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(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to new coverage periods begin-
ning on or after January 1, 2009. 
Subtitle D—Populations 
SEC. 131. OPTIONAL COVERAGE OF CHILDREN UP TO AGE 
21 UNDER CHIP. 
(a) IN GENERAL.—Section 2110(c)(1) of the Social 
Security Act (42 U.S.C. 1397jj(c)(1)) is amended by in-
serting ‘‘(or, at the option of the State, under 20 or 21 
years of age)’’ after ‘‘19 years of age’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on January 1, 2008. 
SEC. 132. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 
UNDER THE MEDICAID PROGRAM AND CHIP. 
(a) MEDICAID PROGRAM.—Section 1903(v) of the 
Social Security Act (42 U.S.C. 1396b(v)) is amended— 
(1) in paragraph (1), by striking ‘‘paragraph 
(2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4)(A) A State may elect (in a plan amendment 
under this title) to provide medical assistance under this 
title, notwithstanding sections 401(a), 402(b), 403, and 
421 of the Personal Responsibility and Work Opportunity 
Reconciliation Act of 1996, for aliens who are lawfully re-
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siding in the United States (including battered aliens de-
scribed in section 431(c) of such Act) and who are other-
wise eligible for such assistance, within either or both of 
the following eligibility categories: 
‘‘(i) PREGNANT WOMEN.—Women during preg-
nancy (and during the 60-day period beginning on 
the last day of the pregnancy). 
‘‘(ii) CHILDREN.—Individuals under age 19 (or 
such higher age as the State has elected under sec-
tion 1902(l)(1)(D)), including optional targeted low- 
income children described in section 1905(u)(2)(B). 
‘‘(B) In the case of a State that has elected to provide 
medical assistance to a category of aliens under subpara-
graph (A), no debt shall accrue under an affidavit of sup-
port against any sponsor of such an alien on the basis 
of provision of medical assistance to such category and 
the cost of such assistance shall not be considered as an 
unreimbursed cost.’’. 
(b) CHIP.—Section 2107(e)(1) of such Act (42 
U.S.C. 1397gg(e)(1)), as amended by section 112(b), 
112(d)(2),and 121(a)(2), is amended by inserting after 
subparagraph (E) the following new subparagraphs: 
‘‘(F) Section 1903(v)(4)(A) (relating to op-
tional coverage of certain categories of lawfully 
residing immigrants), insofar as it relates to the 
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category of pregnant women described in clause 
(i) of such section, but only if the State has 
elected to apply such section with respect to 
such women under title XIX and the State has 
elected the option under section 2111 to provide 
assistance for pregnant women under this title. 
‘‘(G) Section 1903(v)(4)(A) (relating to 
optional coverage of categories of lawfully resid-
ing immigrants), insofar as it relates to the cat-
egory of children described in clause (ii) of such 
section, but only if the State has elected to 
apply such section with respect to such children 
under title XIX.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on the date of the enactment of 
this Act. 
SEC. 133. STATE OPTION TO EXPAND OR ADD COVERAGE 
OF 
CERTAIN 
PREGNANT 
WOMEN 
UNDER 
CHIP. 
(a) CHIP.— 
(1) COVERAGE.—Title XXI (42 U.S.C. 1397aa 
et seq.) of the Social Security Act is amended by 
adding at the end the following new section: 
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‘‘SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-IN-
COME PREGNANT WOMEN. 
‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any 
other provision of this title, a State may provide for cov-
erage, through an amendment to its State child health 
plan under section 2102, of assistance for pregnant 
women for targeted low-income pregnant women in ac-
cordance with this section, but only if— 
‘‘(1) the State has established an income eligi-
bility level— 
‘‘(A) for pregnant women, under any of 
clauses (i)(III), (i)(IV), or (ii)(IX) of section 
1902(a)(10)(A), that is at least 185 percent (or 
such higher percent as the State has in effect 
for pregnant women under this title) of the pov-
erty line applicable to a family of the size in-
volved, but in no case a percent lower than the 
percent in effect under any such clause as of 
July 1, 2007; and 
‘‘(B) for children under 19 years of age 
under this title (or title XIX) that is at least 
200 percent of the poverty line applicable to a 
family of the size involved; and 
‘‘(2) the State does not impose, with respect to 
the enrollment under the State child health plan of 
targeted low-income children during the quarter, any 
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enrollment cap or other numerical limitation on en-
rollment, any waiting list, any procedures designed 
to delay the consideration of applications for enroll-
ment, or similar limitation with respect to enroll-
ment. 
‘‘(b) DEFINITIONS.—For purposes of this title: 
‘‘(1) ASSISTANCE
FOR
PREGNANT
WOMEN.— 
The term ‘assistance for pregnant women’ 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-in-
come pregnant women. 
‘‘(2) 
TARGETED
LOW-INCOME
PREGNANT 
WOMAN.—The term ‘targeted low-income pregnant 
woman’ means a woman— 
‘‘(A) during pregnancy and through the 
end of the month in which the 60-day period 
(beginning on the last day of her pregnancy) 
ends; 
‘‘(B) whose family income exceeds 185 per-
cent (or, if higher, the percent applied under 
subsection (a)(1)(A)) of the poverty level appli-
cable to a family of the size involved, but does 
not exceed the income eligibility level estab-
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lished under the State child health plan under 
this title for a targeted low-income child; and 
‘‘(C) who satisfies the requirements of 
paragraphs (1)(A), (1)(C), (2), and (3) of sec-
tion 2110(b), applied as if any reference to a 
child was a reference to a pregnant woman. 
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL 
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of assistance for pregnant women to 
targeted low-income pregnant women under subsection 
(a), the following special rules apply: 
‘‘(1) Any reference in this title (other than in 
subsection (b)) to a targeted low-income child is 
deemed to include a reference to a targeted low-in-
come pregnant woman. 
‘‘(2) Any reference in this title to child health 
assistance (other than with respect to the provision 
of early and periodic screening, diagnostic, and 
treatment services) with respect to such women is 
deemed a reference to assistance for pregnant 
women. 
‘‘(3) Any such reference (other than in section 
2105(d)) to a child is deemed a reference to a 
woman during pregnancy and the period described 
in subsection (b)(2)(A). 
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‘‘(4) In applying section 2102(b)(3)(B), any 
reference to children found through screening to be 
eligible for medical assistance under the State med-
icaid plan under title XIX is deemed a reference to 
pregnant women. 
‘‘(5) There shall be no exclusion of benefits for 
services described in subsection (b)(1) based on any 
preexisting condition and no waiting period (includ-
ing any waiting period imposed to carry out section 
2102(b)(3)(C)) shall apply. 
‘‘(6) In applying section 2103(e)(3)(B) in the 
case of a pregnant woman provided coverage under 
this section, the limitation on total annual aggregate 
cost-sharing shall be applied to such pregnant 
woman. 
‘‘(7) In applying section 2104(i)— 
‘‘(A) in the case of a State which did not 
provide for coverage for pregnant women under 
this title (under a waiver or otherwise) during 
fiscal year 2007, the allotment amount other-
wise computed for the first fiscal year in which 
the State elects to provide coverage under this 
section shall be increased by an amount (deter-
mined by the Secretary) equal to the enhanced 
FMAP of the expenditures under this title for 
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