I 
109TH CONGRESS 
2D SESSION 
H. R. 4760 
To amend title XXI of the Social Security Act to make all uninsured children 
eligible for the State children’s health insurance program, to encourage 
States to increase the number of children enrolled in the Medicaid and 
State children’s health insurance programs by simplifying the enrollment 
and renewal procedures for those programs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 15, 2006 
Mr. EMANUEL (for himself, Ms. SCHAKOWSKY, Mr. RUSH, Mr. GUTIERREZ, 
Mr. DAVIS of Illinois, and Mr. EVANS) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XXI of the Social Security Act to make 
all uninsured children eligible for the State children’s 
health insurance program, to encourage States to in-
crease the number of children enrolled in the Medicaid 
and State children’s health insurance programs by sim-
plifying the enrollment and renewal procedures for those 
programs, 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 ‘‘All Kids Health Insur-
ance Coverage Act of 2006’’. 
SEC. 2. FINDINGS. 
The House of Representatives finds the following: 
(1) There are more than 9,000,000 children in 
the United States with no health insurance coverage. 
(2) Uninsured children, when compared to pri-
vately insured children, are— 
(A) 3.5 times more likely to have gone 
without needed medical, dental, or other health 
care; 
(B) 4 times more likely to have delayed 
seeking medical care; 
(C) 5 times more likely to go without need-
ed prescription drugs; and 
(D) 6.5 times less likely to have a regular 
source of care. 
(3) Children without health insurance coverage 
are at a disadvantage in the classroom, as shown by 
the following studies: 
(A) The Florida Healthy Kids Annual Re-
port published in 1997, found that children who 
do not have health care coverage are 25 percent 
more likely to miss school.
(B) In a study of the California Health 
Families program, children enrolled in public 
health coverage experienced a 68 percent im-
provement in school performance and school at-
tendance. 
(C) A 2002 Building Bridges to Healthy 
Kids and Better Students study conducted by 
the Council of Chief State School Officers in 
Vermont concluded that children who started 
out without health insurance saw their reading 
scores more than double after obtaining health 
care coverage. 
(4) More than half of uninsured children in the 
United States are eligible for coverage under either 
the State Children’s Health Insurance Program 
(SCHIP) or Medicaid, but are not enrolled in those 
safety net programs. 
(5) Some States, seeing that the Federal Gov-
ernment is not providing assistance to middle class 
families who are unable to afford health insurance, 
are trying to extend health care coverage to some or 
all children in the State. 
(6) State efforts to cover all children may not 
be successful without financial assistance from the 
Federal Government.
SEC. 3. ELIGIBILITY OF ALL UNINSURED CHILDREN FOR 
SCHIP. 
(a) IN GENERAL.—Section 2110(b) of the Social Se-
curity Act (42 U.S.C. 1397jj(b)) is amended— 
(1) in paragraph (1)— 
(A) by striking subparagraph (B); and 
(B) by redesignating subparagraph (C) as 
subparagraph (B); 
(2) in paragraph (2)— 
(A) by striking ‘‘include’’ and all that fol-
lows through ‘‘a child who is an’’ and inserting 
‘‘include a child who is an’’; and 
(B) by striking the semicolon and all that 
follows through the period and inserting a pe-
riod; and 
(3) by striking paragraph (4). 
(b) NO EXCLUSION OF CHILDREN WITH ACCESS TO 
HIGH-COST COVERAGE.—Section 2110(b)(3) of the Social 
Security Act (42 U.S.C. 1397jj(b)(3)) is amended— 
(1) in the paragraph heading, by striking 
‘‘RULE’’ and inserting ‘‘RULES’’; 
(2) by striking ‘‘A child shall not be considered 
to be described in paragraph (1)(C)’’ and inserting 
the following:
‘‘(A) CERTAIN NON FEDERALLY FUNDED 
COVERAGE.—A child shall not be considered to 
be described in paragraph (1)(C)’’; and 
(3) by adding at the end the following: 
‘‘(B) NO EXCLUSION OF CHILDREN WITH 
ACCESS
TO
HIGH-COST
COVERAGE.—A State 
may include a child as a targeted vulnerable 
child if the child has access to coverage under 
a group health plan or health insurance cov-
erage and the total annual aggregate cost for 
premiums, deductibles, cost sharing, and similar 
charges imposed under the group health plan or 
health insurance coverage with respect to all 
targeted vulnerable children in the child’s fam-
ily exceeds 5 percent of such family’s income 
for the year involved.’’. 
(c) CONFORMING AMENDMENTS.— 
(1) Titles XIX and XXI of the Social Security 
Act (42 U.S.C. 1396 et seq.; 1397aa et. seq.) are 
amended by striking ‘‘targeted low-income’’ each 
place it appears and inserting ‘‘targeted vulnerable’’. 
(2) Section 2101(a) of such Act (42 U.S.C. 
1397aa(a)) is amended by striking ‘‘uninsured, low- 
income’’ and inserting ‘‘low-income’’.
(3) Section 2102(b)(3)(C) of such Act (42 
U.S.C. 1397bb(b)(3)(C)) is amended by inserting ‘‘, 
particularly with respect to children whose family in-
come exceeds 200 percent of the poverty line’’ before 
the semicolon. 
(4) 
Section 
2102(b)(3)(E), 
section 
2105(a)(1)(D)(ii), paragraphs (1)(C) and (2) of sec-
tion 2107, and subsections (a)(1) and (d)(1)(B) of 
section 
2108 
of 
such 
Act 
(42 
U.S.C. 
1397bb(b)(3)(E); 
1397ee(a)(1)(D)(ii); 
1397gg; 
1397hh) are amended by striking ‘‘low-income’’ each 
place it appears. 
(5) Section 2110(a)(27) of such Act (42 U.S.C. 
1397jj(a)(27)) is amended by striking ‘‘eligible low- 
income individuals’’ and inserting ‘‘targeted vulner-
able individuals’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2006. 
SEC. 4. INCREASE IN FEDERAL FINANCIAL PARTICIPATION 
UNDER SCHIP AND MEDICAID FOR STATES 
WITH SIMPLIFIED ENROLLMENT AND RE-
NEWAL PROCEDURES FOR CHILDREN. 
(a) SCHIP.—Section 2105(c)(2) of the Social Secu-
rity Act (42 U.S.C. 1397ee(c)(2)) is amended by adding 
at the end the following:
‘‘(C) NONAPPLICATION
OF
LIMITATION 
AND
INCREASE
IN
FEDERAL
PAYMENT
FOR 
STATES
WITH
SIMPLIFIED
ENROLLMENT
AND 
RENEWAL PROCEDURES.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
subsection (a)(1) and subparagraph (A)— 
‘‘(I) the limitation under sub-
paragraph (A) on expenditures for 
items 
described 
in 
subsection 
(a)(1)(D) shall not apply with respect 
to expenditures incurred to carry out 
any of the outreach strategies de-
scribed in clause (ii), but only if the 
State carries out the same outreach 
strategies for children under title 
XIX; and 
‘‘(II) the enhanced FMAP for a 
State for a fiscal year otherwise deter-
mined under subsection (b) shall be 
increased by 5 percentage points 
(without regard to the application of 
the 85 percent limitation under that 
subsection) with respect to such ex-
penditures.
‘‘(ii) OUTREACH
STRATEGIES
DE-
SCRIBED.—For purposes of clause (i), the 
outreach strategies described in this clause 
are the following: 
‘‘(I) 
PRESUMPTIVE
ELIGI-
BILITY.—The State provides for pre-
sumptive eligibility for children under 
this title and under title XIX. 
‘‘(II) ADOPTION
OF
12-MONTH 
CONTINUOUS
ELIGIBILITY.—The 
State provides that eligibility for chil-
dren shall not be redetermined more 
often than once every year under this 
title or under title XIX. 
‘‘(III) ELIMINATION
OF
ASSET 
TEST.—The State does not apply any 
asset test for eligibility under this title 
or title XIX with respect to children. 
‘‘(IV) PASSIVE
RENEWAL.—The 
State provides for the automatic re-
newal of the eligibility of children for 
assistance under this title and under 
title XIX if the family of which such 
a child is a member does not report 
any changes to family income or other
relevant circumstances, subject to 
verification of information from State 
databases.’’. 
(b) MEDICAID.— 
(1) IN GENERAL.—Section 1902(l) of the Social 
Security Act (42 U.S.C. 1396a(l)) is amended— 
(A) in paragraph (3), by inserting ‘‘subject 
to paragraph (5)’’, after ‘‘Notwithstanding sub-
section (a)(17),’’; and 
(B) by adding at the end the following: 
‘‘(5)(A) Notwithstanding the first sentence of section 
1905(b), with respect to expenditures incurred to carry 
out any of the outreach strategies described in subpara-
graph (B) for individuals under 19 years of age who are 
eligible 
for 
medical 
assistance 
under 
subsection 
(a)(10)(A), the Federal medical assistance percentage is 
equal to the enhanced FMAP described in section 2105(b) 
and increased under section 2105(c)(2)(C)(i)(II), but only 
if the State carries out the same outreach strategies for 
children under title XXI. 
‘‘(B) For purposes of subparagraph (A), the outreach 
strategies described in this subparagraph are the fol-
lowing:
‘‘(i) PRESUMPTIVE
ELIGIBILITY.—The State 
provides for presumptive eligibility for such individ-
uals under this title and title XXI. 
‘‘(ii) ADOPTION OF 12-MONTH CONTINUOUS ELI-
GIBILITY.—The State provides that eligibility for 
such individuals shall not be redetermined more 
often than once every year under this title or under 
title XXI. 
‘‘(iii) ELIMINATION
OF
ASSET
TEST.—The 
State does not apply any asset test for eligibility 
under this title or title XXI with respect to such in-
dividuals. 
‘‘(iv) PASSIVE RENEWAL.—The State provides 
for the automatic renewal of the eligibility of such 
individuals for assistance under this title and under 
title XXI if the family of which such an individual 
is a member does not report any changes to family 
income or other relevant circumstances, subject to 
verification of information from State databases.’’. 
(2) CONFORMING AMENDMENT.—The first sen-
tence of section 1905(b) of the Social Security Act 
(42 U.S.C. 1396d(b)) is amended by striking ‘‘sec-
tion 1933(d)’’ and inserting ‘‘sections 1902(l)(5) 
and 1933(d)’’.
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2006. 
SEC. 5. LIMITATION ON PAYMENTS TO STATES THAT HAVE 
AN ENROLLMENT CAP BUT HAVE NOT EX-
HAUSTED THE STATE’S AVAILABLE ALLOT-
MENTS. 
(a) IN GENERAL.—Section 2105 of the Social Secu-
rity Act (42 U.S.C. 1397ee) is amended by adding at the 
end the following: 
‘‘(h) LIMITATION ON PAYMENTS TO STATES THAT 
HAVE AN ENROLLMENT CAP BUT HAVE NOT EXHAUSTED 
THE STATE’S AVAILABLE ALLOTMENTS.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of this section, payment shall not be made 
to a State under this section if the State has an en-
rollment freeze, enrollment cap, procedures to delay 
consideration of, or not to consider, submitted appli-
cations for child health assistance, or a waiting list 
for the submission or consideration of such applica-
tions or for such assistance, and the State has not 
fully expended the amount of all allotments available 
with respect to a fiscal year for expenditure by the 
State, including allotments for prior fiscal years that 
remain available for expenditure during the fiscal 
year under subsection (c) or (g) of section 2104 or
that were redistributed to the State under subsection 
(f) or (g) of section 2104. 
‘‘(2) RULE OF CONSTRUCTION.—Paragraph (1) 
shall not be construed as prohibiting a State from 
establishing regular open enrollment periods for the 
submission of applications for child health assist-
ance.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2006. 
SEC. 6. ADDITIONAL ENHANCEMENT TO FMAP TO PRO-
MOTE EXPANSION OF COVERAGE TO ALL UN-
INSURED CHILDREN UNDER MEDICAID AND 
SCHIP. 
(a) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et 
seq.) is amended by adding at the end the following: 
‘‘SEC. 2111. ADDITIONAL ENHANCEMENT TO FMAP TO PRO-
MOTE EXPANSION OF COVERAGE TO ALL UN-
INSURED CHILDREN UNDER MEDICAID AND 
SCHIP. 
‘‘(a) IN GENERAL.—Notwithstanding subsection (b) 
of section 2105 (and without regard to the application of 
the 85 percent limitation under that subsection), the en-
hanced FMAP with respect to expenditures in a quarter 
for providing child health assistance to uninsured children
whose family income exceeds 200 percent of the poverty 
line, shall be increased by 5 percentage points. 
‘‘(b) UNINSURED CHILD DEFINED.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a), subject to paragraph (2), the term ‘uninsured 
child’ means an uncovered child who has been with-
out creditable coverage for a period determined by 
the Secretary, except that such period shall not be 
less than 6 months. 
‘‘(2) SPECIAL
RULE
FOR
NEWBORN
CHIL-
DREN.—In the case of a child 12 months old or 
younger, the period determined under paragraph (1) 
shall be 0 months and such child shall be considered 
uninsured upon birth. 
‘‘(3) SPECIAL
RULE
FOR
CHILDREN
LOSING 
MEDICAID OR SCHIP COVERAGE DUE TO INCREASED 
FAMILY INCOME.—In the case of a child who, due to 
an increase in family income, becomes ineligible for 
coverage under title XIX or this title during the pe-
riod beginning on the date that is 12 months prior 
to the date of enactment of the All Kids Health In-
surance Coverage Act of 2005 and ending on the 
date of enactment of such Act, the period deter-
mined under paragraph (1) shall be 0 months and 
such child shall be considered uninsured upon the
date of enactment of the All Kids Health Insurance 
Coverage Act of 2005. 
‘‘(4) MONITORING
AND
ADJUSTMENT
OF
PE-
RIOD REQUIRED TO BE UNINSURED.—The Secretary 
shall— 
‘‘(A) monitor the availability and retention 
of employer-sponsored health insurance cov-
erage of dependent children; and 
‘‘(B) adjust the period determined under 
paragraph (1) as needed for the purpose of pro-
moting the retention of private or employer- 
sponsored health insurance coverage of depend-
ent children and timely access to health care 
services for such children.’’. 
(b) COST-SHARING
FOR CHILDREN
IN FAMILIES 
WITH HIGH FAMILY INCOME.—Section 2103(e)(3) of the 
Social Security Act (42 U.S.C. 1397cc(e)(3)) is amended 
by adding at the end the following new subparagraph: 
‘‘(C) CHILDREN IN FAMILIES WITH HIGH 
FAMILY INCOME.— 
‘‘(i) IN GENERAL.—For children not 
described in subparagraph (A) whose fam-
ily income exceeds 400 percent of the pov-
erty line for a family of the size involved, 
subject to paragraphs (1)(B) and (2), the
State shall impose a premium that is not 
less than the cost of providing child health 
assistance to children in such families, and 
deductibles, 
cost 
sharing, 
or 
similar 
charges shall be imposed under the State 
child health plan (without regard to a slid-
ing scale based on income), except that the 
total annual aggregate cost-sharing with 
respect to all such children in a family 
under this title may not exceed 5 percent 
of such family’s income for the year in-
volved. 
‘‘(ii) INFLATION
ADJUSTMENT.—The 
dollar amount specified in clause (i) shall 
be increased, beginning with fiscal year 
2008, from year to year based on the per-
centage increase in the consumer price 
index for all urban consumers (all items; 
United States city average). Any dollar 
amount established under this clause that 
is not a multiple of $100 shall be rounded 
to the nearest multiple of $100.’’. 
(c) ADDITIONAL ALLOTMENTS
FOR STATES PRO-
VIDING COVERAGE TO ALL UNINSURED CHILDREN IN 
THE STATE.—
(1) IN GENERAL.—Section 2104 of the Social 
Security Act (42 U.S.C. 1397dd) is amended by in-
serting after subsection (c) the following: 
‘‘(d) ADDITIONAL ALLOTMENTS FOR STATES PRO-
VIDING COVERAGE TO ALL UNINSURED CHILDREN IN 
THE STATE.— 
‘‘(1) APPROPRIATION; TOTAL
ALLOTMENT.— 
For the purpose of providing additional allotments 
to States to provide coverage of all uninsured chil-
dren (as defined in section 2111(b)) in the State 
under the State child health plan, there is appro-
priated, out of any money in the Treasury not other-
wise appropriated— 
‘‘(A) for fiscal years 2007 and 2008, 
$3,000,000,000; 
‘‘(B) for fiscal year 2009, $5,000,000,000; 
and 
‘‘(C) for fiscal year 2010, $7,000,000,000. 
‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.— 
‘‘(A) IN GENERAL.—In addition to the al-
lotments provided under subsections (b) and 
(c), subject to subparagraph (B) and para-
graphs (3) and (4), of the amount available for 
the additional allotments under paragraph (1) 
for a fiscal year, the Secretary shall allot to
each State with a State child health plan that 
provides coverage of all uninsured children (as 
so defined) in the State approved under this 
title— 
‘‘(i) in the case of such a State other 
than a commonwealth or territory de-
scribed in subsection (ii), the same propor-
tion as the proportion of the State’s allot-
ment under subsection (b) (determined 
without regard to subsection (f)) to 98.95 
percent of the total amount of the allot-
ments under such section for such States 
eligible for an allotment under this sub-
paragraph for such fiscal year; and 
‘‘(ii) in the case of a commonwealth or 
territory described in subsection (c)(3), the 
same proportion as the proportion of the 
commonwealth’s or territory’s allotment 
under subsection (c) (determined without 
regard to subsection (f)) to 1.05 percent of 
the total amount of the allotments under 
such section for commonwealths and terri-
tories eligible for an allotment under this 
subparagraph for such fiscal year. 
‘‘(B) MINIMUM ALLOTMENT.—
‘‘(i) IN GENERAL.—No allotment to a 
State for a fiscal year under this sub-
section shall be less than 50 percent of the 
amount of the allotment to the State deter-
mined under subsections (b) and (c) for 
the preceding fiscal year. 
‘‘(ii) PRO
RATA
REDUCTIONS.—The 
Secretary shall make such pro rata reduc-
tions to the allotments determined under 
this subsection as are necessary to comply 
with the requirements of clause (i). 
‘‘(C) AVAILABILITY AND REDISTRIBUTION 
OF
UNUSED
ALLOTMENTS.—In applying sub-
sections (e) and (f) with respect to additional 
allotments made available under this subsection, 
the procedures established under such sub-
sections shall ensure such additional allotments 
are only made available to States which have 
elected to provide coverage under section 2111. 
‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi-
tional allotments provided under this subsection are 
not available for amounts expended before October 
1, 2005. Such amounts are available for amounts ex-
pended on or after such date for child health assist-
ance for uninsured children (as defined in section 
2111(b)). 
‘‘(4) REQUIRING ELECTION TO PROVIDE COV-
ERAGE.—No payments may be made to a State 
under this title from an allotment provided under 
this subsection unless the State has made an elec-
tion to provide child health assistance for all unin-
sured children (as so defined) in the State, including 
such children whose family income exceeds 200 per-
cent of the poverty line.’’. 
(2) CONFORMING AMENDMENTS.—Section 2104 
of the Social Security Act (42 U.S.C. 1397dd) is 
amended— 
(A) in subsection (a), by inserting ‘‘subject 
to subsection (d),’’ after ‘‘under this section,’’; 
(B) in subsection (b)(1), by inserting ‘‘and 
subsection (d)’’ after ‘‘Subject to paragraph 
(4)’’; and 
(C) in subsection (c)(1), by inserting ‘‘sub-
ject to subsection (d),’’ after ‘‘for a fiscal 
year,’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2006.
SEC. 7. REPEAL OF THE SCHEDULED PHASEOUT OF THE 
LIMITATIONS ON PERSONAL EXEMPTIONS 
AND ITEMIZED DEDUCTIONS. 
(a) IN GENERAL.—The Internal Revenue Code of 
1986 is amended— 
(1) by striking subparagraphs (E) and (F) of 
section 151(d)(3), and 
(2) by striking subsections (f) and (g) of section 
68. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2005. 
(c) APPLICATION
OF
EGTRRA SUNSET.—The 
amendments made by this section shall be subject to title 
IX of the Economic Growth and Tax Relief Reconciliation 
Act of 2001 to the same extent and in the same manner 
as the provision of such Act to which such amendment 
relates. 
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