H. R. 3963—20 
under this title) of the poverty line applicable to a family 
of the size involved, but in no case lower than the percent 
in effect under any such subsection 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. 
‘‘(2) NO
CHIP
INCOME
ELIGIBILITY
LEVEL
FOR
PREGNANT 
WOMEN LOWER THAN THE STATE’S MEDICAID LEVEL.—The State 
does not apply an effective income level for pregnant women 
under the State plan amendment that is lower than the effective 
income level (expressed as a percent of the poverty line and 
considering applicable income disregards) specified under sub-
section (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of section 
1902, on the date of enactment of this paragraph to be eligible 
for medical assistance as a pregnant woman. 
‘‘(3) NO COVERAGE FOR HIGHER INCOME PREGNANT WOMEN 
WITHOUT
COVERING
LOWER
INCOME
PREGNANT
WOMEN.—The 
State does not provide coverage for pregnant women with 
higher family income without covering pregnant women with 
a lower family income. 
‘‘(4) APPLICATION OF REQUIREMENTS FOR COVERAGE OF TAR-
GETED LOW-INCOME CHILDREN.—The State provides pregnancy- 
related assistance for targeted low-income pregnant women 
in the same manner, and subject to the same requirements, 
as the State provides child health assistance for targeted low- 
income children under the State child health plan, and in 
addition to providing child health assistance for such women. 
‘‘(5) NO
PREEXISTING
CONDITION
EXCLUSION
OR
WAITING 
PERIOD.—The State does not apply any exclusion of benefits 
for pregnancy-related assistance based on any preexisting condi-
tion or any waiting period (including any waiting period 
imposed to carry out section 2102(b)(3)(C)) for receipt of such 
assistance. 
‘‘(6) APPLICATION OF COST-SHARING PROTECTION.—The State 
provides pregnancy-related assistance to a targeted low-income 
woman consistent with the cost-sharing protections under sec-
tion 2103(e) and applies the limitation on total annual aggre-
gate cost sharing imposed under paragraph (3)(B) of such sec-
tion to the family of such a woman. 
‘‘(7) NO WAITING LIST FOR CHILDREN.—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 enrollment, 
any waiting list, any procedures designed to delay the consider-
ation of applications for enrollment, or similar limitation with 
respect to enrollment. 
‘‘(c) OPTION TO PROVIDE PRESUMPTIVE ELIGIBILITY.—A State 
that elects the option under subsection (a) and satisfies the condi-
tions described in subsection (b) may elect to apply section 1920 
(relating to presumptive eligibility for pregnant women) to the 
State child health plan in the same manner as such section applies 
to the State plan under title XIX. 
‘‘(d) DEFINITIONS.—For purposes of this section: 
‘‘(1) PREGNANCY-RELATED
ASSISTANCE.—The term ‘preg-
nancy-related assistance’ has the meaning given the term ‘child
H. R. 3963—21 
health assistance’ in section 2110(a) with respect to an indi-
vidual during the period described in paragraph (2)(A). 
‘‘(2) TARGETED LOW-INCOME PREGNANT WOMAN.—The term 
‘targeted low-income pregnant woman’ means an individual— 
‘‘(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 percent (or, if 
higher, the percent applied under subsection (b)(1)(A)) of 
the poverty line applicable to a family of the size involved, 
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 section 2110(b) in the same 
manner as a child applying for child health assistance 
would have to satisfy such requirements. 
‘‘(e) AUTOMATIC ENROLLMENT FOR CHILDREN BORN TO WOMEN 
RECEIVING PREGNANCY-RELATED ASSISTANCE.—If a child is born 
to a targeted low-income pregnant woman who was receiving preg-
nancy-related assistance 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 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 medical assistance, the child health or medical 
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 identification number for the child before such 
period expires). 
‘‘(f) STATES PROVIDING ASSISTANCE THROUGH OTHER OPTIONS.— 
‘‘(1) CONTINUATION
OF
OTHER
OPTIONS
FOR
PROVIDING 
ASSISTANCE.—The option to provide assistance in accordance 
with the preceding subsections of this section shall not limit 
any other option for a State to provide— 
‘‘(A) child health assistance through the application 
of 
sections 
457.10, 
457.350(b)(2), 
457.622(c)(5), 
and 
457.626(a)(3) of title 42, Code of Federal Regulations (as 
in effect after the final rule adopted by the Secretary and 
set forth at 67 Fed. Reg. 61956–61974 (October 2, 2002)), 
or 
‘‘(B) pregnancy-related services through the application 
of any waiver authority (as in effect on June 1, 2007). 
‘‘(2) CLARIFICATION OF AUTHORITY TO PROVIDE POSTPARTUM 
SERVICES.—Any State that provides child health assistance 
under any authority described in paragraph (1) may continue 
to provide such assistance, as well as postpartum services, 
through the end of the month in which the 60-day period 
(beginning on the last day of the pregnancy) ends, in the 
same manner as such assistance and postpartum services would 
be provided if provided under the State plan under title XIX, 
but only if the mother would otherwise satisfy the eligibility
H. R. 3963—22 
requirements that apply under the State child health plan 
(other than with respect to age) during such period. 
‘‘(3) NO INFERENCE.—Nothing in this subsection shall be 
construed— 
‘‘(A) to infer congressional intent regarding the legality 
or illegality of the content of the sections specified in para-
graph (1)(A); or 
‘‘(B) to modify the authority to provide pregnancy- 
related services under a waiver specified in paragraph 
(1)(B).’’. 
(b) ADDITIONAL CONFORMING AMENDMENTS.— 
(1) NO COST SHARING FOR PREGNANCY-RELATED BENEFITS.— 
Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended— 
(A) in the heading, by inserting ‘‘OR
PREGNANCY- 
RELATED ASSISTANCE’’ after ‘‘PREVENTIVE SERVICES’’; and 
(B) by inserting before the period at the end the fol-
lowing: ‘‘or for pregnancy-related assistance’’. 
(2) NO WAITING PERIOD.—Section 2102(b)(1)(B) (42 U.S.C. 
1397bb(b)(1)(B)) is amended— 
(A) in clause (i), by striking ‘‘, and’’ at the end and 
inserting a semicolon; 
(B) in clause (ii), by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by adding at the end the following 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 pro-
vided pregnancy-related assistance under section 
2112.’’. 
SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS 
ADULTS UNDER CHIP; CONDITIONS FOR COVERAGE OF 
PARENTS. 
(a) PHASE-OUT RULES.— 
(1) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et seq.) is 
amended by adding at the end the following new section: 
‘‘SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS 
ADULTS; CONDITIONS FOR COVERAGE OF PARENTS. 
‘‘(a) TERMINATION OF COVERAGE FOR NONPREGNANT CHILDLESS 
ADULTS.— 
‘‘(1) NO
NEW
CHIP
WAIVERS; AUTOMATIC
EXTENSIONS
AT 
STATE OPTION THROUGH 2008.—Notwithstanding section 1115 
or any other provision of this title, except as provided in this 
subsection— 
‘‘(A) the Secretary shall not on or after the date of 
the enactment of the Children’s Health Insurance Program 
Reauthorization Act of 2007, approve or renew a waiver, 
experimental, pilot, or demonstration project that would 
allow funds made available under this title to be used 
to provide child health assistance or other health benefits 
coverage to a nonpregnant childless adult; and 
‘‘(B) notwithstanding the terms and conditions of an 
applicable existing waiver, the provisions of paragraph (2) 
shall apply for purposes of any period beginning on or 
after January 1, 2009, in determining the period to which 
the waiver applies, the individuals eligible to be covered
H. R. 3963—23 
by the waiver, and the amount of the Federal payment 
under this title. 
‘‘(2) TERMINATION OF CHIP COVERAGE UNDER APPLICABLE 
EXISTING WAIVERS AT THE END OF 2008.— 
‘‘(A) IN GENERAL.—No funds shall be available under 
this title for child health assistance or other health benefits 
coverage that is provided to a nonpregnant childless adult 
under an applicable existing waiver after December 31, 
2008. 
‘‘(B) EXTENSION UPON STATE REQUEST.—If an applicable 
existing waiver described in subparagraph (A) would other-
wise expire before January 1, 2009, and the State requests 
an extension of such waiver, the Secretary shall grant 
such an extension, but only through December 31, 2008. 
‘‘(C) APPLICATION OF ENHANCED FMAP.—The enhanced 
FMAP determined under section 2105(b) shall apply to 
expenditures under an applicable existing waiver for the 
provision of child health assistance or other health benefits 
coverage to a nonpregnant childless adult during the period 
beginning on the date of the enactment of this subsection 
and ending on December 31, 2008. 
‘‘(3) STATE OPTION TO APPLY FOR MEDICAID WAIVER TO CON-
TINUE COVERAGE FOR NONPREGNANT CHILDLESS ADULTS.— 
‘‘(A) IN GENERAL.—Each State for which coverage under 
an applicable existing waiver is terminated under para-
graph (2)(A) may submit, not later than September 30, 
2008, an application to the Secretary for a waiver under 
section 1115 of the State plan under title XIX to provide 
medical assistance to a nonpregnant childless adult whose 
coverage is so terminated (in this subsection referred to 
as a ‘Medicaid nonpregnant childless adults waiver’). 
‘‘(B) DEADLINE
FOR
APPROVAL.—The Secretary shall 
make a decision to approve or deny an application for 
a Medicaid nonpregnant childless adults waiver submitted 
under subparagraph (A) within 90 days of the date of 
the submission of the application. If no decision has been 
made by the Secretary as of December 31, 2008, on the 
application of a State for a Medicaid nonpregnant childless 
adults waiver that was submitted to the Secretary by Sep-
tember 30, 2008, the application shall be deemed approved. 
‘‘(C) STANDARD FOR BUDGET NEUTRALITY.—The budget 
neutrality requirement applicable with respect to expendi-
tures for medical assistance under a Medicaid nonpregnant 
childless adults waiver shall— 
‘‘(i) in the case of 2009, allow expenditures for 
medical assistance under title XIX for all such adults 
to not exceed the total amount of payments made to 
the State under paragraph (3)(B) for 2008, increased 
by the percentage increase (if any) in the projected 
nominal per capita amount of National Health 
Expenditures for 2009 over 2008, as most recently 
published by the Secretary; and 
‘‘(ii) in the case of any succeeding year, allow such 
expenditures to not exceed the amount in effect under 
this subparagraph for the preceding year, increased 
by the percentage increase (if any) in the projected 
nominal per capita amount of National Health