I 
110TH CONGRESS 
1ST SESSION H. R. 3171 
To amend titles XIX and XXI of the Social Security Act to provide for 
an express lane for simplified Medicaid and SCHIP eligibility determina-
tions for children. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 25, 2007 
Mr. KAGEN introduced the following bill; which was referred to the Committee 
on Energy and Commerce 
A BILL 
To amend titles XIX and XXI of the Social Security Act 
to provide for an express lane for simplified Medicaid 
and SCHIP eligibility determinations for children. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Fast Track for 
Healthy Children Act of 2007’’. 
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SEC. 2. STATE OPTION TO RELY ON FINDINGS FROM AN EX-
PRESS LANE AGENCY TO CONDUCT SIM-
PLIFIED ELIGIBILITY DETERMINATIONS. 
(a) MEDICAID.—Section 1902(e) of the Social Secu-
rity Act (42 U.S.C. 1396a(e)) is amended by adding at 
the end the following: 
‘‘(13) EXPRESS LANE OPTION.— 
‘‘(A) IN GENERAL.— 
‘‘(i) OPTION TO USE A FINDING FROM AN 
EXPRESS LANE AGENCY.—At the option of the 
State, the State plan may provide that in deter-
mining eligibility under this title for a child (as 
defined in subparagraph (F)), the State may 
rely on a finding made within a reasonable pe-
riod (as determined by the State) from an Ex-
press Lane agency (as defined in subparagraph 
(E)) when it determines whether a child satis-
fies one or more components of eligibility for 
medical assistance under this title. The State 
may rely on a finding from an Express Lane 
agency 
notwithstanding 
sections 
1902(a)(46)(B), 1903(x), and 1137(d) and any 
differences in budget unit, disregard, deeming 
or other methodology, if the following require-
ments are met: 
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‘‘(I) PROHIBITION ON DETERMINING 
CHILDREN INELIGIBLE FOR COVERAGE.— 
If a finding from an Express Lane agency 
would result in a determination that a 
child does not satisfy an eligibility require-
ment for medical assistance under this title 
and for child health assistance under title 
XXI, the State shall determine eligibility 
for assistance using its regular procedures. 
‘‘(II) NOTICE
REQUIREMENT.—For 
any child who is found eligible for medical 
assistance under the State plan under this 
title or child health assistance under title 
XXI and who is subject to premiums based 
on an Express Lane agency’s finding of 
such child’s income level, the State shall 
provide notice that the child may qualify 
for lower premium payments if evaluated 
by the State using its regular policies and 
of the procedures for requesting such an 
evaluation. 
‘‘(III) COMPLIANCE
WITH
SCREEN 
AND
ENROLL
REQUIREMENT.—The State 
shall satisfy the requirements under (A) 
and (B) of section 2102(b)(3) (relating to 
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screen and enroll) before enrolling a child 
in child health assistance under title XXI. 
At its option, the State may fulfill such re-
quirements in accordance with either op-
tion provided under subparagraph (C) of 
this paragraph. 
‘‘(ii) OPTION TO APPLY TO RENEWALS AND 
REDETERMINATIONS.—The State may apply the 
provisions of this paragraph when conducting 
initial determinations of eligibility, redetermina-
tions of eligibility, or both, as described in the 
State plan. 
‘‘(B) RULES OF CONSTRUCTION.—Nothing in 
this paragraph shall be construed— 
‘‘(i) to limit or prohibit a State from tak-
ing any actions otherwise permitted under this 
title or title XXI in determining eligibility for 
or enrolling children into medical assistance 
under this title or child health assistance under 
title XXI; or 
‘‘(ii) to modify the limitations in section 
1902(a)(5) concerning the agencies that may 
make a determination of eligibility for medical 
assistance under this title. 
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‘‘(C) OPTIONS FOR SATISFYING THE SCREEN 
AND ENROLL REQUIREMENT.— 
‘‘(i) IN GENERAL.—With respect to a child 
whose eligibility for medical assistance under 
this title or for child health assistance under 
title XXI has been evaluated by a State agency 
using an income finding from an Express Lane 
agency, a State may carry out its duties under 
subparagraphs 
(A) 
and 
(B) 
of 
section 
2102(b)(3) (relating to screen and enroll) in ac-
cordance with either clause (ii) or clause (iii). 
‘‘(ii) 
ESTABLISHING
A
SCREENING 
THRESHOLD.— 
‘‘(I) IN GENERAL.—Under this clause, 
the State establishes a screening threshold 
set as a percentage of the Federal poverty 
level that exceeds the highest income 
threshold applicable under this title to the 
child by a minimum of 30 percentage 
points or, at State option, a higher number 
of percentage points that reflects the value 
(as determined by the State and described 
in the State plan) of any differences be-
tween income methodologies used by the 
program administered by the Express Lane 
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agency and the methodologies used by the 
State in determining eligibility for medical 
assistance under this title. 
‘‘(II) CHILDREN
WITH
INCOME
NOT 
ABOVE THRESHOLD.—If the income of a 
child does not exceed the screening thresh-
old, the child is deemed to satisfy the in-
come eligibility criteria for medical assist-
ance under this title regardless of whether 
such child would otherwise satisfy such cri-
teria. 
‘‘(III) 
CHILDREN
WITH
INCOME 
ABOVE THRESHOLD.—If the income of a 
child exceeds the screening threshold, the 
child shall be considered to have an income 
above the Medicaid applicable income level 
described in section 2110(b)(4) and to sat-
isfy 
the 
requirement 
under 
section 
2110(b)(1)(C) (relating to the requirement 
that SCHIP matching funds be used only 
for children not eligible for Medicaid). If 
such a child is enrolled in child health as-
sistance under title XXI, the State shall 
provide the parent, guardian, or custodial 
relative with the following: 
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‘‘(aa) Notice that the child may 
be eligible to receive medical assist-
ance under the State plan under this 
title if evaluated for such assistance 
under the State’s regular procedures 
and notice of the process through 
which a parent, guardian, or custodial 
relative can request that the State 
evaluate the child’s eligibility for med-
ical assistance under this title using 
such regular procedures. 
‘‘(bb) A description of differences 
between the medical assistance pro-
vided under this title and child health 
assistance under title XXI, including 
differences in cost-sharing require-
ments and covered benefits. 
‘‘(iii) TEMPORARY ENROLLMENT IN SCHIP 
PENDING SCREEN AND ENROLL.— 
‘‘(I) IN GENERAL.—Under this clause, 
a State enrolls a child in child health as-
sistance under title XXI for a temporary 
period if the child appears eligible for such 
assistance based on an income finding by 
an Express Lane agency. 
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‘‘(II) 
DETERMINATION
OF
ELIGI-
BILITY.—During such temporary enroll-
ment period, the State shall determine the 
child’s eligibility for child health assistance 
under title XXI or for medical assistance 
under this title in accordance with this 
clause. 
‘‘(III) PROMPT FOLLOW UP.—In mak-
ing such a determination, the State shall 
take prompt action to determine whether 
the child should be enrolled in medical as-
sistance under this title or child health as-
sistance under title XXI pursuant to sub-
paragraphs 
(A) 
and 
(B) 
of 
section 
2102(b)(3) (relating to screen and enroll). 
‘‘(IV) REQUIREMENT FOR SIMPLIFIED 
DETERMINATION.—In making such a de-
termination, the State shall use procedures 
that, to the maximum feasible extent, re-
duce the burden imposed on the individual 
of such determination. Such procedures 
may not require the child’s parent, guard-
ian, or custodial relative to provide or 
verify information that already has been 
provided to the State agency by an Ex-
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press Lane agency or another source of in-
formation unless the State agency has rea-
son to believe the information is erroneous. 
‘‘(V) AVAILABILITY OF SCHIP MATCH-
ING FUNDS DURING TEMPORARY ENROLL-
MENT
PERIOD.—Medical assistance for 
items and services that are provided to a 
child enrolled in title XXI during a tem-
porary enrollment period under this clause 
shall be treated as child health assistance 
under such title. 
‘‘(D) OPTION FOR AUTOMATIC ENROLLMENT.— 
‘‘(i) IN GENERAL.—At its option, a State 
may initiate an evaluation of an individual’s eli-
gibility for medical assistance under this title 
without an application and determine the indi-
vidual’s eligibility for such assistance using 
findings from one or more Express Lane agen-
cies and information from sources other than a 
child, if the requirements of clauses (ii) and (iii) 
are met. 
‘‘(ii) 
INDIVIDUAL
CHOICE
REQUIRE-
MENT.—The requirement of this clause is that 
the child is enrolled in medical assistance under 
this title or child health assistance under title 
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XXI only if the child (or a parent, caretaker 
relative, or guardian on the behalf of the child) 
has affirmatively assented to such enrollment. 
‘‘(iii) INFORMATION
REQUIREMENT.—The 
requirement of this clause is that the State in-
forms the parent, guardian, or custodial relative 
of the child of the services that will be covered, 
appropriate methods for using such services, 
premium or other cost sharing charges (if any) 
that apply, medical support obligations (under 
section 1912(a)) created by enrollment (if appli-
cable), and the actions the parent, guardian, or 
relative must take to maintain enrollment and 
renew coverage. 
‘‘(E) EXPRESS
LANE
AGENCY
DEFINED.—In 
this paragraph, the term ‘express lane agency’ 
means an agency that meets the following require-
ments: 
‘‘(i) The agency determines eligibility for 
assistance under the Food Stamp Act of 1977, 
the Richard B. Russell National School Lunch 
Act, the Child Nutrition Act of 1966, or the 
Child Care and Development Block Grant Act 
of 1990. 
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‘‘(ii) The agency notifies the child (or a 
parent, caretaker relative, or guardian on the 
behalf of the child)— 
‘‘(I) of the information which shall be 
disclosed; 
‘‘(II) that the information will be used 
by the State solely for purposes of deter-
mining eligibility for and for providing 
medical assistance under this title or child 
health assistance under title XXI; and 
‘‘(III) that the child, or parent, care-
taker relative, or guardian, may elect to 
not have the information disclosed for such 
purposes. 
‘‘(iii) The agency and the State agency are 
subject to an interagency agreement limiting 
the disclosure and use of such information to 
such purposes. 
‘‘(iv) The agency is determined by the 
State agency to be capable of making the deter-
minations described in this paragraph and is 
identified in the State plan under this title or 
title XXI. 
For purposes of this subparagraph, the term ‘State 
agency’ refers to the agency determining eligibility 
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