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‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of this title, each State plan approved 
under this title may provide, at the option of the 
State, that the State shall offer to each family which 
received assistance during the entire 6-month period 
under subsection (b) and which meets the applicable 
requirement of paragraph (2), in the last month of 
the period the option of extending coverage under this 
subsection for the succeeding period not to exceed 12 
months. 
‘‘(2) INCOME RESTRICTION.—The option under 
paragraph (1) shall not be made available to a family 
for a succeeding period unless the State determines 
that the family’s average gross monthly earnings (less 
such costs for such child care as is necessary for the 
employment of the caretaker relative) as of the end of 
the 6-month period under subsection (b) does not ex-
ceed 185 percent of the official poverty line (as de-
fined by the Office of Management and Budget, and 
revised annually in accordance with section 673(2) of 
the Omnibus Budget Reconciliation Act of 1981) ap-
plicable to a family of the size involved. 
‘‘(3) APPLICATION OF EXTENSION RULES.—The 
provisions of paragraphs (2), (3), (4), and (5) of sub-
section (b) shall apply to the extension provided
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under this subsection in the same manner as they 
apply to the extension provided under subsection 
(b)(1), except that for purposes of this subsection—
‘‘(A) any reference to a 6-month period 
under subsection (b)(1) is deemed a reference to 
the extension period provided under paragraph 
(1) and any deadlines for any notices or report-
ing and the premium payment periods shall be 
modified to correspond to the appropriate cal-
endar quarters of coverage provided under this 
subsection; and 
‘‘(B) any reference to a provision of sub-
section (a) or (b) is deemed a reference to the 
corresponding provision of subsection (b) or of 
this subsection, respectively.’’. 
(b) STATE OPTION TO WAIVE RECEIPT OF MEDICAID 
FOR 3 OF PREVIOUS 6 MONTHS TO QUALIFY FOR TMA.—
Section 1925(a)(1) (42 U.S.C. 1396r–6(a)(1)) is amended 
by adding at the end the following: ‘‘A State may, at its 
option, also apply the previous sentence in the case of a 
family that was receiving such aid for fewer than 3 months, 
or that had applied for and was eligible for such aid for 
fewer than 3 months, during the 6 immediately preceding 
months described in such sentence.’’. 
(c) EXTENSION OF SUNSET FOR TMA.—
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(1) IN GENERAL.—Subsection (g) of section 1925 
(42 U.S.C. 1396r–6), as so redesignated under sub-
section (a)(2)(A), and as amended by section 7 of the 
Welfare Reform Extension Act of 2003, is further re-
designated as subsection (i) and is amended by strik-
ing ‘‘2003’’ and inserting ‘‘2008’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1902(e)(1)(B) (42 U.S.C. 1396a(e)(1)(B)), as so 
amended, is amended by striking ‘‘September 30, 
2003’’ and inserting ‘‘the last date (if any) on which 
section 1925 applies under subsection (f) of that sec-
tion’’. 
(d) CMS REPORT ON ENROLLMENT AND PARTICIPA-
TION RATES UNDER TMA.—Section 1925 (42 U.S.C. 
1396r–6), as amended by subsections (a)(2)(A) and (c)(1), 
is amended by inserting after subsection (f) the following: 
‘‘(g) ADDITIONAL PROVISIONS.—
‘‘(1) COLLECTION AND REPORTING OF PARTICI-
PATION INFORMATION.—Each State shall—
‘‘(A) collect and submit to the Secretary, in 
a format specified by the Secretary, information 
on average monthly enrollment and average 
monthly participation rates for adults and chil-
dren under this section; and
349
‘‘(B) make such information publicly avail-
able. 
Such information shall be submitted under subpara-
graph (A) at the same time and frequency in which 
other enrollment information under this title is sub-
mitted to the Secretary. Using such information, the 
Secretary shall submit to Congress annual reports 
concerning such rates.’’. 
(e) COORDINATION OF WORK.—Section 1925(g) (42 
U.S.C. 1396r–6(g)), as added by subsection (d), is amended 
by adding at the end the following: 
‘‘(2) COORDINATION WITH ADMINISTRATION FOR 
CHILDREN AND FAMILIES.—The Administrator of the 
Centers for Medicare & Medicaid Services, in car-
rying out this section, shall work with the Assistant 
Secretary for the Administration for Children and 
Families to develop guidance or other technical assist-
ance for States regarding best practices in guaran-
teeing access to transitional medical assistance under 
this section.’’. 
(f) ELIMINATION OF TMA REQUIREMENT FOR STATES 
THAT EXTEND COVERAGE TO CHILDREN AND PARENTS 
THROUGH 185 PERCENT OF POVERTY.—
350
(1) IN
GENERAL.—Section 1925 (42 U.S.C. 
1396r–6) is amended by inserting after subsection (g), 
as added by subsection (d), the following: 
‘‘(h) PROVISIONS OPTIONAL FOR STATES THAT EX-
TEND COVERAGE TO CHILDREN AND PARENTS THROUGH 
185 PERCENT OF POVERTY.—A State may meet (but is not 
required to meet) the requirements of subsections (a) and 
(b) if it provides for medical assistance under section 1931 
to families (including both children and caretaker relatives) 
the average gross monthly earning of which (less such costs 
for such child care as is necessary for the employment of 
a caretaker relative) is at or below a level that is at least 
185 percent of the official poverty line (as defined by the 
Office of Management and Budget, and revised annually 
in accordance with section 673(2) of the Omnibus Budget 
Reconciliation Act of 1981) applicable to a family of the 
size involved.’’. 
(2) CONFORMING
AMENDMENTS.—Section 1925 
(42 U.S.C. 1396r–6) is amended, in subsections (a)(1) 
and (b)(1), by inserting ‘‘, but subject to subsection 
(h),’’ after ‘‘Notwithstanding any other provision of 
this title,’’ each place it appears. 
(g) REQUIREMENT OF NOTICE FOR ALL FAMILIES 
LOSING TANF.—Subsection (a)(2) of section 1925 (42
351
U.S.C. 1396r–6) is amended by adding at the end the fol-
lowing flush sentences: 
‘‘Each State shall provide, to families whose aid 
under part A or E of title IV has terminated but 
whose eligibility for medical assistance under this 
title continues, written notice of their ongoing eligi-
bility for such medical assistance. If a State makes a 
determination that any member of a family whose aid 
under part A or E of title IV is being terminated is 
also no longer eligible for medical assistance under 
this title, the notice of such determination shall be 
supplemented by a 1-page notification form describ-
ing the different ways in which individuals and fami-
lies may qualify for such medical assistance and ex-
plaining that individuals and families do not have to 
be receiving aid under part A or E of title IV in 
order to qualify for such medical assistance. Such no-
tice shall further be supplemented by information on 
how to apply for child health assistance under the 
State children’s health insurance program under title 
XXI and how to apply for medical assistance under 
this title.’’. 
(h) EXTENDING USE OF OUTSTATIONED WORKERS TO 
ACCEPT APPLICATIONS FOR TRANSITIONAL MEDICAL AS-
SISTANCE.—Section 1902(a)(55) (42 U.S.C. 1396a(a)(55))