I
106TH CONGRESS
2D SESSION
H. R. 4927
To amend title XIX and XXI of the Social Security Act to provide for
FamilyCare coverage for parents of enrolled children, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JULY 24, 2000
Mr. DINGELL (for himself, Mr. BROWN of Ohio, Mr. WAXMAN, Mr. STARK,
Mr. BERRY, Mr. GEPHARDT, Mr. ABERCROMBIE, Mr. ALLEN, MR. AN-
DREWS, Mr. BALDACCI, Ms. BALDWIN, Mr. CROWLEY, Ms. DELAURO,
Mr. DAVIS of Illinois, Mr. DEUTSCH, Mr. DOYLE, Mr. FRANK of Massa-
chusetts, Mr. FROST, Mr. GONZALEZ, Mr. GREEN of Texas, Ms. HOOLEY
of Oregon, Ms. KILPATRICK, Mr. KLINK, Mr. MENENDEZ, Mr. MORAN
of Virginia, Mr. MOORE, Mr. PALLONE, Mr. PAYNE, Ms. ROYBAL-AL-
LARD, Mr. RAHALL, Mr. RODRIGUEZ, Ms. SCHAKOWSKY, Mrs. LOWEY,
and Mr. WEYGAND) introduced the following bill; which was referred to
the Committee on Commerce
A BILL
To amend title XIX and XXI of the Social Security Act
to provide for FamilyCare coverage for parents of en-
rolled children, 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; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘FamilyCare Act of 2000’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Renaming of title XXI program.
Sec. 3. FamilyCare coverage of parents under the medicaid program and title
XXI.
Sec. 4. Automatic enrollment of children born to title XXI parents.
Sec. 5. Optional coverage of legal immigrants under the medicaid program and
title XXI.
Sec. 6. Optional coverage of children through age 20 under the medicaid pro-
gram and title XXI.
Sec. 7. Application of simplified title XXI procedures under the medicaid pro-
gram.
Sec. 8. Improving welfare-to-work transition under the medicaid program.
Sec. 9. Elimination of 100 hour rule and other AFDC-related eligibility restric-
tions.
Sec. 10. State grant program for market innovation.
Sec. 11. Limitations on conflicts of interest.
Sec. 12. Increase in CHIP allotment for each of fiscal years 2002 through
2004.
Sec. 13. Demonstration programs to improve medicaid and chip outreach to
homeless individuals and families.
Sec. 14. Authority to pay medicaid expansion costs from title XXI appropria-
tion.
Sec. 15. Creation of community access program.
SEC. 2. RENAMING OF TITLE XXI PROGRAM.
(a) IN GENERAL.—The heading of title XXI of the
Social Security Act (42 U.S.C. 1397aa et seq.) is amended
to read as follows:
‘‘TITLE XXI—FAMILYCARE PROGRAM’’.
(b) PROGRAM REFERENCES.—Any reference in any
provision of Federal law or regulation to ‘‘SCHIP’’ or
‘‘State children’s health insurance program’’ under title
XXI of the Social Security Act shall be deemed a reference
to the FamilyCare program under such title.
SEC. 3. FAMILYCARE COVERAGE OF PARENTS UNDER THE
MEDICAID PROGRAM AND TITLE XXI.
(a) INCENTIVES TO IMPLEMENT FAMILYCARE COV-
ERAGE.—
(1) UNDER MEDICAID.—
(A) ESTABLISHMENT OF NEW OPTIONAL
ELIGIBILITY
CATEGORY.—Section
1902(a)(10)(A)(ii) of the Social Security Act
(42 U.S.C. 1396a(a)(10)(A)(ii)) is amended—
(i) by striking ‘‘or’’ at the end of sub-
clause (XVI);
(ii) by adding ‘‘or’’ at the end of sub-
clause (XVII); and
(iii) by adding at the end the fol-
lowing new subclause:
‘‘(XVIII) who are parents de-
scribed in subsection (k)(1), but only
if the State meets the conditions de-
scribed in subsection (k)(2);’’.
(B) CONDITIONS FOR COVERAGE.—Section
1902 of such Act is further amended by insert-
ing after subsection (j) the following new sub-
section:
‘‘(k)(1)(A) Parents described in this paragraph are
the parents of an individual who is under 19 years of age
(or such higher age as the State may have elected under
(II) by inserting after paragraph
(3) the following new paragraph:
‘‘(4) For purposes of subsection (b) and section
2105(a)(1):
‘‘(A) FAMILYCARE
PARENTS.—The expendi-
tures described in this subparagraph are the fol-
lowing:
‘‘(i) PARENTS.—Expenditures for medical
assistance made available under section 1931,
or under section 1902(a)(10)(A)(ii)(XVIII) for
parents described in section 1902(k)(1), in a
family the income of which exceeds the income
level applicable under such section 1931 to a
family of the size involved as of January 1,
2000.
‘‘(ii) CERTAIN
PREGNANT
WOMEN.—Ex-
penditures for medical assistance for pregnant
women under section 1902(l)(1)(A) in a family
the income of which exceeds the income level
applicable under section 1902(l)(2)(A) to a
family of the size involved as of January 1,
2000.’’.
(D) APPROPRIATION FROM TITLE XXI AL-
LOTMENT FOR CERTAIN MEDICAID EXPANSION
COSTS.—Subparagraph 
(C) 
of 
section
2105(a)(1) of such Act, as inserted by section
14(a)(3), is amended to read as follows:
‘‘(C) FAMILYCARE
PARENTS.—Expendi-
tures for medical assistance that is attributable
to 
expenditures 
described 
in 
section
1905(u)(4)(A).’’.
(E) ONLY COUNTING ENHANCED PORTION
FOR
COVERAGE
OF
ADDITIONAL
PREGNANT
WOMEN.—Section 1905 of such Act (42 U.S.C.
1396d) is amended—
(i) in the fourth sentence of sub-
section (b), by inserting ‘‘(except in the
case of expenditures described in sub-
section (u)(5))’’ after ‘‘do not exceed’’;
(ii) in subsection (u), by inserting
after paragraph (4) (as inserted by sub-
paragraph (C)), the following new para-
graph:
‘‘(5) For purposes of the fourth sentence of sub-
section (b) and section 2105(a), the following payments
under this title do not count against a State’s allotment
under section 2104:
‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR
PREGNANT WOMEN WITH INCOME ABOVE JANUARY
1, 2000 INCOME LEVEL AND BELOW 185 PERCENT OF
POVERTY.—The portion of the payments made for
expenditures described in paragraph (4)(A)(ii) that
represents the amount that would have been paid if
the enhanced FMAP had not been substituted for
the Federal medical assistance percentage.’’.
(2) UNDER TITLE XXI.—
(A) FAMILYCARE COVERAGE.—Title XXI
of such Act is amended by adding at the end
the following new section:
‘‘SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PAR-
ENTS OF TARGETED LOW-INCOME CHILDREN.
‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any
other provision of this title, a State child health plan may
provide for coverage, through an amendment to its State
child health plan under section 2102, of FamilyCare as-
sistance for targeted low-income parents in accordance
with this section, but only if—
‘‘(1) the State meets the conditions described in
section 1902(k)(2); and
‘‘(2) the State elects to provide medical assist-
ance under section 1902(a)(10)(A)(ii)(XVIII) and
elects an applicable income limit that is not lower
than the limit described in subsection (b)(2)(A).
‘‘(b) DEFINITIONS.—For purposes of this section:
‘‘(1) FAMILYCARE
ASSISTANCE.—The term
‘FamilyCare assistance’ has the meaning given the
term child health assistance in section 2110(a) as if
any reference to targeted low-income children were
a reference to targeted low-income parents.
‘‘(2) TARGETED
LOW-INCOME
PARENT.—The
term ‘targeted low-income parent’ has the meaning
given the term targeted low-income child in section
2110(b) as if the reference to a child were deemed
a reference to a parent (as defined in paragraph (3))
of the child; except that in applying such section—
‘‘(A) there shall be substituted for the in-
come limit described in paragraph (1)(B)(ii)(I)
the applicable income limit in effect for a tar-
geted low-income child;
‘‘(B) in paragraph (3), January 1, 2000,
shall be substituted for July 1, 1997; and
‘‘(C) in paragraph (4), January 1, 2000,
shall be substituted for March 31, 1997.
‘‘(3) PARENT.—The term ‘parent’ has the
meaning given the term ‘caretaker’ for purposes of
carrying out section 1931.
‘‘(4) OPTIONAL
TREATMENT
OF
PREGNANT
WOMEN
AS
PARENTS.—A State child health plan
may treat a pregnant woman who is not otherwise
a parent as a targeted low-income parent for pur-
poses of this section but only if the State has estab-
lished an income level under section 1902(l)(2)(A)(i)
for pregnant women that is at least 185 percent of
the income official poverty line described in such sec-
tion.
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of FamilyCare assistance to targeted
low-income parents under subsection (a), the following
special rules apply:
‘‘(1) Any reference in this title (other than sub-
section (b)) to a targeted low-income child is deemed
to include a reference to a targeted low-income par-
ent.
‘‘(2) Any such reference to child health assist-
ance with respect to such parents is deemed a ref-
erence to FamilyCare assistance.
‘‘(3) In applying section 2103(e)(3)(B) in the
case of a family provided coverage under this sec-
tion, the limitation on total annual aggregate cost-
sharing shall be applied to the entire family.
‘‘(4) In applying section 2110(b)(4), any ref-
erence to ‘section 1902(l)(2) or 1905(n)(2) (as se-
lected by a State)’ is deemed a reference to the in-
come level applicable to parents under section 1931,
or, in the case of a pregnant woman described in
subsection (b)(4), the income level established under
section 1902(l)(2)(A).’’.
(B) ADDITIONAL ALLOTMENT FOR STATES
PROVIDING FAMILYCARE.—
(i) IN
GENERAL.—Section 2104 of
such Act (42 U.S.C. 1397dd), as amended
by section 14(b), is amended by inserting
after subsection (c) the following new sub-
section:
‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE PRO-
VIDING FAMILYCARE.—
‘‘(1) APPROPRIATION; TOTAL
ALLOTMENT.—
For the purpose of providing additional allotments
to States electing to provide FamilyCare coverage
under section 2111, there is appropriated, out of any
money in the Treasury not otherwise appropriated—
‘‘(A) for fiscal year 2002, $2,000,000,000;
‘‘(B) for fiscal year 2003, $2,000,000,000;
‘‘(C) for fiscal year 2004, $3,000,000,000;
‘‘(D) for fiscal year 2005, $3,000,000,000;
‘‘(E) for fiscal year 2006, $6,000,000,000;
‘‘(F) for fiscal year 2007, $7,000,000,000;
‘‘(G) for fiscal year 2008, $8,000,000,000;
‘‘(H) for fiscal year 2009, $9,000,000,000;
‘‘(I) for fiscal year 2010, $10,000,000,000;
and
‘‘(J) for fiscal year 2011 and each fiscal
year thereafter, the amount of the allotment
provided under this paragraph for the preceding
fiscal year increased by the percentage increase
(if any) in the medical care expenditure cat-
egory of the Consumer Price Index for All
Urban Consumers (United States city average).
‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.—
‘‘(A) IN GENERAL.—In addition to the al-
lotments provided under subsections (b) and
(c), subject to paragraph (3), of the amount
available for the additional allotments under
paragraph (1) for a fiscal year, the Secretary
shall allot to each State with a State child
health plan approved under this title and which
has elected to provide coverage under section
2111 during the fiscal year—
‘‘(i) in the case of such a State other
than a commonwealth or territory de-
scribed in clause (ii), the same proportion
as the proportion of the State’s allotment
under section 2104(b) (determined without
regard to section 2104(f)) to 98.95 percent
of the total amount of the allotments
under such section for such States eligible
for an allotment under this subparagraph
for such fiscal year; and
‘‘(ii) in the case of a commonwealth or
territory described in section 2104(c)(3),
the same proportion as the proportion of
the commonwealth’s or territory’s allot-
ment under section 2104(c) (determined
without regard to section 2104(f)) to 1.05
percent of the total amount of the allot-
ments under such section for common-
wealths and territories eligible for an allot-
ment under this subparagraph for such fis-
cal year.
‘‘(B) REDISTRIBUTION OF UNUSED ALLOT-
MENTS.—In applying subsection (f) with re-
spect to additional allotments made available
under this subsection, the procedures estab-
lished under such subsection shall ensure such
additional allotments are only made available to
States which have elected to provide coverage
under section 2111.
‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi-
tional allotments provided under this subsection are
not available for amounts expended before October
1, 2001. Such amounts are available for amounts ex-
pended on or after such date for child health assist-
ance for targeted low-income children, as well as for
FamilyCare assistance.’’.
(ii) 
CONFORMING
AMENDMENTS.—
Section 2104 of such Act (42 U.S.C.
1397dd), as amended by section 14(d)(3),
is further amended—
(I) in subsection (a), by inserting
‘‘subject to subsection (d),’’ after
‘‘under this section,’’;
(II) in subsection (b)(1), by in-
serting ‘‘and subsection (d)’’ after
‘‘Subject to paragraph (4)’’; and
(III) in subsection (c)(1), by in-
serting ‘‘subject to subsection (d),’’
after ‘‘for a fiscal year,’’.
(C) NO COST-SHARING FOR PREGNANCY-
RELATED
BENEFITS.—Section 2103(e)(2) of
such 
Act 
(42 
U.S.C. 
1397cc(e)(2)) 
is
amended—
(i) in the heading, by inserting ‘‘AND
PREGNANCY-RELATED
SERVICES’’ 
after
‘‘PREVENTIVE SERVICES’’; and
(ii) by inserting before the period at
the end the following: ‘‘and for pregnancy-
related services’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection apply to items and services fur-
nished on or after October 1, 2000.
(b) RULES FOR IMPLEMENTATION BEGINNING WITH
FISCAL YEAR 2006.—
(1) REQUIRED COVERAGE OF FAMILYCARE PAR-
ENTS.—Section 1902(a)(10)(A)(i) of the Social Se-
curity Act (42 U.S.C. 1396a(a)(10)(A)(i)) is
amended—
(A) by striking ‘‘or’’ at the end of sub-
clause (VI);
(B) by striking the semicolon at the end of
subclause (VII) and insert ‘‘, or’’; and
(C) by adding at the end the following new
subclause:
‘‘(VIII) who would be parents de-
scribed in subsection (k)(1) if the in-
come level specified in subsection
(k)(2)(B) were equal to at least 100
percent of the poverty line referred to
in such subsection;’’.
(2) EXPANSION
OF
AVAILABILITY
OF
EN-
HANCED
MATCH
UNDER
MEDICAID
FOR
PRE-CHIP
EXPANSIONS.—Paragraph (4) of section 1905(u) of
such Act (42 U.S.C. 1396d(u)), as inserted by sub-
section (a)(1)(C), is amended—
(A) by amending clause (ii) of subpara-
graph (A) to read as follows:
‘‘(ii) CERTAIN
PREGNANT
WOMEN.—Ex-
penditures for medical assistance for pregnant
women under section 1902(l)(1)(A) in a family
the income of which exceeds the 133 percent of
the income official poverty line.’’; and
(B) by adding at the end the following new
subparagraphs:
‘‘(B) PARENTS WITH INCOME ABOVE 100 PER-
CENT OF POVERTY BUT BELOW JANUARY 1, 2000 IN-
COME LEVEL.—The expenditures described in this
subparagraph are expenditures for medical assist-
ance made available for any parents described in
section 1902(a)(10)(A)(i)(VIII), whose income ex-
ceeds 100 percent of the income official poverty line
applicable to a family of the size involved but does
not exceed the applicable income level established
under this title (under section 1931 or otherwise) for
a parent in a family of the size involved as of Janu-
ary 1, 2000.
‘‘(C) CHILDREN
IN
FAMILIES
WITH
INCOME
ABOVE
MEDICAID
MANDATORY
LEVEL
NOT
PRE-
VIOUSLY
DESCRIBED.—The expenditures described
in this subparagraph are expenditures (other than
expenditures described in paragraph (2) or (3)) for
medical assistance made available to any child who
is 
eligible 
for 
assistance 
under 
section
1902(a)(10)(A) and the income of whose family ex-
ceeds the minimum income level required under sub-
section 1902(l)(2) for a child of the age involved
(treating any child who is 19 or 20 years of age as
being 18 years of age).’’.
(3) OFFSET
OF
ADDITIONAL
EXPENDITURES
FOR ENHANCED MATCH FOR PRE-CHIP EXPANSION;
ELIMINATION OF OFFSET FOR REQUIRED COVERAGE
OF FAMILYCARE PARENTS.—
(A) IN GENERAL.—Section 1905(u)(5) of
such Act (42 U.S.C. 1396d(u)(5)), as added by
subsection (a)(1)(E), is amended—
(i) by amending subparagraph (A) to
read as follows:
‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR
PREGNANT WOMEN WITH INCOME ABOVE 133 PER-
CENT OF POVERTY.—The portion of the payments
made for expenditures described in paragraph
(4)(A)(ii) that represents the amount that would
have been paid if the enhanced FMAP had not been
substituted for the Federal medical assistance per-
centage.’’; and
(ii) by adding at the end the following
new subparagraphs:
‘‘(B) FAMILYCARE PARENTS UNDER 100 PER-
CENT OF POVERTY.—Payments for expenditures de-
scribed in paragraph (4)(A)(i) in the case of parents
whose income does not exceed 100 percent of the in-
come official poverty line applicable to a family of
the size involved.
‘‘(C) REGULAR FMAP FOR EXPENDITURES FOR
PARENTS
WITH
INCOME
ABOVE
100
PERCENT
OF
POVERTY
BUT
BELOW
JANUARY
1, 2000
INCOME
LEVEL.—The portion of the payments made for ex-
penditures described in paragraph (4)(B) that rep-
resents the amount that would have been paid if the
enhanced FMAP had not been substituted for the
Federal medical assistance percentage.
‘‘(D) REGULAR FMAP FOR EXPENDITURES FOR
CERTAIN
CHILDREN
IN
FAMILIES
WITH
INCOME
ABOVE MEDICAID MANDATORY LEVEL.—The portion
of the payments made for expenditures described in
paragraph (4)(C) that represents the amount that
would have been paid if the enhanced FMAP had
not been substituted for the Federal medical assist-
ance percentage.’’.
(B) CONFORMING
AMENDMENTS.—Sub-
paragraph (C) of section 2105(a)(1) of such
Act, as inserted by section 14(a)(3) and as
amended by subsection (a)(1)(D), is amended
to read as follows:
‘‘(C) CERTAIN FAMILYCARE PARENTS AND
OTHERS.—Expenditures for medical assistance
that is attributable to expenditures described in
section 1905(u)(4), except as provided in sec-
tion 1905(u)(5).’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection apply as of October 1, 2005, to
fiscal years beginning on or after such date and to
expenditures under the State plan on and after such
date.
(c) MAKING TITLE XXI BASE ALLOTMENTS PERMA-
NENT.—Section 2104(a) of such Act (42 U.S.C.
1397dd(a)) is amended—
(1) by striking ‘‘and’’ at the end of paragraph
(9);
(2) by striking the period at the end of para-
graph (10) and inserting ‘‘; and’’; and
(3) by adding at the end the following new
paragraph:
‘‘(11) for fiscal year 2008 and each fiscal year
thereafter, the amount of the allotment provided
under this subsection for the preceding fiscal year
increased by the percentage increase (if any) in the
medical care expenditure category of the Consumer
Price Index for All Urban Consumers (United States
city average).’’.
(d) OPTIONAL APPLICATION OF PRESUMPTIVE ELI-
GIBILITY PROVISIONS TO PARENTS.—Section 1920A of
such Act (42 U.S.C. 1396r–1a) is amended by adding at
the end the following new subsection:
‘‘(e) In accordance with regulations, a State may
elect to apply the previous provisions of this section to pro-
vide for a period of presumptive eligibility for medical as-
sistance for a parent of a child with respect to whom such
a period is provided under this section.’’.
(e) CONFORMING AMENDMENTS.—
(1) 
ELIGIBILITY
CATEGORIES.—Section
1905(a) of such Act (42 U.S.C. 1396d(a)) is amend-
ed, in the matter before paragraph (1)—
(A) by striking ‘‘or’’ at the end of clause
(xi);
(B) by inserting ‘‘or’’ at the end of clause
(xii); and
(C) by inserting after clause (xii) the fol-
lowing new clause:
‘‘(xiii) who are parents described (or treated as
if described) in section 1902(k)(1),’’.
(2) INCOME LIMITATIONS.—Section 1903(f)(4)
of such Act (42 U.S.C. 1396b(f)(4))—
(A) effective October 1, 2005, by inserting
‘‘1902(a)(10)(A)(i)(VIII),’’ 
after
‘‘1902(a)(10)(A)(i)(VII),’’; and
(B) 
by 
inserting
‘‘1902(a)(10)(A)(ii)(XVII),
1902(a)(10)(A)(ii)(XVIII),’’ 
after
‘‘1902(a)(10)(A)(ii)(XVI),’’.
(3) CONFORMING
AMENDMENT
RELATING
TO
NO WAITING PERIOD FOR CERTAIN WOMEN.—Section
2102(b)(1)(B) 
of 
such 
Act 
(42 
U.S.C.
1397bb(b)(1)(B)) is amended—
(A) by striking ‘‘, and’’ at the end of
clause (i) and inserting a semicolon;
(B) by striking the period at the end of
clause (ii) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
clause:
‘‘(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of targeted
low-income women who are pregnant.’’.
SEC. 4. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO
TITLE XXI PARENTS.
Section 2102(b)(1) of the Social Security Act (42
U.S.C. 1397bb(b)(1)) is amended by adding at the end
the following new subparagraph:
‘‘(C) AUTOMATIC
ELIGIBILITY
OF
CHIL-
DREN
BORN
TO
A
PARENT
BEING
PROVIDED
FAMILYCARE.—Such eligibility standards shall
provide for automatic coverage of a child born
to an individual who is provided assistance
under this title in the same manner as medical
assistance would be provided under section
1902(e)(4) to a child described in such sec-
tion.’’.
SEC. 5. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS
UNDER THE MEDICAID PROGRAM AND TITLE
XXI.
(a) MEDICAID PROGRAM.—Section 1903(v) of the
Social Security Act (42 U.S.C. 1396b(v)) is amended—
(1) in paragraph (1), by striking ‘‘paragraph
(2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and
(2) by adding at the end the following new
paragraph:
‘‘(4)(A) A State may elect (in a plan amendment
under this title) to provide medical assistance under this
title, notwithstanding sections 401(a), 402(b), 403, and
421 of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, for aliens who are lawfully re-
siding in the United States (including battered aliens de-
scribed in section 431(c) of such Act) and who are other-
wise eligible for such assistance, within any of the fol-
lowing eligibility categories:
‘‘(i) PREGNANT WOMEN.—Women during preg-
nancy (and during the 60-day period beginning on
the last day of the pregnancy).
‘‘(ii) CHILDREN.—Children (as defined under
such plan), including optional targeted low-income
children described in section 1905(u)(2)(B).
‘‘(iii) PARENTS.—If the State has elected the
eligibility category described in clause (ii), caretaker
relatives who are parents (as defined by the State)
of children (described in such clause or otherwise)
who are eligible for medical assistance under the
plan.
‘‘(B) In the case of a State that has elected to provide
medical assistance to a category of aliens under subpara-
graph (A), no action may be brought under an affidavit
of support against any sponsor of such an alien on the
basis of provision of assistance to such category.’’.
(b) TITLE XXI.—Section 2107(e)(1) of such Act (42
U.S.C. 1397gg(e)(1)) is amended by adding at the end
the following new subparagraph:
‘‘(D) Section 1903(v)(4) (relating to op-
tional coverage of categories of permanent resi-
dent alien children and parents), but only, with
respect to an eligibility category under this title,
if the same eligibility category has been elected
under such section for purposes of title XIX.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section take effect on October 1, 2000, and apply to
medical assistance and child health assistance furnished
on or after such date.
SEC. 6. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE
20 UNDER THE MEDICAID PROGRAM AND
TITLE XXI.
(a) MEDICAID.—
(1) IN GENERAL.—Section 1902(l)(1)(D) of the
Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is
amended by inserting ‘‘(or, at the election of a
State, 20 or 21 years of age)’’ after ‘‘19 years of
age’’.
(2) CONFORMING AMENDMENTS.—
(A) Section 1902(e)(3)(A) of such Act (42
U.S.C. 1396a(e)(3)(A)) is amended by inserting
‘‘(or 1 year less than the age the State has
elected under subsection (l)(1)(D))’’ after ‘‘18
years of age’’.
(B) Section 1902(e)(12) of such Act (42
U.S.C. 1396a(e)(12)) is amended by inserting
‘‘or such higher age as the State has elected
under subsection (l)(1)(D)’’ after ‘‘19 years of
age’’.
(C) Section 1902(l)(5) of such Act (42
U.S.C. 1396a(l)(5)), as added by section
7(a)(2), is amended by inserting ‘‘(or such
higher age as the State has elected under para-
graph (1)(D))’’ after ‘‘19 years of age’’.
(D) Section 1920A(b)(1) of such Act (42
U.S.C. 1396r–1a(b)(1)) is amended by insert-
ing ‘‘or such higher age as the State has elected
under section 1902(l)(1)(D)’’ after ‘‘19 years of
age’’.
(E) Section 1928(h)(1) of such Act (42
U.S.C. 1396s(h)(1)) is amended by inserting
‘‘or 1 year less than the age the State has elect-
ed under section 1902(l)(1)(D)’’ before the pe-
riod at the end.
(F) Section 1932(a)(2)(A) of such Act (42
U.S.C. 1396u–2(a)(2)(A)) is amended by in-
serting ‘‘(or such higher age as the State has
elected under section 1902(l)(1)(D))’’ after ‘‘19
years of age’’.
(b) TITLE XXI.—Section 2110(c)(1) of such Act (42
U.S.C. 1397jj(c)(1)) is amended by inserting ‘‘(or such
higher age as the State has elected under section
1902(l)(1)(D))’’.
(c) EFFECTIVE DATE.—The amendments made by
this section take effect on October 1, 2000, and apply to
medical assistance and child health assistance provided on
or after such date.
SEC. 7. APPLICATION OF SIMPLIFIED TITLE XXI PROCE-
DURES UNDER THE MEDICAID PROGRAM.
(a) APPLICATION UNDER MEDICAID.—
(1) IN GENERAL.—Section 1902(l) of the Social
Security Act (42 U.S.C. 1396a(l)) is amended—
(A) in paragraph (3), by inserting ‘‘subject
to paragraph (5)’’, after ‘‘Notwithstanding sub-
section (a)(17),’’; and
(B) by adding at the end the following new
paragraph:
‘‘(5) With respect to determining the eligibility of in-
dividuals under 19 years of age (or such higher age as
the State has elected under paragraph (1)(D)) for medical
assistance under subsection (a)(10)(A) and, separately,
with respect to determining the eligibility of individuals
for 
medical 
assistance 
under 
subsection
(a)(10)(A)(i)(VIII) or (a)(10)(A)(ii)(XVIII), notwith-
standing any other provision of this title, if the State has
established a State child health plan under title XXI—
‘‘(A) the State may not apply a resource stand-
ard if the State does not apply such a standard
under such child health plan with respect to such in-
dividuals;
‘‘(B) the State shall use the same simplified eli-
gibility form (including, if applicable, permitting ap-
plication other than in person) as the State uses
under such State child health plan with respect to
such individuals;
‘‘(C) the State shall provide for initial eligibility
determinations and redeterminations of eligibility
using the same verification policies, forms, and fre-
quency as the State uses for such purposes under
such State child health plan with respect to such in-
dividuals; and
‘‘(D) the State shall not require a face-to-face
interview for purposes of initial eligibility determina-
tions and redeterminations unless the State requires
such an interview for such purposes under such child
health plan with respect to such individuals.’’.
(2) EFFECTIVE DATE.—The amendments made
by paragraph (1) apply to determinations of eligi-
bility made on or after the date that is 1 year after
the date of the enactment of this Act.
(b) ADDITIONAL ENTITIES QUALIFIED TO DETER-
MINE MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-IN-
COME CHILDREN.—
(1) IN GENERAL.—Section 1920A(b)(3)(A)(i) of
such Act (42 U.S.C. 1396r–1a(b)(3)(A)(i)) is
amended—
(A) by striking ‘‘or (II)’’ and inserting ‘‘,
(II)’’; and
(B) by inserting ‘‘eligibility of a child for
medical assistance under the State plan under
this title, or eligibility of a child for child health
assistance under the program funded under
title XXI, (III) is an elementary school or sec-
ondary school, as such terms are defined in sec-
tion 14101 of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 8801), an el-
ementary or secondary school operated or sup-
ported by the Bureau of Indian Affairs, a State
child support enforcement agency, a child care
resource and referral agency, an organization
that is providing emergency food and shelter
under a grant under the Stewart B. McKinney
Homeless Assistance Act, or a State office or
entity involved in enrollment in the program
under this title, under part A of title IV, under
title XXI, or that determines eligibility for any
assistance or benefits provided under any pro-
gram of public or assisted housing that receives
Federal funds, including the program under
section 8 or any other section of the United
States Housing Act of 1937 (42 U.S.C. 1437 et
seq.), or (IV) any other entity the State so
deems, as approved by the Secretary’’ before
the semicolon.
(2) TECHNICAL AMENDMENTS.—Section 1920A
of such Act (42 U.S.C. 1396r-1a) is amended—
(A) in subsection (b)(3)(A)(ii), by striking
‘‘paragraph (1)(A)’’ and inserting ‘‘paragraph
(2)(A)’’; and
(B) in subsection (c)(2), in the matter pre-
ceding subparagraph (A), by striking ‘‘sub-
section (b)(1)(A)’’ and inserting ‘‘subsection
(b)(2)(A)’’.
(3) APPLICATION TO PRESUMPTIVE ELIGIBILITY
FOR PREGNANT WOMEN UNDER MEDICAID.—Section
1920(b) of such Act (42 U.S.C. 1396r-1(b)) is
amended by adding at the end after and below para-
graph (2) the following flush sentence:
‘‘The term ‘qualified provider’ includes a qualified entity
as defined in section 1920A(b)(3).’’.
(4) APPLICATION UNDER TITLE XXI.—
(A) IN GENERAL.—Section 2107(e)(1) of
such Act (42 U.S.C. 1397gg(e)(1)), as amended
by section 5(b), is amended by adding at the
end the following new subparagraph:
‘‘(E) Sections 1920 and 1920A (relating to
presumptive eligibility).’’.
(B) EXCEPTION FROM LIMITATION ON AD-
MINISTRATIVE EXPENSES.—Section 2105(c)(2)
of such Act (42 U.S.C. 1397ee(c)(2)) is amend-
ed by adding at the end the following new sub-
paragraph:
‘‘(C) EXCEPTION FOR PRESUMPTIVE ELI-
GIBILITY
EXPENDITURES.—The 
limitation
under subparagraph (A) on expenditures shall
not apply to expenditures attributable to the
application of section 1920A (pursuant to sec-
tion 2107(e)(1)(E)), regardless of whether the
child is determined to be ineligible for the pro-
gram under this title or title XIX.’’.
(c) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR
TITLE XXI AND MEDICAID BENEFITS FOR CHILDREN
LOSING MEDICAID OR TITLE XXI ELIGIBILITY.—
(1) LOSS OF MEDICAID ELIGIBILITY.—Section
1902(a) of the Social Security Act (42 U.S.C.
1396a(a)) is amended—
(A) by striking the period at the end of
paragraph (65) and inserting ‘‘; and’’, and
(B) by inserting after paragraph (65) the
following new paragraph:
‘‘(66) provide, by not later than the first day of
the first month that begins more than 1 year after
the date of the enactment of this paragraph and in
the case of a State with a State child health plan
under title XXI, that before medical assistance to a
child (or a parent of a child) is discontinued under
this title, a determination of whether the child (or
parent) is eligible for benefits under title XXI shall
be made and, if determined to be so eligible, the
child (or parent) shall be automatically enrolled in
the program under such title without the need for a
new application.’’.
(2) LOSS OF TITLE XXI ELIGIBILITY.—Section
2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended by
redesignating subparagraphs (D) and (E) as sub-
paragraphs (E) and (F), respectively, and by insert-
ing after subparagraph (C) the following new sub-
paragraph:
‘‘(D) that before health assistance to a
child (or a parent of a child) is discontinued
under this title, a determination of whether the
child (or parent) is eligible for benefits under
title XIX is made and, if determined to be so
eligible, the child (or parent) is automatically
enrolled in the program under such title with-
out the need for a new application;’’.
(3) EFFECTIVE DATE.—The amendments made
by paragraphs (1) and (2) apply to individuals who
lose eligibility under the medicaid program under
title XIX, or under a State child health insurance
plan under title XXI, respectively, of the Social Se-
curity Act on or after the date that is 60 days after
the date of the enactment of this Act.
(d) PROVISION OF MEDICAID AND CHIP APPLICA-
TIONS AND INFORMATION UNDER THE SCHOOL LUNCH
PROGRAM.—Section 9(b)(2)(B) of the Richard B. Russell
National School Lunch Act (42 U.S.C. 1758(b)(2)(B) is
amended—
(1) by striking ‘‘(B) Applications’’ and inserting
‘‘(B)(i) Applications’’; and
(2) by adding at the end the following new
clause:
‘‘(ii)(I) Applications for free and reduced price
lunches that are distributed pursuant to clause (i) to par-
ents or guardians of children in attendance at schools par-
ticipating in the school lunch program under this Act shall
also contain information on the availability of medical as-
sistance under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) (commonly referred to as the ‘med-
icaid program’) and of child health assistance under title
XXI of such Act (commonly referred to as ‘CHIP’), in-
cluding information on how to obtain an application for
assistance under such program.
‘‘(II) Information on the medicaid program and
CHIP under subclause (I) shall be provided on a form sep-
arate from the application form for free and reduced price
lunches under clause (i).’’.
SEC. 
8. 
IMPROVING 
WELFARE-TO-WORK 
TRANSITION
UNDER THE MEDICAID PROGRAM.
(a) MAKING PROVISION PERMANENT.—
(1) IN
GENERAL.—Subsection (f) of section
1925 of the Social Security Act (42 U.S.C. 1396r–
6) is repealed.
(2) 
CONFORMING
AMENDMENT.—Section
1902(e)(1) of such Act (42 U.S.C. 1396a(e)(1)) is
repealed.
(b) STATE OPTION OF INITIAL 12-MONTH ELIGI-
BILITY.—Section 1925 of such Act (42 U.S.C. 1396r–6)
is amended—
(1) in subsection (a), by adding at the end the
following new paragraph:
‘‘(5) OPTION OF 12-MONTH INITIAL ELIGIBILITY
PERIOD.—A State may elect to treat any reference
in this subsection to a 6-month period (or 6 months)
as a reference to a 12-month period (or 12 months).
In the case of such an election, subsection (b) shall
not apply.’’; and
(2) in subsection (b)(1), by inserting ‘‘and sub-
section (a)(5)’’ after ‘‘paragraph (3)’’.
(c) SIMPLIFICATION OPTIONS.—
(1) REMOVAL OF ADMINISTRATIVE REPORTING
REQUIREMENTS FOR ADDITIONAL 6-MONTH EXTEN-
SION.—Section 1925(b)(2) of such Act (42 U.S.C.
1396r–6(b)(2)) is amended—
(A) by striking subparagraph (B);
(B) in subparagraph (A)(i)—
(i) by striking ‘‘(I)’’ and all that fol-
lows through ‘‘(II)’’ and inserting ‘‘(i)’’;
(ii) by striking ‘‘, and (III)’’ and in-
serting ‘‘and (ii)’’; and
(iii) by redesignating such subpara-
graph as subparagraph (A) (with appro-
priate indentation); and
(C) in subparagraph (A)(ii)—
(i) by striking ‘‘notify the family of
the reporting requirement under subpara-
graph (B)(ii) and’’ and inserting ‘‘provide
the family with notification of’’; and
(ii) by redesignating such subpara-
graph as subparagraph (B) (with appro-
priate indentation).
(2) REMOVAL OF REQUIREMENT FOR PREVIOUS
RECEIPT
OF
MEDICAL
ASSISTANCE.—Section
1925(a)(1) of such Act (42 U.S.C. 1396r–6(a)(1)) is
amended—
(A) by redesignating the matter after ‘‘RE-
QUIREMENT.—’’ as a subparagraph (A) with
the heading ‘‘IN GENERAL.—’’ and with appro-
priate indentation; and
(B) by adding at the end the following new
subparagraph:
‘‘(B) STATE OPTION TO WAIVE REQUIRE-
MENT FOR PREVIOUS RECEIPT OF MEDICAL AS-
SISTANCE.—A State may elect to apply sub-
paragraph (A) to any family whose eligibility
for assistance under section 1931 would other-
wise terminate because of hours of, or income
from, employment, without regard to the period
of previous receipt of assistance or aid.’’.
(3) PERMITTING INCREASE OR WAIVER OF 185
PERCENT
OF
POVERTY
EARNING
LIMIT.—Section
1925(b)(3)(A)(iii)(III) of such Act (42 U.S.C.
1396r–6(b)(3)(A)(iii)(III)) is amended—
(A) by inserting ‘‘(at its option)’’ after
‘‘the State’’; and
(B) by inserting ‘‘(or such higher percent
as the State may specify)’’ after ‘‘185 percent’’.
(4) EXEMPTION FOR STATES COVERING NEEDY
FAMILIES UP TO 185 PERCENT OF POVERTY.—Sec-
tion 1925 of such Act (42 U.S.C. 1396r–6), as
amended by subsection (a), is amended—
(A) in each of subsections (a)(1) and
(b)(1), by inserting ‘‘but subject to subsection
(f),’’ after ‘‘Notwithstanding any other provi-
sion of this title,’’; and
(B) by adding at the end the following new
subsection:
‘‘(f) EXEMPTION
FOR STATE COVERING NEEDY
FAMILIES UP TO 185 PERCENT OF POVERTY.—
‘‘(1) IN GENERAL.—At State option, the provi-
sions of this section shall not apply to a State that
uses the authority under section 1931(b)(2)(C) to
make medical assistance available under the State
plan under this title, at a minimum, to all individ-
uals described in section 1931(b)(1) in families with
gross incomes (determined without regard to work-
related child care expenses of such individuals) at or
below 185 percent of the income official poverty line
(as defined by the Office of Management and Budg-
et, and revised annually in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of
1981) applicable to a family of the size involved.
‘‘(2) APPLICATION TO OTHER PROVISIONS OF
THIS TITLE.—The State plan of a State described in
paragraph (1) shall be deemed to meet the require-
ments 
of 
sections 
1902(a)(10)(A)(i)(I) 
and
1902(e)(1).’’.
(d) EFFECTIVE DATE.—The amendments made by
this section take effect on October 1, 2000.
SEC. 9. ELIMINATION OF 100 HOUR RULE AND OTHER
AFDC-RELATED ELIGIBILITY RESTRICTIONS.
(a) IN GENERAL.—Section 1931(b)(1)(A)(ii) of the
Social Security Act (42 U.S.C. 1396u–1(b)(1)(A)(ii)) is
amended by inserting ‘‘other than the requirement that
the child be deprived of parental support or care by reason
of the death, continued absence from the home, incapacity,
or unemployment of a parent,’’ after ‘‘section 407(a),’’.
(b) CONFORMING AMENDMENT.—Section 1905(a) of
such Act (42 U.S.C. 1396d(a)) is amended, in the matter
before paragraph (1), in clause (ii), by striking ‘‘if such
child is (or would, if needy, be) a dependent child under
part A of title IV’’.
(c) EFFECTIVE DATE.—The amendments made by
this section apply to eligibility determinations made on or
after October 1, 2000.
SEC. 10. STATE GRANT PROGRAM FOR MARKET INNOVA-
TION.
(a) IN GENERAL.—The Secretary of Health and
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall establish a program (in this section referred
to as the ‘‘program’’) to award demonstration grants
under this section to States to allow States to demonstrate
the effectiveness of innovative ways to increase access to
health insurance through market reforms and other inno-
vative means. Such innovative means may include any of
the following:
(1) Alternative group purchasing or pooling ar-
rangements, such as a purchasing cooperatives for
small businesses, reinsurance pools, or high risk
pools.
(2) Individual or small group market reforms.
(3) Consumer education and outreach.
(4) Subsidies to individuals, employers, or both,
in obtaining health insurance.
(b) SCOPE; DURATION.—The program shall be lim-
ited to not more than 10 States and to a total period of
5 years, beginning on the date the first demonstration
grant is made.
(c) CONDITIONS FOR DEMONSTRATION GRANTS.—
(1) IN GENERAL.—The Secretary may not pro-
vide for a demonstration grant to a State under the
program unless the Secretary finds that under the
proposed demonstration grant—
(A) the State will provide for demonstrated
increase of access for some portion of the exist-
ing uninsured population through a market in-
novation (other than merely through a financial
expansion of a program initiated before the
date of the enactment of this Act);
(B) the State will comply with applicable
Federal laws;
(C) the State will not discriminate among
participants on the basis of any health status-
related factor (as defined in section 2791(d)(9)
of the Public Health Service Act), except to the
extent a State wishes to focus on populations
that otherwise would not obtain health insur-
ance because of such factors; and
(D) the State will provide for such evalua-
tion, in coordination with the evaluation re-
riod. Such evaluation shall include an analysis of improve-
ments in access, costs, quality of care, or choice of cov-
erage, under different demonstration grants.
(e) OPTION TO PROVIDE FOR INITIAL PLANNING
GRANTS.—Notwithstanding the previous provisions of this
section, under the program the Secretary may provide for
a portion of the amounts appropriated under subsection
(f) (not to exceed $5,000,000) to be made available to any
State for initial planning grants to permit States to de-
velop demonstration grant proposals under the previous
provisions of this section.
(f) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated $100,000,000 for each
fiscal year to carry out this section. Amounts appropriated
under this subsection shall remain available until ex-
pended.
(g) STATE DEFINED.—For purposes of this section,
the term ‘‘State’’ has the meaning given such term for
purposes of title XIX of the Social Security Act.
SEC. 11. LIMITATIONS ON CONFLICTS OF INTEREST.
(a) LIMITATION
ON CONFLICTS
OF INTEREST
IN
MARKETING ACTIVITIES.—
(1) TITLE XXI.—Section 2105(c) of the Social
Security Act (42 U.S.C. 300aa–5(c)) is amended by
adding at the end the following new paragraph:
‘‘(8) LIMITATION ON EXPENDITURES FOR MAR-
KETING ACTIVITIES.—Amounts expended by a State
for the use of an administrative vendor in marketing
health benefits coverage to low-income children
under this title shall not be considered, for purposes
of subsection (a)(2)(D), to be reasonable costs to ad-
minister the plan unless the following conditions are
met with respect to the vendor:
‘‘(A) The vendor is independent of any en-
tity offering the coverage in the same area of
the State in which the vendor is conducting
marketing activities.
‘‘(B) No person who is an owner, em-
ployee, consultant, or has a contract with the
vendor either has any direct or indirect finan-
cial interest with such an entity or has been ex-
cluded from participation in the program under
this title or title XVIII or XIX or debarred by
any Federal agency, or subject to a civil money
penalty under this Act.’’.
(b) PROHIBITION OF AFFILIATION WITH DEBARRED
INDIVIDUALS.—
(1) MEDICAID.—Section 1903(i) of such Act
(42 U.S.C. 1396b(i))is amended—
(A) by striking the period at the end of
paragraph (20) and inserting ‘‘; or’’; and
(B) by inserting after paragraph (20) the
following new paragraph:
‘‘(21) with respect to any amounts expended for
an entity that receives payments under the plan
unless—
‘‘(A) no person with an ownership or con-
trol interest (as defined in section 1124(a)(3))
in the entity is a person that is debarred, sus-
pended, or otherwise excluded from partici-
pating in procurement or non-procurement ac-
tivities under the Federal Acquisition Regula-
tion; and
‘‘(B) such entity has not entered into an
employment, consulting, or other agreement for
the provision of items or services that are mate-
rial to such entity’s obligations under the plan
with a person described in subparagraph (A).’’.
(2) TITLE XXI.—Section 2107(e)(1) of such Act
(42 U.S.C. 1397gg(e)(1)), as amended by sections
5(b) and 7(c)(3), is further amended by adding at
the end the following new subparagraph:
‘‘(F) Section 1902(a)(67) (relating to pro-
hibition of affiliation with debarred individ-
uals).’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to expenditures made on or after
the date of the enactment of this Act.
SEC. 12. INCREASE IN CHIP ALLOTMENT FOR EACH OF FIS-
CAL YEARS 2002 THROUGH 2004.
Paragraphs (5), (6), and (7) of Section 2104(a) of
the Social Security Act (42 U.S.C. 1397dd(a)) are amend-
ed by striking ‘‘$3,150,000,000’’ each place it appears and
inserting ‘‘$4,150,000,000’’.
SEC. 13. DEMONSTRATION PROGRAMS TO IMPROVE MED-
ICAID AND CHIP OUTREACH TO HOMELESS
INDIVIDUALS AND FAMILIES.
(a) AUTHORITY.—The Secretary of Health and
Human Services may award demonstration grants to not
more than 7 States (or other qualified entities) to conduct
innovative programs that are designed to improve out-
reach to homeless individuals and families under the pro-
grams described in subsection (b) with respect to enroll-
ment of such individuals and families under such pro-
grams and the provision of services (and coordinating the
provision of such services) under such programs.
(b) PROGRAMS FOR HOMELESS DESCRIBED.—The
programs described in this subsection are as follows:
(1) MEDICAID.—The program under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.).
(2) CHIP.—The program under title XXI of
such Act (42 U.S.C. 1397aa et seq.).
(3) TANF.—The program under part of A of
title IV of such Act (42 U.S.C. 601 et seq.).
(4) SAMHSA BLOCK GRANTS.—The program
of grants under part B of title XIX of the Public
Health Service Act (42 U.S.C. 300x–1 et seq.).
(5) FOOD
STAMP
PROGRAM.—The program
under the Food Stamp Act of 1977 (7 U.S.C. 2011
et seq.).
(6) WORKFORCE INVESTMENT ACT.—The pro-
gram under the Workforce Investment Act of 1999
(29 U.S.C. 2801 et seq.).
(7) WELFARE-TO-WORK.—The welfare-to-work
program under section 403(a)(5) of the Social Secu-
rity Act (42 U.S.C. 603(a)(5)).
(8) OTHER PROGRAMS.—Other public and pri-
vate benefit programs that serve low-income individ-
uals.
(c) APPROPRIATIONS.—For the purposes of carrying
out this section, there is appropriated, out of any funds
in the Treasury not otherwise appropriated, $10,000,000,
to remain available until expended.
SEC. 14. AUTHORITY TO PAY MEDICAID EXPANSION COSTS
FROM TITLE XXI APPROPRIATION.
(a) AUTHORITY TO PAY MEDICAID EXPANSION
COSTS
FROM
TITLE
XXI APPROPRIATION.—Section
2105(a) of the Social Security Act (42 U.S.C. 1397ee(a))
is amended—
(1) in paragraph (1)—
(A) by inserting ‘‘CHILD HEALTH ASSIST-
ANCE UNDER THIS TITLE.—Expenditures’’ be-
fore ‘‘for child health assistance’’;
(B) by striking ‘‘; and’’ at the end and in-
serting a period; and
(C) by redesignating such paragraph as
subparagraph (D) and indenting appropriately;
(2) in paragraph (2)—
(A) in subparagraph (A), by striking ‘‘for
payment’’;
(B) by inserting ‘‘ASSISTANCE AND ADMIN-
ISTRATIVE
EXPENDITURES
SUBJECT
TO
LIMIT.—Expenditures’’ before ‘‘only to the ex-
tent’’;
(C) by redesignating subparagraphs (A)
through (D) as clauses (i) through (iv), respec-
tively, and indenting appropriately; and
(D) by redesignating such paragraph as
subparagraph (E) and indenting appropriately;
(3) by striking ‘‘(a) IN GENERAL.—’’ and all
that follows up to subparagraph (D), as so redesig-
nated, and inserting the following:
‘‘(a) ALLOWABLE EXPENDITURES.—
‘‘(1) IN GENERAL.—Subject to the succeeding
provisions of this section, the Secretary shall pay to
each State with a plan approved under this title,
from its allotment under section 2104, an amount
for each quarter equal to the enhanced FMAP (or,
in the case of expenditures described in subpara-
graph (B), the Federal medical assistance percent-
age (as defined in the first sentence of section
1905(b))) of the following expenditures in the quar-
ter:
‘‘(A) CHILD HEALTH ASSISTANCE UNDER
MEDICAID.—Expenditures for child health as-
sistance under the plan for targeted low-income
children in the form of providing medical assist-
ance for expenditures described in the fourth
sentence of section 1905(b).
‘‘(B) MEDICAID PRESUMPTIVE ELIGIBILITY
FOR
CHILDREN.—Expenditures for the provi-
sion of medical assistance on behalf of a child
during a presumptive eligibility period under
section 1920A.
‘‘(C) RESERVED.—[reserved].’’; and
(4) by adding at the end the following new
paragraphs:
‘‘(2) ORDER OF PAYMENTS.—Payments under a
subparagraph of paragraph (1) from a State’s allot-
ment for expenditures described in each such sub-
paragraph shall be made on a quarterly basis in the
order of such subparagraph in such paragraph.
‘‘(3) NO DUPLICATIVE PAYMENT.—In the case
of expenditures for which payment is made under
paragraph (1), no payment shall be made under title
XIX.’’.
(b) ELIMINATION
OF REQUIREMENT TO REDUCE
TITLE
XXI ALLOTMENT
BY
MEDICAID
EXPANSION
COSTS.—Section 2104 of such Act (42 U.S.C. 1397dd)
is amended by striking subsection (d).
(c) AUTHORITY TO TRANSFER TITLE XXI APPRO-
PRIATIONS TO TITLE XIX APPROPRIATION ACCOUNT AS
REIMBURSEMENT
FOR MEDICAID EXPENDITURES
FOR
MEDICAID EXPANSION SERVICES.—Notwithstanding any
other provision of law, all amounts appropriated under
title XXI of the Social Security Act and allotted to a State
pursuant to subsection (b) or (c) of section 2104 of such
Act (42 U.S.C. 1397dd) for fiscal years 1998 through
2000 (including any amounts that, but for this provision,
would be considered to no longer be available) and not ex-
pended in providing child health assistance or related serv-
ices for which payment may be made pursuant to subpara-
graph (D) or (E) of section 2105(a)(1) of such Act (42
U.S.C. 1397ee(a)(1)), as redesignated by subsection (a),
shall be available to reimburse the Grants to States for
Medicaid account in an amount equal to the total pay-
ments made to such State under section 1903(a) of such
Act (42 U.S.C. 1396b(a)) for expenditures in such years
for medical assistance described in subparagraphs (A) and
(B) of section 2105(a)(1) of such Act (42 U.S.C.
1397ee(a)(1)), as so amended.
(d) CONFORMING AMENDMENTS.—
(1) SECTION 1905(b).—Section 1905(b) of such
Act (42 U.S.C. 1396d(b)) is amended in the fourth
sentence by striking ‘‘the State’s allotment under
section 2104 (not taking into account reductions
under section 2104(d)(2)) for the fiscal year reduced
by the amount of any payments made under section
2105 to the State from such allotment for such fis-
cal year’’ and inserting ‘‘the State’s allotment under
section 2104’’.
(2) SECTION
1905(u).—Section 1905(u)(1)(B)
of such Act (42 U.S.C. 1396d(u)(1)(B)) is amended
by striking ‘‘and section 2104(d)’’ and inserting
‘‘and section 2105(a)(1)’’.
(3) SECTION 2104.—Section 2104 of such Act
(42 U.S.C. 1397dd), as amended by subsection (b),
is further amended—
(A) in subsection (b)(1), by striking ‘‘and
subsection (d)’’; and
(B) in subsection (c)(1), by striking ‘‘sub-
ject to subsection (d),’’.
(4) SECTION 2105(c).—Section 2105(c) of such
Act (42 U.S.C. 1397ee(c)) is amended—
(A) in paragraph (2)(A), by striking all
that follows ‘‘Except as provided in this para-
graph,’’ and inserting ‘‘the amount of payment
that may be made under subsection (a) for a
fiscal year for expenditures for items described
in paragraph (1)(E) of such subsection shall
not exceed 10 percent of the total amount of ex-
penditures for which payment is made under
paragraph (1) of such subsection (other than
subparagraph (B)).’’;
(B) in paragraph (2)(B), by striking ‘‘de-
scribed in subsection (a)(2)’’ and inserting ‘‘de-
scribed in subsection (a)(1)(E)’’; and
(C) in paragraph (6)(B), by striking ‘‘Ex-
cept as otherwise provided by law,’’ and insert-
ing ‘‘Except as provided in subparagraph (A) or
(B) of subsection (a)(1) or any other provision
of law,’’.
(5) SECTION 2110(a).—Section 2110(a) of such
Act (42 U.S.C. 1397jj) is amended by striking ‘‘sec-
tion 
2105(a)(2)(A)’’ 
and 
inserting 
‘‘section
2105(a)(1)(E)(i)’’.
(e) 
TECHNICAL
AMENDMENT.—Section
2105(d)(2)(B)(ii) 
of 
such 
Act 
(42 
U.S.C.
1397ee(d)(2)(B)(ii)) is amended by striking ‘‘enhanced
FMAP under section 1905(u)’’ and inserting ‘‘enhanced
FMAP under the fourth sentence of section 1905(b)’’.
(f) EFFECTIVE DATE.—The amendments made by
this section shall be effective as if included in the enact-
ment of the Balanced Budget Act of 1997.
SEC. 15. CREATION OF COMMUNITY ACCESS PROGRAM.
Part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended by inserting after
subpart IV the following new subpart:
‘‘Subpart V—Community Access Program
‘‘SEC. 340. GRANTS TO STRENGTHEN THE EFFECTIVENESS,
EFFICIENCY, AND COORDINATION OF SERV-
ICES FOR THE UNINSURED AND UNDER-
INSURED.
‘‘(a) IN GENERAL.—The Secretary may make grants
for the purpose of assisting the development of integrated
health care delivery systems—
‘‘(1) to serve communities of individuals who
are uninsured and individuals who are underinsured;
‘‘(2) to expand the scope of services provided;
and
‘‘(3) to improve the efficiency and coordination
among the providers of such services.
‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive
a grant under this section, an entity must—
‘‘(1) be a public or nonprofit private entity such
as—
‘‘(A) a Federally qualified health center
(as defined under section 1861(aa)(4) of the
Social Security Act);
‘‘(B) a hospital that meets the require-
ments of section 340B(a)(4)(L) (or, if none are
available in the area, a hospital that is a pro-
vider of a substantial volume of non-emergency
health services to uninsured individuals and
families without regard to their ability to pay)
without regard to 340B (a)(4)(L)(iii); or
‘‘(C) a public health department; and
‘‘(2) represent a consortium of providers and,
as appropriate, related agencies or entities—
‘‘(A) whose principal purpose is to provide
a broad range of coordinated health care serv-
ices for a community defined in the entity’s
grant application (which may be a special popu-
lation group such as migrant and seasonal farm
workers, homeless persons or individuals with
disabilities);
‘‘(B) that includes all health care providers
that serve the community and that have tradi-
tionally provided care (beyond emergency serv-
ices) to uninsured and underinsured individuals
without regard to the individuals’ ability to pay
(if there are any such providers) unless any
such provider or providers declines to partici-
pate; and
‘‘(C) that may include other health care
providers and related agencies and organiza-
tions; except that preference shall be given to
applicants that are health care providers identi-
fied in paragraph (1).
‘‘(c) APPLICATIONS.—To be eligible to receive a grant
under this section, an eligible entity shall submit to the
Secretary an application, in such form and manner as the
Secretary shall prescribe, that shall—
‘‘(1) define a community of uninsured and
underinsured individuals that consists of all such
individuals—
‘‘(A) in a specified geographical area; or
‘‘(B) in a specified population within such
an area;
‘‘(2) identify the providers who will participate
in the consortium’s program under the grant, and
specify each one’s contribution to the care of unin-
sured and underinsured individuals in the commu-
nity, including the volume of care it provides to
medicare and medicaid beneficiaries and to privately
paid patients;
‘‘(3) describe the activities that the applicant
and the consortium propose to perform under the
grant to further the purposes of this section;
‘‘(4) demonstrate the consortium’s ability to
build on the current system for serving uninsured
and underinsured individuals by involving providers
who have traditionally provided a significant volume
of care for that community;
‘‘(5) demonstrate the consortium’s ability to de-
velop coordinated systems of care that either directly
provide or ensure the prompt provision of a broad
range of high-quality, accessible services, including,
as appropriate, primary, secondary, and tertiary
services, as well as substance abuse treatment and
mental health services in a manner which assures
continuity of care in the community;
‘‘(6) provide evidence of community involvement
in the development, implementation, and direction of
the program that it proposes to operate;
‘‘(7) demonstrate the consortium’s ability to en-
sure that individuals participating in the program
are enrolled in public insurance programs for which
they are eligible;
‘‘(8) present a plan for leveraging other sources
of revenue, which may include State and local
sources and private grant funds, and integrating
current and proposed new funding sources in a way
to assure long-term sustainability;
‘‘(9) describe a plan for evaluation of the activi-
ties carried out under the grant, including measure-
ment of progress toward the goals and objectives of
the program;
‘‘(10) demonstrate fiscal responsibility through
the use of appropriate accounting procedures and
appropriate management systems;
‘‘(11) include such other information as the
Secretary may prescribe; and
‘‘(12) demonstrate the commitment to serve the
community without regard to the ability of the indi-
vidual or family to pay by arranging for or providing
free or reduced charge care for the poor.
‘‘(d) PRIORITIES.—In awarding grants under this
section, the Secretary may accord priority to applicants—
‘‘(1) whose consortium includes public hospitals,
Federally qualified health centers (as defined in sec-
tion 1905(l)(2)(B) of the Social Security Act), and
other providers that are covered entities as defined
by section 340B(a)(4) of this Act (or that would be
covered entities as so defined but for subparagraph
(L)(iii) of such section);
‘‘(2) that identify a community whose geo-
graphical area has a high or increasing percentage
of individuals who are uninsured;
‘‘(3) whose consortium includes other health
care providers that have a tradition of serving unin-
sured individuals and underinsured individuals in
the community;
‘‘(4) who show evidence that the program would
expand utilization of preventive and primary care
services for uninsured and underinsured individuals
and families in the community, including mental
health services or substance abuse services;
‘‘(5) whose proposed program would improve
coordination between health care providers and ap-
propriate social service providers, including local and
regional human services agencies, school systems,
and agencies on aging;
‘‘(6) that demonstrate collaboration with State
and local governments;
‘‘(7) that make use of non-Federal contribu-
tions to the greatest extent possible; or
‘‘(8) that demonstrate a likelihood that the pro-
posed program will continue after support under this
section ceases.
‘‘(e) USE OF FUNDS.—
‘‘(1) USE BY GRANTEES.—
‘‘(A) IN GENERAL.—Except as provided in
paragraphs (2) and (3), a grantee may use
amounts provided under this section only for—
‘‘(i) direct expenses associated with
planning, developing, and operating the
greater integration of a health care deliv-
ery system so that it either directly pro-
vides or ensures the provision of a broad
range of services, as appropriate, including
primary, secondary, and tertiary services,
as well as substance abuse treatment and
mental health services; and
‘‘(ii) direct patient care and service
expansions to fill identified or documented
gaps within an integrated delivery system.
‘‘(B) SPECIFIC USES.—The following are
examples of purposes for which a grantee may
use grant funds, when such use meets the con-
ditions stated in subparagraph (A):
‘‘(i) Increase in outreach activities.
‘‘(ii) Improvements to case manage-
ment.
‘‘(iii) Improvements to coordination of
transportation to health care facilities.
‘‘(iv) Development of provider net-
works.
‘‘(v) Recruitment, training, and com-
pensation of necessary personnel.