119 
‘‘(D) Old section 1903(e) (relating to costs 
with respect to certain hospital services). 
‘‘(E) Old section 1903(i) (relating to limi-
tations on payments). 
‘‘(F) Old section 1903(r) (relating to re-
quirements for mechanized claims processing 
and information retrieval systems). 
‘‘(G) Subsections (b)(5) and (w) of old sec-
tion 1903 (relating to limitations on payments 
related to provider taxes). 
‘‘(H) Old section 1904 (relating to oper-
ation of State plans). 
‘‘(I) Old sections 1902(a)(60) and 1908A 
(relating to medical child support). 
‘‘(J) Paragraphs (32)(D) and (62) of old 
section 1902(a) and section 1928 (relating to 
program for distribution of pediatric vaccines). 
‘‘PART F—OTHER PROVISIONS 
‘‘SEC. 1961. APPLICATION OF CERTAIN REQUIREMENTS 
UNDER PRE-MODERNIZED MEDICAID. 
‘‘The following old provisions shall apply under this 
part: 
‘‘(1) The third sentence of old section 1902 (re-
lating to nonapplication of certain old provisions to 
a religious nonmedical health care institution). 
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‘‘(2) Old section 1918 (relating to application of 
provisions of title II relating to subpoenas). 
‘‘(3) Old section 1939 (relating to references to 
laws directly affecting the Medicaid program.’’. 
(b) REPEAL OF TITLE XXI.—Effective January 1, 
2011, title XXI of the Social Security Act (42 U.S.C. 
1397aa et seq.) is repealed. 
SEC. 402. OUTREACH. 
(a) AUTHORIZATION OF APPROPRIATIONS.—The fol-
lowing amounts are authorized to be appropriated to the 
Secretary of Health and Human Services: 
(1) For fiscal year 2009, $100,000,000 for the 
design and implementation of a public outreach cam-
paign to inform the public about the changes to the 
programs under such titles that take effect on Janu-
ary 1, 2011, as a result of the amendment made by 
section 401. 
(2) For each of fiscal years 2010 and 2011, 
$200,000,000 to carry out such public outreach 
campaign. 
(3) For fiscal year 2012, $50,000,000 to carry 
out such public outreach campaign. 
(b) AVAILABILITY.—Funds appropriated under sub-
section (a) shall remain available for expenditure through 
September 30, 2012. 
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(c) AUTHORITY FOR USE OF FUNDS.—The Secretary 
may use funds made available under paragraphs (2) and 
(3) of subsection (a) to award grants to, or enter into con-
tracts with, public or private entities, including States, 
local governments, schools, churches, and community 
groups. 
SEC. 403. TRANSITION RULES; MISCELLANEOUS PROVI-
SIONS. 
(a) IN GENERAL.— 
(1) Not later than June 30, 2010, a State that 
is one of the 50 States or the District of Columbia 
shall inform all individuals enrolled in a State plan 
under title XIX or XXI of the Social Security Act 
on such date (and any new enrollees after such date) 
of the changes to the programs under such titles 
that take effect on January 1, 2011, as a result of 
the amendment made by section 401. 
(2) No State that is one of the 50 States or the 
District of Columbia shall approve any applications 
for medical assistance or child health assistance 
under a State plan under title XIX or XXI (as in 
effect for fiscal year 2010) after December 31, 
2010. 
(b) SUBMISSION OF LEGISLATIVE PROPOSAL FOR 
TECHNICAL AND CONFORMING AMENDMENTS.—Not later 
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than 6 months after the date of enactment of this Act, 
the Secretary of Health and Human Services shall submit 
to Congress a legislative proposal for such technical and 
conforming amendments as are necessary to carry out the 
amendments made by this Act. 
Subtitle B—Supplemental Health 
Care Assistance for Low-Income 
Families 
SEC. 411. SUPPLEMENTAL HEALTH CARE ASSISTANCE FOR 
LOW-INCOME FAMILIES. 
Part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.) is amended by adding at the end 
the following: 
‘‘Subpart XI—Health Care Assistance to Low-Income 
Families 
‘‘SEC. 340A–1. FINANCIAL ASSISTANCE TO LOW-INCOME 
FAMILIES. 
‘‘(a) IN GENERAL.—The Secretary shall supplement 
the costs of private health insurance for eligible low-in-
come families through the distribution of supplemental 
debit cards to eligible families, which may be used to pay 
for costs associated with health care for the members of 
such eligible families and provide direct support to such 
families in accessing health care. 
‘‘(b) ELIGIBILITY.— 
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‘‘(1) ELIGIBLE FAMILIES.—To be eligible for fi-
nancial assistance under this section— 
‘‘(A) a family shall— 
‘‘(i) consist of 2 or more individuals 
living together who are related by mar-
riage, birth, adoption, or guardianship; 
‘‘(ii) have a gross income that does 
not exceed 200 percent of the poverty line, 
as applicable to a family of the size in-
volved; and 
‘‘(iii) include at least 1 individual who 
is a dependent under the age of 19; and 
‘‘(B) no member of the family shall be cov-
ered by private health insurance. 
‘‘(2) DETERMINATION OF GROSS INCOME.—The 
gross income of a family shall be determined by tak-
ing the sum of the income of each family member 
who is at least age 21 but not older than age 65, 
except that the income of any member of the family 
who qualifies for coverage under Medicaid Part A or 
B shall not be counted. 
‘‘(3) LIMITATION ON INDIVIDUAL ELIGIBILITY; 
ASSISTANCE.— 
‘‘(A) IN GENERAL.—No individual who is a 
member of an eligible family under paragraph 
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(1) is eligible to qualify separately for financial 
assistance under this section. 
‘‘(B) ALIENS.—The Secretary shall ensure 
that financial assistance under this section is 
not provided for costs associated with health 
care for any member of an eligible family who 
is an alien individual who is not a lawful per-
manent resident of the United States. 
‘‘(c) SUPPLEMENTAL DEBIT CARD
FOR HEALTH 
CARE EXPENDITURES.— 
‘‘(1) IN GENERAL.—The Secretary shall issue 
to each eligible family that enrolls in the program in 
accordance with subsection (f) a supplemental debit 
card with a dollar-amount value, in accordance with 
subsection (d), that may be used to pay for quali-
fying health care expenses. 
‘‘(2) USE OF THE DEBIT CARD.— 
‘‘(A) QUALIFYING
HEALTH
CARE
EX-
PENSES.—A supplemental debit card issued 
under this section may be used by members of 
the eligible family to pay for— 
‘‘(i) the purchase of health care insur-
ance for any member of the family; 
‘‘(ii) cost sharing expenses related to 
health care, including deductibles, copay-
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125 
ments, and coinsurance, for any member of 
the family; and 
‘‘(iii) the direct purchase of health 
care services and supplies for any member 
of the family. 
‘‘(B) GEOGRAPHIC RANGE.—Each supple-
mental debit card may be used to pay for quali-
fying health care expenses incurred anywhere in 
the 50 States or the District of Columbia. 
‘‘(C) 
LIMITATIONS.—No 
supplemental 
debit card shall be used to make a payment for 
any cost— 
‘‘(i) incurred prior to the determina-
tion of the family’s eligibility for assistance 
under this section; or 
‘‘(ii) that is not a health-related ex-
pense. 
‘‘(3) ROLLOVER
OF
UNUSED
AMOUNTS.—Not 
more than one-quarter of the annual dollar amount 
of a supplemental debit card that is unexpended at 
the end of each 12-month period may rollover— 
‘‘(A) to the family’s supplemental debit 
card for expenditure during the subsequent 12- 
month period, provided that the family to which 
the supplemental debit card was issued in the 
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previous 12-month period is eligible to receive a 
supplemental debit card in the subsequent 12- 
month period; or 
‘‘(B) to the family’s health savings account 
(as defined in section 223(g)(2) of the Internal 
Revenue Code of 1986). 
‘‘(4) MONTHLY
STATEMENTS.—The Secretary 
shall issue a monthly statement to each family to 
which a supplemental debit card has been issued 
under this section, which shall state each payment 
made with the family’s supplemental debit card dur-
ing the month covered by the statement, the dollar 
amount of each such payment, and the provider to 
which each such payment was made. 
‘‘(d) AMOUNT OF FINANCIAL ASSISTANCE.— 
‘‘(1) AMOUNTS FOR CALENDAR YEAR 2011.— 
Subject to paragraph (5), the amount of financial 
assistance available to each eligible family during the 
calendar year 2011 shall be determined as follows: 
‘‘(A) Each family whose annual income 
does not exceed 100 percent of the poverty 
level, as applicable to a family of the size in-
volved, shall receive $5,000. 
‘‘(B) Each family whose annual income ex-
ceeds 100 percent, but does not exceed 200 per-
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cent, of the poverty level, as applicable to a 
family of the size involved, shall receive an 
amount as follows: 
‘‘(i) For families whose annual income 
exceeds 100 percent but does not exceed 
120 percent, of the poverty level, $4,000. 
‘‘(ii) For families whose annual in-
come exceeds 120 percent but does not ex-
ceed 140 percent, of the poverty level, 
$3,500. 
‘‘(iii) For families whose annual in-
come exceeds 140 percent but does not ex-
ceed 160 percent, of the poverty level, 
$3,000. 
‘‘(iv) For families whose annual in-
come exceeds 160 percent but does not ex-
ceed 180 percent, of the poverty level, 
$2,500. 
‘‘(v) For families whose annual in-
come exceeds 180 percent but does not ex-
ceed 200 percent, of the poverty level, 
$2,000. 
‘‘(2) ADDITIONAL
AMOUNTS.—In addition to 
the amounts under paragraph (1), subject to para-
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graph (5), the following amounts shall be added to 
the supplemental debit cards of qualifying families: 
‘‘(A) For each pregnancy during which a 
pregnant woman’s family is eligible for assist-
ance under this section, an additional amount 
of $1,000 shall be added to the family’s supple-
mental debit card, except that no family shall 
receive such additional $1,000 for any preg-
nancy for which the family received such 
amount in the previous 12-month period. 
‘‘(B) For each member of an eligible fam-
ily who is less than 1 year old on any day with-
in the calendar year in which the family is eligi-
ble for assistance, an additional amount of 
$500 shall be added to the family’s supple-
mental debit card. 
‘‘(3) COST OF LIVING ADJUSTMENTS.—In the 
case of any taxable year beginning in a calendar 
year after 2011, each dollar amount contained in 
paragraphs (1) and (2) shall be increased in the 
same manner as the dollar amounts specified in sec-
tion 25E(b)(3) of the Internal Revenue Code of 
1986 are increased by the blended cost-of-living ad-
justment determined under subsection (k)(2) of sec-
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tion 25E of the Internal Revenue Code for the tax-
able year involved. 
‘‘(4) STATE OPTION TO INCREASE AMOUNTS.— 
At the option of each State, amounts in excess of 
the annual dollar amounts under paragraphs (1) and 
(2) may be provided through the supplemental debit 
card to eligible families in that State, but no Federal 
funds shall be paid to any State for any amount pro-
vided in excess of such annual dollar amount. 
‘‘(5) RISK ADJUSTMENT.—The Secretary may 
adjust the amount of financial assistance available to 
an eligible family for a calendar year under this sec-
tion based on age, health indicators, and other fac-
tors that represent distinct patterns of health care 
services utilization and costs. 
‘‘(e) CONTRIBUTIONS OF STATES.— 
‘‘(1) IN GENERAL.—As a condition for receiving 
Federal funds under Part A or Part B of Medicaid, 
each State shall contribute 50 percent of the total 
amount expended under the supplemental debit card 
program by the participating families that reside 
within the State during the time that the family re-
sides in that State. For purposes of this section, the 
residency of a family is determined by the residency 
the legally responsible head of the household. 
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