151 
† HR 2 EAS 
THROUGH
PREMIUM
ASSISTANCE
SUB-
SIDIES.—Expenditures for outreach activi-
ties to families of children likely to be eligi-
ble for premium assistance subsidies in ac-
cordance with paragraph (2)(B), (3), or 
(10), or a waiver approved under section 
1115, to inform such families of the avail-
ability of, and to assist them in enrolling 
their children in, such subsidies, and to em-
ployers likely to provide qualified employer- 
sponsored coverage (as defined in subpara-
graph (B) of such paragraph), but not to 
exceed an amount equal to 1.25 percent of 
the maximum amount permitted to be ex-
pended under subparagraph (A) for items 
described in subsection (a)(1)(D).’’.
152 
† HR 2 EAS 
Subtitle B—Coordinating Premium 
Assistance With Private Coverage 
SEC. 311. SPECIAL ENROLLMENT PERIOD UNDER GROUP 
HEALTH PLANS IN CASE OF TERMINATION OF 
MEDICAID OR CHIP COVERAGE OR ELIGI-
BILITY FOR ASSISTANCE IN PURCHASE OF 
EMPLOYMENT-BASED COVERAGE; COORDINA-
TION OF COVERAGE. 
(a) AMENDMENTS TO INTERNAL REVENUE CODE OF 
1986.—Section 9801(f) of the Internal Revenue Code of 
1986 (relating to special enrollment periods) is amended 
by adding at the end the following new paragraph: 
‘‘(3) SPECIAL
RULES
RELATING
TO
MEDICAID 
AND CHIP.— 
‘‘(A) IN GENERAL.—A group health plan 
shall permit an employee who is eligible, but not 
enrolled, for coverage under the terms of the plan 
(or a dependent of such an employee if the de-
pendent is eligible, but not enrolled, for coverage 
under such terms) to enroll for coverage under 
the terms of the plan if either of the following 
conditions is met: 
‘‘(i) TERMINATION
OF
MEDICAID
OR 
CHIP COVERAGE.—The employee or depend-
ent is covered under a Medicaid plan under
153 
† HR 2 EAS 
title XIX of the Social Security Act or 
under a State child health plan under title 
XXI of such Act and coverage of the em-
ployee or dependent under such a plan is 
terminated as a result of loss of eligibility 
for such coverage and the employee requests 
coverage under the group health plan not 
later than 60 days after the date of termi-
nation of such coverage. 
‘‘(ii) ELIGIBILITY
FOR
EMPLOYMENT 
ASSISTANCE UNDER MEDICAID OR CHIP.— 
The employee or dependent becomes eligible 
for assistance, with respect to coverage 
under the group health plan under such 
Medicaid plan or State child health plan 
(including under any waiver or demonstra-
tion project conducted under or in relation 
to such a plan), if the employee requests 
coverage under the group health plan not 
later than 60 days after the date the em-
ployee or dependent is determined to be eli-
gible for such assistance. 
‘‘(B) EMPLOYEE
OUTREACH
AND
DISCLO-
SURE.—
154 
† HR 2 EAS 
‘‘(i) OUTREACH
TO
EMPLOYEES
RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.— 
‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity Act, or child health assistance 
under a State child health plan under 
title XXI of such Act, in the form of 
premium assistance for the purchase of 
coverage under a group health plan, 
shall provide to each employee a writ-
ten notice informing the employee of 
potential opportunities then currently 
available in the State in which the em-
ployee resides for premium assistance 
under such plans for health coverage of 
the employee or the employee’s depend-
ents. For purposes of compliance with 
this clause, the employer may use any 
State-specific model notice developed in 
accordance 
with 
section 
701(f)(3)(B)(i)(II) of the Employee Re-
155 
† HR 2 EAS 
tirement Income Security Act of 1974 
(29 U.S.C. 1181(f)(3)(B)(i)(II)). 
‘‘(II) OPTION
TO
PROVIDE
CON-
CURRENT
WITH
PROVISION
OF
PLAN 
MATERIALS
TO
EMPLOYEE.—An em-
ployer may provide the model notice 
applicable to the State in which an 
employee resides concurrent with the 
furnishing of materials notifying the 
employee of health plan eligibility, con-
current with materials provided to the 
employee in connection with an open 
season or election process conducted 
under the plan, or concurrent with the 
furnishing of the summary plan de-
scription as provided in section 104(b) 
of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1024). 
‘‘(ii) 
DISCLOSURE
ABOUT
GROUP 
HEALTH
PLAN
BENEFITS
TO
STATES
FOR 
MEDICAID
AND
CHIP
ELIGIBLE
INDIVID-
UALS.—In the case of a participant or bene-
ficiary of a group health plan who is cov-
ered under a Medicaid plan of a State 
under title XIX of the Social Security Act
156 
† HR 2 EAS 
or under a State child health plan under 
title XXI of such Act, the plan adminis-
trator of the group health plan shall disclose 
to the State, upon request, information 
about the benefits available under the group 
health plan in sufficient specificity, as de-
termined under regulations of the Secretary 
of Health and Human Services in consulta-
tion with the Secretary that require use of 
the model coverage coordination disclosure 
form developed under section 311(b)(1)(C) 
of the Children’s Health Insurance Program 
Reauthorization Act of 2009, so as to per-
mit the State to make a determination 
(under paragraph (2)(B), (3), or (10) of 
section 2105(c) of the Social Security Act or 
otherwise) concerning the cost-effectiveness 
of the State providing medical or child 
health assistance through premium assist-
ance for the purchase of coverage under such 
group health plan and in order for the 
State to provide supplemental benefits re-
quired under paragraph (10)(E) of such sec-
tion or other authority.’’. 
(b) CONFORMING AMENDMENTS.—
157 
† HR 2 EAS 
(1) AMENDMENTS
TO
EMPLOYEE
RETIREMENT 
INCOME SECURITY ACT.— 
(A) IN
GENERAL.—Section 701(f) of the 
Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1181(f)) is amended by adding 
at the end the following new paragraph: 
‘‘(3) SPECIAL RULES FOR APPLICATION IN CASE 
OF MEDICAID AND CHIP.— 
‘‘(A) IN GENERAL.—A group health plan, 
and a health insurance issuer offering group 
health insurance coverage in connection with a 
group health plan, shall permit an employee who 
is eligible, but not enrolled, for coverage under 
the terms of the plan (or a dependent of such an 
employee if the dependent is eligible, but not en-
rolled, for coverage under such terms) to enroll 
for coverage under the terms of the plan if either 
of the following conditions is met: 
‘‘(i) TERMINATION
OF
MEDICAID
OR 
CHIP COVERAGE.—The employee or depend-
ent is covered under a Medicaid plan under 
title XIX of the Social Security Act or 
under a State child health plan under title 
XXI of such Act and coverage of the em-
ployee or dependent under such a plan is
158 
† HR 2 EAS 
terminated as a result of loss of eligibility 
for such coverage and the employee requests 
coverage under the group health plan (or 
health insurance coverage) not later than 60 
days after the date of termination of such 
coverage. 
‘‘(ii) ELIGIBILITY
FOR
EMPLOYMENT 
ASSISTANCE UNDER MEDICAID OR CHIP.— 
The employee or dependent becomes eligible 
for assistance, with respect to coverage 
under the group health plan or health in-
surance coverage, under such Medicaid plan 
or State child health plan (including under 
any waiver or demonstration project con-
ducted under or in relation to such a plan), 
if the employee requests coverage under the 
group health plan or health insurance cov-
erage not later than 60 days after the date 
the employee or dependent is determined to 
be eligible for such assistance. 
‘‘(B) COORDINATION WITH MEDICAID AND 
CHIP.— 
‘‘(i) OUTREACH
TO
EMPLOYEES
RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.—
159 
† HR 2 EAS 
‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity Act, or child health assistance 
under a State child health plan under 
title XXI of such Act, in the form of 
premium assistance for the purchase of 
coverage under a group health plan, 
shall provide to each employee a writ-
ten notice informing the employee of 
potential opportunities then currently 
available in the State in which the em-
ployee resides for premium assistance 
under such plans for health coverage of 
the employee or the employee’s depend-
ents. 
‘‘(II) MODEL NOTICE.—Not later 
than 1 year after the date of enactment 
of the Children’s Health Insurance 
Program Reauthorization Act of 2009, 
the Secretary and the Secretary of 
Health and Human Services, in con-
sultation with Directors of State Med-
160 
† HR 2 EAS 
icaid agencies under title XIX of the 
Social Security Act and Directors of 
State CHIP agencies under title XXI 
of such Act, shall jointly develop na-
tional and State-specific model notices 
for purposes of subparagraph (A). The 
Secretary shall provide employers with 
such model notices so as to enable em-
ployers to timely comply with the re-
quirements of subparagraph (A). Such 
model notices shall include information 
regarding how an employee may con-
tact the State in which the employee 
resides for additional information re-
garding potential opportunities for 
such premium assistance, including 
how to apply for such assistance. 
‘‘(III) OPTION TO PROVIDE CON-
CURRENT
WITH
PROVISION
OF
PLAN 
MATERIALS
TO
EMPLOYEE.—An em-
ployer may provide the model notice 
applicable to the State in which an 
employee resides concurrent with the 
furnishing of materials notifying the 
employee of health plan eligibility, con-
161 
† HR 2 EAS 
current with materials provided to the 
employee in connection with an open 
season or election process conducted 
under the plan, or concurrent with the 
furnishing of the summary plan de-
scription as provided in section 104(b). 
‘‘(ii) 
DISCLOSURE
ABOUT
GROUP 
HEALTH
PLAN
BENEFITS
TO
STATES
FOR 
MEDICAID
AND
CHIP
ELIGIBLE
INDIVID-
UALS.—In the case of a participant or bene-
ficiary of a group health plan who is cov-
ered under a Medicaid plan of a State 
under title XIX of the Social Security Act 
or under a State child health plan under 
title XXI of such Act, the plan adminis-
trator of the group health plan shall disclose 
to the State, upon request, information 
about the benefits available under the group 
health plan in sufficient specificity, as de-
termined under regulations of the Secretary 
of Health and Human Services in consulta-
tion with the Secretary that require use of 
the model coverage coordination disclosure 
form developed under section 311(b)(1)(C) 
of the Children’s Health Insurance Program
167 
† HR 2 EAS 
to the Working Group, including technical 
assistance. The Working Group may use the 
services and facilities of either such Depart-
ment, with or without reimbursement, as 
jointly determined by such Departments. 
(v) REPORT.— 
(I) REPORT BY WORKING GROUP 
TO THE SECRETARIES.—Not later than 
18 months after the date of the enact-
ment of this Act, the Working Group 
shall submit to the Secretary of Labor 
and the Secretary of Health and 
Human Services the model form de-
scribed in clause (i)(II) along with a 
report containing recommendations for 
appropriate measures to address the 
impediments to the effective coordina-
tion of coverage between group health 
plans and the State plans under titles 
XIX and XXI of the Social Security 
Act. 
(II) REPORT BY SECRETARIES TO 
THE
CONGRESS.—Not later than 2 
months after receipt of the report pur-
suant to subclause (I), the Secretaries