I
107TH CONGRESS
1ST SESSION
H. R. 1142
To amend title XIX of the Social Security Act to permit uninsured individuals
to obtain coverage under the Medicaid Program, to assure coverage
of prescription drugs, alcohol and drug abuse treatment services, mental
health services, long-term care services, and other services, and for other
purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 21, 2001
Mr. CONYERS (for himself, Mrs. CHRISTENSEN, Mr. BONIOR, and Mrs. JONES
of Ohio) 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
uninsured individuals to obtain coverage under the Med-
icaid Program, to assure coverage of prescription drugs,
alcohol and drug abuse treatment services, mental health
services, long-term care services, and other services, and
for other purposes.
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 ‘‘Working American
Families Access to Health Care Act of 2001’’ or ‘‘Medi-
Access Act of 2001’’.
SEC. 2. MEDI-ACCESS PROGRAM.
(a) AVAILABILITY OF MEDICAID COVERAGE FOR UN-
INSURED INDIVIDUAL UNDER MEDI-ACCESS.—
(1) EXPANSION TO INDIVIDUALS WITH FAMILY
INCOME BELOW 400 PERCENT (OR 600 PERCENT IN
2004) OF POVERTY LINE WITHOUT APPLYING ANY
ASSET TEST.—
(A) IN GENERAL.—Section 1902 of the So-
cial Security Act (42 U.S.C. 1396a) is
amended—
(i) in subsection (a)(10)(A)(i)—
(I) by striking ‘‘or’’ at the end of
subclause (VI);
(II) by striking the semicolon at
the end of subclause (VII) and insert-
ing ‘‘, or’’; and
(III) by adding at the end the
following new subclause:
‘‘(VIII) described in subsection
(cc);’’; and
(ii) by adding at the end, as amended
by section 2(a) of the Breast and Cervical
Cancer Prevention and Treatment Act of
2000 (Public Law 106–354; 114 Stat.
1381) and section 702(b) of the Medicare,
Medicaid, and SCHIP Benefits Improve-
ment and Protection Act of 2000 (as en-
acted into law by section 1(a)(6) of Public
Law 106–554), the following new sub-
section:
‘‘(cc)(1) For purposes of (a)(10)(A)(i)(VIII), individ-
uals described in this subsection are individuals who meet
the following requirements:
‘‘(A) Subject to paragraph (2), the income of
the individual’s family does not exceed 400 percent
(or, effective January 1, 2004, 600 percent) of the
poverty line (as defined in section 2110(c)(5)) appli-
cable to a family of the size involved.
‘‘(B) The individual is not otherwise described
or covered under this title under any other provision.
‘‘(C) Subject to paragraph (2), the individual
does not have creditable coverage (described in sec-
tion 2701(c)(1) of the Public Health Service Act,
but not taking into account subparagraph (F) of
that section or eligibility for benefits under title
XXI).
‘‘(2) The requirements of subparagraphs (A) and (C)
of paragraph (1) shall not apply in the case of an indi-
vidual if it is clearly demonstrated with respect to that
individual that—
‘‘(A) the individual has a life threatening, or a
severe and debilitating, illness or injury; and
‘‘(B)(i) any private health plan or health bene-
fits coverage under which the individual is covered
will not cover the illness or injury due to pre-existing
condition policies, or (ii) the individual or family
member would pay excessively high monthly pre-
miums or out-of-pocket expenses if covered under
such a plan or coverage due to having such illness
or injury.
Eligibility under this paragraph shall be determined by the
State on a case-by-case basis.
‘‘(3) An individual who is described in this subsection
is eligible for medical assistance without regard to the
amount of the assets or resources of the individual or the
individual’s family.’’.
(B) NO PREMIUMS FOR INDIVIDUALS WITH
INCOME
BELOW
300
PERCENT
OF
POVERTY
LINE; REQUIRING PREMIUMS ONLY FOR INDI-
VIDUALS WITH HIGHER INCOME.—Section 1916
of such Act (42 U.S.C. 1396o) is amended—
(i) in subsection (a), by striking ‘‘Sub-
ject to subsection (g)’’ and inserting ‘‘Sub-
ject to subsections (g) and (h)’’; and
(ii) by adding at the end the following
new subsection:
‘‘(h) With respect to an individual provided medical
assistance only under subclause (VIII) of section
1902(a)(10)(A)(i), if the individual’s family income—
‘‘(1) does not exceed 300 percent of the poverty
line (as defined in section 2110(c)(5)) applicable to
a family of the size involved, a State shall not re-
quire payment of any monthly premium;
‘‘(2) exceeds 300 percent (but does not exceed
350 percent) of such poverty line applicable to a
family of the size involved, a State shall require such
individuals to pay a monthly premium equal to $25
per month for each individual in the family so cov-
ered, but not to exceed $100 per month for all indi-
viduals in the family;
‘‘(3) exceeds 350 percent (but does not exceed
400 percent) of such poverty line, the State shall re-
quire such individuals to pay a monthly premium
equal to $50 per month for each individual in the
family so covered, but not to exceed $150 per month
for all individuals in the family; or
‘‘(4) exceeds 400 percent of such poverty line,
the State shall require such individuals to pay a
monthly premium equal to $150 per month for each
individual in the family so covered, but not to exceed
$450 per month for all individuals in the family.
A State may enter into an arrangement with an employer
that employs at least 2, but fewer than 51, employees
under which the employer will pay directly for premiums
established under this subsection. Nothing in this sub-
section shall be construed as authorizing the use of pre-
miums collected under this subsection for vouchers for the
purchase of private health insurance.’’.
(C) 
MISCELLANEOUS
CONFORMING
AMENDMENT.—(i) Section 1903(f)(4) of such
Act (42 U.S.C. 1396b(f)(4)) is amended by in-
serting 
‘‘1902(a)(10)(A)(i)(VIII),’’ 
after
‘‘1902(a)(10)(A)(i)(VII),’’.
(D) TECHNICAL
AMENDMENTS.—(i) Sec-
tion 1902 of such Act (42 U.S.C. 1396a), as
amended by section 702(b) of the Medicare,
Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000 (as enacted into law
by section 1(a)(6) of Public Law 106–554), is
amended by redesignating the subsection (aa)
added by such section as subsection (bb).
(ii) Section 1902(a)(15) of such Act (42
U.S.C. 1396a(a)(15)), as added by section
702(a)(2) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection
Act of 2000 (as so enacted into law), is amend-
ed by striking ‘‘subsection (aa)’’ and inserting
‘‘subsection (bb)’’.
(iii) Section 1915(b) of such Act (42
U.S.C. 1396n(b)), as amended by section
702(c)(2) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection
Act of 2000 (as so enacted into law), is amend-
ed by striking ‘‘1902(aa)’’ and inserting
‘‘1902(bb)’’.
(2) CLARIFICATION
OF
COVERAGE
OF
UNIN-
SURED MEN AND WOMEN, REGARDLESS OF MARITAL
STATUS.—Section 1905(a) of such Act (42 U.S.C.
1396d(a)) is amended, in the matter before para-
graph (1)—
(A) by striking ‘‘or’’ at the end of clause
(xi);
(B) by adding ‘‘or’’ at the end of clause
(xii); and
(C) by inserting after clause (xii) the fol-
lowing new clause:
‘‘(xiii) individuals described in section 1902(cc)
(which includes uninsured men and women, regard-
less of marital status),’’.
(3) MAKING PRESUMPTIVE ELIGIBILITY MANDA-
TORY.—
(A) IN
GENERAL.—Sections 1920 and
1920A of such Act (42 U.S.C. 1396r–1, 1396r–
1a) are each amended by striking ‘‘may pro-
vide’’ and inserting ‘‘shall provide’’.
(B) EXPANSION OF PRESUMPTIVE ELIGI-
BILITY TO ALL INDIVIDUALS.—Title XIX of the
Act is amended by inserting after section
1920A the following new section:
‘‘PRESUMPTIVE ELIGIBILITY FOR OTHER INDIVIDUALS
‘‘SEC. 1920B. (a) A State plan approved under sec-
tion 1902 shall provide for making medical assistance with
respect to health care items and services covered under
the State plan available to all individuals during a pre-
sumptive eligibility period.
‘‘(b) For purposes of this section:
‘‘(1) The term ‘presumptive eligibility period’
means, with respect to an individual, the period
that—
‘‘(A) begins with the date on which a
qualified entity determines, on the basis of pre-
liminary information, that the family income of
the individual does not exceed the applicable in-
come level of eligibility under the State plan,
and
‘‘(B) ends with (and includes) the earlier
of—
‘‘(i) the day on which a determination
is made with respect to the eligibility of
the individual for medical assistance under
the State plan, or
‘‘(ii) in the case of an individual on
whose behalf an application is not filed by
the last day of the month following the
month during which the entity makes the
determination referred to in subparagraph
(A), such last day.
‘‘(3)(A) Subject to subparagraph (B), the term
‘qualified entity’ means any entity that—
‘‘(i)(I) is eligible for payments under a
State plan approved under this title and pro-
vides items and services described in subsection
(a) or (II) is a qualified provider described in
section 1920(b)(2); and
‘‘(ii) is determined by the State agency to
be capable of making determinations of the type
described in paragraph (1)(A).
‘‘(B) The Secretary may issue regulations fur-
ther limiting those entities that may become quali-
fied entities in order to prevent fraud and abuse and
for other reasons.
‘‘(C) Nothing in this section shall be construed
as preventing a State from limiting the classes of en-
tities that may become qualified entities, consistent
with any limitations imposed under subparagraph
(B).
‘‘(c)(1) The State agency shall provide qualified enti-
ties with—
‘‘(A) such forms as are necessary for an appli-
cation to be made on behalf of a child for medical
assistance under the State plan, and
‘‘(B) information on how to assist parents,
guardians, and other persons in completing and fil-
ing such forms.
‘‘(2) A qualified entity that determines under sub-
section (b)(1)(A) that an individual is presumptively eligi-
ble for medical assistance under a State plan shall—
‘‘(A) notify the State agency of the determina-
tion within 5 working days after the date on which
determination is made, and
‘‘(B) inform the individual at the time the de-
termination is made that an application for medical
assistance under the State plan is required to be
made by not later than the last day of the month
following the month during which the determination
is made.
‘‘(3) In the case of an individual who is determined
by a qualified entity to be presumptively eligible for med-
ical assistance under a State plan, the individual shall
make application for medical assistance under such plan
by not later than the last day of the month following the
month during which the determination is made.
‘‘(d) Notwithstanding any other provision of this title,
medical assistance for items and services described in sub-
section (a) that—
‘‘(1) are furnished to an individual—
‘‘(A) during a presumptive eligibility pe-
riod,
‘‘(B) by an entity that is eligible for pay-
ments under the State plan; and
‘‘(2) are included in the care and services cov-
ered by a State plan;
shall be treated as medical assistance provided by such
plan for purposes of section 1903.’’.
(C) CONFORMING
AMENDMENT.—Section
1902(a)(47) 
of 
such 
Act 
(42 
U.S.C.
1396a(a)(47)) is amended by striking ‘‘at the
option of the State,’’.
(4) MINIMUM
ELIGIBILITY
PERIOD
FOR
CAT-
EGORICALLY NEEDY.—Section 1902(e) of such Act
(42 U.S.C. 1396a(e)) is amended by adding at the
end the following new paragraph:
‘‘(13) The State plan shall provide that an individual
who is determined to be eligible for benefits under a State
plan approved under this title under subsection (a)(10)(A)
shall remain eligible for those benefits until the end of the
12-month period following the date of such determina-
tion.’’.
(5) COVERAGE OF LEGAL IMMIGRANTS.—Sec-
tion 1902 of such Act (42 U.S.C. 1396a), as amend-
ed by paragraph (1)(A)(ii), is amended by adding at
the end the following new subsection:
‘‘(dd) Notwithstanding any other provision of law, the
provisions title IV of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (and of sec-
tion 213A of the Immigration and Nationality Act) shall
not apply to eligibility for medical assistance under this
title for individuals who are lawful permanent residents
of the United States.’’.
(6) MAIL-IN AND ON-LINE APPLICATION PROC-
ESS.—Section 1902(a)(8) of such Act (42 U.S.C.
1396a(a)(8)) is amended after ‘‘opportunity to do
so’’ the following: ‘‘and may do so through an appli-
cation submitted by mail or through electronic
means through the Internet, provide that applica-
tions are not longer than 3 pages and are made
available in different languages in order to provide
a fair and accessible application process,’’.
(7) CONFORMING
TERMINATION
OF
SCHIP.—
With respect to items and services furnished on or
after October 1, 2002, no Federal payments shall be
made under section 2105(a) of the Social Security
Act (42 U.S.C. 1397ee(a)).
(b) REQUIRING COVERAGE OF EARLY AND PERIODIC
SCREENING, DIAGNOSTIC, AND TREATMENT SERVICES
(EPSDT), COVERAGE
OF REHABILITATIVE SERVICES
FOR DISABLED OR DEVELOPMENTALLY DELAYED CHIL-
DREN, PRESCRIPTION DRUGS, MENTAL HEALTH
AND
PSYCHIATRIC SERVICES, ASSISTIVE TECHNOLOGY DE-
VICES AND SERVICES, DURABLE MEDICAL EQUIPMENT,
DRUG AND ALCOHOL TREATMENT SERVICES FOR ALL
MEDICAID ELIGIBLE INDIVIDUALS, ASSISTIVE TECH-
NOLOGY DEVICES AND SERVICES, DURABLE MEDICAL
EQUIPMENT, PRENATAL AND POSTNATAL CARE, AND RE-
PRODUCTIVE HEALTH SERVICES.—
(1) REQUIRING
COVERAGE
OF
SCREENING,
DENTAL, VISION, HEARING, AND FOLLOWUP SERV-
ICES (EPSDT) FOR INDIVIDUALS OF ALL AGES.—
(A) IN GENERAL.—Section 1905(a)(4)(B)
of such Act (42 U.S.C. 1396d(a)(4)(B)) is
amended by striking ‘‘and are under the age of
21’’.
(B) CONFORMING AMENDMENTS.—Section
1905(r) of such Act (42 U.S.C. 1396d(r)) is
amended, in each of paragraphs (1)(A)(i),
(2)(A)(i), (3)(A)(i), and (4)(A)(i), by inserting
‘‘, including for children, organizations’’ after
‘‘organizations’’.
(2) REQUIRING COVERAGE OF REHABILITATIVE
SERVICES AND ASSISTIVE TECHNOLOGIES FOR DIS-
ABLED
OR
DEVELOPMENTALLY
DELAYED
CHIL-
DREN.—Section 1905(r)(5) of such Act (42 U.S.C.
1396d(r)(5)) is amended by inserting before the pe-
riod at the end the following: ‘‘, and including reha-
bilitative services and assistive technologies for dis-
abled or developmentally disabled children, regard-
less of whether the disability was discovered by the
screening services’’.
(3) REQUIRING
COVERAGE
OF
PRESCRIPTION
DRUGS.—Section 1902(a)(10) of such Act (42
U.S.C. 1396a(a)(10)) is amended—
(A) in subparagraph (A), by inserting
‘‘(12),’’ after ‘‘(5),’’;
(B) in subparagraph (D)(iv), by inserting
‘‘, (12),’’ after ‘‘(5)’’;
(C) by striking ‘‘and’’ at the end of sub-
paragraph (F);
(D) by adding ‘‘and’’ at the end of sub-
paragraph (G); and
(E) by inserting after subparagraph (G)
the following new subparagraph:
‘‘(H) that the plan shall not deny medical
assistance for prescribed drugs for individuals
described in subparagraph (A)(i) if the drugs
have been prescribed by a treating physician (or
any other treating health care professional au-
thorized under law to prescribe the drugs);’’.
(4) REQUIRING COVERAGE OF DRUG AND ALCO-
HOL TREATMENT SERVICES.—
(A) REQUIREMENT.—Section 1902(a)(10)
of such Act (42 U.S.C. 1396a(a)(10)) is
amended—
(i) in subparagraph (A), by striking
‘‘(17) and (21)’’ and inserting ‘‘(10), (17),
(21), and (27)’’; and
(ii) in subparagraph (D)(iv), by strik-
ing ‘‘and (17)’’ and inserting ‘‘(10), (17),
and (27)’’ and by striking ‘‘through (24)’’
and inserting ‘‘through (27)’’.
(B) DRUG
AND
ALCOHOL
TREATMENT
SERVICES
DESCRIBED.—Section 1905(a) of
such Act (42 U.S.C. 1396d(a)) is amended—
(i) by striking ‘‘and’’ at the end of
paragraph (26);
(ii) by redesignating paragraph (27)
as paragraph (28); and
(iii) by inserting after paragraph (26)
the following new paragraph:
‘‘(27) alcohol and drug treatment services, in-
cluding coverage of inpatient and outpatient treat-
ment without durational restriction; and’’.
(5) REQUIRING COVERAGE OF INPATIENT AND
OUTPATIENT
MENTAL
HEALTH
AND
PSYCHIATRIC
SERVICES.—Section 1905(a)(5) of such Act (42
U.S.C. 1396d(a)(5)) is amended—
(A) by striking ‘‘and’’ before ‘‘(B)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (C) mental health
services and psychiatric services furnished by a
physician or other qualified mental health pro-
fessional, whether furnished on an inpatient or
outpatient basis’’.
(6) REQUIRING COVERAGE OF MENTAL HEALTH
SERVICES
WITHOUT
DURATIONAL
RESTRICTION.—
Section 1902(a)(10) of such Act (42 U.S.C.
1396a(a)(10)) is amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (F);
(B) by adding ‘‘and’’ at the end of sub-
paragraph (G); and
(C) by inserting after subparagraph (G)
the following new subparagraph:
‘‘(H) that does not impose durational lim-
its with respect to medical assistance for mental
health services;’’.
(7) REQUIRING
COVERAGE
OF
SOME
CHIRO-
PRACTIC SERVICES.—Section 1902(a)(10)(A) of such
Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the
matter before clause (i), by inserting ‘‘and profes-
sional services of chiropractors (other than electrical