I 
111TH CONGRESS 
1ST SESSION 
H. R. 464 
To provide for a 5-year SCHIP reauthorization for coverage of low-income 
children, an expansion of child health care insurance coverage through 
tax fairness, and a health care Federalism initiative, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 13, 2009 
Mr. PRICE of Georgia (for himself, Mr. BLUNT, Mr. BISHOP of Utah, Mr. 
BARTLETT, Mr. SESSIONS, Mr. GOHMERT, Mrs. BLACKBURN, Mr. 
BROWN of South Carolina, Mr. CRENSHAW, Mr. KLINE of Minnesota, 
Mr. FRANKS of Arizona, Mr. BURTON of Indiana, Mr. SOUDER, Mr. 
CASSIDY, Mr. SHUSTER, Mrs. BACHMANN, Mr. GINGREY of Georgia, Mr. 
COBLE, Mr. SMITH of Texas, Mr. THORNBERRY, Mr. ROSKAM, and Mr. 
FLEMING) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means and Rules, for a period to be subsequently determined 
by the Speaker, in each case for consideration of such provisions as fall 
within the jurisdiction of the committee concerned 
A BILL 
To provide for a 5-year SCHIP reauthorization for coverage 
of low-income children, an expansion of child health care 
insurance coverage through tax fairness, and a health 
care Federalism initiative, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘More Children, More Choices Act of 2009’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—SCHIP REAUTHORIZATION 
Sec. 101. Requiring outreach and coverage before expansion of eligibility. 
Sec. 102. Application of citizenship documentation requirements; increased 
Federal matching rate for citizenship documentation enforce-
ment under Medicaid and SCHIP. 
Sec. 103. Limitations on eligibility based on substantial net assets. 
Sec. 104. Clarification of State authorities. 
Sec. 105. Easing administrative barriers to State cooperation with employer- 
sponsored insurance coverage. 
Sec. 106. Improving beneficiary choice in SCHIP. 
Sec. 107. Allotment distribution formula. 
Sec. 108. Five-year reauthorization. 
Sec. 109. Enhancing the programmatic focus on children and pregnant women. 
Sec. 110. Grants for outreach and enrollment. 
TITLE II—CHILD HEALTH INSURANCE COVERAGE THROUGH TAX 
FAIRNESS 
Sec. 201. Expansion of child health care insurance coverage through tax fair-
ness. 
TITLE III—STATE HEALTH REFORM PROJECTS 
Sec. 301. State health reform projects. 
TITLE IV—SENSE OF THE HOUSE OF REPRESENTATIVES 
Sec. 401. Medicare and Medicaid reform and savings. 
TITLE I—SCHIP 
REAUTHORIZATION 
SEC. 101. REQUIRING OUTREACH AND COVERAGE BEFORE 
EXPANSION OF ELIGIBILITY. 
(a) STATE PLAN REQUIRED TO SPECIFY HOW IT 
WILL ACHIEVE COVERAGE FOR 90 PERCENT OF TAR-
GETED LOW-INCOME CHILDREN.— 
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(1) IN GENERAL.—Section 2102(a) of the So-
cial Security Act (42 U.S.C. 1397bb(a)) is amend-
ed— 
(A) in paragraph (6), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (7), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(8) how the eligibility and benefits provided 
for under the plan for each fiscal year (beginning 
with fiscal year 2010) will allow for the State’s an-
nual funding allotment to cover at least 90 percent 
of the eligible targeted low-income children in the 
State.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to State child health 
plans for fiscal years beginning with fiscal year 
2010. 
(b) LIMITATION ON PROGRAM EXPANSIONS UNTIL 
LOWEST INCOME ELIGIBLE INDIVIDUALS ENROLLED.— 
Section 2105(c) of such Act (42 U.S.C. 1397dd(c)) is 
amended by adding at the end the following new para-
graph: 
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‘‘(8) LIMITATION ON INCREASED COVERAGE OF 
HIGHER INCOME CHILDREN.—For child health as-
sistance furnished in a fiscal year beginning with fis-
cal year 2010: 
‘‘(A) NO PAYMENT FOR CHILDREN WITH 
FAMILY INCOME ABOVE 250 PERCENT OF POV-
ERTY LINE.—Payment shall not be made under 
this section for child health assistance for a tar-
geted low-income child in a family the income 
of which exceeds 250 percent of the poverty line 
applicable to a family of the size involved. 
‘‘(B) SPECIAL RULES FOR PAYMENT FOR 
CHILDREN
WITH
FAMILY
INCOME
ABOVE
200 
PERCENT OF POVERTY LINE.—In the case of 
child health assistance for a targeted low-in-
come child in a family the income of which ex-
ceeds 200 percent (but does not exceed 250 
percent) of the poverty line applicable to a fam-
ily of the size involved no payment shall be 
made under this section for such assistance un-
less the State demonstrates to the satisfaction 
of the Secretary that— 
‘‘(i) the State has met the 90 percent 
retrospective coverage test specified in sub-
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tion of the post-partum period following 
completion of her pregnancy; and 
‘‘(iii) for items and services furnished 
before October 1, 2009, to an individual 
who is not a targeted low-income child and 
who is enrolled for assistance under this 
title as of September 30, 2008. 
‘‘(E) 
TREATMENT
OF
PREGNANT 
WOMEN.—In 
this 
paragraph 
and 
sections 
2102(a)(8) and 2104(a)(2), the term ‘targeted 
low-income child’ includes an individual under 
age 19, including the period from conception to 
birth, who is eligible for child health assistance 
under this title by virtue of the definition of the 
term ‘child’ under section 457.10 of title 42, 
Code of Federal Regulations.’’. 
(c) STANDARDIZATION
OF
INCOME
DETERMINA-
TIONS.— 
(1) IN GENERAL.—Section 2110(d) of such Act 
(42 U.S.C. 1397jj) is amended by adding at the end 
the following new subsection: 
‘‘(d) STANDARDIZATION
OF INCOME DETERMINA-
TIONS.—In determining family income under this title (in-
cluding in the case of a State child health plan that pro-
vides health benefits coverage in the manner described in 
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section 2101(a)(2)), a State shall base such determination 
on gross income (including amounts that would be in-
cluded in gross income if they were not exempt from in-
come taxation) and may only take into consideration such 
income disregards as the Secretary shall develop.’’. 
(2) EFFECTIVE DATE.—(A) Subject to subpara-
graph (B), the amendment made by paragraph (1) 
shall apply to determinations (and redeterminations) 
of income made on or after April 1, 2009. 
(B) In the case of a State child health plan 
under title XXI of the Social Security Act which the 
Secretary of Health and Human Services determines 
requires State legislation (other than legislation ap-
propriating funds) in order for the plan to meet the 
additional requirement imposed by the amendment 
made by paragraph (1), the State child health plan 
shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its 
failure to meet this additional requirement before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of such session shall be 
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deemed to be a separate regular session of the State 
legislature. 
SEC. 102. APPLICATION OF CITIZENSHIP DOCUMENTATION 
REQUIREMENTS; 
INCREASED 
FEDERAL 
MATCHING RATE FOR CITIZENSHIP DOCU-
MENTATION 
ENFORCEMENT 
UNDER 
MED-
ICAID AND SCHIP. 
(a) APPLICATION OF REQUIREMENTS.— 
(1) IN GENERAL.—Section 2105(c) of the So-
cial Security Act (42 U.S.C. 1397dd(c)), as amended 
by section 101(b), is amended by adding at the end 
the following new paragraph: 
‘‘(9) APPLICATION
OF
CITIZENSHIP
DOCU-
MENTATION REQUIREMENTS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), no payment may be made under this 
section to a State with respect to amounts ex-
pended for child health assistance for an indi-
vidual 
who 
declares 
under 
section 
1137(d)(1)(A) to be a citizen or national of the 
United States for purposes of establishing eligi-
bility for benefits under this title, unless the re-
quirement of section 1903(x) is met. 
‘‘(B) 
TREATMENT
OF
PREGNANT 
WOMEN.—For purposes of applying subpara-
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graph (A) in the case of a pregnant woman who 
qualifies for child health assistance by virtue of 
the application of section 457.10 of title 42, 
Code of Federal Regulations, the requirement 
of such section shall be deemed to be satisfied 
by the presentation of documentation of per-
sonal 
identity 
described 
in 
section 
274A(b)(1)(D) of the Immigration and Nation-
ality Act or any other documentation of per-
sonal identity of such other type as the Sec-
retary finds, by regulation, provides a reliable 
means of identification.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to eligibility determina-
tions and redeterminations made on or after April 1, 
2009. 
(b) TEMPORARY INCREASE IN FEDERAL MATCHING 
RATE FOR ADMINISTRATIVE COSTS UNDER MEDICAID 
AND SCHIP.—— 
(1) MEDICAID.— 
(A) IN GENERAL.—With respect to admin-
istrative costs incurred on or after July 1, 
2006, and before October 1, 2009, in imple-
menting the amendments made by section 6036 
of the Deficit Reduction Act of 2005 (Public 
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Law 109–171), 75 percent shall be substituted 
for 50 per centum in section 1903(a)(7) of the 
Social Security Act (42 U.S.C. 1396b(a)(7)). 
(B) 
RETROACTIVE
ADJUSTMENT.—The 
Secretary of Health and Human Services shall 
take such steps as may be necessary to provide 
for the adjustment of payments under section 
1903(a) of the Social Security Act (42 U.S.C. 
1396b(a)) to take into account the application 
of subparagraph (A) for periods before the date 
of the enactment of this Act. 
(2) SCHIP.—With respect to administrative 
costs incurred on or after April 1, 2009, and before 
October 1, 2009, in implementing the amendment 
made by subsection (a)(1), the enhanced FMAP ap-
plied under section 2105(a)(1)(D)(iv) of the Social 
Security Act (42 U.S.C. 1397d(a)(1)(D)(iv)) shall 
not be less than 75 percent. 
SEC. 103. LIMITATIONS ON ELIGIBILITY BASED ON SUB-
STANTIAL NET ASSETS. 
(a) IN GENERAL.—Section 2110(b) of the Social Se-
curity Act (42 U.S.C. 1397jj(b)) is amended— 
(1) in paragraph (1), by striking ‘‘paragraph 
(2)’’ and inserting ‘‘paragraphs (2) and (5)’’; and 
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(2) by adding at the end the following new 
paragraph: 
‘‘(5) DISQUALIFICATION FOR INDIVIDUALS IN 
FAMILIES WITH SUBSTANTIAL NET ASSETS.—An in-
dividual in a family is not eligible for child health 
assistance under this title if the individual’s family 
has net assets (including the equity interest in any 
home) that exceeds $500,000 or unless there is pro-
vided a document (in such a form and manner as 
the Secretary shall specify) signed under penalty of 
perjury by an applicant for child health assistance 
on behalf of the individual that the net assets of the 
individual’s family (including the equity interest in 
the any home) does not exceed $500,000. The Sec-
retary may increase the dollar amount specified in 
the previous sentence from year to year beginning 
with 2014 based on the percentage increase in the 
consumer price index for all urban consumers (all 
items; United States city average), rounded to the 
nearest $1,000.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to eligibility determinations and 
redeterminations made on or after April 1, 2009. 
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SEC. 104. CLARIFICATION OF STATE AUTHORITIES. 
Section 2102 of the Social Security Act (42 U.S.C. 
1397bb) is amended by adding at the end the following 
new subsection: 
‘‘(d) CLARIFICATION
OF STATE AUTHORITIES.— 
Nothing in this title shall be construed as preventing a 
State, under its child health plan, from doing any of the 
following: 
‘‘(1) USE OF WAITING PERIODS TO PREVENT 
CROWD OUT.—From using waiting periods and other 
tools to prevent crowding out private sector insur-
ance coverage. 
‘‘(2) 
USE
OF
PRIVATE
PROVIDERS
AND 
PLANS.—From cooperating or contracting with pri-
vate sector providers and plans in order to provide 
care to targeted low-income children. 
‘‘(3) USE OF STATE FUNDS FOR INELIGIBLE 
INDIVIDUALS.—From providing medical benefits for 
individuals who are not targeted low-income children 
with State funds.’’. 
SEC. 105. EASING ADMINISTRATIVE BARRIERS TO STATE 
COOPERATION WITH EMPLOYER-SPONSORED 
INSURANCE COVERAGE. 
(a) REQUIRING SOME COVERAGE FOR EMPLOYER- 
SPONSORED INSURANCE.— 
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(1) IN GENERAL.—Section 2102(a) of the So-
cial Security Act (42 U.S.C. 1397b(a)), as amended 
by section 101(a), is amended— 
(A) in paragraph (7), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (8), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(9) effective for plan years beginning on or 
after October 1, 2009, how the plan will provide for 
child health assistance with respect to targeted low- 
income children covered under a group health 
plan.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply beginning with fiscal 
year 2010. 
(b) FEDERAL FINANCIAL PARTICIPATION FOR EM-
PLOYER-SPONSORED INSURANCE.—Section 2105 of such 
Act (42 U.S.C. 1397d) is amended— 
(1) in subsection (a)(1)(C), by inserting before 
the semicolon at the end the following: ‘‘and, subject 
to paragraph (3)(C), in the form of payment of the 
premiums for coverage under a group health plan 
that includes coverage of targeted low-income chil-
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dren and benefits supplemental to such coverage’’; 
and 
(2) paragraph (3) of subsection (c) is amended 
to read as follows: 
‘‘(3) PURCHASE OF EMPLOYER-SPONSORED IN-
SURANCE.— 
‘‘(A) IN
GENERAL.—Payment may be 
made to a State under subsection (a)(1)(C), 
subject to the provisions of this paragraph, for 
the purchase of family coverage under a group 
health plan that includes coverage of targeted 
low-income children unless such coverage would 
otherwise substitute for coverage that would be 
provided to such children but for the purchase 
of family coverage. 
‘‘(B) WAIVER OF CERTAIN PROVISIONS.— 
With respect to coverage described in subpara-
graph (A)— 
‘‘(i) notwithstanding section 2102, no 
minimum benefits requirement (other than 
those otherwise applicable with respect to 
services referred to in section 2102(a)(7)) 
under this title shall apply; and 
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‘‘(ii) no limitation on beneficiary cost- 
sharing otherwise applicable under this 
title or title XIX shall apply. 
‘‘(C) REQUIRED
PROVISION
OF
SUPPLE-
MENTAL BENEFITS.—If the coverage described 
in subparagraph (A) does not provide coverage 
for 
the 
services 
referred 
to 
in 
section 
2102(a)(7), the State child health plan shall 
provide coverage of such services as supple-
mental benefits. 
‘‘(D) LIMITATION ON FFP.—The amount 
of the payment under paragraph (1)(C) for cov-
erage described in subparagraph (A) (and sup-
plemental benefits under subparagraph (C) for 
individuals so covered) during a fiscal year may 
not exceed the product of— 
‘‘(i) the national per capita expendi-
ture under this title (taking into account 
both Federal and State expenditures) for 
the previous fiscal year (as determined by 
the Secretary using the best available 
data); 
‘‘(ii) the enhanced FMAP for the 
State and fiscal year involved; and 
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‘‘(iii) the number of targeted low-in-
come children for whom such coverage is 
provided. 
‘‘(E) VOLUNTARY ENROLLMENT.—A State 
child health plan— 
‘‘(i) may not require a targeted low- 
income child to enroll in coverage described 
in subparagraph (A) in order to obtain 
child health assistance under this title; 
‘‘(ii) before providing such child 
health assistance for such coverage of a 
child, shall make available (which may be 
through an Internet website or other 
means) to the parent or guardian of the 
child information on the coverage available 
under this title, including benefits and 
cost-sharing; and 
‘‘(iii) shall provide at least one oppor-
tunity per fiscal year for beneficiaries to 
switch coverage under this title from cov-
erage described in subparagraph (A) to the 
coverage that is otherwise made available 
under this title. 
‘‘(F) INFORMATION
ON
COVERAGE
OP-
TIONS.—A State child health plan shall— 
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‘‘(i) describe how the State will notify 
potential beneficiaries of coverage de-
scribed in subparagraph (A); 
‘‘(ii) provide such notification in writ-
ing at least during the initial application 
for enrollment under this title and during 
redeterminations of eligibility if the indi-
vidual was enrolled before October 1, 2009; 
and 
‘‘(iii) post a description of these cov-
erage options on any official website that 
may be established by the State in connec-
tion with the plan. 
‘‘(G) SEMIANNUAL VERIFICATION OF COV-
ERAGE.—If coverage described in subparagraph 
(A) is provided under a group health plan with 
respect to a targeted low-income child, the 
State child health plan shall provide for the col-
lection, at least once every six months, of proof 
from the plan that the child is enrolled in such 
coverage. 
‘‘(H) RULE OF CONSTRUCTION.—Nothing 
in this section is to be construed to prohibit a 
State from— 
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another coverage option available under 
this title at any time; or 
‘‘(viii) providing any guidance or in-
formation it deems appropriate in order to 
help beneficiaries make an informed deci-
sion regarding the option to enroll in cov-
erage described in subparagraph (A). 
‘‘(I) GROUP HEALTH PLAN DEFINED.—In 
this paragraph, the term ‘group health plan’ 
has the meaning given such term in section 
2791(a)(1) of the Public Health Service Act (42 
U.S.C. 300gg–91(a)(1)).’’. 
SEC. 106. IMPROVING BENEFICIARY CHOICE IN SCHIP. 
(a) REQUIRING OFFERING OF ALTERNATIVE COV-
ERAGE OPTIONS.—Section 2102 of the Social Security Act 
(42 U.S.C. 1397b), as amended by sections 101(a), 104, 
and 105(a), is amended— 
(1) in subsection (a)— 
(A) in paragraph (8), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (9), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
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‘‘(10) effective for plan years beginning on or 
after October 1, 2009, how the plan will provide for 
child health assistance with respect to targeted low- 
income children through alternative coverage options 
in accordance with subsection (e).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(e) ALTERNATIVE COVERAGE OPTIONS.— 
‘‘(1) IN GENERAL.—Effective October 1, 2009, 
a State child health plan shall provide for the offer-
ing of any qualified alternative coverage that a 
qualified entity seeks to offer to targeted low-income 
children through the plan in the State. 
‘‘(2) APPLICATION
OF
UNIFORM
FINANCIAL 
LIMITATION FOR ALL ALTERNATIVE COVERAGE OP-
TIONS.—With respect to all qualified alternative cov-
erage offered in a State, the State child health plan 
shall establish a uniform dollar limitation on the per 
capita monthly amount that will be paid by the 
State to the qualified entity with respect to such 
coverage provided to a targeted low-income child. 
Such limitation may not be less than 90 percent of 
the per capita monthly payment made for coverage 
offered under the State child health plan that is not 
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in the form of an alternative coverage option. Noth-
ing in this paragraph shall be construed— 
‘‘(A) as requiring a State to provide for 
the full payment of premiums for qualified al-
ternative coverage; 
‘‘(B) as preventing a State from charging 
additional premiums to cover the difference be-
tween the cost of qualified alternative coverage 
and the amount of such payment limitation; 
‘‘(C) as preventing a State from using its 
own funds to provide a dollar limitation that ex-
ceeds the Federal financial participation as lim-
ited under section 2105(c)(10). 
‘‘(3) QUALIFIED ALTERNATIVE COVERAGE DE-
FINED.—In this section, the term ‘qualified alter-
native coverage’ means health insurance coverage 
that— 
‘‘(A) meets the coverage requirements of 
section 2103 (other than cost-sharing require-
ments of such section); and 
‘‘(B) is offered by a qualified insurer, and 
not directly by the State. 
‘‘(4) QUALIFIED
INSURER
DEFINED.—In this 
section, the term ‘qualified insurer’ means, with re-
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spect to a State, an entity that is licensed to offer 
health insurance coverage in the State.’’. 
(b) FEDERAL
FINANCIAL
PARTICIPATION
FOR 
QUALIFIED ALTERNATIVE COVERAGE.—Section 2105 of 
such Act (42 U.S.C. 1397d) is amended— 
(1) in subsection (a)(1)(C), as amended by sec-
tion 105(b), by inserting before the semicolon at the 
end the following: ‘‘and, subject to paragraph 
(8)(C), in the form of payment of the premiums for 
coverage for qualified alternative coverage’’; and 
(2) in subsection (c), as amended by sections 
101(b) and 102(a)(1), by adding at the end the fol-
lowing new paragraph: 
‘‘(10) PURCHASE OF QUALIFIED ALTERNATIVE 
COVERAGE.— 
‘‘(A) IN
GENERAL.—Payment may be 
made to a State under subsection (a)(1)(C), 
subject to the provisions of this paragraph, for 
the purchase of qualified alternative coverage. 
‘‘(B) WAIVER OF CERTAIN PROVISIONS.— 
With respect to coverage described in subpara-
graph (A), no limitation on beneficiary cost- 
sharing otherwise applicable under this title or 
title XIX shall apply. 
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‘‘(C) LIMITATION ON FFP.—The amount of 
the payment under paragraph (1)(C) for cov-
erage described in subparagraph (A) during a 
fiscal year in the aggregate for all such cov-
erage in the State may not exceed the product 
of— 
‘‘(i) the national per capita expendi-
ture under this title (taking into account 
both Federal and State expenditures) for 
the previous fiscal year (as determined by 
the Secretary using the best available 
data); 
‘‘(ii) the enhanced FMAP for the 
State and fiscal year involved; and 
‘‘(iii) the number of targeted low-in-
come children for whom such coverage is 
provided. 
‘‘(D) VOLUNTARY ENROLLMENT.—A State 
child health plan— 
‘‘(i) may not require a targeted low- 
income child to enroll in coverage described 
in subparagraph (A) in order to obtain 
child health assistance under this title; 
‘‘(ii) before providing such child 
health assistance for such coverage of a 
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child, shall make available (which may be 
through an Internet website or other 
means) to the parent or guardian of the 
child information on the coverage available 
under this title, including benefits and 
cost-sharing; and 
‘‘(iii) shall provide at least one oppor-
tunity per fiscal year for beneficiaries to 
switch coverage under this title from cov-
erage described in subparagraph (A) to the 
coverage that is otherwise made available 
under this title. 
‘‘(E) INFORMATION
ON
COVERAGE
OP-
TIONS.—A State child health plan shall— 
‘‘(i) describe how the State will notify 
potential beneficiaries of coverage de-
scribed in subparagraph (A); 
‘‘(ii) provide such notification in writ-
ing at least during the initial application 
for enrollment under this title and during 
redeterminations of eligibility if the indi-
vidual was enrolled before October 1, 2009; 
and 
‘‘(iii) post a description of these cov-
erage options on any official website that 
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may be established by the State in connec-
tion with the plan. 
‘‘(F) RULE OF CONSTRUCTION.—Nothing 
in this section is to be construed to prohibit a 
State from— 
‘‘(i) establishing limits on beneficiary 
cost-sharing under such alternative cov-
erage; 
‘‘(ii) paying all or part of a bene-
ficiary’s cost-sharing requirements under 
such coverage; 
‘‘(iii) paying less than the full cost of 
a child’s share of the premium under such 
coverage, insofar as the premium for such 
coverage exceeds the limitation established 
by the State under subparagraph (C); 
‘‘(iv) using State funds to pay for 
benefits above the Federal upper limit es-
tablished under subparagraph (C); or 
‘‘(v) providing any guidance or infor-
mation it deems appropriate in order to 
help beneficiaries make an informed deci-
sion regarding the option to enroll in cov-
erage described in subparagraph (A).’’. 
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SEC. 107. ALLOTMENT DISTRIBUTION FORMULA. 
(a) ALLOTMENTS TO 50 STATES AND THE DISTRICT 
OF COLUMBIA.— 
(1) IN GENERAL.—Section 2104(b) of the So-
cial Security Act (42 U.S.C. 1397dd(b)) is amend-
ed— 
(A) in paragraph (1), by striking ‘‘the 
same proportion’’ and all that follows and in-
serting ‘‘the product of the number of SCHIP 
targeted children, as determined under para-
graph (2) for the second preceding fiscal year, 
the State and Federal per capita SCHIP ex-
penditures for the second preceding fiscal year, 
as determined under such paragraph, and the 
enhanced FMAP for the State for the second 
preceding fiscal year.’’; 
(B) by amending paragraph (2) to read as 
follows: 
‘‘(2) NUMBER OF SCHIP TARGETED CHILDREN 
AND PREGNANT WOMEN AND NATIONAL PER CAPITA 
SCHIP EXPENDITURES.— 
‘‘(A) IN
GENERAL.—By not later than 
September 30 of each year (beginning with 
2009), the Secretary (in consultation with the 
Director of the Bureau of the Census and using 
the best available data for the fiscal year ending 
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in the previous year) shall determine and pub-
lish in the Federal Register— 
‘‘(i) the average number of low-income 
targeted children (described in subpara-
graph (B)) for any month during such pre-
ceding fiscal year; and 
‘‘(ii) the combined State and Federal 
per capita SCHIP expenditures (described 
in subparagraph (C)) for such preceding 
fiscal year. 
‘‘(B) LOW-INCOME SCHIP TARGETED CHIL-
DREN.—Low-income targeted children described 
in this subparagraph with respect to a sub-
section (b) State are children (including preg-
nant women described in section 2105(c)(8)(E)) 
residing in the State who are not covered under 
a group health plan or health insurance cov-
erage (as defined for purposes of section 
2110(b)(1)(C)) and whose family income— 
‘‘(i) exceeds the lesser of— 
‘‘(I) the Medicaid applicable in-
come level (as defined in section 
2110(b)(4)); or 
‘‘(II) 150 percent of the poverty 
line; but 
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‘‘(ii) does not exceed 200 percent of 
the poverty line. 
‘‘(C) STATE
AND
FEDERAL
PER
CAPITA 
SCHIP EXPENDITURES.—The State and Federal 
per capita SCHIP expenditures for a fiscal year 
is equal to— 
‘‘(i) the aggregate Federal and State 
expenditures made that are attributable to 
allotments under this title for subsection 
(b) States for the fiscal year; divided by 
‘‘(ii) the average total number of tar-
geted low-income children (including preg-
nant 
women 
described 
in 
section 
2105(c)(8)(E)) for whom health assistance 
was made available from such allotments 
for such fiscal year.’’; and 
(C) by striking paragraphs (3) and (4) and 
inserting the following: 
‘‘(3) SUBSECTION (b) STATE DEFINED.—In this 
subsection, the term ‘subsection (b) State’ means 
one of the 50 States or the District of Columbia. 
‘‘(4) PROPORTIONAL REDUCTION IF TOTAL AL-
LOTMENTS
EXCEED
AMOUNT
AVAILABLE.—If the 
Secretary estimates that the total of the allotments 
under this subsection for a fiscal year (in combina-
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tion with allotments made under subsection (c)) will 
exceed the aggregate amount available for allotments 
for such fiscal year under subsection (a), the Sec-
retary shall reduce the amount of each allotment 
under this subsection in a pro-rata manner so that 
such total does not exceed the aggregate amount 
available for allotments.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to allotments for fiscal 
years beginning with fiscal year 2010. 
(b) NO
REDISTRIBUTION
OF
UNUSED
ALLOT-
MENTS.— 
(1) IN GENERAL.—Section 2104(f) of such Act 
(42 U.S.C. 1397dd) is amended to read as follows: 
‘‘(f) NO
REDISTRIBUTION
OF
UNUSED
ALLOT-
MENTS.—There shall be no redistribution of allotments 
from States that are not expended within the period of 
availability under subsection (e).’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to allotments for fiscal 
years beginning with fiscal year 2007. 
SEC. 108. FIVE-YEAR REAUTHORIZATION. 
(a) IN GENERAL.—Section 2104(a) of the Social Se-
curity Act (42 U.S.C. 1397dd(a)) is amended— 
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(1) by striking ‘‘and’’ at the end of paragraph 
(10); 
(2) by striking the period at the end of para-
graph (11) and inserting a semicolon; and 
(3) by adding at the end the following new 
paragraphs: 
‘‘(12) for fiscal year 2010, $7,000,000,000; 
‘‘(13) for fiscal year 2011, $7,000,000,000; 
‘‘(14) for fiscal year 2012, $7,000,000,000; 
‘‘(15) for fiscal year 2013, $7,500,000,000; and 
‘‘(16) for fiscal year 2014, $8,000,000,000.’’. 
(b) CONTINUATION OF ADDITIONAL ALLOTMENTS TO 
TERRITORIES.—Section 2104(c)(4)(B) of the Social Secu-
rity Act (42 U.S.C. 1397dd(c)(4)(B)) is amended by strik-
ing ‘‘2009’’ and inserting ‘‘2014’’. 
(c) APPLICATION TO OTHER SCHIP FUNDING FOR 
FISCAL YEAR 2010.—Notwithstanding any other provi-
sion of law, if funds are appropriated under any law (other 
than this Act) to provide allotments to States under title 
XXI of the Social Security Act for all (or any portion) 
of fiscal year 2010— 
(1) any amounts that are so appropriated that 
are not so allotted and obligated before the date of 
the enactment of this Act are rescinded; and 
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(2) any amount provided for such title XXI al-
lotments to a State under this Act (and the amend-
ments made by this Act) for such fiscal year shall 
be reduced by the amount of such appropriations so 
allotted and obligated before such date. 
SEC. 109. ENHANCING THE PROGRAMMATIC FOCUS ON 
CHILDREN AND PREGNANT WOMEN. 
(a) IN GENERAL.—Section 2107(f) of the Social Se-
curity Act (42 U.S.C. 1397gg(f)) is amended by striking 
‘‘childless’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act but shall not apply to projects, including 
extensions, amendments, or renewals to such projects, that 
are in effect or have been approved on the date of the 
enactment of this Act. 
SEC. 110. GRANTS FOR OUTREACH AND ENROLLMENT. 
(a) GRANTS.—Title XXI of the Social Security Act 
(42 U.S.C. 1397aa et seq.) is amended by adding at the 
end the following: 
‘‘SEC. 2111. GRANTS TO IMPROVE OUTREACH AND ENROLL-
MENT. 
‘‘(a) OUTREACH AND ENROLLMENT GRANTS; NA-
TIONAL CAMPAIGN.— 
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‘‘(1) IN GENERAL.—From the amounts appro-
priated for a fiscal year under subsection (f), subject 
to paragraph (2), the Secretary shall award grants 
to eligible entities to conduct outreach and enroll-
ment efforts that are designed to increase the enroll-
ment and participation of eligible children under this 
title and title XIX. 
‘‘(2) 10 PERCENT SET ASIDE FOR NATIONAL 
ENROLLMENT CAMPAIGN.—An amount equal to 10 
percent of such amounts for the fiscal year shall be 
used by the Secretary for expenditures during the 
fiscal year to carry out a national enrollment cam-
paign in accordance with subsection (g). 
‘‘(b) AWARD OF GRANTS.— 
‘‘(1) PRIORITY FOR AWARDING.— 
‘‘(A) IN
GENERAL.—In awarding grants 
under subsection (a), the Secretary shall give 
priority to eligible entities that— 
‘‘(i) propose to target geographic 
areas with high rates of— 
‘‘(I) eligible but unenrolled chil-
dren, including such children who re-
side in rural areas; or 
‘‘(II) racial and ethnic minorities 
and health disparity populations, in-
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cluding those proposals that address 
cultural and linguistic barriers to en-
rollment; and 
‘‘(ii) submit the most demonstrable 
evidence required under paragraphs (1) 
and (2) of subsection (c). 
‘‘(B) 10 PERCENT SET ASIDE FOR OUT-
REACH
TO
INDIAN
CHILDREN.—An amount 
equal to 10 percent of the funds appropriated 
under subsection (f) for a fiscal year shall be 
used by the Secretary to award grants to In-
dian Health Service providers and urban Indian 
organizations receiving funds under title V of 
the Indian Health Care Improvement Act (25 
U.S.C. 1651 et seq.) for outreach to, and en-
rollment of, children who are Indians. 
‘‘(2) 2-YEAR AVAILABILITY.—A grant awarded 
under this section for a fiscal year shall remain 
available for expenditure through the end of the suc-
ceeding fiscal year. 
‘‘(c) APPLICATION.—An eligible entity that desires to 
receive a grant under subsection (a) shall submit an appli-
cation to the Secretary in such form and manner, and con-
taining such information, as the Secretary may decide. 
Such application shall include— 
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‘‘(1) evidence demonstrating that the entity in-
cludes members who have access to, and credibility 
with, ethnic or low-income populations in the com-
munities in which activities funded under the grant 
are to be conducted; 
‘‘(2) evidence demonstrating that the entity has 
the ability to address barriers to enrollment, such as 
lack of awareness of eligibility, stigma concerns and 
punitive fears associated with receipt of benefits, 
and other cultural barriers to applying for and re-
ceiving child health assistance or medical assistance; 
‘‘(3) specific quality or outcomes performance 
measures to evaluate the effectiveness of activities 
funded by a grant awarded under this section; and 
‘‘(4) an assurance that the eligible entity 
shall— 
‘‘(A) conduct an assessment of the effec-
tiveness of such activities against the perform-
ance measures; 
‘‘(B) cooperate with the collection and re-
porting of enrollment data and other informa-
tion in order for the Secretary to conduct such 
assessments; and 
‘‘(C) in the case of an eligible entity that 
is not the State, provide the State with enroll-
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ment data and other information as necessary 
for the State to make necessary projections of 
eligible children and pregnant women. 
‘‘(d) SUPPLEMENT, NOT SUPPLANT.—Federal funds 
awarded under this section shall be used to supplement, 
not supplant, non-Federal funds that are otherwise avail-
able for activities funded under this section. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means any of the following: 
‘‘(A) A State with an approved child health 
plan under this title. 
‘‘(B) A local government. 
‘‘(C) An Indian tribe or tribal consortium, 
a tribal organization, an urban Indian organiza-
tion receiving funds under title V of the Indian 
Health Care Improvement Act (25 U.S.C. 1651 
et seq.), or an Indian Health Service provider. 
‘‘(D) A Federal health safety net organiza-
tion. 
‘‘(E) A State, national, local, or commu-
nity-based public or nonprofit private organiza-
tion. 
‘‘(F) A faith-based organization or con-
sortia, to the extent that a grant awarded to 
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such an entity is consistent with the require-
ments of section 1955 of the Public Health 
Service Act (42 U.S.C. 300x–65) relating to a 
grant award to non-governmental entities. 
‘‘(G) An elementary or secondary school. 
‘‘(H) A national, local, or community-based 
public or nonprofit private organization, includ-
ing organizations that use community health 
workers or community-based doula programs. 
‘‘(2) FEDERAL HEALTH SAFETY NET ORGANI-
ZATION.—The term ‘Federal health safety net orga-
nization’ means— 
‘‘(A) a federally qualified health center (as 
defined in section 1905(l)(2)(B)); 
‘‘(B) a hospital defined as a dispropor-
tionate share hospital for purposes of section 
1923; 
‘‘(C) a covered entity described in section 
340B(a)(4) of the Public Health Service Act 
(42 U.S.C. 256b(a)(4)); and 
‘‘(D) any other entity or consortium that 
serves children under a federally funded pro-
gram, including the special supplemental nutri-
tion program for women, infants, and children 
(WIC) established under section 17 of the Child 
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Nutrition Act of 1966 (42 U.S.C. 1786), the 
head start and early head start programs under 
the Head Start Act (42 U.S.C. 9801 et seq.), 
the school lunch program established under the 
Richard B. Russell National School Lunch Act, 
and an elementary or secondary school. 
‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANI-
ZATION; URBAN INDIAN ORGANIZATION.—The terms 
‘Indian’, ‘Indian tribe’, ‘tribal organization’, and 
‘urban Indian organization’ have the meanings given 
such terms in section 4 of the Indian Health Care 
Improvement Act (25 U.S.C. 1603). 
‘‘(4) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
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‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health or nutrition needs; and 
‘‘(F) by providing referral and followup 
services. 
‘‘(f) APPROPRIATION.— 
‘‘(1) IN GENERAL.—There is appropriated, out 
of any money in the Treasury not otherwise appro-
priated, for the purpose of awarding grants under 
this section $100,000,000 for each of fiscal years 
2010 through 2014. 
‘‘(2) GRANTS IN ADDITION TO OTHER AMOUNTS 
PAID.—Amounts appropriated and paid under the 
authority of this section shall be in addition to 
amounts appropriated under section 2104 and paid 
to States in accordance with section 2105, including 
with respect to expenditures for outreach activities 
in accordance with subsections (a)(1)(D)(iii) and 
(c)(2)(C) of that section. 
‘‘(g) NATIONAL ENROLLMENT CAMPAIGN.—From 
the amounts made available under subsection (a)(2) for 
a fiscal year, the Secretary shall develop and implement 
a national enrollment campaign to improve the enrollment 
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of underserved child populations in the programs estab-
lished under this title and title XIX. Such campaign may 
include— 
‘‘(1) the establishment of partnerships with the 
Secretary of Education and the Secretary of Agri-
culture to develop national campaigns to link the eli-
gibility and enrollment systems for the assistance 
programs each Secretary administers that often 
serve the same children; 
‘‘(2) the integration of information about the 
programs established under this title and title XIX 
in public health awareness campaigns administered 
by the Secretary; 
‘‘(3) increased financial and technical support 
for enrollment hotlines maintained by the Secretary 
to ensure that all States participate in such hotlines; 
‘‘(4) the establishment of joint public awareness 
outreach initiatives with the Secretary of Education 
and the Secretary of Labor regarding the impor-
tance of health insurance to building strong commu-
nities and the economy; 
‘‘(5) the development of special outreach mate-
rials for Native Americans or for individuals with 
limited English proficiency; and 
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‘‘(6) such other outreach initiatives as the Sec-
retary determines would increase public awareness of 
the programs under this title and title XIX.’’. 
(b) NONAPPLICATION OF ADMINISTRATIVE EXPENDI-
TURES CAP.—Section 2105(c)(2) of the Social Security 
Act (42 U.S.C. 1397ee(c)(2)) is amended by adding at the 
end the following: 
‘‘(C) NONAPPLICATION TO EXPENDITURES 
FOR OUTREACH AND ENROLLMENT.—The limi-
tation under subparagraph (A) shall not apply 
with respect to expenditures for outreach activi-
ties under section 2102(c)(1), or for enrollment 
activities, for children eligible for child health 
assistance under the State child health plan or 
medical assistance under the State plan under 
title XIX.’’. 
TITLE II—CHILD HEALTH INSUR-
ANCE COVERAGE THROUGH 
TAX FAIRNESS 
SEC. 201. EXPANSION OF CHILD HEALTH CARE INSURANCE 
COVERAGE THROUGH TAX FAIRNESS. 
(a) IN GENERAL.—Subpart C of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to refundable credits) is amended by redes-
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ignating section 37 as section 38 and by inserting after 
section 36 the following new section: 
‘‘SEC. 37. CHILD HEALTH INSURANCE COSTS. 
‘‘(a) IN GENERAL.—In the case of an eligible tax-
payer, there shall be allowed as a credit against the tax 
imposed by this subtitle an amount equal to the amount 
paid by the taxpayer during the taxable year for qualified 
health insurance for any dependent child of such taxpayer. 
‘‘(b) LIMITATIONS.— 
‘‘(1) IN GENERAL.—The amount allowed as a 
credit under subsection (a) to an eligible taxpayer 
for the taxable year shall not exceed the sum of the 
monthly limitations for coverage months during such 
taxable year for the individual referred to in sub-
section (a) for whom such taxpayer paid during the 
taxable year any amount for coverage under quali-
fied health insurance. 
‘‘(2) MONTHLY LIMITATION.—The monthly lim-
itation for an individual for each coverage month of 
such individual during the taxable year is the 
amount equal to 1⁄12 of $1,400. 
‘‘(3) COVERAGE MONTH.—For purposes of this 
subsection— 
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‘‘(A) IN
GENERAL.—The term ‘coverage 
month’ means, with respect to an individual, 
any month if— 
‘‘(i) as of the first day of such month 
such individual is covered by qualified 
health insurance, and 
‘‘(ii) the premium for coverage under 
such insurance for such month is paid by 
an eligible taxpayer. 
‘‘(B) MEDICARE
AND
MEDICAID.—Such 
term shall not include any month with respect 
to an individual if, as of the first day of such 
month, such individual— 
‘‘(i) is entitled to any benefits under 
title XVIII of the Social Security Act, or 
‘‘(ii) is a participant in the program 
under title XIX or XXI of such Act. 
‘‘(C) CERTAIN
OTHER
COVERAGE.—Such 
term shall not include any month during a tax-
able year with respect to an individual if, at any 
time during such year, any benefit is provided 
to such individual under chapter 89 of title 5, 
United States Code. 
‘‘(D) INSUFFICIENT PRESENCE IN UNITED 
STATES.—Such term shall not include any 
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