‘‘(E) by advocating for individual and com-
munity health or nutrition needs; and 
‘‘(F) by providing referral and followup 
services. 
‘‘(g) APPROPRIATION.—There is appropriated, out of 
any money in the Treasury not otherwise appropriated, 
$100,000,000 for the period of fiscal years 2008 through 
2012, to remain available until expended, for the purpose 
of awarding grants under this section. Amounts appro-
priated and paid under the authority of this section shall 
be in addition to amounts appropriated under section 
2104 and paid to States in accordance with section 2105, 
including with respect to expenditures for outreach activi-
ties in accordance with subsections (a)(1)(D)(iii) and 
(c)(2)(C) of that section. 
‘‘(h) NATIONAL ENROLLMENT CAMPAIGN.—From 
the amounts made available under subsection (a)(2), the 
Secretary shall develop and implement a national enroll-
ment campaign to improve the enrollment of underserved 
child populations in the programs established under this 
title and title XIX. Such campaign may include— 
‘‘(1) the establishment of partnerships with the 
Secretary of Education and the Secretary of Agri-
culture to develop national campaigns to link the eli-
gibility and enrollment systems for the assistance 
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programs each Secretary administers that often 
serve the same children; 
‘‘(2) the integration of information about the 
programs established under this title and title XIX 
in public health awareness campaigns administered 
by the Secretary; 
‘‘(3) increased financial and technical support 
for enrollment hotlines maintained by the Secretary 
to ensure that all States participate in such hotlines; 
‘‘(4) the establishment of joint public awareness 
outreach initiatives with the Secretary of Education 
and the Secretary of Labor regarding the impor-
tance of health insurance to building strong commu-
nities and the economy; 
‘‘(5) the development of special outreach mate-
rials for Native Americans or for individuals with 
limited English proficiency; and 
‘‘(6) such other outreach initiatives as the Sec-
retary determines would increase public awareness of 
the programs under this title and title XIX.’’. 
(b) ENHANCED
ADMINISTRATIVE
FUNDING
FOR 
TRANSLATION
OR INTERPRETATION SERVICES UNDER 
CHIP.—Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as 
amended by section 603, is amended— 
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(1) in the matter preceding subparagraph (A), 
by inserting ‘‘(or, in the case of expenditures de-
scribed in subparagraph (D)(iv), the higher of 75 
percent or the sum of the enhanced FMAP plus 5 
percentage points)’’ after ‘‘enhanced FMAP’’; and 
(2) in subparagraph (D)— 
(A) in clause (iii), by striking ‘‘and’’ at the 
end; 
(B) by redesignating clause (iv) as clause 
(v); and 
(C) by inserting after clause (iii) the fol-
lowing new clause: 
‘‘(iv) for translation or interpretation 
services in connection with the enrollment 
and use of services under this title by indi-
viduals for whom English is not their pri-
mary language (as found necessary by the 
Secretary for the proper and efficient ad-
ministration of the State plan); and’’. 
(c) NONAPPLICATION OF ADMINISTRATIVE EXPENDI-
TURES
CAP.—Section 
2105(c)(2) 
(42 
U.S.C. 
1397ee(c)(2)) is amended by adding at the end the fol-
lowing: 
‘‘(C) NONAPPLICATION
TO
CERTAIN
EX-
PENDITURES.—The limitation under subpara-
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graph (A) shall not apply with respect to the 
following expenditures: 
‘‘(i) EXPENDITURES FUNDED UNDER 
SECTION 2113.—Expenditures for outreach 
and enrollment activities funded under a 
grant awarded to the State under section 
2113.’’. 
SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF IN-
DIANS. 
(a) IN GENERAL.—Section 1139 (42 U.S.C. 1320b– 
9) is amended to read as follows: 
‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 
HEALTH CARE FOR INDIANS UNDER TITLES 
XIX AND XXI. 
‘‘(a) AGREEMENTS WITH STATES
FOR MEDICAID 
AND CHIP OUTREACH ON OR NEAR RESERVATIONS TO 
INCREASE
THE ENROLLMENT
OF INDIANS
IN THOSE 
PROGRAMS.— 
‘‘(1) IN GENERAL.—In order to improve the ac-
cess of Indians residing on or near a reservation to 
obtain benefits under the Medicaid and State chil-
dren’s health insurance programs established under 
titles XIX and XXI, the Secretary shall encourage 
the State to take steps to provide for enrollment on 
or near the reservation. Such steps may include out-
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reach efforts such as the outstationing of eligibility 
workers, entering into agreements with the Indian 
Health Service, Indian Tribes, Tribal Organizations, 
and Urban Indian Organizations to provide out-
reach, education regarding eligibility and benefits, 
enrollment, and translation services when such serv-
ices are appropriate. 
‘‘(2) CONSTRUCTION.—Nothing in paragraph 
(1) shall be construed as affecting arrangements en-
tered into between States and the Indian Health 
Service, Indian Tribes, Tribal Organizations, or 
Urban Indian Organizations for such Service, 
Tribes, or Organizations to conduct administrative 
activities under such titles. 
‘‘(b) REQUIREMENT
TO
FACILITATE
COOPERA-
TION.—The Secretary, acting through the Centers for 
Medicare & Medicaid Services, shall take such steps as are 
necessary to facilitate cooperation with, and agreements 
between, States and the Indian Health Service, Indian 
Tribes, Tribal Organizations, or Urban Indian Organiza-
tions with respect to the provision of health care items 
and services to Indians under the programs established 
under title XIX or XXI. 
‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN 
HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN IN-
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DIAN ORGANIZATION.—In this section, the terms ‘Indian’, 
‘Indian Tribe’, ‘Indian Health Program’, ‘Tribal Organi-
zation’, and ‘Urban Indian Organization’ have the mean-
ings given those terms in section 4 of the Indian Health 
Care Improvement Act.’’. 
(b) NONAPPLICATION
OF 10 PERCENT LIMIT
ON 
OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec-
tion 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as added 
by section 201(c), is amended by adding at the end the 
following new clause: 
‘‘(ii) EXPENDITURES
TO
INCREASE 
OUTREACH TO, AND THE ENROLLMENT OF, 
INDIAN CHILDREN UNDER THIS TITLE AND 
TITLE XIX.—Expenditures for outreach ac-
tivities to families of Indian children likely 
to be eligible for child health assistance 
under the plan or medical assistance under 
the State plan under title XIX (or under 
a waiver of such plan), to inform such 
families of the availability of, and to assist 
them in enrolling their children in, such 
plans, including such activities conducted 
under grants, contracts, or agreements en-
tered into under section 1139(a).’’. 
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SEC. 203. DEMONSTRATION PROGRAM TO PERMIT STATES 
TO RELY ON FINDINGS BY AN EXPRESS LANE 
AGENCY TO DETERMINE COMPONENTS OF A 
CHILD’S 
ELIGIBILITY 
FOR 
MEDICAID 
OR 
CHIP. 
(a) REQUIREMENT TO CONDUCT DEMONSTRATION 
PROGRAM.— 
(1) IN GENERAL.—The Secretary shall establish 
a 3–year demonstration program under which up to 
10 States shall be authorized to rely on a finding 
made within the preceding 12 months by an Express 
Lane agency to determine whether a child has met 
1 or more of the eligibility requirements, such as in-
come, assets or resources, citizenship status, or 
other criteria, necessary to determine the child’s ini-
tial eligibility, eligibility redetermination, or renewal 
of eligibility, for medical assistance under the State 
Medicaid plan or child health assistance under the 
State CHIP plan. A State selected to participate in 
the demonstration program— 
(A) shall not be required to direct a child 
(or a child’s family) to submit information or 
documentation previously submitted by the 
child or family to an Express Lane agency that 
the State relies on for its Medicaid or CHIP eli-
gibility determination; and 
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(B) may rely on information from an Ex-
press Lane agency when evaluating a child’s eli-
gibility for medical assistance under the State 
Medicaid plan or child health assistance under 
the State CHIP plan without a separate, inde-
pendent confirmation of the information at the 
time of enrollment, redetermination, or renewal. 
(2) PAYMENTS TO STATES.—From the amount 
appropriated under paragraph (1) of subsection (f), 
after the application of paragraph (2) of that sub-
section, the Secretary shall pay the States selected 
to participate in the demonstration program such 
sums as the Secretary shall determine for expendi-
tures made by the State for systems upgrades and 
implementation of the demonstration program. In no 
event shall a payment be made to a State from the 
amount appropriated under subsection (f) for any 
expenditures incurred for providing medical assist-
ance or child health assistance to a child enrolled in 
the State Medicaid plan or the State CHIP plan 
through reliance on a finding made by an Express 
Lane agency. 
(b) REQUIREMENTS; OPTIONS FOR APPLICATION.— 
(1) STATE REQUIREMENTS.—A State selected 
to participate in the demonstration program estab-
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lished under this section may rely on a finding of an 
Express Lane agency only if the following conditions 
are met: 
(A) REQUIREMENT TO DETERMINE ELIGI-
BILITY USING REGULAR PROCEDURES IF CHILD 
IS FIRST FOUND INELIGIBLE.—If reliance on a 
finding from an Express Lane agency results in 
a child not being found eligible for the State 
Medicaid plan or the State CHIP plan, the 
State would be required to determine eligibility 
under such plan using its regular procedures. 
(B) NOTICE.—The State shall inform the 
families (especially those whose children are en-
rolled in the State CHIP plan) that they may 
qualify for lower premium payments or more 
comprehensive health coverage under the State 
Medicaid plan if the family’s income were di-
rectly evaluated for an eligibility determination 
by the State Medicaid agency, and that, at the 
family’s option, the family may seek an eligi-
bility determination by the State Medicaid 
agency. 
(C) COMPLIANCE WITH DEPARTMENT OF 
HOMELAND
SECURITY
PROCEDURES.—The 
State may rely on an Express Lane agency 
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finding that a child is a qualified alien as long 
as the Express Lane agency complies with guid-
ance and regulatory procedures issued by the 
Secretary of Homeland Security for eligibility 
determinations of qualified aliens (as defined in 
subsections (b) and (c) of section 431 of the 
Personal Responsibility and Work Opportunity 
Reconciliation Act of 1996 (8 U.S.C. 1641)). 
(D) VERIFICATION OF CITIZENSHIP OR NA-
TIONALITY
STATUS.—The State shall satisfy 
the requirements of section 1902(a)(46)(B) or 
2105(c)(9) of the Social Security Act, as appli-
cable (and as added by section 301 of this Act) 
for verifications of citizenship or nationality sta-
tus. 
(E) CODING; APPLICATION
TO
ENROLL-
MENT ERROR RATES.— 
(i) IN
GENERAL.—The State agrees 
to— 
(I) assign such codes as the Sec-
retary shall require to the children 
who are enrolled in the State Med-
icaid plan or the State CHIP plan 
through reliance on a finding made by 
an Express Lane agency for the dura-
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100 
tion of the State’s participation in the 
demonstration program; 
(II) annually provide the Sec-
retary with a statistically valid sample 
(that is approved by Secretary) of the 
children 
enrolled 
in 
such 
plans 
through reliance on such a finding by 
conducting a full Medicaid eligibility 
review of the children identified for 
such sample for purposes of deter-
mining an eligibility error rate with 
respect to the enrollment of such chil-
dren; 
(III) submit the error rate deter-
mined under subclause (II) to the 
Secretary; 
(IV) if such error rate exceeds 3 
percent for either of the first 2 fiscal 
years in which the State participates 
in the demonstration program, dem-
onstrate to the satisfaction of the Sec-
retary the specific corrective actions 
implemented by the State to improve 
upon such error rate; and 
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107 
(c) LIMITED WAIVER OF OTHER APPLICABLE RE-
QUIREMENTS.— 
(1) SOCIAL
SECURITY
ACT.—The Secretary 
shall waive only such requirements of the Social Se-
curity Act as the Secretary determines are necessary 
to carry out the demonstration program established 
under this section. 
(2) 
AUTHORIZATION
FOR
PARTICIPATING 
STATES TO RECEIVE CERTAIN DATA DIRECTLY REL-
EVANT TO DETERMINING ELIGIBILITY AND CORRECT 
AMOUNT OF ASSISTANCE.—For provisions relating to 
the authority of States participating in the dem-
onstration program to receive certain data directly, 
see section 204(c). 
(d) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary shall con-
duct, by grant, contract, or interagency agreement, 
a comprehensive, independent evaluation of the dem-
onstration program established under this section. 
Such evaluation shall include an analysis of the ef-
fectiveness of the program, and shall include— 
(A) obtaining a statistically valid sample of 
the children who were enrolled in the State 
Medicaid plan or the State CHIP plan through 
reliance on a finding made by an Express Lane 
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108 
agency and determining the percentage of chil-
dren who were erroneously enrolled in such 
plans; 
(B) determining whether enrolling children 
in such plans through reliance on a finding 
made by an Express Lane agency improves the 
ability of a State to identify and enroll low-in-
come, uninsured children who are eligible but 
not enrolled in such plans; 
(C) evaluating the administrative costs or 
savings related to identifying and enrolling chil-
dren in such plans through reliance on such 
findings, and the extent to which such costs dif-
fer from the costs that the State otherwise 
would have incurred to identify and enroll low- 
income, uninsured children who are eligible but 
not enrolled in such plans; and 
(D) any recommendations for legislative or 
administrative changes that would improve the 
effectiveness of enrolling children in such plans 
through reliance on such findings. 
(2) REPORT
TO
CONGRESS.—Not later than 
September 30, 2012, the Secretary shall submit a 
report to Congress on the results of the evaluation 
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109 
of the demonstration program established under this 
section. 
(e) DEFINITIONS.—In this section: 
(1) CHILD; CHILDREN.—With respect to a 
State selected to participate in the demonstration 
program established under this section, the terms 
‘‘child’’ and ‘‘children’’ have the meanings given 
such terms for purposes of the State plans under ti-
tles XIX and XXI of the Social Security Act. 
(2) EXPRESS LANE AGENCY.— 
(A) IN
GENERAL.—The term ‘‘Express 
Lane agency’’ means a public agency that— 
(i) is determined by the State Med-
icaid agency or the State CHIP agency (as 
applicable) to be capable of making the de-
terminations of 1 or more eligibility re-
quirements described in subsection (a)(1); 
(ii) is identified in the State Medicaid 
plan or the State CHIP plan; and 
(iii) notifies the child’s family— 
(I) of the information which shall 
be disclosed in accordance with this 
section; 
(II) that the information dis-
closed will be used solely for purposes 
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110 
of determining eligibility for medical 
assistance under the State Medicaid 
plan or for child health assistance 
under the State CHIP plan; and 
(III) that the family may elect to 
not have the information disclosed for 
such purposes; and 
(iv) enters into, or is subject to, an 
interagency agreement to limit the disclo-
sure and use of the information disclosed. 
(B) INCLUSION OF SPECIFIC PUBLIC AGEN-
CIES.—Such term includes the following: 
(i) A public agency that determines 
eligibility for assistance under any of the 
following: 
(I) The temporary assistance for 
needy families program funded under 
part A of title IV of the Social Secu-
rity Act (42 U.S.C. 601 et seq.). 
(II) A State program funded 
under part D of title IV of such Act 
(42 U.S.C. 651 et seq.). 
(III) The State Medicaid plan. 
(IV) The State CHIP plan. 
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111 
(V) The Food Stamp Act of 1977 
(7 U.S.C. 2011 et seq.). 
(VI) The Head Start Act (42 
U.S.C. 9801 et seq.). 
(VII) The Richard B. Russell 
National 
School 
Lunch 
Act 
(42 
U.S.C. 1751 et seq.). 
(VIII) The Child Nutrition Act of 
1966 (42 U.S.C. 1771 et seq.). 
(IX) The Child Care and Devel-
opment Block Grant Act of 1990 (42 
U.S.C. 9858 et seq.). 
(X) The Stewart B. McKinney 
Homeless Assistance Act (42 U.S.C. 
11301 et seq.). 
(XI) The United States Housing 
Act of 1937 (42 U.S.C. 1437 et seq.). 
(XII) 
The 
Native 
American 
Housing Assistance and Self-Deter-
mination Act of 1996 (25 U.S.C. 
4101 et seq.). 
(ii) A State-specified governmental 
agency that has fiscal liability or legal re-
sponsibility for the accuracy of the eligi-
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112 
bility determination findings relied on by 
the State. 
(iii) A public agency that is subject to 
an interagency agreement limiting the dis-
closure and use of the information dis-
closed for purposes of determining eligi-
bility under the State Medicaid plan or the 
State CHIP plan. 
(C) EXCLUSIONS.—Such term does not in-
clude an agency that determines eligibility for a 
program established under the Social Services 
Block Grant established under title XX of the 
Social Security Act (42 U.S.C. 1397 et seq.) or 
a private, for-profit organization. 
(D) RULES OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as— 
(i) affecting the authority of a State 
Medicaid agency to enter into contracts 
with nonprofit and for-profit agencies to 
administer the Medicaid application proc-
ess; 
(ii) exempting a State Medicaid agen-
cy from complying with the requirements 
of section 1902(a)(4) of the Social Security 
Act (relating to merit-based personnel 
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115 
(3) BUDGET AUTHORITY.—Paragraph (1) con-
stitutes budget authority in advance of appropria-
tions Act and represents the obligation of the Fed-
eral Government to provide for the payment to 
States selected to participate in the demonstration 
program established under this section of the 
amounts provided under such paragraph (after the 
application of paragraph (2)). 
SEC. 204. AUTHORIZATION OF CERTAIN INFORMATION DIS-
CLOSURES TO SIMPLIFY HEALTH COVERAGE 
DETERMINATIONS. 
(a) AUTHORIZATION
OF
INFORMATION
DISCLO-
SURE.—Title XIX (42 U.S.C. 1396 et seq.) is amended— 
(1) by redesignating section 1939 as section 
1940; and 
(2) by inserting after section 1938 the following 
new section: 
‘‘AUTHORIZATION TO RECEIVE PERTINENT INFORMATION 
‘‘SEC. 1939. (a) IN GENERAL.—Notwithstanding any 
other provision of law, a Federal or State agency or pri-
vate entity in possession of the sources of data directly 
relevant to eligibility determinations under this title (in-
cluding eligibility files, information described in paragraph 
(2) or (3) of section 1137(a), vital records information 
about births in any State, and information described in 
sections 453(i) and 1902(a)(25)(I)) is authorized to con-
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116 
vey such data or information to the State agency admin-
istering the State plan under this title, but only if such 
conveyance meets the requirements of subsection (b). 
‘‘(b) REQUIREMENTS FOR CONVEYANCE.—Data or 
information may be conveyed pursuant to this section only 
if the following requirements are met: 
‘‘(1) The child whose circumstances are de-
scribed in the data or information (or such child’s 
parent, guardian, caretaker relative, or authorized 
representative) has either provided advance consent 
to disclosure or has not objected to disclosure after 
receiving advance notice of disclosure and a reason-
able opportunity to object. 
‘‘(2) Such data or information are used solely 
for the purposes of— 
‘‘(A) identifying children who are eligible 
or potentially eligible for medical assistance 
under this title and enrolling (or attempting to 
enroll) such children in the State plan; and 
‘‘(B) verifying the eligibility of children for 
medical assistance under the State plan. 
‘‘(3) An interagency or other agreement, con-
sistent with standards developed by the Secretary— 
‘‘(A) prevents the unauthorized use, disclo-
sure, or modification of such data and other-
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117 
wise meets applicable Federal requirements for 
safeguarding privacy and data security; and 
‘‘(B) requires the State agency admin-
istering the State plan to use the data and in-
formation obtained under this section to seek to 
enroll children in the plan. 
‘‘(c) CRIMINAL PENALTY.—A person described in 
subsection (a) who publishes, divulges, discloses, or makes 
known in any manner, or to any extent, not authorized 
by Federal law, any information obtained under this sec-
tion shall be fined not more than $1,000 or imprisoned 
not more than 1 year, or both, for each such unauthorized 
activity. 
‘‘(d) RULE OF CONSTRUCTION.—The limitations and 
requirements that apply to disclosure pursuant to this sec-
tion shall not be construed to prohibit the conveyance or 
disclosure of data or information otherwise permitted 
under Federal law (without regard to this section).’’. 
(b) CONFORMING AMENDMENT TO TITLE XXI.— 
Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is amended 
by adding at the end the following new subparagraph: 
‘‘(E) Section 1939 (relating to authoriza-
tion to receive data directly relevant to eligi-
bility determinations).’’. 
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118 
(c) AUTHORIZATION FOR STATES PARTICIPATING IN 
THE EXPRESS LANE DEMONSTRATION PROGRAM TO RE-
CEIVE CERTAIN DATA DIRECTLY RELEVANT TO DETER-
MINING ELIGIBILITY AND CORRECT AMOUNT OF ASSIST-
ANCE.—Only in the case of a State selected to participate 
in the Express Lane demonstration program established 
under section 203, the Secretary shall enter into such 
agreements as are necessary to permit such a State to re-
ceive data directly relevant to eligibility determinations 
and determining the correct amount of benefits under the 
State CHIP plan or the State Medicaid plan (as such 
terms are defined in paragraphs (7) and (9) section 
203(e)) from the following: 
(1) The National Directory of New Hires estab-
lished under section 453(i) of the Social Security 
Act (42 U.S.C. 653(i)). 
(2) The National Income Data collected by the 
Commissioner of Social Security from information 
described in subparagraphs (A) and (B) of section 
6103(l)(7) of the Internal Revenue Code of 1986, in 
accordance with the requirements of that section. 
(3) Data regarding enrollment in insurance that 
may help to facilitate outreach and enrollment under 
the State Medicaid plan, the State CHIP plan, and 
such other programs as the Secretary may specify. 
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119 
TITLE III—REDUCING BARRIERS 
TO ENROLLMENT 
SEC. 301. VERIFICATION OF DECLARATION OF CITIZENSHIP 
OR NATIONALITY FOR PURPOSES OF ELIGI-
BILITY FOR MEDICAID AND CHIP. 
(a) STATE OPTION TO VERIFY DECLARATION OF 
CITIZENSHIP OR NATIONALITY FOR PURPOSES OF ELIGI-
BILITY
FOR
MEDICAID
THROUGH
VERIFICATION
OF 
NAME AND SOCIAL SECURITY NUMBER.— 
(1) ALTERNATIVE
TO
DOCUMENTATION
RE-
QUIREMENT.— 
(A) IN
GENERAL.—Section 1902 (42 
U.S.C. 1396a) is amended— 
(i) in subsection (a)(46)— 
(I) by inserting ‘‘(A)’’ after 
‘‘(46)’’; 
(II) by adding ‘‘and’’ after the 
semicolon; and 
(III) by adding at the end the 
following new subparagraph: 
‘‘(B) provide, with respect to an individual de-
claring to be a citizen or national of the United 
States for purposes of establishing eligibility under 
this title, that the State shall satisfy the require-
ments of— 
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120 
‘‘(i) section 1903(x); or 
‘‘(ii) subsection (dd);’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(dd)(1) For purposes of section 1902(a)(46)(B)(ii), 
the requirements of this subsection with respect to an indi-
vidual declaring to be a citizen or national of the United 
States for purposes of establishing eligibility under this 
title, are, in lieu of requiring the individual to present sat-
isfactory documentary evidence of citizenship or nation-
ality under section 1903(x) (if the individual is not de-
scribed in paragraph (2) of that section), as follows: 
‘‘(A) The State submits the name and social se-
curity number of the individual to the Commissioner 
of Social Security as part of the plan established 
under paragraph (2). 
‘‘(B) If the State receives notice from the Com-
missioner of Social Security that the name or social 
security number of the individual is invalid, the 
State— 
‘‘(i) notifies the individual of such fact; 
‘‘(ii) provides the individual with an oppor-
tunity to cure the invalid determination with 
the Commissioner of Social Security, followed 
by a period of 90 days from the date on which 
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125 
(A) by redesignating clause (v) as clause 
(vi); and 
(B) by inserting after clause (iv), the fol-
lowing new clause: 
‘‘(v)(I) Except as provided in subclause (II), a 
document issued by a federally recognized Indian 
tribe evidencing membership or enrollment in, or af-
filiation 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 inter-
national border whose membership includes individ-
uals 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 satis-
fying the requirement of this subsection.’’. 
(2) REQUIREMENT
TO
PROVIDE
REASONABLE 
OPPORTUNITY
TO
PRESENT
SATISFACTORY
DOCU-
MENTARY EVIDENCE.—Section 1903(x) (42 U.S.C. 
1396b(x)) is amended by adding at the end the fol-
lowing new paragraph: 
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126 
‘‘(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 individual shall be provided 
at least the reasonable opportunity to present satisfactory 
documentary evidence of citizenship or nationality 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 immigra-
tion 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 strik-
ing ‘‘or’’ at the end; 
(II) by redesignating subpara-
graph (D) as subparagraph (E); and 
(III) by inserting after subpara-
graph (C) the following new subpara-
graph: 
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127 
‘‘(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 in-
dividual shall be deemed to have provided satisfac-
tory documentary evidence of citizenship or nation-
ality and shall not be required to provide further 
documentary evidence on any date that occurs dur-
ing or after the period in which the individual is eli-
gible for medical assistance on such basis); or’’; and 
(ii) by adding at the end the following 
new paragraph: 
‘‘(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 re-
quirement of section 1902(e)(4) that a child born in the 
United States to an alien mother for whom medical assist-
ance 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 SEPA-
RATE
IDENTIFICATION
NUMBER.—Section 
1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended 
by adding at the end the following new sen-
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128 
tence: ‘‘Notwithstanding the preceding sentence, 
in the case of a child who is born in the United 
States to an alien mother for whom medical as-
sistance 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. 
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129 
(c) APPLICATION OF DOCUMENTATION SYSTEM TO 
CHIP.— 
(1) IN GENERAL.—Section 2105(c) (42 U.S.C. 
1397ee(c)), as amended by section 110(a), is amend-
ed by adding at the end the following new para-
graph: 
‘‘(9) CITIZENSHIP DOCUMENTATION REQUIRE-
MENTS.— 
‘‘(A) IN GENERAL.—No payment may be 
made under this section with respect to an indi-
vidual 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.—Notwith-
standing subsection (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 EX-
PENDITURES
CAP.—Section 
2105(c)(2)(C) 
(42 
U.S.C. 1397ee(c)(2)(C)), as amended by section 
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130 
202(b), is amended by adding at the end the fol-
lowing: 
‘‘(iii) EXPENDITURES
TO
COMPLY 
WITH
CITIZENSHIP
OR
NATIONALITY 
VERIFICATION
REQUIREMENTS.—Expendi-
tures necessary for the State to comply 
with paragraph (9)(A).’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
this section shall take effect on October 1, 2008. 
(2) RESTORATION
OF
ELIGIBILITY.—In the 
case of an individual who, during the period that 
began on July 1, 2006, and ends on October 1, 
2008, was determined to be ineligible for medical as-
sistance under a State Medicaid plan, including any 
waiver of such plan, solely as a result of the applica-
tion 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 subsections, 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 de-
termined to be ineligible for such medical assistance 
on such basis. 
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131 
(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 individual who is a member of a fed-
erally-recognized Indian tribe described in subclause 
(II) of that section who presents a document de-
scribed in subclause (I) of such section that is issued 
by such Indian tribe, shall be deemed to have pre-
sented satisfactory evidence of citizenship or nation-
ality for purposes of satisfying the requirement of 
subsection (x) of section 1903 of such Act. 
SEC. 302. REDUCING ADMINISTRATIVE BARRIERS TO EN-
ROLLMENT. 
Section 2102(b) (42 U.S.C. 1397bb(b)) is amended— 
(1) by redesignating paragraph (4) as para-
graph (5); and 
(2) by inserting after paragraph (3) the fol-
lowing new paragraph: 
‘‘(4) REDUCTION
OF
ADMINISTRATIVE
BAR-
RIERS TO ENROLLMENT.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the plan shall include a description 
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132 
of the procedures used to reduce administrative 
barriers to the enrollment of children and preg-
nant women who are eligible for medical assist-
ance under title XIX or for child health assist-
ance or health benefits coverage under this title. 
Such procedures shall be established and re-
vised as often as the State determines appro-
priate to take into account the most recent in-
formation available to the State identifying 
such barriers. 
‘‘(B) DEEMED COMPLIANCE IF JOINT AP-
PLICATION AND RENEWAL PROCESS THAT PER-
MITS APPLICATION OTHER THAN IN PERSON.— 
A State shall be deemed to comply with sub-
paragraph (A) if the State’s application and re-
newal forms and supplemental forms (if any) 
and information verification process is the same 
for purposes of establishing and renewing eligi-
bility 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.’’. 
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133 
TITLE IV—REDUCING BARRIERS 
TO PROVIDING PREMIUM AS-
SISTANCE 
Subtitle A—Additional State Op-
tion for Providing Premium As-
sistance 
SEC. 401. ADDITIONAL STATE OPTION FOR PROVIDING 
PREMIUM ASSISTANCE. 
(a) IN
GENERAL.—Section 2105(c) (42 U.S.C. 
1397ee(c)), as amended by section 301(c), is amended by 
adding at the end the following: 
‘‘(10) STATE OPTION TO OFFER PREMIUM AS-
SISTANCE.— 
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding provisions of this paragraph, a State 
may elect to offer a premium assistance subsidy 
(as defined in subparagraph (C)) for qualified 
employer-sponsored coverage (as defined in sub-
paragraph (B)) to all targeted low-income chil-
dren who are eligible for child health assistance 
under the plan and have access to such cov-
erage in accordance with the requirements of 
this paragraph. 
‘‘(B) QUALIFIED
EMPLOYER-SPONSORED 
COVERAGE.— 
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134 
‘‘(i) IN GENERAL.—Subject to clauses 
(ii) and (iii), in this paragraph, the term 
‘qualified 
employer-sponsored 
coverage’ 
means a group health plan or health insur-
ance coverage offered through an em-
ployer— 
‘‘(I) that qualifies as creditable 
coverage as a group health plan under 
section 2701(c)(1) of the Public 
Health Service Act; 
‘‘(II) for which the employer con-
tribution toward any premium for 
such coverage is at least 40 percent; 
and 
‘‘(III) to all individuals in a man-
ner that would be considered a non-
discriminatory eligibility classification 
for purposes of paragraph (3)(A)(ii) 
of section 105(h) of the Internal Rev-
enue Code of 1986 (but determined 
without regard to clause (i) of sub-
paragraph (B) of such paragraph). 
‘‘(ii) EXCEPTION.—Such term does 
not include coverage consisting of— 
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135 
‘‘(I) benefits provided under a 
health flexible spending arrangement 
(as defined in section 106(c)(2) of the 
Internal Revenue Code of 1986); or 
‘‘(II) a high deductible health 
plan (as defined in section 223(c)(2) 
of such Code) purchased in conjunc-
tion with a health savings account (as 
defined under section 223(d) of such 
Code). 
‘‘(iii) COST-EFFECTIVENESS
ALTER-
NATIVE
TO
REQUIRED
EMPLOYER
CON-
TRIBUTION.—A group health plan or 
health insurance coverage offered through 
an employer that would be considered 
qualified employer-sponsored coverage but 
for the application of clause (i)(II) may be 
deemed to satisfy the requirement of such 
clause if either of the following applies: 
‘‘(I) APPLICATION
OF
CHILD- 
BASED OR FAMILY-BASED TEST.—The 
State establishes to the satisfaction of 
the Secretary that the cost of such 
coverage is less than the expenditures 
that the State would have made to en-
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136 
roll the child or the family (as appli-
cable) in the State child health plan. 
‘‘(II) 
AGGREGATE
PROGRAM 
OPERATIONAL COSTS DO NOT EXCEED 
THE COST OF PROVIDING COVERAGE 
UNDER
THE
STATE
CHILD
HEALTH 
PLAN.—If subclause (I) does not 
apply, the State establishes to the sat-
isfaction of the Secretary that the ag-
gregate amount of expenditures by the 
State for the purchase of all such cov-
erage for targeted low-income children 
under the State child health plan (in-
cluding administrative expenditures) 
does not exceed the aggregate amount 
of expenditures that the State would 
have made for providing coverage 
under the State child health plan for 
all such children. 
‘‘(C) PREMIUM ASSISTANCE SUBSIDY.— 
‘‘(i) IN GENERAL.—In this paragraph, 
the term ‘premium assistance subsidy’ 
means, with respect to a targeted low-in-
come child, the amount equal to the dif-
ference between the employee contribution 
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145 
manner as such a subsidy for such coverage may be of-
fered under a State child health plan under title XXI in 
accordance with section 2105(c)(10) (except that subpara-
graph (E)(i)(II) of such section shall be applied by sub-
stituting ‘1916 or, if applicable, 1916A’ for ‘2103(e)’).’’. 
(c) GAO STUDY AND REPORT.—Not later than Janu-
ary 1, 2009, the Comptroller General of the United States 
shall study cost and coverage issues relating to any State 
premium assistance programs for which Federal matching 
payments are made under title XIX or XXI of the Social 
Security Act, including under waiver authority, and shall 
submit a report to the appropriate committees of Congress 
on the results of such study. 
SEC. 402. OUTREACH, EDUCATION, AND ENROLLMENT AS-
SISTANCE. 
(a) REQUIREMENT TO INCLUDE DESCRIPTION OF 
OUTREACH, EDUCATION, AND ENROLLMENT EFFORTS 
RELATED TO PREMIUM ASSISTANCE SUBSIDIES IN STATE 
CHILD HEALTH PLAN.—Section 2102(c) (42 U.S.C. 
1397bb(c)) is amended by adding at the end the following 
new paragraph: 
‘‘(3) PREMIUM ASSISTANCE SUBSIDIES.—Out-
reach, education, and enrollment assistance for fami-
lies of children likely to be eligible for premium as-
sistance subsidies under the State child health plan 
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146 
in accordance with paragraphs (2)(B), (3), or (10) 
of section 2105(c), or a waiver approved under sec-
tion 1115, to inform such families of the availability 
of, and to assist them in enrolling their children in, 
such subsidies, and for employers likely to provide 
coverage that is eligible for such subsidies, including 
the specific, significant resources the State intends 
to apply to educate employers about the availability 
of premium assistance subsidies under the State 
child health plan.’’. 
(b) NONAPPLICATION
OF 10 PERCENT LIMIT
ON 
OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec-
tion 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as 
amended by section 301(c)(2), is amended by adding at 
the end the following new clause: 
‘‘(iv) EXPENDITURES FOR OUTREACH 
TO INCREASE THE ENROLLMENT OF CHIL-
DREN UNDER THIS TITLE AND TITLE XIX 
THROUGH
PREMIUM
ASSISTANCE
SUB-
SIDIES.—Expenditures for outreach activi-
ties to families of children likely to be eligi-
ble for premium assistance subsidies in ac-
cordance with paragraphs (2)(B), (3), or 
(10), or a waiver approved under section 
1115, to inform such families of the avail-
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147 
ability of, and to assist them in enrolling 
their children in, such subsidies, and to 
employers likely to provide qualified em-
ployer-sponsored coverage (as defined in 
subparagraph (B) of such paragraph).’’. 
Subtitle B—Coordinating Premium 
Assistance With Private Coverage 
SEC. 411. SPECIAL ENROLLMENT PERIOD UNDER GROUP 
HEALTH PLANS IN CASE OF TERMINATION OF 
MEDICAID OR CHIP COVERAGE OR ELIGI-
BILITY FOR ASSISTANCE IN PURCHASE OF 
EMPLOYMENT-BASED COVERAGE; COORDINA-
TION OF COVERAGE. 
(a) AMENDMENTS TO INTERNAL REVENUE CODE OF 
1986.—Section 9801(f) of the Internal Revenue Code of 
1986 (relating to special enrollment periods) is amended 
by adding at the end the following new paragraph: 
‘‘(3) SPECIAL RULES RELATING TO MEDICAID 
AND CHIP.— 
‘‘(A) IN GENERAL.—A group health plan 
shall permit an employee who is eligible, but 
not enrolled, for coverage under the terms of 
the plan (or a dependent of such an employee 
if the dependent is eligible, but not enrolled, for 
coverage under such terms) to enroll for cov-
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148 
erage under the terms of the plan if either of 
the following conditions is met: 
‘‘(i) TERMINATION OF MEDICAID OR 
CHIP
COVERAGE.—The employee or de-
pendent is covered under a Medicaid plan 
under title XIX of the Social Security Act 
or under a State child health plan under 
title XXI of such Act and coverage of the 
employee or dependent under such a plan 
is terminated as a result of loss of eligi-
bility for such coverage and the employee 
requests coverage under the group health 
plan not later than 60 days after the date 
of termination of such coverage. 
‘‘(ii) ELIGIBILITY FOR EMPLOYMENT 
ASSISTANCE UNDER MEDICAID OR CHIP.— 
The employee or dependent becomes eligi-
ble for assistance, with respect to coverage 
under the group health plan under such 
Medicaid plan or State child health plan 
(including under any waiver or demonstra-
tion project conducted under or in relation 
to such a plan), if the employee requests 
coverage under the group health plan not 
later than 60 days after the date the em-
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149 
ployee or dependent is determined to be el-
igible for such assistance. 
‘‘(B) EMPLOYEE OUTREACH AND DISCLO-
SURE.— 
‘‘(i) OUTREACH TO EMPLOYEES RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.— 
‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity Act, or child health assistance 
under a State child health plan under 
title XXI of such Act, in the form of 
premium assistance for the purchase 
of coverage under a group health 
plan, shall provide to each employee a 
written notice informing the employee 
of potential opportunities then cur-
rently available in the State in which 
the employee resides for premium as-
sistance under such plans for health 
coverage of the employee or the em-
ployee’s dependents. For purposes of 
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150 
compliance with this clause, the em-
ployer may use any State-specific 
model notice issued by the Secretary 
of Labor or the Secretary of Health 
and Human Services in accordance 
with section 701(f)(3)(B) of the Em-
ployee Retirement Income Security 
Act 
of 
1974 
(29 
U.S.C. 
1181(f)(3)(B)). 
‘‘(II) OPTION TO PROVIDE CON-
CURRENT WITH PROVISION OF SUM-
MARY
PLAN
DESCRIPTION.—An em-
ployer may provide the model notice 
applicable to the State in which an 
employee resides concurrent with the 
furnishing of the summary plan de-
scription as provided in section 104(b) 
of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 
1024). 
‘‘(ii) 
DISCLOSURE
ABOUT
GROUP 
HEALTH PLAN BENEFITS TO STATES FOR 
MEDICAID
AND
CHIP
ELIGIBLE
INDIVID-
UALS.—In the case of a participant or ben-
eficiary of a group health plan who is cov-
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166 
providers of items and services under such pro-
grams. 
‘‘(2) IDENTIFICATION OF INITIAL CORE MEAS-
URES.—In consultation with the individuals and en-
tities described in subsection (b)(3), the Secretary 
shall identify existing quality of care measures for 
children that are in use under public and privately 
sponsored health care coverage arrangements, or 
that are part of reporting systems that measure both 
the presence and duration of health insurance cov-
erage over time. 
‘‘(3) 
RECOMMENDATIONS
AND
DISSEMINA-
TION.—Based on such existing and identified meas-
ures, the Secretary shall publish an initial core set 
of child health quality measures that includes (but 
is not limited to) the following: 
‘‘(A) The duration of children’s health in-
surance coverage over a 12-month time period. 
‘‘(B) The availability of a full range of— 
‘‘(i) preventive services, treatments, 
and services for acute conditions, including 
services to promote healthy birth and pre-
vent and treat premature birth; and 
‘‘(ii) treatments to correct or amelio-
rate the effects of chronic physical and 
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mental conditions in infants, young chil-
dren, school-age children, and adolescents. 
‘‘(C) The availability of care in a range of 
ambulatory and inpatient health care settings 
in which such care is furnished. 
‘‘(D) The types of measures that, taken to-
gether, can be used to estimate the overall na-
tional quality of health care for children and to 
perform comparative analyses of pediatric 
health care quality and racial, ethnic, and socio-
economic disparities in child health and health 
care for children. 
‘‘(4) ENCOURAGE VOLUNTARY AND STANDARD-
IZED REPORTING.—Not later than 2 years after the 
date of enactment of the Children’s Health Insur-
ance Program Reauthorization Act of 2007, the Sec-
retary, in consultation with States, shall develop a 
standardized format for reporting information and 
procedures and approaches that encourage States to 
use the initial core measurement set to voluntarily 
report information regarding the quality of pediatric 
health care under titles XIX and XXI. 
‘‘(5) ADOPTION OF BEST PRACTICES IN IMPLE-
MENTING QUALITY PROGRAMS.—The Secretary shall 
disseminate information to States regarding best 
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practices among States with respect to measuring 
and reporting on the quality of health care for chil-
dren, and shall facilitate the adoption of such best 
practices. In developing best practices approaches, 
the Secretary shall give particular attention to State 
measurement techniques that ensure the timeliness 
and accuracy of provider reporting, encourage pro-
vider reporting compliance, encourage successful 
quality improvement strategies, and improve effi-
ciency in data collection using health information 
technology. 
‘‘(6) REPORTS TO CONGRESS.—Not later than 
January 1, 2010, and every 3 years thereafter, the 
Secretary shall report to Congress on— 
‘‘(A) the status of the Secretary’s efforts 
to improve— 
‘‘(i) quality related to the duration 
and stability of health insurance coverage 
for children under titles XIX and XXI; 
‘‘(ii) the quality of children’s health 
care under such titles, including preventive 
health services, health care for acute condi-
tions, chronic health care, and health serv-
ices to ameliorate the effects of physical 
and mental conditions and to aid in growth 
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and development of infants, young chil-
dren, school-age children, and adolescents 
with special health care needs; and 
‘‘(iii) the quality of children’s health 
care under such titles across the domains 
of quality, including clinical quality, health 
care safety, family experience with health 
care, health care in the most integrated 
setting, and elimination of racial, ethnic, 
and socioeconomic disparities in health and 
health care; 
‘‘(B) the status of voluntary reporting by 
States under titles XIX and XXI, utilizing the 
initial core quality measurement set; and 
‘‘(C) any recommendations for legislative 
changes needed to improve the quality of care 
provided to children under titles XIX and XXI, 
including recommendations for quality reporting 
by States. 
‘‘(7) TECHNICAL ASSISTANCE.—The Secretary 
shall provide technical assistance to States to assist 
them in adopting and utilizing core child health 
quality measures in administering the State plans 
under titles XIX and XXI. 
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‘‘(8) DEFINITION OF CORE SET.—In this sec-
tion, the term ‘core set’ means a group of valid, reli-
able, and evidence-based quality measures that, 
taken together— 
‘‘(A) provide information regarding the 
quality of health coverage and health care for 
children; 
‘‘(B) 
address 
the 
needs 
of 
children 
throughout the developmental age span; and 
‘‘(C) allow purchasers, families, and health 
care providers to understand the quality of care 
in relation to the preventive needs of children, 
treatments aimed at managing and resolving 
acute conditions, and diagnostic and treatment 
services whose purpose is to correct or amelio-
rate physical, mental, or developmental condi-
tions that could, if untreated or poorly treated, 
become chronic. 
‘‘(b) ADVANCING AND IMPROVING PEDIATRIC QUAL-
ITY MEASURES.— 
‘‘(1) ESTABLISHMENT OF PEDIATRIC QUALITY 
MEASURES PROGRAM.—Not later than January 1, 
2010, the Secretary shall establish a pediatric qual-
ity measures program to— 
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