265 
cial Security Act (42 U.S.C. 1396u–7(b)) is amended by 
adding at the end the following: 
‘‘(5) COVERAGE OF FAMILY PLANNING SERVICES 
AND SUPPLIES.—Notwithstanding the previous provi-
sions of this section, a State may not provide for 
medical assistance through enrollment of an indi-
vidual with benchmark coverage or benchmark-equiva-
lent coverage under this section unless such coverage 
includes for any individual described in section 
1905(a)(4)(C), medical assistance for family planning 
services and supplies in accordance with such sec-
tion.’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section take effect on the date of the enactment of this Act 
and shall apply to items and services furnished on or after 
such date. 
SEC. 5005. PROTECTIONS FOR INDIANS UNDER MEDICAID 
AND CHIP. 
(a) PREMIUMS
AND COST SHARING PROTECTION 
UNDER MEDICAID.— 
(1) IN GENERAL.—Section 1916 of the Social Se-
curity Act (42 U.S.C. 1396o) is amended— 
(A) in subsection (a), in the matter pre-
ceding paragraph (1), by striking ‘‘and (i)’’ and 
inserting ‘‘, (i), and (j)’’; and 
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266 
(B) by adding at the end the following new 
subsection: 
‘‘(j) NO PREMIUMS OR COST SHARING FOR INDIANS 
FURNISHED ITEMS OR SERVICES DIRECTLY BY INDIAN 
HEALTH PROGRAMS OR THROUGH REFERRAL UNDER CON-
TRACT HEALTH SERVICES.— 
‘‘(1) NO COST SHARING FOR ITEMS OR SERVICES 
FURNISHED TO INDIANS THROUGH INDIAN HEALTH 
PROGRAMS.— 
‘‘(A) IN GENERAL.—No enrollment fee, pre-
mium, or similar charge, and no deduction, co-
payment, cost sharing, or similar charge shall be 
imposed against an Indian who is furnished an 
item or service directly by the Indian Health 
Service, an Indian Tribe, Tribal Organization, 
or Urban Indian Organization or through refer-
ral under contract health services for which pay-
ment may be made under this title. 
‘‘(B) NO REDUCTION IN AMOUNT OF PAY-
MENT TO INDIAN HEALTH PROVIDERS.—Payment 
due under this title to the Indian Health Service, 
an Indian Tribe, Tribal Organization, or Urban 
Indian Organization, or a health care provider 
through referral under contract health services 
for the furnishing of an item or service to an In-
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267 
dian who is eligible for assistance under such 
title, may not be reduced by the amount of any 
enrollment fee, premium, or similar charge, or 
any deduction, copayment, cost sharing, or simi-
lar charge that would be due from the Indian but 
for the operation of subparagraph (A). 
‘‘(2) RULE OF CONSTRUCTION.—Nothing in this 
subsection shall be construed as restricting the appli-
cation of any other limitations on the imposition of 
premiums or cost sharing that may apply to an indi-
vidual receiving medical assistance under this title 
who is an Indian.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1916A(b)(3) of such Act (42 U.S.C. 1396o–1(b)(3)) is 
amended— 
(A) in subparagraph (A), by adding at the 
end the following new clause: 
‘‘(vi) An Indian who is furnished an 
item or service directly by the Indian 
Health Service, an Indian Tribe, Tribal Or-
ganization or Urban Indian Organization 
or through referral under contract health 
services.’’; and 
(B) in subparagraph (B), by adding at the 
end the following new clause: 
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‘‘(ix) Items and services furnished to 
an Indian directly by the Indian Health 
Service, an Indian Tribe, Tribal Organiza-
tion or Urban Indian Organization or 
through referral under contract health serv-
ices.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on October 1, 2009. 
(b) TREATMENT OF CERTAIN PROPERTY FROM RE-
SOURCES FOR MEDICAID AND CHIP ELIGIBILITY.— 
(1) MEDICAID.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a), as amended by section 
3003(a) of the Health Insurance Assistance for the 
Unemployed Act of 2009 and section 5004, is amend-
ed by adding at the end the following new subsection: 
‘‘(ff) Notwithstanding any other requirement of this 
title or any other provision of Federal or State law, a State 
shall disregard the following property from resources for 
purposes of determining the eligibility of an individual who 
is an Indian for medical assistance under this title: 
‘‘(1) Property, including real property and im-
provements, that is held in trust, subject to Federal 
restrictions, or otherwise under the supervision of the 
Secretary of the Interior, located on a reservation, in-
cluding any federally recognized Indian Tribe’s res-
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ervation, pueblo, or colony, including former reserva-
tions in Oklahoma, Alaska Native regions established 
by the Alaska Native Claims Settlement Act, and In-
dian allotments on or near a reservation as des-
ignated and approved by the Bureau of Indian Af-
fairs of the Department of the Interior. 
‘‘(2) For any federally recognized Tribe not de-
scribed in paragraph (1), property located within the 
most recent boundaries of a prior Federal reservation. 
‘‘(3) Ownership interests in rents, leases, royal-
ties, or usage rights related to natural resources (in-
cluding extraction of natural resources or harvesting 
of timber, other plants and plant products, animals, 
fish, and shellfish) resulting from the exercise of feder-
ally protected rights. 
‘‘(4) Ownership interests in or usage rights to 
items not covered by paragraphs (1) through (3) that 
have unique religious, spiritual, traditional, or cul-
tural significance or rights that support subsistence or 
a traditional lifestyle according to applicable tribal 
law or custom.’’. 
(2) APPLICATION TO CHIP.—Section 2107(e)(1) 
of such Act (42 U.S.C. 1397gg(e)(1)) is amended by 
adding at the end the following new subparagraph: 
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