† HR 2 EAS 
child health assistance or other health benefits 
coverage to a parent of a targeted low-income 
child during the third and fourth quarters of fis-
cal year 2009 and during fiscal years 2010 and 
2011. 
‘‘(2) RULES FOR FISCAL YEARS 2012 THROUGH 
2013.— 
‘‘(A) PAYMENTS FOR COVERAGE LIMITED TO 
BLOCK
GRANT
FUNDED
FROM
STATE
ALLOT-
MENT.—Any State that provides child health as-
sistance or health benefits coverage under an ap-
plicable existing waiver for a parent of a tar-
geted low-income child may elect to continue to 
provide such assistance or coverage through fiscal 
year 2012 or 2013, subject to the same terms and 
conditions that applied under the applicable ex-
isting waiver, unless otherwise modified in sub-
paragraph (B). 
‘‘(B) TERMS AND CONDITIONS.— 
‘‘(i) BLOCK GRANT SET ASIDE FROM 
STATE ALLOTMENT.—If the State makes an 
election under subparagraph (A), the Sec-
retary shall set aside for the State for each 
such fiscal year an amount equal to the 
Federal share of 110 percent of the State’s
† HR 2 EAS 
projected expenditures under the applicable 
existing waiver for providing child health 
assistance or health benefits coverage to all 
parents of targeted low-income children en-
rolled under such waiver for the fiscal year 
(as certified by the State and submitted to 
the Secretary by not later than August 31 
of the preceding fiscal year). In the case of 
fiscal year 2013, the set aside for any State 
shall be computed separately for each period 
described in subparagraphs (A) and (B) of 
section 2104(a)(16) and any reduction in 
the allotment for either such period under 
section 2104(m)(4) shall be allocated on a 
pro rata basis to such set aside. 
‘‘(ii) 
PAYMENTS
FROM
BLOCK 
GRANT.—The Secretary shall pay the State 
from the amount set aside under clause (i) 
for the fiscal year, an amount for each 
quarter of such fiscal year equal to the ap-
plicable percentage determined under clause 
(iii) or (iv) for expenditures in the quarter 
for providing child health assistance or 
other health benefits coverage to a parent of 
a targeted low-income child.
† HR 2 EAS 
‘‘(iii) ENHANCED FMAP ONLY IN FIS-
CAL YEAR 2012 FOR STATES WITH SIGNIFI-
CANT CHILD OUTREACH OR THAT ACHIEVE 
CHILD COVERAGE BENCHMARKS; FMAP FOR 
ANY
OTHER
STATES.—For purposes of 
clause (ii), the applicable percentage for 
any quarter of fiscal year 2012 is equal 
to— 
‘‘(I) the enhanced FMAP deter-
mined under section 2105(b) in the 
case of a State that meets 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 assist-
ance 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 quar-
ter of fiscal year 2013 is equal to— 
‘‘(I) the REMAP percentage if—
† HR 2 EAS 
‘‘(aa) the applicable percent-
age 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 assist-
ance percentage (as so determined) in 
the case of any State to which sub-
clause (I) does not apply. 
For purposes of subclause (I), the REMAP 
percentage is the percentage which is the 
sum of such Federal medical assistance per-
centage 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 ex-
penditures described in clause (ii) after the
† HR 2 EAS 
total amount set aside under clause (i) for 
a fiscal year has been paid to the State. 
‘‘(vi) NO INCREASE IN INCOME ELIGI-
BILITY 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 
assistance or health benefits coverage to a 
parent of a targeted low-income child whose 
family income exceeds the income eligibility 
level applied under the applicable existing 
waiver to parents of targeted low-income 
children on the date of enactment of the 
Children’s Health Insurance Program Re-
authorization Act of 2009. 
‘‘(3) OUTREACH OR COVERAGE BENCHMARKS.— 
For purposes of paragraph (2), the outreach or cov-
erage benchmarks described in this paragraph are as 
follows: 
‘‘(A) SIGNIFICANT CHILD OUTREACH CAM-
PAIGN.—The State— 
‘‘(i) was awarded a grant under sec-
tion 2113 for fiscal year 2011;
† HR 2 EAS 
‘‘(ii) implemented 1 or more of the en-
rollment 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 accu-
rate published estimates of the Bureau of the 
Census, ranks in the lowest 1⁄3 of States 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 ap-
plicable 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.
† HR 2 EAS 
‘‘(c) APPLICABLE EXISTING WAIVER.—For purposes of 
this section— 
‘‘(1) IN GENERAL.—The term ‘applicable existing 
waiver’ means a waiver, experimental, pilot, or dem-
onstration 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 car-
rying out section 1931) and a legal guardian. 
‘‘(B) NONPREGNANT CHILDLESS ADULT.— 
The term ‘nonpregnant childless adult’ has the 
meaning given such term by section 2107(f).’’. 
(2) CONFORMING AMENDMENTS.—
† HR 2 EAS 
(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 pregnant, 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 paragraph: 
‘‘(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 in-
serting ‘‘Subject to section 2111 of the Social Se-
curity Act, as added by section 112 of the Chil-
† HR 2 EAS 
dren’s Health Insurance Program Reauthoriza-
tion Act of 2009, nothing’’. 
(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 in-
creases the enrollment of, or the quality of care 
for, children, and 
(B) such parents, relatives, and legal guard-
ians 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 Com-
mittee on Energy and Commerce of the House of Rep-
resentatives, including recommendations (if any) for 
changes in legislation.
† HR 2 EAS 
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 re-
mains (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:
† HR 2 EAS 
‘‘The term ‘qualified provider’ also includes a qualified en-
tity, as defined in section 1920A(b)(3).’’. 
SEC. 114. LIMITATION ON MATCHING RATE FOR STATES 
THAT PROPOSE 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 EX-
PENDITURES FOR CHILD HEALTH ASSISTANCE PRO-
VIDED TO CHILDREN WHOSE EFFECTIVE FAMILY IN-
COME
EXCEEDS
300
PERCENT
OF
THE
POVERTY 
LINE.— 
‘‘(A) FMAP APPLIED TO EXPENDITURES.— 
Except as provided in subparagraph (B), for fis-
cal years beginning with fiscal year 2009, the 
Federal medical assistance percentage (as deter-
mined 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
† HR 2 EAS 
line but for the application of a general exclu-
sion 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 en-
actment of the Children’s Health Insurance Pro-
gram Reauthorization Act of 2009, has an ap-
proved 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 amend-
ments made by this section shall be construed as— 
(1) changing any income eligibility level for chil-
dren 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 methodologies 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 Security Act (42 U.S.C. 1396d) or subsection (u) of
† HR 2 EAS 
such section, at State option, the Secretary shall provide 
the State with the Federal medical assistance percentage de-
termined for the State for Medicaid with respect to expendi-
tures described in section 1905(u)(2)(A) of such Act or oth-
erwise 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 FUND-
ING 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 ENROLL-
MENT. 
‘‘(a) OUTREACH
AND ENROLLMENT GRANTS; NA-
TIONAL CAMPAIGN.— 
‘‘(1) IN GENERAL.—From the amounts appro-
priated under subsection (g), subject to paragraph 
(2), the Secretary shall award grants to eligible enti-
ties during the period of fiscal years 2009 through 
2013 to conduct outreach and enrollment efforts that
† HR 2 EAS 
are designed to increase the enrollment and participa-
tion of eligible children under this title and title XIX. 
‘‘(2) TEN PERCENT SET ASIDE FOR NATIONAL 
ENROLLMENT
CAMPAIGN.—An amount equal to 10 
percent of such amounts shall be used by the Sec-
retary for expenditures during such period to carry 
out a national enrollment campaign in accordance 
with subsection (h). 
‘‘(b) PRIORITY FOR AWARD OF GRANTS.— 
‘‘(1) IN GENERAL.—In awarding grants under 
subsection (a), the Secretary shall give priority to eli-
gible entities that— 
‘‘(A) propose to target geographic areas 
with high rates of— 
‘‘(i) eligible but unenrolled children, 
including such children who reside in rural 
areas; or 
‘‘(ii) racial and ethnic minorities and 
health disparity populations, including 
those proposals that address cultural and 
linguistic barriers to enrollment; and 
‘‘(B) submit the most demonstrable evidence 
required under paragraphs (1) and (2) of sub-
section (c).
† HR 2 EAS 
‘‘(2) TEN PERCENT SET ASIDE FOR OUTREACH 
TO INDIAN CHILDREN.—An amount equal to 10 per-
cent of the funds appropriated under subsection (g) 
shall be used by the Secretary to award grants to In-
dian Health Service providers and urban Indian or-
ganizations receiving funds under title V of the In-
dian Health Care Improvement Act (25 U.S.C. 1651 
et seq.) for outreach to, and enrollment of, children 
who are Indians. 
‘‘(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— 
‘‘(1) evidence demonstrating that the entity in-
cludes members who have access to, and credibility 
with, ethnic or low-income populations in the commu-
nities 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 receiving 
child health assistance or medical assistance;
† HR 2 EAS 
‘‘(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 effective-
ness of such activities against the performance 
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 enrollment 
data and other information as necessary for the 
State to make necessary projections of eligible 
children and pregnant women. 
‘‘(d) DISSEMINATION OF ENROLLMENT DATA AND IN-
FORMATION DETERMINED FROM EFFECTIVENESS ASSESS-
MENTS; ANNUAL REPORT.—The Secretary shall— 
‘‘(1) make publicly available the enrollment data 
and information collected and reported in accordance 
with subsection (c)(4)(B); and 
‘‘(2) submit an annual report to Congress on the 
outreach and enrollment activities conducted with 
funds appropriated under this section.
† HR 2 EAS 
‘‘(e) MAINTENANCE OF EFFORT FOR STATES AWARDED 
GRANTS; NO MATCH REQUIRED FOR ANY ELIGIBLE ENTITY 
AWARDED A GRANT.— 
‘‘(1) STATE MAINTENANCE OF EFFORT.—In the 
case of a State that is awarded a grant under this 
section, the State share of funds expended for outreach 
and enrollment activities under the State child health 
plan shall not be less than the State share of such 
funds expended in the fiscal year preceding the first 
fiscal year for which the grant is awarded. 
‘‘(2) NO MATCHING REQUIREMENT.—No eligible 
entity awarded a grant under subsection (a) shall be 
required to provide any matching funds as a condi-
tion for receiving the grant. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible enti-
ty’ 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 organi-
zation receiving funds under title V of the In-
dian Health Care Improvement Act (25 U.S.C.
† HR 2 EAS 
1651 et seq.), or an Indian Health Service pro-
vider. 
‘‘(D) A Federal health safety net organiza-
tion. 
‘‘(E) A national, State, local, or commu-
nity-based public or nonprofit private organiza-
tion, including organizations that use commu-
nity health workers or community-based doula 
programs. 
‘‘(F) A faith-based organization or con-
sortia, to the extent that a grant awarded to such 
an entity is consistent with the requirements of 
section 1955 of the Public Health Service Act (42 
U.S.C. 300x–65) relating to a grant award to 
nongovernmental entities. 
‘‘(G) An elementary or secondary school. 
‘‘(2) FEDERAL HEALTH SAFETY NET ORGANIZA-
TION.—The term ‘Federal health safety net organiza-
tion’ 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;
† HR 2 EAS 
‘‘(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 
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 ORGANIZA-
TION; URBAN INDIAN ORGANIZATION.—The terms ‘In-
dian’, ‘Indian tribe’, ‘tribal organization’, and ‘urban 
Indian organization’ have the meanings given such 
terms in section 4 of the Indian Health Care Im-
provement 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—
† HR 2 EAS 
‘‘(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; 
‘‘(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. 
‘‘(g) APPROPRIATION.—There is appropriated, out of 
any money in the Treasury not otherwise appropriated, 
$100,000,000 for the period of fiscal years 2009 through 
2013, for the purpose of awarding grants under this section. 
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.
† HR 2 EAS 
‘‘(5) the development of special outreach mate-
rials for Native Americans or for individuals with 
limited English proficiency; and 
‘‘(6) such other outreach initiatives as the Sec-
retary determines would increase public awareness of 
the programs under this title and title XIX.’’. 
(b) 
ENHANCED
ADMINISTRATIVE
FUNDING
FOR 
TRANSLATION
OR
INTERPRETATION
SERVICES
UNDER 
CHIP AND MEDICAID.— 
(1) CHIP.—Section 2105(a)(1) (42 U.S.C. 
1397ee(a)(1)), as amended by section 113, is amend-
ed— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘(or, in the case of expenditures 
described in subparagraph (D)(iv), the higher of 
75 percent or the sum of the enhanced FMAP 
plus 5 percentage points)’’ after ‘‘enhanced 
FMAP’’; and 
(B) in subparagraph (D)— 
(i) in clause (iii), by striking ‘‘and’’ at 
the end; 
(ii) by redesignating clause (iv) as 
clause (v); and 
(iii) by inserting after clause (iii) the 
following new clause:
† HR 2 EAS 
‘‘(iv) for translation or interpretation 
services in connection with the enrollment 
of, retention of, and use of services under 
this title by, individuals for whom English 
is not their primary language (as found 
necessary by the Secretary for the proper 
and efficient administration of the State 
plan); and’’. 
(2) MEDICAID.— 
(A) USE
OF
MEDICAID
FUNDS.—Section 
1903(a)(2) (42 U.S.C. 1396b(a)(2)) is amended 
by adding at the end the following new subpara-
graph: 
‘‘(E) an amount equal to 75 percent of so much 
of the sums expended during such quarter (as found 
necessary by the Secretary for the proper and efficient 
administration of the State plan) as are attributable 
to translation or interpretation services in connection 
with the enrollment of, retention of, and use of serv-
ices under this title by, children of families for whom 
English is not the primary language; plus’’. 
(B) USE OF COMMUNITY HEALTH WORKERS 
FOR OUTREACH ACTIVITIES.— 
(i) IN
GENERAL.—Section 2102(c)(1) 
of such Act (42 U.S.C. 1397bb(c)(1)) is
† HR 2 EAS 
amended by inserting ‘‘(through community 
health workers and others)’’ after ‘‘Out-
reach’’. 
(ii) IN
FEDERAL
EVALUATION.—Sec-
tion 2108(c)(3)(B) of such Act (42 U.S.C. 
1397hh(c)(3)(B)) is amended by inserting 
‘‘(such as through community health work-
ers and others)’’ after ‘‘including practices’’. 
SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF IN-
DIANS. 
(a) IN GENERAL.—Section 1139 (42 U.S.C. 1320b–9) 
is amended to read as follows: 
‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 
HEALTH CARE FOR INDIANS UNDER TITLES 
XIX AND XXI. 
‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID AND 
CHIP OUTREACH ON OR NEAR RESERVATIONS TO IN-
CREASE THE ENROLLMENT OF INDIANS IN THOSE PRO-
GRAMS.— 
‘‘(1) IN GENERAL.—In order to improve the ac-
cess of Indians residing on or near a reservation to 
obtain benefits under the Medicaid and State chil-
dren’s health insurance programs established under 
titles XIX and XXI, the Secretary shall encourage the 
State to take steps to provide for enrollment on or
† HR 2 EAS 
near the reservation. Such steps may include outreach 
efforts such as the outstationing of eligibility workers, 
entering into agreements with the Indian Health 
Service, Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations to provide outreach, 
education regarding eligibility and benefits, enroll-
ment, and translation services when such services are 
appropriate. 
‘‘(2) CONSTRUCTION.—Nothing in paragraph (1) 
shall be construed as affecting arrangements entered 
into between States and the Indian Health Service, 
Indian Tribes, Tribal Organizations, or Urban In-
dian Organizations for such Service, Tribes, or Orga-
nizations to conduct administrative activities under 
such titles. 
‘‘(b) REQUIREMENT TO FACILITATE COOPERATION.— 
The Secretary, acting through the Centers for Medicare & 
Medicaid Services, shall take such steps as are necessary 
to facilitate cooperation with, and agreements between, 
States and the Indian Health Service, Indian Tribes, Trib-
al Organizations, or Urban Indian Organizations with re-
spect to the provision of health care items and services to 
Indians under the programs established under title XIX or 
XXI.
† HR 2 EAS 
‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN 
HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN INDIAN 
ORGANIZATION.—In this section, the terms ‘Indian’, ‘In-
dian Tribe’, ‘Indian Health Program’, ‘Tribal Organiza-
tion’, and ‘Urban Indian Organization’ have the meanings 
given those terms in section 4 of the Indian Health Care 
Improvement Act.’’. 
(b) NONAPPLICATION OF 10 PERCENT LIMIT ON OUT-
REACH
AND CERTAIN OTHER EXPENDITURES.—Section 
2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is amended by adding 
at the end the following: 
‘‘(C) NONAPPLICATION
TO
CERTAIN
EX-
PENDITURES.—The limitation under subpara-
graph (A) shall not apply with respect to the fol-
lowing expenditures: 
‘‘(i) 
EXPENDITURES
TO
INCREASE 
OUTREACH TO, AND THE ENROLLMENT OF, 
INDIAN CHILDREN UNDER THIS TITLE AND 
TITLE xix.—Expenditures for outreach ac-
tivities to families of Indian children likely 
to be eligible for child health assistance 
under the plan or medical assistance under 
the State plan under title XIX (or under a 
waiver of such plan), to inform such fami-
lies of the availability of, and to assist them
† HR 2 EAS 
in enrolling their children in, such plans, 
including such activities conducted under 
grants, contracts, or agreements entered into 
under section 1139(a).’’. 
SEC. 203. STATE OPTION TO RELY ON FINDINGS FROM AN 
EXPRESS LANE AGENCY TO CONDUCT SIM-
PLIFIED ELIGIBILITY DETERMINATIONS. 
(a) APPLICATION UNDER MEDICAID AND CHIP PRO-
GRAMS.— 
(1) MEDICAID.—Section 1902(e) (42 U.S.C. 
1396a(e)) is amended by adding at the end the fol-
lowing: 
‘‘(13) EXPRESS LANE OPTION.— 
‘‘(A) IN GENERAL.— 
‘‘(i) OPTION TO USE A FINDING FROM AN 
EXPRESS LANE AGENCY.—At the option of the 
State, the State plan may provide that in deter-
mining eligibility under this title for a child (as 
defined in subparagraph (G)), the State may 
rely on a finding made within a reasonable pe-
riod (as determined by the State) from an Ex-
press Lane agency (as defined in subparagraph 
(F)) when it determines whether a child satisfies 
one or more components of eligibility for medical 
assistance under this title. The State may rely
† HR 2 EAS 
on a finding from an Express Lane agency not-
withstanding 
sections 
1902(a)(46)(B) 
and 
1137(d) or any differences in budget unit, dis-
regard, deeming or other methodology, if the fol-
lowing requirements are met: 
‘‘(I) PROHIBITION
ON
DETERMINING 
CHILDREN INELIGIBLE FOR COVERAGE.—If 
a finding from an Express Lane agency 
would result in a determination that a 
child does not satisfy an eligibility require-
ment for medical assistance under this title 
and for child health assistance under title 
XXI, the State shall determine eligibility for 
assistance using its regular procedures. 
‘‘(II) 
NOTICE
REQUIREMENT.—For 
any child who is found eligible for medical 
assistance under the State plan under this 
title or child health assistance under title 
XXI and who is subject to premiums based 
on an Express Lane agency’s finding of 
such child’s income level, the State shall 
provide notice that the child may qualify 
for lower premium payments if evaluated 
by the State using its regular policies and
† HR 2 EAS 
of the procedures for requesting such an 
evaluation. 
‘‘(III) COMPLIANCE WITH SCREEN AND 
ENROLL
REQUIREMENT.—The State shall 
satisfy the requirements under subpara-
graphs (A) and (B) of section 2102(b)(3) 
(relating to screen and enroll) before enroll-
ing a child in child health assistance under 
title XXI. At its option, the State may ful-
fill such requirements in accordance with 
either option provided under subparagraph 
(C) of this paragraph. 
‘‘(IV) VERIFICATION
OF
CITIZENSHIP 
OR NATIONALITY STATUS.—The State shall 
satisfy 
the 
requirements 
of 
section 
1902(a)(46)(B) or 2105(c)(9), as applicable 
for verifications of citizenship or nation-
ality status. 
‘‘(V) CODING.—The State meets the re-
quirements of subparagraph (E). 
‘‘(ii) OPTION TO APPLY TO RENEWALS AND 
REDETERMINATIONS.—The State may apply the 
provisions of this paragraph when conducting 
initial determinations of eligibility, redetermina-
† HR 2 EAS 
tions of eligibility, or both, as described in the 
State plan. 
‘‘(B) RULES
OF
CONSTRUCTION.—Nothing in 
this paragraph shall be construed— 
‘‘(i) to limit or prohibit a State from taking 
any actions otherwise permitted under this title 
or title XXI in determining eligibility for or en-
rolling children into medical assistance under 
this title or child health assistance under title 
XXI; or 
‘‘(ii) to modify the limitations in section 
1902(a)(5) concerning the agencies that may 
make a determination of eligibility for medical 
assistance under this title. 
‘‘(C) OPTIONS FOR SATISFYING THE SCREEN AND 
ENROLL REQUIREMENT.— 
‘‘(i) IN GENERAL.—With respect to a child 
whose eligibility for medical assistance under 
this title or for child health assistance under title 
XXI has been evaluated by a State agency using 
an income finding from an Express Lane agen-
cy, a State may carry out its duties under sub-
paragraphs (A) and (B) of section 2102(b)(3) 
(relating to screen and enroll) in accordance 
with either clause (ii) or clause (iii).
† HR 2 EAS 
‘‘(ii) ESTABLISHING A SCREENING THRESH-
OLD.— 
‘‘(I) IN GENERAL.—Under this clause, 
the State establishes a screening threshold 
set as a percentage of the Federal poverty 
level that exceeds the highest income thresh-
old applicable under this title to the child 
by a minimum of 30 percentage points or, 
at State option, a higher number of percent-
age points that reflects the value (as deter-
mined by the State and described in the 
State plan) of any differences between in-
come methodologies used by the program ad-
ministered by the Express Lane agency and 
the methodologies used by the State in deter-
mining eligibility for medical assistance 
under this title. 
‘‘(II) CHILDREN
WITH
INCOME
NOT 
ABOVE
THRESHOLD.—If the income of a 
child does not exceed the screening threshold, 
the child is deemed to satisfy the income eli-
gibility criteria for medical assistance 
under this title regardless of whether such 
child would otherwise satisfy such criteria.
† HR 2 EAS 
‘‘(III) CHILDREN WITH INCOME ABOVE 
THRESHOLD.—If the income of a child ex-
ceeds the screening threshold, the child shall 
be considered to have an income above the 
Medicaid applicable income level described 
in section 2110(b)(4) and to satisfy the re-
quirement under section 2110(b)(1)(C) (re-
lating to the requirement that CHIP match-
ing funds be used only for children not eli-
gible for Medicaid). If such a child is en-
rolled in child health assistance under title 
XXI, the State shall provide the parent, 
guardian, or custodial relative with the fol-
lowing: 
‘‘(aa) Notice that the child may be 
eligible to receive medical assistance 
under the State plan under this title if 
evaluated for such assistance under the 
State’s regular procedures and notice 
of the process through which a parent, 
guardian, or custodial relative can re-
quest that the State evaluate the child’s 
eligibility for medical assistance under 
this title using such regular procedures.
† HR 2 EAS 
‘‘(bb) A description of differences 
between the medical assistance pro-
vided under this title and child health 
assistance under title XXI, including 
differences in cost-sharing requirements 
and covered benefits. 
‘‘(iii) TEMPORARY
ENROLLMENT
IN
CHIP 
PENDING SCREEN AND ENROLL.— 
‘‘(I) IN GENERAL.—Under this clause, 
a State enrolls a child in child health as-
sistance under title XXI for a temporary 
period if the child appears eligible for such 
assistance based on an income finding by 
an Express Lane agency. 
‘‘(II) 
DETERMINATION
OF
ELIGI-
BILITY.—During such temporary enrollment 
period, the State shall determine the child’s 
eligibility for child health assistance under 
title XXI or for medical assistance under 
this title in accordance with this clause. 
‘‘(III) PROMPT FOLLOW UP.—In mak-
ing such a determination, the State shall 
take prompt action to determine whether the 
child should be enrolled in medical assist-
ance under this title or child health assist-
† HR 2 EAS 
ance under title XXI pursuant to subpara-
graphs (A) and (B) of section 2102(b)(3) 
(relating to screen and enroll). 
‘‘(IV) REQUIREMENT FOR SIMPLIFIED 
DETERMINATION.—In making such a deter-
mination, the State shall use procedures 
that, to the maximum feasible extent, reduce 
the burden imposed on the individual of 
such determination. Such procedures may 
not require the child’s parent, guardian, or 
custodial relative to provide or verify infor-
mation that already has been provided to 
the State agency by an Express Lane agen-
cy or another source of information unless 
the State agency has reason to believe the 
information is erroneous. 
‘‘(V) AVAILABILITY OF CHIP MATCHING 
FUNDS
DURING
TEMPORARY
ENROLLMENT 
PERIOD.—Medical assistance for items and 
services that are provided to a child enrolled 
in title XXI during a temporary enrollment 
period under this clause shall be treated as 
child health assistance under such title. 
‘‘(D) OPTION FOR AUTOMATIC ENROLLMENT.—
† HR 2 EAS 
‘‘(i) IN GENERAL.—The State may initiate 
and determine eligibility for medical assistance 
under the State Medicaid plan or for child 
health assistance under the State CHIP plan 
without a program application from, or on be-
half of, the child based on data obtained from 
sources other than the child (or the child’s fam-
ily), but a child can only be automatically en-
rolled in the State Medicaid plan or the State 
CHIP plan if the child or the family affirma-
tively consents to being enrolled through affirma-
tion in writing, by telephone, orally, through 
electronic signature, or through any other means 
specified by the Secretary or by signature on an 
Express Lane agency application, if the require-
ment of clause (ii) is met. 
‘‘(ii) INFORMATION REQUIREMENT.—The re-
quirement of this clause is that the State informs 
the parent, guardian, or custodial relative of the 
child of the services that will be covered, appro-
priate methods for using such services, premium 
or other cost sharing charges (if any) that apply, 
medical support obligations (under section 
1912(a)) created by enrollment (if applicable), 
and the actions the parent, guardian, or relative
† HR 2 EAS 
must take to maintain enrollment and renew 
coverage. 
‘‘(E) CODING; APPLICATION
TO
ENROLLMENT 
ERROR RATES.— 
‘‘(i) IN
GENERAL.—For purposes of sub-
paragraph (A)(iv), the requirement of this sub-
paragraph for a State is that the State agrees 
to— 
‘‘(I) assign such codes as the Secretary 
shall require to the children who are en-
rolled in the State Medicaid plan or the 
State CHIP plan through reliance on a 
finding made by an Express Lane agency 
for the duration of the State’s election under 
this paragraph; 
‘‘(II) annually provide the Secretary 
with a statistically valid sample (that is 
approved by Secretary) of the children en-
rolled in such plans through reliance on 
such a finding by conducting a full Med-
icaid eligibility review of the children iden-
tified for such sample for purposes of deter-
mining an eligibility error rate (as de-
scribed in clause (iv)) with respect to the 
enrollment of such children (and shall not
† HR 2 EAS 
include such children in any data or sam-
ples used for purposes of complying with a 
Medicaid 
Eligibility 
Quality 
Control 
(MEQC) review or a payment error rate 
measurement (PERM) requirement); 
‘‘(III) submit the error rate determined 
under subclause (II) to the Secretary; 
‘‘(IV) if such error rate exceeds 3 per-
cent for either of the first 2 fiscal years in 
which the State elects to apply this para-
graph, demonstrate to the satisfaction of the 
Secretary the specific corrective actions im-
plemented by the State to improve upon 
such error rate; and 
‘‘(V) if such error rate exceeds 3 per-
cent for any fiscal year in which the State 
elects to apply this paragraph, a reduction 
in the amount otherwise payable to the 
State under section 1903(a) for quarters for 
that fiscal year, equal to the total amount 
of erroneous excess payments determined for 
the fiscal year only with respect to the chil-
dren included in the sample for the fiscal 
year that are in excess of a 3 percent error 
rate with respect to such children.
† HR 2 EAS 
‘‘(ii) NO
PUNITIVE
ACTION
BASED
ON 
ERROR RATE.—The Secretary shall not apply the 
error rate derived from the sample under clause 
(i) to the entire population of children enrolled 
in the State Medicaid plan or the State CHIP 
plan through reliance on a finding made by an 
Express Lane agency, or to the population of 
children enrolled in such plans on the basis of 
the State’s regular procedures for determining 
eligibility, or penalize the State on the basis of 
such error rate in any manner other than the re-
duction of payments provided for under clause 
(i)(V). 
‘‘(iii) RULE
OF
CONSTRUCTION.—Nothing 
in this paragraph shall be construed as relieving 
a State that elects to apply this paragraph from 
being subject to a penalty under section 1903(u), 
for payments made under the State Medicaid 
plan with respect to ineligible individuals and 
families that are determined to exceed the error 
rate permitted under that section (as determined 
without regard to the error rate determined 
under clause (i)(II)). 
‘‘(iv) ERROR RATE DEFINED.—In this sub-
paragraph, the term ‘error rate’ means the rate
100 
† HR 2 EAS 
of erroneous excess payments for medical assist-
ance (as defined in section 1903(u)(1)(D)) for 
the period involved, except that such payments 
shall be limited to individuals for which eligi-
bility determinations are made under this para-
graph and except that in applying this para-
graph under title XXI, there shall be substituted 
for references to provisions of this title cor-
responding provisions within title XXI. 
‘‘(F) EXPRESS LANE AGENCY.— 
‘‘(i) IN GENERAL.—In this paragraph, the 
term ‘Express Lane agency’ means a public 
agency that— 
‘‘(I) is determined by the State Med-
icaid agency or the State CHIP agency (as 
applicable) to be capable of making the de-
terminations of one or more eligibility re-
quirements 
described 
in 
subparagraph 
(A)(i); 
‘‘(II) is identified in the State Med-
icaid plan or the State CHIP plan; and 
‘‘(III) notifies the child’s family— 
‘‘(aa) of the information which 
shall be disclosed in accordance with 
this paragraph;
101 
† HR 2 EAS 
‘‘(bb) that the information dis-
closed will be used solely for purposes 
of determining eligibility for medical 
assistance under the State Medicaid 
plan or for child health assistance 
under the State CHIP plan; and 
‘‘(cc) that the family may elect to 
not have the information disclosed for 
such purposes; and 
‘‘(IV) enters into, or is subject to, an 
interagency agreement to limit the disclo-
sure and use of the information disclosed. 
‘‘(ii) INCLUSION OF SPECIFIC PUBLIC AGEN-
CIES.—Such term includes the following: 
‘‘(I) A public agency that determines 
eligibility for assistance under any of the 
following: 
‘‘(aa) The temporary assistance 
for needy families program funded 
under part A of title IV. 
‘‘(bb) A State program funded 
under part D of title IV. 
‘‘(cc) The State Medicaid plan. 
‘‘(dd) The State CHIP plan.
102 
† HR 2 EAS 
‘‘(ee) The Food and Nutrition Act 
of 2008 (7 U.S.C. 2011 et seq.). 
‘‘(ff) The Head Start Act (42 
U.S.C. 9801 et seq.). 
‘‘(gg) The Richard B. Russell Na-
tional School Lunch Act (42 U.S.C. 
1751 et seq.). 
‘‘(hh) The Child Nutrition Act of 
1966 (42 U.S.C. 1771 et seq.). 
‘‘(ii) The Child Care and Develop-
ment Block Grant Act of 1990 (42 
U.S.C. 9858 et seq.). 
‘‘(jj) The Stewart B. McKinney 
Homeless Assistance Act (42 U.S.C. 
11301 et seq.). 
‘‘(kk) The United States Housing 
Act of 1937 (42 U.S.C. 1437 et seq.). 
‘‘(ll) The Native American Hous-
ing Assistance and Self-Determination 
Act of 1996 (25 U.S.C. 4101 et seq.). 
‘‘(II) A State-specified governmental 
agency that has fiscal liability or legal re-
sponsibility for the accuracy of the eligi-
bility determination findings relied on by 
the State.
103 
† HR 2 EAS 
‘‘(III) A public agency that is subject 
to an interagency agreement limiting the 
disclosure and use of the information dis-
closed for purposes of determining eligibility 
under the State Medicaid plan or the State 
CHIP plan. 
‘‘(iii) EXCLUSIONS.—Such term does not 
include an agency that determines eligibility for 
a program established under the Social Services 
Block Grant established under title XX or a pri-
vate, for-profit organization. 
‘‘(iv) RULES OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as— 
‘‘(I) exempting a State Medicaid agen-
cy from complying with the requirements of 
section 1902(a)(4) relating to merit-based 
personnel standards for employees of the 
State Medicaid agency and safeguards 
against conflicts of interest); or 
‘‘(II) authorizing a State Medicaid 
agency that elects to use Express Lane agen-
cies under this subparagraph to use the Ex-
press Lane option to avoid complying with 
such requirements for purposes of making
104 
† HR 2 EAS 
eligibility determinations under the State 
Medicaid plan. 
‘‘(v) ADDITIONAL
DEFINITIONS.—In this 
paragraph: 
‘‘(I) STATE.—The term ‘State’ means 1 
of the 50 States or the District of Columbia. 
‘‘(II) STATE CHIP AGENCY.—The term 
‘State CHIP agency’ means the State agen-
cy responsible for administering the State 
CHIP plan. 
‘‘(III) STATE CHIP PLAN.—The term 
‘State CHIP plan’ means the State child 
health plan established under title XXI and 
includes any waiver of such plan. 
‘‘(IV) STATE MEDICAID AGENCY.—The 
term ‘State Medicaid agency’ means the 
State agency responsible for administering 
the State Medicaid plan. 
‘‘(V) STATE
MEDICAID
PLAN.—The 
term ‘State Medicaid plan’ means the State 
plan established under title XIX and in-
cludes any waiver of such plan. 
‘‘(G) CHILD
DEFINED.—For purposes of this 
paragraph, the term ‘child’ means an individual 
under 19 years of age, or, at the option of a State,
105 
† HR 2 EAS 
such higher age, not to exceed 21 years of age, as the 
State may elect. 
‘‘(H) STATE OPTION TO RELY ON STATE INCOME 
TAX DATA OR RETURN.—At the option of the State, a 
finding from an Express Lane agency may include 
gross income or adjusted gross income shown by State 
income tax records or returns. 
‘‘(I) APPLICATION.—This paragraph shall not 
apply with respect to eligibility determinations made 
after September 30, 2013.’’. 
(2) CHIP.—Section 2107(e)(1) (42 U.S.C. 
1397gg(e)(1)) is amended by redesignating subpara-
graphs (B), (C), and (D) as subparagraphs (C), (D), 
and (E), respectively, and by inserting after subpara-
graph (A) the following new subparagraph: 
‘‘(B) Section 1902(e)(13) (relating to the 
State option to rely on findings from an Express 
Lane agency to help evaluate a child’s eligibility 
for medical assistance).’’. 
(b) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary shall conduct, 
by grant, contract, or interagency agreement, a com-
prehensive, independent evaluation of the option pro-
vided under the amendments made by subsection (a).
106 
† HR 2 EAS 
Such evaluation shall include an analysis of the effec-
tiveness of the option, and shall include— 
(A) obtaining a statistically valid sample of 
the children who were enrolled in the State Med-
icaid plan or the State CHIP plan through reli-
ance on a finding made by an Express Lane 
agency and determining the percentage of chil-
dren who were erroneously enrolled in such 
plans; 
(B) determining whether enrolling children 
in such plans through reliance on a finding 
made by an Express Lane agency improves the 
ability of a State to identify and enroll low-in-
come, uninsured children who are eligible but 
not enrolled in such plans; 
(C) evaluating the administrative costs or 
savings related to identifying and enrolling chil-
dren in such plans through reliance on such 
findings, and the extent to which such costs differ 
from the costs that the State otherwise would 
have incurred to identify and enroll low-income, 
uninsured children who are eligible but not en-
rolled in such plans; and 
(D) any recommendations for legislative or 
administrative changes that would improve the
107 
† HR 2 EAS 
effectiveness of enrolling children in such plans 
through reliance on such findings. 
(2) REPORT TO CONGRESS.—Not later than Sep-
tember 30, 2012, the Secretary shall submit a report 
to Congress on the results of the evaluation under 
paragraph (1). 
(3) FUNDING.— 
(A) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there is 
appropriated to the Secretary to carry out the 
evaluation under this subsection $5,000,000 for 
the period of fiscal years 2009 through 2012. 
(B) BUDGET
AUTHORITY.—Subparagraph 
(A) constitutes budget authority in advance of 
appropriations Act and represents the obligation 
of the Federal Government to provide for the 
payment of such amount to conduct the evalua-
tion under this subsection. 
(c) ELECTRONIC TRANSMISSION OF INFORMATION.— 
Section 1902 (42 U.S.C. 1396a) is amended by adding at 
the end the following new subsection: 
‘‘(dd) ELECTRONIC
TRANSMISSION
OF
INFORMA-
TION.—If the State agency determining eligibility for med-
ical assistance under this title or child health assistance 
under title XXI verifies an element of eligibility based on
108 
† HR 2 EAS 
information from an Express Lane Agency (as defined in 
subsection (e)(13)(F)), or from another public agency, then 
the applicant’s signature under penalty of perjury shall not 
be required as to such element. Any signature requirement 
for an application for medical assistance may be satisfied 
through an electronic signature, as defined in section 
1710(1) of the Government Paperwork Elimination Act (44 
U.S.C. 3504 note). The requirements of subparagraphs (A) 
and (B) of section 1137(d)(2) may be met through evidence 
in digital or electronic form.’’. 
(d) AUTHORIZATION OF INFORMATION DISCLOSURE.— 
(1) IN GENERAL.—Title XIX is amended by add-
ing at the end the following new section: 
‘‘SEC. 1942. AUTHORIZATION TO RECEIVE RELEVANT IN-
FORMATION. 
‘‘(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, a Federal or State agency or private entity 
in possession of the sources of data directly relevant to eligi-
bility determinations under this title (including eligibility 
files maintained by Express Lane agencies described in sec-
tion 1902(e)(13)(F), information described in paragraph 
(2) or (3) of section 1137(a), vital records information 
about births in any State, and information described in 
sections 453(i) and 1902(a)(25)(I)) is authorized to convey 
such data or information to the State agency administering
109 
† HR 2 EAS 
the State plan under this title, to the extent such conveyance 
meets the requirements of subsection (b). 
‘‘(b) REQUIREMENTS FOR CONVEYANCE.—Data or in-
formation may be conveyed pursuant to subsection (a) only 
if the following requirements are met: 
‘‘(1) The individual whose circumstances are de-
scribed in the data or information (or such individ-
ual’s parent, guardian, caretaker relative, or author-
ized representative) has either provided advance con-
sent to disclosure or has not objected to disclosure 
after receiving advance notice of disclosure and a rea-
sonable opportunity to object. 
‘‘(2) Such data or information are used solely for 
the purposes of— 
‘‘(A) identifying individuals who are eligi-
ble or potentially eligible for medical assistance 
under this title and enrolling or attempting to 
enroll such individuals in the State plan; and 
‘‘(B) verifying the eligibility of individuals 
for medical assistance under the State plan. 
‘‘(3) An interagency or other agreement, con-
sistent with standards developed by the Secretary— 
‘‘(A) prevents the unauthorized use, disclo-
sure, or modification of such data and otherwise
110 
† HR 2 EAS 
meets applicable Federal requirements safe-
guarding privacy and data security; and 
‘‘(B) requires the State agency admin-
istering the State plan to use the data and infor-
mation obtained under this section to seek to en-
roll individuals in the plan. 
‘‘(c) PENALTIES FOR IMPROPER DISCLOSURE.— 
‘‘(1) CIVIL MONEY PENALTY.—A private entity 
described in the subsection (a) that publishes, dis-
closes, or makes known in any manner, or to any ex-
tent not authorized by Federal law, any information 
obtained under this section is subject to a civil money 
penalty in an amount equal to $10,000 for each such 
unauthorized publication or disclosure. The provisions 
of section 1128A (other than subsections (a) and (b) 
and the second sentence of subsection (f)) shall apply 
to a civil money penalty under this paragraph in the 
same manner as such provisions apply to a penalty 
or proceeding under section 1128A(a). 
‘‘(2) CRIMINAL PENALTY.—A private entity de-
scribed in the subsection (a) that willfully publishes, 
discloses, or makes known in any manner, or to any 
extent not authorized by Federal law, any informa-
tion obtained under this section shall be fined not 
more than $10,000 or imprisoned not more than 1
111 
† HR 2 EAS 
year, or both, for each such unauthorized publication 
or disclosure. 
‘‘(d) RULE OF CONSTRUCTION.—The limitations and 
requirements that apply to disclosure pursuant to this sec-
tion shall not be construed to prohibit the conveyance or 
disclosure of data or information otherwise permitted under 
Federal law (without regard to this section).’’. 
(2) CONFORMING AMENDMENT TO TITLE XXI.— 
Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as 
amended by subsection (a)(2), is amended by adding 
at the end the following new subparagraph: 
‘‘(F) Section 1942 (relating to authorization 
to receive data directly relevant to eligibility de-
terminations).’’. 
(3) CONFORMING AMENDMENT TO PROVIDE AC-
CESS TO DATA ABOUT ENROLLMENT IN INSURANCE 
FOR PURPOSES OF EVALUATING APPLICATIONS AND 
FOR
CHIP.—Section 1902(a)(25)(I)(i) (42 U.S.C. 
1396a(a)(25)(I)(i)) is amended— 
(A) by inserting ‘‘(and, at State option, in-
dividuals who apply or whose eligibility for med-
ical assistance is being evaluated in accordance 
with section 1902(e)(13)(D))’’ after ‘‘with respect 
to individuals who are eligible’’; and
112 
† HR 2 EAS 
(B) by inserting ‘‘under this title (and, at 
State option, child health assistance under title 
XXI)’’ after ‘‘the State plan’’. 
(e) AUTHORIZATION FOR STATES ELECTING EXPRESS 
LANE OPTION TO RECEIVE CERTAIN DATA DIRECTLY REL-
EVANT
TO
DETERMINING
ELIGIBILITY
AND
CORRECT 
AMOUNT OF ASSISTANCE.—The Secretary shall enter into 
such agreements as are necessary to permit a State that 
elects the Express Lane option under section 1902(e)(13) 
of the Social Security Act to receive data directly relevant 
to eligibility determinations and determining the correct 
amount of benefits under a State child health plan under 
CHIP or a State plan under Medicaid from the following: 
(1) The National Directory of New Hires estab-
lished under section 453(i) of the Social Security Act 
(42 U.S.C. 653(i)). 
(2) Data regarding enrollment in insurance that 
may help to facilitate outreach and enrollment under 
the State Medicaid plan, the State CHIP plan, and 
such other programs as the Secretary may specify. 
(f) EFFECTIVE DATE.—The amendments made by this 
section are effective on the date of the enactment of this Act.