I
105TH CONGRESS
1ST SESSION
H. R. 1564
To amend title XIX of the Social Security Act to permit presumptive eligibility
for low-income children under the Medicaid Program.
IN THE HOUSE OF REPRESENTATIVES
MAY 8, 1997
Ms. DEGETTE (for herself, Mr. DINGELL, Mr. BROWN of Ohio, and Mr. WAX-
MAN) introduced the following bill; which was referred to the Committee
on Commerce
A BILL
To amend title XIX of the Social Security Act to permit
presumptive eligibility for low-income children under the
Medicaid Program.
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 ‘‘Medicaid Low-Income
Children Presumptive Eligibility Amendments of 1997’’.
SEC. 2. MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-IN-
COME CHILDREN.
(a) IN GENERAL.—Title XIX of the Social Security
Act is amended by inserting after section 1920 the follow-
ing new section:
‘‘PRESUMPTIVE ELIGIBILITY FOR CHILDREN
‘‘SEC. 1920A. (a) A State plan approved under sec-
tion 1902 may provide for making medical assistance with
respect to health care items and services covered under
the State plan available to a child during a presumptive
eligibility period.
‘‘(b) For purposes of this section:
‘‘(1) The term ‘child’ means an individual
under 19 years of age.
‘‘(2) The term ‘presumptive eligibility period’
means, with respect to a child, the period that—
‘‘(A) begins with the date on which a
qualified entity determines, on the basis of pre-
liminary information, that the family income of
the child does not exceed the applicable income
level of eligibility under the State plan, and
‘‘(B) ends with (and includes) the earlier
of—
‘‘(i) the day on which a determination
is made with respect to the eligibility of
the child for medical assistance under the
State plan, or
‘‘(ii) in the case of a child on whose
behalf an application is not filed by the
last day of the month following the month
during which the entity makes the deter-
mination referred to in subparagraph (A),
such last day.
‘‘(3)(A) Subject to subparagraph (B), the term
‘qualified entity’ means any entity that—
‘‘(i)(I) is eligible for payments under a
State plan approved under this title and pro-
vides items and services described in subsection
(a) or (II) is authorized to determine eligibility
of a child to participate in a Head Start pro-
gram under the Head Start Act (42 U.S.C.
9821 et seq.), eligibility of a child to receive
child care services for which financial assistance
is provided under the Child Care and Develop-
ment Block Grant Act of 1990 (42 U.S.C. 9858
et seq.), eligibility of an infant or child to re-
ceive assistance under the special supplemental
nutrition program for women, infants, and chil-
dren (WIC) under section 17 of the Child Nu-
trition Act of 1966 (42 U.S.C. 1786); and
‘‘(A) notify the State agency of the determina-
tion within 5 working days after the date on which
determination is made, and
‘‘(B) inform the parent or custodian of the
child at the time the determination is made that an
application for medical assistance under the State
plan is required to be made by not later than the
last day of the month following the month during
which the determination is made.
‘‘(3) In the case of a child who is determined by a
qualified entity to be presumptively eligible for medical as-
sistance under a State plan, the parent, guardian, or other
person shall make application on behalf of the child for
medical assistance under such plan by not later than the
last day of the month following the month during which
the determination is made, which application may be the
application used for the receipt of medical assistance by
individuals described in section 1902(l)(1).
‘‘(d) Notwithstanding any other provision of this title,
medical assistance for items and services described in sub-
section (a) that—
‘‘(1) are furnished to a child—
‘‘(A) during a presumptive eligibility pe-
riod,
‘‘(B) by a entity that is eligible for pay-
ments under the State plan; and
‘‘(2) are included in the care and services cov-
ered by a State plan;
shall be treated as medical assistance provided by such
plan for purposes of section 1903.’’.
(b) 
CONFORMING
AMENDMENTS.—(1) 
Section
1902(a)(47) of such Act (42 U.S.C. 1396a(a)(47)) is
amended by inserting before the semicolon at the end the
following: ‘‘and provide for making medical assistance for
items and services described in subsection (a) of section
1920A available to children during a presumptive eligi-
bility period in accordance with such section’’.
(2) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C.
1396b(u)(1)(D)(v)) is amended by inserting before the pe-
riod at the end the following: ‘‘or for items and services
described in subsection (a) of section 1920A provided to
a child during a presumptive eligibility period under such
section’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect on the date of the enactment
of this Act.
Æ