I
106TH CONGRESS
1ST SESSION
H. R. 458
To amend title XIX of the Social Security Act to allow States to use the
funds available under the State children’s health insurance program
for an enhanced matching rate for coverage of additional children under
the Medicaid Program.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 2, 1999
Ms. DUNN (for herself, Mr. MCDERMOTT, Mr. DICKS, Mr. HASTINGS of
Washington, Mr. NETHERCUTT, Mr. METCALF, Mr. SMITH of Washing-
ton, Mr. INSLEE, and Mr. BAIRD) introduced the following bill; which was
referred to the Committee on Commerce
A BILL
To amend title XIX of the Social Security Act to allow
States to use the funds available under the State chil-
dren’s health insurance program for an enhanced match-
ing rate for coverage of additional children under the
Medicaid Program.
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 Health Eq-
uity Act of 1999’’.
SEC, 2. USE OF STATE CHILDREN’S HEALTH INSURANCE
PROGRAM FUNDS FOR ENHANCED MATCH-
ING RATE FOR COVERAGE OF ADDITIONAL
CHILDREN UNDER THE MEDICAID PROGRAM.
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended—
(1) in subsection (b), by striking ‘‘or subsection
(u)(3)’’ and inserting ‘‘, subsection (u)(3), or sub-
section (u)(4)(A)’’; and
(2) in subsection (u) (as added by section
4911(a)(2) of the Balanced Budget Act of 1997 and
as amended by section 162 of Public Law 105–
100)—
(A) by redesignating paragraph (4) as
paragraph (5); and
(B) by inserting after paragraph (3) the
following new paragraph:
‘‘(4)(A) For purposes of subsection (b), the expendi-
tures described in this subparagraph are expenditures for
medical assistance for waivered low-income children de-
scribed in subparagraph (B) but—
‘‘(i) only in the case of children residing in a
State described in subparagraph (C); and
‘‘(ii) only to the extent the number of full-year
equivalent waivered low-income children enrolled
under the State plan under this title for the fiscal
year exceeds the number of waivered low-income
children described in subparagraph (D)(i) for the
State for the fiscal year.
‘‘(B) For purposes of this paragraph, the term
‘waivered low-income child’ means a child whose family in-
come exceeds the minimum income level required to be es-
tablished for the age of such child under section
1902(l)(2) in order for the child to be eligible for medical
assistance under this title, but does not exceed the medic-
aid applicable income level (as defined in section
2110(b)(4) but determined as if ‘June 1, 1997’ were sub-
stituted for ‘March 31, 1997’) for that child.
‘‘(C) A State described in this subparagraph is a
State that—
‘‘(i) has under a waiver authorized by the Sec-
retary or under section 1902(r)(2) established a
medicaid applicable income level (as defined in sec-
tion 2110(b)(4) but determined as if ‘June 1, 1997’
were substituted for ‘March 31, 1997’) for children
under 19 years of age residing in the State that is
at or above 200 percent of the poverty line; and
‘‘(ii) demonstrates to the satisfaction of the
Secretary a commitment to reach and enroll children
who are eligible for, but not enrolled under, the
State plan through means, such as the following:
‘‘(I) Eliminating the assets test for eligi-
bility of waivered low-income children.
‘‘(II) Using shortened and simplified appli-
cations for such children.
‘‘(III) Allowing applications for such chil-
dren to be submitted by mail or through tele-
phone.
‘‘(IV) Outstationing State eligibility work-
ers at sites that are frequented by families with
children, including schools, child care centers,
churches, centers providing Head Start services,
local offices of the special supplemental food
program for women, infants and young children
(WIC) established under section 17 of the Child
Nutrition Act of 1966, community centers, Job
Corps centers established under part B of title
IV of the Job Training Partnership Act or sub-
title C of title I of the Workforce Investment
Act of 1998, sites offering the recognized equiv-
alent of a secondary school degree, offices of
tribal organizations (as defined in section 4(l)
of the Indian Self-Determination and Education
Assistance Act), and Social Security Adminis-
tration field offices.
‘‘(V) Using presumptive eligibility for
waivered low-income children.
‘‘(VI) Collaborating with public and private
entities to conduct outreach campaigns to enroll
such children.
‘‘(D)(i) For purposes of subparagraph (A)(ii), the
number of waivered low-income children for a State de-
scribed in this clause for—
‘‘(I) fiscal year 1998, is equal to the number of
full-year equivalent waivered low-income children en-
rolled under the State plan under this title for fiscal
year 1997; and
‘‘(II) fiscal year 1999 or a succeeding fiscal
year, is equal to the number of waivered low-income
children determined under this clause for the preced-
ing fiscal year increased by the number of percent-
age points determined under clause (ii) for the State
for the fiscal year involved.
‘‘(ii) The number of percentage points determined
under this clause for a State for a fiscal year is equal to
the number of percentage points by which—
‘‘(I) the arithmetic average of the total number
of children in the State set forth in the 3 most re-
cent March supplements to the Current Population
Survey of the Bureau of the Census before the be-
ginning of the fiscal year; exceeds
‘‘(II) the arithmetic average of such total num-
ber set forth in the second, third, and fourth most
recent March supplements to such Survey before the
beginning of the fiscal year.
‘‘(E) For purposes of section 2104(d) (regarding the
reduction of an allotment under title XXI) the amount de-
termined under paragraph (2) of that section shall, with
respect to expenditures described in subparagraph (A),
only take into account the amount by which—
‘‘(i) the payments made to a State for such ex-
penditures for a fiscal year on the basis of an en-
hanced FMAP under the fourth sentence of sub-
section (b); exceed
‘‘(ii) the amount of payments that would have
been made for the expenditures if the enhanced
FMAP did not apply.
‘‘(F) Each State shall submit to the Secretary such
information, at such time and in such manner, as the Sec-
retary determines is necessary to ensure that the require-
ments of this paragraph are satisfied. The Secretary shall
ensure that information is provided under this subsection
in a manner that is consistent with other reporting re-
quirements for information required to be submitted by
(1) by striking ‘‘or (II)’’ and inserting ‘‘, (II)’’;
and
(2) by inserting before the semicolon ‘‘, eligi-
bility for assistance under the State plan under part
A of title IV, eligibility of a child to receive medical
assistance under the State plan under this title or
title XXI, (III) is a staff member of an elementary
school or secondary school, as such terms are de-
fined in section 14101 of the Elementary and Sec-
ondary Education Act of 1965 (20 U.S.C. 8801), a
child care resource and referral center, or an agency
administering a State plan under part D of title IV,
or (IV) is so designated by the State’’.
(b) CONFORMING AMENDMENTS.—Section 1920A of
such Act (42 U.S.C. 1396r–1a) is amended—
(1) in subsection (b)(3)(A)(ii), by striking
‘‘paragraph 
(1)(A)’’ 
and 
inserting 
‘‘paragraph
(2)(A)’’; and
(2) in subsection (c)(2), in the matter preceding
subparagraph 
(A), 
by 
striking 
‘‘subsection
(b)(1)(A)’’ and inserting ‘‘subsection (b)(2)(A)’’.
Æ