(1) in paragraph (1), by striking ‘‘paragraph 
(2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and 
(2) by adding at the end the following: 
‘‘(4)(A) A State may elect (in a plan amendment 
under this title) to provide medical assistance under this 
title for aliens who are lawfully residing in the United 
States (including battered aliens described in section 
431(c) of the Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996) and who are otherwise 
eligible for such assistance, within any of the following eli-
gibility categories: 
‘‘(i) PREGNANT WOMEN.—Women during preg-
nancy (and during the 60-day period beginning on 
the last day of the pregnancy). 
‘‘(ii) CHILDREN.—Children (as defined under 
such plan), including optional targeted low-income 
children described in section 1905(u)(2)(B). 
‘‘(iii) PARENTS.—If the State has elected the 
eligibility category described in clause (ii), caretaker 
relatives who are parents (including individuals 
treated as a caretaker for purposes of carrying out 
section 1931) of children (described in such clause 
or otherwise) who are eligible for medical assistance 
under the plan.
‘‘(B)(i) In the case of a State that has elected to pro-
vide medical assistance to a category of aliens under sub-
paragraph (A), no debt shall accrue under an affidavit of 
support against any sponsor of such an alien on the basis 
of provision of assistance to such category and the cost 
of such assistance shall not be considered as an unreim-
bursed cost. 
‘‘(ii) The provisions of sections 401(a), 402(b), 403, 
and 421 of the Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996 shall not apply to a 
State that makes an election under subparagraph (A).’’. 
(b) TITLE XXI.—Section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)) is amended by add-
ing at the end the following: 
‘‘(E) Section 1903(v)(4) (relating to op-
tional coverage of permanent resident alien chil-
dren and parents), but only if the State has 
elected to apply such section to that category of 
children under title XIX.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2005, and apply to 
medical assistance and child health assistance furnished 
on or after such date, whether or not regulations imple-
menting such amendments have been issued.
SEC. 6. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 
20 UNDER THE MEDICAID PROGRAM AND 
TITLE XXI. 
(a) MEDICAID.— 
(1) IN GENERAL.—Section 1902(l)(1)(D) of the 
Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is 
amended by inserting ‘‘(or, at the election of a 
State, 20 or 21 years of age)’’ after ‘‘19 years of 
age’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1902(e)(3)(A) of the Social Se-
curity Act (42 U.S.C. 1396a(e)(3)(A)) is 
amended by inserting ‘‘(or 1 year less than the 
age the State has elected under subsection 
(l)(1)(D))’’ after ‘‘18 years of age’’. 
(B) Section 1902(e)(12) of the Social Se-
curity Act (42 U.S.C. 1396a(e)(12)) is amend-
ed by inserting ‘‘or such higher age as the State 
has elected under subsection (l)(1)(D)’’ after 
‘‘19 years of age’’. 
(C) Section 1920A(b)(1) of the Social Se-
curity Act (42 U.S.C. 1396r–1a(b)(1)) is 
amended by inserting ‘‘or such higher age as 
the 
State 
has 
elected 
under 
section 
1902(l)(1)(D)’’ after ‘‘19 years of age’’.
(D) Section 1928(h)(1) of the Social Secu-
rity Act (42 U.S.C. 1396s(h)(1)) is amended by 
inserting ‘‘or 1 year less than the age the State 
has elected under section 1902(l)(1)(D)’’ before 
the period at the end. 
(E) Section 1932(a)(2)(A) of the Social 
Security Act (42 U.S.C. 1396u–2(a)(2)(A)) is 
amended by inserting ‘‘(or such higher age as 
the 
State 
has 
elected 
under 
section 
1902(l)(1)(D))’’ after ‘‘19 years of age’’. 
(b) TITLE XXI.—Section 2110(c)(1) of the Social 
Security Act (42 U.S.C. 1397jj(c)(1)) is amended by in-
serting ‘‘(or such higher age as the State has elected under 
section 1902(l)(1)(D))’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on January 1, 2006, and apply to 
medical assistance and child health assistance provided on 
or after such date, whether or not regulations imple-
menting such amendments have been issued. 
SEC. 7. ALLOWING STATES TO SIMPLIFY RULES FOR FAMI-
LIES. 
(a) PRESUMPTIVE ELIGIBILITY.— 
(1) APPLICATION TO PRESUMPTIVE ELIGIBILITY 
FOR PREGNANT WOMEN UNDER MEDICAID.—Section 
1920(b) of the Social Security Act (42 U.S.C.
1396r–1(b)) is amended by adding at the end after 
and below paragraph (2) the following flush sen-
tence: 
‘‘The term ‘qualified provider’ includes a qualified entity 
as defined in section 1920A(b)(3).’’. 
(2) OPTIONAL APPLICATION OF PRESUMPTIVE 
ELIGIBILITY
PROVISIONS
TO
PARENTS.—Section 
1920A of the Social Security Act (42 U.S.C. 1396r– 
1a) is amended by adding at the end the following: 
‘‘(e) A State may elect to apply the previous provi-
sions of this section to provide for a period of presumptive 
eligibility for medical assistance for a parent of a child 
with respect to whom such a period is provided under this 
section.’’. 
(3) APPLICATION UNDER TITLE XXI.—Section 
2107(e)(1)(D) of the Social Security Act (42 U.S.C. 
1397gg(e)(1)) is amended to read as follows: 
‘‘(D) Sections 1920 and 1920A (relating to 
presumptive eligibility).’’. 
(b) 12-MONTHS CONTINUOUS ELIGIBILITY.— 
(1) MEDICAID.—Section 1902(e)(12) of the So-
cial Security Act (42 U.S.C. 1396a(e)(12)) is 
amended— 
(A) by striking ‘‘At the option of the State, 
the plan may’’ and inserting ‘‘The plan shall’’;
(B) by striking ‘‘an age specified by the 
State (not to exceed 19 years of age)’’ and in-
serting ‘‘19 years of age (or such higher age as 
the 
State 
has 
elected 
under 
subsection 
(l)(1)(D)) or, at the option of the State, who is 
eligible for medical assistance as the parent of 
such a child’’; and 
(C) in subparagraph (A), by striking ‘‘a 
period (not to exceed 12 months) ’’ and insert-
ing ‘‘the 12-month period beginning on the 
date’’. 
(2) TITLE XXI.—Section 2102(b)(2) of such 
Act (42 U.S.C. 1397bb(b)(2)) is amended by adding 
at the end the following: ‘‘Such methods shall pro-
vide continuous eligibility for children under this 
title in a manner that is no less generous than the 
12-months continuous eligibility provided under sec-
tion 1902(e)(12) for children described in such sec-
tion under title XIX. If a State has elected to apply 
section 1902(e)(12) to parents, such methods may 
provide continuous eligibility for parents under this 
title in a manner that is no less generous than the 
12-months continuous eligibility provided under such 
section for parents described in such section under 
title XIX.’’.