I
106TH CONGRESS
2D SESSION
H. R. 4825
To amend title XIX of the Social Security Act to provide families of disabled
children with the opportunity to purchase coverage under the Medicaid
Program for such children, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JULY 12, 2000
Mr. SESSIONS (for himself, Mr. WAXMAN, Mr. UPTON, Mr. BARRETT of Wis-
consin, Ms. PRYCE of Ohio, Mr. STRICKLAND, Mr. HAYWORTH, Mr.
BROWN of Ohio, Mr. DREIER, Mr. LAZIO, Mr. DINGELL, Mr. DOGGETT,
Mr. RAMSTAD, Mr. NUSSLE, Mr. NETHERCUTT, Mr. GILCHREST, and
Mr. TAUZIN) introduced the following bill; which was referred to the
Committee on Commerce
A BILL
To amend title XIX of the Social Security Act to provide
families of disabled children with the opportunity to pur-
chase coverage under the Medicaid Program for such
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; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Family Opportunity Act of 2000’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Opportunity for families of disabled children to purchase medicaid cov-
erage for such children.
Sec. 3. Treatment of inpatient psychiatric hospital services for individuals
under age 21 in home or community-based services waivers.
Sec. 4. Demonstration of coverage under the medicaid program of children with
potentially severe disabilities.
Sec. 5. Development and support of family-to-family health information centers.
Sec. 6. Restoration of medicaid eligibility for certain SSI beneficiaries.
SEC. 2. OPPORTUNITY FOR FAMILIES OF DISABLED CHIL-
DREN TO PURCHASE MEDICAID COVERAGE
FOR SUCH CHILDREN.
(a) STATE OPTION TO ALLOW FAMILIES OF DIS-
ABLED CHILDREN TO PURCHASE MEDICAID COVERAGE
FOR SUCH CHILDREN.—
(1) IN GENERAL.—Section 1902 of the Social
Security Act (42 U.S.C. 1396a), as amended by the
Foster Care Independence Act of 1999 (Public Law
106–169; 113 Stat. 1822) and the Ticket to Work
and Work Incentives Improvement Act of 1999
(Public 
Law 
106–170; 
113 
Stat. 
1860), 
is
amended—
(A) in subsection (a)(10)(A)(ii)—
(i) by striking ‘‘or’’ at the end of sub-
clause (XVI);
(ii) by adding ‘‘or’’ at the end of sub-
clause (XVII); and
(iii) by adding at the end the fol-
lowing new subclause:
‘‘(XVIII) who are disabled chil-
dren described in subsection (aa);’’;
and
(B) by adding at the end the following new
subsection:
‘‘(aa)(1) Individuals described in this subsection are
individuals—
‘‘(A) who have not attained 21 years of age;
‘‘(B) who would be considered disabled under
section 1614(a)(3)(C) (determined without regard to
the reference to age in that section) but for having
family income or resources (as determined under
title XVI for children) that exceed the requirements
for receipt of supplemental security income benefits;
and
‘‘(C) whose family income (as so determined)
does not exceed—
‘‘(i) 600 percent of the income official pov-
erty line (as defined by the Office of Manage-
ment and Budget, and revised annually in ac-
cordance with section 673(2) of the Omnibus
Budget Reconciliation Act of 1981) applicable
to a family of the size involved; or
relative’s child being or remaining eligible for med-
ical 
assistance 
under 
subsection
(a)(10)(A)(ii)(XVIII) if the parent or caretaker rel-
ative is determined eligible for such coverage and the
employer contributes at least 50 percent of the total
cost of annual premiums for such coverage; and
‘‘(ii) if such coverage is obtained—
‘‘(I) subject to paragraph (2) of section
1916(h), reduce the premium imposed by the
State under that section (if any) in an amount
that reasonably reflects the premium contribu-
tion made by the family for private coverage on
behalf of a child with a disability; and
‘‘(II) treat such coverage as a third party
liability under subsection (a)(25).
‘‘(B) In the case of a parent or caretaker relative to
which subparagraph (A) applies—
‘‘(i) if the family income (as so determined) of
such parent or caretaker relative does not exceed
300 percent of the income official poverty line (as so
defined), a State may provide for payment of any
portion of the annual premium for such family cov-
erage that the parent or caretaker relative is re-
quired to pay; and
‘‘(ii) any payments made by the State under
clause (i) shall be considered, for purposes of section
1903(a), to be payments for medical assistance.’’.
(b) STATE OPTION TO IMPOSE INCOME-RELATED
PREMIUMS.—Section 1916 of the Social Security Act (42
U.S.C. 1396o), as amended by the Ticket to Work and
Work Incentives Improvement Act of 1999 (Public Law
106–170; 113 Stat. 1860), is amended—
(1) in subsection (a), by striking ‘‘subsection
(g)’’ and inserting ‘‘subsections (g) and (h)’’; and
(2) by adding at the end the following new sub-
section:
‘‘(h)(1) With respect to disabled children provided
medical 
assistance 
under 
section
1902(a)(10)(A)(ii)(XVIII), subject to paragraph (2), a
State may (in a uniform manner for such children) require
the families of such children to pay monthly premiums set
on a sliding scale based on family income (as determined
under title XVI for children).
‘‘(2) A premium requirement imposed under para-
graph (1) may only apply to the extent that—
‘‘(A) the aggregate amount of such premium
and any premium that the parent or caretaker rel-
ative is required to pay for family coverage under
section 1902(aa)(3)(A)(i) does not exceed 5 percent
of the family’s income; and
‘‘(B) the requirement is imposed consistent with
section 1902(aa)(3)(A)(ii)(I).
‘‘(3) A State shall not require prepayment of a pre-
mium imposed pursuant to paragraph (1) and shall not
terminate 
eligibility 
of 
a 
child 
under 
section
1902(a)(10)(A)(ii)(XVIII) for medical assistance under
this title on the basis of failure to pay any such premium
until such failure continues for a period of not less than
60 days from the date on which the premium became past
due. The State may waive payment of any such premium
in any case where the State determines that requiring
such payment would create an undue hardship.’’.
(c) INCREASED FEDERAL FINANCIAL ASSISTANCE
FOR ADMINISTRATIVE COSTS.—Section 1903(a)(7) of the
Social Security Act (42 U.S.C. 1396b(a)(7)) is amended—
(1) by inserting ‘‘(A)’’ after ‘‘(7)’’;
(2) by striking the period and inserting ‘‘,
and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(B) 90 percent of the sums expended during
such a quarter within the twelve-quarter period be-
ginning with the first quarter in which a payment is
made to the State pursuant to this subparagraph.’’.
(d) CONFORMING AMENDMENT.—Section 1903(f)(4)
of the Social Security Act (42 U.S.C. 1396b(f)(4)) is
amended in the matter preceding subparagraph (A) by in-
serting ‘‘1902(a)(10)(A)(ii)(XVIII)’’ before ‘‘1905(p)(1)’’.
(e) EFFECTIVE DATE.—The amendments made by
this section shall apply to medical assistance for items and
services furnished on or after October 1, 2000.
SEC. 3. TREATMENT OF INPATIENT PSYCHIATRIC HOS-
PITAL SERVICES FOR INDIVIDUALS UNDER
AGE 21 IN HOME OR COMMUNITY-BASED
SERVICES WAIVERS.
(a) IN GENERAL.—Section 1915(c) of the Social Se-
curity Act (42 U.S.C. 1396n(c)) is amended—
(1) in paragraph (1)—
(A) in the first sentence, by inserting ‘‘, or
inpatient psychiatric hospital services for indi-
viduals under age 21,’’ after ‘‘intermediate care
facility for the mentally retarded’’; and
(B) in the second sentence, by inserting ‘‘,
or inpatient psychiatric hospital services for in-
dividuals under age 21’’ before the period;
(2) in paragraph (2)(B), by striking ‘‘or serv-
ices in an intermediate care facility for the mentally
retarded’’ each place it appears and inserting ‘‘,
services in an intermediate care facility for the men-
tally retarded, or inpatient psychiatric hospital serv-
ices for individuals under age 21’’;
(3) by striking paragraph (2)(C) and inserting
the following:
‘‘(C) such individuals who are determined to be
likely to require the level of care provided in a hos-
pital, nursing facility, or intermediate care facility
for the mentally retarded, or inpatient psychiatric
hospital services for individuals under age 21, are
informed of the feasible alternatives, if available
under the waiver, at the choice of such individuals,
to the provision of inpatient hospital services, nurs-
ing facility services, services in an intermediate care
facility for the mentally retarded, or inpatient psy-
chiatric hospital services for individuals under age
21;’’; and
(4) in paragraph (7)(A)—
(A) by inserting ‘‘, or inpatient psychiatric
hospital services for individuals under age 21,’’
after ‘‘intermediate care facility for the men-
tally retarded’’; and
(B) by inserting ‘‘, or who would require
inpatient psychiatric hospital services for indi-
viduals under age 21’’ before the period.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply with respect to medical assistance
provided on or after October 1, 2000.
SEC. 4. DEMONSTRATION OF COVERAGE UNDER THE MED-
ICAID PROGRAM OF CHILDREN WITH POTEN-
TIALLY SEVERE DISABILITIES.
(a) STATE APPLICATION.—A State may apply to the
Secretary of Health and Human Services (in this section
referred to as the ‘‘Secretary’’) for approval of a dem-
onstration project (in this section referred to as a ‘‘dem-
onstration project’’) under which up to a specified max-
imum number of children with a potentially severe dis-
ability (as defined in subsection (b)) are provided medical
assistance under the State medicaid plan under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.).
(b) CHILD WITH
A POTENTIALLY SEVERE DIS-
ABILITY DEFINED.—
(1) IN
GENERAL.—In this section, the term
‘‘child with a potentially severe disability’’ means,
with respect to a demonstration project, an indi-
vidual who—
(A) has not attained 6 years of age;