funds made available under this title to be used 
to provide child health assistance or other 
health benefits coverage to a nonpregnant child-
less adult; and 
‘‘(B) notwithstanding the terms and condi-
tions of an applicable existing waiver, the provi-
sions of paragraphs (2) and (3) shall apply for 
purposes of any period beginning on or after 
October 1, 2010, in determining the period to 
which the waiver applies, the individuals eligible 
to be covered by the waiver, and the amount of 
the Federal payment under this title. 
‘‘(2) TERMINATION OF CHIP COVERAGE UNDER 
APPLICABLE
EXISTING
WAIVERS
AT
THE
END
OF 
FISCAL YEAR 2010.— 
‘‘(A) IN
GENERAL.—No funds shall be 
available under this title for child health assist-
ance or other health benefits coverage that is 
provided to a nonpregnant childless adult under 
an applicable existing waiver after September 
30, 2010. 
‘‘(B) 
EXTENSION
UPON
STATE
RE-
QUEST.—If an applicable existing waiver de-
scribed in subparagraph (A) would otherwise 
expire before October 1, 2010, and the State
requests an extension of such waiver, the Sec-
retary shall grant such an extension, but only 
through September 30, 2011. 
‘‘(C) APPLICATION OF ENHANCED FMAP.— 
The enhanced FMAP determined under section 
2105(b) shall apply to expenditures under an 
applicable existing waiver for the provision of 
child health assistance or other health benefits 
coverage to a nonpregnant childless adult dur-
ing fiscal year 2010. 
‘‘(3) OPTIONAL
1-YEAR
TRANSITIONAL
COV-
ERAGE BLOCK GRANT FUNDED FROM STATE ALLOT-
MENT.—Subject to paragraph (4)(B), each State for 
which coverage under an applicable existing waiver 
is terminated under paragraph (2)(A) may elect to 
provide nonpregnant childless adults who were pro-
vided child health assistance or health benefits cov-
erage under the applicable existing waiver at any 
time during fiscal year 2010 with such assistance or 
coverage during fiscal year 2011, as if the authority 
to provide such assistance or coverage under an ap-
plicable existing waiver was extended through that 
fiscal year, but subject to the following terms and 
conditions:
‘‘(A) BLOCK
GRANT
SET
ASIDE
FROM 
STATE
ALLOTMENT.—The Secretary shall set 
aside for the State an amount equal to the Fed-
eral share of the State’s projected expenditures 
under the applicable existing waiver for pro-
viding child health assistance or health benefits 
coverage to all nonpregnant childless adults 
under such waiver for fiscal year 2010 (as cer-
tified by the State and submitted to the Sec-
retary by not later than August 31, 2010, and 
without regard to whether any such individual 
lost coverage during fiscal year 2010 and was 
later provided child health assistance or other 
health benefits coverage under the waiver in 
that fiscal year), increased by the annual ad-
justment for fiscal year 2011 determined under 
section 2104(m)(5)(A). The Secretary may ad-
just the amount set aside under the preceding 
sentence, as necessary, on the basis of the ex-
penditure data for fiscal year 2010 reported by 
States on CMS Form 64 or CMS Form 21 not 
later than November 30, 2010, but in no case 
shall the Secretary adjust such amount after 
December 31, 2010.
‘‘(B) NO
COVERAGE
FOR
NONPREGNANT 
CHILDLESS ADULTS WHO WERE NOT COVERED 
DURING FISCAL YEAR 2010.— 
‘‘(i) FMAP APPLIED
TO
EXPENDI-
TURES.—The Secretary shall pay the State 
for each quarter of fiscal year 2011, from 
the amount set aside under subparagraph 
(A), an amount equal to the Federal med-
ical assistance percentage (as determined 
under section 1905(b) without regard to 
clause (4) of such section) of expenditures 
in the quarter for providing child health 
assistance or other health benefits coverage 
to a nonpregnant childless adult but only 
if such adult was enrolled in the State pro-
gram under this title during fiscal year 
2010 (without regard to whether the indi-
vidual lost coverage during fiscal year 
2010 and was reenrolled in that fiscal year 
or in fiscal year 2011). 
‘‘(ii) FEDERAL
PAYMENTS
LIMITED 
TO
AMOUNT
OF
BLOCK
GRANT
SET- 
ASIDE.—No payments shall be made to a 
State for expenditures described in this 
subparagraph after the total amount set
aside under subparagraph (A) for fiscal 
year 2011 has been paid to the State. 
‘‘(4) STATE OPTION TO APPLY FOR MEDICAID 
WAIVER
TO
CONTINUE
COVERAGE
FOR
NONPREG-
NANT CHILDLESS ADULTS.— 
‘‘(A) IN GENERAL.—Each State for which 
coverage under an applicable existing waiver is 
terminated under paragraph (2)(A) may sub-
mit, not later than June 30, 2011, an applica-
tion to the Secretary for a waiver under section 
1115 of the State plan under title XIX to pro-
vide medical assistance to a nonpregnant child-
less adult whose coverage is so terminated (in 
this subsection referred to as a ‘Medicaid non-
pregnant childless adults waiver’). 
‘‘(B) DEADLINE
FOR
APPROVAL.—The 
Secretary shall make a decision to approve or 
deny an application for a Medicaid nonpregnant 
childless adults waiver submitted under sub-
paragraph (A) within 90 days of the date of the 
submission of the application. If no decision has 
been made by the Secretary as of September 
30, 2011, on the application of a State for a 
Medicaid nonpregnant childless adults waiver 
that was submitted to the Secretary by June
30, 2011, the application shall be deemed ap-
proved. 
‘‘(C) 
STANDARD
FOR
BUDGET
NEU-
TRALITY.—The budget neutrality requirement 
applicable with respect to expenditures for med-
ical assistance under a Medicaid nonpregnant 
childless adults waiver shall— 
‘‘(i) in the case of fiscal year 2012, 
allow expenditures for medical assistance 
under title XIX for all such adults to not 
exceed the total amount of payments made 
to the State under paragraph (3)(B) for 
fiscal year 2011, increased by the percent-
age increase (if any) in the projected nomi-
nal per capita amount of National Health 
Expenditures for calendar year 2012 over 
2011, as most recently published by the 
Secretary; and 
‘‘(ii) in the case of any succeeding fis-
cal year, allow such expenditures to not ex-
ceed the amount in effect under this sub-
paragraph for the preceding fiscal year, in-
creased by the percentage increase (if any) 
in the projected nominal per capita amount 
of National Health Expenditures for the
calendar year that begins during the fiscal 
year involved over the preceding calendar 
year, as most recently published by the 
Secretary. 
‘‘(b) RULES AND CONDITIONS FOR COVERAGE OF 
PARENTS OF TARGETED LOW-INCOME CHILDREN.— 
‘‘(1) TWO-YEAR
TRANSITION
PERIOD; AUTO-
MATIC EXTENSION AT STATE OPTION THROUGH FIS-
CAL YEAR 2011.— 
‘‘(A) NO NEW CHIP WAIVERS.—Notwith-
standing section 1115 or any other provision of 
this title, except as provided in this sub-
section— 
‘‘(i) the Secretary shall not on or after 
the date of the enactment of the Children’s 
Health Insurance Program Reauthoriza-
tion Act of 2009 approve or renew a waiv-
er, experimental, pilot, or demonstration 
project that would allow funds made avail-
able under this title to be used to provide 
child health assistance or other health ben-
efits coverage to a parent of a targeted 
low-income child; and 
‘‘(ii) notwithstanding the terms and 
conditions of an applicable existing waiver,
the provisions of paragraphs (2) and (3) 
shall apply for purposes of any fiscal year 
beginning on or after October 1, 2011, in 
determining the period to which the waiver 
applies, the individuals eligible to be cov-
ered by the waiver, and the amount of the 
Federal payment under this title. 
‘‘(B) 
EXTENSION
UPON
STATE
RE-
QUEST.—If an applicable existing waiver de-
scribed in subparagraph (A) would otherwise 
expire before October 1, 2011, and the State 
requests an extension of such waiver, the Sec-
retary shall grant such an extension, but only, 
subject to paragraph (2)(A), through Sep-
tember 30, 2011. 
‘‘(C) APPLICATION OF ENHANCED FMAP.— 
The enhanced FMAP determined under section 
2105(b) shall apply to expenditures under an 
applicable existing waiver for the provision of 
child health assistance or other health benefits 
coverage to a parent of a targeted low-income 
child during the third and fourth quarters of 
fiscal year 2009 and during fiscal years 2010 
and 2011.
‘‘(2) RULES FOR FISCAL YEARS 2012 THROUGH 
2013.— 
‘‘(A) PAYMENTS FOR COVERAGE LIMITED 
TO BLOCK GRANT FUNDED FROM STATE ALLOT-
MENT.—Any State that provides child health 
assistance or health benefits coverage under an 
applicable existing waiver for a parent of a tar-
geted low-income child may elect to continue to 
provide such assistance or coverage through fis-
cal year 2012 or 2013, subject to the same 
terms and conditions that applied under the ap-
plicable existing waiver, unless otherwise modi-
fied in subparagraph (B). 
‘‘(B) TERMS AND CONDITIONS.— 
‘‘(i) BLOCK GRANT SET ASIDE FROM 
STATE ALLOTMENT.—If the State makes 
an election under subparagraph (A), the 
Secretary shall set aside for the State for 
each such fiscal year an amount equal to 
the Federal share of 110 percent of the 
State’s projected expenditures under the 
applicable existing waiver for providing 
child health assistance or health benefits 
coverage to all parents of targeted low-in-
come children enrolled under such waiver
for the fiscal year (as certified by the State 
and submitted to the Secretary by not 
later than August 31 of the preceding fis-
cal year). In the case of fiscal year 2013, 
the set aside for any State shall be com-
puted separately for each period described 
in subparagraphs (A) and (B) of section 
2104(a)(16) and any reduction in the allot-
ment for either such period under section 
2104(m)(4) shall be allocated on a pro 
rata basis to such set aside. 
‘‘(ii) 
PAYMENTS
FROM
BLOCK 
GRANT.—The Secretary shall pay the State 
from the amount set aside under clause (i) 
for the fiscal year, an amount for each 
quarter of such fiscal year equal to the ap-
plicable 
percentage 
determined 
under 
clause (iii) or (iv) for expenditures in the 
quarter for providing child health assist-
ance or other health benefits coverage to a 
parent of a targeted low-income child. 
‘‘(iii) ENHANCED FMAP ONLY IN FIS-
CAL YEAR 2012 FOR STATES WITH SIGNIFI-
CANT CHILD OUTREACH OR THAT ACHIEVE 
CHILD
COVERAGE
BENCHMARKS; 
FMAP
FOR ANY OTHER STATES.—For purposes 
of clause (ii), the applicable percentage for 
any quarter of fiscal year 2012 is equal 
to— 
‘‘(I) the enhanced FMAP deter-
mined under section 2105(b) in the 
case of a State that meets the out-
reach or coverage benchmarks de-
scribed in any of subparagraph (A), 
(B), or (C) of paragraph (3) for fiscal 
year 2011; or 
‘‘(II) the Federal medical assist-
ance percentage (as determined under 
section 1905(b) without regard to 
clause (4) of such section) in the case 
of any other State. 
‘‘(iv) AMOUNT OF FEDERAL MATCH-
ING PAYMENT IN 2013.—For purposes of 
clause (ii), the applicable percentage for 
any quarter of fiscal year 2013 is equal 
to— 
‘‘(I) the REMAP percentage if— 
‘‘(aa) the applicable percent-
age for the State under clause
(iii) was the enhanced FMAP for 
fiscal year 2012; and 
‘‘(bb) the State met either of 
the coverage benchmarks de-
scribed in subparagraph (B) or 
(C) of paragraph (3) for 2012; or 
‘‘(II) the Federal medical assist-
ance percentage (as so determined) in 
the case of any State to which sub-
clause (I) does not apply. 
For purposes of subclause (I), the REMAP 
percentage is the percentage which is the 
sum of such Federal medical assistance 
percentage and a number of percentage 
points equal to one-half of the difference 
between such Federal medical assistance 
percentage and such enhanced FMAP. 
‘‘(v) NO FEDERAL PAYMENTS OTHER 
THAN FROM BLOCK GRANT SET ASIDE.— 
No payments shall be made to a State for 
expenditures described in clause (ii) after 
the total amount set aside under clause (i) 
for a fiscal year has been paid to the 
State.
‘‘(vi) NO INCREASE IN INCOME ELIGI-
BILITY
LEVEL
FOR
PARENTS.—No pay-
ments shall be made to a State from the 
amount set aside under clause (i) for a fis-
cal year for expenditures for providing 
child health assistance or health benefits 
coverage to a parent of a targeted low-in-
come child whose family income exceeds 
the income eligibility level applied under 
the applicable existing waiver to parents of 
targeted low-income children on the date of 
enactment of the Children’s Health Insur-
ance Program Reauthorization Act of 
2009. 
‘‘(3) 
OUTREACH
OR
COVERAGE
BENCH-
MARKS.—For purposes of paragraph (2), the out-
reach or coverage benchmarks described in this 
paragraph are as follows: 
‘‘(A) SIGNIFICANT CHILD OUTREACH CAM-
PAIGN.—The State— 
‘‘(i) was awarded a grant under sec-
tion 2113 for fiscal year 2011; 
‘‘(ii) implemented 1 or more of the en-
rollment and retention provisions described