I 
108TH CONGRESS 
1ST SESSION H. R. 1143
To amend title XIX of the Social Security Act to permit States to expand 
Medicaid eligibility to uninsured, poor adults. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 6, 2003
Ms. MILLENDER-MCDONALD (for herself, Mrs. CHRISTENSEN, Mr. FRANK of 
Massachusetts, Mr. MCNULTY, Ms. WOOLSEY, Mr. MCDERMOTT, and 
Mr. OWENS) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to permit 
States to expand Medicaid eligibility to uninsured, poor 
adults.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Keep America Healthy 
Act of 2003’’. 
SEC. 2. OPTIONAL MEDICAID COVERAGE OF UNINSURED, 
POOR ADULTS. 
(a) AVAILABILITY OF MEDICAID COVERAGE FOR UN-
INSURED, POOR ADULTS.—
(1) 
ADDITION
OF
OPTIONAL
COVERAGE 
GROUP.—Section 1902(a)(10)(A)(ii) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is 
amended—
(A) by striking ‘‘or’’ at the end of sub-
clause (XVII); 
(B) by striking the semicolon at the end of 
subclause (XVIII) and inserting ‘‘, or’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(XIX) described in subsection 
(cc);’’. 
(2) ELIGIBILITY STANDARDS FOR NEW ELIGI-
BILITY GROUP.—Section 1902 of such Act is further 
amended by adding at the end the following new 
subsection: 
‘‘(cc) COVERAGE OF UNINSURED, POOR ADULTS.—
For purposes of subsection (a)(10)(A)(ii)(XIX), individ-
uals described in this subsection are individuals who meet 
the following requirements: 
‘‘(1) AGE.—The individual is at least 21 years 
of age but is under 65 years of age. 
‘‘(2) INCOME.—The income of the individual’s 
family does not exceed a percentage (not to exceed 
200 percent) specified by the State of the poverty
line (as defined in section 2110(c)(5)) applicable to 
a family of the size involved and, at the option of 
a State, the individual’s resources do not exceed 
such resource level as the State may establish, so 
long as such resource level is not more restrictive 
than the resources an individual may have and ob-
tain benefits under the supplemental security income 
program under title XVI.’’. 
(b) PROVISION OF ENHANCED FEDERAL MEDICAL 
ASSISTANCE AS INCENTIVE FOR STATES TO INCREASE 
COVERAGE.—
(1) APPLICATION
OF
ENHANCED
FEDERAL 
MEDICAL
ASSISTANCE
PERCENTAGE.—Section 
1905(b)(4) of such Act (42 U.S.C. 1396d(b)(4)) is 
amended 
by 
inserting 
‘‘or 
section 
1902(a)(10)(A)(ii)(XIX)’’ 
after 
‘‘section 
1902(a)(10)(A)(ii)(XVIII)’’. 
(2) INCREASE
IN
MEDICAID
PAYMENT
LIMIT 
FOR
TERRITORIES
TO
ACCOMMODATE
EXPANDED 
COVERAGE FOR RESIDENTS OF PUERTO RICO, THE 
VIRGIN ISLANDS, GUAM, AMERICAN SAMOA, AND THE 
NORTHERN
MARIANA
ISLANDS.—Section 1108 of 
such Act (42 U.S.C. 1308) is amended—
(A) in subsection (f), by striking ‘‘sub-
section (g)’’ and inserting ‘‘subsections (g) and 
(h)’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(h) INCREASE IN MEDICAID PAYMENT LIMIT TO 
ACCOMMODATE EXPANDED COVERAGE UNDER THE KEEP 
AMERICA HEALTHY ACT.—
‘‘(1) FISCAL YEAR 2004 AND THEREAFTER.—
With respect to fiscal year 2004 and each succeeding 
fiscal year, if Puerto Rico, the Virgin Islands, Guam, 
the Northern Mariana Islands, or American Samoa 
provides for coverage of individuals under section 
1902(a)(10)(A)(ii)(XIX) in a fiscal year, the 
amounts otherwise determined for the respective ter-
ritory under subsections (f) and (g) for such fiscal 
year shall be increased by a percentage (estimated 
by the Secretary) equal to 120 percent of the State 
average Keep America Healthy percentage, esti-
mated by the Secretary under paragraph (2) for the 
fiscal year involved. 
‘‘(2) ANNUAL ESTIMATION OF STATE AVERAGE 
KEEP AMERICA HEALTHY PERCENTAGE.—For each 
such fiscal year the Secretary shall estimate a State 
average Keep America Healthy percentage equal to
(A) the total Federal payments under title XIX for 
the fiscal year for the 50 States and the District of 
Columbia that are attributable to individuals made 
eligible 
for 
benefits 
under 
section 
1902(a)(10)(A)(ii)(XIX), divided by (B) the total 
Federal payments under such title the fiscal year for 
such States and District.’’. 
(c) CONFORMING AND TECHNICAL AMENDMENTS.—
(1) Section 1903(f)(4) of such Act (42 U.S.C. 
1396b(f)(4)) 
is 
amended 
by 
inserting 
‘‘1902(a)(10)(A)(ii)(XIX),’’ 
after 
‘‘1902(a)(10)(A)(ii)(XVIII),’’. 
(2) Section 1905(a) of such Act (42 U.S.C. 
1396d(a)) is amended, in the matter before paragraph 
(1)—
(A) by striking ‘‘or’’ at the end of clause (xii); 
(B) by adding ‘‘or’’ at the end of clause (xiii); 
and 
(C) by inserting after clause (xiii) the following 
new clause: 
‘‘(xiv) 
individuals 
described 
in 
section 
1902(cc),’’. 
(3) Section 1905(u)(4) of such Act (42 U.S.C. 
1396d(u)(4)) is amended by inserting before the period
at the end the following: ‘‘for individuals not covered 
under section 1902(a)(10)(A)(ii)(XIX)’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on October 1, 2003.
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