I 
110TH CONGRESS 
1ST SESSION H. R. 2746 
To amend titles XIX and XXI of the Social Security Act to provide States 
with the option to expand or add coverage of pregnant women under 
the Medicaid and State children’s health insurance programs, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 15, 2007 
Ms. DEGETTE 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 provide States with the option to expand or add cov-
erage of pregnant women under the Medicaid and State 
children’s health insurance programs, and for other pur-
poses. 
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 the ‘‘Prevent Prematurity 
and Improve Child Health Act of 2007’’. 
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS
SEC. 2. STATE OPTION TO EXPAND OR ADD COVERAGE OF 
CERTAIN PREGNANT WOMEN UNDER MED-
ICAID AND SCHIP. 
(a) MEDICAID.— 
(1) AUTHORITY TO EXPAND COVERAGE.—Sec-
tion 1902(l)(2)(A)(i) of the Social Security Act (42 
U.S.C. 1396a(l)(2)(A)(i)) is amended by inserting 
‘‘(or such higher percentage as the State may elect 
for purposes of expenditures for medical assistance 
for 
pregnant 
women 
described 
in 
section 
1905(u)(4)(A))’’ after ‘‘185 percent’’. 
(2) ENHANCED MATCHING FUNDS AVAILABLE 
IF CERTAIN CONDITIONS MET.—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)’’; and 
(B) in subsection (u)— 
(i) by redesignating paragraph (4) as 
paragraph (5); and 
(ii) 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 the following: 
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS
‘‘(A) CERTAIN PREGNANT WOMEN.—If the con-
ditions described in subparagraph (B) are met, ex-
penditures for medical assistance for pregnant 
women described in subsection (n) or in section 
1902(l)(1)(A) in a family the income of which ex-
ceeds 185 percent of the poverty line, but does not 
exceed the income eligibility level established under 
title XXI for a targeted low-income child. 
‘‘(B) CONDITIONS.—The conditions described 
in this subparagraph are the following: 
‘‘(i) The State plans under this title and 
title XXI do not provide coverage for pregnant 
women described in subparagraph (A) with 
higher family income without covering such 
pregnant women with a lower family income. 
‘‘(ii) The State does not apply an effective 
income level for pregnant women that is lower 
than the effective income level (expressed as a 
percent of the poverty line and considering ap-
plicable income disregards) specified under the 
State plan under subsection (a)(10)(A)(i)(III) 
or (l)(2)(A) of section 1902, on January 1, 
2008, to be eligible for medical assistance as a 
pregnant woman. 
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS
‘‘(C) DEFINITION OF POVERTY LINE.—In this 
subsection, the term ‘poverty line’ has the meaning 
given such term in section 2110(c)(5).’’. 
(3) PAYMENT
FROM
TITLE
XXI
ALLOTMENT 
FOR MEDICAID EXPANSION COSTS; ELIMINATION OF 
COUNTING
MEDICAID
CHILD
PRESUMPTIVE
ELIGI-
BILITY COSTS AGAINST TITLE XXI ALLOTMENT.— 
Section 2105(a)(1) of the Social Security Act (42 
U.S.C. 1397ee(a)(1)) is amended— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘(or, in the case of expendi-
tures described in subparagraph (B), the Fed-
eral medical assistance percentage (as defined 
in the first sentence of section 1905(b)))’’; and 
(B) by striking subparagraph (B) and in-
serting the following new subparagraph: 
‘‘(B) for the provision of medical assist-
ance that is attributable to expenditures de-
scribed in section 1905(u)(4)(A);’’. 
(b) SCHIP.— 
(1) COVERAGE.—Title XXI of the Social Secu-
rity Act (42 U.S.C. 1397aa et seq.) is amended by 
adding at the end the following new section: 
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS
‘‘SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-IN-
COME PREGNANT WOMEN. 
‘‘(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 pregnancy-related assistance 
for targeted low-income pregnant women in accordance 
with this section, but only if— 
‘‘(1) the State has established an income eligi-
bility level for pregnant women under subsection 
(a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 that is 
at least 185 percent of the income official poverty 
line; and 
‘‘(2) the State meets the conditions described in 
section 1905(u)(4)(B). 
‘‘(b) DEFINITIONS.—For purposes of this title: 
‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The 
term ‘pregnancy-related 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 
pregnant women. 
‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT 
WOMAN.—The term ‘targeted low-income pregnant 
woman’ means a woman— 
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS
‘‘(A) during pregnancy and through the 
end of the month in which the 60-day period 
(beginning on the last day of her pregnancy) 
ends; 
‘‘(B) whose family income exceeds the ef-
fective income level (expressed as a percent of 
the poverty line and considering applicable in-
come disregards) specified under subsection 
(a)(10)(A)(i)(III) or (l)(2)(A) of section 1902, 
on January 1, 2008, to be eligible for medical 
assistance as a pregnant woman under title 
XIX but does not exceed the income eligibility 
level established under the State child health 
plan under this title for a targeted low-income 
child; and 
‘‘(C) who satisfies the requirements of 
paragraphs (1)(A), (1)(C), (2), and (3) of sec-
tion 2110(b) in the same manner as a child ap-
plying for child health assistance would have to 
satisfy such requirements. 
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL 
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of pregnancy-related assistance to tar-
geted low-income pregnant women under subsection (a), 
the following special rules apply: 
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS
‘‘(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 pregnant woman. 
‘‘(2) Any such reference to child health assist-
ance with respect to such women is deemed a ref-
erence to pregnancy-related assistance. 
‘‘(3) Any such reference to a child is deemed a 
reference to a woman during pregnancy and the pe-
riod described in subsection (b)(2)(A). 
‘‘(4) 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 
pregnant women. 
‘‘(5) There shall be no exclusion of benefits for 
services described in subsection (b)(1) based on any 
preexisting condition and no waiting period (includ-
ing any waiting period imposed to carry out section 
2102(b)(3)(C)) shall apply. 
‘‘(6) In applying section 2103(e)(3)(B) in the 
case of a pregnant woman provided coverage under 
this section, the limitation on total annual aggregate 
cost sharing shall be applied to such pregnant 
woman. 
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS
‘‘(7) The reference in section 2107(e)(1)(D) to 
section 1920A (relating to presumptive eligibility for 
children) is deemed a reference to section 1920 (re-
lating to presumptive eligibility for pregnant 
women). 
‘‘(d) AUTOMATIC
ENROLLMENT
FOR
CHILDREN 
BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS-
SISTANCE.—If a child is born to a targeted low-income 
pregnant woman who was receiving pregnancy-related as-
sistance under this section on the date of the child’s birth, 
the child shall be deemed to have applied for child health 
assistance under the State child health plan and to have 
been found eligible for such assistance under such plan 
or to have applied 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 at-
tains 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 med-
ical 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 identifica-
tion number for the child before such period expires).’’. 
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS
(2) ADDITIONAL ALLOTMENTS FOR PROVIDING 
COVERAGE OF PREGNANT WOMEN.— 
(A) IN GENERAL.—Section 2104 of the So-
cial Security Act (42 U.S.C. 1397dd) is amend-
ed by adding at the end the following new sub-
section: 
‘‘(i) ADDITIONAL ALLOTMENTS FOR PROVIDING COV-
ERAGE OF PREGNANT WOMEN.— 
‘‘(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 2008 through 2012, 
$200,000,000. 
‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.— 
In addition to the allotments provided under sub-
sections (b) and (c), subject to paragraphs (3) and 
(4), of the amount available for the additional allot-
ments under paragraph (1) for a fiscal year, the 
Secretary shall allot to each State with a State child 
health plan approved 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-
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS
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, 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 
pregnancy-related assistance for targeted low-income 
pregnant women. 
‘‘(4) NO PAYMENTS UNLESS ELECTION TO EX-
PAND COVERAGE OF PREGNANT WOMEN.—No pay-
ments may be made to a State under this title from 
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS
an allotment provided under this subsection unless 
the State provides pregnancy-related assistance for 
targeted low-income pregnant women under this 
title, or provides medical assistance for pregnant 
women under title XIX, whose family income ex-
ceeds the effective income level applicable under sub-
section (a)(10)(A)(i)(III) or (l)(2)(A) of section 
1902 to a family of the size involved on January 1, 
2008.’’. 
(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 striking ‘‘sub-
section (d)’’ and inserting ‘‘subsections (d) 
and (i)’’; 
(ii) in subsection (b)(1), by striking 
‘‘subsection (d)’’ and inserting ‘‘sub-
sections (d) and (i)’’; and 
(iii) in subsection (c)(1), by striking 
‘‘subsection (d),’’ and inserting ‘‘sub-
sections (d) and (i)’’. 
(3) ADDITIONAL CONFORMING AMENDMENTS.— 
(A) NO COST SHARING FOR PREGNANCY- 
RELATED
BENEFITS.—Section 2103(e)(2) of 
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397cc(e)(2)) is amended— 
(i) in the heading, by inserting ‘‘OR 
PREGNANCY-RELATED
SERVICES’’ 
after 
‘‘PREVENTIVE SERVICES’’; and 
(ii) by inserting before the period at 
the end the following: ‘‘or for pregnancy- 
related services’’. 
(B) 
NO
WAITING
PERIOD.—Section 
2102(b)(1)(B) of the Social Security Act (42 
U.S.C. 1397bb(b)(1)(B)) is amended— 
(i) in clause (i), by striking ‘‘, and’’ at 
the end and inserting a semicolon; 
(ii) in clause (ii), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing 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.’’. 
(c) AUTHORITY FOR STATES THAT PROVIDE MED-
ICAID OR SCHIP COVERAGE FOR PREGNANT WOMEN 
WITH INCOME ABOVE 185 PERCENT OF THE POVERTY 
LINE TO USE PORTION OF SCHIP FUNDS FOR MEDICAID 
VerDate Aug 31 2005 
03:36 Jun 19, 2007
Jkt 059200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H2746.IH
H2746
mstockstill on PROD1PC66 with BILLS