I 
110TH CONGRESS 
1ST SESSION H. R. 3888 
To provide for a 5-year SCHIP reauthorization for coverage of low-income 
children, an expansion of child health care insurance coverage through 
tax fairness, and a health care Federalism initiative, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 18, 2007 
Mrs. MUSGRAVE (for herself, Mr. PRICE of Georgia, Mr. FEENEY, Mr. 
WALBERG, Mr. BOEHNER, Mr. BLUNT, Mr. CANTOR, Mr. PUTNAM, Mr. 
KELLER of Florida, Mr. TERRY, Mr. ROSKAM, Mr. THORNBERRY, Mr. 
SESSIONS, Mr. CHABOT, Mr. DAVID DAVIS of Tennessee, Mr. HELLER 
of Nevada, Mr. KLINE of Minnesota, Mr. PENCE, Mr. CARTER, Mr. 
GOHMERT, Mr. WELDON of Florida, Mr. WESTMORELAND, Mr. PITTS, 
Mr. BISHOP of Utah, Mrs. BLACKBURN, Mr. ISSA, Mr. BARTLETT of 
Maryland, Mr. SMITH of Nebraska, Mr. HOEKSTRA, Mrs. SCHMIDT, Mr. 
BROWN of South Carolina, Mr. COBLE, Mr. MILLER of Florida, Mr. 
BURTON of Indiana, Mr. GINGREY, Mr. BOOZMAN, Mr. SMITH of Texas, 
Mr. GARY G. MILLER of California, Mr. CRENSHAW, Mr. WAMP, Mrs. 
CUBIN, and Mr. FRANKS of Arizona) introduced the following bill; which 
was referred to the Committee on Energy and Commerce, and in addition 
to the Committees on Ways and Means and Rules, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To provide for a 5-year SCHIP reauthorization for coverage 
of low-income children, an expansion of child health care 
insurance coverage through tax fairness, and a health 
care Federalism initiative, and for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘More Children, More Choices Act of 2007’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—SCHIP REAUTHORIZATION 
Sec. 101. Requiring outreach and coverage before expansion of eligibility. 
Sec. 102. Application of citizenship documentation requirements; increased 
Federal matching rate for citizenship documentation enforce-
ment under Medicaid and SCHIP. 
Sec. 103. Limitations on eligibility based on substantial net assets. 
Sec. 104. Clarification of State authorities. 
Sec. 105. Easing administrative barriers to State cooperation with employer- 
sponsored insurance coverage. 
Sec. 106. Improving beneficiary choice in SCHIP. 
Sec. 107. Allotment distribution formula. 
Sec. 108. Five-year reauthorization. 
Sec. 109. Enhancing the programmatic focus on children and pregnant women. 
Sec. 110. Grants for outreach and enrollment. 
TITLE II—CHILD HEALTH INSURANCE COVERAGE THROUGH TAX 
FAIRNESS 
Sec. 201. Expansion of child health care insurance coverage through tax fair-
ness. 
TITLE III—STATE HEALTH REFORM PROJECTS 
Sec. 301. State health reform projects. 
TITLE IV—SENSE OF THE HOUSE OF REPRESENTATIVES 
Sec. 401. Medicare and Medicaid reform and savings. 
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TITLE I—SCHIP 
REAUTHORIZATION 
SEC. 101. REQUIRING OUTREACH AND COVERAGE BEFORE 
EXPANSION OF ELIGIBILITY. 
(a) STATE PLAN REQUIRED TO SPECIFY HOW IT 
WILL ACHIEVE COVERAGE FOR 90 PERCENT OF TAR-
GETED LOW-INCOME CHILDREN.— 
(1) IN GENERAL.—Section 2102(a) of the So-
cial Security Act (42 U.S.C. 1397bb(a)) is amend-
ed— 
(A) in paragraph (6), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (7), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(8) how the eligibility and benefits provided 
for under the plan for each fiscal year (beginning 
with fiscal year 2009) will allow for the State’s an-
nual funding allotment to cover at least 90 percent 
of the eligible targeted low-income children in the 
State.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to State child health 
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plans for fiscal years beginning with fiscal year 
2009. 
(b) LIMITATION ON PROGRAM EXPANSIONS UNTIL 
LOWEST INCOME ELIGIBLE INDIVIDUALS ENROLLED.— 
Section 2105(c) of such Act (42 U.S.C. 1397dd(c)) is 
amended by adding at the end the following new para-
graph: 
‘‘(8) LIMITATION ON INCREASED COVERAGE OF 
HIGHER INCOME CHILDREN.—For child health as-
sistance furnished in a fiscal year beginning with fis-
cal year 2008: 
‘‘(A) NO PAYMENT FOR CHILDREN WITH 
FAMILY INCOME ABOVE 250 PERCENT OF POV-
ERTY LINE.—Payment shall not be made under 
this section for child health assistance for a tar-
geted low-income child in a family the income 
of which exceeds 250 percent of the poverty line 
applicable to a family of the size involved. 
‘‘(B) SPECIAL RULES FOR PAYMENT FOR 
CHILDREN
WITH
FAMILY
INCOME
ABOVE
200 
PERCENT OF POVERTY LINE.—In the case of 
child health assistance for a targeted low-in-
come child in a family the income of which ex-
ceeds 200 percent (but does not exceed 250 
percent) of the poverty line applicable to a fam-
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ily of the size involved no payment shall be 
made under this section for such assistance un-
less the State demonstrates to the satisfaction 
of the Secretary that— 
‘‘(i) the State has met the 90 percent 
retrospective coverage test specified in sub-
paragraph (C)(i) for the previous fiscal 
year; and 
‘‘(ii) the State will meet the 90 per-
cent prospective coverage test specified in 
subparagraph (C)(ii) for the fiscal year. 
‘‘(C) 90 PERCENT COVERAGE TESTS.— 
‘‘(i) RETROSPECTIVE TEST.—The 90 
percent retrospective coverage test speci-
fied in this clause is, for a State for a fis-
cal year, that on average during the fiscal 
year, the State has enrolled under this title 
or title XIX at least 90 percent of the indi-
viduals residing in the State who— 
‘‘(I) are children under 19 years 
of age (or are pregnant women) and 
are eligible for medical assistance 
under title XIX; or 
‘‘(II) are targeted low-income 
children whose family income does not 
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exceed 200 percent of the poverty line 
and who are eligible for child health 
assistance under this title. 
‘‘(ii) PROSPECTIVE
TEST.—The 90 
percent prospective test specified in this 
clause is, for a State for a fiscal year, that 
on average during the fiscal year, the State 
will enroll under this title or title XIX at 
least 90 percent of the individuals residing 
in the State who— 
‘‘(I) are children under 19 years 
of age (or are pregnant women) and 
are eligible for medical assistance 
under title XIX; or 
‘‘(II) are targeted low-income 
children whose family income does not 
exceed such percent of the poverty 
line (in excess of 200 percent) as the 
State elects consistent with this para-
graph and who are eligible for child 
health assistance under this title. 
‘‘(D) GRANDFATHER.—Subparagraphs (A) 
and (B) shall not apply to the provision of child 
health assistance— 
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‘‘(i) to a targeted low-income child 
who is enrolled for child health assistance 
under this title as of September 30, 2007; 
‘‘(ii) to a pregnant woman who is en-
rolled for assistance under this title as of 
September 30, 2007, through the comple-
tion of the post-partum period following 
completion of her pregnancy; and 
‘‘(iii) for items and services furnished 
before October 1, 2008, to an individual 
who is not a targeted low-income child and 
who is enrolled for assistance under this 
title as of September 30, 2007. 
‘‘(E) 
TREATMENT
OF
PREGNANT 
WOMEN.—In 
this 
paragraph 
and 
sections 
2102(a)(8) and 2104(a)(2), the term ‘targeted 
low-income child’ includes an individual under 
age 19, including the period from conception to 
birth, who is eligible for child health assistance 
under this title by virtue of the definition of the 
term ‘child’ under section 457.10 of title 42, 
Code of Federal Regulations.’’. 
(c) STANDARDIZATION
OF
INCOME
DETERMINA-
TIONS.— 
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(1) IN GENERAL.—Section 2110(d) of such Act 
(42 U.S.C. 1397jj) is amended by adding at the end 
the following new subsection: 
‘‘(d) STANDARDIZATION
OF INCOME DETERMINA-
TIONS.—In determining family income under this title (in-
cluding in the case of a State child health plan that pro-
vides health benefits coverage in the manner described in 
section 2101(a)(2)), a State shall base such determination 
on gross income (including amounts that would be in-
cluded in gross income if they were not exempt from in-
come taxation) and may only take into consideration such 
income disregards as the Secretary shall develop.’’. 
(2) EFFECTIVE DATE.—(A) Subject to subpara-
graph (B), the amendment made by paragraph (1) 
shall apply to determinations (and redeterminations) 
of income made on or after April 1, 2008. 
(B) In the case of a State child health plan 
under title XXI of the Social Security Act which the 
Secretary of Health and Human Services determines 
requires State legislation (other than legislation ap-
propriating funds) in order for the plan to meet the 
additional requirement imposed by the amendment 
made by paragraph (1), the State child health plan 
shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its 
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failure to meet this additional requirement before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
SEC. 102. APPLICATION OF CITIZENSHIP DOCUMENTATION 
REQUIREMENTS; 
INCREASED 
FEDERAL 
MATCHING RATE FOR CITIZENSHIP DOCU-
MENTATION 
ENFORCEMENT 
UNDER 
MED-
ICAID AND SCHIP. 
(a) APPLICATION OF REQUIREMENTS.— 
(1) IN GENERAL.—Section 2105(c) of the So-
cial Security Act (42 U.S.C. 1397dd(c)), as amended 
by section 101(b), is amended by adding at the end 
the following new paragraph: 
‘‘(9) APPLICATION
OF
CITIZENSHIP
DOCU-
MENTATION REQUIREMENTS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), no payment may be made under this 
section to a State with respect to amounts ex-
pended for child health assistance for an indi-
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vidual 
who 
declares 
under 
section 
1137(d)(1)(A) to be a citizen or national of the 
United States for purposes of establishing eligi-
bility for benefits under this title, unless the re-
quirement of section 1903(x) is met. 
‘‘(B) 
TREATMENT
OF
PREGNANT 
WOMEN.—For purposes of applying subpara-
graph (A) in the case of a pregnant woman who 
qualifies for child health assistance by virtue of 
the application of section 457.10 of title 42, 
Code of Federal Regulations, the requirement 
of such section shall be deemed to be satisfied 
by the presentation of documentation of per-
sonal 
identity 
described 
in 
section 
274A(b)(1)(D) of the Immigration and Nation-
ality Act or any other documentation of per-
sonal identity of such other type as the Sec-
retary finds, by regulation, provides a reliable 
means of identification.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to eligibility determina-
tions and redeterminations made on or after April 1, 
2008. 
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(b) TEMPORARY INCREASE IN FEDERAL MATCHING 
RATE FOR ADMINISTRATIVE COSTS UNDER MEDICAID 
AND SCHIP.—— 
(1) MEDICAID.— 
(A) IN GENERAL.—With respect to admin-
istrative costs incurred on or after July 1, 
2006, and before October 1, 2008, in imple-
menting the amendments made by section 6036 
of the Deficit Reduction Act of 2005 (Public 
Law 109–171), 75 percent shall be substituted 
for 50 per centum in section 1903(a)(7) of the 
Social Security Act (42 U.S.C. 1396b(a)(7)). 
(B) 
RETROACTIVE
ADJUSTMENT.—The 
Secretary of Health and Human Services shall 
take such steps as may be necessary to provide 
for the adjustment of payments under section 
1903(a) of the Social Security Act (42 U.S.C. 
1396b(a)) to take into account the application 
of subparagraph (A) for periods before the date 
of the enactment of this Act. 
(2) SCHIP.—With respect to administrative 
costs incurred on or after April 1, 2008, and before 
October 1, 2008 in implementing the amendment 
made by subsection (a)(1), the enhanced FMAP ap-
plied under section 2105(a)(1)(D)(iv) of the Social 
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Security Act (42 U.S.C. 1397d(a)(1)(D)(iv)) shall 
not be less than 75 percent. 
SEC. 103. LIMITATIONS ON ELIGIBILITY BASED ON SUB-
STANTIAL NET ASSETS. 
(a) IN GENERAL.—Section 2110(b) of the Social Se-
curity Act (42 U.S.C. 1397jj(b)) is amended— 
(1) in paragraph (1), by striking ‘‘paragraph 
(2)’’ and inserting ‘‘paragraphs (2) and (5)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(5) DISQUALIFICATION FOR INDIVIDUALS IN 
FAMILIES WITH SUBSTANTIAL NET ASSETS.—An in-
dividual in a family is not eligible for child health 
assistance under this title if the individual’s family 
has net assets (including the equity interest in any 
home) that exceeds $500,000 or unless there is pro-
vided a document (in such a form and manner as 
the Secretary shall specify) signed under penalty of 
perjury by an applicant for child health assistance 
on behalf of the individual that the net assets of the 
individual’s family (including the equity interest in 
the any home) does not exceed $500,000. The Sec-
retary may increase the dollar amount specified in 
the previous sentence from year to year beginning 
with 2013 based on the percentage increase in the 
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consumer price index for all urban consumers (all 
items; United States city average), rounded to the 
nearest $1,000.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to eligibility determinations and 
redeterminations made on or after April 1, 2008. 
SEC. 104. CLARIFICATION OF STATE AUTHORITIES. 
Section 2102 of the Social Security Act (42 U.S.C. 
1397bb) is amended by adding at the end the following 
new subsection: 
‘‘(d) CLARIFICATION
OF STATE AUTHORITIES.— 
Nothing in this title shall be construed as preventing a 
State, under its child health plan, from doing any of the 
following: 
‘‘(1) USE OF WAITING PERIODS TO PREVENT 
CROWD OUT.—From using waiting periods and other 
tools to prevent crowding out private-sector insur-
ance coverage. 
‘‘(2) 
USE
OF
PRIVATE
PROVIDERS
AND 
PLANS.—From cooperating or contracting with pri-
vate sector providers and plans in order to provide 
care to targeted low-income children. 
‘‘(3) USE OF STATE FUNDS FOR INELIGIBLE 
INDIVIDUALS.—From providing medical benefits for 
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individuals who are not targeted low-income children 
with State funds.’’. 
SEC. 105. EASING ADMINISTRATIVE BARRIERS TO STATE 
COOPERATION WITH EMPLOYER-SPONSORED 
INSURANCE COVERAGE. 
(a) REQUIRING SOME COVERAGE FOR EMPLOYER- 
SPONSORED INSURANCE.— 
(1) IN GENERAL.—Section 2102(a) of the So-
cial Security Act (42 U.S.C. 1397b(a)), as amended 
by section 101(a), is amended— 
(A) in paragraph (7), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (8), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(9) effective for plan years beginning on or 
after October 1, 2008, how the plan will provide for 
child health assistance with respect to targeted low- 
income children covered under a group health 
plan.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply beginning with fiscal 
year 2009. 
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