H. R. 2—29 
efforts that are designed to increase the enrollment and partici-
pation of eligible children under this title and title XIX. 
‘‘(2) TEN PERCENT SET ASIDE FOR NATIONAL ENROLLMENT 
CAMPAIGN.—An amount equal to 10 percent of such amounts 
shall be used by the Secretary for expenditures during such 
period to carry out a national enrollment campaign in accord-
ance with subsection (h). 
‘‘(b) PRIORITY FOR AWARD OF GRANTS.— 
‘‘(1) IN GENERAL.—In awarding grants under subsection 
(a), the Secretary shall give priority to eligible entities that— 
‘‘(A) propose to target geographic areas with high rates 
of— 
‘‘(i) eligible but unenrolled children, including such 
children who reside in rural areas; or 
‘‘(ii) racial and ethnic minorities and health dis-
parity populations, including those proposals that 
address cultural and linguistic barriers to enrollment; 
and 
‘‘(B) submit the most demonstrable evidence required 
under paragraphs (1) and (2) of subsection (c). 
‘‘(2) TEN
PERCENT
SET
ASIDE
FOR
OUTREACH
TO
INDIAN 
CHILDREN.—An amount equal to 10 percent of the funds appro-
priated under subsection (g) shall be used by the Secretary 
to award grants to Indian Health Service providers and urban 
Indian organizations receiving funds under title V of the Indian 
Health Care Improvement Act (25 U.S.C. 1651 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 application to the 
Secretary in such form and manner, and containing such informa-
tion, as the Secretary may decide. Such application shall include— 
‘‘(1) evidence demonstrating that the entity includes mem-
bers who have access to, and credibility with, ethnic or low- 
income populations in the communities 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 receiving 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— 
‘‘(A) conduct an assessment of the effectiveness of such 
activities against the performance measures; 
‘‘(B) cooperate with the collection and reporting of 
enrollment data and other information 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 enrollment 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
ASSESSMENTS; 
ANNUAL 
REPORT.—The Secretary shall—
H. R. 2—30 
‘‘(1) make publicly available the enrollment data and 
information collected and reported in accordance with sub-
section (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 MATCH REQUIRED
FOR ANY ELIGIBLE ENTITY AWARDED
A 
GRANT.— 
‘‘(1) STATE
MAINTENANCE
OF
EFFORT.—In the case of a 
State that is awarded a grant under this section, the State 
share of funds expended for outreach 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. 
‘‘(2) NO
MATCHING
REQUIREMENT.—No eligible entity 
awarded a grant under subsection (a) shall be required to 
provide any matching funds as a condition for receiving the 
grant. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible entity’ 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 organization receiving funds 
under title V of the Indian Health Care Improvement Act 
(25 U.S.C. 1651 et seq.), or an Indian Health Service pro-
vider. 
‘‘(D) A Federal health safety net organization. 
‘‘(E) A national, State, local, or community-based public 
or nonprofit private organization, including organizations 
that use community health workers or community-based 
doula programs. 
‘‘(F) A faith-based organization or consortia, to the 
extent that a grant awarded to such an entity is consistent 
with the requirements 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
ORGANIZATION.—The 
term ‘Federal health safety net organization’ means— 
‘‘(A) a Federally-qualified health center (as defined in 
section 1905(l)(2)(B)); 
‘‘(B) a hospital defined as a disproportionate 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 program, including the special 
supplemental nutrition 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 under the Head Start 
Act (42 U.S.C. 9801 et seq.), the school lunch program
H. R. 2—31 
established under the Richard B. Russell National School 
Lunch Act, and an elementary or secondary school. 
‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANIZATION; 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 communities and 
health care agencies; 
‘‘(B) by providing guidance and social assistance to 
community residents; 
‘‘(C) by enhancing community residents’ ability to effec-
tively communicate with health care providers; 
‘‘(D) by providing culturally and linguistically appro-
priate health or nutrition education; 
‘‘(E) by advocating for individual and community health 
or nutrition needs; and 
‘‘(F) by providing referral and followup services. 
‘‘(g) APPROPRIATION.—There is appropriated, out of any money 
in the Treasury not otherwise appropriated, $100,000,000 for the 
period of fiscal years 2009 through 2013, for the purpose of awarding 
grants under this section. Amounts appropriated and paid under 
the authority of this section shall be in addition to amounts appro-
priated under section 2104 and paid to States in accordance with 
section 2105, including with respect to expenditures for outreach 
activities in accordance with subsections (a)(1)(D)(iii) and (c)(2)(C) 
of that section. 
‘‘(h) NATIONAL ENROLLMENT CAMPAIGN.—From the amounts 
made available under subsection (a)(2), the Secretary shall develop 
and implement a national enrollment campaign to improve the 
enrollment of underserved child populations in the programs estab-
lished under this title and title XIX. Such campaign may include— 
‘‘(1) the establishment of partnerships with the Secretary 
of Education and the Secretary of Agriculture to develop 
national campaigns to link the eligibility and enrollment sys-
tems for the assistance programs each Secretary administers 
that often serve the same children; 
‘‘(2) the integration of information about the programs 
established under this title and title XIX in public health aware-
ness campaigns administered by the Secretary; 
‘‘(3) increased financial and technical support for enroll-
ment hotlines maintained by the Secretary to ensure that all 
States participate in such hotlines; 
‘‘(4) the establishment of joint public awareness outreach 
initiatives with the Secretary of Education and the Secretary 
of Labor regarding the importance of health insurance to 
building strong communities and the economy; 
‘‘(5) the development of special outreach materials for 
Native Americans or for individuals with limited English pro-
ficiency; and 
‘‘(6) such other outreach initiatives as the Secretary deter-
mines would increase public awareness of the programs under 
this title and title XIX.’’.
H. R. 2—32 
(b) ENHANCED ADMINISTRATIVE FUNDING FOR TRANSLATION OR 
INTERPRETATION SERVICES UNDER CHIP AND MEDICAID.— 
(1) CHIP.—Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as 
amended by section 113, is amended— 
(A) in the matter preceding subparagraph (A), by 
inserting ‘‘(or, in the case of expenditures described in 
subparagraph (D)(iv), the higher of 75 percent or the sum 
of the enhanced FMAP plus 5 percentage points)’’ after 
‘‘enhanced FMAP’’; and 
(B) in subparagraph (D)— 
(i) in clause (iii), by striking ‘‘and’’ at the end; 
(ii) by redesignating clause (iv) as clause (v); and 
(iii) by inserting after clause (iii) the following 
new clause: 
‘‘(iv) for translation or interpretation services in 
connection with the enrollment of, retention of, and 
use of services under this title by, individuals for whom 
English is not their primary language (as found nec-
essary by the Secretary for the proper and efficient 
administration of the State plan); and’’. 
(2) MEDICAID.— 
(A) USE OF MEDICAID FUNDS.—Section 1903(a)(2) (42 
U.S.C. 1396b(a)(2)) is amended by adding at the end the 
following new subparagraph: 
‘‘(E) an amount equal to 75 percent of so much of the 
sums expended during such quarter (as found necessary by 
the Secretary for the proper and efficient administration of 
the State plan) as are attributable to translation or interpreta-
tion services in connection with the enrollment of, retention 
of, and use of services under this title by, children of families 
for whom English is not the primary language; plus’’. 
(B) USE OF COMMUNITY HEALTH WORKERS FOR OUT-
REACH ACTIVITIES.— 
(i) IN
GENERAL.—Section 2102(c)(1) of such Act 
(42 U.S.C. 1397bb(c)(1)) is amended by inserting 
‘‘(through community health workers and others)’’ after 
‘‘Outreach’’. 
(ii) IN FEDERAL EVALUATION.—Section 2108(c)(3)(B) 
of such Act (42 U.S.C. 1397hh(c)(3)(B)) is amended 
by inserting ‘‘(such as through community health 
workers and others)’’ after ‘‘including practices’’. 
SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS. 
(a) IN GENERAL.—Section 1139 (42 U.S.C. 1320b–9) is amended 
to read as follows: 
‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE 
FOR INDIANS UNDER TITLES XIX AND XXI. 
‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID AND CHIP OUT-
REACH ON OR NEAR RESERVATIONS TO INCREASE THE ENROLLMENT 
OF INDIANS IN THOSE PROGRAMS.— 
‘‘(1) IN GENERAL.—In order to improve the access of Indians 
residing on or near a reservation to obtain benefits under 
the Medicaid and State children’s health insurance programs 
established under titles XIX and XXI, the Secretary shall 
encourage the State to take steps to provide for enrollment 
on or near the reservation. Such steps may include outreach 
efforts such as the outstationing of eligibility workers, entering