beneficiaries, shall develop a model process for the coordi-
nation of the enrollment, retention, and coverage under 
such programs of children who, because of migration of 
families, emergency evacuations, educational needs, or 
otherwise, frequently change their State of residency or 
otherwise are temporarily located outside of the State of 
their residency. 
(b) REPORT TO CONGRESS.—After development of 
such model process, the Comptroller General shall submit 
to Congress a report describing additional steps or author-
ity needed to make further improvements to coordinate the 
enrollment, retention, and coverage under CHIP and Med-
icaid of children described in subsection (a). 
SEC. 143. MEDICAID CITIZENSHIP DOCUMENTATION RE-
QUIREMENTS. 
(a) STATE OPTION TO REQUIRE CHILDREN TO 
PRESENT SATISFACTORY DOCUMENTARY EVIDENCE OF 
PROOF OF CITIZENSHIP OR NATIONALITY FOR PURPOSES 
OF ELIGIBILITY FOR MEDICAID; REQUIREMENT FOR AU-
DITING.— 
(1) IN GENERAL.—Section 1902 of the Social 
Security Act (42 U.S.C. 1396a) is amended— 
(A) in subsection (a)(46)— 
(i) by inserting ‘‘(A)’’ after ‘‘(46)’’; 
and 
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(B) by adding at the end the following new 
sbparagraphs: 
‘‘(B) at the option of the State, require that, 
with respect to a child under 21 years of age (other 
than an individual described in section 1903(x)(2)) 
who declares to be a citizen or national of the 
United States for purposes of establishing initial eli-
gibility for medical assistance under this title (or, at 
State option, for purposes of renewing or redeter-
mining such eligibility to the extent that such satis-
factory documentary evidence of citizenship or na-
tionality has not yet been presented), there is pre-
sented satisfactory documentary evidence of citizen-
ship or nationality of the individual (using criteria 
determined by the State, which shall be no more re-
strictive than the documentation specified in section 
1903(x)(3)); and 
‘‘(C) comply with the auditing requirements of 
section 1903(x)(4);’’; and 
(C) in subsection (b)(3), by inserting ‘‘or 
any citizenship documentation requirement for 
a child under 21 years of age that is more re-
strictive than what a State may provide under 
section 1903(x)’’ before the period at the end. 
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(2) AUDITING REQUIREMENT.—Section 1903(x) 
of such Act (as amended by section 405(c)(1)(A) of 
division B of the Tax Relief and Health Care Act of 
2006 (Public Law 109–432)) is amended by adding 
at the end the following new paragraph: 
‘‘(4)(A) Regardless of whether a State has chosen to 
take the option specified in section 1902(a)(46)(B), each 
State shall audit a statistically-based sample of cases of 
children under 21 years of age in order to demonstrate 
to the satisfaction of the Secretary that the percentage 
of Federal Medicaid funds being spent for non-emergency 
benefits for aliens described in subsection (v)(1) who are 
under 21 years of age does not exceed 3 percent of total 
expenditures for medical assistance under the plan for 
items and services for individuals under 21 years of age 
for the period for which the sample is taken. In conducting 
such audits, a State may rely on case reviews regularly 
conducted pursuant to their Medicaid Quality Control or 
Payment Error Rate Measurement (PERM) eligibility re-
views under subsection (u). 
‘‘(B) In conducting audits under subparagraph (A), 
payments for non-emergency benefits shall be treated as 
erroneous if the audit could not confirm the citizenship 
of the individual based either on documentation in the case 
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file or on documentation obtained independently during 
the audit. 
‘‘(C) If the erroneous error rate described in subpara-
graph (A)— 
‘‘(i) exceeds 3 percent, the State shall— 
‘‘(I) remit to the Secretary the Federal 
share of improper expenditures in excess of the 
3 percent level described in such subparagraph; 
‘‘(II) shall develop a corrective action plan; 
and 
‘‘(III) shall conduct another audit the fol-
lowing fiscal year, after the corrective action 
plan is implemented; or 
‘‘(ii) does not exceed 3 percent, the State is not 
required to conduct another audit under subpara-
graph (A) until the third fiscal year succeeding the 
fiscal year for which the audit was conducted.’’; 
(3) ELIMINATION
OF
DENIAL
OF
PAYMENTS 
FOR CHILDREN.—Section 1903(i)(22) of such Act 
(42 U.S.C. 1396b(i)(22)) is amended by inserting 
‘‘(other than a child under the age of 21)’’ after ‘‘for 
an individual’’. 
(b) CLARIFICATION OF RULES FOR CHILDREN BORN 
IN THE UNITED STATES TO MOTHERS ELIGIBLE FOR 
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MEDICAID.—Section 1903(x)(2) of such Act (42 U.S.C. 
1396b(x)(2)) is amended— 
(1) in subparagraph (C), by striking ‘‘or’’ at 
the end; 
(2) by redesignating subparagraph (D) as sub-
paragraph (E); and 
(3) by inserting after subparagraph (C) the fol-
lowing new subparagraph: 
‘‘(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 in-
dividual shall be deemed to have provided satisfac-
tory documentary evidence of citizenship or nation-
ality and shall not be required to provide further 
documentary evidence on any date that occurs dur-
ing or after the period in which the individual is eli-
gible for medical assistance on such basis; or’’. 
(c) DOCUMENTATION FOR NATIVE AMERICANS .— 
Section 1903(x)(3)(B) of such Act is amended— 
(1) by redesignating clause (v) as clause (vi); 
and 
(2) by inserting after clause (iv) the following 
new clause: 
‘‘(v) For an individual who is a member of, 
or enrolled in or affiliated with, a federally-rec-
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