I 
110TH CONGRESS 
2D SESSION 
H. R. 5961 
To amend titles XIX and XXI of the Social Security Act to place a general 
eligibility ceiling of 250 percent of the poverty level on gross income 
for eligibility for benefits under Medicaid and SCHIP. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 5, 2008 
Mr. GINGREY (for himself, Mr. FEENEY, Mr. WALDEN of Oregon, Mr. 
HERGER, Mr. BARTLETT of Maryland, Mr. KINGSTON, Mr. BROUN of 
Georgia, Mr. MILLER of Florida, Mr. WILSON of South Carolina, Mr. 
PRICE of Georgia, Mr. WESTMORELAND, and Mr. DEAL of Georgia) in-
troduced 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 place a general eligibility ceiling of 250 percent of 
the poverty level on gross income for eligibility for bene-
fits under Medicaid and SCHIP. 
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 ‘‘Medicaid and SCHIP 
Abuse Prevention Act of 2008’’. 
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SEC. 2. SCHIP AND MEDICAID GROSS INCOME ELIGIBILITY 
CEILING. 
(a) APPLICATION
OF SCHIP ELIGIBILITY CEIL-
ING.— 
(1) IN GENERAL.—Section 2110 of the Social 
Security Act (42 U.S.C. 1397jj) is amended— 
(A) in subsection (b)(1)— 
(i) by striking ‘‘and’’ at the end of 
subparagraph (B); 
(ii) by striking the period at the end 
of subparagraph (C) and inserting ‘‘; and’’; 
and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) whose gross family income (as de-
fined in subsection (c)(9)) does not exceed 250 
percent of the poverty line.’’; and 
(B) in subsection (c), by adding at the end 
the following new paragraph: 
‘‘(9) GROSS FAMILY INCOME.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘gross family income’ 
means, with respect to an individual, gross in-
come (as defined by the Secretary in regula-
tions) for the members of the individual’s fam-
ily. For purposes of the previous sentence, in 
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defining ‘gross income’ the Secretary shall, to 
the maximum extent practicable, include income 
from whatever source, other than amounts de-
ducted under section 62(a)(1) of the Internal 
Revenue Code of 1986. 
‘‘(B) INCOME DISREGARDS AUTHORIZED.— 
A State may provide, through a State plan 
amendment and with the approval of the Sec-
retary, for the disregard from gross family in-
come of one or more amounts so long as the 
total amount of such disregards for a family 
does not exceed $250 per month, or $3,000 per 
year.’’. 
(2) DENIAL OF FEDERAL MATCHING PAYMENTS 
FOR STATE SCHIP EXPENDITURES FOR INDIVIDUALS 
WITH GROSS FAMILY INCOME ABOVE 250 PERCENT 
OF THE POVERTY LINE.—Section 2105(c) of the So-
cial Security Act (42 U.S.C. 1397ee(c)) is amended 
by adding at the end the following new paragraph: 
‘‘(8) DENIAL
OF
PAYMENTS
FOR
EXPENDI-
TURES FOR CHILD HEALTH ASSISTANCE FOR INDI-
VIDUALS WHOSE GROSS FAMILY INCOME EXCEEDS 
250 PERCENT OF THE POVERTY LINE.—No payment 
may be made under this section, for any expendi-
tures for providing child health assistance or health 
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benefits coverage under a State child health plan 
under this title, including under a waiver under sec-
tion 1115, with respect to an individual whose gross 
family income (as defined in section 2110(c)(9)) ex-
ceeds 250 percent of the poverty line.’’. 
(3) CONFORMING
AMENDMENT
TO
MAINTE-
NANCE OF EFFORT.—Section 2105(d)(1) of such Act 
(42 U.S.C. 1397ee(d)(1)) is amended by inserting 
before the period at the end the following: ‘‘, unless 
such income standards were adopted in order to 
comply with the requirements of section 1939’’. 
(b) MEDICAID GROSS INCOME ELIGIBILITY CEIL-
ING.— 
(1) IN GENERAL.—Title XIX of the Social Se-
curity Act is amended by redesignating section 1939 
as section 1940 and by inserting after section 1940 
the following new section: 
‘‘SEC. 1939. INCOME ELIGIBILITY LIMITATION. 
‘‘Notwithstanding any other provision of this title, no 
individual with gross family income (as defined in section 
2110(c)(9)) that exceeds 250 percent of the poverty line 
shall be eligible to receive medical assistance under a State 
plan under this title, including under a waiver under sec-
tion 1915 or 1115.’’. 
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(2) DENIAL OF FEDERAL MATCHING PAYMENTS 
FOR STATE EXPENDITURES FOR MEDICAL ASSIST-
ANCE FOR INDIVIDUALS WHOSE GROSS FAMILY IN-
COME
EXCEEDS
250
PERCENT
OF
THE
FEDERAL 
POVERTY LINE.—Section 1903(i) of such Act (42 
U.S.C. 1396b(i)) is amended— 
(A) in paragraph (22) by striking ‘‘or’’ at 
the end; 
(B) in paragraph (23) by striking the pe-
riod at the end and inserting ‘‘; or’’; and 
(C) by inserting after paragraph (23) the 
following new paragraph: 
‘‘(24) if a State fails to comply with the provi-
sions of section 1939, with respect to amounts ex-
pended by a State for medical assistance for individ-
uals to whom the income eligibility limitation under 
such section applies.’’. 
(3) MEDICAID STATE PLAN REQUIREMENTS.— 
Section 1902(a) of such Act (42 U.S.C. 1396a(a)) 
is amended— 
(A) in paragraph (69) by striking ‘‘and’’ at 
the end; 
(B) in paragraph (70) by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
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(C) by inserting after paragraph (70) the 
following new paragraph: 
‘‘(71) provide that the State complies with the 
requirements of section 1939.’’. 
(4) CONFORMING
AMENDMENT
RELATING
TO 
INCOME
ELIGIBILITY.—Section 1903(f)(1)(A) of 
such Act (42 U.S.C. 1396b(f)(1)(A)) is amended by 
inserting before the period at the end the following: 
‘‘, if such payments are not otherwise prohibited 
under subsection (i)(24),’’. 
(c) EFFECTIVE DATE; TRANSITION.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall apply to 
payments made for items and services furnished on 
or after the first day of the first calendar quarter 
beginning more than 90 days after the date of the 
enactment of this Act. 
(2) TRANSITION.—The amendments made by— 
(A)(i) subsection (a)(1) shall not apply to 
an individual who was receiving, or was deter-
mined eligible to receive, child health assistance 
or health benefits coverage under a State child 
health plan under title XXI of the Social Secu-
rity Act, including under a waiver under section 
1115 of such Act, as of the day before the date 
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of the enactment of this Act, until such date as 
the individual is determined ineligible using in-
come standards or methodologies in place as of 
the day before the date of the enactment of this 
Act; and 
(ii) subsection (a)(2) shall not apply to 
payment for items and services furnished to an 
individual described in clause (i); 
(B)(i) subsection (b)(1) shall not apply to 
an individual who was receiving, or was deter-
mined eligible to receive, medical assistance or 
health benefits coverage under a State plan 
under title XIX of the Social Security Act, in-
cluding under a waiver under section 1115 of 
such Act, as of the day before the date of the 
enactment of this Act, until such date as the in-
dividual is determined ineligible using income 
standards or methodologies in place as of the 
day before the date of the enactment of this 
Act; and 
(ii) subsection (b)(2) shall not apply to 
payment for items and services furnished to an 
individual described in clause (i). 
Æ 
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