tion receiving funds under title V of the Indian 
Health Care Improvement Act (25 U.S.C. 1651 
et seq.), or an Indian Health Service provider. 
‘‘(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 require-
ments 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 ORGANI-
ZATION.—The term ‘Federal health safety net orga-
nization’ 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; 
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‘‘(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 
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 ORGANI-
ZATION; URBAN INDIAN ORGANIZATION.—The terms 
‘Indian’, ‘Indian tribe’, ‘tribal organization’, and 
‘urban Indian organization’ have the meanings given 
such terms in section 4 of the Indian Health Care 
Improvement 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— 
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‘‘(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; 
‘‘(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 2009 through 
2013, for the purpose of awarding grants under this sec-
tion. Amounts appropriated and paid under the authority 
of this section shall be in addition to amounts appro-
priated under section 2104 and paid to States in accord-
ance with section 2105, including with respect to expendi-
tures for outreach activities in accordance with subsections 
(a)(1)(D)(iii) and (c)(2)(C) of that section. 
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‘‘(h) NATIONAL ENROLLMENT CAMPAIGN.—From 
the amounts made available under subsection (a)(2), the 
Secretary shall develop and implement a national enroll-
ment 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-
culture to develop national campaigns to link the eli-
gibility and enrollment systems for the assistance 
programs 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 impor-
tance of health insurance to building strong commu-
nities and the economy; 
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‘‘(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. 
‘‘(i) GRANTS FOR OUTREACH AND ENROLLMENT OF 
NATIVE AMERICAN BENEFICIARIES.— 
‘‘(1) IN GENERAL.—To overcome language and 
cultural barriers to program access by Native Ameri-
cans, the Secretary shall establish grant programs to 
conduct outreach and enrollment efforts to increase 
the enrollment and participation of eligible individ-
uals in programs of the Social Security Act (42 
U.S.C. 1397aa et seq.) and other Federal health and 
social service programs. 
‘‘(2) USE
OF
TRIBAL
BENEFITS-COUNSELORS 
MODEL.—The grant program under this subsection 
shall incorporate expansion and stabilization of the 
tribal benefits-counselors model developed in the 
State of Washington to overcome language and cul-
tural barriers to Federal programs. 
‘‘(3) RECIPIENTS.—In order to qualify for a 
grant under this subsection, an applicant shall be a 
national, nonprofit organization with successful and 
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verifiable experience in assisting Native Americans 
access Federal programs. 
‘‘(4) REPORT.—At the end of the period of 
funding provided under subsection (f), the Secretary 
shall submit to Congress a report on the grants 
made under this subsection, including the efficacy of 
outreach efforts and the cost effectiveness of 
projects funded by such grants in improving access 
to Federal programs by Native Americans.’’. 
(b) ENHANCED
ADMINISTRATIVE
FUNDING
FOR 
TRANSLATION
OR INTERPRETATION SERVICES UNDER 
CHIP AND MEDICAID.— 
(1) CHIP.—Section 2105(a)(1) (42 U.S.C. 
1397ee(a)(1)), as amended by section 113, is 
amended— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘(or, in the case of expendi-
tures described in subparagraph (D)(iv), the 
higher of 75 percent or the sum of the en-
hanced FMAP plus 5 percentage points)’’ after 
‘‘enhanced FMAP’’; and 
(B) in subparagraph (D)— 
(i) in clause (iii), by striking ‘‘and’’ at 
the end; 
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lies for whom English is not the primary language; 
plus’’. 
(B) USE OF COMMUNITY HEALTH WORK-
ERS 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 commu-
nity health workers and others)’’ after 
‘‘Outreach’’. 
(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 prac-
tices’’. 
SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF IN-
DIANS. 
(a) IN GENERAL.—Section 1139 (42 U.S.C. 1320b– 
9) is amended to read as follows: 
‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 
HEALTH CARE FOR INDIANS UNDER TITLES 
XIX AND XXI. 
‘‘(a) AGREEMENTS WITH STATES
FOR MEDICAID 
AND CHIP OUTREACH ON OR NEAR RESERVATIONS TO 
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INCREASE
THE ENROLLMENT
OF INDIANS
IN THOSE 
PROGRAMS.— 
‘‘(1) IN GENERAL.—In order to improve the ac-
cess of Indians residing on or near a reservation to 
obtain benefits under the Medicaid and State chil-
dren’s health insurance programs established under 
titles XIX and XXI, the Secretary shall encourage 
the State to take steps to provide for enrollment on 
or near the reservation. Such steps may include out-
reach efforts such as the outstationing of eligibility 
workers, entering into agreements with the Indian 
Health Service, Indian Tribes, Tribal Organizations, 
and Urban Indian Organizations to provide out-
reach, education regarding eligibility and benefits, 
enrollment, and translation services when such serv-
ices are appropriate. 
‘‘(2) CONSTRUCTION.—Nothing in paragraph 
(1) shall be construed as affecting arrangements en-
tered into between States and the Indian Health 
Service, Indian Tribes, Tribal Organizations, or 
Urban Indian Organizations for such Service, 
Tribes, or Organizations to conduct administrative 
activities under such titles. 
‘‘(b) REQUIREMENT
TO
FACILITATE
COOPERA-
TION.—The Secretary, acting through the Centers for 
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Medicare & Medicaid Services, shall take such steps as are 
necessary to facilitate cooperation with, and agreements 
between, States and the Indian Health Service, Indian 
Tribes, Tribal Organizations, or Urban Indian Organiza-
tions with respect to the provision of health care items 
and services to Indians under the programs established 
under title XIX or XXI. 
‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN 
HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN IN-
DIAN ORGANIZATION.—In this section, the terms ‘Indian’, 
‘Indian Tribe’, ‘Indian Health Program’, ‘Tribal Organi-
zation’, and ‘Urban Indian Organization’ have the mean-
ings given those terms in section 4 of the Indian Health 
Care Improvement Act.’’. 
(b) NONAPPLICATION
OF 10 PERCENT LIMIT
ON 
OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec-
tion 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is amended by 
adding at the end the following: 
‘‘(C) NONAPPLICATION
TO
CERTAIN
EX-
PENDITURES.—The limitation under subpara-
graph (A) shall not apply with respect to the 
following expenditures: 
‘‘(i) EXPENDITURES
TO
INCREASE 
OUTREACH TO, AND THE ENROLLMENT OF, 
INDIAN CHILDREN UNDER THIS TITLE AND 
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TITLE xix.—Expenditures for outreach ac-
tivities to families of Indian children likely 
to be eligible for child health assistance 
under the plan or medical assistance under 
the State plan under title XIX (or under 
a waiver of such plan), to inform such 
families of the availability of, and to assist 
them in enrolling their children in, such 
plans, including such activities conducted 
under grants, contracts, or agreements en-
tered into under section 1139(a).’’. 
SEC. 203. STATE OPTION TO RELY ON FINDINGS FROM AN 
EXPRESS LANE AGENCY TO CONDUCT SIM-
PLIFIED ELIGIBILITY DETERMINATIONS. 
(a) APPLICATION UNDER MEDICAID AND CHIP PRO-
GRAMS.— 
(1) MEDICAID.—Section 1902(e) (42 U.S.C. 
1396a(e)) is amended by adding at the end the fol-
lowing: 
‘‘(13) EXPRESS LANE OPTION.— 
‘‘(A) IN GENERAL.— 
‘‘(i) OPTION TO USE A FINDING FROM AN 
EXPRESS LANE AGENCY.—At the option of the 
State, the State plan may provide that in deter-
mining eligibility under this title for a child (as 
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defined in subparagraph (G)), the State may 
rely on a finding made within a reasonable pe-
riod (as determined by the State) from an Ex-
press Lane agency (as defined in subparagraph 
(F)) when it determines whether a child satis-
fies one or more components of eligibility for 
medical assistance under this title. The State 
may rely on a finding from an Express Lane 
agency notwithstanding any differences in 
budget unit, disregard, deeming or other meth-
odology, if the following requirements are met: 
‘‘(I) PROHIBITION ON DETERMINING 
CHILDREN INELIGIBLE FOR COVERAGE.— 
If a finding from an Express Lane agency 
would result in a determination that a 
child does not satisfy an eligibility require-
ment for medical assistance under this title 
and for child health assistance under title 
XXI, the State shall determine eligibility 
for assistance using its regular procedures. 
‘‘(II) NOTICE
REQUIREMENT.—For 
any child who is found eligible for medical 
assistance under the State plan under this 
title or child health assistance under title 
XXI and who is subject to premiums based 
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on an Express Lane agency’s finding of 
such child’s income level, the State shall 
provide notice that the child may qualify 
for lower premium payments if evaluated 
by the State using its regular policies and 
of the procedures for requesting such an 
evaluation. 
‘‘(III) COMPLIANCE
WITH
SCREEN 
AND
ENROLL
REQUIREMENT.—The State 
shall satisfy the requirements under sub-
paragraphs 
(A) 
and 
(B) 
of 
section 
2102(b)(3) (relating to screen and enroll) 
before enrolling a child in child health as-
sistance under title XXI. At its option, the 
State may fulfill such requirements in ac-
cordance with either option provided under 
subparagraph (C) of this paragraph. 
‘‘(IV) VERIFICATION OF CITIZENSHIP, 
NATIONALITY
STATUS, 
OR
QUALIFIED 
ALIEN
STATUS.—The State shall satisfy 
the requirements of sections 1137(d) and 
1902(a)(46)(B) for verifications of citizen-
ship, nationality status, or qualified alien 
status. 
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‘‘(V) CODING.—The State meets the 
requirements of subparagraph (E). 
‘‘(ii) OPTION TO APPLY TO RENEWALS AND 
REDETERMINATIONS.—The State may apply the 
provisions of this paragraph when conducting 
initial determinations of eligibility, redetermina-
tions of eligibility, or both, as described in the 
State plan. 
‘‘(B) RULES OF CONSTRUCTION.—Nothing in 
this paragraph shall be construed— 
‘‘(i) to relieve a State of the obligation to 
determine components of eligibility that are not 
the subject of an Express Lane agency’s find-
ing, as described in subparagraph (A); 
‘‘(ii) to limit or prohibit a State from tak-
ing any actions otherwise permitted under this 
title or title XXI in determining eligibility for 
or enrolling children into medical assistance 
under this title or child health assistance under 
title XXI; or 
‘‘(iii) to modify the limitations in section 
1902(a)(5) concerning the agencies that may 
make a determination of eligibility for medical 
assistance under this title. 
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‘‘(C) OPTIONS FOR SATISFYING THE SCREEN 
AND ENROLL REQUIREMENT.— 
‘‘(i) IN GENERAL.—With respect to a child 
whose eligibility for medical assistance under 
this title or for child health assistance under 
title XXI has been evaluated by a State agency 
using an income finding from an Express Lane 
agency, a State may carry out its duties under 
subparagraphs 
(A) 
and 
(B) 
of 
section 
2102(b)(3) (relating to screen and enroll) in ac-
cordance with either clause (ii) or clause (iii). 
‘‘(ii) 
ESTABLISHING
A
SCREENING 
THRESHOLD.— 
‘‘(I) IN GENERAL.—Under this clause, 
the State establishes a screening threshold 
set as a percentage of the Federal poverty 
level that exceeds the highest income 
threshold applicable under this title to the 
child by a minimum of 30 percentage 
points or, at State option, a higher number 
of percentage points that reflects the value 
(as determined by the State and described 
in the State plan) of any differences be-
tween income methodologies used by the 
program administered by the Express Lane 
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100 
agency and the methodologies used by the 
State in determining eligibility for medical 
assistance under this title. 
‘‘(II) CHILDREN
WITH
INCOME
NOT 
ABOVE THRESHOLD.—If the income of a 
child does not exceed the screening thresh-
old, the child is deemed to satisfy the in-
come eligibility criteria for medical assist-
ance under this title regardless of whether 
such child would otherwise satisfy such cri-
teria. 
‘‘(III) 
CHILDREN
WITH
INCOME 
ABOVE THRESHOLD.—If the income of a 
child exceeds the screening threshold, the 
child shall be considered to have an income 
above the Medicaid applicable income level 
described in section 2110(b)(4) and to sat-
isfy 
the 
requirement 
under 
section 
2110(b)(1)(C) (relating to the requirement 
that CHIP matching funds be used only 
for children not eligible for Medicaid). If 
such a child is enrolled in child health as-
sistance under title XXI, the State shall 
provide the parent, guardian, or custodial 
relative with the following: 
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101 
‘‘(aa) Notice that the child may 
be eligible to receive medical assist-
ance under the State plan under this 
title if evaluated for such assistance 
under the State’s regular procedures 
and notice of the process through 
which a parent, guardian, or custodial 
relative can request that the State 
evaluate the child’s eligibility for med-
ical assistance under this title using 
such regular procedures. 
‘‘(bb) A description of differences 
between the medical assistance pro-
vided under this title and child health 
assistance under title XXI, including 
differences in cost-sharing require-
ments and covered benefits. 
‘‘(iii) TEMPORARY ENROLLMENT IN CHIP 
PENDING SCREEN AND ENROLL.— 
‘‘(I) IN GENERAL.—Under this clause, 
a State enrolls a child in child health as-
sistance under title XXI for a temporary 
period if the child appears eligible for such 
assistance based on an income finding by 
an Express Lane agency. 
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102 
‘‘(II) 
DETERMINATION
OF
ELIGI-
BILITY.—During such temporary enroll-
ment period, the State shall determine the 
child’s eligibility for child health assistance 
under title XXI or for medical assistance 
under this title in accordance with this 
clause. 
‘‘(III) PROMPT FOLLOW UP.—In mak-
ing such a determination, the State shall 
take prompt action to determine whether 
the child should be enrolled in medical as-
sistance under this title or child health as-
sistance under title XXI pursuant to sub-
paragraphs 
(A) 
and 
(B) 
of 
section 
2102(b)(3) (relating to screen and enroll). 
‘‘(IV) REQUIREMENT FOR SIMPLIFIED 
DETERMINATION.—In making such a de-
termination, the State shall use procedures 
that, to the maximum feasible extent, re-
duce the burden imposed on the individual 
of such determination. Such procedures 
may not require the child’s parent, guard-
ian, or custodial relative to provide or 
verify information that already has been 
provided to the State agency by an Ex-
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103 
press Lane agency or another source of in-
formation unless the State agency has rea-
son to believe the information is erroneous. 
‘‘(V) AVAILABILITY OF CHIP MATCH-
ING FUNDS DURING TEMPORARY ENROLL-
MENT
PERIOD.—Medical assistance for 
items and services that are provided to a 
child enrolled in title XXI during a tem-
porary enrollment period under this clause 
shall be treated as child health assistance 
under such title. 
‘‘(D) OPTION FOR AUTOMATIC ENROLLMENT.— 
‘‘(i) IN GENERAL.—The State may initiate 
and determine eligibility for medical assistance 
under the State Medicaid plan or for child 
health assistance under the State CHIP plan 
without a program application from, or on be-
half of, the child based on data obtained from 
sources other than the child (or the child’s fam-
ily), but a child can only be automatically en-
rolled in the State Medicaid plan or the State 
CHIP plan if the child or the family affirma-
tively consents to being enrolled through affir-
mation and signature on an Express Lane 
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104 
agency application, if the requirement of clause 
(ii) is met. 
‘‘(ii) INFORMATION
REQUIREMENT.—The 
requirement of this clause is that the State in-
forms the parent, guardian, or custodial relative 
of the child of the services that will be covered, 
appropriate methods for using such services, 
premium or other cost sharing charges (if any) 
that apply, medical support obligations (under 
section 1912(a)) created by enrollment (if appli-
cable), and the actions the parent, guardian, or 
relative must take to maintain enrollment and 
renew coverage. 
‘‘(E) CODING; APPLICATION TO ENROLLMENT 
ERROR RATES.— 
‘‘(i) IN GENERAL.—For purposes of sub-
paragraph (A)(iv), the requirement of this sub-
paragraph for a State is that the State agrees 
to— 
‘‘(I) assign such codes as the Sec-
retary shall require to the children who are 
enrolled in the State Medicaid plan or the 
State CHIP plan through reliance on a 
finding made by an Express Lane agency 
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105 
for the duration of the State’s election 
under this paragraph; 
‘‘(II) annually provide the Secretary 
with a statistically valid sample (that is ap-
proved by Secretary) of the children en-
rolled in such plans through reliance on 
such a finding by conducting a full Med-
icaid eligibility review of the children iden-
tified for such sample for purposes of de-
termining an eligibility error rate (as de-
scribed in clause (iv)) with respect to the 
enrollment of such children (and shall not 
include such children in any data or sam-
ples used for purposes of complying with a 
Medicaid 
Eligibility 
Quality 
Control 
(MEQC) review or a payment error rate 
measurement (PERM) requirement); 
‘‘(III) submit the error rate deter-
mined under subclause (II) to the Sec-
retary; 
‘‘(IV) if such error rate exceeds 3 per-
cent for either of the first 2 fiscal years in 
which the State elects to apply this para-
graph, demonstrate to the satisfaction of 
the Secretary the specific corrective actions 
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106 
implemented by the State to improve upon 
such error rate; and 
‘‘(V) if such error rate exceeds 3 per-
cent for any fiscal year in which the State 
elects to apply this paragraph, a reduction 
in the amount otherwise payable to the 
State under section 1903(a) for quarters 
for that fiscal year, equal to the total 
amount of erroneous excess payments de-
termined for the fiscal year only with re-
spect to the children included in the sam-
ple for the fiscal year that are in excess of 
a 3 percent error rate with respect to such 
children. 
‘‘(ii) NO
PUNITIVE
ACTION
BASED
ON 
ERROR RATE.—The Secretary shall not apply 
the error rate derived from the sample under 
clause (i) to the entire population of children 
enrolled in the State Medicaid plan or the State 
CHIP plan through reliance on a finding made 
by an Express Lane agency, or to the popu-
lation of children enrolled in such plans on the 
basis of the State’s regular procedures for de-
termining eligibility, or penalize the State on 
the basis of such error rate in any manner 
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107 
other than the reduction of payments provided 
for under clause (i)(V). 
‘‘(iii) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as relieving 
a State that elects to apply this paragraph from 
being subject to a penalty under section 
1903(u), for payments made under the State 
Medicaid plan with respect to ineligible individ-
uals and families that are determined to exceed 
the error rate permitted under that section (as 
determined without regard to the error rate de-
termined under clause (i)(II)). 
‘‘(iv) ERROR RATE DEFINED.—In this sub-
paragraph, the term ‘error rate’ means the rate 
of erroneous excess payments for medical as-
sistance (as defined in section 1903(u)(1)(D)) 
for the period involved, except that such pay-
ments shall be limited to individuals for which 
eligibility determinations are made under this 
paragraph and except that in applying this 
paragraph under title XXI, there shall be sub-
stituted for references to provisions of this title 
corresponding provisions within title XXI. 
‘‘(F) EXPRESS LANE AGENCY.— 
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‘‘(i) IN GENERAL.—In this paragraph, the 
term ‘Express Lane agency’ means a public 
agency that— 
‘‘(I) is determined by the State Med-
icaid agency or the State CHIP agency (as 
applicable) to be capable of making the de-
terminations of one or more eligibility re-
quirements 
described 
in 
subparagraph 
(A)(i); 
‘‘(II) is identified in the State Med-
icaid plan or the State CHIP plan; and 
‘‘(III) notifies the child’s family— 
‘‘(aa) of the information which 
shall be disclosed in accordance with 
this paragraph; 
‘‘(bb) that the information dis-
closed will be used solely for purposes 
of determining eligibility for medical 
assistance under the State Medicaid 
plan or for child health assistance 
under the State CHIP plan; and 
‘‘(cc) that the family may elect to 
not have the information disclosed for 
such purposes; and 
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109 
‘‘(IV) enters into, or is subject to, an 
interagency agreement to limit the disclo-
sure and use of the information disclosed. 
‘‘(ii) INCLUSION
OF
SPECIFIC
PUBLIC 
AGENCIES.—Such term includes the following: 
‘‘(I) A public agency that determines 
eligibility for assistance under any of the 
following: 
‘‘(aa) The temporary assistance 
for needy families program funded 
under part A of title IV. 
‘‘(bb) A State program funded 
under part D of title IV. 
‘‘(cc) The State Medicaid plan. 
‘‘(dd) The State CHIP plan. 
‘‘(ee) The Food and Nutrition 
Act of 2008 (7 U.S.C. 2011 et seq.). 
‘‘(ff) The Head Start Act (42 
U.S.C. 9801 et seq.). 
‘‘(gg) The Richard B. Russell 
National 
School 
Lunch 
Act 
(42 
U.S.C. 1751 et seq.). 
‘‘(hh) The Child Nutrition Act of 
1966 (42 U.S.C. 1771 et seq.). 
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110 
‘‘(ii) The Child Care and Devel-
opment Block Grant Act of 1990 (42 
U.S.C. 9858 et seq.). 
‘‘(jj) The Stewart B. McKinney 
Homeless Assistance Act (42 U.S.C. 
11301 et seq.). 
‘‘(kk) The United States Housing 
Act of 1937 (42 U.S.C. 1437 et seq.). 
‘‘(ll) The Native American Hous-
ing Assistance and Self-Determination 
Act of 1996 (25 U.S.C. 4101 et seq.). 
‘‘(II) A State-specified governmental 
agency that has fiscal liability or legal re-
sponsibility for the accuracy of the eligi-
bility determination findings relied on by 
the State. 
‘‘(III) A public agency that is subject 
to an interagency agreement limiting the 
disclosure and use of the information dis-
closed for purposes of determining eligi-
bility under the State Medicaid plan or the 
State CHIP plan. 
‘‘(iii) EXCLUSIONS.—Such term does not 
include an agency that determines eligibility for 
a program established under the Social Services 
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111 
Block Grant established under title XX or a 
private, for-profit organization. 
‘‘(iv) RULES OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as— 
‘‘(I) exempting a State Medicaid 
agency from complying with the require-
ments of section 1902(a)(4) relating to 
merit-based personnel standards for em-
ployees of the State Medicaid agency and 
safeguards against conflicts of interest); or 
‘‘(II) authorizing a State Medicaid 
agency that elects to use Express Lane 
agencies under this subparagraph to use 
the Express Lane option to avoid com-
plying with such requirements for purposes 
of making eligibility determinations under 
the State Medicaid plan. 
‘‘(v) ADDITIONAL
DEFINITIONS.—In this 
paragraph: 
‘‘(I) STATE.—The term ‘State’ means 
1 of the 50 States or the District of Co-
lumbia. 
‘‘(II) 
STATE
CHIP
AGENCY.—The 
term ‘State CHIP agency’ means the State 
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112 
agency responsible for administering the 
State CHIP plan. 
‘‘(III) STATE CHIP PLAN.—The term 
‘State CHIP plan’ means the State child 
health plan established under title XXI 
and includes any waiver of such plan. 
‘‘(IV) STATE
MEDICAID
AGENCY.— 
The term ‘State Medicaid agency’ means 
the State agency responsible for admin-
istering the State Medicaid plan. 
‘‘(V) STATE
MEDICAID
PLAN.—The 
term ‘State Medicaid plan’ means the 
State plan established under title XIX and 
includes any waiver of such plan. 
‘‘(G) CHILD DEFINED.—For purposes of this 
paragraph, the term ‘child’ means an individual 
under 19 years of age, or, at the option of a State, 
such higher age, not to exceed 21 years of age, as 
the State may elect. 
‘‘(H) APPLICATION.—This paragraph shall not 
apply to with respect to eligibility determinations 
made after September 30, 2013.’’. 
(2) CHIP.—Section 2107(e)(1) (42 U.S.C. 
1397gg(e)(1)) is amended by redesignating subpara-
graphs (B), (C), and (D) as subparagraphs (C), (D), 
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113 
and (E), respectively, and by inserting after sub-
paragraph (A) the following new subparagraph: 
‘‘(B) Section 1902(e)(13) (relating to the 
State option to rely on findings from an Ex-
press Lane agency to help evaluate a child’s eli-
gibility for medical assistance).’’. 
(b) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary shall con-
duct, by grant, contract, or interagency agreement, 
a comprehensive, independent evaluation of the op-
tion provided under the amendments made by sub-
section (a). Such evaluation shall include an analysis 
of the effectiveness of the option, and shall include— 
(A) obtaining a statistically valid sample of 
the children who were enrolled in the State 
Medicaid plan or the State CHIP plan through 
reliance on a finding made by an Express Lane 
agency and determining the percentage of chil-
dren who were erroneously enrolled in such 
plans; 
(B) determining whether enrolling children 
in such plans through reliance on a finding 
made by an Express Lane agency improves the 
ability of a State to identify and enroll low-in-
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114 
come, uninsured children who are eligible but 
not enrolled in such plans; 
(C) evaluating the administrative costs or 
savings related to identifying and enrolling chil-
dren in such plans through reliance on such 
findings, and the extent to which such costs dif-
fer from the costs that the State otherwise 
would have incurred to identify and enroll low- 
income, uninsured children who are eligible but 
not enrolled in such plans; and 
(D) any recommendations for legislative or 
administrative changes that would improve the 
effectiveness of enrolling children in such plans 
through reliance on such findings. 
(2) REPORT
TO
CONGRESS.—Not later than 
September 30, 2012, the Secretary shall submit a 
report to Congress on the results of the evaluation 
under paragraph (1). 
(3) FUNDING.— 
(A) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there is 
appropriated to the Secretary to carry out the 
evaluation under this subsection $5,000,000 for 
the period of fiscal years 2009 through 2012. 
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115 
(B) BUDGET AUTHORITY.—Subparagraph 
(A) constitutes budget authority in advance of 
appropriations Act and represents the obliga-
tion of the Federal Government to provide for 
the payment of such amount to conduct the 
evaluation under this subsection. 
(c) ELECTRONIC TRANSMISSION OF INFORMATION.— 
Section 1902 (42 U.S.C. 1396a) is amended by adding 
at the end the following new subsection: 
‘‘(dd) ELECTRONIC TRANSMISSION
OF INFORMA-
TION.—If the State agency determining eligibility for med-
ical assistance under this title or child health assistance 
under title XXI verifies an element of eligibility based on 
information from an Express Lane Agency (as defined in 
subsection (e)(13)(F)), or from another public agency, 
then the applicant’s signature under penalty of perjury 
shall not be required as to such element. Any signature 
requirement for an application for medical assistance may 
be satisfied through an electronic signature, as defined in 
section 1710(1) of the Government Paperwork Elimi-
nation Act (44 U.S.C. 3504 note). The requirements of 
subparagraphs (A) and (B) of section 1137(d)(2) may be 
met through evidence in digital or electronic form.’’. 
(d) AUTHORIZATION
OF
INFORMATION
DISCLO-
SURE.— 
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116 
(1) IN GENERAL.—Title XIX is amended by 
adding at the end the following new section: 
‘‘SEC. 1942. AUTHORIZATION TO RECEIVE RELEVANT IN-
FORMATION. 
‘‘(a) IN GENERAL.—Notwithstanding any other pro-
vision of law, a Federal or State agency or private entity 
in possession of the sources of data directly relevant to 
eligibility determinations under this title (including eligi-
bility files maintained by Express Lane agencies described 
in section 1902(e)(13)(F), information described in para-
graph (2) or (3) of section 1137(a), vital records informa-
tion about births in any State, and information described 
in sections 453(i) and 1902(a)(25)(I)) is authorized to 
convey such data or information to the State agency ad-
ministering the State plan under this title, to the extent 
such conveyance meets the requirements of subsection (b). 
‘‘(b) REQUIREMENTS FOR CONVEYANCE.—Data or 
information may be conveyed pursuant to subsection (a) 
only if the following requirements are met: 
‘‘(1) The individual whose circumstances are 
described in the data or information (or such indi-
vidual’s parent, guardian, caretaker relative, or au-
thorized representative) has either provided advance 
consent to disclosure or has not objected to disclo-
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117 
sure after receiving advance notice of disclosure and 
a reasonable opportunity to object. 
‘‘(2) Such data or information are used solely 
for the purposes of— 
‘‘(A) identifying individuals who are eligi-
ble or potentially eligible for medical assistance 
under this title and enrolling or attempting to 
enroll such individuals in the State plan; and 
‘‘(B) verifying the eligibility of individuals 
for medical assistance under the State plan. 
‘‘(3) An interagency or other agreement, con-
sistent with standards developed by the Secretary— 
‘‘(A) prevents the unauthorized use, disclo-
sure, or modification of such data and other-
wise meets applicable Federal requirements 
safeguarding privacy and data security; and 
‘‘(B) requires the State agency admin-
istering the State plan to use the data and in-
formation obtained under this section to seek to 
enroll individuals in the plan. 
‘‘(c) PENALTIES FOR IMPROPER DISCLOSURE.— 
‘‘(1) CIVIL MONEY PENALTY.—A private entity 
described in the subsection (a) that publishes, dis-
closes, or makes known in any manner, or to any ex-
tent not authorized by Federal law, any information 
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118 
obtained under this section is subject to a civil 
money penalty in an amount equal to $10,000 for 
each such unauthorized publication or disclosure. 
The provisions of section 1128A (other than sub-
sections (a) and (b) and the second sentence of sub-
section (f)) shall apply to a civil money penalty 
under this paragraph in the same manner as such 
provisions apply to a penalty or proceeding under 
section 1128A(a). 
‘‘(2) CRIMINAL PENALTY.—A private entity de-
scribed in the subsection (a) that willfully publishes, 
discloses, or makes known in any manner, or to any 
extent not authorized by Federal law, any informa-
tion obtained under this section shall be fined not 
more than $10,000 or imprisoned not more than 1 
year, or both, for each such unauthorized publication 
or disclosure. 
‘‘(d) RULE OF CONSTRUCTION.—The limitations and 
requirements that apply to disclosure pursuant to this sec-
tion shall not be construed to prohibit the conveyance or 
disclosure of data or information otherwise permitted 
under Federal law (without regard to this section).’’. 
(2) CONFORMING AMENDMENT TO TITLE XXI.— 
Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as 
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119 
amended by subsection (a)(2), is amended by adding 
at the end the following new subparagraph: 
‘‘(F) Section 1942 (relating to authoriza-
tion to receive data directly relevant to eligi-
bility determinations).’’. 
(3) CONFORMING AMENDMENT TO PROVIDE AC-
CESS TO DATA ABOUT ENROLLMENT IN INSURANCE 
FOR PURPOSES OF EVALUATING APPLICATIONS AND 
FOR
CHIP.—Section 1902(a)(25)(I)(i) (42 U.S.C. 
1396a(a)(25)(I)(i)) is amended— 
(A) by inserting ‘‘(and, at State option, in-
dividuals who apply or whose eligibility for med-
ical assistance is being evaluated in accordance 
with section 1902(e)(13)(D))’’ after ‘‘with re-
spect to individuals who are eligible’’; and 
(B) by inserting ‘‘under this title (and, at 
State option, child health assistance under title 
XXI)’’ after ‘‘the State plan’’. 
(e) AUTHORIZATION
FOR STATES ELECTING EX-
PRESS LANE OPTION TO RECEIVE CERTAIN DATA DI-
RECTLY RELEVANT TO DETERMINING ELIGIBILITY AND 
CORRECT AMOUNT OF ASSISTANCE.—The Secretary shall 
enter into such agreements as are necessary to permit a 
State that elects the Express Lane option under section 
1902(e)(13) of the Social Security Act to receive data di-
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120 
rectly relevant to eligibility determinations and deter-
mining the correct amount of benefits under a State child 
health plan under CHIP or a State plan under Medicaid 
from the following: 
(1) The National Directory of New Hires estab-
lished under section 453(i) of the Social Security 
Act (42 U.S.C. 653(i)). 
(2) Data regarding enrollment in insurance that 
may help to facilitate outreach and enrollment under 
the State Medicaid plan, the State CHIP plan, and 
such other programs as the Secretary may specify. 
(f) EFFECTIVE DATE.—The amendments made by 
this section are effective on the date of the enactment of 
this Act. 
Subtitle B—Reducing Barriers to 
Enrollment 
SEC. 211. VERIFICATION OF DECLARATION OF CITIZENSHIP 
OR NATIONALITY FOR PURPOSES OF ELIGI-
BILITY FOR MEDICAID AND CHIP. 
(a) 
ALTERNATIVE
STATE
PROCESS
FOR 
VERIFICATION OF DECLARATION OF CITIZENSHIP OR NA-
TIONALITY FOR PURPOSES OF ELIGIBILITY FOR MED-
ICAID.— 
(1) ALTERNATIVE
TO
DOCUMENTATION
RE-
QUIREMENT.— 
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122 
ality under section 1903(x) (if the individual is not de-
scribed in paragraph (2) of that section), as follows: 
‘‘(A) The State submits the name and social se-
curity number of the individual to the Commissioner 
of Social Security as part of the program established 
under paragraph (2). 
‘‘(B) If the State receives notice from the Com-
missioner of Social Security that the name or social 
security number, or the declaration of citizenship or 
nationality, of the individual is inconsistent with in-
formation in the records maintained by the Commis-
sioner— 
‘‘(i) the State makes a reasonable effort to 
identify and address the causes of such incon-
sistency, including through typographical or 
other clerical errors, by contacting the indi-
vidual to confirm the accuracy of the name or 
social security number submitted or declaration 
of citizenship or nationality and by taking such 
additional actions as the Secretary, through 
regulation or other guidance, or the State may 
identify, and continues to provide the individual 
with medical assistance while making such ef-
fort; and 
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123 
‘‘(ii) in the case such inconsistency is not 
resolved under clause (i), the State— 
‘‘(I) notifies the individual of such 
fact; 
‘‘(II) provides the individual with a 
period of 90 days from the date on which 
the notice required under subclause (I) is 
received by the individual to either present 
satisfactory documentary evidence of citi-
zenship or nationality (as defined in sec-
tion 1903(x)(3)) or resolve the inconsist-
ency with the Commissioner of Social Se-
curity (and continues to provide the indi-
vidual with medical assistance during such 
90-day period); and 
‘‘(III) disenrolls the individual from 
the State plan under this title within 30 
days after the end of such 90-day period if 
no such documentary evidence is presented 
or if such inconsistency is not resolved. 
‘‘(2)(A) Each State electing to satisfy the require-
ments of this subsection for purposes of section 
1902(a)(46)(B) shall establish a program under which the 
State submits at least monthly to the Commissioner of So-
cial Security for comparison of the name and social secu-
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124 
rity number, of each individual newly enrolled in the State 
plan under this title that month who is not described in 
section 1903(x)(2) and who declares to be a United States 
citizen or national, with information in records maintained 
by the Commissioner. 
‘‘(B) In establishing the State program under this 
paragraph, the State may enter into an agreement with 
the Commissioner of Social Security— 
‘‘(i) to provide, through an on-line system or 
otherwise, for the electronic submission of, and re-
sponse to, the information submitted under subpara-
graph (A) for an individual enrolled in the State 
plan under this title who declares to be citizen or na-
tional on at least a monthly basis; or 
‘‘(ii) to provide for a determination of the con-
sistency of the information submitted with the infor-
mation maintained in the records of the Commis-
sioner through such other method as agreed to by 
the State and the Commissioner and approved by 
the Secretary, provided that such method is no more 
burdensome for individuals to comply with than any 
burdens that may apply under a method described in 
clause (i). 
‘‘(C) The program established under this paragraph 
shall provide that, in the case of any individual who is 
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125 
required to submit a social security number to the State 
under subparagraph (A) and who is unable to provide the 
State with such number, shall be provided with at least 
the reasonable opportunity to present satisfactory docu-
mentary evidence of citizenship or nationality (as defined 
in section 1903(x)(3)) as is provided under clauses (i) and 
(ii) of section 1137(d)(4)(A) to an individual for the sub-
mittal to the State of evidence indicating a satisfactory 
immigration status. 
‘‘(3)(A) The State agency implementing the plan ap-
proved under this title shall, at such times and in such 
form as the Secretary may specify, provide information on 
the percentage each month that the inconsistent submis-
sions bears to the total submissions made for comparison 
for such month. For purposes of this subparagraph, a 
name, social security number, or declaration of citizenship 
or nationality of an individual shall be treated as incon-
sistent and included in the determination of such percent-
age only if— 
‘‘(i) the information submitted by the individual 
is not consistent with information in records main-
tained by the Commissioner of Social Security; 
‘‘(ii) the inconsistency is not resolved by the 
State; 
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126 
‘‘(iii) the individual was provided with a reason-
able period of time to resolve the inconsistency with 
the Commissioner of Social Security or provide satis-
factory documentation of citizenship status and did 
not successfully resolve such inconsistency; and 
‘‘(iv) payment has been made for an item or 
service furnished to the individual under this title. 
‘‘(B) If, for any fiscal year, the average monthly per-
centage determined under subparagraph (A) is greater 
than 3 percent— 
‘‘(i) the State shall develop and adopt a correc-
tive plan to review its procedures for verifying the 
identities of individuals seeking to enroll in the State 
plan under this title and to identify and implement 
changes in such procedures to improve their accu-
racy; and 
‘‘(ii) pay to the Secretary an amount equal to 
the amount which bears the same ratio to the total 
payments under the State plan for the fiscal year for 
providing medical assistance to individuals who pro-
vided inconsistent information as the number of in-
dividuals with inconsistent information in excess of 
3 percent of such total submitted bears to the total 
number of individuals with inconsistent information. 
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127 
‘‘(C) The Secretary may waive, in certain limited 
cases, all or part of the payment under subparagraph 
(B)(ii) if the State is unable to reach the allowable error 
rate despite a good faith effort by such State. 
‘‘(D) Subparagraphs (A) and (B) shall not apply to 
a State for a fiscal year if there is an agreement described 
in paragraph (2)(B) in effect as of the close of the fiscal 
year that provides for the submission on a real-time basis 
of the information described in such paragraph. 
‘‘(4) Nothing in this subsection shall affect the rights 
of any individual under this title to appeal any 
disenrollment from a State plan.’’. 
(B) COSTS OF IMPLEMENTING AND MAIN-
TAINING
SYSTEM.—Section 
1903(a)(3) 
(42 
U.S.C. 1396b(a)(3)) is amended— 
(i) by striking ‘‘plus’’ at the end of 
subparagraph (E) and inserting ‘‘and’’, 
and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(F)(i) 90 percent of the sums expended 
during the quarter as are attributable to the de-
sign, development, or installation of such 
mechanized verification and information re-
trieval systems as the Secretary determines are 
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128 
necessary to implement section 1902(ee) (in-
cluding a system described in paragraph (2)(B) 
thereof), and 
‘‘(ii) 75 percent of the sums expended dur-
ing the quarter as are attributable to the oper-
ation of systems to which clause (i) applies, 
plus’’. 
(2) LIMITATION ON WAIVER AUTHORITY.—Not-
withstanding any provision of section 1115 of the 
Social Security Act (42 U.S.C. 1315), or any other 
provision of law, the Secretary may not waive the re-
quirements of section 1902(a)(46)(B) of such Act 
(42 U.S.C. 1396a(a)(46)(B)) with respect to a 
State. 
(3) CONFORMING AMENDMENTS.—Section 1903 
(42 U.S.C. 1396b) is amended— 
(A) in subsection (i)(22), by striking ‘‘sub-
section 
(x)’’ 
and 
inserting 
‘‘section 
1902(a)(46)(B)’’; and 
(B) in subsection (x)(1), by striking ‘‘sub-
section 
(i)(22)’’ 
and 
inserting 
‘‘section 
1902(a)(46)(B)(i)’’. 
(4) APPROPRIATION.—Out of any money in the 
Treasury of the United States not otherwise appro-
priated, there are appropriated to the Commissioner 
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129 
of Social Security $5,000,000 to remain available 
until expended to carry out the Commissioner’s re-
sponsibilities under section 1902(ee) of the Social 
Security Act, as added by subsection (a). 
(b) CLARIFICATION OF REQUIREMENTS RELATING 
TO PRESENTATION
OF SATISFACTORY DOCUMENTARY 
EVIDENCE OF CITIZENSHIP OR NATIONALITY.— 
(1) ACCEPTANCE OF DOCUMENTARY EVIDENCE 
ISSUED
BY
A
FEDERALLY
RECOGNIZED
INDIAN 
TRIBE.—Section 
1903(x)(3)(B) 
(42 
U.S.C. 
1396b(x)(3)(B)) is amended— 
(A) by redesignating clause (v) as clause 
(vi); and 
(B) by inserting after clause (iv), the fol-
lowing new clause: 
‘‘(v)(I) Except as provided in subclause (II), a 
document issued by a federally recognized Indian 
tribe evidencing membership or enrollment in, or af-
filiation with, such tribe (such as a tribal enrollment 
card or certificate of degree of Indian blood). 
‘‘(II) With respect to those federally recognized 
Indian tribes located within States having an inter-
national border whose membership includes individ-
uals who are not citizens of the United States, the 
Secretary shall, after consulting with such tribes, 
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130 
issue regulations authorizing the presentation of 
such other forms of documentation (including tribal 
documentation, if appropriate) that the Secretary 
determines to be satisfactory documentary evidence 
of citizenship or nationality for purposes of satis-
fying the requirement of this subsection.’’. 
(2) REQUIREMENT
TO
PROVIDE
REASONABLE 
OPPORTUNITY
TO
PRESENT
SATISFACTORY
DOCU-
MENTARY EVIDENCE.—Section 1903(x) (42 U.S.C. 
1396b(x)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(4) In the case of an individual declaring to be a 
citizen or national of the United States with respect to 
whom a State requires the presentation of satisfactory 
documentary evidence of citizenship or nationality under 
section 1902(a)(46)(B)(i), the individual shall be provided 
at least the reasonable opportunity to present satisfactory 
documentary evidence of citizenship or nationality under 
this subsection as is provided under clauses (i) and (ii) 
of section 1137(d)(4)(A) to an individual for the submittal 
to the State of evidence indicating a satisfactory immigra-
tion status.’’. 
(3) CHILDREN BORN IN THE UNITED STATES 
TO MOTHERS ELIGIBLE FOR MEDICAID.— 
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131 
(A) CLARIFICATION
OF
RULES.—Section 
1903(x) (42 U.S.C. 1396b(x)), as amended by 
paragraph (2), is amended— 
(i) in paragraph (2)— 
(I) in subparagraph (C), by strik-
ing ‘‘or’’ at the end; 
(II) by redesignating subpara-
graph (D) as subparagraph (E); and 
(III) by inserting after subpara-
graph (C) the following new subpara-
graph: 
‘‘(D) pursuant to the application of section 
1902(e)(4) (and, in the case of an individual who is 
eligible for medical assistance on such basis, the in-
dividual shall be deemed to have provided satisfac-
tory documentary evidence of citizenship or nation-
ality and shall not be required to provide further 
documentary evidence on any date that occurs dur-
ing or after the period in which the individual is eli-
gible for medical assistance on such basis); or’’; and 
(ii) by adding at the end the following 
new paragraph: 
‘‘(5) Nothing in subparagraph (A) or (B) of section 
1902(a)(46), the preceding paragraphs of this subsection, 
or the Deficit Reduction Act of 2005, including section 
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132 
6036 of such Act, shall be construed as changing the re-
quirement of section 1902(e)(4) that a child born in the 
United States to an alien mother for whom medical assist-
ance for the delivery of such child is available as treatment 
of an emergency medical condition pursuant to subsection 
(v) shall be deemed eligible for medical assistance during 
the first year of such child’s life.’’. 
(B) STATE REQUIREMENT TO ISSUE SEPA-
RATE
IDENTIFICATION
NUMBER.—Section 
1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended 
by adding at the end the following new sen-
tence: ‘‘Notwithstanding the preceding sentence, 
in the case of a child who is born in the United 
States to an alien mother for whom medical as-
sistance for the delivery of the child is made 
available pursuant to section 1903(v), the State 
immediately shall issue a separate identification 
number for the child upon notification by the 
facility at which such delivery occurred of the 
child’s birth.’’. 
(4) 
TECHNICAL
AMENDMENTS.—Section 
1903(x)(2) (42 U.S.C. 1396b(x)) is amended— 
(A) in subparagraph (B)— 
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133 
(i) by realigning the left margin of the 
matter preceding clause (i) 2 ems to the 
left; and 
(ii) by realigning the left margins of 
clauses (i) and (ii), respectively, 2 ems to 
the left; and 
(B) in subparagraph (C)— 
(i) by realigning the left margin of the 
matter preceding clause (i) 2 ems to the 
left; and 
(ii) by realigning the left margins of 
clauses (i) and (ii), respectively, 2 ems to 
the left. 
(c) APPLICATION OF DOCUMENTATION SYSTEM TO 
CHIP.— 
(1) IN GENERAL.—Section 2105(c) (42 U.S.C. 
1397ee(c)), as amended by section 114(a), is amend-
ed by adding at the end the following new para-
graph: 
‘‘(9) CITIZENSHIP DOCUMENTATION REQUIRE-
MENTS.— 
‘‘(A) IN GENERAL.—No payment may be 
made under this section with respect to an indi-
vidual who has, or is, declared to be a citizen 
or national of the United States for purposes of 
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134 
establishing eligibility under this title unless the 
State meets the requirements of section 
1902(a)(46)(B) with respect to the individual. 
‘‘(B) ENHANCED
PAYMENTS.—Notwith-
standing subsection (b), the enhanced FMAP 
with respect to payments under subsection (a) 
for expenditures described in clause (i) or (ii) of 
section 1903(a)(3)(F) necessary to comply with 
subparagraph (A) shall in no event be less than 
90 percent and 75 percent, respectively.’’. 
(2) NONAPPLICATION OF ADMINISTRATIVE EX-
PENDITURES
CAP.—Section 
2105(c)(2)(C) 
(42 
U.S.C. 1397ee(c)(2)(C)), as amended by section 
202(b), is amended by adding at the end the fol-
lowing: 
‘‘(ii) 
EXPENDITURES
TO
COMPLY 
WITH
CITIZENSHIP
OR
NATIONALITY 
VERIFICATION
REQUIREMENTS.—Expendi-
tures necessary for the State to comply 
with paragraph (9)(A).’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the amendments made by 
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this section shall take effect on October 1, 
2009. 
(B) 
TECHNICAL
AMENDMENTS.—The 
amendments made by— 
(i) paragraphs (1), (2), and (3) of 
subsection (b) shall take effect as if in-
cluded in the enactment of section 6036 of 
the Deficit Reduction Act of 2005 (Public 
Law 109–171; 120 Stat. 80); and 
(ii) paragraph (4) of subsection (b) 
shall take effect as if included in the enact-
ment of section 405 of division B of the 
Tax Relief and Health Care Act of 2006 
(Public Law 109–432; 120 Stat. 2996). 
(2) RESTORATION
OF
ELIGIBILITY.—In the 
case of an individual who, during the period that 
began on July 1, 2006, and ends on October 1, 
2009, was determined to be ineligible for medical as-
sistance under a State Medicaid plan, including any 
waiver of such plan, solely as a result of the applica-
tion of subsections (i)(22) and (x) of section 1903 
of the Social Security Act (as in effect during such 
period), but who would have been determined eligible 
for such assistance if such subsections, as amended 
by subsection (b), had applied to the individual, a 
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136 
State may deem the individual to be eligible for such 
assistance as of the date that the individual was de-
termined to be ineligible for such medical assistance 
on such basis. 
(3) SPECIAL TRANSITION RULE FOR INDIANS.— 
During the period that begins on July 1, 2006, and 
ends on the effective date of final regulations issued 
under subclause (II) of section 1903(x)(3)(B)(v) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(x)(3)(B)(v)) 
(as 
added 
by 
subsection 
(b)(1)(B)), an individual who is a member of a fed-
erally-recognized Indian tribe described in subclause 
(II) of that section who presents a document de-
scribed in subclause (I) of such section that is issued 
by such Indian tribe, shall be deemed to have pre-
sented satisfactory evidence of citizenship or nation-
ality for purposes of satisfying the requirement of 
subsection (x) of section 1903 of such Act. 
SEC. 212. REDUCING ADMINISTRATIVE BARRIERS TO EN-
ROLLMENT. 
Section 2102(b) (42 U.S.C. 1397bb(b)) is amended— 
(1) by redesignating paragraph (4) as para-
graph (5); and 
(2) by inserting after paragraph (3) the fol-
lowing new paragraph: 
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137 
‘‘(4) REDUCTION
OF
ADMINISTRATIVE
BAR-
RIERS TO ENROLLMENT.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the plan shall include a description 
of the procedures used to reduce administrative 
barriers to the enrollment of children and preg-
nant women who are eligible for medical assist-
ance under title XIX or for child health assist-
ance or health benefits coverage under this title. 
Such procedures shall be established and re-
vised as often as the State determines appro-
priate to take into account the most recent in-
formation available to the State identifying 
such barriers. 
‘‘(B) DEEMED COMPLIANCE IF JOINT AP-
PLICATION AND RENEWAL PROCESS THAT PER-
MITS APPLICATION OTHER THAN IN PERSON.— 
A State shall be deemed to comply with sub-
paragraph (A) if the State’s application and re-
newal forms and supplemental forms (if any) 
and information verification process is the same 
for purposes of establishing and renewing eligi-
bility for children and pregnant women for 
medical assistance under title XIX and child 
health assistance under this title, and such 
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138 
process does not require an application to be 
made in person or a face-to-face interview.’’. 
SEC. 213. MODEL OF INTERSTATE COORDINATED ENROLL-
MENT AND COVERAGE PROCESS. 
(a) IN GENERAL.—In order to assure continuity of 
coverage of low-income children under the Medicaid pro-
gram and the State Children’s Health Insurance Program 
(CHIP), not later than 18 months after the date of the 
enactment of this Act, the Secretary of Health and 
Human Services, in consultation with State Medicaid and 
CHIP directors and organizations representing program 
beneficiaries, shall develop a model process for the coordi-
nation of the enrollment, retention, and coverage under 
such programs of children who, because of migration of 
families, emergency evacuations, natural or other disas-
ters, public health emergencies, educational needs, or oth-
erwise, frequently change their State of residency or other-
wise are temporarily located outside of the State of their 
residency. 
(b) REPORT TO CONGRESS.—After development of 
such model process, the Secretary of Health and Human 
Services shall submit to Congress a report describing addi-
tional steps or authority needed to make further improve-
ments to coordinate the enrollment, retention, and cov-
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