I 
108TH CONGRESS 
1ST SESSION H. R. 2000
To amend title XIX of the Social Security Act to provide fiscal relief and 
program simplification to States, to improve coverage and services to 
Medicaid beneficiaries, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 7, 2003
Mr. DINGELL (for himself, Mr. BROWN of Ohio, Mr. WAXMAN, Mr. BOUCHER, 
Mr. PALLONE, Mr. TOWNS, Ms. MCCARTHY of Missouri, Mr. RUSH, Mr. 
MARKEY, Ms. SCHAKOWSKY, Mr. ALLEN, Mrs. CAPPS, Mr. STRICKLAND, 
Mr. GORDON, and Mr. ENGEL) introduced the following bill; which was 
referred to the Committee on Energy and Commerce, and in addition to 
the Committee on Ways and Means, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XIX of the Social Security Act to provide 
fiscal relief and program simplification to States, to im-
prove coverage and services to Medicaid beneficiaries, 
and for other purposes.
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 
‘‘Strengthening Our States Act of 2003’’ or the ‘‘SOS Act 
of 2003’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows:
Sec. 1. Short title; table of contents. 
TITLE I—STRENGTHENING FEDERAL RESPONSIBILITY FOR 
MEDICARE BENEFICIARIES 
Sec. 101. Assuming Federal responsibility for all medicare cost-sharing. 
Sec. 102. Expanded protections for low income medicare beneficiaries. 
TITLE II—PROVIDING STATES FISCAL RELIEF 
Sec. 201. Temporary increase of medicaid FMAP. 
Sec. 202. Temporary grants for State fiscal relief. 
Sec. 203. Increasing medicaid DSH allotments. 
Sec. 204. Increased State access to unspent SCHIP funds. 
Sec. 205. Federal responsibility for emergency care for illegal immigrants. 
Sec. 206. Increased Federal responsibility for translation services. 
Sec. 207. Increased Federal matching rates for certain services. 
TITLE III—HELPING STATES WITH COMMITMENT TO ELDERLY 
AND DISABLED; FAMILY OPPORTUNITY ACT 
Subtitle A—Elderly and Persons With Disabilities 
Sec. 301. Full accounting of savings in determining cost-effectiveness. 
Sec. 302. Extension of medicaid coverage under the ticket to work program to 
cover spouses. 
Sec. 303. Encouraging transition to home and community care. 
Sec. 304. Enhanced matching rate for disabled individuals awaiting medicare 
eligibility. 
Sec. 305. Providing initial term of 5 years for section 1915 waivers. 
Sec. 306. Optional coverage of community-based attendant services and sup-
ports under the medicaid program. 
Subtitle B—Family Opportunity Act 
Sec. 311. Short title. 
Sec. 312. Opportunity for families of disabled children to purchase medicaid 
coverage for such children. 
Sec. 313. Treatment of inpatient psychiatric hospital services for individuals 
under age 21 in home or community-based services waivers. 
Sec. 314. Demonstration of coverage under the medicaid program of children 
with potentially severe disabilities. 
Sec. 315. Development and support of family-to-family health information cen-
ters.
Sec. 316. Restoration of medicaid eligibility for certain SSI beneficiaries. 
TITLE IV—FACILITATING PROGRAM ADMINISTRATION AND 
PRESERVING COVERAGE 
Sec. 401. Allowing uniform coverage of all low income Americans. 
Sec. 402. Facilitating coverage of families. 
Sec. 403. Assistance with coverage of legal immigrants under the medicaid pro-
gram and SCHIP. 
Sec. 404. Flexibility in eligibility determinations.
TITLE I—STRENGTHENING FED-
ERAL RESPONSIBILITY FOR 
MEDICARE BENEFICIARIES 
SEC. 101. ASSUMING FEDERAL RESPONSIBILITY FOR ALL 
MEDICARE COST-SHARING. 
(a) IN GENERAL.—Section 1905(b) of the Social Se-
curity Act (42 U.S.C. 1396d(b)) is amended—
(1) by striking ‘‘and’’ before ‘‘(4)’’; and 
(2) by inserting before the period the following: 
‘‘, and (5) the Federal medical assistance percentage 
shall be 100 percent with respect to medical assist-
ance provided with costs described in section 
1905(p)(3)’’. 
(b) CONFORMING AMENDMENT.—Section 1902 of 
such Act (42 U.S.C. 1396a) is amended by striking sub-
section (n). 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to medical assistance for medicare 
cost-sharing for months beginning with July 2003.
SEC. 102. EXPANDED PROTECTIONS FOR LOW INCOME 
MEDICARE BENEFICIARIES. 
(a) IN GENERAL.—Section 1902(a)(10)(E) of the So-
cial Security Act (42 U.S.C. 1396a(a)(10)(E)) is amend-
ed—
(1) by adding ‘‘and’’ at the end of clause (ii); 
(2) in clause (iii), by striking ‘‘110 percent in 
1993 and 1994, and 120 percent in 1995 and 
years’’ and inserting ‘‘135 percent’’; and 
(3) by striking clause (iv). 
(b) CONFORMING AMENDMENT.—Section 1933 of 
such Act (42 U.S.C. 1396v) is repealed. 
(c) EFFECTIVE DATE.—The amendments made by 
subsection (a), and the repeal made by subsection (b), 
shall apply to months after September 2003. 
TITLE II—PROVIDING STATES 
FISCAL RELIEF 
SEC. 201. TEMPORARY INCREASE OF MEDICAID FMAP. 
(a) PERMITTING MAINTENANCE OF FISCAL YEAR 
2002 FMAP FOR LAST 2 CALENDAR QUARTERS OF FIS-
CAL YEAR 2003.—Notwithstanding any other provision of 
law, but subject to subsection (e), if the FMAP deter-
mined without regard to this section for a State for fiscal 
year 2003 is less than the FMAP as so determined for 
fiscal year 2002, the FMAP for the State for fiscal year 
2002 shall be substituted for the State’s FMAP for the
third and fourth calendar quarters of fiscal year 2003, be-
fore the application of this section. 
(b) PERMITTING MAINTENANCE OF FISCAL YEAR 
2003 FMAP FOR FISCAL YEAR 2004.—Notwithstanding 
any other provision of law, but subject to subsection (e), 
if the FMAP determined without regard to this section 
for a State for fiscal year 2004 is less than the FMAP 
as so determined for fiscal year 2003, the FMAP for the 
State for fiscal year 2003 shall be substituted for the 
State’s FMAP for each calendar quarter of fiscal year 
2004, before the application of this section. 
(c) GENERAL 3.73 PERCENTAGE POINTS INCREASE 
FOR LAST 2 CALENDAR QUARTERS OF FISCAL YEAR 2003 
AND FISCAL YEAR 2004.—Notwithstanding any other 
provision of law, but subject to subsections (e) and (f), 
for each State for the third and fourth calendar quarters 
of fiscal year 2003 and each calendar quarter of fiscal year 
2004, the FMAP (taking into account the application of 
subsections (a) and (b)) shall be increased by 3.73 per-
centage points. 
(d) INCREASE IN CAP ON MEDICAID PAYMENTS TO 
TERRITORIES.—Notwithstanding any other provision of 
law, but subject to subsection (f), with respect to the third 
and fourth calendar quarters of fiscal year 2003 and each 
calendar quarter of fiscal year 2004, the amounts other-
wise determined for Puerto Rico, the Virgin Islands, 
Guam, the Northern Mariana Islands, and American 
Samoa under subsections (f) and (g) of section 1108 of 
the Social Security Act (42 U.S.C. 1308) shall each be 
increased by an amount equal to 7.46 percent of such 
amounts. 
(e) SCOPE OF APPLICATION.—The increases in the 
FMAP for a State under this section shall apply only for 
purposes of title XIX of the Social Security Act and shall 
not apply with respect to—
(1) disproportionate share hospital payments 
described in section 1923 of such Act (42 U.S.C. 
1396r–4); or 
(2) payments under title IV or XXI of such Act 
(42 U.S.C. 601 et seq. and 1397aa et seq.). 
(f) STATE ELIGIBILITY.—
(1) IN GENERAL.—Subject to paragraph (2), a 
State is eligible for an increase in its FMAP under 
subsection (c) or an increase in a cap amount under 
subsection (d) only if the eligibility under its State 
plan under title XIX of the Social Security Act (in-
cluding any waiver under such title or under section 
1115 of such Act (42 U.S.C. 1315)) is no more re-
strictive than the eligibility under such plan (or 
waiver) as in effect on September 2, 2003.
(2) STATE
REINSTATEMENT
OF
ELIGIBILITY 
PERMITTED.—A State that has restricted eligibility 
under its State plan under title XIX of the Social 
Security Act (including any waiver under such title 
or under section 1115 of such Act (42 U.S.C. 
1315)) after September 2, 2003, but prior to the 
date of enactment of this Act is eligible for an in-
crease in its FMAP under subsection (c) or an in-
crease in a cap amount under subsection (d) in the 
first calendar quarter (and subsequent calendar 
quarters) in which the State has reinstated eligibility 
that is no more restrictive than the eligibility under 
such plan (or waiver) as in effect on September 2, 
2003. 
(3) RULE
OF
CONSTRUCTION.—Nothing in 
paragraph (1) or (2) shall be construed as affecting 
a State’s flexibility with respect to benefits offered 
under the State medicaid program under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.) 
(including any waiver under such title or under sec-
tion 1115 of such Act (42 U.S.C. 1315)). 
(g) DEFINITIONS.—In this section: 
(1) FMAP.—The term ‘‘FMAP’’ means the 
Federal medical assistance percentage, as defined in