‘‘(B) The family or individual is covered under
private health insurance coverage, has sought bene-
fits under the coverage for specific procedures, medi-
cations, or tests recommended by a physician, but
has been denied in writing such benefits, whether or
not such denial is due to limitations of such cov-
erage, the application of any pre-existing condition
exclusion, or any other reason.
‘‘(C) Because of pre-existing conditions or risks
of the family, the premiums for coverage of the fam-
ily or individual under private health insurance cov-
erage are at least 200 percent of the average private
market premium rate for the same or similar cov-
erage of such a family or individual in the area in-
volved.
‘‘(3) An individual who is described in this subsection
is eligible for medical assistance without regard to the
value of the individual’s or individual family’s automobiles,
land, or home or the amount of any other assets or re-
sources of the individual or the individual’s family.’’.
(D) EXPANSION
OF
ELIGIBILITY
ON
A
CASE-BY-CASE
HARDSHIP
BASIS
FOR
UNIN-
SURED FAMILIES WITH INCOME ABOVE 600 PER-
CENT
OF
THE
POVERTY
LINE
WHO
CANNOT
OTHERWISE ACCESS HEALTH INSURANCE COV-
ERAGE
AND
WHO
HAVE
SERIOUS
OR
LIFE-
THREATENING
ILLNESSES.—Section
1902(cc)(1) of such Act, as added by subpara-
graph (C)(ii), is amended—
(i) in subparagraph (A) by inserting
‘‘or (4)’’ after ‘‘paragraph (2)’’; and
(ii) by adding at the end the following
new paragraph:
‘‘(4) A State may, in the State’s discretion and effec-
tive on and after January 1, 2004, waive the requirements
of subparagraphs (A) and (C) on a case-by-case basis
based on hardship for individuals and families the income
of which exceeds 600 percent of the poverty line (as de-
fined in section 2110(c)(5)) and who meet any of the con-
ditions described in paragraph (2).’’.
(E) PREMIUMS FOR UNINSURED INDIVID-
UALS WITH INCOMES HIGHER THAN 350 PER-
CENT OF THE POVERTY LINE.—Effective Janu-
ary 1, 2004, section 1916(h)(1) of the Social
Security Act, as added by subparagraph (A), is
further amended by adding at the end the fol-
lowing:
‘‘(E) exceeds 350 percent (but does not exceed
400 percent) of such poverty line, the State shall re-
quire such individuals to pay a monthly premium
equal to $50 per month for each individual in the
family so covered, but not to exceed $150 per month
for all individuals in the family;
‘‘(F) exceeds 400 percent (but does not exceed
500 percent) of such poverty line, the State shall re-
quire such individuals to pay a monthly premium
equal to $100 per month for each individual in the
family so covered, but not to exceed $250 per month
for all individuals in the family;
‘‘(G) exceeds 500 percent (but does not exceed
600 percent) of such poverty line, the State shall re-
quire such individuals to pay a monthly premium
equal to $150 per month for each individual in the
family so covered, but not to exceed $350 per month
for all individuals in the family; or
‘‘(H) exceeds 600 percent of such poverty line,
the State shall require such individuals to pay a
monthly premium equal to $200 per month for each
individual in the family so covered, but not to exceed
$550 per month for all individuals in the family.’’.
(F) 
MISCELLANEOUS
CONFORMING
AMENDMENT.—(i) Section 1903(f)(4) of such
Act (42 U.S.C. 1396b(f)(4)) is amended by in-
serting 
‘‘1902(a)(10)(A)(i)(VIII),’’ 
after
‘‘1902(a)(10)(A)(i)(VII),’’.
(G) TECHNICAL
AMENDMENTS.—(i) Sec-
tion 1902 of such Act (42 U.S.C. 1396a), as
amended by section 702(b) of the Medicare,
Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000 (as enacted into law
by section 1(a)(6) of Public Law 106–554), is
amended by redesignating the subsection (aa)
added by such section as subsection (bb).
(ii) Section 1902(a)(15) of such Act (42
U.S.C. 1396a(a)(15)), as added by section
702(a)(2) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection
Act of 2000 (as so enacted into law), is amend-
ed by striking ‘‘subsection (aa)’’ and inserting
‘‘subsection (bb)’’.
(iii) Section 1915(b) of such Act (42
U.S.C. 1396n(b)), as amended by section
702(c)(2) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection
Act of 2000 (as so enacted into law), is amend-
ed by striking ‘‘1902(aa)’’ and inserting
‘‘1902(bb)’’.
(2) CLARIFICATION
OF
COVERAGE
OF
UNIN-
SURED MEN AND WOMEN, REGARDLESS OF MARITAL
STATUS.—Section 1905(a) of such Act (42 U.S.C.
1396d(a)) is amended, in the matter before para-
graph (1)—
(A) by striking ‘‘or’’ at the end of clause
(xi);
(B) by adding ‘‘or’’ at the end of clause
(xii); and
(C) by inserting after clause (xii) the fol-
lowing new clause:
‘‘(xiii) individuals described in section 1902(cc)
(which includes uninsured men and women, regard-
less of marital status),’’.
(3) MAKING PRESUMPTIVE ELIGIBILITY MANDA-
TORY.—
(A) IN
GENERAL.—Sections 1920 and
1920A of such Act (42 U.S.C. 1396r–1, 1396r–
1a) are each amended by striking ‘‘may pro-
vide’’ and inserting ‘‘shall provide’’.
(B) EXPANSION OF PRESUMPTIVE ELIGI-
BILITY TO ALL INDIVIDUALS.—Title XIX of the
Act is amended by inserting after section
1920A the following new section:
‘‘PRESUMPTIVE ELIGIBILITY FOR OTHER INDIVIDUALS
‘‘SEC. 1920B. (a) A State plan approved under sec-
tion 1902 shall provide for making medical assistance with
respect to health care items and services covered under
the State plan available to all individuals during a pre-
sumptive eligibility period.
‘‘(b) For purposes of this section:
‘‘(1) The term ‘presumptive eligibility period’
means, with respect to an individual, the period
that—
‘‘(A) begins with the date on which a
qualified entity determines, on the basis of pre-
liminary information, that the family income of
the individual does not exceed the applicable in-
come level of eligibility under the State plan,
and
‘‘(B) ends with (and includes) the earlier
of—
‘‘(i) the day on which a determination
is made with respect to the eligibility of
the individual for medical assistance under
the State plan, or
‘‘(ii) in the case of an individual on
whose behalf an application is not filed by
the last day of the month following the
month during which the entity makes the
determination referred to in subparagraph
(A), such last day.
‘‘(2)(A) Subject to subparagraph (B), the term
‘qualified entity’ means any entity that—
‘‘(i)(I) is eligible for payments under a
State plan approved under this title and pro-
vides items and services described in subsection
(a) or (II) is a qualified provider described in
section 1920(b)(2); and
‘‘(ii) is determined by the State agency to
be capable of making determinations of the type
described in paragraph (1)(A).
‘‘(B) The Secretary may issue regulations fur-
ther limiting those entities that may become quali-
fied entities in order to prevent fraud and abuse and
for other reasons.
‘‘(C) Nothing in this section shall be construed
as preventing a State from limiting the classes of en-
tities that may become qualified entities, consistent
with any limitations imposed under subparagraph
(B).
‘‘(c)(1) The State agency shall provide qualified enti-
ties with—
‘‘(A) such forms as are necessary for an appli-
cation to be made on behalf of a child for medical
assistance under the State plan, and
‘‘(B) information on how to assist parents,
guardians, and other persons in completing and fil-
ing such forms.
‘‘(2) A qualified entity that determines under sub-
section (b)(1)(A) that an individual is presumptively eligi-
ble for medical assistance under a State plan shall—
‘‘(A) notify the State agency of the determina-
tion within 5 working days after the date on which
determination is made, and
‘‘(B) inform the individual at the time the de-
termination is made that an application for medical
assistance under the State plan is required to be
made by not later than the last day of the month
following the month during which the determination
is made.
‘‘(3) In the case of an individual who is determined
by a qualified entity to be presumptively eligible for med-
ical assistance under a State plan, the individual shall
make application for medical assistance under such plan
by not later than the last day of the month following the
month during which the determination is made.
‘‘(d) Notwithstanding any other provision of this title,
medical assistance for items and services described in sub-
section (a) that—
‘‘(1) are furnished to an individual—
‘‘(A) during a presumptive eligibility pe-
riod,
‘‘(B) by an entity that is eligible for pay-
ments under the State plan; and
‘‘(2) are included in the care and services cov-
ered by a State plan;
shall be treated as medical assistance provided by such
plan for purposes of section 1903.’’.
(C) CONFORMING
AMENDMENT.—Section
1902(a)(47) 
of 
such 
Act 
(42 
U.S.C.
1396a(a)(47)) is amended by striking ‘‘at the
option of the State,’’.
(4) MINIMUM
ELIGIBILITY
PERIOD
FOR
CAT-
EGORICALLY NEEDY.—Section 1902(e) of such Act
(42 U.S.C. 1396a(e)) is amended by adding at the
end the following new paragraph:
‘‘(13) The State plan shall provide that an individual
who is determined to be eligible for benefits under a State
plan approved under this title under subsection (a)(10)(A)
shall remain eligible for those benefits until the end of the
12-month period following the date of such determina-
tion.’’.
(5) COVERAGE OF LEGAL IMMIGRANTS.—Sec-
tion 1902 of such Act (42 U.S.C. 1396a), as amend-
ed by paragraph (1)(C)(ii), is amended by adding at
the end the following new subsection:
‘‘(dd) Notwithstanding any other provision of law, the
provisions of title IV of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (and of sec-
tion 213A of the Immigration and Nationality Act) shall
not apply to eligibility for medical assistance under this
title for individuals who are lawful permanent residents
of the United States.’’.
(6) MAIL-IN AND ON-LINE APPLICATION PROC-
ESS.—Section 1902(a)(8) of such Act (42 U.S.C.
1396a(a)(8)) is amended after ‘‘opportunity to do
so’’ the following: ‘‘and may do so through an appli-
cation submitted by mail or through electronic
means through the Internet, provide that applica-
tions are not longer than 2 pages and are made
available in different languages in order to provide
a fair and accessible application process,’’.
(7) LIMITATIONS ON OTHER COST-SHARING.—
Section 1916 of such Act (42 U.S.C. 1396o), as
amended by paragraph (1)(A), is further amended—
(A) in subsection (a), by striking ‘‘(g) and
(h)’’ and inserting ‘‘(g), (h), and (i)’’; and
(B) by adding at the end the following new
subsection:
‘‘(i) With respect to an individual provided medical
assistance only under subclause (VIII) of section
1902(a)(10)(A)(i), notwithstanding the preceding provi-
sions of this section, if the individual’s family income—
‘‘(1) does not exceed 200 percent of the poverty
line (as defined in section 2110(c)(5)) applicable to
a family of the size involved, a State shall not im-
pose any deduction, cost sharing or similar charge;
or
‘‘(2) exceeds 200 percent of such poverty line,
a State shall impose—
‘‘(A) a copayment of $10 for each chiro-
practic service visit; and
‘‘(B) $5 for each doctor’s visit, prescrip-
tion dispensed, laboratory test, or other item or
service;
except that no copayment shall be imposed under
this paragraph with respect to preventive services
(including pap smears, immunizations, vaccinations,
flu shots, annual check-ups, screening mammog-
raphy, and pre-natal and post-natal care), or with
respect to early and periodic screening, diagnosis,
and treatment services under section 1905(a)(4)(B)
and the total of such copayments may not exceed
$30 in a month for a family the income of which
does not exceed 300 percent of such poverty line. No
individual may be denied benefits under this title by
virtue of a failure to pay a copayment under this
section.’’.
(8) CONFORMING
TERMINATION
OF
SCHIP.—
With respect to items and services furnished on or
after October 1, 2002, no Federal payments shall be
made under section 2105(a) of the Social Security
Act (42 U.S.C. 1397ee(a)).
(9) REQUIRING
CROWD-OUT
PLAN.—No pay-
ment may be made to a State under title XIX of the
Social Security Act under the amendments made by
this subsection unless the State has developed and
implemented a plan that, to the maximum extent
possible, would minimize businesses terminating pri-
vate group health coverage for employees who would
be eligible for medical assistance under the Medi-Ac-
cess program provided under such amendments.
(b) REQUIRING COVERAGE OF EARLY AND PERIODIC
SCREENING, DIAGNOSTIC, AND TREATMENT SERVICES
(EPSDT), COVERAGE
OF REHABILITATIVE SERVICES
FOR DISABLED OR DEVELOPMENTALLY DELAYED CHIL-
DREN, PRESCRIPTION DRUGS, MENTAL HEALTH
AND
PSYCHIATRIC SERVICES, ASSISTIVE TECHNOLOGY DE-
VICES AND SERVICES, DURABLE MEDICAL EQUIPMENT,
DRUG AND ALCOHOL TREATMENT SERVICES FOR ALL
MEDICAID ELIGIBLE INDIVIDUALS, ASSISTIVE TECH-
NOLOGY DEVICES AND SERVICES, DURABLE MEDICAL
EQUIPMENT, PRENATAL AND POSTNATAL CARE, REPRO-
DUCTIVE HEALTH SERVICES, AND PERSONAL ASSISTIVE
SERVICES.—
(1) REQUIRING
COVERAGE
OF
SCREENING,
DENTAL, VISION, HEARING, AND FOLLOWUP SERV-
ICES (EPSDT) FOR INDIVIDUALS OF ALL AGES.—
(A) IN GENERAL.—Section 1905(a)(4)(B)
of such Act (42 U.S.C. 1396d(a)(4)(B)) is
amended by striking ‘‘ and are under the age
of 21’’.
(B) CONFORMING AMENDMENTS.—Section
1905(r) of such Act (42 U.S.C. 1396d(r)) is
amended, in each of paragraphs (1)(A)(i),
(2)(A)(i), (3)(A)(i), and (4)(A)(i), by inserting
‘‘, including for children, organizations’’ after
‘‘organizations’’.
(2) REQUIRING COVERAGE OF REHABILITATIVE
SERVICES AND ASSISTIVE TECHNOLOGIES FOR DIS-
ABLED
OR
DEVELOPMENTALLY
DELAYED
CHIL-
DREN.—Section 1905(r)(5) of such Act (42 U.S.C.
1396d(r)(5)) is amended by inserting before the pe-
riod at the end the following: ‘‘, and including reha-
bilitative services and assistive technologies for dis-
abled or developmentally disabled children, regard-
less of whether the disability was discovered by the
screening services’’.
(3) REQUIRING
COVERAGE
OF
PRESCRIPTION
DRUGS, INCLUDING
DRUGS
AND
SERVICES
FOR
TREATMENT OF HIV INFECTION OR AIDS.—Section
1902(a)(10) of such Act (42 U.S.C. 1396a(a)(10))
is amended—
(A) in subparagraph (A), by inserting
‘‘(12),’’ after ‘‘(5),’’;
(B) in subparagraph (D)(iv), by inserting
‘‘, (12),’’ after ‘‘(5)’’;
(C) by striking ‘‘and’’ at the end of sub-
paragraph (F);
(D) by adding ‘‘and’’ at the end of sub-
paragraph (G); and
(E) by inserting after subparagraph (G)
the following new subparagraph:
‘‘(H) that the plan shall not deny medical
assistance for prescribed drugs for individuals
described in subparagraph (A)(i) if the drugs
have been prescribed by a treating physician (or
any other treating health care professional au-
thorized under law to prescribe the drugs), in-
cluding drugs and services prescribed for treat-
ment of HIV infection or AIDS;’’.
(4) REQUIRING COVERAGE OF DRUG AND ALCO-
HOL TREATMENT SERVICES.—
(A) REQUIREMENT.—Section 1902(a)(10)
of such Act (42 U.S.C. 1396a(a)(10)) is
amended—
(i) in subparagraph (A), by striking
‘‘(17) and (21)’’ and inserting ‘‘(10), (17),
(21), and (27)’’; and
(ii) in subparagraph (D)(iv), by strik-
ing ‘‘and (17)’’ and inserting ‘‘(10), (17),
and (27)’’ and by striking ‘‘through (24)’’
and inserting ‘‘through (27)’’.
(B) DRUG
AND
ALCOHOL
TREATMENT
SERVICES
DESCRIBED.—Section 1905(a) of
such Act (42 U.S.C. 1396d(a)) is amended—
(i) by striking ‘‘and’’ at the end of
paragraph (26);
(ii) by redesignating paragraph (27)
as paragraph (28); and
(iii) by inserting after paragraph (26)
the following new paragraph: