I 
108TH CONGRESS 
1ST SESSION H. R. 1811
To amend title XIX of the Social Security Act to provide families of disabled 
children with the opportunity to purchase coverage under the Medicaid 
Program for such children, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 11, 2003
Mr. SESSIONS (for himself, Mr. WAXMAN, Mr. ABERCROMBIE, Mr. BACHUS, 
Mr. BARTLETT of Maryland, Mr. BROWN of Ohio, Mr. CAMP, Mrs. 
CAPPS, Mrs. CHRISTENSEN, Mr. CROWLEY, Mrs. JO ANN DAVIS of Vir-
ginia, Ms. DEGETTE, Mr. DEUTSCH, Mr. DINGELL, Mr. DOYLE, Mr. 
ENGEL, Mr. FARR, Mr. FROST, Mr. GORDON, Mr. GREEN of Texas, Mr. 
HINCHEY, Mr. HOEFFEL, Mr. INSLEE, Mr. ISAKSON, Mr. KILDEE, Ms. 
KILPATRICK, Mr. LANTOS, Mrs. MALONEY, Mr. MARKEY, Mr. MATSUI, 
Mr. MCNULTY, Mr. GEORGE MILLER of California, Mr. MOORE, Mr. 
MORAN of Virginia, Mr. MURTHA, Mrs. NORTHUP, Mr. OXLEY, Mr. 
PALLONE, Mr. PAUL, Mr. PAYNE, Mr. RAHALL, Ms. SCHAKOWSKY, Mr. 
SCHIFF, Mr. SCOTT of Virginia, Mr. SHAYS, Ms. SOLIS, Mr. SOUDER, 
Mr. STARK, Mr. STRICKLAND, Mr. TERRY, Mr. THORNBERRY, Mr. 
TOWNS, Mr. UDALL of Colorado, Mr. WOLF, Mrs. CAPITO, Mrs. JOHN-
SON of Connecticut, Mr. JOHN, Mr. REYNOLDS, and Mr. KUCINICH) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to provide 
families of disabled children with the opportunity to pur-
chase coverage under the Medicaid Program for such 
children, and for other purposes.
(1) IN
GENERAL.—Section 1902 (42 U.S.C. 
1396a) is amended—
(A) in subsection (a)(10)(A)(ii)—
(i) by striking ‘‘or’’ at the end of sub-
clause (XVII); 
(ii) by adding ‘‘or’’ at the end of sub-
clause (XVIII); and 
(iii) by adding at the end the fol-
lowing new subclause: 
‘‘(XIX) who are disabled children 
described in subsection (cc)(1);’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(cc)(1) Individuals described in this paragraph are 
individuals—
‘‘(A) who have not attained 18 years of age; 
‘‘(B) who would be considered disabled under 
section 1614(a)(3)(C) but for having earnings or 
deemed income or resources (as determined under 
title XVI for children) that exceed the requirements 
for receipt of supplemental security income benefits; 
and 
‘‘(C) whose family income does not exceed such 
income level as the State establishes and does not 
exceed—
‘‘(i) 250 percent of the income official pov-
erty line (as defined by the Office of Manage-
ment and Budget, and revised annually in ac-
cordance with section 673(2) of the Omnibus 
Budget Reconciliation Act of 1981) applicable 
to a family of the size involved; or 
‘‘(ii) such higher percent of such poverty 
line as a State may establish, except that—
‘‘(I) any medical assistance provided 
to an individual whose family income ex-
ceeds 250 percent of such poverty line may 
only be provided with State funds; and 
‘‘(II) no Federal financial participa-
tion shall be provided under section 
1903(a) for any medical assistance pro-
vided to such an individual.’’. 
(2) INTERACTION WITH EMPLOYER-SPONSORED 
FAMILY
COVERAGE.—Section 1902(cc) (42 U.S.C. 
1396a(cc)), as added by paragraph (1)(B), is 
amended by adding at the end the following new 
paragraph: 
‘‘(2)(A) If an employer of a parent of an individual 
described in paragraph (1) offers family coverage under 
a group health plan (as defined in section 2791(a) of the 
Public Health Service Act), the State shall—
‘‘(i) require such parent to apply for, enroll in, 
and pay premiums for, such coverage as a condition 
of such parent’s child being or remaining eligible for 
medical 
assistance 
under 
subsection 
(a)(10)(A)(ii)(XIX) if the parent is determined eligi-
ble for such coverage and the employer contributes 
at least 50 percent of the total cost of annual pre-
miums for such coverage; and 
‘‘(ii) if such coverage is obtained—
‘‘(I) subject to paragraph (2) of section 
1916(h), reduce the premium imposed by the 
State under that section in an amount that rea-
sonably reflects the premium contribution made 
by the parent for private coverage on behalf of 
a child with a disability; and 
‘‘(II) treat such coverage as a third party 
liability under subsection (a)(25). 
‘‘(B) In the case of a parent to which subparagraph 
(A) applies, a State, subject to paragraph (1)(C)(ii), may 
provide for payment of any portion of the annual premium 
for such family coverage that the parent is required to 
pay. Any payments made by the State under this subpara-
graph shall be considered, for purposes of section 1903(a), 
to be payments for medical assistance.’’.
(b) STATE OPTION TO IMPOSE INCOME-RELATED 
PREMIUMS.—Section 1916 (42 U.S.C. 1396o) is amend-
ed—
(1) in subsection (a), by striking ‘‘subsection 
(g)’’ and inserting ‘‘subsections (g) and (h)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(h)(1) With respect to disabled children provided 
medical assistance under section 1902(a)(10)(A)(ii)(XIX), 
subject to paragraph (2), a State may (in a uniform man-
ner for such children) require the families of such children 
to pay monthly premiums set on a sliding scale based on 
family income. 
‘‘(2) A premium requirement imposed under para-
graph (1) may only apply to the extent that—
‘‘(A) the aggregate amount of such premium 
and any premium that the parent is required to pay 
for family coverage under section 1902(cc)(2)(A)(i) 
does not exceed 5 percent of the family’s income; 
and 
‘‘(B) the requirement is imposed consistent with 
section 1902(cc)(2)(A)(ii)(I). 
‘‘(3) A State shall not require prepayment of a pre-
mium imposed pursuant to paragraph (1) and shall not 
terminate 
eligibility 
of 
a 
child 
under 
section
1902(a)(10)(A)(ii)(XIX) for medical assistance under this 
title on the basis of failure to pay any such premium until 
such failure continues for a period of not less than 60 days 
from the date on which the premium became past due. 
The State may waive payment of any such premium in 
any case where the State determines that requiring such 
payment would create an undue hardship.’’. 
(c) 
CONFORMING
AMENDMENTS.—Section 
1903(f)(4) (42 U.S.C. 1396b(f)(4)) is amended in the 
matter 
preceding 
subparagraph 
(A), 
by 
inserting 
‘‘1902(a)(10)(A)(ii)(XIX),’’ 
after 
‘‘1902(a)(10)(A)(ii)(XVIII),’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to medical assistance for items and 
services furnished on or after October 1, 2005. 
SEC. 3. TREATMENT OF INPATIENT PSYCHIATRIC HOS-
PITAL SERVICES FOR INDIVIDUALS UNDER 
AGE 21 IN HOME OR COMMUNITY-BASED 
SERVICES WAIVERS. 
(a) IN
GENERAL.—Section 1915(c) (42 U.S.C. 
1396n(c)) is amended—
(1) in paragraph (1)—
(A) in the first sentence, by inserting ‘‘, or 
would require inpatient psychiatric hospital 
services for individuals under age 21,’’ after