I 
110TH CONGRESS 
1ST SESSION H. R. 2055 
To improve children’s access to health care coverage under the Medicaid 
Program and the State Children’s Health Insurance Program (SCHIP). 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 26, 2007 
Ms. CASTOR introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To improve children’s access to health care coverage under 
the Medicaid Program and the State Children’s Health 
Insurance Program (SCHIP). 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Improving Children’s Access to Health Care Act of 
2007’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents; findings. 
Sec. 2. State options for ‘‘express lane’’ eligibility. 
Sec. 3. Medicaid citizenship documentation requirements. 
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Sec. 4. Give States the option to allow children of low-income state employees 
to enroll in SCHIP. 
Sec. 5. Establishment of new base SCHIP allotments that are responsive to in-
creases in health care costs and enrollment expansions. 
Sec. 6. 2-year initial availability of SCHIP allotments. 
Sec. 7. SCHIP Premium grace period. 
(c) FINDINGS.—Congress finds the following: 
(1) 9 million children in the United States 
under the age of 19 are uninsured. 
(2) 6.8 million of these children are eligible for, 
but not enrolled in, the Medicaid program or the 
State 
Children’s 
Health 
Insurance 
Program 
(SCHIP). 
(3) Two-thirds of the 9 million uninsured chil-
dren come from working families in which one or 
both parents are working but were not offered em-
ployer-based health insurance or were unable to buy 
private health insurance. 
(4) Uninsured children are five times less likely 
than insured children to have a primary care physi-
cian, or to have visited a doctor or dentist in the 
past two years. 
SEC. 2. STATE OPTIONS FOR ‘‘EXPRESS LANE’’ ELIGIBILITY. 
Notwithstanding any other provision of law, any 
State with a plan under title XIX or XXI of the Social 
Security Act has the option of doing any or all of the fol-
lowing in order to promote enrollment of eligible children 
under the programs under those titles: 
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(1) The option to create ‘‘express lane eligi-
bility’’ so that children who meet other low-income 
public program eligibility requirements (such as the 
WIC program, the school lunch program, and other 
means-tested programs) are automatically enrolled 
for benefits under the appropriate plan under such 
titles, with appropriate notice to the parents of chil-
dren so enrolled. 
(2) The option to create one enrollment form 
for all low-income public programs, including such 
programs. 
(3) The option to receive a 75 percent Federal 
matching percentage under such titles for expenses 
relating to the implementation of electronic tech-
nology needed to make their information and com-
puter system infrastructure facilitate Express Lane 
eligibility, presumptive eligibility, continuous eligi-
bility, and automatic renewals of coverage for chil-
dren for whom the State already has data from 
other programs on income. 
SEC. 3. MEDICAID CITIZENSHIP DOCUMENTATION RE-
QUIREMENTS. 
(a) STATE OPTION TO REQUIRE CERTAIN INDIVID-
UALS TO PRESENT SATISFACTORY DOCUMENTARY EVI-
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DENCE OF PROOF OF CITIZENSHIP OR NATIONALITY FOR 
PURPOSES OF ELIGIBILITY FOR MEDICAID.— 
(1) IN GENERAL.—Section 1902(a)(46) of the 
Social Security Act (42 U.S.C. 1396a(a)(46)) is 
amended— 
(A) by inserting ‘‘(A)’’ after ‘‘(46)’’; 
(B) by adding ‘‘and’’ after the semicolon; 
and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(B) at the option of the State and subject to 
section 1903(x), require that, with respect to an in-
dividual (other than an individual described in sec-
tion 1903(x)(1)) who declares to be a citizen or na-
tional of the United States for purposes of estab-
lishing initial eligibility for medical assistance under 
this title (or, at State option, for purposes of renew-
ing or redetermining such eligibility to the extent 
that such satisfactory documentary evidence of citi-
zenship or nationality has not yet been presented), 
there is presented satisfactory documentary evidence 
of citizenship or nationality of the individual (using 
criteria determined by the State, which shall be no 
more restrictive than the criteria used by the Social 
Security Administration to determine citizenship, 
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and which shall accept as such evidence a document 
issued by a federally-recognized Indian tribe evidenc-
ing membership or enrollment in, or affiliation with, 
such tribe (such as a tribal enrollment card or cer-
tificate of degree of Indian blood, and, with respect 
to those federally-recognized Indian tribes located 
within States having an international border whose 
membership includes individuals who are not citizens 
of the United States, such other forms of docu-
mentation (including tribal documentation, if appro-
priate) that the Secretary, after consulting with such 
tribes, determines to be satisfactory documentary 
evidence of citizenship or nationality for purposes of 
satisfying the requirement of this subparagraph));’’. 
(2) LIMITATION ON WAIVER AUTHORITY.—Not-
withstanding any provision of section 1115 of the 
Social Security Act (42 U.S.C. 1315), or any other 
provision of law, the Secretary of Health and 
Human Services may not waive the requirements of 
section 1902(a)(46)(B) of such Act (42 U.S.C. 
1396a(a)(46)(B)) with respect to a State. 
(3) CONFORMING AMENDMENTS.—Section 1903 
of such Act (42 U.S.C. 1396b) is amended— 
(A) in subsection (i)— 
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(i) in paragraph (20), by adding ‘‘or’’ 
after the semicolon; 
(ii) in paragraph (21), by striking ‘‘; 
or’’ and inserting a period; and 
(iii) by striking paragraph (22); and 
(B) in subsection (x) (as amended by sec-
tion 405(c)(1)(A) of division B of the Tax Re-
lief and Health Care Act of 2006 (Public Law 
109–432))— 
(i) by striking paragraphs (1) and (3); 
(ii) by redesignating paragraph (2) as 
paragraph (1); 
(iii) in paragraph (1), as so redesig-
nated, by striking ‘‘paragraph (1)’’ and in-
serting ‘‘section 1902(a)(46)(B)’’; and 
(iv) by adding at the end the following 
new paragraph: 
‘‘(2) 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), 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) 
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of section 1137(d)(4)(A) to an individual for the submittal 
to the State of evidence indicating a satisfactory immigra-
tion status.’’. 
(b) CLARIFICATION OF RULES FOR CHILDREN BORN 
IN THE UNITED STATES TO MOTHERS ELIGIBLE FOR 
MEDICAID.—Section 1903(x) of such Act (42 U.S.C. 
1396b(x)), as amended by subsection (a)(3)(B), is amend-
ed— 
(1) in paragraph (1)— 
(A) in subparagraph (C), by striking ‘‘or’’ 
at the end; 
(B) by redesignating subparagraph (D) as 
subparagraph (E); and 
(C) by inserting after subparagraph (C) 
the following new subparagraph: 
‘‘(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 
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(2) by adding at the end the following new 
paragraph: 
‘‘(3) 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.’’. 
(c) EFFECTIVE DATE.— 
(1) RETROACTIVE APPLICATION.—The amend-
ments made by this section shall take effect as if in-
cluded in the enactment of the Deficit Reduction Act 
of 2005 (Public Law 109–171; 120 Stat. 4). 
(2) RESTORATION
OF
ELIGIBILITY.—In the 
case of an individual who, during the period that 
began on July 1, 2006, and ends on the date of en-
actment of this Act, was determined to be ineligible 
for medical assistance under a State Medicaid pro-
gram solely as a result of the application of sub-
sections (i)(22) and (x) of section 1903 of the Social 
Security Act (as in effect during such period), but 
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who would have been determined eligible for such as-
sistance if such subsections, as amended by sub-
sections (a) and (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 determined to be ineligible for such medical as-
sistance on such basis. 
SEC. 4. GIVE STATES THE OPTION TO ALLOW CHILDREN OF 
LOW-INCOME STATE EMPLOYEES TO ENROLL 
IN SCHIP. 
(a) IN GENERAL.—Section 2110(b)(2)(B) of the So-
cial Security Act (42 U.S.C. 1397jj(b)(2)(B)) is amended 
by inserting ‘‘at the option of a State,’’ after ‘‘(B)’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act. 
SEC. 5. ESTABLISHMENT OF NEW BASE SCHIP ALLOT-
MENTS 
THAT 
ARE 
RESPONSIVE 
TO 
IN-
CREASES IN HEALTH CARE COSTS AND EN-
ROLLMENT EXPANSIONS. 
Section 2104 of the Social Security Act (42 U.S.C. 
1397dd) is amended— 
(1) in subsection (a)— 
(A) in paragraph (9), by striking ‘‘and’’ at 
the end; 
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(B) in paragraph (10), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(11) for fiscal year 2008 and each succeeding 
fiscal year, the sum of the State allotments provided 
under subsection (i) for such fiscal year.’’; 
(2) in each of subsections (b)(1) and (c)(1), by 
striking ‘‘subsection (d)’’ and inserting ‘‘subsections 
(d) and (i)’’; and 
(3) by adding at the end the following new sub-
section: 
‘‘(i) ALLOTMENTS FOR STATES AND TERRITORIES 
BEGINNING WITH FISCAL YEAR 2008.— 
‘‘(1) GENERAL ALLOTMENT COMPUTATION.— 
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding provisions of this subsection, the Sec-
retary shall compute a State allotment for each 
State for each fiscal year as follows: 
‘‘(i) REBASING IN FISCAL YEAR 2008 
AND
EACH
SECOND
SUCCEEDING
FISCAL 
YEAR.—For fiscal year 2008 and each sec-
ond succeeding fiscal year, the allotment of 
a State is equal to the Federal payments 
to the State that are attributable to (and 
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countable towards) the allotment under 
this section for the State for the previous 
fiscal year multiplied by the allotment in-
crease factor under subparagraph (B) for 
the fiscal year involved. 
‘‘(ii) USING PROJECTIONS FOR FISCAL 
YEAR 2009 AND EACH SECOND SUCCEEDING 
FISCAL YEAR.—For fiscal year 2009 and 
each second succeeding fiscal year, the al-
lotment of a State is equal to the amount 
of the State allotment under this subpara-
graph for the previous fiscal year multi-
plied by the allotment increase factor 
under subparagraph (B) for the fiscal year 
involved. 
‘‘(B) ALLOTMENT
INCREASE
FACTOR.— 
The allotment increase factor under this sub-
paragraph for a fiscal year is equal to the prod-
uct of the following: 
‘‘(i) 
PER
CAPITA
HEALTH
CARE 
GROWTH FACTOR.—One plus the percent-
age increase in the projected per capita 
amount of National Health Expenditures 
from the second previous fiscal year to the 
previous fiscal year, as most recently pub-
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lished by the Secretary before the begin-
ning of the fiscal year involved. 
‘‘(ii) CHILD
POPULATION
GROWTH 
FACTOR.—One plus the percentage in-
crease in the population of children under 
20 years of age in the State from July 1 
in such second previous fiscal year to July 
1 in the previous fiscal year, as determined 
by the Secretary based on the most recent 
published estimates of the Bureau of the 
Census before the beginning of the fiscal 
year involved. 
‘‘(C) OUTREACH ADJUSTMENT.— 
‘‘(i) IN
GENERAL.—If a State’s ex-
penditures under this title in a fiscal year 
(beginning with fiscal year 2008) exceeds 
the allotment provided under this section 
(determined without regard to any reallot-
ment it receives that is available for ex-
penditure during such fiscal year) and if 
the average number of enrollees in the 
State under this title for such fiscal year 
exceeds its target number of enrollees for 
that year, for the subsequent fiscal year 
the allotment under this section for the 
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State shall be increased by the amount by 
which— 
‘‘(I) the product of— 
‘‘(aa) such additional num-
ber of enrollees; and 
‘‘(bb) the projected per cap-
ita Federal expenditures under 
the State child health plan (as 
determined under clause (iii) for 
such subsequent fiscal year); re-
duced by 
‘‘(II) the amount of any allot-
ment redistributed to the State under 
this section for such subsequent fiscal 
year. 
‘‘(ii) TARGET
NUMBER
OF
ENROLL-
EES.—In this subsection, the target num-
ber of enrollees for a State for a fiscal year 
is equal to the average number of enrollees 
enrolled in the State child health plan 
under this title during fiscal year 2007 in-
creased (for each subsequent fiscal year 
through the fiscal year involved) by the 
population growth for children in that 
State for the year ending on June 30 be-
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fore the beginning of the fiscal year (as es-
timated by the Bureau of the Census). 
‘‘(iii) PROJECTED
PER
CAPITA
FED-
ERAL
EXPENDITURES.—For purposes of 
subparagraph (A)(i)(II), the projected per 
capita Federal expenditures under a State 
child health plan for a fiscal year is equal 
to the average per capita Federal expendi-
tures under such plan for fiscal year 2007, 
increased (for each subsequent fiscal year 
up to and including the fiscal year in-
volved) by the annual percentage increase 
in per capita amount of National Health 
Expenditures (as estimated by the Sec-
retary) for the respective subsequent fiscal 
year. 
‘‘(iv) 
AVAILABILITY.—Notwith-
standing subsection (e), an increase in al-
lotment under this paragraph shall only be 
available for expenditure during the fiscal 
year in which it is provided. 
‘‘(v) INTERACTION WITH OTHER PRO-
VISIONS.— 
‘‘(I) 
COVERAGE
EXPANSION 
STATES.—In the case of a State that 
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has an increased allotment under sec-
tion 2105(i)— 
‘‘(aa) there shall be no in-
creased allotment under para-
graph (2); and 
‘‘(bb) the allotment under 
this subsection shall not be sub-
ject to reallotment or redistribu-
tion to other States. 
‘‘(II) NO REALLOTMENT OF OUT-
REACH
ADJUSTMENT.—In no case 
shall any increase in allotment under 
paragraph (2) for a State be subject 
to reallotment or redistribution to 
other States.’’. 
SEC. 6. 2-YEAR INITIAL AVAILABILITY OF SCHIP ALLOT-
MENTS. 
Section 2104(e) of the Social Security Act (42 U.S.C. 
1397dd(e)) is amended to read as follows: 
‘‘(e) AVAILABILITY OF AMOUNTS ALLOTTED.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), amounts allotted to a State pursuant to 
this section— 
‘‘(A) for each of fiscal years 1998 through 
2007, shall remain available for expenditure by 
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the State through the end of the second suc-
ceeding fiscal year; and 
‘‘(B) for fiscal year 2008 and each fiscal 
year thereafter, shall remain available for ex-
penditure by the State through the end of the 
succeeding fiscal year. 
‘‘(2) AVAILABILITY
OF
AMOUNTS
REALLOT-
TED.—Amounts reallotted to a State under sub-
section (f) shall be available for expenditure by the 
State through the end of the fiscal year in which 
they are reallotted.’’. 
SEC. 7. SCHIP PREMIUM GRACE PERIOD. 
(a) IN GENERAL.—Section 2103(e)(3) of the Social 
Security Act (42 U.S.C. 1397bb(e)(3)) is amended by add-
ing at the end the following new subparagraph: 
‘‘(C) PREMIUM GRACE PERIOD.— 
‘‘(i) IN
GENERAL.—The State child 
health plan shall provide a grace period of 
at least 30 days from the beginning of a 
new coverage period to make premium pay-
ments before coverage under this title may 
be terminated. For purposes of this clause, 
the term ‘new coverage period’ means the 
month following the last month for which 
the premium has been paid. 
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