SEC. 107. OPTION FOR QUALIFYING STATES TO RECEIVE 
THE ENHANCED PORTION OF THE CHIP 
MATCHING RATE FOR MEDICAID COVERAGE 
OF CERTAIN CHILDREN. 
Section 2105(g) (42 U.S.C. 1397ee(g)) is amended— 
(1) in paragraph (1)(A), by inserting ‘‘subject to 
paragraph (4),’’ after ‘‘Notwithstanding any other 
provision of law,’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(4) OPTION
FOR
ALLOTMENTS
FOR
FISCAL 
YEARS 2008 THROUGH 2012.— 
‘‘(A) PAYMENT OF ENHANCED PORTION OF 
MATCHING RATE FOR CERTAIN EXPENDITURES.— 
In the case of expenditures described in subpara-
graph (B), a qualifying State (as defined in 
paragraph (2)) may elect to be paid from the 
State’s allotment made under section 2104 for 
any of fiscal years 2008 through 2012 (insofar as 
the allotment is available to the State under sub-
sections (e) and (i) of such section) an amount 
each quarter equal to the additional amount that 
would have been paid to the State under title 
XIX with respect to such expenditures if the en-
hanced FMAP (as determined under subsection 
(b)) had been substituted for the Federal medical
assistance percentage (as defined in section 
1905(b)). 
‘‘(B) 
EXPENDITURES
DESCRIBED.—For 
purposes of subparagraph (A), the expenditures 
described in this subparagraph are expenditures 
made after the date of the enactment of this 
paragraph and during the period in which funds 
are available to the qualifying State for use 
under subparagraph (A), for the provision of 
medical assistance to individuals residing in the 
State who are eligible for medical assistance 
under the State plan under title XIX or under 
a waiver of such plan and who have not attained 
age 19 (or, if a State has so elected under the 
State plan under title XIX, age 20 or 21), and 
whose family income equals or exceeds 133 per-
cent of the poverty line but does not exceed the 
Medicaid applicable income level.’’. 
SEC. 108. ONE-TIME APPROPRIATION. 
There is appropriated to the Secretary, out of any 
money in the Treasury not otherwise appropriated, 
$12,500,000,000 to accompany the allotment made for the 
period beginning on October 1, 2011, and ending on March 
31, 2012, under section 2104(a)(15)(A) of the Social Secu-
rity Act (42 U.S.C. 1397dd(a)(15)(A)) (as added by section
101), to remain available until expended. Such amount 
shall be used to provide allotments to States under para-
graph (3) of section 2104(i) of the Social Security Act (42 
U.S.C. 1397dd(i)), as added by section 102, for the first 
6 months of fiscal year 2012 in the same manner as allot-
ments are provided under subsection (a)(15)(A) of such sec-
tion 2104 and subject to the same terms and conditions as 
apply to the allotments provided from such subsection 
(a)(15)(A). 
SEC. 109. IMPROVING FUNDING FOR THE TERRITORIES 
UNDER CHIP AND MEDICAID. 
(a) REMOVAL OF FEDERAL MATCHING PAYMENTS FOR 
DATA REPORTING SYSTEMS FROM THE OVERALL LIMIT ON 
PAYMENTS TO TERRITORIES UNDER TITLE XIX.—Section 
1108(g) (42 U.S.C. 1308(g)) is amended by adding at the 
end the following new paragraph: 
‘‘(4) EXCLUSION
OF
CERTAIN
EXPENDITURES 
FROM PAYMENT LIMITS.—With respect to fiscal years 
beginning with fiscal year 2008, if Puerto Rico, the 
Virgin Islands, Guam, the Northern Mariana Islands, 
or American Samoa qualify for a payment under 
subparagraph (A)(i), (B), or (F) of section 1903(a)(3) 
for a calendar quarter of such fiscal year, the pay-
ment shall not be taken into account in applying sub-
section (f) (as increased in accordance with para-
graphs (1), (2), and (3) of this subsection) to such 
commonwealth or territory for such fiscal year.’’. 
(b) GAO STUDY AND REPORT.—Not later than Sep-
tember 30, 2009, the Comptroller General of the United 
States shall submit a report to the Committee on Finance 
of the Senate and the Committee on Energy and Commerce 
of the House of Representatives regarding Federal funding 
under Medicaid and CHIP for Puerto Rico, the United 
States Virgin Islands, Guam, American Samoa, and the 
Northern Mariana Islands. The report shall include the fol-
lowing: 
(1) An analysis of all relevant factors with re-
spect to— 
(A) eligible Medicaid and CHIP popu-
lations in such commonwealths and territories; 
(B) historical and projected spending needs 
of such commonwealths and territories and the 
ability of capped funding streams to respond to 
those spending needs; 
(C) the extent to which Federal poverty 
guidelines are used by such commonwealths and 
territories to determine Medicaid and CHIP eli-
gibility; and 
(D) the extent to which such commonwealths 
and territories participate in data collection and
reporting related to Medicaid and CHIP, includ-
ing an analysis of territory participation in the 
Current Population Survey versus the American 
Community Survey. 
(2) Recommendations regarding methods for the 
collection and reporting of reliable data regarding the 
enrollment under Medicaid and CHIP of children in 
such commonwealths and territories 
(3) Recommendations for improving Federal 
funding under Medicaid and CHIP for such common-
wealths and territories. 
Subtitle B—Focus on Low-Income 
Children and Pregnant Women 
SEC. 111. STATE OPTION TO COVER LOW-INCOME PREG-
NANT WOMEN UNDER CHIP THROUGH A 
STATE PLAN AMENDMENT. 
(a) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et 
seq.), as amended by section 112(a), is amended by adding 
at the end the following new section: 
‘‘SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-IN-
COME PREGNANT WOMEN THROUGH A STATE 
PLAN AMENDMENT. 
‘‘(a) IN GENERAL.—Subject to the succeeding provi-
sions of this section, a State may elect through an amend-
ment to its State child health plan under section 2102 to
provide pregnancy-related assistance under such plan for 
targeted low-income pregnant women. 
‘‘(b) CONDITIONS.—A State may only elect the option 
under subsection (a) if the following conditions are satis-
fied: 
‘‘(1) MINIMUM INCOME ELIGIBILITY LEVELS FOR 
PREGNANT WOMEN AND CHILDREN.—The State has es-
tablished an income eligibility level— 
‘‘(A) for pregnant women under subsection 
(a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) 
of section 1902 that is at least 185 percent (or 
such higher percent as the State has in effect 
with regard to pregnant women under this title) 
of the poverty line applicable to a family of the 
size involved, but in no case lower than the per-
cent in effect under any such subsection as of 
July 1, 2007; and 
‘‘(B) for children under 19 years of age 
under this title (or title XIX) that is at least 200 
percent of the poverty line applicable to a family 
of the size involved. 
‘‘(2) NO CHIP INCOME ELIGIBILITY LEVEL FOR 
PREGNANT WOMEN LOWER THAN THE STATE’S MED-
ICAID LEVEL.—The State does not apply an effective 
income level for pregnant women under the State
plan amendment that is lower than the effective in-
come level (expressed as a percent of the poverty line 
and considering applicable income disregards) speci-
fied 
under 
subsection 
(a)(10)(A)(i)(III), 
(a)(10)(A)(i)(IV), or (l)(1)(A) of section 1902, on the 
date of enactment of this paragraph to be eligible for 
medical assistance as a pregnant woman. 
‘‘(3) NO COVERAGE FOR HIGHER INCOME PREG-
NANT
WOMEN
WITHOUT
COVERING
LOWER
INCOME 
PREGNANT WOMEN.—The State does not provide cov-
erage for pregnant women with higher family income 
without covering pregnant women with a lower fam-
ily income. 
‘‘(4) APPLICATION OF REQUIREMENTS FOR COV-
ERAGE OF TARGETED LOW-INCOME CHILDREN.—The 
State provides pregnancy-related assistance for tar-
geted low-income pregnant women in the same man-
ner, and subject to the same requirements, as the 
State provides child health assistance for targeted 
low-income children under the State child health 
plan, and in addition to providing child health as-
sistance for such women. 
‘‘(5) NO PREEXISTING CONDITION EXCLUSION OR 
WAITING PERIOD.—The State does not apply any ex-
clusion of benefits for pregnancy-related assistance
based on any preexisting condition or any waiting 
period (including any waiting period imposed to 
carry out section 2102(b)(3)(C)) for receipt of such 
assistance. 
‘‘(6) APPLICATION
OF
COST-SHARING
PROTEC-
TION.—The State provides pregnancy-related assist-
ance to a targeted low-income woman consistent with 
the cost-sharing protections under section 2103(e) and 
applies the limitation on total annual aggregate cost 
sharing imposed under paragraph (3)(B) of such sec-
tion to the family of such a woman. 
‘‘(7) NO
WAITING
LIST
FOR
CHILDREN.—The 
State does not impose, with respect to the enrollment 
under the State child health plan of targeted low-in-
come children during the quarter, any enrollment cap 
or other numerical limitation on enrollment, any 
waiting list, any procedures designed to delay the 
consideration of applications for enrollment, or simi-
lar limitation with respect to enrollment. 
‘‘(c) OPTION
TO
PROVIDE
PRESUMPTIVE
ELIGI-
BILITY.—A State that elects the option under subsection (a) 
and satisfies the conditions described in subsection (b) may 
elect to apply section 1920 (relating to presumptive eligi-
bility for pregnant women) to the State child health plan
in the same manner as such section applies to the State 
plan under title XIX. 
‘‘(d) DEFINITIONS.—For purposes of this section: 
‘‘(1) PREGNANCY-RELATED
ASSISTANCE.—The 
term ‘pregnancy-related assistance’ has the meaning 
given the term ‘child health assistance’ in section 
2110(a) and includes any medical assistance that the 
State would provide for a pregnant woman under the 
State plan under title XIX during the period de-
scribed in paragraph (2)(A). 
‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT 
WOMAN.—The term ‘targeted low-income pregnant 
woman’ means a woman— 
‘‘(A) during pregnancy and through the end 
of the month in which the 60-day period (begin-
ning on the last day of her pregnancy) ends; 
‘‘(B) whose family income exceeds 185 per-
cent (or, if higher, the percent applied under sub-
section (b)(1)(A)) of the poverty line applicable 
to a family of the size involved, but does not ex-
ceed the income eligibility level established under 
the State child health plan under this title for a 
targeted low-income child; and 
‘‘(C) who satisfies the requirements of para-
graphs (1)(A), (1)(C), (2), and (3) of section
2110(b) in the same manner as a child applying 
for child health assistance would have to satisfy 
such requirements. 
‘‘(e) AUTOMATIC ENROLLMENT FOR CHILDREN BORN 
TO
WOMEN
RECEIVING
PREGNANCY-RELATED
ASSIST-
ANCE.—If a child is born to a targeted low-income pregnant 
woman who was receiving pregnancy-related assistance 
under this section on the date of the child’s birth, the child 
shall be deemed to have applied for child health assistance 
under the State child health plan and to have been found 
eligible for such assistance under such plan or to have ap-
plied for medical assistance under title XIX and to have 
been found eligible for such assistance under such title, as 
appropriate, on the date of such birth and to remain eligible 
for such assistance until the child attains 1 year of age. 
During the period in which a child is deemed under the 
preceding sentence to be eligible for child health or medical 
assistance, the child health or medical assistance eligibility 
identification number of the mother shall also serve as the 
identification number of the child, and all claims shall be 
submitted and paid under such number (unless the State 
issues a separate identification number for the child before 
such period expires). 
‘‘(f) STATES
PROVIDING
ASSISTANCE
THROUGH 
OTHER OPTIONS.—
‘‘(1) CONTINUATION
OF
OTHER
OPTIONS
FOR 
PROVIDING ASSISTANCE.—The option to provide as-
sistance in accordance with the preceding subsections 
of this section shall not limit any other option for a 
State to provide— 
‘‘(A) child health assistance through the ap-
plication of sections 457.10, 457.350(b)(2), 
457.622(c)(5), and 457.626(a)(3) of title 42, 
Code of Federal Regulations (as in effect after 
the final rule adopted by the Secretary and set 
forth at 67 Fed. Reg. 61956–61974 (October 2, 
2002)), or 
‘‘(B) pregnancy-related services through the 
application of any waiver authority (as in effect 
on June 1, 2007). 
‘‘(2) CLARIFICATION OF AUTHORITY TO PROVIDE 
POSTPARTUM
SERVICES.—Any State that provides 
child health assistance under any authority described 
in paragraph (1) may continue to provide such as-
sistance, as well as postpartum services, through the 
end of the month in which the 60-day period (begin-
ning on the last day of the pregnancy) ends, in the 
same manner as such assistance and postpartum serv-
ices would be provided if provided under the State 
plan under title XIX, but only if the mother would
otherwise satisfy the eligibility requirements that 
apply under the State child health plan (other than 
with respect to age) during such period. 
‘‘(3) NO INFERENCE.—Nothing in this subsection 
shall be construed— 
‘‘(A) to infer congressional intent regarding 
the legality or illegality of the content of the sec-
tions specified in paragraph (1)(A); or 
‘‘(B) to modify the authority to provide 
pregnancy-related services under a waiver speci-
fied in paragraph (1)(B).’’. 
(b) ADDITIONAL CONFORMING AMENDMENTS.— 
(1) NO COST SHARING FOR PREGNANCY-RELATED 
BENEFITS.—Section 
2103(e)(2) 
(42 
U.S.C. 
1397cc(e)(2)) is amended— 
(A) in the heading, by inserting ‘‘OR 
PREGNANCY-RELATED
ASSISTANCE’’ after 
‘‘PREVENTIVE SERVICES’’; and 
(B) by inserting before the period at the end 
the following: ‘‘or for pregnancy-related assist-
ance’’. 
(2) NO WAITING PERIOD.—Section 2102(b)(1)(B) 
(42 U.S.C. 1397bb(b)(1)(B)) is amended— 
(A) in clause (i), by striking ‘‘, and’’ at the 
end and inserting a semicolon;
(B) in clause (ii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(iii) may not apply a waiting period 
(including a waiting period to carry out 
paragraph (3)(C)) in the case of a targeted 
low-income pregnant woman provided preg-
nancy-related 
assistance 
under 
section 
2112.’’. 
SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT 
CHILDLESS ADULTS UNDER CHIP; CONDI-
TIONS FOR COVERAGE OF PARENTS. 
(a) PHASE-OUT RULES.— 
(1) IN GENERAL.—Title XXI (42 U.S.C. 1397aa 
et seq.) is amended by adding at the end the following 
new section: 
‘‘SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT 
CHILDLESS ADULTS; CONDITIONS FOR COV-
ERAGE OF PARENTS. 
‘‘(a) TERMINATION OF COVERAGE FOR NONPREGNANT 
CHILDLESS ADULTS.— 
‘‘(1) NO NEW CHIP WAIVERS; AUTOMATIC EXTEN-
SIONS
AT
STATE
OPTION
THROUGH
FISCAL
YEAR 
2008.—Notwithstanding section 1115 or any other
provision of this title, except as provided in this sub-
section— 
‘‘(A) the Secretary shall not on or after the 
date of the enactment of the Children’s Health 
Insurance Program Reauthorization Act of 2007, 
approve or renew a waiver, experimental, pilot, 
or demonstration project that would allow funds 
made available under this title to be used to pro-
vide child health assistance or other health bene-
fits coverage to a nonpregnant childless adult; 
and 
‘‘(B) notwithstanding the terms and condi-
tions of an applicable existing waiver, the provi-
sions of paragraphs (2) and (3) shall apply for 
purposes of any fiscal year beginning on or after 
October 1, 2008, in determining the period to 
which the waiver applies, the individuals eligible 
to be covered by the waiver, and the amount of 
the Federal payment under this title. 
‘‘(2) TERMINATION OF CHIP COVERAGE UNDER 
APPLICABLE EXISTING WAIVERS AT THE END OF FIS-
CAL YEAR 2008.— 
‘‘(A) IN GENERAL.—No funds shall be avail-
able under this title for child health assistance or 
other health benefits coverage that is provided to
a nonpregnant childless adult under an applica-
ble existing waiver after September 30, 2008. 
‘‘(B) EXTENSION UPON STATE REQUEST.— 
If an applicable existing waiver described in 
subparagraph (A) would otherwise expire before 
October 1, 2008, and the State requests an exten-
sion of such waiver, the Secretary shall grant 
such an extension, but only through September 
30, 2008. 
‘‘(C) APPLICATION OF ENHANCED FMAP.— 
The enhanced FMAP determined under section 
2105(b) shall apply to expenditures under an 
applicable existing waiver for the provision of 
child health assistance or other health benefits 
coverage to a nonpregnant childless adult during 
fiscal year 2008. 
‘‘(3) OPTIONAL 1-YEAR TRANSITIONAL COVERAGE 
BLOCK GRANT FUNDED FROM STATE ALLOTMENT.— 
Subject to paragraph (4)(B), each State for which 
coverage under an applicable existing waiver is ter-
minated under paragraph (2)(A) may elect to provide 
nonpregnant childless adults who were provided child 
health assistance or health benefits coverage under the 
applicable existing waiver at any time during fiscal 
year 2008 with such assistance or coverage during fis-
cal year 2009, as if the authority to provide such as-
sistance or coverage under an applicable existing 
waiver was extended through that fiscal year, but sub-
ject to the following terms and conditions: 
‘‘(A) BLOCK GRANT SET ASIDE FROM STATE 
ALLOTMENT.—The Secretary shall set aside for 
the State an amount equal to the Federal share 
of the State’s projected expenditures under the 
applicable existing waiver for providing child 
health assistance or health benefits coverage to 
all nonpregnant childless adults under such 
waiver for fiscal year 2008 (as certified by the 
State and submitted to the Secretary by not later 
than August 31, 2008, and without regard to 
whether any such individual lost coverage during 
fiscal year 2008 and was later provided child 
health assistance or other health benefits coverage 
under the waiver in that fiscal year), increased 
by the annual adjustment for fiscal year 2009 
determined under section 2104(i)(5)(A). The Sec-
retary may adjust the amount set aside under 
the preceding sentence, as necessary, on the basis 
of the expenditure data for fiscal year 2008 re-
ported by States on CMS Form 64 or CMS 
Form 21 not later than November 30, 2008, but
in no case shall the Secretary adjust such 
amount after December 31, 2008. 
‘‘(B) NO
COVERAGE
FOR
NONPREGNANT 
CHILDLESS ADULTS WHO WERE NOT COVERED 
DURING FISCAL YEAR 2008.— 
‘‘(i) FMAP 
APPLIED
TO
EXPENDI-
TURES.—The Secretary shall pay the State 
for each quarter of fiscal year 2009, from 
the amount set aside under subparagraph 
(A), an amount equal to the Federal med-
ical assistance percentage (as determined 
under section 1905(b) without regard to 
clause (4) of such section) of expenditures in 
the quarter for providing child health assist-
ance or other health benefits coverage to a 
nonpregnant childless adult but only if such 
adult was enrolled in the State program 
under this title during fiscal year 2008 
(without regard to whether the individual 
lost coverage during fiscal year 2008 and 
was reenrolled in that fiscal year or in fis-
cal year 2009). 
‘‘(ii) FEDERAL PAYMENTS LIMITED TO 
AMOUNT OF BLOCK GRANT SET-ASIDE.—No 
payments shall be made to a State for ex-
penditures described in this subparagraph 
after the total amount set aside under sub-
paragraph (A) for fiscal year 2009 has been 
paid to the State. 
‘‘(4) STATE
OPTION
TO
APPLY
FOR
MEDICAID 
WAIVER TO CONTINUE COVERAGE FOR NONPREGNANT 
CHILDLESS ADULTS.— 
‘‘(A) IN GENERAL.—Each State for which 
coverage under an applicable existing waiver is 
terminated under paragraph (2)(A) may submit, 
not later than June 30, 2009, an application to 
the Secretary for a waiver under section 1115 of 
the State plan under title XIX to provide med-
ical assistance to a nonpregnant childless adult 
whose coverage is so terminated (in this sub-
section referred to as a ‘Medicaid nonpregnant 
childless adults waiver’). 
‘‘(B) DEADLINE FOR APPROVAL.—The Sec-
retary shall make a decision to approve or deny 
an application for a Medicaid nonpregnant 
childless adults waiver submitted under subpara-
graph (A) within 90 days of the date of the sub-
mission of the application. If no decision has 
been made by the Secretary as of September 30, 
2009, on the application of a State for a Med-
icaid nonpregnant childless adults waiver that 
was submitted to the Secretary by June 30, 
2009, the application shall be deemed approved. 
‘‘(C) 
STANDARD
FOR
BUDGET
NEU-
TRALITY.—The budget neutrality requirement 
applicable with respect to expenditures for med-
ical assistance under a Medicaid nonpregnant 
childless adults waiver shall— 
‘‘(i) in the case of fiscal year 2010, 
allow expenditures for medical assistance 
under title XIX for all such adults to not 
exceed the total amount of payments made 
to the State under paragraph (3)(B) for fis-
cal year 2009, increased by the percentage 
increase (if any) in the projected nominal 
per capita amount of National Health Ex-
penditures for calendar year 2010 over cal-
endar year 2009, as most recently published 
by the Secretary; and 
‘‘(ii) in the case of any succeeding fis-
cal year, allow such expenditures to not ex-
ceed the amount in effect under this sub-
paragraph for the preceding fiscal year, in-
creased by the percentage increase (if any) 
in the projected nominal per capita amount
of National Health Expenditures for the 
calendar year that begins during the fiscal 
year involved over the preceding calendar 
year, as most recently published by the Sec-
retary. 
‘‘(b) RULES AND CONDITIONS FOR COVERAGE OF PAR-
ENTS OF TARGETED LOW-INCOME CHILDREN.— 
‘‘(1) TWO-YEAR TRANSITION PERIOD; AUTOMATIC 
EXTENSION AT STATE OPTION THROUGH FISCAL YEAR 
2009.— 
‘‘(A) NO
NEW
CHIP
WAIVERS.—Notwith-
standing section 1115 or any other provision of 
this title, except as provided in this subsection— 
‘‘(i) the Secretary shall not on or after 
the date of the enactment of the Children’s 
Health Insurance Program Reauthorization 
Act of 2007 approve or renew a waiver, ex-
perimental, pilot, or demonstration project 
that would allow funds made available 
under this title to be used to provide child 
health assistance or other health benefits 
coverage to a parent of a targeted low-in-
come child; and 
‘‘(ii) notwithstanding the terms and 
conditions of an applicable existing waiver,
the provisions of paragraphs (2) and (3) 
shall apply for purposes of any fiscal year 
beginning on or after October 1, 2009, in 
determining the period to which the waiver 
applies, the individuals eligible to be cov-
ered by the waiver, and the amount of the 
Federal payment under this title. 
‘‘(B) EXTENSION UPON STATE REQUEST.— 
If an applicable existing waiver described in 
subparagraph (A) would otherwise expire before 
October 1, 2009, and the State requests an exten-
sion of such waiver, the Secretary shall grant 
such an extension, but only, subject to paragraph 
(2)(A), through September 30, 2009. 
‘‘(C) APPLICATION OF ENHANCED FMAP.— 
The enhanced FMAP determined under section 
2105(b) shall apply to expenditures under an 
applicable existing waiver for the provision of 
child health assistance or other health benefits 
coverage to a parent of a targeted low-income 
child during fiscal years 2008 and 2009. 
‘‘(2) RULES FOR FISCAL YEARS 2010 THROUGH 
2012.— 
‘‘(A) PAYMENTS FOR COVERAGE LIMITED TO 
BLOCK
GRANT
FUNDED
FROM
STATE
ALLOT-
MENT.—Any State that provides child health as-
sistance or health benefits coverage under an ap-
plicable existing waiver for a parent of a tar-
geted low-income child may elect to continue to 
provide such assistance or coverage through fiscal 
year 2010, 2011, or 2012, subject to the same 
terms and conditions that applied under the ap-
plicable existing waiver, unless otherwise modi-
fied in subparagraph (B). 
‘‘(B) TERMS AND CONDITIONS.— 
‘‘(i) BLOCK GRANT SET ASIDE FROM 
STATE ALLOTMENT.—If the State makes an 
election under subparagraph (A), the Sec-
retary shall set aside for the State for each 
such fiscal year an amount equal to the 
Federal share of 110 percent of the State’s 
projected expenditures under the applicable 
existing waiver for providing child health 
assistance or health benefits coverage to all 
parents of targeted low-income children en-
rolled under such waiver for the fiscal year 
(as certified by the State and submitted to 
the Secretary by not later than August 31 
of the preceding fiscal year). In the case of 
fiscal year 2012, the set aside for any State
shall be computed separately for each period 
described in subparagraphs (A) and (B) of 
section 2104(a)(15) and any reduction in 
the allotment for either such period under 
section 2104(i)(4) shall be allocated on a 
pro rata basis to such set aside. 
‘‘(ii) 
PAYMENTS
FROM
BLOCK 
GRANT.—The Secretary shall pay the State 
from the amount set aside under clause (i) 
for the fiscal year, an amount for each 
quarter of such fiscal year equal to the ap-
plicable percentage determined under clause 
(iii) or (iv) for expenditures in the quarter 
for providing child health assistance or 
other health benefits coverage to a parent of 
a targeted low-income child. 
‘‘(iii) ENHANCED FMAP ONLY IN FIS-
CAL YEAR 2010 FOR STATES WITH SIGNIFI-
CANT CHILD OUTREACH OR THAT ACHIEVE 
CHILD COVERAGE BENCHMARKS; FMAP FOR 
ANY
OTHER
STATES.—For purposes of 
clause (ii), the applicable percentage for 
any quarter of fiscal year 2010 is equal 
to—
‘‘(I) the enhanced FMAP deter-
mined under section 2105(b) in the 
case of a State that meets the outreach 
or coverage benchmarks described in 
any of subparagraph (A), (B), or (C) 
of paragraph (3) for fiscal year 2009; 
or 
‘‘(II) the Federal medical assist-
ance percentage (as determined under 
section 1905(b) without regard to 
clause (4) of such section) in the case 
of any other State. 
‘‘(iv) AMOUNT OF FEDERAL MATCHING 
PAYMENT IN 2011 OR 2012.—For purposes of 
clause (ii), the applicable percentage for 
any quarter of fiscal year 2011 or 2012 is 
equal to— 
‘‘(I) the REMAP percentage if— 
‘‘(aa) the applicable percent-
age for the State under clause 
(iii) was the enhanced FMAP for 
fiscal year 2009; and 
‘‘(bb) the State met either of 
the coverage benchmarks described 
in subparagraph (B) or (C) of
paragraph (3) for the preceding 
fiscal year; or 
‘‘(II) the Federal medical assist-
ance percentage (as so determined) in 
the case of any State to which sub-
clause (I) does not apply. 
For purposes of subclause (I), the REMAP 
percentage is the percentage which is the 
sum of such Federal medical assistance per-
centage and a number of percentage points 
equal to one-half of the difference between 
such Federal medical assistance percentage 
and such enhanced FMAP. 
‘‘(v) NO
FEDERAL
PAYMENTS
OTHER 
THAN FROM BLOCK GRANT SET ASIDE.—No 
payments shall be made to a State for ex-
penditures described in clause (ii) after the 
total amount set aside under clause (i) for 
a fiscal year has been paid to the State. 
‘‘(vi) NO INCREASE IN INCOME ELIGI-
BILITY LEVEL FOR PARENTS.—No payments 
shall be made to a State from the amount 
set aside under clause (i) for a fiscal year 
for expenditures for providing child health 
assistance or health benefits coverage to a
parent of a targeted low-income child whose 
family income exceeds the income eligibility 
level applied under the applicable existing 
waiver to parents of targeted low-income 
children on the date of enactment of the 
Children’s Health Insurance Program Re-
authorization Act of 2007. 
‘‘(3) OUTREACH OR COVERAGE BENCHMARKS.— 
For purposes of paragraph (2), the outreach or cov-
erage benchmarks described in this paragraph are as 
follows: 
‘‘(A) SIGNIFICANT CHILD OUTREACH CAM-
PAIGN.—The State— 
‘‘(i) was awarded a grant under sec-
tion 2113 for fiscal year 2009; 
‘‘(ii) implemented 1 or more of the en-
rollment and retention provisions described 
in section 2105(a)(4) for such fiscal year; or 
‘‘(iii) has submitted a specific plan for 
outreach for such fiscal year. 
‘‘(B) 
HIGH-PERFORMING
STATE.—The 
State, on the basis of the most timely and accu-
rate published estimates of the Bureau of the 
Census, ranks in the lowest 1⁄3 of States in terms
of the State’s percentage of low-income children 
without health insurance. 
‘‘(C) STATE INCREASING ENROLLMENT OF 
LOW-INCOME CHILDREN.—The State qualified for 
a performance bonus payment under section 
2105(a)(3)(B) for the most recent fiscal year ap-
plicable under such section. 
‘‘(4) RULES OF CONSTRUCTION.—Nothing in this 
subsection shall be construed as prohibiting a State 
from submitting an application to the Secretary for 
a waiver under section 1115 of the State plan under 
title XIX to provide medical assistance to a parent of 
a targeted low-income child that was provided child 
health assistance or health benefits coverage under an 
applicable existing waiver. 
‘‘(c) APPLICABLE EXISTING WAIVER.—For purposes of 
this section— 
‘‘(1) IN GENERAL.—The term ‘applicable existing 
waiver’ means a waiver, experimental, pilot, or dem-
onstration project under section 1115, grandfathered 
under section 6102(c)(3) of the Deficit Reduction Act 
of 2005, or otherwise conducted under authority 
that—
‘‘(A) would allow funds made available 
under this title to be used to provide child health 
assistance or other health benefits coverage to— 
‘‘(i) a parent of a targeted low-income 
child; 
‘‘(ii) a nonpregnant childless adult; or 
‘‘(iii) individuals described in both 
clauses (i) and (ii); and 
‘‘(B) was in effect during fiscal year 2007. 
‘‘(2) DEFINITIONS.— 
‘‘(A) PARENT.—The term ‘parent’ includes 
a caretaker relative (as such term is used in car-
rying out section 1931) and a legal guardian. 
‘‘(B) NONPREGNANT CHILDLESS ADULT.— 
The term ‘nonpregnant childless adult’ has the 
meaning given such term by section 2107(f).’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 2107(f) (42 U.S.C. 1397gg(f)) is 
amended— 
(i) by striking ‘‘, the Secretary’’ and 
inserting ‘‘: 
‘‘(1) The Secretary’’; 
(ii) in the first sentence, by inserting 
‘‘or a parent (as defined in section
2111(c)(2)(A)), who is not pregnant, of a 
targeted low-income child’’ before the period; 
(iii) by striking the second sentence; 
and 
(iv) by adding at the end the following 
new paragraph: 
‘‘(2) The Secretary may not approve, extend, 
renew, or amend a waiver, experimental, pilot, or 
demonstration project with respect to a State after the 
date of enactment of the Children’s Health Insurance 
Program Reauthorization Act of 2007 that would 
waive or modify the requirements of section 2111.’’. 
(B) Section 6102(c) of the Deficit Reduction 
Act of 2005 (Public Law 109–171; 120 Stat. 
131) is amended by striking ‘‘Nothing’’ and in-
serting ‘‘Subject to section 2111 of the Social Se-
curity Act, as added by section 112 of the Chil-
dren’s Health Insurance Program Reauthoriza-
tion Act of 2007, nothing’’. 
(b) GAO STUDY AND REPORT.— 
(1) IN GENERAL.—The Comptroller General of 
the United States shall conduct a study of whether— 
(A) the coverage of a parent, a caretaker 
relative (as such term is used in carrying out 
section 1931), or a legal guardian of a targeted
low-income child under a State health plan 
under title XXI of the Social Security Act in-
creases the enrollment of, or the quality of care 
for, children, and 
(B) such parents, relatives, and legal guard-
ians who enroll in such a plan are more likely 
to enroll their children in such a plan or in a 
State plan under title XIX of such Act. 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Comptroller 
General shall report the results of the study to the 
Committee on Finance of the Senate and the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives, including recommendations (if any) for 
changes in legislation. 
SEC. 113. ELIMINATION OF COUNTING MEDICAID CHILD 
PRESUMPTIVE ELIGIBILITY COSTS AGAINST 
TITLE XXI ALLOTMENT. 
(a) IN GENERAL.—Section 2105(a)(1) (42 U.S.C. 
1397ee(a)(1)) is amended— 
(1) in the matter preceding subparagraph (A), 
by striking ‘‘(or, in the case of expenditures described 
in subparagraph (B), the Federal medical assistance 
percentage (as defined in the first sentence of section 
1905(b)))’’; and
(2) by striking subparagraph (B) and inserting 
the following new subparagraph: 
‘‘(B) [reserved]’’. 
(b) AMENDMENTS TO MEDICAID.— 
(1) 
ELIGIBILITY
OF
A
NEWBORN.—Section 
1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended in the 
first sentence by striking ‘‘so long as the child is a 
member of the woman’s household and the woman re-
mains (or would remain if pregnant) eligible for such 
assistance’’. 
(2) APPLICATION
OF
QUALIFIED
ENTITIES
TO 
PRESUMPTIVE
ELIGIBILITY
FOR
PREGNANT
WOMEN 
UNDER
MEDICAID.—Section 1920(b) (42 U.S.C. 
1396r–1(b)) is amended by adding after paragraph 
(2) the following flush sentence: 
‘‘The term ‘qualified provider’ also includes a qualified en-
tity, as defined in section 1920A(b)(3).’’. 
SEC. 114. LIMITATION ON MATCHING RATE FOR STATES 
THAT PROPOSE TO COVER CHILDREN WITH 
EFFECTIVE FAMILY INCOME THAT EXCEEDS 
300 PERCENT OF THE POVERTY LINE. 
(a) FMAP APPLIED
TO EXPENDITURES.—Section 
2105(c) (42 U.S.C. 1397ee(c)) is amended by adding at the 
end the following new paragraph:
‘‘(8) LIMITATION ON MATCHING RATE FOR EX-
PENDITURES FOR CHILD HEALTH ASSISTANCE PRO-
VIDED TO CHILDREN WHOSE EFFECTIVE FAMILY IN-
COME
EXCEEDS
300
PERCENT
OF
THE
POVERTY 
LINE.— 
‘‘(A) FMAP APPLIED TO EXPENDITURES.— 
Except as provided in subparagraph (B), for fis-
cal years beginning with fiscal year 2008, the 
Federal medical assistance percentage (as deter-
mined under section 1905(b) without regard to 
clause (4) of such section) shall be substituted for 
the enhanced FMAP under subsection (a)(1) with 
respect to any expenditures for providing child 
health assistance or health benefits coverage for a 
targeted low-income child whose effective family 
income would exceed 300 percent of the poverty 
line but for the application of a general exclu-
sion of a block of income that is not determined 
by type of expense or type of income. 
‘‘(B) EXCEPTION.—Subparagraph (A) shall 
not apply to any State that, on the date of en-
actment of the Children’s Health Insurance Pro-
gram Reauthorization Act of 2007, has an ap-
proved State plan amendment or waiver to pro-
vide, or has enacted a State law to submit a
State plan amendment to provide, expenditures 
described in such subparagraph under the State 
child health plan.’’. 
(b) RULE OF CONSTRUCTION.—Nothing in the amend-
ments made by this section shall be construed as— 
(1) changing any income eligibility level for chil-
dren under title XXI of the Social Security Act; or 
(2) changing the flexibility provided States 
under such title to establish the income eligibility 
level for targeted low-income children under a State 
child health plan and the methodologies used by the 
State to determine income or assets under such plan. 
SEC. 115. STATE AUTHORITY UNDER MEDICAID. 
(a) STATE AUTHORITY TO EXPAND INCOME OR RE-
SOURCE ELIGIBILITY LEVELS FOR CHILDREN.—Nothing in 
this Act, the amendments made by this Act, or title XIX 
of the Social Security Act, including paragraph (2)(B) of 
section 1905(u) of such Act, shall be construed as limiting 
the flexibility afforded States under such title to increase 
the income or resource eligibility levels for children under 
a State plan or waiver under such title. 
(b) STATE AUTHORITY TO RECEIVE PAYMENTS UNDER 
MEDICAID FOR PROVIDING MEDICAL ASSISTANCE TO CHIL-
DREN ELIGIBLE AS A RESULT OF AN INCOME OR RESOURCE 
ELIGIBILITY LEVEL EXPANSION.—A State may, notwith-
standing the fourth sentence of subsection (b) of section 1905 
of the Social Security Act (42 U.S.C. 1396d) or subsection 
(u) of such section— 
(1) cover individuals described in section 
1902(a)(10)(A)(ii)(IX) of the Social Security Act and 
thereby receive Federal financial participation for 
medical assistance for such individuals under title 
XIX of the Social Security Act; or 
(2) receive Federal financial participation for 
expenditures for medical assistance under Medicaid 
for children described in paragraph (2)(B) or (3) of 
section 1905(u) of such Act based on the Federal med-
ical assistance percentage, as otherwise determined 
based on the first and third sentences of subsection (b) 
of section 1905 of the Social Security Act, rather than 
on the basis of an enhanced FMAP (as defined in sec-
tion 2105(b) of such Act). 
SEC. 116. PREVENTING SUBSTITUTION OF CHIP COVERAGE 
FOR PRIVATE COVERAGE. 
(a) FINDINGS.— 
(1) Congress agrees with the President that low- 
income children should be the first priority of all 
States in providing child health assistance under 
CHIP.
(2) Congress agrees with the President and the 
Congressional Budget Office that the substitution of 
CHIP coverage for private coverage occurs more fre-
quently for children in families at higher income lev-
els. 
(3) Congress agrees with the President that it is 
appropriate that States that expand CHIP eligibility 
to children at higher income levels should have 
achieved a high level of health benefits coverage for 
low-income children and should implement strategies 
to address such substitution. 
(4) Congress concludes that the policies specified 
in this section (and the amendments made by this 
section) are the appropriate policies to address these 
issues. 
(b) ANALYSES OF BEST PRACTICES AND METHOD-
OLOGY IN ADDRESSING CROWD-OUT.— 
(1) GAO REPORT.—Not later than 18 months 
after the date of the enactment of this Act, the Comp-
troller General of the United States shall submit to 
the Committee on Finance of the Senate and the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives and the Secretary a report describing the 
best practices by States in addressing the issue of
CHIP crowd-out. Such report shall include analyses 
of— 
(A) the impact of different geographic areas, 
including urban and rural areas, on CHIP 
crowd-out; 
(B) the impact of different State labor mar-
kets on CHIP crowd-out; 
(C) the impact of different strategies for ad-
dressing CHIP crowd-out; 
(D) the incidence of crowd-out for children 
with different levels of family income; and 
(E) the relationship (if any) between 
changes in the availability and affordability of 
dependent coverage under employer-sponsored 
health insurance and CHIP crowd-out. 
(2) IOM REPORT ON METHODOLOGY.—The Sec-
retary shall enter into an arrangement with the Insti-
tute of Medicine under which the Institute submits to 
the Committee on Finance of the Senate and the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives and the Secretary, not later than 18 
months after the date of the enactment of this Act, a 
report on— 
(A) the most accurate, reliable, and timely 
way to measure—
(i) on a State-by-State basis, the rate 
of public and private health benefits cov-
erage among low-income children with fam-
ily income that does not exceed 200 percent 
of the poverty line; and 
(ii) CHIP crowd-out, including in the 
case of children with family income that ex-
ceeds 200 percent of the poverty line; and 
(B) the least burdensome way to gather the 
necessary data to conduct the measurements de-
scribed in subparagraph (A). 
Out of any money in the Treasury not otherwise ap-
propriated, there are hereby appropriated $2,000,000 
to carry out this paragraph for the period ending 
September 30, 2009. 
(3) INCORPORATION
OF
DEFINITIONS.—In this 
section, the terms ‘‘CHIP crowd-out’’, ‘‘children’’, 
‘‘poverty line’’, and ‘‘State’’ have the meanings given 
such terms for purposes of CHIP. 
(4) DEFINITION OF CHIP CROWD-OUT.—Section 
2110(c) (42 U.S.C. 1397jj(c)) is amended by adding 
at the end the following: 
‘‘(9) CHIP 
CROWD-OUT.—The term ‘CHIP 
crowd-out’ means the substitution of—
‘‘(A) health benefits coverage for a child 
under this title, for 
‘‘(B) health benefits coverage for the child 
other than under this title or title XIX.’’. 
(c) DEVELOPMENT OF BEST PRACTICE RECOMMENDA-
TIONS.—Section 2107 (42 U.S.C. 1397gg) is amended by 
adding at the end the following: 
‘‘(g) DEVELOPMENT
OF
BEST
PRACTICE
REC-
OMMENDATIONS.—Within 6 months after the date of receipt 
of the reports under subsections (a) and (b) of section 116 
of the Children’s Health Insurance Program Reauthoriza-
tion Act of 2007, the Secretary, in consultation with States, 
including Medicaid and CHIP directors in States, shall 
publish in the Federal Register, and post on the public 
website for the Department of Health and Human Serv-
ices— 
‘‘(1) recommendations regarding best practices 
for States to use to address CHIP crowd-out; and 
‘‘(2) uniform standards for data collection by 
States to measure and report— 
‘‘(A) health benefits coverage for children 
with family income below 200 percent of the pov-
erty line; and
‘‘(B) on CHIP crowd-out, including for 
children with family income that exceeds 200 
percent of the poverty line. 
The Secretary, in consultation with States, including Med-
icaid and CHIP directors in States, may from time to time 
update the best practice recommendations and uniform 
standards set published under paragraphs (1) and (2) and 
shall provide for publication and posting of such updated 
recommendations and standards.’’. 
(d) REQUIREMENT TO ADDRESS CHIP CROWD-OUT; 
SECRETARIAL REVIEW.—Section 2106 (42 U.S.C. 1397ff) 
is amended by adding at the end the following: 
‘‘(f) REQUIREMENT TO ADDRESS CHIP CROWD-OUT; 
SECRETARIAL REVIEW.— 
‘‘(1) IN GENERAL.—Each State that, on or after 
the best practice application date described in para-
graph (3), submits a plan amendment (or waiver re-
quest) to provide for eligibility for child health assist-
ance under the State child health plan for higher in-
come children described in section 2105(c)(9)(D) (re-
lating to children whose effective family income ex-
ceeds 300 percent of the poverty line) shall include 
with such plan amendment or request a description 
of how the State—
‘‘(A) will address CHIP crowd-out for such 
children; and 
‘‘(B) will incorporate recommended best 
practices referred to in such paragraph. 
‘‘(2) APPLICATION TO CERTAIN STATES.—Each 
State that, as of the best practice application date de-
scribed in paragraph (3), has a State child health 
plan that provides (whether under the plan or 
through a waiver) for eligibility for child health as-
sistance for children referred to in paragraph (1) 
shall submit to the Secretary, not later than 6 months 
after the date of such application, a State plan 
amendment describing how the State— 
‘‘(A) will address CHIP crowd-out for such 
children; and 
‘‘(B) will incorporate recommended best 
practices referred to in such paragraph. 
‘‘(3) BEST PRACTICE APPLICATION DATE.—The 
best practice application date described in this para-
graph is the date that is 6 months after the date of 
publication of recommendations regarding best prac-
tices under section 2107(g)(1). 
‘‘(4) 
SECRETARIAL
REVIEW.—The 
Secretary 
shall—
‘‘(A) review each State plan amendment or 
waiver request submitted under paragraph (1) or 
(2); 
‘‘(B) determine whether the amendment or 
request incorporates recommended best practices 
referred to in paragraph (3); 
‘‘(C) determine whether the State meets the 
enrollment targets required under reference sec-
tion 2105(c)(9)(C); and 
‘‘(D) notify the State of such determina-
tions.’’. 
(e) LIMITATION ON PAYMENTS FOR STATES COVERING 
HIGHER INCOME CHILDREN.—Section 2105(c) (42 U.S.C. 
1397ee(c)), as amended by section 114(a), is amended by 
adding at the end the following new subsection: 
‘‘(9) LIMITATION ON PAYMENTS FOR STATES COV-
ERING HIGHER INCOME CHILDREN.— 
‘‘(A) DETERMINATIONS.— 
‘‘(i) IN GENERAL.—The Secretary shall 
determine, for each State that is a higher 
income eligibility State as of April 1 of 
2010 and each subsequent year, whether the 
State meets the target rate of coverage of 
low-income children required under sub-
paragraph (C) and shall notify the State in 
that month of such determination. 
‘‘(ii) DETERMINATION OF FAILURE.—If 
the Secretary determines in such month that 
a higher income eligibility State does not 
meet such target rate of coverage, subject to 
subparagraph (E), no payment shall be 
made as of October 1 of such year on or 
after October 1, 2010, under this section for 
child health assistance provided for higher- 
income children (as defined in subpara-
graph (D)) under the State child health 
plan unless and until the State establishes 
it is in compliance with such requirement. 
‘‘(B) 
HIGHER
INCOME
ELIGIBILITY 
STATE.—A higher income eligibility State de-
scribed in this clause is a State that— 
‘‘(i) applies under its State child 
health plan an eligibility income standard 
for targeted low-income children that ex-
ceeds 300 percent of the poverty line; or 
‘‘(ii) because of the application of a 
general exclusion of a block of income that 
is not determined by type of expense or type 
of income, applies an effective income
standard under the State child health plan 
for such children that exceeds 300 percent of 
the poverty line. 
‘‘(C) REQUIREMENT FOR TARGET RATE OF 
COVERAGE OF LOW-INCOME CHILDREN.— 
‘‘(i) IN GENERAL.—The requirement of 
this subparagraph for a State is that the 
rate of health benefits coverage (both private 
and public) for low-income children in the 
State is not statistically significantly (at a 
p=0.05 level) less than the target rate of 
coverage specified in clause (ii). 
‘‘(ii) TARGET RATE.—The target rate 
of coverage specified in this clause is the av-
erage rate (determined by the Secretary) of 
health benefits coverage (both private and 
public) as of January 1, 2010, among the 
10 of the 50 States and the District of Co-
lumbia with the highest percentage of health 
benefits coverage (both private and public) 
for low-income children. 
‘‘(iii) STANDARDS FOR DATA.— In ap-
plying this subparagraph, rates of health 
benefits coverage for States shall be deter-
mined using the uniform standards identi-
fied 
by 
the 
Secretary 
under 
section 
2107(g)(2). 
‘‘(D) HIGHER-INCOME
CHILD.—For pur-
poses of this paragraph, the term ‘higher income 
child’ means, with respect to a State child health 
plan, a targeted low-income child whose family 
income— 
‘‘(i) exceeds 300 percent of the poverty 
line; or 
‘‘(ii) would exceed 300 percent of the 
poverty line if there were not taken into ac-
count any general exclusion described in 
subparagraph (B)(ii). 
‘‘(E) NOTICE AND OPPORTUNITY TO COMPLY 
WITH TARGET RATE.—If the Secretary makes a 
determination described in subparagraph (A)(ii) 
in April of a year, the Secretary— 
‘‘(i) shall provide the State with the 
opportunity to submit and implement a 
corrective action plan for the State to come 
into compliance with the requirement of 
subparagraph (C) before October 1 of such 
year; 
‘‘(ii) shall not effect a denial of pay-
ment under subparagraph (A) on the basis
of such determination before October 1 of 
such year; and 
‘‘(iii) shall not effect such a denial if 
the Secretary determines that there is a rea-
sonable likelihood that the implementation 
of such a correction action plan will bring 
the State into compliance with the require-
ment of subparagraph (C).’’. 
(f) TREATMENT OF MEDICAL SUPPORT ORDERS.—Sec-
tion 2102(b) (42 U.S.C. 1397bb(c)) is amended by adding 
at the end the following: 
‘‘(5) TREATMENT
OF
MEDICAL
SUPPORT
OR-
DERS.— 
‘‘(A) IN
GENERAL.—Nothing in this title 
shall be construed to allow the Secretary to re-
quire that a State deny eligibility for child 
health assistance to a child who is otherwise eli-
gible on the basis of the existence of a valid med-
ical support order being in effect. 
‘‘(B) STATE ELECTION.—A State may elect 
to limit eligibility for child health assistance to 
a targeted low-income child on the basis of the 
existence of a valid medical support order on the 
child’s behalf, but only if the State does not deny 
such eligibility for a child on such basis if the
child asserts that the order is not being complied 
with for any of the reasons described in subpara-
graph (C) unless the State demonstrates that 
none of such reasons applies in the case involved. 
‘‘(C) REASONS FOR NONCOMPLIANCE.—The 
reasons described in this subparagraph for non-
compliance with a medical support order with 
respect to a child are that the child is not being 
provided health benefits coverage pursuant to 
such order because— 
‘‘(i) of failure of the noncustodial par-
ent to comply with the order; 
‘‘(ii) of the failure of an employer, 
group health plan or health insurance issuer 
to comply with such order; or 
‘‘(iii) the child resides in a geographic 
area in which benefits under the health ben-
efits coverage are generally unavailable.’’. 
(g) EFFECTIVE DATE OF AMENDMENTS; CONSISTENCY 
OF POLICIES.—The amendments made by this section shall 
take effect as if enacted on August 16, 2007. The Secretary 
may not impose (or continue in effect) any requirement, 
prevent the implementation of any provision, or condition 
the approval of any provision under any State child health 
plan, State plan amendment, or waiver request on the basis
of any policy or interpretation relating to CHIP crowd- 
out or medical support order other than under the amend-
ments made by this section. 
TITLE II—OUTREACH AND 
ENROLLMENT 
Subtitle A—Outreach and 
Enrollment Activities 
SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUND-
ING FOR OUTREACH AND ENROLLMENT. 
(a) GRANTS.—Title XXI (42 U.S.C. 1397aa et seq.), 
as amended by section 107, is amended by adding at the 
end the following: 
‘‘SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLL-
MENT. 
‘‘(a) OUTREACH
AND ENROLLMENT GRANTS; NA-
TIONAL CAMPAIGN.— 
‘‘(1) IN GENERAL.—From the amounts appro-
priated under subsection (g), subject to paragraph 
(2), the Secretary shall award grants to eligible enti-
ties during the period of fiscal years 2008 through 
2012 to conduct outreach and enrollment efforts that 
are designed to increase the enrollment and participa-
tion of eligible children under this title and title XIX. 
‘‘(2) TEN PERCENT SET ASIDE FOR NATIONAL 
ENROLLMENT
CAMPAIGN.—An amount equal to 10
percent of such amounts shall be used by the Sec-
retary for expenditures during such period to carry 
out a national enrollment campaign in accordance 
with subsection (h). 
‘‘(b) PRIORITY FOR AWARD OF GRANTS.— 
‘‘(1) IN GENERAL.—In awarding grants under 
subsection (a), the Secretary shall give priority to eli-
gible entities that— 
‘‘(A) propose to target geographic areas 
with high rates of— 
‘‘(i) eligible but unenrolled children, 
including such children who reside in rural 
areas; or 
‘‘(ii) racial and ethnic minorities and 
health disparity populations, including 
those proposals that address cultural and 
linguistic barriers to enrollment; and 
‘‘(B) submit the most demonstrable evidence 
required under paragraphs (1) and (2) of sub-
section (c). 
‘‘(2) TEN PERCENT SET ASIDE FOR OUTREACH 
TO INDIAN CHILDREN.—An amount equal to 10 per-
cent of the funds appropriated under subsection (g) 
shall be used by the Secretary to award grants to In-
dian Health Service providers and urban Indian or-
ganizations receiving funds under title V of the In-
dian Health Care Improvement Act (25 U.S.C. 1651 
et seq.) for outreach to, and enrollment of, children 
who are Indians. 
‘‘(c) APPLICATION.—An eligible entity that desires to 
receive a grant under subsection (a) shall submit an appli-
cation to the Secretary in such form and manner, and con-
taining such information, as the Secretary may decide. 
Such application shall include— 
‘‘(1) evidence demonstrating that the entity in-
cludes members who have access to, and credibility 
with, ethnic or low-income populations in the commu-
nities in which activities funded under the grant are 
to be conducted; 
‘‘(2) evidence demonstrating that the entity has 
the ability to address barriers to enrollment, such as 
lack of awareness of eligibility, stigma concerns and 
punitive fears associated with receipt of benefits, and 
other cultural barriers to applying for and receiving 
child health assistance or medical assistance; 
‘‘(3) specific quality or outcomes performance 
measures to evaluate the effectiveness of activities 
funded by a grant awarded under this section; and 
‘‘(4) an assurance that the eligible entity shall—
‘‘(A) conduct an assessment of the effective-
ness of such activities against the performance 
measures; 
‘‘(B) cooperate with the collection and re-
porting of enrollment data and other informa-
tion in order for the Secretary to conduct such 
assessments; and 
‘‘(C) in the case of an eligible entity that is 
not the State, provide the State with enrollment 
data and other information as necessary for the 
State to make necessary projections of eligible 
children and pregnant women. 
‘‘(d) DISSEMINATION OF ENROLLMENT DATA AND IN-
FORMATION DETERMINED FROM EFFECTIVENESS ASSESS-
MENTS; ANNUAL REPORT.—The Secretary shall— 
‘‘(1) make publicly available the enrollment data 
and information collected and reported in accordance 
with subsection (c)(4)(B); and 
‘‘(2) submit an annual report to Congress on the 
outreach and enrollment activities conducted with 
funds appropriated under this section. 
‘‘(e) MAINTENANCE OF EFFORT FOR STATES AWARDED 
GRANTS; NO STATE MATCH REQUIRED.—In the case of a 
State that is awarded a grant under this section—
‘‘(1) the State share of funds expended for out-
reach and enrollment activities under the State child 
health plan shall not be less than the State share of 
such funds expended in the fiscal year preceding the 
first fiscal year for which the grant is awarded; and 
‘‘(2) no State matching funds shall be required 
for the State to receive a grant under this section. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible enti-
ty’ means any of the following: 
‘‘(A) A State with an approved child health 
plan under this title. 
‘‘(B) A local government. 
‘‘(C) An Indian tribe or tribal consortium, 
a tribal organization, an urban Indian organi-
zation receiving funds under title V of the In-
dian Health Care Improvement Act (25 U.S.C. 
1651 et seq.), or an Indian Health Service pro-
vider. 
‘‘(D) A Federal health safety net organiza-
tion. 
‘‘(E) A national, State, local, or commu-
nity-based public or nonprofit private organiza-
tion, including organizations that use commu-
nity health workers or community-based doula 
programs. 
‘‘(F) A faith-based organization or con-
sortia, to the extent that a grant awarded to such 
an entity is consistent with the requirements of 
section 1955 of the Public Health Service Act (42 
U.S.C. 300x–65) relating to a grant award to 
nongovernmental entities. 
‘‘(G) An elementary or secondary school. 
‘‘(2) FEDERAL HEALTH SAFETY NET ORGANIZA-
TION.—The term ‘Federal health safety net organiza-
tion’ means— 
‘‘(A) a Federally-qualified health center (as 
defined in section 1905(l)(2)(B)); 
‘‘(B) a hospital defined as a dispropor-
tionate share hospital for purposes of section 
1923; 
‘‘(C) a covered entity described in section 
340B(a)(4) of the Public Health Service Act (42 
U.S.C. 256b(a)(4)); and 
‘‘(D) any other entity or consortium that 
serves children under a federally funded pro-
gram, including the special supplemental nutri-
tion program for women, infants, and children 
(WIC) established under section 17 of the Child
100 
Nutrition Act of 1966 (42 U.S.C. 1786), the 
Head Start and Early Head Start programs 
under the Head Start Act (42 U.S.C. 9801 et 
seq.), the school lunch program established under 
the Richard B. Russell National School Lunch 
Act, and an elementary or secondary school. 
‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANIZA-
TION; URBAN INDIAN ORGANIZATION.—The terms ‘In-
dian’, ‘Indian tribe’, ‘tribal organization’, and ‘urban 
Indian organization’ have the meanings given such 
terms in section 4 of the Indian Health Care Im-
provement Act (25 U.S.C. 1603). 
‘‘(4) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers;
101 
‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health or nutrition needs; and 
‘‘(F) by providing referral and followup 
services. 
‘‘(g) APPROPRIATION.—There is appropriated, out of 
any money in the Treasury not otherwise appropriated, 
$100,000,000 for the period of fiscal years 2008 through 
2012, for the purpose of awarding grants under this section. 
Amounts appropriated and paid under the authority of this 
section shall be in addition to amounts appropriated under 
section 2104 and paid to States in accordance with section 
2105, including with respect to expenditures for outreach 
activities in accordance with subsections (a)(1)(D)(iii) and 
(c)(2)(C) of that section. 
‘‘(h) NATIONAL ENROLLMENT CAMPAIGN.—From the 
amounts made available under subsection (a)(2), the Sec-
retary shall develop and implement a national enrollment 
campaign to improve the enrollment of underserved child 
populations in the programs established under this title and 
title XIX. Such campaign may include— 
‘‘(1) the establishment of partnerships with the 
Secretary of Education and the Secretary of Agri-
102 
culture to develop national campaigns to link the eli-
gibility and enrollment systems for the assistance pro-
grams each Secretary administers that often serve the 
same children; 
‘‘(2) the integration of information about the 
programs established under this title and title XIX in 
public health awareness campaigns administered by 
the Secretary; 
‘‘(3) increased financial and technical support 
for enrollment hotlines maintained by the Secretary 
to ensure that all States participate in such hotlines; 
‘‘(4) the establishment of joint public awareness 
outreach initiatives with the Secretary of Education 
and the Secretary of Labor regarding the importance 
of health insurance to building strong communities 
and the economy; 
‘‘(5) the development of special outreach mate-
rials for Native Americans or for individuals with 
limited English proficiency; and 
‘‘(6) such other outreach initiatives as the Sec-
retary determines would increase public awareness of 
the programs under this title and title XIX.’’. 
(b) 
ENHANCED
ADMINISTRATIVE
FUNDING
FOR 
TRANSLATION
OR
INTERPRETATION
SERVICES
UNDER 
CHIP AND MEDICAID.—
103 
(1) CHIP.—Section 2105(a)(1) (42 U.S.C. 
1397ee(a)(1)), as amended by section 113, is amend-
ed— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘(or, in the case of expenditures 
described in subparagraph (D)(iv), the higher of 
75 percent or the sum of the enhanced FMAP 
plus 5 percentage points)’’ after ‘‘enhanced 
FMAP’’; and 
(B) in subparagraph (D)— 
(i) in clause (iii), by striking ‘‘and’’ at 
the end; 
(ii) by redesignating clause (iv) as 
clause (v); and 
(iii) by inserting after clause (iii) the 
following new clause: 
‘‘(iv) for translation or interpretation 
services in connection with the enrollment 
of, retention of, and use of services under 
this title by, individuals for whom English 
is not their primary language (as found 
necessary by the Secretary for the proper 
and efficient administration of the State 
plan); and’’. 
(2) MEDICAID.—
104 
(A) USE
OF
MEDICAID
FUNDS.—Section 
1903(a)(2) (42 U.S.C. 1396b(a)(2)) is amended 
by adding at the end the following new subpara-
graph: 
‘‘(E) an amount equal to 75 percent of so much 
of the sums expended during such quarter (as found 
necessary by the Secretary for the proper and efficient 
administration of the State plan) as are attributable 
to translation or interpretation services in connection 
with the enrollment of, retention of, and use of serv-
ices under this title by, children of families for whom 
English is not the primary language; plus’’. 
(B) USE OF COMMUNITY HEALTH WORKERS 
FOR OUTREACH ACTIVITIES.— 
(i) IN
GENERAL.—Section 2102(c)(1) 
of such Act (42 U.S.C. 1397bb(c)(1)) is 
amended by inserting ‘‘(through community 
health workers and others)’’ after ‘‘Out-
reach’’. 
(ii) IN
FEDERAL
EVALUATION.—Sec-
tion 2108(c)(3)(B) of such Act (42 U.S.C. 
1397hh(c)(3)(B)) is amended by inserting 
‘‘(such as through community health work-
ers and others)’’ after ‘‘including practices’’.