H. R. 2—25 
the outreach or coverage benchmarks described 
in any of subparagraph (A), (B), or (C) of paragraph 
(3) for fiscal year 2011; or 
‘‘(II) the Federal medical assistance percentage 
(as determined under section 1905(b) without 
regard to clause (4) of such section) in the case 
of any other State. 
‘‘(iv) AMOUNT OF FEDERAL MATCHING PAYMENT IN 
2013.—For purposes of clause (ii), the applicable 
percentage for any quarter of fiscal year 2013 is equal 
to— 
‘‘(I) the REMAP percentage if— 
‘‘(aa) the applicable percentage for the 
State under clause (iii) was the enhanced 
FMAP for fiscal year 2012; and 
‘‘(bb) the State met either of the coverage 
benchmarks described in subparagraph (B) or 
(C) of paragraph (3) for fiscal year 2012; or 
‘‘(II) the Federal medical assistance percentage 
(as so determined) in the case of any State to 
which subclause (I) does not apply. 
For purposes of subclause (I), the REMAP percentage 
is the percentage which is the sum of such Federal 
medical assistance percentage and a number of 
percentage points equal to one-half of the difference 
between 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 expenditures 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 ELIGIBILITY 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 assist-
ance or health benefits coverage to a parent of a tar-
geted low-income child whose family income exceeds 
the income eligibility level applied under the applicable 
existing waiver to parents of targeted low-income chil-
dren on the date of enactment of the Children’s Health 
Insurance Program Reauthorization Act of 2009. 
‘‘(3) OUTREACH OR COVERAGE BENCHMARKS.—For purposes 
of paragraph (2), the outreach or coverage benchmarks 
described in this paragraph are as follows: 
‘‘(A) SIGNIFICANT
CHILD
OUTREACH
CAMPAIGN.—The 
State— 
‘‘(i) was awarded a grant under section 2113 for 
fiscal year 2011; 
‘‘(ii) implemented 1 or more of the enrollment and 
retention provisions described in section 2105(a)(4) 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 accurate published estimates of 
the Bureau of the Census, ranks in the lowest 1⁄3 of States
H. R. 2—26 
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 performance bonus 
payment under section 2105(a)(3)(B) for the most recent 
fiscal year applicable 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 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 sec-
tion— 
‘‘(1) IN
GENERAL.—The term ‘applicable existing waiver’ 
means a waiver, experimental, pilot, or demonstration 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 2009. 
‘‘(2) DEFINITIONS.— 
‘‘(A) PARENT.—The term ‘parent’ includes a caretaker 
relative (as such term is used in carrying out section 1931) 
and a legal guardian. 
‘‘(B) NONPREGNANT CHILDLESS ADULT.—The term ‘non-
pregnant 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 preg-
nant, 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 para-
graph: 
‘‘(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 
2009 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. 131) is amended 
by striking ‘‘Nothing’’ and inserting ‘‘Subject to section 
2111 of the Social Security Act, as added by section 112 
of the Children’s Health Insurance Program Reauthoriza-
tion Act of 2009, nothing’’.
H. R. 2—27 
(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 
increases the enrollment of, or the quality of care for, 
children, and 
(B) such parents, relatives, and legal guardians 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 Committee on Finance of the 
Senate and the Committee on Energy and Commerce of the 
House of Representatives, including recommendations (if any) 
for changes in legislation. 
SEC. 113. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE 
ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT. 
(a) IN GENERAL.—Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)) 
is amended— 
(1) in the matter preceding subparagraph (A), by striking 
‘‘(or, in the case of expenditures described in subparagraph 
(B), the Federal medical assistance percentage (as defined in 
the first sentence of section 1905(b)))’’; and 
(2) by striking subparagraph (B) and inserting the following 
new subparagraph: 
‘‘(B) [reserved]’’. 
(b) AMENDMENTS TO MEDICAID.— 
(1) ELIGIBILITY
OF
A
NEWBORN.—Section 1902(e)(4) (42 
U.S.C. 1396a(e)(4)) is amended in the first sentence by striking 
‘‘so long as the child is a member of the woman’s household 
and the woman remains (or would remain if pregnant) eligible 
for such assistance’’. 
(2) APPLICATION OF QUALIFIED ENTITIES TO PRESUMPTIVE 
ELIGIBILITY FOR PREGNANT WOMEN UNDER MEDICAID.—Section 
1920(b) (42 U.S.C. 1396r–1(b)) is amended by adding after 
paragraph (2) the following flush sentence: 
‘‘The term ‘qualified provider’ also includes a qualified entity, as 
defined in section 1920A(b)(3).’’. 
SEC. 114. LIMITATION ON MATCHING RATE FOR STATES THAT PRO-
POSE 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 EXPENDITURES FOR 
CHILD
HEALTH
ASSISTANCE
PROVIDED
TO
CHILDREN
WHOSE 
EFFECTIVE FAMILY INCOME EXCEEDS 300 PERCENT OF THE POV-
ERTY LINE.— 
‘‘(A) FMAP APPLIED TO EXPENDITURES.—Except as pro-
vided in subparagraph (B), for fiscal years beginning with 
fiscal year 2009, the Federal medical assistance percentage
H. R. 2—28 
(as determined 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 
exclusion 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 enactment of the Children’s 
Health Insurance Program Reauthorization Act of 2009, 
has an approved 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) RULE OF CONSTRUCTION.—Nothing in the amendments made 
by this section shall be construed as— 
(1) changing any income eligibility level for children under 
title XXI of the Social Security Act; or 
(2) changing the flexibility provided States under such 
title to establish the income eligibility level for targeted low- 
income children under a State child health plan and the meth-
odologies used by the State to determine income or assets 
under such plan. 
SEC. 115. STATE AUTHORITY UNDER MEDICAID. 
Notwithstanding any other provision of law, including the 
fourth sentence of subsection (b) of section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) or subsection (u) of such section, at 
State option, the Secretary shall provide the State with the Federal 
medical assistance percentage determined for the State for Medicaid 
with respect to expenditures described in section 1905(u)(2)(A) of 
such Act or otherwise made to provide medical assistance under 
Medicaid to a child who could be covered by the State under 
CHIP. 
TITLE II—OUTREACH AND 
ENROLLMENT 
Subtitle A—Outreach and Enrollment 
Activities 
SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUNDING FOR 
OUTREACH AND ENROLLMENT. 
(a) GRANTS.—Title XXI (42 U.S.C. 1397aa et seq.), as amended 
by section 111, is amended by adding at the end the following: 
‘‘SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT. 
‘‘(a) OUTREACH
AND ENROLLMENT GRANTS; NATIONAL CAM-
PAIGN.— 
‘‘(1) IN GENERAL.—From the amounts appropriated under 
subsection (g), subject to paragraph (2), the Secretary shall 
award grants to eligible entities during the period of fiscal 
years 2009 through 2013 to conduct outreach and enrollment