ject to subparagraph (C), the ‘enhanced FMAP’
is equal to 90 percent with respect to amounts
expended on enrollment and outreach activities.
‘‘(B) REQUIREMENTS.—Subparagraph (A)
shall only apply to a State if the State meets
the following requirements:
‘‘(i) NO ASSET TEST.—The State does
not impose an asset test for eligibility
under the State child health plan or under
section 1902(l) with respect to children.
‘‘(ii) 
COMPLIANCE
WITH
OUTSTATIONING REQUIREMENT.—The Sec-
retary finds that the State is providing for
the receipt and initial processing of appli-
cations of certain individuals at facilities
defined as disproportionate share hospitals
under section 1923(a)(1)(A) and Feder-
ally-qualified health centers described in
section 1905(1)(2)(B) consistent with the
requirements of section 1902(a)(55).
‘‘(iii) COMPLIANCE WITH SIMPLIFIED
OUTREACH
AND
ENROLLMENT
PROVI-
SIONS.—The Secretary finds that the State
is providing for outreach and enrollment
under this title and title XIX consistent
with the requirements of sections 2102(c),
2102(d), and 1902(a)(66).
‘‘(C) LIMITATION TO 3 PERCENT OF AN-
NUAL
ALLOTMENT.—Subparagraph (A) shall
not apply to amounts expended by a State in a
fiscal year in excess of 3 percent of the amount
of the amount of its allotment under section
2104 for that fiscal year.’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection take effect on the date of the en-
actment of this Act and apply to expenditures made
on or after the date of the enactment of this Act.
(d) ADDITIONAL ENTITIES QUALIFIED TO DETER-
MINE MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-IN-
COME CHILDREN.—Section 1920A(b)(3)(A)(i) (42 U.S.C.
1396r–1a(b)(3)(A)(i)) is amended—
(1) by striking ‘‘or (II)’’ and inserting ‘‘, (II)’’;
and
(2) by inserting ‘‘eligibility of a child for medi-
cal assistance under the State plan under this title,
or eligibility of a child for child health assistance
under the program funded under title XXI, (III) is
an elementary school or secondary school, as such
terms are defined in section 14101 of the Elemen-
tary and Secondary Education Act of 1965 (20
U.S.C. 8801), an elementary or secondary school op-
erated or supported by the Bureau of Indian Affairs,
a State child support enforcement agency, a child
care resource and referral agency, or a State office
or private contractor that accepts applications for or
administers a program funded under part A of title
IV or that determines eligibility for any assistance
or benefits provided under any program of public or
assisted housing that receives Federal funds, includ-
ing the program under section 8 or any other section
of the United States Housing Act of 1937 (42
U.S.C. 1437 et seq.), or (IV) any other entity the
State so deems’’ before the semicolon.
SEC. 3. FAMILY FRIENDLY COVERAGE AND ENROLLMENT.
(a) ASSURING COORDINATION OF PEDIATRIC PRO-
VIDERS WITHIN A FAMILY.—
(1) IN
GENERAL.—Section 2103 (42 U.S.C.
1397cc) is amended by adding at the end the follow-
ing new subsection:
‘‘(g) STEPS TAKEN TO COORDINATE PROVISION OF
PEDIATRIC CARE WITHIN A FAMILY.—To the extent a
State child health plan provides coverage other than
through providing benefits under the State’s medicaid
plan under title XIX, the State child health plan—
‘‘(1) shall specify methods being used to ensure
that children within a family who are eligible for as-
sistance under the plan are allowed to be seen by the
same pediatric provider or group of pediatric provid-
ers in a manner that permits the coordinated receipt
of care by children in the same family; and
‘‘(2) shall include a description of such methods
in each annual report submitted under section
2108(a).’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) applies on the date of the enact-
ment of this Act and to reports submitted for years
beginning with 1999.
(b) REDUCTION
IN BURDEN
OF ADMINISTERING
COST-SHARING PROVISIONS.—
(1) STATE
RESPONSIBLE
FOR
ASSURING
CAP
ON
COST-SHARING
NOT
EXCEEDED.—Section
2103(e)(3) (42 U.S.C. 1397cc(e)(3)) is amended by
adding at the end the following new subparagraph:
‘‘(C) STATE AND CONTRACTORS RESPON-
SIBLE FOR APPLYING LIMITATIONS ON COST-
SHARING.—The State child health plan shall
provide that responsibility for assuring compli-
ance with the limitations on cost-sharing under
this paragraph falls on the State and on its
contractors, and not on beneficiaries and their
families.’’.
(2) STATE OPTION OF FLAT LIMIT ON OUT-OF-
POCKET
EXPENDITURES.—Section 
2103(e)(3)(B)
(42 U.S.C. 1397cc(e)(3)(B)) is amended by insert-
ing before the period at the end the following: ‘‘(or,
at the option of a State, a limiting amount which is
not greater $500)’’.
(3) EFFECTIVE DATE.—The amendment made
by paragraph (1) takes effect on the date that is 30
days after the date of the enactment of this Act.
(c) PROHIBITION OF WAITING PERIODS.—
(1) IN GENERAL.—Section 2102(b)(1)(B) (42
U.S.C. 1397bb(b)(1)(B)) is amended—
(A) by striking ‘‘and’’ at the end of clause
(i);
(B) by striking the period at the end of
clause (ii) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
clause:
‘‘(iii) shall not permit the use of any
mandatory waiting period (including any
such period in order to carry out para-
graph (3)(C)), unless the Secretary finds
that the imposition of such a period would
not be contrary to the provisions of this
title.’’.
(2) EFFECTIVE DATE.—The amendments made
by paragraph (1) apply to assistance furnished on or
after the date of the enactment of this Act.
(d) GRACE PERIOD BEFORE DISENROLLMENT FOR
NONPAYMENT OF PREMIUMS.—
(1) IN GENERAL.—Section 2103(e) (42 U.S.C.
1397ee(e)) is amended by adding at the end the fol-
lowing new paragraph:
‘‘(5) DISENROLLMENT
FOR
NONPAYMENT
OF
PREMIUMS.—
‘‘(A) NOTICE
OF
NONPAYMENT.—If a
State child health plan requires the payment of
a premium for enrollment and such a premium
is not paid on a timely basis, the State shall
provide, before terminating coverage under the
plan, for—
‘‘(i) notice of nonpayment at such
time and at the beginning of the last
month of the State specified enrollment pe-
riod described in subparagraph (C) if the
premium is still unpaid at that time; and
‘‘(ii) an opportunity for a hearing and
a grace period (described in subparagraph
(B)) in which the premium may be paid
and no penalty will apply for the late pay-
ment.
‘‘(B) GRACE
PERIOD.—The grace period
under this subparagraph, in the case of non-
payment for a month—
‘‘(i) before the last month of a State
specified enrollment period described in
subparagraph (C), is for the remainder of
the State specified enrollment period; or
‘‘(ii) for the last month of such pe-
riod, is for a period of at least 1 month.
‘‘(C) STATE SPECIFIED ENROLLMENT PE-
RIOD.—For 
purposes 
of 
applying 
this
paragraph—
‘‘(i) the State child health plan shall
specify an enrollment period, which shall
be a period of at least 3 months; and
‘‘(ii) after each such enrollment period
for an individual (if coverage is not termi-
nated under the plan during such period),
a new enrollment period (of the length
specified in clause (i)) shall start again for
the individual at the end of the previously
specified enrollment period.
‘‘(D) GOOD
CAUSE
WAIVER.—The State
child health plan shall establish rules allowing
waiver for good cause of termination of enroll-
ment for nonpayment of premiums.
‘‘(E) PERMITTING APPLICATION OF WAIT-
ING
PERIOD
IN
CERTAIN
REENROLLMENT
CASES.—In the case of a child whose coverage
under a State child health plan has been termi-
nated under this paragraph for nonpayment of
premiums and whose period of coverage under
the plan without premium payment exceeded 1
month, the plan may require, as a condition of
reenrollment under the plan, a waiting period
that equals the number of months of such cov-
erage without premium payment, but in no case
may such a waiting period exceed 3 months.’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) applies to disenrollments occurring
on or after the date that is 30 days after the date
of the enactment of this Act.
SEC. 4. EXPANDED COVERAGE OPTIONS.
(a) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR
SCHIP AND MEDICAID BENEFITS FOR CHILDREN LOS-
ING MEDICAID OR SCHIP ELIGIBILITY.—
(1) LOSS OF MEDICAID ELIGIBILITY.—Section
1902(a)(66) (42 U.S.C. 1396a(a)(66)), as inserted
by section 2(a)(2), is amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (B),
(B) by striking the period at the end of
subparagraph (C) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
subparagraph:
‘‘(D) the automatic assessment, in the case
of a child who loses eligibility for medical assist-
ance under this title on the basis of changes in
income, assets, or age, of whether the child is
eligible for benefits under title XXI.’’.
(2) LOSS
OF
SCHIP
ELIGIBILITY.—Section
2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended by
redesignating subparagraphs (D) and (E) as sub-
paragraphs (E) and (F), respectively, and by insert-
ing after subparagraph (C) the following new sub-
paragraph:
‘‘(D) that there is an automatic assess-
ment, in the case of a child who loses eligibility
for child health assistance under this title on
the basis of changes in income, assets, or age,
of whether the child is eligible for medical as-
sistance under title XIX;’’.
(3) EFFECTIVE DATE.—The amendments made
by paragraphs (1) and (2) apply to children who lose
eligibility under the medicaid program under title
XIX, or under a State child health insurance plan
under title XXI, respectively, of the Social Security
Act on or after the date that is 30 days after the
date of the enactment of this Act.
(b) OPTIONAL COVERAGE OF LOW-INCOME, UNIN-
SURED PREGNANT WOMEN UNDER
A STATE CHILD
HEALTH PLAN.—
(1) IN GENERAL.—Title XXI is amended by
adding at the end the following new section:
‘‘SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNIN-
SURED PREGNANT WOMEN.
‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any
other provision of this title, a State child health plan may
provide for coverage of pregnancy-related assistance for
targeted low-income pregnant women in accordance with
this section, but only if the State has established an in-
come eligibility level under section 1902(l)(2)(A) for
women described in section 1902(l)(1)(A) that is 185 per-
cent of the income official poverty line.
‘‘(b) DEFINITIONS.—For purposes of this section:
‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The
term ‘pregnancy-related assistance’ has the meaning
given the term child health assistance in section
2110(a) as if any reference to targeted low-income
children were a reference to targeted low-income
pregnant women, except that the assistance shall be
limited to services related to pregnancy (which in-
clude prenatal, delivery, and postpartum services)
and to other conditions that may complicate preg-
nancy and shall not include prepregnancy services
and supplies.
‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT
WOMAN.—The term ‘targeted low-income pregnant
woman’ has the meaning given the term targeted
low-income child in section 2110(b) as if any ref-
erence to a child were deemed a reference to a
woman during pregnancy and through the end of the
month in which the 60-day period (beginning on the
last day of her pregnancy) ends.
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of pregnancy-related assistance to tar-
geted low-income pregnant women under subsection (a),
the following special rules apply:
‘‘(1) Any reference in this title (other than sub-
section (b)) to a targeted low income child is deemed
to include a reference to a targeted low-income preg-
nant woman.
‘‘(2) Any such reference to child health assist-
ance with respect to such women is deemed a ref-
erence to pregnancy-related assistance.
‘‘(3) Any such reference to a child is deemed a
reference to a woman during pregnancy and the pe-
riod described in subsection (b)(2).
‘‘(4) The medicaid applicable income level is
deemed a reference to the income level established
under section 1902(l)(2)(A).
‘‘(5) Subsection (a) of section 2103 (relating to
required scope of health insurance coverage) shall
not apply insofar as a State limits coverage to serv-
ices described in subsection (b)(1) and the reference
to such section in section 2105(a)(1) is deemed not
to require, in such case, compliance with the require-
ments of section 2103(a).
‘‘(6) There shall be no exclusion of benefits for
services described in subsection (b)(1) based on any
pre-existing condition and no waiting period (includ-
ing any waiting period imposed to carry out section
2102(b)(3)(C)) shall apply.
‘‘(d) NO IMPACT ON ALLOTMENTS.—Nothing in this
section shall be construed as affecting the amount of any
initial allotment provided to a State under section
2104(b).
‘‘(e) APPLICATION OF FUNDING RESTRICTIONS.—
The coverage under this section (and the funding of such
coverage) is subject to the restrictions of section 2105(c).
‘‘(f) AUTOMATIC
ENROLLMENT
FOR
CHILDREN
BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS-
SISTANCE.—Notwithstanding any other provision of this
title or title XIX, if a child is born to a targeted low-in-
come pregnant woman who was receiving pregnancy-relat-
ed assistance under this section on the date of the chil-
dren’s birth, the child shall be deemed to have applied for
child health assistance under the State child health plan
and to have been found eligible for such assistance under
such plan (or, in the case of a State that provides such
assistance through the provision of medical assistance
under a plan under title XIX, to have applied for medical
assistance under such title and to have been found eligible
for such assistance under such title) on the date of such
birth and to remain eligible for such assistance until the
child attains 1 year of age so long as the child is a member
of the woman’s household and the woman remains (or
would remain if pregnant) eligible for such assistance.
During the period in which a child is deemed under the
preceding sentence to be eligible for child health or medi-
cal assistance, the child health or medical assistance eligi-
bility identification number of the mother shall also serve
as the identification number of the child, and all claims
shall be submitted and paid under such number (unless
the State issues a separate identification number for the
child before such period expires).’’.
(2) STATE OPTION TO USE ENHANCED FMAP
FOR COVERAGE OF ADDITIONAL PREGNANT WOMEN
UNDER THE MEDICAID PROGRAM.—Section 1905 (42
U.S.C. 1396d) is amended—
(A) in subsection (b), by inserting ‘‘and in
the case of a State plan that meets the condi-
tion described in subsections (u)(1) and
(u)(4)(A), with respect to expenditures de-
scribed in subsection (u)(4)(B) for the State for
a fiscal year’’ after ‘‘for a fiscal year,’’;
(B) by redesignating paragraph (4) of sub-
section (u) as paragraph (5); and
(C) by inserting after paragraph (3) of
subsection (u) the following new paragraph:
‘‘(4)(A) The condition described in this subparagraph
for a State plan is that the plan has established an income
level under section 1902(l)(2)(A) with respect to individ-
uals described in section 1902(l)(1)(A) that is 185 percent
of the income official poverty line.
‘‘(B) For purposes of subsection (b), the expenditures
described in this paragraph are expenditures for medical
assistance for women described in section 1902(l)(1)(A)
whose income exceeds the income level established for such
women under section 1902(l)(2)(A)(i) as of the date of
the enactment of this paragraph but does not exceed than
185 percent of the income official poverty line.’’.
(3) 
CONFORMING
AMENDMENTS.—Section
2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is
amended—
(A) by striking ‘‘and’’ at the end of clause
(i);
(B) by striking the period at the end of
clause (ii) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
clause:
‘‘(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income child who is pregnant, if the
State provides for coverage of pregnancy-
related assistance for targeted low-income
pregnant women in accordance section
2111.’’.
(4) EFFECTIVE DATE.—The amendments made
by this subsection take effect on the date of the en-
actment of this Act and apply to allotments for all
fiscal years.
(c) STATE OPTION FOR COVERAGE OF QUALIFIED
ALIEN CHILDREN UNDER MEDICAID AND CHILDREN’S
HEALTH INSURANCE PROGRAMS.—
(1) MEDICAID.—
(A) 
CATEGORICALLY
NEEDY.—Section
1902(a)(10)(a)(ii) 
(42 
U.S.C.
1396a(a)(10)(A)(ii)) is amended—
(i) by striking ‘‘or’’ at the end of sub-
clause (XIII);
(ii) by adding ‘‘or’’ at the end of sub-
clause (XIV); and
(iii) by adding at the end the follow-
ing new subclause:
‘‘(XV) who are described in sec-
tion 1905(a)(i) and who would be eli-
gible for medical assistance (or for a
greater amount of medical assistance)
under the State plan under this title
but for the provisions of section 403
or section 421 of Public Law 104–
193, but the State may not exercise
the option of providing medical assist-
ance under this subclause with respect
to a subcategory of individuals de-
scribed in this subclause;’’.
(B) 
MEDICALLY
NEEDY.—Section
1902(a)(10)(C)(i)(I) 
(42 
U.S.C.
1396a(a)(10)(C)(i)(I)) is amended by inserting
‘‘(and such criteria may provide for eligibility of
individuals 
described 
in 
subparagraph
(A)(ii)(XV))’’ after ‘‘medical assistance’’.
(2) CHILDREN’S
HEALTH
INSURANCE
PRO-
GRAM.—Section 2110(b) (42 U.S.C. 1397jj(b)) is
amended—
(A) in paragraph (1)(A), by inserting be-
fore the semicolon ‘‘(including, at the option of
the State, a child described in paragraph
(3)(B))’’; and
(B) in paragraph (3)—
(i) by striking ‘‘SPECIAL
RULE.—’’
and inserting ‘‘SPECIAL RULES.—
‘‘(i) 
HEALTH
INSURANCE
COV-
ERAGE.—’’ by indenting the remainder of
the text accordingly; and
(ii) by adding at the end the following
new subparagraph:
‘‘(B) ELIGIBILITY FOR QUALIFIED ALIEN
CHILDREN.—For purposes of paragraph (1)(A),
a child is described in this subparagraph if—
‘‘(i) the child would be determined eli-
gible for child health assistance under this
title but for any or all of the provisions of
sections 403 and 421 of Public Law 104–
193; and
‘‘(ii) the State exercises the option to
provide medical assistance to the category
of 
individuals 
described 
in 
section
1902(a)(10)(A)(ii)(XV).’’.
(3) PROHIBITION ON SEEKING SUPPORT FROM
SPONSOR.—Section 213A(b) of the Immigration and
Nationality Act (8 U.S.C. 1183a(b)) is amended by
adding at the end the following new paragraph:
‘‘(4) EXCEPTION
FOR
CHILD
MEDICAID
OR
SCHIP
ASSISTANCE.—The preceding provisions of
this subsection shall not apply to—
‘‘(A) medical assistance furnished under
the State plan under title XIX of the Social Se-
curity Act to an individual eligible for such as-
sistance because of subclause (XV) of para-
graph (10)(A)(ii) of section 1902(a) of such Act
(42 U.S.C. 1396a(a)) or because of the ref-
erence to such subclause in paragraph (10)(C)
of such section; or
‘‘(B) child health assistance furnished
under the State child health plan under title
XXI of such Act to a child eligible for such as-
sistance because of the provisions of section
2110(b)(3)(B) 
of 
such 
Act 
(42 
U.S.C.
1397jj(b)(3)(B)).’’.
(d) CLARIFICATION OF COVERAGE UNDER VACCINE
FOR CHILDREN PROGRAM.—
(1) IN
GENERAL.—Section 1928(b)(2)(A)(ii)
(42 U.S.C. 1396s(b)(2)(A)(ii) is amended by insert-
ing ‘‘, except that for purposes of this paragraph a
child who is only insured under title XXI shall be
considered as being not insured’’ after ‘‘not in-
sured’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall take effect as if included in
the enactment of the Balanced Budget Act of 1997.
(e) ELIMINATION OF FUNDING OFFSET FOR EXER-
CISE OF PRESUMPTIVE ELIGIBILITY OPTION.—
(1) IN GENERAL.—Section 2104(d) (42 U.S.C.
1397dd(d)) is amended by striking ‘‘shall be reduced
by the sum of’’ and all that follows through ‘‘(2) the
amount of payments under such section’’ and insert-
ing ‘‘shall be reduced by the amount of payments
under section 1903(a)(1)’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) first applies for allotments for fis-
cal year 1999.
(f) PROGRAM COORDINATION WITH THE MATERNAL
AND CHILD HEALTH PROGRAM (TITLE V).—
(1) IN
GENERAL.—Section 2102(b)(3) (42
U.S.C. 1397bb(b)(3)) is amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (D);
(B) by striking the period at the end of
subparagraph (E) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
subparagraph:
‘‘(F) that operations and activities under
this title are developed and implemented in con-
sultation and coordination with the program op-
erated by the State under title V in areas in-
cluding outreach and enrollment, benefits and
services, service delivery standards, public
health and social service agency relationships,
and quality assurance and data reporting.’’.
(2) CONFORMING
MEDICAID
AMENDMENT.—
Section 1902(a)(11) (42 U.S.C. 1306a(a)(11)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(C)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (D) provide that
operations and activities under this title are de-
veloped and implemented in consultation and
coordination with the program operated by the
State under title V in areas including outreach
and enrollment, benefits and services, service
delivery standards, public health and social
service agency relationships, and quality assur-
ance and data reporting’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection take effect on January 1, 1999.
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