‘‘(ii) ADMINISTRATIVE
VERIFICATION 
OF ASSETS.—The State— 
‘‘(I) permits a parent or care-
taker relative who is applying on be-
half of a child for medical assistance 
under title XIX or child health assist-
ance under this title to declare and 
certify by signature under penalty of 
perjury information relating to family 
assets for purposes of determining 
and redetermining financial eligibility; 
and 
‘‘(II) takes steps to verify assets 
through means other than by requir-
ing documentation from parents and 
applicants except in individual cases 
of discrepancies or where otherwise 
justified. 
‘‘(C) ELIMINATION OF IN-PERSON INTER-
VIEW REQUIREMENT.—The State does not re-
quire an application of a child for medical as-
sistance under title XIX (or for child health as-
sistance under this title), including an applica-
tion for renewal of such assistance, to be made 
in person nor does the State require a face-to- 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00029
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
face interview, unless there are discrepancies or 
individual circumstances justifying an in-person 
application or face-to-face interview. 
‘‘(D) USE
OF
JOINT
APPLICATION
FOR 
MEDICAID
AND
CHIP.—The application form 
and supplemental forms (if any) and informa-
tion verification process is the same for pur-
poses of establishing and renewing eligibility for 
children for medical assistance under title XIX 
and child health assistance under this title. 
‘‘(E) AUTOMATIC RENEWAL (USE OF AD-
MINISTRATIVE RENEWAL).— 
‘‘(i) IN
GENERAL.—The State pro-
vides, in the case of renewal of a child’s 
eligibility for medical assistance under title 
XIX or child health assistance under this 
title, a pre-printed form completed by the 
State based on the information available to 
the State and notice to the parent or care-
taker relative of the child that eligibility of 
the child will be renewed and continued 
based on such information unless the State 
is provided other information. Nothing in 
this clause shall be construed as preventing 
a State from verifying, through electronic 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00030
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
and other means, the information so pro-
vided. 
‘‘(ii) SATISFACTION
THROUGH
DEM-
ONSTRATED USE OF EX PARTE PROCESS.— 
A State shall be treated as satisfying the 
requirement of clause (i) if renewal of eli-
gibility of children under title XIX or this 
title is determined without any require-
ment for an in-person interview, unless 
sufficient information is not in the State’s 
possession and cannot be acquired from 
other sources (including other State agen-
cies) without the participation of the appli-
cant or the applicant’s parent or caretaker 
relative. 
‘‘(F) 
PRESUMPTIVE
ELIGIBILITY
FOR 
CHILDREN.—The State is implementing section 
1920A under title XIX as well as, pursuant to 
section 2107(e)(1), under this title . 
‘‘(G) EXPRESS LANE.—The State is imple-
menting 
the 
option 
described 
in 
section 
1902(e)(13) under title XIX as well as, pursu-
ant to section 2107(e)(1), under this title.’’. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00031
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
SEC. 112. STATE OPTION TO RELY ON FINDINGS FROM AN 
EXPRESS LANE AGENCY TO CONDUCT SIM-
PLIFIED ELIGIBILITY DETERMINATIONS. 
(a) MEDICAID.—Section 1902(e) of the Social Secu-
rity Act (42 U.S.C. 1396a(e)) is amended by adding at 
the end the following: 
‘‘(13) EXPRESS LANE OPTION.— 
‘‘(A) IN GENERAL.— 
‘‘(i) OPTION TO USE A FINDING FROM AN 
EXPRESS LANE AGENCY.—At the option of the 
State, the State plan may provide that in deter-
mining eligibility under this title for a child (as 
defined in subparagraph (F)), the State may 
rely on a finding made within a reasonable pe-
riod (as determined by the State) from an Ex-
press Lane agency (as defined in subparagraph 
(E)) when it determines whether a child satis-
fies one or more components of eligibility for 
medical assistance under this title. The State 
may rely on a finding from an Express Lane 
agency 
notwithstanding 
sections 
1902(a)(46)(B), 1903(x), and 1137(d) and any 
differences in budget unit, disregard, deeming 
or other methodology, if the following require-
ments are met: 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00032
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
‘‘(I) PROHIBITION ON DETERMINING 
CHILDREN INELIGIBLE FOR COVERAGE.— 
If a finding from an Express Lane agency 
would result in a determination that a 
child does not satisfy an eligibility require-
ment for medical assistance under this title 
and for child health assistance under title 
XXI, the State shall determine eligibility 
for assistance using its regular procedures. 
‘‘(II) NOTICE
REQUIREMENT.—For 
any child who is found eligible for medical 
assistance under the State plan under this 
title or child health assistance under title 
XXI and who is subject to premiums based 
on an Express Lane agency’s finding of 
such child’s income level, the State shall 
provide notice that the child may qualify 
for lower premium payments if evaluated 
by the State using its regular policies and 
of the procedures for requesting such an 
evaluation. 
‘‘(III) COMPLIANCE
WITH
SCREEN 
AND
ENROLL
REQUIREMENT.—The State 
shall satisfy the requirements under (A) 
and (B) of section 2102(b)(3) (relating to 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00033
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
screen and enroll) before enrolling a child 
in child health assistance under title XXI. 
At its option, the State may fulfill such re-
quirements in accordance with either op-
tion provided under subparagraph (C) of 
this paragraph. 
‘‘(ii) OPTION TO APPLY TO RENEWALS AND 
REDETERMINATIONS.—The State may apply the 
provisions of this paragraph when conducting 
initial determinations of eligibility, redetermina-
tions of eligibility, or both, as described in the 
State plan. 
‘‘(B) RULES OF CONSTRUCTION.—Nothing in 
this paragraph shall be construed— 
‘‘(i) to limit or prohibit a State from tak-
ing any actions otherwise permitted under this 
title or title XXI in determining eligibility for 
or enrolling children into medical assistance 
under this title or child health assistance under 
title XXI; or 
‘‘(ii) to modify the limitations in section 
1902(a)(5) concerning the agencies that may 
make a determination of eligibility for medical 
assistance under this title. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00034
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
‘‘(C) OPTIONS FOR SATISFYING THE SCREEN 
AND ENROLL REQUIREMENT.— 
‘‘(i) IN GENERAL.—With respect to a child 
whose eligibility for medical assistance under 
this title or for child health assistance under 
title XXI has been evaluated by a State agency 
using an income finding from an Express Lane 
agency, a State may carry out its duties under 
subparagraphs 
(A) 
and 
(B) 
of 
section 
2102(b)(3) (relating to screen and enroll) in ac-
cordance with either clause (ii) or clause (iii). 
‘‘(ii) 
ESTABLISHING
A
SCREENING 
THRESHOLD.— 
‘‘(I) IN GENERAL.—Under this clause, 
the State establishes a screening threshold 
set as a percentage of the Federal poverty 
level that exceeds the highest income 
threshold applicable under this title to the 
child by a minimum of 30 percentage 
points or, at State option, a higher number 
of percentage points that reflects the value 
(as determined by the State and described 
in the State plan) of any differences be-
tween income methodologies used by the 
program administered by the Express Lane 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00035
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
agency and the methodologies used by the 
State in determining eligibility for medical 
assistance under this title. 
‘‘(II) CHILDREN
WITH
INCOME
NOT 
ABOVE THRESHOLD.—If the income of a 
child does not exceed the screening thresh-
old, the child is deemed to satisfy the in-
come eligibility criteria for medical assist-
ance under this title regardless of whether 
such child would otherwise satisfy such cri-
teria. 
‘‘(III) 
CHILDREN
WITH
INCOME 
ABOVE THRESHOLD.—If the income of a 
child exceeds the screening threshold, the 
child shall be considered to have an income 
above the Medicaid applicable income level 
described in section 2110(b)(4) and to sat-
isfy 
the 
requirement 
under 
section 
2110(b)(1)(C) (relating to the requirement 
that CHIP matching funds be used only 
for children not eligible for Medicaid). If 
such a child is enrolled in child health as-
sistance under title XXI, the State shall 
provide the parent, guardian, or custodial 
relative with the following: 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00036
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
‘‘(aa) Notice that the child may 
be eligible to receive medical assist-
ance under the State plan under this 
title if evaluated for such assistance 
under the State’s regular procedures 
and notice of the process through 
which a parent, guardian, or custodial 
relative can request that the State 
evaluate the child’s eligibility for med-
ical assistance under this title using 
such regular procedures. 
‘‘(bb) A description of differences 
between the medical assistance pro-
vided under this title and child health 
assistance under title XXI, including 
differences in cost-sharing require-
ments and covered benefits. 
‘‘(iii) TEMPORARY ENROLLMENT IN CHIP 
PENDING SCREEN AND ENROLL.— 
‘‘(I) IN GENERAL.—Under this clause, 
a State enrolls a child in child health as-
sistance under title XXI for a temporary 
period if the child appears eligible for such 
assistance based on an income finding by 
an Express Lane agency. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00037
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
‘‘(II) 
DETERMINATION
OF
ELIGI-
BILITY.—During such temporary enroll-
ment period, the State shall determine the 
child’s eligibility for child health assistance 
under title XXI or for medical assistance 
under this title in accordance with this 
clause. 
‘‘(III) PROMPT FOLLOW UP.—In mak-
ing such a determination, the State shall 
take prompt action to determine whether 
the child should be enrolled in medical as-
sistance under this title or child health as-
sistance under title XXI pursuant to sub-
paragraphs 
(A) 
and 
(B) 
of 
section 
2102(b)(3) (relating to screen and enroll). 
‘‘(IV) REQUIREMENT FOR SIMPLIFIED 
DETERMINATION.—In making such a de-
termination, the State shall use procedures 
that, to the maximum feasible extent, re-
duce the burden imposed on the individual 
of such determination. Such procedures 
may not require the child’s parent, guard-
ian, or custodial relative to provide or 
verify information that already has been 
provided to the State agency by an Ex-
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00038
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
press Lane agency or another source of in-
formation unless the State agency has rea-
son to believe the information is erroneous. 
‘‘(V) AVAILABILITY OF CHIP MATCH-
ING FUNDS DURING TEMPORARY ENROLL-
MENT
PERIOD.—Medical assistance for 
items and services that are provided to a 
child enrolled in title XXI during a tem-
porary enrollment period under this clause 
shall be treated as child health assistance 
under such title. 
‘‘(D) OPTION FOR AUTOMATIC ENROLLMENT.— 
‘‘(i) IN GENERAL.—At its option, a State 
may initiate an evaluation of an individual’s eli-
gibility for medical assistance under this title 
without an application and determine the indi-
vidual’s eligibility for such assistance using 
findings from one or more Express Lane agen-
cies and information from sources other than a 
child, if the requirements of clauses (ii) and (iii) 
are met. 
‘‘(ii) 
INDIVIDUAL
CHOICE
REQUIRE-
MENT.—The requirement of this clause is that 
the child is enrolled in medical assistance under 
this title or child health assistance under title 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00039
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
XXI only if the child (or a parent, caretaker 
relative, or guardian on the behalf of the child) 
has affirmatively assented to such enrollment. 
‘‘(iii) INFORMATION
REQUIREMENT.—The 
requirement of this clause is that the State in-
forms the parent, guardian, or custodial relative 
of the child of the services that will be covered, 
appropriate methods for using such services, 
premium or other cost sharing charges (if any) 
that apply, medical support obligations (under 
section 1912(a)) created by enrollment (if appli-
cable), and the actions the parent, guardian, or 
relative must take to maintain enrollment and 
renew coverage. 
‘‘(E) EXPRESS
LANE
AGENCY
DEFINED.—In 
this paragraph, the term ‘express lane agency’ 
means an agency that meets the following require-
ments: 
‘‘(i) The agency determines eligibility for 
assistance under the Food Stamp Act of 1977, 
the Richard B. Russell National School Lunch 
Act, the Child Nutrition Act of 1966, or the 
Child Care and Development Block Grant Act 
of 1990. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00040
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
‘‘(ii) The agency notifies the child (or a 
parent, caretaker relative, or guardian on the 
behalf of the child)— 
‘‘(I) of the information which shall be 
disclosed; 
‘‘(II) that the information will be used 
by the State solely for purposes of deter-
mining eligibility for and for providing 
medical assistance under this title or child 
health assistance under title XXI; and 
‘‘(III) that the child, or parent, care-
taker relative, or guardian, may elect to 
not have the information disclosed for such 
purposes. 
‘‘(iii) The agency and the State agency are 
subject to an interagency agreement limiting 
the disclosure and use of such information to 
such purposes. 
‘‘(iv) The agency is determined by the 
State agency to be capable of making the deter-
minations described in this paragraph and is 
identified in the State plan under this title or 
title XXI. 
For purposes of this subparagraph, the term ‘State 
agency’ refers to the agency determining eligibility 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00041
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
for medical assistance under this title or child health 
assistance under title XXI. 
‘‘(F) CHILD DEFINED.—For purposes of this 
paragraph, the term ‘child’ means an individual 
under 19 years of age, or, at the option of a State, 
such higher age, not to exceed 21 years of age, as 
the State may elect.’’. 
(b) CHIP.—Section 2107(e)(1) of such Act (42 
U.S.C. 1397gg(e)(1)) is amended by redesignating sub-
paragraph (B) and succeeding subparagraphs as subpara-
graph (C) and succeeding subparagraphs and by inserting 
after subparagraph (A) the following new subparagraph: 
‘‘(B) Section 1902(e)(13) (relating to the 
State option to rely on findings from an Ex-
press Lane agency to help evaluate a child’s eli-
gibility for medical assistance).’’. 
(c) ELECTRONIC TRANSMISSION OF INFORMATION.— 
Section 1902 of such Act (42 U.S.C. 1396a) is amended 
by adding at the end the following new subsection: 
‘‘(dd) ELECTRONIC TRANSMISSION
OF INFORMA-
TION.—If the State agency determining eligibility for med-
ical assistance under this title or child health assistance 
under title XXI verifies an element of eligibility based on 
information from an Express Lane Agency (as defined in 
subsection (e)(13)(F)), or from another public agency, 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00042
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
then the applicant’s signature under penalty of perjury 
shall not be required as to such element. Any signature 
requirement for an application for medical assistance may 
be satisfied through an electronic signature, as defined in 
section 1710(1) of the Government Paperwork Elimi-
nation Act (44 U.S.C. 3504 note). The requirements of 
subparagraphs (A) and (B) of section 1137(d)(2) may be 
met through evidence in digital or electronic form.’’. 
(d) AUTHORIZATION
OF
INFORMATION
DISCLO-
SURE.— 
(1) IN GENERAL.—Title XIX of the Social Se-
curity Act is amended— 
(A) by redesignating section 1939 as sec-
tion 1940; and 
(B) by inserting after section 1938 the fol-
lowing new section: 
‘‘SEC. 1939. AUTHORIZATION TO RECEIVE PERTINENT IN-
FORMATION. 
‘‘(a) IN GENERAL.—Notwithstanding any other pro-
vision of law, a Federal or State agency or private entity 
in possession of the sources of data potentially pertinent 
to eligibility determinations under this title (including eli-
gibility files maintained by Express Lane agencies de-
scribed in section 1902(e)(13)(F), information described 
in paragraph (2) or (3) of section 1137(a), vital records 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00043
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
information about births in any State, and information de-
scribed in sections 453(i) and 1902(a)(25)(I)) is author-
ized to convey such data or information to the State agen-
cy administering the State plan under this title, to the 
extent such conveyance meets the requirements of sub-
section (b). 
‘‘(b) REQUIREMENTS FOR CONVEYANCE.—Data or 
information may be conveyed pursuant to subsection (a) 
only if the following requirements are met: 
‘‘(1) The individual whose circumstances are 
described in the data or information (or such indi-
vidual’s parent, guardian, caretaker relative, or au-
thorized representative) has either provided advance 
consent to disclosure or has not objected to disclo-
sure after receiving advance notice of disclosure and 
a reasonable opportunity to object. 
‘‘(2) Such data or information are used solely 
for the purposes of— 
‘‘(A) identifying individuals who are eligi-
ble or potentially eligible for medical assistance 
under this title and enrolling or attempting to 
enroll such individuals in the State plan; and 
‘‘(B) verifying the eligibility of individuals 
for medical assistance under the State plan. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00044
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
‘‘(3) An interagency or other agreement, con-
sistent with standards developed by the Secretary— 
‘‘(A) prevents the unauthorized use, disclo-
sure, or modification of such data and other-
wise meets applicable Federal requirements 
safeguarding privacy and data security; and 
‘‘(B) requires the State agency admin-
istering the State plan to use the data and in-
formation obtained under this section to seek to 
enroll individuals in the plan. 
‘‘(c) CRIMINAL PENALTY.—A private entity described 
in the subsection (a) that publishes, discloses, or makes 
known in any manner, or to any extent not authorized by 
Federal law, any information obtained under this section 
shall be fined not more than $1,000 or imprisoned not 
more than 1 year, or both, for each such unauthorized 
publication or disclosure. 
‘‘(d) RULE OF CONSTRUCTION.—The limitations and 
requirements that apply to disclosure pursuant to this sec-
tion shall not be construed to prohibit the conveyance or 
disclosure of data or information otherwise permitted 
under Federal law (without regard to this section).’’. 
(2) CONFORMING AMENDMENT TO TITLE XXI.— 
Section 
2107(e)(1) 
of 
such 
Act 
(42 
U.S.C. 
1397gg(e)(1)), as amended by subsection (b), is 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00045
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
amended by adding at the end the following new 
subparagraph: 
‘‘(F) Section 1939 (relating to authoriza-
tion to receive data potentially pertinent to eli-
gibility determinations).’’. 
(3) CONFORMING AMENDMENT TO PROVIDE AC-
CESS TO DATA ABOUT ENROLLMENT IN INSURANCE 
FOR PURPOSES OF EVALUATING APPLICATIONS AND 
FOR CHIP.—Section 1902(a)(25)(I)(i) of such Act 
(42 U.S.C. 1396a(a)(25)(I)(i)) is amended— 
(A) by inserting ‘‘(and, at State option, in-
dividuals who are potentially eligible or who 
apply)’’ after ‘‘with respect to individuals who 
are eligible’’; and 
(B) by inserting ‘‘under this title (and, at 
State option, child health assistance under title 
XXI)’’ after ‘‘the State plan’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section are effective on January 1, 2008. 
SEC. 113. APPLICATION OF MEDICAID OUTREACH PROCE-
DURES TO ALL CHILDREN AND PREGNANT 
WOMEN. 
(a) IN GENERAL.—Section 1902(a)(55) of the Social 
Security Act (42 U.S.C. 1396a(a)(55)) is amended— 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00046
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
(1) in the matter before subparagraph (A), by 
striking ‘‘individuals for medical assistance under 
subsection 
(a)(10)(A)(i)(IV), 
(a)(10)(A)(i)(VI), 
(a)(10)(A)(i)(VII), or (a)(10)(A)(ii)(IX)’’ and insert-
ing ‘‘children and pregnant women for medical as-
sistance under any provision of this title’’; and 
(2) in subparagraph (B), by inserting before 
the semicolon at the end the following: ‘‘, which need 
not be the same application form for all such indi-
viduals’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) take effect on January 1, 2008. 
SEC. 114. ENCOURAGING CULTURALLY APPROPRIATE EN-
ROLLMENT AND RETENTION PRACTICES. 
(a) USE OF MEDICAID FUNDS.—Section 1903(a)(2) 
of the Social Security Act (42 U.S.C. 1396b(a)(2)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(E) an amount equal to 75 percent of so much 
of the sums expended during such quarter (as found 
necessary by the Secretary for the proper and effi-
cient administration of the State plan) as are attrib-
utable to translation or interpretation services in 
connection with the enrollment and retention under 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00047
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
this title of children of families for whom English is 
not the primary language; plus’’. 
(b) USE OF COMMUNITY HEALTH WORKERS FOR 
OUTREACH ACTIVITIES.— 
(1) IN GENERAL.—Section 2102(c)(1) of such 
Act (42 U.S.C. 1397bb(c)(1)) is amended by insert-
ing ‘‘(through community health workers and oth-
ers)’’ after ‘‘Outreach’’. 
(2) 
IN
FEDERAL
EVALUATION.—Section 
2108(c)(3)(B) 
of 
such 
Act 
(42 
U.S.C. 
1397hh(c)(3)(B)) is amended by inserting ‘‘(such as 
through community health workers and others)’’ 
after ‘‘including practices’’. 
Subtitle C—Coverage 
SEC. 121. ENSURING CHILD-CENTERED COVERAGE. 
(a) ADDITIONAL REQUIRED SERVICES.— 
(1) 
CHILD-CENTERED
COVERAGE.—Section 
2103 of the Social Security Act (42 U.S.C. 1397cc) 
is amended—— 
(A) in subsection (a)— 
(i) in the matter before paragraph 
(1), by striking ‘‘subsection (c)(5)’’ and in-
serting ‘‘paragraphs (5) and (6) of sub-
section (c)’’; and 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00048
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
(ii) in paragraph (1), by inserting ‘‘at 
least’’ after ‘‘that is’’; and 
(B) in subsection (c)— 
(i) by redesignating paragraph (5) as 
paragraph (6); and 
(ii) by inserting after paragraph (4), 
the following: 
‘‘(5) DENTAL, FQHC, AND RHC SERVICES.—The 
child health assistance provided to a targeted low-in-
come child (whether through benchmark coverage or 
benchmark-equivalent coverage or otherwise) shall 
include coverage of the following: 
‘‘(A) Dental services necessary to prevent 
disease and promote oral health, restore oral 
structures to health and function, and treat 
emergency conditions. 
‘‘(B) Federally-qualified health center serv-
ices (as defined in section 1905(l)(2)) and rural 
health clinic services (as defined in section 
1905(l)(1)). 
Nothing in this section shall be construed as pre-
venting a State child health plan from providing 
such services as part of benchmark coverage or in 
addition to the benefits provided through benchmark 
coverage.’’. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00049
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
(2) REQUIRED PAYMENT FOR FQHC AND RHC 
SERVICES.—Section 2107(e)(1) of such Act (42 
U.S.C. 1397gg(e)(1)), as amended by sections 
112(b) and 112(d)(2), is amended by inserting after 
subparagraph (B) the following new subparagraph 
(and redesignating the succeeding subparagraphs ac-
cordingly): 
‘‘(C) Section 1902(bb) (relating to pay-
ment for services provided by Federally-quali-
fied health centers and rural health clinics).’’. 
(3) 
MENTAL
HEALTH
PARITY.—Section 
2103(a)(2)(C) 
of 
such 
Act 
(42 
U.S.C. 
1397aa(a)(2)(C)) is amended by inserting ‘‘(or 100 
percent in the case of the category of services de-
scribed in subparagraph (B) of such subsection)’’ 
after ‘‘75 percent’’. 
(4) EFFECTIVE DATE.—The amendments made 
by this subsection and subsection (d) shall apply to 
health benefits coverage provided on or after October 
1, 2008. 
(b) CLARIFICATION OF REQUIREMENT TO PROVIDE 
EPSDT SERVICES FOR ALL CHILDREN IN BENCHMARK 
BENEFIT PACKAGES UNDER MEDICAID .— 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00050
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
(1) IN GENERAL.—Section 1937(a)(1) of the 
Social Security Act (42 U.S.C. 1396u–7(a)(1)) is 
amended— 
(A) in subparagraph (A)— 
(i) in the matter before clause (i), by 
striking ‘‘Notwithstanding any other provi-
sion of this title’’ and inserting ‘‘Subject to 
subparagraph (E)’’; and 
(ii) by striking ‘‘enrollment in cov-
erage that provides’’ and all that follows 
and inserting ‘‘benchmark coverage de-
scribed in subsection (b)(1) or benchmark 
equivalent coverage described in subsection 
(b)(2).’’; 
(B) by striking subparagraph (C) and in-
serting the following new subparagraph: 
‘‘(C) STATE
OPTION
TO
PROVIDE
ADDI-
TIONAL BENEFITS.—A State, at its option, may 
provide such additional benefits to benchmark 
coverage described in subsection (b)(1) or 
benchmark equivalent coverage described in 
subsection (b)(2) as the State may specify.’’; 
and 
(C) by adding at the end the following new 
subparagraph: 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00051
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
‘‘(E) REQUIRING
COVERAGE
OF
EPSDT 
SERVICES.—Nothing in this paragraph shall be 
construed as affecting a child’s entitlement to 
care and services described in subsections 
(a)(4)(B) and (r) of section 1905 and provided 
in accordance with section 1902(a)(43) whether 
provided through benchmark coverage, bench-
mark equivalent coverage, or otherwise.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall take effect as if included in 
the amendment made by section 6044(a) of the Def-
icit Reduction Act of 2005. 
(c) CLARIFICATION OF COVERAGE OF SERVICES IN 
SCHOOL-BASED HEALTH CENTERS INCLUDED AS CHILD 
HEALTH ASSISTANCE.— 
(1) IN GENERAL.—Section 2110(a)(5) of such 
Act (42 U.S.C. 1397jj(a)(5)) is amended by insert-
ing after ‘‘health center services’’ the following: ‘‘and 
school-based health center servicesservices for which 
coverage is otherwise provided under this title when 
furnished by a school-based health center that is au-
thorized to furnish such services under State law’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to child health assist-
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00052
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
ance furnished on or after the date of the enactment 
of this Act. 
(d) ASSURING ACCESS TO CARE.— 
(1) STATE
CHILD
HEALTH
PLAN
REQUIRE-
MENT.—Section 2102(a)(7)(B) of such Act (42 
U.S.C. 1397bb(c)(2)) is amended by inserting ‘‘and 
services described in section 2103(c)(5)’’ after 
‘‘emergency services’’. 
(2) REFERENCE TO EFFECTIVE DATE.—For the 
effective date for the amendments made by this sub-
section, see subsection (a)(5). 
SEC. 122. IMPROVING BENCHMARK COVERAGE OPTIONS. 
(a) LIMITATION
ON SECRETARY-APPROVED COV-
ERAGE.— 
(1) UNDER CHIP.—Section 2103(a)(4) of the 
Social Security Act (42 U.S.C. 1397cc(a)(4)) is 
amended by inserting before the period at the end 
the following: ‘‘if the health benefits coverage is at 
least equivalent to the benefits coverage in a bench-
mark benefit package described in subsection (b)’’. 
(2) UNDER MEDICAID.—Section 1937(b)(1)(D) 
of the Social Security Act (42 U.S.C. 1396u– 
7(b)(1)(D)) is amended by inserting before the pe-
riod at the end the following: ‘‘if the health benefits 
coverage is at least equivalent to the benefits cov-
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00053
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
erage in benchmark coverage described in subpara-
graph (A), (B), or (C)’’. 
(b) REQUIREMENT
FOR MOST POPULAR FAMILY 
COVERAGE FOR STATE EMPLOYEE COVERAGE BENCH-
MARK.— 
(1) CHIP.—Section 2103(b)(2) of such Act (42 
U.S.C. 1397(b)(2)) is amended by inserting ‘‘and 
that has been selected most frequently by employees 
seeking dependent coverage, among such plans that 
provide such dependent coverage, in either of the 
previous 2 plan years’’ before the period at the end. 
(2) MEDICAID.—Section 1937(b)(1)(B) of such 
Act is amended by inserting ‘‘and that has been se-
lected most frequently, by employees seeking depend-
ent coverage, among such plans that provide such 
dependent coverage, in either of the previous 2 plan 
years’’ before the period at the end. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to health benefits coverage pro-
vided on or after October 1, 2008. 
SEC. 123. PREMIUM GRACE PERIOD. 
(a) IN GENERAL.—Section 2103(e)(3) of the Social 
Security Act (42 U.S.C. 1397cc(e)(3)) is amended by add-
ing at the end the following new subparagraph: 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00054
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
‘‘(C) PREMIUM GRACE PERIOD.—The State 
child health plan— 
‘‘(i) shall afford individuals enrolled 
under the plan a grace period of at least 
30 days from the beginning of a new cov-
erage period to make premium payments 
before the individual’s coverage under the 
plan may be terminated; and 
‘‘(ii) shall provide to such an indi-
vidual, not later than 7 days after the first 
day of such grace period, notice— 
‘‘(I) that failure to make a pre-
mium payment within the grace pe-
riod will result in termination of cov-
erage under the State child health 
plan; and 
‘‘(II) of the individual’s right to 
challenge the proposed termination 
pursuant to the applicable Federal 
regulations. 
For purposes of clause (i), the term ‘new cov-
erage period’ means the month immediately fol-
lowing the last month for which the premium 
has been paid.’’. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00055
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to new coverage periods begin-
ning on or after January 1, 2009. 
Subtitle D—Populations 
SEC. 131. OPTIONAL COVERAGE OF OLDER CHILDREN 
UNDER MEDICAID AND CHIP. 
(a) MEDICAID.— 
(1) IN GENERAL.—Section 1902(l)(1)(D) of the 
Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is 
amended by striking ‘‘but have not attained 19 years 
of age’’ and inserting ‘‘but is under 19 years of age 
(or, at the option of a State and subject to section 
131(d) of the Children’s Health and Medicare Pro-
tection Act of 2007, under such higher age, not to 
exceed 25 years of age, as the State may elect)’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1902(e)(3)(A) of such Act (42 
U.S.C. 1396a(e)(3)(A)) is amended by striking 
‘‘18 years of age or younger’’ and inserting 
‘‘under 19 years of age (or under such higher 
age as the State has elected under subsection 
(l)(1)(D))’’ after ‘‘18 years of age’’. 
(B) Section 1902(e)(12) of such Act (42 
U.S.C. 1396a(e)(12)) is amended by inserting 
‘‘or such higher age as the State has elected 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00056
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
under subsection (l)(1)(D)’’ after ‘‘19 years of 
age’’. 
(C) Section 1905(a) of such Act (42 
U.S.C. 1396d(a)) is amended, in clause (i), by 
inserting ‘‘or under such higher age as the 
State has elected under subsection (l)(1)(D)’’ 
after ‘‘as the State may choose’’. 
(D) Section 1920A(b)(1) of such Act (42 
U.S.C. 1396r–1a(b)(1)) is amended by insert-
ing ‘‘or under such higher age as the State has 
elected under section 1902(l)(1)(D)’’ after ‘‘19 
years of age’’. 
(E) Section 1928(h)(1) of such Act (42 
U.S.C. 1396s(h)(1)) is amended by striking ‘‘18 
years of age or younger’’ and inserting ‘‘under 
19 years of age or under such higher age as the 
State has elected under section 1902(l)(1)(D)’’. 
(F) Section 1932(a)(2)(A) of such Act (42 
U.S.C. 1396u–2(a)(2)(A)) is amended by in-
serting ‘‘(or under such higher age as the State 
has elected under section 1902(l)(1)(D))’’ after 
‘‘19 years of age’’. 
(b) TITLE XXI.—Section 2110(c)(1) of such Act (42 
U.S.C. 1397jj(c)(1)) is amended by inserting ‘‘(or, at the 
option of the State and subject to section 131(d) of the 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00057
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
Children’s Health and Medicare Protection Act of 2007, 
under such higher age as the State has elected under sec-
tion 1902(l)(1)(D))’’. 
(c) EFFECTIVE DATE.—Subject to subsection (d), 
the amendments made by this section take effect on Janu-
ary 1, 2010. 
(d) TRANSITION.—In carrying out the amendments 
made by subsections (a) and (b)— 
(1) for 2010, a State election under section 
1902(l)(1)(D) shall only apply with respect to title 
XXI of such Act and the age elected may not exceed 
21 years of age; 
(2) for 2011, a State election under section 
1902(l)(1)(D) may apply under titles XIX and XXI 
of such Act and the age elected may not exceed 23 
years of age; 
(3) for 2012, a State election under section 
1902(l)(1)(D) may apply under titles XIX and XXI 
of such Act and the age elected may not exceed 24 
years of age; and 
(4) for 2013 and each subsequent year, a State 
election under section 1902(l)(1)(D) may apply 
under titles XIX and XXI of such Act and the age 
elected may not exceed 25 years of age. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00058
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
SEC. 132. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 
UNDER THE MEDICAID PROGRAM AND CHIP. 
(a) MEDICAID PROGRAM.—Section 1903(v) of the 
Social Security Act (42 U.S.C. 1396b(v)) is amended— 
(1) in paragraph (1), by striking ‘‘paragraph 
(2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4)(A) A State may elect (in a plan amendment 
under this title) to provide medical assistance under this 
title, notwithstanding sections 401(a), 402(b), 403, and 
421 of the Personal Responsibility and Work Opportunity 
Reconciliation Act of 1996, for aliens who are lawfully re-
siding in the United States (including battered aliens de-
scribed in section 431(c) of such Act) and who are other-
wise eligible for such assistance, within either or both of 
the following eligibility categories: 
‘‘(i) PREGNANT WOMEN.—Women during preg-
nancy (and during the 60-day period beginning on 
the last day of the pregnancy). 
‘‘(ii) CHILDREN.—Individuals under age 19 (or 
such higher age as the State has elected under sec-
tion 1902(l)(1)(D)), including optional targeted low- 
income children described in section 1905(u)(2)(B). 
‘‘(B) In the case of a State that has elected to provide 
medical assistance to a category of aliens under subpara-
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00059
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
graph (A), no debt shall accrue under an affidavit of sup-
port against any sponsor of such an alien on the basis 
of provision of medical assistance to such category and 
the cost of such assistance shall not be considered as an 
unreimbursed cost.’’. 
(b) CHIP.—Section 2107(e)(1) of such Act (42 
U.S.C. 1397gg(e)(1)), as amended by section 112(b), 
112(d)(2),and 121(a)(2), is amended by redesignating 
subparagraphs (E) through (G) as subparagraphs (G) 
through (I), respectively, and by inserting after subpara-
graph (D) the following new subparagraphs: 
‘‘(E) Section 1903(v)(4)(A) (relating to 
optional coverage of certain categories of law-
fully residing immigrants), insofar as it relates 
to the category of pregnant women described in 
clause (i) of such section, but only if the State 
has elected to apply such section with respect to 
such women under title XIX and the State has 
elected the option under section 2111 to provide 
assistance for pregnant women under this title. 
‘‘(F) Section 1903(v)(4)(A) (relating to op-
tional coverage of categories of lawfully residing 
immigrants), insofar as it relates to the cat-
egory of children described in clause (ii) of such 
section, but only if the State has elected to 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00060
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
apply such section with respect to such children 
under title XIX.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on the date of the enactment of 
this Act. 
SEC. 133. STATE OPTION TO EXPAND OR ADD COVERAGE 
OF 
CERTAIN 
PREGNANT 
WOMEN 
UNDER 
CHIP. 
(a) CHIP.— 
(1) COVERAGE.—Title XXI (42 U.S.C. 1397aa 
et seq.) of the Social Security Act is amended by 
adding at the end the following new section: 
‘‘SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-IN-
COME PREGNANT WOMEN. 
‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any 
other provision of this title, a State may provide for cov-
erage, through an amendment to its State child health 
plan under section 2102, of assistance for pregnant 
women for targeted low-income pregnant women in ac-
cordance with this section, but only if— 
‘‘(1) the State has established an income eligi-
bility level— 
‘‘(A) for pregnant women, under any of 
clauses (i)(III), (i)(IV), or (ii)(IX) of section 
1902(a)(10)(A), that is at least 185 percent (or 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00061
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
such higher percent as the State has in effect 
for pregnant women under this title) of the pov-
erty line applicable to a family of the size in-
volved, but in no case a percent lower than the 
percent in effect under any such clause as of 
July 1, 2007; and 
‘‘(B) for children under 19 years of age 
under this title (or title XIX) that is at least 
200 percent of the poverty line applicable to a 
family of the size involved; and 
‘‘(2) the State does not impose, with respect to 
the enrollment under the State child health plan of 
targeted low-income children during the quarter, any 
enrollment cap or other numerical limitation on en-
rollment, any waiting list, any procedures designed 
to delay the consideration of applications for enroll-
ment, or similar limitation with respect to enroll-
ment. 
‘‘(b) DEFINITIONS.—For purposes of this title: 
‘‘(1) ASSISTANCE
FOR
PREGNANT
WOMEN.— 
The term ‘assistance for pregnant women’ has the 
meaning given the term child health assistance in 
section 2110(a) as if any reference to targeted low- 
income children were a reference to targeted low-in-
come pregnant women. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00062
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT 
WOMAN.—The term ‘targeted low-income pregnant 
woman’ means a woman— 
‘‘(A) during pregnancy and through the 
end of the month in which the 60-day period 
(beginning on the last day of her pregnancy) 
ends; 
‘‘(B) whose family income exceeds 185 per-
cent (or, if higher, the percent applied under 
subsection (a)(1)(A)) of the poverty level appli-
cable to a family of the size involved, but does 
not exceed the income eligibility level estab-
lished under the State child health plan under 
this title for a targeted low-income child; and 
‘‘(C) who satisfies the requirements of 
paragraphs (1)(A), (1)(C), (2), and (3) of sec-
tion 2110(b), applied as if any reference to a 
child was a reference to a pregnant woman. 
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL 
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of assistance for pregnant women to 
targeted low-income pregnant women under subsection 
(a), the following special rules apply: 
‘‘(1) Any reference in this title (other than in 
subsection (b)) to a targeted low-income child is 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00063
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
deemed to include a reference to a targeted low-in-
come pregnant woman. 
‘‘(2) Any reference in this title to child health 
assistance (other than with respect to the provision 
of early and periodic screening, diagnostic, and 
treatment services) with respect to such women is 
deemed a reference to assistance for pregnant 
women. 
‘‘(3) Any such reference (other than in section 
2105(d)) to a child is deemed a reference to a 
woman during pregnancy and the period described 
in subsection (b)(2)(A). 
‘‘(4) In applying section 2102(b)(3)(B), any 
reference to children found through screening to be 
eligible for medical assistance under the State med-
icaid plan under title XIX is deemed a reference to 
pregnant women. 
‘‘(5) There shall be no exclusion of benefits for 
services described in subsection (b)(1) based on any 
preexisting condition and no waiting period (includ-
ing any waiting period imposed to carry out section 
2102(b)(3)(C)) shall apply. 
‘‘(6) In applying section 2103(e)(3)(B) in the 
case of a pregnant woman provided coverage under 
this section, the limitation on total annual aggregate 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00064
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
cost-sharing shall be applied to such pregnant 
woman. 
‘‘(7) In applying section 2104(i)— 
‘‘(A) in the case of a State which did not 
provide for coverage for pregnant women under 
this title (under a waiver or otherwise) during 
fiscal year 2007, the allotment amount other-
wise computed for the first fiscal year in which 
the State elects to provide coverage under this 
section shall be increased by an amount (deter-
mined by the Secretary) equal to the enhanced 
FMAP of the expenditures under this title for 
such coverage, based upon projected enrollment 
and per capita costs of such enrollment; and 
‘‘(B) in the case of a State which provided 
for coverage of pregnant women under this title 
for the previous fiscal year— 
‘‘(i) in applying paragraph (2)(B) of 
such section, there shall also be taken into 
account (in an appropriate proportion) the 
percentage increase in births in the State 
for the relevant period; and 
‘‘(ii) in applying paragraph (3), preg-
nant women (and per capita expenditures 
for such women) shall be accounted for 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00065
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
separately from children, but shall be in-
cluded in the total amount of any allot-
ment adjustment under such paragraph. 
‘‘(d) AUTOMATIC
ENROLLMENT
FOR
CHILDREN 
BORN TO WOMEN RECEIVING ASSISTANCE FOR PREG-
NANT WOMEN.—If a child is born to a targeted low-in-
come pregnant woman who was receiving assistance for 
pregnant women under this section on the date of the 
child’s birth, the child shall be deemed to have applied for 
child health assistance under the State child health plan 
and to have been found eligible for such assistance under 
such plan or to have applied for medical assistance under 
title XIX and to have been found eligible for such assist-
ance under such title on the date of such birth, based on 
the mother’s reported income as of the time of her enroll-
ment under this section and applicable income eligibility 
levels under this title and title XIX, and to remain eligible 
for such assistance until the child attains 1 year of age. 
During the period in which a child is deemed under the 
preceding sentence to be eligible for child health or med-
ical assistance, the assistance for pregnant women or med-
ical assistance eligibility identification number of the 
mother shall also serve as the identification number of the 
child, and all claims shall be submitted and paid under 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00066
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
such number (unless the State issues a separate identifica-
tion number for the child before such period expires).’’. 
(2) 
ADDITIONAL
AMENDMENT.—Section 
2107(e)(1)(H) 
of 
such 
Act 
(42 
U.S.C. 
1397gg(e)(1)(H)), 
as 
redesignated 
by 
section 
133(b), is amended to read as follows: 
‘‘(H) Sections 1920 and 1920A (relating 
to presumptive eligibility for pregnant women 
and children).’’. 
(b) AMENDMENTS TO MEDICAID.— 
(1) ELIGIBILITY
OF
A
NEWBORN.—Section 
1902(e)(4) of the Social Security Act (42 U.S.C. 
1396a(e)(4)) is amended in the first sentence by 
striking ‘‘so long as the child is a member of the 
woman’s household and the woman remains (or 
would remain if pregnant) eligible for such assist-
ance’’. 
(2) APPLICATION OF QUALIFIED ENTITIES TO 
PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN 
UNDER MEDICAID.—Section 1920(b) of the Social 
Security Act (42 U.S.C. 1396r–1(b)) is amended by 
adding after paragraph (2) the following flush sen-
tence: 
‘‘The term ‘qualified provider’ also includes a qualified en-
tity, as defined in section 1920A(b)(3).’’. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00067
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
SEC. 134. LIMITATION ON WAIVER AUTHORITY TO COVER 
ADULTS. 
Section 2102 of the Social Security Act (42 U.S.C. 
1397bb) is amended by adding at the end the following 
new subsection: 
‘‘(d) LIMITATION ON COVERAGE OF ADULTS.—Not-
withstanding any other provision of this title, the Sec-
retary may not, through the exercise of any waiver author-
ity on or after January 1, 2008, provide for Federal finan-
cial participation to a State under this title for health care 
services for individuals who are not targeted low-income 
children or pregnant women unless the Secretary deter-
mines that no eligible targeted low-income child in the 
State would be denied coverage under this title for health 
care services because of such eligibility. In making such 
determination, the Secretary must receive assurances 
that— 
‘‘(1) there is no waiting list under this title in 
the State for targeted low-income children to receive 
child health assistance under this title; and 
‘‘(2) the State has in place an outreach pro-
gram to reach all targeted low-income children in 
families with incomes less than 200 percent of the 
poverty line.’’. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00068
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
Subtitle E—Access 
SEC. 141. CHILDREN’S ACCESS, PAYMENT, AND EQUALITY 
COMMISSION. 
Title XIX of the Social Security Act is amended by 
inserting before section 1901 the following new section: 
‘‘CHILDREN’S ACCESS, PAYMENT, AND EQUALITY 
COMMISSION 
‘‘SEC. 1900. (a) ESTABLISHMENT.—There is hereby 
established as an agency of Congress the Children’s Ac-
cess, Payment, and Equality Commission (in this section 
referred to as the ‘Commission’). 
‘‘(b) DUTIES.— 
‘‘(1) REVIEW OF PAYMENT POLICIES AND AN-
NUAL REPORTS.—The Commission shall— 
‘‘(A) review Federal and State payment 
policies of the Medicaid program established 
under this title (in this section referred to as 
‘Medicaid’) and the State Children’s Health In-
surance Program established under title XXI 
(in this section referred to as ‘CHIP’), includ-
ing topics described in paragraph (2); 
‘‘(B) review access to, and affordability of, 
coverage and services for enrollees under Med-
icaid and CHIP; 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00069
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
‘‘(C) make recommendations to Congress 
concerning such policies; 
‘‘(D) by not later than March 1 of each 
year, submit to Congress a report containing 
the results of such reviews and its recommenda-
tions concerning such policies; and 
‘‘(E) by not later than June 1 of each 
year, submit to Congress a report containing an 
examination of issues affecting Medicaid and 
CHIP, including the implications of changes in 
health care delivery in the United States and in 
the market for health care services on such pro-
grams. 
‘‘(2) SPECIFIC TOPICS TO BE REVIEWED.—Spe-
cifically, the Commission shall review the following: 
‘‘(A) The factors affecting expenditures for 
services in different sectors (such as physician, 
hospital and other sectors), payment methodolo-
gies, and their relationship to access and qual-
ity of care for Medicaid and CHIP beneficiaries. 
‘‘(B) The impact of Federal and State 
Medicaid and CHIP payment policies on access 
to services (including dental services) for chil-
dren (including children with disabilities) and 
other Medicaid and CHIP populations. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00070
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
‘‘(C) The impact of Federal and State 
Medicaid and CHIP policies on reducing health 
disparities, including geographic disparities and 
disparities among minority populations. 
‘‘(D) The overall financial stability of the 
health care safety net, including Federally- 
qualified health centers, rural health centers, 
school-based clinics, disproportionate share hos-
pitals, public hospitals, providers and grantees 
under section 2612(a)(5) of the Public Health 
Service Act (popularly known as the Ryan 
White CARE Act), and other providers that 
have a patient base which includes a dispropor-
tionate number of uninsured or low-income in-
dividuals and the impact of CHIP and Medicaid 
policies on such stability. 
‘‘(E) The relation (if any) between pay-
ment rates for providers and improvement in 
care for children as measured under the chil-
dren’s health quality measurement program es-
tablished under section 151 of the Children’s 
Health and Medicare Protection Act of 2007. 
‘‘(F) The affordability, cost effectiveness, 
and accessibility of services needed by special 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00071
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
populations under Medicaid and CHIP as com-
pared with private-sector coverage. 
‘‘(G) The extent to which the operation of 
Medicaid and CHIP ensures access, comparable 
to access under employer-sponsored or other 
private health insurance coverage (or in the 
case of federally-qualified health center services 
(as defined in section 1905(l)(2)) and rural 
health clinic services (as defined in section 
1905(l)(1)), access comparable to the access to 
such services under title XIX), for targeted low- 
income children. 
‘‘(H) The effect of demonstrations under 
section 1115, benchmark coverage under section 
1937, and other coverage under section 1938, 
on access to care, affordability of coverage, pro-
vider ability to achieve children’s health quality 
performance measures, and access to safety net 
services. 
‘‘(3) COMMENTS ON CERTAIN SECRETARIAL RE-
PORTS.—If the Secretary submits to Congress (or a 
committee of Congress) a report that is required by 
law and that relates to payment policies under Med-
icaid or CHIP, the Secretary shall transmit a copy 
of the report to the Commission. The Commission 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00072
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
shall review the report and, not later than 6 months 
after the date of submittal of the Secretary’s report 
to Congress, shall submit to the appropriate commit-
tees of Congress written comments on such report. 
Such comments may include such recommendations 
as the Commission deems appropriate. 
‘‘(4) AGENDA AND ADDITIONAL REVIEWS.—The 
Commission shall consult periodically with the 
Chairmen and Ranking Minority Members of the ap-
propriate committees of Congress regarding the 
Commission’s agenda and progress towards achiev-
ing the agenda. The Commission may conduct addi-
tional reviews, and submit additional reports to the 
appropriate committees of Congress, from time to 
time on such topics relating to the program under 
this title or title XXI as may be requested by such 
Chairmen and Members and as the Commission 
deems appropriate. 
‘‘(5) AVAILABILITY
OF
REPORTS.—The Com-
mission shall transmit to the Secretary a copy of 
each report submitted under this subsection and 
shall make such reports available to the public. 
‘‘(6) 
APPROPRIATE
COMMITTEE
OF
CON-
GRESS.—For purposes of this section, the term ‘ap-
propriate committees of Congress’ means the Com-
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00073
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
mittees on Energy and Commerce of the House of 
Representatives and the Committee on Finance of 
the Senate. 
‘‘(7) 
VOTING
AND
REPORTING
REQUIRE-
MENTS.—With respect to each recommendation con-
tained in a report submitted under paragraph (1), 
each member of the Commission shall vote on the 
recommendation, and the Commission shall include, 
by member, the results of that vote in the report 
containing the recommendation. 
‘‘(8) 
EXAMINATION
OF
BUDGET
CON-
SEQUENCES.—Before making any recommendations, 
the Commission shall examine the budget con-
sequences of such recommendations, directly or 
through consultation with appropriate expert enti-
ties. 
‘‘(c) APPLICATION OF PROVISIONS.—The following 
provisions of section 1805 shall apply to the Commission 
in the same manner as they apply to the Medicare Pay-
ment Advisory Commission: 
‘‘(1) Subsection (c) (relating to membership), 
except that the membership of the Commission shall 
also include representatives of children, pregnant 
women, individuals with disabilities, seniors, low-in-
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00074
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
come families, and other groups of CHIP and Med-
icaid beneficiaries. 
‘‘(2) Subsection (d) (relating to staff and con-
sultants). 
‘‘(3) Subsection (e) (relating to powers). 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) REQUEST
FOR
APPROPRIATIONS.—The 
Commission shall submit requests for appropriations 
in the same manner as the Comptroller General sub-
mits requests for appropriations, but amounts ap-
propriated for the Commission shall be separate 
from amounts appropriated for the Comptroller Gen-
eral. 
‘‘(2) AUTHORIZATION.—There are authorized to 
be appropriated such sums as may be necessary to 
carry out the provisions of this section.’’. 
SEC. 142. MODEL OF INTERSTATE COORDINATED ENROLL-
MENT AND COVERAGE PROCESS. 
(a) IN GENERAL.—In order to assure continuity of 
coverage of low-income children under the Medicaid pro-
gram and the State Children’s Health Insurance Program 
(CHIP), not later than 18 months after the date of the 
enactment of this Act, the Comptroller General of the 
United States, in consultation with State Medicaid and 
CHIP directors and organizations representing program 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00075
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS