Sec. 465. Inclusion of inpatient hospital services for the treatment of tb-in-
fected individuals. 
Subtitle E—Miscellaneous Provisions 
Sec. 471. Health empowerment zones. 
Sec. 472. Overweight and obesity prevention and treatment. 
Sec. 473. Border Health grants. 
Sec. 474. United States-Mexico Border Health Commission Act amendments. 
‘‘Sec. 9. Authorization of appropriations. 
Sec. 475. Prevention and control of injuries. 
TITLE V—DATA COLLECTION AND REPORTING 
Sec. 501. Amendment to the Public Health Service Act. 
‘‘Subtitle C—Strengthening Data Collection, Improving Data Analysis, and 
Expanding Data Reporting 
‘‘Sec. 2931. Data on race, ethnicity, and primary language. 
‘‘Sec. 2932. Provisions relating to Native Americans. 
Sec. 502. Collection of race and ethnicity data by the Social Security Adminis-
tration. 
‘‘Sec. 1150A. Collection of race and ethnicity data by the Social Security 
Administration. 
Sec. 503. Revision of HIPAA claims Standards. 
Sec. 504. National Center for Health Statistics. 
Sec. 505. Geo-access study. 
TITLE VI—ACCOUNTABILITY 
Subtitle A—General Provisions 
Sec. 601. Report on workforce Diversity. 
Sec. 602. Federal Agency plan to eliminate disparities and improve the Health 
of minority populations. 
Sec. 603. Accountability within the Department of Health and Human Services. 
‘‘Subtitle D—Strengthening Accountability 
‘‘Sec. 2941. Elevation of the Office of Civil Rights. 
‘‘Sec. 2942. Establishment of Health Program offices for Civil Rights 
within Federal Health and human services agencies. 
Sec. 604. Office of Minority Health. 
Sec. 605. Establishment of the Indian Health Service as an Agency of the pub-
lic Health Service. 
Sec. 606. Establishment of individual offices of Minority Health within agencies 
of public Health Service. 
‘‘Sec. 1707A. Individual offices of Minority Health within public Health 
Service. 
Sec. 607. Office of Minority Health at the Centers for Medicare and Medicaid 
Services. 
Sec. 608. Office of Minority Affairs at the Food and Drug Administration. 
‘‘Sec. 908. Office of Minority Affairs. 
Sec. 609. Safety and effectiveness of drugs with respect to racial and ethnic 
background. 
‘‘Sec. 505C. Safety and effectiveness of drugs with respect to racial and 
ethnic background.
Sec. 610. United States Commission on Civil Rights. 
Sec. 610A. Sense of Congress concerning full funding of activities to eliminate 
racial and ethnic Health disparities. 
Subtitle B—Minority Health and Genomics Commission 
Sec. 611. Short title. 
Sec. 612. Minority Health and Genomics Commission. 
Sec. 613. Report. 
Sec. 614. Membership. 
Sec. 615. Powers of Commission. 
Sec. 616. Termination. 
Subtitle C—Improving Environmental Justice 
Sec. 621. Definitions. 
Sec. 622. Environmental justice responsibilities of Federal agencies. 
Sec. 623. Interagency environmental justice Working Group. 
Sec. 624. Federal Agency strategies. 
Sec. 625. Federal Environmental Justice Advisory Committee. 
Sec. 626. Human Health and environmental research, data collection and anal-
ysis. 
TITLE VII—STRENGTHENING HEALTH INSTITUTIONS THAT 
PROVIDE HEALTHCARE TO MINORITY POPULATIONS 
Subtitle A—General Provisions 
Sec. 701. Amendment to the Public Health Service Act. 
‘‘Subtitle E—Strengthening Health Institutions that provide Healthcare to 
minority populations 
‘‘CHAPTER 1—GENERAL PROGRAMS 
‘‘Sec. 2951. Grant support for quality improvement initiatives. 
‘‘Sec. 2951A. Centers of excellence. 
‘‘Sec. 2951B. Consultation, construction and renovation of American In-
dian and Alaska Native facilities; reports. 
‘‘Sec. 2951C. Reconstruction and improvement grants for Public Health 
care facilities serving Pacific Islanders and the insular 
areas. 
‘‘CHAPTER 2—NATIONAL HEALTH SAFETY NET INFRASTRUCTURE 
‘‘SUBCHAPTER A—GENERAL PROVISIONS 
‘‘Sec. 2952. Payments to Healthcare facilities. 
‘‘Sec. 2952A. Application for assistance. 
‘‘Sec. 2952B. Public Service responsibilities. 
‘‘Sec. 2952C. Health Safety Net Infrastructure Trust Fund. 
‘‘Sec. 2952D. Administration. 
‘‘SUBCHAPTER B—LOAN GUARANTEES 
‘‘Sec. 2953. Provision of loan guarantees to safety net Healthcare facili-
ties. 
‘‘Sec. 2953A. Eligible loans. 
‘‘Sec. 2953B. Guarantee allotments.
‘‘Sec. 2953C. Terms and conditions of loan guarantees. 
‘‘Sec. 2953D. Premiums for loan guarantees. 
‘‘Sec. 2953E. Procedures in the event of loan default. 
‘‘SUBCHAPTER C—GRANTS FOR URGENT CAPITAL NEEDS 
‘‘Sec. 2956. Provision of grants. 
‘‘Sec. 2956A. Eligible projects. 
Sec. 702. Establishment of Alejandro Garcia National Center for Social Work 
Research. 
‘‘PART J—ALEJANDRO GARCIA NATIONAL CENTER FOR SOCIAL WORK 
RESEARCH 
‘‘Sec. 597. Purpose of Center. 
‘‘Sec. 597A. Specific authorities. 
‘‘Sec. 597B. Advisory Council. 
‘‘Sec. 597C. Biennial report. 
‘‘Sec. 597D. Quarterly report. 
‘‘Sec. 597E. Authorization of appropriations. 
Sec. 703. Annie Dodge Wauneka and Susan Laflesche-Picotte Native American 
Health and Wellness Foundation. 
‘‘TITLE VIII—ANNIE DODGE WAUNEKA AND SUSAN LAFLESCHE- 
PICOTTE NATIVE AMERICAN HEALTH AND WELLNESS FOUN-
DATION 
‘‘Sec. 801. Definitions. 
‘‘Sec. 802. Annie Dodge Wauneka and Susan Laflesche-Picotte Native 
American Health and Wellness Foundation. 
‘‘Sec. 803. Administrative services and support. 
Subtitle B—Rural and Underserved Urban America Telehealth Programs 
Sec. 711. Increasing types of originating telehealth sites and facilitating the 
provision of telehealth services across State lines. 
Sec. 712. Strengthening telehealth services in rural and underserved urban 
America. 
‘‘Sec. 330M. Integrative eldercare telehealth demonstration project. 
‘‘Sec. 330N. American Indian and Alaska Native telehealth demonstration 
project. 
‘‘Sec. 330O. Oral Health telehealth demonstration project. 
Sec. 713. Joint Working Group on Telehealth. 
TITLE VIII—MISCELLANEOUS PROVISIONS 
Sec. 801. Definitions. 
Sec. 802. Davis-Bacon Act. 
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—Congress makes the following find-
ings:
(1) Despite significant advances in public 
health and health care, the health status of racial 
and ethnic minority populations continues to lag be-
hind that of the white population. 
(2) The United States is becoming increasingly 
diverse. According to the 2000 United States Cen-
sus, African Americans, American Indians and Alas-
ka Natives, Asians, Hispanics, and Native Hawai-
ians and other Pacific Islanders comprise 30 percent 
of the United States population. Racial and ethnic 
minorities are expected to comprise 40 percent of 
the United States population by 2030. 
(3) To improve the health care of racial and 
ethnic minorities and to reduce and eliminate dis-
parities in health care and health outcomes, the fol-
lowing issues must be addressed: 
(A) NEED FOR INSURANCE COVERAGE.— 
(i) Disparities in health status can be 
attributed largely to underlying differences 
in socioeconomic status and insurance cov-
erage. Minorities are at a greater risk of 
being uninsured than their white counter-
parts. Lack of health insurance has con-
sistently been associated with worse health 
outcomes.
(ii) Even after adjusting for dif-
ferences in socioeconomic and insurance 
status, however, racial and ethnic health 
and health care disparities remain. 
(iii) Through treaties and Federal 
statutes, the Federal Government has es-
tablished a trust responsibility to provide 
health care to American Indians and Alas-
ka Natives. In the Indian Health Amend-
ments 
of 
1992, 
Congress 
specifically 
pledged to ‘‘assure the highest possible 
health status for Indians and urban Indi-
ans and to provide all resources necessary 
to effect that policy.’’ Despite those com-
mitments, the unmet health needs of 
American Indians and Alaska Natives re-
main alarmingly severe and their health 
status is far below the health status of the 
general population of the United States. 
The critical shortfall of funding for the In-
dian Health Service is a major source of 
this problem. 
(iv) At least 26,000,000 children in 
the United States lack dental coverage. 
These children include many from ‘‘work-
ing poor families’’ who cannot access 
SCHIP because they have some medical 
coverage. White children are 1.7 times 
more likely to have private dental coverage 
than non-white children. 
(v) As few as 7 States continue to 
provide reasonably comprehensive dental 
care to poor adults through Medicaid. 
About half the States provide no dental 
coverage or provide emergency services 
only. 
(B) NEED FOR CULTURALLY AND LINGUIS-
TICALLY APPROPRIATE CARE.— 
(i) Limited English proficiency ad-
versely affects the care of many racial and 
ethnic minority patients. The lack of avail-
able interpretation and translation services 
or bilingual providers contributes to racial 
and ethnic disparities in health and health 
care. The Federal Government provides 
and funds an array of services that should 
be made accessible to eligible persons who 
are not proficient in the English language. 
(ii) Title VI of the Civil Rights Act of 
1964 (42 U.S.C. 2000d et seq.) prohibits
discrimination on the basis of race, color, 
and national origin in programs and activi-
ties receiving Federal financial assistance. 
Discrimination on the basis of primary lan-
guage has consistently been interpreted as 
discrimination on the basis of national ori-
gin. 
(iii) The provision of effective lan-
guage services has been shown to improve 
care for limited English proficient (re-
ferred to in this section as ‘‘LEP’’) pa-
tients by increasing patient satisfaction, 
access to care, compliance with rec-
ommended medical advice, and appropriate 
utilization. 
(iv) A 2002 study by the Office of 
Management and Budget found that lan-
guage assistance services can substantially 
improve the health and quality of life of 
LEP individuals and their families, in-
crease the efficiency of distribution of gov-
ernment services to LEP individuals, and 
measurably increase the effectiveness of 
public health and safety programs.
(v) The same study estimated that 
language translation services would only 
increase the cost of the average health care 
visit by less than one percent. 
(vi) Increasing racial and ethnic diver-
sity among health professionals is vitally 
important because evidence indicates that 
diversity is associated with improved access 
to care for racial and ethnic minority pa-
tients, greater patient satisfaction, and 
better educational experiences for health 
profession students, among many other 
benefits. 
(C) NEED FOR HEALTH WORKFORCE DI-
VERSITY.— 
(i) Research has demonstrated that 
minority health professionals dramatically 
increase access to care for minority pa-
tients and improve the quality of care that 
they receive. African Americans, American 
Indians and Alaska Natives, Hispanics, 
Native Hawaiians and other Pacific Island-
ers, and Southeast Asians are significantly 
underrepresented in the health professions, 
exacerbating health disparities.
(ii) Minority physicians are more like-
ly than white physicians to serve minority 
populations. Nearly 40 percent of all mi-
nority medical school graduates will prac-
tice medicine in underserved areas, com-
pared to 10 percent of their white col-
leagues. 
(iii) Minorities often report experi-
ences with discrimination when seeking 
health care. 
(iv) There is substantial evidence to 
demonstrate that race concordance be-
tween physicians and patients increases 
patient satisfaction and participation in 
health decisionmaking. 
(v) Minority health care providers can 
bridge linguistic, cultural, and other bar-
riers that hamper access to care. 
(vi) African Americans, Hispanics, 
and American Indians remain severely 
underrepresented in health professions 
schools. African Americans and Hispanics 
constitute 20 percent and 16 percent, re-
spectively, of the students in public health 
and baccalaureate nursing programs, and
less than 15 percent of students in all 
other health professions. 
(vi) The number of minorities enroll-
ing in health professional schools has re-
mained stagnant. For example, in 1994, 
1,307 African American and 1,090 His-
panic students enrolled in American med-
ical colleges. In 2000, the figures were es-
sentially unchanged at 1,307 African 
American and 1,033 Hispanic students. 
(vii) While the need for a racially and 
ethnically diverse workforce is clear, the 
practitioners, faculty, and students of the 
fields of nursing, medicine, dentistry, psy-
chology, social work, behavioral science, 
and health education have yet to reflect the 
diversity of the Nation. 
(viii) In 2003, only 2 percent of prac-
ticing dentists and 3 percent of dental hy-
gienists were African-American, and only 4 
percent of practicing dentists and 1 per-
cent of hygienists were Hispanic. 
(ix) Underrepresented minority re-
cruitment into dental education is a seri-
ous problem. In 2003, the first-year enroll-
ment of underrepresented minority stu-
dents in dental school was only 11.6 per-
cent of the total first year enrollment. In 
1990, the percentage of underrepresented 
minority students in the first year class 
was 13.8 percent of the total first year en-
rollment. 
(x) Given the fact that the patients of 
Black dentists are 61.8 percent black and 
the patients of Hispanic dentists are 45.4 
percent Hispanic, increasing minority en-
rollment is an immediate and practical ap-
proach to addressing the problem. Only 
10.5 percent of Black patients are seen by 
white dentists. 
(D) NEED FOR REDUCTION OF DISEASE 
OCCURRENCE
AND
DISEASE-RELATED
COM-
PLICATIONS AMONG MINORITIES.— 
(i) Despite notable progress in the 
overall health of the Nation, there are con-
tinuing disparities in the burden of illness 
and death experienced by minorities com-
pared to the United States population as a 
whole. Minority populations are dispropor-
tionately impacted by acute and chronic 
diseases. 
(ii) In 2000, 6 of the 10 leading 
causes of death for all age groups in this 
country were behaviorally based. In addi-
tion, many modifiable behavioral factors 
are now known to increase an individual’s 
risk for disease and physical disability, rep-
resenting the largest amount of prevent-
able healthcare expenses. 
(iii) Despite suffering a greater bur-
den of acute and chronic disease, minori-
ties are less likely to receive needed health 
care. Numerous studies have documented 
that minorities receive less preventive care, 
medical therapy, and surgical interven-
tions. 
(iv) Culturally appropriate, commu-
nity-driven programs are essential to elimi-
nating health disparities. To be successful, 
these programs need to be based on sound 
prevention research and supported by new 
and innovative partnerships among govern-
ments, businesses, faith-based organiza-
tions, and communities.
(v) Parents reported seeking care for 
relief of their child’s pain for 10 percent of 
white children, 16 percent of Black chil-
dren, and 17 percent of Hispanic children. 
Parents of American Indian and Alaska 
Native schoolchildren report that one third 
miss school because of dental pain each 
year. They also report that 1 in 4 avoid 
laughing or smiling and 1 in 5 avoid meet-
ing other people because of the way their 
teeth look. 
(vi) Five-year survival statistics for 
Blacks are poorer at 33 percent versus 55 
percent for whites. 
(vii) Hispanic adults are twice as like-
ly, Black adults 3 times as likely, and 
Asian adults 4 times as likely as whites to 
report missed work or missed school be-
cause of a dental problem. 
(E) NEED FOR MINORITY HEALTH DATA 
COLLECTION AND REPORTING.— 
(i) Efforts to study disparities in 
health and health care for minorities have 
been hampered by the lack of available
data on race, ethnicity, and primary lan-
guage. 
(ii) Data collection, analysis, and re-
porting by race, ethnicity, and primary lan-
guage is permissible under the law and 
necessary to assure equity and non-
discrimination in the quality of health care 
services. Collection, analysis, and reporting 
of such data is authorized under Title VI 
of the Civil Rights Act of 1964 (42 U.S.C. 
2000d et seq.). Such collection, analysis, 
and reporting should be conducted with ap-
propriate privacy protections in place. 
(F) NEED FOR GREATER ACCOUNTABILITY 
IN GOVERNMENT INSTITUTIONS.—A number of 
studies have shown that differences in health 
care quality contribute to health disparities 
among minority populations. These differences 
may result from bias, stereotyping, and dis-
crimination. Government institutions must be 
held accountable for the quality of health care 
delivered to all patient populations and result-
ant health outcomes. 
(G) 
NEED
FOR
EQUITABLE
SOCIO-
ECONOMIC POLICIES.—Literature suggests that
equitable socioeconomic policies are needed to 
improve the health status of racial and ethnic 
minorities and economically disadvantaged pop-
ulations. 
(H) NEED FOR STRENGTHENING HEALTH 
INSTITUTIONS THAT PROVIDE CARE TO MINOR-
ITY POPULATIONS.— 
(i) A small segment of health care in-
stitutions 
provide 
a 
disproportionate 
amount of health care to minority popu-
lations. 
(ii) Safety net institutions, including 
public hospitals, community health centers 
and community clinics, provide a dis-
proportionate share of health care to mi-
nority and underserved populations. 
(iii) Financial stress, negative oper-
ating margins, and the overall burden of 
caring for the uninsured and delivering 
high-cost specialty care to the entire com-
munity place undue pressure on core safety 
net providers. These providers are increas-
ingly challenged in their ability to meet the 
day-to-day needs of their patients.
(b) PURPOSES.—It is the purpose of this Act to im-
prove the health and healthcare of minority populations 
and to eliminate racial and ethnic disparities in health and 
healthcare by— 
(1) increasing access to health care for all pop-
ulations; 
(2) expanding culturally and linguistically ap-
propriate health services for all populations; 
(3) promoting health workforce diversity; 
(4) supporting and expanding programs and ac-
tivities that will improve the prevention, diagnosis, 
and management of disease in minority populations; 
(5) enhancing racial, ethnic, and primary lan-
guage health data collection at the local, State, and 
Federal level; 
(6) ensuring accountability for the quality of 
health care and health outcomes for minority popu-
lations; and 
(7) strengthening the technical and financial re-
sources of the safety net institutions of the United 
States.
TITLE I—COVERAGE OF THE 
UNINSURED 
Subtitle A—FamilyCare 
SEC. 101. SHORT TITLE. 
This subtitle may be cited as the ‘‘FamilyCare Act 
of 2005’’. 
SEC. 102. RENAMING OF TITLE XXI PROGRAM. 
(a) IN GENERAL.—The heading of title XXI of the 
Social Security Act (42 U.S.C. 1397aa et seq.) is amended 
to read as follows: 
‘‘TITLE XXI—FAMILYCARE 
PROGRAM’’. 
(b) PROGRAM REFERENCES.—Any reference in any 
provision of Federal law or regulation to ‘‘SCHIP’’ or 
‘‘State children’s health insurance program’’ under title 
XXI of the Social Security Act shall be deemed a reference 
to the FamilyCare program under such title. 
SEC. 103. FAMILYCARE COVERAGE OF PARENTS UNDER 
THE MEDICAID PROGRAM AND TITLE XXI. 
(a) INCENTIVES TO IMPLEMENT FAMILYCARE COV-
ERAGE.— 
(1) UNDER MEDICAID.— 
(A) ESTABLISHMENT OF NEW OPTIONAL 
ELIGIBILITY
CATEGORY.—Section 1902(a)(10)
(A)(ii) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)(ii)) is amended— 
(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: 
‘‘(XIX) who are individuals de-
scribed in subsection (k)(1) (relating 
to parents of categorically eligible chil-
dren);’’. 
(B) PARENTS DESCRIBED.—Section 1902 
of the Social Security Act is further amended 
by inserting after subsection (j) the following: 
‘‘(k)(1)(A) Individuals described in this paragraph 
are individuals— 
‘‘(i) who are the parents of an individual who 
is under 19 years of age (or such higher age as the 
State may have elected under section 1902(l)(1)(D)) 
and who is eligible for medical assistance under sub-
section (a)(10)(A); 
‘‘(ii) who are not otherwise eligible for medical 
assistance under such subsection or under a waiver 
approved under section 1115 or otherwise (except
under 
section 
1931 
or 
under 
subsection 
(a)(10)(A)(ii)(XIX)); and 
‘‘(iii) whose family income or resources exceeds 
the effective income level or resource level applicable 
under the State plan under part A of title IV as in 
effect as of July 16, 1996, but does not exceed the 
highest effective income or resource level (if any) ap-
plicable to a child in the family under this title. 
‘‘(B) In establishing an income eligibility level for in-
dividuals described in this paragraph, a State may vary 
such level consistent with the various income levels estab-
lished under subsection (l)(2) in order to ensure, to the 
maximum extent possible, that such individuals shall be 
enrolled in the same program as their children. 
‘‘(C) An individual may not be treated as being de-
scribed in this paragraph unless, at the time of the individ-
ual’s enrollment under this title, the child referred to in 
subparagraph (A)(i) of the individual is also enrolled 
under this title or otherwise insured. 
‘‘(D) In this subsection, the term ‘parent’ includes 
an individual treated as a caretaker for purposes of car-
rying out section 1931. 
‘‘(E) In this subsection, the term ‘effective income 
level’ means the income level expressed as a percent of
the poverty line and considering applicable income dis-
regards. 
‘‘(2) The State shall provide for coverage of a parent 
described in paragraph (1) or section 2111 of a child who 
is covered under this title or title XXI under the same 
title as the title as such child is covered. In the case of 
a parent described in paragraph (1) who is also the parent 
of a child who is eligible for child health assistance under 
title XXI, the State may elect (on a uniform basis) to 
cover all such parents under section 2111 or under this 
title.’’. 
(C) ENHANCED MATCHING FUNDS AVAIL-
ABLE IF CERTAIN CONDITIONS MET.—Section 
1905 of the Social Security Act (42 U.S.C. 
1396d) is amended— 
(i) in the fourth sentence of sub-
section (b), by striking ‘‘or subsection 
(u)(3)’’ and inserting ‘‘, (u)(3), or (u)(4)’’; 
and 
(ii) in subsection (u)— 
(I) by redesignating paragraph 
(4) as paragraph (6), and 
(II) by inserting after paragraph 
(3) the following:
‘‘(4) For purposes of subsection (b) and section 
2105(a)(1): 
‘‘(A) FAMILYCARE
PARENTS.—The expendi-
tures described in this subparagraph are the expend-
itures described in the following clauses (i) and (ii): 
‘‘(i) PARENTS.—If the conditions described 
in clauses (iii) and (iv) are met, expenditures 
for medical assistance for parents described in 
section 1902(k)(1) and for parents who would 
be described in such section but for the fact 
that they are eligible for medical assistance 
under section 1931 or under a waiver approved 
under section 1115. 
‘‘(ii) CERTAIN PREGNANT WOMEN.—If the 
conditions described in clause (v) are met, ex-
penditures for medical assistance for pregnant 
women described in subsection (n) or under sec-
tion 1902(l)(1)(A) in a family the income of 
which exceeds the effective income level applica-
ble under subsection (a)(10)(A)(i)(III) or 
(l)(2)(A) of section 1902 to a family of the size 
involved as of January 1, 2006. 
‘‘(iii) CONDITIONS RELATING TO ENSURING 
CHILDREN’S COVERAGE FOR ENHANCED MATCH
FOR
PARENTS.—The conditions described in 
this clause are the following: 
‘‘(I) The State has a State child 
health plan under title XXI which (wheth-
er implemented under such title or under 
this title) has an effective income level for 
children that is at least 200 percent of the 
poverty line. 
‘‘(II) Such State child health plan 
does not limit the acceptance of applica-
tions, does not use a waiting list for chil-
dren who meet eligibility standards to 
qualify for assistance, and provides bene-
fits to all children in the State who apply 
for and meet eligibility standards. 
‘‘(III) Effective for determinations of 
eligibility made on or after the date that is 
1 year after the date of the enactment of 
this clause, the application and renewal 
procedures for individuals under 19 years 
of age (or such higher age as the State has 
elected under section 1902(l)(1)(D)) for 
medical 
assistance 
under 
section 
1902(a)(10)(A) are not be more restrictive 
or burdensome than such procedures used
for children with higher income under the 
State child health plan under title XXI. 
‘‘(iv) CONDITIONS RELATING TO MINIMUM 
COVERAGE
FOR
PARENTS
FOR
ENHANCED 
MATCH
FOR
PARENTS.—The conditions de-
scribed in this clause are the following: 
‘‘(I) The State does not apply an in-
come level for parents that is lower than 
the effective income level (expressed as a 
percent of the poverty line) that has been 
specified under the State plan under title 
XIX (including under a waiver authorized 
by 
the 
Secretary 
or 
under 
section 
1902(r)(2)), as of January 1, 2006, to be 
eligible for medical assistance as a parent 
under this title. 
‘‘(II) The State plans under this title 
and title XXI do not provide coverage for 
parents with higher family income without 
covering parents with a lower family in-
come. 
‘‘(v) CONDITIONS FOR ENHANCED MATCH 
FOR CERTAIN PREGNANT WOMEN.—The condi-
tions described in this clause are the following:
‘‘(I) The State has established an ef-
fective income eligibility level for pregnant 
women under subsection (a)(10)(A)(i)(III) 
or (l)(2)(A) of section 1902 that is at least 
185 percent of the poverty line. 
‘‘(II) The State plans under this title 
and title XXI do not provide coverage for 
pregnant women described in subpara-
graph (A)(ii) with higher family income 
without covering such pregnant women 
with a lower family income. 
‘‘(III) The State does not apply an in-
come level for pregnant women that is 
lower than the effective income level that 
has been specified under the State plan 
under 
subsection 
(a)(10)(A)(i)(III) 
or 
(l)(2)(A) of section 1902, as of January 1, 
2006, to be eligible for medical assistance 
as a pregnant woman. 
‘‘(IV) The State satisfies the condi-
tions described in subclauses (I) and (II) 
of clause (iii). 
‘‘(vi) DEFINITIONS.—For purposes of this 
subsection:
‘‘(I) The term ‘parent’ has the mean-
ing given such term for purposes of section 
1902(k)(1). 
‘‘(II) The term ‘poverty line’ has the 
meaning given such term in section 
2110(c)(5).’’. 
(D) APPROPRIATION FROM TITLE XXI AL-
LOTMENT FOR CERTAIN MEDICAID EXPANSION 
COSTS.—Section 2105(a) of the Social Security 
Act (42 U.S.C. 1397ee(a)) is amended— 
(i) in paragraph (1), by redesignating 
subparagraphs (B) through (D) as sub-
paragraphs (C) through (E), respectively, 
and by inserting after subparagraph (A) 
the following new subparagraph: 
‘‘(B) for medical assistance that is attrib-
utable to expenditures described in section 
1905(u)(4)(A);’’; and 
(ii) in paragraph (2), by adding at the 
end the following new subparagraph: 
‘‘(E) Fifth, for expenditures for items de-
scribed in paragraph (1)(E).’’. 
(2) UNDER TITLE XXI.— 
(A) FAMILYCARE
COVERAGE.—Title XXI 
of the Social Security Act (42 U.S.C. 1397aa et