‘‘(C) DEFINITION OF POVERTY LINE.—In this 
subsection, the term ‘poverty line’ has the meaning 
given such term in section 2110(c)(5).’’. 
(3) PAYMENT
FROM
TITLE
XXI
ALLOTMENT 
FOR MEDICAID EXPANSION COSTS; ELIMINATION OF 
COUNTING
MEDICAID
CHILD
PRESUMPTIVE
ELIGI-
BILITY COSTS AGAINST TITLE XXI ALLOTMENT.—
Section 2105(a)(1) of the Social Security Act (42 
U.S.C. 1397ee(a)(1)) is amended—
(A) in the matter preceding subparagraph 
(A), by striking ‘‘(or, in the case of expendi-
tures described in subparagraph (B), the Fed-
eral medical assistance percentage (as defined 
in the first sentence of section 1905(b)))’’; and 
(B) by striking subparagraph (B) and in-
serting the following new subparagraph: 
‘‘(B) for the provision of medical assist-
ance that is attributable to expenditures de-
scribed in section 1905(u)(4)(A);’’. 
(b) SCHIP.—
(1) COVERAGE.—Title XXI of the Social Secu-
rity Act (42 U.S.C. 1397aa et seq.) 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 pregnancy-related assistance 
for targeted low-income pregnant women in accordance 
with this section, but only if—
‘‘(1) the State has established an income eligi-
bility level for pregnant women under subsection 
(a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 that is 
at least 185 percent of the income official poverty 
line; and 
‘‘(2) the State meets the conditions described in 
section 1905(u)(4)(B). 
‘‘(b) DEFINITIONS.—For purposes of this title: 
‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The 
term ‘pregnancy-related assistance’ 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-income 
pregnant women, except that the assistance shall be 
limited to services related to pregnancy (which in-
clude prenatal, delivery, and postpartum services 
and services described in section 1905(a)(4)(C)) and 
to other conditions that may complicate pregnancy.
‘‘(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 the ef-
fective income level (expressed as a percent of 
the poverty line and considering applicable in-
come disregards) that has been specified under 
subsection (a)(10)(A)(i)(III) or (l)(2)(A) of sec-
tion 1902, as of January 1, 2003, to be eligible 
for medical assistance as a pregnant woman 
under title XIX but does not exceed the income 
eligibility level established 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). 
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL 
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of pregnancy-related assistance to tar-
geted 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 
deemed to include a reference to a targeted low-in-
come pregnant woman. 
‘‘(2) Any such reference to child health assist-
ance with respect to such women is deemed a ref-
erence to pregnancy-related assistance. 
‘‘(3) Any such reference to a child is deemed a 
reference to a woman during pregnancy and the pe-
riod 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) Subsection (a) of section 2103 (relating to 
required scope of health insurance coverage) shall 
not apply insofar as a State limits coverage to serv-
ices described in subsection (b)(1) and the reference 
to such section in section 2105(a)(1)(C) is deemed 
not to require, in such case, compliance with the re-
quirements of section 2103(a). 
‘‘(7) 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 
cost-sharing shall be applied to such pregnant 
woman. 
‘‘(8) The reference in section 2107(e)(1)(D) to 
section 1920A (relating to presumptive eligibility for 
children) is deemed a reference to section 1920 (re-
lating to presumptive eligibility for pregnant 
women). 
‘‘(d) AUTOMATIC
ENROLLMENT
FOR
CHILDREN 
BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS-
SISTANCE.—If a child is born to a targeted low-income 
pregnant woman who was receiving pregnancy-related as-
sistance 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 assistance under 
such title, as appropriate, on the date of such birth and
to remain eligible for such assistance until the child at-
tains 1 year of age. During the period in which a child 
is deemed under the preceding sentence to be eligible for 
child health or medical assistance, the child health 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 
such number (unless the State issues a separate identifica-
tion number for the child before such period expires).’’. 
(2) ADDITIONAL ALLOTMENTS FOR PROVIDING 
COVERAGE OF PREGNANT WOMEN.—
(A) IN GENERAL.—Section 2104 of the So-
cial Security Act (42 U.S.C. 1397dd) is amend-
ed by inserting after subsection (c) the fol-
lowing new subsection: 
‘‘(d) ADDITIONAL ALLOTMENTS
FOR PROVIDING 
COVERAGE OF PREGNANT WOMEN.—
‘‘(1) APPROPRIATION; TOTAL
ALLOTMENT.—
For the purpose of providing additional allotments 
to States under this title, there is appropriated, out 
of any money in the Treasury not otherwise appro-
priated, for each of fiscal years 2004 through 2007, 
$200,000,000. 
‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.—
In addition to the allotments provided under sub-
sections (b) and (c), subject to paragraphs (3) and 
(4), of the amount available for the additional allot-
ments under paragraph (1) for a fiscal year, the 
Secretary shall allot to each State with a State child 
health plan approved under this title—
‘‘(A) in the case of such a State other than 
a commonwealth or territory described in sub-
paragraph (B), the same proportion as the pro-
portion of the State’s allotment under sub-
section (b) (determined without regard to sub-
section (f)) to the total amount of the allot-
ments under subsection (b) for such States eli-
gible for an allotment under this paragraph for 
such fiscal year; and 
‘‘(B) in the case of a commonwealth or ter-
ritory described in subsection (c)(3), the same 
proportion as the proportion of the common-
wealth’s or territory’s allotment under sub-
section (c) (determined without regard to sub-
section (f)) to the total amount of the allot-
ments under subsection (c) for commonwealths 
and territories eligible for an allotment under 
this paragraph for such fiscal year. 
‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi-
tional allotments provided under this subsection are
not available for amounts expended before October 
1, 2003. Such amounts are available for amounts ex-
pended on or after such date for child health assist-
ance for targeted low-income children, as well as for 
pregnancy-related assistance for targeted low-income 
pregnant women. 
‘‘(4) NO PAYMENTS UNLESS ELECTION TO EX-
PAND COVERAGE OF PREGNANT WOMEN.—No pay-
ments may be made to a State under this title from 
an allotment provided under this subsection unless 
the State provides pregnancy-related assistance for 
targeted low-income pregnant women under this 
title, or provides medical assistance for pregnant 
women under title XIX, whose family income ex-
ceeds the effective income level applicable under sub-
section (a)(10)(A)(i)(III) or (l)(2)(A) of section 
1902 to a family of the size involved as of January 
1, 2003.’’. 
(B) CONFORMING AMENDMENTS.—Section 
2104 of the Social Security Act (42 U.S.C. 
1397dd) is amended—
(i) in subsection (a), in the matter 
preceding paragraph (1), by inserting 
‘‘subject to subsection (d),’’ after ‘‘under 
this section,’’;
(ii) in subsection (b)(1), by inserting 
‘‘and subsection (d)’’ after ‘‘Subject to 
paragraph (4)’’; and 
(iii) in subsection (c)(1), by inserting 
‘‘subject to subsection (d),’’ after ‘‘for a 
fiscal year,’’. 
(3) ADDITIONAL CONFORMING AMENDMENTS.—
(A) NO COST-SHARING FOR PREGNANCY-
RELATED
BENEFITS.—Section 2103(e)(2) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397cc(e)(2)) is amended—
(i) in the heading, by inserting ‘‘OR 
PREGNANCY-RELATED
SERVICES’’ 
after 
‘‘PREVENTIVE SERVICES’’; and 
(ii) by inserting before the period at 
the end the following: ‘‘or for pregnancy-
related services’’. 
(B) 
NO
WAITING
PERIOD.—Section 
2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is 
amended—
(i) in clause (i), by striking ‘‘, and’’ at 
the end and inserting a semicolon; 
(ii) in clause (ii), by striking the pe-
riod at the end and inserting ‘‘; and’’; and
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(iii) may not apply a waiting period 
(including a waiting period to carry out 
paragraph (3)(C)) in the case of a targeted 
low-income pregnant woman.’’. 
(c) AUTHORITY FOR STATES THAT PROVIDE MED-
ICAID OR SCHIP COVERAGE FOR PREGNANT WOMEN 
WITH INCOME ABOVE 185 PERCENT OF THE POVERTY 
LINE TO USE PORTION OF SCHIP FUNDS FOR MEDICAID 
EXPENDITURES.—Section 2105(g) of the Social Security 
Act (42 U.S.C. 1397ee(g)), as added by section 1(b) of 
Public Law 108–74, is amended—
(1) in the subsection heading, by inserting 
‘‘AND CERTAIN PREGNANCY COVERAGE EXPANSION 
STATES’’ after ‘‘QUALIFYING STATES’’; 
(2) by adding at the end the following: 
‘‘(4) SPECIAL AUTHORITY FOR CERTAIN PREG-
NANCY COVERAGE EXPANSION STATES.—
‘‘(A) IN GENERAL.—In the case of a State 
that, as of the date of enactment of the Prevent 
Prematurity and Improve Child Health Act of 
2003, has an income eligibility standard under 
title 
XIX 
or 
this 
title 
(under 
section 
1902(a)(10)(A) or under a statewide waiver in
effect under section 1115 with respect to title 
XIX or this title) that is at least 185 percent 
of the poverty line with respect to pregnant 
women, the State may elect to use not more 
than 20 percent of any allotment under section 
2104 for any fiscal year (insofar as it is avail-
able under subsections (e) and (g) of such sec-
tion) for payments under title XIX in accord-
ance with subparagraph (B), instead of for ex-
penditures under this title. 
‘‘(B) PAYMENTS TO STATES.—
‘‘(i) IN GENERAL.—In the case of a 
State described in subparagraph (A) that 
has elected the option described in that 
subparagraph, subject to the availability of 
funds under such subparagraph and, if ap-
plicable, paragraph (1)(A), with respect to 
the State, the Secretary shall pay the State 
an amount each quarter equal to the addi-
tional amount that would have been paid 
to the State under title XIX with respect 
to expenditures described in clause (ii) if 
the enhanced FMAP (as determined under 
subsection (b)) had been substituted for
the Federal medical assistance percentage 
(as defined in section 1905(b)). 
‘‘(ii) EXPENDITURES
DESCRIBED.—
For purposes of this subparagraph, the ex-
penditures described in this clause are ex-
penditures, made after the date of the en-
actment of this paragraph and during the 
period in which funds are available to the 
State for use under subparagraph (A), for 
medical assistance under title XIX for 
pregnant women whose family income is at 
least 185 percent of the poverty line. 
‘‘(iii) NO IMPACT ON DETERMINATION 
OF BUDGET NEUTRALITY FOR WAIVERS.—
In the case of a State described in sub-
paragraph (A) that uses amounts paid 
under this paragraph for expenditures de-
scribed in clause (ii) that are incurred 
under a waiver approved for the State, any 
budget neutrality determinations with re-
spect to such waiver shall be determined 
without regard to such amounts paid.’’; 
and 
(3) in paragraph (3), by striking ‘‘and (2)’’ and 
inserting ‘‘(2), and (4)’’.
(d) OTHER 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’ includes a qualified entity 
as defined in section 1920A(b)(3).’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section apply to items and services furnished on or 
after October 1, 2003, without regard to whether regula-
tions implementing such amendments have been promul-
gated.
SEC. 3. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 
UNDER THE MEDICAID PROGRAM AND SCHIP. 
(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 for aliens who are lawfully residing in the United 
States (including battered aliens described in section 
431(c) of the Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996) and who are otherwise 
eligible for such assistance, within any of the following eli-
gibility categories: 
‘‘(i) PREGNANT WOMEN.—Women during preg-
nancy (and during the 60-day period beginning on 
the last day of the pregnancy). 
‘‘(ii) CHILDREN.—Children (as defined under 
such plan), including optional targeted low-income 
children described in section 1905(u)(2)(B). 
‘‘(B)(i) In the case of a State that has elected to pro-
vide medical assistance to a category of aliens under sub-
paragraph (A), no debt shall accrue under an affidavit of 
support against any sponsor of such an alien on the basis 
of provision of assistance to such category and the cost 
of such assistance shall not be considered as an unreim-
bursed cost.
‘‘(ii) The provisions of sections 401(a), 402(b), 403, 
and 421 of the Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996 shall not apply to a 
State that makes an election under subparagraph (A).’’. 
(b) TITLE XXI.—Section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)) is amended by add-
ing at the end the following new subparagraph: 
‘‘(E) Section 1903(v)(4) (relating to op-
tional coverage of permanent resident alien 
pregnant women and children), but only with 
respect to an eligibility category under this title, 
if the same eligibility category has been elected 
under such section for purposes of title XIX.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2003, and apply to 
medical assistance and child health assistance furnished 
on or after such date. 
SEC. 4. PROMOTING CESSATION OF TOBACCO USE UNDER 
THE MEDICAID PROGRAM. 
(a) DROPPING EXCEPTION FROM MEDICAID PRE-
SCRIPTION DRUG COVERAGE FOR TOBACCO CESSATION 
MEDICATIONS.—Section 1927(d)(2) of the Social Security 
Act (42 U.S.C. 1396r–8(d)(2)) is amended—
(1) by striking subparagraph (E);
(2) 
by 
redesignating 
subparagraphs 
(F) 
through (J) as subparagraphs (E) through (I), re-
spectively; and 
(3) in subparagraph (F) (as redesignated by 
paragraph (2)), by inserting before the period at the 
end the following: ‘‘, except agents approved by the 
Food and Drug Administration for purposes of pro-
moting, and when used to promote, tobacco ces-
sation’’. 
(b) REQUIRING COVERAGE OF TOBACCO CESSATION 
COUNSELING SERVICES FOR PREGNANT WOMEN.—Sec-
tion 1905 of the Social Security Act (42 U.S.C. 
1396d(a)(4)) is amended—
(1) in subsection (a)(4)—
(A) by striking ‘‘and’’ before ‘‘(C)’’; and 
(B) by inserting before the semicolon at 
the end the following new subparagraph: ‘‘; and 
(D) counseling for cessation of tobacco use (as 
defined in subsection (x)) for pregnant women’’; 
and 
(2) by adding at the end the following: 
‘‘(x)(1) For purposes of this title, the term ‘coun-
seling for cessation of tobacco use’ means therapy and 
counseling for cessation of tobacco use for pregnant
women who use tobacco products or who are being treated 
for tobacco use that is furnished—
‘‘(A) by or under the supervision of a physician; 
or 
‘‘(B) by any other health care professional 
who— 
‘‘(i) is legally authorized to furnish such 
services under State law (or the State regu-
latory mechanism provided by State law) of the 
State in which the services are furnished; and 
‘‘(ii) is authorized to receive payment for 
other services under this title or is designated 
by the Secretary for this purpose. 
‘‘(2) Subject to paragraph (3), such term is limited 
to—
‘‘(A) therapy and counseling services rec-
ommended in ‘Treating Tobacco Use and Depend-
ence: A Clinical Practice Guideline’, published by the 
Public Health Service in June 2000, or any subse-
quent modification of such Guideline; and 
‘‘(B) such other therapy and counseling services 
that the Secretary recognizes to be effective. 
‘‘(3) Such term shall not include coverage for drugs 
or biologicals that are not otherwise covered under this 
title.’’.
(c) REMOVAL OF COST-SHARING FOR TOBACCO CES-
SATION
COUNSELING
SERVICES
FOR
PREGNANT 
WOMEN.—Section 1916 of the Social Security Act (42 
U.S.C. 1396o) is amended in each of subsections (a)(2)(B) 
and (b)(2)(B) by inserting ‘‘, and counseling for cessation 
of tobacco use (as defined in section 1905(x))’’ after ‘‘com-
plicate the pregnancy’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
the date that is 1 year after the date of enactment of this 
Act. 
SEC. 5. PROMOTING CESSATION OF TOBACCO USE UNDER 
THE MATERNAL AND CHILD HEALTH SERV-
ICES BLOCK GRANT PROGRAM. 
(a) QUALITY MATERNAL AND CHILD HEALTH SERV-
ICES INCLUDES TOBACCO CESSATION COUNSELING AND 
MEDICATIONS.—
(1) IN GENERAL.—Section 501 of the Social 
Security Act (42 U.S.C. 701) is amended by adding 
at the end the following new subsection: 
‘‘(c) For purposes of this title, counseling for ces-
sation of tobacco use (as defined in section 1905(x)), 
drugs and biologicals used to promote smoking cessation, 
and the inclusion of antitobacco messages in health pro-
motion counseling shall be considered to be part of quality 
maternal and child health services.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall take effect on the date that 
is 1 year after the date of enactment of this Act. 
(b) EVALUATION OF NATIONAL CORE PERFORMANCE 
MEASURES.—
(1) IN
GENERAL.—The Administrator of the 
Health Resources and Services Administration shall 
assess the current national core performance meas-
ures and national core outcome measures utilized 
under the Maternal and Child Health Block Grant 
under title V of the Social Security Act (42 U.S.C. 
701 et seq.) for purposes of expanding such meas-
ures to include some of the known causes of low 
birthweight and prematurity, including the percent-
age of infants born to pregnant women who smoked 
during pregnancy. 
(2) REPORT.—Not later than 1 year after the 
date of enactment of this Act, the Administrator of 
the Health Resources and Services Administration 
shall submit to the appropriate committees of Con-
gress a report concerning the results of the evalua-
tion conducted under paragraph (1).