I 
111TH CONGRESS 
1ST SESSION 
H. R. 321 
To amend title XXI of the Social Security Act to expand coverage options 
under the State Children’s Health Insurance Program (SCHIP) through 
premium assistance. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 8, 2009 
Mr. FORTENBERRY (for himself, Mr. BURGESS, Mr. SESSIONS, Mr. TERRY, 
Mr. PRICE of Georgia, and Mr. SHADEGG) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committees on Ways and Means and Education and 
Labor, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To amend title XXI of the Social Security Act to expand 
coverage options under the State Children’s Health In-
surance Program (SCHIP) through premium assistance. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘SCHIP Plus Act of 
2009’’. 
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SEC. 
2. 
EXPANDING 
COVERAGE 
OPTIONS 
IN 
SCHIP 
THROUGH PREMIUM ASSISTANCE. 
(a) REQUIRING OFFERING OF ALTERNATIVE COV-
ERAGE OPTIONS.—Section 2102 of the Social Security Act 
(42 U.S.C. 1397b) is amended— 
(1) in subsection (a)— 
(A) in paragraph (6), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (7), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(8) effective for plan years beginning on or 
after October 1, 2010, how the plan will provide for 
child health assistance with respect to applicable tar-
geted low-income children through alternative cov-
erage options in accordance with subsection (d).’’; 
and 
(2) by adding at the end the following new sub-
section: 
‘‘(d) ALTERNATIVE COVERAGE OPTIONS.— 
‘‘(1) IN GENERAL.—Effective October 1, 2010, 
a State child health plan shall provide for the offer-
ing of any qualified alternative coverage that a 
qualified entity seeks to offer to applicable targeted 
low-income children through the plan in the State. 
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‘‘(2) APPLICATION
OF
UNIFORM
FINANCIAL 
LIMITATION FOR ALL ALTERNATIVE COVERAGE OP-
TIONS.—With respect to all qualified alternative cov-
erage offered in a State, the State child health plan 
shall establish a uniform dollar limitation on the per 
capita monthly amount that will be paid by the 
State to the qualified entity with respect to such 
coverage provided to a targeted low-income child. 
Such limitation may not be less than 90 percent of 
the per capita monthly payment made for coverage 
offered under the State child health plan that is not 
in the form of an alternative coverage option. Noth-
ing in this paragraph shall be construed— 
‘‘(A) as requiring a State to provide for 
the full payment of premiums for qualified al-
ternative coverage; 
‘‘(B) as preventing a State from charging 
additional premiums to cover the difference be-
tween the cost of qualified alternative coverage 
and the amount of such payment limitation; 
‘‘(C) as preventing a State from using its 
own funds to provide a dollar limitation that ex-
ceeds the Federal financial participation as lim-
ited under section 2105(c)(8). 
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