I 
111TH CONGRESS 
1ST SESSION 
H. R. 465 
To amend titles XIX and XXI of the Social Security Act to permit States 
to ensure coverage without a 5-year delay of certain children and preg-
nant women under the Medicaid program and SCHIP. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 13, 2009 
Mr. GENE GREEN of Texas (for himself, Mr. LINCOLN DIAZ-BALART of Flor-
ida, and Mr. WAXMAN) introduced the following bill; which was referred 
to the Committee on Energy and Commerce 
A BILL 
To amend titles XIX and XXI of the Social Security Act 
to permit States to ensure coverage without a 5-year 
delay of certain children and pregnant women under 
the Medicaid program and SCHIP. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. PERMITTING STATES TO ENSURE COVERAGE 
WITHOUT A 5-YEAR DELAY OF CERTAIN CHIL-
DREN AND PREGNANT WOMEN UNDER THE 
MEDICAID PROGRAM AND SCHIP. 
(a) PURPOSE.—In order to promote the health of 
needy children and pregnant women residing lawfully in 
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the United States, States should be permitted to waive 
certain restrictions which result in a 5-year delay for cov-
erage of necessary health services for such children and 
women under the Medicaid program and SCHIP. 
(b) 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, notwithstanding sections 
401(a), 402(b), 403, and 421 of Public Law 104–193, 
medical assistance under a State plan under this title to 
children and pregnant women who are lawfully residing 
in the United States (including battered individuals de-
scribed in section 431(c) of such Act) and are otherwise 
eligible for such assistance. 
‘‘(B) Such election may be made only with respect 
to either or both of the following categories of individuals: 
‘‘(i) Children. 
‘‘(ii) Pregnant women. 
‘‘(C) In this paragraph: 
‘‘(i) The term ‘pregnant women’ means 
women during pregnancy (and during the 60- 
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day period beginning on the last day of the 
pregnancy). 
‘‘(ii) The term ‘children’ means individuals 
under age 19 (or such higher age as the State 
has elected under section 1902(l)(1)(D)), in-
cluding optional targeted low-income children 
described in section 1905(u)(2)(B).’’. 
(c) CHIP.—Section 2107(e)(1) of such Act (42 
U.S.C. 1397gg(e)(1)) is amended by redesignating sub-
paragraphs (C) and (D) as subparagraphs (D) and (E), 
respectively, and by inserting after subparagraph (B) the 
following new subparagraph: 
‘‘(C) Paragraph (4) of section 1903(v), in-
sofar as it relates to the category of children or 
pregnant women (as such terms are defined in 
such paragraph), but only if the State has elect-
ed to apply such paragraph with respect to such 
category of children or pregnant women under 
title XIX and only if, in the case of pregnant 
women, the State has elected the option under 
section 2111 to provide assistance for pregnant 
women under this title.’’. 
(d) CONFORMING AMENDMENT.—Section 423(d)(1) 
of Public Law 104–193 is amended by inserting before 
the period the following: ‘‘and medical or child health as-
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sistance 
furnished 
under 
section 
1903(v)(4) 
or 
2107(e)(1)(E), respectively, of the Social Security Act’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section take effect on the date of the enactment of 
this Act. 
Æ 
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