL EDUCATION FUNDING FOR CHILDREN’S
HOSPITALS.
Section 340E of the Public Health Service Act (42
U.S.C. 256e) is amended—
(1) in subsection (a), by striking ‘‘and 2001’’
and inserting ‘‘through 2005’’; and
(2) in subsection (f)—
(A) in paragraph (1)(A)(ii), by striking
‘‘for fiscal year 2001’’ and inserting ‘‘for each
of fiscal years 2001 through 2005’’;
(B) in paragraph (1)(B), by striking ‘‘for
fiscal year 2000 shall remain available for obli-
gation through the end of fiscal year 2001’’ and
inserting ‘‘for a fiscal year shall remain avail-
able for obligation through the end of the suc-
ceeding fiscal year’’; and
(C) in paragraph (2)(B), by striking ‘‘for
fiscal year 2001’’ and inserting ‘‘for each of fis-
cal years 2001 through 2005’’.
SEC. 9. OPTIONAL COVERAGE OF LOW-INCOME, UNIN-
SURED PREGNANT WOMEN UNDER A STATE
CHILD HEALTH PLAN.
(a) IN GENERAL.—Title XXI of the Social Security
Act, as amended by section 3, is further amended by add-
ing at the end the following new section:
‘‘SEC. 2112. OPTIONAL COVERAGE OF LOW-INCOME, UNIN-
SURED PREGNANT WOMEN.
‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any
other provision of this title, a State child health plan may
provide for coverage of pregnancy-related assistance for
targeted low-income pregnant women in accordance with
this section, but only if the State has established an in-
come eligibility level under section 1902(l)(2)(A) for
women described in section 1902(l)(1)(A) that is 185 per-
cent of the income official poverty line.
‘‘(b) 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) as if any reference to targeted low-income
children were a reference to targeted low-income
pregnant women, except that the assistance shall be
limited to services related to pregnancy (which in-
clude prenatal, delivery, and postpartum services)
and to other conditions that may complicate preg-
nancy and shall not include prepregnancy services
and supplies.
‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT
WOMAN.—The term ‘targeted low-income pregnant
woman’ has the meaning given the term ‘targeted
low-income child’ in section 2110(b) as if any ref-
erence to a child were deemed a reference to a
woman during pregnancy and through the end of the
month in which the 60-day period (beginning on the
last day of her pregnancy) ends.
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of pregnancy-related assistance to tar-
geted low-income pregnant women under subsection (a),
the following special rules apply:
‘‘(1) Any reference in this title (other than sub-
section (b)) to a targeted low-income child is deemed
to include a reference to a targeted low-income preg-
nant woman.
‘‘(2) Any such reference to child health assist-
ance with respect to such women is deemed a ref-
erence to pregnancy-related assistance.
‘‘(3) Any such reference to a child is deemed a
reference to a woman during pregnancy and the pe-
riod described in subsection (b)(2).
‘‘(4) The medicaid applicable income level is
deemed a reference to the income level established
under section 1902(l)(2)(A).
‘‘(5) Subsection (a) of section 2103 (relating to
required scope of health insurance coverage) shall
not apply insofar as a State limits coverage to serv-
ices described in subsection (b)(1) and the reference
to such section in section 2105(a)(1) is deemed not
to require, in such case, compliance with the require-
ments of section 2103(a).
‘‘(6) There shall be no exclusion of benefits for
services described in subsection (b)(1) based on any
pre-existing condition and no waiting period (includ-
ing any waiting period imposed to carry out section
2102(b)(3)(C)) shall apply.
‘‘(d) NO IMPACT ON ALLOTMENTS.—Nothing in this
section shall be construed as affecting the amount of any
initial allotment provided to a State under section
2104(b).
‘‘(e) APPLICATION OF FUNDING RESTRICTIONS.—
The coverage under this section (and the funding of such
coverage) is subject to the restrictions of section 2105(c).
‘‘(f) AUTOMATIC
ENROLLMENT
FOR
CHILDREN
BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS-
SISTANCE.—Notwithstanding any other provision of this
title or title XIX, if a child is born to a targeted low-in-
come pregnant woman who was receiving pregnancy-re-
lated assistance under this section on the date of the chil-
dren’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, in the case of a State that provides such
assistance through the provision of medical assistance
under a plan under title XIX, to have applied for medical
assistance under such title and to have been found eligible
for such assistance under such title) on the date of such
birth and to remain eligible for such assistance until the
child attains 1 year of age 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.
During the period in which a child is deemed under the
preceding sentence to be eligible for child health or med-
ical assistance, the child health or medical assistance eligi-
bility 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).’’.
(b) STATE OPTION TO USE ENHANCED FMAP FOR
COVERAGE OF ADDITIONAL PREGNANT WOMEN UNDER
(c) 
CONFORMING
AMENDMENTS.—Section
2102(b)(1)(B) of the Social Security Act (42 U.S.C.
1397bb(b)(1)(B)) is amended—
(1) by striking ‘‘and’’ at the end of clause (i);
(2) by striking the period at the end of clause
(ii) and inserting ‘‘; and’’; and
(3) by adding at the end the following new
clause:
‘‘(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income child who is pregnant, if the
State provides for coverage of pregnancy-
related assistance for targeted low-income
pregnant women in accordance section
2112.’’.
(d) EFFECTIVE DATE.—The amendments made by
this section take effect on the date of the enactment of
this Act and apply to allotments for all fiscal years.
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