In the Senate of the United States,
August 2, 2007.
Resolved, That the bill from the House of Representa-
tives (H.R. 976) entitled ‘‘An Act to amend the Internal Rev-
enue Code of 1986 to provide tax relief for small businesses,
and for other purposes.’’, do pass with the following
AMENDMENTS:
Strike out all after the enacting clause and insert:
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECU-
RITY ACT; REFERENCES; TABLE OF CON-
TENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Children’s Health Insurance Program Reauthorization
Act of 2007’’.
(b) AMENDMENTS TO SOCIAL SECURITY ACT.—Except
as otherwise specifically provided, whenever in this Act an
amendment is expressed in terms of an amendment to or
repeal of a section or other provision, the reference shall
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be considered to be made to that section or other provision
of the Social Security Act.
(c) REFERENCES TO MEDICAID; CHIP; SECRETARY.—
In this Act:
(1) CHIP.—The term ‘‘CHIP’’ means the State
Children’s Health Insurance Program established
under title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.).
(2) MEDICAID.—The term ‘‘Medicaid’’ means the
program for medical assistance established under title
XIX of the Social Security Act (42 U.S.C. 1396 et
seq.).
(3) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
(d) TABLE OF CONTENTS.—The table of contents for
this Act is as follows:
Sec. 1. Short title; amendments to Social Security Act; references; table of con-
tents.
TITLE I—FINANCING OF CHIP
Sec. 101. Extension of CHIP.
Sec. 102. Allotments for the 50 States and the District of Columbia.
Sec. 103. One-time appropriation.
Sec. 104. Improving funding for the territories under CHIP and Medicaid.
Sec. 105. Incentive bonuses for States.
Sec. 106. Phase-out of coverage for nonpregnant childless adults under CHIP;
conditions for coverage of parents.
Sec. 107. State option to cover low-income pregnant women under CHIP through
a State plan amendment.
Sec. 108. CHIP Contingency fund.
Sec. 109. Two-year availability of allotments; expenditures counted against oldest
allotments.
Sec. 110. Limitation on matching rate for States that propose to cover children
with effective family income that exceeds 300 percent of the pov-
erty line.
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Sec. 111. Option for qualifying States to receive the enhanced portion of the
CHIP matching rate for Medicaid coverage of certain children.
TITLE II—OUTREACH AND ENROLLMENT
Sec. 201. Grants for outreach and enrollment.
Sec. 202. Increased outreach and enrollment of Indians.
Sec. 203. Demonstration program to permit States to rely on findings by an Ex-
press Lane agency to determine components of a child’s eligi-
bility for Medicaid or CHIP.
Sec. 204. Authorization of certain information disclosures to simplify health cov-
erage determinations.
TITLE III—REDUCING BARRIERS TO ENROLLMENT
Sec. 301. Verification of declaration of citizenship or nationality for purposes of
eligibility for Medicaid and CHIP.
Sec. 302. Reducing administrative barriers to enrollment.
TITLE IV—REDUCING BARRIERS TO PROVIDING PREMIUM
ASSISTANCE
Subtitle A—Additional State Option for Providing Premium Assistance
Sec. 401. Additional State option for providing premium assistance.
Sec. 402. Outreach, education, and enrollment assistance.
Subtitle B—Coordinating Premium Assistance With Private Coverage
Sec. 411. Special enrollment period under group health plans in case of termi-
nation of Medicaid or CHIP coverage or eligibility for assistance
in purchase of employment-based coverage; coordination of cov-
erage.
TITLE V—STRENGTHENING QUALITY OF CARE AND HEALTH
OUTCOMES OF CHILDREN
Sec. 501. Child health quality improvement activities for children enrolled in
Medicaid or CHIP.
Sec. 502. Improved information regarding access to coverage under CHIP.
Sec. 503. Application of certain managed care quality safeguards to CHIP.
TITLE VI—MISCELLANEOUS
Sec. 601. Technical correction regarding current State authority under Medicaid.
Sec. 602. Payment error rate measurement (‘‘PERM’’).
Sec. 603. Elimination of counting medicaid child presumptive eligibility costs
against title XXI allotment.
Sec. 604. Improving data collection.
Sec. 605. Deficit Reduction Act technical corrections.
Sec. 606. Elimination of confusing program references.
Sec. 607. Mental health parity in CHIP plans.
Sec. 608. Dental health grants.
Sec. 609. Application of prospective payment system for services provided by Fed-
erally-qualified health centers and rural health clinics.
Sec. 610. Support for injured servicemembers.
Sec. 611. Military family job protection.
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Sec. 612. Sense of Senate regarding access to affordable and meaningful health
insurance coverage.
Sec. 613. Demonstraion projects relating to diabetes prevention.
Sec. 614. Outreach regarding health insurance options available to children.
TITLE VII—REVENUE PROVISIONS
Sec. 701. Increase in excise tax rate on tobacco products.
Sec. 702. Administrative improvements.
Sec. 703. Time for payment of corporate estimated taxes.
TITLE VIII—EFFECTIVE DATE
Sec. 801. Effective date.
TITLE I—FINANCING OF CHIP
SEC. 101. EXTENSION OF CHIP.
Section 2104(a) (42 U.S.C. 1397dd(a)) is amended—
(1) in paragraph (9), by striking ‘‘and’’ at the
end;
(2) in paragraph (10), by striking the period at
the end and inserting a semicolon; and
(3) by adding at the end the following new para-
graphs:
‘‘(11) for fiscal year 2008, $9,125,000,000;
‘‘(12) for fiscal year 2009, $10,675,000,000;
‘‘(13) for fiscal year 2010, $11,850,000,000;
‘‘(14) for fiscal year 2011, $13,750,000,000; and
‘‘(15) for fiscal year 2012, for purposes of mak-
ing 2 semi-annual allotments—
‘‘(A) $1,750,000,000 for the period begin-
ning on October 1, 2011, and ending on March
31, 2012, and
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‘‘(B) $1,750,000,000 for the period begin-
ning on April 1, 2012, and ending on September
30, 2012.’’.
SEC. 102. ALLOTMENTS FOR THE 50 STATES AND THE DIS-
TRICT OF COLUMBIA.
(a) IN GENERAL.—Section 2104 (42 U.S.C. 1397dd)
is amended by adding at the end the following new sub-
section:
‘‘(i) DETERMINATION OF ALLOTMENTS FOR THE 50
STATES AND THE DISTRICT OF COLUMBIA FOR FISCAL
YEARS 2008 THROUGH 2012.—
‘‘(1) COMPUTATION OF ALLOTMENT.—
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding paragraphs of this subsection, the Sec-
retary shall for each of fiscal years 2008 through
2012 allot to each subsection (b) State from the
available national allotment an amount equal to
110 percent of—
‘‘(i) in the case of fiscal year 2008, the
highest of the amounts determined under
paragraph (2);
‘‘(ii) in the case of each of fiscal years
2009 through 2011, the Federal share of the
expenditures determined under subpara-
graph (B) for the fiscal year; and
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‘‘(iii) beginning with fiscal year 2012,
subject to subparagraph (E), each semi-an-
nual allotment determined under subpara-
graph (D).
‘‘(B) PROJECTED
STATE
EXPENDITURES
FOR THE FISCAL YEAR.—For purposes of sub-
paragraphs (A)(ii) and (D), the expenditures de-
termined under this subparagraph for a fiscal
year are the projected expenditures under the
State child health plan for the fiscal year (as
certified by the State and submitted to the Sec-
retary by not later than August 31 of the pre-
ceding fiscal year).
‘‘(C) AVAILABLE NATIONAL ALLOTMENT.—
For purposes of this subsection, the term ‘avail-
able national allotment’ means, with respect to
any fiscal year, the amount available for allot-
ment under subsection (a) for the fiscal year, re-
duced by the amount of the allotments made for
the fiscal year under subsection (c). Subject to
paragraph (3)(B), the available national allot-
ment with respect to the amount available under
subsection (a)(15)(A) for fiscal year 2012 shall
be increased by the amount of the appropriation
for the period beginning on October 1 and end-
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ing on March 31 of such fiscal year under sec-
tion 103 of the Children’s Health Insurance Pro-
gram Reauthorization Act of 2007.
‘‘(D) 
SEMI-ANNUAL
ALLOTMENTS.—For
purposes of subparagraph (A)(iii), the semi-an-
nual allotments determined under this para-
graph with respect to a fiscal year are as follows:
‘‘(i) For the period beginning on Octo-
ber 1 and ending on March 31 of the fiscal
year, the Federal share of the portion of the
expenditures determined under subpara-
graph (B) for the fiscal year which are allo-
cable to such period.
‘‘(ii) For the period beginning on April
1 and ending on September 30 of the fiscal
year, the Federal share of the portion of the
expenditures determined under subpara-
graph (B) for the fiscal year which are allo-
cable to such period.
‘‘(E) AVAILABILITY.—Each semi-annual al-
lotment made under subparagraph (A)(iii) shall
remain available for expenditure under this title
for periods after the period specified in subpara-
graph (D) for purposes of determining the allot-
ment in the same manner as the allotment would
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have been available for expenditure if made for
an entire fiscal year.
‘‘(2) SPECIAL RULE FOR FISCAL YEAR 2008.—
‘‘(A) IN GENERAL.—For purposes of para-
graph (1)(A)(i), the amounts determined under
this paragraph for fiscal year 2008 are as fol-
lows:
‘‘(i) The total Federal payments to the
State under this title for fiscal year 2007,
multiplied by the annual adjustment deter-
mined under subparagraph (B) for fiscal
year 2008.
‘‘(ii) The Federal share of the amount
allotted to the State for fiscal year 2007
under subsection (b), multiplied by the an-
nual adjustment determined under subpara-
graph (B) for fiscal year 2008.
‘‘(iii) Only in the case of—
‘‘(I) a State that received a pay-
ment, 
redistribution, 
or 
allotment
under any of paragraphs (1), (2), or
(4) of subsection (h), the amount of the
projected total Federal payments to the
State under this title for fiscal year
2007, as determined on the basis of the
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November 2006 estimates certified by
the State to the Secretary;
‘‘(II) a State whose projected total
Federal payments to the State under
this title for fiscal year 2007, as deter-
mined on the basis of the May 2006 es-
timates certified by the State to the
Secretary, were at least $95,000,000
but not more than $96,000,000 higher
than the projected total Federal pay-
ments to the State under this title for
fiscal year 2007 on the basis of the No-
vember 2006 estimates, the amount of
the projected total Federal payments to
the State under this title for fiscal year
2007 on the basis of the May 2006 esti-
mates; or
‘‘(III) a State whose projected
total Federal payments under this title
for fiscal year 2007, as determined on
the basis of the November 2006 esti-
mates certified by the State to the Sec-
retary, exceeded all amounts available
to the State for expenditure for fiscal
year 2007 (including any amounts
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paid, allotted, or redistributed to the
State in prior fiscal years), the
amount of the projected total Federal
payments to the State under this title
for fiscal year 2007, as determined on
the basis of the November 2006 esti-
mates certified by the State to the Sec-
retary,
multiplied by the annual adjustment deter-
mined under subparagraph (B) for fiscal
year 2008.
‘‘(iv) The projected total Federal pay-
ments to the State under this title for fiscal
year 2008, as determined on the basis of the
August 2007 projections certified by the
State to the Secretary by not later than
September 30, 2007.
‘‘(B) ANNUAL
ADJUSTMENT
FOR
HEALTH
CARE
COST
GROWTH
AND
CHILD
POPULATION
GROWTH.—The annual adjustment determined
under this subparagraph for a fiscal year with
respect to a State is equal to the product of the
amounts determined under clauses (i) and (ii):
‘‘(i) 
PER
CAPITA
HEALTH
CARE
GROWTH.—1 plus the percentage increase (if
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fiscal year 2008, the Secretary shall reduce each
such allotment on a proportional basis.
‘‘(3) ALTERNATIVE
ALLOTMENTS
FOR
FISCAL
YEARS 2009 THROUGH 2012.—
‘‘(A) IN GENERAL.—If the sum of the State
allotments 
determined 
under 
paragraph
(1)(A)(ii) for any of fiscal years 2009 through
2011 exceeds the available national allotment for
the fiscal year, the Secretary shall allot to each
subsection (b) State from the available national
allotment for the fiscal year an amount equal to
the product of—
‘‘(i) the available national allotment
for the fiscal year; and
‘‘(ii) the percentage equal to the sum of
the State allotment factors for the fiscal
year determined under paragraph (4) with
respect to the State.
‘‘(B) SPECIAL RULES BEGINNING IN FISCAL
YEAR 2012.—Beginning in fiscal year 2012—
‘‘(i) this paragraph shall be applied
separately with respect to each of the peri-
ods described in clauses (i) and (ii) of para-
graph (1)(D) and the available national al-
lotment for each such period shall be the
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amount appropriated for such period (rath-
er than the amount appropriated for the en-
tire fiscal year), reduced by the amount of
the allotments made for the fiscal year
under subsection (c) for each such period,
and
‘‘(ii) if—
‘‘(I) the sum of the State allot-
ments determined under paragraph
(1)(A)(iii) for either such period ex-
ceeds the amount of such available na-
tional allotment for such period, the
Secretary shall make the allotment for
each State for such period in the same
manner as under subparagraph (A),
and
‘‘(II) the amount of such available
national allotment for either such pe-
riod exceeds the sum of the State allot-
ments determined under paragraph
(1)(A)(iii) for such period, the Sec-
retary shall increase the allotment for
each State for such period by the
amount that bears the same ratio to
such excess as the State’s allotment de-
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termined under paragraph (1)(A)(iii)
for such period (without regard to this
subparagraph) bears to the sum of such
allotments for all States.
‘‘(4) WEIGHTED FACTORS.—
‘‘(A) FACTORS DESCRIBED.—For purposes
of paragraph (3), the factors described in this
subparagraph are the following:
‘‘(i) PROJECTED STATE EXPENDITURES
FOR THE FISCAL YEAR.—The ratio of the
projected expenditures under the State child
health plan for the fiscal year (as certified
by the State to the Secretary by not later
than August 31 of the preceding fiscal year)
to the sum of the projected expenditures
under all such plans for all subsection (b)
States for the fiscal year, multiplied by the
applicable percentage weight assigned under
subparagraph (B).
‘‘(ii) NUMBER OF LOW-INCOME CHIL-
DREN
IN
THE
STATE.—The ratio of the
number of low-income children in the State,
as determined on the basis of the most time-
ly and accurate published estimates of the
Bureau of the Census, to the sum of the
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number of low-income children so deter-
mined for all subsection (b) States for such
fiscal year, multiplied by the applicable
percentage weight assigned under subpara-
graph (B).
‘‘(iii) PROJECTED
STATE
EXPENDI-
TURES
FOR
THE
PRECEDING
FISCAL
YEAR.—The ratio of the projected expendi-
tures under the State child health plan for
the preceding fiscal year (as determined on
the basis of the projections certified by the
State to the Secretary for November of the
fiscal year), to the sum of the projected ex-
penditures under all such plans for all sub-
section (b) States for such preceding fiscal
year (as so determined), multiplied by the
applicable percentage weight assigned under
subparagraph (B).
‘‘(iv) ACTUAL
STATE
EXPENDITURES
FOR
THE
SECOND
PRECEDING
FISCAL
YEAR.—The ratio of the actual expenditures
under the State child health plan for the
second preceding fiscal year, as determined
by the Secretary on the basis of expenditure
data reported by States on CMS Form 64
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or CMS Form 21, to such sum of the actual
expenditures under all such plans for all
subsection (b) States for such second pre-
ceding fiscal year, multiplied by the appli-
cable percentage weight assigned under sub-
paragraph (B).
‘‘(B) ASSIGNMENT OF WEIGHTS.—For each
of fiscal years 2009 through 2012, the applicable
weights assigned under this subparagraph are
the following:
‘‘(i) With respect to the factor described
in subparagraph (A)(i), a weight of 75 per-
cent for each such fiscal year.
‘‘(ii) With respect to the factor de-
scribed in subparagraph (A)(ii), a weight of
121⁄2 percent for each such fiscal year.
‘‘(iii) With respect to the factor de-
scribed in subparagraph (A)(iii), a weight
of 71⁄2 percent for each such fiscal year.
‘‘(iv) With respect to the factor de-
scribed in subparagraph (A)(iv), a weight of
5 percent for each such fiscal year.
‘‘(5) DEMONSTRATION OF NEED FOR INCREASED
ALLOTMENT BASED ON PROJECTED STATE EXPENDI-
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TURES EXCEEDING 10 PERCENT OF THE PRECEDING
FISCAL YEAR ALLOTMENT.—
‘‘(A) IN GENERAL.—If the projected expend-
itures under the State child health plan described
in paragraph (1)(B) for any of fiscal years 2009
through 2012 are at least 10 percent more than
the allotment determined for the State for the
preceding fiscal year (determined without regard
to paragraph (2)(D) or paragraph (3)), and,
during the preceding fiscal year, the State did
not receive approval for a State plan amendment
or waiver to expand coverage under the State
child health plan or did not receive a CHIP con-
tingency fund payment under subsection (k)—
‘‘(i) the State shall submit to the Sec-
retary, by not later than August 31 of the
preceding fiscal year, information relating
to the factors that contributed to the need
for the increase in the State’s allotment for
the fiscal year, as well as any other addi-
tional information that the Secretary may
require for the State to demonstrate the
need for the increase in the State’s allot-
ment for the fiscal year;
‘‘(ii) the Secretary shall—
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‘‘(I) review the information sub-
mitted under clause (i);
‘‘(II) notify the State in writing
within 60 days after receipt of the in-
formation that—
‘‘(aa) the projected expendi-
tures under the State child health
plan are approved or disapproved
(and if disapproved, the reasons
for disapproval); or
‘‘(bb) specified additional in-
formation is needed; and
‘‘(III) 
if 
the 
Secretary 
dis-
approved the projected expenditures or
determined additional information is
needed, provide the State with a rea-
sonable opportunity to submit addi-
tional information to demonstrate the
need for the increase in the State’s al-
lotment for the fiscal year.
‘‘(B) PROVISIONAL
AND
FINAL
ALLOT-
MENT.—In the case of a State described in sub-
paragraph (A) for which the Secretary has not
determined by September 30 of a fiscal year
whether the State has demonstrated the need for
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the increase in the State’s allotment for the suc-
ceeding fiscal year, the Secretary shall provide
the State with a provisional allotment for the fis-
cal year equal to 110 percent of the allotment de-
termined for the State under this subsection for
the preceding fiscal year (determined without re-
gard to paragraph (2)(D) or paragraph (3)),
and may, not later than November 30 of the fis-
cal year, adjust the State’s allotment (and the al-
lotments of other subsection (b) States), as nec-
essary (and, if applicable, subject to paragraph
(3)), on the basis of information submitted by
the State in accordance with subparagraph (A).
‘‘(6) SPECIAL RULES.—
‘‘(A) DEADLINE
AND
DATA
FOR
DETER-
MINING
FISCAL
YEAR
2008
ALLOTMENTS.—In
computing the amounts under paragraph (2)(A)
and subsection (c)(5)(A) that determine the allot-
ments to subsection (b) States and territories for
fiscal year 2008, the Secretary shall use the most
recent data available to the Secretary before the
start of that fiscal year. The Secretary may ad-
just such amounts and allotments, as necessary,
on the basis of the expenditure data for the prior
year reported by States on CMS Form 64 or
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CMS Form 21 not later than November 30,
2007, but in no case shall the Secretary adjust
the allotments provided under paragraph (2)(A)
or subsection (c)(5)(A) for fiscal year 2008 after
December 31, 2007.
‘‘(B) INCLUSION
OF
CERTAIN
EXPENDI-
TURES.—
‘‘(i) PROJECTED
EXPENDITURES
OF
QUALIFYING
STATES.—Payments made or
projected to be made to a qualifying State
described in paragraph (2) of section
2105(g) for expenditures described in para-
graph (1)(B)(ii) or (4)(B) of that section
shall be included for purposes of deter-
mining the projected expenditures described
in paragraph (1)(B) with respect to the al-
lotments determined for each of fiscal years
2009 through 2012 and for purposes of de-
termining the amounts described in clauses
(i) and (iv) of paragraph (2)(A) with re-
spect to the allotments determined for fiscal
year 2008.
‘‘(ii) 
PROJECTED
EXPENDITURES
UNDER BLOCK GRANT SET-ASIDES FOR NON-
PREGNANT
CHILDLESS
ADULTS
AND
PAR-
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ENTS.—Payments projected to be made to a
State under subsection (a) or (b) of section
2111 shall be included for purposes of deter-
mining the projected expenditures described
in paragraph (1)(B) with respect to the al-
lotments determined for each of fiscal years
2009 through 2012 (to the extent such pay-
ments are permitted under such section), in-
cluding for purposes of allocating such ex-
penditures for purposes of clauses (i) and
(ii) of paragraph (1)(D).
‘‘(7) SUBSECTION (b) STATE.—In this subsection,
the term ‘subsection (b) State’ means 1 of the 50
States or the District of Columbia.’’.
(b) CONFORMING AMENDMENTS.—Section 2104 (42
U.S.C. 1397dd) is amended—
(1) in subsection (a), by striking ‘‘subsection
(d)’’ and inserting ‘‘subsections (d), (h), and (i)’’;
(2) in subsection (b)(1), by striking ‘‘subsection
(d)’’ and inserting ‘‘subsections (d), (h), and (i)’’; and
(3) in subsection (c)(1), by striking ‘‘subsection
(d)’’ and inserting ‘‘subsections (d), (h), and (i)’’.
SEC. 103. ONE-TIME APPROPRIATION.
There is appropriated to the Secretary, out of any
money in the Treasury not otherwise appropriated,
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$12,500,000,000 to accompany the allotment made for the
period beginning on October 1, 2011, and ending on March
31, 2012, under section 2104(a)(15)(A) of the Social Secu-
rity Act (42 U.S.C. 1397dd(a)(15)(A)) (as added by section
101), to remain available until expended. Such amount
shall be used to provide allotments to States under sub-
sections (c)(5) and (i) of section 2104 of the Social Security
Act (42 U.S.C. 1397dd) for the first 6 months of fiscal year
2012 in the same manner as allotments are provided under
subsection (a)(15)(A) of such section and subject to the same
terms and conditions as apply to the allotments provided
from such subsection (a)(15)(A).
SEC. 104. IMPROVING FUNDING FOR THE TERRITORIES
UNDER CHIP AND MEDICAID.
(a) UPDATE OF CHIP ALLOTMENTS.—Section 2104(c)
(42 U.S.C. 1397dd(c)) is amended—
(1) in paragraph (1), by inserting ‘‘and para-
graphs (5) and (6)’’ after ‘‘and (i)’’; and
(2) by adding at the end the following new para-
graphs:
‘‘(5) ANNUAL
ALLOTMENTS
FOR
TERRITORIES
BEGINNING WITH FISCAL YEAR 2008.—Of the total al-
lotment amount appropriated under subsection (a) for
a fiscal year beginning with fiscal year 2008, the Sec-
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retary shall allot to each of the commonwealths and
territories described in paragraph (3) the following:
‘‘(A) FISCAL
YEAR
2008.—For fiscal year
2008, the highest amount of Federal payments to
the commonwealth or territory under this title
for any fiscal year occurring during the period
of fiscal years 1998 through 2007, multiplied by
the annual adjustment determined under sub-
section (i)(2)(B) for fiscal year 2008, except that
clause (ii) thereof shall be applied by sub-
stituting ‘the United States’ for ‘the State’.
‘‘(B) FISCAL YEARS 2009 THROUGH 2012.—
‘‘(i) IN GENERAL.—For each of fiscal
years 2009 through 2012, except as provided
in clause (ii), the amount determined under
this paragraph for the preceding fiscal year
multiplied by the annual adjustment deter-
mined under subsection (i)(2)(B) for the fis-
cal year, except that clause (ii) thereof shall
be applied by substituting ‘the United
States’ for ‘the State’.
‘‘(ii) SPECIAL RULE FOR FISCAL YEAR
2012.—In the case of fiscal year 2012—
‘‘(I) 89 percent of the amount al-
located to the commonwealth or terri-
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tory for such fiscal year (without re-
gard to this subclause) shall be allo-
cated for the period beginning on Octo-
ber 1, 2011, and ending on March 31,
2012, and
‘‘(II) 11 percent of such amount
shall be allocated for the period begin-
ning on April 1, 2012, and ending on
September 30, 2012.’’.
(b) REMOVAL OF FEDERAL MATCHING PAYMENTS FOR
DATA REPORTING SYSTEMS FROM THE OVERALL LIMIT ON
PAYMENTS TO TERRITORIES UNDER TITLE XIX.—Section
1108(g) (42 U.S.C. 1308(g)) is amended by adding at the
end the following new paragraph:
‘‘(4) EXCLUSION
OF
CERTAIN
EXPENDITURES
FROM PAYMENT LIMITS.—With respect to fiscal years
beginning with fiscal year 2008, if Puerto Rico, the
Virgin Islands, Guam, the Northern Mariana Islands,
or American Samoa qualify for a payment under
subparagraph (A)(i), (B), or (F) of section 1903(a)(3)
for a calendar quarter of such fiscal year, the pay-
ment shall not be taken into account in applying sub-
section (f) (as increased in accordance with para-
graphs (1), (2), and (3) of this subsection) to such
commonwealth or territory for such fiscal year.’’.
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(c) GAO STUDY AND REPORT.—Not later than Sep-
tember 30, 2009, the Comptroller General of the United
States shall submit a report to the appropriate committees
of Congress regarding Federal funding under Medicaid and
CHIP for Puerto Rico, the United States Virgin Islands,
Guam, American Samoa, and the Northern Mariana Is-
lands. The report shall include the following:
(1) An analysis of all relevant factors with re-
spect to—
(A) eligible Medicaid and CHIP popu-
lations in such commonwealths and territories;
(B) historical and projected spending needs
of such commonwealths and territories and the
ability of capped funding streams to respond to
those spending needs;
(C) the extent to which Federal poverty
guidelines are used by such commonwealths and
territories to determine Medicaid and CHIP eli-
gibility; and
(D) the extent to which such commonwealths
and territories participate in data collection and
reporting related to Medicaid and CHIP, includ-
ing an analysis of territory participation in the
Current Population Survey versus the American
Community Survey.
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(2) Recommendations for improving Federal
funding under Medicaid and CHIP for such common-
wealths and territories.
SEC. 105. INCENTIVE BONUSES FOR STATES.
(a) IN GENERAL.—Section 2104 (42 U.S.C. 1397dd),
as amended by section 102, is amended by adding at the
end the following new subsection:
‘‘(j) INCENTIVE BONUSES.—
‘‘(1) ESTABLISHMENT OF INCENTIVE POOL FROM
UNOBLIGATED
NATIONAL
ALLOTMENT
AND
UNEX-
PENDED STATE ALLOTMENTS.—
‘‘(A) IN GENERAL.—There is hereby estab-
lished in the Treasury of the United States a
fund which shall be known as the ‘CHIP Incen-
tive Bonuses Pool’ (in this subsection referred to
as the ‘Incentive Pool’). Amounts in the Incen-
tive Pool are authorized to be appropriated for
payments under this subsection and shall remain
available until expended.
‘‘(B) DEPOSITS THROUGH INITIAL APPRO-
PRIATION AND TRANSFERS OF FUNDS.—
‘‘(i) INITIAL
APPROPRIATION.—There
is appropriated to the Incentive Pool, out of
any money in the Treasury not otherwise
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appropriated, $3,000,000,000 for fiscal year
2008.
‘‘(ii) 
TRANSFERS.—Notwithstanding
any other provision of law, the following
amounts are hereby appropriated or trans-
ferred to, deposited in, and made available
for expenditure from the Incentive Pool on
the following dates:
‘‘(I) UNEXPENDED
FISCAL
YEAR
2006 AND 2007 ALLOTMENTS.—On De-
cember 31, 2007, the sum for all States
of the excess (if any) for each State
of—
‘‘(aa) the aggregate allot-
ments provided for the State
under subsection (b) or (c) for fis-
cal years 2006 and 2007 that are
not expended by September 30,
2007, over
‘‘(bb) an amount equal to 50
percent of the allotment provided
for the State under subsection (c)
or (i) for fiscal year 2008 (as de-
termined in accordance with sub-
section (i)(6)).
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‘‘(II) UNOBLIGATED NATIONAL AL-
LOTMENT.—
‘‘(aa) FISCAL
YEARS
2008
THROUGH 2011.—On December 31
of fiscal year 2008, and on De-
cember 31 of each succeeding fis-
cal year through fiscal year 2011,
the portion, if any, of the amount
appropriated under subsection (a)
for such fiscal year that is unobli-
gated for allotment to a State
under subsection (c) or (i) for
such fiscal year or set aside under
subsection (a)(3) or (b)(2) of sec-
tion 2111 for such fiscal year.
‘‘(bb) FIRST HALF OF FISCAL
YEAR 2012.—On December 31 of
fiscal year 2012, the portion, if
any, of the sum of the amounts
appropriated 
under 
subsection
(a)(15)(A) and under section 103
of the Children’s Health Insurance
Program Reauthorization Act of
2007 for the period beginning on
October 1, 2011, and ending on
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March 31, 2012, that is unobli-
gated for allotment to a State
under subsection (c) or (i) for
such fiscal year or set aside under
subsection (b)(2) of section 2111
for such fiscal year.
‘‘(cc) SECOND HALF OF FIS-
CAL YEAR 2012.—On June 30 of
fiscal year 2012, the portion, if
any, of the amount appropriated
under subsection (a)(15)(B) for
the period beginning on April 1,
2012, and ending on September
30, 2012, that is unobligated for
allotment to a State under sub-
section (c) or (i) for such fiscal
year or set aside under subsection
(b)(2) of section 2111 for such fis-
cal year.
‘‘(III) PERCENTAGE OF STATE AL-
LOTMENTS THAT ARE UNEXPENDED BY
THE
END
OF
THE
FIRST
YEAR
OF
AVAILABILITY
BEGINNING
WITH
THE
FISCAL
YEAR
2009
ALLOTMENTS.—On
October 1 of each of fiscal years 2009
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through 2012, the sum for all States
for such fiscal year (the ‘current fiscal
year’) of the excess (if any) for each
State of—
‘‘(aa) the allotment made for
the State under subsection (b), (c),
or (i) for the fiscal year preceding
the current fiscal year (reduced by
any amounts set aside under sec-
tion 2111(a)(3)) that is not ex-
pended by the end of such pre-
ceding fiscal year, over
‘‘(bb) an amount equal to the
applicable percentage (for the fis-
cal year) of the allotment made
for the State under subsection (b),
(c), or (i) (as so reduced) for such
preceding fiscal year.
For purposes of item (bb), the applica-
ble percentage is 20 percent for fiscal
year 2009, and 10 percent for each of
fiscal years 2010, 2011, and 2012.
‘‘(IV) REMAINDER OF STATE AL-
LOTMENTS THAT ARE UNEXPENDED BY
THE END OF THE PERIOD OF AVAIL-
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ABILITY BEGINNING WITH THE FISCAL
YEAR 2006 ALLOTMENTS.—On October
1 of each of fiscal years 2009 through
2012, the total amount of allotments
made to States under subsection (b),
(c), or (i) for the second preceding fis-
cal year (third preceding fiscal year in
the case of the fiscal year 2006 allot-
ments) and remaining after the appli-
cation of subclause (III) that are not
expended by September 30 of the pre-
ceding fiscal year.
‘‘(V) UNEXPENDED TRANSITIONAL
COVERAGE
BLOCK
GRANT
FOR
NON-
PREGNANT
CHILDLESS
ADULTS.—On
October 1, 2009, any amounts set aside
under section 2111(a)(3) that are not
expended by September 30, 2009.
‘‘(VI) EXCESS CHIP CONTINGENCY
FUNDS.—
‘‘(aa) AMOUNTS
IN
EXCESS
OF
THE
AGGREGATE
CAP.—On
October 1 of each of fiscal years
2010 through 2012, any amount
in excess of the aggregate cap ap-
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plicable to the CHIP Contingency
Fund for the fiscal year under
subsection (k)(2)(B).
‘‘(bb) 
UNEXPENDED
CHIP
CONTINGENCY FUND PAYMENTS.—
On October 1 of each of fiscal
years 2010 through 2012, any
portion of a CHIP Contingency
Fund payment made to a State
that remains unexpended at the
end of the period for which the
payment is available for expendi-
ture under subsection (e)(3).
‘‘(VII) 
EXTENSION
OF
AVAIL-
ABILITY FOR PORTION OF UNEXPENDED
STATE
ALLOTMENTS.—The portion of
the allotment made to a State for a fis-
cal year that is not transferred to the
Incentive Pool under subclause (I) or
(III) shall remain available for ex-
penditure by the State only during the
fiscal year in which such transfer oc-
curs, in accordance with subclause (IV)
and subsection (e)(4).
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‘‘(C) INVESTMENT OF FUND.—The Secretary
of the Treasury shall invest, in interest bearing
securities of the United States, such currently
available portions of the Incentive Pool as are
not immediately required for payments from the
Pool. The income derived from these investments
constitutes a part of the Incentive Pool.
‘‘(2) PAYMENTS TO STATES INCREASING ENROLL-
MENT.—
‘‘(A) IN GENERAL.—Subject to paragraph
(3)(D), with respect to each of fiscal years 2009
through 2012, the Secretary shall make payments
to States from the Incentive Pool determined
under subparagraph (B).
‘‘(B) DETERMINATION
OF
PAYMENTS.—If,
for any coverage period ending in a fiscal year
ending after September 30, 2008, the average
monthly enrollment of children in the State plan
under title XIX exceeds the baseline monthly av-
erage for such period, the payment made for the
fiscal year shall be equal to the applicable
amount determined under subparagraph (C).
‘‘(C) APPLICABLE AMOUNT.—For purposes
of subparagraph (B), the applicable amount is
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the product determined in accordance with the
following:
‘‘(i) If such excess with respect to the
number of individuals who are enrolled in
the State plan under title XIX does not ex-
ceed 2 percent, the product of $75 and the
number of such individuals included in
such excess.
‘‘(ii) If such excess with respect to the
number of individuals who are enrolled in
the State plan under title XIX exceeds 2,
but does not exceed 5 percent, the product of
$300 and the number of such individuals
included in such excess, less the amount of
such excess calculated in clause (i).
‘‘(iii) If such excess with respect to the
number of individuals who are enrolled in
the State plan under title XIX exceeds 5
percent, the product of $625 and the num-
ber of such individuals included in such ex-
cess, less the sum of the amount of such ex-
cess calculated in clauses (i) and (ii).
‘‘(D) INDEXING OF DOLLAR AMOUNTS.—For
each coverage period ending in a fiscal year end-
ing after September 30, 2009, the dollar amounts
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specified in subparagraph (C) shall be increased
by the percentage increase (if any) in the pro-
jected nominal per capita amount of National
Health Expenditures for the calendar year begin-
ning on January 1 of the coverage period over
the preceding coverage period, as most recently
published by the Secretary before the beginning
of the coverage period involved.
‘‘(3) RULES
RELATING
TO
ENROLLMENT
IN-
CREASES.—For purposes of paragraph (2)(B)—
‘‘(A) BASELINE
MONTHLY
AVERAGE.—Ex-
cept as provided in subparagraph (C), the base-
line monthly average for any fiscal year for a
State is equal to—
‘‘(i) the baseline monthly average for
the preceding fiscal year; multiplied by
‘‘(ii) the sum of 1 plus the sum of—
‘‘(I) 0.01; and
‘‘(II) the percentage increase in
the population of low-income children
in the State from the preceding fiscal
year to the fiscal year involved, as de-
termined by the Secretary based on the
most timely and accurate published es-
timates of the Bureau of the Census be-
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fore the beginning of the fiscal year in-
volved.
‘‘(B) COVERAGE PERIOD.—Except as pro-
vided in subparagraph (C), the coverage period
for any fiscal year consists of the last 2 quarters
of the preceding fiscal year and the first 2 quar-
ters of the fiscal year.
‘‘(C) SPECIAL
RULES
FOR
FISCAL
YEAR
2009.—With respect to fiscal year 2009—
‘‘(i) the coverage period for that fiscal
year shall be based on the first 2 quarters
of fiscal year 2009; and
‘‘(ii) the baseline monthly average shall
be—
‘‘(I) the average monthly enroll-
ment of low-income children enrolled
in the State’s plan under title XIX for
the first 2 quarters of fiscal year 2007
(as determined over a 6-month period
on the basis of the most recent infor-
mation reported through the Medicaid
Statistical 
Information 
System
(MSIS)); multiplied by
‘‘(II) the sum of 1 plus the sum
of—
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‘‘(aa) 0.02; and
‘‘(bb) the percentage increase
in the population of low-income
children in the State from fiscal
year 2007 to fiscal year 2009, as
determined by the Secretary based
on the most timely and accurate
published estimates of the Bureau
of the Census before the beginning
of the fiscal year involved.
‘‘(D) ADDITIONAL REQUIREMENT FOR ELI-
GIBILITY FOR PAYMENT.—For purposes of sub-
paragraphs (B) and (C), the average monthly
enrollment shall be determined without regard to
children who do not meet the income eligibility
criteria in effect on July 19, 2007, for enroll-
ment under the State plan under title XIX or
under a waiver of such plan.
‘‘(4) TIME OF PAYMENT.—Payments under para-
graph (2) for any fiscal year shall be made during the
last quarter of such year.
‘‘(5) USE OF PAYMENTS.—Payments made to a
State from the Incentive Pool shall be used for any
purpose that the State determines is likely to reduce
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the percentage of low-income children in the State
without health insurance.
‘‘(6) PRORATION RULE.—If the amount available
for payment from the Incentive Pool is less than the
total amount of payments to be made for such fiscal
year, the Secretary shall reduce the payments de-
scribed in paragraph (2) on a proportional basis.
‘‘(7) REFERENCES.—With respect to a State
plan under title XIX, any references to a child in this
subsection shall include a reference to any individual
provided medical assistance under the plan who has
not attained age 19 (or, if a State has so elected
under such State plan, age 20 or 21).’’.
(b) REDISTRIBUTION OF UNEXPENDED FISCAL YEAR
2005 ALLOTMENTS.—Notwithstanding section 2104(f) of
the Social Security Act (42 U.S.C. 1397dd(f)), with respect
to fiscal year 2008, the Secretary shall provide for a redis-
tribution under such section from the allotments for fiscal
year 2005 under subsection (b) and (c) of such section that
are not expended by the end of fiscal year 2007, to each
State described in clause (iii) of section 2104(i)(2)(A) of
the Social Security Act, as added by section 102(a), of an
amount that bears the same ratio to such unexpended fiscal
year 2005 allotments as the ratio of the fiscal year 2007
allotment determined for each such State under subsection
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(b) of section 2104 of such Act for fiscal year 2007 (without
regard to any amounts paid, allotted, or redistributed to
the State under section 2104 for any preceding fiscal year)
bears to the total amount of the fiscal year 2007 allotments
for all such States (as so determined).
(c) CONFORMING AMENDMENT ELIMINATING RULES
FOR REDISTRIBUTION OF UNEXPENDED ALLOTMENTS FOR
FISCAL YEARS AFTER 2005.—Effective January 1, 2008,
section 2104(f) (42 U.S.C. 1397dd(f)) is amended to read
as follows:
‘‘(f) UNALLOCATED PORTION OF NATIONAL ALLOT-
MENT AND UNUSED ALLOTMENTS.—For provisions relating
to the distribution of portions of the unallocated national
allotment under subsection (a) for fiscal years beginning
with fiscal year 2008, and unexpended allotments for fiscal
years beginning with fiscal year 2006, see subsection (j).’’.
(d) ADDITIONAL FUNDING FOR THE SECRETARY TO
IMPROVE TIMELINESS OF DATA REPORTING AND ANALYSIS
FOR PURPOSES OF DETERMINING ENROLLMENT INCREASES
UNDER MEDICAID AND CHIP.—
(1) APPROPRIATION.—There is appropriated, out
of any money in the Treasury not otherwise appro-
priated, $5,000,000 to the Secretary for fiscal year
2008 for the purpose of improving the timeliness of
the data reported and analyzed from the Medicaid
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Statistical Information System (MSIS) for purposes
of carrying out section 2104(j)(2)(B) of the Social Se-
curity Act (as added by subsection (a)) and to pro-
vide guidance to States with respect to any new re-
porting requirements related to such improvements.
Amounts appropriated under this paragraph shall re-
main available until expended.
(2) REQUIREMENTS.—The improvements made
by the Secretary under paragraph (1) shall be de-
signed and implemented (including with respect to
any necessary guidance for States) so that, beginning
no later than October 1, 2008, data regarding the en-
rollment of low-income children (as defined in section
2110(c)(4) of the Social Security Act (42 U.S.C.
1397jj(c)(4)) of a State enrolled in the State plan
under Medicaid or the State child health plan under
CHIP with respect to a fiscal year shall be collected
and analyzed by the Secretary within 6 months of
submission.
SEC. 106. PHASE-OUT OF COVERAGE FOR NONPREGNANT
CHILDLESS ADULTS UNDER CHIP; CONDI-
TIONS FOR COVERAGE OF PARENTS.
(a) PHASE-OUT RULES.—
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(1) IN GENERAL.—Title XXI (42 U.S.C. 1397aa
et seq.) is amended by adding at the end the following
new section:
‘‘SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT
CHILDLESS ADULTS; CONDITIONS FOR COV-
ERAGE OF PARENTS.
‘‘(a) TERMINATION OF COVERAGE FOR NONPREGNANT
CHILDLESS ADULTS.—
‘‘(1) NO NEW CHIP WAIVERS; AUTOMATIC EXTEN-
SIONS
AT
STATE
OPTION
THROUGH
FISCAL
YEAR
2008.—Notwithstanding section 1115 or any other
provision of this title, except as provided in this
subsection—
‘‘(A) the Secretary shall not on or after the
date of the enactment of the Children’s Health
Insurance Program Reauthorization Act of 2007,
approve or renew a waiver, experimental, pilot,
or demonstration project that would allow funds
made available under this title to be used to pro-
vide child health assistance or other health bene-
fits coverage to a nonpregnant childless adult;
and
‘‘(B) notwithstanding the terms and condi-
tions of an applicable existing waiver, the provi-
sions of paragraphs (2) and (3) shall apply for
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purposes of any fiscal year beginning on or after
October 1, 2008, in determining the period to
which the waiver applies, the individuals eligible
to be covered by the waiver, and the amount of
the Federal payment under this title.
‘‘(2) TERMINATION OF CHIP COVERAGE UNDER
APPLICABLE EXISTING WAIVERS AT THE END OF FIS-
CAL YEAR 2008.—
‘‘(A) IN GENERAL.—No funds shall be avail-
able under this title for child health assistance or
other health benefits coverage that is provided to
a nonpregnant childless adult under an applica-
ble existing waiver after September 30, 2008.
‘‘(B) EXTENSION UPON STATE REQUEST.—
If an applicable existing waiver described in
subparagraph (A) would otherwise expire before
October 1, 2008, and the State requests an exten-
sion of such waiver, the Secretary shall grant
such an extension, but only through September
30, 2008.
‘‘(C) APPLICATION OF ENHANCED FMAP.—
The enhanced FMAP determined under section
2105(b) shall apply to expenditures under an
applicable existing waiver for the provision of
child health assistance or other health benefits
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coverage to a nonpregnant childless adult during
fiscal year 2008.
‘‘(3) OPTIONAL 1-YEAR TRANSITIONAL COVERAGE
BLOCK GRANT FUNDED FROM STATE ALLOTMENT.—
Subject to paragraph (4)(B), each State for which
coverage under an applicable existing waiver is ter-
minated under paragraph (2)(A) may elect to provide
nonpregnant childless adults who were provided child
health assistance or health benefits coverage under the
applicable existing waiver at any time during fiscal
year 2008 with such assistance or coverage during fis-
cal year 2009, as if the authority to provide such as-
sistance or coverage under an applicable existing
waiver was extended through that fiscal year, but sub-
ject to the following terms and conditions:
‘‘(A) BLOCK GRANT SET ASIDE FROM STATE
ALLOTMENT.—The Secretary shall set aside for
the State an amount equal to the Federal share
of the State’s projected expenditures under the
applicable existing waiver for providing child
health assistance or health benefits coverage to
all nonpregnant childless adults under such
waiver for fiscal year 2008 (as certified by the
State and submitted to the Secretary by not later
than August 31, 2008, and without regard to
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whether any such individual lost coverage during
fiscal year 2008 and was later provided child
health assistance or other health benefits coverage
under the waiver in that fiscal year), increased
by the annual adjustment for fiscal year 2009
determined under section 2104(i)(2)(B)(i). The
Secretary may adjust the amount set aside under
the preceding sentence, as necessary, on the basis
of the expenditure data for fiscal year 2008 re-
ported by States on CMS Form 64 or CMS
Form 21 not later than November 30, 2008, but
in no case shall the Secretary adjust such
amount after December 31, 2008.
‘‘(B) NO
COVERAGE
FOR
NONPREGNANT
CHILDLESS ADULTS WHO WERE NOT COVERED
DURING FISCAL YEAR 2008.—
‘‘(i) FMAP 
APPLIED
TO
EXPENDI-
TURES.—The Secretary shall pay the State
for each quarter of fiscal year 2009, from
the amount set aside under subparagraph
(A), an amount equal to the Federal med-
ical assistance percentage (as determined
under section 1905(b) without regard to
clause (4) of such section) of expenditures in
the quarter for providing child health assist-
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ance or other health benefits coverage to a
nonpregnant childless adult but only if such
adult was enrolled in the State program
under this title during fiscal year 2008
(without regard to whether the individual
lost coverage during fiscal year 2008 and
was reenrolled in that fiscal year or in fis-
cal year 2009).
‘‘(ii) FEDERAL PAYMENTS LIMITED TO
AMOUNT OF BLOCK GRANT SET-ASIDE.—No
payments shall be made to a State for ex-
penditures described in this subparagraph
after the total amount set aside under sub-
paragraph (A) for fiscal year 2009 has been
paid to the State.
‘‘(4) STATE
OPTION
TO
APPLY
FOR
MEDICAID
WAIVER TO CONTINUE COVERAGE FOR NONPREGNANT
CHILDLESS ADULTS.—
‘‘(A) IN GENERAL.—Each State for which
coverage under an applicable existing waiver is
terminated under paragraph (2)(A) may submit,
not later than June 30, 2009, an application to
the Secretary for a waiver under section 1115 of
the State plan under title XIX to provide med-
ical assistance to a nonpregnant childless adult
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whose coverage is so terminated (in this sub-
section referred to as a ‘Medicaid nonpregnant
childless adults waiver’).
‘‘(B) DEADLINE FOR APPROVAL.—The Sec-
retary shall make a decision to approve or deny
an application for a Medicaid nonpregnant
childless adults waiver submitted under subpara-
graph (A) within 90 days of the date of the sub-
mission of the application. If no decision has
been made by the Secretary as of September 30,
2009, on the application of a State for a Med-
icaid nonpregnant childless adults waiver that
was submitted to the Secretary by June 30,
2009, the application shall be deemed approved.
‘‘(C) 
STANDARD
FOR
BUDGET
NEU-
TRALITY.—The budget neutrality requirement
applicable with respect to expenditures for med-
ical assistance under a Medicaid nonpregnant
childless adults waiver shall—
‘‘(i) in the case of fiscal year 2010,
allow expenditures for medical assistance
under title XIX for all such adults to not
exceed the total amount of payments made
to the State under paragraph (3)(B) for fis-
cal year 2009, increased by the percentage
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increase (if any) in the projected nominal
per capita amount of National Health Ex-
penditures for calendar year 2010 over cal-
endar year 2009, as most recently published
by the Secretary; and
‘‘(ii) in the case of any succeeding fis-
cal year, allow such expenditures to not ex-
ceed the amount in effect under this sub-
paragraph for the preceding fiscal year, in-
creased by the percentage increase (if any)
in the projected nominal per capita amount
of National Health Expenditures for the
calendar year that begins during the fiscal
year involved over the preceding calendar
year, as most recently published by the Sec-
retary.
‘‘(b) RULES AND CONDITIONS FOR COVERAGE OF PAR-
ENTS OF TARGETED LOW-INCOME CHILDREN.—
‘‘(1) TWO-YEAR TRANSITION PERIOD; AUTOMATIC
EXTENSION AT STATE OPTION THROUGH FISCAL YEAR
2009.—
‘‘(A) NO
NEW
CHIP
WAIVERS.—Notwith-
standing section 1115 or any other provision of
this title, except as provided in this subsection—
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‘‘(i) the Secretary shall not on or after
the date of the enactment of the Children’s
Health Insurance Program Reauthorization
Act of 2007 approve or renew a waiver, ex-
perimental, pilot, or demonstration project
that would allow funds made available
under this title to be used to provide child
health assistance or other health benefits
coverage to a parent of a targeted low-in-
come child; and
‘‘(ii) notwithstanding the terms and
conditions of an applicable existing waiver,
the provisions of paragraphs (2) and (3)
shall apply for purposes of any fiscal year
beginning on or after October 1, 2009, in
determining the period to which the waiver
applies, the individuals eligible to be cov-
ered by the waiver, and the amount of the
Federal payment under this title.
‘‘(B) EXTENSION UPON STATE REQUEST.—
If an applicable existing waiver described in
subparagraph (A) would otherwise expire before
October 1, 2009, and the State requests an exten-
sion of such waiver, the Secretary shall grant
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such an extension, but only, subject to paragraph
(2)(A), through September 30, 2009.
‘‘(C) APPLICATION OF ENHANCED FMAP.—
The enhanced FMAP determined under section
2105(b) shall apply to expenditures under an
applicable existing waiver for the provision of
child health assistance or other health benefits
coverage to a parent of a targeted low-income
child during fiscal years 2008 and 2009.
‘‘(2) RULES FOR FISCAL YEARS 2010 THROUGH
2012.—
‘‘(A) PAYMENTS FOR COVERAGE LIMITED TO
BLOCK
GRANT
FUNDED
FROM
STATE
ALLOT-
MENT.—Any State that provides child health as-
sistance or health benefits coverage under an ap-
plicable existing waiver for a parent of a tar-
geted low-income child may elect to continue to
provide such assistance or coverage through fiscal
year 2010, 2011, or 2012, subject to the same
terms and conditions that applied under the ap-
plicable existing waiver, unless otherwise modi-
fied in subparagraph (B).
‘‘(B) TERMS AND CONDITIONS.—
‘‘(i) BLOCK GRANT SET ASIDE FROM
STATE ALLOTMENT.—If the State makes an
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election under subparagraph (A), the Sec-
retary shall set aside for the State for each
such fiscal year an amount equal to the
Federal share of 110 percent of the State’s
projected expenditures under the applicable
existing waiver for providing child health
assistance or health benefits coverage to all
parents of targeted low-income children en-
rolled under such waiver for the fiscal year
(as certified by the State and submitted to
the Secretary by not later than August 31
of the preceding fiscal year). In the case of
fiscal year 2012, the set aside for any State
shall be computed separately for each period
described in clauses (i) and (ii) of sub-
section (i))(1)(D) and any increase or re-
duction in the allotment for either such pe-
riod under subsection (i)(3)(B)(ii) shall be
allocated on a pro rata basis to such set
aside.
‘‘(ii) 
PAYMENTS
FROM
BLOCK
GRANT.—The Secretary shall pay the State
from the amount set aside under clause (i)
for the fiscal year, an amount for each
quarter of such fiscal year equal to the ap-
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plicable percentage determined under clause
(iii) or (iv) for expenditures in the quarter
for providing child health assistance or
other health benefits coverage to a parent of
a targeted low-income child.
‘‘(iii) ENHANCED FMAP ONLY IN FIS-
CAL YEAR 2010 FOR STATES WITH SIGNIFI-
CANT CHILD OUTREACH OR THAT ACHIEVE
CHILD COVERAGE BENCHMARKS; FMAP FOR
ANY
OTHER
STATES.—For purposes of
clause (ii), the applicable percentage for
any quarter of fiscal year 2010 is equal
to—
‘‘(I) the enhanced FMAP deter-
mined under section 2105(b) in the
case of a State that meets the outreach
or coverage benchmarks described in
any of subparagraphs (A), (B), or (C)
of paragraph (3) for fiscal year 2009;
or
‘‘(II) the Federal medical assist-
ance percentage (as determined under
section 1905(b) without regard to
clause (4) of such section) in the case
of any other State.
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‘‘(iv) AMOUNT OF FEDERAL MATCHING
PAYMENT IN 2011 OR 2012.—For purposes of
clause (ii), the applicable percentage for
any quarter of fiscal year 2011 or 2012 is
equal to—
‘‘(I) the REMAP percentage if—
‘‘(aa) the applicable percent-
age for the State under clause
(iii) was the enhanced FMAP for
fiscal year 2009; and
‘‘(bb) the State met either of
the coverage benchmarks described
in subparagraph (B) or (C) of
paragraph (3) for the preceding
fiscal year; or
‘‘(II) the Federal medical assist-
ance percentage (as so determined) in
the case of any State to which sub-
clause (I) does not apply.
For purposes of subclause (I), the REMAP
percentage is the percentage which is the
sum of such Federal medical assistance per-
centage and a number of percentage points
equal to one-half of the difference between
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such Federal medical assistance percentage
and such enhanced FMAP.
‘‘(v) NO
FEDERAL
PAYMENTS
OTHER
THAN FROM BLOCK GRANT SET ASIDE.—No
payments shall be made to a State for ex-
penditures described in clause (ii) after the
total amount set aside under clause (i) for
a fiscal year has been paid to the State.
‘‘(vi) NO INCREASE IN INCOME ELIGI-
BILITY LEVEL FOR PARENTS.—No payments
shall be made to a State from the amount
set aside under clause (i) for a fiscal year
for expenditures for providing child health
assistance or health benefits coverage to a
parent of a targeted low-income child whose
family income exceeds the income eligibility
level applied under the applicable existing
waiver to parents of targeted low-income
children on the date of enactment of the
Children’s Health Insurance Program Re-
authorization Act of 2007.
‘‘(3) OUTREACH OR COVERAGE BENCHMARKS.—
For purposes of paragraph (2), the outreach or cov-
erage benchmarks described in this paragraph are as
follows:
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‘‘(A) SIGNIFICANT CHILD OUTREACH CAM-
PAIGN.—The State—
‘‘(i) was awarded a grant under sec-
tion 2113 for fiscal year 2009;
‘‘(ii) implemented 1 or more of the
process 
measures 
described 
in 
section
2104(j)(3)(A)(i) for such fiscal year; or
‘‘(iii) has submitted a specific plan for
outreach for such fiscal year.
‘‘(B) 
HIGH-PERFORMING
STATE.—The
State, on the basis of the most timely and accu-
rate published estimates of the Bureau of the
Census, ranks in the lowest 1⁄3 of States in terms
of the State’s percentage of low-income children
without health insurance.
‘‘(C) STATE INCREASING ENROLLMENT OF
LOW-INCOME CHILDREN.—The State qualified for
a payment from the Incentive Fund under clause
(ii) or (iii) of paragraph (2)(C) of section
2104(j) for the most recent coverage period appli-
cable under such section.
‘‘(4) RULES OF CONSTRUCTION.—Nothing in this
subsection shall be construed as prohibiting a State
from submitting an application to the Secretary for
a waiver under section 1115 of the State plan under
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title XIX to provide medical assistance to a parent of
a targeted low-income child that was provided child
health assistance or health benefits coverage under an
applicable existing waiver.
‘‘(c) APPLICABLE EXISTING WAIVER.—For purposes of
this section—
‘‘(1) IN GENERAL.—The term ‘applicable existing
waiver’ means a waiver, experimental, pilot, or dem-
onstration project under section 1115, grandfathered
under section 6102(c)(3) of the Deficit Reduction Act
of 2005, or otherwise conducted under authority
that—
‘‘(A) would allow funds made available
under this title to be used to provide child health
assistance or other health benefits coverage to—
‘‘(i) a parent of a targeted low-income
child;
‘‘(ii) a nonpregnant childless adult; or
‘‘(iii) individuals described in both
clauses (i) and (ii); and
‘‘(B) was in effect during fiscal year 2007.
‘‘(2) DEFINITIONS.—
‘‘(A) PARENT.—The term ‘parent’ includes
a caretaker relative (as such term is used in car-
rying out section 1931) and a legal guardian.
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‘‘(B) NONPREGNANT CHILDLESS ADULT.—
The term ‘nonpregnant childless adult’ has the
meaning given such term by section 2107(f).’’.
(2) CONFORMING AMENDMENTS.—
(A) Section 2107(f) (42 U.S.C. 1397gg(f)) is
amended—
(i) by striking ‘‘, the Secretary’’ and
inserting ‘‘:
‘‘(1) The Secretary’’;
(ii) in the first sentence, by inserting
‘‘or a parent (as defined in section
2111(c)(2)(A)), who is not pregnant, of a
targeted low-income child’’ before the period;
(iii) by striking the second sentence;
and
(iv) by adding at the end the following
new paragraph:
‘‘(2) The Secretary may not approve, extend,
renew, or amend a waiver, experimental, pilot, or
demonstration project with respect to a State after the
date of enactment of the Children’s Health Insurance
Program Reauthorization Act of 2007 that would
waive or modify the requirements of section 2111.’’.
(B) Section 6102(c) of the Deficit Reduction
Act of 2005 (Public Law 109–171; 120 Stat.
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131) is amended by striking ‘‘Nothing’’ and in-
serting ‘‘Subject to section 2111 of the Social Se-
curity Act, as added by section 106(a)(1) of the
Children’s Health Insurance Program Reauthor-
ization Act of 2007, nothing’’.
(b) GAO STUDY AND REPORT.—
(1) IN GENERAL.—The Comptroller General of
the United States shall conduct a study of whether—
(A) the coverage of a parent, a caretaker
relative (as such term is used in carrying out
section 1931), or a legal guardian of a targeted
low-income child under a State health plan
under title XXI of the Social Security Act in-
creases the enrollment of, or the quality of care
for, children, and
(B) such parents, relatives, and legal guard-
ians who enroll in such a plan are more likely
to enroll their children in such a plan or in a
State plan under title XIX of such Act.
(2) REPORT.—Not later than 2 years after the
date of the enactment of this Act, the Comptroller
General shall report the results of the study to the ap-
propriate committees of Congress, including rec-
ommendations (if any) for changes in legislation.
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SEC. 107. STATE OPTION TO COVER LOW-INCOME PREG-
NANT WOMEN UNDER CHIP THROUGH A
STATE PLAN AMENDMENT.
(a) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et
seq.), as amended by section 106(a), is amended by adding
at the end the following new section:
‘‘SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-IN-
COME PREGNANT WOMEN THROUGH A STATE
PLAN AMENDMENT.
‘‘(a) IN GENERAL.—Subject to the succeeding provi-
sions of this section, a State may elect through an amend-
ment to its State child health plan under section 2102 to
provide pregnancy-related assistance under such plan for
targeted low-income pregnant women.
‘‘(b) CONDITIONS.—A State may only elect the option
under subsection (a) if the following conditions are satis-
fied:
‘‘(1) MEDICAID INCOME ELIGIBILITY LEVEL FOR
PREGNANT WOMEN OF AT LEAST 185 PERCENT OF POV-
ERTY.—The State has established an income eligi-
bility level for pregnant women under subsection
(a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of
section 1902 that is at least 185 percent of the income
official poverty line.
‘‘(2) NO CHIP INCOME ELIGIBILITY LEVEL FOR
PREGNANT WOMEN LOWER THAN THE STATE’S MED-
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ICAID LEVEL.—The State does not apply an effective
income level for pregnant women under the State
plan amendment that is lower than the effective in-
come level (expressed as a percent of the poverty line
and considering applicable income disregards) speci-
fied 
under 
subsection 
(a)(10)(A)(i)(III),
(a)(10)(A)(i)(IV), or (l)(1)(A) of section 1902, on the
date of enactment of this paragraph to be eligible for
medical assistance as a pregnant woman.
‘‘(3) NO COVERAGE FOR HIGHER INCOME PREG-
NANT
WOMEN
WITHOUT
COVERING
LOWER
INCOME
PREGNANT WOMEN.—The State does not provide cov-
erage for pregnant women with higher family income
without covering pregnant women with a lower fam-
ily income.
‘‘(4) APPLICATION OF REQUIREMENTS FOR COV-
ERAGE OF TARGETED LOW-INCOME CHILDREN.—The
State provides pregnancy-related assistance for tar-
geted low-income pregnant women in the same man-
ner, and subject to the same requirements, as the
State provides child health assistance for targeted
low-income children under the State child health
plan, and in addition to providing child health as-
sistance for such women.
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‘‘(5) NO PREEXISTING CONDITION EXCLUSION OR
WAITING PERIOD.—The State does not apply any ex-
clusion of benefits for pregnancy-related assistance
based on any preexisting condition or any waiting
period (including any waiting period imposed to
carry out section 2102(b)(3)(C)) for receipt of such
assistance.
‘‘(6) APPLICATION
OF
COST-SHARING
PROTEC-
TION.—The State provides pregnancy-related assist-
ance to a targeted low-income woman consistent with
the cost-sharing protections under section 2103(e) and
applies the limitation on total annual aggregate cost
sharing imposed under paragraph (3)(B) of such sec-
tion to the family of such a woman.
‘‘(c) OPTION
TO
PROVIDE
PRESUMPTIVE
ELIGI-
BILITY.—A State that elects the option under subsection (a)
and satisfies the conditions described in subsection (b) may
elect to apply section 1920 (relating to presumptive eligi-
bility for pregnant women) to the State child health plan
in the same manner as such section applies to the State
plan under title XIX.
‘‘(d) DEFINITIONS.—For purposes of this section:
‘‘(1) PREGNANCY-RELATED
ASSISTANCE.—The
term ‘pregnancy-related assistance’ has the meaning
given the term ‘child health assistance’ in section
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2110(a) and includes any medical assistance that the
State would provide for a pregnant woman under the
State plan under title XIX during pregnancy and the
period described in paragraph (2)(A).
‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT
WOMAN.—The term ‘targeted low-income pregnant
woman’ means a woman—
‘‘(A) during pregnancy and through the end
of the month in which the 60-day period (begin-
ning on the last day of her pregnancy) ends;
‘‘(B) whose family income does not exceed
the income eligibility level established under the
State child health plan under this title for a tar-
geted low-income child; and
‘‘(C) who satisfies the requirements of para-
graphs (1)(A), (1)(C), (2), and (3) of section
2110(b) in the same manner as a child applying
for child health assistance would have to satisfy
such requirements.
‘‘(e) AUTOMATIC ENROLLMENT FOR CHILDREN BORN
TO
WOMEN
RECEIVING
PREGNANCY-RELATED
ASSIST-
ANCE.—If a child is born to a targeted low-income pregnant
woman who was receiving pregnancy-related assistance
under this section on the date of the child’s birth, the child
shall be deemed to have applied for child health assistance
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under the State child health plan and to have been found
eligible for such assistance under such plan or to have ap-
plied for medical assistance under title XIX and to have
been found eligible for such assistance under such title, as
appropriate, on the date of such birth and to remain eligible
for such assistance until the child attains 1 year of age.
During the period in which a child is deemed under the
preceding sentence to be eligible for child health or medical
assistance, the child health or medical assistance eligibility
identification number of the mother shall also serve as the
identification number of the child, and all claims shall be
submitted and paid under such number (unless the State
issues a separate identification number for the child before
such period expires).
‘‘(f) STATES
PROVIDING
ASSISTANCE
THROUGH
OTHER OPTIONS.—
‘‘(1) CONTINUATION
OF
OTHER
OPTIONS
FOR
PROVIDING ASSISTANCE.—The option to provide as-
sistance in accordance with the preceding subsections
of this section shall not limit any other option for a
State to provide—
‘‘(A) child health assistance through the ap-
plication of sections 457.10, 457.350(b)(2),
457.622(c)(5), and 457.626(a)(3) of title 42,
Code of Federal Regulations (as in effect after
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the final rule adopted by the Secretary and set
forth at 67 Fed. Reg. 61956–61974 (October 2,
2002)), or
‘‘(B) pregnancy-related services through the
application of any waiver authority (as in effect
on June 1, 2007).
‘‘(2) CLARIFICATION OF AUTHORITY TO PROVIDE
POSTPARTUM
SERVICES.—Any State that provides
child health assistance under any authority described
in paragraph (1) may continue to provide such as-
sistance, as well as postpartum services, through the
end of the month in which the 60-day period (begin-
ning on the last day of the pregnancy) ends, in the
same manner as such assistance and postpartum serv-
ices would be provided if provided under the State
plan under title XIX, but only if the mother would
otherwise satisfy the eligibility requirements that
apply under the State child health plan (other than
with respect to age) during such period.
‘‘(3) NO INFERENCE.—Nothing in this subsection
shall be construed—
‘‘(A) to infer congressional intent regarding
the legality or illegality of the content of the sec-
tions specified in paragraph (1)(A); or
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‘‘(B) to modify the authority to provide
pregnancy-related services under a waiver speci-
fied in paragraph (1)(B).’’.
(b) ADDITIONAL CONFORMING AMENDMENTS.—
(1) NO COST SHARING FOR PREGNANCY-RELATED
BENEFITS.—Section 
2103(e)(2) 
(42 
U.S.C.
1397cc(e)(2)) is amended—
(A) in the heading, by inserting ‘‘OR PREG-
NANCY-RELATED
ASSISTANCE’’ after ‘‘PREVEN-
TIVE SERVICES’’; and
(B) by inserting before the period at the end
the following: ‘‘or for pregnancy-related assist-
ance’’.
(2) NO WAITING PERIOD.—Section 2102(b)(1)(B)
(42 U.S.C. 1397bb(b)(1)(B)) is amended—
(A) in clause (i), by striking ‘‘, and’’ at the
end and inserting a semicolon;
(B) in clause (ii), by striking the period at
the end and inserting ‘‘; and’’; and
(C) by adding at the end the following new
clause:
‘‘(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income pregnant woman provided preg-
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nancy-related 
assistance 
under 
section
2112.’’.
SEC. 108. CHIP CONTINGENCY FUND.
Section 2104 (42 U.S.C. 1397dd), as amended by sec-
tion 105, is amended by adding at the end the following
new subsection:
‘‘(k) CHIP CONTINGENCY FUND.—
‘‘(1) ESTABLISHMENT.—There is hereby estab-
lished in the Treasury of the United States a fund
which shall be known as the ‘CHIP Contingency
Fund’ (in this subsection referred to as the ‘Fund’).
Amounts in the Fund are authorized to be appro-
priated for payments under this subsection.
‘‘(2) DEPOSITS INTO FUND.—
‘‘(A) INITIAL AND SUBSEQUENT APPROPRIA-
TIONS.—Subject to subparagraphs (B) and (E),
out of any money in the Treasury of the United
States not otherwise appropriated, there are ap-
propriated to the Fund—
‘‘(i) for fiscal year 2009, an amount
equal to 12.5 percent of the available na-
tional allotment under subsection (i)(1)(C)
for the fiscal year; and
‘‘(ii) for each of fiscal years 2010
through 2012, such sums as are necessary
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for making payments to eligible States for
such fiscal year, but not in excess of the ag-
gregate cap described in subparagraph (B).
‘‘(B) AGGREGATE CAP.—Subject to subpara-
graph (E), the total amount available for pay-
ment from the Fund for each of fiscal years 2009
through 2012 (taking into account deposits made
under subparagraph (C)), shall not exceed 12.5
percent of the available national allotment under
subsection (i)(1)(C) for the fiscal year.
‘‘(C) INVESTMENT OF FUND.—The Secretary
of the Treasury shall invest, in interest bearing
securities of the United States, such currently
available portions of the Fund as are not imme-
diately required for payments from the Fund.
The income derived from these investments con-
stitutes a part of the Fund.
‘‘(D) TRANSFER OF EXCESS FUNDS TO THE
INCENTIVE FUND.—The Secretary of the Treas-
ury shall transfer to, and deposit in, the CHIP
Incentive Bonuses Pool established under sub-
section (j) any amounts in excess of the aggre-
gate cap described in subparagraph (B) for a fis-
cal year.
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‘‘(E) SPECIAL
RULES
FOR
AMOUNTS
SET
ASIDE FOR PARENTS AND CHILDLESS ADULTS.—
For purposes of subparagraphs (A) and (B)—
‘‘(i) the available national allotment
under subsection (i)(1)(C) shall be reduced
by any amount set aside under section
2111(a)(3) for block grant payments for
transitional coverage for childless adults;
and
‘‘(ii) the Secretary shall establish a
separate account in the Fund for the por-
tion of any amount appropriated to the
Fund for any fiscal year which is allocable
to the portion of the available national al-
lotment under subsection (i)(1)(C) which is
set aside for the fiscal year under section
2111(b)(2)(B)(i) for coverage of parents of
low-income children.
The Secretary shall include in the account estab-
lished under clause (ii) any income derived
under subparagraph (C) which is allocable to
amounts in such account.
‘‘(3) CHIP CONTINGENCY FUND PAYMENTS.—
‘‘(A) PAYMENTS.—
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‘‘(i) IN GENERAL.—Subject to clauses
(ii) and (iii) and the succeeding subpara-
graphs of this paragraph, the Secretary
shall pay from the Fund to a State that is
an eligible State for a month of a fiscal
year a CHIP contingency fund payment
equal to the Federal share of the shortfall
determined under subparagraph (D). In the
case of an eligible State under subpara-
graph (D)(i), the Secretary shall not make
the payment under this subparagraph until
the State makes, and submits to the Sec-
retary, a projection of the amount of the
shortfall.
‘‘(ii) SEPARATE
DETERMINATIONS
OF
SHORTFALLS.—The Secretary shall sepa-
rately compute the shortfall under subpara-
graph (D) for expenditures for eligible indi-
viduals other than nonpregnant childless
adults and parents with respect to whom
amounts are set aside under section 2111,
for expenditures for such childless adults,
and for expenditures for such parents.
‘‘(iii) PAYMENTS.—
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‘‘(I) NONPREGNANT
CHILDLESS
ADULTS.—No payments shall be made
from the Fund for nonpregnant child-
less adults with respect to whom
amounts are set aside under section
2111(a)(3).
‘‘(II) PARENTS.—Any payments
with respect to any shortfall for par-
ents who are paid from amounts set
aside under section 2111(b)(2)(B)(i)
shall be made only from the account es-
tablished under paragraph (2)(E)(ii)
and not from any other amounts in the
Fund. No other payments may be
made from such account.
‘‘(iv) 
SPECIAL
RULES.—Subpara-
graphs (B) and (C) shall be applied sepa-
rately with respect to shortfalls described in
clause (ii).
‘‘(B) USE OF FUNDS.—Amounts paid to an
eligible State from the Fund shall be used only
to eliminate the Federal share of a shortfall in
the State’s allotment under subsection (i) for a
fiscal year.
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‘‘(C) PRORATION
RULE.—If the amounts
available for payment from the Fund for a fiscal
year are less than the total amount of payments
determined under subparagraph (A) for the fiscal
year, the amount to be paid under such subpara-
graph to each eligible State shall be reduced pro-
portionally.
‘‘(D) ELIGIBLE STATE.—
‘‘(i) IN GENERAL.—A State is an eligi-
ble State for a month if the State is a sub-
section (b) State (as defined in subsection
(i)(7)), the State requests access to the Fund
for the month, and it is described in clause
(ii) or (iii).
‘‘(ii) SHORTFALL OF FEDERAL ALLOT-
MENT FUNDING OF NOT MORE THAN 5 PER-
CENT.—The Secretary estimates, on the
basis of the most recent data available to
the Secretary or requested from the State by
the Secretary, that the State’s allotment for
the fiscal year is at least 95 percent, but less
than 100 percent, of the projected expendi-
tures under the State child health plan for
the State for the fiscal year determined
under subsection (i) (without regard to in-
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centive bonuses or payments for which the
State is eligible for under subsection (j)(2)
for the fiscal year).
‘‘(iii) SHORTFALL OF FEDERAL ALLOT-
MENT FUNDING OF MORE THAN 5 PERCENT
CAUSED
BY
SPECIFIC
EVENTS.—The Sec-
retary estimates, on the basis of the most re-
cent data available to the Secretary or re-
quested from the State by the Secretary,
that the State’s allotment for the fiscal year
is less than 95 percent of the projected ex-
penditures under the State child health plan
for the State for the fiscal year determined
under subsection (i) (without regard to in-
centive bonuses or payments for which the
State is eligible for under subsection (j)(2)
for the fiscal year) and that such shortfall
is attributable to 1 or more of the following
events:
‘‘(I) STAFFORD
ACT
OR
PUBLIC
HEALTH
EMERGENCY.—The 
State
has—
‘‘(aa) 1 or more parishes or
counties for which a major dis-
aster has been declared in accord-
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ance with section 401 of the Rob-
ert T. Stafford Disaster Relief and
Emergency Assistance Act (42
U.S.C. 5170) and which the Presi-
dent has determined warrants in-
dividual and public assistance
from the Federal Government
under such Act; or
‘‘(bb) a public health emer-
gency declared by the Secretary
under section 319 of the Public
Health Service Act.
‘‘(II) STATE
ECONOMIC
DOWN-
TURN.—The State unemployment rate
is at least 5.5 percent during any 3-
month period during the fiscal year
and such rate is at least 120 percent of
the State unemployment rate for the
same period as averaged over the last
3 fiscal years.
‘‘(III) EVENT RESULTING IN RISE
IN PERCENTAGE OF LOW-INCOME CHIL-
DREN WITHOUT HEALTH INSURANCE.—
The State experienced a recent event
that resulted in an increase in the per-
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centage of low-income children in the
State without health insurance (as de-
termined on the basis of the most time-
ly and accurate published estimates of
the Bureau of the Census) that was
outside the control of the State and
warrants granting the State access to
the Fund (as determined by the Sec-
retary).
‘‘(E) PAYMENTS
MADE
TO
ALL
ELIGIBLE
STATES ON A MONTHLY BASIS; AUTHORITY FOR
PRO RATA PAYMENTS.—The Secretary shall make
monthly payments from the Fund to all States
that are determined to be eligible States with re-
spect to a month. If the sum of the payments to
be made from the Fund for a month exceed the
amount in the Fund, the Secretary shall reduce
each such payment on a proportional basis.
‘‘(F) PAYMENTS LIMITED TO FISCAL YEAR
OF
ELIGIBILITY
DETERMINATION
UNLESS
NEW
ELIGIBILITY
BASIS
DETERMINED.—No 
State
shall receive a CHIP contingency fund payment
under this section for a month beginning after
September 30 of the fiscal year in which the
State is determined to be an eligible State under
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this subsection, except that in the case of an
event described in subclause (I) or (III) of sub-
paragraph (D)(iii) that occurred after July 1 of
the fiscal year, any such payment with respect
to such event shall remain available until Sep-
tember 30 of the subsequent fiscal year. Nothing
in the preceding sentence shall be construed as
prohibiting a State from being determined to be
an eligible State under this subsection for any
fiscal year occurring after a fiscal year in which
such a determination is made.
‘‘(G) EXEMPTION FROM DETERMINATION OF
PERCENTAGE OF ALLOTMENT RETAINED AFTER
FIRST YEAR OF AVAILABILITY.—In no event shall
payments made to a State under this subsection
be treated as part of the allotment determined for
a State for a fiscal year under subsection (i) for
purposes of subsection (j)(1)(B)(ii)(III).
‘‘(H) APPLICATION OF ALLOTMENT REPORT-
ING RULES.—Rules applicable to States for pur-
poses of receiving payments from an allotment
determined under subsection (c) or (i) shall
apply in the same manner to an eligible State
for purposes of receiving a CHIP contingency
fund payment under this subsection.
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‘‘(4) ANNUAL REPORTS.—The Secretary shall an-
nually report to the Congress on the amounts in the
Fund, the specific events that caused States to apply
for payments from the Fund, and the payments made
from the Fund.’’.
SEC. 109. TWO-YEAR AVAILABILITY OF ALLOTMENTS; EX-
PENDITURES COUNTED AGAINST OLDEST AL-
LOTMENTS.
Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to
read as follows:
‘‘(e) AVAILABILITY OF AMOUNTS ALLOTTED.—
‘‘(1) IN GENERAL.—Except as provided in sub-
section (j)(1)(B)(ii)(III), amounts allotted to a State
pursuant to this section—
‘‘(A) for each of fiscal years 1998 through
2006, shall remain available for expenditure by
the State through the end of the second suc-
ceeding fiscal year; and
‘‘(B) for each of fiscal years 2007 through
2012, shall remain available for expenditure by
the State only through the end of the succeeding
fiscal year for which such amounts are allotted.
‘‘(2) INCENTIVE
BONUSES.—Incentive bonuses
paid to a State under subsection (j)(2) for a fiscal
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year shall remain available for expenditure by the
State without limitation.
‘‘(3) CHIP CONTINGENCY FUND PAYMENTS.—Ex-
cept as provided in paragraph (3)(F) of subsection
(k), CHIP Contingency Fund payments made to a
State under such subsection for a month of a fiscal
year shall remain available for expenditure by the
State through the end of the fiscal year.
‘‘(4) 
RULE
FOR
COUNTING
EXPENDITURES
AGAINST CHIP CONTINGENCY FUND PAYMENTS, FISCAL
YEAR ALLOTMENTS, AND INCENTIVE BONUSES.—
‘‘(A) IN GENERAL.—Expenditures under the
State child health plan made on or after October
1, 2007, shall be counted against—
‘‘(i) first, any CHIP Contingency
Fund payment made to the State under
subsection (k) for the earliest month of the
earliest fiscal year for which the payment
remains available for expenditure; and
‘‘(ii) second, amounts allotted to the
State for the earliest fiscal year for which
amounts remain available for expenditure.
‘‘(B) INCENTIVE BONUSES.—A State may
elect, but is not required, to count expenditures
under the State child health plan against any
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incentive bonuses paid to the State under sub-
section (j)(2) for a fiscal year.
‘‘(C) BLOCK GRANT SET-ASIDES.—Expendi-
tures for coverage of—
‘‘(i) nonpregnant childless adults for
fiscal year 2009 shall be counted only
against the amount set aside for such cov-
erage under section 2111(a)(3); and
‘‘(ii) parents of targeted low-income
children for each of fiscal years 2010
through 2012, shall be counted only against
the amount set aside for such coverage
under section 2111(b)(2)(B)(i).’’.
SEC. 110. LIMITATION ON MATCHING RATE FOR STATES
THAT PROPOSE TO COVER CHILDREN WITH
EFFECTIVE FAMILY INCOME THAT EXCEEDS
300 PERCENT OF THE POVERTY LINE.
(a) FMAP APPLIED
TO EXPENDITURES.—Section
2105(c) (42 U.S.C. 1397ee(c)) is amended by adding at the
end the following new paragraph:
‘‘(8) LIMITATION ON MATCHING RATE FOR EX-
PENDITURES FOR CHILD HEALTH ASSISTANCE PRO-
VIDED TO CHILDREN WHOSE EFFECTIVE FAMILY IN-
COME
EXCEEDS
300
PERCENT
OF
THE
POVERTY
LINE.—
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‘‘(A) FMAP APPLIED TO EXPENDITURES.—
Except as provided in subparagraph (B), for fis-
cal years beginning with fiscal year 2008, the
Federal medical assistance percentage (as deter-
mined under section 1905(b) without regard to
clause (4) of such section) shall be substituted for
the enhanced FMAP under subsection (a)(1) with
respect to any expenditures for providing child
health assistance or health benefits coverage for a
targeted low-income child whose effective family
income would exceed 300 percent of the poverty
line but for the application of a general exclu-
sion of a block of income that is not determined
by type of expense or type of income.
‘‘(B) EXCEPTION.—Subparagraph (A) shall
not apply to any State that, on the date of en-
actment of the Children’s Health Insurance Pro-
gram Reauthorization Act of 2007, has an ap-
proved State plan amendment or waiver to pro-
vide, or has enacted a State law to submit a
State plan amendment to provide, expenditures
described in such subparagraph under the State
child health plan.’’.
(b) CONFORMING AMENDMENT.—Section 2105(a)(1)
(42 U.S.C. 1397dd(a)(1)) is amended, in the matter pre-
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ceding subparagraph (A), by inserting ‘‘or subsection
(c)(8)’’ after ‘‘subparagraph (B)’’.
SEC. 111. OPTION FOR QUALIFYING STATES TO RECEIVE
THE ENHANCED PORTION OF THE CHIP
MATCHING RATE FOR MEDICAID COVERAGE
OF CERTAIN CHILDREN.
Section 2105(g) (42 U.S.C. 1397ee(g)) is amended—
(1) in paragraph (1)(A), by inserting ‘‘subject to
paragraph (4),’’ after ‘‘Notwithstanding any other
provision of law,’’; and
(2) by adding at the end the following new para-
graph:
‘‘(4) OPTION
FOR
ALLOTMENTS
FOR
FISCAL
YEARS 2008 THROUGH 2012.—
‘‘(A) PAYMENT OF ENHANCED PORTION OF
MATCHING RATE FOR CERTAIN EXPENDITURES.—
In the case of expenditures described in subpara-
graph (B), a qualifying State (as defined in
paragraph (2)) may elect to be paid from the
State’s allotment made under section 2104 for
any of fiscal years 2008 through 2012 (insofar as
the allotment is available to the State under sub-
sections (e) and (i) of such section) an amount
each quarter equal to the additional amount that
would have been paid to the State under title
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XIX with respect to such expenditures if the en-
hanced FMAP (as determined under subsection
(b)) had been substituted for the Federal medical
assistance percentage (as defined in section
1905(b)).
‘‘(B) 
EXPENDITURES
DESCRIBED.—For
purposes of subparagraph (A), the expenditures
described in this subparagraph are expenditures
made after the date of the enactment of this
paragraph and during the period in which funds
are available to the qualifying State for use
under subparagraph (A), for the provision of
medical assistance to individuals residing in the
State who are eligible for medical assistance
under the State plan under title XIX or under
a waiver of such plan and who have not attained
age 19 (or, if a State has so elected under the
State plan under title XIX, age 20 or 21), and
whose family income equals or exceeds 133 per-
cent of the poverty line but does not exceed the
Medicaid applicable income level.’’.
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TITLE II—OUTREACH AND
ENROLLMENT
SEC. 201. GRANTS FOR OUTREACH AND ENROLLMENT.
(a) GRANTS.—Title XXI (42 U.S.C. 1397aa et seq.),
as amended by section 107, is amended by adding at the
end the following:
‘‘SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLL-
MENT.
‘‘(a) OUTREACH
AND ENROLLMENT GRANTS; NA-
TIONAL CAMPAIGN.—
‘‘(1) IN GENERAL.—From the amounts appro-
priated under subsection (g), subject to paragraph
(2), the Secretary shall award grants to eligible enti-
ties during the period of fiscal years 2008 through
2012 to conduct outreach and enrollment efforts that
are designed to increase the enrollment and participa-
tion of eligible children under this title and title XIX.
‘‘(2) TEN PERCENT SET ASIDE FOR NATIONAL
ENROLLMENT
CAMPAIGN.—An amount equal to 10
percent of such amounts shall be used by the Sec-
retary for expenditures during such period to carry
out a national enrollment campaign in accordance
with subsection (h).
‘‘(b) PRIORITY FOR AWARD OF GRANTS.—
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‘‘(1) IN GENERAL.—In awarding grants under
subsection (a), the Secretary shall give priority to eli-
gible entities that—
‘‘(A) propose to target geographic areas
with high rates of—
‘‘(i) eligible but unenrolled children,
including such children who reside in rural
areas; or
‘‘(ii) racial and ethnic minorities and
health disparity populations, including
those proposals that address cultural and
linguistic barriers to enrollment; and
‘‘(B) submit the most demonstrable evidence
required under paragraphs (1) and (2) of sub-
section (c).
‘‘(2) TEN PERCENT SET ASIDE FOR OUTREACH
TO INDIAN CHILDREN.—An amount equal to 10 per-
cent of the funds appropriated under subsection (g)
shall be used by the Secretary to award grants to In-
dian Health Service providers and urban Indian or-
ganizations receiving funds under title V of the In-
dian Health Care Improvement Act (25 U.S.C. 1651
et seq.) for outreach to, and enrollment of, children
who are Indians.
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‘‘(c) APPLICATION.—An eligible entity that desires to
receive a grant under subsection (a) shall submit an appli-
cation to the Secretary in such form and manner, and con-
taining such information, as the Secretary may decide.
Such application shall include—
‘‘(1) evidence demonstrating that the entity in-
cludes members who have access to, and credibility
with, ethnic or low-income populations in the commu-
nities in which activities funded under the grant are
to be conducted;
‘‘(2) evidence demonstrating that the entity has
the ability to address barriers to enrollment, such as
lack of awareness of eligibility, stigma concerns and
punitive fears associated with receipt of benefits, and
other cultural barriers to applying for and receiving
child health assistance or medical assistance;
‘‘(3) specific quality or outcomes performance
measures to evaluate the effectiveness of activities
funded by a grant awarded under this section; and
‘‘(4) an assurance that the eligible entity shall—
‘‘(A) conduct an assessment of the effective-
ness of such activities against the performance
measures;
‘‘(B) cooperate with the collection and re-
porting of enrollment data and other informa-
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tion in order for the Secretary to conduct such
assessments; and
‘‘(C) in the case of an eligible entity that is
not the State, provide the State with enrollment
data and other information as necessary for the
State to make necessary projections of eligible
children and pregnant women.
‘‘(d) DISSEMINATION OF ENROLLMENT DATA AND IN-
FORMATION DETERMINED FROM EFFECTIVENESS ASSESS-
MENTS; ANNUAL REPORT.—The Secretary shall—
‘‘(1) make publicly available the enrollment data
and information collected and reported in accordance
with subsection (c)(4)(B); and
‘‘(2) submit an annual report to Congress on the
outreach and enrollment activities conducted with
funds appropriated under this section.
‘‘(e) MAINTENANCE OF EFFORT FOR STATES AWARDED
GRANTS; NO STATE MATCH REQUIRED.—In the case of a
State that is awarded a grant under this section—
‘‘(1) the State share of funds expended for out-
reach and enrollment activities under the State child
health plan shall not be less than the State share of
such funds expended in the fiscal year preceding the
first fiscal year for which the grant is awarded; and
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‘‘(2) no State matching funds shall be required
for the State to receive a grant under this section.
‘‘(f) DEFINITIONS.—In this section:
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible enti-
ty’ means any of the following:
‘‘(A) A State with an approved child health
plan under this title.
‘‘(B) A local government.
‘‘(C) An Indian tribe or tribal consortium,
a tribal organization, an urban Indian organi-
zation receiving funds under title V of the In-
dian Health Care Improvement Act (25 U.S.C.
1651 et seq.), or an Indian Health Service pro-
vider.
‘‘(D) A Federal health safety net organiza-
tion.
‘‘(E) A national, State, local, or commu-
nity-based public or nonprofit private organiza-
tion, including organizations that use commu-
nity health workers or community-based doula
programs.
‘‘(F) A faith-based organization or con-
sortia, to the extent that a grant awarded to such
an entity is consistent with the requirements of
section 1955 of the Public Health Service Act (42
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U.S.C. 300x–65) relating to a grant award to
nongovernmental entities.
‘‘(G) An elementary or secondary school.
‘‘(2) FEDERAL HEALTH SAFETY NET ORGANIZA-
TION.—The term ‘Federal health safety net organiza-
tion’ means—
‘‘(A) a Federally-qualified health center (as
defined in section 1905(l)(2)(B));
‘‘(B) a hospital defined as a dispropor-
tionate share hospital for purposes of section
1923;
‘‘(C) a covered entity described in section
340B(a)(4) of the Public Health Service Act (42
U.S.C. 256b(a)(4)); and
‘‘(D) any other entity or consortium that
serves children under a federally funded pro-
gram, including the special supplemental nutri-
tion program for women, infants, and children
(WIC) established under section 17 of the Child
Nutrition Act of 1966 (42 U.S.C. 1786), the
Head Start and Early Head Start programs
under the Head Start Act (42 U.S.C. 9801 et
seq.), the school lunch program established under
the Richard B. Russell National School Lunch
Act, and an elementary or secondary school.
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‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANIZA-
TION; URBAN INDIAN ORGANIZATION.—The terms ‘In-
dian’, ‘Indian tribe’, ‘tribal organization’, and ‘urban
Indian organization’ have the meanings given such
terms in section 4 of the Indian Health Care Im-
provement Act (25 U.S.C. 1603).
‘‘(4) COMMUNITY HEALTH WORKER.—The term
‘community health worker’ means an individual who
promotes health or nutrition within the community
in which the individual resides—
‘‘(A) by serving as a liaison between com-
munities and health care agencies;
‘‘(B) by providing guidance and social as-
sistance to community residents;
‘‘(C) by enhancing community residents’
ability to effectively communicate with health
care providers;
‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation;
‘‘(E) by advocating for individual and com-
munity health or nutrition needs; and
‘‘(F) by providing referral and followup
services.
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‘‘(g) APPROPRIATION.—There is appropriated, out of
any money in the Treasury not otherwise appropriated,
$100,000,000 for the period of fiscal years 2008 through
2012, to remain available until expended, for the purpose
of awarding grants under this section. Amounts appro-
priated and paid under the authority of this section shall
be in addition to amounts appropriated under section 2104
and paid to States in accordance with section 2105, includ-
ing with respect to expenditures for outreach activities in
accordance with subsections (a)(1)(D)(iii) and (c)(2)(C) of
that section.
‘‘(h) NATIONAL ENROLLMENT CAMPAIGN.—From the
amounts made available under subsection (a)(2), the Sec-
retary shall develop and implement a national enrollment
campaign to improve the enrollment of underserved child
populations in the programs established under this title and
title XIX. Such campaign may include—
‘‘(1) the establishment of partnerships with the
Secretary of Education and the Secretary of Agri-
culture to develop national campaigns to link the eli-
gibility and enrollment systems for the assistance pro-
grams each Secretary administers that often serve the
same children;
‘‘(2) the integration of information about the
programs established under this title and title XIX in
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public health awareness campaigns administered by
the Secretary;
‘‘(3) increased financial and technical support
for enrollment hotlines maintained by the Secretary
to ensure that all States participate in such hotlines;
‘‘(4) the establishment of joint public awareness
outreach initiatives with the Secretary of Education
and the Secretary of Labor regarding the importance
of health insurance to building strong communities
and the economy;
‘‘(5) the development of special outreach mate-
rials for Native Americans or for individuals with
limited English proficiency; and
‘‘(6) such other outreach initiatives as the Sec-
retary determines would increase public awareness of
the programs under this title and title XIX.’’.
(b) 
ENHANCED
ADMINISTRATIVE
FUNDING
FOR
TRANSLATION
OR
INTERPRETATION
SERVICES
UNDER
CHIP.—Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as
amended by section 603, is amended—
(1) in the matter preceding subparagraph (A),
by inserting ‘‘(or, in the case of expenditures de-
scribed in subparagraph (D)(iv), the higher of 75 per-
cent or the sum of the enhanced FMAP plus 5 per-
centage points)’’ after ‘‘enhanced FMAP’’; and
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(2) in subparagraph (D)—
(A) in clause (iii), by striking ‘‘and’’ at the
end;
(B) by redesignating clause (iv) as clause
(v); and
(C) by inserting after clause (iii) the fol-
lowing new clause:
‘‘(iv) for translation or interpretation
services in connection with the enrollment
and use of services under this title by indi-
viduals for whom English is not their pri-
mary language (as found necessary by the
Secretary for the proper and efficient ad-
ministration of the State plan); and’’.
(c) NONAPPLICATION OF ADMINISTRATIVE EXPENDI-
TURES CAP.—Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2))
is amended by adding at the end the following:
‘‘(C) NONAPPLICATION
TO
CERTAIN
EX-
PENDITURES.—The limitation under subpara-
graph (A) shall not apply with respect to the fol-
lowing expenditures:
‘‘(i) EXPENDITURES
FUNDED
UNDER
SECTION
2113.—Expenditures for outreach
and enrollment activities funded under a
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grant awarded to the State under section
2113.’’.
SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF IN-
DIANS.
(a) IN GENERAL.—Section 1139 (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
XIX AND XXI.
‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID AND
CHIP 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,
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-
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ment, and translation services when such services are
appropriate.
‘‘(2) CONSTRUCTION.—Nothing in paragraph (1)
shall be construed as affecting arrangements entered
into between States and the Indian Health Service,
Indian Tribes, Tribal Organizations, or Urban In-
dian Organizations for such Service, Tribes, or Orga-
nizations 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 XIX or
XXI.
‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN
HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN INDIAN
ORGANIZATION.—In this section, the terms ‘Indian’, ‘In-
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.’’.
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(b) NONAPPLICATION OF 10 PERCENT LIMIT ON OUT-
REACH
AND CERTAIN OTHER EXPENDITURES.—Section
2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as added by sec-
tion 201(c), is amended by adding at the end the following
new clause:
‘‘(ii) EXPENDITURES
TO
INCREASE
OUTREACH TO, AND THE ENROLLMENT OF,
INDIAN CHILDREN UNDER THIS TITLE AND
TITLE XIX.—Expenditures for outreach ac-
tivities to families of Indian children likely
to be eligible for child health assistance
under the plan or medical assistance under
the State plan under title XIX (or under a
waiver of such plan), to inform such fami-
lies of the availability of, and to assist them
in enrolling their children in, such plans,
including such activities conducted under
grants, contracts, or agreements entered into
under section 1139(a).’’.
SEC. 203. DEMONSTRATION PROGRAM TO PERMIT STATES
TO RELY ON FINDINGS BY AN EXPRESS LANE
AGENCY TO DETERMINE COMPONENTS OF A
CHILD’S ELIGIBILITY FOR MEDICAID OR CHIP.
(a) REQUIREMENT TO CONDUCT DEMONSTRATION
PROGRAM.—
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pendent confirmation of the information at the
time of enrollment, redetermination, or renewal.
(2) PAYMENTS TO STATES.—From the amount
appropriated under paragraph (1) of subsection (f),
after the application of paragraph (2) of that sub-
section, the Secretary shall pay the States selected to
participate in the demonstration program such sums
as the Secretary shall determine for expenditures
made by the State for systems upgrades and imple-
mentation of the demonstration program. In no event
shall a payment be made to a State from the amount
appropriated under subsection (f) for any expendi-
tures incurred for providing medical assistance or
child health assistance to a child enrolled in the State
Medicaid plan or the State CHIP plan through reli-
ance on a finding made by an Express Lane agency.
(b) REQUIREMENTS; OPTIONS FOR APPLICATION.—
(1) STATE REQUIREMENTS.—A State selected to
participate in the demonstration program established
under this section may rely on a finding of an Ex-
press Lane agency only if the following conditions are
met:
(A) REQUIREMENT TO DETERMINE ELIGI-
BILITY USING REGULAR PROCEDURES IF CHILD
IS FIRST FOUND INELIGIBLE.—If reliance on a
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finding from an Express Lane agency results in
a child not being found eligible for the State
Medicaid plan or the State CHIP plan, the State
would be required to determine eligibility under
such plan using its regular procedures.
(B) NOTICE.—The State shall inform the
families (especially those whose children are en-
rolled in the State CHIP plan) that they may
qualify for lower premium payments or more
comprehensive health coverage under the State
Medicaid plan if the family’s income were di-
rectly evaluated for an eligibility determination
by the State Medicaid agency, and that, at the
family’s option, the family may seek an eligi-
bility determination by the State Medicaid agen-
cy.
(C) COMPLIANCE
WITH
DEPARTMENT
OF
HOMELAND SECURITY PROCEDURES.—The State
may rely on an Express Lane agency finding
that a child is a qualified alien as long as the
Express Lane agency complies with guidance
and regulatory procedures issued by the Sec-
retary of Homeland Security for eligibility deter-
minations of qualified aliens (as defined in sub-
sections (b) and (c) of section 431 of the Personal
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Responsibility and Work Opportunity Reconcili-
ation Act of 1996 (8 U.S.C. 1641)).
(D) VERIFICATION OF CITIZENSHIP OR NA-
TIONALITY STATUS.—The State shall satisfy the
requirements 
of 
section 
1902(a)(46)(B) 
or
2105(c)(9) of the Social Security Act, as applica-
ble (and as added by section 301 of this Act) for
verifications of citizenship or nationality status.
(E) CODING; APPLICATION TO ENROLLMENT
ERROR RATES.—
(i) IN
GENERAL.—The State agrees
to—
(I) assign such codes as the Sec-
retary shall require to the children who
are enrolled in the State Medicaid plan
or the State CHIP plan through reli-
ance on a finding made by an Express
Lane agency for the duration of the
State’s participation in the demonstra-
tion program;
(II) annually provide the Sec-
retary with a statistically valid sample
(that is approved by Secretary) of the
children enrolled in such plans through
reliance on such a finding by con-
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ducting a full Medicaid eligibility re-
view of the children identified for such
sample for purposes of determining an
eligibility error rate with respect to the
enrollment of such children;
(III) submit the error rate deter-
mined under subclause (II) to the Sec-
retary;
(IV) if such error rate exceeds 3
percent for either of the first 2 fiscal
years in which the State participates
in the demonstration program, dem-
onstrate to the satisfaction of the Sec-
retary the specific corrective actions
implemented by the State to improve
upon such error rate; and
(V) if such error rate exceeds 3
percent for any fiscal year in which
the State participates in the dem-
onstration program, a reduction in the
amount otherwise payable to the State
under section 1903(a) of the Social Se-
curity Act (42 Secretary 1396b(a)) for
quarters for that fiscal year, equal to
the total amount of erroneous excess
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payments determined for the fiscal
year only with respect to the children
included in the sample for the fiscal
year that are in excess of a 3 percent
error rate with respect to such chil-
dren.
(ii) NO
PUNITIVE
ACTION
BASED
ON
ERROR
RATE.—The Secretary shall not
apply the error rate derived from the sam-
ple under clause (i) to the entire population
of children enrolled in the State Medicaid
plan or the State CHIP plan through reli-
ance on a finding made by an Express
Lane agency, or to the population of chil-
dren enrolled in such plans on the basis of
the State’s regular procedures for deter-
mining eligibility, or penalize the State on
the basis of such error rate in any manner
other than the reduction of payments pro-
vided for under clause (i)(V).
(iii) RULE OF CONSTRUCTION.—Noth-
ing in this section shall be construed as re-
lieving a State that participates in the
demonstration program established under
this section from being subject to a penalty
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under section 1903(u) of the Social Security
Act (42 U.S.C. 1396b(u)) for payments
made under the State Medicaid plan with
respect to ineligible individuals and fami-
lies that are determined to exceed the error
rate permitted under that section (as deter-
mined without regard to the error rate de-
termined under clause (i)(II)).
(2) STATE OPTIONS FOR APPLICATION.—A State
selected to participate in the demonstration program
may elect to apply any of the following:
(A) SATISFACTION
OF
CHIP
SCREEN
AND
ENROLL REQUIREMENTS.—If the State relies on
a finding of an Express Lane agency for pur-
poses of determining eligibility under the State
CHIP plan, the State may meet the screen and
enroll requirements imposed under subpara-
graphs (A) and (B) of section 2102(b)(3) of the
Social Security Act (42 U.S.C. 1397bb(b)(3)) by
using any of the following:
(i) Establishing a threshold percentage
of the poverty line that is 30 percentage
points (or such other higher number of per-
centage points) as the State determines re-
flects the income methodologies of the pro-
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gram administered by the Express Lane
Agency and the State Medicaid plan.
(ii) Providing that a child satisfies all
income requirements for eligibility under
the State Medicaid plan.
(iii) Providing that a child has a fam-
ily income that exceeds the Medicaid appli-
cable income level.
(B) PRESUMPTIVE ELIGIBILITY.—The State
may provide for presumptive eligibility under
the State CHIP plan for a child who, based on
an eligibility determination of an income find-
ing from an Express Lane agency, would qualify
for child health assistance under the State CHIP
plan. During the period of presumptive eligi-
bility, the State may determine the child’s eligi-
bility for child health assistance under the State
CHIP plan based on telephone contact with fam-
ily members, access to data available in elec-
tronic or paper format, or other means that min-
imize to the maximum extent feasible the burden
on the family.
(C) AUTOMATIC ENROLLMENT.—
(i) IN GENERAL.—The State may ini-
tiate and determine eligibility for medical
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assistance under the State Medicaid plan or
for child health assistance under the State
CHIP plan without a program application
from, or on behalf of, the child based on
data obtained from sources other than the
child (or the child’s family), but a child can
only be automatically enrolled in the State
Medicaid plan or the State CHIP plan if
the child or the family affirmatively con-
sents to being enrolled through affirmation
and signature on an Express Lane agency
application.
(ii) INFORMATION
REQUIREMENT.—A
State that elects the option under clause (i)
shall have procedures in place to inform the
child or the child’s family of the services
that will be covered under the State Med-
icaid plan or the State CHIP plan (as ap-
plicable), appropriate methods for using
such services, premium or other cost sharing
charges (if any) that apply, medical sup-
port obligations created by the enrollment
(if applicable), and the actions the child or
the child’s family must take to maintain en-
rollment and renew coverage.
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(iii) OPTION TO WAIVE SIGNATURES.—
The State may waive any signature re-
quirements for enrollment for a child who
consents to, or on whose behalf consent is
provided for, enrollment in the State Med-
icaid plan or the State CHIP plan.
(3) SIGNATURE REQUIREMENTS.—In the case of
a State selected to participate in the demonstration
program—
(A) no signature under penalty of perjury
shall be required on an application form for
medical assistance under the State Medicaid
plan or child health assistance under the State
CHIP plan to attest to any element of the appli-
cation for which eligibility is based on informa-
tion received from an Express Lane agency or a
source other than an applicant; and
(B) any signature requirement for deter-
mination of an application for medical assist-
ance under the State Medicaid plan or child
health assistance under the State CHIP plan
may be satisfied through an electronic signature.
(4) RULES OF CONSTRUCTION.—Nothing in this
subsection shall be construed to—
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(A) relieve a State of the obligation under
section 1902(a)(5) of the Social Security Act (42
U.S.C. 1396a(a)(5)) to determine eligibility for
medical assistance under the State Medicaid
plan; or
(B) prohibit any State options otherwise
permitted under Federal law (without regard to
this paragraph or the demonstration program es-
tablished under this section) that are intended to
increase the enrollment of eligible children for
medical assistance under the State Medicaid
plan or child health assistance under the State
CHIP plan, including options related to out-
reach, enrollment, applications, or the deter-
mination or redetermination of eligibility.
(c) LIMITED WAIVER OF OTHER APPLICABLE RE-
QUIREMENTS.—
(1) SOCIAL SECURITY ACT.—The Secretary shall
waive only such requirements of the Social Security
Act as the Secretary determines are necessary to
carry out the demonstration program established
under this section.
(2) AUTHORIZATION FOR PARTICIPATING STATES
TO RECEIVE CERTAIN DATA DIRECTLY RELEVANT TO
DETERMINING ELIGIBILITY AND CORRECT AMOUNT OF
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ASSISTANCE.—For provisions relating to the author-
ity of States participating in the demonstration pro-
gram to receive certain data directly, see section
204(c).
(d) EVALUATION AND REPORT.—
(1) EVALUATION.—The Secretary shall conduct,
by grant, contract, or interagency agreement, a com-
prehensive, independent evaluation of the demonstra-
tion program established under this section. Such
evaluation shall include an analysis of the effective-
ness of the program, and shall include—
(A) obtaining a statistically valid sample of
the children who were enrolled in the State Med-
icaid plan or the State CHIP plan through reli-
ance on a finding made by an Express Lane
agency and determining the percentage of chil-
dren who were erroneously enrolled in such
plans;
(B) determining whether enrolling children
in such plans through reliance on a finding
made by an Express Lane agency improves the
ability of a State to identify and enroll low-in-
come, uninsured children who are eligible but
not enrolled in such plans;
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(C) evaluating the administrative costs or
savings related to identifying and enrolling chil-
dren in such plans through reliance on such
findings, and the extent to which such costs differ
from the costs that the State otherwise would
have incurred to identify and enroll low-income,
uninsured children who are eligible but not en-
rolled in such plans; and
(D) any recommendations for legislative or
administrative changes that would improve the
effectiveness of enrolling children in such plans
through reliance on such findings.
(2) REPORT TO CONGRESS.—Not later than Sep-
tember 30, 2012, the Secretary shall submit a report
to Congress on the results of the evaluation of the
demonstration program established under this section.
(e) DEFINITIONS.—In this section:
(1) CHILD; CHILDREN.—With respect to a State
selected to participate in the demonstration program
established under this section, the terms ‘‘child’’ and
‘‘children’’ have the meanings given such terms for
purposes of the State plans under titles XIX and XXI
of the Social Security Act.
(2) EXPRESS LANE AGENCY.—
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(A) IN GENERAL.—The term ‘‘Express Lane
agency’’ means a public agency that—
(i) is determined by the State Medicaid
agency or the State CHIP agency (as appli-
cable) to be capable of making the deter-
minations of 1 or more eligibility require-
ments described in subsection (a)(1);
(ii) is identified in the State Medicaid
plan or the State CHIP plan; and
(iii) notifies the child’s family—
(I) of the information which shall
be disclosed in accordance with this
section;
(II) that the information disclosed
will be used solely for purposes of de-
termining eligibility for medical assist-
ance under the State Medicaid plan or
for child health assistance under the
State CHIP plan; and
(III) that the family may elect to
not have the information disclosed for
such purposes; and
(iv) enters into, or is subject to, an
interagency agreement to limit the disclo-
sure and use of the information disclosed.
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(B) INCLUSION OF SPECIFIC PUBLIC AGEN-
CIES.—Such term includes the following:
(i) A public agency that determines eli-
gibility for assistance under any of the fol-
lowing:
(I) The temporary assistance for
needy families program funded under
part A of title IV of the Social Secu-
rity Act (42 U.S.C. 601 et seq.).
(II) A State program funded
under part D of title IV of such Act
(42 U.S.C. 651 et seq.).
(III) The State Medicaid plan.
(IV) The State CHIP plan.
(V) The Food Stamp Act of 1977
(7 U.S.C. 2011 et seq.).
(VI) The Head Start Act (42
U.S.C. 9801 et seq.).
(VII) The Richard B. Russell Na-
tional School Lunch Act (42 U.S.C.
1751 et seq.).
(VIII) The Child Nutrition Act of
1966 (42 U.S.C. 1771 et seq.).
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(IX) The Child Care and Develop-
ment Block Grant Act of 1990 (42
U.S.C. 9858 et seq.).
(X) The Stewart B. McKinney
Homeless Assistance Act (42 U.S.C.
11301 et seq.).
(XI) The United States Housing
Act of 1937 (42 U.S.C. 1437 et seq.).
(XII) The Native American Hous-
ing Assistance and Self-Determination
Act of 1996 (25 U.S.C. 4101 et seq.).
(ii) A State-specified governmental
agency that has fiscal liability or legal re-
sponsibility for the accuracy of the eligi-
bility determination findings relied on by
the State.
(iii) A public agency that is subject to
an interagency agreement limiting the dis-
closure and use of the information disclosed
for purposes of determining eligibility
under the State Medicaid plan or the State
CHIP plan.
(C) EXCLUSIONS.—Such term does not in-
clude an agency that determines eligibility for a
program established under the Social Services
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Block Grant established under title XX of the So-
cial Security Act (42 U.S.C. 1397 et seq.) or a
private, for-profit organization.
(D) RULES OF CONSTRUCTION.—Nothing in
this paragraph shall be construed as—
(i) affecting the authority of a State
Medicaid agency to enter into contracts
with nonprofit and for-profit agencies to
administer the Medicaid application proc-
ess;
(ii) exempting a State Medicaid agen-
cy from complying with the requirements of
section 1902(a)(4) of the Social Security
Act (relating to merit-based personnel
standards for employees of the State Med-
icaid agency and safeguards against con-
flicts of interest); or
(iii) authorizing a State Medicaid
agency that participates in the demonstra-
tion program established under this section
to use the Express Lane option to avoid
complying with such requirements for pur-
poses of making eligibility determinations
under the State Medicaid plan.
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(3) MEDICAID
APPLICABLE
INCOME
LEVEL.—
With respect to a State, the term ‘‘Medicaid applica-
ble income level’’ has the meaning given that term for
purposes of such State under section 2110(b)(4) of the
Social Security Act (42 U.S.C. 1397jj(4)).
(4) POVERTY
LINE.—The term ‘‘poverty line’’
has the meaning given that term in section 2110(c)(5)
of the Social Security Act (42 U.S.C. 1397jj(c)(5)).
(5) STATE.—The term ‘‘State’’ means 1 of the 50
States or the District of Columbia.
(6) STATE
CHIP
AGENCY.—The term ‘‘State
CHIP agency’’ means the State agency responsible for
administering the State CHIP plan.
(7) STATE CHIP PLAN.—The term ‘‘State CHIP
plan’’ means the State child health plan established
under title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.), and includes any waiver of such
plan.
(8) STATE MEDICAID AGENCY.—The term ‘‘State
Medicaid agency’’ means the State agency responsible
for administering the State Medicaid plan.
(9) STATE MEDICAID PLAN.—The term ‘‘State
Medicaid plan’’ means the State plan established
under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.), and includes any waiver of such plan.
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(f) APPROPRIATION.—
(1) OPERATIONAL FUNDS.—Out of any funds in
the Treasury not otherwise appropriated, there is ap-
propriated to the Secretary to carry out the dem-
onstration program established under this section,
$49,000,000 for the period of fiscal years 2008
through 2012.
(2) EVALUATION
FUNDS.—$5,000,000 of the
funds appropriated under paragraph (1) shall be used
to conduct the evaluation required under subsection
(d).
(3) BUDGET AUTHORITY.—Paragraph (1) con-
stitutes budget authority in advance of appropria-
tions Act and represents the obligation of the Federal
Government to provide for the payment to States se-
lected to participate in the demonstration program es-
tablished under this section of the amounts provided
under such paragraph (after the application of para-
graph (2)).
SEC. 204. AUTHORIZATION OF CERTAIN INFORMATION DIS-
CLOSURES TO SIMPLIFY HEALTH COVERAGE
DETERMINATIONS.
(a) AUTHORIZATION OF INFORMATION DISCLOSURE.—
Title XIX (42 U.S.C. 1396 et seq.) is amended—
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(1) by redesignating section 1939 as section
1940; and
(2) by inserting after section 1938 the following
new section:
‘‘AUTHORIZATION TO RECEIVE PERTINENT INFORMATION
‘‘SEC. 1939. (a) IN GENERAL.—Notwithstanding any
other provision of law, a Federal or State agency or private
entity in possession of the sources of data directly relevant
to eligibility determinations under this title (including eli-
gibility files, information described in paragraph (2) or (3)
of section 1137(a), vital records information about births
in any State, and information described in sections 453(i)
and 1902(a)(25)(I)) is authorized to convey such data or
information to the State agency administering the State
plan under this title, but only if such conveyance meets the
requirements of subsection (b).
‘‘(b) REQUIREMENTS FOR CONVEYANCE.—Data or in-
formation may be conveyed pursuant to this section only
if the following requirements are met:
‘‘(1) The child whose circumstances are described
in the data or information (or such child’s parent,
guardian, caretaker relative, or authorized representa-
tive) has either provided advance consent to disclosure
or has not objected to disclosure after receiving ad-
vance notice of disclosure and a reasonable oppor-
tunity to object.
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‘‘(2) Such data or information are used solely for
the purposes of—
‘‘(A) identifying children who are eligible or
potentially eligible for medical assistance under
this title and enrolling (or attempting to enroll)
such children in the State plan; and
‘‘(B) verifying the eligibility of children for
medical assistance under the State plan.
‘‘(3) An interagency or other agreement, con-
sistent with standards developed by the Secretary—
‘‘(A) prevents the unauthorized use, disclo-
sure, or modification of such data and otherwise
meets applicable Federal requirements for safe-
guarding privacy and data security; and
‘‘(B) requires the State agency admin-
istering the State plan to use the data and infor-
mation obtained under this section to seek to en-
roll children in the plan.
‘‘(c) CRIMINAL PENALTY.—A person described in sub-
section (a) who publishes, divulges, discloses, or makes
known in any manner, or to any extent, not authorized by
Federal law, any information obtained under this section
shall be fined not more than $1,000 or imprisoned not more
than 1 year, or both, for each such unauthorized activity.
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‘‘(d) RULE OF CONSTRUCTION.—The limitations and
requirements that apply to disclosure pursuant to this sec-
tion shall not be construed to prohibit the conveyance or
disclosure of data or information otherwise permitted under
Federal law (without regard to this section).’’.
(b) CONFORMING AMENDMENT TO TITLE XXI.—Sec-
tion 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is amended by
adding at the end the following new subparagraph:
‘‘(E) Section 1939 (relating to authoriza-
tion to receive data directly relevant to eligi-
bility determinations).’’.
(c) AUTHORIZATION FOR STATES PARTICIPATING IN
THE EXPRESS LANE DEMONSTRATION PROGRAM TO RE-
CEIVE CERTAIN DATA DIRECTLY RELEVANT TO DETER-
MINING ELIGIBILITY AND CORRECT AMOUNT OF ASSIST-
ANCE.—Only in the case of a State selected to participate
in the Express Lane demonstration program established
under section 203, the Secretary shall enter into such agree-
ments as are necessary to permit such a State to receive
data directly relevant to eligibility determinations and de-
termining the correct amount of benefits under the State
CHIP plan or the State Medicaid plan (as such terms are
defined in paragraphs (7) and (9) section 203(e)) from the
following:
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(1) The National Directory of New Hires estab-
lished under section 453(i) of the Social Security Act
(42 U.S.C. 653(i)).
(2) Data regarding enrollment in insurance that
may help to facilitate outreach and enrollment under
the State Medicaid plan, the State CHIP plan, and
such other programs as the Secretary may specify.
TITLE III—REDUCING BARRIERS
TO ENROLLMENT
SEC. 301. VERIFICATION OF DECLARATION OF CITIZENSHIP
OR NATIONALITY FOR PURPOSES OF ELIGI-
BILITY FOR MEDICAID AND CHIP.
(a) STATE OPTION TO VERIFY DECLARATION OF CITI-
ZENSHIP OR NATIONALITY FOR PURPOSES OF ELIGIBILITY
FOR MEDICAID THROUGH VERIFICATION OF NAME AND SO-
CIAL SECURITY NUMBER.—
(1) ALTERNATIVE TO DOCUMENTATION REQUIRE-
MENT.—
(A) IN GENERAL.—Section 1902 (42 U.S.C.
1396a) is amended—
(i) in subsection (a)(46)—
(I) 
by 
inserting 
‘‘(A)’’ 
after
‘‘(46)’’;
(II) by adding ‘‘and’’ after the
semicolon; and
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(III) by adding at the end the fol-
lowing new subparagraph:
‘‘(B) provide, with respect to an individual de-
claring to be a citizen or national of the United
States for purposes of establishing eligibility under
this title, that the State shall satisfy the requirements
of—
‘‘(i) section 1903(x); or
‘‘(ii) subsection (dd);’’; and
(ii) by adding at the end the following
new subsection:
‘‘(dd)(1) For purposes of subsection (a)(46)(B)(ii), the
requirements of this subsection with respect to an indi-
vidual declaring to be a citizen or national of the United
States for purposes of establishing eligibility under this
title, are, in lieu of requiring the individual to present sat-
isfactory documentary evidence of citizenship or nationality
under section 1903(x) (if the individual is not described in
paragraph (2) of that section), as follows:
‘‘(A) The State submits the name and social se-
curity number of the individual to the Commissioner
of Social Security as part of the plan established
under paragraph (2).
‘‘(B) If the State receives notice from the Com-
missioner of Social Security that the name or social
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security number of the individual is invalid, the
State—
‘‘(i) notifies the individual of such fact;
(ii) provides the individual with a period of
90 days from the date on which the notice re-
quired under clause (i) is received by the indi-
vidual to either present satisfactory documentary
evidence of citizenship or nationality (as defined
in section 1903(x)(3)) or cure the invalid deter-
mination with the Commissioner of Social Secu-
rity; and
‘‘(iii) disenrolls the individual from the
State plan under this title within 30 days after
the end of such 90-day period if no such docu-
mentary evidence is presented.
‘‘(2)(A) Each State electing to satisfy the requirements
of this subsection for purposes of section 1902(a)(46)(B)
shall establish a program under which the State submits
each month to the Commissioner of Social Security for
verification the name and social security number of each
individual enrolled in the State plan under this title that
month who has attained the age of 1 before the date of the
enrollment.
‘‘(B) In establishing the State program under this
paragraph, the State may enter into an agreement with the
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Commissioner of Social Security to provide for the elec-
tronic submission and verification of the name and social
security number of an individual before the individual is
enrolled in the State plan.
‘‘(3)(A) The State agency implementing the plan ap-
proved under this title shall, at such times and in such form
as the Secretary may specify, provide information on the
percentage each month that the invalid names and numbers
submitted bears to the total submitted for verification.
‘‘(B) If, for any fiscal year, the average monthly per-
centage determined under subparagraph (A) is greater than
7 percent—
‘‘(i) the State shall develop and adopt a correc-
tive plan to review its procedures for verifying the
identities of individuals seeking to enroll in the State
plan under this title and to identify and implement
changes in such procedures to improve their accuracy;
and
‘‘(ii) pay to the Secretary an amount equal to
the amount which bears the same ratio to the total
payments under the State plan for the fiscal year for
providing medical assistance to individuals who pro-
vided invalid information as the number of individ-
uals with invalid information in excess of 7 percent
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of such total submitted bears to the total number of
individuals with invalid information.
‘‘(C) The Secretary may waive, in certain limited
cases, all or part of the payment under subparagraph
(B)(ii) if the State is unable to reach the allowable error
rate despite a good faith effort by such State.
‘‘(D) This paragraph shall not apply to a State for
a fiscal year if there is an agreement described in para-
graph (2)(B) in effect as of the close of the fiscal year.
‘‘(4) Nothing in this subsection shall affect the rights
of any individual under this title to appeal any
disenrollment from a State plan.’’.
(B) COSTS OF IMPLEMENTING AND MAIN-
TAINING
SYSTEM.—Section 
1903(a)(3) 
(42
U.S.C. 1396b(a)(3)) is amended—
(i) by striking ‘‘plus’’ at the end of
subparagraph (E) and inserting ‘‘and’’, and
(ii) by adding at the end the following
new subparagraph:
‘‘(F)(i) 90 percent of the sums expended
during the quarter as are attributable to the de-
sign, development, or installation of such mecha-
nized verification and information retrieval sys-
tems as the Secretary determines are necessary to
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implement section 1902(dd) (including a system
described in paragraph (2)(B) thereof), and
‘‘(ii) 75 percent of the sums expended dur-
ing the quarter as are attributable to the oper-
ation of systems to which clause (i) applies,
plus’’.
(2) LIMITATION ON WAIVER AUTHORITY.—Not-
withstanding any provision of section 1115 of the So-
cial Security Act (42 U.S.C. 1315), or any other pro-
vision of law, the Secretary may not waive the re-
quirements of section 1902(a)(46)(B) of such Act (42
U.S.C. 1396a(a)(46)(B)) with respect to a State.
(3) CONFORMING
AMENDMENTS.—Section 1903
(42 U.S.C. 1396b) is amended—
(A) in subsection (i)(22), by striking ‘‘sub-
section 
(x)’’ 
and 
inserting 
‘‘section
1902(a)(46)(B)’’; and
(B) in subsection (x)(1), by striking ‘‘sub-
section 
(i)(22)’’ 
and 
inserting 
‘‘section
1902(a)(46)(B)(i)’’.
(b) CLARIFICATION OF REQUIREMENTS RELATING TO
PRESENTATION
OF SATISFACTORY DOCUMENTARY EVI-
DENCE OF CITIZENSHIP OR NATIONALITY.—
(1) ACCEPTANCE
OF
DOCUMENTARY
EVIDENCE
ISSUED
BY
A
FEDERALLY
RECOGNIZED
INDIAN
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TRIBE.—Section 
1903(x)(3)(B) 
(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 (such as a tribal enrollment
card or certificate of degree of Indian blood).
‘‘(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) REQUIREMENT TO PROVIDE REASONABLE OP-
PORTUNITY
TO
PRESENT
SATISFACTORY
DOCUMEN-
TARY
EVIDENCE.—Section 
1903(x) 
(42 
U.S.C.
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1396b(x)) is amended by adding at the end the fol-
lowing new paragraph:
‘‘(4) In the case of an individual declaring to be a
citizen or national of the United States with respect to
whom a State requires the presentation of satisfactory docu-
mentary evidence of citizenship or nationality under section
1902(a)(46)(B)(i), the individual shall be provided at least
the reasonable opportunity to present satisfactory documen-
tary evidence of citizenship or nationality under this sub-
section as is provided under clauses (i) and (ii) of section
1137(d)(4)(A) to an individual for the submittal to the
State of evidence indicating a satisfactory immigration sta-
tus.’’.
(3) CHILDREN BORN IN THE UNITED STATES TO
MOTHERS ELIGIBLE FOR MEDICAID.—
(A) CLARIFICATION
OF
RULES.—Section
1903(x) (42 U.S.C. 1396b(x)), as amended by
paragraph (2), is amended—
(i) in paragraph (2)—
(I) in subparagraph (C), by strik-
ing ‘‘or’’ at the end;
(II) by redesignating subpara-
graph (D) as subparagraph (E); and
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(III) by inserting after subpara-
graph (C) the following new subpara-
graph:
‘‘(D) pursuant to the application of section
1902(e)(4) (and, in the case of an individual who is
eligible for medical assistance on such basis, the indi-
vidual shall be deemed to have provided satisfactory
documentary evidence of citizenship or nationality
and shall not be required to provide further documen-
tary evidence on any date that occurs during or after
the period in which the individual is eligible for med-
ical assistance on such basis); or’’; and
(ii) by adding at the end the following
new paragraph:
‘‘(5) Nothing in subparagraph (A) or (B) of section
1902(a)(46), the preceding paragraphs of this subsection,
or the Deficit Reduction Act of 2005, including section 6036
of such Act, shall be construed as changing the requirement
of section 1902(e)(4) that a child born in the United States
to an alien mother for whom medical assistance for the de-
livery of such child is available as treatment of an emer-
gency medical condition pursuant to subsection (v) shall be
deemed eligible for medical assistance during the first year
of such child’s life.’’.
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(B) STATE REQUIREMENT TO ISSUE SEPA-
RATE
IDENTIFICATION
NUMBER.—Section
1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended
by adding at the end the following new sentence:
‘‘Notwithstanding the preceding sentence, in the
case of a child who is born in the United States
to an alien mother for whom medical assistance
for the delivery of the child is made available
pursuant to section 1903(v), the State imme-
diately shall issue a separate identification num-
ber for the child upon notification by the facility
at which such delivery occurred of the child’s
birth.’’.
(4) 
TECHNICAL
AMENDMENTS.—Section
1903(x)(2) (42 U.S.C. 1396b(x)) is amended—
(A) in subparagraph (B)—
(i) by realigning the left margin of the
matter preceding clause (i) 2 ems to the left;
and
(ii) by realigning the left margins of
clauses (i) and (ii), respectively, 2 ems to
the left; and
(B) in subparagraph (C)—