H. R. 976—53 
(b) CLARIFICATION
OF REQUIREMENTS RELATING
TO PRESEN-
TATION OF SATISFACTORY DOCUMENTARY EVIDENCE OF CITIZENSHIP 
OR NATIONALITY.— 
(1) ACCEPTANCE OF DOCUMENTARY EVIDENCE ISSUED BY A 
FEDERALLY
RECOGNIZED
INDIAN
TRIBE.—Section 1903(x)(3)(B) 
(42 U.S.C. 1396b(x)(3)(B)) is amended— 
(A) by redesignating clause (v) as clause (vi); and 
(B) by inserting after clause (iv), the following new 
clause: 
‘‘(v)(I) Except as provided in subclause (II), a document 
issued by a federally recognized Indian tribe evidencing mem-
bership or enrollment in, or affiliation with, such tribe (such 
as a tribal enrollment card or certificate of degree of Indian 
blood). 
‘‘(II) With respect to those federally recognized Indian tribes 
located within States having an international border whose 
membership includes individuals who are not citizens of the 
United States, the Secretary shall, after consulting with such 
tribes, issue regulations authorizing the presentation of such 
other forms of documentation (including tribal documentation, 
if appropriate) that the Secretary determines to be satisfactory 
documentary evidence of citizenship or nationality for purposes 
of satisfying the requirement of this subsection.’’. 
(2) REQUIREMENT TO PROVIDE REASONABLE OPPORTUNITY 
TO PRESENT SATISFACTORY DOCUMENTARY EVIDENCE.—Section 
1903(x) (42 U.S.C. 1396b(x)) is amended by adding at the 
end the following new paragraph: 
‘‘(4) In the case of an individual declaring to be a citizen 
or national of the United States with respect to whom a State 
requires the presentation of satisfactory documentary evidence of 
citizenship or nationality under section 1902(a)(46)(B)(i), the indi-
vidual shall be provided at least the reasonable opportunity to 
present satisfactory documentary evidence of citizenship or nation-
ality under this subsection as is provided under clauses (i) and 
(ii) of section 1137(d)(4)(A) to an individual for the submittal to 
the State of evidence indicating a satisfactory immigration status.’’. 
(3) CHILDREN BORN IN THE UNITED STATES TO MOTHERS 
ELIGIBLE FOR MEDICAID.— 
(A) CLARIFICATION
OF
RULES.—Section 1903(x) (42 
U.S.C. 1396b(x)), as amended by paragraph (2), is 
amended— 
(i) in paragraph (2)— 
(I) in subparagraph (C), by striking ‘‘or’’ at 
the end; 
(II) by redesignating subparagraph (D) as 
subparagraph (E); and 
(III) by inserting after subparagraph (C) the 
following new subparagraph: 
‘‘(D) pursuant to the application of section 1902(e)(4) (and, 
in the case of an individual who is eligible for medical assistance 
on such basis, the individual shall be deemed to have provided 
satisfactory documentary evidence of citizenship or nationality 
and shall not be required to provide further documentary evi-
dence on any date that occurs during or after the period in 
which the individual is eligible for medical assistance on such 
basis); or’’; and
H. R. 976—54 
(ii) by adding at the end the following new para-
graph: 
‘‘(5) Nothing in subparagraph (A) or (B) of section 1902(a)(46), 
the preceding paragraphs of this subsection, or the Deficit Reduction 
Act of 2005, including section 6036 of such Act, shall be construed 
as changing the requirement of section 1902(e)(4) that a child 
born in the United States to an alien mother for whom medical 
assistance for the delivery of such child is available as treatment 
of an emergency medical condition pursuant to subsection (v) shall 
be deemed eligible for medical assistance during the first year 
of such child’s life.’’. 
(B) STATE REQUIREMENT TO ISSUE SEPARATE IDENTI-
FICATION
NUMBER.—Section 
1902(e)(4) 
(42 
U.S.C. 
1396a(e)(4)) is amended by adding at the end the following 
new sentence: ‘‘Notwithstanding the preceding sentence, 
in the case of a child who is born in the United States 
to an alien mother for whom medical assistance for the 
delivery of the child is made available pursuant to section 
1903(v), the State immediately shall issue a separate 
identification number for the child upon notification by 
the facility at which such delivery occurred of the child’s 
birth.’’. 
(4) TECHNICAL AMENDMENTS.—Section 1903(x)(2) (42 U.S.C. 
1396b(x)) is amended— 
(A) in subparagraph (B)— 
(i) by realigning the left margin of the matter 
preceding clause (i) 2 ems to the left; and 
(ii) by realigning the left margins of clauses (i) 
and (ii), respectively, 2 ems to the left; and 
(B) in subparagraph (C)— 
(i) by realigning the left margin of the matter 
preceding clause (i) 2 ems to the left; and 
(ii) by realigning the left margins of clauses (i) 
and (ii), respectively, 2 ems to the left. 
(c) APPLICATION OF DOCUMENTATION SYSTEM TO CHIP.— 
(1) IN GENERAL.—Section 2105(c) (42 U.S.C. 1397ee(c)), as 
amended by sections 114(a) and 116(c), is amended by adding 
at the end the following new paragraph: 
‘‘(10) CITIZENSHIP DOCUMENTATION REQUIREMENTS.— 
‘‘(A) IN GENERAL.—No payment may be made under 
this section with respect to an individual who has, or 
is, declared to be a citizen or national of the United States 
for purposes of establishing eligibility under this title 
unless the State meets the requirements of section 
1902(a)(46)(B) with respect to the individual. 
‘‘(B) ENHANCED
PAYMENTS.—Notwithstanding sub-
section (b), the enhanced FMAP with respect to payments 
under subsection (a) for expenditures described in clause 
(i) or (ii) of section 1903(a)(3)(F) necessary to comply with 
subparagraph (A) shall in no event be less than 90 percent 
and 75 percent, respectively.’’. 
(2) NONAPPLICATION
OF
ADMINISTRATIVE
EXPENDITURES 
CAP.—Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as 
amended by section 202(b), is amended by adding at the end 
the following: 
‘‘(ii) EXPENDITURES TO COMPLY WITH CITIZENSHIP 
OR
NATIONALITY
VERIFICATION
REQUIREMENTS.—
H. R. 976—55 
Expenditures necessary for the State to comply with 
paragraph (9)(A).’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.— 
(A) IN GENERAL.—Except as provided in subparagraph 
(B), the amendments made by this section shall take effect 
on October 1, 2008. 
(B) TECHNICAL AMENDMENTS.—The amendments made 
by— 
(i) paragraphs (1), (2), and (3) of subsection (b) 
shall take effect as if included in the enactment of 
section 6036 of the Deficit Reduction Act of 2005 
(Public Law 109–171; 120 Stat. 80); and 
(ii) paragraph (4) of subsection (b) shall take effect 
as if included in the enactment of section 405 of divi-
sion B of the Tax Relief and Health Care Act of 2006 
(Public Law 109–432; 120 Stat. 2996). 
(2) RESTORATION OF ELIGIBILITY.—In the case of an indi-
vidual who, during the period that began on July 1, 2006, 
and ends on October 1, 2008, was determined to be ineligible 
for medical assistance under a State Medicaid plan, including 
any waiver of such plan, solely as a result of the application 
of subsections (i)(22) and (x) of section 1903 of the Social 
Security Act (as in effect during such period), but who would 
have been determined eligible for such assistance if such sub-
sections, as amended by subsection (b), had applied to the 
individual, a State may deem the individual to be eligible 
for such assistance as of the date that the individual was 
determined to be ineligible for such medical assistance on such 
basis. 
(3) SPECIAL TRANSITION RULE FOR INDIANS.—During the 
period that begins on July 1, 2006, and ends on the effective 
date of final regulations issued under subclause (II) of section 
1903(x)(3)(B)(v) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an indi-
vidual who is a member of a federally-recognized Indian tribe 
described in subclause (II) of that section who presents a docu-
ment described in subclause (I) of such section that is issued 
by such Indian tribe, shall be deemed to have presented satis-
factory evidence of citizenship or nationality for purposes of 
satisfying the requirement of subsection (x) of section 1903 
of such Act. 
SEC. 212. REDUCING ADMINISTRATIVE BARRIERS TO ENROLLMENT. 
Section 2102(b) (42 U.S.C. 1397bb(b)) is amended— 
(1) by redesignating paragraph (4) as paragraph (5); and 
(2) by inserting after paragraph (3) the following new para-
graph: 
‘‘(4) REDUCTION OF ADMINISTRATIVE BARRIERS TO ENROLL-
MENT.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B), the 
plan shall include a description of the procedures used 
to reduce administrative barriers to the enrollment of chil-
dren and pregnant women who are eligible for medical 
assistance under title XIX or for child health assistance 
or health benefits coverage under this title. Such proce-
dures shall be established and revised as often as the
H. R. 976—56 
State determines appropriate to take into account the most 
recent information available to the State identifying such 
barriers. 
‘‘(B) DEEMED COMPLIANCE IF JOINT APPLICATION AND 
RENEWAL PROCESS THAT PERMITS APPLICATION OTHER THAN 
IN
PERSON.—A State shall be deemed to comply with 
subparagraph (A) if the State’s application and renewal 
forms and supplemental forms (if any) and information 
verification process is the same for purposes of establishing 
and renewing eligibility for children and pregnant women 
for medical assistance under title XIX and child health 
assistance under this title, and such process does not 
require an application to be made in person or a face- 
to-face interview.’’. 
SEC. 213. MODEL OF INTERSTATE COORDINATED ENROLLMENT AND 
COVERAGE PROCESS. 
(a) IN GENERAL.—In order to assure continuity of coverage 
of low-income children under the Medicaid program and the State 
Children’s Health Insurance Program (CHIP), not later than 18 
months after the date of the enactment of this Act, the Secretary 
of Health and Human Services, in consultation with State Medicaid 
and CHIP directors and organizations representing program bene-
ficiaries, shall develop a model process for the coordination of the 
enrollment, retention, and coverage under such programs of children 
who, because of migration of families, emergency evacuations, nat-
ural or other disasters, public health emergencies, educational 
needs, or otherwise, frequently change their State of residency 
or otherwise are temporarily located outside of the State of their 
residency. 
(b) REPORT TO CONGRESS.—After development of such model 
process, the Secretary of Health and Human Services shall submit 
to Congress a report describing additional steps or authority needed 
to make further improvements to coordinate the enrollment, reten-
tion, and coverage under CHIP and Medicaid of children described 
in subsection (a). 
TITLE III—REDUCING BARRIERS TO 
PROVIDING PREMIUM ASSISTANCE 
Subtitle A—Additional State Option for 
Providing Premium Assistance 
SEC. 301. ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM 
ASSISTANCE. 
(a) CHIP.— 
(1) IN GENERAL.—Section 2105(c) (42 U.S.C. 1397ee(c)), as 
amended by sections 114(a), 116(c), and 211(c), is amended 
by adding at the end the following: 
‘‘(11) STATE OPTION TO OFFER PREMIUM ASSISTANCE.— 
‘‘(A) IN GENERAL.—A State may elect to offer a pre-
mium 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