236
Title I, Subtitle H
ing medical assistance to individuals enrolled in
the State plan under this title; and
‘‘(C) in the case of an individual who is en-
titled to benefits under the State plan under
this title as of the first month during which the
State health allowance program is in effect, an
approved plan may not require the individual to
contribute a greater amount of cost-sharing
than the individual would have been required to
contribute under the State plan (except as may
be imposed on an individual described in sub-
paragraph (B) or subparagraph (C) of sub-
section (d)(1)).
In applying subparagraph (A), in determining the
standard actuarial value, instead of adjustments
made to reflect the population under section 1931
there shall be adjustments made to reflect the popu-
lation covered under this section.
‘‘(3) WAIVER
OF
STATEWIDENESS
REQUIRE-
MENT.—At the request of a State, the Secretary
may waive for a period not to exceed 3 years (sub-
ject to one 3-year extension) the requirement under
paragraph (1) that the State health allowance pro-
gram be in effect in all political subdivisions of the
State.
237
Title I, Subtitle H
‘‘(d) ELIGIBILITY OF INDIVIDUALS TO PARTICIPATE
IN ALLOWANCE PROGRAM.—
‘‘(1) AUTOMATIC
ELIGIBILITY
OF
MEDICAID
CATEGORICALLY
ELIGIBLE
INDIVIDUALS.—Subject
to subsection (e), any individual to whom the State
makes medical assistance available under the State
plan under this title pursuant to clause (i) of section
1902(a)(10)(A) shall be eligible to participate in the
State health allowance program.
‘‘(2) MANDATORY
ELIGIBILITY
OF
PREGNANT
WOMEN WITH INCOME UNDER 150 PERCENT OF THE
POVERTY LEVEL.—
‘‘(A) IN GENERAL.—Subject to subsection
(e) and subparagraph (B), an individual law-
fully residing in the State shall be eligible to
participate in the program if the individual is a
pregnant woman and the income of the individ-
ual’s family is equal to or less than 240 percent
of the official poverty line (as defined by the
Office of Management and Budget, and revised
annually in accordance with section 673(2) of
the Omnibus Budget Reconciliation Act of
1991) applicable to a family of the size in-
volved.
238
Title I, Subtitle H
‘‘(B) EXCEPTION.—If the application of
subparagraph (A) would result in—
‘‘(i) the total State expenditures for a
quarter under this title (including expendi-
tures attributable to this section and sec-
tion 1923, but not including expenditures
under section 1931), exceeding
‘‘(ii) the total State expenditures that
the Secretary estimates would have been
made under this title for the quarter if the
State did not have a program under this
section,
then there shall be substituted for 150 percent
in subparagraph (A) such percent as would re-
sult in the amount described in clause (i) equal-
ing the amount described in clause (ii).
‘‘(C) PHASING OUT PREMIUM SUBSIDY FOR
CERTAIN INDIVIDUALS.—
‘‘(i) IN GENERAL.—In the case of an
individual eligible to participate in the pro-
gram pursuant to this paragraph who has
income equal to or greater than 185 per-
cent of the official poverty line applicable
to a family of the size involved, the amount
paid by the State under subsection (c)(1)
239
Title I, Subtitle H
with respect to the individual shall be
equal to the individual’s subsidy percent-
age of the amount that would otherwise be
paid under such subsection with respect to
the individual but for this subparagraph.
‘‘(ii) 
SUBSIDY
PERCENTAGE
DE-
FINED.—In clause (i), an individual’s ‘sub-
sidy percentage’ means 100 percent re-
duced (but not below zero percent) by 1.8
percentage points for each percentage
point (or portion thereof) by which the in-
dividual’s income equals or exceeds 185
percent of the official poverty line.
‘‘(3) OPTIONAL ELIGIBILITY OF OTHER INDI-
VIDUALS WITH INCOME UP TO 150 PERCENT OF POV-
ERTY LEVEL.—
‘‘(A) IN GENERAL.—Subject to subsection
(e), a State operating a State health allowance
program under this section may make an indi-
vidual lawfully residing in the State who is not
described in paragraph (2) eligible to partici-
pate in the program if the income of the indi-
vidual’s family is not greater than 150 percent
of such official poverty line.
240
Title I, Subtitle H
‘‘(B) CONTRIBUTION MAY BE REQUIRED.—
In the case of an individual who is participating
in the program under this paragraph and whose
family income is greater than 100 percent of
the official poverty line, the program may re-
quire such an individual to contribute all (or a
portion) of the premiums for such a group
health plan if the amount of such contribution
is determined in accordance with a sliding scale
based on the individual’s family income.
‘‘(4) RESTRICTION ON ELIGIBILITY OF OTHER
MEDICAID BENEFICIARIES.—An individual is not eli-
gible to participate in the program pursuant to para-
graph (2) or paragraph (3) if the individual is eligi-
ble for medical assistance under the State plan
under this title (or would be eligible for such assist-
ance on the basis of the plan in effect as of the date
of the enactment of the Affordable Health Care Now
Act of 1994).
‘‘(e) EXCLUSION AND USE OF RESOURCE STAND-
ARD.—
‘‘(1) EXCLUSION OF ELDERLY MEDICARE-ELIGI-
BLE INDIVIDUALS.—No individual shall be eligible to
participate in the program if the individual is enti-
241
Title I, Subtitle H
tled to benefits under title XVIII pursuant to section
226.
‘‘(2) USE OF RESOURCE STANDARD.—A State
may require an individual to meet a resource stand-
ard as a condition of eligibility to participate in the
program only if the Secretary approves the State’s
use of such a standard.
‘‘(f) CONSTRUCTION.—No provision of any Federal
law shall prevent a State from enrolling any employee or
other individual in accordance with this section. The pre-
vious sentence shall not be construed as permitting a State
to require the employer of an individual participating in
the program to contribute toward the individual’s pre-
mium required for such participation.
‘‘(g) EVALUATIONS AND REPORTS.—
‘‘(1) EVALUATIONS.—Not later than 3 years
after the date of the enactment of this section (and
at such subsequent intervals as the Secretary consid-
ers appropriate), the Secretary shall evaluate the ef-
fectiveness of the State health allowance programs
for which Federal financial participation is provided
under this section, and the impact of such programs
on increasing the number of individuals with health
insurance coverage in participating States and in
controlling the costs of health care in such States.