seq.) is amended by adding at the end the fol-
lowing: 
‘‘SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PAR-
ENTS OF TARGETED LOW-INCOME CHILDREN. 
‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any 
other provision of this title, a State may provide for cov-
erage, through an amendment to its State child health 
plan under section 2102, of parent health assistance for 
targeted low-income parents, health care assistance for 
targeted low-income pregnant women, or both, in accord-
ance with this section, but only if— 
‘‘(1) with respect to the provision of parent 
health assistance, the State meets the conditions de-
scribed in clause (iii) of section 1905(u)(4)(A); 
‘‘(2) with respect to the provision of health care 
assistance for pregnant women, the State meets the 
conditions described in clause (iv) of section 
1905(u)(4)(A); and 
‘‘(3) in the case of parent health assistance for 
targeted low-income parents, the State elects to pro-
vide 
medical 
assistance 
under 
section 
1902(a)(10)(A)(ii)(XIX), under section 1931, or 
under a waiver under section 1115 to individuals de-
scribed in section 1902(k)(1)(A)(i) and elects an ef-
fective income level that, consistent with paragraphs
(1)(B) and (2) of section 1902(k), ensures to the 
maximum extent possible, that such individuals shall 
be enrolled in the same program as their children if 
their children are eligible for coverage under title 
XIX (including under a waiver authorized by the 
Secretary or under section 1902(r)(2)). 
‘‘(b) DEFINITIONS.—For purposes of this title: 
‘‘(1) PARENT HEALTH ASSISTANCE.—The term 
‘parent health assistance’ has the meaning given the 
term child health assistance in section 2110(a) as if 
any reference to targeted low-income children were 
a reference to targeted low-income parents. 
‘‘(2) PARENT.—The term ‘parent’ has the 
meaning given the term ‘caretaker relative’ for pur-
poses of carrying out section 1931. 
‘‘(3) HEALTH
CARE
ASSISTANCE
FOR
PREG-
NANT WOMEN.—The term ‘health care assistance for 
pregnant women’ has the meaning given the term 
child health assistance in section 2110(a) as if any 
reference to targeted low-income children were a ref-
erence to targeted low-income pregnant women. 
‘‘(4) TARGETED
LOW-INCOME
PARENT.—The 
term ‘targeted low-income parent’ has the meaning 
given the term targeted low-income child in section 
2110(b) as if the reference to a child were deemed
a reference to a parent (as defined in paragraph (3)) 
of the child; except that in applying such section— 
‘‘(A) there shall be substituted for the in-
come level described in paragraph (1)(B)(ii)(I) 
the applicable income level in effect for a tar-
geted low-income child; 
‘‘(B) in paragraph (3), January 1, 2006, 
shall be substituted for July 1, 1997; and 
‘‘(C) in paragraph (4), January 1, 2006, 
shall be substituted for March 31, 1997. 
‘‘(5) 
TARGETED
LOW-INCOME
PREGNANT 
WOMAN.—The term ‘targeted low-income pregnant 
woman’ has the meaning given the term targeted 
low-income child in section 2110(b) as if any ref-
erence to a child were a reference to a woman dur-
ing pregnancy and through the end of the month in 
which the 60-day period beginning on the last day 
of her pregnancy ends; except that in applying such 
section— 
‘‘(A) there shall be substituted for the in-
come level described in paragraph (1)(B)(ii)(I) 
the applicable income level in effect for a tar-
geted low-income child; 
‘‘(B) in paragraph (3), January 1, 2006, 
shall be substituted for July 1, 1997; and
‘‘(C) in paragraph (4), January 1, 2006, 
shall be substituted for March 31, 1997. 
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL 
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of parent health assistance to targeted 
low-income parents or health care assistance to targeted 
low-income pregnant women under subsection (a), the fol-
lowing special rules apply: 
‘‘(1) Any reference in this title (other than in 
subsection (b)) to a targeted low-income child is 
deemed to include a reference to a targeted low-in-
come parent or a targeted low-income pregnant 
woman (as applicable). 
‘‘(2) Any such reference to child health assist-
ance— 
‘‘(A) with respect to such parents is 
deemed a reference to parent health assistance; 
and 
‘‘(B) with respect to such pregnant women, 
is deemed a reference to health care assistance 
for pregnant women. 
‘‘(3) In applying section 2103(e)(3)(B) in the 
case of a family (consisting of a parent and one or 
more children) provided coverage under this section 
or a pregnant woman provided coverage under this
section without covering other family members, the 
limitation on total annual aggregate cost-sharing 
shall be applied to such entire family or such preg-
nant woman, respectively. 
‘‘(4) In applying section 2110(b)(4), any ref-
erence to ‘section 1902(l)(2) or 1905(n)(2) (as se-
lected by a State)’ is deemed a reference to the ef-
fective income level applicable to parents under sec-
tion 1931 or under a waiver approved under section 
1115, or, in the case of a pregnant woman, the in-
come level established under section 1902(l)(2)(A). 
‘‘(5) In applying section 2102(b)(3)(B), any 
reference to children found through screening to be 
eligible for medical assistance under the State med-
icaid plan under title XIX is deemed a reference to 
parents and pregnant women.’’. 
(B) ADDITIONAL ALLOTMENT FOR STATES 
PROVIDING FAMILYCARE.— 
(i) IN GENERAL.—Section 2104 of the 
Social Security Act (42 U.S.C. 1397dd) is 
amended by inserting after subsection (c) 
the following: 
‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE PRO-
VIDING FAMILYCARE.—
‘‘(1) APPROPRIATION; TOTAL
ALLOTMENT.— 
For the purpose of providing additional allotments 
to States to provide FamilyCare coverage under sec-
tion 2111, there is appropriated, out of any money 
in the Treasury not otherwise appropriated— 
‘‘(A) for fiscal year 2006, $2,000,000,000; 
‘‘(B) for fiscal year 2007, $2,000,000,000; 
‘‘(C) for fiscal year 2008, $3,000,000,000; 
and 
‘‘(D) for fiscal year 2009, $3,000,000,000. 
‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.— 
‘‘(A) IN GENERAL.—In addition to the al-
lotments provided under subsections (b) and 
(c), subject to paragraphs (3) and (4), of the 
amount available for the additional allotments 
under paragraph (1) for a fiscal year, the Sec-
retary shall allot to each State with a State 
child health plan approved under this title— 
‘‘(i) in the case of such a State other 
than a commonwealth or territory de-
scribed in clause (ii), the same proportion 
as the proportion of the State’s allotment 
under subsection (b) (determined without 
regard to subsection (f)) to 98.95 percent 
of the total amount of the allotments
under such section for such States eligible 
for an allotment under this subparagraph 
for such fiscal year; and 
‘‘(ii) in the case of a commonwealth or 
territory described in subsection (c)(3), the 
same proportion as the proportion of the 
commonwealth’s or territory’s allotment 
under subsection (c) (determined without 
regard to subsection (f)) to 1.05 percent of 
the total amount of the allotments under 
such section for commonwealths and terri-
tories eligible for an allotment under this 
subparagraph for such fiscal year. 
‘‘(B) AVAILABILITY AND REDISTRIBUTION 
OF
UNUSED
ALLOTMENTS.—In applying sub-
sections (e) and (f) with respect to additional 
allotments made available under this subsection, 
the procedures established under such sub-
sections shall ensure such additional allotments 
are only made available to States which have 
elected to provide coverage under section 2111. 
‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi-
tional allotments provided under this subsection are 
not available for amounts expended before October 
1, 2007. Such amounts are available for amounts ex-
pended on or after such date for child health assist-
ance for targeted low-income children, as well as for 
parent health assistance for targeted low-income 
parents, and health care assistance for targeted low- 
income pregnant women. 
‘‘(4) REQUIRING ELECTION TO PROVIDE COV-
ERAGE.—No payments may be made to a State 
under this title from an allotment provided under 
this subsection unless the State has made an elec-
tion to provide parent health assistance for targeted 
low-income parents, or health care assistance for 
targeted low-income pregnant women.’’. 
(ii) 
CONFORMING
AMENDMENTS.— 
Section 2104 of the Social Security Act 
(42 U.S.C. 1397dd) is amended— 
(I) in subsection (a), by inserting 
‘‘subject to subsection (d),’’ after 
‘‘under this section,’’; 
(II) in subsection (b)(1), by in-
serting ‘‘and subsection (d)’’ after 
‘‘Subject to paragraph (4)’’; and 
(III) in subsection (c)(1), by in-
serting ‘‘subject to subsection (d),’’ 
after ‘‘for a fiscal year,’’.
(C) NO COST-SHARING FOR PREGNANCY- 
RELATED
BENEFITS.—Section 2103(e)(2) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397cc(e)(2)) is amended— 
(i) in the heading, by inserting ‘‘AND 
PREGNANCY-RELATED SERVICES’’ after 
‘‘PREVENTIVE SERVICES’’; and 
(ii) by inserting before the period at 
the end the following: ‘‘and for pregnancy- 
related services’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection apply to items and services fur-
nished on or after October 1, 2007, whether or not 
regulations implementing such amendments have 
been issued. 
(b) RULES FOR IMPLEMENTATION BEGINNING WITH 
FISCAL YEAR 2007.— 
(1) EXPANSION
OF
AVAILABILITY
OF
EN-
HANCED
MATCH
UNDER
MEDICAID
FOR
PRE-CHIP 
EXPANSIONS.—Paragraph (4) of section 1905(u) of 
the Social Security Act (42 U.S.C. 1396d(u)), as in-
serted by subsection (a)(1)(C), is amended— 
(A) by amending clause (ii) of subpara-
graph (A) to read as follows:
‘‘(ii) CERTAIN
PREGNANT
WOMEN.—Ex-
penditures for medical assistance for pregnant 
women under section 1902(l)(1)(A) in a family 
the income of which exceeds the 133 percent of 
the income official poverty line, but only if the 
income 
level 
established 
under 
section 
1902(l)(2) (or under a Statewide waiver under 
section 1115) for pregnant women is 185 per-
cent of the income official poverty line.’’; and 
(B) by adding at the end the following: 
‘‘(B) CHILDREN
IN
FAMILIES
WITH
INCOME 
ABOVE
MEDICAID
MANDATORY
LEVEL
NOT
PRE-
VIOUSLY
DESCRIBED.—The expenditures described 
in this subparagraph are expenditures (other than 
expenditures described in paragraph (2) or (3)) for 
medical assistance made available to any child who 
is 
eligible 
for 
assistance 
under 
section 
1902(a)(10)(A) (other than under clause (i)) and 
the income of whose family exceeds the minimum in-
come level required under subsection 1902(l)(2) (or, 
if higher, the minimum level required under section 
1931 for that State) for a child of the age involved 
(treating any child who is 19 or 20 years of age as 
being 18 years of age).’’.
(2) OFFSET
OF
ADDITIONAL
EXPENDITURES 
FOR
ENHANCED
MATCH
FOR
PRE-CHIP
EXPAN-
SION.—Section 1905 of the Social Security Act (42 
U.S.C. 1396d) is amended— 
(A) in the fourth sentence of subsection 
(b), by inserting ‘‘(except in the case of expend-
itures described in subsection (u)(5))’’ after ‘‘do 
not exceed’’; 
(B) in subsection (u), by inserting after 
paragraph (4) (as inserted by subparagraph 
(C)), the following: 
‘‘(5) For purposes of the fourth sentence of sub-
section (b) and section 2105(a), the following payments 
under this title do not count against a State’s allotment 
under section 2104: 
‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR 
PREGNANT WOMEN WITH INCOME ABOVE 133 PER-
CENT OF POVERTY.—The portion of the payments 
made for expenditures described in paragraph 
(4)(A)(ii) that represents the amount that would 
have been paid if the enhanced FMAP had not been 
substituted for the Federal medical assistance per-
centage. 
‘‘(B) FAMILYCARE
PARENTS.—Payments for 
expenditures described in paragraph (4)(A)(i).
‘‘(C) REGULAR FMAP FOR EXPENDITURES FOR 
CERTAIN
CHILDREN
IN
FAMILIES
WITH
INCOME 
ABOVE MEDICAID MANDATORY LEVEL.—The portion 
of the payments made for expenditures described in 
paragraph (4)(B) that represents the amount that 
would have been paid if the enhanced FMAP had 
not been substituted for the Federal medical assist-
ance percentage.’’. 
(3) 
CONFORMING
AMENDMENTS.—Subpara-
graph (B) of section 2105(a)(1) of the Social Secu-
rity Act, as amended by subsection (a)(1)(D), is 
amended to read as follows: 
‘‘(B) CERTAIN FAMILYCARE PARENTS AND 
OTHERS.—Expenditures for medical assistance 
that is attributable to expenditures described in 
section 1905(u)(4), except as provided in sec-
tion 1905(u)(5).’’. 
(4) EFFECTIVE DATE.—The amendments made 
by this subsection apply as of October 1, 2006, to 
fiscal years beginning on or after such date and to 
expenditures under the State plan on and after such 
date, whether or not regulations implementing such 
amendments have been issued. 
(c) GAO STUDY.—
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study regarding fund-
ing under title XXI of the Social Security Act that 
examines— 
(A) the adequacy of overall funding under 
such title; 
(B) the formula for determining allotments 
and for redistribution of unspent funds under 
such title; and 
(C) the effect of waiting lists and caps on 
enrollment under such title. 
(2) REPORT.—Not later than July 1, 2007, the 
Comptroller General shall submit a report on the 
study conducted under paragraph (1). Such report 
shall include recommendations regarding a better 
mechanism for determining State allotments and re-
distribution of unspent funds under such title in 
order to ensure all eligible families in need can ac-
cess coverage through such title. 
(d) CONFORMING AMENDMENTS.— 
(1) 
ELIGIBILITY
CATEGORIES.—Section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended, in the matter before para-
graph (1)—
(A) by striking ‘‘or’’ at the end of clause 
(xii); 
(B) by inserting ‘‘or’’ at the end of clause 
(xiii); and 
(C) by inserting after clause (xiii) the fol-
lowing: 
‘‘(xiv) who are parents described (or treated as 
if described) in section 1902(k)(1),’’. 
(2) INCOME LIMITATIONS.—Section 1903(f)(4) 
of the Social Security Act (42 U.S.C. 1396b(f)(4)) 
is amended by inserting ‘‘1902(a)(10)(A)(ii)(XIX),’’ 
after ‘‘1902(a)(10)(A)(ii)(XVIII),’’. 
(3) CONFORMING
AMENDMENT
RELATING
TO 
NO WAITING PERIOD FOR PREGNANT WOMEN.—Sec-
tion 2102(b)(1)(B) of the Social Security Act (42 
U.S.C. 1397bb(b)(1)(B)) is amended— 
(A) by striking ‘‘, and’’ at the end of 
clause (i) and inserting a semicolon; 
(B) by striking the period at the end of 
clause (ii) and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(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 parent who is pregnant.’’.
SEC. 104. AUTOMATIC ENROLLMENT OF CHILDREN BORN 
TO TITLE XXI PARENTS. 
Section 2102(b)(1) of the Social Security Act (42 
U.S.C. 1397bb(b)(1)) is amended by adding at the end 
the following: 
‘‘(C) AUTOMATIC
ELIGIBILITY
OF
CHIL-
DREN
BORN
TO
A
PARENT
BEING
PROVIDED 
FAMILYCARE.—Such eligibility standards shall 
provide for automatic coverage of a child born 
to an individual who is provided assistance 
under this title in the same manner as medical 
assistance would be provided under section 
1902(e)(4) to a child described in such sec-
tion.’’. 
SEC. 105. OPTIONAL COVERAGE OF CHILDREN THROUGH 
AGE 20 UNDER THE MEDICAID PROGRAM AND 
TITLE XXI. 
(a) MEDICAID.— 
(1) IN GENERAL.—Section 1902(l)(1)(D) of the 
Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is 
amended by inserting ‘‘(or, at the election of a 
State, 20 or 21 years of age)’’ after ‘‘19 years of 
age’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1902(e)(3)(A) of the Social Se-
curity Act (42 U.S.C. 1396a(e)(3)(A)) is
amended by inserting ‘‘(or 1 year less than the 
age the State has elected under subsection 
(l)(1)(D))’’ after ‘‘18 years of age’’. 
(B) Section 1902(e)(12) of the Social Se-
curity Act (42 U.S.C. 1396a(e)(12)) is amend-
ed by inserting ‘‘or such higher age as the State 
has elected under subsection (l)(1)(D)’’ after 
‘‘19 years of age’’. 
(C) Section 1920A(b)(1) of the Social Se-
curity Act (42 U.S.C. 1396r–1a(b)(1)) is 
amended by inserting ‘‘or such higher age as 
the 
State 
has 
elected 
under 
section 
1902(l)(1)(D)’’ after ‘‘19 years of age’’. 
(D) Section 1928(h)(1) of the Social Secu-
rity Act (42 U.S.C. 1396s(h)(1)) is amended by 
inserting ‘‘or 1 year less than the age the State 
has elected under section 1902(l)(1)(D)’’ before 
the period at the end. 
(E) Section 1932(a)(2)(A) of the Social 
Security Act (42 U.S.C. 1396u–2(a)(2)(A)) is 
amended by inserting ‘‘(or such higher age as 
the 
State 
has 
elected 
under 
section 
1902(l)(1)(D))’’ after ‘‘19 years of age’’. 
(b) TITLE XXI.—Section 2110(c)(1) of the Social 
Security Act (42 U.S.C. 1397jj(c)(1)) is amended by in-