I 
108TH CONGRESS 
2D SESSION 
H. R. 4031
To give States the flexibility to reduce bureaucracy by streamlining enrollment 
processes for the Medicaid and State children’s health insurance pro-
grams through better linkages with programs providing nutrition and 
related assistance to low-income families. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 25, 2004
Ms. CARSON of Indiana (for herself, Mr. FATTAH, Mr. WEXLER, Mr. EMAN-
UEL, Ms. MILLENDER-MCDONALD, Mr. OWENS, Mr. FILNER, Mr. 
FROST, and Ms. EDDIE BERNICE JOHNSON of Texas) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To give States the flexibility to reduce bureaucracy by 
streamlining enrollment processes for the Medicaid and 
State children’s health insurance programs through bet-
ter linkages with programs providing nutrition and re-
lated assistance to low-income families.
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 ‘‘Children’s Express 
Lane to Health Coverage Act of 2004’’.
SEC. 2. FINDINGS; PURPOSE. 
(a) FINDINGS.—Congress finds the following: 
(1) Despite gains made in recent years, 
8,900,000 children in the United States are unin-
sured. Of those, 6,900,000 are eligible for public 
health insurance coverage. 
(2) Most low-income uninsured children are en-
rolled in nutrition and related programs that operate 
under income guidelines similar to those of the med-
icaid program. In fact, 63 percent, or 4,300,000, 
low-income uninsured children are in families that 
receive benefits through the food stamps program, 
the National school lunch program, or the special 
supplemental nutrition program for women, infants 
and children (commonly referred to as ‘‘WIC’’). 
(3) The public would be well served if Federal 
means-tested public programs were able to improve 
administrative efficiency and coordination as well as 
reduce unnecessary bureaucracy. 
(4) Uninsured children would be well served if 
their enrollment in a nutrition-based or other means-
tested program could serve as a gateway to health 
coverage. 
(5) Existing law already allows children to be 
found income eligible for WIC based on their enroll-
ment in the medicaid program. Current law does
not, however, give States adequate flexibility to 
make an income determination for eligibility for the 
medicaid or State children’s health insurance pro-
gram based on an uninsured child’s enrollment in 
WIC or another public program. 
(b) PURPOSE.—The purpose of this Act is to give 
States the flexibility to find children income eligible for 
the medicaid program or State children’s health insurance 
program based on the fact that the children are eligible 
for nutrition assistance or similar public programs with 
comparable income standards and methodologies. 
SEC. 3. STATE OPTION TO PROVIDE FOR SIMPLIFIED DE-
TERMINATIONS OF A CHILD’S FINANCIAL ELI-
GIBILITY FOR MEDICAL ASSISTANCE UNDER 
MEDICAID OR CHILD HEALTH ASSISTANCE 
UNDER SCHIP. 
(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)(A) At the option of the State, the plan 
may provide that financial eligibility requirements 
for medical assistance are met for an individual who 
is under an age specified by the State (not to exceed 
21 years of age) by using a determination (made 
within a reasonable period, as found by the State,