I 
108TH CONGRESS 
1ST SESSION H. R. 3192
To amend titles XIX and XXI of the Social Security Act to permit States 
to cover low-income youth up to age 23 with an enhanced matching rate. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 25, 2003
Mr. SNYDER (for himself, Mr. ALLEN, Mr. HINCHEY, Mr. SERRANO, Mr. 
ROSS, Mr. MCDERMOTT, and Mr. EMANUEL) introduced the following 
bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend titles XIX and XXI of the Social Security Act 
to permit States to cover low-income youth up to age 
23 with an enhanced matching rate.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as ‘‘Medicaid/SCHIP Optional 
Coverage for Young Adults Act of 2003’’. 
SEC. 2. PROVIDING STATE OPTION FOR SCHIP AND MED-
ICAID COVERAGE OF YOUNG ADULTS UP TO 
AGE 23. 
(a) IN GENERAL.—
(1) MEDICAID.—(A) 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 option of the 
State, who have not attained 20, 21, or 22 years of 
age, as the State may elect)’’ after ‘‘have not at-
tained 19 years of age’’. 
(B) Clause (i) of section 1905(a) of the Social 
Security Act (42 U.S.C. 1396d(a)) is amended by 
striking ‘‘under the age of 21, or, at the option of 
the State, under the age of 20, 19, or 18 as the 
State may choose’’ and inserting ‘‘under the age of 
23, or, at the option of the State, under the age of 
22, 21, 20, 19, or 18 as the State may elect’’. 
(2) SCHIP.—Section 2110(c)(1) of such Act 
(42 U.S.C. 1397jj(c)(1)) is amended by inserting 
after ‘‘19 years of age’’ the following: ‘‘(or, at the 
option of the State and subject to the availability of 
additional allotments under section 2104(d), 20, 21, 
22, or 23 years of age)’’. 
(b) 
AVAILABILITY
OF
ENHANCED
MATCHING 
FUNDS.—
(1) UNDER
MEDICAID.—Section 1905 of the 
Social Security Act (42 U.S.C. 1396d) is amended—
(A) in the fourth sentence of subsection 
(b), by striking ‘‘or subsection (u)(3)’’ and in-
serting ‘‘, (u)(3), or (u)(4)(A)’’; and 
(B) in subsection (u)—
(i) by adding at the end of paragraph 
(1) the following new subparagraph: 
‘‘(C) Only with respect to expenditures de-
scribed in paragraph (4)(A), if the State is providing 
for benefits under its State child health plan under 
title XXI for children under 19 years of age exclu-
sively through benefits under its State plan under 
this title, the State is also providing under such plan 
the benefits for individuals over 18 years of age who 
are eligible for such benefits only because of an elec-
tion referred to in such paragraph.’’; 
(ii) by redesignating paragraph (4) as 
paragraph (5); and 
(iii) by inserting after paragraph (3) 
the following new paragraph: 
‘‘(4) For purposes of the fourth sentence of sub-
section (b) and section 2105(a), the expenditures de-
scribed in this paragraph are expenditures for medical as-
sistance for individuals who are over 18 (and less than 
23) years of age and who are eligible for such medical
assistance because of an election by the State under sec-
tion 1902(l)(1)(D) or clause (i) of section 1905(a).’’. 
(2) ADDITIONAL ALLOTMENTS FOR PROVIDING 
COVERAGE OF OPTIONAL YOUNG ADULTS.—
(A) IN GENERAL.—Section 2104 of such 
Act (42 U.S.C. 1397dd) is amended by insert-
ing after subsection (c) the following: 
‘‘(d) ADDITIONAL ALLOTMENTS FOR THE PROVISION 
OF COVERAGE TO OPTIONAL YOUNG ADULTS.—
‘‘(1) APPROPRIATION; TOTAL
ALLOTMENT.—
For the purpose of providing additional allotments 
to States under this title, there is appropriated, out 
of any money in the Treasury not otherwise appro-
priated, for each of fiscal years 2004 through 2007, 
$200,000,000. 
‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.—
In addition to the allotments provided under sub-
sections (b) and (c), subject to paragraph (3), of the 
amount available for the additional allotments under 
paragraph (1) for a fiscal year, the Secretary shall 
allot to each State with a State child health plan ap-
proved under this title—
‘‘(A) in the case of such a State other than 
a commonwealth or territory described in sub-
paragraph (B), the same proportion as the pro-
portion of the State’s allotment under sub-
section (b) (determined without regard to sub-
section (f)) to the total amount of the allot-
ments under subsection (b) for such States eli-
gible for an allotment under this paragraph for 
such fiscal year; and 
‘‘(B) in the case of a commonwealth or ter-
ritory described in subsection (c)(3), the same 
proportion as the proportion of the common-
wealth’s or territory’s allotment under sub-
section (c) (determined without regard to sub-
section (f)) to the total amount of the allot-
ments under subsection (c) for commonwealths 
and territories eligible for an allotment under 
this paragraph for such fiscal year. 
‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi-
tional allotments provided under this subsection are 
not available for amounts expended before October 
1, 2003. Such amounts are available for amounts ex-
pended on or after such date only for—
‘‘(A) expenditures described in section 
1905(u)(4)(A); and 
‘‘(B) child health assistance for individuals 
who are targeted low-income children and over 
18 years of age and who are low-income chil-
dren only because of an election by the State 
under section 2110(c)(1).’’. 
(B) CONFORMING AMENDMENTS.—Section 
2104 of the Social Security Act (42 U.S.C. 
1397dd) is amended—
(i) in subsection (a), in the matter 
preceding paragraph (1), by inserting 
‘‘subject to subsection (d),’’ after ‘‘under 
this section,’’; 
(ii) in subsection (b)(1), by inserting 
‘‘and subsection (d)’’ after ‘‘Subject to 
paragraph (4)’’; and 
(iii) in subsection (c)(1), by inserting 
‘‘subject to subsection (d),’’ after ‘‘for a 
fiscal year,’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section apply to items and services furnished on or 
after October 1, 2003, without regard to whether regula-
tions implementing such amendments have been promul-
gated. 
SEC. 3. GRANTS TO IMPLEMENT MEDICAID AND SCHIP EX-
PANSIONS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall provide for grants to small and 
rural States (as defined by the Secretary) in order to en-
able such States to implement expansions of eligibility for 
children and young adults their State medicaid plans 
under title XIX of the Social Security Act and State child 
health plans under title XXI of such Act. Such grants 
shall be available for planning, implementation, and out-
reach with respect to such expanded eligibility populations. 
(b) TERMS AND CONDITIONS.—Grants under this 
section shall be made available under such terms and con-
ditions, including the approval of a grant application, as 
the Secretary shall specify. 
(c) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to provide for grants under this section.
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