I 
109TH CONGRESS 
2D SESSION 
H. R. 5795 
To amend title XIX of the Social Security Act to expand access to contracep-
tive services for women and men under the Medicaid program, help 
low income women and couples prevent unintended pregnancies and re-
duce abortion, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 13, 2006 
Mrs. LOWEY (for herself, Mr. WAXMAN, Mrs. CAPPS, Mr. RYAN of Ohio, Mr. 
CROWLEY, Ms. MCCOLLUM of Minnesota, Mrs. MALONEY, Mr. PAYNE, 
Mr. GEORGE MILLER of California, Mr. OWENS, Ms. BALDWIN, Mr. 
FARR, Mr. NADLER, Ms. SLAUGHTER, Ms. SCHAKOWSKY, Mr. LANTOS, 
Mr. BROWN of Ohio, Mr. ALLEN, Mr. STARK, Ms. SOLIS, and Mr. CON-
YERS) introduced the following bill; which was referred to the Committee 
on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to expand 
access to contraceptive services for women and men 
under the Medicaid program, help low income women 
and couples prevent unintended pregnancies and reduce 
abortion, 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. 
This Act may be cited as the ‘‘Unintended Pregnancy 
Reduction Act of 2006’’. 
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SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Rates of unintended pregnancy in the 
United States increased by nearly 30 percent among 
low-income women between 1994 and 2002, and a 
low-income woman today is 4 times as likely to have 
an unintended pregnancy as her higher income coun-
terpart. 
(2) Abortion rates decreased among higher in-
come women but increased among low income 
women between 1994 and 2002, and a low income 
woman is more than 4 times as likely to have an 
abortion as her higher income counterpart. 
(3) Contraceptive use reduces a woman’s prob-
ability of having an abortion by 85 percent. 
(4) Levels of contraceptive use among low-in-
come women at risk of unintended pregnancy de-
clined significantly between 1994 and 2002, from 92 
percent to 86 percent. 
(5) Publicly funded contraceptive services have 
been shown to prevent 1,300,000 unintended preg-
nancies each year, and in the absence of these serv-
ices the United States abortion rate would likely be 
40 percent higher than it is. 
(6) By helping couples avoid unintended preg-
nancy, Medicaid-funded contraceptive services are 
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highly cost-effective, and every public dollar spent on 
family planning saves $3 in the cost of pregnancy- 
related care alone. 
(7) Federal law requires State Medicaid pro-
grams to cover pregnancy-related care for women 
with incomes up to 133 percent of poverty, and 17 
States have expanded this coverage to women with 
incomes up to 200 percent of poverty. 
(8) 18 States have expanded Medicaid coverage 
for family planning services to the same level at 
which they provide Medicaid funded pregnancy-re-
lated care. 
(9) Equalizing the eligibility levels for family 
planning and pregnancy-related care nationwide 
would maximize the cost-savings to both the Federal 
and State Governments. 
(10) A woman should have equal access to con-
traceptive services to help prevent an unintended 
pregnancy and to pregnancy-related care if she does 
become pregnant. 
SEC. 3. CLARIFICATION OF COVERAGE OF FAMILY PLAN-
NING SERVICES AND SUPPLIES. 
Section 1937(b) of the Social Security Act (42 U.S.C. 
1396u–7(b)) is amended by adding at the end the fol-
lowing: 
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‘‘(5) COVERAGE OF FAMILY PLANNING SERV-
ICES AND SUPPLIES.—Notwithstanding the previous 
provisions of this section, a State may not provide 
for medical assistance through enrollment of an indi-
vidual with benchmark coverage or benchmark-equiv-
alent coverage under this section unless that cov-
erage includes family planning services and supplies 
as described in section 1905(a)(4)(C).’’. 
SEC. 4. EXPANSION OF FAMILY PLANNING SERVICES. 
(a) COVERAGE
AS
MANDATORY
CATEGORICALLY 
NEEDY GROUP.— 
(1) IN GENERAL.—Section 1902(a)(10)(A)(i) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)(i)) is amended— 
(A) in subclause (VI), by striking ‘‘or’’ at 
the end; 
(B) in subclause (VII), by adding ‘‘or’’ at 
the end; and 
(C) by adding at the end the following new 
subclause: 
‘‘(VIII) who are described in sub-
section (dd) (relating to individuals 
who meet the income standards for 
pregnant women);’’. 
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(2) GROUP DESCRIBED.—Section 1902 of the 
Social Security Act (42 U.S.C. 1396a) is amended 
by adding at the end the following new subsection: 
‘‘(dd)(1) Individuals described in this subsection are 
individuals who— 
‘‘(A) meet at least the income eligibility stand-
ards established under the State plan as of May 1, 
2006, for pregnant women or such higher income 
eligibility standard for such women as the State may 
establish; and 
‘‘(B) are not pregnant. 
‘‘(2) At the option of a State, individuals described 
in this subsection may include individuals who are deter-
mined to meet the income eligibility standards referred to 
in paragraph (1)(A) under the terms and conditions appli-
cable to making eligibility determinations for medical as-
sistance under this title under a waiver to provide the ben-
efits described in clause (XV) of the matter following sub-
paragraph (G) of section 1902(a)(10) granted to the State 
under section 1115 as of May 1, 2006.’’. 
(3) 
LIMITATION
ON
BENEFITS.—Section 
1902(a)(10) of the Social Security Act (42 U.S.C. 
1396a(a)(10)) is amended in the matter following 
subparagraph (G)— 
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(A) by striking ‘‘and (XIV)’’ and inserting 
‘‘(XIV)’’; and 
(B) by inserting ‘‘, and (XV) the medical 
assistance made available to an individual de-
scribed in subsection (dd) who is eligible for 
medical assistance only because of subpara-
graph (A)(10)(i)(VIII) shall be limited to family 
planning services and supplies described in 
1905(a)(4)(C) and, at the State’s option, med-
ical diagnosis or treatment services that are 
provided in conjunction with a family planning 
service in a family planning setting provided 
during the period in which such an individual is 
eligible;’’ after ‘‘cervical cancer’’. 
(4) 
CONFORMING
AMENDMENTS.—Section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended in the matter preceding para-
graph (1)— 
(A) in clause (xii), by striking ‘‘or’’ at the 
end; 
(B) in clause (xii), by adding ‘‘or’’ at the 
end; and 
(C) by inserting after clause (xiii) the fol-
lowing: 
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‘‘(xiv) individuals described in section 
1902(dd),’’. 
(b) PRESUMPTIVE ELIGIBILITY.— 
(1) IN GENERAL.—Title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.) is amended by 
inserting after section 1920B the following: 
‘‘PRESUMPTIVE ELIGIBILITY FOR FAMILY PLANNING 
SERVICES 
‘‘SEC. 1920C. (a) STATE OPTION.—A State plan ap-
proved under section 1902 may provide for making med-
ical assistance available to an individual described in sec-
tion 1902(dd) (relating to individuals who meet the in-
come eligibility standard for pregnant women in the State) 
during a presumptive eligibility period. In the case of an 
individual described in section 1902(dd) who is eligible for 
medical 
assistance 
only 
because 
of 
subparagraph 
(A)(10)(i)(VIII), such medical assistance may be limited 
to family planning services and supplies described in 
1905(a)(4)(C) and, at the State’s option, medical diag-
nosis or treatment services that are provided in conjunc-
tion with a family planning service in a family planning 
setting provided during the period in which such an indi-
vidual is eligible. 
‘‘(b) DEFINITIONS.—For purposes of this section: 
‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The 
term ‘presumptive eligibility period’ means, with re-
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spect to an individual described in subsection (a), 
the period that— 
‘‘(A) begins with the date on which a 
qualified entity determines, on the basis of pre-
liminary information, that the individual is de-
scribed in section 1902(dd); and 
‘‘(B) ends with (and includes) the earlier 
of— 
‘‘(i) the day on which a determination 
is made with respect to the eligibility of 
such individual for services under the State 
plan; or 
‘‘(ii) in the case of such an individual 
who does not file an application by the last 
day of the month following the month dur-
ing which the entity makes the determina-
tion referred to in subparagraph (A), such 
last day. 
‘‘(2) QUALIFIED ENTITY.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘qualified entity’ means 
any entity that— 
‘‘(i) is eligible for payments under a 
State plan approved under this title; and 
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‘‘(ii) is determined by the State agen-
cy to be capable of making determinations 
of the type described in paragraph (1)(A). 
‘‘(B) REGULATIONS.—The Secretary may 
issue regulations further limiting those entities 
that may become qualified entities in order to 
prevent fraud and abuse and for other reasons. 
‘‘(C) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as pre-
venting a State from limiting the classes of en-
tities that may become qualified entities, con-
sistent with any limitations imposed under sub-
paragraph (B). 
‘‘(c) ADMINISTRATION.— 
‘‘(1) IN GENERAL.—The State agency shall pro-
vide qualified entities with— 
‘‘(A) such forms as are necessary for an 
application to be made by an individual de-
scribed in subsection (a) for medical assistance 
under the State plan; and 
‘‘(B) information on how to assist such in-
dividuals in completing and filing such forms. 
‘‘(2) NOTIFICATION REQUIREMENTS.—A quali-
fied 
entity 
that 
determines 
under 
subsection 
(b)(1)(A) that an individual described in subsection 
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(a) is presumptively eligible for medical assistance 
under a State plan shall— 
‘‘(A) notify the State agency of the deter-
mination within 5 working days after the date 
on which determination is made; and 
‘‘(B) inform such individual at the time 
the determination is made that an application 
for medical assistance is required to be made by 
not later than the last day of the month fol-
lowing the month during which the determina-
tion is made. 
‘‘(3) 
APPLICATION
FOR
MEDICAL
ASSIST-
ANCE.—In the case of an individual described in 
subsection (a) who is determined by a qualified enti-
ty to be presumptively eligible for medical assistance 
under a State plan, the individual shall apply for 
medical assistance by not later than the last day of 
the month following the month during which the de-
termination is made. 
‘‘(d) PAYMENT.—Notwithstanding any other provi-
sion of this title, medical assistance that— 
‘‘(1) is furnished to an individual described in 
subsection (a)— 
‘‘(A) during a presumptive eligibility pe-
riod; 
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‘‘(B) by a entity that is eligible for pay-
ments under the State plan; and 
‘‘(2) is included in the care and services covered 
by the State plan, shall be treated as medical assist-
ance provided by such plan for purposes of clause 
(4) of the first sentence of section 1905(b).’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1902(a)(47) of the Social Se-
curity Act (42 U.S.C. 1396a(a)(47)) is amend-
ed by inserting before the semicolon at the end 
the following: ‘‘and provide for making medical 
assistance available to individuals described in 
subsection (a) of section 1920C during a pre-
sumptive eligibility period in accordance with 
such section.’’. 
(B) Section 1903(u)(1)(D)(v) of such Act 
(42 U.S.C. 1396b(u)(1)(D)(v)) is amended— 
(i) by striking ‘‘or for’’ and inserting 
‘‘, for’’; and 
(ii) by inserting before the period the 
following: ‘‘, or for medical assistance pro-
vided to an individual described in sub-
section (a) of section 1920C during a pre-
sumptive eligibility period under such sec-
tion’’. 
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SEC. 5. EFFECTIVE DATE. 
(a) IN GENERAL.—Except as provided in paragraph 
(2), the amendments made by this Act take effect on Octo-
ber 1, 2006. 
(b) EXTENSION OF EFFECTIVE DATE FOR STATE 
LAW AMENDMENT.—In the case of a State plan under 
title XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.) which the Secretary of Health and Human Services 
determines requires State legislation in order for the plan 
to meet the additional requirements imposed by the 
amendments made by this Act, the State plan shall not 
be regarded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet these 
additional requirements before the first day of the first 
calendar quarter beginning after the close of the first reg-
ular session of the State legislature that begins after the 
date of enactment of this Act. For purposes of the pre-
vious sentence, in the case of a State that has a 2-year 
legislative session, each year of the session is considered 
to be a separate regular session of the State legislature. 
Æ 
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