343 
Program or Organization for which payment is made under 
this title, see section 401(d) of the Indian Health Care Im-
provement Act.’’. 
(B) CONFORMING AMENDMENT.—Paragraph 
(3) of section 1880(e) of such Act (42 U.S.C. 
1395qq(e)) is amended by inserting ‘‘and section 
401(c)(1) of the Indian Health Care Improve-
ment Act’’ after ‘‘Subsection (c)’’. 
(4) 
DEFINITIONS.—Such 
section 
is 
further 
amended by amending subsection (f) to read as fol-
lows: 
‘‘(f) DEFINITIONS.—In this section, the terms ‘Indian 
Health Program’, ‘Indian Tribe’, ‘Service Unit’, ‘Tribal 
Health Program’, ‘Tribal Organization’, and ‘Urban In-
dian Organization’ have the meanings given those terms in 
section 4 of the Indian Health Care Improvement Act.’’. 
(c) APPLICATION TO SCHIP.—Section 2107(e)(1) of 
the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amend-
ed— 
(1) by redesignating subparagraph (D) as sub-
paragraph (E); and 
(2) by inserting after subparagraph (C), the fol-
lowing new subparagraph: 
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344 
‘‘(D) Section 1911 (relating to Indian 
Health Programs, other than subsection (d) of 
such section).’’. 
SEC. 202. INCREASED OUTREACH TO INDIANS UNDER MED-
ICAID AND SCHIP AND IMPROVED COOPERA-
TION IN THE PROVISION OF ITEMS AND SERV-
ICES TO INDIANS UNDER SOCIAL SECURITY 
ACT HEALTH BENEFIT PROGRAMS. 
Section 1139 of the Social Security Act (42 U.S.C. 
1320b–9) is amended to read as follows: 
‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 
HEALTH CARE FOR INDIANS UNDER TITLES 
XVIII, XIX, AND XXI. 
‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID AND 
SCHIP OUTREACH ON OR NEAR RESERVATIONS TO IN-
CREASE THE ENROLLMENT OF INDIANS IN THOSE PRO-
GRAMS.— 
‘‘(1) IN GENERAL.—In order to improve the ac-
cess of Indians residing on or near a reservation to 
obtain benefits under the Medicaid and State chil-
dren’s health insurance programs established under 
titles XIX and XXI, the Secretary shall encourage the 
State to take steps to provide for enrollment on or 
near the reservation. Such steps may include outreach 
efforts such as the outstationing of eligibility workers, 
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345 
entering into agreements with the Indian Health 
Service, Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations to provide outreach, 
education regarding eligibility and benefits, enroll-
ment, and translation services when such services are 
appropriate. 
‘‘(2) CONSTRUCTION.—Nothing in subparagraph 
(A) shall be construed as affecting arrangements en-
tered into between States and the Indian Health 
Service, Indian Tribes, Tribal Organizations, or 
Urban Indian Organizations for such Service, Tribes, 
or Organizations to conduct administrative activities 
under such titles. 
‘‘(b) REQUIREMENT TO FACILITATE COOPERATION.— 
The Secretary, acting through the Centers for Medicare & 
Medicaid Services, shall take such steps as are necessary 
to facilitate cooperation with, and agreements between, 
States and the Indian Health Service, Indian Tribes, Trib-
al Organizations, or Urban Indian Organizations with re-
spect to the provision of health care items and services to 
Indians under the programs established under title XVIII, 
XIX, or XXI. 
‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN 
HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN INDIAN 
ORGANIZATION.—In this section, the terms ‘Indian’, ‘In-
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346 
dian Tribe’, ‘Indian Health Program’, ‘Tribal Organiza-
tion’, and ‘Urban Indian Organization’ have the meanings 
given those terms in section 4 of the Indian Health Care 
Improvement Act.’’. 
SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUT-
REACH TO, AND ENROLLMENT OF, INDIANS 
IN SCHIP AND MEDICAID. 
(a) NONAPPLICATION OF 10 PERCENT LIMIT ON OUT-
REACH
AND CERTAIN OTHER EXPENDITURES.—Section 
2105(c)(2) of the Social Security Act (42 U.S.C. 
1397ee(c)(2)) is amended by adding at the end the following 
new subparagraph: 
‘‘(C) NONAPPLICATION
TO
EXPENDITURES 
FOR OUTREACH TO INCREASE THE ENROLLMENT 
OF INDIAN CHILDREN UNDER THIS TITLE AND 
TITLE XIX.—The limitation under subparagraph 
(A) on expenditures for items described in sub-
section (a)(1)(D) shall not apply in the case of 
expenditures for outreach activities to families of 
Indian children likely to be eligible for child 
health assistance under the plan or medical as-
sistance under the State plan under title XIX (or 
under a waiver of such plan), to inform such 
families of the availability of, and to assist them 
in enrolling their children in, such plans, includ-
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347 
ing such activities conducted under grants, con-
tracts, or agreements entered into under section 
1139(a).’’. 
(b) ASSURANCE OF PAYMENTS TO INDIAN HEALTH 
CARE PROVIDERS FOR CHILD HEALTH ASSISTANCE.—Sec-
tion 2102(b)(3)(D) of such Act (42 U.S.C. 1397bb(b)(3)(D)) 
is amended by striking ‘‘(as defined in section 4(c) of the 
Indian Health Care Improvement Act, 25 U.S.C. 1603(c))’’ 
and inserting ‘‘, including how the State will ensure that 
payments are made to Indian Health Programs and Urban 
Indian Organizations operating in the State for the provi-
sion of such assistance’’. 
(c) INCLUSION OF OTHER INDIAN FINANCED HEALTH 
CARE PROGRAMS IN EXEMPTION FROM PROHIBITION ON 
CERTAIN PAYMENTS.—Section 2105(c)(6)(B) of such Act 
(42 U.S.C. 1397ee(c)(6)(B)) is amended by striking ‘‘insur-
ance program, other than an insurance program operated 
or financed by the Indian Health Service’’ and inserting 
‘‘program, other than a health care program operated or 
financed by the Indian Health Service or by an Indian 
Tribe, Tribal Organization, or Urban Indian Organiza-
tion’’. 
(d) SATISFACTION OF MEDICAID DOCUMENTATION RE-
QUIREMENTS.— 
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348 
(1) IN GENERAL.—Section 1903(x)(3)(B) of the 
Social Security Act (42 U.S.C. 1396b(x)(3)(B)) is 
amended— 
(A) by redesignating clause (v) as clause 
(vi); and 
(B) by inserting after clause (iv), the fol-
lowing new clause: 
‘‘(v)(I) Except as provided in subclause (II), a 
document issued by a federally-recognized Indian 
tribe evidencing membership or enrollment in, or af-
filiation with, such tribe. 
‘‘(II) With respect to those federally-recognized 
Indian tribes located within States having an inter-
national border whose membership includes individ-
uals who are not citizens of the United States, the 
Secretary shall, after consulting with such tribes, 
issue regulations authorizing the presentation of such 
other forms of documentation (including tribal docu-
mentation, if appropriate) that the Secretary deter-
mines to be satisfactory documentary evidence of citi-
zenship or nationality for purposes of satisfying the 
requirement of this subsection.’’. 
(2) TRANSITION RULE.—During the period that 
begins on July 1, 2006, and ends on the effective date 
of final regulations issued under subclause (II) of sec-
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349 
tion 1903(x)(3)(B)(v) of the Social Security Act (42 
U.S.C. 1396b(x)(3)(B)(v)) (as added by paragraph 
(1)), an individual who is a member of a federally- 
recognized Indian tribe described in subclause (II) of 
that section who presents a document described in 
subclause (I) of such section that is issued by such In-
dian tribe, shall be deemed to have presented satisfac-
tory evidence of citizenship or nationality for pur-
poses of satisfying the requirement of subsection (x) of 
section 1903 of such Act. 
(e) DEFINITIONS.—Section 2110(c) of such Act (42 
U.S.C. 1397jj(c)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(9) INDIAN; INDIAN HEALTH PROGRAM; INDIAN 
TRIBE; ETC.—The terms ‘Indian’, ‘Indian Health 
Program’, ‘Indian Tribe’, ‘Tribal Organization’, and 
‘Urban Indian Organization’ have the meanings 
given those terms in section 4 of the Indian Health 
Care Improvement Act.’’. 
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350 
SEC. 204. PREMIUMS AND COST SHARING PROTECTIONS 
UNDER MEDICAID, ELIGIBILITY DETERMINA-
TIONS UNDER MEDICAID AND SCHIP, AND 
PROTECTION OF CERTAIN INDIAN PROPERTY 
FROM MEDICAID ESTATE RECOVERY. 
(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 
(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 THE 
CONTRACT HEALTH SERVICE.— 
‘‘(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 
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351 
Service, an Indian Tribe, Tribal Organization, 
or Urban Indian Organization or through refer-
ral under the contract health service for which 
payment 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 the contract health service 
for the furnishing of an item or service to an In-
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. 
‘‘(3) DEFINITIONS.—In this subsection, the terms 
‘contract health service’, ‘Indian’, ‘Indian Tribe’, 
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