Sec. 1. Short title; amendments to Social Security Act; references; table of con-
tents. 
TITLE I—FINANCING OF CHIP 
Sec. 101. Extension of CHIP. 
Sec. 102. Allotments for the 50 States and the District of Columbia. 
Sec. 103. One-time appropriation. 
Sec. 104. Improving funding for the territories under CHIP and Medicaid. 
Sec. 105. Incentive bonuses for States. 
Sec. 106. Phase-out of coverage for nonpregnant childless adults under CHIP; 
conditions for coverage of parents. 
Sec. 107. State option to cover low-income pregnant women under CHIP 
through a State plan amendment. 
Sec. 108. CHIP Contingency fund. 
Sec. 109. Two-year availability of allotments; expenditures counted against old-
est allotments. 
Sec. 110. Limitation on matching rate for States that propose to cover children 
with effective family income that exceeds 300 percent of the 
poverty line. 
Sec. 111. Option for qualifying States to receive the enhanced portion of the 
CHIP matching rate for Medicaid coverage of certain children. 
TITLE II—OUTREACH AND ENROLLMENT 
Sec. 201. Grants for outreach and enrollment. 
Sec. 202. Increased outreach and enrollment of Indians. 
Sec. 203. Demonstration project to permit States to rely on findings by an Ex-
press Lane agency to determine components of a child’s eligi-
bility for Medicaid or CHIP. 
Sec. 204. Authorization of certain information disclosures to simplify health 
coverage determinations. 
TITLE III—REDUCING BARRIERS TO ENROLLMENT 
Sec. 301. Verification of declaration of citizenship or nationality for purposes 
of eligibility for Medicaid and CHIP. 
Sec. 302. Reducing administrative barriers to enrollment. 
TITLE IV—REDUCING BARRIERS TO PROVIDING PREMIUM 
ASSISTANCE 
Subtitle A—Additional State Option for Providing Premium Assistance 
Sec. 401. Additional State option for providing premium assistance. 
Sec. 402. Outreach, education, and enrollment assistance. 
Subtitle B—Coordinating Premium Assistance With Private Coverage 
Sec. 411. Special enrollment period under group health plans in case of termi-
nation of Medicaid or CHIP coverage or eligibility for assist-
ance in purchase of employment-based coverage; coordination 
of coverage. 
TITLE V—STRENGTHENING QUALITY OF CARE AND HEALTH 
OUTCOMES OF CHILDREN 
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Sec. 501. Child health quality improvement activities for children enrolled in 
Medicaid or CHIP. 
Sec. 502. Improved information regarding access to coverage under CHIP. 
Sec. 503. Application of certain managed care quality safeguards to CHIP. 
TITLE VI—MISCELLANEOUS 
Sec. 601. Technical correction regarding current State authority under Med-
icaid. 
Sec. 602. Payment error rate measurement (‘‘PERM’’). 
Sec. 603. Elimination of counting medicaid child presumptive eligibility costs 
against title XXI allotment. 
Sec. 604. Improving data collection. 
Sec. 605. Deficit Reduction Act technical corrections. 
Sec. 606. Elimination of confusing program references. 
Sec. 607. Mental health parity in CHIP plans. 
Sec. 608. Dental health grants. 
Sec. 609. Application of prospective payment system for services provided by 
Federally-qualified health centers and rural health clinics. 
TITLE VII—REVENUE PROVISIONS 
Sec. 701. Increase in excise tax rate on tobacco products. 
Sec. 702. Administrative improvements. 
Sec. 703. Time for payment of corporate estimated taxes. 
TITLE VIII—EFFECTIVE DATE 
Sec. 801. Effective date. 
TITLE I—FINANCING OF CHIP 
SEC. 101. EXTENSION OF CHIP. 
Section 2104(a) (42 U.S.C. 1397dd(a)) is amended— 
(1) in paragraph (9), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (10), by striking the period at 
the end and inserting a semicolon; and 
(3) by adding at the end the following new 
paragraphs: 
‘‘(11) for fiscal year 2008, $9,125,000,000; 
‘‘(12) for fiscal year 2009, $10,675,000,000; 
‘‘(13) for fiscal year 2010, $11,850,000,000; 
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‘‘(14) for fiscal year 2011, $13,750,000,000; 
and 
‘‘(15) for fiscal year 2012, for purposes of mak-
ing 2 semi-annual allotments— 
‘‘(A) $1,750,000,000 for the period begin-
ning on October 1, 2011, and ending on March 
31, 2012, and 
‘‘(B) $1,750,000,000 for the period begin-
ning on April 1, 2012, and ending on Sep-
tember 30, 2012.’’. 
SEC. 102. ALLOTMENTS FOR THE 50 STATES AND THE DIS-
TRICT OF COLUMBIA. 
(a) IN GENERAL.—Section 2104 (42 U.S.C. 1397dd) 
is amended by adding at the end the following new sub-
section: 
‘‘(i) DETERMINATION OF ALLOTMENTS FOR THE 50 
STATES AND THE DISTRICT OF COLUMBIA FOR FISCAL 
YEARS 2008 THROUGH 2012.— 
‘‘(1) COMPUTATION OF ALLOTMENT.— 
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding paragraphs of this subsection, the Sec-
retary shall for each of fiscal years 2008 
through 2012 allot to each subsection (b) State 
from the available national allotment an 
amount equal to 110 percent of— 
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‘‘(i) in the case of fiscal year 2008, 
the highest of the amounts determined 
under paragraph (2); 
‘‘(ii) in the case of each of fiscal years 
2009 through 2011, the Federal share of 
the expenditures determined under sub-
paragraph (B) for the fiscal year; and 
‘‘(iii) beginning with fiscal year 2012, 
subject to subparagraph (E), each semi-an-
nual allotment determined under subpara-
graph (D). 
‘‘(B) PROJECTED
STATE
EXPENDITURES 
FOR THE FISCAL YEAR.—For purposes of sub-
paragraphs (A)(ii) and (D), the expenditures 
determined under this subparagraph for a fiscal 
year are the projected expenditures under the 
State child health plan for the fiscal year (as 
certified by the State and submitted to the Sec-
retary by not later than August 31 of the pre-
ceding fiscal year). 
‘‘(C) 
AVAILABLE
NATIONAL
ALLOT-
MENT.—For purposes of this subsection, the 
term ‘available national allotment’ means, with 
respect to any fiscal year, the amount available 
for allotment under subsection (a) for the fiscal 
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year, reduced by the amount of the allotments 
made for the fiscal year under subsection (c). 
Subject to paragraph (3)(B), the available na-
tional allotment with respect to the amount 
available under subsection (a)(15)(A) for fiscal 
year 2012 shall be increased by the amount of 
the appropriation for the period beginning on 
October 1 and ending on March 31 of such fis-
cal year under section 103 of the Children’s 
Health Insurance Program Reauthorization Act 
of 2007. 
‘‘(D) SEMI-ANNUAL
ALLOTMENTS.—For 
purposes of subparagraph (A)(iii), the semi-an-
nual allotments determined under this para-
graph with respect to a fiscal year are as fol-
lows: 
‘‘(i) For the period beginning on Oc-
tober 1 and ending on March 31 of the fis-
cal year, the Federal share of the portion 
of the expenditures determined under sub-
paragraph (B) for the fiscal year which are 
allocable to such period. 
‘‘(ii) For the period beginning on 
April 1 and ending on September 30 of the 
fiscal year, the Federal share of the por-
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tion of the expenditures determined under 
subparagraph (B) for the fiscal year which 
are allocable to such period. 
‘‘(E) AVAILABILITY.—Each semi-annual 
allotment made under subparagraph (A)(iii) 
shall remain available for expenditure under 
this title for periods after the period specified 
in subparagraph (D) for purposes of deter-
mining the allotment in the same manner as 
the allotment would have been available for ex-
penditure if made for an entire fiscal year. 
‘‘(2) SPECIAL RULE FOR FISCAL YEAR 2008.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1)(A)(i), the amounts determined under 
this paragraph for fiscal year 2008 are as fol-
lows: 
‘‘(i) The total Federal payments to 
the State under this title for fiscal year 
2007, multiplied by the annual adjustment 
determined under subparagraph (B) for 
fiscal year 2008. 
‘‘(ii) The Federal share of the amount 
allotted to the State for fiscal year 2007 
under subsection (b), multiplied by the an-
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nual adjustment determined under sub-
paragraph (B) for fiscal year 2008. 
‘‘(iii) Only in the case of— 
‘‘(I) a State that received a pay-
ment, redistribution, or allotment 
under any of paragraphs (1), (2), or 
(4) of subsection (h), the amount of 
the projected total Federal payments 
to the State under this title for fiscal 
year 2007, as determined on the basis 
of the November 2006 estimates cer-
tified by the State to the Secretary; 
‘‘(II) a State whose projected 
total Federal payments to the State 
under this title for fiscal year 2007, 
as determined on the basis of the May 
2006 estimates certified by the State 
to the Secretary, were at least 
$95,000,000 but not more than 
$96,000,000 higher than the projected 
total Federal payments to the State 
under this title for fiscal year 2007 on 
the basis of the November 2006 esti-
mates, the amount of the projected 
total Federal payments to the State 
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subsections (c)(5) and (i) of section 2104 of the Social 
Security Act (42 U.S.C. 1397dd) for the first 6 months 
of fiscal year 2012 in the same manner as allotments are 
provided under subsection (a)(15)(A) of such section and 
subject to the same terms and conditions as apply to the 
allotments provided from such subsection (a)(15)(A). 
SEC. 104. IMPROVING FUNDING FOR THE TERRITORIES 
UNDER CHIP AND MEDICAID. 
(a) UPDATE
OF
CHIP ALLOTMENTS.—Section 
2104(c) (42 U.S.C. 1397dd(c)) is amended— 
(1) in paragraph (1), by inserting ‘‘and para-
graphs (5) and (6)’’ after ‘‘and (i)’’; and 
(2) by adding at the end the following new 
paragraphs: 
‘‘(5) ANNUAL ALLOTMENTS FOR TERRITORIES 
BEGINNING WITH FISCAL YEAR 2008.—Of the total 
allotment amount appropriated under subsection (a) 
for a fiscal year beginning with fiscal year 2008, the 
Secretary shall allot to each of the commonwealths 
and territories described in paragraph (3) the fol-
lowing: 
‘‘(A) FISCAL YEAR 2008.—For fiscal year 
2008, the highest amount of Federal payments 
to the commonwealth or territory under this 
title for any fiscal year occurring during the pe-
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riod of fiscal years 1998 through 2007, multi-
plied by the annual adjustment determined 
under subsection (i)(2)(B) for fiscal year 2008, 
except that clause (ii) thereof shall be applied 
by substituting ‘the United States’ for ‘the 
State’. 
‘‘(B) FISCAL YEARS 2009 THROUGH 2012.— 
‘‘(i) IN GENERAL.—For each of fiscal 
years 2009 through 2012, except as pro-
vided in clause (ii), the amount determined 
under this paragraph for the preceding fis-
cal year multiplied by the annual adjust-
ment 
determined 
under 
subsection 
(i)(2)(B) for the fiscal year, except that 
clause (ii) thereof shall be applied by sub-
stituting ‘the United States’ for ‘the 
State’. 
‘‘(ii) SPECIAL RULE FOR FISCAL YEAR 
2012.—In the case of fiscal year 2012— 
‘‘(I) 89 percent of the amount al-
located to the commonwealth or terri-
tory for such fiscal year (without re-
gard to this subclause) shall be allo-
cated for the period beginning on Oc-
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tober 1, 2011, and ending on March 
31, 2012, and 
‘‘(II) 11 percent of such amount 
shall be allocated for the period begin-
ning on April 1, 2012, and ending on 
September 30, 2012.’’. 
(b) REMOVAL OF FEDERAL MATCHING PAYMENTS 
FOR DATA REPORTING SYSTEMS FROM THE OVERALL 
LIMIT ON PAYMENTS TO TERRITORIES UNDER TITLE 
XIX.—Section 1108(g) (42 U.S.C. 1308(g)) is amended 
by adding at the end the following new paragraph: 
‘‘(4) EXCLUSION OF CERTAIN EXPENDITURES 
FROM
PAYMENT
LIMITS.—With respect to fiscal 
years beginning with fiscal year 2008, if Puerto 
Rico, the Virgin Islands, Guam, the Northern Mar-
iana Islands, or American Samoa qualify for a pay-
ment under subparagraph (A)(i), (B), or (F) of sec-
tion 1903(a)(3) for a calendar quarter of such fiscal 
year, the payment shall not be taken into account in 
applying subsection (f) (as increased in accordance 
with paragraphs (1), (2), and (3) of this subsection) 
to such commonwealth or territory for such fiscal 
year.’’. 
(c) GAO STUDY AND REPORT.—Not later than Sep-
tember 30, 2009, the Comptroller General of the United 
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States shall submit a report to the appropriate committees 
of Congress regarding Federal funding under Medicaid 
and CHIP for Puerto Rico, the United States Virgin Is-
lands, Guam, American Samoa, and the Northern Mar-
iana Islands. The report shall include the following: 
(1) An analysis of all relevant factors with re-
spect to— 
(A) eligible Medicaid and CHIP popu-
lations in such commonwealths and territories; 
(B) historical and projected spending needs 
of such commonwealths and territories and the 
ability of capped funding streams to respond to 
those spending needs; 
(C) the extent to which Federal poverty 
guidelines are used by such commonwealths and 
territories to determine Medicaid and CHIP eli-
gibility; and 
(D) the extent to which such common-
wealths and territories participate in data col-
lection and reporting related to Medicaid and 
CHIP, including an analysis of territory partici-
pation in the Current Population Survey versus 
the American Community Survey. 
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(2) Recommendations for improving Federal 
funding under Medicaid and CHIP for such com-
monwealths and territories. 
SEC. 105. INCENTIVE BONUSES FOR STATES. 
(a) 
IN
GENERAL.—Section 
2104 
(42 
U.S.C. 
1397dd), as amended by section 102, is amended by add-
ing at the end the following new subsection: 
‘‘(j) INCENTIVE BONUSES.— 
‘‘(1) ESTABLISHMENT
OF
INCENTIVE
POOL 
FROM
UNOBLIGATED
NATIONAL
ALLOTMENT
AND 
UNEXPENDED STATE ALLOTMENTS.— 
‘‘(A) IN GENERAL.—There is hereby estab-
lished in the Treasury of the United States a 
fund which shall be known as the ‘CHIP Incen-
tive Bonuses Pool’ (in this subsection referred 
to as the ‘Incentive Pool’). Amounts in the In-
centive Pool are authorized to be appropriated 
for payments under this subsection and shall 
remain available until expended. 
‘‘(B) DEPOSITS THROUGH INITIAL APPRO-
PRIATION AND TRANSFERS OF FUNDS.— 
‘‘(i) INITIAL APPROPRIATION.—There 
is appropriated to the Incentive Pool, out 
of any money in the Treasury not other-
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wise appropriated, $3,000,000,000 for fis-
cal year 2008. 
‘‘(ii) 
TRANSFERS.—Notwithstanding 
any other provision of law, the following 
amounts are hereby appropriated or trans-
ferred to, deposited in, and made available 
for expenditure from the Incentive Pool on 
the following dates: 
‘‘(I) UNEXPENDED FISCAL YEAR 
2006 AND 2007 ALLOTMENTS.—On De-
cember 31, 2007, the sum for all 
States of the excess (if any) for each 
State of— 
‘‘(aa) the aggregate allot-
ments provided for the State 
under subsection (b) or (c) for 
fiscal years 2006 and 2007 that 
are not expended by September 
30, 2007, over 
‘‘(bb) an amount equal to 50 
percent of the allotment provided 
for the State under subsection (c) 
or (i) for fiscal year 2008 (as de-
termined in accordance with sub-
section (i)(6)). 
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bility criteria in effect on July 19, 2007, for en-
rollment under the State plan under title XIX 
or under a waiver of such plan. 
‘‘(4) TIME
OF
PAYMENT.—Payments under 
paragraph (2) for any fiscal year shall be made dur-
ing the last quarter of such year. 
‘‘(5) USE OF PAYMENTS.—Payments made to a 
State from the Incentive Pool shall be used for any 
purpose that the State determines is likely to reduce 
the percentage of low-income children in the State 
without health insurance. 
‘‘(6) PRORATION RULE.—If the amount avail-
able for payment from the Incentive Pool is less 
than the total amount of payments to be made for 
such fiscal year, the Secretary shall reduce the pay-
ments described in paragraph (2) on a proportional 
basis. 
‘‘(7) REFERENCES.—With respect to a State 
plan under title XIX, any references to a child in 
this subsection shall include a reference to any indi-
vidual provided medical assistance under the plan 
who has not attained age 19 (or, if a State has so 
elected under such State plan, age 20 or 21).’’. 
(b) REDISTRIBUTION
OF
UNEXPENDED
FISCAL 
YEAR
2005 ALLOTMENTS.—Notwithstanding section 
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2104(f) of the Social Security Act (42 U.S.C. 1397dd(f)), 
with respect to fiscal year 2008, the Secretary shall pro-
vide for a redistribution under such section from the allot-
ments for fiscal year 2005 under subsection (b) and (c) 
of such section that are not expended by the end of fiscal 
year 2007, to each State described in clause (iii) of section 
2104(i)(2)(A) of the Social Security Act, as added by sec-
tion 102(a), of an amount that bears the same ratio to 
such unexpended fiscal year 2005 allotments as the ratio 
of the fiscal year 2007 allotment determined for each such 
State under subsection (b) of section 2104 of such Act 
for fiscal year 2007 (without regard to any amounts paid, 
allotted, or redistributed to the State under section 2104 
for any preceding fiscal year) bears to the total amount 
of the fiscal year 2007 allotments for all such States (as 
so determined). 
(c) CONFORMING AMENDMENT ELIMINATING RULES 
FOR REDISTRIBUTION
OF UNEXPENDED ALLOTMENTS 
FOR FISCAL YEARS AFTER 2005.—Effective January 1, 
2008, section 2104(f) (42 U.S.C. 1397dd(f)) is amended 
to read as follows: 
‘‘(f) UNALLOCATED PORTION OF NATIONAL ALLOT-
MENT AND UNUSED ALLOTMENTS.—For provisions relat-
ing to the distribution of portions of the unallocated na-
tional allotment under subsection (a) for fiscal years be-
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ginning with fiscal year 2008, and unexpended allotments 
for fiscal years beginning with fiscal year 2006, see sub-
section (j).’’. 
(d) ADDITIONAL FUNDING FOR THE SECRETARY TO 
IMPROVE TIMELINESS OF DATA REPORTING AND ANAL-
YSIS FOR PURPOSES OF DETERMINING ENROLLMENT IN-
CREASES UNDER MEDICAID AND CHIP.— 
(1) APPROPRIATION.—There is appropriated, 
out of any money in the Treasury not otherwise ap-
propriated, $5,000,000 to the Secretary for fiscal 
year 2008 for the purpose of improving the timeli-
ness of the data reported and analyzed from the 
Medicaid Statistical Information System (MSIS) for 
purposes of carrying out section 2104(j)(2)(B) of 
the Social Security Act (as added by subsection (a)) 
and to provide guidance to States with respect to 
any new reporting requirements related to such im-
provements. Amounts appropriated under this para-
graph shall remain available until expended. 
(2) REQUIREMENTS.—The improvements made 
by the Secretary under paragraph (1) shall be de-
signed and implemented (including with respect to 
any necessary guidance for States) so that, begin-
ning no later than October 1, 2008, data regarding 
the enrollment of low-income children (as defined in 
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section 2110(c)(4) of the Social Security Act (42 
U.S.C. 1397jj(c)(4)) of a State enrolled in the State 
plan under Medicaid or the State child health plan 
under CHIP with respect to a fiscal year shall be 
collected and analyzed by the Secretary within 6 
months of submission. 
SEC. 106. PHASE-OUT OF COVERAGE FOR NONPREGNANT 
CHILDLESS ADULTS UNDER CHIP; CONDI-
TIONS FOR COVERAGE OF PARENTS. 
(a) PHASE-OUT RULES.— 
(1) IN
GENERAL.—Title XXI (42 U.S.C. 
1397aa et seq.) is amended by adding at the end the 
following new section: 
‘‘SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT 
CHILDLESS ADULTS; CONDITIONS FOR COV-
ERAGE OF PARENTS. 
‘‘(a) TERMINATION OF COVERAGE FOR NONPREG-
NANT CHILDLESS ADULTS.— 
‘‘(1) NO NEW CHIP WAIVERS; AUTOMATIC EX-
TENSIONS AT STATE OPTION THROUGH FISCAL YEAR 
2008.—Notwithstanding section 1115 or any other 
provision of this title, except as provided in this sub-
section— 
‘‘(A) the Secretary shall not on or after the 
date of the enactment of the Children’s Health 
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Insurance Program Reauthorization Act of 
2007, approve or renew a waiver, experimental, 
pilot, or demonstration project that would allow 
funds made available under this title to be used 
to provide child health assistance or other 
health benefits coverage to a nonpregnant child-
less adult; and 
‘‘(B) notwithstanding the terms and condi-
tions of an applicable existing waiver, the provi-
sions of paragraphs (2) and (3) shall apply for 
purposes of any fiscal year beginning on or 
after October 1, 2008, in determining the pe-
riod to which the waiver applies, the individuals 
eligible to be covered by the waiver, and the 
amount of the Federal payment under this title. 
‘‘(2) TERMINATION OF CHIP COVERAGE UNDER 
APPLICABLE
EXISTING
WAIVERS
AT
THE
END
OF 
FISCAL YEAR 2008.— 
‘‘(A) IN
GENERAL.—No funds shall be 
available under this title for child health assist-
ance or other health benefits coverage that is 
provided to a nonpregnant childless adult under 
an applicable existing waiver after September 
30, 2008. 
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‘‘(B) 
EXTENSION
UPON
STATE
RE-
QUEST.—If an applicable existing waiver de-
scribed in subparagraph (A) would otherwise 
expire before October 1, 2008, and the State 
requests an extension of such waiver, the Sec-
retary shall grant such an extension, but only 
through September 30, 2008. 
‘‘(C) APPLICATION OF ENHANCED FMAP.— 
The enhanced FMAP determined under section 
2105(b) shall apply to expenditures under an 
applicable existing waiver for the provision of 
child health assistance or other health benefits 
coverage to a nonpregnant childless adult dur-
ing fiscal year 2008. 
‘‘(3) OPTIONAL
1-YEAR
TRANSITIONAL
COV-
ERAGE BLOCK GRANT FUNDED FROM STATE ALLOT-
MENT.—Subject to paragraph (4)(B), each State for 
which coverage under an applicable existing waiver 
is terminated under paragraph (2)(A) may elect to 
provide nonpregnant childless adults who were pro-
vided child health assistance or health benefits cov-
erage under the applicable existing waiver at any 
time during fiscal year 2008 with such assistance or 
coverage during fiscal year 2009, as if the authority 
to provide such assistance or coverage under an ap-
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plicable existing waiver was extended through that 
fiscal year, but subject to the following terms and 
conditions: 
‘‘(A) BLOCK
GRANT
SET
ASIDE
FROM 
STATE
ALLOTMENT.—The Secretary shall set 
aside for the State an amount equal to the Fed-
eral share of the State’s projected expenditures 
under the applicable existing waiver for pro-
viding child health assistance or health benefits 
coverage to all nonpregnant childless adults 
under such waiver for fiscal year 2008 (as cer-
tified by the State and submitted to the Sec-
retary by not later than August 31, 2008, and 
without regard to whether any such individual 
lost coverage during fiscal year 2008 and was 
later provided child health assistance or other 
health benefits coverage under the waiver in 
that fiscal year), increased by the annual ad-
justment for fiscal year 2009 determined under 
section 2104(i)(2)(B)(i). The Secretary may ad-
just the amount set aside under the preceding 
sentence, as necessary, on the basis of the ex-
penditure data for fiscal year 2008 reported by 
States on CMS Form 64 or CMS Form 21 not 
later than November 30, 2008, but in no case 
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shall the Secretary adjust such amount after 
December 31, 2008. 
‘‘(B) NO
COVERAGE
FOR
NONPREGNANT 
CHILDLESS ADULTS WHO WERE NOT COVERED 
DURING FISCAL YEAR 2008.— 
‘‘(i) FMAP APPLIED
TO
EXPENDI-
TURES.—The Secretary shall pay the State 
for each quarter of fiscal year 2009, from 
the amount set aside under subparagraph 
(A), an amount equal to the Federal med-
ical assistance percentage (as determined 
under section 1905(b) without regard to 
clause (4) of such section) of expenditures 
in the quarter for providing child health 
assistance or other health benefits coverage 
to a nonpregnant childless adult but only 
if such adult was enrolled in the State pro-
gram under this title during fiscal year 
2008 (without regard to whether the indi-
vidual lost coverage during fiscal year 
2008 and was reenrolled in that fiscal year 
or in fiscal year 2009). 
‘‘(ii) FEDERAL
PAYMENTS
LIMITED 
TO
AMOUNT
OF
BLOCK
GRANT
SET- 
ASIDE.—No payments shall be made to a 
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State for expenditures described in this 
subparagraph after the total amount set 
aside under subparagraph (A) for fiscal 
year 2009 has been paid to the State. 
‘‘(4) STATE OPTION TO APPLY FOR MEDICAID 
WAIVER
TO
CONTINUE
COVERAGE
FOR
NONPREG-
NANT CHILDLESS ADULTS.— 
‘‘(A) IN GENERAL.—Each State for which 
coverage under an applicable existing waiver is 
terminated under paragraph (2)(A) may sub-
mit, not later than June 30, 2009, an applica-
tion to the Secretary for a waiver under section 
1115 of the State plan under title XIX to pro-
vide medical assistance to a nonpregnant child-
less adult whose coverage is so terminated (in 
this subsection referred to as a ‘Medicaid non-
pregnant childless adults waiver’). 
‘‘(B) DEADLINE
FOR
APPROVAL.—The 
Secretary shall make a decision to approve or 
deny an application for a Medicaid nonpregnant 
childless adults waiver submitted under sub-
paragraph (A) within 90 days of the date of the 
submission of the application. If no decision has 
been made by the Secretary as of September 
30, 2009, on the application of a State for a 
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Medicaid nonpregnant childless adults waiver 
that was submitted to the Secretary by June 
30, 2009, the application shall be deemed ap-
proved. 
‘‘(C) 
STANDARD
FOR
BUDGET
NEU-
TRALITY.—The budget neutrality requirement 
applicable with respect to expenditures for med-
ical assistance under a Medicaid nonpregnant 
childless adults waiver shall— 
‘‘(i) in the case of fiscal year 2010, 
allow expenditures for medical assistance 
under title XIX for all such adults to not 
exceed the total amount of payments made 
to the State under paragraph (3)(B) for 
fiscal year 2009, increased by the percent-
age increase (if any) in the projected nomi-
nal per capita amount of National Health 
Expenditures for calendar year 2010 over 
calendar year 2009, as most recently pub-
lished by the Secretary; and 
‘‘(ii) in the case of any succeeding fis-
cal year, allow such expenditures to not ex-
ceed the amount in effect under this sub-
paragraph for the preceding fiscal year, in-
creased by the percentage increase (if any) 
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in the projected nominal per capita amount 
of National Health Expenditures for the 
calendar year that begins during the fiscal 
year involved over the preceding calendar 
year, as most recently published by the 
Secretary. 
‘‘(b) RULES AND CONDITIONS FOR COVERAGE OF 
PARENTS OF TARGETED LOW-INCOME CHILDREN.— 
‘‘(1) TWO-YEAR
TRANSITION
PERIOD; AUTO-
MATIC EXTENSION AT STATE OPTION THROUGH FIS-
CAL YEAR 2009.— 
‘‘(A) NO NEW CHIP WAIVERS.—Notwith-
standing section 1115 or any other provision of 
this title, except as provided in this sub-
section— 
‘‘(i) the Secretary shall not on or after 
the date of the enactment of the Children’s 
Health Insurance Program Reauthoriza-
tion Act of 2007 approve or renew a waiv-
er, experimental, pilot, or demonstration 
project that would allow funds made avail-
able under this title to be used to provide 
child health assistance or other health ben-
efits coverage to a parent of a targeted 
low-income child; and 
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Census, ranks in the lowest 1⁄3 of States in 
terms of the State’s percentage of low-income 
children without health insurance. 
‘‘(C) STATE INCREASING ENROLLMENT OF 
LOW-INCOME
CHILDREN.—The State qualified 
for a payment from the Incentive Fund under 
paragraph (2)(C) of section 2104(j) for the 
most recent coverage period applicable under 
such section. 
‘‘(4) RULES
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed as prohibiting a 
State from submitting an application to the Sec-
retary for a waiver under section 1115 of the State 
plan under title XIX to provide medical assistance to 
a parent of a targeted low-income child that was 
provided child health assistance or health benefits 
coverage under an applicable existing waiver. 
‘‘(c) APPLICABLE EXISTING WAIVER.—For purposes 
of this section— 
‘‘(1) IN GENERAL.—The term ‘applicable exist-
ing waiver’ means a waiver, experimental, pilot, or 
demonstration project under section 1115, grand-
fathered under section 6102(c)(3) of the Deficit Re-
duction Act of 2005, or otherwise conducted under 
authority that— 
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‘‘(A) would allow funds made available 
under this title to be used to provide child 
health assistance or other health benefits cov-
erage to— 
‘‘(i) a parent of a targeted low-income 
child; 
‘‘(ii) a nonpregnant childless adult; or 
‘‘(iii) individuals described in both 
clauses (i) and (ii); and 
‘‘(B) was in effect during fiscal year 2007. 
‘‘(2) DEFINITIONS.— 
‘‘(A) PARENT.—The term ‘parent’ includes 
a caretaker relative (as such term is used in 
carrying out section 1931) and a legal guard-
ian. 
‘‘(B) NONPREGNANT CHILDLESS ADULT.— 
The term ‘nonpregnant childless adult’ has the 
meaning given such term by section 2107(f).’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 2107(f) (42 U.S.C. 1397gg(f)) 
is amended— 
(i) by striking ‘‘, the Secretary’’ and 
inserting ‘‘: 
‘‘(1) The Secretary’’; 
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(ii) in the first sentence, by inserting 
‘‘or a parent (as defined in section 
2111(c)(2)(A)), who is not pregnant, of a 
targeted low-income child’’ before the pe-
riod; 
(iii) by striking the second sentence; 
and 
(iv) by adding at the end the following 
new paragraph: 
‘‘(2) The Secretary may not approve, extend, 
renew, or amend a waiver, experimental, pilot, or 
demonstration project with respect to a State after 
the date of enactment of the Children’s Health In-
surance Program Reauthorization Act of 2007 that 
would waive or modify the requirements of section 
2111.’’. 
(B) Section 6102(c) of the Deficit Reduc-
tion Act of 2005 (Public Law 109–171; 120 
Stat. 131) is amended by striking ‘‘Nothing’’ 
and inserting ‘‘Subject to section 2111 of the 
Social Security Act, as added by section 
106(a)(1) of the Children’s Health Insurance 
Program Reauthorization Act of 2007, noth-
ing’’. 
(b) GAO STUDY AND REPORT.— 
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(1) IN GENERAL.—The Comptroller General of 
the United States shall conduct a study of wheth-
er— 
(A) the coverage of a parent, a caretaker 
relative (as such term is used in carrying out 
section 1931), or a legal guardian of a targeted 
low-income child under a State health plan 
under title XXI of the Social Security Act in-
creases the enrollment of, or the quality of care 
for, children, and 
(B) such parents, relatives, and legal 
guardians who enroll in such a plan are more 
likely to enroll their children in such a plan or 
in a State plan under title XIX of such Act. 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Comptroller 
General shall report the results of the study to the 
appropriate committees of Congress, including rec-
ommendations (if any) for changes in legislation. 
SEC. 107. STATE OPTION TO COVER LOW-INCOME PREG-
NANT WOMEN UNDER CHIP THROUGH A 
STATE PLAN AMENDMENT. 
(a) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et 
seq.), as amended by section 106(a), is amended by adding 
at the end the following new section: 
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‘‘SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-IN-
COME PREGNANT WOMEN THROUGH A STATE 
PLAN AMENDMENT. 
‘‘(a) IN GENERAL.—Subject to the succeeding provi-
sions of this section, a State may elect through an amend-
ment to its State child health plan under section 2102 to 
provide pregnancy-related assistance under such plan for 
targeted low-income pregnant women. 
‘‘(b) CONDITIONS.—A State may only elect the option 
under subsection (a) if the following conditions are satis-
fied: 
‘‘(1) MEDICAID
INCOME
ELIGIBILITY
LEVEL 
FOR PREGNANT WOMEN OF AT LEAST 185 PERCENT 
OF POVERTY.—The State has established an income 
eligibility level for pregnant women under subsection 
(a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of 
section 1902 that is at least 185 percent of the in-
come official poverty line. 
‘‘(2) NO CHIP INCOME ELIGIBILITY LEVEL FOR 
PREGNANT WOMEN LOWER THAN THE STATE’S MED-
ICAID LEVEL.—The State does not apply an effective 
income level for pregnant women under the State 
plan amendment that is lower than the effective in-
come level (expressed as a percent of the poverty line 
and considering applicable income disregards) speci-
fied 
under 
subsection 
(a)(10)(A)(i)(III), 
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(a)(10)(A)(i)(IV), or (l)(1)(A) of section 1902, on 
the date of enactment of this paragraph to be eligi-
ble for medical assistance as a pregnant woman. 
‘‘(3) NO COVERAGE FOR HIGHER INCOME PREG-
NANT WOMEN WITHOUT COVERING LOWER INCOME 
PREGNANT
WOMEN.—The State does not provide 
coverage for pregnant women with higher family in-
come without covering pregnant women with a lower 
family income. 
‘‘(4) APPLICATION
OF
REQUIREMENTS
FOR 
COVERAGE OF TARGETED LOW-INCOME CHILDREN.— 
The State provides pregnancy-related assistance for 
targeted low-income pregnant women in the same 
manner, and subject to the same requirements, as 
the State provides child health assistance for tar-
geted low-income children under the State child 
health plan, and in addition to providing child health 
assistance for such women. 
‘‘(5) NO PREEXISTING CONDITION EXCLUSION 
OR WAITING PERIOD.—The State does not apply any 
exclusion of benefits for pregnancy-related assistance 
based on any preexisting condition or any waiting 
period (including any waiting period imposed to 
carry out section 2102(b)(3)(C)) for receipt of such 
assistance. 
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‘‘(6) APPLICATION OF COST-SHARING PROTEC-
TION.—The State provides pregnancy-related assist-
ance to a targeted low-income woman consistent 
with the cost-sharing protections under section 
2103(e) and applies the limitation on total annual 
aggregate cost sharing imposed under paragraph 
(3)(B) of such section to the family of such a 
woman. 
‘‘(c) OPTION TO PROVIDE PRESUMPTIVE ELIGI-
BILITY.—A State that elects the option under subsection 
(a) and satisfies the conditions described in subsection (b) 
may elect to apply section 1920 (relating to presumptive 
eligibility for pregnant women) to the State child health 
plan in the same manner as such section applies to the 
State plan under title XIX. 
‘‘(d) DEFINITIONS.—For purposes of this section: 
‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The 
term ‘pregnancy-related assistance’ has the meaning 
given the term ‘child health assistance’ in section 
2110(a) and includes any medical assistance that 
the State would provide for a pregnant woman 
under the State plan under title XIX during preg-
nancy and the period described in paragraph (2)(A). 
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‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT 
WOMAN.—The term ‘targeted low-income pregnant 
woman’ means a woman— 
‘‘(A) during pregnancy and through the 
end of the month in which the 60-day period 
(beginning on the last day of her pregnancy) 
ends; 
‘‘(B) whose family income does not exceed 
the income eligibility level established under the 
State child health plan under this title for a 
targeted low-income child; and 
‘‘(C) who satisfies the requirements of 
paragraphs (1)(A), (1)(C), (2), and (3) of sec-
tion 2110(b) in the same manner as a child ap-
plying for child health assistance would have to 
satisfy such requirements. 
‘‘(e) AUTOMATIC
ENROLLMENT
FOR
CHILDREN 
BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS-
SISTANCE.—If a child is born to a targeted low-income 
pregnant woman who was receiving pregnancy-related as-
sistance under this section on the date of the child’s birth, 
the child shall be deemed to have applied for child health 
assistance under the State child health plan and to have 
been found eligible for such assistance under such plan 
or to have applied for medical assistance under title XIX 
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and to have been found eligible for such assistance under 
such title, as appropriate, on the date of such birth and 
to remain eligible for such assistance until the child at-
tains 1 year of age. During the period in which a child 
is deemed under the preceding sentence to be eligible for 
child health or medical assistance, the child health or med-
ical assistance eligibility identification number of the 
mother shall also serve as the identification number of the 
child, and all claims shall be submitted and paid under 
such number (unless the State issues a separate identifica-
tion number for the child before such period expires). 
‘‘(f) STATES
PROVIDING
ASSISTANCE
THROUGH 
OTHER OPTIONS.— 
‘‘(1) CONTINUATION OF OTHER OPTIONS FOR 
PROVIDING ASSISTANCE.—The option to provide as-
sistance in accordance with the preceding sub-
sections of this section shall not limit any other op-
tion for a State to provide— 
‘‘(A) child health assistance through the 
application of sections 457.10, 457.350(b)(2), 
457.622(c)(5), and 457.626(a)(3) of title 42, 
Code of Federal Regulations (as in effect after 
the final rule adopted by the Secretary and set 
forth at 67 Fed. Reg. 61956–61974 (October 2, 
2002)), or 
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‘‘(B) pregnancy-related services through 
the application of any waiver authority (as in 
effect on June 1, 2007). 
‘‘(2) CLARIFICATION OF AUTHORITY TO PRO-
VIDE POSTPARTUM SERVICES.—Any State that pro-
vides child health assistance under any authority de-
scribed in paragraph (1) may continue to provide 
such assistance, as well as postpartum services, 
through the end of the month in which the 60-day 
period (beginning on the last day of the pregnancy) 
ends, in the same manner as such assistance and 
postpartum services would be provided if provided 
under the State plan under title XIX, but only if the 
mother would otherwise satisfy the eligibility re-
quirements that apply under the State child health 
plan (other than with respect to age) during such 
period. 
‘‘(3) NO
INFERENCE.—Nothing in this sub-
section shall be construed— 
‘‘(A) to infer congressional intent regard-
ing the legality or illegality of the content of the 
sections specified in paragraph (1)(A); or 
‘‘(B) to modify the authority to provide 
pregnancy-related services under a waiver speci-
fied in paragraph (1)(B).’’. 
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(b) ADDITIONAL CONFORMING AMENDMENTS.— 
(1) NO
COST
SHARING
FOR
PREGNANCY-RE-
LATED BENEFITS.—Section 2103(e)(2) (42 U.S.C. 
1397cc(e)(2)) is amended— 
(A) in the heading, by inserting ‘‘OR PREG-
NANCY-RELATED ASSISTANCE’’ after ‘‘PREVEN-
TIVE SERVICES’’; and 
(B) by inserting before the period at the 
end the following: ‘‘or for pregnancy-related as-
sistance’’. 
(2) 
NO
WAITING
PERIOD.—Section 
2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is 
amended— 
(A) in clause (i), by striking ‘‘, and’’ at the 
end and inserting a semicolon; 
(B) in clause (ii), by striking the period at 
the end 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 a targeted 
low-income pregnant woman provided preg-
nancy-related 
assistance 
under 
section 
2112.’’. 
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State is determined to be an eligible State 
under this subsection, except that in the case of 
an event described in subclause (I) or (III) of 
subparagraph (D)(iii) that occurred after July 
1 of the fiscal year, any such payment with re-
spect to such event shall remain available until 
September 30 of the subsequent fiscal year. 
Nothing in the preceding sentence shall be con-
strued as prohibiting a State from being deter-
mined to be an eligible State under this sub-
section for any fiscal year occurring after a fis-
cal year in which such a determination is made. 
‘‘(G) EXEMPTION
FROM
DETERMINATION 
OF
PERCENTAGE
OF
ALLOTMENT
RETAINED 
AFTER FIRST YEAR OF AVAILABILITY.—In no 
event shall payments made to a State under 
this subsection be treated as part of the allot-
ment determined for a State for a fiscal year 
under subsection (i) for purposes of subsection 
(j)(1)(B)(ii)(III). 
‘‘(H) APPLICATION
OF
ALLOTMENT
RE-
PORTING
RULES.—Rules applicable to States 
for purposes of receiving payments from an al-
lotment determined under subsection (c) or (i) 
shall apply in the same manner to an eligible 
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State for purposes of receiving a CHIP contin-
gency fund payment under this subsection. 
‘‘(4) ANNUAL REPORTS.—The Secretary shall 
annually report to the Congress on the amounts in 
the Fund, the specific events that caused States to 
apply for payments from the Fund, and the pay-
ments made from the Fund.’’. 
SEC. 109. TWO-YEAR AVAILABILITY OF ALLOTMENTS; EX-
PENDITURES COUNTED AGAINST OLDEST AL-
LOTMENTS. 
Section 2104(e) (42 U.S.C. 1397dd(e)) is amended 
to read as follows: 
‘‘(e) AVAILABILITY OF AMOUNTS ALLOTTED.— 
‘‘(1) IN GENERAL.—Except as provided in sub-
section (j)(1)(B)(ii)(III), amounts allotted to a State 
pursuant to this section— 
‘‘(A) for each of fiscal years 1998 through 
2006, shall remain available for expenditure by 
the State through the end of the second suc-
ceeding fiscal year; and 
‘‘(B) for each of fiscal years 2007 through 
2012, shall remain available for expenditure by 
the State only through the end of the suc-
ceeding fiscal year for which such amounts are 
allotted. 
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‘‘(2) INCENTIVE BONUSES.—Incentive bonuses 
paid to a State under subsection (j)(2) for a fiscal 
year shall remain available for expenditure by the 
State without limitation. 
‘‘(3) CHIP CONTINGENCY FUND PAYMENTS.— 
Except as provided in paragraph (3)(F) of sub-
section (k), CHIP Contingency Fund payments 
made to a State under such subsection for a month 
of a fiscal year shall remain available for expendi-
ture by the State through the end of the fiscal year. 
‘‘(4) RULE
FOR
COUNTING
EXPENDITURES 
AGAINST CHIP CONTINGENCY FUND PAYMENTS, FIS-
CAL
YEAR
ALLOTMENTS, 
AND
INCENTIVE
BO-
NUSES.— 
‘‘(A) IN
GENERAL.—Expenditures under 
the State child health plan made on or after 
October 1, 2007, shall be counted against— 
‘‘(i) first, any CHIP Contingency 
Fund payment made to the State under 
subsection (k) for the earliest month of the 
earliest fiscal year for which the payment 
remains available for expenditure; and 
‘‘(ii) second, amounts allotted to the 
State for the earliest fiscal year for which 
amounts remain available for expenditure. 
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‘‘(B) INCENTIVE BONUSES.—A State may 
elect, but is not required, to count expenditures 
under the State child health plan against any 
incentive bonuses paid to the State under sub-
section (j)(2) for a fiscal year. 
‘‘(C) BLOCK GRANT SET-ASIDES.—Expend-
itures for coverage of— 
‘‘(i) nonpregnant childless adults for 
fiscal year 2009 shall be counted only 
against the amount set aside for such cov-
erage under section 2111(a)(3); and 
‘‘(ii) parents of targeted low-income 
children for each of fiscal years 2010 
through 2012, shall be counted only 
against the amount set aside for such cov-
erage under section 2111(b)(2)(B)(i).’’. 
SEC. 110. LIMITATION ON MATCHING RATE FOR STATES 
THAT PROPOSE TO COVER CHILDREN WITH 
EFFECTIVE FAMILY INCOME THAT EXCEEDS 
300 PERCENT OF THE POVERTY LINE. 
(a) FMAP APPLIED TO EXPENDITURES.—Section 
2105(c) (42 U.S.C. 1397ee(c)) is amended by adding at 
the end the following new paragraph: 
‘‘(8) LIMITATION ON MATCHING RATE FOR EX-
PENDITURES FOR CHILD HEALTH ASSISTANCE PRO-
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VIDED TO CHILDREN WHOSE EFFECTIVE FAMILY IN-
COME
EXCEEDS
300
PERCENT
OF
THE
POVERTY 
LINE.— 
‘‘(A) 
FMAP 
APPLIED
TO
EXPENDI-
TURES.—Except as provided in subparagraph 
(B), for fiscal years beginning with fiscal year 
2008, the Federal medical assistance percent-
age (as determined under section 1905(b) with-
out regard to clause (4) of such section) shall 
be substituted for the enhanced FMAP under 
subsection (a)(1) with respect to any expendi-
tures for providing child health assistance or 
health benefits coverage for a targeted low-in-
come child whose effective family income would 
exceed 300 percent of the poverty line but for 
the application of a general exclusion of a block 
of income that is not determined by type of ex-
pense or type of income. 
‘‘(B) 
EXCEPTION.—Subparagraph 
(A) 
shall not apply to any State that, on the date 
of enactment of the Children’s Health Insur-
ance Program Reauthorization Act of 2007, has 
an approved State plan amendment or waiver to 
provide, or has enacted a State law to submit 
a State plan amendment to provide, expendi-
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tures described in such subparagraph under the 
State child health plan.’’. 
(b) CONFORMING AMENDMENT.—Section 2105(a)(1) 
( 42 U.S.C. 1397dd(a)(1)) is amended, in the matter pre-
ceding subparagraph (A), by inserting ‘‘or subsection 
(c)(8)’’ after ‘‘subparagraph (B)’’. 
SEC. 111. OPTION FOR QUALIFYING STATES TO RECEIVE 
THE ENHANCED PORTION OF THE CHIP 
MATCHING RATE FOR MEDICAID COVERAGE 
OF CERTAIN CHILDREN. 
Section 2105(g) (42 U.S.C. 1397ee(g)) is amended— 
(1) in paragraph (1)(A), by inserting ‘‘subject 
to paragraph (4),’’ after ‘‘Notwithstanding any other 
provision of law,’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4) OPTION
FOR
ALLOTMENTS
FOR
FISCAL 
YEARS 2008 THROUGH 2012.— 
‘‘(A) PAYMENT OF ENHANCED PORTION OF 
MATCHING
RATE
FOR
CERTAIN
EXPENDI-
TURES.—In the case of expenditures described 
in subparagraph (B), a qualifying State (as de-
fined in paragraph (2)) may elect to be paid 
from the State’s allotment made under section 
2104 for any of fiscal years 2008 through 2012 
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(insofar as the allotment is available to the 
State under subsections (e) and (i) of such sec-
tion) an amount each quarter equal to the addi-
tional amount that would have been paid to the 
State under title XIX with respect to such ex-
penditures if the enhanced FMAP (as deter-
mined under subsection (b)) had been sub-
stituted for the Federal medical assistance per-
centage (as defined in section 1905(b)). 
‘‘(B) EXPENDITURES
DESCRIBED.—For 
purposes of subparagraph (A), the expenditures 
described in this subparagraph are expenditures 
made after the date of the enactment of this 
paragraph and during the period in which funds 
are available to the qualifying State for use 
under subparagraph (A), for the provision of 
medical assistance to individuals residing in the 
State who are eligible for medical assistance 
under the State plan under title XIX or under 
a waiver of such plan and who have not at-
tained age 19 (or, if a State has so elected 
under the State plan under title XIX, age 20 
or 21), and whose family income equals or ex-
ceeds 133 percent of the poverty line but does 
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et seq.) for outreach to, and enrollment of, children 
who are Indians. 
‘‘(c) APPLICATION.—An eligible entity that desires to 
receive a grant under subsection (a) shall submit an appli-
cation to the Secretary in such form and manner, and con-
taining such information, as the Secretary may decide. 
Such application shall include— 
‘‘(1) evidence demonstrating that the entity in-
cludes members who have access to, and credibility 
with, ethnic or low-income populations in the com-
munities in which activities funded under the grant 
are to be conducted; 
‘‘(2) evidence demonstrating that the entity has 
the ability to address barriers to enrollment, such as 
lack of awareness of eligibility, stigma concerns and 
punitive fears associated with receipt of benefits, 
and other cultural barriers to applying for and re-
ceiving child health assistance or medical assistance; 
‘‘(3) specific quality or outcomes performance 
measures to evaluate the effectiveness of activities 
funded by a grant awarded under this section; and 
‘‘(4) an assurance that the eligible entity 
shall— 
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‘‘(A) conduct an assessment of the effec-
tiveness of such activities against the perform-
ance measures; 
‘‘(B) cooperate with the collection and re-
porting of enrollment data and other informa-
tion in order for the Secretary to conduct such 
assessments; and 
‘‘(C) in the case of an eligible entity that 
is not the State, provide the State with enroll-
ment data and other information as necessary 
for the State to make necessary projections of 
eligible children and pregnant women. 
‘‘(d) DISSEMINATION OF ENROLLMENT DATA AND 
INFORMATION DETERMINED FROM EFFECTIVENESS AS-
SESSMENTS; ANNUAL REPORT.—The Secretary shall— 
‘‘(1) make publicly available the enrollment 
data and information collected and reported in ac-
cordance with subsection (c)(4)(B); and 
‘‘(2) submit an annual report to Congress on 
the outreach and enrollment activities conducted 
with funds appropriated under this section. 
‘‘(e) MAINTENANCE
OF
EFFORT
FOR
STATES 
AWARDED GRANTS; NO STATE MATCH REQUIRED.—In 
the case of a State that is awarded a grant under this 
section— 
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‘‘(1) the State share of funds expended for out-
reach and enrollment activities under the State child 
health plan shall not be less than the State share of 
such funds expended in the fiscal year preceding the 
first fiscal year for which the grant is awarded; and 
‘‘(2) no State matching funds shall be required 
for the State to receive a grant under this section. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means any of the following: 
‘‘(A) A State with an approved child health 
plan under this title. 
‘‘(B) A local government. 
‘‘(C) An Indian tribe or tribal consortium, 
a tribal organization, an urban Indian organiza-
tion receiving funds under title V of the Indian 
Health Care Improvement Act (25 U.S.C. 1651 
et seq.), or an Indian Health Service provider. 
‘‘(D) A Federal health safety net organiza-
tion. 
‘‘(E) A national, State, local, or commu-
nity-based public or nonprofit private organiza-
tion, including organizations that use commu-
nity health workers or community-based doula 
programs. 
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‘‘(F) A faith-based organization or con-
sortia, to the extent that a grant awarded to 
such an entity is consistent with the require-
ments of section 1955 of the Public Health 
Service Act (42 U.S.C. 300x–65) relating to a 
grant award to nongovernmental entities. 
‘‘(G) An elementary or secondary school. 
‘‘(2) FEDERAL HEALTH SAFETY NET ORGANI-
ZATION.—The term ‘Federal health safety net orga-
nization’ means— 
‘‘(A) a Federally-qualified health center (as 
defined in section 1905(l)(2)(B)); 
‘‘(B) a hospital defined as a dispropor-
tionate share hospital for purposes of section 
1923; 
‘‘(C) a covered entity described in section 
340B(a)(4) of the Public Health Service Act 
(42 U.S.C. 256b(a)(4)); and 
‘‘(D) any other entity or consortium that 
serves children under a federally funded pro-
gram, including the special supplemental nutri-
tion program for women, infants, and children 
(WIC) established under section 17 of the Child 
Nutrition Act of 1966 (42 U.S.C. 1786), the 
Head Start and Early Head Start programs 
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under the Head Start Act (42 U.S.C. 9801 et 
seq.), the school lunch program established 
under the Richard B. Russell National School 
Lunch Act, and an elementary or secondary 
school. 
‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANI-
ZATION; URBAN INDIAN ORGANIZATION.—The terms 
‘Indian’, ‘Indian tribe’, ‘tribal organization’, and 
‘urban Indian organization’ have the meanings given 
such terms in section 4 of the Indian Health Care 
Improvement Act (25 U.S.C. 1603). 
‘‘(4) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
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