I 
111TH CONGRESS 
1ST SESSION H. R. 1117 
To amend title XIX of the Social Security Act to establish a State plan 
option under Medicaid to provide an all-inclusive program of care for 
children who are medically fragile or have one or more chronic conditions 
that impede their ability to function. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 23, 2009 
Ms. BALDWIN (for herself, Mr. BROWN of South Carolina, and Mr. SPRATT) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to establish 
a State plan option under Medicaid to provide an all- 
inclusive program of care for children who are medically 
fragile or have one or more chronic conditions that im-
pede their ability to function. 
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 ‘‘Medically Fragile Chil-
dren’s Act of 2009’’. 
VerDate Nov 24 2008 
07:07 Feb 24, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H1117.IH
H1117
rfrederick on PROD1PC67 with BILLS
SEC. 2. ESTABLISHMENT OF PROGRAM OF ALL-INCLUSIVE 
CARE FOR MEDICALLY FRAGILE CHILDREN 
AS A MEDICAID STATE OPTION. 
(a) IN GENERAL.—Title XIX of the Social Security 
Act is amended— 
(1) in section 1902(a)(10)(A)(ii) (42 U.S.C. 
1396b(a)(10)(A)(ii))— 
(A) in subclause (XVIII) by striking ‘‘or’’ 
at the end; 
(B) in subclause (XIX), by adding ‘‘or’’ 
after the semicolon; and 
(C) by inserting after subclause (XIX) the 
following: 
‘‘(XX) who are medically fragile 
children described in section 1942;’’; 
(2) in section 1905(a) (42 U.S.C. 1396d(a)), in 
the matter preceding paragraph (1)— 
(A) in clause (xii), by striking ‘‘or’’ at the 
end; 
(B) in clause (xiii), by adding ‘‘or’’ after 
the comma; and 
(C) by inserting after clause (xiii) the fol-
lowing: 
‘‘(xiv) medically fragile children de-
scribed in section 1942;’’; and 
(3) by adding at the end the following: 
VerDate Nov 24 2008 
07:07 Feb 24, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H1117.IH
H1117
rfrederick on PROD1PC67 with BILLS
‘‘PROGRAM OF ALL-INCLUSIVE CARE FOR MEDICALLY 
FRAGILE CHILDREN 
‘‘SEC. 1942. (a) STATE OPTION TO ESTABLISH ALL- 
INCLUSIVE
CARE
FOR
MEDICALLY
FRAGILE
CHIL-
DREN.— 
‘‘(1) STATE PLAN AMENDMENT.— 
‘‘(A) IN
GENERAL.—A State may elect 
through a State plan amendment to provide 
medical assistance and other services described 
under this section by means of a program of 
all-inclusive care described in subsection (b) for 
eligible children described in paragraph (2). In 
the case of an eligible child enrolled with an all- 
inclusive care program pursuant to such an 
election— 
‘‘(i) the child shall receive benefits 
under the plan, as well as items and serv-
ices described in section 1905(r) solely 
through such programs; and 
‘‘(ii) program providers shall receive 
an all-inclusive payment in accordance with 
a program agreement for the provision of 
such care that meets the requirements of 
this section. 
VerDate Nov 24 2008 
07:07 Feb 24, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H1117.IH
H1117
rfrederick on PROD1PC67 with BILLS
‘‘(B) OPTION TO LIMIT ENROLLMENT.—A 
State may establish a numerical limit on the 
number of eligible children who may be enrolled 
in an all-inclusive care program under a pro-
gram agreement under this section. 
‘‘(2) DEFINITION
OF
ELIGIBLE
CHILD; PRO-
GRAM PROVIDER.—In this section, 
‘‘(A) ELIGIBLE CHILD.—The term ‘eligible 
child’ means an individual who— 
‘‘(i) has not attained age 25; 
‘‘(ii) is— 
‘‘(I) determined by the State to 
be medically fragile based on health 
status and related indicators (such as 
medical diagnoses and measures of ac-
tivities of daily living, instrumental 
activities of daily living, and cognitive 
impairment); or 
‘‘(II) diagnosed as having 1 or 
more chronic conditions; 
‘‘(iii) requires daily monitoring of a 
significant medical condition necessitating 
overall care planning in order to achieve or 
maintain optimum health and develop-
mental status, achieve community integra-
VerDate Nov 24 2008 
07:07 Feb 24, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H1117.IH
H1117
rfrederick on PROD1PC67 with BILLS