I 
111TH CONGRESS 
1ST SESSION 
H. R. 542 
To amend titles XIX and XXI of the Social Security Act to permit States 
to rely on findings from an express plan agency to conduct simplified 
eligibility determinations under Medicaid and the State Children’s Health 
Insurance Program. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 14, 2009 
Mr. PUTNAM introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To amend titles XIX and XXI of the Social Security Act 
to permit States to rely on findings from an express 
plan agency to conduct simplified eligibility determina-
tions under Medicaid and the State Children’s Health 
Insurance Program. 
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 ‘‘Healthy Kids One Stop 
Act’’. 
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SEC. 2. STATE OPTION TO RELY ON FINDINGS FROM AN EX-
PRESS LANE AGENCY TO CONDUCT SIM-
PLIFIED 
ELIGIBILITY 
DETERMINATIONS 
UNDER MEDICAID AND SCHIP. 
(a) APPLICATION UNDER MEDICAID AND SCHIP.— 
(1) MEDICAID.—Section 1902(e) of the Social 
Security Act (42 U.S.C. 1396a(e)) is amended by 
adding at the end the following: 
‘‘(13) EXPRESS LANE OPTION.— 
‘‘(A) IN GENERAL.— 
‘‘(i) OPTION TO USE A FINDING FROM 
AN EXPRESS LANE AGENCY.—At the op-
tion of the State, the State plan may pro-
vide that in determining eligibility under 
this title for a child (as defined in subpara-
graph (G)), the State may rely on a find-
ing made within a reasonable period (as 
determined by the State) from an Express 
Lane agency (as defined in subparagraph 
(F)) when it determines whether a child 
satisfies one or more components of eligi-
bility for medical assistance under this 
title. The State may rely on a finding from 
an Express Lane agency notwithstanding 
any differences in budget unit, disregard, 
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deeming, or other methodology, if the fol-
lowing requirements are met: 
‘‘(I) PROHIBITION
ON
DETER-
MINING
CHILDREN
INELIGIBLE
FOR 
COVERAGE.—If a finding from an Ex-
press Lane agency would result in a 
determination that a child does not 
satisfy an eligibility requirement for 
medical assistance under this title and 
for child health assistance under title 
XXI, the State shall determine eligi-
bility 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 Ex-
press 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 reg-
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ular policies and of the procedures for 
requesting such an evaluation. 
‘‘(III) 
COMPLIANCE
WITH 
SCREEN
AND
ENROLL
REQUIRE-
MENT.—The State shall satisfy the re-
quirements under subparagraphs (A) 
and (B) of section 2102(b)(3) (relat-
ing to screen and enroll) before enroll-
ing a child in child health assistance 
under title XXI. At its option, the 
State may fulfill such requirements in 
accordance with either option provided 
under subparagraph (C) of this para-
graph. 
‘‘(IV) CODING.—The State meets 
the requirements 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, redeterminations of eligibility, or 
both, as described in the State plan. 
‘‘(B) RULES OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed— 
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‘‘(i) to limit or prohibit a State from 
taking any actions otherwise permitted 
under this title or title XXI in determining 
eligibility for or enrolling children into 
medical assistance under this title or child 
health assistance under title XXI; 
‘‘(ii) to modify the limitations in sec-
tion 1902(a)(5) concerning the agencies 
that may make a determination of eligi-
bility for medical assistance under this 
title; or 
‘‘(iii) to modify the application of sec-
tions 1137(d), 1902(a)(46), 1903(i)(22), 
or 1903(x). 
‘‘(C) 
OPTIONS
FOR
SATISFYING
THE 
SCREEN AND ENROLL REQUIREMENT.— 
‘‘(i) IN GENERAL.—With respect to a 
child whose eligibility for medical assist-
ance under this title or for child health as-
sistance under title XXI has been evalu-
ated by a State agency using an income 
finding from an Express Lane agency, a 
State may carry out its duties under sub-
paragraphs 
(A) 
and 
(B) 
of 
section 
2102(b)(3) (relating to screen and enroll) 
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in accordance with either clause (ii) or 
clause (iii). 
‘‘(ii) ESTABLISHING
A
SCREENING 
THRESHOLD.— 
‘‘(I) IN
GENERAL.—Under this 
clause, the State establishes a screen-
ing threshold set as a percentage of 
the Federal poverty level that exceeds 
the highest income threshold applica-
ble under this title to the child by a 
minimum of 30 percentage points or, 
at State option, a higher number of 
percentage points that reflects the 
value (as determined by the State and 
described in the State plan) of any 
differences between income methodolo-
gies used by the program adminis-
tered by the Express Lane agency and 
the methodologies used by the State 
in determining eligibility for medical 
assistance under this title. 
‘‘(II) CHILDREN
WITH
INCOME 
NOT ABOVE THRESHOLD.—If the in-
come of a child does not exceed the 
screening threshold, the child is 
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deemed to satisfy the income eligi-
bility criteria for medical assistance 
under this title regardless of whether 
such child would otherwise satisfy 
such criteria. 
‘‘(III) CHILDREN WITH INCOME 
ABOVE THRESHOLD.—If the income of 
a child exceeds the screening thresh-
old, 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 
requirement 
under 
section 
2110(b)(1)(C) (relating to the re-
quirement that CHIP matching funds 
be used only for children not eligible 
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 following: 
‘‘(aa) Notice that the child 
may be eligible to receive medical 
assistance under the State plan 
under this title if evaluated for 
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such assistance under the State’s 
regular procedures and notice of 
the process through which a par-
ent, guardian, or custodial rel-
ative can request that the State 
evaluate the child’s eligibility for 
medical assistance under this 
title using such regular proce-
dures. 
‘‘(bb) A description of dif-
ferences between the medical as-
sistance provided 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 assistance under title XXI for 
a temporary period if the child ap-
pears eligible for such assistance 
based on an income finding by an Ex-
press Lane agency. 
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‘‘(II) DETERMINATION OF ELIGI-
BILITY.—During such temporary en-
rollment period, the State shall deter-
mine 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 
making such a determination, the 
State shall take prompt action to de-
termine whether the child should be 
enrolled in medical assistance under 
this title or child health assistance 
under title XXI pursuant to subpara-
graphs 
(A) 
and 
(B) 
of 
section 
2102(b)(3) (relating to screen and en-
roll). 
‘‘(IV) REQUIREMENT
FOR
SIM-
PLIFIED
DETERMINATION.—In mak-
ing such a determination, the State 
shall use procedures that, to the max-
imum feasible extent, reduce the bur-
den imposed on the individual of such 
determination. Such procedures may 
not require the child’s parent, guard-
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ian, or custodial relative to provide or 
verify information that already has 
been provided to the State agency by 
an Express Lane agency or another 
source of information unless the State 
agency has reason to believe the infor-
mation is erroneous. 
‘‘(V) 
AVAILABILITY
OF
CHIP 
MATCHING
FUNDS
DURING
TEM-
PORARY ENROLLMENT PERIOD.—Med-
ical assistance for items and services 
that are provided to a child enrolled in 
title XXI during a temporary enroll-
ment period under this clause shall be 
treated as child health assistance 
under such title. 
‘‘(D) OPTION
FOR
AUTOMATIC
ENROLL-
MENT.— 
‘‘(i) IN
GENERAL.—The State may 
initiate and determine eligibility for med-
ical assistance under the State Medicaid 
plan or for child health assistance under 
the State CHIP plan without a program 
application from, or on behalf of, the child 
based on data obtained from sources other 
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than the child (or the child’s family), but 
a child can only be automatically enrolled 
in the State Medicaid plan or the State 
CHIP plan if the child or the family af-
firmatively consents to being enrolled 
through affirmation and signature on an 
Express Lane agency application, if the re-
quirement of clause (ii) is met. 
‘‘(ii) INFORMATION REQUIREMENT.— 
The requirement of this clause is that the 
State informs the parent, guardian, or cus-
todial relative of the child of the services 
that will be covered, appropriate 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 applica-
ble), and the actions the parent, guardian, 
or relative must take to maintain enroll-
ment and renew coverage. 
‘‘(E) CODING; APPLICATION TO ENROLL-
MENT ERROR RATES.— 
‘‘(i) IN
GENERAL.—For purposes of 
subparagraph (A)(iv), the requirement of 
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this subparagraph for a State is that the 
State agrees to— 
‘‘(I) assign such codes as the 
Secretary shall require to the children 
who are enrolled in the State Med-
icaid plan or the State CHIP plan 
through reliance on a finding made by 
an Express Lane agency for the dura-
tion of the State’s election under this 
paragraph; 
‘‘(II) annually provide the Sec-
retary with a statistically valid sample 
(that is approved by Secretary) of the 
children 
enrolled 
in 
such 
plans 
through reliance on such a finding by 
conducting a full Medicaid eligibility 
review of the children identified 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 include such children in any 
data or samples used for purposes of 
complying with a Medicaid Eligibility 
Quality Control (MEQC) review or a 
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payment 
error 
rate 
measurement 
(PERM) requirement); 
‘‘(III) submit the error rate de-
termined under subclause (II) to the 
Secretary; 
‘‘(IV) if such error rate exceeds 3 
percent for either of the first 2 fiscal 
years in which the State elects to 
apply this paragraph, demonstrate to 
the satisfaction of the Secretary the 
specific corrective actions implemented 
by the State to improve upon such 
error rate; and 
‘‘(V) if such error rate exceeds 3 
percent for any fiscal year in which 
the State elects to apply this para-
graph, a reduction in the amount oth-
erwise payable to the State under sec-
tion 1903(a) for quarters for that fis-
cal year, equal to the total amount of 
erroneous excess payments determined 
for the fiscal year only with respect to 
the children included in the sample 
for the fiscal year that are in excess 
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of a 3 percent error rate with respect 
to such children. 
‘‘(ii) NO PUNITIVE ACTION BASED ON 
ERROR
RATE.—The Secretary shall not 
apply the error rate derived from the sam-
ple under clause (i) to the entire popu-
lation 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 reduction of pay-
ments provided for under clause (i)(V). 
‘‘(iii) RULE
OF
CONSTRUCTION.— 
Nothing in this paragraph shall be con-
strued as relieving a State that elects to 
apply this paragraph from being subject to 
a penalty under section 1903(u), for pay-
ments 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 
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determined without regard to the error 
rate determined under clause (i)(II)). 
‘‘(iv) ERROR RATE DEFINED.—In this 
subparagraph, the term ‘error rate’ means 
the rate of erroneous excess payments for 
medical assistance (as defined in section 
1903(u)(1)(D)) for the period involved, ex-
cept that such payments shall be limited to 
individuals for which eligibility determina-
tions are made under this paragraph and 
except that in applying this paragraph 
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 
Medicaid agency or the State CHIP 
agency (as applicable) to be capable of 
making the determinations of one or 
more eligibility requirements described 
in subparagraph (A)(i); 
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‘‘(II) is identified in the State 
Medicaid plan or the State CHIP 
plan; and 
‘‘(III) notifies the child’s fam-
ily— 
‘‘(aa) of the information 
which shall be disclosed in ac-
cordance with this paragraph; 
‘‘(bb) that the information 
disclosed will be used solely for 
purposes of determining eligi-
bility 
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 disclosure and use of the informa-
tion disclosed. 
‘‘(ii) INCLUSION OF SPECIFIC PUBLIC 
AGENCIES.—Such term includes the fol-
lowing: 
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‘‘(I) A public agency that deter-
mines eligibility for assistance under 
any of the following: 
‘‘(aa) The temporary assist-
ance 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. 
‘‘(ee) The supplemental nu-
trition assistance program under 
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. Rus-
sell National School Lunch Act 
(42 U.S.C. 1751 et seq.). 
‘‘(hh) The Child Nutrition 
Act of 1966 (42 U.S.C. 1771 et 
seq.). 
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‘‘(ii) The Child Care and 
Development Block Grant Act of 
1990 (42 U.S.C. 9858 et seq.). 
‘‘(jj) The Stewart B. McKin-
ney 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 
Housing Assistance and Self-De-
termination Act of 1996 (25 
U.S.C. 4101 et seq.). 
‘‘(II) A State-specified govern-
mental agency that has fiscal liability 
or legal responsibility for the accuracy 
of the eligibility determination find-
ings relied on by the State. 
‘‘(III) A public agency that is 
subject to an interagency agreement 
limiting the disclosure and use of the 
information disclosed for purposes of 
determining eligibility under the State 
Medicaid plan or the State CHIP 
plan. 
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