I 
108TH CONGRESS 
1ST SESSION 
H. R. 819
To amend the Balanced Budget Act of 1997 to extend and modify the 
reimbursement of State and local funds expended for emergency health 
services furnished to undocumented aliens. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 13, 2003
Mr. KOLBE (for himself, Mr. FLAKE, Mr. SHADEGG, Mr. HAYWORTH, Mr. 
RENZI, Mr. PASTOR, Mr. GRIJALVA, and Mr. REYES) introduced the fol-
lowing bill; which was referred to the Committee on Appropriations, and 
in addition to the Committee on Energy and Commerce, for a period to 
be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend the Balanced Budget Act of 1997 to extend and 
modify the reimbursement of State and local funds ex-
pended for emergency health services furnished to un-
documented aliens.
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 ‘‘Local Emergency 
Health Services Reimbursement Act of 2003’’.
SEC. 
2. 
FEDERAL 
REIMBURSEMENT 
OF 
EMERGENCY 
HEALTH SERVICES FURNISHED TO UNDOCU-
MENTED ALIENS. 
Section 4723 of the Balanced Budget Act of 1997 
(8 U.S.C. 1611 note) is amended to read as follows: 
‘‘SEC. 4723. FEDERAL REIMBURSEMENT OF EMERGENCY 
HEALTH SERVICES FURNISHED TO UNDOCU-
MENTED ALIENS. 
‘‘(a) TOTAL
AMOUNT
AVAILABLE
FOR
ALLOT-
MENT.—There is appropriated, out of any funds in the 
Treasury not otherwise appropriated, $1,450,000,000 for 
each of fiscal years 2004 through 2008, for the purpose 
of making allotments under this section to States de-
scribed in paragraph (1) or (2) of subsection (b). Funds 
appropriated under the preceding sentence shall remain 
available until expended. 
‘‘(b) STATE ALLOTMENTS.—
‘‘(1) BASED
ON
PERCENTAGE
OF
UNDOCU-
MENTED ALIENS.—
‘‘(A) IN
GENERAL.—Out of the amount 
appropriated under subsection (a) for each fis-
cal year, the Secretary shall use $957,000,000 
of such amount to make allotments for each 
such fiscal year in accordance with subpara-
graph (B).
‘‘(B) FORMULA.—The amount of the allot-
ment for each State for a fiscal year shall be 
equal to the product of—
‘‘(i) the total amount available for al-
lotments under this paragraph for the fis-
cal year; and 
‘‘(ii) the percentage of undocumented 
aliens residing in the State with respect to 
the total number of such aliens residing in 
all States, as determined by the Statistics 
Division of the Immigration and Natu-
ralization Service, as of January 2003, 
based on the 2000 decennial census. 
‘‘(2) BASED ON NUMBER OF UNDOCUMENTED 
ALIEN APPREHENSION STATES.—
‘‘(A) IN
GENERAL.—Out of the amount 
appropriated under subsection (a) for a fiscal 
year, the Secretary shall use $493,000,000 of 
such amount to make allotments for each such 
fiscal year for each of the 6 States with the 
highest number of undocumented alien appre-
hensions for such fiscal year. 
‘‘(B) DETERMINATION OF ALLOTMENTS.—
The amount of the allotment for each State de-
scribed in subparagraph (A) for a fiscal year
a State, local government, hospital, or other provider 
with respect to the provision of such services. 
‘‘(d) APPLICATIONS; ADVANCE PAYMENTS; REAL-
LOTMENT OF UNUSED FUNDS.—
‘‘(1) DEADLINE FOR ESTABLISHMENT OF AP-
PLICATION PROCESS.—
‘‘(A) IN GENERAL.—Not later than July 
31, 2003, the Secretary shall establish a proc-
ess under which States, local governments, hos-
pitals, or other providers located in the State 
may apply for payments from allotments made 
under subsection (b) for a fiscal year for un-
compensated emergency health services fur-
nished to undocumented aliens during that fis-
cal year. 
‘‘(B) INCLUSION OF MEASURES TO COM-
BAT
FRAUD.—The Secretary shall include in 
the process established under subparagraph (A) 
measures to ensure that fraudulent payments 
are not made from the allotments determined 
under subsection (b) or from amounts reallotted 
under paragraph (3). 
‘‘(2) ADVANCE PAYMENT; RETROSPECTIVE AD-
JUSTMENT.—The process established under para-
graph (1) shall allow for making payments under
this section for each quarter of a fiscal year on the 
basis of advance estimates of expenditures submitted 
by applicants for such payments and such other in-
vestigation as the Secretary may find necessary, and 
for making reductions or increases in the payments 
as necessary to adjust for any overpayment or un-
derpayment for prior quarters. 
‘‘(3) REALLOTMENT OF UNUSED FUNDS.—
‘‘(A) IN GENERAL.—With respect to allot-
ments made under subsection (b) for a fiscal 
year, the amount of any allotment to a State 
for a fiscal year that the Secretary determines 
will not be expended during that fiscal year or 
the succeeding fiscal year shall be available for 
reallotment during the second succeeding fiscal 
year, on such date as the Secretary may deter-
mine, to other States with allotments under 
that subsection that the Secretary determines 
will use such excess amounts during that sec-
ond succeeding fiscal year. 
‘‘(B) 
DETERMINATION
OF
REALLOT-
MENTS.—Reallotments under subparagraph (A) 
shall be made in the same manner as allotments 
are determined under paragraphs (1) and (2) of 
subsection (b) but only with respect to those
States that the Secretary determines qualify for 
a reallotment for a fiscal year under that sub-
paragraph. 
‘‘(C) TREATMENT.—Any amount reallotted 
under subparagraph (A) to a State is deemed 
to be part of its allotment under subsection (b) 
for the fiscal year in which the reallotment oc-
curs. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) HOSPITAL.—The term ‘hospital’ has the 
meaning given such term in section 1861(e) of the 
Social Security Act (42 U.S.C. 1395x(e)). 
‘‘(2) INDIAN TRIBE; TRIBAL ORGANIZATION.—
The terms ‘Indian tribe’ and ‘tribal organization’ 
have the meanings given such terms in section 4 of 
the Indian Health Care Improvement Act. 
‘‘(3) PROVIDER.—The term ‘provider’ includes 
a physician, any other health care professional li-
censed under State law, and any other entity that 
furnishes emergency health services, including ambu-
lance services. 
‘‘(4) SECRETARY.—The term ‘Secretary’ means 
the Secretary of Health and Human Services. 
‘‘(5) STATE.—The term ‘State’ means the 50 
States and the District of Columbia.
‘‘(f) ENTITLEMENT.—This section constitutes budget 
authority in advance of appropriations Acts and rep-
resents the obligation of the Federal Government to pro-
vide for the payment of amounts provided under this sec-
tion.’’.
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