139 
erage under CHIP and Medicaid of children described in 
subsection (a). 
SEC. 214. PERMITTING STATES TO ENSURE COVERAGE 
WITHOUT A 5-YEAR DELAY OF CERTAIN CHIL-
DREN AND PREGNANT WOMEN UNDER THE 
MEDICAID PROGRAM AND CHIP. 
(a) PURPOSE.—In order to promote the health of 
needy children and pregnant women residing lawfully in 
the United States, States should be permitted to waive 
certain restrictions which result in a 5-year delay for cov-
erage of necessary health services for such children and 
women under the Medicaid program and CHIP. 
(b) 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, notwithstanding sections 
401(a), 402(b), 403, and 421 of Public Law 104–193, 
medical assistance under a State plan under this title to 
children and pregnant women who are lawfully residing 
in the United States (including battered individuals de-
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scribed in section 431(c) of such Act) and are otherwise 
eligible for such assistance. 
‘‘(B) Such election may be made only with respect 
to either or both of the following categories of individuals: 
‘‘(i) Children. 
‘‘(ii) Pregnant women. 
‘‘(C) In this paragraph: 
‘‘(i) The term ‘pregnant women’ means 
women during pregnancy (and during the 60- 
day period beginning on the last day of the 
pregnancy). 
‘‘(ii) The term ‘children’ means individuals 
under age 19 (or such higher age as the State 
has elected under section 1902(l)(1)(D)), in-
cluding optional targeted low-income children 
described in section 1905(u)(2)(B).’’. 
(c) CHIP.—Section 2107(e)(1) of such Act (42 
U.S.C. 1397gg(e)(1)), as amended by section 203(a)(2) 
and 203(d)(2), is amended by redesignating subpara-
graphs (E) and (F) as subparagraphs (F) and (G), respec-
tively and by inserting after subparagraph (D) the fol-
lowing new subparagraph: 
‘‘(E) Paragraph (4) of section 1903(v), in-
sofar as it relates to the category of children or 
pregnant women (as such terms are defined in 
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such paragraph), but only if the State has elect-
ed to apply such paragraph with respect to such 
category of children or pregnant women under 
title XIX and only if, in the case of pregnant 
women, the State has elected the option under 
section 2111 to provide assistance for pregnant 
women under this title.’’. 
(d) CONFORMING AMENDMENT.—Section 423(d)(1) 
of Public Law 104–193 is amended by inserting before 
the period the following: ‘‘and medical or child health as-
sistance 
furnished 
under 
section 
1903(v)(4) 
or 
2107(e)(1)(E), respectively, of the Social Security Act’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section take effect on the date of the enactment of 
this Act. 
TITLE III—REDUCING BARRIERS 
TO PROVIDING PREMIUM AS-
SISTANCE 
Subtitle A—Additional State Op-
tion for Providing Premium As-
sistance 
SEC. 301. ADDITIONAL STATE OPTION FOR PROVIDING 
PREMIUM ASSISTANCE. 
(a) CHIP.— 
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(1) IN GENERAL.—Section 2105(c) (42 U.S.C. 
1397ee(c)), as amended by sections 114(a) and 
211(c), is amended by adding at the end the fol-
lowing: 
‘‘(10) STATE OPTION TO OFFER PREMIUM AS-
SISTANCE.— 
‘‘(A) IN GENERAL.—A State may elect to 
offer a premium assistance subsidy (as defined 
in subparagraph (C)) for qualified employer- 
sponsored coverage (as defined in subparagraph 
(B)) to all targeted low-income children who are 
eligible for child health assistance under the 
plan and have access to such coverage in ac-
cordance with the requirements of this para-
graph. No subsidy shall be provided to a tar-
geted low-income child under this paragraph 
unless the child (or the child’s parent) volun-
tarily elects to receive such a subsidy. A State 
may not require such an election as a condition 
of receipt of child health assistance. 
‘‘(B) QUALIFIED
EMPLOYER-SPONSORED 
COVERAGE.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), in this paragraph, the term ‘qualified 
employer-sponsored coverage’ means a 
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group health plan or health insurance cov-
erage offered through an employer— 
‘‘(I) that qualifies as creditable 
coverage as a group health plan under 
section 2701(c)(1) of the Public 
Health Service Act; 
‘‘(II) for which the employer con-
tribution toward any premium for 
such coverage is at least 40 percent; 
and 
‘‘(III) that is offered to all indi-
viduals in a manner that would be 
considered a nondiscriminatory eligi-
bility classification for purposes of 
paragraph (3)(A)(ii) of section 105(h) 
of the Internal Revenue Code of 1986 
(but determined without regard to 
clause (i) of subparagraph (B) of such 
paragraph). 
‘‘(ii) EXCEPTION.—Such term does 
not include coverage consisting of— 
‘‘(I) benefits provided under a 
health flexible spending arrangement 
(as defined in section 106(c)(2) of the 
Internal Revenue Code of 1986); or 
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‘‘(II) a high deductible health 
plan (as defined in section 223(c)(2) 
of such Code), without regard to 
whether the plan is purchased in con-
junction with a health savings account 
(as defined under section 223(d) of 
such Code). 
‘‘(C) PREMIUM ASSISTANCE SUBSIDY.— 
‘‘(i) IN GENERAL.—In this paragraph, 
the term ‘premium assistance subsidy’ 
means, with respect to a targeted low-in-
come child, the amount equal to the dif-
ference between the employee contribution 
required for enrollment only of the em-
ployee under qualified employer-sponsored 
coverage and the employee contribution re-
quired for enrollment of the employee and 
the child in such coverage, less any appli-
cable premium cost-sharing applied under 
the State child health plan (subject to the 
limitations imposed under section 2103(e), 
including the requirement to count the 
total amount of the employee contribution 
required for enrollment of the employee 
and the child in such coverage toward the 
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annual aggregate cost-sharing limit applied 
under paragraph (3)(B) of such section). 
‘‘(ii) STATE
PAYMENT
OPTION.—A 
State may provide a premium assistance 
subsidy either as reimbursement to an em-
ployee for out-of-pocket expenditures or, 
subject to clause (iii), directly to the em-
ployee’s employer. 
‘‘(iii) EMPLOYER OPT-OUT.—An em-
ployer may notify a State that it elects to 
opt-out of being directly paid a premium 
assistance subsidy on behalf of an em-
ployee. In the event of such a notification, 
an employer shall withhold the total 
amount of the employee contribution re-
quired for enrollment of the employee and 
the child in the qualified employer-spon-
sored coverage and the State shall pay the 
premium assistance subsidy directly to the 
employee. 
‘‘(iv) TREATMENT AS CHILD HEALTH 
ASSISTANCE.—Expenditures for the provi-
sion of premium assistance subsidies shall 
be considered child health assistance de-
scribed in paragraph (1)(C) of subsection 
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(a) for purposes of making payments 
under that subsection. 
‘‘(D) APPLICATION OF SECONDARY PAYOR 
RULES.—The State shall be a secondary payor 
for any items or services provided under the 
qualified employer-sponsored coverage for which 
the State provides child health assistance under 
the State child health plan. 
‘‘(E) REQUIREMENT TO PROVIDE SUPPLE-
MENTAL COVERAGE FOR BENEFITS AND COST- 
SHARING PROTECTION PROVIDED UNDER THE 
STATE CHILD HEALTH PLAN.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
section 2110(b)(1)(C), the State shall pro-
vide for each targeted low-income child en-
rolled in qualified employer-sponsored cov-
erage, supplemental coverage consisting 
of— 
‘‘(I) items or services that are 
not covered, or are only partially cov-
ered, under the qualified employer- 
sponsored coverage; and 
‘‘(II) cost-sharing protection con-
sistent with section 2103(e). 
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‘‘(ii) RECORD
KEEPING
REQUIRE-
MENTS.—For purposes of carrying out 
clause (i), a State may elect to directly pay 
out-of-pocket expenditures for cost-sharing 
imposed under the qualified employer-spon-
sored coverage and collect or not collect all 
or any portion of such expenditures from 
the parent of the child. 
‘‘(F) APPLICATION
OF
WAITING
PERIOD 
IMPOSED UNDER THE STATE.—Any waiting pe-
riod imposed under the State child health plan 
prior to the provision of child health assistance 
to a targeted low-income child under the State 
plan shall apply to the same extent to the provi-
sion of a premium assistance subsidy for the 
child under this paragraph. 
‘‘(G) 
OPT-OUT
PERMITTED
FOR
ANY 
MONTH.—A State shall establish a process for 
permitting the parent of a targeted low-income 
child receiving a premium assistance subsidy to 
disenroll the child from the qualified employer- 
sponsored coverage and enroll the child in, and 
receive child health assistance under, the State 
child health plan, effective on the first day of 
any month for which the child is eligible for 
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148 
such assistance and in a manner that ensures 
continuity of coverage for the child. 
‘‘(H) APPLICATION
TO
PARENTS.—If a 
State provides child health assistance or health 
benefits coverage to parents of a targeted low- 
income 
child 
in 
accordance 
with 
section 
2111(b), the State may elect to offer a pre-
mium assistance subsidy to a parent of a tar-
geted low-income child who is eligible for such 
a subsidy under this paragraph in the same 
manner as the State offers such a subsidy for 
the enrollment of the child in qualified em-
ployer-sponsored coverage, except that— 
‘‘(i) the amount of the premium as-
sistance subsidy shall be increased to take 
into account the cost of the enrollment of 
the parent in the qualified employer-spon-
sored coverage or, at the option of the 
State if the State determines it cost-effec-
tive, the cost of the enrollment of the 
child’s family in such coverage; and 
‘‘(ii) any reference in this paragraph 
to a child is deemed to include a reference 
to the parent or, if applicable under clause 
(i), the family of the child. 
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‘‘(I) ADDITIONAL STATE OPTION FOR PRO-
VIDING PREMIUM ASSISTANCE.— 
‘‘(i) IN GENERAL.—A State may es-
tablish an employer-family premium assist-
ance purchasing pool for employers with 
less than 250 employees who have at least 
1 employee who is a pregnant woman eligi-
ble for assistance under the State child 
health plan (including through the applica-
tion of an option described in section 
2112(f)) or a member of a family with at 
least 1 targeted low-income child and to 
provide a premium assistance subsidy 
under this paragraph for enrollment in 
coverage made available through such pool. 
‘‘(ii) ACCESS
TO
CHOICE
OF
COV-
ERAGE.—A State that elects the option 
under clause (i) shall identify and offer ac-
cess to not less than 2 private health plans 
that are health benefits coverage that is 
equivalent to the benefits coverage in a 
benchmark benefit package described in 
section 2103(b) or benchmark-equivalent 
coverage that meets the requirements of 
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section 2103(a)(2) for employees described 
in clause (i). 
‘‘(iii) CLARIFICATION
OF
PAYMENT 
FOR
ADMINISTRATIVE
EXPENDITURES.— 
Nothing in this subparagraph shall be con-
strued as permitting payment under this 
section for administrative expenditures at-
tributable to the establishment or oper-
ation of such pool, except to the extent 
that such payment would otherwise be per-
mitted under this title. 
‘‘(J) NO EFFECT ON PREMIUM ASSISTANCE 
WAIVER
PROGRAMS.—Nothing in this para-
graph shall be construed as limiting the author-
ity of a State to offer premium assistance under 
section 1906 or 1906A, a waiver described in 
paragraph (2)(B) or (3), a waiver approved 
under section 1115, or other authority in effect 
prior to the date of enactment of the Children’s 
Health Insurance Program Reauthorization Act 
of 2009. 
‘‘(K) NOTICE
OF
AVAILABILITY.—If a 
State elects to provide premium assistance sub-
sidies in accordance with this paragraph, the 
State shall— 
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‘‘(i) include on any application or en-
rollment form for child health assistance a 
notice of the availability of premium assist-
ance subsidies for the enrollment of tar-
geted low-income children in qualified em-
ployer-sponsored coverage; 
‘‘(ii) provide, as part of the applica-
tion and enrollment process under the 
State child health plan, information de-
scribing the availability of such subsidies 
and how to elect to obtain such a subsidy; 
and 
‘‘(iii) establish such other procedures 
as the State determines necessary to en-
sure that parents are fully informed of the 
choices for receiving child health assistance 
under the State child health plan or 
through the receipt of premium assistance 
subsidies. 
‘‘(L) APPLICATION
TO
QUALIFIED
EM-
PLOYER-SPONSORED BENCHMARK COVERAGE.— 
If a group health plan or health insurance cov-
erage offered through an employer is certified 
by an actuary as health benefits coverage that 
is equivalent to the benefits coverage in a 
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152 
benchmark benefit package described in section 
2103(b) or benchmark-equivalent coverage that 
meets the requirements of section 2103(a)(2), 
the State may provide premium assistance sub-
sidies for enrollment of targeted low-income 
children in such group health plan or health in-
surance coverage in the same manner as such 
subsidies are provided under this paragraph for 
enrollment in qualified employer-sponsored cov-
erage, but without regard to the requirement to 
provide supplemental coverage for benefits and 
cost-sharing protection provided under the 
State child health plan under subparagraph 
(E). 
‘‘(M) SATISFACTION OF COST-EFFECTIVE-
NESS TEST.—Premium assistance subsidies for 
qualified employer-sponsored coverage offered 
under this paragraph shall be deemed to meet 
the requirement of subparagraph (A) of para-
graph (3).’’. 
(2) DETERMINATION OF COST-EFFECTIVENESS 
FOR PREMIUM ASSISTANCE OR PURCHASE OF FAM-
ILY COVERAGE.— 
(A) IN GENERAL.—Section 2105(c)(3)(A) 
(42 U.S.C. 1397ee(c)(3)(A)) is amended by 
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153 
striking ‘‘relative to’’ and all that follows 
through the comma and inserting ‘‘relative to 
‘‘(i) the amount of expenditures under 
the State child health plan, including ad-
ministrative expenditures, that the State 
would have made to provide comparable 
coverage of the targeted low-income child 
involved or the family involved (as applica-
ble); or 
‘‘(ii) the aggregate amount of expendi-
tures that the State would have made 
under the State child health plan, includ-
ing administrative expenditures, for pro-
viding coverage under such plan for all 
such children or families.’’. 
(B) NONAPPLICATION TO PREVIOUSLY AP-
PROVED COVERAGE.—The amendment made by 
subparagraph (A) shall not apply to coverage 
the purchase of which has been approved by the 
Secretary under section 2105(c)(3) of the Social 
Security Act prior to the date of enactment of 
this Act. 
(b) MEDICAID.—Title XIX is amended by inserting 
after section 1906 the following new section: 
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154 
‘‘PREMIUM ASSISTANCE OPTION FOR CHILDREN 
‘‘SEC. 1906A. (a) IN GENERAL.—A State may elect 
to offer a premium assistance subsidy (as defined in sub-
section (c)) for qualified employer-sponsored coverage (as 
defined in subsection (b)) to all individuals under age 19 
who are entitled to medical assistance under this title (and 
to the parent of such an individual) who have access to 
such coverage if the State meets the requirements of this 
section. 
‘‘(b) 
QUALIFIED
EMPLOYER-SPONSORED
COV-
ERAGE.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2)), 
in this paragraph, the term ‘qualified employer-spon-
sored coverage’ means a group health plan or health 
insurance coverage offered through an employer— 
‘‘(A) that qualifies as creditable coverage 
as a group health plan under section 2701(c)(1) 
of the Public Health Service Act; 
‘‘(B) for which the employer contribution 
toward any premium for such coverage is at 
least 40 percent; and 
‘‘(C) that is offered to all individuals in a 
manner that would be considered a nondiscrim-
inatory eligibility classification for purposes of 
paragraph (3)(A)(ii) of section 105(h) of the 
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155 
Internal Revenue Code of 1986 (but determined 
without regard to clause (i) of subparagraph 
(B) of such paragraph). 
‘‘(2) EXCEPTION.—Such term does not include 
coverage consisting of— 
‘‘(A) benefits provided under a health flexi-
ble spending arrangement (as defined in section 
106(c)(2) of the Internal Revenue Code of 
1986); or 
‘‘(B) a high deductible health plan (as de-
fined in section 223(c)(2) of such Code), with-
out regard to whether the plan is purchased in 
conjunction with a health savings account (as 
defined under section 223(d) of such Code). 
‘‘(3) TREATMENT
AS
THIRD
PARTY
LIABIL-
ITY.—The State shall treat the coverage provided 
under qualified employer-sponsored coverage as a 
third party liability under section 1902(a)(25). 
‘‘(c) PREMIUM ASSISTANCE SUBSIDY.—In this sec-
tion, the term ‘premium assistance subsidy’ means the 
amount of the employee contribution for enrollment in the 
qualified employer-sponsored coverage by the individual 
under age 19 or by the individual’s family. Premium as-
sistance subsidies under this section shall be considered, 
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for purposes of section 1903(a), to be a payment for med-
ical assistance. 
‘‘(d) VOLUNTARY PARTICIPATION.— 
‘‘(1) EMPLOYERS.—Participation by an em-
ployer in a premium assistance subsidy offered by a 
State under this section shall be voluntary. An em-
ployer may notify a State that it elects to opt-out of 
being directly paid a premium assistance subsidy on 
behalf of an employee. 
‘‘(2) BENEFICIARIES.—No subsidy shall be pro-
vided to an individual under age 19 under this sec-
tion unless the individual (or the individual’s parent) 
voluntarily elects to receive such a subsidy. A State 
may not require such an election as a condition of 
receipt of medical assistance. State may not require, 
as a condition of an individual under age 19 (or the 
individual’s parent) being or remaining eligible for 
medical assistance under this title, apply for enroll-
ment in qualified employer-sponsored coverage under 
this section. 
‘‘(3) OPT-OUT PERMITTED FOR ANY MONTH.— 
A State shall establish a process for permitting the 
parent of an individual under age 19 receiving a pre-
mium assistance subsidy to disenroll the individual 
from the qualified employer-sponsored coverage. 
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‘‘(e) REQUIREMENT TO PAY PREMIUMS AND COST- 
SHARING AND PROVIDE SUPPLEMENTAL COVERAGE.—In 
the case of the participation of an individual under age 
19 (or the individual’s parent) in a premium assistance 
subsidy under this section for qualified employer-spon-
sored coverage, the State shall provide for payment of all 
enrollee premiums for enrollment in such coverage and all 
deductibles, coinsurance, and other cost-sharing obliga-
tions for items and services otherwise covered under the 
State plan under this title (exceeding the amount other-
wise permitted under section 1916 or, if applicable, section 
1916A). The fact that an individual under age 19 (or a 
parent) elects to enroll in qualified employer-sponsored 
coverage under this section shall not change the individ-
ual’s (or parent’s) eligibility for medical assistance under 
the State plan, except insofar as section 1902(a)(25) pro-
vides that payments for such assistance shall first be made 
under such coverage.’’. 
(c) GAO STUDY AND REPORT.—Not later than Janu-
ary 1, 2010, the Comptroller General of the United States 
shall study cost and coverage issues relating to any State 
premium assistance programs for which Federal matching 
payments are made under title XIX or XXI of the Social 
Security Act, including under waiver authority, and shall 
submit a report to the Committee on Finance of the Sen-
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158 
ate and the Committee on Energy and Commerce of the 
House of Representatives on the results of such study. 
SEC. 302. OUTREACH, EDUCATION, AND ENROLLMENT AS-
SISTANCE. 
(a) REQUIREMENT TO INCLUDE DESCRIPTION OF 
OUTREACH, EDUCATION, AND ENROLLMENT EFFORTS 
RELATED TO PREMIUM ASSISTANCE SUBSIDIES IN STATE 
CHILD HEALTH PLAN.—Section 2102(c) (42 U.S.C. 
1397bb(c)) is amended by adding at the end the following 
new paragraph: 
‘‘(3) PREMIUM ASSISTANCE SUBSIDIES.—In the 
case of a State that provides for premium assistance 
subsidies under the State child health plan in ac-
cordance with paragraph (2)(B), (3), or (10) of sec-
tion 2105(c), or a waiver approved under section 
1115, outreach, education, and enrollment assistance 
for families of children likely to be eligible for such 
subsidies, to inform such families of the availability 
of, and to assist them in enrolling their children in, 
such subsidies, and for employers likely to provide 
coverage that is eligible for such subsidies, including 
the specific, significant resources the State intends 
to apply to educate employers about the availability 
of premium assistance subsidies under the State 
child health plan.’’. 
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(b) NONAPPLICATION
OF 10 PERCENT LIMIT
ON 
OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec-
tion 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as 
amended by section 211(c)(2), is amended by adding at 
the end the following new clause: 
‘‘(iii) EXPENDITURES FOR OUTREACH 
TO INCREASE THE ENROLLMENT OF CHIL-
DREN UNDER THIS TITLE AND TITLE xix 
THROUGH
PREMIUM
ASSISTANCE
SUB-
SIDIES.—Expenditures for outreach activi-
ties to families of children likely to be eligi-
ble for premium assistance subsidies in ac-
cordance with paragraph (2)(B), (3), or 
(10), or a waiver approved under section 
1115, to inform such families of the avail-
ability of, and to assist them in enrolling 
their children in, such subsidies, and to 
employers likely to provide qualified em-
ployer-sponsored coverage (as defined in 
subparagraph (B) of such paragraph), but 
not to exceed an amount equal to 1.25 per-
cent of the maximum amount permitted to 
be expended under subparagraph (A) for 
items described in subsection (a)(1)(D).’’. 
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Subtitle B—Coordinating Premium 
Assistance With Private Coverage 
SEC. 311. SPECIAL ENROLLMENT PERIOD UNDER GROUP 
HEALTH PLANS IN CASE OF TERMINATION OF 
MEDICAID OR CHIP COVERAGE OR ELIGI-
BILITY FOR ASSISTANCE IN PURCHASE OF 
EMPLOYMENT-BASED COVERAGE; COORDINA-
TION OF COVERAGE. 
(a) AMENDMENTS TO INTERNAL REVENUE CODE OF 
1986.—Section 9801(f) of the Internal Revenue Code of 
1986 (relating to special enrollment periods) is amended 
by adding at the end the following new paragraph: 
‘‘(3) SPECIAL RULES RELATING TO MEDICAID 
AND CHIP.— 
‘‘(A) IN GENERAL.—A group health plan 
shall permit an employee who is eligible, but 
not enrolled, for coverage under the terms of 
the plan (or a dependent of such an employee 
if the dependent is eligible, but not enrolled, for 
coverage under such terms) to enroll for cov-
erage under the terms of the plan if either of 
the following conditions is met: 
‘‘(i) TERMINATION OF MEDICAID OR 
CHIP
COVERAGE.—The employee or de-
pendent is covered under a Medicaid plan 
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under title XIX of the Social Security Act 
or under a State child health plan under 
title XXI of such Act and coverage of the 
employee or dependent under such a plan 
is terminated as a result of loss of eligi-
bility for such coverage and the employee 
requests coverage under the group health 
plan not later than 60 days after the date 
of termination of such coverage. 
‘‘(ii) ELIGIBILITY FOR EMPLOYMENT 
ASSISTANCE UNDER MEDICAID OR CHIP.— 
The employee or dependent becomes eligi-
ble for assistance, with respect to coverage 
under the group health plan under such 
Medicaid plan or State child health plan 
(including under any waiver or demonstra-
tion project conducted under or in relation 
to such a plan), if the employee requests 
coverage under the group health plan not 
later than 60 days after the date the em-
ployee or dependent is determined to be el-
igible for such assistance. 
‘‘(B) EMPLOYEE OUTREACH AND DISCLO-
SURE.— 
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162 
‘‘(i) OUTREACH TO EMPLOYEES RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.— 
‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity Act, or child health assistance 
under a State child health plan under 
title XXI of such Act, in the form of 
premium assistance for the purchase 
of coverage under a group health 
plan, shall provide to each employee a 
written notice informing the employee 
of potential opportunities then cur-
rently available in the State in which 
the employee resides for premium as-
sistance under such plans for health 
coverage of the employee or the em-
ployee’s dependents. For purposes of 
compliance with this clause, the em-
ployer may use any State-specific 
model notice developed in accordance 
with section 701(f)(3)(B)(i)(II) of the 
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163 
Employee Retirement Income Security 
Act 
of 
1974 
(29 
U.S.C. 
1181(f)(3)(B)(i)(II)). 
‘‘(II) OPTION TO PROVIDE CON-
CURRENT WITH PROVISION OF PLAN 
MATERIALS
TO
EMPLOYEE.—An em-
ployer may provide the model notice 
applicable to the State in which an 
employee resides concurrent with the 
furnishing of materials notifying the 
employee of health plan eligibility, 
concurrent with materials provided to 
the employee in connection with an 
open season or election process con-
ducted under the plan, or concurrent 
with the furnishing of the summary 
plan description as provided in section 
104(b) of the Employee Retirement 
Income Security Act of 1974 (29 
U.S.C. 1024). 
‘‘(ii) 
DISCLOSURE
ABOUT
GROUP 
HEALTH PLAN BENEFITS TO STATES FOR 
MEDICAID
AND
CHIP
ELIGIBLE
INDIVID-
UALS.—In the case of a participant or ben-
eficiary of a group health plan who is cov-
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164 
ered under a Medicaid plan of a State 
under title XIX of the Social Security Act 
or under a State child health plan under 
title XXI of such Act, the plan adminis-
trator of the group health plan shall dis-
close to the State, upon request, informa-
tion about the benefits available under the 
group health plan in sufficient specificity, 
as determined under regulations of the 
Secretary of Health and Human Services 
in consultation with the Secretary that re-
quire use of the model coverage coordina-
tion disclosure form developed under sec-
tion 311(b)(1)(C) of the Children’s Health 
Insurance Program Reauthorization Act of 
2009, so as to permit the State to make a 
determination (under paragraph (2)(B), 
(3), or (10) of section 2105(c) of the So-
cial Security Act or otherwise) concerning 
the cost-effectiveness of the State pro-
viding medical or child health assistance 
through premium assistance for the pur-
chase of coverage under such group health 
plan and in order for the State to provide 
supplemental benefits required under para-
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165 
graph (10)(E) of such section or other au-
thority.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) AMENDMENTS TO EMPLOYEE RETIREMENT 
INCOME SECURITY ACT.— 
(A) IN GENERAL.—Section 701(f) of the 
Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1181(f)) is amended by adding 
at the end the following new paragraph: 
‘‘(3) SPECIAL RULES FOR APPLICATION IN CASE 
OF MEDICAID AND CHIP.— 
‘‘(A) IN GENERAL.—A group health plan, 
and a health insurance issuer offering group 
health insurance coverage in connection with a 
group health plan, shall permit an employee 
who is eligible, but not enrolled, for coverage 
under the terms of the plan (or a dependent of 
such an employee if the dependent is eligible, 
but not enrolled, for coverage under such 
terms) to enroll for coverage under the terms of 
the plan if either of the following conditions is 
met: 
‘‘(i) TERMINATION OF MEDICAID OR 
CHIP
COVERAGE.—The employee or de-
pendent is covered under a Medicaid plan 
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under title XIX of the Social Security Act 
or under a State child health plan under 
title XXI of such Act and coverage of the 
employee or dependent under such a plan 
is terminated as a result of loss of eligi-
bility for such coverage and the employee 
requests coverage under the group health 
plan (or health insurance coverage) not 
later than 60 days after the date of termi-
nation of such coverage. 
‘‘(ii) ELIGIBILITY FOR EMPLOYMENT 
ASSISTANCE UNDER MEDICAID OR CHIP.— 
The employee or dependent becomes eligi-
ble for assistance, with respect to coverage 
under the group health plan or health in-
surance coverage, under such Medicaid 
plan or State child health plan (including 
under any waiver or demonstration project 
conducted under or in relation to such a 
plan), if the employee requests coverage 
under the group health plan or health in-
surance coverage not later than 60 days 
after the date the employee or dependent is 
determined to be eligible for such assist-
ance. 
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167 
‘‘(B) COORDINATION WITH MEDICAID AND 
CHIP.— 
‘‘(i) OUTREACH TO EMPLOYEES RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.— 
‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity Act, or child health assistance 
under a State child health plan under 
title XXI of such Act, in the form of 
premium assistance for the purchase 
of coverage under a group health 
plan, shall provide to each employee a 
written notice informing the employee 
of potential opportunities then cur-
rently available in the State in which 
the employee resides for premium as-
sistance under such plans for health 
coverage of the employee or the em-
ployee’s dependents. 
‘‘(II) MODEL NOTICE.—Not later 
than 1 year after the date of enact-
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ment of the Children’s Health Insur-
ance Program Reauthorization Act of 
2009, the Secretary and the Secretary 
of Health and Human Services, in 
consultation with Directors of State 
Medicaid agencies under title XIX of 
the Social Security Act and Directors 
of State CHIP agencies under title 
XXI of such Act, shall jointly develop 
national and State-specific model no-
tices for purposes of subparagraph 
(A). The Secretary shall provide em-
ployers with such model notices so as 
to enable employers to timely comply 
with the requirements of subpara-
graph (A). Such model notices shall 
include information regarding how an 
employee may contact the State in 
which the employee resides for addi-
tional information regarding potential 
opportunities for such premium assist-
ance, including how to apply for such 
assistance. 
‘‘(III) OPTION TO PROVIDE CON-
CURRENT WITH PROVISION OF PLAN 
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