I 
109TH CONGRESS 
1ST SESSION H. R. 2071 
To amend titles XIX and XXI of the Social Security Act to provide for 
FamilyCare coverage for parents of enrolled children, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 4, 2005 
Mr. DINGELL (for himself, Mr. WAXMAN, Mr. BROWN of Ohio, Mr. PALLONE, 
Mr. GEORGE MILLER of California, Mr. VAN HOLLEN, Mr. HOLT, Ms. 
SCHAKOWSKY, Mr. GENE GREEN of Texas, Mr. KILDEE, Ms. JACKSON- 
LEE of Texas, Mr. MENENDEZ, Mr. REYES, Mr. MEEHAN, Mr. HINCHEY, 
Mr. LANTOS, Mr. NADLER, Mr. GRIJALVA, Mr. FARR, Mr. BERRY, Mr. 
OLVER, Mr. OWENS, Mrs. MCCARTHY, Mr. TIERNEY, Ms. WOOLSEY, Mr. 
MCNULTY, Mr. SCHIFF, Ms. CORRINE
BROWN
of Florida, Mr. 
BUTTERFIELD, Mr. HASTINGS of Florida, Mr. MURTHA, Mr. MICHAUD, 
Mr. RUPPERSBERGER, Mr. LYNCH, Mr. CUMMINGS, Ms. NORTON, Mr. 
MORAN of Virginia, Mrs. MALONEY, Mr. BACA, Ms. KILPATRICK of 
Michigan, Mr. HIGGINS, Mr. SERRANO, Ms. HERSETH, Ms. WASSERMAN 
SCHULTZ, Mr. ANDREWS, Ms. BALDWIN, Mr. CROWLEY, Mr. CLEAVER, 
Ms. PELOSI, Mr. CLAY, Mr. STUPAK, Ms. DEGETTE, Mr. PASCRELL, Ms. 
MCCOLLUM of Minnesota, Mr. HONDA, Mr. STRICKLAND, Ms. BERKLEY, 
Mrs. DAVIS of California, Mr. JACKSON of Illinois, Ms. SLAUGHTER, Ms. 
MILLENDER-MCDONALD, Mrs. CAPPS, Mr. CARNAHAN, Ms. LINDA T. 
SA´NCHEZ of California, Ms. ROYBAL-ALLARD, Ms. SOLIS, Mr. CUELLAR, 
Mr. ROSS, Ms. MATSUI, Mr. AL GREEN of Texas, Mr. SCOTT of Virginia, 
Mr. SALAZAR, Ms. HOOLEY, Mr. ISRAEL, Mr. RYAN of Ohio, Mr. LEWIS 
of Georgia, Mr. KIND, Mr. OBERSTAR, Mr. KENNEDY of Rhode Island, 
Mr. DOGGETT, Mr. GONZALEZ, Mr. HOYER, Mr. MCGOVERN, Mr. 
KUCINICH, Mr. ORTIZ, Mr. BOUCHER, Mr. MARKEY, Mr. HINOJOSA, Ms. 
SCHWARTZ of Pennsylvania, Mr. LARSON of Connecticut, Mr. EMANUEL, 
Ms. CARSON, Mr. MCDERMOTT, Mr. STARK, and Mr. MOORE of Kansas) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce
A BILL 
To amend titles XIX and XXI of the Social Security Act 
to provide for FamilyCare coverage for parents of en-
rolled children, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE OF TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘FamilyCare Act of 2005’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title of title; table of contents. 
Sec. 2. Renaming of title XXI program. 
Sec. 3. FamilyCare coverage of parents and pregnant women under the med-
icaid program and title XXI. 
Sec. 4. Automatic enrollment of children born to title XXI parents. 
Sec. 5. Optional coverage of legal immigrants under the medicaid program and 
title XXI. 
Sec. 6. Optional coverage of children through age 20 under the medicaid pro-
gram and title XXI. 
Sec. 7. Allowing States to simplify rules for families. 
Sec. 8. Revision and simplification of the transitional medical assistance pro-
gram (TMA). 
Sec. 9. Limitations on conflicts of interest. 
Sec. 10. Demonstration programs to improve medicaid and CHIP outreach to 
homeless individuals and families. 
Sec. 11. Additional CHIP revisions. 
Sec. 12. Increased federal reimbursement for language services under the med-
icaid program and title XXI. 
SEC. 2. RENAMING OF TITLE XXI PROGRAM. 
(a) IN GENERAL.—The heading of title XXI of the 
Social Security Act (42 U.S.C. 1397aa et seq.) is amended 
to read as follows:
‘‘TITLE XXI—FAMILYCARE PROGRAM’’. 
(b) PROGRAM REFERENCES.—Any reference in any 
provision of Federal law or regulation to ‘‘SCHIP’’ or 
‘‘State children’s health insurance program’’ under title 
XXI of the Social Security Act shall be deemed a reference 
to the FamilyCare program under such title. 
SEC. 3. FAMILYCARE COVERAGE OF PARENTS AND PREG-
NANT WOMEN UNDER THE MEDICAID PRO-
GRAM AND TITLE XXI. 
(a) INCENTIVES TO IMPLEMENT FAMILYCARE COV-
ERAGE.— 
(1) UNDER MEDICAID.— 
(A) ESTABLISHMENT OF NEW OPTIONAL 
ELIGIBILITY
CATEGORY.—Section 
1902(a)(10)(A)(ii) of the Social Security Act 
(42 U.S.C. 1396a(a)(10)(A)(ii)) is amended— 
(i) by striking ‘‘or’’ at the end of sub-
clause (XVII); 
(ii) by adding ‘‘or’’ at the end of sub-
clause (XVIII); and 
(iii) by adding at the end the fol-
lowing: 
‘‘(XIX) who are individuals de-
scribed in subsection (k)(1) (relating
to parents of categorically eligible chil-
dren);’’. 
(B) PARENTS DESCRIBED.—Section 1902 
of the Social Security Act is further amended 
by inserting after subsection (j) the following: 
‘‘(k)(1)(A) Individuals described in this paragraph 
are individuals— 
‘‘(i) who are the parents of an individual who 
is under 19 years of age (or such higher age as the 
State may have elected under section 1902(l)(1)(D)) 
and who is eligible for medical assistance under sub-
section (a)(10)(A); 
‘‘(ii) who are not otherwise eligible for medical 
assistance under such subsection or under a waiver 
approved under section 1115 or otherwise (except 
under 
section 
1931 
or 
under 
subsection 
(a)(10)(A)(ii)(XIX)); and 
‘‘(iii) whose family income or resources exceeds 
the effective income level or resource level applicable 
under the State plan under part A of title IV as in 
effect as of July 16, 1996, but does not exceed the 
highest effective income or resource level (if any) ap-
plicable to a child in the family under this title. 
‘‘(B) In establishing an income eligibility level for in-
dividuals described in this paragraph, a State may vary
such level consistent with the various income levels estab-
lished under subsection (l)(2) in order to ensure, to the 
maximum extent possible, that such individuals shall be 
enrolled in the same program as their children. 
‘‘(C) An individual may not be treated as being de-
scribed in this paragraph unless, at the time of the individ-
ual’s enrollment under this title, the child referred to in 
subparagraph (A)(i) of the individual is also enrolled 
under this title or otherwise insured. 
‘‘(D) In this subsection, the term ‘parent’ includes 
an individual treated as a caretaker for purposes of car-
rying out section 1931. 
‘‘(E) In this subsection, the term ‘effective income 
level’ means the income level expressed as a percent of 
the poverty line and considering applicable income dis-
regards. 
‘‘(2) The State shall provide for coverage of a parent 
described in paragraph (1) or section 2111 of a child who 
is covered under this title or title XXI under the same 
title as the title as such child is covered. In the case of 
a parent described in paragraph (1) who is also the parent 
of a child who is eligible for child health assistance under 
title XXI, the State may elect (on a uniform basis) to 
cover all such parents under section 2111 or under this 
title.’’.
(C) ENHANCED MATCHING FUNDS AVAIL-
ABLE IF CERTAIN CONDITIONS MET.—Section 
1905 of the Social Security Act (42 U.S.C. 
1396d) is amended— 
(i) in the fourth sentence of sub-
section (b), by striking ‘‘or subsection 
(u)(3)’’ 
and 
inserting 
‘‘, 
(u)(3), 
or 
(u)(4)(A)’’; and 
(ii) in subsection (u)— 
(I) by redesignating paragraph 
(4) as paragraph (6), and 
(II) by inserting after paragraph 
(3) the following: 
‘‘(4) For purposes of subsection (b) and section 
2105(a)(1): 
‘‘(A) FAMILYCARE
PARENTS.—The expendi-
tures described in this subparagraph are the expend-
itures described in the following clauses (i) and (ii): 
‘‘(i) PARENTS.—If the conditions described 
in clauses (iii) and (iv) are met, expenditures 
for medical assistance for parents described in 
section 1902(k)(1) and for parents who would 
be described in such section but for the fact 
that they are eligible for medical assistance
under section 1931 or under a waiver approved 
under section 1115. 
‘‘(ii) CERTAIN PREGNANT WOMEN.—If the 
conditions described in clause (v) are met, ex-
penditures for medical assistance for pregnant 
women described in subsection (n) or under sec-
tion 1902(l)(1)(A) in a family the income of 
which exceeds the effective income level applica-
ble under subsection (a)(10)(A)(i)(III) or 
(l)(2)(A) of section 1902 to a family of the size 
involved as of January 1, 2006. 
‘‘(iii) CONDITIONS RELATING TO ENSURING 
CHILDREN’S COVERAGE FOR ENHANCED MATCH 
FOR
PARENTS.—The conditions described in 
this clause are the following: 
‘‘(I) The State has a State child 
health plan under title XXI which (wheth-
er implemented under such title or under 
this title) has an effective income level for 
children that is at least 200 percent of the 
poverty line. 
‘‘(II) Such State child health plan 
does not limit the acceptance of applica-
tions, does not use a waiting list for chil-
dren who meet eligibility standards to
qualify for assistance, and provides bene-
fits to all children in the State who apply 
for and meet eligibility standards. 
‘‘(III) Effective for determinations of 
eligibility made on or after the date that is 
1 year after the date of the enactment of 
this clause, the application and renewal 
procedures for individuals under 19 years 
of age (or such higher age as the State has 
elected under section 1902(l)(1)(D)) for 
medical 
assistance 
under 
section 
1902(a)(10)(A) are not be more restrictive 
or burdensome than such procedures used 
for children with higher income under the 
State child health plan under title XXI. 
‘‘(iv) CONDITIONS RELATING TO MINIMUM 
COVERAGE
FOR
PARENTS
FOR
ENHANCED 
MATCH
FOR
PARENTS.—The conditions de-
scribed in this clause are the following: 
‘‘(I) The State does not apply an in-
come level for parents that is lower than 
the effective income level (expressed as a 
percent of the poverty line) that has been 
specified under the State plan under title 
XIX (including under a waiver authorized
by 
the 
Secretary 
or 
under 
section 
1902(r)(2)), as of January 1, 2005, to be 
eligible for medical assistance as a parent 
under this title. 
‘‘(II) The State plans under this title 
and title XXI do not provide coverage for 
parents with higher family income without 
covering parents with a lower family in-
come. 
‘‘(v) CONDITIONS FOR ENHANCED MATCH 
FOR CERTAIN PREGNANT WOMEN.—The condi-
tions described in this clause are the following: 
‘‘(I) The State has established an ef-
fective income eligibility 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 poverty line. 
‘‘(II) The State plans under this title 
and title XXI do not provide coverage for 
pregnant women described in subpara-
graph (A)(ii) with higher family income 
without covering such pregnant women 
with a lower family income. 
‘‘(III) The State does not apply an in-
come level for pregnant women that is
lower than the effective income level that 
has been specified under the State plan 
under 
subsection 
(a)(10)(A)(i)(III) 
or 
(l)(2)(A) of section 1902, as of January 1, 
2005, to be eligible for medical assistance 
as a pregnant woman. 
‘‘(IV) The State satisfies the condi-
tions described in subclauses (I) and (II) 
of clause (iii). 
‘‘(vi) DEFINITIONS.—For purposes of this 
subsection: 
‘‘(I) The term ‘parent’ has the mean-
ing given such term for purposes of section 
1902(k)(1). 
‘‘(II) The term ‘poverty line’ has the 
meaning given such term in section 
2110(c)(5).’’. 
(D) APPROPRIATION FROM TITLE XXI AL-
LOTMENT FOR CERTAIN MEDICAID EXPANSION 
COSTS.—Section 2105(a) of the Social Security 
Act (42 U.S.C. 1397ee(a)) is amended— 
(i) in paragraph (1), by redesignating 
subparagraphs (B) through (D) as sub-
paragraphs (C) through (E), respectively,
and by inserting after subparagraph (A) 
the following new subparagraph: 
‘‘(B) for medical assistance that is attrib-
utable to expenditures described in section 
1905(u)(4)(A);’’; and 
(ii) in paragraph (2), by adding at the 
end the following new subparagraph: 
‘‘(E) Fifth, for expenditures for items de-
scribed in paragraph (1)(E).’’. 
(E) INCREASING ENHANCED FMAP TO 100 
PERCENT FOR FISCAL YEARS 2006 AND 2007 FOR 
COVERAGE
OF
PARENTS.—Section 2105(b) of 
such Act (42 U.S.C. 1397ee(b)) is amended by 
adding at the end the following new sentence: 
‘‘Notwithstanding the previous sentence, the 
‘enhanced FMAP’ shall be 100 percent with re-
spect to medical assistance under title XIX for 
expenditures 
described 
in 
section 
1905(u)(4)(A)(i), but only for such assistance 
furnished during fiscal year 2006 and fiscal 
year 2007.’’. 
(2) UNDER TITLE XXI.— 
(A) FAMILYCARE COVERAGE.—Title XXI 
of the Social Security Act (42 U.S.C. 1397aa et
seq.) is amended by adding at the end the fol-
lowing: 
‘‘SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PAR-
ENTS OF TARGETED LOW-INCOME CHILDREN. 
‘‘(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 parent health assistance for 
targeted low-income parents, health care assistance for 
targeted low-income pregnant women, or both, in accord-
ance with this section, but only if— 
‘‘(1) with respect to the provision of parent 
health assistance, the State meets the conditions de-
scribed in clause (iii) of section 1905(u)(4)(A); 
‘‘(2) with respect to the provision of health care 
assistance for pregnant women, the State meets the 
conditions described in clause (iv) of section 
1905(u)(4)(A); and 
‘‘(3) in the case of parent health assistance for 
targeted low-income parents, the State elects to pro-
vide 
medical 
assistance 
under 
section 
1902(a)(10)(A)(ii)(XIX), under section 1931, or 
under a waiver under section 1115 to individuals de-
scribed in section 1902(k)(1)(A)(i) and elects an ef-
fective income level that, consistent with paragraphs
(1)(B) and (2) of section 1902(k), ensures to the 
maximum extent possible, that such individuals shall 
be enrolled in the same program as their children if 
their children are eligible for coverage under title 
XIX (including under a waiver authorized by the 
Secretary or under section 1902(r)(2)). 
‘‘(b) DEFINITIONS.—For purposes of this title: 
‘‘(1) PARENT HEALTH ASSISTANCE.—The term 
‘parent health 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 parents. 
‘‘(2) PARENT.—The term ‘parent’ has the 
meaning given the term ‘caretaker relative’ for pur-
poses of carrying out section 1931. 
‘‘(3) HEALTH
CARE
ASSISTANCE
FOR
PREG-
NANT WOMEN.—The term ‘health care 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 ref-
erence to targeted low-income pregnant women. 
‘‘(4) TARGETED
LOW-INCOME
PARENT.—The 
term ‘targeted low-income parent’ has the meaning 
given the term targeted low-income child in section 
2110(b) as if the reference to a child were deemed
a reference to a parent (as defined in paragraph (3)) 
of the child; except that in applying such section— 
‘‘(A) there shall be substituted for the in-
come level described in paragraph (1)(B)(ii)(I) 
the applicable income level in effect for a tar-
geted low-income child; 
‘‘(B) in paragraph (3), January 1, 2006, 
shall be substituted for July 1, 1997; and 
‘‘(C) in paragraph (4), January 1, 2006, 
shall be substituted for March 31, 1997. 
‘‘(5) 
TARGETED
LOW-INCOME
PREGNANT 
WOMAN.—The term ‘targeted low-income pregnant 
woman’ has the meaning given the term targeted 
low-income child in section 2110(b) as if any ref-
erence to a child were a reference to a woman dur-
ing pregnancy and through the end of the month in 
which the 60-day period beginning on the last day 
of her pregnancy ends; except that in applying such 
section— 
‘‘(A) there shall be substituted for the in-
come level described in paragraph (1)(B)(ii)(I) 
the applicable income level in effect for a tar-
geted low-income child; 
‘‘(B) in paragraph (3), January 1, 2006, 
shall be substituted for July 1, 1997; and
‘‘(C) in paragraph (4), January 1, 2006, 
shall be substituted for March 31, 1997. 
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL 
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of parent health assistance to targeted 
low-income parents or health care assistance to targeted 
low-income pregnant women under subsection (a), the fol-
lowing 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 parent or a targeted low-income pregnant 
woman (as applicable). 
‘‘(2) Any such reference to child health assist-
ance— 
‘‘(A) with respect to such parents is 
deemed a reference to parent health assistance; 
and 
‘‘(B) with respect to such pregnant women, 
is deemed a reference to health care assistance 
for pregnant women. 
‘‘(3) In applying section 2103(e)(3)(B) in the 
case of a family (consisting of a parent and one or 
more children) provided coverage under this section 
or a pregnant woman provided coverage under this
section without covering other family members, the 
limitation on total annual aggregate cost-sharing 
shall be applied to such entire family or such preg-
nant woman, respectively. 
‘‘(4) In applying section 2110(b)(4), any ref-
erence to ‘section 1902(l)(2) or 1905(n)(2) (as se-
lected by a State)’ is deemed a reference to the ef-
fective income level applicable to parents under sec-
tion 1931 or under a waiver approved under section 
1115, or, in the case of a pregnant woman, the in-
come level established under section 1902(l)(2)(A). 
‘‘(5) 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 
parents and pregnant women.’’. 
(B) ADDITIONAL ALLOTMENT FOR STATES 
PROVIDING FAMILYCARE.— 
(i) IN GENERAL.—Section 2104 of the 
Social Security Act (42 U.S.C. 1397dd) is 
amended by inserting after subsection (c) 
the following: 
‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE PRO-
VIDING FAMILYCARE.—
‘‘(1) APPROPRIATION; TOTAL
ALLOTMENT.— 
For the purpose of providing additional allotments 
to States to provide FamilyCare coverage under sec-
tion 2111, there is appropriated, out of any money 
in the Treasury not otherwise appropriated— 
‘‘(A) for fiscal year 2006, $7,000,000,000; 
‘‘(B) for fiscal year 2007, $7,000,000,000; 
‘‘(C) for fiscal year 2008, $3,000,000,000; 
‘‘(D) for fiscal year 2009, $3,000,000,000; 
‘‘(E) for fiscal year 2010, $6,000,000,000; 
‘‘(F) for fiscal year 2011, $7,000,000,000; 
‘‘(G) for fiscal year 2012, $8,000,000,000; 
‘‘(H) for fiscal year 2013, $9,000,000,000; 
and 
‘‘(I) for fiscal year 2014 and each fiscal 
year thereafter, the amount of the allotment 
provided under this paragraph for the preceding 
fiscal year increased by the percentage increase 
(if any) in the medical care expenditure cat-
egory of the Consumer Price Index for All 
Urban Consumers (United States city average). 
‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.— 
‘‘(A) IN GENERAL.—In addition to the al-
lotments provided under subsections (b) and 
(c), subject to paragraphs (3) and (4), of the